Michael Gwarisa in Cape Town
For decades, Evelyn’s smoking and repeated lung infections from tuberculosis (TB) took a toll she barely noticed. What started as a simple cough or occasional shortness of breath gradually turned into a constant struggle for air. Now, even walking across her hospital room or climbing a single flight of stairs leaves the 78-year-old former nurse gasping, a stark reminder that lung injuries sustained years ago can develop into life-threatening disease later in life.
Evelyn lives with Chronic Obstructive Pulmonary Disease (COPD), a progressive lung condition, and now relies on an oxygen pump. Her condition recently worsened, leading to her admission at Heideveld Community Day Clinic.
“I now use a pump and get my refill every month at the hospital,” she said, her voice barely above a whisper. “Some days it’s hard, and I run out of breath, but it doesn’t happen every time or every day.”
Understanding COPD
COPD affects millions worldwide, yet many people only seek medical help when their lungs are already severely damaged. Dr. Richard van Zyl-Smit, Professor and Consultant Pulmonologist at the University of Cape Town and Groote Schuur Hospital, calls it a “silent killer.”
“Damage to the lungs can start decades earlier, from smoking, vaping, tuberculosis, or air pollution, but symptoms often appear later in life,” he explains.
“By the time patients reach us, they already face serious limitations in daily activities and a higher risk of early mortality.”
Unlike asthma, which comes and goes, COPD develops slowly and insidiously.
“With asthma, today you may be fine, tomorrow coughing and wheezing. COPD worsens steadily. Patients cannot keep up with friends, feel constantly tired, and experience shortness of breath even with minimal effort,” Dr. van Zyl-Smit says. Diagnosis requires careful medical assessment, often including lung function tests.
The World Health Organisation (WHO) estimates COPD caused 3.5 million deaths in 2021, roughly 5 percent of all global deaths. Nearly 90 percent of deaths under 70 occur in low- and middle-income countries. COPD also ranks as the eighth leading cause of poor health worldwide, measured by disability-adjusted life years (DALYs).
“Chronic respiratory diseases like asthma and COPD remain largely invisible on the global health agenda,” said Dr. Jose Luis Castro, WHO Director General Special Envoy for Chronic Respiratory Diseases. “Yet they cause millions of deaths every year and affect productivity, income, and quality of life, pushing families into poverty.”
Risk Factors and Symptoms
Tobacco smoking accounts for over 70 percent of COPD cases in high-income countries. In low- and middle-income countries, smoking accounts for 30–40 percent, with household air pollution a major contributor. “COPD is traditionally seen after age 30 or 40 from long-term smoking, but many other causes exist: air pollution, childhood infections, tuberculosis, HIV, and drugs. We are seeing COPD even in people in their 20s and 30s,” Dr. van Zyl-Smit explains.
In South Africa, additional risk factors include carbon emissions from vehicles, industrial pollution, smoke from firewood or charcoal, and occupational dust exposure. Substance use also plays a role, particularly in the Cape Flats.
“Patients with chronic lung diseases account for almost a third of monthly admissions,” said Dr. Porcia Williams, Medical Officer at Heideveld Community Day Clinic. “Smoking, substance use, and TB are major contributors. Drugs such as heroin, methaqualone, cannabis, and crystal meth are widespread in the community. Gang violence is another cause of lung injuries, with punctured lungs from stab wounds and gunshot injuries.”
COPD symptoms include chronic cough, shortness of breath, and fatigue. Flare-ups can last days and require additional medication. People with COPD are also at higher risk of lung infections like flu or pneumonia, lung cancer, heart disease, muscle weakness, brittle bones, depression, and anxiety.
Community Interventions and Rehabilitation
At Heideveld Community Day Clinic, where Evelyn is admitted, a COPD clinic with a palliative care program serves patients across Heideveld, Manenberg, and low-income communities in the Cape Flats and Atlantis. The program leverages local networks, including government, NGOs, and community-based organizations, to create ownership of palliative care and improve access.
“Distance to healthcare facilities is a major challenge. This project is community-led, using participatory research. We focus on building trust, creating advisory groups, and training community caregivers to provide hands-on care at home,” said Senior Research Officer at the Division of Public Health Medicine, School of Public Health, UCT.
Community health workers visit patients in their homes, teaching families how to manage symptoms and improve quality of life. “We demonstrate breathing exercises, pacing techniques, and ways to reduce fatigue,” said Galiema Isaacs, a health worker implementing the palliative care program.
Physiotherapy is a central component. “Through guided exercises, breathing techniques, and mobility training, patients gradually regain lung function, strength, and stamina,” explained Heidi Simon, Physiotherapist at Heideveld Community Clinic. “We train rehabilitation workers to provide support in the community, helping bedridden or immobile patients regain independence.”
Before her admission, Evelyn would participate in these exercises daily. Simple routines, like sitting up in bed while doing breathing drills, walking short distances, and gentle stretching, help maintain her strength. Over time, she has regained some independence, allowing her to perform small tasks without constant reliance on her oxygen pump.
A Life with COPD
For patients like Evelyn, interventions such as physiotherapy and community-based palliative care provide not just medical support but dignity and hope.
Experts emphasise that preventing COPD requires early action: reducing smoking, improving air quality, timely treatment of infections like TB, and awareness of environmental risks. While COPD is irreversible, comprehensive care, rehabilitation, and community support can dramatically improve quality of life and longevity for millions worldwide.
