Breathing is one of those things that you don’t really think about until you’re unable to do so.
The Covid-19 pandemic was a jarring reminder of the importance of lung health, especially during the early days when the public went on a very steep learning curve on various respiratory issues – from the importance of wearing face masks to prevent respiratory infections, to the use of ventilators when the lungs fail.
However, lung diseases have been a clear and present danger even before the pandemic.
Despite its ubiquity, lung diseases do not receive as much attention as other conditions such as heart disease, diabetes and cancer.
For World Lung Day, which happens to fall today (Sept 25), the Forum of International Respiratory Societies (FIRS) has decided to highlight the impact of “The Big Five Respiratory Diseases”.
COPD kills more than three million people annually, making it the third-leading cause of death worldwide.
This progressive, non-curable disease is estimated to affect at least half a million Malaysians, although it is well-known to be underdiagnosed, and therefore, undertreated.
Besides increasing breathlessness and coughing, it is characterised by systemic symptoms, such as increased cardiovascular (heart) problems and weakening of skeletal muscles.
The most significant risk factor for COPD is tobacco – smoking destroys lung tissue and obstructs the airways due to inflammation and mucous, leading to the characteristic “smoker’s cough” and bronchitis that are associated with COPD.
Other factors that increase the risk are air pollution, secondhand smoking and childhood respiratory diseases.
Asthma is a condition where the airways become inflamed and more sensitive, leading to symptoms such as chest tightness, wheezing, coughing and breathlessness.
The frequency has been increasing over the past three decades, especially as society becomes more urban-centric, and we become more exposed to air pollutants and asthma triggers both indoors and outdoors.
The vast majority of asthma patients can be well-controlled with the appropriate use of existing inhaled medications, especially inhaled steroids.
However, more needs to be done to improve accessibility, as well as to raise awareness on the need for better disease control.
Globally, pneumonia kills more than HIV (human immunodeficiency virus) infection, tuberculosis and malaria combined.
It is also the second-leading cause of years or life lost due to premature death, and one of the most frequent reasons for hospitalisation.
The statistics are abysmal.
Four out of five pneumonia deaths occur in those under the age of two and those above the age of 65. One child dies from pneumonia every 20 seconds.
It also happens to be leading cause of death among women in Malaysia (12.8% of deaths in women in 2019) and is second only to ischaemic heart disease among men.
Despite these deplorable numbers, the majority of pneumonia and its complications are largely preventable with the use of existing vaccinations.
Once again, improving accessibility and awareness will lead to far better outcomes.
On Oct 14, 2021, the World Health Organization (WHO) released its annual global report on TB, which shows that TB deaths have risen for the first time in more than a decade due to the Covid-19 pandemic.
TB has been with us since biblical times, and still causes 1.5 million deaths annually – mostly among children under the age of five and adults 20-35 years old.
It claims up to 2,000 lives in Malaysia every year, the majority of which occur due to delays in seeking medical treatment.
Although the majority of patients have lung involvement, TB can affect any part of the body.
Its onset is usually insidious, with characteristic symptoms including a persistent cough, fever, weight loss and night sweats.
Deaths, both global and domestic, occur disproportionately in the poorer and more marginalised segments of society, reflecting the role of socioeconomic circumstances in obtaining good outcomes.
Lung cancer is the deadliest of all cancers.
The five-year relative survival rate is approximately 10%.
In other words, in a group of 100 patients with lung cancer, approximately 10 will be alive after five years.
This is primarily due to the fact that more than 90% of patients are only diagnosed when the disease has advanced to stage 3 or 4, where it can be controlled, but not cured.
As many of us know, the largest single modifiable risk factor for lung cancer is tobacco smoking.
The many chemicals in tobacco smoke cause undesirable mutations to the genes that protect our lungs, as well as those that promote cancerous changes.
The risk of lung cancer increases with the intensity and duration of smoking.
Improving lung health
There are various factors associated with poor lung health, such as:
- Socioeconomic deprivation
- Smoking
- Vaping
- Air pollution
- Poor nutrition
- Lack of immunisation
- Climate change
Patient outcomes can be vastly improved by ensuring that we have the appropriate policies to tackle these factors.
These can include specific targeted policies such as the Generational Endgame (where those born after 2007 are not allowed to purchase/use cigarettes in all forms) to broader approaches that reduce carbon emissions or introduce mechanisms to protect workers from inhaling toxic fumes.
Increasing health literacy and addressing poverty, overcrowding and poor living conditions will go a long way to reducing the death and impact on daily function for those who suffer from respiratory conditions.
Breathing clean air and going about our daily lives is not something we can take for granted.
As we edge ever closer to election season, it would be worth asking our leaders to provide their policy proposals to address these very pertinent issues.
Dr Helmy Haja Mydin is a consultant respiratory physician and and the Technical Advisor to the Health Minister on tobacco control. He would like to acknowledge and credit FIRS for the data provided. For further information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
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