Chronic obstructive airway disease

Chronic obstructive airway disease (COAD) is a condition which causes symptoms very similar to asthma as the patient presents with wheezing (whistling in the chest on inspiration and expiration), shortness of breath and catarrh. However, unlike asthma, it is chronic, that is it affects the person during every single day of his life. Year after year the patient notices a progressive increase in cough during the day and night. A decrease in exercise tolerance becomes evident and the person may also start getting tired while walking up stairs or even dressing. Eventually the patient may become dependent on oxygen for simple daily activity.

The principal cause of this condition is cigarette smoking, both active and passive. It is estimated that a person sitting next to a smoker may inhale up to three quarters of the smoked cigarettes. This is to prove the selfishness of smokers who are polluting the air around them. It is essential that cigarette smoking is restricted in all public areas and that their cost continues to rise. At least, the revenue raised by the government could be used by the health department to make up for the costs of hospitalisation and heart operations provided for these people who tend to suffer more from lung problems and heart attacks. After all, the non-smoker is also paying the national insurance contribution.

It is more difficult to establish the effects of air pollution in causing chronic airway disease than asthma. This is because the effects of the former are long term. I often meet people suffering from asthma who claim they have to leave a disco party or any other crowded place simply because someone is smoking nearby. However, although a person who is not suffering from asthma may not be bothered by someone smoking nearby, the fact still remains that recurrent exposure will still result in damage to the delicate structures in the lungs. Incidentally, this also applies to the arteries in the heart; a person who spends much time close to a smoker may develop coronary heart disease leading to heart attacks only because of passive smoking.

Remains of early humans reveal that they also suffered from the effects of polluted air. Blackening of lung tissues through lung exposure to particulate air pollution in smoky dwellings appears to be common in mummified lung tissue of ancient humans. Therefore, most people with COAD are or were smokers but some have lived in homes filled with fumes from cooking stoves or fumes from heaters used to warm up the home. Others have developed COAD after having worked for many years in places that were dusty or exposed to smoke.

Car exhaust may be another factor in the cause of this disease. The damage caused by cigarette smoke and car exhaust may be similar but the latter is difficult to assess.

A common excuse which smoking people give me for not stopping is that they are anyway exposed to car smoke. This is partly true but smoking will surely speed up the process. The VRT testing should include control of vehicle emissions and commercial vehicles should be removed from circulation after a number of years, say 15 years.

The outrageous taxes on cars do not encourage people to dispose of their old cars to buy a new one.

Limits on carbon monoxide, nitrogen oxides, particulate matter and hydrocarbons must be imposed. The number of cars on our roads is always increasing (at present over 260,000) and this inevitably raises the concentration of pollutants. Improving public transport may encourage people to make less use of their own cars, at least to go to work. This will decrease considerably the amount of vehicles on the road at a given time of the day.

Patients suffering from COAD require regular inhaled medicines, pills and syrups for the productive cough. They also tend to suffer from frequent chest infections that are more difficult to treat than usual. Hospital admissions for severe shortness of breath or severe chest infections are frequent in these patients. Sometimes their condition is so bad that they have to rely on a continuous supply of oxygen to be able to continue with daily life as they become short of breath even during simple tasks such as dressing.

The government (we tax payers) supplies patients suffering from COAD with free medicines which are very expensive.

In my opinion we should abolish cigarette smoking from all public places and preferably ban them from entering the country!

Dr Farrugia Randon has been a committee member of Din l-Art Helwa for the past 12 years. This contribution is part in a series aimed at raising awareness on the topics addressed.