DO NOT DIAGNOSE COPD IN A NON-SMOKER WITH A NORMAL X-RAY CHEST
Ex. Hon. Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.
The most common cause of chronic obstructive pulmonary disease (COPD) is smoking. In the past, specially 30-40 years back, the medical wards in the teaching hospitals were full of patients suffering from COPD (at that time, diagnosed as chronic bronchitis with emphysema). Often we saw these patients having frank congestive cardiac failure (CCF) due to Cor Pulmonale.
Over the years, incidence of COPD has reduced markedly because smoking habit has become less common. The point I would like to stress is, that recently it has been shown that many COPD patients respond quite well to steroid inhalers. In the past, except broncho-dilators and antibiotics, we had nothing to offer them and the improvement was hardly 40-50% provided they stopped smoking completely and permanently.
Nowadays if associated emphysema is ruled out by X-ray chest, which if normal, then by high resolution CT scan of the lungs, these patients can be assured of additional improvement of 20-30% if steroid inhalers are added to the treatment.
Irrespective of the literature on the subject, it appears to me that the private practitioners see a lot of patients of COPD who have additional allergic element responsible for their complaints of cough with expectoration and dyspnoea.
We also know that besides smoking, there are other causes of COPD, one of them being allergic bronchial asthma. Therefore, my advice to all the practitioners is that if you diagnose COPD and the patient is not a smoker, do treat the patient just like a typical case of allergic bronchial asthma, specially with the help of steroid inhalers in adequate doses. I can assure you that you would be amply rewarded.
Of course, the X-ray chest should be clear and should not show fibrotic areas due to old tuberculosis, bronchiectasis or emphysematous changes. The patients will appreciate heartily the improvement and the better quality of life which they will start enjoying under your treatment.