Chronic Obstructive Pulmonary disease (COPD) has been around for almost 205 years and is one of the most prevalent non-infectious diseases in our country. It is the 2nd leading cause of death and disability adjusted life years (DALYs) in India. Although well known to be a result of Smoking. Now it is broadly divided into first hand smoke and second hand smoke (SHS) which include use of cooking fuel, hookah, biomass fuel and firewood, and outdoor air pollution. Other risk factors like increasing age, occupational exposure, gender, pulmonary impairment after tuberculosis and socio-economic status leading to less awareness about these risk factors. It has also been found that smokeless tobacco agents like in India, the most common form of tobacco use is chewing paan masala/gutkha, betel, areca nut might not directly cause COPD, but can lead to chronic bronchitis a type of COPD due to chronic aspiration of these spit products.

Given the burden of disease, most of us might have to live with someone suffering from COPD. Let us throw some light on how to deal with day to day problems.

1. Diagnosis and appropriate treatment plan: Consulting a pulmonologist and getting to a diagnosis by doing spirometry, chest x ray. The grading of severity plays a crucial role for yearly monitoring and prescribing medicines like inhalers and exercises and supplemental oxygen.

2. Make the switch: For active smokers it is essential to quit smoking, also to remember E- cigarettes are no better. Instead use nicotine patches or gums. Switch over to cleaner fuels for cooking. Use of electric burners. contributing in any small way possible to reduce air pollution, ensuring good ventilation at home.

3. Managing your Flare ups: knowing what is a “good day” for the body and early recognition of exacerbations which might present like cough with thick yellow phlegm, wheezing, inability to sleep, feeling tired, more effort needed for activities lasting for more than 2 days’ warrants for early hospital visits and allowing time to recover. As a prevention avoid triggers like flu, pollen, dust, smoke.

4. Getting the most of your diet: Metabolism is when you convert food to energy. Along with this energy carbon dioxide is released which needs to be exhaled. COPD is known to have retention of the same due to impaired breathing. So avoiding a high carb diet might reduce the amount of CO2 produced. Also the amount of energy spent for breathing might be more advocating for a highly protein, fat nutritious diet.

5. Staying active physically: Diaphragm, the main muscle of respiration is often the most affected in COPD due to hyperinflation of lungs. This leads to chipping in by other muscles to breathe. Hence it's essential to exercise the upper body and limb muscles by stretching, progressive strength training. One such important technique is “pursed lip breathing”, a type of deep breathing exercise. Pulmonary rehabilitation with the help of physiotherapists help us in making an exercise plan.

6. Managing daily activities: Patients often find certain day to day activities to worsen symptoms. It's important to pace your activities, take breaks between chores, avoid excessive bending or standing or doing overhead tasks. For example, keeping utilities in floor cabinets in the kitchen, using shower and shower chairs to take bath to avoid lifting and pouring water, sitting down during shaving or make up. Using shoes without lace, loose fitted clothes as tight clothes might make them more breathless.

7. Emotional support: It is not easy to live with COPD due to the decline in quality of life. Having a support group of family, friends or other people suffering from COPD should be encouraged. Lot of patients go into depression and need professional support. Also not to forget to empathise with such patients.

8. Deciding future directives: As the decline in lung functions is imperative it is important to discuss end of life directives with care providers. Even though these facilities are not very well accepted and applied in our country, it is a step in the future that the patient has a choice when he is in a state to concur.

-   Dr Udaya Sureshkumar, Consultant Pulmonologist, KMC Hospital, Mangaluru