Respiratory diseases continue to impose a heavy toll on the health condition in our country. Based on the latest statistics published by the World Health Organization (WHO), if we were to categorize the ten leading causes of deaths in the Philippines into three, pulmonary diseases would rank second, next to cardiovascular diseases, with cancer as the third leading cause.
Pneumonia, pulmonary tuberculosis and chronic pulmonary diseases are the three lung problems that put a major weight on the health burden of Filipinos, impairing the quality of lives and diminishing productivity of patients afflicted with them. They also drain the financial resources of the family and the government because of the treatments, hospitalizations and other healthcare costs.
We’re focusing on the Philippine College of Chest Physicians (PCCP) in this issue, and we’d like to commend them for the gallant work they’ve been doing to address various health gaps that make pulmonary diseases still a major health problem in the country. Its members have gone beyond the scientific scope of their charter, and have devoted equal dedication to their advocacy activities—to educate the public on the harms of smoking and other risk factors, and also the misuse and abuse of antimicrobials.
The PCCP has been one of the staunch advocates in the health alliance that pressured both Congress and the Senate to finally pass a heavier taxation on cigarettes and other ‘sin’ products. The bill languished in both legislative houses for more than a decade.
The sin taxes have increased revenues which are now being channeled back to finance healthcare reforms. Hopefully, the smoking rate would also significantly go down; and whether or not this would translate to a lower incidence of pulmonary and cardiovascular diseases remains to be seen.
Another prevalent practice which may be responsible for the increasing rate of pulmonary diseases in the country is inappropriate antibiotic use, often due to self medication.
The WHO warns that antimicrobial resistance (AMR) hampers the effective prevention and treatment of an increasing range of infections caused by bacteria, parasites, viruses and fungi. Pneumonia is now actually the third leading cause of deaths in the country, and the microbes causing it now seem to have mutated to potent ones resistant to treatment. It’s not a remote possibility that in the foreseeable future, we’ll run out of effective antimicrobials to treat prevalent infections in the lungs and elsewhere.
Time was when practically all infections would respond to the ordinary penicillin. Now, even ordinary microbes sometimes don’t respond anymore to potent antibiotics.
I recall my good friend, renowned pulmonologist Dr. Camilo Roa, Jr. lamenting in one of his many lectures that pulmonary tuberculosis (PTB), which is almost non-existent in some first-world countries, remains a major cause of illness and death in our country because of the increasing incidence of drug-resistant PTB.
Cases of PTB should be treated with a minimum of 6-month course of anti-TB drugs. Some take it without doctor’s prescription when they have long-standing cough, and stop it when their coughs are gone. They may not even have PTB to start with.
On the other hand, some who really have PTB take it only for a few weeks or months, and when they get better, they stop taking their prescribed anti-TB regimen. The result is treatment-resistant TB. The TB bacteria will come back with a vengeance and will be resistant to the commonly prescribed anti-TB drugs. More potent drugs will have to be given, which unfortunately have bothersome side-effects.
So, are we seeing the light at the end of the tunnel for pulmonary diseases in our country? With a multisectoral collaboration, which the PCCP is continually forging, I believe there’s good reason to be optimistic.
However, lung specialists and other health experts I’ve talked to still find significant gaps between national policies and local implementation, especially noting the lack of trained pulmonologists in other areas in the country. The inertia of various sectors in taking part in addressing pulmonary and other prevalent diseases also remains a major issue. And this inertia issue is like a wedge that prevent the bridging of the health gaps.
RAFAEL R. CASTILLO, MD
Aug 2018 Health and Lifestyle