Department of Health, Taipei City Government

Chronic Obstructive Pulmonary Disease (COPD) has been one of the top ten leading causes of death in Taiwan for 7 consecutive years. Based on data from the Health Promotion Administration, Ministry of Health and Welfare, globally, one person dies every 10 seconds from COPD. In Taiwan, more than 5,000 people die from COPD every year. On the eve of World COPD Day, November 16, the Department of Health, Taipei City Government appealed to the public to "say no to COPD, protect your lungs and health and find a professional to quit smoking!"

Quitting smoking is the most effective way to prevent COPD

Shier-Chieg Huang, Commissioner of the Department of Health, Taipei City Government, stated that COPD is a disease where the respiratory tract becomes chronically inflamed, obstructing airflow. As the ability of the lungs to exchange gas is reduced, symptoms such as coughing, wheezing, chest tightness, and excess phlegm are often shown by patients. They are also more likely to be accompanied by comorbidities like cardiovascular disease, osteoporosis, diabetes, lung cancer etc., which may worsen patients' quality of life and shorten their life expectancy.

The theme of World COPD Day 2022 on November 16 is "Your lungs for life". This theme aims to highlight that a person only has one set of lungs in their lifetime, and so they should continually maintain and promote healthy lungs. In practical terms, this means not only providing appropriate treatment and rehabilitation for COPD patients, but also removing risk factors (including smoking and second-hand smoking) from groups potentially at risk of the disease.

Based on domestic research results, about 90 percent of all COPD cases are caused by cigarette smoking. Quitting smoking and getting away from smoking hazards is the most effective way to keep away from COPD. To help ease the burden on quitting smokers, the Department of Health, Taipei City Government has joined forces with the Health Promotion Administration, Ministry of Health and Welfare and 350 contracted smoking cessation service medical institutions in Taipei City to continue offering various convenient smoking cessation services, including provision for smoking cessation drug treatments upon paying registration fees, smoking cessation health education consultation, free smoking cessation service line (0800-636363) etc., as well as holding free 12-hour smoking cessation classes in places including hospitals, communities, workplaces, and schools on a continuous basis. As a result, a total of 107,937 people has been offered smoking cessation services in the recent 8 years (from 2015 to October 2022), the success rate of smoking cessation 6 months after contracting smoking cessation services in Taipei City increased from 30.53% in year 2018 (the national average was 27.24%) to 33.57% in 2021 (when the national average was 30.09%). Success rates of years 2018 to 2021 were all greater than the national average.

To diminish the harm brought about by the second-hand smoke and protect the health rights and interests of the community, the Department of Health, Taipei City Government has been actively coordinating the resources of the city government’s relevant departments, schools, businesses, village chiefs, and community NGOs, as well as anti-smoking volunteers, to work on the expansion of construction of healthy outdoor non-smoking amenities. As of October 2022, 3,607 outdoor non-smoking venues had been announced for construction by Taipei City, including the Xiangti Avenue Plaza non-smoking shopping district, Ximen MRT Station Square, the outdoor area surrounding Taipei Main Station, and the sidewalks, hiking trails, bus stop shelters, arcades, chain convenience stores, coffee shops etc., surrounding 280 high schools / vocational high schools of the city. According to the Health Promotion Administration’s Smoking Behavior Survey, Taipei City’s adult smoking rate has fallen from 11.1% in 2015 (when the national average was 13.1%) to 8.9% in 2020 (when the national average was 10.1%), and that the adult smoking rates between 2015 and 2020 were all lower than the national average, as well as the lowest among the six municipalities.

Commissioner Shier-Chieg Huang reminded us that cigarette products that have emerged in recent years, like electronic cigarettes and heated tobacco products, are the same as the traditional cigarettes, in that most of them include nicotine and harmful particles that are harmful to the human body. Furthermore, there is no evidence showing that e-cigarettes are safe or can help smokers quit smoking. In addition, on March 25, 2022, the Taipei City Government announced the Taipei Municipal Novel and Emerging Nicotine and Tobacco Products Self-Government Ordinance, effective as of March 27, and is appealing to the public to adhere to the relevant regulations and stay away from the emerging cigarette products.

The public lacks knowledge of COPD; follow doctor's orders, protect the lungs to strengthen the body

Fu-Kang Chang, Director of the Division of Thoracic Medicine and Intensive Care Unit of Taipei City Hospital Zhongxiao Branch, said that COPD is a chronic disease of the lower respiratory tract which can be prevented and treated. The primary cause of the disease is chronic inflammation of the respiratory tract and the lungs due to inhalation of harmful gas or particles, and in the long run, it causes the lung structure to change and the airways to narrow, making the airways unable to stay cleared and unobstructed, resulting in symptoms such as dyspnea, coughing, coughing with phlegm, etc. In severe cases, the ability of the lungs to exchange gases is damaged, resulting in a respirator being required for the rest of one’s life.

Domestic research has shown that the average lifespan of patients with pulmonary obstruction is 11 years less than that of a normal healthy person. In cases of severely impacted lung function with two severe attacks in a year, the three-year mortality reaches 24%. This shows that pulmonary obstruction is clearly a clinical issue which requires more attention. The most important risk factor for pulmonary obstruction is smoking; about 90% of patients with pulmonary obstruction have a history of smoking. Other risk factors include air pollution, exposure to harmful particles, asthma or bronchial hyperresponsiveness, and infection. In addition, pulmonary obstruction often leads to many comorbidities, including cardiovascular disease, lung cancer, and metabolic syndrome. These comorbidities have an impact on the prognosis of pulmonary obstruction, and increase the difficulty of treatment. The most direct way to avoid contracting them is to avoid pulmonary obstruction.

Dr. Fu-Kang Chang said that he once met a Mr. Chen in the outpatient clinic who had started smoking at a young age. He had to smoke a pack of cigarettes every day. Despite the fact that he understood that smoking was bad, he had no intention whatsoever of quitting smoking, as he had been running regularly, and the fact that he smoked did not seem to have an impact on his daily life or exercise. However, not long after he retired, running, which had been easy, became a difficult task for him. Worried about his health, he visited the thoracic outpatient clinic for a consultation. After visiting the clinic, it was discovered that besides having shortness of breath due to lowered exercise tolerance, in recent years, Mr. Chen always coughed and suffered weeks of chest tightness every time the season or weather changed. With the assistance of the doctor, Mr. Chen arranged to have lung X-rays and pulmonary function examinations. Because emphysema had already begun to take shape, causing obvious obstruction of airflow after exhalation, he was diagnosed with COPD. A few months after Mr. Chen started quitting smoking and receiving treatment with inhaled bronchodilators, his coughing and chest tightness conditions had already improved. Gradually, Mr. Chen’s running gradually reverted back his previous standard.

Dr. Fu-Kang Chang said that quitting smoking is certainly the most important way to treat COPD. Currently, apart from nicotine replacement therapy, another option is smoking cessation drugs, which increases the success rate of smoking cessation when paired with health education from smoking cessation outpatient clinics. However, the emergence of many new cigarette products in recent years have made thoracic physicians worry, as electronic cigarettes and heated tobacco products are the same as the traditional cigarettes, in that they all include nicotine and harmful particles and lead to diseases like pulmonary obstruction, lung cancer, etc. Physicians are therefore appealing to the public that if they find themselves developing symptoms of pulmonary obstruction, “such as long-term coughing with phlegm, or dyspnea”, to immediately consult with a specialist for diagnosis, and stay away from any form of smoking products, as well as emerging cigarette products, including heated tobacco products and electronic cigarettes.