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Lung disease left out in the cold
Editorial
Lung disease kills over 115 000 people per year in the UK—equivalent to one death every 5 min. This was the headline statistic of The Battle for Breath, a recent report by the British Lung Foundation that summarised findings of an epidemiological analysis of respiratory health in the UK over the last 3 years. The burden is worryingly high, but perhaps more concerning is the fact that the figure is roughly the same as it was 10 years ago. By comparison, between 2009 and 2013, deaths from heart disease went down by 17% in the UK. The problem isn’t limited to the UK. Data from the Centers for Disease Control and Prevention in the USA show that, of the top three causes of death, chronic lower respiratory disease saw by far the smallest reduction in age-adjusted mortality between 2005 and 2014; while deaths from heart disease declined by 33% and deaths from cancer by 13% in that time, mortality due to chronic lower respiratory disease declined by only 8%. Lung cancer and COPD research are underfunded in both the UK and the USA, indicating a lack of enthusiasm for tackling lung disease. A 2015 analysis of cancer research funding compared with societal burden found that funding for lung cancer was not proportionate to the disease’s burden on society, and while lung cancer accounted for almost 26% of cancer deaths in the UK, it received only 6% of funding. Similarly, an analysis of the correlation between US National Institutes of Health funding and disability-adjusted life-years lost to disease found that COPD and lung cancer were among the most underfunded conditions, and although pneumonia and asthma fared slightly better, neither received funding that matched the disability-adjusted life-years lost to them. This is, in part, because lung disease has an image problem. Much of this is related to stigma and a lack of awareness about symptoms. A study of lung cancer patients found that both ever and never smokers experienced stigma and that this led to depression and reduced quality of life. It is no wonder that up to 38% of lung cancer diagnoses in the UK aren’t made until an emergency admission to hospital. The situation for COPD is similar, with widespread late diagnosis. Despite being the third leading cause of death worldwide, COPD is still very poorly understood in the general population. www.thelancet.com/respiratory Vol 4 July 2016
Other previously stigmatised conditions, such as HIV and mental illness, have seen widespread and effective campaigns to reduce social stigma and thereby improve diagnosis and treatment. In the case of lung cancer and COPD, however, the situation is more complex because a major aim of anti-smoking campaigns has been to de-normalise smoking. These campaigns have been highly effective, driving down smoking rates in most high-income countries; however, the de-normalisation of smoking has also led to increased levels of stigma, and this is detracting from efforts to combat smokingrelated respiratory diseases. Anti-smoking campaigns need to focus on de-normalising smoking without demonising smokers, and should emphasise that quitting has health benefits at any stage of life. Tobacco addiction must be better recognised as an illness, and patients treated accordingly, to encourage smokers to seek medical help without shame or fear. Patient champions could also play a vital part in improving public understanding of chronic lung disease. Patient bloggers, fundraisers, and campaigners have helped to raise the profile of a range of diseases, and although there are some vocal champions who have survived or who are currently undergoing treatment for lung cancer, there are far fewer patient champions for diseases such as COPD, idiopathic pulmonary fibrosis, and bronchiectasis. If patients with these diseases could be encouraged to speak out about their experiences, it could do much to improve public understanding and visibility of chronic respiratory diseases. Respiratory disease is a major cause of morbidity and mortality in every country worldwide and its negative impact is only likely to increase in the future. Global climate change, coupled with an increase in smokingrelated disease and rising obesity rates in low-income and middle-income countries, and air pollution globally could combine to cause a health crisis unless the issue is taken seriously by governments, funding bodies, and the public. For this to happen, perceptions must change. Awareness campaigns about early symptoms could encourage more timely diagnosis of conditions such as COPD and lung cancer, but efforts should not stop there. The stigma associated with lung disease needs to be removed and the social and psychological barriers to early diagnosis must be overcome. ■ The Lancet Respiratory Medicine
Dr Gary Settles/Science Photo Library
Lung disease left out in the cold
For the British Lung Foundation report see https://cdn.shopify. com/s/files/1/0221/4446/files/ The_Battle_for_Breath_FINAL_ lr.pdf?3097671307211108218 For the CDC dataset see http:// www.cdc.gov/nchs/data/hus/ hus15.pdf#019 For the analysis of cancer research funding see http:// health-policy-systems. biomedcentral.com/ articles/10.1186/s12961-0150050-7 For the analysis of NIH funding and disability-adjusted life-years see PLoS One 2011; 6: e16837 For the study of lung cancer patients and depression see Eur J Oncol Nurs 2012; 16: 264–69 For the campaigns of other stigmatised conditions see J Int AIDS Soc 2013; 16 (suppl 2): 18734 and Br J Psychiatry 2015; 207: 377–84
