Lung diseases or respiratory diseases are one of the most common conditions in Singapore. They interfere with our very basic daily activity - breathing. Poor breathing affects the amount of oxygen the lung supplies to the rest of the body. In chronic cases, lung diseases can have an adverse impact on our overall well-being and productivity. In acute cases, prolonged inability to breathe can cause death.
Prevalence of respiratory illnesses also presents a cost burden to individuals and the community. One study estimated the mean annual treatment cost for a respiratory patient in Singapore to be almost SG$8,500, with additional annual work impairment and productivity loss to be $10,000 and $9,000 respectively. That is a total cost of $27,500 per year per case for a working adult patient!
Almost everyone can expect to develop a different type of respiratory disease at some point in life. However, the most vulnerable groups are those with weakened immunity systems, such as young children, elderlies and individuals with other existing illnesses. In this comprehensive guide, we discuss top 3 common respiratory conditions in Singapore - Chronic Obstructive Pulmonary Disease (COPD), Asthma and Pneumonia - their prevalence, causes, symptoms, treatment and complications to avoid. We hope it equips you with the necessary knowledge to protect yourself and your elderlies from these common yet debilitating conditions.
Table of Contents
1. Chronic Obstructive Pulmonary Disease
Overview of Chronic Obstructive Pulmonary Diseases (COPD) in Singapore
Chronic obstructive pulmonary disease, or COPD, is a progressive chronic lung disease that includes emphysema and bronchitis. As chronic conditions, COPD does not have a curative treatment. However, doctors are able to improve the symptoms and lower the rates of complications. In advanced COPD cases, palliative care can help to relieve symptoms and suffering for the patients.
In Singapore, COPD was the 10th leading cause of death. The surprising and concerning fact, according to various studies, is that a large portion of those who have COPD-related symptoms are unaware of it. COPD symptoms are easily mistaken as asthma, or just old age by elderly patients and their families. Lack of awareness leads to under-diagnosis, which hinders the effectiveness of treatment and management in the long-term. Awareness and early diagnosis therefore are key in improving prognosis for COPD patients.
Types of COPD
Emphysema and chronic bronchitis are two common types of COPD.
Emphysema leads to the destruction of the small air sacs in your lungs, called alveoli. In healthy individuals, about 300 million air sacs located in bronchial tubes in the lung work to help turn deoxygenated blood into oxygenated blood with each breath. In people with emphysema, the damaged air sacs are less efficient in exchanging carbon dioxide with oxygen, causing shortness of breath, wheezing or coughing.
Chronic bronchitis refers to the long-term inflammation of the airway in the bronchial tubes of the lung. As a result, they get obstructed by the swelling and excess mucus, making breathing difficult and less efficient. People with chronic bronchitis often develop chronic cough, as a natural response of the body to get rid of the persistent phlegm or mucus.
Causes of COPD
In developed countries like Singapore, the single most influential risk factor for COPD is smoking, including cigarette, pipe, cigar, and secondhand smoke. Smoking precipitates exposure to chemical irritants that destroy the air sacs. For reference, around 90% of patients with COPD have some connection to smoking such as being an active smoker or a former smoker. Furthermore, COPD usually affects elderly individuals due to the cumulative nature of smoking. In other words, the longer your history of smoking is, the higher the risks of developing COPD.
Besides tobacco products, occupational exposure to chemicals and pollution can also trigger COPD. This process is more prevalent in developing countries due to poor housing ventilation and unintentional inhalation of the chemicals that stem from burning fuel.
Individually, a childhood with repeated respiratory infections and family history of COPD can augment your risk. Elderlies with chronic asthma are more likely to develop COPD, although they are also at higher risk of overlooking their COPD, thinking their symptoms are due to asthma.
Finally, a small portion of patients develop COPD without a medical history of smoking. In fact, 5% of people have a genetic mutation that leads to alpha C-antitrypsin deficiency, which causes lung and liver tissue destruction.
The Symptoms of COPD
COPD makes breathing difficult. Shortness of breath (sometimes referred to by doctors as dyspnea) is the most typical symptom. Initially, symptoms start off mild with episodes of dyspnea and coughing. As COPD advances, you can expect more frequent and severe symptoms.
