Doc Talk

Smokers who are breathless and clueless

Many smokers who find themselves panting are not aware that they have COPD, a chronic respiratory disease

I saw Mr Lee, a 75-year-old retiree, two years ago. His daughter had taken him to see me as he had been feeling more and more breathless over the past year.

In fact, he was no longer able to carry out his daily activities like driving and shopping.

Mr Lee started smoking at the age of 15 and was still smoking around 40 cigarettes a day. He had felt all right until his symptoms started.

By the time he saw me, he was constantly breathless and could manage to walk only 50m before he needed to rest. His appetite had worsened and he had lost 10kg.

He had consulted many doctors as he was very worried about the likelihood of cancer and heart disease, but the tests were negative.


When he related his symptoms to me, I suspected that he might be suffering from COPD or chronic obstructive pulmonary disease.

COPD is an umbrella term that includes chronic bronchitis and emphysema. It is a respiratory disease that limits airflow to the lungs, causing breathing difficulties.

COPD patients often do not recognise the early warning signs and visit a doctor only at a more advanced stage of their illness.

They may visit only when they have an exacerbation, commonly known as a "lung attack". By then, almost half of their lung function would already have been lost.

A spirometry test, which measures the function of the lungs, confirmed that Mr Lee was suffering from a very severe stage of COPD.

He was started on two inhalers, a Lama (long-acting muscarinic antagonist) inhaler and a combination (inhaled corticosteroid and long-acting bronchodilator) inhaler. Over time, the inhalers helped to improve his condition and quality of life.

Many people mistake shortness of breath as part of the normal ageing process, but that may not necessarily be the case. It can be COPD and this is especially true for smokers.

They may visit (the doctor) only when they have an exacerbation, commonly known as a "lung attack". By then, almost half of their lung function would already have been lost.

In Singapore, there are nearly 88,000 people with COPD. It is the seventh most common reason for hospitalisation, with more than 10,000 admissions in 2011.

Early diagnosis and appropriate treatment is key in managing patients, given that exacerbation is the main reason for loss of lung function and hospital admission.

It is important that patients stop smoking to prevent further deterioration of their lung function. A proactive approach in managing the condition can prevent exacerbations, leading to fewer hospital admissions. Doctors are in the best position to detect, assess and manage these patients.

As for Mr Lee, he made a remarkable recovery over six months and his lung function improved by half. He was able to walk much further without the need to stop and rest frequently. His appetite also improved and he regained some weight.

Best of all, with his family's support and professional counselling, he managed to quit smoking.

If he had continued to smoke, he would not have been able to make such a good recovery and his lung function would likely have deteriorated even more quickly.

I am very happy that he continues to be stable and is able to resume his active lifestyle.

There are various treatment options for COPD and they are either oral or inhaled therapies.

Inhaled therapy consists of bronchodilators that relax the airway muscles to make breathing easier, and inhaled corticosteroids, which reduce inflammation.

These inhalers are preferred as they have been found to reduce and prevent subsequent exacerbations. Much research has been done on COPD treatment. These studies are very important as they demonstrate the effectiveness of new treatment options.

For example, the recent Salford Lung Study, based on real-world evidence, found an 8.4 per cent reduction in the rate of exacerbations in patients when they were treated with a new once-daily inhaled corticosteroid and long-acting bronchodilator combination treatment.

This reduction is important as patients on the new treatment were less likely to suffer from a lung attack, compared to patients in the usual care group who were on standard medication.

Remembering to take your medications regularly is just as important in managing the disease.

If you are a smoker and think you have COPD, consult your doctor early.

•Adjunct Assistant Professor Tan Tze Lee is a family physician at The Edinburgh Clinic and president of the Chronic Obstructive Pulmonary Disease Association of Singapore.

A version of this article appeared in the print edition of The Straits Times on November 29, 2016, with the headline 'Smokers who are breathless and clueless'. Print Edition | Subscribe