Professor Tim McDonnell:

Deputy Colreavy spoke about social deprivation and the link to respiratory diseases. It is particularly acute in chronic obstructive pulmonary disease, COPD, because of co-factors with smoking and a past history of smoking clearly related to deprivation. Early intervention makes a difference in these diseases and people in lower socioeconomic groups have poor access to health care and we know this. On the other side of the coin, as one goes through life with COPD one falls down the economic ladder because one suffers from winter infections, one cannot turn up for work, one gets passed over for promotion, one loses one's job and one must go on disability benefit. It has a social impact as well as being promoted by social factors.

Deputy Doherty asked about nihilism. Perhaps I was nihilistic about it. A huge positive message is coming out at present about COPD. Mr. McGloin has been on oxygen for six years and despite this he will take on running the support group when we get going. An issue is slowness with regard to establishing a COPD support group. This is an international issue not just an Irish one. Very few good COPD support groups exist in other countries. The British Lung Foundation is an umbrella organisation which looks after COPD. The United States has a separate COPD support group. The factors for this include that many of the patients are socioeconomically deprived and by the time many of them are aware of the problem and want to do something about it, they are significantly disabled. There is also a little bit of embarrassment. I have known politicians with the disease who did not want to be involved with a support organisation. There is a huge positive message because the drugs have improved and improvements are being made. COPD tends to be at the bottom of the queue.

We are dealing with real numbers in terms of getting the programme going. We can say we have 100,000 patients and we are fairly confident 200,000 people have not been diagnosed, which comes to Deputy McLellan's point about making a diagnosis. We know spirometry is available in some general practices. It is a relatively simple test but it requires training. This training goes to practice nurses who get pulled to look after all of the other issues. We are running a course at the moment, which is accredited through DIT and has European accreditation. However, we have a feeling some of the people who do the course and go back to their practices will get pulled to look after diabetes patients, blood pressure monitoring, vaccination and everything else. The COPD programme may have to consider something else but in the current climate we went for the most cost-effective option available. We probably require outreach spirometry from hospitals. Deputy Doherty spoke about experience from other countries. In Scotland spirometry is done through outreach, as is the case in Denmark and the Netherlands. Of course this costs money.

Deputy Byrne mentioned housing. Anecdotally I have been examining requests for disability stickers for patients with bad COPD. Dún Laoghaire-Rathdown County Council did not provide them for lung disease for a long time and one had to write letters and create hassle, whereas those with cardiac disease automatically received a sticker. Most of those respiratory patients seeking disability stickers were COPD patients, but patients with respiratory disease in general suffered also.