Early symptoms of COPD include:
- Avoiding stairs and physical activity
- Feeling that you need to clear your throat
- Occasional shortness of breath
- Recurrent cough
As the destruction affects more areas of your lungs, the following symptoms may present:
- Shortness of breath (dyspnea), even after mild exercise
- Wheezing
- Chronic coughing
- Tightness in the chest
- Feeling tired all the time
- Frequent respiratory tract infections
The Treatment of COPD
The treatment of COPD focuses on preventing exacerbations by prescribing drugs that open up the airways (e.g., bronchodilators). There is currently no cure for COPD. Doctors often recommend lifestyle modifications to control symptoms and ease breathing, including:
- Quitting smoking
- Getting influenza and pneumococca vaccine
- Seeking respiratory therapy to improve breathing.
- Being physically active: Exercise is well-documented as an effective part of pulmonary rehabilitation, promoting the well-being of COPD patients.
The Complications of COPD
COPD can cause serious complications, which is aggravated by lack of awareness and under-diagnosis. In many cases, early symptoms are easily missed and patients are only diagnosed when COPD has advanced to serious stages. Below are the complications of COPD:
- Respiratory infections – patients with COPD are more likely to catch colds, flu, and pneumonia.
- Heart problems – while this is not fully understood, it is known that COPD increases the risk of heart attacks. Learn more about heart disease in our article here.
- Pulmonary hypertension – COPD may cause high blood pressure in the arteries that bring blood to your lungs. Learn more about high blood pressure in our article here.
- Lung cancer – people with COPD may have a slightly higher risk of developing lung cancer.
- Depression – dyspnea (breathing difficulty) can make it very challenging to perform daily tasks that you used to enjoy. As a result, patients become at risk of mental disorders, such as anxiety and depression.
Recognizing COPD & Get Treated
2. Asthma
Overview of Asthma in Singapore
Asthma is a chronic respiratory condition that results in inflammation in the airways of the lung, leading to shortness of breath, wheezing, and coughing. Asthma is characterised by asthma attacks or asthma flare-ups, which are episodes of severe symptoms. Patients often need medical intervention urgently to ease breathing difficulty, and sometimes hospitalisation. The mechanisms that trigger asthma are very complex and include an immune reaction that recruits inflammatory cells to the bronchioles.
Asthma is one of the most common respiratory diseases in the world and Singapore. One report stated that over 339 million people in the world have asthma. In Singapore, asthma affects around 5% of adults and 20% of children, which is one of the highest asthma prevalence globally. Asthma is often more threatening to elderlies compared to younger adults, as they are likely to experience more severe symptoms, including near-fatal incidents, according to statistics. Singapore’s asthma mortality rate is unusually high for developed countries, surpassing the United States’ and New Zealand’s by three times. Experts attribute this to several factors, including the under-reporting of symptoms, poor compliance to prescribed treatments and the aging population.
Causes of Asthma
The exact causes of asthma are still vague. Scientists believe that asthma is the result of genetic predisposition followed by environmental triggers, similar to other autoimmune diseases. Recognised causes of asthma include:
- Genetics – having a close relative with asthma.
- Recurrent viral infections – viral infections may be a trigger that leads to the first asthma reaction.
- Predisposition to allergic diseases, such as hives, nasal polyposis, and asthma. This condition is known medically as atopy.
In summary, the risk of developing asthma is substantially higher in individuals who have one or more of the risk factors cited above.
The Symptoms of Asthma
Patients with asthma develop symptoms in a periodic manner. You might be symptom-free for weeks, then develop a severe episode of wheezing and difficulty breathing. The frequency and severity of these episodes also vary from one person to another. For instance, a patient may experience shortness of breath once a month, whereas a second patient deals with shortness of breath (dyspnea) every hour of every day.
Here are the common signs and symptoms of asthma attacks:
- Coughing
- Wheezing
- Shortness of breath (Dyspnea)
- Rapid heartbeat
- Bluish lips or fingers
- Fatigue
In clinical practice, the doctor may use results from your lung function test, and/or lung and chest x-ray together with the information about the frequency of your asthma attack to classify your asthma into one of four categories: mild intermittent, mild persistent, moderate persistent, and severe persistent. Based on this data, your doctor will choose the appropriate treatment. If you experience any severe or unusual symptoms of asthma, get in touch with your doctor immediately or head to the hospital.
