The traditional view of COPD (chronic obstructive pulmonary disease) is that it is a self-inflicted disease caused by smoking. However, it is increasingly likely that this description is something of an oversimplification. While still very much associated with smoking, clinicians and researchers alike are getting to grips with the reality that COPD is a more complex and heterogeneous disease than previously thought. We are also becoming more aware of the fact that it is a disease which rarely occurs in isolation. The vast majority of people who present with COPD have at least one other co-existing disease or condition, and around 50% have four or more accompanying chronic diseases or ‘comorbidities’.
A disease still on the rise
This changing perception of COPD comes not before time. Unlike the situation for some other leading causes of death, we have not seen the same downturn in COPD mortality and morbidity rates over the last decade or so. Better screening programmes and primary prevention strategies have contributed much to reduced mortality rates from ischaemic heart disease in both North America and Europe, but in the meantime, the proportion of deaths due to COPD has risen. More significantly, COPD is projected to move from fourth to third place in the World Health Organization’s (WHO) top-ten list of causes of global mortality, overtaking deaths due to lower respiratory tract infections in the process.
Smoking, not the only guilty party
So is COPD really all about smoking or are there other preventable risk factors that we should be targeting in order to reduce the rising burden of COPD morbidity and mortality? Two pieces of epidemiological evidence, in particular, suggest that there may well be. The first is the observation that – entirely contrary to expectations – the global distribution of COPD mortality and patterns of smoking prevalence do not in fact overlap but are instead almost mirror images of one another. According to WHO’s Global Burden Disease data, COPD mortality is higher in Ethiopia than it is in Russia.
Tempting though it is to point the finger of accusation at the use of biomass fuels, a recent analysis of data collected as part of the Burden of Obstructive Lung Disease (BOLD) study suggests that this might not necessarily be the explanation either. This analysis, to which several National Heart and Lung Institute staff contributed, was unable to find evidence of an association between the use of solid fuels for cooking or heating and airflow obstruction. (more…)
Public awareness of the hazards of asbestos can be dated to the period immediately following the death of Nellie Kershaw aged 33 in 1924. She had worked during the previous seven years in a textile factory spinning asbestos fibre into yarn. She died of severe fibrosis of the lungs. The pathologist, William Cooke, who found retained asbestos fibres in the lungs, called the cause of death asbestosis. Nellie Kershaw was not the first case to be reported of lung fibrosis caused by asbestos. Montague Murray in 1899 had reported the case of a 33-year-old man who had worked for 14 years in an asbestos textile factory. He had died of fibrosis of the lungs which Montague Murray, also finding asbestos in the lungs, had attributed to inhaled asbestos fibres. The patient had told Murray he was the only survivor from ten others who had worked in his workshop.
However, unlike the Montague Murray case, which had aroused little interest, the death of Nellie Kershaw and its cause was widely reported. It led to the government commissioning the Chief Inspector of Factories, Edward Merewether, with an engineer, Charles Price, to report on workers’ health in the asbestos industry. They found, among those still at work who had been employed for more than five years, one third had asbestosis and of those still working in the factory after 20 years, four-fifths had the disease.
The government introduced regulations in 1931 to control exposure to asbestos, together with arrangements for regular medical surveillance of the workforce and eligibility for compensation for factory workers with asbestosis. A benefit commented on by the workers in one factory was a clock on the wall becoming visible to them for the first time. (more…)
Singing carols is a big part of Christmas cheer, but not many people realise that singing can also be helpful for people with lung disease. COPD is an extremely common condition – there are 1.3 million people with this diagnosis in the UK. Existing treatments help to some extent, but do not reverse the underlying pathology, meaning that even with optimal care many patients remain breathless with activity limitation and poor quality of life. This symptom burden represents a major area of unmet need. Singing for Lung Health (SLH) groups are a potential way for patients to gain skills to improve control of their breathing and posture, reducing symptom burden and enhancing wellbeing.
What is singing for lung health?
Singing for lung health involves taking part in classes led by a specially trained singing teacher. Patients learn techniques to help control their breathing and posture as part of a group activity which is fun and sociable. The goal for the groups is to get better at singing, an artistic objective. By doing this individuals gain skills that help them to cope with their lung condition, a health improvement objective. The classes have a particular focus on activities and exercises that are helpful for people with lung disease and so differ from more generic “singing for well-being” groups.
