The BC Lung Foundation’s Bicycle Trek 2022, exploring the beautiful and fresh-air-filled Fraser Valley, was supposed to take place 10–11 September 2022. It was planned as a 200 km ride—part fundraiser, part weekend getaway to support the one in five BC citizens affected by lung disease, primarily in its chronic obstructive pulmonary disease (COPD) format. Currently, there are few options beyond symptom control for this progressive condition. For a long time, COPD has been thought of as a self-inflicted disorder by chronic smokers. Perhaps that may explain why there has not been any major progress in the treatment or prevention of this life-threatening disorder.
As a wicked irony of the realities of life, this year’s fundraising attempt to promote lung health had to be canceled at the last moment because of smoke pollution in the air, this time because of nearby forest fires.
Recently, a framework was published by one of the Lancet’s commissions to rethink the elimination of at least some forms of COPD. The framework reminds the reader that the lung has 2400 km of airways and 300–500 million microscopic air sacs or alveoli. Yet this essential organ does not receive much attention in medical undergraduate programs or in daily medical practice, until a disease is diagnosed.
The Lancet Commission on COPD proposes to classify COPD into five types, determined by certain risk factors: tobacco smoke exposure, air pollution, genetics, early life events, and pulmonary infections. As to tobacco use, in the opinion of the Commission the best outcome for long health is for both tobacco and vaping to be eliminated worldwide.
Both outdoor and indoor air pollution require urgent attention. The United Nations already advocates for the right for a healthy environment and clean air. It is not yet appreciated that indoor stoves using wood, biomass, or coal produce pollution with disproportionate effects on women’s lung health around the world.
The Commission’s report points out that genetics and early-life experiences are not usually considered in the context of COPD. Yet more prematurely born babies survive now and, as they reach adulthood with potentially smaller lungs or prematurity-related lung disorders, are not being routinely monitored. Lung health needs to be monitored with appropriate tests, similar to heart health examinations that usually include blood pressure testing and blood work of various sorts.
As to pulmonary infections, the Commission points out that lower respiratory tract infections are not currently identified as risk factors for later-life COPD.
The Commission recognizes that in clinical practice COPD is often approached with a sense of futility and even stigma. In the office setting, identifying risk factors may lead to early diagnosis and treatment. Public health measures on an international scale may lead to substantial preventive measures.
The Commission’s goal is clear: lung health for all. This is a long-term goal, requiring international, scientific, educational, professional, public, and individual support. Hopefully next year’s Bicycle Trek will take place under a blue sky in pollution-free clear sunshine.
—George Szasz, CM, MD
Stolz D, Mkorombindo T, Schumann D, et al. Towards the elimination of chronic obstructive pulmonary disease: A Lancet Commission. Lancet 2022;400(10356):921-972.
This post has not been peer reviewed by the BCMJ Editorial Board.
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