Respiratory Health - Q2 - Jul 2016

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LEARN What is Pulmonary Hypertension (PH?) P10

READ Innovations in lung cancer treatment P11

Respiratory health

COPD See your GP for early diagnosis, says Dr Aidan O’Brien

PHOTO: ROBBIE REYNOLDS

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Breathe easy Understand the causes of sleep apnoea – from Professor JJ Gilmartin P4

Innovative treatments Read how advances in asthma treatment are leading to more tailored solutions for patients P8

Raising awareness Read the results of the largest pan-European survey of its kind, which investigated levels of asthma control

PHOTO: ASTHMA SOCIETY OF IRELAND

Moving forward on respiratory conditions We are making good progress on dealing with respiratory conditions, but more action is required, says Dr Jacqueline Rendall, President of the Irish Thoracic Society (ITS)

R

espiratory conditions are an often under-recognised problem in Ireland.

Lung disease causes one in five deaths and are the third biggest reason for hospital admission.

The number of cases is set to rise as the population grows and the over-65s group increases. The elderly are more vulnerable to respiratory conditions.

However, there is progress on recognition and treatment, and the ITS is lobbying to increase the medical workforce, to provide more training and for better access to treatment.

Under-recognised conditions include obstructive sleep apnoea.

One in 15 adults and 3 per cent of Follow us

children have it, often without realising. It carries an increased risk of heart failure, and the resulting fatigue can cause accidents. Rates of diagnosis are expected to increase two- to three-fold but we are working to raise awareness of this condition and to encourage screening.

Pulmonary hypertension is an ’orphan’ disease, under-resourced in terms of specialists and treatment. We now have a hypertension centre and a consultant in Dublin, but provision must expand.

Lung cancer is the most common cause of cancer deaths in Ireland. The incidence of lung cancer is 46 per 100,000; the fourth highest in the world. While overall incidence and mortality is falling, it is increasing among women, among whom it causes more

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Dr Jacqueline Rendall President, Irish Thoracic Society (ITS)

“ Ireland has the fourth highest prevalence of asthma in the world” @MediaplanetIE

deaths than breast cancer. However, improved services mean faster access to specialist teams and test results, so we expect better outcomes for more patients.

Meanwhile it is estimated that 440,000 people in Ireland have COPD, but only about half are diagnosed. By 2020, 20 per cent of adults are forecast to have it. It is still a largely hidden disease so we are developing a better community outreach service to reduce repeat hospital admissions, shorten hospital stays and promote better care.

Ireland has the fourth highest prevalence of asthma in the world.

More than one person still dies each week from asthma and 14 per cent of asthmatics attend emergency services each year. Studies show that allergy-related asthma is

increasing. There have been recent therapeutic advances but access to these is still limited.

Ireland has the world’s highest prevalence of cystic fibrosis (CF) and 50 new cases are diagnosed annually. The recently introduced newborn screening programme should pick up cases earlier, so patients can be referred to CF specialist centres.

New drugs, the CFTR modulators, can change the path of the disease, and we are lobbying alongside patients for greater access.

The medical profession is making progress on diagnosis and treatment for respiratory conditions, but everyone has a part to play. To maintain your own respiratory health, avoid or seek help for smoking and obesity, and make use of screening services.

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Dan Smyth Honorary secretary general of the Irish Sleep Apnoea Trust, chair, European Lung Foundation

It’s time to take sleep apnoea seriously The public need to be more aware that sleep apnoea is condition which can have serious health consequences says Dan Smyth, Chair of the European Lung Foundation.

Does the public understand the implications of sleep apnoea?

In general, no. It’s seen as an inconvenience and, because it’s linked to snoring, it’s also laughed at — but it can be serious. Sleep apnoea won’t kill you, but the conditions associated with it — stroke, heart disease and diabetes, for example — could. Quality structured sleep is so important. It helps rejuvenate tissues and cleans out toxins and it releases growth hormones in children.

