Jakarta, IO – 2019 WHO data reports that globally Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of death (3.23 million), and is estimated to be 5.4 million by 2060. In Indonesia, data on COPD patients is relatively minimal.
However, data from the 2018 Basic Health Research (Riskesdas) shows that the prevalence of COPD in Indonesia, based on interviews with people aged ≥ 30 years is 3.7%; the highest in East Nusa Tenggara Province (10%) and the lowest in Lampung Province (1.4%). Meanwhile, the Epidemiology and Impact of COPD (EPIC) Asia Survey revealed that the prevalence of COPD in Indonesia has reached 4.5%.
COPD is a chronic lung inflammation condition that obstructs airflow from the lungs, and risks reducing quality of life. Patients will suffer worsening shortness of breath, and are susceptible to infection, resulting in acute attacks/ exacerbations. Complications of COPD that arise outside the lungs, one of which is cognitive impairment (CI), also need to be addressed properly. Dr. dr. Yopi Simargi, Sp.Rad., Subsp.TR(K), MARS, studied the relationship, elaborated in his dissertation entitled “The Role of Quantitative Thoracic CT Scan, HIF-1α, and Clinical Factors on the Incidence of Cognitive Impairment in COPD”.
“CI is a condition between normal mental acuity and dementia, which then has the potential to degenerate into dementia. COPD and dementia share major risk factors, namely, air pollution, including smoking, which is considered a form of ‘heavy air pollution’. In a study of 534 COPD patients with CI, 28.7% developed dementia. This condition is directly related to a decline in cognitive abilities, including the loss of compliance of COPD patients with CI to carry out routine treatment. Not intentionally disobedient, but rather their cognitive abilities decline, causing patients to often forget,” said a radiologist, subspecializing in thoracic radiology from Atma Jaya Catholic University of Indonesia, Jakarta, Wednesday (31/7/2024).
Necessity of Multidisciplinary Cooperation
Triggers for CI in COPD patients include systemic inflammation, chronic hypoxia, oxidative stress, vascular disorders, sedentary lifestyle, or comorbid cognitive disorders. Chronic hypoxia is considered the biggest factor causing CI in COPD patients.
“Chronic hypoxia has been seen from the increase in HIF-1 alpha expression (the effect of the homeostasis response to low oxygen pressure), a basic factor in COPD. In my research, I emphasize the pathomechanism theory of CI in COPD patients, that health workers need to pay more attention to systemic inflammation. This theory is obtained by looking at the extent of lung damage that can be detected with a Quantitative Thoracic CT Scan (QCT). QCT has the potential as an initial screening for early detection of decreased lung function and the occurrence of CI. Hopefully in the future QCT will be included in guidelines as a routine examination for COPD patients.”
In fact, until now, the diagnosis of COPD uses spirometry: patients must blow into a device to see if there is an obstacle or obstruction so that an assessment of lung function is obtained. The use of QCT for COPD is still very limited, only for high-risk groups, such as lung cancer patients or as screening before surgery. “With the significant findings of QCT parameters with CI, and how systemic inflammation needs to be studied in COPD patients, QCT can be proposed for earlier use, so that it can work as an alarm for CI in COPD patients and immediately get appropriate management for CI in parallel,” Dr. Yopi explained.
He warned that considering the impact on decreasing independence and quality of life, as well as increasing hospitalization, the support system is very important for COPD patients with CI. “COPD patients with CI experience decreased cognitive function, especially those who have reached a level of dementia. The biggest challenge is that they are less compliant with treatment, because they often forget. Therefore, awareness from a support system – such as family – is needed to remind patients about their treatment. Multidisciplinary cooperation is also needed between pulmonologists, radiologists, neurologists, and psychiatrists. Education to increase awareness of health service providers, policymakers, and patient families needs to be carried out so that challenges in management can be overcome appropriately.” (est)