Prof. Dr. Mohammad Rashidul Hassan
Ex-Director
National Institute of Diseases
of the Chest and Hospital,
Mohakhali, Dhaka
President Bangladesh Lung Foundation
As an eminent Chest Specialist of the country, how do you assess the facilities available in Bangladesh for treatment of chest diseases?
We can divide our facilities into two components:
Would you please tell us about the prevalence of COPD in Bangladesh and its management?
According to first National COPD Prevalence Survey 2007 (BOLD-BD) prevalence of COPD in 40 years or more population was about 21.24%, i.e. about 6.5 million people are suffering from COPD in Bangladesh. It was seen than 86% COPD patients were symptomatic, 63% sufferers were male and 37% were female. 62% sufferers were from urban population, 88% COPD patients were associated with smoking, whereas 80% female COPD were associated with exposure to smoke related to Bio-mass fuel.
Do you think Bangladesh has all the state-of-the-art facilities to diagnose chest disease ailment? Do common people have access to such facilities?
Yes, all facilities are available only in Dhaka city, for example body Plethysmography, PET CT is now available in Dhaka. End bronchial ultrasound (EBUS) is still now only available in National Chest Diseases Institute and Hospital (NIDCH). All types of investigations should be available in peripheral hospitals.
Does NIDCH organize awareness building campaign for the COPD patients?
While I was the Director, NIDCH, and now working as President of Bangladesh Lung Foundation. We (Bangladesh Lung Foundation) are providing training of our doctors by two days master class on COPD and hands on training on spirometry. We want to orient our Physicians on spirometry as main diagnosis of COPD depends on spirometry. But, in our country, spirometry is not so popular among general practitioner as well as among specialist Physicians due to lack of awareness. Even in Europe & USA, 30% COPD patients are not diagnosed early due to less use of spirometry for diagnosis of COPD. It is important to create awareness among General Physicians as 80% people in our country under the treatment of general Practitioners and Specialists Physicians. It is important to understand that control of COPD depends on understanding of this chronic disease.
Do you have all the modern facilities in NIDCH to cater to the needs of Asthma and COPD patients?
National Asthma Center was established in 2005 to serve people with asthma and COPD patients. Those patients attended the center they got diagnostic facilities including pirometry, Arterial blood gas analysis, Bronchoprovocation tests, 6 minutes’ walk test and etc. We are trying to give flu vaccine free of cost to all Asthma and COPD patient during early winter season. This year Director General of Health Services supplied 6000 PFS Flu vaccines for our patient and staff.
In addition, we have 70-bedded indoor and 10-bedded ICU to control Asthma & COPD Patients. Non-Invasive ventilator support is unique for our ICU.
What are the challenges in Asthma and COPD care in Bangladesh?
Our slogan to control Asthma as well as COPD is “Education, Caution, Medication and regular follow up are the key words of treatment of Asthma & COPD”. We should educate our patients to control Asthma & COPD. 30% patients are still very much concerned to use Inhaler medicine. In 1999, according to 1st National Prevalence Study of Asthma (NAPS) demonstrated that 90% of our people are reluctant to use inhaler. But after 10 years, it is now about 30% people still not using Inhaler devices.
What are your suggestions to the Asthma and COPD patients to lead a normal life despite his being Asthma or COPD?
1st advice: is to live in a smoke free environment. Indoor pollution is most important which triggers pollution and is most important which triggers Asthma and exposure to smoke (including cigarette, Bidi Hukka smoke as well as wood smoke) is most important risk factors for COPD.
2nd advice: Flu Vaccine and Pneumococcal vaccine are available in Bangladesh. All COPD patients should take one of Injection of flu vaccine every year & one pneumococcal vaccine every 3 years interval. Special 10 valent conjugated pneumococcal vaccine (Synflorix) is also available for 6 weeks to 5 years of age.
3rd advice: for COPD patient, if cough exacerbation or color of sputum changed, then take a course of antibitic like Co-Amoxiclav or Azithromycin. But Antibiotic has little role in asthma exacerbation as 90% exacerbation of Asthma is due to virus infection.
4th advice: Asthma patient should continue corticosteroid based inhaler during asymptomatic period as inflammation control is our goal in Asthma. But maximum bronchodilation is our goal in COPD.
5th advice: After control of Asthma and COPD, we should encourage patient for free hand exercise.
6th advice: Always importance to other co-morbidities like allergy, hypertension, diabetes, IHD, peptic ulcer disease, depression, insomnia, anorexia along with treatment of Asthma and COPD.
Compared to government hospitals, charges in private Asthma Care Centres are very expensive. What are the reasons behind this? How can we make it affordable for the common people?
It is not possible to compare government health services with private services. Government health services has very big infrastructure with huge logistics. Private services always follow our government facilities. Unlike government service, there is no subsidy in private sector. That’s why everything is costly in private sector.
It is clear that General Physician can manage most of Asthma and COPD patients, if they are oriented properly by appropriate short training program. It is the way to make treatment affordable for the common people.
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