Cross-cutting solutions for chronic obstructive pulmonary disease

Cross-cutting solutions for chronic obstructive pulmonary disease
The European Union adopted the Clean Air Package in 2014, with norms to regulate the pollutants emitted by industrial activities, the level of traffic emissions and how to tackle dangerous chemicals coming from agriculture

Isabel Proaño Gómez, director of policy and communications at the European Federation of Allergies and Airways Diseases Patients’ Associations, reflects on how best to address chronic obstructive pulmonary disease.

Despite COPD (chronic obstructive pulmonary disease) being the third leading cause of death worldwide, many people have never heard about it. While there is very accessible information about the first and second causes of death, ischaemic heart disease and stroke, COPD lacks public attention. COPD causes inflammation in the lungs, irreversibly damaging lung tissue and narrowing the airways. Chronic respiratory diseases contributed to 8.96% of non-communicable disease deaths in 2016, with COPD leading to the most deaths from these conditions: 2.93 million deaths worldwide.1

At the European Federation of Allergy and Airways Diseases Patients’ Associations (EFA), we represent more than 40 allergy, asthma and COPD associations, advocating for a health in all policies approach so that patients live uncompromised lives, have the right and access to best-quality care, to participate in their care and to have a safe environment.2

An EU chronic disease strategy to reduce the main causes of death in Europe

In Europe, COPD is a confirmed public health crisis, affecting one in ten adults over 45 mainly due to tobacco consumption and air pollution. Despite having such a toll on human lives for decades, COPD continues to be a catastrophe for patients, their families and healthcare systems.

Recent data from Sweden show that healthcare costs and sick leave costs due to COPD per patient are putting a great stress on healthcare systems (on average €17,518 annually per patient).3 In a moment where the future of the European Union is at stake, we need more than ever a strong leadership to push for decisions to protect our health and human resources.

In the case of COPD, the EU can lead the way to reduce COPD management symptoms and emergency costs by adopting a disease-specific chronic diseases strategy, addressing care, risk factors, diagnosis and social life.

Invest in multidisciplinary care to pause COPD degradation

The reality is that resources established to tackle COPD to date remain scarce and fail to consistently reduce worsening symptoms and hospitalisations. In France alone, hospitalisations due to COPD have risen by 15% from 2007 to 2012.4 What’s more, according to recent data from Sweden, most COPD hospitalisations are due to the co-morbidities linked to the disease, among them heart failure and stroke, diabetes and depression.5

The good news is that there are cost-effective interventions that can turn down the COPD card. At EFA we have prioritised them as Minimum Standards of Care for COPD Patients in Europe:

  • Early diagnosis;
  • Smoking cessation programmes; and
  • Rehabilitation.6

We think it should be compulsory in all the EU that people over 40 undergo spirometry – a lung function test – within health check-ups. Right now, some EU countries do not easily prescribe spirometry tests, and education for interpretation of the results is often not sufficient. Even worse, smokers, ex-smokers, and others at risk of developing COPD do not systematically have spirometry tests in their health check-ups. However, early diagnosis can literally extend the lives of COPD patients – months and years of good quality life, and probably productive ones.

Patients cannot beat COPD alone, especially if they smoke. Nicotine is a highly addictive substance. Patients willing to quit smoking need access to smoking cessation programmes. At EFA, we would like patients to have access to professional cessation support and free-of-charge treatments for all respiratory patients, especially those living with COPD, to reduce the burden tobacco poses on them.

We also recommend the reimbursement of pulmonary rehabilitation to unlock the potential of patients to better manage their disease. COPD patients need guided physical training and psychological support as much as they need medicines, oxygen therapy, and support to quit smoking. Pulmonary physiotherapy allows COPD patients to get fit to go back to work, keep up with their lives and be independent. Compared to the expenditure linked to hospitalisation, rehabilitation is not a cost but an investment to reduce COPD deaths in Europe.

Prescribe active lives to COPD patients

COPD is a kind of ‘blame disease’, meaning that it is your fault if you get it. However, the true face of people with COPD and their families is not like that: COPD patients can remain active contributors to our society. Not only is COPD severity lower in employed patients, but active patients also visit the pneumologist less often, take less cortisone and antibiotics, and end up in hospital less often.

Given that the disease quickly progresses when patients are discouraged to move because of breathlessness, healthcare systems should embrace patients quickly. It is capital for the EU not to lose these halfway, through ageing measures, such as pulmonary rehabilitation, daily exercise and active lives, to keep COPD patients in the workforce and at home as long as possible. Rehabilitation and daily exercise should be a non-negotiable part of the treatment for COPD.

More specifically, physical exercise in groups helps COPD patients to be out in the community, encouraged by others, and communicate about the disease – as we have seen in our #COPDMove video series with patients.7

Enable healthy environments that do not compromise our lives

Key actions to reduce the number of deaths due to COPD are the policies to tackle air quality. The EU is committed to the WHO action plan for the prevention and control of non-communicable diseases, by promoting clean air and reducing premature deaths by 25% by 2025.

The European Union adopted the Clean Air Package in 2014, with norms to regulate the pollutants emitted by industrial activities, the level of traffic emissions and how to tackle dangerous chemicals coming from agriculture – all modelling the air we should be breathing in by 2030. These measures focus mainly on burning fuels. However, they are not the only ones polluting the air.