Singing for lung health has grown from a few small clinical trials to more than 80 groups nationally. As well as the plausibility of an approach based on learning to control the breath in people with lung disease, singing is also a fun social activity. Results from the Royal College of Physicians COPD audit show that provision of pulmonary rehabilitation is still limited, so there is a need for activities to sustain the physical and social benefits that these produce once people have completed them. For some people, taking part in a singing group may be a useful stepping stone to agreeing to join a formal rehabilitation program. (more…)
COPD, chronic obstructive pulmonary disease, has traditionally been thought of as an irreversible and somewhat hopeless condition. Many patients with COPD may be missing out on the possibility for a dramatic improvement in their condition. They deserve better.
COPD, is a common and important condition. There are 1.3 million people with a diagnosis of COPD in the UK and it’s now the third leading cause of death worldwide. The main symptoms are breathlessness, cough and sputum production.
The term COPD encompasses a range of pathological processes, usually caused by smoking or inhaling other noxious materials. It includes chronic bronchitis – inflammation and damage to airways as well as emphysema – destruction of the lung tissue itself and damage to the blood vessels in the lung. In emphysema the walls of the alveoli (air sacs) break down. The lung tissue loses its elasticity and becomes baggy, and air gets trapped in the lungs making breathing uncomfortable. In some people the condition is caused by alpha one antitrypsin (A1AT) deficiency; the inherited lack of a defensive enzyme, which makes their lungs much more vulnerable.
There are treatments including inhaled medication, pulmonary rehabilitation and flu vaccination, and for people who continue to smoke, smoking cessation is the most effective. Despite the best standard care the condition is progressive and conventional treatments cannot so far reverse the underlying process. (more…)
I was always a sickly child – when I was eleven years old, doctors injected my forearm with tuberculin in order to check whether my immune system raised a response to the bits and bobs of dead tuberculosis (TB) bacteria in it. If it did, it meant my immune system had already been prodded into battling TB, that is, it had previously encountered or was currently encountering an infection with TB bacteria. The injection site swelled like a furious bee sting, the doctors decided TB was the root cause of all my troubles, and I was intensely medicated for the next six months. My symptoms improved, and I have since evolved (visibly even!) towards the hale and hearty end of the healthiness spectrum.
In retrospect, now that I am medically trained and pursuing a PhD in TB immunology, I can appreciate all that my care team must have had to consider before starting an eleven-year-old child on a rigorous anti-TB treatment based on an educated guess. My symptoms were not typical of classical lung TB, the most common and infectious form of TB, they were mostly gastrointestinal, but then TB has also been known to stitch the gut into uncomfortable knots. My mother had recently been diagnosed with a cold abscess, due to TB of the bone, and though this could not possibly be infectious (based on centuries of observation) it still raised flags as it meant I had a history of contact with a TB patient. I showed an immune response to the tuberculin skin test (TST), but then I had received the BCG vaccine, which is a close relative of TB bacteria. This meant I could elicit a cross-reactive immune response and result in a positive TST even in the absence of TB infection due to the similarity of the two bacteria. (more…)
Smoking is a leading cause of preventable death and disease in the world. It is estimated that the society costs associated with smoking are approximately ₤12.9 billion a year, including the NHS cost of treating smoking related diseases and loss of productivity.
Chronic obstructive pulmonary disease (COPD) is one of the major diseases caused by smoking. The disease ranks third among the leading causes of death worldwide. Around 1.2 million Britons suffer from the disease (Source: British Lung Foundation). The usual clinical picture is that of a smoker with symptoms that include shortness of breath and chronic cough. The muscle lab team at the Royal Brompton Hospital’s BRU, led by Professor Michael Polkey and Dr Nicholas Hopkinson is looking at different ways to improve COPD care, and at the different mechanisms by which interventions improve patient outcomes in the disease.
In recent years, it has been discovered that the negative consequences of the pulmonary disease are not just limited to within the rib cage. The wider effects of the disease on multiple body systems has a large and solid evidence base to support it. More than half of COPD patients suffer simultaneously from at least two other conditions known to often occur alongside the disease (so-called ‘comorbid’ conditions); the presence of which is commonly used as an indication of disease severity (1). The disease burden usually takes its toll on the patients’ quality of life, daily physical activities and social interactions. (more…)