RESPIRATORY
ResPIRATORY DIseAses ARe ONe OF THe WORLD’s BIGGesT HeALTH CONCeRNs, CAUsING ONe sIXTH OF ALL DeATHs WORLDWIDe. PIF LOOKs AT sOMe OF THe MOsT COMMON CONDITIONs.
Take your breath away
R
espiratory diseases are a major healthcare issue around the world. each year, there are
600,000 respiratory-related deaths in the european Union, with more than half of these deaths due to lung cancer and chronic obstructive pulmonary disease (COPD).
Respiratory illnesses are also the most common long-term conditions in children and babies, with 21 per cent of children now diagnosed with asthma. In addition to the fact that respiratory diseases cause disability and often premature death, they are also an economic burden, especially the ones that are preventable.
Tobacco smoking is the biggest risk factor in the development of respiratory conditions. It is estimated that about 90 per cent of COPD cases are caused by cigarette smoke. Inhalation of oxidative toxins from occupational exposure (exposure to dust, chemicals and particles), air pollution and from second-hand smoke are all risk factors for developing COPD, asthma and pneumonia.
54 - PHARMACY IN FOCUs
Risk factors for asthma include: being overweight and genetics (having a blood relative with asthma or having another allergic condition such as eczema or hay fever). Genetic risk factors for would include people who have an alpha-1 antitrypsin deficiency.
Risk factors for developing pneumonia include: being immunocompromised, being older than 65 years of age, malnourishment and taking certain medications (such as amiodarone and methotrexate).
Diagnosis There are a range of investigations that can be used to diagnose various respiratory conditions, however, spirometry is the first-line diagnostic test that is generally performed on a patient that presents with either asthma or COPD. since the symptoms of asthma and COPD are similar, the doctor will look at: the age of onset of the symptoms, characteristics of the cough and the symptom variability.
According to NICe guidelines, a diagnosis of COPD should be
considered in patients over 35 years that have exposure to a risk factor and presents with one or more of the following: • exertional breathlessness • chronic cough • regular sputum production • recurrent chest infections or frequent winter 'bronchitis'
• wheeze
COPD COPD is one of the United Kingdom’s most common, life-threatening inherited diseases. The disease causes thickened mucus to form in the lungs, blocking the airways and resulting in inflammation, which can often make it difficult to breathe. The average life expectancy in the UK is 40 years old, with a much lower life expectancy in developing countries.
COPD is the fourth leading cause of death worldwide, and the World Health Organization estimates that, by 2030, it will be the third leading cause of death worldwide. One in eight emergency hospital admissions are for COPD patients, making it the second largest cause of emergency
admissions. This also makes it one of the most expensive inpatient conditions treated by the NHs, as it is estimated to cost around £982 million each year.
The primary cause of COPD is exposure to tobacco smoke (either active smoking or through second- hand smoke), but it can also be the result of conditions, such as long- term asthma.
COPD is caused by a combination of two conditions: chronic bronchitis and emphysema (parenchymal damage). In chronic bronchitis, there is inflammation and fibrosis of the bronchial wall, which causes bronchoconstriction.
The combination of broncho- constriction and excess mucus leads to obstruction of airflow, thus causing the mismatch of ventilation and perfusion. emphysema is caused by an inflammatory response which causes the breakdown of elastin in the alveolar wall, leading to loss of alveolar integrity as the alveoli are unable to recoil. Loss of alveolar recoil
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