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.

Con 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.

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I began as CEO of Cystic Fibrosis Ireland in 2009. The first priority identified by the Board was to organise a series of meetings around Ireland to hear at first hand the issues facing people with Cystic Fibrosis (CF) and their families.

The fear for adult CF patients was going into hospitals. They often ended up in multi-bed respiratory wards. Sometimes they ended up beside very ill elderly patients who posed a health threat to them (not their fault, of course). In addition, the double-lung transplant programme in Ireland was only managing to transplant about 2-3 patients a year. There had been a major advances in drug therapy during the 1980’s and 1990’s. However, there had been no major medication breakthroughs for CF since the nebulised antibiotic Tobramycin became available in Ireland in 1998.

CFTR drug therapy

It took scientists a further 23 years before the first CFTR drug therapy was approved in Europe in 2012. Most people who took the drug found it transformed their lives because it was the first drug that impacted on the underlying cause of CF. The underlying cause is in fact related to blockages to the inter-cellular transfer of salt and water, which leads to a build of mucus especially in the lungs.

Drug developments and their impact

The positive impact of this therapy was immediate and profound. Word about this quickly spread throughout the CF community in Ireland. Eventually, the news became global about the potential of further research for drugs that could impact on a much higher percentage of the CF population. These began to appear five years later.

In 2017, two further drug therapies were approved by the HSE. The drug therapies had potential to impact on about half of the CF population in Ireland (those with two copies of the F508d gene mutation).

Then, in 2019, came an announcement that had been anticipated since 1989. A drug therapy had the potential to impact on a huge 90% of the CF population worldwide. This drug therapy was approved in October 2019, some five months ahead of schedule in the United States. It could be available in Ireland as early as the summer of 2020.

Resources still needed to ensure progress

The Director of the US National Institutes of Health, Dr Francis Collins, one of the pioneers who led the team that found the CF gene mutation in 1989, stated in a recent editorial in the prestigious New England Journal of Medicine “This should be a cause for major celebration.”

Dr Collins further described the improvement in lung function of patients treated with the triple-combination therapy in the Vertex-funded trial as ‘striking’.

The emergence of these wonderful new medications is to be celebrated. However, they are not a cure and we still need to ensure there is sustained adequate resources also given to lung transplantation. We also need to ensure resources to our CF centres (including Beaumont Hospital’s long promised 20 bed adult CF in patient unit). And lastly, adequate resourcing of clinical staff positions in CF centres.

Multi-disciplinary efforts needed

In short, we are in a period of significant hope for people with CF in Ireland. CF is rapidly moving from a life-limiting to a manageable condition, but not without further challenges to come. Cystic Fibrosis Ireland has been proud to have played ‘a not insignificant role’ in improvements to CF care. Most recently, with the emergence of the National Clinical Programme for CF which came about through our initial advocacy to the Department of Health and the HSE and which is beginning to make an impact.

With all this progress, many are involved. Not least the clinicians and their multi disciplinary teams; the hospitals with CF centres; the HSE and successive government Ministers and the support of the public. If you are interested in fundraising for Cystic Fibrosis Ireland you can find many ideas on www.cfireland.ie. Thank you for previous support.

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Air pollution is a leading cause of death worldwide, accounting for around seven million premature deaths each year.

In 2016, air pollution was responsible for an estimated 1,180 early deaths in Ireland. Air pollution is considered by the World Health Organization to be as harmful to an individual as smoking. It is linked to heart disease, strokes, lung cancer, and respiratory illness and infection. Similarly, according to the same organisation, nine out of ten of us breathe air containing high levels of pollutants.

What is air pollution?

Air pollution is caused by the excessive presence of tiny particles in the air. These particles are hazardous to human health and the environment. Because of this, 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, factory emissions and cleaning products. Subsequently air pollution is carried in the air outside and indoors, into our bodies. It 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.

Air pollution

Why is the Asthma Society interested in 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. They must build awareness so that we can each take 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 study published in April this year reviewed the occurrence of asthma in children caused by traffic pollution in 194 countries around the world. Through this, 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 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 instead choose to walk when possible. We can also 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.

In conclusion, this strategy urgently needs to lay out an ambitious set of steps to achieve dramatic improvements to our air quality. A government-led public awareness campaign is desperately needed. As a result, this will fully inform the Irish public about the effects of air pollution and to better equip them with the knowledge to tackle it.

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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 explained

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.

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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.

