As we mark World Asthma Day on May 2, Dr Jaideep A Gogtay, Chief Medical Officer, Cipla explains to Viveka Roychowdhury why unlike the rest of the world, 70 per cent of COPD patients in India are non-smokers and why increasing patient compliance, monitoring and awareness are key to tackling chronic respiratory disease. Excerpts from the interaction
Why do we see an increase in patients with chronic respiratory diseases (CRD)?
Dr Jaideep A Gogtay
Globally, CRD are believed to affect one billion people. Asthma and chronic obstructive pulmonary disease (COPD) are the two main CRD, while there are several others, like allergic rhinitis for example. Asthma affects just over 300 million, and for the first time, this year, estimates for COPD crossed asthma. (One reason for the increase could be that) we are now able to diagnose more COPD cases in the last five to 10 years and with this better data, COPD incidence is today around 330 million, up from the previous estimate of 210 million. These figures are as per the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017 guidelines.
So, while there is a focus on cardiovascular diseases (CVDs), diabetes and cancer, CRD has now also been recognised as a big issue. In fact, COPD is included by the Government of India in the list of non-communicable diseases (NCDs). The challenge with some of the CRD is that in most countries, the ratio of patients diagnosed to undiagnosed is 1:8 or 1:9. So, COPD is vastly under-diagnosed. For example, there was a study in Latin America, which showed that 90 per cent patients were undiagnosed, as diagnosis requires a spirometry or a lung function test.
Where does India stand?
In India, again, the estimates are guesstimates. Asthma patients make up roughly 2-2.5 per cent of the population, which is 30 million people of India’s 1.2 billion total population. An equal number could have COPD. There are some who believe it may be more than 2.3 per cent. Our guesstimate is that there are at least 60 million to 80 million people with CRD in India.
The unique part of COPD in India is that 70 per cent, that’s almost two thirds of the COPD patients are non-smokers, whereas in most Western countries 90 per cent of COPD patients are smokers. The reason is that we have a huge contribution (to COPD figures) from biomass fuel, which women use for cooking in the rural communities. That is why we see the push to move to LPG for cooking. Biomass is also used for heating in the winter, which adds to the COPD burden among non-smokers in India. Of late, we realised that Africa, parts of Latin America too have high numbers of non-smoker COPD patients.
Besides COPD, allergic rhinitis in India is quite high, estimated at around 15 per cent, meaning it is several times more common than asthma. India also has a fairly large population of smokers, estimated around 15-18 per cent. What’s worrying is that while smokers in their 40s are giving up smoking, youngsters seem to be picking it up earlier than before. Also, more young women seem to be picking up (smoking) of late. And beedis do not seem to have lost their appeal. So, we need to track these changes on the smoking front very carefully.
Air pollution too adds to the CRD burden. The Lancet has recently carried an article on the impact of air pollution in various cities and India ranks second in terms of PM2.5, following Bangladesh. This data tells us that air pollution is a big looming problem that will add to our lung health incidence.
We don’t as yet know what is the exact contribution of pollution to CRD but there is an interesting hypothesis put forward around a decade back, that when air pollution, like diesel exhaust, combines with allergies/ allergens like dust mites, cockroach allergies, etc, the lungs amplify the allergic response. So while air pollution may not directly cause asthma, when combined with allergens, the symptoms of asthma may be amplified.
How will these factors impact treatment?
You would see more severe asthma attacks, more difficult patients to deal with, etc. Increasing urbanisation too will add to air pollution levels, with increasing number of vehicles, leading to increased incidence of CRDs. The recent Supreme Court ban on BS III vehicles is a welcome...
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