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Special Features

COPD: Chronic Obstructive Pulmonary Disease or Chronic Out of Pocket Dilemma?

By: Risa Caldoza-De Leon, MD, FPAPSHPI article_12

Trisha and Anton, the ultimate power couple, were high school sweethearts who wed after college and had three lovely kids. They worked hard, but loved to party harder! For more than three decades, they shared their exciting lives as well as their cigarettes. Anton, 54, first succumbed to emphysema and after a long costly battle with the disease, died in 2015.  Trisha, 52, was found with lung cancer in 2017 and died four months after diagnosis. Both were dear friends of mine.

Everywhere around the world, people lose their loved ones left and right to lung disease. Chronic obstructive pulmonary disease (COPD) refers to a group of lung diseases that block airflow, including chronic bronchitis and emphysema. Most COPD patients suffer from both. This progressive and incurable disease (yes, there is no cure) makes breathing very hard for the 210 million people suffering worldwide. The Global Burden of Disease Study by World Health Organization (WHO) warns that COPD may become the third leading cause of death worldwide by 2030.

One of 10 Filipino adults aged 40 and up may have COPD and a mere 2% of them will be clinically diagnosed. Every single hour, 10 Filipinos die of smoke-related disease, with COPD ranking 7th as the top cause of death. So when you take your 20,000 breaths a day for granted, think again.

Yosi Kadiri

Nine of 10 cases of COPD are due to cigarette smoking. There are 13 million adult Filipino smokers, giving us the second highest smoking prevalence rate among ASEAN members. Sadly, the Global Youth Tobacco Survey revealed that almost three of 10 Filipino students aged 13 to 15 years old, mostly boys, have already smoked cigarettes. Men smoke about 11 cigarettes a day while women smoke seven. Studies confirm that even those smoking less than five cigarettes a day can have early signs of cardiovascular disease.

Ironically, even cigarette makers warn us of COPD. According to the Philip Morris International official website: “We agree with the overwhelming medical and scientific consensus that cigarette smoking causes lung cancer, heart disease, emphysema, and other serious diseases in smokers. Smokers are far more likely to develop serious diseases, like lung cancer, than non-smokers. There is no ‘safe’ cigarette.”

Not everyone who has COPD smokes. Being exposed to certain gases or fumes, copious amounts of secondhand smoke and pollution, and continuous use of a cooking fire without proper ventilation are other factors linked to COPD. An unusual case is of non-smokers developing emphysema due to their lack of protein called alpha-1 antitrypsin.

Pink Puffer vs. Blue Bloater

COPD patients may complain of cough (with or without mucus), fatigue, and shortness of breath (dyspnea) that gets worse with mild activity and wheezing. They all usually develop slowly. 

In medical school, we use the facetious term ‘pink puffer’ for a patient with emphysema, who has a pink complexion due to facial flushing as he constantly puffs. In emphysema, about 480 million of tiny delicate air sacs (alveoli) in your lungs are stretched and damaged, making it harder to move air in and out.

The ‘blue bloater’ chronic bronchitis is bluish, especially on lips and limbs. They are bloated due to swelling (edema), which later on progress to heart failure. Their airways are inflamed so they produce a lot of mucus and try to cough it out.

COPD also brings possible complications such as pneumonia, irregular heartbeat (arrhythmia), osteoporosis, extreme weight loss and malnutrition, and heightened anxiety.

The Price Tag

Life does not have a market price, but every disease has, and it sure is hefty! Doctor consultations, hospitalizations, home care, medications, and pulmonary rehabilitation do not come cheap. Doctors usually prescribe quick-relief drugs to help open the airways and make breathing easier, control drugs to reduce lung inflammation, anti-inflammatory drugs to reduce swelling in the airways, or antibiotics. More serious cases may require steroids, nebulization, oxygen therapy, machines to assist breathing, or surgery.

In the United States alone, direct medical costs of COPD were around $32 billion for just one year (2010). With 16 million workdays lost yearly, the value of absenteeism is pegged at $4 billion.

COPD hugely affects productivity of our workforce. Income is lost for the inflicted. For a worker who misses 7 days’ work while being treated or recovering, that’s PHP 3,584 down the drain. Most often, an employed family member also skips work to watch over the patient, incurring the loss of wages twice. The devastating impact of COPD doesn’t stop there as sometimes, children quit school and/or work to provide added source of income. Worst still, with our country’s life expectancy of 67 years, a COPD patient who dies at 50 loses 17 potential years where he could have earned around PHP 2.8 million (based on the minimum daily wage of PHP 512 for NCR). But is that all? What is the price of being denied to live a long and healthy life?

Outpatient Treatment (Estimated Cost)

  • Pulmonologist Professional Fee (Lung Center of the Philippines) – P3,000
  • Diagnostics (Chest x-ray, spirometry, blood tests, etc.) – P8,000
  • Medications (Bronchodilator inhaler, steroids, etc.)  – P10,000/month
  • Pulmonary Rehab (Done twice a week) – P300/session

SAVINGS IF YOU STOP SMOKING TODAY (1 pack/day) – P43,800/year

Never Too Late

You can prevent COPD and treat its symptoms to keep it from getting worse. Experts agree on these things:

1. NOW IS THE TIME TO QUIT if you smoke. Make sure no one smokes in your home.


2. Walk to build up strength. Exercise is the cornerstone of pulmonary rehabilitation.


3. Use pursed lip breathing when you breathe out to empty your lungs before the next breath.


4.  Avoid very cold air or very hot weather.


5. Manage stress and your mood. Stress is a leading risk factor in COPD flare-ups. Experiment with relaxation techniques.


6. Eat well to manage your weight. Eat smaller meals more frequently throughout the day. 


7. Get vaccinated against flu and pneumonia. COPD flare-ups can be triggered by a cold or flu.


8. Visit your doctor regularly. Having a good relationship with your doctor is crucial when living with COPD.


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Keywords: pneumonia, flu vaccine, weight management, relaxation techniques, stress, pursed lip breathing, pulmonary rehabilitation, exercise, absenteeism, oxygen therapy, nebulization, steroids, chronic bronchitis, dyspnea, alpha-1 antitrypsin, lung cancer, smoking, emphysema, chronic obstructive pulmonary disease   
  
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