Chronic obstructive pulmonary disease (COPD) is one of the world’s leading causes of death—yet in the Philippines, it remains underdiagnosed, undertreated, and misunderstood. Millions of Filipinos live with chronic cough, breathlessness, or “asthma” without knowing they may have a progressive lung disease that can be prevented, controlled, and treated. This article examines the burden of COPD in the Philippines, how to recognize its warning signs, what treatments work best, and what families and communities can do to protect lung health in an increasingly polluted and disaster-prone nation.

By Rafael R. Castillo, MD

Chronic Obstructive Pulmonary Disease (COPD) is a progressive, preventable, and treatable lung condition characterized by airflow limitation that is not fully reversible. The two most common manifestations are:

• Chronic bronchitis – chronic productive cough
• Emphysema – destruction of alveoli leading to breathlessness

According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD), COPD affects over390 million people worldwide, and is projected to become the third leading cause of death globally.

In the Philippines, estimates suggest 2.5–3 million adults may have COPD, but up to 90% remain undiagnosed—often mislabeled as recurrent bronchitis or asthma. This under-recognition stems from stigma, lack of access to spirometry, and normalization of chronic cough among smokers and workers exposed to pollution.

Why COPD Matters in the Philippines

1. High Smoking Prevalence

Although smoking rates have declined, 1 in 4 Filipino men continues to smoke. Even occasional smoking doubles COPD risk.

2. Widespread Biomass Fuel Exposure

Millions of Filipino families still cook using uling, kahoy,or kerosene, often in poorly ventilated areas—exposing women and children to toxic fumes daily.

3. Occupational Risks

4. Severe Air Pollution

Metro Manila’s PM2.5 levels frequently exceed WHO standards. Urban dwellers inhale pollutants that both trigger and worsen COPD.

5. Aging population

As Filipinos live longer, age-related lung decline compounds the effects of earlier exposures.

Recognizing COPD: Early Diagnosis Saves Lives

Key Warning Signs

A Filipino adult should be evaluated for COPD if they have:

• Chronic cough (lasting >3 months per year for 2 consecutive years)
• Cough with phlegm
• Breathlessness, especially during climbing stairs or walking fast
• Frequent “asthma” attacks in later adulthood
• Difficulty blowing out air
• Tiring easily

Many Filipinos dismiss these symptoms as “ubo ng paninigarilyo,” “hangin,” “asthma,” or “signs of aging”—leading to late-stage diagnosis.

The Gold Standard for Diagnosis: Spirometry

Spirometry is a simple 10-minute test that measures airflow obstruction.
A post-bronchodilator FEV1/FVC < 0.70 confirms COPD.

Why spirometry is underused in the Philippines

• Limited availability in rural areas
• Cost barriers
• Misconception that COPD is diagnosed by symptoms alone

Every DOH-accredited primary care facility should ideally have spirometry capability.

Understanding COPD Severity

GOLD classifies COPD according to:

1. Airflow Limitation

From GOLD 1 (mild) to GOLD 4 (very severe)

2. Symptom Burden

• mMRC dyspnea scale
• COPD Assessment Test (CAT score)

3. Risk of Exacerbations

Frequent flare-ups require more aggressive therapy.

Preventing COPD in the Philippines

1. Smoking Cessation – The Most Powerful Intervention

• Brief physician advice increases quit rates
• NRT, varenicline, bupropion double or triple success rates
• Community-level peer support groups help sustain abstinence

Stopping smoking slows COPD progression more than any medication.

2. Clean Cooking Solutions

• Promote electric or LPG stoves
• Improve ventilation
• DOH-LGU programs can subsidize cleaner household energy

3. Reduce Exposure to Air Pollution

• Use masks during high-pollution days
• Encourage LGUs to enforce clean air policies
• Plant more trees; promote clean transportation

4. Protect Workers

• Mandatory PPE for industries
• Occupational health monitoring
• Eliminating illegal open burning

5. Vaccination

COPD patients benefit from:

• Annual influenza vaccine
• Pneumococcal vaccine
• Updated COVID-19 vaccination

These reduce life-threatening infections and prevent exacerbations.

Treatment of COPD: What Works Best

Step 1: Bronchodilators

Long-acting bronchodilators (first-line)

• LABA: salmeterol, formoterol
• LAMA: tiotropium, glycopyrrolate

Combination LABA + LAMA improves lung function and reduces symptoms.

Step 2: Inhaled Corticosteroids (ICS)

Not for all patients.
Reserved for:

• Frequent exacerbations
• High eosinophil counts

ICS must be combined with a bronchodilator (LABA/ICS or triple therapy).

Step 3: Triple Therapy

LABA + LAMA + ICS.
Indicated for severe symptoms and recurrent exacerbations.

