The COPD paradox. This is the third cause of death of Poles, almost nobody knows what it is

90 percent Poles know what a heart attack and cancer are, and the same number of people do not know what COPD is. So almost no one is aware of what the third most common disease causing the death of Poles is. This is a great paradox – says Dr. Tadeusz M. Zielonka, specialist in lung diseases. What is COPD, what is its risk and why is it particularly dangerous during the COVID-19 epidemic, he told Medonet.

1. Dr hab. Tadeusz Zielonka: COPD is one of the most important diseases of the modern world. It is the third cause of death in the world – after cardiovascular and oncological diseases
2. Specialist: almost no one is aware of what the third most common disease causing the death of Poles is. This is a great paradox. We do not know one of the most common causes of death, and we focus more on other causes, such as diabetes and hypertension
3. COPD is inextricably linked with cigarette smoking and air pollution
4. Patients with COPD are at risk of a more severe course of infection, they are also more susceptible to SARS-CoV-2 infection.
5. You can find more up-to-date information on the TvoiLokony home page

Monika Mikołajska / Medonet: COPD, or chronic obstructive pulmonary disease, is a very serious disease. Every year more than ten thousand Poles die because of it.

Dr hab. Tadeusz Zielonka: COPD is one of the most important diseases of the modern world. It is the third cause of death in the world – after cardiovascular and oncological diseases. In Poland, 15 die every year from COPD. people, which is more than today due to COVID-19.

Why is COPD at the forefront of diseases that kill Poles?

Remember, this disease is inseparable from cigarette smoking. While fortunately fewer and fewer people smoke tobacco today, it is now that we are feeling the effects of the enormous consumption of cigarettes that took place years ago. During the People’s Republic of Poland, nicotine was used by 2/3 of men – these are often people suffering from chronic obstructive pulmonary disease today. It takes more than 20 years from the onset of addiction to the development of COPD.

I emphasize, we are talking about addiction. There is a large group of patients who, even in the advanced stage of the disease with severe dyspnea, still smoke cigarettes. It may seem absurd to non-smokers, but I observe how difficult it is for some patients to give it up, how addictive nicotine is.

1. When is breathlessness a serious illness? [WE EXPLAIN]

The fashion for smoking has ended / weakened, at least in our part of the world, but the number of COPD patients is not declining. Why?

First and foremost, this fashion applies to rich countries, while in African countries, and especially in Asia, the consumption of cigarettes is constantly increasing. We also touch upon another important cause of the disease – air pollution. Inhaling smog causes damage to the respiratory tract and changes leading, among others, to for chronic obstructive pulmonary disease.

Diseases change with civilization. Once upon a time, digestive system disorders related to poor food quality were a huge problem. Today it is a thing of the past, but we are struggling with respiratory diseases. Our civilization promotes them, in a way, through activities that cause progressive air pollution. Unfortunately, the situation is getting worse and more and more sick. In the times of the Polish People’s Republic, there were coal quality standards and it was not allowed to throw fine coal into the furnace, which today is widely used in many households, causing the death of thousands of people.

As the doctor said, COPD is the third cause of death in the world. Despite this, hardly anyone knows what it is and how enormous its consequences are.

90 percent Poles know what a heart attack is and what cancer is, and the same number of people do not know what COPD is. So almost no one is aware of what the third most common disease causing the death of Poles is. This is a great paradox. We do not know one of the most common causes of death, and we focus more on other causes, such as diabetes and hypertension.

So let’s explain what COPD is all about? What does the word “obstructive” really mean? To most of us, it doesn’t say much.

Obstruction means narrowing. The bronchial constriction occurs in COPD and this is the essence of this disease. The reasons for this vary, for example, mucosal edema, muscle spasm or laxity of the bronchi. The symptoms observed in patients depend on which of these mechanisms is dominant. Sometimes we deal with a bit of everything.

Therefore, is it possible to identify typical symptoms of COPD that could be a signal of anxiety and a stimulus for testing?

Among them, we can mention a chronic cough, which patients do not notice at all because they have got used to it and perceive it as a constant “normal” symptom accompanying smoking for years. Another is progressive, albeit slowly, exercise dyspnea – felt, for example, when climbing stairs. It mainly worsens in people over 40 years of age. This is very important, because if these people had experienced such dyspnea earlier, when they were 20 or 30 years old, they would find it disturbing and consult a doctor. Meanwhile, now in your forties or fifties, this symptom is often considered a normal sign of aging. It can therefore be said that the symptoms of COPD do not cause anxiety in patients for a long time.

1. Cough – when does it appear and what can it signal?

A great test to find out if we have problems with lung function is to check whether we are keeping up with a spouse or loved one who is of a similar age, e.g. when we go up the stairs together. The problem of keeping up with him means that our physical performance is worse. This is very often a signal of a developing COPD.

Why can’t we keep up with our husband or wife when we try? What is the cause of decreased physical performance in COPD?

