Respiratory Health Ireland Q4 Dec 2019

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DR AIDAN O’BRIEN, IRISH THORACIC SOCIETY

“Respiratory disease affects people at all stages of life” » p2

PROFESSOR KAREN REDMOND

“When successful, treated patients breathe easier and enjoy a better quality of life” » p3

PHILIP WATT, CYSTIC FIBROSIS IRELAND

“Cystic fibrosis is rapidly moving from a life-limiting to a manageable condition” » ONLINE

Respiratory Health HEALTHNEWS.IE

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Air pollution requires urgent and concerted action in Ireland Air pollution is a leading cause of death worldwide, accounting for around seven million premature deaths each year.

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n 2016, air pollution was responsible for an estimated 1,180 early deaths in Ireland.

Considered by the World Health Organization to be as harmful to an individual as smoking, air pollution is linked to heart disease, strokes, lung cancer, and respiratory illness and infection. And, according to the same organisation, nine out of ten of us breathe air containing high levels of pollutants.

factory emissions and cleaning products. Air pollution is carried in the air outside and indoors, into our bodies, and causes greatest harm to the most vulnerable in our society; to children, the elderly, people who are homeless or living in substandard accommodation and those with chronic illness like asthma.

What is air pollution?

Air pollution is a critical public health issue that requires urgent and concerted action. In Ireland, 380,000 people have asthma and almost 900,000 will have asthma at some point in their lifetime. For people with asthma, some triggers that worsen their symptoms - such as pet dander and mould - can be avoided, however, air pollution cannot. It requires the government to act as leaders to protect us from this serious harm and to build awareness so that we can each take

Air pollution is caused by the excessive presence of tiny particles in the air that are hazardous to human health and the environment. It can be naturally occurring, like pollen, or man-made, like soot or smoke. The particles are sometimes so minuscule they are invisible to the naked eye.

The main sources of harmful air pollution are smoky fuels, transport vehicles, agricultural activities, Follow us

Why is the Asthma Society interested in air pollution?

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steps to safeguard ourselves, our families and our communities.

What are the benefits of tackling air pollution?

Each and every one of us will benefit from any long-term improvements to air pollution, but children in particular will benefit as they are most impacted by it. Children have faster breathing rates and their lungs are still developing. Research shows that children who breathe polluted air can have life-long reduced lung capacity, they may develop asthma and their neurological development could be affected.

A global study1 published in April this year reviewed the occurrence of asthma in children caused by traffic pollution in 194 countries around the world. It identified that 1,700 new cases of the disease in Ireland a year were as a consequence of pollutants emitted from vehicles. That is 1,700 children who @MediaplanetIE

SARAH O’CONNOR CEO, The Asthma Society of Ireland

will have to take medication daily, might be limited in how they play or exercise and will know how it feels to struggle to breathe.

How do we tackle air pollution?

Both the government and the public will play an important role in reducing air pollution. We can all make changes in our own lives that will help make the air we breathe cleaner. Instead of driving to work, we can choose to walk when possible; we can choose to buy our food from local sources to ensure the products we consume have caused less pollution.

However, our government needs to take the lead and act now on air pollution by publishing its long-overdue national Clean Air Strategy.

This strategy urgently needs to lay out an ambitious set of steps to achieve dramatic improvements to our air quality. A government-led @MediaplanetUK

public awareness campaign is desperately needed alongside this to fully inform the Irish public about the effects of air pollution and to better equip them with the knowledge to tackle it.

Source: 1. https://www.thelancet.com/journals/lanpla/ article/PIIS2542-5196(19)30046-4/fulltext

Info box In a 2019 survey, nine out of ten people who used our advice line felt better equipped in managing their asthma and/or COPD. Call free on 1800 44 54 64 to speak to a respiratory specialist nurse.

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The respiratory health of the nation The lungs are essential for life and all of us at one time or another have experienced breathlessness, a common and often chronic and disabling symptom for people with respiratory disease.

