Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of death worldwide, causing more than 32 lac deaths in 2019. COPD is a highly prevalent and grossly underdiagnosed public health problem in Bangladeshi adults aged 40 years or older. Illiteracy, smoking and biomass fuel burning are modifiable determinants of COPD. It is estimated from a population study that between 10-13% of people above the age of 40 in Bangladesh fulfil the international criteria for diagnosing COPD. Older age, male sex, illiteracy, underweight, history of smoking (both current and former), history of asthma and solid fuel use were significant predictors of COPD.

Chronic obstructive pulmonary disease, or COPD, describes a group of lung conditions that make it difficult to empty air out of the lungs because the airways have become narrowed. COPD is a common, preventable, and treatable chronic lung disease which affects men and women worldwide.

Abnormalities in the small airways of the lungs lead to limitation of airflow in and out of the lungs. A number of processes cause the airways to become narrow. There may be destruction of parts of the lung, mucus blocking the airways, and inflammation and swelling of the airway lining.

COPD usually develops because of long-term damage to your lungs from breathing in a harmful substance, usually cigarette smoke, as well as smoke from other sources and air pollution.

Cigarette smoking is the leading cause of chronic obstructive pulmonary disease (COPD) worldwide. The majority of people with COPD are current or former smokers. There is a huge amount of evidence that links tobacco smoking with COPD:

Between 15% and 20% of smokers develop COPD.

Up to 90% of COPD cases are the result of lung damage caused by smoking.

Tobacco smoking is the cause of 90% of deaths that are related to COPD.

The risk of developing COPD gets higher the more years a person smokes, and the more they smoke per day. However, the good news is that it is never too late to stop smoking. When people smoke tobacco, they breathe tiny particles of irritants into their lungs each time they inhale the smoke. This has two damaging effects:

The small airways inside the lungs become swollen and inflamed.

The lining of these airways produces a larger amount of secretions to trap the irritants.

The combined result of these effects is that the airways become thickened and narrowed because of the swelling and mucus. This reduces the amount of air that can flow through them. The increased amount of mucus also causes a persistent cough, in an attempt to clear the airways. Over a period of time, this constant irritation and inflammation in the airways causes many smokers to develop COPD.

If a smoker is also regularly exposed to other kinds of irritants that can cause COPD, then his or her risk of getting this condition is even higher. For example, smokers who also work in an environment where they are exposed to toxic fumes, chemicals, or dusts have a much higher chance of getting COPD than their co-workers who do not smoke.

Research also shows that women who smoke experience worse respiratory symptoms than men who smoke the same amount. This means that female smokers may be more likely to develop COPD than male smokers.

Jobs where people are exposed to dust, fumes and chemicals can also contribute to developing COPD. There is strong research evidence that COPD can be caused or made worse by dusts, fumes and irritating gases at work. Work related COPD is a priority because of the human costs in terms of suffering, its effects on the quality of life and the financial costs due to working days lost and medical treatment.

You’re most likely to develop COPD if you’re over 35 and are, or have been, a smoker or had chest problems as a child. Some people are more affected than others by breathing in noxious materials. COPD does seem to run in families, so if your parents had chest problems then your own risk is higher.

There is no cure for COPD but early diagnosis and treatment are important to slow the progression of symptoms and reduce the risk of flare-ups.

COPD should be suspected if a person has typical symptoms, and the diagnosis confirmed by a breathing test called spirometry, which measures how the lungs are working. In low- and middle-income countries, spirometry is often not available and so the diagnosis may be missed. 

There are several actions that people with COPD can take to improve their overall health and help control their COPD:

  • stop smoking: people with COPD should be offered support to quit smoking;
  • take regular exercise; and
  • get vaccinated against pneumonia, influenza and coronavirus. 

Inhaled medication can be used to improve symptoms and reduce flare-ups. There are different types of inhaled medication which work in different ways and can be given in combination inhalers, if available. Inhalers must be taken using the correct technique, and in some cases with a spacer device to help deliver the medication into the airways more effectively.

As COPD progresses, people find it more difficult to carry out their normal daily activities, often due to breathlessness. There may be a considerable financial burden due to limitation of workplace and home productivity, and costs of medical treatment.

During flare-ups, people with COPD find their symptoms become much worse – they may need to receive extra treatment at home or be admitted to hospital for emergency care. Severe flare-ups can be life-threatening. People with COPD often have other medical conditions such as heart disease, osteoporosis, musculoskeletal disorders, lung cancer, depression and anxiety.

As COPD constitutes a huge hidden burden of disease in people of 40 years of age or older in Bangladesh, it has become a major public health problem here and there should be more research and action to be directed toward preventive measures and intensive efforts must be made to target smoking cessation and reduction of indoor air pollution due to biomass fuel burning.

Dr. Ziaul Huq

Senior Consultant

Respiratory Medicine

Evercare Hospital Dhaka