In COPD, exercise-induced dyspnea is associated with disturbed ventilation. Narrow bronchi are unable to supply the lungs with enough air because the breathing becomes “too short”. Dyspnoea can also occur due to heart failure. Remember about the relationship between the heart and lungs – if we have COPD, it is often accompanied by heart failure. On the other hand, it happens that patients with chronic obstructive pulmonary disease see a cardiologist for a long time, but it is as if they were treating the effect, not the cause. Patients have been under the care of a specialist in another field for too long, without noticing the worsening bronchial obstruction and the developing COPD.

We already know that a person with COPD experiences shortness of breath and coughs. However, if we were to imagine how such a patient feels on a daily basis …

I would ask you to breathe as much into your lungs as possible – as much as you can, and while you are at the top of your breath, still trying to breathe without exhaling….

It is heavy and very tiring …

This is exactly how people with COPD feel. They are at the top of an inhale and gasp like a quick “gasp”, similar to a dog in hot weather. Remember that in COPD we are dealing with bronchial constriction, therefore the lungs do not empty of air completely and they become distended.

It can be compared to a traffic jam when, for example, one lane is excluded from traffic. Behind this narrowing, even if it is only punctual in nature, a long queue of cars forms. The road capacity drops. If we relate this situation to the lungs – the residual air causes the lungs to lose their elasticity and even if we remove the aforementioned constriction, the air will not leave the lungs so easily – because of the aforementioned long-lasting distension. Then, the walls of the alveoli are destroyed and large air spaces are created. The area of ​​gas exchange is dropping dramatically. For this reason, even if we administer medications that dilate the bronchial tubes, i.e. eliminate the stenosis, we are not able to reduce breathlessness. This is the essence of emphysema, a condition that is part of COPD.

COPD is said to be incurable. However, this absolutely does not mean that nothing can be done

Using the term “incurable” may provoke an attitude of nihilism in patients. The patient, hearing that he has an incurable disease, states that since nothing can be done, there is no point in going to the doctor. This is not true – a lot can be done.

First, you need to remove the cause of the disease, that is, to quit smoking. And please do not believe the fairy tales that are repeated often that if the lungs are already destroyed, it is not worth giving up nicotine. It’s always worth it. Even if it is already very bad with our lungs, smoking cigarettes and breathing smog will get even worse with each passing year. Lung function will decrease and physical capacity will decrease. While at the beginning the patient will be able to go to the second floor, then he will only be able to go to the first floor, after some time he will not even go to the landing, eventually, due to breathlessness, he will not be able to even walk around the house, and simple hairdoing will become a challenge like climbing Mount Everest.

So it is extremely important that a person with COPD improves the quality of the air they breathe, as it is a causal treatment. Thanks to this, the progress of the disease will be stopped. And even if it is 50 percent. lung capacity is always better than if it were to drop to 25 percent. Believe me, the difference in the quality of life in both of these situations is enormous. These are two worlds. At 50 percent efficiency, it is still possible to work (although no longer physical work) and a relatively normal life. At 25 percent we lose our independence. The help of third parties is already needed, because even simply going out for bread will be an unimaginable effort. And that’s all because we once said, “There’s nothing more can be done with my COPD.”

The second important thing is the treatment of bronchoconstriction, that is, widening them. The medications we used to have reduced the feeling of breathlessness, but did not improve the spirometry result. The preparations we have now improve respiratory function.

We cannot fail to mention the ongoing coronavirus epidemic. Patients with COPD are not only at risk of a more severe course of infection, but are also more susceptible to SARS-CoV-2 infection.

This is unfortunately true. Respiratory failure in COVID-19 is caused by interstitial pneumonia. In the case of SARS-CoV-2 infection in COPD patients, the pathogen will superimpose on already damaged lungs. In this situation, respiratory failure is much easier.

Another thing – people suffering from COVID-19 are given oxygen, thanks to which we compensate for deficiencies. When the lungs are sick, gas exchange is disturbed, and when we administer a lot of oxygen, carbon dioxide is more easily retained, leading to complete respiratory failure. Complications after oxygen therapy are easier to find. Therefore, patients with COPD cannot receive too much oxygen, as this worsens gas exchange in them. So we are dealing with the failure of a therapy that brings results and allows healthy people to survive. Such patients require the use of a ventilator more quickly, but are not always qualified for this treatment for fear that the damaged lungs will be able to resume normal function after SARS-CoV-2 infection.

As for the greater susceptibility to coronavirus infection in COPD patients, it is associated with the condition of the respiratory mucosa, which creates a barrier that protects us against microbes. In the case of COPD, it is damaged, inflamed, and this facilitates the penetration of the pathogen and thus the infection.

Therefore, should patients with chronic obstructive pulmonary disease take special precautions against the coronavirus?

There are no special recommendations. I see a lot of COPD patients and I have to note that they, like very few people, follow the rules. While I happened to meet young asthmatics who have different approaches to COVID-19, patients with COPD show great responsibility. I don’t have to give them advice on how to behave in times of epidemics. They are the ones who watch over others. They can be set as models.

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