Imagine living with a ticking time bomb in your chest, yet it only grabs attention when it's about to explode. That's the harsh reality for many patients with Chronic Obstructive Pulmonary Disease (COPD), especially when they're battling multiple non-communicable diseases (NCDs). But here's where it gets controversial: Is our healthcare system failing these patients by treating COPD as an afterthought until it turns critical? Let’s dive in.
In a recent media workshop titled ‘Unpacking the Chronic Respiratory Disease Epidemic’ held in Kuala Lumpur on November 13, clinicians shed light on this pressing issue. Dr. Murallitharan Munisamy, Medical Director of the National Cancer Society Malaysia (NCSM), pointed out that care for patients with multiple chronic conditions is often dictated by immediate risks rather than the overall disease burden. ‘It’s always about what’s going to kill you tomorrow,’ he remarked, highlighting the reactive nature of current healthcare practices.
COPD, a progressive lung disease characterized by persistent and irreversible airflow obstruction, is primarily caused by smoking, air pollution, and prolonged exposure to harmful fumes. Symptoms like chronic cough, phlegm, breathlessness, wheezing, and fatigue can severely impact quality of life. Unlike asthma, where airways can often be reopened with treatment, COPD causes permanent damage to lung tissue and airways. Management focuses on slowing lung function decline through inhalers, pulmonary rehabilitation, smoking cessation, and reducing exposure to pollutants.
And this is the part most people miss: COPD is often interchangeably referred to as emphysema or chronic bronchitis. While once considered separate conditions, research now groups them under the COPD umbrella due to overlapping risk factors, symptoms, and treatment responses. However, managing COPD becomes exponentially more challenging when it coexists with other NCDs like lung cancer, diabetes, or sepsis. Clinicians are forced to prioritize the condition most likely to cause immediate deterioration.
Dr. Murallitharan illustrated this with a scenario: ‘If a patient has COPD and lung cancer but the cancer is under control, an acute COPD exacerbation that threatens their life tomorrow will take precedence. Similarly, if COPD is paired with diabetes leading to septic shock, the latter becomes the urgent priority.’ This triage approach, while necessary, often leaves the chronic aspects of COPD unaddressed due to systemic constraints like limited bed capacity and rushed consultations.
The National Health and Morbidity Survey (NHMS) 2023 revealed that over two million Malaysians live with three NCDs, typically diabetes, hypertension, and high cholesterol, while half a million juggle four, including obesity. Dr. Murallitharan emphasized the need for a more holistic approach: ‘We should investigate everything simultaneously, but do we have the resources? Can we keep a patient in bed for three weeks to address all their conditions?’
Follow-up care for comorbidities is often recommended, but comprehensive multimorbidity management remains a challenge. ‘We try our best,’ Dr. Murallitharan admitted. ‘But are we doing enough? We must do better.’
Dr. Sarah Rylance, a medical officer in the NCD Management Unit at the World Health Organization (WHO), added that patients themselves often prioritize the most urgent or distressing condition. ‘If someone has hypertension without symptoms but struggles with breathlessness, they might opt for an inhaler over antihypertensive medication,’ she explained. ‘The more conditions, the tougher the trade-offs.’
Diagnostic limitations further complicate COPD management. According to WHO’s 2023 NCD Country Capacity Survey, only 40% of countries globally have spirometry—a simple breathing test to diagnose COPD—available in public primary care. This gap leads to misdiagnosis, with COPD often labeled as asthma, a ‘lung infection,’ or general breathlessness, delaying proper treatment until symptoms worsen.
José Luis Castro, WHO’s special envoy for chronic respiratory diseases, warned that COPD is one of the most underestimated global health threats. ‘Anyone who breathes can develop COPD,’ he stated. ‘It kills over three million people annually and affects hundreds of millions, yet it receives far less attention than other NCDs.’ He urged governments to tackle smoking, air pollution, and indoor smoke exposure, emphasizing that ‘every polluted breath and every child exposed to secondhand smoke represents preventable harm.’
Here’s a thought-provoking question for you: Should COPD be treated as a global environmental crisis rather than just a health issue? Share your thoughts in the comments—let’s spark a conversation that could save lives.
