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For COPD patients, it's never too late

If you find yourself short of breath after climbing two or three flights of stairs, don't be too quick to blame it on getting older. You just might have Chronic Obstructive Pulmonary Disease (COPD).
The World Health Organization predicts that by 2030, COPD will become the third leading cause of death worldwide. In 2004, 64 million people were suffering from COPD. Still, not too many people know about the disease. 
Last September, veteran television reporter Jun Bautista died after a long battle with COPD. King of Comedy Rodolfo "Dolphy" Quizon, who passed away in July, also had COPD.   
In Manila, 14 percent of Filipinos have COPD, but only three percent are seen by doctors, according to Dr. Tim Trinidad, chair of the Philippine College of Chest Physicians (PCCP) Council on COPD and Pulmonary Rehabilitation. Twenty-five to 50 percent of people with COPD don't know they have it, Trinidad said during a media briefing on November 7. 
Romeo Fernandez, a Filipino jeepney driver, first experienced symptoms in 1996. He recalled having difficulty breathing, which made him unable to keep up with his friends during a drinking session. "Nauunahan nila akong maubos 'yung isang bote. Naibababa na nila ‘yung beer nila, ako nandoon pa lang," Mang Romy shared during the media briefing.
Like many who have symptoms of COPD, Fernandez ignored the symptoms and even continued smoking, which is a major risk factor for the disease.
Dr. Benilda Galvez, PCCP president, stressed that cigarette smoking and COPD are directly linked to each other. "With no smoking, we can expect a dramatic decrease in COPD," she said.
Fernandez, now 75, shared that COPD made it difficult for him to do his work, as he would have to rest often. He said the disease also affected his family life, as he became irritable. Two years after he first experienced symptoms, he had himself checked at the hospital, and was diagnosed with COPD. Still, he didn't quit smoking.
It was only after Fernandez was rushed to the emergency room that he stopped smoking. He eventually became the first patient at the pulmonary rehabilitation center at the University of Santo Tomas Hospital, and by religiously following his doctors' orders, Fernandez was able to manage his COPD.
Pulmonary rehabilitation is one of the most effective treatments for COPD, and requires the patient to go to the rehabilitation center at least twice a week. During rehabilitation sessions, patients do warm-up exercises, endurance exercises, strengthening exercises, as well as receive education and psychosocial support.
Fernandez noted that it is very important for a patient with COPD to have continuous rehabilitation, as he knew some other patients who would stop after a short while, only to end up in intensive care. "Kailangan mag-consult na sila ‘pag nalaman na mayroon na silang COPD o emphysema. Kailangan maniwala sila sa sinabi ng doctor kasi ‘yun ang makakabuti sa kanila," he said.
The danger of firsthand, secondhand, thirdhand smoke  
Dr. Imelda Mateo, chair of PCCP Tobacco and Air Pollution Council, noted that a major part of COPD is caused by smoking, and not only firsthand smoking, but secondhand and thirdhand smoke. 
Mateo explained that thirdhand smoke is the smoke from a lighted cigarette that combines with the nitric acid of the ambient air and settles on surfaces. "It stays there, it's more permanent and more damaging than first and secondhand smoke," she said.
Stressing that it's never too late to stop smoking, Trinidad explained that COPD starts when an individual inhales toxic gases, including cigarette smoke, biomass fuel such as charcoal (uling) and firewood, air pollution, and industrial chemicals.
"Once COPD sets in, it damages the airways and airsacs, and because of this, the patient develops breathlessness, cough, and phlegm production," Trinidad said. However, it takes time before the patient may feel anything, as the damage is usually slow and progressive, Trinidad said. 
"The early stages of COPD are often unrecognized partly because many individuals discount the symptoms such as breathlessness, chronic cough, and bringing up phlegm as a normal part of getting old, or an expected consequence of cigarette smoking. Binabalewala ng pasyente," he said.
Painless test  
Finding COPD during the early stage of the disease gives the best chance of preventing further lung damage, Trinidad said, adding that people at risk of COPD can undergo a simple, painless test called lung function testing. The test, which is called spirometry, can help diagnose the disease early, thus allowing the doctors to do more for COPD patients.
Dr. Janeth Samson, chair of the PCCP Council on Diagnostics and Therapeutics, described spirometry as a simple, painless breathing test which measures how well our lungs function. "It's an important tool in monitoring patients with respiratory diseases, such as COPD and asthma," she said.
To test lung function, the patient is asked to breathe through a mouthpiece with his nose clipped. Despite it being simple and painless, spirometry is underutilized, Samson said. In order to promote spirometry, PCCP has been conducting spirometry workshops since 2010. They have also come up with PCCP consensus statement on spirometry testing to create a generic report. "This will make it simple and understandable even to non-pulmonologists," she said. Spirometry is a very useful tool in early detection of COPD.
Trinidad explained that there are pharmacological as well as non-pharmacological therapies available to help people at all stages of the disease live better and a more active life.
Treatment may include use of a bronchodilator, which dilates the airways, while anti-inflammatory drugs may be used to prevent further lung damage.
"The treatment we offer is one thing, but also we want to create education and awareness, or for example this program we provide the spirometry machine so we can earlier identify and intervene," said Thomas Weigold, country president and managing director of Novartis Healthcare Philippines, which is collaborating with PCCP in the campaign to raise awareness about COPD.
A number of activities will be held on November 14, World COPD Day, to raise awareness about the disease. These activities include free spirometry, walk, clinics and health fairs, and seminars for healthcare providers. On November 24, there will be a COPD Olympics at a cinema at the SM Mall of Asia.
As for non-pharmacological therapy, the number one treatment is making sure a person stops smoking. Those with COPD are also advised to take steps to prevent continuous exposure to toxic gases. For instance, cooking using uling should be done outside, where the ventilation is better.
"It's never too late to stop smoking. It is never too late to have a lung function test done. It is never too late to religiously follow the prescription of your COPD doctor, and it's never too late to enroll in a pulmonary rehabilitation program," Trinidad said. –KG, GMA News