Step 4: Pulmonary Rehabilitation

One of the most effective interventions:

• Improves exercise tolerance
• Reduces hospitalizations
• Enhances quality of life

Should be available in provincial DOH hospitals.

Step 5: Long-Term Oxygen Therapy

For advanced COPD with chronic hypoxemia
Improves survival when used ≥15 hours/day.

Step 6: Treatment of Exacerbations

• Oral steroids (5–7 days)
• Antibiotics if purulent sputum
• Nebulized bronchodilators
• Oxygen supplementation
• Early follow-up

“The biggest tragedy of COPD is not the disease itself—but the years lost to late diagnosis and missed opportunities for prevention.”

Living Well with COPD

Despite its chronic nature, COPD can be controlled. With proper treatment, pulmonary rehabilitation, vaccination, and a smoke-free lifestyle, patients can enjoy:

• Better breathing
• Fewer hospitalizations
• Improved activity and exercise capacity
• Longer, healthier lives

The key is early detection and consistent follow-through.

The Call to Action: A Philippine Public Health Priority

COPD must be recognized as a major public health threat requiring:

• Stronger DOH anti-smoking campaigns
• Expanded access to spirometry
• Integration of COPD care into primary care networks
• PhilHealth coverage for pulmonary rehab
• Cleaner household energy policies
• Air quality improvement measures

COPD is preventable, treatable, and manageable — but only if we act early and act together.

“COPD is not a death sentence. With the right therapy, patients can live full, productive lives.”

References:

1. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global Strategy for the Diagnosis, Management, and Prevention of COPD. 2024 Report. Available from: https://goldcopd.org
2. World Health Organization. Chronic Obstructive Pulmonary Disease (COPD): Key Facts. Geneva: WHO; 2023.
   https://www.who.int/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd)
3. Soriano JB, Kendrick PJ, Paulson KR, et al. Prevalence and attributable health burden of chronic respiratory diseases, 1990–2019. Lancet Respir Med. 2022;10(1):47–60. doi:10.1016/S2213-2600(21)00331-2
4. Adeloye D, Song PW, Lee C, et al. Global and regional estimates of COPD prevalence: Systematic review and meta-analysis. J Glob Health. 2022;12:04052. doi:10.7189/jogh.12.04052
5. Qaseem A, Wilt TJ, Weinberger SE, et al. Diagnosis and management of stable COPD: A clinical practice guideline. Ann Intern Med. 2020;173(9):643–651. doi:10.7326/M20-2006
6. Lamprecht B, Castro AA, Schirnhofer L, et al. COPD underdiagnosis and its relationship to comorbidities. BMC Public Health. 2021;21:2063. doi:10.1186/s12889-021-12145-8
7. Barnes PJ, Celli BR. Systemic manifestations and comorbidities of COPD. N Engl J Med. 2009;360:1121–1131. doi:10.1056/NEJMra0803839
8. Anzueto A, Miravitlles M. COPD exacerbations: Epidemiology and prevention. Lancet. 2021;398(10302):857–872. doi:10.1016/S0140-6736(21)01223-4
9. Criner GJ, Bourbeau J, Diekemper RL, et al. Prevention of acute exacerbations of COPD: ATS/ERS guidelines. Am J Respir Crit Care Med. 2022;205(6):e29–e50. doi:10.1164/rccm.202109-2034ST
10. Salvi S, Barnes PJ. Chronic obstructive pulmonary disease in non-smokers. Lancet. 2009;374(9691):733–743. doi:10.1016/S0140-6736(09)61303-9
11. Torres-Duque C, et al. Biomass fuels and COPD: A systematic review. Chest. 2019;156(2):303–332. doi:10.1016/j.chest.2019.04.016
12. Bellou V, et al. Indoor and outdoor air pollution as risk factors for COPD. Environ Int. 2022;170:107560. doi:10.1016/j.envint.2022.107560
13. Dela Cruz CS, Tanoue LT, Matthay RA. Lung cancer and COPD: The overlapping picture. Clin Chest Med. 2020;41(3):481–495. doi:10.1016/j.ccm.2020.06.001
14. Vogelmeier CF, et al. Global strategy for diagnosis, management, and prevention of COPD—2023 Report. Am J Respir Crit Care Med. 2023;207(1):e1–e24. doi:10.1164/rccm.202211-2065ST
15. Nici L, ZuWallack R. Pulmonary rehabilitation in COPD: Evidence and implementation. Lancet Respir Med. 2014;2:869–880. doi:10.1016/S2213-2600(14)70155-2
16. Cazzola M, Matera MG, Rogliani P, et al. LABA/LAMA fixed-dose combinations in COPD: Evidence to date. Drugs. 2020;80:185–203. doi:10.1007/s40265-019-01239-4
17. Calverley PMA, et al. Triple therapy versus dual therapy in COPD. Lancet. 2017;390(10098):2247–2255. doi:10.1016/S0140-6736(17)32510-7
18. Global Burden of Disease (GBD) 2021 Chronic Respiratory Collaborators. COPD global burden estimates. Lancet. 2021;398(10303):1341–1391. doi:10.1016/S0140-6736(21)00941-0
19. Philippine College of Chest Physicians. Clinical Practice Guidelines on COPD. PCCP; 2023.
20. Department of Health (Philippines). National Unified Health Research Agenda: Lung Health and NCDs. DOH; 2023.

