Hundreds of thousands of Lebanese adults suffering from a smoking-related lung disease known as Chronic Obstructive Pulmonary Disease (COPD) are being wrongly treated with asthma medications, a leading respiratory specialist has warned.

COPD, which causes wheezing, on-going cough and shortness of breath, is normally seen in people over the age of 40 years and is strongly linked to smoking of cigarettes or shisha. Official figures put the prevalence of COPD in Lebanon at two percent [1] but local experts believe it to be higher at 10 to 15 percent.

Because the symptoms of COPD are similar to those seen in asthma, the disease is often mismanaged with many patients being prescribed long-term treatment with an asthma drug that has no affect on the everyday symptoms of COPD and could lead to serious side-effects, according to Dr. Mirna Waked, Chest Physician at University Medical Centre, St George’s Hospital in Beirut.

“Many COPD patients in Lebanon are being treated as if they have asthma and have been prescribed inhaled corticosteroids as a first line treatment. Corticosteroids are not recommended in international guidelines for long-term use in COPD as they have no effect on the cause of the disease and can lead to an increased risk of osteoporosis,” explained Dr. Waked.

“International guidelines [2] state that COPD patients should be treated with bronchodilators, with inhaled corticosteroids only used for the short-term treatment of an exacerbation of the disease, which is usually caused by a respiratory infection,” added Dr. Waked.



“There needs to be greater awareness among doctors and the general public about COPD; its symptoms, diagnosis and treatment. With newer medications coming on the market, such as the once daily bronchodilator indacaterol, it is a good time for medical professionals to review the management of all their respiratory patients, especially those with COPD, to ensure their treatment regimens are in line with international best practice,” concluded Dr. Waked.  

First-line maintenance therapy for most patients with asthma is an inhaled corticosteroid, which reduces the inflammation that causes the asthma, with the addition of a short-acting and/or long-acting bronchodilator to control symptoms.

The reverse is true for the treatment of COPD, where short-acting and long-acting bronchodilators are the first-line maintenance treatment, and inhaled corticosteroids are reserved for an exacerbation of COPD symptoms.