Check your emphysema risk


If you think that COPD (chronic obstructive pulmonary disease) is something that shouldn't concern anyone under 50, think about it like this: the older people who do get this disease had the foundations for this disease laid decades before the first symptoms appeared.

Here are 10 things everyone should know about COPD – and that includes young people.

COPD is rated by the World Health Organization as the fourth most common cause of death worldwide. It is estimated that by the year 2030 it will be the third most common cause of death, as there is an alarming rise in the prevalence of this condition, particularly among women.

  • Patients with this condition experience a prolonged decline of exercise capacity and in the final years of their life are severely short of breath, often unable to lead a normal life, and needing to access healthcare services regularly.
  • This incurs great personal and national expense. The financial burden of COPD, particularly in developing countries, will parallel the ongoing abuse of factors that cause the disease, such as smoking.
  • Reversing this trend will take time: the effects of successful public education programmes will only be noticed after several decades, given that the negative effects of smoking only become apparent 30 - 40 years after its onset.
  • Risk factors include age (post 45), genetic susceptibility, poor lung growth as a baby, poor nutrition and low socio-economic status. Smokers are at particular risk, as are people who have been exposed over a length of time to indoor pollution from heating and cooking with coal and wood. Outdoor air pollution, occupational dusts and chemicals and, respiratory infections also increase a person's risk for this disease.
  • The role of tobacco smoke as a causative agent for COPD has been proven beyond all doubt. It appears that starting smoking at a young age, the "total pack years" (the number of cigarettes smoked per year multiplied by the number of years of smoking) and the person's current smoking status all contribute to the final state of respiratory impairment due to COPD.
  • In spite of this, only an estimated 20% of smokers develop the disease. However, this figure does not take into consideration the combined effect of several other risk factors that commonly occur in individuals in underprivileged communities, with a subsequent greater likelihood of developing the disease.
  • Evidence has been found that secondary cigarette smoke can cause COPD in non-smoking bystanders. This has serious health and legal implications, as smokers could jeopardise the health of the non-smoking population.
  • In a number of occupations, including mining and industry, dust and exposure to welding gases and fumes have been associated with the development of COPD. Enforcement of protective measures in the workplace, including wearing masks and monitoring levels of dust and toxic fumes, have minimised and in some cases abolished the danger of industrial exposure.
  • Low socio-economic status is a risk factor for the development of COPD due to the high prevalence of other risk factors, including secondary cigarette smoke exposure, particularly in childhood, and tuberculosis, which tends to occur in deprived communities. There is some evidence that tuberculosis (TB), particularly recurrent episodes of the disease, leads to the development of COPD in patients in developing countries. 
  • The fact that many industrial workers and miners smoke and contract tuberculosis serves as one example of how combinations of risk factors contribute through a final common pathway of airway inflammation to create an accumulative burden for causing COPD.
  • There is also growing evidence that HIV infection, either alone or together with other opportunistic infections and tuberculosis, may be an independent risk factor for the development of COPD. Whether this is due to repeated respiratory infections, the effect of the virus on the lung tissue itself, or simply the result of decreased immunity is unknown, and is currently under investigation. This interaction obviously has enormous public health implications for a country like South Africa, with its high rate of both HIV and TB.

(Sources: Based on an article written by Prof J.R. Joubert, MSc, MBChB (Stell), FCP (SA), MMed (Int. Med), MD (Stell).)

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