Sample Case 1

Si Mang Lito at ang Ubo na Inakala Niyang Karaniwan Lang

For more than 20 years, Mang Lito, a 57-year-old jeepney driver from Tondo, had lived with what he simply called “ubo ng paninigarilyo.” Every morning, even before he made his instant coffee, he would start the day with a heavy fit of coughing—deep, wet, and chest-rattling. His wife often joked, “Ay naku, gumising na naman ang tambutso mo,” and they would both laugh it off.

Lito never thought much about it. All the drivers in his terminal coughed the same way. His closest friends—who had been smoking since their teens—believed it was “normal sa may edad,” and besides, the roads of Manila were always thick with usok ng tambutso anyway.

Like many Filipino workers, he assumed chronic cough was just part of life.

Years of Mislabeling

Lito visited a barangay health center several times over the years, especially whenever his cough worsened. Each time, he was told the same thing:
“May sipon lang. Bronchitis. I-inhale mo lang ‘tong nebulization, uminom ng antibiotics, pahinga ka.”

On one occasion, during a particularly difficult episode of breathlessness, a young doctor suggested he might have late-onset asthma, and prescribed him a short-acting inhaler. The inhaler helped a little—but only for a few hours at a time.

No one ever suggested spirometry.
No one ever mentioned COPD.

And Lito didn’t know to ask.

The Slow Decline

By age 54, climbing the footbridge beside Divisoria Market left him breathless.
At first, he blamed it on “kulang sa exercise.”
Then he blamed it on stress.
When his passengers noticed him wheezing at the wheel, he brushed it aside:
“Mainit lang. Napagod lang ako magmaneho.”

Still, the cough persisted—louder, deeper, and more frequent. He began avoiding long routes and refused evening shifts because the colder air made breathing harder. His income suffered, and pressure on his family grew.

But like many Filipinos, he normalized it.
He accepted shortness of breath as part of aging, and no one corrected him.

The Breaking Point

Everything changed one rainy July morning.

While driving along España, Lito suddenly felt like he “couldn’t pull air in.” He stopped his jeep, gasping for breath, trembling as passengers panicked and rushed him to the nearest ER.

There, after a battery of tests, a pulmonologist finally said the words he had never heard in his entire life:
“Mang Lito, may Chronic Obstructive Pulmonary Disease po kayo—COPD.”

Lito was stunned.
How could he have a serious lung disease when he had been “just coughing” for decades?

When his wife asked why no one had diagnosed it earlier, the doctor answered gently:
“Sa totoo lang po, maraming Pilipino ang may COPD na hindi nila alam. Halos 90% hindi nada-diagnose. Kasi akala normal lang ang ubo.”

Why Lito Was Missed for So Long

Lito’s story reflects a national problem:

1. Stigma and Normalization

People think:

• “Normal lang sa naninigarilyo ito.”
• “Ubo lang ‘yan.”
• “Ganyan talaga pag may edad.”
  This delays recognition.

2. Lack of Access to Spirometry

Lito’s health center did not have spirometry—the gold standard for diagnosing COPD.

3. Mislabeling as “Bronchitis” or “Asthma”

Since chronic cough is common among smokers and drivers, most clinicians attribute symptoms to:

• recurrent infections
• aging
• pollution
• or asthma

COPD rarely enters the conversation without spirometry.

4. Occupational Exposure

Years of inhaling jeepney exhaust, dust, and fumes significantly contributed to Lito’s lung injury.

A New Beginning

With correct diagnosis, Lito finally received long-acting bronchodilators, smoking cessation support, and was enrolled in pulmonary rehabilitation. Within months, his breathlessness improved. He no longer feared collapsing behind the wheel.

But he often wondered:
“Kung nalaman ko lang nang mas maaga… mas maganda sana takbo ng buhay ko.”