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he Irish Thoracic Society, the national organisation representing respiratory healthcare professionals on the island of Ireland, recently published ‘Respiratory Health of the Nation’, a comprehensive report on the size and the burden of respiratory disease in Ireland. This provides a picture of our nation’s respiratory health and brings into sharp focus the severe impact of respiratory disease on individuals, the Irish population and the health service.

Key findings: • Hospitalisation: respiratory disease accounts for more hospitalisations than for cardiovascular and non-lung cancer cases combined (14% versus 8% and 5% respectively) • Deaths: in the period 2008 to 2016 the number of deaths f rom re s pi rator y d i se a se increased by 14.6% compared to a 7.5% drop in cardiovascular deaths • EU: Ireland’s death rate from respirator y disease is the fourth highest in the EU-28 and is 38% higher than the EU average • Disease types: respiratory diseases make up three of

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the top six causes of death, with the big three being lung cancer, COPD and pneumonia.

The report includes an overview of 11 common respiratory conditions and includes the following key statistics: • Lung cancer: this causes the greatest number of cancer deaths in Ireland accounting for 21% of total cancer deaths in 2016 • COPD: Ireland has the highest h o s p i t a l i s at i o n r at e fo r COPD (Chronic Obstructive Pulmonary Disease) among selected OECD countries with over 87% of these admitted as emergencies • Asthma: Ireland has one of the highest rates of asthma in the world • Cystic fibrosis: Ireland has one of the highest global incidences of cystic fibrosis.

Impact and reach of respiratory disease What is clear from this report is that respiratory disease affects people at all stages of life. It disproportionately affects those from lower socio-economic groups and includes

DR AIDAN O’BRIEN Consultant Respiratory Physician, President, The Irish Thoracic Society

In order to lift some of the burden from families, communities and our health services, we must take the approach that every breath counts. conditions that may be prevented or detected earlier through awareness, lifestyle choices and access to appropriate services.

While smoking is a key risk factor for many respiratory diseases, we are also seeing the influence of other social and environmental factors on respiratory health. As a result of our growing and ageing population the burden of lung disease is set to increase into the future - we need to prepare for this by ensuring adequate resources and best evidence-based practice is in place to care for our citizens.

Addressing the challenges of too few specialists It is important to acknowledge that there have been improvements in respiratory care in Ireland in recent years thanks to a leadership approach to tobacco control and progress under National Clinical Programmes for some respiratory diseases. Measures planned as part of the Sláintecare Strategy prov ide f u r t her g rou nd s for

optimism. However, significant challenges exist.

There are too few respiratory specialists, in particular consultants, the numbers of which lag well behind other EU countries, but also nurses, physiotherapists, physiologists and other allied healthcare professionals involved in respirator y care. Access to elements of good quality care such as pulmonary rehabilitation is severely limited, and we need to meet the challenge of providing integrated care for conditions such as COPD with a properly resourced primary care community.

Every breath counts In order to lift some of the burden from families, communities and our health ser vices, we must take the approach that ever y breath counts. This will require a cross-sectoral com m itment to add ressi ng env iron menta l and other threats to respiratory health. It will require availability of timely access to evidence-based

i nter vent ion s, suppor t s, a nd s e r v ic e s at c om mu n it y a nd hospital level for people with re s pi r ator y s y mptom s, s uch as shor t ness of breat h or chronic cough.

At population level, geographical and socio-economic variations in respiratory health must be addressed, new respiratory programmes implemented and existing programmes evaluated.

Emerging threats such as antibiotic resistance and vaccination upta ke complacenc y must be stemmed. All of these measures must be underpinned by timely, comprehensive data.

Info box The Irish Thoracic Society thanks the authors of the report - Dr Máire O’Connor, Ms Eimir Hurley, Professor Terry O’Connor and Ms Suzanne McCormack.

Read the full report at: irishthoracicsociety.com/ respiratory-health-of-thenation-2018/

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A spotlight on emphysema and COPD in Ireland PROFESSOR KAREN REDMOND MB BCH BAO MD FRCS CTH Consultant Thoracic and Transplant Surgeon, Irish Throracic Society Council Member

Feeling like you cannot get a full breath could be a sign of ‘air hunger’ caused by emphysema or chronic obstruction pulmonary disease (COPD). With half a million people aged 40 years and over suffering with emphysema or COPD in Ireland, more funding is needed for treatment.

