That smoker’s cough could be deadly

IF you are a smoker, have been a smoker or are exposed to passive smoking, or toxic fumes/gases, you may be at risk of developing COPD.

COPD (chronic obstructive pulmonary disease) is a lung disease that makes it hard for a person to breathe.

According to WHO (World Health Organisation) estimates in 2007, 210 million people have COPD worldwide with 80 million of them having moderate to severe levels of the disease.

COPD was ranked as the 12th leading cause of disability in 1990, but it is projected to rank 5th in 2020.

The number of deaths from COPD has increased more than 60% over the last 20 years and more than 95% of all COPD-related deaths occur in people over 55.

COPD will become the 3rd leading cause of death worldwide by 2030.

“In people with COPD, the airways (the branching tubes that carry air within the lungs) become narrow and damaged. This makes them feel out of breath and tired,” says Dr Ng Teck Han, consultant physician and chest physician.

Dr Ng Teck Han ... 'COPD cannot be cured and it usually gets worse over time.'
Dr Ng Teck Han … ‘COPD cannot be cured and it usually gets worse over time.’

“COPD can be a serious illness. It cannot be cured and it usually gets worse over time. But there are treatments that can help.

“You might have heard COPD being referred to as ‘chronic bronchitis’ or ’emphysema’. These are the two terms that belong to two different types of entities of COPD. Some patients have both, some have just one,” he adds.

Signs and symptoms

At the early stages, COPD does not manifest in any symptoms. However, as it gets worse it can make you:

  • Feel short of breath, especially when you are moving around. In severe cases, you would be short of breath even when resting.
  • Wheeze (make a whistling or squeaking noise as you breathe).
  • Cough and spit up phlegm (mucus) on and off.

Is it flu or pneumonia?

The flu, pneumonia and COPD are three different things.

Pneumonia is an infection of the lung and COPD is just the airways. Those with pneumonia don’t have airway obstruction. When you treat pneumonia, it will resolve, although it may leave some scars. But it won’t present with wheezing and shortness of breath chronically, nor will it progressively get worse. When it is treated, it will be cured.

“Some people may think that the flu (influenza) is just a slightly worse version of the common cold, but the flu can be a serious respiratory disease. Two basic types of viruses can cause the flu, influenza A and B. Both types can be potentially serious and cause upper respiratory tract infection. This is presented in a high fever, aching muscles, sore throat, dry cough, a runny or stuffy nose, headache, and stomach symptoms can include nausea, vomiting or diarrhoea. For most people, the flu is self-limiting and its symptoms last a few days.

“As opposed to the flu, COPD is not an infectious disease. It is a chronic obstructive airway disease which is progressive in nature, not acute, in which the symptoms may get worse over time. It won’t present as a runny nose and headache,” says Dr Ng.

While the flu and COPD are separate and different, COPD patients should try to avoid getting the flu as it can exacerbate their COPD symptoms. It may make the COPD worse and the patient may then have more difficulty breathing and may require hospitalisation.

What are the causes?

According to Dr Ng, the most common cause of COPD is smoking.

“Smoke can damage the lungs forever and cause COPD. People can also get COPD from breathing in toxic fumes or gases (from air pollution, vapours, irritants and fumes, or even from biomass fuel for cooking and heating),” says Dr Ng.

He explains that shortness of breath can be due to many reasons, especially for retirees and senior citizens. Apart from COPD, it could also be due to lung or heart problems. These are the two common organs which can have problems resulting in a shortness of breath. Other remote organ problems that can cause shortness of breath are renal failure, kidney failure or those with high acid in the body. They may breathe a bit faster and heavier. Or it could be an allergy – that could cause asthma-like symptoms like wheezing.

“However, if they are smokers or have risk factors, and they start to have an intermittent cough, sometimes worse in the morning or on rainy days, or if they have phlegm or breathlessness on exertion, then they should go see a doctor for a thorough examination. Some patients may have just coughing and no other symptoms,” he informs.

Who is more prone to getting it?

  • Those who have prolonged exposure to cigarette smoke (smoker or passive smoker), toxic fumes or gases.
  • Any factor that affects lung growth during gestation and childhood.
  • Lower socioeconomic status.

How serious is it?

It can be a serious disease and progressively debilitating and potentially life threatening as it might eventually affect their oxygenation.

According to Dr Ng, the patient’s carbon dioxide will build up over time and they will have low oxygen and they will feel short of breath.

“This carbon dioxide retention can cause carbon dioxide narcosis, which will make them feel sleepy and drowsy. If you don’t treat them, they won’t make it. They will die because of a lack of oxygen.

“A lack of oxygen can cause so much damage – renal failure, malfunction of the brain and the heart may stop. All these are the complications related to low oxygen,” he adds.

People who have had COPD for a while are also at increased risk of:

  • Infections, such as pneumonia.
  • Lung cancer.
  • Heart problems.
  • Osteoporosis (comorbidity).
  • Metabolic syndrom (comorbidity) – which comprises of hypertension, diabetes, cholesterol problems and obesity as well.


There are four main types of treatment for COPD:

Medication – Most seniors use inhalers that help open up their airways or that decrease swelling in the airways. Often seniors need more than one inhaler at a time. Sometimes they need to take steroid medication in pill form for a flare up of COPD. The medication would open up the airways.

Oxygen – As the disease gets worse, some seniors would need to use oxygen for the long term.

Pulmonary rehab – In pulmonary rehab, seniors learn to improve their symptoms in new ways. They learn exercises and ways to breathe that can help ease symptoms.

Not all seniors will need all these models of treatment. Some may just need medication and oxygen or rehabilitation.

“If all these fail and they are a candidate for surgery, then the patient might go for surgery to remove the more diseased lung because that lung will affect the other lung’s ability to expand and allow effective gas exchange. Then they will feel less breathless and better, but surgery is rare and does not always work.

“With all these treatments, it is hoped that they will be able to live better and are less breathless and with less suffering. If the disease gets worse, some will need to use the oxygen for the long-term to improve their survival rate,” explains Dr Ng.

He recommends COPD patients stop smoking and get the flu vaccine yearly and the pneumococcal vaccine at least once.

“Infections like the flu and pneumococcal lung infection can be very hard on your lungs. It’s important to try to prevent them. Because having the flu will exacerbate the COPD, so they should prevent from getting the flu. With the vaccine, even if they get the flu, it will not be that serious,” says Dr Ng.


COPD is a serious illness. It cannot be cured and it usually gets worse over time. But there are treatments that can help.

“There are people with mild COPD. If they stop smoking early enough, go through rehabilitation and are careful not to get infections, they may actually live a bit longer. They may not progress so fast to the moderate, severe and very severe stages.

“If they still continue smoking and not limit their exposure to all the risk factors, they will get worse year by year. This is in addition to the fact that yearly our lung function deteriorates. If you continue smoking, that deterioration will be even faster,” says Dr Ng.

He advises families of elderly COPD patients to find out about the disease and understand that it may lead to morbidity and depression.

They should also help their elderly family member follow the doctor’s instructions, including going for rehabilitation and reducing or stopping exposure to the risk factors.

They should recognise the signs and symptoms of exacerbation and lung infection and take prompt action to overcome it rather than waiting for it to get serious before seeking treatment.

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