“NIDCH involved in various research activities in the field of Chest Diseases”

Prof. Dr. MD. Shahedur Rahman Khan

Director

National Institute of Diseases of

the Chest and Hospital (NIDCH),

Dhaka

As Director of NIDCH, please tell us about the services available in your organization

NIDCH is a tertiary institute, a Center of Excellence in Bangladesh representing chest disease treatment and also an institute for higher degrees, post-graduation degrees in chest medicine and surgery. We offer 5 post-graduate degree-DTCD, MD chest, FCPS pulmonology, MS thoracic surgery, and FCPS thoracic surgery. You see our outdoor services are attended by respective unit chief (Professor/Associate Professor) with his team doctors besides the resident physician and resident surgeon’s team. Outdoor services are open from 8 am to 2 pm. Our emergency services are open for 24 hours round the clock. Emergency medical officer with his staff and logistic support control the emergency situation for both Medical and Surgical patients. Our indoor service includes Medicine, Thoracic Surgery, Pathology and microbiology, Radiology & Imaging Transfusion Medicine, Anesthesia, ICU, RCU & Physical Medicine. In 16 separate blocks, the hospital has accommodation of 690 patients suffering from Pulmonary Tuberculosis and allied diseases of the chest. Of the total 280 beds are allotted for Non-Tubercular Chest diseases and 390 for Tuberculosis cases. The Hospital has 10 beds each for ICU and RCU. In order to facilitate management of patients, the Hospital beds are divided and put in 10 medical units & 8 surgical units with care of highly experienced Professor or Associate Professor as unit chief. It has some specialized investigational facilities like CT Scan Chest, CT-guided FANC, USG, Pleural Biopsy, FOB, EBUS-TBNA, Fluoroscopy, VATS, Sleep Lab. NIDCH is also involved in various research activities in the field of chest diseases. You see, NIDCH is the only institute of Bangladesh which extend modern specialized medical and surgical treatment to complicated chest and TB patients and also offer training of medical manpower in the specialization of tuberculosis and chest disease. We have 4 professional organizations to gear up the medical science related to chest disease & chest surgery i.e. Asthma Association of Bangladesh, The Chest & Heart Association of Bangladesh, Bangladesh Lung Foundation, Bangladesh Society of Allergy and Immunology. Two journals are being published by our affiliated associations Bangladesh Journal of Pulmonology & Chest & Heart Journal. We also published the 5th edition of the standard national guidelines earlier this year on Asthma & COPD management. At the same time, we are performing CME (Continuous Medical Education) Program all over the country to disseminate the latest knowledge among the physicians.

What are the common Chronic Respiratory Diseases prevalent in Bangladesh? What is the status of management of these diseases in our country?

The most prevalent chronic respiratory diseases in our country are Pulmonary Tuberculosis, Asthma & COPD. Chronic bronchitis & emphysema are two diseases which often coexist in COPD. Tubercular Pleural effusion is another common chronic disease, which is the build-up of excess fluid between the layers of linings outside the lungs. Other diseases like pulmonary fibrosis, ILD bronchiectasis, occupational lung diseases including occupational Asthma pneumoconiosis, silicosis etc. Actually, management of the diseases I mentioned is almost in parallel with the world standard. We are no more lagging behind in the management of these diseases. But, problem is that our people are less aware of their conditions. So they make delay to consult the physicians, thereby making the diseases more complicated. Otherwise, the standard of treatment in our country is at par with the developed countries, at least in this institute.

As an eminent Chest Specialist of the country, how do you assess the facilities available in Bangladesh for treatment of Chronic Respiratory diseases?

Bangladesh is a densely populated country, with a population of 16 crore people according to government statistics. The number of qualified doctors and specialists in proportion to the patients is very low. So, we are facing a very poor doctor-patient ratio in our country. We need more and more specialists, we need more & more centers with proper treatment facilities and diagnostic tools. We have many centers here in Dhaka, including NIDCH. There are district level Chest hospitals also. But in upazila level, there is no organized dedicated chest hospital and asthma medications, especially essential inhalers and facilities are not easily available. We have sputum examination facility, GeneX-pert investigation throughout Bangladesh. It is possible to give treatment to the patients. Even the rural dispensaries offer some asthma medications & full range of anti-tuberculosis medication. A network still exists, but we need a much stronger network. The treatment of chronic respiratory disease in the rural level needs to be more updated. The patients also need to be more aware and educated about their illness, so that they go to the doctors without wasting time.

