Chronic Obstructive Pulmonary Disease (COPD) is a common lung condition in the Philippines. It is a progressive lung condition characterized by airflow limitation and chronic respiratory symptoms. COPD in the Philippines is treatable but requires proper knowledge about the causes of this disease and how it should be managed.
TL;DR
- COPD is one of the top 10 causes of death among Filipinos with prevalence in adults recorded at around 14%.
- It affects lung function progressively in an irreversible manner, causing symptoms such as chronic cough, phlegm, difficulty breathing, wheezing, and tiredness.
- The primary causes in the Philippines include tobacco smoking (majority of cases), exposure to indoor pollutants like charcoal smoke, chemical fumes, low outdoor air quality, and recurring lower respiratory infections.
- A study in rural Nueva Ecija found a COPD prevalence of 20.8% for GOLD Stage I or higher, with risk factors including smoking, prolonged use of firewood for cooking, farming for over 40 years, and history of tuberculosis.
- COPD is incurable but manageable; avoidance of smoking and air pollution exposure as well as vaccination and treatment can improve symptoms.
- Smoking remains a grave threat to lung health in the Philippines, which also has high smoking rates, contributing to the COPD burden.
- COPD contributes significantly to health system burdens in the country and is a leading cause of chronic respiratory disease morbidity and mortality.
In the Philippines, COPD primarily arises from long-term exposure to lung irritants, especially cigarette smoke, which causes inflammation and damage within the airways and lung tissues. Recent statistics on tobacco smoking from the Global State of Tobacco Harm Reduction show that in 2022, the prevalent of smoking among adults 15 years old and higher is at 20.4 percent. This prevalence was 36.2 percent among males and 4.3 percent among females.
This is an increase from 2021 figures where smoking prevalence was 33.3 percent among males and 2.6 percent among females. The study also show that in total, the total number of individual Filipino smokers is at 15.8 million.
Vaping makes one’s vulnerability to COPD worse. In the Philippines, vaping is often touted among youths as a good alternative to cigarettes. But a study from Respiratory Medicine shows that vapes are more dangerous than cigarettes. Vapes, also known as e-cigarettes, indicates a 4% increase risk of COPD than those who smoke tobacco.
Despite national health initiatives to discourage cigarette smoking, many Filipinos find it difficult to eliminate cigarettes from their daily habits. Thus, it is not surprising to have COPD cases are prevalent in the Philippines, including Davao del Norte, making locals with COPD highly vulnerable to more severe conditions like pneumonia, tuberculosis, and lung cancer.
What is COPD?
COPD is defined as a chronic inflammatory lung disease. These are conditions that causes obstructed airflow from the lungs. The obstruction results from swelling and irritation inside the airways due to inhaled noxious particles or gases, most commonly from cigarette smoke, which is prevalent in the Philippines.
Obstruction caused by this irritation leads to difficulty breathing, chronic cough with mucus, and wheezing. The disease is progressive and typically becomes worse over time, with an increasingly limited airflow making routine activities like walking or dressing challenging. COPD includes two main clinical subtypes that often coexist: chronic bronchitis and emphysema.
Chronic bronchitis is diagnosed by a productive cough lasting at least three months for two consecutive years, while emphysema involves destruction of the alveoli, causing decreased lung elasticity and impaired oxygen exchange. COPD may also include mixed phenotypes incorporating features of both diseases and may overlap with asthma in some patients.
What are the common causes of COPD in the Philippines?
The primary cause of COPD in the Philippines, which is the same worldwide, is long-term exposure to cigarette smoke. Smoking damages the lungs by causing inflammation and airway narrowing, ultimately resulting in airway obstruction and tissue destruction.
Cigarette smoke remains the most significant risk factor, although not every smoker develops COPD, suggesting genetic susceptibility plays a role. Genetics is a minimal contributor in COPD prevalence. Approximately 1% of COPD cases are linked to alpha-1 antitrypsin deficiency, a hereditary condition affecting the body’s ability to protect lung tissue from damage.
Besides cigarette smoking, other causes of COPD include exposure to secondhand smoke, air pollution, workplace dust, fumes, and chemicals such as cadmium. Indoor air pollution from cooking and heating fires is a significant cause in some regions. In 2023, the Philippines was 6th among South Asian countries with the most polluted air, and the 79th worst in the world in air pollution levels.
