Respiratory Health campaign 2017

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READ Respiratory health in Ireland: an overview P03

LEARN The evolution of the COPD treatment P05

INCREASING The number of women with lung cancer P02

Respiratory Health

What’s the difference between asthma and COPD?

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IN THIS ISSUE

Kevin Kelly How improving indoor air quality can help control your asthma

Cancer survivor Rory Mooney on the importance of early diagnosis

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Aoife McNamara Information Development Manager, Irish Cancer Society gives lung cancer advice that may save your life ONLINE

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Don’t smoke, take exercise

Air quality improvements are very welcome but people still need to heed doctors’ advice to not smoke and take regular exercise, says Dr Ross Morgan, President of the Irish Thoracic Society

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here are huge advances being made in the prevention and treatment of lung diseases in Ireland and internationally but the fact remains, the biggest improvement in lung health lies in people’s own hands.

It’s an old message but it still holds true today: to maintatin good lung health do not smoke and take regular exercise. Be aware of your lungs and seek medical attention if you have a persistent or unexplained cough or shortness of breath.

It’s hugely important because lung disease has been a quiet killer. If you ask anyone which type of cancer kills the most people in Ireland, they normally presume it’s breast, but it’s actually lung cancer.

Very few people are familiar with the term COPD, yet it’s one of the main conditions behind lung disease being a leading cause for people to be Follow us

Moving away from cars with harmful emissions can only improve the cleaner air we’re already breathing.

Individuals, though, still have to take personal responsibility for their lung health. Legislators can only do so much.

hospitalised through the emergency department. Around one in three admissions to Irish hospitals are due to a respiratory condition. These facts still surprise a lot of people.

Cleaner air is a start Legislators have made huge strides in improving air quality. Ireland was at the forefront of a global movement to ban smoking in offices and public spaces. If you think back now, it seems truly odd that people were allowed to smoke at the desk next to you or in a pub just 13 years ago.

The move towards hybrid and electric cars is very encouraging too, particularly the switch from diesels.

You only have to think about the massive difference moving to clean home-heating fuels has made to air quality to see what this could mean for public health.

The smog we used to regularly see several decades ago has gone.

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Dr Ross Morgan Consultant Respiratory Physican and President, Irish Thoracic Society

“You don’t immediately get lung cancer from smoking, it will take 20 or 30 years” @MediaplanetIE

Old message still holds true Doctors have been telling people to quit smoking and take regular exercise for decades. Among many in society the message has started to hit home. However, it’s an area of huge social imbalance in healthcare provision because it tends to be people from a lower socio-economic background who still smoke – in particular, young women.

This will result in a lung disease time bomb ticking away for future generations. We’re currently seeing an increase in women presenting with lung cancer. You don’t immediately get lung cancer from smoking,

it will take twenty or thirty years.

Smoking rates in women rose from the 1960s and 1970s onwards and even though many will have quit many years ago, the risk of lung disease never returns to that of the non-smoker.

What’s needed is a joined-up national plan to not only educate but also to incentivise people to improve their lung health. If we want to move people away from smoking to less harmful ways of taking nicotine, we need to invest further in preventative strategies.

We could consider giving nicotine replacement and other evidence-based ‘quit smoking’ products or harm reduction products away for free. It makes sense. Just think of the reduction in days taken off work and the reduced cost to the health system in treating what are, in many cases, completely preventable diseases.

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Asthma is the most chronic disease affecting children in Ireland.

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How’s your respiratory health?

By Alex Van Den Broek

Respiratory ill-health is all too familiar in Ireland.

Through a brief overview of the state of the nation and professional consultation it’s time to see the value in education for prevention.

Poor respiratory health is linked to a number of lifestyle and environmental factors. With recent reports from the WHO calling on Ireland to improve their air quality standards1 and obesity levels set to reach the highest in Europe2 within the decade, it could mean bad news for respiratory health levels. Conversley, according to data released by the European Commission, smoking rates are falling faster in Ireland than any other EU country. Professor Tim McDonnell, Consultant Respiratory Physician discusses our respiratory health and what we can do about it.