The 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 from respiratory disease increased by 14.6% compared to a 7.5% drop in cardiovascular deaths
• EU: Ireland’s death rate from respiratory 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 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 hospitalisation rate for 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 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 provide further grounds 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 respiratory 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 services, we must take the approach that every breath counts. This will require a cross-sectoral commitment to addressing environmental and other threats to respiratory health. It will require availability of timely access to evidence-based interventions, supports, and services at community and hospital level for people with respiratory symptoms, such as shortness of breath 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 uptake complacency must be stemmed. All of these measures must be underpinned by timely, comprehensive data.

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Respiratory ill-health is all too familiar in Ireland. Through a brief overview of the state of the nation and professional consultation it’s time to see the value in education for prevention.

Poor respiratory health is linked to a number of lifestyle and environmental factors. With recent reports from the WHO calling on Ireland to improve their air quality standards¹ and obesity levels set to reach the highest in Europe² within the decade, it could mean bad news for respiratory health levels. Conversley, according to data released by the European Commission, smoking rates are falling faster in Ireland than any other EU country. Professor Tim McDonnell, Consultant Respiratory Physician discusses our respiratory health and what we can do about it.

Respiratory health : a brief overview

Chronic obstructive pulmonary disorder (COPD)

COPD is an often-lesser known chronic lung disease caused by narrowing of the airways which affects around 440,000 people in Ireland – only half of which are diagnosed.  Like many medical issues there is a strong social and economic cost as  “each COPD admission costs €4,500-€6,000,” says McDonnell. “Improving awareness of the problem is crucial to patient understanding and early treatment.”

Asthma

Ireland has one of the highest rates of asthma (per capita) in the world and it is the most chronic disease affecting children. Asthma is also the most common chronic respiratory disease in adults in Ireland, with 450,000 people with doctor-diagnosed asthma³. “[After cancer] COPD and asthma are the principle illnesses leading to mortality… Raising awareness for the correct use of preventative medication is crucial to improving these rates,” says McDonnell.

Lung cancer

Although, in recent years, cases of lung cancer have been declining in men, the disease is increasing among women. Around 2,300 Irish people are diagnosed with lung cancer every year, with nine out of ten caused by smoking⁴. “Lung cancer is the biggest killer – early detection and early intervention are crucial to improving mortality rates,” says McDonnell.

Sleep apnoea

Sleep Apnoea is a lesser-known respiratory disorder where you stop breathing for a short period during sleep, often due to temporary obstruction of the airways. Dr Elaine Purcell, Sleep Clinic in the Mater Private Hospital says: “the overall incidence is 1 in 20,” but respiratory specialists believe up to 90 per cent of sleep apnoea in adults and children goes undiagnosed. (Purcell, 2013)

Education & awareness

Having worked on developing care and services to treat COPD and general respiratory work at St Vincent’s University Hospital, Professor Tim McDonnell has an important and valuable insight into respiratory health and COPD in Ireland. 

Education in the form of social awareness campaigns have been huge in getting patients aware of the problem.

Often, one of the key elements to improving the success rate of treatments is “early presentation and diagnosis in primary care,” says McDonnell. Identification of symptoms and early consultation with your GP can significantly improve the impact and type of treatment you receive.

“Education is pivotal to prevent the disease [where possible], is pivotal to ensure the patient is diagnosed early and for patient compliance” says McDonnell. Education in the form of social awareness campaigns such as the ‘Save Your Breath Campaign’ and the impact of advocacy groups have been “huge in getting patients aware of the problem”.

Educating patients about the alternatives to smoking, the resources available (i.e. telephone helpline for COPD) and emphasis on the “overwhelmingly positive impact of exercise on respiratory health” are crucial for the nation’s respiratory health according to McDonnell.  Predictions indicate that by 2020, 20 per cent of adults are forecast to have COPD alone. Although not totally representative, this is a rise that highlights the need for both health education and individual action.

If you want to learn more about COPD, visit copd.ie

^{1 Irish Examiner}

^{2 Irish Times}

^{3 HSE, 2017}

^{4 ICS, 2017}

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Breathlessness, chest infections and a chronic cough forced Bernie’s early retirement from Aer Lingus. But she never suspected it would be COPD.

Bernie Leonard was 53 years of age when she was diagnosed with Chronic Obstructive Pulmonary Disease (COPD).

For the former Aer Lingus worker and non-smoker, the diagnosis was a shock. Bernie, from Dublin, had suffered from bad health for years with breathlessness, chest infections and a chronic cough.

Her illness forced her to retire early from the job she’d worked at for 31 years.

I knew my symptoms were serious.

“I haven’t ever smoked and to find out I had COPD was strange as most with the condition have smoked. “But I also knew my symptoms were serious. Finding out it was COPD meant I finally had a name for my suffering when I found out it was COPD. There was an umbrella term for how I was feeling.”

