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Over 40 and go for a routine visit to the GP

Respiratory Diseases: The Poor Relation

If you are over 40 and go for a routine visit to the GP anywhere in Europe, he will run a series of checks, but - even if he hears you cough - there is little chance that he will offer you a spirometry test, a simple way of measuring your breathing capacity and overall lung health.
Why not? There are an increasing number of reasons - not least an inadequate level of training amongst healthcare professionals and a lack of awareness from the profession, and the public, about lung disease. The question is, how much longer can we tolerate lung diseases like Chronic Obstructive Pulmonary Disease (chronic bronchitis and emphysema)being overlooked and leave millions of people in pain and distress?
Contrary perhaps to the amount, or lack of, attention it receives, COPD is a common illness; it affects 4 to 10% of the European population, more than breast cancer and diabetes. People with COPD have trouble breathing in and out. This is referred to as airflow obstruction. COPD took the lives of more than three million people worldwide this year and the number of deaths from COPD has increased more than 60% over the last 20 years. According to the World Health Organisation, it will become the third cause of death worldwide by 2030 without interventions to cut risks. COPD costs in the region of 8.3 billion GBP (10,3 billion Euro) a year across Europe. In Canada, France, Germany, Italy, Spain and the UK, the cost of COPD averages 3,038 GBP (3,767 Euro) per patient each year. The numbers make it clear this is a priority. So what are we doing about it?
Despite pockets of best practice, there is a real lack of political momentum in Europe when it comes to COPD. The notable exceptions are actually England, which recently launched a COPD outcomes strategy, and Finland, whose national COPD programme has been running for over 10 years.
We must learn from these examples and put a framework in place across the EU to prevent COPD; diagnose it before it becomes a killer; and develop more effective treatment, research and rehabilitation for patients. At present, very few EU policy makers know that COPD exists and, as a result, no action is taken at pan-European level to tackle the disease and its impact.
In a recent communication from the European Commission on the future EU funding programme for research, respiratory diseases weren't even mentioned in the list of chronic diseases. Once again, whilst cancer, cardiovascular diseases and diabetes took centre stage, lung diseases were entirely overlooked. It's tempting to post a big bill-board image of a chest without lungs in front of the decision-makers offices to open their eyes to their error.
So how do we make lung health a bigger priority? First and foremost, lung testing should be made a basic health right all across Europe. Regular and early checks of the lungs can help people identify debilitating conditions before too much damage is done, giving patients a chance to slow the disease's progression before it completely ruins their lung function. COPD is still very much underdiagnosed and research amongst healthcare professionals suggests spirometry is either not being used or is being used inefficiently, leading to inaccurate results.
Awareness drives like World Spirometry Day help to put testing on radar but further education and training of healthcare professionals would allow them to better identify and diagnose COPD. Rather than creating a new policy, one opportunity would be to work within the existing EU strategy on the cross-borders mobility of healthcare professionals to include criteria for ensuring that training levels were consistent. With a broad objective to improve the quality and equity of care, it's only right that it's the EU which should pay greater attention to the scientific and technical knowledge our doctors, nurses and other care givers acquire throughout the course of their careers.
COPD is mostly preventable and policies tackling the risk factors and determinants of health must be deployed widely, with the EU leading the way. It is our role as advocates of public health to raise awareness about COPD and the solutions, and support policy makers in the drafting of strategies and measures that will relieve the burden of the disease. We must help them understand that "health in all policies" is not just a buzz word in Brussels but that transport, housing, education and the environment all play a key role in people's health and well-being. Coercive (legally mandatory) measures as well as incentives would be part of the COPD framework following the English and Finnish example, which provides solutions to prevent COPD and care for COPD patients. We know the problems we need to solve and we know the solutions which work. The EU must follow the existing examples to deliver a successful COPD strategy.
Catherine Hartmann
Secretary General, European COPD Coalition
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