Respiratory health: a brief overview Chronic Obstructive Pulmonary Disorder (COPD) COPD is an often lesser-known

chronic lung disease caused by narrowing of the airways which affects around 440,000 people in Ireland – only half of which are diagnosed.

Like many medical issues there is a strong social and economic cost as “each COPD admission costs €4,500-€6,000,” says McDonnell.

“Improving awareness of the problem is crucial to patient understanding and early treatment.”

Asthma Ireland has one of the highest rates of asthma (per capita) in the world and it is the most chronic disease affecting children. Asthma is also the most common chronic respiratory disease in adults in Ireland, with 450,000 people with doctordiagnosed asthma3. “[After cancer] COPD and asthma are the principle illnesses leading to mortality… Raising awareness for the correct use of preventative medication is crucial to improving these rates,” says McDonnell.

Lung cancer Although, in recent years, cases of lung cancer have been declining in men, the disease is increasing

Elaine Purcell, Sleep Clinic in the Mater Private Hospital says: “the overall incidence is 1 in 20,” but respiratory specialists believe up to 90 per cent of sleep apnoea in adults and children goes undiagnosed5.

Professor Tim McDonnell Consultant Respiratory Physician and HSE National Clinical Lead, COPD Programme

among women. Around 2,300 Irish people are diagnosed with lung cancer every year, with nine out of ten caused by smoking4. “Lung cancer is the biggest killer – early detection and early intervention are crucial to improving mortality rates,” says McDonnell.

Sleep apnoea Sleep apnoea is a lesser-known respiratory disorder where you stop breathing for a short period during sleep, often due to temporary obstruction of the airways. Dr

Education and awareness Having worked on developing care and services to treat COPD and general respiratory work at St Vincent’s University Hospital, Professor Tim McDonnell has an important and valuable insight into respiratory health and COPD in Ireland.

Often, one of the key elements to improving the success rate of treatments is “early presentation and diagnosis in primary care,” says McDonnell. Identification of symptoms and early consultation with your GP can significantly improve the impact and type of treatment you receive.

“Education is pivotal in [where possible] preventing the disease, ensuring the patient is diagnosed early and for patient compliance,” says McDonnell. Education in the form of social awareness campaigns such as the ‘Save Your Breath Campaign’ and the impact of advocacy

groups have been “huge in getting patients aware of the problem”.

Educating patients about the alternatives to smoking, the resources available (i.e. telephone helpline for COPD) and emphasis on the “overwhelmingly positive impact of exercise on respiratory health” are crucial for the nation’s respiratory health according to McDonnell. Predictions indicate that by 2020, 20 per cent of adults are forecast to have COPD alone.

Although not totally representative, this is a rise that highlights the need for both health education and individual action.

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http://www.irishexaminer.com/breakingnews/ireland/1500-irish-people-die-prematurely-every-year-due-to-poor-air-quality-812877.html

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https://www.irishtimes.com/news/health/ ireland-s-obesity-rate-among-world-sworst-1.2594266

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HSE, 2017

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ICS, 2017

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Purcell, 2013

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NEWS

Confusing COPD and asthma can be dangerous Chronic obstructive pulmonary disease and asthma can appear superficially similar in some cases, but tailored treatment is vital.

By Linda Whitney

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sthma and chronic obstructive pulmonary disease (COPD) are often confused with each other – but when it comes to treatment, there’s a vital difference.

Professor Stephen Lane, Consultant Respiratory Physician at Tallaght Hospital and Peamount Healthcare, says: “Confusion between asthma and COPD is a big issue. Misdiagnosis means treatment may not be effective.”

The National Healthcare Quality Reporting System 2017 report states that in Ireland there are approximately 450,000 people with doctor-diagnosed asthma, and that around 500,000 people aged 40 and over have COPD, but only half are diagnosed.

What’s the difference?

“COPD usually affects people over 40 and the biggest cause is smoking. Asthma, however, can develop at any time of life, and although it is more common in children, it is also very common in adults,” says Lane. Some people have both and this is known as Asthma-COPD overlap (ACO).