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was standing in the lift one day when a couple – Mr and Mrs Smith – stepped in. They were going up just one flight. Mr Smith asked directions, preoccupied with working out where to go. Mrs Smith seemed flustered, wondering if they would make it to his hospital appointment on time.

I noticed her laboured breathing getting into the lift, as she struggled with the effort of walking in from the car park just meters away. She was unable to talk in full sentences, pursing her lips to grasp a breath in between words.

‘Oh dear,’ I wondered, ‘who is helping her to manage her COPD?’.

I suddenly had this impulse to tap her on the shoulder and offer her lung volume reduction surgery, but held off; after all she was there to support her husband, she certainly wasn’t looking for a consultation in the lift.

Emphysema explained Emphysema occurs when the normal lung is destroyed either by smoking or other causes including genetically linked diseases. The space left behind is filled with trapped air causing the lung to hyper-inflate over time, pushing the chest wall out and the diaphragm down. All this trapped air limits air f low in and out, causing debilitating breathlessness.

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As a form of air hunger, patients complain by saying ‘I just cannot get a deep breath in or out’. Symptoms progress over time and, eventually, everyday activities such as walking or getting dressed become difficult.

Often, patients will have trouble feeling confident leaving their home. The implications can be devastating for both the patient and their loved ones.

Valves for example, are tiny valves placed in the airways to block a diseased part of the lungs and reduce hyperinflation. This makes room for the healthier parts of the lungs to expand and lifts pressure off the diaphragm, thereby making breathing easier.

The substantial burden of lung diseases

When successful, treated patients breathe easier, are more active, and enjoy a better quality of life.

Indeed, some outcomes exceed all expectations for those patients most in need. Funding of regional treatment centres with COPD specialists will soon be required to deal with what will be an overwhelming demand for this level of care.

Mrs Smith is one of half a million people aged 40 years and over suffering with emphysema or chronic obstruction pulmonary disease (COPD) in Ireland. The age standardised death rate for COPD in 2011 was 27.87 per 100,000 for Ireland, compared with 18 per 100,000 for the WHO European region. In other words, the burden of disease is substantial, with models of care being proposed by advisory groups within the Health Service Executive.

Treatments include smoking c e s s at ion , me d ic a l t he r ap y, vacc i nat ion s a nd pu l mona r y rehabilitation, and in extreme c a s e s s i n g le or double lu n g transplantation. Innovation in medical technology has led to surgical lung volume reduction options, either endobronchial valves or robotic surgery. Zephyr

Funding needed to match demand for treatment

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Living with emphysema: the story of Con Power Ex-international showjumper, 66-year-old Con Power, led an active life, but his 40-a-day habit finally caught up with him and he faced an unhappy diagnosis.

CAPTAIN CON POWER Ex-International Showjumper and Emphysema Patient

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on Power led an active life, surrounded by the Irish hills of County Meath. Each morning he climbed up and down the hills attending to his four horses but, seven years ago, he noticed himself struggling for breath. “I would always go down to muck out in the morning but be out of breath halfway back up the hill,” he said.

“I knew I needed to get my lungs checked out.”

Con smoked two packets of cigarettes daily for 44 years, and spent most of his time in dusty stables. It was an interview for a radio station that prompted him to quit the cigarettes and go to the doctor about his shortness of breath. He said, “I sat in my car and had one last cigarette, and I’ve never

smoked again since.”

When Con was told he had emphysema it was initially a shock, but the consultant was keen to stress that the condition can be managed. There have been some lifestyle changes, Con has given up competing and mucking out the horses although he still teaches. And he now enjoys a daily 20-minute walk in the morning to keep up his fitness. Most importantly, he never leaves the house without one of his inhalers.

WRITTEN BY GINA CLARKE Read more at healthnews.ie

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