A Conversation on COPD
By Arunima Rajan
In a conversation with Arunima Rajan, Dr. Azmat Karim, Senior Consultant in pulmonary medicine at Fortis Escorts, Okhla Road, New Delhi, discusses the challenges, solutions, and future of managing Chronic Obstructive Pulmonary Disease (COPD).
COPD is often described as a preventable and manageable disease, yet millions suffer silently. Does this reflect more on healthcare system failures or society's indifference to chronic illness?
COPD, or Chronic Obstructive Pulmonary Disease, is a glaring example of neglect on both fronts. On the healthcare side, we focus heavily on acute care—heart attacks, strokes—but chronic diseases like COPD are ignored until they become severe. Prevention and early diagnosis, which are critical, are often overlooked. From a societal perspective, there's a general indifference to chronic conditions. Smoking, the leading cause of COPD, is normalised in many cultures, and early symptoms like persistent coughing are often dismissed. It's only when the disease reaches an advanced stage that it garners attention, and by then, the options are limited to symptom management rather than a cure.
Public health messaging on COPD often focuses on tobacco. Why don't we hear more about the emotional toll of this disease?
That's an important point. Tobacco is a leading cause, but it's not the only one. Environmental pollution, genetic predisposition, and infections like tuberculosis also contribute to COPD. The emotional toll is immense. Imagine the frustration and isolation of struggling to breathe every single day. It impacts relationships, careers, and mental health. Rehabilitation programs that address the disease's physical and emotional aspects are essential. Highlighting this human cost could shift the narrative and foster greater patient empathy and support.
Air pollution is a significant contributor to COPD. If you had unrestricted authority, what policy changes would you implement?
Air pollution is a complex but solvable issue. First, we need to enforce existing pollution control laws more rigorously. Industries and vehicles routinely bypass regulations, and the penalties are often too lenient to deter violations. Second, we must incentivise electric vehicles and invest in public transportation infrastructure. Biomass fuels remain a primary energy source in rural areas despite initiatives like Ujjwala Yojana. Sustained adoption of clean fuels requires both subsidies and behavioural change campaigns. Crop stubble burning is another primary culprit. Affordable machinery and bioenergy initiatives could replace this harmful practice. Lastly, linking air pollution directly to health outcomes in public campaigns would raise awareness and drive behavioural change.
If you could speak candidly with policymakers, what would you say is the most frustrating aspect of how COPD is handled?
The lack of enforcement is deeply frustrating. We have air pollution laws, but they're not implemented effectively. Tobacco elimination remains largely theoretical. Rural households continue to rely on unsafe cooking fuels despite government initiatives. The cost of COPD treatment is another issue. Unlike diseases like tuberculosis, which benefit from government-subsidised programs, COPD patients face significant out-of-pocket expenses. We need targeted policies, proper implementation, and financial support for those most affected.
If COPD were treated with the same urgency as heart disease or diabetes—celebrity endorsements, awareness drives—would that change how it's perceived?
Absolutely. COPD is unfairly seen as a disease of the lower socio-economic classes, and that stigma keeps it in the shadows. Public health campaigns are almost non-existent, which compounds the issue. Imagine if prominent figures or celebrities highlighted COPD. It would normalise discussions around lung health, encourage early diagnosis, and attract funding for research and treatment. With proper awareness, we could significantly reduce the disease burden.
Let's say you were tasked with eradicating COPD in India within a decade. What radical policy would you implement?
A radical but necessary first step would be banning tobacco production, advertising, and sales. Tobacco is the single most significant contributor to COPD, and without addressing it head-on, eradication isn't possible. Beyond that, I would mandate routine respiratory screenings for high-risk groups, such as smokers and industrial workers. We need strict enforcement of air quality regulations and incentives for renewable energy adoption. Public awareness campaigns, combined with accessible smoking cessation programs and vaccinations against respiratory infections, would also play a vital role. Finally, a global COPD eradication fund, similar to the initiatives for HIV/AIDS or malaria, could provide the resources needed for research, innovation, and large-scale implementation of preventive measures.
How do you reconcile prescribing lifelong treatments for COPD while knowing that the root causes—pollution, poverty, and lack of awareness—remain unaddressed?
It's a frustrating paradox, but as a doctor, I prioritise the patient in front of me. Treating symptoms improves their quality of life, even if it doesn't address the systemic issues that caused their condition. At the same time, I see advocacy as part of my role. Educating patients, engaging with policymakers, and raising awareness within the medical community are all ways to address the bigger picture.
Technology is often touted as a game-changer in healthcare. Are we relying too heavily on gadgets to fix COPD while ignoring socio-environmental factors?
Technology has its place—it can improve access to care, reduce treatment costs, and enable real-time health monitoring. But it's not a panacea. The real solution lies in addressing socio-environmental factors. Cleaner energy, stricter pollution controls, and preventive healthcare are the keys to reducing COPD cases. Technology should support these efforts, not replace them.
Will COPD still exist 50 years from now, or could it become a thing of the past?
That depends entirely on the choices we make today. If we continue with half-hearted measures, COPD will remain a significant public health issue. But with concerted effort—reducing pollution, improving healthcare access, and prioritising prevention—we could make it a relic of the past. The future of COPD is in our hands. The question is whether we have the will to act decisively.