“Because of these age profiles, there is a tendency to diagnose older people who have ‘chestiness’ and wheezing with COPD, when in fact they may have asthma (particularly if they have never smoked) – or have both asthma and COPD (ACO),” Lane says.

Both diseases are commonly treated by inhaled drugs, but whereas in the past both were treated with a combination of an inhaled corticosteroid and a long-acting ß2-agonist (LABA), now treatments are

tailored to each disease.

For COPD, inhaled corticosteroids are no longer recommended as first-line treatment. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines now recommend bronchodilators as first line treatment, initially a long-acting muscarinic antagonists (LAMA). If necessary, a long-acting ß2-agonist (LABA) can be added for more severe cases, where both are commonly packaged together for optimum effect.

For asthma, however, the Global Initiative for Asthma (GINA) guidelines recommend inhaled corticosteroids as the first-line treatment to tackle the inflammation, which is a greater feature of asthma than of COPD.

The risks of misdiagnosis “If you use LAMAs and LABAs as

Professor Stephen Lane Consultant Respiratory Physician

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first-line treatment for asthma (or combined asthma and COPD), you risk not fully treating the inflammation caused by the asthma,” says Lane. “Hence, early and accurate diagnosis is vital.” If you treat COPD with inhaled corticosteroids you are increasing the risk of pneumonia.

To sum up, Lane says: “For a patient with chestiness and wheezing, who is a heavy smoker and over 40, a COPD diagnosis is likely correct. They may also have asthma if they were chesty as a child or have allergies (ACO). COPD is treated with LAMA and LABAs, whereas asthma is treated through inhaled corticosteroids in the main. Treating asthma or ACO with LAMA and LABA may worsen the condition and treating COPD with inhaled corticosteroids may cause pneumonia. Thus it is important to get the diagnosis right.”

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Age-sex standardised hospitalisation rates for COPD per 100,000 population for selected OECD countries, 2013 (or nearest year)

Ireland Hungary New Zealand Australia Austria Denmark Germany Canada United States Israel Norway United Kingdom Korea Belgium Iceland Sweden OECD (31) Spain Poland Slovak Republic Luxembourgh Netherlands Finland Czech Republic Chile France Slovenia Mexico Switzerland Portugal Italy Japan 0

Source: OECD Health Statistics, NHQRS 2017 Annual Report Note on international comparability: Differences in coding practices among countries and the definition of an admission may affect the comparability of data. Differences in disease classification systems, for example between ICD-9-CM and ICD-10-AM/ACHI, may also affect data comparability.

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COPD treatments have changed – has yours?

By Linda Whitney

Getting the right treatment for chronic obstructive pulmonary disease (COPD) can save your life, so it’s vital to check that your treatment reflects the latest thinking.

Too many of Ireland’s COPD patients end up in hospital too often.

Figures from 2016 show that Ireland had the highest rate of hospitalisations due to COPD of all OECD countries, at 389 per 100,000 people.

“There is a national clinical programme, which, among other things, is addressing this issue,” says Professor Stephen Lane, Consultant Respiratory Physician and Tallaght

hospital and Peamount Healthcare.

Smoking is the cause of COPD, which is the commonest cause of adult emergency hospital admissions in Ireland, usually resulting from exacerbations, when symptoms of cough, breathlessness and wheeze worsen.

If you think you have COPD, Lane says: “Discuss with your GP and ask for a diagnostic spirometry [breathing] test.”

Letting patients know about new COPD treatments could reduce hospitalisations, as better and earlier treatment could reduce exacerbations.

In the past, inhaled corticosteroids (ICS) were used to treat COPD, but this is no longer recommended.

“Inhaled steroids do not reduce mortality in COPD patients and there is an increased rate of pneumonia in patients who use them,” says Lane.

New treatments The main treatment for COPD is smoking cessation. Lane says: “Ask your doctors for help in giving up. Nicotine replacement products and drugs such as varenicline help in smoking cessation.

E-cigarettes are controversial but I consider them a help.”

As a second line of defence, people with COPD should get an annual flu jab and a pneumococcal vaccination to reduce the risk of exacerbations.

