World Chronic Obstructive Pulmonary Disease Day:
Smoking: main cause for chronic lung diseases
World Chronic Obstructive Pulmonary Disease (COPD) Day was marked in
November with the theme “It’s not too late,” to raise awareness
worldwide of this widespread disease. Efforts to improve early
diagnosis, develop new treatments and better predict patients’ prognoses
are leading to renewed optimism in the fight against one of the world’s
most prevalent respiratory diseases.COPD Day is organised by the Global
Initiative for Chronic Obstructive Lung Disease (GOLD) in collaboration
with health care professionals and COPD patient groups aims at raising
awareness about chronic obstructive pulmonary disease (COPD) and improve
COPD care throughout the world.
In Sri Lanka, recent clinical studies of health officials have shown
a steady rise in COPD over the past 20 years. Officials have warned the
disease could escalate in the future, if the smoking which is the main
cause for it, is not minimised.
Sri Lanka Pulmonary Association President and Consultant Physician,
National Hospital for Respiratory Diseases, Welisara, Dr SAMAN KULARATNE
gives us some insights into how and why the disease is caused and more
importantly how it could be prevented. Excerpts…
Q. Nov.19 was World Chronic Obstructive Pulmonary Disease (COPD)
Day. Could you tell us more about it?
A. COPD is a general term which includes the conditions,
Chronic Bronchitis and Emphysema. Chronic means persistent. In chronic
bronchitis you get persistent inflammation of the bronchi (breathing
tubes). Emphysema is damage to the smaller airways and air sacs
(alveoli) of the lungs. Pulmonary means ‘affecting the lungs'. Chronic
bronchitis or emphysema can cause narrowing (obstruction) of the
airways. These two conditions commonly occur together. The term Chronic
Obstructive Pulmonary Disease (COPD) describes a lung disease with a
persistent narrowing (obstruction) of the airways due to chronic
bronchitis, emphysema, or both.
Q. What causes it? Environmental pollutants such as dust,
diesel fumes, pollen, genetic disorders? Or smoking over a long period?
A. Smoking is the most common cause of COPD. Environmental
pollutants may cause some cases of COPD. The combination effect of work
place exposure to air pollutants (vapors, irritants, and fumes) and
smoking increases the risk of developing COPD. Exposure to indoor air
pollution, such as the use of biomass fuels for cooking is a significant
cause of COPD in developing countries.
Biomass fuels used by women for cooking account for the high
prevalence of COPD among non smoking women in these countries. A very
rare genetic disorder known as alpha-1-antitrypsin deficiency, a protein
deficiency, can be the cause of COPD in less than one percent of cases.
Pollen is known to cause Asthma which has similar symptoms to COPD. But
of all of these causes, smoking heads the list.
Fifteen percent of people who smoke one packet of cigarettes a day,
and 25 percent of people who smoke 40 a day develop COPD if they
continue to smoke. Some may develop COPD even with passive smoking.
Cigarette (tobacco) smoke and other air pollutants can irritate the
walls of the airways (bronchi) and air sacs (alveoli), and with
persistent exposure will lead to inflammation and permanent damage to
lungs. As a result of this inflammation, walls of the airways thicken
and more mucus (phlegm) is produced. Damage to walls of the air sacs
causes emphysema and the lungs lose their normal elasticity. The smaller
airways also become scarred and narrowed. These changes cause the
symptoms of breathlessness, cough, and phlegm associated with COPD.
Q. Who is most at risk? Young, old, men or women?
A. COPD mainly affects people over the age of 40 and becomes
more common with increasing age. It is more common in men than in women.
Q. Can children get it from passive smoking or environmental
A. COPD is not a well defined entity in children. But passive
smoking, air pollution, and irritants may cause asthma and persistent
cough in children.
Q. What parts of the human body are affected by the disease?
All? Lungs? Upper respiratory tract?
A. In COPD, the changes are mainly in the lungs.
Q. Is it infectious?
A. No. However infections (viral, Bacterial) can exacerbate
the symptoms of COPD.
Q. How long does it take for it to develop? Is it a sudden
illness or does it occur over a period of time?
A. It is not a sudden onset illness. It occurs through
exposure to tobacco smoke and other environmental pollutants over a
period of time (months, years).
Q. When is it usually diagnosed?
A. COPD is usually diagnosed when they develop symptoms. Main
symptoms of COPD include cough, breathlessness and wheeze, and
production of sputum. Cough tends to come and go at first, and then
gradually become persistent (chronic). It is productive with phlegm.
Breathlessness and wheeze may occur only with exertion at first. These
symptoms become gradually worse over the years if continue to smoke.
Patients produce lot of sputum due to damaged airways.
Q. How is it detected and diagnosed? X-rays? Sputum test?
A. COPD is suspected because of the symptoms and the signs.
The chest may show signs of over-inflation (hyperinflation) and the
doctor may hear wheezes in the chest.
The most important test to diagnose COPD is called Spirometry. The
test estimates lung volumes by measuring how much air you can blow into
This test will help the doctor to detect the airway obstruction as
well as the severity of the disease.
Chest X-ray may show evidence of over inflation of the lungs.