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Lung disease kills over 115 000 people per year in the UK—equivalent to one death every 5 min. This was the headline statistic of The Battle for Breath, a recent report by the British Lung Foundation that summarised findings of an epidemiological analysis of respiratory health in the UK over the last 3 years. The burden is worryingly high, but perhaps more concerning is the fact that the figure is roughly the same as it was 10 years ago. By comparison, between 2009 and 2013, deaths from heart disease went down by 17% in the UK. The problem isn’t limited to the UK. Data from the Centers for Disease Control and Prevention in the USA show that, of the top three causes of death, chronic lower respiratory disease saw by far the smallest reduction in age-adjusted mortality between 2005 and 2014; while deaths from heart disease declined by 33% and deaths from cancer by 13% in that time, mortality due to chronic lower respiratory disease declined by only 8%. Lung cancer and COPD research are underfunded in both the UK and the USA, indicating a lack of enthusiasm for tackling lung disease. A 2015 analysis of cancer research funding compared with societal burden found that funding for lung cancer was not proportionate to the disease’s burden on society, and while lung cancer accounted for almost 26% of cancer deaths in the UK, it received only 6% of funding. Similarly, an analysis of the correlation between US National Institutes of Health funding and disability-adjusted life-years lost to disease found that COPD and lung cancer were among the most underfunded conditions, and although pneumonia and asthma fared slightly better, neither received funding that matched the disability-adjusted life-years lost to them. This is, in part, because lung disease has an image problem. Much of this is related to stigma and a lack of awareness about symptoms. A study of lung cancer patients found that both ever and never smokers experienced stigma and that this led to depression and reduced quality of life. It is no wonder that up to 38% of lung cancer diagnoses in the UK aren’t made until an emergency admission to hospital. The situation for COPD is similar, with widespread late diagnosis. Despite being the third leading cause of death worldwide, COPD is still very poorly understood in the general population. www.thelancet.com/respiratory Vol 4 July 2016
Other previously stigmatised conditions, such as HIV and mental illness, have seen widespread and effective campaigns to reduce social stigma and thereby improve diagnosis and treatment. In the case of lung cancer and COPD, however, the situation is more complex because a major aim of anti-smoking campaigns has been to de-normalise smoking. These campaigns have been highly effective, driving down smoking rates in most high-income countries; however, the de-normalisation of smoking has also led to increased levels of stigma, and this is detracting from efforts to combat smokingrelated respiratory diseases. Anti-smoking campaigns need to focus on de-normalising smoking without demonising smokers, and should emphasise that quitting has health benefits at any stage of life. Tobacco addiction must be better recognised as an illness, and patients treated accordingly, to encourage smokers to seek medical help without shame or fear. Patient champions could also play a vital part in improving public understanding of chronic lung disease. Patient bloggers, fundraisers, and campaigners have helped to raise the profile of a range of diseases, and although there are some vocal champions who have survived or who are currently undergoing treatment for lung cancer, there are far fewer patient champions for diseases such as COPD, idiopathic pulmonary fibrosis, and bronchiectasis. If patients with these diseases could be encouraged to speak out about their experiences, it could do much to improve public understanding and visibility of chronic respiratory diseases. Respiratory disease is a major cause of morbidity and mortality in every country worldwide and its negative impact is only likely to increase in the future. Global climate change, coupled with an increase in smokingrelated disease and rising obesity rates in low-income and middle-income countries, and air pollution globally could combine to cause a health crisis unless the issue is taken seriously by governments, funding bodies, and the public. For this to happen, perceptions must change. Awareness campaigns about early symptoms could encourage more timely diagnosis of conditions such as COPD and lung cancer, but efforts should not stop there. The stigma associated with lung disease needs to be removed and the social and psychological barriers to early diagnosis must be overcome. ■ The Lancet Respiratory Medicine
Dr Gary Settles/Science Photo Library
Lung disease left out in the cold
For the British Lung Foundation report see https://cdn.shopify. com/s/files/1/0221/4446/files/ The_Battle_for_Breath_FINAL_ lr.pdf?3097671307211108218 For the CDC dataset see http:// www.cdc.gov/nchs/data/hus/ hus15.pdf#019 For the analysis of cancer research funding see http:// health-policy-systems. biomedcentral.com/ articles/10.1186/s12961-0150050-7 For the analysis of NIH funding and disability-adjusted life-years see PLoS One 2011; 6: e16837 For the study of lung cancer patients and depression see Eur J Oncol Nurs 2012; 16: 264–69 For the campaigns of other stigmatised conditions see J Int AIDS Soc 2013; 16 (suppl 2): 18734 and Br J Psychiatry 2015; 207: 377–84
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