Dr. Edward McKone:

I thank the Chair, Professor Crown for inviting us to speak to the committee today, and the Senators and Deputies. I want to talk to them about lung disease. It is an extremely important public health challenge. Lung disease is any disease, or medical condition, that affects the lungs. It includes conditions, as mentioned, that are related to smoking such as COPD and lung cancer but also, as members can see from the groups represented here, many other conditions that are not related to smoking such as asthma, cystic fibrosis, sleep apneoa and lung fibrosis as well as genetic conditions such as CF and alpha 1-antitrypsin deficiency. The symptoms of lung disease include breathlessness, cough and wheeze, among others. It is important to emphasise that breathlessness is an extraordinary difficult symptom with which to live. We look after patients who have severe breathlessness. They feel like they are breathing through a straw all the time, they are very disabled, they feel a sense of panic all the time because of the sensation of breathlessness and this is because of respiratory disease. It is important to emphasise the level of disability that takes place in the Irish population because of lung disease.

Lung disease is extremely common in Ireland. One in five people in Ireland will die of a respiratory or lung disease. It is the second most more common reason for admission to any acute medical hospital in the country and in this respect Ireland has the second highest mortality rate in Europe. It is the most common reason for people attending their GPs and the annual cost involved in 2006 was around €560 million.

If one notes how outcomes have changed for people with respiratory disease over time, one will see there has been no impact in that respect during the past ten years. If one compares that to outcomes achieved by our colleagues who look after people with coronary artery disease, one will note that they, through a very concerted public health programme, have seen a dramatic reduction in coronary artery disease deaths over ten years, which is now less than that of respiratory disease.

What are the big challenges that face respiratory disease and that have led to a lack of public awareness of it and a lack of public policy to improve outcomes for people with respiratory disease? The first is a lack of awareness of the condition both among policymakers and among people who have the disease. We recognise that the symptoms of lung disease such as breathlessness are often put off to other factors such as not being fit or getting older when in fact there is disease present. Therefore, people present with quite advanced disease whereby it is very difficult to treat and very difficult to recover lung function. Another issue is the public perception of respiratory disease. People perceive lung disease to be all about a lifestyle choice because of cigarette smoking. The majority of lung disease is not smoking-related. Public policy impacts on reducing exposure to smoking, and although we support it in every sense because it does impact on the incidence of lung disease, there are still many cases of lung disease that will not be affected by this. Outcomes in Ireland are already poor despite having relatively low smoking rates compared to other European countries where outcomes are better.

Another issue which is important to mention is that respiratory disease is a disease of the poor. There is a four times higher incidence of chronic bronchitis in people who have a poor background, a two times higher mortality rate for conditions such as pneumonia and COPD if one is in the lowest socioeconomic class, and a four times higher mortality rate for lung cancer and TB. ITS data that we collected on World Spirometry Day recently identified that one in five people had abnormal lung function who never had a history of lung disease and of those the two biggest predictors of whether they had lung problems was whether they smoked, which we expected, but also their educational level. People who did not get an education level beyond junior certificate had much lower lung function than those who got to leaving certificate or beyond.

Another issue, which is an important reason we are here today, is that there has been a lack of a clear message about lung disease in the past. Twelve charities were focusing on different lung diseases with no cohesive message but in past year we have come together as a group to form lung health alliance to promote lung health as best we can. That is what we have been doing and we have been doing this through the World Spirometry Day, the Love Your Lungs campaign, about which members will hear more later.

Lung disease is a huge public health challenge. It has not been addressed properly and we need to work together to develop a national public health strategy to improve lung health outcomes and increase awareness of lung disease.