Risk factors associated with lung disease

Risk factors associated with lung disease:
A major problem facing modern populations
___
By Thomas Smith
Introduction
Lung disease is responsible for 20.1% of United Kingdom (UK) deaths, which is one every 5 minutes, 12 an hour, or 228 a day and only 2.5% less than all non-lung cancers 1 with many deaths being preventable. This is a key issue for the UK at present and there is a need to reduce lung disease and deaths from these.
The modern world is filled with a multitude of factors that can exacerbate lung disease such as pollution from cars and smoking There are 12.7 million British people with a diagnosed lung disease, and that cause 700,000 hospital admissions annually, taking up 6 million patient bed days 1, costing the NHS £9.9 Billion and the UK an extra £1.2 Billion through work days lost per annum 2. Asthma and Chronic Obstructive Pulmonary Disease (COPD) are amongst the main causes for concern and are associated with the highest number of hospital admissions and mortalities. This is an area where measures to make improvements in the human, and economic effects of lung diseases need to be addressed. It is imperative that through research and public education which addresses risk factors directly that the incidence of lung disease can be reduced.
The following assignment will focus on the main lung diseases of asthma, pneumonia, chronic obstructive pulmonary disease (COPD), and lung cancer, and will consider the key risk factors such as vehicles/air pollution and smoking affect these conditions.
Common Lung Diseases
Asthma:
Asthma affects over 8 million people in the UK 3 and although a manageable condition there are 1200 deaths per year 3, which considerably high for such a manageable respiratory condition. The cause of asthma is not fully known, but research suggests it is due to various factors that cause sensitive, inflamed airways in the respiratory tract (see diagram 2 in appendix) that become narrow and clogged with mucus.4. This cases difficulty breathing and low oxygen saturation levels. Associated factors that can trigger an inflammatory response include, pollution, pollen, sudden changes in weather conditions, exercise, illness, allergies, medicines (particularly non-steroidal anti-inflammatory drugs like ibuprofen), and moldy damp conditions.
There are several treatments that can be used to treat the condition with the two common ones being reliever and preventer inhalers. Reliever inhalers open up the airways and are used to relieve an asthma attack when it happens and are taken when symptoms present themselves. Preventer inhalers contain corticosteroids and are used to reduce inflammation and sensitivity of airways. Inhalers need to be taken regularly and are the two most common treatments, although there are a variety of injections and tablets that are used to treat more severe cases
Pneumonia:
Pneumonia is the third biggest group of lung diseases causing mortality in the UK 1, and the largest cause of infant mortality on a global scale 5. It causes inflammation of the alveoli resulting in them filling with fluid. The most common cause is bacterial infection, but a few viral and fungal infections are also associated.
The most common bacterial cause is Streptococcus pneumoniae6, and as well as this there is aspiration pneumonia, caused by inhaling vomit, foreign objects (e.g. food) or harmful substances (e.g. cigarette smoke). Most of the deaths to pneumonia are in children, elderly, and those who have pre-existing lung conditions such as COPD. 6 One of the main ways of preventing pneumonia is the same as how you would stop cold and flu spreading, and Health Promotion Campaigns such as ‘catch it, bin it, kill it’ help in highlighting this. The NHS suggests the following “cover your mouth and nose with a handkerchief or tissue when you cough or sneeze
throw away used tissues immediately – germs can live for several hours after they leave your nose or mouth
wash your hands regularly to avoid transferring germs to other people or objects ” 6
Smoking increases the risk of pneumonia contraction and mortality 6. Treatment of pneumonia involves rest and antibiotics, and can involve hospitalization for severe cases. There is a vaccine available for some more common strains for those most at risk.6