Inhaled drugs are also very beneficial. New international guidelines for the treatment of COPD recommend bronchodilators, initially a long-acting muscarinic antagonist (LAMA). If necessary, a long-acting ß2-agonist (LABA) can be added. For moderate to severe cases, both are commonly packaged together for optimum bronchodilation. Steroids should generally be avoided but do still have role in patients with severe disease who are still exacerbating.

Cutting the toll A 2016 trial showed that a fixed-dose combination of LABAs and LAMAs, when used in an exacerbating pop-

ulation with moderate to severe COPD, reduced exacerbations by 19 per cent, compared to patients using a combination of LABAs and ICS. Fewer exacerbations could mean fewer hospitalisations.

The HSE National Clinical Programme for COPD aims to reduce hospital admissions by 1,500 a year by improving access to spirometry for earlier diagnoses and providing pulmonary rehabilitation for symptomatic patients.

Patients can act to help themselves. Lane says: “COPD therapies are changing, so ask your GP for an annual review to ensure you are getting the right treatment.”

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INSPIRATION

By Alex Van Den Broek

Air quality a key factor in controlling asthma

By Victoria Briggs

Rory Mooney Ex-Fire Fighter and Cancer Survivor

Living with cancer and fighting fire

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hen I sat down to speak to Rory Mooney about his battle with 2 seperate cases of lung cancer and a stroke – I didn’t know what to expect. Rory’s humor, strength and love for his wife Marion shone through instantly.

Let’s talk about the man before the illness. “A p***-artist chimney” Rory joked. Although a heavy smoker in his earlier years, Rory had not smoked for eight years before his first diagnosis and was an active man. Having grown up in Dublin, playing rugby in his younger years and committing 31 years to the Dublin Fire Brigade, Rory was no slouch. Over 31 years in the service, Rory had seen it all from ‘cradle to grave’ – an unpredicatable, dangerous job that he loved.

“You never know what you’re going to get.”

In 2003, Rory married Marion in Belarus, having previously spent time volunteering in areas affected by the Chenobyl disaster – they shared a loving marriage. It was only after they returned from Rory’s daughter’s 18th in New York that ill health presented itself when Marion noticed Rory holding his chest. Despite his efforts to ignore the pain, Rory recalls being given two options. “You’re either getting the car or getting the ambulance,” Marion reasoned with him. “So I took the car” he said.

Rory was sent home from hospital initially but the next day he was called back in. He was diagnosed with primary cancer of the left lung. “We hadn’t been married for a year before the diagnosis” back in 2008.

“My world fell apart” After surgery and two rounds of chemotherapy, Rory was given the all clear and continued work as a firefighter. Early detection of the cancer was crucial to Rory’s survival: around 70 per cent of lung cancer patients will survive for at least a year if diagnosed at the earliest stage, compared to around 14 per cent for people diagnosed with the most advanced stage of disease .

For nine years, his health was good, but in March 2016 he suffered a stroke getting out of bed. Four weeks later, a CT scan proved not only this but that he had a second cancer in the right lung. When asked how this double diagnosis felt Rory replied “Well I’m not going to buy a lottery ticket this week then”.

Unfortunately, this lead to Rory’s retirement from the Dublin Fire Brigade. Instead he chose to “take a walk in the sunshine”.

Despite a reduced lung capacity of 62 per cent, with the help of his wife Marion, Rory is able to continue his commitment to the Leinster rugby team, play golf and volunteer at the Dublin Fire Brigade Museum.

Early diagnosis and a strong support network has allowed Rory a quality of life that he otherwise may have missed. Support is crucial for recovery, as proven with Rory’s thanks to his wife – who is now his full-time carer – and the on-going bond with the Dublin Fire Brigade. His advice is to put out the cigarettes and heed the advice of loved ones and experts before it’s too late.

“The worst thing you can do is nothing. Listen to your body, listen to the doctors… Then just get on with it.”

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Winter can be a worrying time for asthma sufferers as damp air, pollution and more time spent indoors can exacerbate asthma symptoms, but improving air quality inside the home could help.

