By Dr. Simon Walusimbi

Background

The World Health Organisation (WHO) and the Forum of the International Respiratory Society (FIRS)) jointly designated September 25 of each year as the World Lung Day (WLD) to raise awareness of the burden of respiratory diseases and mobilise action towards better lung health.

The vital importance of the lungs was highlighted by the COVID pandemic, which clearly illustrated that respiratory diseases impose an immense health and socio-economic burden and taking care of our lungs is therefore more important than ever. According to the Global Impact of Respiratory Disease report (2021), respiratory diseases are the third leading cause of death worldwide after heart diseases and stroke.

Statistics

Respiratory health is vital for one to enjoy full health. It is now recognized that childhood respiratory disease has long-term negative consequences on adult health.

The main respiratory diseases are asthma, chronic obstructive pulmonary disease (COPD), pneumonia, tuberculosis (TB) and lung cancer-the so called ‘Big Five’. These five lung diseases are responsible for 4 million deaths globally.

Asthma for example affects 1%–18% of world population, including both children and adults.¹ Childhood asthma can adversely impact the physical and psychological development of children, besides being fatal. Similarly, among adults with suboptimal control, asthma may be fatal, or may result in absence from work or psychosocial morbidity.

About 10% of people aged 30-79 years have COPD worldwide. Sufferers of COPD require increased use of medications and hospitalizations from acute exacerbations which are usually recurrent events. Sadly, patients with COPD usually also present with co-morbidities like heart disease, depression and anxiety.

Pneumonia accounts for 14% of all deaths of children under 5 years old worldwide. Elderly people aged above 70 years,  with medical co-morbidities are also at a very high risk of dying from pneumonia related causes.⁴ 

Before the COVID pandemic, TB was the main cause of death from a single infectious agent claiming the lives of 1.5 million people annually, while causing sickness to than 10 million people per year.⁴ Unfortunately, more and more people are diagnosed with drug-resistant forms of TB which requires longer and more costly treatment.

Finally, among the ‘Big Five’ is lung cancer. While lung cancer is not the most prevalent cancer (second to breast cancer), it the most lethal form of cancer responsible for 1 in 4 cancer deaths worldwide accounting for 1.8 million deaths each year. Lung cancer is more common in men than women. The condition is common in current and former smokers.  The most common symptoms of lung cancer are persistent cough and chest pain that often worsen with deep breathing, coughing, or laughing.

Situation in Uganda

Respiratory diseases are among the leading cause of ill health among Ugandans, despite being preventable and economical to treat. According to health statistics from the Ministry of health, lung related complaints account for 30% of the hospital visits in Ugandan health facilities.

Landmark studies conducted by Makerere University Lung Institute (MLI) showed that one in five Ugandan adults (20%) suffered from a chronic respiratory disease such as asthma or COPD.

Risk factors included air pollution particularly in urban settings, exposure to tobacco/shisha smoke, and history of having suffered from tuberculosis-which is a disease that primarily affects the lungs.

Exposure to biomass smoke as a result of the combustion of wood or animal dung or crop for cooking and heating in many Ugandan households was the main risk factor for developing COPD in early adult life for both men and women in their mid-30s. Additional data from studies conducted in Kampala and Jinja showed that air pollution in Uganda was on the rise, thus adding more fuel to the already existing high-risk factors for respiratory diseases in the country.

Unfortunately, access to diagnostics and treatment for asthma and COPD are not widely available in Uganda and remain largely unaffordable. Across all public or private health facilities and pharmacies only 45%-75% have the essential range of medicines that are critical in treatment of asthma.

None of the assessed sites in the above survey had the principal long-acting medicines that are used prevent severe attacks (exacerbations) in asthma/COPD patients. These exacerbations are the main reasons for patient hospitalization and death.

In addition, the key diagnostic tests for chronic respiratory diseases namely, spirometry and peak-flowmetry were available in only 7%-24% of the health facilities and pharmacies. Sufferers of asthma/COPD often required 2 to 17 days wages in order to afford treatment for their lung condition and 28 days' wages for spirometry testing.

