With Prof. dr hab. n. med. Władysław Pierzchała, President of the Polish Society of Lung Diseases, we talk about the prevention and treatment of chronic lung diseases and the challenges of modern pulmonology.
Lung diseases are common because the contact area of the lungs with the environment in which a person lives is huge. As long as the skin area is 2 m2, intestine area about 20 m2, the area of the alveoli is as much as 200 m2. It is the surface of our “respiratory” contact with the environment. Why is it so important? Diseases are the result of an interplay between genetic factors (over which we have no control) and environmental factors (over which we have little control). The third element is the hygiene of our lives, directly dependent on us. If we realize that the external environment may contain certain factors that harm the lungs, then they must be avoided. Such a toxic agent, acting on the surface of 200 m2 our lungs, there is cigarette smoke, of which awareness is still insufficient. Young people seeing old men smoking cigarettes may think: “Oh please, so old and cigarettes did not hurt him”. Yes, they didn’t hurt him. Others, who have been harmed by cigarettes, have already died and are nowhere to be seen. Diseases that originate from harmful environmental factors and hygiene negligence strengthened by genetic factors are, above all, chronic obstructive pulmonary disease (COPD), bronchial asthma and lung cancer. These are the three diseases that plague our society the most today. Asthma is relatively a disease with good prognosis. It sometimes has a dramatic course, but the disease is generally under control today and its symptoms can be controlled with drugs. In contrast, COPD shortens life, leads to disability, and unfortunately there is no way to stop it, although symptoms can be relieved. The third disease is lung cancer, against which we are defenseless in the advanced stage. Unfortunately, all treatments except surgery in the early stages are ineffective. Here, prevention is more important.
Chronic lung disease
Late detection of obstructive pulmonary diseases in the population is due to two elements: the first is that the lungs have a very large breathing reserve. Symptoms that worry the patient, such as decreased exercise tolerance, shortness of breath – appear relatively late – there is no reason to see a doctor. Thus, the doctor is not able to diagnose the disease earlier. The second reason is that these are non-specific symptoms. They can be associated with the aging of the body (poor exercise tolerance), emotions (cough, dyspnoea). The cough may be associated with the minor cold (viral infection). The patient does not pay special attention to it, because similar symptoms also occur in other people. Early detection of obstructive diseases alone requires screening tests. Their voluntary nature requires awakening pro-health awareness. Among obstructive diseases, COPD is the biggest problem – because it is a disease that increases with age and our population grows older. The challenge is not only its early diagnosis, but also greater availability of drugs. Make a diagnosis through fast spirometry – for example, for all smokers, people over 50. Availability of drugs is often related to their price, which is why, as PTChP, we strive for the Ministry of Health to make these drugs more available through reimbursement.
Another disease that is very common is obstructive sleep apnea (OSA). It is related to snoring, which patients pay attention to, but they are not aware that it is only one of the symptoms of the disease. It is sleep apnea, or repeated pauses in breathing, that is at the heart of the disease. In the future, this condition will cause cardiovascular ailments: drug-resistant hypertension, heart attack, arrhythmias, and stroke. Therefore, if OSA could be detected earlier and treated effectively, cardiovascular morbidity would probably be lower in our population.
A very rare disease (the incidence is five people in 10) is idiopathic pulmonary fibrosis. It usually affects the elderly, over 50 years of age. I draw my attention to this disease because, unfortunately, there is still no effective drug in Poland that would slow down its progress. The challenge is to increase knowledge about the disease and make available drugs that are on the global market.
Challenges of contemporary pulmonology
There are also diseases that have always existed but are now presenting new challenges. These include, for example, cystic fibrosis, which mainly affects children (the disease has a genetic basis). Thanks to the activities of pediatricians, these children who once died live to adulthood and are under the care of lung diseases doctors. The challenge is to provide these patients with continuous pulmonary care and, if necessary, the possibility of treatment with the method of lung transplantation. This method of treatment was initiated in Poland by prof. Marian Zembala. This is a huge challenge that concerns a small group of patients, but preparing them for a possible transplant and postoperative care is the peak of the skills of pneumologists in cooperation with transplantologists.
Finally, tuberculosis, which is somewhat “dormant” in our population, but with the increasing migration of people in Europe and the influx of people from endemic areas, may become a new problem. An additional problem is mycobacterial infection in patients undergoing the so-called biological treatments that may activate tuberculosis in them.
Lung diseases (including cancer) are the most common in our population after cardiovascular disease. They require medical effort on the part of pulmonologists to maintain the health of our society.
Read more in “Your Breath” appendix
Prof. dr hab. n. med. Władysław Pierzchała
President of the Polish Society of Lung Diseases
acting Deputy Medical Director of the University Clinical Center SUM in Katowice