Chronic obstructive pulmonary disease (COPD) is a severe and progressive lung condition that can destroy one’s health and quality of life. This is the most common non-communicable disease (NCD) resulting in the highest fatality rate in low- and middle-income countries. Nepal has the world's highest age-adjusted casualty rate for chronic lung disease, at 183 deaths per 100,000 population and a 12 percent prevalence in adults.

COPD is primarily caused by long-term exposure to irritating substances, such as tobacco smoke, indoor and outdoor air pollution, and occupational hazards. Due to smoking, open-fire kitchens in rural regions, and air pollution in urban areas, Nepal remains a perfect breeding ground for respiratory diseases, including COPD. Some of its symptoms include shortness of breath, coughing, wheezing, and chest tightness. Over time, COPD can lead to significant lung damage and respiratory complications, making it a leading cause of morbidity and mortality worldwide.

In many cases, COPD develops gradually, and its symptoms may go unnoticed or be dismissed as part of the normal ageing process. Unfortunately, delayed recognition and diagnosis can result in the disease progressing to more advanced stages before appropriate treatment is initiated. COPD is rapidly spreading at the community level in countries with weak healthcare facilities. Especially in Nepal, there are severe challenges related to tobacco smoking, use of biomass fuel for cooking and heating, indoor and outdoor air pollution, and occupational exposure to dust and chemicals. These risk factors contribute significantly to the development of COPD.

Moreover, the lack of awareness about COPD and its risk factors among the general population, healthcare professionals and policymakers is hindering its early detection and effective management. Educational initiatives on the disease can play a crucial role in narrowing this gap. Accessibility to healthcare facilities, especially in rural areas, is also a barrier to the early diagnosis and treatment of COPD in Nepal. The limited availability of trained healthcare professionals, diagnostic tools and appropriate medications will exacerbate the issue. Due to the silent progression of COPD, many cases remain undiagnosed until the disease has significantly advanced.

Strengthening non-communicable disease-related healthcare services in low-income countries is a principal aspect of the current globalisation and health goals and debates set by global institutions. In this regard, the World Health Organization (WHO), as one of the targets of the Sustainable Development Goals (SDG), has announced that premature mortality from NCDs will be reduced by a third through prevention and treatment, as well as by promoting mental health and wellbeing by 2030. Nepal, as a member of the United Nations (UN), is committed to the SDGs.

The Ministry of Health and Population (MoHP) and other concerned health authorities seem determined to fulfil this commitment. However, with a vertically aligned primary healthcare system, where disease management programs lie at the core and are surrounded by a vast network of community health workers at the periphery, it is a herculean task for Nepal to efficiently address these issues. Hence, Nepal needs to act swiftly and sensibly to maintain pace with the SDG targets. One of the strategies should be to adequately address the impact of NCDs, including COPD. Some of the essential approaches to evidence-based management of COPD are discussed in this article.

First, community-level policies and interventions should be implemented to reduce exposure to risk factors such as tobacco smoke, indoor and outdoor air pollution, and occupational hazards. This will be achieved through community-wide awareness campaigns and educational programmes to increase understanding of COPD, its risk factors, and the importance of early detection and treatment. This initiative will empower individuals to seek timely and appropriate healthcare services and motivate them to make necessary lifestyle adjustments. The local executive bodies, including the municipalities and village development committees, should be given the responsibility to initiate such public awareness programmes. These administrative bodies should recruit well-trained and competent healthcare workers.

Second, general physicians should be trained to diagnose and treat COPD in accordance with state-of-the-art technological interventions. Contemporary pulmonology training should be offered to aspiring pulmonologists. Recently, renowned respiratory physicians from Nepal came together to establish the Nepal Respiratory Society (NRS), which is regularly conducting courses on various obstructive airway diseases, including COPD. In addition, annual conferences are also being organised to discuss the recent advancements in the field of respiratory diseases. Now, the NRS can design accredited training courses on COPD and other respiratory diseases that are tailor-made for the Nepali healthcare context. The respiratory physicians trained through NRS-endorsed courses will be perfect ambassadors for addressing COPD related issues in Nepal.

In addition, collaborations should be initiated with renowned international academic institutes. There are many international global health funding programmes intended to support international cooperation, sustainable development and international education work in low-income countries. For example, the Hospital Partnership programme carried out by the German Society for International Cooperation (GIZ) supports diverse global health projects in underdeveloped countries, especially in Africa and Asia. Such opportunities should be grabbed to strengthen the evidence-based management of respiratory diseases.

Third, ubiquitous access to quality healthcare facilities should be expanded to ensure the availability of diagnostic tools and medications and train healthcare professionals in diagnosing and managing COPD. This includes accumulating accurate data on the prevalence, burden, and risk factors of COPD in Nepal through research and surveillance. This will aid in formulating evidence-based policies, interventions and resource allocation. COPD diagnosis and treatment should be made affordable and accessible in all community-level healthcare facilities.

Evidence-based management of COPD is essential in Nepal to hinder the pace of this silent killer, which claims many people’s lives every year. The country should follow international guidelines on managing this disease, with some adaptations to suit the local context. Moreover, it is important to note that the management of COPD should be tailored to individual patient needs and may require adjustments based on local resources, cultural factors, and healthcare infrastructure in Nepal. It is recommended to consult local COPD guidelines and collaborate with healthcare professionals experienced in managing COPD for the best outcomes. This will help Nepal move closer to achieving one of the primary healthcare targets of the SDG by 2030.