Scientists at MLI have demonstrated that failure to address the burden of respiratory diseases including asthma, COPD, and TB will result increased household poverty. For example, A survey was designed to assess the economic burden due to tuberculosis (TB) patients found that 53% of households were pushed into poverty as a result of a household member suffering from TB. The situation is similarly dire for sufferers of asthma/COPD where nearly 47% miss work due asthma/COPD.

How to keep your lungs healthy.

Taking care of our lungs is now more important than ever because lungs are vital for health. Unfortunately, the lungs are in constant exposure to a variety of air pollutants which are present in the air we normally breath. By far, air pollution is the most significant environmental risk to respiratory health. It is estimated that at least two billion people globally are exposed to unclean air as a result of indoor or outdoor smoke produced by the burning biomass fuels such as wood, cow dung, car fuels  for cooking or warming.⁷ The significance of air pollution was well demonstrated during the COVID-19 pandemic. During the pandemic, there was reduction in outdoor activities which resulted in relatively lower emissions causing air pollutants. Hospital admission for acute exacerbation of COPD and asthma reduced markedly with the COVID-19 pandemics.

In general, we can achieve good care for our lungs by focusing on the following interventions.

Breathe clean air

Air pollution kills an estimated 7 million people worldwide every year. WHO data shows that 9 out of 10 people breathe air containing high levels of pollutants.

Air pollution has a negative impact on human health and exposure to it can affect 100% of the population, from unborn babies to the very elderly. The lungs are the first point of entry for air pollution into the body and are therefore the first affected organ. Air pollution affects everyone−rich or poor. Public health authorities must realize that breathing safe (clean) air is as important as drinking safe (clean) water for the prevention of water-borne diseases. Therefore, the efforts invested for delivery of safe piped water, should be replicated to ensure communities breathe safe and clean air for prevention of lung diseases.

Say no to tobacco

Tobacco and similar products (vaping, shisha) cause an estimated 8 million deaths every year and is the main cause of many lung diseases. Tobacco smoke contains more than 4,000 chemicals, many of which are toxic and can cause cancer. Stopping smoking is the best way to improve your lung health and overall health. Quitting tobacco has the potential to reverse some of the damage done by tobacco smoke to the lungs, but not all. Early cessation is therefore essential to preventing the onset of chronic lung disease, which is irreversible once developed. Several policies to end the use of tobacco have been formulated. These have been guided by the international convention on tobacco control which has been in place for more than 20 years. However, regulation and enforcement of the convention, such as the restriction of smoking in public places remains weak.

Protect your lungs through vaccination

Getting vaccinated can protect you from lots of different infectious diseases and help you keep your lungs healthy. Pneumococcal pneumonia, COVID-19, influenza and whooping cough are examples of respiratory infections that can be prevented by vaccination.

Vaccination can also help to protect other people. People can be protected if those close to them (like friends and family members) and enough people in their communities (including healthcare professionals) are vaccinated, because it stops infections from spreading.

Take regular physical activity

Regular physical activity and exercise improves quality of life, whether you are healthy or you have a lung condition. Many people associate keeping fit with maintaining a healthy heart, losing weight and reducing the risk of illnesses such as diabetes, but exercise also helps keep lungs healthy.

When you exercise, your heart beats faster and your lungs work harder. Your body needs more oxygen to fuel your muscles. Your lungs step up their activity to deliver that oxygen while expelling additional carbon dioxide. In addition, your lungs expand during exercise compared to when not exercising, preventing compression of lower lung areas.

About Makerere University Lung Institute

MLI is Uganda’s eminent research organization in lung health. Established in 2015, Driven by the Slogan: Science for healthy lungs, MLI partners with the Ministry of Health and local and international partners to conduct World class research that integrates disease prevention, clinical care and training. During the COVID-19 outbreak, scientists from MLI were actively engaged in the national COVID-19 response through guideline development and patient care.

MLI continues to support the national response for TB and other chronic respiratory diseases such as asthma and COPD. MLI joins the rest of the world to advocate for lung health to be a top priority for policy and decision makers, encourage individuals to adopt personal behaviours that promote healthy lungs.

The writer is a Public Health Physician and Research Scientist at Makerere Lung Institute.