Noticing changes to respiratory health with chest infections

Bernie’s life was busy before her health started to demise in her late 40s. A keen walker, she would exercise daily.

As her condition deteriorated however, so too did her quality of life.

“I went from being someone who was extremely active to housebound and unable to move,” she said. “I went from being able to do any activity I please, to someone who struggled to walk a few steps.”

Life-changing decisions

“I had to retire from my job in Aer Lingus after 31 years at the age of 49. I was an extremely active person. I’d walk every day and got by on an inhaler. From mild asthma to someone who was housebound and unable to even bend down.”

I was housebound and unable to bend down.

Bernie decided to find out more about COPD and why it was so debilitating and isolating for those with the condition. She joined a COPD Support Ireland group in Whitehall and discovered Siel Bleu, a group who organise exercise classes for sufferers of COPD.

Support from others around COPD

“I learned two things from making that change: one, there are so many others like me out there who can offer support and help; and two, people with COPD can exercise, no matter what you might think,” she said. “You have to start with baby steps and even if you can only walk for a minute, you might walk for a minute more the next day and more the day after and so on.

Work together, walk together.

“This year’s World COPD Week means so much to me because there are so many of us in Ireland who want to help others learn about the condition and how we can all help each other and focus on the positives.

COPD can be tough but there is strength in numbers and information is powerful. People can reach out to COPD Support Ireland, join our support groups and get involved. Together we can make the conversation about COPD a powerful one. Work together, walk together.”

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Air quality improvements are very welcome. But we could incentivise people to heed doctors’ advice to not smoke and take regular exercise, says Dr Ross Morgan.

There are huge advances being made in the prevention and treatment of lung diseases in Ireland and internationally. However the fact remains, the biggest improvement in lung health lies in people’s own hands.

Ask anyone which type of cancer kills the most people in Ireland, they normally presume breast… it’s actually lung cancer.

It’s an old message but it still holds true today. To maintain good lung health do not smoke and take regular exercise. Be aware of your lungs. Seek medical attention if you have a persistent or unexplained cough or shortness of breath.

It’s hugely important because lung disease has been a quiet killer. If you ask anyone which type of cancer kills the most people in Ireland, they normally presume it’s breast. But it’s actually lung cancer.

Very few people are familiar with the term COPD,  yet it’s one of the main conditions behind lung disease being a leading cause for people to be hospitalied through the emergency department. Around one in three admissions to Irish hospitals are due to a respiratory condition. These facts still surprise a lot of people.

Cleaner air is a start

Legislators have made huge strides in air quality improvements. Ireland was at the forefront of a global movement to ban smoking in offices and public spaces. If you think back now, it seems truly odd that people were allowed to smoke at the desk next to you or in a pub just 13 years ago.

The move towards hybrid and electric cars is very encouraging too, particularly the switch from diesels. You only have to think about the massive difference moving to clean home-heating fuels has made to air quality improvement to see what this could mean for public health.

The smog we used to regularly see several decades ago has gone. Moving away from cars with harmful emissions can only improve the cleaner air we’re already breathing. Indivuals, though, still have to take personal responsibility for their lung health. Legislators can only do so much.

Old message still holds true

Doctors have been telling people to quit smoking and take regular exercise for decades.

Among many in society the message has started to hit home. However, it’s an area of huge social imbalance in healthcare provision because it tends to be people from a lower socio-economic background who still smoke – in particular, young women.

We’re currently seeing an increase in women presenting with lung cancer.

This will result in a lung disease time bomb ticking away for future generations. We’re currently seeing a increase in women presenting with lung cancer. You don’t immediately get lung cancer from smoking, it will take twenty or thirty years. Smoking rates in women rose from the 1960s and 1970s onwards and even though many will have quit many years ago, the risk of lung disease never returns to that of the non-smoker.

What’s needed is a joined-up national plan to not only educate but also to incentivise people to improve their lung health. If we want to move people away from smoking to less harmful ways of taking nicotine, we need to invest further in preventative strategies. We could consider giving nicotine replacement and other evidence-based ‘quit smoking’ products or harm reduction products away for free.

It makes sense. Just think of the reduction in days taken off work and the reduced cost to the health system in treating what are, in many cases, completely preventable diseases. Together we can push for further air quality improvements.

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Professor Stephen Lane

Consultant Respiratory Physician

People often confuse asthma and chronic obstructive pulmonary disease (COPD). However, when it comes to treatment, there’s a vital difference.

Professor Stephen Lane, Consultant Respiratory Physician at Tallaght Hospital and Peamount Healthcare, says: “Confusion between asthma and COPD is a big issue. Misdiagnosis means treatment may not be effective.”

