FIRS The Global Impact of Respiratory Disease – Second Edition | Page 29

What can be done to
combat respiratory disease?
of the air is an important step in promoting
respiratory health.
Prevention
The fi rst step for respiratory health is to
prevent illness before it occurs. Identifying and
ameliorating the factors that cause or promote
respiratory diseases can prevent them. Because
respiratory diseases are often linked to the
environment, respiratory conditions are more
preventable than most other system diseases.
The cost of prevention is only a fraction of the
cost of treatment. Preventing and combating
respiratory disease is a highly cost-effective
“best buy” described by the WHO [46].
Prevention starts before birth. In utero and
childhood exposure are major determinants
of chronic adult respiratory disease. Paediatric
factors associated with COPD in adults include
maternal and paternal asthma, maternal
smoking, childhood asthma and severe
respiratory infections [47]. Furthermore,
smoking in the grandmother increases the risk of
asthma in both the mother and grandchild, even
if the mother does not smoke. The deleterious
effects of nicotine and tobacco smoke exposure
are augmented if certain genes’ alleles are
present in either the mother or the foetus [47].
Antenatal and early child exposure to indoor
or outdoor air pollution affect lung growth and
are associated with accelerated lung function
decline later in life [47].
Breathing unhealthy air is a cause or contributor
to most respiratory conditions. The most
common so urces of unhealthy air are tobacco
smoke, indoor air pollution from the smoke of
burning fuels, unhealthy air in the workplace,
air pollution from traffi c and industrial sources,
and air containing microbes, toxic particles,
fumes or allergens. Improving the quality
28
The best measure to prevent lung disease is to
reduce tobacco use. Smoking was estimated
to be responsible for one in seven deaths in
men and one in 15 deaths in women globally
in 2004 [48]. It is projected that as many as 1
billion people will die from tobacco smoking
in the twenty-fi rst century [49]. Of these
deaths, most will result from cardiovascular
or respiratory disease, including lung cancer
and COPD. In the USA, current smokers are
25 times more likely to die of lung cancer than
those who never smoked [50]. The rate of
death from all causes is three times higher in
smokers than non-smokers and life expectancy
is shortened by 10 years in smokers [51]. In
Europe, the total health cost of tobacco is
about €544 billion annually, which represents
about 5% of the European Union GDP [52].
Passive smoke exposure also leads to
respiratory disease. Since 1964, about
2.5 million non-smokers died from health
problems caused by exposure to second-
hand smoke [53]. In children, second-hand
smoke causes ear infections, asthma attacks,
bronchitis and pneumonia. It increases the
risk for sudden infant death syndrome. Heart
disease and stroke are also increased. An
estimated 34,000 heart disease deaths and
more than 7,300 lung cancer deaths have been
attributed to second-hand smoke annually in
the USA [53].
Intensive educational campaigns in Western
Europe and North and South America have
decreased the number of smokers in many
countries, but the tobacco industry moved its
Forum of International Respiratory Societies