COPD: From terminal illness to lifelong lung health
Chronic Obstructive Pulmonary Disease (COPD) has too long been viewed as a progressive, self-inflicted smoking disorder late in life with few treatment options beyond symptom control. There have been no major advances in treatment or prevention for decades. The global burden of COPD is expected to continue to increase in the future. To achieve better results and ultimately prevent at least some forms of COPD, a complete overhaul is needed. A new Commission published in The Lancet, Towards the elimination of chronic obstructive pulmonary disease, provides the framework. He proposes classifying COPD into five different types based on major risk factors – genetics, early events, lung infections, exposure to tobacco smoke and air pollution – to draw attention to the potential for intervention. and early prevention.
Tobacco exposure remains an important risk factor for COPD. New Zealand is aiming to be the first country to eliminate tobacco use by introducing legislation for a so-called smoke-free generation, gradually raising the age at which cigarettes can be legally purchased. Anyone born on or after January 1, 2009 will not be allowed to buy cigarettes. The legislation will also drastically reduce the nicotine content of cigarettes and only allow them to be sold in dedicated stores. The New Zealand parliament passed the first bill on July 26. Other countries, such as Denmark and Malaysia, are considering similar rules. However, vaping will continue to be allowed in New Zealand and tobacco companies are already shifting their marketing efforts towards electronic nicotine delivery systems (ENDS), under the guise of helping people quit smoking. However, ENDS often contain more nicotine than cigarettes, and many target teens and young adults using appealing designs and flavors. They contain chemicals that are harmful to the lungs and whose long-term effects are likely to contribute to the burden of COPD. The best outcome for lung health is for tobacco and vaping to be eliminated worldwide.
Indoor and outdoor air pollution are increasingly important risk factors for COPD that require urgent attention. Indoor air pollution has a disproportionate effect on women in low- and middle-income countries because of indoor stoves that use wood, biomass or charcoal. So far, attempts to introduce cleaner cookstoves have not been successful despite clear evidence of improved health effects due to cost, cultural habits and a lack of knowledge about the consequences of traditional indoor cooking. Outdoor air pollution and wildfires also affect many people around the world with cumulative chronic lung damage. The UN resolution that everyone has the right to a healthy environment, adopted on July 28 this year, is a step in the right direction. Every healthcare worker must defend the right to clean air.
Early childhood events are not routinely considered in the context of COPD. A consequence of better survival of babies born prematurely is that more will reach adulthood with small lungs or lungs damaged by chronic lung disease of prematurity. Yet lung function is not routinely tested in young people born prematurely and those with obstructive lung disease are not asked about their birth history. Monitoring patients after such early events could lead to new disease-modifying treatments, as well as form the basis of screening and risk prediction policies. Lung health should be monitored similarly to heart health by testing blood pressure and blood lipids before organ damage is apparent and irreversible. Prevention of further lung injury in this group is particularly important. Lung infections, including COVID-19, tuberculosis, and lower respiratory tract infections are currently not often recognized as risk factors for COPD, which could develop later in life.
The lung is an incredible organ. It has 2400 km of airways and 300 to 500 million alveoli. Yet traditionally, the lung does not receive attention until a disease is diagnosed. The two most common lung diseases, asthma and COPD, have no clear definition beyond a physiological description. Currently, a COPD diagnosis often comes with a sense of futility and a degree of stigma. This Commission, by highlighting risk factors across the lifespan and recommending far-reaching measures for prevention, early diagnosis and treatment changes, aims for nothing less than to transform the way COPD is thought. Lung health for all throughout life is the goal to aspire to.
Posted: September 05, 2022
© 2022 Published by Elsevier Ltd.
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