The Treatment of Asthma
Although there is no cure, asthma is highly treatable. The primary goal of asthma treatment is to reverse the triggers of asthma on a pathophysiological level. Asthma treatment truly demonstrates the beauty of modern medicine and the importance of understanding the fundamentals of a disease to treat it.
In general, asthma treatment aims to ease short term symptoms by reducing inflammation and swelling of the airway, clearing up mucus for better breathing. This is often done via inhalation of an aerosolised form of medication (the famous ‘blue inhaler’). Long term prevention medication includes medication such as antihistamine to control allergic reactions or other triggers, depending on the patient's specific condition. Aside from medication, active management by the patient is crucial in preventing asthma attacks.
Successful management of chronic asthma often involves regular check-up with the doctor in clinic and adherence to the do's and don'ts in the action plan drawn out by the doctor at home. It's not effective to turn to the doctor and his advice only when asthma flares up. Lifestyle changes such as quitting smoking if you smoke, staying physically active are also found to be helpful for individuals with asthma.
The Complications of Asthma
Asthma complications include:
- Symptoms that interfere with sleep and work
- Sick days from work during asthma flare-ups
- A permanent narrowing of the tubes that carry air to and from your lungs
- Emergency room visits and hospitalisations for asthma exacerbations
- Side effects from long-term use of some medications
Managing Asthma Attacks
3. Pneumonia
Overview of Pneumonia in Singapore
Pneumonia is a serious acute infection of the lung tissues caused by bacteria or viruses, or sometimes fungi. Pneumonia’s infection area is primarily the air sacs inside the lungs (alveoli), which is the same area affected in emphysema discussed above. As a result, one or both lungs become inflamed and start to accumulate pus (fluid), making it difficult for the patient to breathe. This disease could present with mild fever and cough, but it can also lead to a life-threatening condition known as acute respiratory distress syndrome (ARDS).
In Singapore, pneumonia was responsible for 20.7% of deaths in Singapore in 2019, the second killer just behind cancer. Fatality rate tends to increase steadily in recent years. Elderlies are the most vulnerable to developing severe forms of this infection, due to their weaker immunity. According to statistics, people aged 65 and above account for more than two thirds of all hospitalisation related to pneumonia in Singapore. Young infants and children and those with underlying diseases are also known to be more vulnerable to pneumonia.
Pneumonia numbers in Singapore
Causes of Pneumonia
- Virus
Viral pneumonia happens when viruses that trigger pneumonia get transmitted from one sick individual to another via respiratory droplets and airborne transmission. The same virus causing common cold, influenza, Covid-19, among others, are also responsible for viral pneumonia.
- Bacteria
Bacterial pneumonia happens when bacteria invade the lung, as a result of another illness such as a flu or another respiratory infection, or on its own. Consequently, the immune system launches a reaction that leads to a widespread inflammatory reaction in the lung, causing breathing difficulty. The treatment of bacterial pneumonia consists of prescribing antibiotics to get rid of the specific type of bacteria causing pneumonia.
Among bacterial pneumonia, you may hear of:
- Atypical pneumonia, also known as walking pneumonia: The type of bacteria causing pneumonia is not among the common ones. Atypical pneumonia usually presents milder symptoms than typical pneumonia.
- Nosocomial pneumonia, or Hospital-acquired pneumonia (HAP): Different from Community acquired pneumonia, patients contract HAP from hospital or clinic where they are being treated for something else.
- Aspiration pneumonia: As the name suggests, this is a result of breathing in (i.e., aspiration of) content that is supposed to be swallowed down to the stomach such as food, saliva or other gastric contents. The bacteria from these types of content enter the lung and cause aspiration pneumonia.
The symptoms of pneumonia
Pneumonia presents with many signs and symptoms that resemble other infections. They may include:
- Fever
- Shortness of breath
- Chest pain
- Coughing
- Confusion
- Digestive symptoms (e.g., diarrhoea, nausea, vomiting)
Doctors may order a chest ray to check the extent of lung inflammation, blood test, or mucus sample test to identify the type of bacteria causing pneumonia.