Fortunately, we can expect other sectors such as agriculture to contribute by emitting less to the air. This is happening with the negotiations of the Common Agricultural Policy (CAP), given that some of the most dangerous pollutants to health come from livestock and fertilisers. It is also the case for other legislations like the directive on carcinogens and mutagens at work, a social decree to reduce occupational exposure to gases, fumes and smoke in the workplace, which actually cause 15-20% of COPD cases.

While all these policies mainly focus on outdoor air pollution, there has been little attention to indoor air quality (IAQ), an environmental determinant of particular importance to COPD patients who might spend much more time indoors than the average 70-90% of citizens.
More than 900 compounds harmful to health have been detected in indoor air. Indoor air quality can be modified today by addressing other variables such as building emissions (construction, surface and finishing materials) and indoor equipment (furnishing, heating and ventilation). Emissions and particles from cleaning products, from cooking and other occupant actions such as smoking and even the opening and closing of windows, can be shaped to reduce harmful impacts in the quality of the air.

As patient advocates, we are approaching the EU Institutions to include IAQ in policies that have a threshold in the issue. This is the case of the recently revised Energy Performance of Buildings Directive (EPBD), which did not even mention the links and benefits of energy consumption reduction and health.

At EFA, we are awaiting policy developments to improve the quality of the air we are breathing in closed spaces, as foreseen by the Seventh EU Environmental Health Programme.

Finally, the EU has the mandate and the responsibility to introduce binding legislation to put an end to tobacco. Despite the 2009 European Commission call for a smoke-free Europe by 2012, the 2009 council recommendations on smoke-free environments, and the great progress made in the last decade, over one in four EU citizens were exposed to tobacco smoke at work in 2013.8 Moreover, half of European general health facilities still allow tobacco consumption inside, profiting from national partial smoking bans.9

It is clear that a total ban on smoking indoors and outdoors, including in the hospitality industry, is the only effective option to protect patients from involuntary exposure to second-hand smoke. For EFA, EU citizens have the right to clean air, and this includes the right to walk, eat outdoors, or wait for the bus without being forced to breathe carcinogenic substances from tobacco. It is time for the European Union to re-launch stricter smoke-free legislation to effectively guarantee our protection from second-hand smoke.

Tobacco products should warn about COPD

Chronic obstructive pulmonary disease is in part a result of the tobacco epidemics, but EU tobacco control policies are not referring much to this disease. Take for example the Tobacco Products Directive adopted in 2014 and regulating the commercialisation of tobacco products.

On the one hand, the new regulation reduced branding spaces in packaging and introduced mandatory and bigger health warnings as a way to increase health awareness and reduce the differentiation and marketing between brands. But as COPD patient representatives we were disappointed that COPD pictograms were not among the ten health warnings adopted by the European Commission that would have been a great opportunity to raise awareness about the disease and its consequences.

On the other hand, it reduced the attractiveness of tobacco to younger people through a ban on flavoured tobacco products and misleading packaging, and the prohibition of the commercialisation of tobacco packages for fewer than 20 cigarettes.10 Given that
countries like France, Ireland and the United Kingdom have already adopted a further commercialisation measure, the introduction of tobacco plain-packaging, the EU has a country base ready to push for stricter tobacco commercialisation policies to protect the health of all EU citizens.

Undoubtedly, the EU has a crucial role to play in tobacco control as a signatory of the
WHO Framework Convention on Tobacco Control (FCTC).11

References

  1. http://thelancet.com/journals/lancet/article/PIIS0140-6736(17)32152-9/fulltext
  2. http://www.efanet.org/
  3. http://erj.ersjournals.com/content/48/suppl_60/PA3926
  4. https://respiratory-research.biomedcentral.com/articles/10.1186/s12931-016-0469-6
  5. http://erj.ersjournals.com/content/44/Suppl_58/4439
  6. http://www.efanet.org/resources/library/2257-76minimum-standards-of-care-for-copd-patients-in-europe
  7. https://www.youtube.com/watch?v=1TQltMqV79Q
  8. Special Eurobarometer 429: Attitudes of Europeans towards tobacco and electronic cigarettes, European Commission, May 2015: http://ec.europa.eu/commfrontoffice/publicopinion/archives/ebs/ebs_429_en.pdf
  9. Overview of smoke-free legislation, European Commission, 2013: https://ec.europa.eu/health/sites/health/files/tobacco/docs/smoke-free_legislation_table_en.pdf
  10. http://europa.eu/rapid/press-release_IP-16-1762_en.htm
  11. http://www.euro.who.int/en/health-topics/disease-prevention/tobacco/publications/key-policy-documents/who-framework-convention-on-tobacco-control-who-fctc

The European Federation of Allergy and Airways Diseases Patients’ Associations (EFA) is a network of 43 allergy, asthma and COPD patients’ organisations in 25 European countries. It works for European patients with allergy, asthma and chronic obstructive pulmonary disease to live uncompromised lives, and have the right and access to the best quality care and a safe environment.

Isabel Proaño Gómez
Director of Policy and Communications
EFA – European Federation of Allergies and Airways Diseases Patients’ Associations
+32 (0)2 227 2712
info@efanet.org
www.efanet.org

This article will appear in issue 6 of Health Europa Quarterly, which will be published in August.

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