The National Healthcare Quality Reporting System 2017 report states that in Ireland there are approximately 450,000 people with doctor-diagnosed asthma. Half-a-million people over 40 have COPD with only half of these receiving diagnosis.

What is the difference?

“COPD usually affects people over 40 and the biggest cause is smoking. Asthma, however, can develop at any time of life. Although it is more common in children, it is also very common in adults,” says Lane. People can have both resulting in Asthma-COPD overlap (ACO).

“Because of these age profiles, there is a tendency to diagnose older people who have ‘chestiness’ and wheezing with COPD. However, often they may have asthma (particularly if they have never smoked). Similarly they may have both asthma and COPD (ACO),” Lane says.

There is a tendency to diagnose young people with asthma, and older people with COPD.

You treat both diseases with inhaled drugs. In the past you could treat both with a combination of an inhaled corticosteroid and a long-acting β2-agonist (LABA). Both treatments are tailored to each disease.

For COPD, inhaled corticosteroids are no longer recommended as first-line treatment. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines now recommend bronchodilators as first line treatment, initially a long-acting muscarinic antagonists (LAMA). If necessary, a long-acting β2-agonist (LABA) can be added for more severe cases, where both are commonly packaged together for optimum effect.

For asthma, however, the Global Initiative for Asthma (GINA) guidelines recommend inhaled corticosteroids as the first-line treatment to tackle the inflammation, which is a greater feature of asthma than of COPD.

The risks of misdiagnosis COPD and asthma

“If you use LAMAs and LABAs as first-line treatment for asthma (or combined asthma and COPD), you risk not fully treating the inflammation caused by the asthma,” says Lane. “Hence, early and accurate diagnosis is vital.”

If you treat COPD with inhaled corticosteroids you are increasing the risk of pneumonia.

To sum up, Lane says: “For a patient with chestiness and wheezing, who is a heavy smoker and over 40, a COPD diagnosis is likely correct. They may also have asthma if they were chesty as a child or have allergies (ACO). You treat COPD with LAMA and LABAs. You can treat asthma with inhaled corticosteroids. Treating asthma or ACO with LAMA and LABA may worsen the condition and treating COPD with inhaled corticosteroids may cause pneumonia. Thus it is important to get the diagnosis right.”

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Lung cancer is one of the most common cancers in Ireland, and sadly, more Irish people die from lung cancer than any other cancer. Here is what you need to know: to reduce your risk of getting cancer.

The statistics on lung cancer

• Around 2,500 people in Ireland get lung cancer each year.
• Lung cancer accounts for one in five cancer deaths here.
• Often, lung cancer is only diagnosed at a late stage, meaning that it is more difficult to treat and there is less chance of cure.
• Lung cancer usually affects people over 40, but the average age of diagnosis is about 70.  

But what causes lung cancer?

Here are a few factors that may increase your risk:

• Smoking causes almost nine in ten lung cancers; the sooner you stop smoking, the more you reduce your risk of getting cancer
• Breathing in other people’s smoke (second-hand smoke)
• A family history – having a parent, brother or sister with the disease – indicates an increased risk
• Being exposed to certain chemicals such as asbestos, metal dust, paints and diesel exhausts
• Being exposed to radon gas in areas where levels are high also puts you in more danger

It’s important to note that having a risk factor doesn’t mean that you’ll definitely get lung cancer.

It’s never too late

Make some lifestyle changes that can reduce your risk of getting cancer:

1. Don’t smoke – this is by far the most important thing you can do to reduce your risk of getting cancer. Cigarettes, pipes, cigars, ‘roll-ups’ and low-tar cigarettes all increase the risk. It’s never too late to quit.
2. Avoid second-hand smoke.
3. Look out for any changes that are not normal for you.
   Talk to your doctor if you notice anything unusual, such as pain, unusual bleeding or new symptoms that don’t clear up after a few weeks.

If you do get lung cancer, you can beat it!

One of the most effective ways of surviving this disease is by early detection and diagnosis. If you spot any of the following symptoms, talk to your doctor:

• Difficulty breathing or wheezing
• A cough that doesn’t go away, or a change in a long-term cough
• Repeated chest infections that won’t go away
• Feeling more tired than usual
• A hoarse voice
• Coughing up blood-stained phlegm
• Pain in your chest, especially when you cough or breathe in
• Loss of appetite or weight loss
• Swelling around your face and neck
• Difficulty swallowing  

Having any one symptom doesn’t automatically mean you have lung cancer. In fact, there’s a good chance it won’t be cancer. But getting your symptoms checked is not wasting anyone’s time. The sooner cancer is spotted, the more likely you are to recover from it.

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