In Patients With Multiple Chronic Diseases, COPD Often Goes Unnoticed Until It's Too Late
KUALA LUMPUR, Nov 18 — Chronic obstructive pulmonary disease (COPD), a progressive lung condition that causes persistent breathing difficulties, often receives clinical attention only when it becomes life-threatening in patients with multiple non-communicable diseases (NCDs).
According to Dr. Murallitharan Munisamy, medical director of the National Cancer Society Malaysia (NCSM), care for patients with multiple chronic conditions is typically shaped by immediate risk rather than the overall disease burden.
"It’s always what will kill me tomorrow," Dr. Murallitharan emphasized during a media workshop on chronic respiratory diseases, held on November 13. This perspective highlights the challenge of managing COPD alongside other diseases, as immediate risks often take precedence over long-term health.
COPD is a long-term lung condition characterized by persistent airflow obstruction and progressive damage, typically caused by smoking, air pollution, and prolonged exposure to smoke from burning solid fuels. Symptoms include chronic cough, phlegm, breathlessness, wheezing, and fatigue. Unlike asthma, COPD causes lasting airway narrowing and lung tissue damage that cannot fully return to normal, requiring management focused on slowing lung function decline through inhalers, pulmonary rehabilitation, smoking cessation, and reducing exposure to smoke and air pollution.
COPD can also be described as emphysema or chronic bronchitis, conditions that were once treated separately but are now recognized as overlapping. They share the same risk factors and cause persistent, irreversible airflow obstruction, leading experts to group them under COPD as different forms of the same condition.
However, managing COPD becomes complex when it co-exists with other diseases. Dr. Murallitharan explained that when a patient with COPD also has lung cancer, diabetes, or sepsis, clinicians prioritize the condition most likely to result in rapid deterioration. For instance, if a patient with COPD and lung cancer is on stable immunotherapy and experiences an acute exacerbation that threatens life, clinicians will manage the COPD as the most urgent priority.
The National Health and Morbidity Survey (NHMS) 2023 revealed that over two million Malaysians live with three NCDs, typically combinations of diabetes, hypertension, and high cholesterol, while around half a million live with four NCDs, including obesity. Dr. Murallitharan noted that the chronic aspects of COPD and other comorbidities often go unaddressed due to system constraints, such as limited bed capacity and time-constrained consultations.
Clinicians strive to organize follow-ups for other underlying conditions, but comprehensive multimorbidity management is challenging within current system limitations. Dr. Murallitharan acknowledges the need for improvement, stating, "We must do better."
Dr. Sarah Rylance, a medical officer at the World Health Organization (WHO), echoed similar concerns from the patient's perspective, where individuals with multiple NCDs often focus on the most urgent or distressing condition. The trade-offs and challenges become more significant with each additional condition.
Furthermore, limitations in diagnostic capacity affect COPD detection and management, particularly in facilities without spirometry or trained respiratory personnel. According to the WHO’s 2023 NCD Country Capacity Survey, only 40% of countries globally report having spirometry for chronic respiratory diseases available in public primary care. Spirometry, a simple breathing test, is the standard way to diagnose COPD.
The lack of consistent diagnostic tools often leads to COPD being mislabeled as asthma, a "lung infection", or general breathlessness, resulting in many cases going undetected until severe symptoms present. José Luis Castro, the WHO’s special envoy for chronic respiratory diseases, warned that COPD remains one of the most underestimated global health threats, killing over three million people annually and affecting hundreds of millions worldwide, yet receiving far less attention than other major NCDs.
Castro emphasized the universal risk of COPD, stating, "Anyone who breathes can develop COPD. The world is at risk, and chronic respiratory diseases must be treated as both a global environmental and public health challenge." He called for stronger government action on smoking, air pollution, and indoor smoke exposure, emphasizing the preventable nature of these harms.