What are the challenges in Asthma & COPD Care in Bangladesh?

Let me highlight some important points. Firstly, the lack of education and awareness among the mass population. Although literacy is increasing, people are still not aware. People should come early to the doctors to avail treatment. Secondly, risk factors of COPD and asthma i.e. pollution, smoking & other occupational hazards are not strictly monitored or controlled. So, we are lagging behind in taking preventive measure as well. Thirdly, the medications for prevention & management of asthma and COPD are very costly. The cost of various inhalers ranges from about 200 taka to 4000 taka. So, these are tough for the general people to buy and to use regularly. Chronic respiratory illnesses require years of treatment or even lifelong. So, to ensure regular use of medication, people need support from the government & NGO’s, as well as from affluent class of the society.

Do we have any specialized facilities in Bangladesh dedicated to Chronic Respiratory diseases?

National Institute of the Diseases of the Chest and Hospital is a specialized institute. We have the state-of-the-art treatment and diagnostic facilities. For Interventional Pulmonology, we offer Rigid Bronchoscopy, Medical Thoracoscopy, Autofluorescence Bronchoscopy (AFB), Endobronchial Ultrasound- Transbronchial Needle Aspiration (EBUS-TBNA), Bronchial provocation test (BPT), Complete Pulmonary Function Test (CPET), Cardiopulmonary Exercise Testing (CPET).

In the near future, we’ll also provide airway dilatation, laser surgery, argon plasma coagulation (APC), cryosurgery, airway sending, bronchoscopic lung volume reduction (BLVR) etc. We also have a fully equipped sleep laboratory for diagnosis & the treatment of sleep disorders. Alongwith that, we are doing CME and free medical camps. Asthma Association is planning to establish an Asthma Bank where all the expensive medicines will be collected from donors, NGOs and affluent society, to be distributed all over the country. It is our will to render service to the people one step further.

Which group or segments of people are more vulnerable to this disease and why?

You see, our respiratory system is an open one. Our circulatory system is closed, our gastrointestinal system is closed but the respiratory system is open to the environment just like our skin. When you are taking a breath, you are taking the surrounding air, fresh or polluted is a crucial risk factor. People who are exposed to pollutants become vulnerable to respiratory diseases. Occupational environment may contain huge factors contributing to respiratory diseases. People working in chemical factories, tanneries, sand blasting, sand crushing, asbestos manufacturing, garment factories etc., who work without proper safety measures are more at risk. They are vulnerable to occupational lung disease, occupational asthma and different types of pneumoconiosis. Chronic respiratory diseases are also common in immune -compromised patients i.e. those who are diabetic, those who have chronic kidney disease, those who have undergone transplantation, people with chronic liver disease, people with auto- immune diseases etc. as they are defenseless against pollution and inflammation. The same is true for cancer patients undergoing chemotherapy who are immunosuppressed. However, in Bangladesh, smoking is the number one cause of such diseases. Non-smokers who are exposed to second hand smoking are also at risk for developing COPD. In rural areas, women are being affected by the smoke from cooking which are not ventilated. These are the way our people are becoming exposed to risk factors so that respiratory illness even COPD, asthma, bronchial carcinoma they are increasing and getting more and more prevalent.

How life style, pollution and smoking are responsible for triggering the respiratory disease?

Life style is very important. Although we need plenty of food now due to decreased poverty, people are still malnourished. Because of abundance of fast food, rich people even do not get proper and balanced nutrition. So, despite eating more, they get malnutrition. If you live in a congested or overcrowded area, you are more at risk than people who live in well-ventilated area surrounded by greenery. You see smoking is also a way of air pollution. Smokers and non-smokers who are exposed to passive smoking, both are susceptible to COPD. It is also one of the causes of the exacerbation of asthma. Then there are pollution from auto-vehicles. Before introduction of CNB, the concentration of lead in the air of Dhaka city was all time high. On the other hand, the industries pollute the environment more than anything. When you go to the Buriganga River, you will see the water is totally polluted due to the disposal of both industrial and domestic wastes. Labors who are working in the industries are not provided with proper safety measures.

Unknowingly, they are taking the sand and dust particles to their lungs and thus become stone and in certain stage the silicosis develops.

Government is already taking different steps including prevention of air pollution, restriction of smoking. But, the real results depend on how the rules are implemented and practiced among general people.