Dr Sundeep Salvi, Director, Chest Research Foundation speaks on the current state of COPD in India, the kind of research underway in understanding its prevalence and the co-relation between CVDs and COPD in conversation with Raelene Kambli
Can you share some latest data on COPD in India?
According to the latest Global Burden of Disease, COPD is the second leading cause of death in India and the third leading cause of death in the world. An earlier report from the Government of Maharashtra (2010) stated that COPD was the first cause of death in Maharashtra. The most objective diagnostic test for COPD in the community is to perform Spirometry after giving a short-acting bronchodilator. Such kind of research studies are only few in India so far. This study has taken place in four centres across India (Mumbai, Pune, Mysore and Kashmir) and the latest COPD has been reported to vary from 5.5 to 18 per cent. My guesstimate is that roughly 10 per cent of people over the age of 40 years have COPD in India.
What kind of research have you done on COPD so far?
CRF studied the prevalence of COPD in 22 rural villages near Pune. The prevalence was found to be 5.5 per cent and that 85 per cent of these had never smoked in their life. Earlier research from the western world established tobacco smoking as the leading cause of COPD. But our research at CRF showed that you don’t have to be a smoker to have COPD in India. In fact, majority of the cases of COPD occur among non-smoker. This seems to be the case in most of the developing countries in the world. The world was not aware about this and the publications of CRF in some of the leading medical journals in the world (Lancet, CHEST, etc) educated the world about Non-Smoking COPD.
What are your learning from this research?
You don’t have to be a smoker in India to develop COPD. Exposure to biomass fuel smoke, mosquito coil smoke, dhoop agarbatti smoke and smoke from outdoor air pollution, industries such as mining, leather and occupations such as farming are the other main risk factors for COPD in India. Also, poorly treated chronic asthma and people who had lung TB in the past are also more vulnerable to develop COPD.
During research, how important it is to take into account the everyday lives of patients and the way they use their medicines?
Very important! Many patients of COPD do not receive a proper diagnosis, therefore do not receive appropriate treatment. Some get diagnosed to have COPD, but do not receive the proper treatment and some get the right diagnosis and right treatment, but do not take their medicines regularly. All this contributes to poor quality of care of COPD patients, that contributes significantly to increasing suffering and death.
What kind of impact will this information have in better management of COPD?
Knowledge about the true burden of COPD, its risk factors and the proper treatment need to be informed to the doctors, so that they will diagnose the disease early, treat it properly and ensure that the patients take their medicines regularly.
Can you elaborate on the association between COPD and CVDs?
COPD not only affects the lungs, but affects all other organs of the body. The harmful air pollutants that get deposited in the lung over a long period of time not only causes lung tissue damage, but also releases a whole host of chemicals and mediators that enter the systemic circulation and get deposited in other organs. The heart is the first organ where the inflammatory soup mediators get deposited and cause damage there. A significantly large number of patients of COPD have an associated heart disease that is directly related to the lung damage. COPD patients have a four to five fold increased risk of having heart disease than those who do not have a heart disease. This manifests an increased rate of heart attacks, hypertension and cardiac failure.
What kind of research is underway to understand this relation further?
We are in the process of research on how common is CVD in COPD and what causes it and how it can be treated better.
What is the need of the hour in term of management of both these conditions, especially in patients who suffer from this dual conditions?
All COPD patients must be screened for heart diseases and all heart disease patients must be screened for COPD. Both diseases need to be treated appropriately for better outcomes. In particular, patients with COPD and heart diseases must not be denied a beta blocker. Many physicians worry about the side effects of beta blockers in causing bronchospasm in patients with COPD. It does not. And being the best drug so far to treat heart disease, these drugs should not be denied.
You talk about ‘Liberation through Research, Education and Advocacy”. Can you elaborate on the same.
Very little research takes place in the field of COPD or asthma in India. We largely rely on research developed from the western world. This imported knowledge is usually not relevant to our people. We need to generate our knowledge that is relevant to the needs of our people. Example: mosquito coil or agarbattis – their impact on our health can only be studied in India, not in the western world. Whatever new knowledge is generated needs to be disseminated to people at large, be they health care providers, researchers or even policy makers. This will enhance the quality of care that we can offer to people. Knowledge generated in our country needs to be translated to policy decisions that will help reduce the disease burden and improve survival and quality of life. This can only be achieved through proper advocacy.
CRF has been working very closely in all these three areas of research, education and advocacy to help reduce the suffering of people with chronic lung diseases.
Do you think an inclusive approach to research would also be beneficial?
Yes, knowledge generation is crucial to create awareness, treat disease better and bring about a policy change. Unfortunately, very little research takes place in the medical field in India.