Ask The Experts

COPD – a risk for all smokers

Q. I smoke but not a lot. Can I still get chronic obstructive pulmonary disease (COPD)?

What is this condition and what are its tell-tale signs and symptoms? What prevention measures can I take?

A. COPD is an umbrella term that includes chronic bronchitis and emphysema.

It is a respiratory disease that can limit airflow in the lungs and cause breathing difficulties.

To explain it better, imagine a piece of meat put into an oven full of smoke. If you leave it there long enough, it will slowly get cooked and all the tenderness will be lost over time.

Most COPD sufferers are current or previous tobacco smokers. In a sense, their lungs have been cooked by the smoke and that results in the lung losing its stretchiness and function, and this damage leads to COPD.

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Loss of lung function cannot be fully recovered, as lung damage is permanent.

But quitting smoking will slow down the rate of deterioration markedly. If you smoke a pack a day for 10 years, you would have a roughly one-in- two chance of getting COPD.

There is a risk of impaired lung function for all smoking patterns, even for those who smoke fewer than five cigarettes a day. There is no such thing as a “safe level” of smoking.

COPD symptoms include having a long-term cough, sputum production and breathlessness when you exert yourself.

EXPLAINING COPD

Imagine a piece of meat put into an oven full of smoke. If you leave it there long enough, it will slowly get cooked and all the tenderness will be lost over time

In 1990, a study by the World Bank and the World Health Organisation ranked COPD the 12th highest contributor of disease burden; by 2020, it is estimated that it will be ranked fifth.

Estimates show that COPD will become the third leading cause of death worldwide in 2030.

Tobacco smoking or exposure to second-hand tobacco smoke are some risk factors.

Smokers should stop smoking. This will help to improve lung function and slow down the rate of deterioration.

Exposure to bio-mass smoke such as wood-burning smoke from cooking with wood or charcoal stoves are also risk factors. Kitchens need to be well ventilated and cooking smoke vented out.

It is a misconception that only old folk and smokers are at risk of COPD. Young smokers, in particular women and children, are at high risk.

You do not have to get very breathless before it is COPD.

A patient in the earliest stages of the condition may just feel tired or “unfit”, or have a so-called chronic smoker’s cough.

People with COPD may first notice breathlessness when they climb stairs or walk uphill. There is often wheezing and coughing that brings up mucus.

Over time, the breathlessness becomes worse, sometimes to the point where dressing and bathing are also difficult.

As oxygen levels in the blood fall and carbon dioxide levels rise, this can lead to tiredness and fatigue.

People usually compensate for this by becoming less active and by the time they finally take notice of the condition, it is usually in an advanced stage.

COPD here is under-diagnosed and under-treated.

Patients can also get a sudden worsening of their COPD, which have been called lung attacks or exacerbations.

These lung attacks lead to worsening of lung function, which can happen very rapidly over a period of hours.

Getting an early diagnosis and treatment is very important. Studies have shown that treatment with the newer, long acting bronchodilator inhalers helps with reducing lung attacks.

The earlier treatment starts, the better. Fewer exacerbations lead to fewer admissions to hospital and lower medical bills.

Primary care doctors are in the best position to detect, assess and manage patients as they are in the frontline of medical care and have the closest interactions with their patients.

Dr Tan Tze Lee

Family physician at The Edinburgh Clinic and president of the Chronic Obstructive Pulmonary Disease Association (Singapore)

A version of this article appeared in the print edition of The Straits Times on June 28, 2016, with the headline 'COPD – a risk for all smokers'. Print Edition | Subscribe