You’re out with some friends and someone pulls out a pack of cigarettes, takes one out and lights up in a sudden plume of smoke.

You know the situation – you might even have been the cigarette smoker yourself, especially with one in four Maltese people being active smokers.

Between the yellow teeth and nails, drain on your pocket, and generally smelling like an ashtray, smokers may slowly self-inflict a condition called Chronic Obstructive Pulmonary Disease (COPD) upon themselves as they continue to smoke – and it can really change someone’s life for the worse.

With so many smoking methods available on the market, Lovin Malta sat down with Dr Brendan Caruana Montaldo MD FACP, a lung specialist, to find out more about COPD, and how it could happen to you.

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1. So, what is COPD?

“COPD is a disease of the airways usually caused by the inhalation of particulate matter, like smoke, which causes narrowing of the airways,” Dr Caruana Montaldo said from his office in Mater Dei. “The patient’s symptoms will typically include a cough, increased sputum production, shortness of breath and wheezing”

“By far the most common cause of COPD worldwide is cigarette smoking, or tobacco smoking, as the tobacco could be in the form of cigarettes, cigars, cigarillos, pipes and nowadays these new electronic cigarettes which use a heater to vaporise the tobacco without actually burning it,” he continued.

People who smoke regularly, usually develop a cough, which just won’t go away – and smokers often don’t check it out until it’s too late.

“Most of the time, the patient presents late; typically they develop a daily morning cough which they dismiss as normal,” he said. “Many smokers will get a cough, they’ll be coughing much more than their partner, for example, who doesn’t smoke, but they accept it as a normal routine, and they wake up in the morning, coughing, they clear up their phlegm, then they go about their day.”

“That’s called bronchitis,” he continued, “which is initially acute and, over time, becomes chronic the longer you smoke.”

2. COPD can develop with constant smoking over a decade or two

“Most people get COPD in or after their 40’s because they would start smoking, say, in their 20’s,” Dr Caruana Montaldo explained. “The problem is that many people are now smoking at an even younger age. Even though it is illegal to sell cigarettes to children under the age of 16 in Malta, you will still see 15-year-olds smoking outside schools, for example, if you start younger, you’re more likely to get COPD at a younger age.”

3. A major problem with COPD is that once you develop it, it can really ruin your quality of life

If you want to know what living with COPD is like, Dr Caruana Montaldo said you should grab a drinking straw and breath through it while walking up and down a staircase.

“Imagine yourself being always short of breath, panting – you wake up in the morning, you go to sleep at night, you’re short of breath all the time,” he said with a serious look.

“Many of these patients mistake their symptoms for asthma and they will use inhalers which are designed for asthma, and get temporary relief. So they will take the inhaler and the wheezing will go away… then they go out and smoke a cigarette and the wheezing comes back.”

Eventually, the good periods become bad periods, and the bad periods get worse.

“COPD causes a gradually progressive decline in lung function and the patient starts giving up on activities: they stop going out, they stop carrying the shopping, they live with a constant cough, they live with bringing up phlegm every single morning and getting progressively short of breath so they can’t walk up a flight of stairs, they can’t walk up a hill and they will often get frequent chest infections, especially in the winter,” he said.

4. When it comes to Malta, an entire 4% of the population suffers from COPD, with nearly 50% of Maltese smokers going on to develop it

Some people are more at risk when it comes to COPD;

“People who smoke more than 20 cigarettes a day, especially women, are more likely to develop COPD. The effect of cigarette smoke on the lungs is greater in women. So a woman smoking 10 to 15 cigarettes is roughly equivalent to a man smoking 20,” Dr Caruana Montaldo pointed out. “This is important because more women are taking up smoking than in the past.”

And some things can make it even worse, fast.

“The most common exacerbator is a viral infection. So many of them get viral infections, especially in the winter, and the viral infection triggers off bronchitis. Very often, they end up going to the polyclinic for a nebuliser and then they’ll need to get admitted to hospital… and in winter a lot of our beds are occupied by COPD patients,” he said.

Besides COPD causing a massive burden to the patient, reducing their own quality of life, it also burdens the family who will need to take care of the sufferer. There is also the added cost to the tax payer.

Health authorities have rolled out education measures to stop young people from smoking, with clear messaging about the dangers of smoking.

“There’s no such thing as a safe level of smoking,” Dr Caruana Montaldo said. “My patients ask me if they can smoke one cigarette per day and I say ‘no’ because cigarettes are inherently addictive and one leads to two, two becomes four, four becomes eight, eight becomes 16, and before you know it, you’re smoking a packet of cigarettes per day.”

5. There are some signs that you are developing COPD which you can pick up.

“Anybody who smokes and has a persistent cough, usually for more than six weeks or so, should know that that is the first cardinal sign of COPD, what we call a smoker’s cough,” Dr Caruana Montaldo points out.

“When they start getting recurrent chest infections, it’s another sign,” he continued, “and when they start getting shortness of breath and wheezing, those are three symptoms. Especially when they get chest infections that should alert them to the fact that they may be developing COPD.

The healthcare practitioner interviewed has not received an honorarium from Novartis for this interview.

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