Chronic Obstructive Pulmonary Disease (COPD):
COPD is a disorder causing obstruction of the airways. It is a progressive disease with no cure, only management options and it can affect a person’s quality of life. Taking many forms, the most common is chronic bronchitis, which is when the bronchi are blocked by thick mucus, and the cilia are damaged and unable to expel the mucus. This leads to narrowed bronchi (see diagram 2 in appendix) and a reduced ability to get air in and out of the lungs for effective gaseous exchange to occur.. Other symptoms include a persistent cough and coughing up phlegm. Cigarettes use cause 90% of chronic bronchitis, with another key factor being air pollution 7.
Another form of COPD is emphysema whereby the walls of the alveoli (the tiny air filled sacs in the lungs), get stretched and make lung capacity greater. This interferes with the delicate pressure shifts that allow breathing in and out, and causes less air to enter the lungs 7. To further compound the issue, air can get trapped in the alveoli, reducing the efficiency of gaseous exchange across the epithelial cells as the diffusion gradient gets lower due to the old air having a lower concentration of oxygen (as some has already diffused into the blood) and a higher carbon dioxide concentration (as some has already diffused into the blood).
COPD is not usually life threatening, though it does affect quality of life greatly, and can reduce person’s ability to be active.
Lung cancer:
Lung cancer killed 35,419 people in the UK in 2012, making it the most deadly lung disease. It is responsible for 31% of all deaths from lung disease, and 6.3% of all deaths in the UK 8. Most cases are caused by smoking so it can be preventable, as >85% of cases are directly linked to nicotine inhalation. Cigarette inhalation has many mutagenic agents in it that damage a cell’s DNA. When the cell repair takes place, a change in the genetic code causes rapid, uncontrolled growth of the cell causing tumour formation. The UK has the 15th lowest mortality rate for lung cancer 8, and therefore measures to improve public education have taken place to reduce the amount of cigarette smoking. Some of these campaigns include bans on cigarette advertising, and programmes to aid people to give up smoking such as fag ends. Furthermore actions have recently been taken to reduce the damage done my secondhand smoke, such as banning smoking in a car with children present.
Factors Related to Lung Disease
Smoking:
Cigarettes increase risk of pneumonia infections 6, and are the leading cause of COPD (emphysema and chronic bronchitis), and lung cancer, but many governments are reluctant to ban tobacco, as tax on cigarettes produces a lot of income for the government.
Cigarette related deaths are a huge global health issue. Half of users die from use directly, and they cause (globally) 7 million deaths per year, with 890,000 mortalities being non smokers affected by second hand smoke. 9
There are some solutions that have recently been adopted such as vaping, however, the long term effects of this are unknown as yet. Over 10% of students over 14 years of age have tried vaping, and 60% think this is safe in terms of effects, 10. Vape liquids contain toxic substances such as aldehydes 10 and are a completely unregulated market. The liquids also have an inaccuracy of up to 20% in nicotine content, and many branded nicotine free ones actually contain this 10. For vaping to be viable, the market needs heavier regulation, with the liquids coming into as much scrutiny as medication, and more research needs to be one on the health effects.
The banning of advertisements and graphic images on cigarettes has proven an effective solution to decreasing smoking, and in countries such as the UK, it has been effective, reducing rates by 7%, and that reduction is estimated to rise to 16%. This is effective but other solutions could be employed alongside these to be wholly effective 10, such as more help schemes run locally by community centers and GP`s, and to encourage engagement with these via awareness and education on health effects.
Vehicles and Air Pollution:
Air pollution can have a devastating effect on lung health with the main pollutants being NoX and particulate matter. Nox, which is all oxides of nitrogen, are heavily linked with increased levels of admission to hospital with pre-existing respiratory issues 11
Particulate matter are tiny particles, less than 10 micrometers in size, and can be expelled by vehicles. When inhaled, they can get into your bloodstream and airways via respiration (see appendix 1 for diagram of the aero-digestive tract). The bigger ones get deposited in the upper airways, while the smaller ones make it to the alveolar passages where they are deposited, both causing an inflammatory response. They cause a range of health issues including sudden death in people with pre-existing heart and lungs conditions, such as aggravated asthma and COPD, decreased lung function and other respiratory symptoms 11 12
Other car pollutants are hydrocarbons in fuels that are unburned in the engine and end up in the atmosphere and can be inhaled. This is an aetiological factor of lung cancer, as they are carcinogenic. 11 There are several solutions that could be considered to reducing these emissions including cycling education/incentives – see table below.

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Table 1: Proportion of journeys made by bicycle and fatal and non-fatal cycling accidents per 100 million km
cycled in select European countries 13

Country
Cycle safety as part of education
Percentage of journeys made by bicycle
Cycling deaths per 100 million km travelled
Cycling injuries per 100 million km travelled
Netherlands
Yes
27%
1.1
14
Germany
Yes
10%
1.7
47
Denmark
Yes
18%
1.5
17
UK
No
1%
3.6
60
Riding a bicycle is greatly beneficial, as they produce no air pollution themselves, so the more people cycling shorter city journeys, rather than driving, the less pollutants that are put into the atmosphere. Cycling also helps individuals avoid pollutants (levels can be as much as 5x lower as someone in a car, and 3 times lower than someone who walks) 14. Cycling is also a cardiovascular workout that anyone can partake in and is easy to adjust intensity so ultimately this lifestyle change could reduce levels of lung, cardiovascular, and weight related health issues. As table 1 illustrates, cycle safety education will greatly increase the safety of those who choose this modality, and will encourage more people to cycle. This would be a fairly cheap option, and could be used alongside a cycle to work initiative, where people can receive money towards a bike for getting to and from work. Overall cycling education and financial initiatives seem to be a great option for both the individual and the general population.

