Chronic Obstructive Pulmonary Disease is now one of the top three causes of death worldwide and 90% of these deaths occur in low and middle-income countries. Tobacco smoking accounts for over 70% of COPD cases in high-income countries. In LMIC tobacco smoking accounts for 30–40% of COPD cases, and household air pollution is a major risk factor.
According to Dr Chetan Rao Vaddepally, Consultant Interventional and Transplant Pulmonologist, Yashoda Hospitals Hyderabad, COPD is a preventable and treatable disease and as said for ages, “prevention is better than cure”.
Identification and reduction of exposure to risk factors are important not only for the primary prevention of COPD but also as a part of the management of a COPD patient.
The main environmental exposures leading to COPD are tobacco smoking, toxic gases and particles from indoor and outdoor air pollution. Genetic risk factors like Alpha 1 antitrypsin deficiency can also lead to COPD.
Cigarette smoking is the most common and easily identifiable risk factor for COPD. Smoking cessation should be continuously encouraged for all individuals who smoke.
Approximately 40 % of people with COPD continue to smoke despite having the disease and this leads to a progression of the disease. There is evidence that a combination of counselling and pharmacotherapy is most effective for smoking cessation. The complexity of the smoking cessation process is largely determined by nicotine dependence. Some indicators of high nicotine dependence are; smoking within 30 minutes of waking up, smoking at night, and smoking 20 cigarettes per day. Legislative smoking bans are also effective in increasing quit rates. Although smoking cessation may be associated with minor short-term adverse effects such as weight gain and constipation, its long-term benefits are unquestionable.
Measures to reduce indoor and outdoor air pollution require public policies, local and national resources and cultural changes. Reduction of exposure to smoke from biomass fuel is crucial to reduce the burden of COPD. Effective ventilation, non-polluting cooking stoves and similar interventions should be recommended. Interventions to reduce exposure to potential irritants like dust, fumes and gases at the workplace will reduce the burden of COPD.
Influenza and pneumococcal vaccinations and recommended for patients with COPD to reduce serious illness and death. Physical activity is recommended for all patients with COPD.
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