COPD: the Invisible killer
Health experts have issued stark warnings on the need or further commitment to effectively tackle asthma and chronic obstructive pulmonary disease (COPD). Martin Banks reports.
The World Health Organization predicts that COPD - a group of progressive lung conditions that cause inflammation and breathing difficulties, including emphysema and chronic bronchitis - will rank as the third highest cause of death worldwide by 2030.
The European Federation of Allergy and Airways Diseases Patients’ Associations (EFA) is even more pessimistic, saying that COPD has already moved up to become the second highest killer. COPD mainly affects adults over 40 with the primary cause being tobacco smoke – including exposure to “second-hand” smoke.
In 2017, 344 children died due to exposure to second-hand smoke. But environmental factors also contribute, with 90 percent of city dwellers in Europe said to be exposed to air pollution levels which are harmful to their health.
It is estimated that COPD accounts for €4bn of the direct cost of air pollution, not including economic loss due to decreased productivity. Expenses in Europe related to outpatient care of COPD are about €4.7bn per year while hospital costs are estimated to be €2.9bn.
Poor air quality exacerbates incidence of COPD as well as allergies, asthma and cardiovascular disease. Health inequalities also play a part because air pollution more severely effects those of low socio-economic status as do chronic diseases like COPD.
While cigarette smoking is known to be the most important risk factor, data also highlights the role of alcohol consumption in the condition. The International Scientific Forum on Alcohol Research says that, given that moderate alcohol intake can cut the risk of many inflammatory conditions, it may also affect the risk of COPD which is associated with “marked inflammation” of lung tissues.
Member States have, over recent years, taken a raft of measures relating to smoking and air pollution in the form of legislation, recommendations and information campaigns to tackle the issue.
Just under three years ago, one in three MEPs also signed a written declaration on the need to guarantee rehabilitation for patients. However, with the new Commission getting down to work, MEPs are now demanding more action from the EU.
They include Finnish EPP deputy Sirpa Pietikäinen, who chairs Parliament’s allergy and asthma intergroup. She told The Parliament Magazine that the “seriousness” of the problem should not be underestimated.
She also said that COPD should be covered by the European Reference Networks (ERNs) which aim to tackle complex or rare diseases and conditions that require highly specialised treatment. This, she believes, could be of use as they help professionals and centres of expertise in different countries to share knowledge.
Pietikäinen said, “We need to act because the impact of these diseases is huge and currently not enough is being done. In fact, this is an example of where we need more Europe, not less.” Pointing to the “economic and human costs” of COPD, Pietikäinen acknowledged the efforts which have been taken to address the issue with, for instance, smoking legislation.
"We need to act because the impact of these diseases is huge and currently not enough is being done. In fact, this is an example of where we need more Europe, not less" Sirpa Pietikäinen MEP
However, she added, “we also have to consider the impact on health of air conditions and air quality. To some extent we are still unaware of the extent of this and climate change could make the situation even worse because heatwaves – and, of course, we’re seeing more of these – exacerbate air quality.”
She hopes that 2020 will bring further awareness and knowledge of the problem, along with better treatment and earlier diagnosis for patients.
She shares the fears of those who say that the official death toll from respiratory diseases may only be the tip of the iceberg. A recent EFA report warns that COPD is dramatically undiagnosed with misdiagnosis taking, on average, five years to be corrected.
In some countries, like Poland, it can take up to seven years. The EFA cautions that despite some progress, these diseases are “not being adequately addressed” by healthcare professionals and public authorities.
This autumn the EFA revealed that one third of asthma and a quarter of COPD patients have to go to the emergency room at least once a year. Two thirds of asthma and COPD patients surveyed by the EFA said that authorities did “too little” to protect them from air pollution.
As Pietikäinen points out, earlier diagnosis, anti-smoking campaigns, tackling pollution and improved treatment are all important, but daily physical activity can also help COPD patients’ quality of life.
The numbers of people with COPD are, she notes, still excessively high - an estimated 1.2 million people are living with diagnosed COPD in the UK alone.
After asthma, COPD is the second most common lung disease in Britain. As early as 2009, a Eurobarometer poll showed that the kind of society most Europeans favour is a healthy one.
The message, then, is clear: with more than 700 million asthma and COPD sufferers worldwide, the onus is on EU policymakers to help shape policy that addresses patients.
Political action is urgently needed to ensure that the four million European citizens with severe asthma routinely have access to specialist care, writes Pascal Chanez.
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