November 21 will be World COPD Day, responsible in France for nearly 20,000 deaths per year. An update on this disease, its symptoms, its diagnosis and its treatments with Dr Frédéric Le Guillou, pulmonologist in Toulon and president of “Santé Respiratoire France”.
– Why Doctor: What definition would you give of COPD (chronic obstructive pulmonary disease)?
Dr Frédéric Le Guillou: This corresponds to chronic bronchitis, that is to say shortness of breath, cough, sputum. It is a serious illness which can lead to a deterioration in the quality of life and a loss of autonomy. Anxiety and depression are also often part of the clinical picture. This disease affects as many women as men and we should not think that it is only an illness of older men who smoke!
– What are the first signs of the disease?
The main symptom is shortness of breath which can be extremely debilitating and then we also have bronchitis, coughing, expectoration. But the big concern is that patients adapt to their shortness of breath. So we have to question them to find out if they are more out of breath than other people their age during the same exercises. We have to find subterfuges!
Two out of three patients undiagnosed
– Are you implying that this disease is underdiagnosed?
Underdiagnosed is a weak word! First of all, it is an often invisible illness. As a result, it is estimated that two thirds of people affected by it are not diagnosed even though COPD is the leading cause of chronic respiratory disease in France with 20,000 deaths per year and 150,000 patients placed on oxygen and it must be remembered that this is the third cause of death in the world. It is therefore an extremely common disease and normally a general practitioner should see two to three per day in his consultations!
– How can we explain this difficulty in identifying COPD?
The first reason is that people underestimate their symptoms. Then, the average consultation time in general medicine is around ten minutes during which the doctor cannot do everything. And above all, in 80% of cases this disease affects smokers who find it normal to be out of breath!
In half of the cases, patients are diagnosed during an outbreak of the disease which led to hospitalization, that is to say that everything was missed in the detection beforehand. And these flare-ups, which we call exacerbations, are to COPD what a heart attack is to coronary artery disease! This makes it clear how serious a disease this is. From the moment we have more than two exacerbations per year, life expectancy at four years drops to 30%…
A disease linked to smoking, pollution and respiratory infections
– We know that COPD is mainly linked to smoking. But are there other causes?
The main cause is indeed smoking, but as other possible causes, anything that impacts the bronchi during pregnancy and childhood can cause COPD, maternal smoking, passive smoking in during early childhood, prematurity, repeated respiratory infections in children such as bronchiolitis can be causes and then of course pollution, exposure to fumes. And then there are professional causes, for example among farmers with all the phytosanitary products and pesticides and also steel workers.
– From what age can the disease appear?
COPD can appear at any age. Most frequently, it is from the age of 40, but among young people who started smoking very early or among cannabis smokers, we can see COPD at 25 years old.
– What are the treatments?
We must first remember that COPD is a disease from which there is no cure but whose deterioration can be avoided. The first treatment is above all stopping exposure to toxic products. The second is to have regular physical activity which helps maintain respiratory capacity. In terms of prevention to avoid outbreaks of the disease, you must avoid infections and therefore be vaccinated against flu, whooping cough and pneumococcus. And then there are inhaled therapies, bronchodilators including corticosteroids. For the most serious forms, oxygen or even non-invasive ventilation is used. And COPD is the leading cause of lung transplantation.
– How to improve the prevention of severe forms of COPD?
There is a lot to do in terms of detection. The earlier this disease is detected, the more it can be treated at the least advanced stages. But the most important thing is to avoid outbreaks of the disease which can quickly lead to a loss of autonomy and the social handicap that this represents. It is therefore essential to take your basic treatment carefully and we can also recommend remote monitoring for severe forms which makes it possible to identify the beginnings of these exacerbations several days in advance.
