Roasted corn, plantain sellers at risk of Chronic Obstructive Pulmonary Disease – Expert
A general practitioner, Dr Enemugwem Rogers, speaks with GODFREY GEORGE about the causes, symptoms and management of Chronic Obstructive Pulmonary Disease
What is Chronic Obstructive Pulmonary Disease? It is basically a disease of the lungs that is characterised by respiratory symptoms that are persistent and also include limitation of airflow into the lungs. From the name, chronic means it has lasted for a period of time with persistent symptoms. Obstruction points to the limitation of airflow into the lungs; pulmonary means it is a disease of the lungs. Normally, if you spread out the surface area of the airway of a person’s lungs, it is supposed to be as wide as a lawn tennis court. It is folded that way into what we know now as lungs. There is supposed to be some level of expansion when we breathe, to allow air to come in and go out, but for many who have COPD, there is an obstruction of the airways such that it is difficult for air to go in and out. So, that is where the airflow limitation comes in.
Does COPD come alone or does it have some accompanying conditions when it plagues a person?
COPD is an entity on its own, but it is made up of several smaller entities. There are smaller noticeable features when you sample a subset of people that have COPD. For instance, people with chronic bronchitis and people with emphysema may not be easily separated, because they share features which mostly overlap in their hosts. One may have more of bronchitis and less of emphysema and vice versa. When we look at it clinically, we find out that they may have COPD. It is not really straightforward.
What are the causes of COPD?
We may talk about long-term exposure to toxic particles and gases. Things like cigarette smoke are an example. In more developed climes like the United States, the majority of the population are people who are chronic tobacco users, ranging from cigarette smoking to every other kind of smoking. In developing countries like Nigeria, we may find the cause to be people who fry or roast things for sale and have to do it for a long time. You can imagine the lady who prepares roasted plantain, or someone who has to inhale smoke everyday while smoking fish, yams and plantains in order to make a living. She is exposed to the fumes coming out from the fire. Most people in places where they flare gas are exposed to soot for a long time. This exposure is responsible for the changes that bring about this disease. This means, there is nobody who is actually free. If you are in traffic, for instance, you will inhale most of these fumes from vehicles on the road.
as you have rightly said, there are people who depend on frying and/or roasting to feed themselves and their families. how do we expect them to cope knowing that they are exposed to this deadly disease? any escape route for them?
Before now, there used to be a lot of firewood used for cooking but we cannot say the same for now. Even in most of the big events, there are safer ways to do cooking so that most of the gases are not emitted. The best thing is to move to healthier alternatives for those people who do it as a job. Instead of burning wood or charcoal, use cooking gas. Another thing is to limit careers in those areas. If for instance you roast plantain or corn, give yourself like two or three years and leave the job for much healthier ones, for your health sake. If you are there, it is also good not to expose your children to that smoke. Most children are very helpful and would want to assist you as you roast. If you have a husband or roommate who smokes, try and leave whenever they want to smoke, so you don’t get affected as a ‘second’ smoker. If you work in a factory or nightclub, or you live close to an industry where they release these gases into the air, please, try and change jobs or move out of that vicinity if you want to stay healthy.
More commonly, people come up with this sickness in their fourth decade of life. So, you may be inhaling it now as a young person and not feel anything, but after your 40th birthday, you’d begin to see how much damage you have done to your system. It is something that you pay the price for much later in life, so it is better you do whatever you can to move into environments that’d give you less exposure to these gases.
What is the difference between asthma and COPD?
The changes in asthma are reversible once the person starts treatment, but in COPD, the changes are not reversible. Asthma may be noticed when the patient is younger, but COPD is mostly towards mid-life.
Is there a role the government should play in the prevention of COPD?
Government has a lot of things to do. They have a huge role to play. There are a lot of things that political will can do. The Nigerian government can reduce the use of hydrocarbon fuel and invest more in reusable sources of energy like what we have in the western world, where they have set up targets to move totally away from hydrocarbon fuel by 2025, some 2050. What are we doing? We are even the ones who need these regulations more with the poor health care system that we have in place. Most countries have stopped gas flaring, but Nigerians are busy fighting themselves on which area they’d go next to flare more gas. There was a bill one time about electric cars, but I am sure that bill died before it was birthed because of some greedy industrialist car dealers who think it would take them out of business. Now, see where we are. These things are disastrous to our own health as a people, but we prefer money to life.
Government can also place heavy tariff on tobacco importation and others. If cigarettes become more expensive, many people would be discouraged from smoking. They can impose stiffer sanctions on companies that pollute the environment so as to save the lives of regular Nigerians. They can also set up companies to use renewable sources of energy to run their activities. They should also invest a lot in educating the public. There are many Nigerians who have no idea what climate change, gas flaring and the likes are all about. All they are interested in is money. Any angle you look at it from, the government has a huge role to play.
What would you say about research in the area?
There is substantial research in the area. COPD is something that affects everybody from all races, so all hands are actually on deck to get all these things fixed. As a matter of fact, there is a body called the Global Initiative for Chronic Obstructive Lung Disease. GOLD is an international body which looks at the definitions of this disease, the classifications and coordinates further research into the area all around the world. For internal medicine, one of the hallmarks of respiratory medicine is the management of COPD. There are also drugs in the area of pharmacotherapy developed for the management of the condition. Drugs are being tested for their efficacy, so there is adequate research in the area. The definitions change with time based on the things we have learnt. Before now, we divided people into chronic bronchitis and emphysema, but that is not the same today as the definitions have been enlarged.
What symptoms should people look out for to know they have COPD?
We should talk about respiratory symptoms that are persistent. Here, we have cough, wheezing (noisy breathing), production of sputum or phlegm. When one has a chronic cough, producing sputum consistently for three consecutive months in two consecutive years, that person is said to have COPD. One should really be concerned when we notice these things, especially if you are one who is exposed to these poisonous gases. It is rare to have just one person with COPD. Other diseases that would complicate this illness may just be lurking around the surface. One can have a chest infection or what we call pneumonia and this worsens the presentation of COPD. Because of how it works, if one is hypertensive, it can worsen their condition. When people who are hypertensive get COPD, it becomes so complicated that their legs may begin to swell and it may seem like their health is deteriorating.
What is the worst that can happen?
The worst that can happen is what happens when your body does not get enough oxygen that it needs for normal processes. Definitely, if you are not getting enough oxygen, you start passing out and can die as a result. Because of the connection with the heart, there may be some structural changes that may make the heart start beating abnormally. So, one can develop pulmonary hypertension, chronic respiratory failure. These changes may progress into cancer. These air spaces that are unable to expand well may become cancerous and the person may begin to cough out blood and all that. If not well managed, it becomes full-blown cancer.
this brings us to the issue of self-medication. Some people claim to have so ‘mastered’ their body system that they know what exactly is wrong with them and what drugs to take. What is your take on this?
I think it is counter-productive. They are harming themselves. When you talk about cough, it could be flu, chest infection, asthma or reaction to an allergy. Many things can cause coughing. If you just go to the patent medicine dealer and tell them you have a cough so they ‘mix’ drugs for you, you are not helping yourself. I heavily discourage such practices. It is better that when you have these symptoms, you visit the hospital and see the doctor, so the doctor can assess you to ascertain what exactly is going on with you. There are some illnesses that are identified just by talking with a patient. Just like COPD, it is usually a clinical-based diagnosis. For some people, from history, you can know that this person has COPD. It makes one much healthier. What most Nigerians do is treat the symptoms and not the illness in itself. When you take some of these drugs, what they do is make you feel as if you are okay for a day or two and then the symptoms are back again.