In diagnosing and treating pneumonia for elderlies, one of the challenges doctors face is their atypical clinical presentation. In other words, an elderly with pneumonia may not present with the symptoms listed above. This is because older individuals have a weakened immune system that is unable to stimulate a powerful inflammatory reaction to manifest the symptoms, which complicates the diagnosis process.
The treatment of pneumonia
The treatment of pneumonia includes:
- Symptomatic therapy
- Specific therapy
The first approach focuses on improving the patient’s status by controlling the symptoms. However, it does not address the underlying disease. For instance, if the patient has a fever, acetaminophen (commonly known as paracetamol), may be prescribed under doctor’s advice to control the fever. Antitussive drugs may be useful to control the coughing and at times, antibiotics may also be taken to curb bacterial pneumonia. These medications, if taken, should be advised appropriately by each individual’s doctor first.
Since we do not have effective antiviral medications, the treatment of viral pneumonia is mostly symptomatic.
The Complications of Pneumonia
Complications of pneumonia include:
- Acute respiratory distress (ARDS) and respiratory failure – these two complications are fatal when immediate care is not provided.
- Kidney, liver, and heart damage – it happens when the organs are not getting enough oxygen to function properly. Sometimes, the immune system plays a role in this as well.
- Pleural disorders – when the thin tissues that cover the lungs become inflamed, the cavity inside may be filled with pus and fluids.
- Sepsis – it happens when bacteria travels through the blood, leading to generalised inflammation in several organs.
Prevention of Pneumonia
Fortunately, common forms of pneumonia can be protected effectively with vaccines. In fact, pneumococcal vaccination is recommended for those with weaker immunity such as infants, elderlies and individuals with chronic conditions leading to compromised immunity such as chronic lung diseases (COPD, asthma), chronic heart diseases or diabetes. Pneumococcal immunisation provides protection against common types of bacteria causing pneumonia. It comes in 2 types:
- Pneumococcal Conjugate Vaccine (PCV13): protecting against 13 common pneumonia- causing bacteria strains.
- Pneumococcal Polysaccharide Vaccine (PPSV23): protecting against 23 common pneumonia- causing bacteria strains.
Seniors above 65 years of age are recommended to take both types for a wider range of protection, with a lapse of time in- between. You should also consult a GP about your personal health history for advice whether pneumococcal vaccination is suitable for you, and if so, which type and when to take it.
Managing Pneumonia
4. Managing Chronic Respiratory Diseases at Home
One important aspect of managing chronic respiratory illnesses revolves around home care and maintaining relationships with a family physician. Studies have suggested that active management of chronic respiratory diseases such as asthma and COPD can be very helpful, especially in older patients. This includes 3 aspects, jointly managed by the patients, their family and a family doctor or clinic.
The first step is awareness of the illness and early diagnosis, based on which the family and doctor will develop an active treatment plan to follow. Secondly, patients are recommended to follow up regularly with the family doctor to prevent exacerbation, such as asthma attacks, or complications of COPD or pneumonia. Thirdly, in the event exacerbation happens, it is important to get in touch with the family doctor or clinic who knows the history of your chronic condition as soon as possible, to take prompt intervention actions and prevent complications. These will help give you the best outcome and possibly reduce medical bills in the long term.
5. How Ninkatec Can Help You Manage Chronic Respiratory Conditions
Like all chronic conditions, self-management is critical. However, self-management does not mean managing the chronic illness on your own. Ninkatec is one of the top home care service providers in Singapore. With our chronic disease management service, we are with you every step of the way. Our team of care consultants, caregivers, nurses and doctors are experienced and skilled in helping you actively develop, follow and adjust treatment plans for the best possible outcome. Additionally, our usage of medical monitoring technology helps us to detect signs of exacerbations when chronic respiratory conditions worsen and dispatch prompt response.
Ninkatec’s chronic disease management programs are customised to your specific condition and needs. Check in with our friendly care consultants today via whatsapp chat, call, email or leave your details below for a personalised consultation.
