Professor Karen Redmond
Mb Bch Bao Md Frcs Cth, Consultant Thoracic & Transplant Surgeon, Irish Thoracic 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.
I 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.
She was a small lady, thin and wiry with a barrel-shaped chest. 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?’. ‘Maybe she left her oxygen cylinder in the car?’ 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 occurs when the normal lung is destroyed either by smoking or, in 15% of cases, other causes including genetically linked diseases. The space left behind is filled with trapped air that causes the lung to hyper-inflate over time, pushing the chest wall out and the diaphragm down. All this trapped air limits air flow in and out, causing debilitating breathlessness. If badly affected, it is like trying to breathe through a straw.
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.
The substantial burden of lung diseases
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. As the third leading cause of death globally in 2010, 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 cessation, medical therapy, vaccinations and pulmonary rehabilitation, and in extreme cases single or double lung transplantation. Innovation in medical technology has led to surgical lung volume reduction options, either endobronchial valves or robotic surgery. Zephyr 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.
Funding needed to match demand for treatment
When successful, treated patients breathe more easily, 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.