The Irish Times – Tuesday, September 28, 2010

When breathing is a struggle

“You have to accept what you have, otherwise you are fighting a battle and you are getting nowhere,” says Michael McGloin.

Chronic obstructive pulmonary disease ranks fourth as cause of death in the western world, but it’s unclear how many people in Ireland have the condition

MICHAEL McGLOIN didn’t know there was anything seriously wrong until he collapsed and couldn’t breathe. “In 1999 I had a respiratory arrest, I stopped breathing,” he says. “It was a very frightening experience.”

Tests revealed he had a condition called chronic obstructive pulmonary disease (COPD), a term McGloin had never heard of until he had the sudden episode at age 45.

In COPD, lung tissue gets progressively damaged and restructured, explains Dr Rory O’Donnell, a consultant respiratory physician at St James’s Hospital in Dublin.

“It means that there is chronic airflow obstruction in the lungs,” he says. “The flow of air through the lungs is impaired and the efficiency and the function of the lungs is very much impaired.”

Last year the World Health Organisation estimated that about 210 million people have COPD worldwide, and that in 2005 it accounted for five per cent of deaths globally, but according to O’Donnell it’s unclear how many people in Ireland have the condition.

“We don’t know what the actual prevalence of the disease is,” he says. “It is very much underdiagnosed, and the majority of people who have got mild COPD don’t know they have it.”

However, smoking is a major risk. “One in every two smokers will get some degree of COPD,” says O’Donnell. “And in general you get it in people who have smoked for decades.”

In COPD, the body reacts to irritants, resulting in lung tissue becoming inflamed and producing mucus, and its airways being restructured. Such conditions are a haven for bacteria and viruses, so a patient may have more infections and spend more time in hospital, and symptoms can range from a “smoker’s cough” to a need to be on oxygen.

“There’s a spectrum of severity, which goes from very mild disease, where you just have a bit of a cough and phlegm, to where you have severely debilitated, immobile, oxygen- dependent patients, who are potentially unable to look after themselves because of this,” says O’Donnell.

The number one recommendation in treating COPD is to stop smoking, while inhaled therapies can help to open the airways and dampen down inflammation, he explains.

Research is ongoing to find better medications to treat the condition, but O’Donnell notes that the “Holy Grail” would be a drug that would reverse some of the structural changes in the lung, and as yet there isn’t one.

Another important factor is education. “If patients know what is going on in their lungs, they are more likely to stop smoking,” says O’Donnell.

Meanwhile, vaccinations can help reduce infections that could cause more damage, and rehabilitation can improve exercise tolerance and quality of life. St James’s Hospital also runs a programme designed to minimise the time spent in hospital by patients.

Michael McGloin sings the praises of pulmonary rehab, which he has undergone both in Dublin and in his native Sligo. “They retrain you how to breathe again, and you get exercises that are geared specially for you,” he says. “When you come out the other side of that you are a new person.”

Getting rehab and coming to terms with the condition were important for him in overcoming the shock of his initial diagnosis.

“You have to accept what you have, otherwise you are fighting a battle and you are getting nowhere.”

McGloin has set up a website (copd support.ie) and support groups where people with COPD can meet up and listen to talks from professionals. Now on the transplant list, he needs to use a ventilator at night, but explains that it’s a case of adapting.

“Life is totally different, a simple thing like tying a shoelace or getting dressed is now a chore, you can’t rush in, you have to do things slowly,” he says. But the bottom line, according to McGloin, is that there is life after diagnosis.

http://www.irishtimes.com/newspaper/health/2010/0928/1224279821761.html