Chronic obstructive pulmonary disease (COPD) ranks third among the causes of death, after cardiovascular disease and cancer. What are the causes and symptoms of COPD? What is the treatment? We are talking about COPD with prof. Andrzej M. Fal, head of the Department of Internal Diseases and Allergology of the Central Clinical Hospital of the Ministry of the Interior in Warsaw.
Chronic obstructive pulmonary disease (COPD) , of all the "killer" diseases, shows the most visible upward trend. Western countries come first in terms of incidence. We talk to prof. Andrzej M. Fal, head of the Department of Internal Diseases and Allergology of the Central Clinical Hospital of the Ministry of the Interior in Warsaw.
- Are we dealing with an epidemic?
Prof. Andrzej M. Fal: What is known today about the epidemiological status of COPD is just the tip of the iceberg. In most cases, the disease is simply undiagnosed, undiagnosed and, consequently, not treated. It is estimated that over 2 million Poles suffer from COPD. Taking into account the fact that the National He alth Fund registers only 600,000 outpatient COPD consultations annually, the issue of diagnosis and treatment of COPD looks particularly dramatic. Annually, there are over 62,000 hospitalizations due to exacerbation of the disease. As a consequence, outpatient treatment expenditure is compared to hospital treatment expenditure in the ratio of 1: 3.5. Unfortunately, there is also a high mortality in Poland, with 15,000 people dying from COPD every year.
- What is PoChP?
A.M.F .: Chronic, progressive, incurable lung disease, limiting the flow of air in the respiratory tract, irreversibly destroying lung tissue. For years, it is asymptomatic or mildly symptomatic. The prolonged inflammatory process in the lungs leads to respiratory failure, weakens strength, and often leads to exclusion from professional and social life, also to permanent disability, with a permanent reduction in the quality of life. Moreover, COPD should be treated as a systemic disease. Research shows that COPD increases the risk of heart attack, stroke, osteoporosis, high blood pressure and many other diseases. It must be remembered that this is always a feedback -Diseases comorbid with COPD make it more severe. It also increases the susceptibility to respiratory infections.
- Only 3 percent of respondents can tell what COPD is.
A.M.F .: This is the biggest problem in early prevention - stopping the morbidity. And not only in Poland. The knowledge deficit of chronic obstructive pulmonary disease is observed everywhere.
- How much does the treatment cost?
A.M.F .: About PLN 165 million is spent annually on COPD treatment, of which as much as PLN 125 million on hospitalization, i.e. the most expensive he alth service. On the other hand, only PLN 34 million is spent on outpatient care (specialists, family doctors), which should be the main link in the care of patients with COPD. This is the case in Poland. Unlike in the European Union countries, where outpatient care expenses, including education, pharmacotherapy and rehabilitation, are the most effective in terms of the patient's quality of life, the public he alth system and public finances. It works and proves in practice. The amounts that we do not notice are indirect costs - expenses related to absenteeism, benefits, disability pensions, etc. In Poland, the Social Insurance Fund spends over PLN 230 million for this purpose only in relation to COPD. If the attitude to both COPD treatment and its financing remains unchanged, it will be difficult to significantly improve he alth indicators.
- What is the root cause of COPD?
A.M.F .: Tobacco smoke. As all studies show, he is the leading culprit of COPD. In the diagnosed cases, 80 percent are patients who smoke.
Only an immediate reduction in exposure to triggers, including, in particular, quitting smoking, and implementing the correct treatment at the same time, are able to slow down the destruction process started in the respiratory system.
Studies also show that approximately 50 percent of smokers develop irreversible airflow limitation in the lungs, and 10-20 percent. there are clinically significant symptoms of COPD. Other risk factors that attract attention are air pollution, which is common, and occupational factors often related to the specificity of the workplace. In turn, in countries where organic residues are burned in furnaces, this exposure is a key risk factor for the development of COPD. As with all chronic diseases, genetic predisposition undoubtedly plays a role. Of course, most often differentThese factors work together to increase the risk of developing COPD. However, this does not change the fact that tobacco smoke is the greatest threat.
- What are the first symptoms of chronic obstructive pulmonary disease?
A.M.F .: Shortness of breath, shortness of breath, daily morning cough, often with expectoration of sputum, noticeable breathing difficulties, e.g. when climbing stairs, difficulty in keeping pace with the accompanying person, when it was not a problem until recently. Unfortunately, such and similar symptoms are usually underestimated, disregarded, and you go to the doctor only when all this becomes really troublesome and disturbs the normal lifestyle. Unfortunately, usually then it turns out that the disease has already made irreversible changes in the respiratory tract. The earlier the treatment is introduced, the greater the chances of stopping the disease development and reducing the number of exacerbations, which have the greatest impact on the quality of life of patients and worsen their he alth. COPD begins to manifest itself clinically most often in people over 40 years of age.
- How is COPD treated?
A.M.F .: The key is to quit the addiction. Only then does the role of drugs come in. Currently, pharmacotherapy is based on two groups of drugs that widen the airways (bronchi). Recently, new preparations have been introduced in both groups, this is a significant progress, giving physicians a greater choice of therapy, especially as some of these preparations can be used once a day and others twice a day. One of the preparations from the group of cholinolytics entered the reimbursement lists, the other is waiting in line - it is being negotiated. This is very good news for patients and doctors, and - I hope - also a good prognosis for the gradual increase, as part of reimbursement, in the availability of modern therapies for chronic obstructive pulmonary disease.
- Medicines are administered mainly by inhalation, directly into the bronchi.
A.M.F .: The doctor should teach the patient the correct use of the inhaler, and then check it in practice at each visit. Unfortunately, many patients, as well as many doctors, do not appreciate the use of the correct inhaler technique in the overall therapy. Research shows that up to 50 percent. patients are using inhalers incorrectly. This means that only a fraction of the dose reaches its destination, which is the lungs. The point is that with the increasing incidence of COPD and its serious he alth and public he alth effects, nothing should be wasted that could help combat the disease in general.
ImportantHow to use the inhaler correctly
It depends on the type of Inhaler. Set the pressure mouthpiece to the "mouthpiece down" position, support it with your thumb, and place your index (or middle) finger on the medicine container. We shake the inhaler vigorously for 5 seconds. Sit or stand and tilt your head slightly back. We breathe calmly for a while, take a long breath, put the mouthpiece of the inhaler in our mouth, take a slow, deep breath, while pressing the medicine container with our finger. We hold the air for 10 seconds and let it out slowly. Instructional videos showing how to use various inhalers, at: www.pta.med.pl/jak-uzywac-inhalatora.html
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