Why This Case Matters

Lito’s story is the story of millions of Filipinos:

• Workers exposed to pollution
• Smokers who normalize cough
• Women who inhale biomass smoke from cooking
• Older adults mislabeled as asthmatics
• Patients without access to spirometry
• Families unaware that COPD is preventable and treatable

This narrative illustrates the urgent need for:

• Expanded spirometry access
• Stronger primary care training
• Public education about chronic cough
• Clean air and anti-smoking policies
• PhilHealth support for pulmonary rehab

“Hindi ko alam na may sakit na pala ako. Akala ko ubo lang. Sana may nagsabi agad.”

Sample Case 2

WHEN BREATH BECOMES A BATTLE:
A Hospital Case of Acute COPD Exacerbation in the Philippines

Chronic Obstructive Pulmonary Disease (COPD) is often described as a “slow illness”—one that creeps in over years of coughing, breathlessness, and gradually shrinking activity. But for many Filipinos with undiagnosed or poorly managed COPD, the disease reveals its deadliest face not in outpatient clinics, but in emergency rooms.

This is one such story.

The Case of Tatay Rogelio: A Night of Breathlessness

Rogelio “Tatay” Mendoza was a 68-year-old retired tricycle driver from Quezon City. Although he quit smoking eight years ago, he had smoked for more than four decades, and had lived most of his working life inhaling exhaust fumes, road dust, and second-hand smoke from passengers and fellow drivers.

For years, he had an “ordinary” morning cough.
His children noticed he became breathless more easily—first while sweeping the yard, then while climbing two steps of the terrace. He was eventually diagnosed with “asthma,” given a short-acting inhaler, and sent home without spirometry.

The Slow Decline

Over the months, his cough worsened. He felt easily fatigued and increasingly dependent on his inhaler. But like many Filipino fathers, he kept quiet to avoid “being a burden.”

The Night It Happened

One humid night in May, after walking to the sari-sari store, Tatay suddenly felt an intense tightness in his chest. He could not finish a sentence. He leaned against a wall, wheezing loudly, and his daughter rushed him to the nearest ER.

In the Emergency Room

When they arrived at past 11 PM, the ER was full, but Tatay was immediately triaged as high-risk.

Vital Signs:

• Respiratory rate: 32/min
• Heart rate: 118/min
• SpO₂: 84% on room air
• Accessory muscles highly active
• Cyanosis around the lips

The Clinical Picture

The attending physician recognized the classic signs of acute exacerbation of COPD (AECOPD): severe breathlessness, wheezing, decreased airflow, and possible respiratory failure.

An arterial blood gas later confirmed:

• pH 7.31
• PaCO₂ 58 mmHg
• PaO₂ 54 mmHg (on low-flow O₂)

This was Type 2 (hypercapnic) respiratory failure.

The Immediate Management

1.   Controlled oxygen therapy

Oxygen was given carefully to avoid worsening CO₂ retention.

2.   Nebulized bronchodilators

Back-to-back nebulizations with salbutamol + ipratropium.

3.   Intravenous corticosteroids

To reduce airway inflammation.

4.   Antibiotics

Because of purulent sputum and suspected infection.

5.    Non-invasive ventilation (BiPAP)

Initiated due to rising CO₂ and increased work of breathing.

Within 30 minutes, Tatay’s breathing eased.
After two hours, his oxygen levels improved.
He was admitted to the medical ward for further monitoring.

The Turning Point

On the second day, Tatay asked his daughter:

“Anak… bakit hindi ko nalaman na ganito na pala baga ko?”

This is the heartbreaking reality in many Filipino families:
COPD is usually diagnosed only when a severe exacerbation brings the patient to the hospital for the first time.

Why Exacerbations Are Deadly

Acute exacerbations are the strongest predictor of mortality in COPD.
They accelerate lung decline and significantly worsen quality of life.

Top triggers include:

• Respiratory infections (viral or bacterial)
• Air pollution spikes
• Non-adherence to medications
• Extreme weather changes
• Misdiagnosis or inadequate long-term therapy

Every exacerbation increases the risk of the next—forming a dangerous downward spiral.

“Most Filipino patients meet COPD for the first time not in a clinic—but in the emergency room.”

Road to Recovery

Tatay was eventually discharged with:

• Dual long-acting bronchodilator therapy (LABA + LAMA)
• Short course of oral steroids and antibiotics
• Vaccination advice (influenza, pneumococcal)
• Enrollment into pulmonary rehabilitation
• Strong recommendation for spirometry follow-up

He learned inhaler technique properly for the first time.
His family committed to keeping their small home smoke-free and better ventilated.

A Family’s New Understanding

The most important outcome was not the treatment—but the realization that:

“Hindi pala talagang asthma si Tatay. COPD pala.”

Correct labeling changed everything.
For the first time, his journey toward real control and better lung health began.

“Exacerbations are not random events. They are preventable, predictable, and treatable.”