Lung-suffering generation

AS a consultant respiratory physician, Dr Neil Munro is at the sharp end of the North-East’s lung disease epidemic. Every time he holds a chest clinic at the University Hospital of North Durham or Shotley Bridge Hospital, he is presented with patients who are coughing, wheezing and struggling to breath.

Twenty years ago, these patients were elderly retired miners, suffering from the effects of working in an environment where they inhaled coal dust every day.

But virtually all the old pitmen are gone now and the people he sees are sometimes men and women as young as 30 who are suffering from the results of years of inhaling tobacco smoke.

In both groups of patients, the diagnosis is that large amounts of lung tissue have been irreversibly damaged or destroyed, making it increasingly difficult to breathe or carry out the simplest of physical tasks.

What is particularly galling for Dr Munro – and for other chest specialists across the region – is that the modern victim of this terrible disease have brought this life-shortening illness on themselves. While you could argue the miners of old breathed in coal dust involuntarily, their descendents have been willingly filling their lungs with tobacco smoke for years.

Dr Munro wants to see more people made aware of smoking-related lung disease, now known as chronic obstructive pulmonary disease, or COPD – because, he reasons, if they knew more about what it does to your ability to breathe, they will think twice before lighting up another cigarette.

“COPD is an umbrella term which covers what we used to call chronic bronchitis and emphysema,” says Dr Munro.

Since Fresh, the North-East tobacco control agency, commissioned a hard-hitting TV ad about COPD – which borrowed the title of one of The Police’s biggest hits, Every Breath You Take – more of Dr Munro’s patients are familiar with the term.

“The Fresh advertising campaign has been very useful. Quite a few of the people I see have said they recognised the symptoms of COPD from the TV advert,” says Dr Munro.

COPD is caused by the inhalation of tobacco smoke, which contains toxic particles and trace elements of a host of dangerous chemicals that irritate the lung, forcing the owner to cough and produce more protective phlegm.

In time, the effect of the smoke gradually degrades the lung tissue and makes it more of an effort to process the air that we breathe.

The declining efficiency of the lungs means the patient finds it more and more difficult to do everyday tasks that we take for granted.

Eventually, the very worst cases have to rely on bottled oxygen in their homes – or, if they are young and fit enough, to be considered for a lung transplant. “One of my patients, a chap in his 40s who had severe emphysema but was still relatively fit, had a lung transplant last month,” the consultant says.

But the patients who get a new lease of life as the result of a transplant are rare and incredibly lucky because organs are in short supply.

The vast majority of COPD patients have to cope with their condition by taking an increasing amount of medication, although their quality of life will deteriorate the older they get.

“When I see people with COPD, they commonly will have smoked cigarettes. They have breathlessness and a cough which produces plenty of sputum, or phlegm,” he says. “If they continue to smoke, these symptoms continue to get worse. Stopping smoking is the only thing that has been shown to improve their condition.

The message is: it is never too late to stop.”

Even patients with quite advanced COPD will see some benefit in terms of reduced symptoms and a longer life expectancy.

“If you are a smoker, you are likely to start getting symptoms in your 40s and 50s, but many people will get symptoms in their 30s. These will steadily worsen if you continue to smoke.”

As far as treatment is concerned, most will start on inhaled medication to open up their bronchial tubes, combined with steroids to reduce inflammation. “This usually results in less phlegm, fewer chest infections and better quality of life,” he adds.

PATIENTS are also invited to take part in pulmonary rehabilitation, exercise programmes designed to help them live a fuller life by making the most of their lung tissue.

Some are breathing exercises, others involve teaching patients how to move more economically so they do not use as much breath.

The more seriously affected patients are prescribed home oxygen.

“When oxygen levels in the blood are persistently low, they can’t get the oxygen they needout of the air, so we put them on oxygen. If you get to this stage, 16 hours a day on oxygen is the minimum you need to keep going.”

While he urges everyone referred to him to give up smoking immediately, he makes a particularly pointed appeal to younger people, especially if they also smoke cannabis mixed with tobacco, which seems to have an even more destructive effect on lung tissue.

He points to studies which have shown that as soon as you stop smoking the decline in your lung function slows down.

“The key thing is to stop smoking now to try to preserve what lung function they have left. Quit now, while you are ahead, is my message.”

• If you want to quit smoking contact the County Durham and Darlington NHS Stop Smoking Service on 0800 0113405