Rolly M., a 62-year-old retiree, had been coughing, on and off, for more than six months when he increasingly felt short of breath just climbing the stairs to his third floor condo unit.
He used to be a heavy smoker but quit cigarettes at age 57. Fearing that he could now be paying for his 25-year tobacco habit, Rolly went for a check-up and was found to be manifesting early signs of emphysema.
Pete L., 45 years old and a non-smoker, fared a tad better. He was diagnosed with chronic bronchitis when he sought professional help after a lingering cough and shortness of breath started to bother him.
Emphysema and chronic bronchitis both fall under Chronic Obstructive Pulmonary Disease (COPD), a long-term lung condition that causes patients to suffer from breathlessness and chronic cough, severely affecting their lifestyle and productivity.
COPD is fast becoming the third leading cause of death worldwide and seventh in the Philippines. This has motivated the government, medical professionals, and the private sector into instituting proactive measures to arrest the alarming prevalence of COPD in the country.
From primary care to the specialists
A major component of these initiatives is the crafting, dissemination, and implementation of the “Philippine COPD Guidelines/Pathway” spearheaded by the Philippine College of Chest Physicians (PCCP) and the Department of Health.
According to Dr. Lenora Cañizares-Fernandez, immediate past-president of PCCP, the “guidelines will become the standard clinical approach in the detection, diagnosis, and management of COPD across all levels of healthcare.”
“This will be incorporated in the Universal Health Care (UHC) Act, so implementation will be from the primary care at the local government unit level up to the specialists.”
The initial phase of the draft, which is meant for primary healthcare providers, or the so-called “frontliners,” has already been submitted by the PCCP to the DOH - Essential Non-Communicable Diseases Division (ENCDD).
The next phase of the COPD Guidelines/Pathway is meant for the specialists. “There are only about 800 (COPD) specialists in the country, so we need the help of all the doctors, especially at the primary healthcare level,” noted Dr. Fernandez.
Section 17(c) of the UHC Act, or Republic Act 11223, mandates that province-wide and city-wide health systems should have proactive and effective health promotion programs or campaigns, while Section 30 institutes health literacy campaigns with focus on reducing non-communicable diseases.
Major risk factor
Locally, the prevalence of COPD among adults was already at 14 percent as of 2007. This is projected to increase rapidly because there are still around 16 million Filipinos who smoke.
“COPD can become apparent in smokers 10 to 20 years after the start of smoking. With the number of Filipinos smoking still high, the prevalence of COPD in the country will continue to grow in the next 10 to 20 years, too,” stated Dr. Fernandez.
And so will the estimated economic costs of COPD in the Philippines. Inclusive of healthcare expenses, productivity losses, and premature death, COPD is costing the country P17.6 billion annually.
Worse, Dr. Fernandez disclosed that even non-smokers develop COPD in the Philippines. These include members of households that depend on firewood and charcoal in cooking their food and those who are exposed to dusty jobs.
More devices to detect COPD
Experts say detection of the disease has been a major problem in the country, mainly because of the inaccessibility of devices that detect COPD in most areas of the country.
The spirometer, an apparatus that measures the movement of air into and out of the lungs, costs around P200,000 per unit. This apparatus is not available in most medical facilities at the primary care level, and even in some private diagnostic centers.
Fernandez said patients who undergo spirometry pay around P600 to P4,000, depending on the hospitals and diagnostic centers. Hopefully, she said, DOH will provide spirometer to all hospitals maintained by LGUs, using funding from the UHC Act.
At the level of health centers, Fernandez said the DOH needs to provide a Peak Flow Meter, a much cheaper handheld device—usually costing around P800—that measures how fast air moves out of the lungs.
She added that consistent with the UHC Act, they are hoping that PhilHealth will extend its coverage for COPD to include outpatient care, diagnosis, and medicines. Right now, the maintenance cost for COPD patients is high at around P2,000 per month. PhilHealth only shoulders COPD-related health expenses during confinement.
Section 6(b) RA 11223, however, mandates that within two years from its effectivity, PhilHealth shall implement a comprehensive outpatient benefit, including outpatient drug benefit.
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