This also helps in detecting associated other illnesses such as
infections and lung cancers. Sputum testing helps to detect infections.
Pulse oximeter is another important device which detects oxygen levels
in the blood. Low levels of oxygen are a frequent finding in COPD
patients especially during exacerbation.
Q. What are the diagnostic tests you do here in Sri Lanka?
A. Spirometry, Testing to detect oxygen levels in the blood,
Chest X-ray, and tests to detect alpha-1-antitrypsin levels.
Q. Can COPD be mistaken for another ailment? E.g. Some people
dismiss it as smokers cough and so delay seeking treatment. What is the
A. As smoker’s cough develops the patients will develop
progressive symptoms if they continue to smoke. Lot of other lung
problems and heart problems can have similar symptoms. Differentiation
between asthma and COPD could be difficult in some patients. Some may
have both these conditions.
Lung cancers, chronic infections such as tuberculosis, lung diseases
due to exposure to dusts are some of the conditions which may have
Q. I understand that in the US a COPD is used to describe two
conditions - Emphysema and Chronic Bronchitis, as most people with COPD
have both these conditions.Your comments?
A. Chronic bronchitis is a condition of increased swelling and
mucus (phlegm, sputum) in the breathing tubes (airways) which leads to
airway obstruction and breathlessness. The diagnosis of chronic
bronchitis is made based on symptoms of cough that produces phlegm on
most days, for three months, for two or more years, after other causes
for the cough have been excluded.
Emphysema is a condition that involves damage to the walls of the air
sacs As a result of that, alveoli (air sacs) lose their stretchiness and
trap air. This air trapping within the lungs causes hyperinflation of
the lungs. Airway obstruction occurs in emphysema because the alveoli
that normally support the air ways open are damaged.
Q. Is it treatable? Is there a cure for it?
A. It is treatable, but there is no cure at present.
Q. Is it true that symptoms often worsen with time and can
limit your ability to do routine activities like walking, cooking or
taking care of yourself?
bYes. The symptoms of COPD worsen with time. If you continue to
smoke, the progression will be very rapid.
Finally you may end up with breathlessness even when resting..
Regular exercises, breathing exercises are important in the management
of COPD. Programs to rehabilitate these patients with COPD are available
in some countries. These programs are called pulmonary rehabilitation
Q. How is it prevented?
A. Stopping smoking is the single most important thing. This prevents
the disease from worsening. Even if you have fairly advanced COPD,
smoking cessation will improve your symptoms and slow down further
There are inhalers to improve the symptoms of COPD. These are called
broncho-dilators and these will dilate the breathing tubes. Some may
need steroid inhalers.
The patients with COPD repeatedly get exacerbations due to infections
(viral, bacterial) and also due to exposure to pollutants. Some may need
admission to hospital. These patients need antibiotics, steroids and
oxygen therapy in addition to other general measures and monitoring.
Severe cases may need assisted breathing with the help of artificial
Surgery is an option in a very small number of cases. Removing a non
– functioning air filled sacs (called bullae) may improve symptoms in
Q. Can it lead to cancer or some other serious health issues?
A. It will not lead to cancer but smoking is the primary cause
of both, the lung cancers and COPD.
Therefore one should suspect the possibility of lung cancer if there
are new symptoms such as presence of blood in sputum, weight loss, and
worsening of cough in a patient with COPD. Reduced level of oxygen in
the blood and changes in the lung can cause increased pressure in the
blood vessels in the lungs.
This increased pressure can put a strain on the heart muscle, leading
to heart failure. In addition to these changes, patients with COPD may
have other problems such as muscle wasting, depression and problems due
to smoking (heart disease, cancers, and stroke).
Q. Can it result in lifelong disabilities?
A. Yes. COPD results in lifelong and permanent disabilities.
Patients with advanced disease need lifelong home oxygen treatment in
addition to their daily medications. Some may even need artificial
breathing apparatuses to assist their breathing at home (NIV - Non
Q. Can the condition be reversed if a person adopts healthy
life styles e.g. quits smoking?
A. This condition cannot be reversed but smoking cessation
will definitely improve the symptoms and life expectancy of these
Q. How can you prevent it?
A. Quitting smoking is the single most important thing. One
has to make the home smoke free and should take measures to protect
against chemicals, dusts, and fumes at home and at work place. Using
respiratory protective equipment at work place is also important. There
should be adequate ventilation if one is using biomass fuel for cooking.
Vaccines such as pneumococcal vaccine and influenza vaccines may prevent
infective exacerbations (flare-ups) of COPD.
Q. Roughly how many patients do you see at the Welisara Chest
Hospital for this disease per day/month?
A. Every day, there are several patients (4-5) with COPD
admitted with exacerbations to National Hospital for Respiratory
Diseases (NHRD), Welisara. The sitation is similar in most other
Q. Are these facilities available in all leading state
hospitals? If not, what is most urgently required to help such patients?
A. Some tests such as spirometry are not available in some of
the hospitals. Development of specialised Respiratory units with smoking
cessation clinics, pulmonary rehabilitation programs in major hospitals
is a priority need.
