FIRS The Global Impact of Respiratory Disease – Second Edition | Page 30

target to susceptible populations in Eastern
Europe, Asia and Africa to increase sales of
its products. More than 300 million Chinese
smoke more than 2 trillion cigarettes per year
– more than the next four highest tobacco-
consuming nations combined. In China, a
person dies every 30 seconds from tobacco
use [54].
Tobacco smoking is a solvable global problem.
The fi rst international treaty developed for
purposes of health was the WHO’s Framework
Convention on Tobacco Control [55]. The
treaty is an important mechanism by which
governments can control the tobacco industry
by using laws, regulations, administrative
decisions and enforcement measures.
Effective strategies, termed MPOWER [49],
have been developed by the WHO Tobacco-
Free Initiative to support implementation of
the Framework to prevent and reduce smoking
and the demand for tobacco products. Much
more remains to do, particularly in low- and
middle-income countries to mitigate the
pernicious impact of tobacco smoking.
Poor indoor air quality is an important
contributor to respiratory disease. About 50%
of all households in the world and 90% of
rural households use fuels that allow smoke to
be present in the living area, exposing over
2 billion people to noxious smoke [56]. The
WHO estimates that 4.3 million deaths per
year can be attributed to indoor air pollution.
Most disease and death attributable to
exposure to poor indoor air quality occurs in
women and children, especially in low-income
families [57]. Exposure to indoor smoke used
for heating and cooking leads to COPD,
lung cancer and, in children, pneumonia and
asthma [57].
People with lung disease are particularly
susceptible to the effects of outdoor air
pollution. Increased concentrations of
airborne fi ne particles are associated with
increased hospital admissions and deaths [58].
It is estimated that poor air quality in Europe
leads to an average loss of 8.6 months of life
expectancy [59]. There is a growing body of
evidence that air pollution affects the unborn
child, leading to enhanced susceptibility to
infection, and respiratory and cardiovascular
disease later in life [60]. Children, especially
those with chronic lung disease, are also
more susceptible to the adverse effects of
air pollution [61]. The environmental risks are
greater in low- and middle-income countries
and among the disadvantaged and low
socioeconomic sections of society.
Appropriate nutrition and physical activity
are critical for health. Both malnutrition and
obesity contribute to respiratory diseases.
Obesity is linked to obstructive sleep apnoea
in Western societies and to asthma, heart
disease and diabetes. Malnutrition is an
important risk factor for childhood pneumonia
and severe illness.
Prevention of respiratory disease entails
strengthening healthcare systems, using
established guidelines for health promotion
and disease prevention, training medical
personnel and educating the populace.
Treatment and cure
Once disease occurs, the goal is to lessen
its effects and cure it if possible. Reducing
its effects is best accomplished by early
detection, prompt diagnosis and early effective
treatment. Successful treatment is based on
sound medical evidence, is cost-effective and
is generally in accordance with standardised
guidelines. Patients and healthcare workers
can manage diseases better if they are properly
trained and necessary resources are available.
The WHO, FIRS member organisations and
other governmental agencies or respiratory
societies have developed recommendations
for standards of care for specifi c clinical
conditions. Unfortunately, effective and
uniform implementation, promotion and
adherence to these standards have been
lacking. Great medical breakthroughs are only
signifi cant when they reach the communities
and patients that need them.
In recent decades, medicine has increased
the length and quality of life, although
changing lifestyles, new types of infection
and changing environments have created
new challenges. These advances have
brought costs. Healthcare for those who are
ill or dying is expensive. Increasing healthcare
costs have threatened the fi nancial health
of many nations. On the other hand, work
losses secondary to ill health affect national
pro