COPD, a neglected respiratory disease

The World Health Organization recently warned that an unknown disease, called chronic obstructive pulmonary disease, will become the third leading cause of death in the world by 2030. In France, 18,000 people die each year from this disease, which also causes admissions between 130,000 and 160,000 people hospitalized.

The Academy of Pharmacy session alerted on Wednesday 1Verse in June “This is a chronic and fatal disease, which is largely underdiagnosed”. Thus, from 5 to 10% of people over the age of 45, that is, 2.5 to 3 million French people, suffer from it. Several experts had already alerted in a column published in our columns on March 14, 2018, asking Declaration of a state of health emergency. Patients’ and scientific societies also published a white paper in 2017 to alert authorities.

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COPD is caused by smoking in 80% of cases, and air pollution is one of the early determinants of the disease, such as occupational exposure and passive exposure to cigarette smoke. Other factors, such as genetics, also explain its development.

vicious circle

“Often the disease is not well diagnosed, and the diseases develop further if smoking continues”Claire Andrejac, a pulmonologist at Amiens University Hospital and General Secretary of the Scientific Council of the French-speaking Lung Association (SPLF) explains. The lungs were changed. For emphysema (which is part of COPD), some specialists give a picture of a healthy lung that looks like Comte cheese and then turns into Swiss cheese, with the appearance of “holes” When the disease has spread.

It is often a vicious cycle, as the patient finds it increasingly difficult to breathe on exertion (dyspnea), which encourages him to move less and less. Along with other symptoms (chronic cough and/or fatigue), this is a source of impairment in daily life. Subsequently, exacerbations can lead the patient to intensive care. “The collective effect is massive”, Nicholas Roche, MD, chief of pulmonology at Cochin Hospital (APHP) confirms.

In the face of these often overlooked symptoms, a consultation and assessment of respiratory capacity (spirometry) is necessary. However, only 21.3% of people identified at risk of developing COPD benefit from this screening, according to the High Authority for Health (HAS).

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“We are in the process of better characterizing patients according to their clinical characteristics, because there is no COPD, but many of its symptoms,” Claire Andrejak abounds. Many treatments can improve symptoms, first of all to stop smoking, which is necessary to prevent the progression of the disease. Then there are inhalation therapies but also respiratory rehabilitation, allowing the patient to be short of breath on exertion. It is necessary to adapt to each patient, especially in the delivery system of bronchodilators. Physical activity also plays an important role. More specific treatments may be offered depending on the patient’s lesions. Finally, treatments are suggested to prevent exacerbations. The goal is to avoid reaching respiratory failure, a stage when long-term oxygen therapy may be necessary. Claire Andrejak details.

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