Additionally, low body weight and a history of childhood respiratory infections contribute to the risk of developing COPD. These inhaled irritants cause chronic lung inflammation that leads to structural damage and airflow limitation characteristic of the disease.
What are the symptoms of COPD?
Symptoms of COPD usually develop gradually and worsen over time. In the Philippines, the main clinical features of COPD include:
- Persistent cough with mucus (chronic bronchitis)
- Shortness of breath, especially during physical activity
- Wheezing and chest tightness
- Increased mucus production
- Frequent respiratory infections
- Fatigue and reduced exercise capacity
Emphysema and Bronchitis: Common COPD in the Philippines
COPD commonly manifests in two overlapping forms: chronic bronchitis and emphysema.
Chronic bronchitis involves inflammation and excess mucus production in the airways, leading to narrowed airflow. In contrast, emphysema is characterized by damage to the tiny air sacs (alveoli) in the lungs, reducing oxygen transfer to the blood.
Emphysema damages the alveoli, the tiny air sacs in the lungs responsible for oxygen exchange. When these air sacs become damaged and lose elasticity, less oxygen enters the bloodstream, leading to symptoms like shortness of breath, fatigue, rapid heartbeat, and a barrel-shaped chest. It is a progressive, irreversible condition that gradually worsens over time.
Chronic bronchitis, on the other hand, primarily affects the airways or bronchi. It causes inflammation and destruction of the cilia, the tiny hair-like structures that help clear mucus. This leads to swollen airways filled with mucus, causing a persistent cough producing mucus, wheezing, chest discomfort, and difficulty breathing. The symptoms may fluctuate and often worsen during infections. Unlike emphysema, chronic bronchitis is characterized by frequent coughing and mucus production for at least three months over two consecutive years.
Both conditions share symptoms such as shortness of breath and wheezing and are often caused by smoking. However, emphysema primarily impairs oxygen transfer through damaged alveoli, while chronic bronchitis mainly causes airway inflammation and mucus buildup restricting airflow
COPD symptoms include persistent cough, mucus production, wheezing, difficulty breathing, and reduced exercise tolerance. Though COPD worsens over time, it is manageable with appropriate medical treatment, lifestyle modifications, and support therapies aimed at reducing symptoms, preventing exacerbations, and improving quality of life.
As both conditions advance, their symptoms become more severe, causing disabling breathlessness and significantly impairing daily activities. Exacerbations or flare-ups—episodes of intensified symptoms often triggered by infections or air pollution—may require additional treatment and can cause further lung damage.
Medical Treatment and Management of COPD
While there is currently no cure for COPD, the disease can be managed effectively to reduce symptoms, prevent complications, and improve patients’ quality of life. Treatment typically involves lifestyle changes, medications, and supportive therapies:
- Smoking cessation is paramount to slowing disease progression and improving outcomes.
- Bronchodilators are the mainstay drug treatments; they relax airway muscles and improve airflow. Short-acting bronchodilators provide quick relief during flare-ups, while long-acting bronchodilators are used daily for maintenance.
- Inhaled corticosteroids reduce airway inflammation and are often combined with bronchodilators to control symptoms and decrease exacerbations.
- Oral steroids and antibiotics may be prescribed to manage acute exacerbations caused by infections.
- Oxygen therapy is indicated for those with severe chronic hypoxemia to maintain adequate oxygen levels.
- Pulmonary rehabilitation includes exercise training, education, and nutritional advice to strengthen respiratory muscles and improve functional status.
- In selected severe cases, surgical options such as lung volume reduction surgery or transplantation may be considered.
- Preventative measures such as vaccinations against influenza and pneumonia are recommended to reduce infection risk.
Correct inhaler technique and adherence to prescribed treatments are critical for effectiveness. Access to inhalers and therapies varies globally, with disparities noted in low- and middle-income countries. COPD patients should also avoid pollutants and manage comorbid conditions associated with the disease.
Treating COPD in Davao del Norte
COPD is a chronic lung disease in the Philippines is largely caused by smoking and environmental exposures, presenting with progressive airflow obstruction and debilitating symptoms. Although incurable, it can be controlled with comprehensive management to enhance patients’ quality of life and reduce complications.
Sources: World Health Organization (WHO), Philippine Department of Health (DOH), Philippine Statistics Authority, Energy Tracker Asia, Global State of Tobacco Harm Reduction