The statistics for asthma are enough to give anyone cause for concern. In Ireland, an estimated 470,000 people suffer from the condition – roughly 10 per cent of the population. In children, the incidences of asthma are even higher, at one in every five.

The prevalence of asthma also puts a considerable strain on the healthcare system and is responsible for 50,000 hospital admissions annually, a visit to Emergency Department every 26 minutes, and one fatality every week.

Winter worsens asthma symptoms With the approach of winter, the number of asthma attacks will inevitably begin to rise.

“The climate in Ireland exacerbates the condition,” says Kevin Kelly, advocacy and communications manager at the Asthma Society of Ireland. “It’s the cold, damp weather. We’re pretty much on a par with Scotland and the rest of the UK in that regard.”

Cold air is one of the biggest triggers for asthma because it causes the airways to spasm, resulting in symptoms such as coughing, wheezing, tightness in the chest and a shortness of breath.

Winter also brings with it the presence of more particle matter in the air, which comes from burning solid fuel, such as coal, wood and peat.

“Open fires can be very dangerous for people with asthma because the particles get trapped in the lungs and trigger an attack,” says Kelly. “Even after the fire is extinguished, particles remain in the air for hours in the home.”

The air quality in rural areas is particularly affected by large numbers of people burning solid fuel.

“Every winter we see a spike in calls to our free advice line (1800 44 54 64), particularly from older people,” says Kelly.

The Asthma Society of Ireland feels the air quality in rural areas would improve if the Government keeps to

can worsen symptoms,” says Kelly, who also advises asthma sufferers not to dry clothes indoors as that can increase the moisture in the air by as much as 30 per cent.

“Damp can cause mould to develop, which releases spores into the atmosphere and gets into the airways,” he says.

Kevin Kelly Advocacy and Communications Manager, Asthma Society of Ireland

their promise of a nationwide smoky coal ban by autumn 2018.

In larger towns and cities, air pollution is more likely to be the result of nitrogen dioxide levels present in diesel emissions.

“Short car journeys are the worst offenders in terms of pollution. Diesel engines fitted with a filter need longer journeys for the technology to work effectively,” Kelly explains.

Asthma link to indoor air Winter also sees an increase in the amount of time that people spend indoors.

In addition to open fires, indoor air quality can be affected by a wide range of factors such as cigarette smoke, animal dander, perfumes and deodorants. Even household cooking can trigger symptoms of asthma due to a combination of smoke and gases released from food cooking.

The Asthma Society of Ireland recently commissioned a report in association with Envirion and NuWave on Asthma and Indoor Air Quality (see https://tinyurl.com/ asi-indoorstudy), exploring the connection between the air particles found inside the homes and the onset of asthma symptoms.

How to prevent asthmatic conditions It also looked at the strategies that can be implemented to help manage the condition and found that effective air circulation was among the most important factors.

“Make sure the home is well ventilated by opening windows to reduce the risk of damp developing, which

Air purification units provide another very effective option.

In the Asthma Society’s study, air monitors were installed in sufferers’ homes to measure the number and types of particles in each room that could trigger an attack, while air purification filters were introduced for a period of six weeks to assess the improvement in air quality.

Professor John Sodeau who authored the report concluded that air filtration systems were “a real help” in improving air quality and that “every asthma management plan should have one.”

Kevin Kelly agrees. “The CliniAir units are portable and can be moved around from room to room to purify the air in about 60 minutes and as our study shows that they significantly reduce particle matter found in the air.”

While there is much about modern life that requires a larger response from society if the incidences of asthma are to be reduced, the air quality inside our homes is something we have a large amount of control over.

“Indoor air quality can be managed,” says Kelly. “There is a lot that can be done to reduce the risk of asthma symptoms as well as an attack.”

Tips for improving indoor air Other ways for improving indoor air quality include: ■ Limiting the amount of exposure to chemicals. When it comes to cleaning products, choose organic.

■ Mould and mildew flourishes in humid houses. Wipe away any build up as soon as it appears using soap, vinegar and water mix.

■ Swap carpets for tiled or wooden floors where possible, to reduce the amount of dust.