What is it and who gets it?
Chronic Obstructive Pulmonary Disease (COPD) is an umbrella term that describes the combination of two chronic lung conditions, chronic bronchitis, in which the airways are narrowed and inflamed, and emphysema in which the air sacs (alveoli) and cells in lung tissue are damaged.
COPD is the most prevalent respiratory disease in Ireland. It is estimated that over 380,000 people in Ireland suffer from COPD, yet only about 110,000 are diagnosed with it. One in four people over 70 suffer from it. COPD is caused by smoking or long term exposure to air pollution from cigarette smoke and/or the burning of smoky fuels. Chronic asthma, premature birth or low birth rate are other risk factors for developing COPD later in life.
It is the third leading cause of death in the world.
What are the symptoms and how is it diagnosed?
The symptoms of COPD include breathlessness (initially following exertion and later even when resting), persistent coughing and frequent chest infections. It is diagnosed via a spirometry test which examines lung function by measuring how much air you breathe out. Chest X-rays will also be given to rule out other lung diseases.
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Prof Tim McDonnell, retired consultant respiratory physician and chairperson of COPD Support Ireland, says that many people don’t seek help with their symptoms until they become severe. “So, if you are over age 35, have breathlessness, a cough, particularly if a smoker, then you need to ask your GP about getting access to a spirometry breathing test,” he says.
And while being a smoker or past smoker and/or being exposed to toxic particles indoors or outdoors causes COPD in most people, five per cent of those with the condition have a deficiency in the Alpha-1 antitrypsin protein. The presence of this protein protects your lungs and other organs from infections and irritants including cigarette smoke and other toxic gases so its absence leads to COPD. Many people with COPD suffer from other conditions such as diabetes, heart disease and osteoporosis so will need to be treated for these conditions too. As with other chronic health conditions, early diagnosis gives people the better chance of preventing or delaying more severe symptoms, understanding the importance of exercise and vaccination.
What treatments are available and are they different to earlier treatments?
People with COPD usually take a daily or twice daily medication via an inhaler. The medications help keep the airways in the lungs open to provide relief from symptoms and reduce inflammation on the lungs. Breathing exercises are also a key element to control breathlessness associated with COPD.
Prof McDonnell says that it is very important that patients are educated in the use of inhalers to get the most out of their medications. “Short and long acting beta agonists and anti-cholinergics are the preferred medications. Steroids are only for patients who have lots of exacerbations,” he explains. Some people require oxygen at advanced stage of the disease.
People with COPD are also strongly advised to keep up to date on influenza, Covid and pneumonia vaccines as the condition leaves them prone to infection. Studies have found that those who learn to self-manage their condition by completing pulmonary rehabilitation programmes, can reduce time spent in hospital or even prevent a hospital stay.
Have there been any breakthroughs in the understanding and management of the condition recently?
A University of Limerick (UL) study found that the introduction of the smoky coal ban has reduced the incidence of new cases of chronic lung diseases including COPD by around 23 per cent. The UL study tracked the health status of over 4,000 older people who were interviewed every two years between 2009 and 2018. The researchers specifically examined chronic lung disease including COPD, chronic bronchitis or chronic emphysema.
The Environmental Protection Agency’s announcement that Ireland will move towards more stringent World Health Organisation air quality guidelines is expected to place further pressure to reduce harmful emissions from vehicular traffic and solid fuel home heating systems which would – in the long term, improve population health.
Members of the public can check air quality in their local area via over 100 real-time air quality monitoring stations throughout the country. The EPA also offers three day forecasting of air quality for particulate matter, nitrogen dioxide and ozone on airquality.ie which would help people with respiratory conditions avoid higher levels of outdoor air pollution at certain times of the day or night.
Ciara Hanrahan a physiotherapist who lectures at University College Cork is doing a PhD on exercise and COPD. “Keeping physically active is so important for people with COPD and I’m looking at what are the most effective behavioural change interventions to help people with COPD stay active,” explains Hanrahan.
What are the health services like for people with COPD?
A new community-based approach to manage patients with COPD is being rolled out by the HSE. When completed, this will include 34 respiratory medicine hubs where people can see respiratory consultants, respiratory physiologists, specialist respiratory nurses and physiotherapists in their local areas instead of attending hospitals. Pulmonary rehabilitation exercise and education programmes will also be integrated into these hubs.
However, as is the case with other community-based services, a shortage of staff to fulfill all the necessary roles in these respiratory medicine hubs is delaying their roll-out. Currently, about 24 of the 34 hubs are partially staffed with some concerns that projected HSE funding cuts for 2024 might cause further delays. The COPD hospital outreach service to people in their own homes which started in 2011 is expected to be linked in to follow-up treatments in community-based respiratory hubs.
The HSE also has a pulmonary rehabilitation education support programme on its website which includes easy-to-follow exercise and education videos. People with COPD can also join free online six-week group self-management programmes. Called Living Well programmes, there are for adults with long-term health conditions (041 685 0676/087 430 8735).
COPD Support Ireland (086 041 5128) has an active network of 40 local branches throughout Ireland that offer education and social support for people with COPD.
What does the future hold for people with COPD?
Ireland has one of the highest rates of avoidable admissions for COPD in 38 countries around the world in the Organization for Economic Co-operation and Development (OECD) according to a new report from the OECD.
About 15,000 people are admitted to hospital due to the escalation of their symptoms of COPD every year in Ireland and COPD is the most common cause of disease-specific emergency admission to hospital in Ireland. Of those admitted each year, 1,500 will die from complications of COPD or other illnesses.
“Diagnosing people earlier and giving them earlier access to pulmonary rehabilitation programmes is very important. We would also like patients to have rescue packs of steroids and antibiotics to treat themselves with more quickly to prevent symptoms exacerbating,” says Prof McDonnell.
This combined early access to medications under the guidance of doctors and respiratory nurses, would, according to experts, prevent acute deterioration of symptoms and subsequent hospital admission. “More care in the community and patient education are crucial,” says Prof McDonnell adding that another concern for the future is how the rise of vaping will contribute to more cases of lung diseases such as COPD. “Vaping is a time bomb. We don’t yet know the long-term toxic effects of inhaling compounds when vaping.”
Dr Stanley Miller, national clinical lead for respiratory conditions in the HSE says: “One of the best single things people can do to prevent COPD is to stop smoking and this includes e-cigarettes.”
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