Liquefied Petroleum Gas (LPG) cars
LPG, or liquefied petroleum gas, are mixes of hydrocarbons (usually propane and butane) that are gasses under standard conditions, but are pressurised so they become a liquid. A move towards LPG powered cars would produce between 80 and 95% less pollutants 15 A conversion for a normal car to LPG costs between £1000 and £4000, but savings are made in running costs, as it costs around 55% as much for the fuel. Depending on distance driven and the MPG of the car, it can pay itself back in as little as a year in fuel savings, and its benefit to lung health is priceless, and the savings to the NHS would more than pay back any cash incentives offered by the government to encourage it.

Conclusion
This assignment has outlined some of the key factors associated with lung disease and how much of an issue (in terms of quality of life and mortality) it is. Through personal and environmental factors, lifestyle changes and education, the cost to life and the NHS could be reduced dramatically, as most lung diseases had the number of new cases reduced in 2012 1, and new treatments come about as medical technology advances. Some key areas to address are: reducing smoking and vaping levels, as they cause and exacerbate a lot of lung diseases, and can be done by reducing the rate at which young people are starting to smoke, by increasing awareness of the risks and gradually reducing the total amount of smokers. Another key issue that is relatively cheap and easy to do is encourage improvements in public hygiene, through campaigns similar to catch it bin it kill it, and other measures such as hand sanitizer dispensers in public spaces, as this would help to reduce the deaths from pneumonia and other infectious lung diseases, (as well as all other infectious diseases). A final key issue to address is reducing car emissions, whether via cycling/ walking short journeys or lpg conversions. These will help individual and public health simultaneously for both those who do and do not adopt it, and combat issues inside lung disease and beyond. Increasing public awareness via campaigns such as Roy Castle foundation fag ends, who helped 100,000 people to stop smoking during its 20 year run, and reduced smoking prevalence in Liverpool by 12% 18.
Other recent public awareness campaigns around health and lifestyle are the key moving forward to promote healthier choices and about how these can be easily adopted.

References
https://statistics.blf.org.uk/ accesed 24/7/2018 1
https://www.blf.org.uk/policy/economic-burden 2 24/7/2018
https://statistics.blf.org.uk/asthma 3 accessed 03/09/2018
https://www.nhs.uk/conditions/asthma/causes / 4 accessed 03/09/2018
https://www.lstmed.ac.uk/research/topics/pneumonia accessed 03/09/2018 5
https://www.nhs.uk/conditions/pneumonia/ accessed 03/09/2018 6
https://www.copdfoundation.org/What-is-COPD/Understanding-COPD/What-is-COPD.aspx 7 accessed 18/8/2018
https://statistics.blf.org.uk/lung-cancer 8accessed 18/8/2018
http://www.who.int/news-room/fact-sheets/detail/tobacco 9accessed 18/8/2018
https://www.physiology.org/doi/abs/10.1152/ajplung.00272.2015 10accessed 18/8/2018

http://www.dft.gov.uk/vca/fcb/cars-and-air-pollution.asp accesed 24/7/2018 11
https://www.epa.gov/pm-pollution/health-and-environmental-effects-particulate-matter-pm accessed 15/8/2018 12

https://www.google.co.uk/url?sa=t;source=web;rct=j;url=https://www.imperial.ac.uk/media/imperial-college/grantham-institute/public/publications/briefing-papers/New-solutions-to-air-pollution-challenges-in-the-UK-LFSP-BP.pdf;ved=2ahUKEwjo7pWgrvHcAhWUT8AKHc0NBx4QFjAKegQICRAB;usg=AOvVaw2-2QJpbdQkNnByAWUcbJu9 13 accessed 18/8/2018
https://www.theguardian.com/environment/video/2014/aug/12/london-air-pollution-public-transport-video 14accessed 18/8/2018

By World Health Organization. Regional Office for Europe https://books.google.co.uk/books?hl=en;lr=;id=b2G3k51rd0oC;oi=fnd;pg=PR1;dq=reducing+pollution+cars;ots=O72t7EKk5x;sig=Zla2HAMLq28yxJ8AwzUSet7-Ajw#v=onepage;q=reducing%20pollution%20cars;f=false 15accessed 18/8/2018

https://www.roycastle.org/news/roy-castle-fagends-a-statement-from-our-chief-executive 16

Appendices:

https://pubs.niaaa.nih.gov/publications/arh293/1

2) https://www.therespiratorysystem.com/wp-content/uploads/2017/10/Trace-the-Airflow-Pathway-Through-the-Respiratory-System.jpg93-198.htm

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