'We now have to buy the air we breathe'

Every evening, Jane Wanjiru helps her husband of 50 years, Joseph Gakuu, to bed.

"I turn on the oxygen concentrator machine and make sure he can breathe comfortably," she says.

As per his doctor's prescription, Gakuu must use the oxygen concentrator for at least 18 (out of every 24) hours.

He was diagnosed with chronic obstructive pulmonary disease (COPD) in 2021.

As far back as 2019, Gakuu started coughing uncontrollably - whenever he smoked or walked into a place with smoke - any kind of smoke.

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"I would cough to the point of coughing up blood," he says.

He was a teenager when he first smoked a cigarette. "In the 1960s it was fun and fashionable to smoke," he says. Gakuu developed an addiction to cigarettes which only came to an end in 2019 when COPD wouldn't let him inhale one more puff.

The World Health Organization (WHO) has concluded that the primary cause of COPD is exposure to tobacco.

Dr Andrew Owuor, a pulmonologist at Kenyatta National Hospital (KNH) says the hallmark of the disease is shortness of breath.

"By the time symptoms are showing it means the disease has been developing for some years," he says, "Once COPD is confirmed, treatment involves drug therapies that are meant to help manage symptoms: COPD has no cure."

Dr Owuor says the disease develops over many years of regular and consistent exposure to smoke, or polluted air.

"Lungs are elastic like balloons. COPD lungs lose their elasticity. During breathing the organ cannot fully recoil, hence not all of the air from inside is expelled," he explains. "Therefore, COPD patients struggle to supply enough oxygen to vital organs as well as the rest of the body."

Sixty-two-year-old Sarah Wanjiku, from Enkashura area in Nakuru Town, is also a COPD patient. But unlike Gakuu, Wanjiku was not a cigarette addict, even though she sparingly used cigarettes in her younger years.

"COPD, by a large margin, affects cigarette smokers. But there could be other causes of the disease. A significant number of COPD patients have used biomass fuels (firewood and charcoal) for a long time. It also affects people who work in polluted environments: like miners, welders and construction workers," Dr Owuor says.

"Generally, sustained and frequent exposure to smoke, or polluted air (like dust) over a long period of time, could lead to COPD," he says.

Growing up, Wanjiku - being a firstborn among her siblings - was often tasked with preparing family meals. "We cooked using firewood and charcoal," she says, something she did for at least three

decades.

She also suspects that she had grown up as an asthmatic. She says: "As far back as 1995, I remember I used to struggle to breath. I was treated often for asthma."

Smoke - or pollution - cause tiny injuries (inflammations) in the lungs. These tiny wounds never fully heal; they leave scars.

Over a long period of time, millions of scars lead to COPD: changing the lung's architecture and its ability to function optimally.

"Due to reduced amount of oxygen reaching body organs, a COPD patient is often tired and lethargic," says Dr Owuor.

"Suddenly, I was feeling exhausted: I had no energy to even lift a blanket over my head," Wanjiku recalls.

Gakuu and Wanjiku are patients enrolled in a comprehensive programme targeting three illnesses: COPD, Hypertension and Diabetes.

Known as Access to Healthcare (ATH), the programme is run by pharmaceutical giant Boehringer Ingelheim, who, in February, launched offices in Nairobi.

According to Ayman Eissa, the head of SD4G for the IMETA (India, Middle East, Turkey and Africa) region, ATH is meant to support Kenya to respond effectively to the growing non-communicable diseases (NCDs) burden.

"It is part of our Sustainable Development for Generations (SD4G) framework and is designed to improve Human and Animal Health," Eissa says.

"ATH provides people in need with a comprehensive programme: supporting them through the whole journey from screening to treatment. Importantly, we make it easier for them to access treatment," he says.

Dr Mangutha Gitangu, ATH programme manager, says COPD places a lot of financial pressure on a patient and their family.

"Once diagnosed, a patient will need to be on medication forever. This, for many underserved families, is a reality that is not easy to deal with," Gitangu says.

Beyond daily drugs, COPD patients are also prone to frequent hospital emergencies.

Adan Ramata, Wanjiku's brother says the family has spent hundreds of thousands in and out of hospitals.

"Hardly three months will go by without an emergency hospital visit. We have lost count of the number of times she has been in hospital since she fell ill in 2016," Ramata says.

The disease has robbed both Gakuu and Wanjiku the ability to be economically productive. They have lacked the energy to perform the simplest of work.

Wanjiku folded up her poultry business in 2016 and has remained dependent on her brother. Gakuu on the other hand is fully dependent on his wife.

WHO estimates that COPD is responsible for about 3 million deaths every year globally. At least 90 per cent of the deaths occur in low to middle-income countries.

"The disease, from what we can tell, has a very high unmet need locally in terms of diagnosis and treatment. We hope to increase awareness, timely diagnosis and medical intervention, affordability of treatment, and adherence to that treatment," says Dr Gitangu.

To cure COPD one would require a brand new set of lungs. This is far-fetched since Kenya has never done a lung transplant.

Dr Owuor says: "We do not have the tools to conduct lung transplants. Even so, lung transplants should be utilised as a last resort.

"To start with, the new lungs would need to be provided by another human being. There would be a lot of legal and ethical hurdles to find a donor.

"Also, the average survival of lung transplant is five years. It is hard to find lung transplant patients who survive past six years after the transplant," Dr Owuor says.

On COPD, he says, the best advice would be:

"If all young people can keep off smoking, COPD numbers would go down in future. COPD is a disease that manifests in older people; except in situations where the disease comes as a result of childhood asthma, or pre-term birth where a baby is born when their lungs have not matured enough," Dr Owuor says.

Dr Owuor adds: "Families that can afford it should consider using clean sources of energy like LPG gas over the use of firewood or charcoal."