How air pollution increases risk of Chronic Obstructive Pulmonary Disease(COPD)

India, which dominates the list of having the world's most polluted cities, also has the highest number of Chronic Obstructive Pulmonary Disease (COPD) cases in the world. Increased exposure to bad air coupled with low awareness can further drive the burden of COPD cases in the country, say experts.

World COPD Day is observed on November 17 annually to spread awareness about the effects of COPD. This year's theme for the day is "Healthy Lungs - Never More Important".

COPD commonly occurs due to significant exposure to noxious particles or gases. It is usually more common in smokers, men, and those above 40 years of age. Traditionally, tobacco smoking has been recognised as an important risk factor for COPD. However, it is being increasingly recognised that women, who use chulla or biogas for cooking purposes (common in rural areas), are also at high risk of COPD.

Exposure to air pollutants has now emerged as a major reason for driving respiratory infections and increasing the risk of COPD.

With the battle against Covid-19 not over yet, COPD can have serious consequences. Research has shown that patients with COPD were much more likely to be admitted to an ICU with greater lengths of stay during their terminal hospitalisation, than patients with lung cancer. They can cause accelerated decline in an already compromised lung function.

Since COPD is progressive in nature, its onset is gradual and occurs over a longer time with the patient often failing to read the symptoms correctly and fails to get the requisite medical attention on time.

While some of the early symptoms include shortness of breath especially after modest physical activity, mild cough, wheezing and feeling of tightness in chest, the more severe and later-stage symptoms would include chronic cough with the need to clear mucus, bouts of frequent cold, fatigue and lack of energy, swelling of feet, ankles and legs, and turning blue or grey of lips and fingernails.

"Although many of us don't realise it and are often dismissive of cold, cough and minor breathing problems as temporary and seasonal, a full-fledged COPD condition stealthily builds up over a period of time. And by the time a patient takes action and gets medical attention, it is too late and the disease becomes a lifelong part of his existence, acutely debilitating and disruptive of his daily and regular functioning," said Dr. Rajesh G Gajara, Consultant Physician and Cardiologist, Fortis-Mulund, Mumbai.

"And for the more unfortunate, it can even reach the terminal stage from where there is no return. And in those cases, ventilators can only serve as end-of-life care devices," Gajara added.

Low public awareness on COPD can result in a delay in COPD diagnosis. A delayed diagnosis and poor COPD management can result in a flare-up of the disease -- COPD exacerbation or lung attack. In a lung attack, symptoms of COPD such as breathlessness and cough increase significantly. This is often accompanied by feeling tired and sometimes swelling of the ankles.

"Identifying the signs and symptoms of COPD and lung attack and getting timely help from a physician is the best way to prevent further worsening of disease progression. Timely diagnosis of the disease is important which can be done by regularly checking lung function in patients who are symptomatic and at risk of COPD," said Dr Prashant Saxena, Director and HOD, Pulmonary and Sleep Dept, Associate Director - Critical Care, MAX Hospital, Saket.