Q. Despite the efforts of the Ministry of Health government to
put an end to smoking, the habit is still widely prevalent and on the
rise especially among adolescents. Do you see this as a setback to
reducing COPD in Sri Lanka in the near future?
A. Yes, not only COPD, there will be a rise in other smoking
related problems too such as lung cancer, heart problems, strokes and
other vascular diseases.
Q What has the Health Ministry put in place in terms of 1)
prevention 2) treatment?
A. The Ministry of health is now establishing Respiratory
units in most of the major hospitals and appointing specialists to far
Q.Your message to the public?
A. Those who develop persistent cough, breathlessness wheeze
should seek medical advice. Quitting smoking and avoiding air pollutants
and regular exercises and adopting healthy lifestyles will help to
improve disabilities arising from COPD.
Does green tea boost health as claimed?
Among many beverages that we consumed for generations, tea is given a
major importance in our day to day lives. Tea from Camellia sinensis
plant has been consumed for centuries as a part of the habitual diet of
many Asian regions in three major forms: fermented black tea,
semi-fermented oolong tea, and non-fermented green tea.
Disregarding the familiar black tea, green tea has been subjected to
many discussions regarding its impressive health beneficial claims.
The chemical compound in green tea that is known as ‘polyphenolic
flavonoids’, is mainly responsible for its health boosting effects
including anti-obesogenic effect, control of fat build up in the body
and liver, reduction of body fat and cholesterol levels, reduction of
blood pressure and blood sugar levels in the body, anti-carcinogenesis,
anti-oxidation and anti-inflammatory properties. Moreover, certain
scientists claim that this compound improves memory power and cognition
with the aid of many research evidence. Others suggest that polyphenolic
flavanoids exert protective effect against psychological diseases as
These claims regarding green tea have made its consumption more and
more popular over a very short course of time. The attention of the
public has turned vastly towards it because, most believe that ‘Health
is Wealth’ and ‘A healthy mind lives in a healthy body’.
Does it really fight obesity?
Obesity has become one of the fastest-rising burdens in today’s
world. The adverse effects of obesity can be seen in physical and mental
health as well as in social lives of many people.
This has made them seek out different alternatives with medicinal
properties rather than avoiding meals that they enjoy or being put under
the surgical knife. More, people find it difficult to allocate enough
time to engage in physical activities with their urbanised, busy
Hence, research results on green tea’s health effects have grabbed
more than their fair share of attention and consumption of this form of
tea is being encouraged by funding organizations and governments all
over the world.
Some studies have successfully proven the anti-obesogenic effect and
the favourable effect on body lipid profile of green tea, suggesting it
as a shield for obesity and related complications.
It has been found that green tea extract influences the thermogenesis
of body fat, leading to fat regulation.
Flavanoids, especially ‘catechins’ interfere with fat absorption in
the intestines as well.
These evidence make us believe that long term consumption of green
tea can have an effect on body fat reduction. However, the effectiveness
of green tea as a source of body fat regulation is on constant debate.
The protective effect is found with high doses of green tea extract
and is not noteworthy according to the much proven research evidence of
physical activity and calorie restriction on body fat mass regulation.
Is it heart-friendly?
Green tea ‘catechins’ are powerful antioxidants that exert protection
against inflammation and oxidative stress in body. Hence, long term
consumption of green tea has been found to inhibit the formation of
oxidised lipids in blood vessels, which is a risk factor for developing
atherosclerosis and strokes.
Moreover, management of oxidative stress and regulation of blood
pressure in patients with obesity-related hypertension is also expected.
High blood cholesterol, atherosclerosis, obesity and its related
hypertension are some of the major risk factors for heart diseases and
heart attacks alike. So, even if it lacks evidence as a cure for heart
diseases, green tea can be considered a heart-friendly beverage.
Battle against diabetes
Green tea has been found to be favorable on blood sugar regulation in
It reduces resistance to the hormone known as ‘Insulin’ within the
body via effective transport of blood sugar into cells. Furthermore, it
reduces absorption of sugar from diet, by controlling the enzymes at
intestines. Hence it controls diabetes.
Yet, the above evidence on blood sugar regulation are still under
discussion. Anyhow, green tea is advised to be consumed without sugar
which will inevitably makes it a better option than any other kind of
sugary drink or fizzy beverage.
Does green tea fight cancer?
The current knowledge on the link between green tea and cancer is
controversial. As evident by different studies, green tea is efficient
in shielding against some forms of cancer including prostate and lung
cancer. The cancerous tumor growth is hindered via reduction of tumor
cell inflammation. But, some evidences reveal that green tea is of no
use against breast cancer.
On the whole, green tea can be recognised as one of the most
nutritive beverages. Although the available evidences reveal a
protective role by green tea on obesity and other complications, they
are contradictory and insufficient to draw a conclusion.
However, it would be better to consider green tea as a preventive
source for several lifestyle diseases rather than a source of cure.
The efficacy of effects is enhanced with increasing doses and the
health beneficial claims of green tea should neither be underestimated
As a herbal beverage, green tea boosts one’s physical, mental and
social well-being with its additional benefits and is a better option
than any other beverage that has only water and sweetening agents with