Professor Tim McDonnell:

I echo my colleagues' thanks to the members for having us here today. In particular, I thank Senator John Crown for organising the invitation.

I have a problem in that most people do not know what chronic obstructive pulmonary disease, COPD, is. It is a chronic disease of the lungs associated with narrowing of the airways. It produces two problems primarily, namely, difficulty with breathing and a propensity to get infections or exacerbation of symptoms that may lead to the patient seeking medical care, either through the general practitioner or in hospital. Patients are very numerous. In the winter, many end up on trolleys, thus contributing to many of the difficulties in emergency departments of which we are well aware.

There is confusion over the disease and people ask whether it is asthma. The name is a difficulty for patients. Many COPD patients with whom I deal tell me they have asthma, COAD or smoker's asthma. COPD is different from asthma. We have heard from my colleague about asthma. Asthma tends to be associated with younger patients and to be more reversible. COPD is a progressive disease that tends to get worse as one goes through life. It is different and tends to affect a different spectrum of the population. Diagnosis is on the basis of a simple spirometer test that examines airflow reduction. It ought to be easily available but unfortunately it is not. It is available only in perhaps 50% of general practitioners' surgeries. That is certainly a problem.

The disease is certainly very common. We have heard a lot of figures today. Much of the problem in the Irish health care system is associated with the provision of accurate figures but we reckon there are approximately 100,000 patients in the country diagnosed with COPD. Perhaps 200,000 more have not been diagnosed. The disease is becoming more common with increasing age. Canadian figures show that approximately one in four people who reach the age of 70 will need treatment for COPD.

We know there are at least 12,000 admissions to hospitals with the disorder each year. There are probably more, but 12,000 are directly related to COPD. Unfortunately, 1,400 people die from COPD every year. To put that in perspective, approximately 1,400 people die annually from lung cancer, which we now know is the biggest cancer killer in the country. COPD, therefore, is a significant cause of morbidity and mortality in patients. It is probably the most frequent reason patients with chronic diseases are admitted to hospital, and is a frequent cause of readmission to hospital. Many of my patients with COPD require multiple admissions. Given that the average length of stay of patients in hospital is approximately nine to ten days, it involves their being in hospital for a quite considerable period.

COPD is predominantly caused by smoking, but not all cases are related to smoking. We have heard already that alpha 1-antitrypsin deficiency can be a contributor. People who are born prematurely may have difficulty with it. It is associated with deprivation and tends to reflect poor nutrition, for example. Unfortunately, smoking is a considerable factor. Many patients with COPD are ex-smokers. An individual who has given up smoking for ten or twenty years may have done enough damage to his lungs to present with COPD. It is not fair to say the problem can be addressed by stopping smoking. Many people who have chosen to give up smoking are inflicted with the disease some time later.

Why is there so little public recognition of the disease? The name is a problem. We have already heard about bronchitis and emphysema. COPD is, pathologically, bronchitis and emphysema. It is a kind of catch-all phrase for chronic bronchitis and emphysema. It is difficult for patients to remember the terms "COPD" and "chronic obstructive pulmonary disease". The disease takes decades to develop and patients sometimes attribute symptoms to the ageing process. They may say they are short of breath because they are getting older but it is actually because their lungs have been damaged. COPD is more common in poorer social groups. I do not need to tell members that poorer social groups tend to receive poorer health care and poorer solutions to their problems. The chronicity of the disease is associated with the degree of guilt. Perhaps people are less likely to demand resources for smoking-related problems. People get used to the disease developing slowly and just do not seek resources.

Along with certain colleagues, I did not study respiratory medicine to look after COPD patients; I was interested in the more exciting end of respiratory medicine. However, I ended up working with COPD. Nihilism has been part of the problem until very recently. Doctors and nurses were not really interested in looking after patients with COPD, and this reflected the public mood. That is changing for the good, and bodies such as the Irish Lung Health Alliance and the Irish Thoracic Society are certainly pushing the agenda, but there has been, both in Ireland and elsewhere, a lack of awareness of and interest in dealing with the problem.

We have heard about various patient advocacy groups today. As of yet, there is not a properly formulated group to support COPD patients, who amount to a considerable number. Mr. McGloin, who travelled here this morning from Sligo, is the chairman elect of COPD Support Ireland, which is in the process of being formed. There has been significant neglect regarding this very common and troublesome disease.

One of my roles is that I am the clinical lead for chronic obstructive pulmonary disease, COPD, in the Health Service Executive's clinical strategies and programme directorate. This has been established for several years. It was originally under Dr. Barry White and more recently under Dr. Áine Carroll. The idea behind the programme is to reduce morbidity and mortality from COPD through several initiatives.

The COPD outreach service allows patients who would ordinarily be admitted to hospital with COPD exacerbations to be dealt with at home or discharged from hospital earlier. This has been pioneered by Professor Gerry McElvaney's colleague in Beaumont Hospital, Professor Richard Costello. This outreach programme is being rolled out in 12 other sites across the country. We have had great success so far but we have had to start in several places with limited staff because of the recruitment pause which has shackled us somewhat.

Many COPD patients can be treated in primary care centres. We have been examining strategies to get spirometry out to primary care centres so diagnosis can be made at that level. We also have pulmonary rehabilitation, an integrated programme for looking after patients with COPD. It primarily revolves around exercise and is a very beneficial programme. We have been trying to spread this programme around the country.

Cost effectiveness is important for the COPD programme. With the events of yesterday bringing money to the fore again, we need to show we are producing benefits for the taxpayer. Already the programme has demonstrated a reduction in the average length of stay in hospital for patients. Between 2008 and 2011, we reduced the number of bed-day units required for patients with this disease by 10,000. We are demonstrating some return on investment for the taxpayer.