Severe Asthma, COPD, Post-Tuberculosis lung disease & Bronchiectasis
Severe asthma, COPD, Post-Tuberculosis lung disease and bronchiectasis are the four most common chronic respiratory diseases in the Indian population that can significantly impair quality of life and affect survival if not optimally treated. These four diseases are distinct with different causes, treatment options and expected outcomes but may have similar symptoms and may be confused in primary care. These conditions sometimes overlap and typically worsen over time without specialized care. It is crucial to meet a pulmonologist regularly over time to optimize treatment and follow-up lung health when any of these diseases are considered likely or diagnosed.
Key Features of These Conditions
Severe Asthma
Bronchiectasis
" Overlap of both conditions often requires advanced, specialist-led care. "
Uncontrolled Asthma:
In a patient with diagnosed asthma; persistent cough, breathlessness, wheezing or chest tightness occurring almost daily and causing limitation in physical activity or need for additional inhaler therapy or nighttime symptoms affecting sleep more than twice a week despite optimal inhaler dose, technique, and compliance. This occurs in 25-30% of all asthmatics. Another additional crucial aspect is poor lung function due to asthma as defined by FEV1 or FVC<70%. This is often missed and lung function testing is neglected by patients. Poor lung function is the single most important predictor of long-term symptoms and asthma risk. Uncontrolled asthma can be corrected by adjusting technique, dose, identifying and managing co-morbidities in the vast majority and typically, <3% of all asthmatics have “severe asthma”. Meeting a pulmonologist is crucial to identifying why asthma is uncontrolled and offering therapies beyond inhalers in patients with “severe asthma”. Asthma phenotyping, immunotherapy, biological therapy and de-sensitization are some of the specialized services available at our centre beyond advanced lung function testing.
Chronic Obstructive lung disease (COPD):
Persistent cough, sputum and breathlessness due to low lung function related to inhaled exposures (active or passive smoking, indoor or outdoor air pollution, occupational exposures), poor respiratory health in childhood, previous severe respiratory infections (bronchiolitis, tuberculosis) is most commonly due to COPD. There are 5.5 crore patients with COPD in India and it is estimated that 10 lakh patients die due to COPD each year in India. It is the 2nd most common cause of death in Indians and 5-8% of the general population has COPD. 90% of patients with COPD in India are not diagnosed and managed correctly and it is important to diagnose and treat appropriately and holistically to prevent admissions and death due to COPD
Post-Tuberculosis lung disease:
Tuberculosis has a huge burden in India but treatment is mostly focused on cure. Post-cure, patients are not followed up systematically, either in government or private services and these patients have up to 80% chance of significance chronic respiratory impairment due to previous tuberculosis. It is important to test lung function after cure of tuberculosis and identify the aspect that can be affected positively by therapy.
Bronchiectasis:
This refers to permanent airway damage causing chronic cough and mucus. It is different from chronic bronchitis in that there is structural permanent disease on CT scans and symptoms are more severe. It leads to repeated infections and leads to additional outpatient or inpatients care for worsening sputum and breathlessness. Bronchiectasis can be caused by a variety of causes and identifying the cause in a systematic manner can prevent the structural change from worsening over time. Our clinic offers a structured evaluation and management protocol for every patient with Bronchiectasis. For example, avoiding inhaled steroids in most patients actually helps in Bronchiectasis and this is not recognised by primary care physicians.
Common Patient Challenges
Dr. Srinivas Rajagopala provides advanced evaluation and individualized treatment plans for uncontrolled asthma, COPD, Post-tuberculosis lung disease and bronchiectasis, helping patients in India and internationally achieve better disease control and long-term lung stability.
