Risk factors associated with lung disease
A major problem facing modern populations
By Thomas Smith
Lung disease- responsible for 20.1% of UK deaths. That is one every 5 minutes, 12 an hour, or 228 a day, only 2.5% less than all non-lung cancers 1, and many of these deaths are preventable. This means that it is a key issue at the moment and we need to reduce instances of this group of diseases. The modern world is filled with a multitude of factors that can exacerbate this issue, they surround us wherever we go. 12.7 million British people have diagnosed lung diseases, and they cause 700,000 hospital admissions annually, taking up 6 million patient bed days 1, and costing the NHS £9.9 Billion and then 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 addressing risk factors, that lung disease incidences can be reduced.
The following assignment will focus on the main lung diseases of asthma, Pneumonia, COPD, lung cancer, and will consider how the main modern risk factors, vehicles/air pollution and smoking affect this group of conditions.
COPD, or Chronic Obstructive Pulmonary disease, is a disorder where there is obstruction of the airways. It is a progressive disease with no cure, only management options. It can take many forms. One common one is chronic bronchitis, which is when the bronchi are blocked by thick mucus, and the cilia are damaged and unable to get rid of it. This leads to narrowed tubes and a reduced ability to get air in and out of the lungs. Other symptoms include a persistent cough and coughing up phlegm. Cigarettes cause 90% of chronic bronchitis, and another cause is air pollution 12. Another form of COPD is Emphysema. In this, the walls of the alveoli, the tiny air sacs in your lungs, get stretched and make your lungs capacity larger, interfering with the delicate pressure shifts that allow us to breathe in and out, and this causes less air to get into the lungs 12. Also, to further compound the issue, air can get trapped in the alveoli, reducing the efficiency of the gas 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 lives greatly, and can greatly reduce people’s abilities to be active.
Lung cancer killed 35,419 people in the UK in 2012, making it the most deadly lung disease, responsible for 31% of all deaths from lung disease, and 6.3% of all deaths in the uk 13. It is mostly preventable, however, as ;85% of cases have smoking to blame. This is because cigarettes have many mutagenic agents in the them, and these damage cell’s DNA. When the cell repair takes place, a change in the genetic code of it causes rapid, uncontrolled growth of the cell. This forms the tumor. In the UK we have the 15th lowest mortality rate for lung cancer 13, however there are still many people who lose loved ones to lung cancer, however that number would drop by over 30,000 to just 5312 from the aforementioned 35419 if we all just stopped smoking, either by choice or via a ban. It’s a truly awful disease and we still have a lot of work to do.
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 3
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 3 4
Some hydrocarbons in fuels go unburned in the engine and in turn end up in the atmosphere and can be inhaled. The effects of these are lung damage, and as they are carcinogenic, which could also result in lung cancer development.3
Vehicle Emissions are a serious issue, but there are several solutions that could be considered. These include cycling education/incentives – see table below.
Table 1: Proportion of journeys made by bicycle and fatal and non-fatal cycling accidents per 100 million km
cycled in select European countries 5
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
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, so everyone will benefit. What’s more is that cycling also helps you avoid pollutants (levels can be as much as 5x lower as someone in a car, and 3 times lower than someone who walks) 6. Also, cycling is a cardiovascular workout that anyone can partake in and is easy to adjust intensity for different people, so if we get more people cycling, it should reduce the 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.
I have refined some of this paragraph – it is a little wordy and could be written more succinctly to avoid using to many words.
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 7 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.
Up until this point is not totally relevant ? refine or leave out.
Cigarettes 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. Due to uk taxes, a pack of 20 cigarettes costs almost twice as much in the uk than in spain, and the total tax revenue from them is £12.3 Bn in the uk and they cost the NHS £2.6 Bn, 8 9 so from that perspective the government wants to leave the market untouched, however health of the citizens should be a government’s priority here.
Cigarette realted deaths are a huge global health issue.nIt kills half its users, and causes (globally) 7 million deaths per year, and 890000 of these are nonsmokers killed by second hand smoke. It’s the leading cause of COPD and Lung cancer. 1.1Bn people smoke worldwide, the majority living in low income areas, so smoking is also a huge financial strain on these people 10. Over 85% of lung cancer is caused by smoking. 11
Vaping- this often is touted as a great solution, however there may be more bad to vaping than it seems. Over 10% of students over 14 have tried vaping , and 60% think they are safe 11 vape liquids contain toxic substances such as aldehydes 11 and are a completely unregulated market. The vape liquids also have an inaccuracy of up to 20% in nicotine content, and many nicotine free ones actually contain nicotine. 11 The oils used can be harmful as well. At the very least 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. A graphic warning on the cigarette packet is another potential solution. These warnings would consist of a gruesome image and a brief warning about possible consequences of smoking reduces the rates of new smokers, especially underage smokers, and is an effective way of reducing the rates of smokers gradually, it doesn’t stop those who already smoke as effectively though 10. furthermore, the banning of advertisements is an effective solution to this issue, and in countries such as the uk, it has been effective, reducing rates by 7%, and that reduction is estimated to rise to 16%. It is good but other solutions need to be employed alongside it to be wholly effective 11.Help Schemes can also be used. A scheme to help people quit is a great option. It helps double the success rate of those trying to quit vs quitting alone 11. The issue with this is it only works for those who want to be helped. Those who don’t want to stop smoking will not be helped by this.
Try to avoid solutions being given with a heading – this needs to flow in a more academic style with a better structure. Try to stick to the topic, the issues and the effects on the body.
Common lung diseases: These need to be earlier in the assignment –discuss the diseases then the risk factors.
This assignment has outlined 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.
Tom – you could highlight here some of the public health campaigns and impact for example smoking. What are the key areas for the future that need addressing in the UK?
https://statistics.blf.org.uk/ accesed 24/7/2018 1
https://www.blf.org.uk/policy/economic-burden 2 24/7/2018
http://www.dft.gov.uk/vca/fcb/cars-and-air-pollution.asp accesed 24/7/2018 3
https://www.epa.gov/pm-pollution/health-and-environmental-effects-particulate-matter-pm accessed 15/8/2018 4
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 5 accessed 18/8/2018
https://www.theguardian.com/environment/video/2014/aug/12/london-air-pollution-public-transport-video 6accessed 18/8/2018
Health Effects of Transport-related Air Pollution
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 7accessed 18/8/2018
http://the-tma.org.uk/tma-publications-research/facts-figures/uk-tobacco-market-summary/ 8accessed 18/8/2018
https://www.gov.uk/government/publications/cost-of-smoking-to-the-nhs-in-england-2015/cost-of-smoking-to-the-nhs-in-england-2015 9accessed 18/8/2018
http://www.who.int/news-room/fact-sheets/detail/tobacco 10accessed 18/8/2018
https://www.physiology.org/doi/abs/10.1152/ajplung.00272.2015 11accessed 18/8/2018
https://www.copdfoundation.org/What-is-COPD/Understanding-COPD/What-is-COPD.aspx 12 accessed 18/8/2018
https://statistics.blf.org.uk/lung-cancer 13accessed 18/8/2018
https://statistics.blf.org.uk/asthma 14 aaccessed 03/09/2018