The respiratory health of the nation

Dr Aidan O’Brien

Consultant Respiratory Physician, and President, The Irish Thoracic Society

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.