It sleep apnoea less common in children?

It is more prevalent in children with cranio-facial issues. Unfortunately, treatment can be a major problem as young children don’t want to wear masks over their nose and mouth at night. And older children have problems with sleepovers as they don’t want their friends to see them using their CPAP machine.

What are your experiences with sleep apnoea?

I was diagnosed in 1994. My doctor said: “If you don’t get this treated, it’s unlikely you’ll see Christmas” because of the likelihood of a stroke. I now use a CPAP machine at night with a mask that goes over my nose and keeps my airways open. It was difficult to get used to at first, but it’s a minor inconvenience in the greater scheme of things. And, touch wood, I feel great.

How has technology improved outcomes?

My CPAP travel machine is a little bit bigger than a Filofax and runs on lithium iron batteries, and I take it all over the world with me: I once camped out with it at Ayers Rock. There are new machines coming out all the time that are lighter and quieter, plus different types of masks. There’s also an oral appliance that pulls your lower jaw forwards, which has had some success for those with mild to moderate sleep apnoea.

Breathe easy: understand the causes of sleep apnoea Sleep apnoea is a respiratory condition which affects people as they sleep. It can have serious consequences — yet treatments are available which can vastly improve a sufferer’s quality of life

By Tony Greenway

“

Most of us are aware of sleep apnoea to some degree because many of us snore,” says consultant respiratory physician Professor JJ Gilmartin. But, he points out, snoring is merely irritating — whereas the consequences of sleep apnoea can be far more serious.

Snoring occurs when there is a partial obstruction of the airway.

On the other hand, sleep apnoea — or, to give it its full name, Obstructive Sleep Apnoea Syndrome — is a sleep disorder where

an individual will frequently stop breathing during sleep because of the total collapse of throat tissues in the upper airway.

This means that sufferers can literally choke or gasp in their sleep.

“The most immediate consequence is that your brain realises you are oxygen deprived and you wake up — to some degree,” says Gilmartin. “This cycle repeats itself throughout the night.”

Impaired performance As a result, patients are excessively tired the following day.

Other symptoms include poor memory and concentration and impaired performance at work or school. It can also affect driving, and is now recognised as an important risk factor for deaths on the road. Plus there are serious long-term consequences of the condition, because it increases risk of high blood pressure, coronary heart disease, stroke and development of irregular heart rhythms.

According to the Irish Sleep Apnoea Trust (ISAT), around 6,500 - 7,500 patients have been

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More than snoring. Sleep Apnoea Syndrome is a sleep disorder where an individual will frequently stop breathing while they sleep.

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diagnosed in Ireland with Obstructive Sleep Apnoea; although, worryingly, EU medical research shows that around 95,000-105,000 people in the country have some form of the condition, ranging from mild to severe.

Indeed, people can suffer from sleep apnoea without realising.

“It’s often a partner who brings it to the sufferer’s attention,” says Gilmartin. “Patients can assess their own risk by thinking about the acronym STOP. Ask yourself: Snoring – does it bother yourself

or others? Tiredness – do you suffer excessively during the day?

Observed apnoea – has your partner told you that you stop breathing in your sleep? Pressure – is your blood pressure high? If you have three of those four, you are at high risk.”

Position dependent The condition usually affects men between 30 and 50 (although it can affect anyone of any age).

People who smoke, drink alcohol or are obese are also at increased risk. “Weight is a factor,” says

Professor JJ Gilmartin Consultant respiratory physician Read more on healthnews.ie

Gilmartin. “Eighty per cent of people with the condition are obese.”

Some cases of sleep apoea are position dependent. “The condition is often worsened when patients sleep on their back, as this blocks the airways,” says Gilmartin. “However, there is a device called the Sleep Positional Trainer, about half the size of a mobile phone, which detects when you lie on your back and vibrates until you move position. It doesn’t seem to disrupt sleep to any significant degree.”

Continuous Positive Airway

Pressure (CPAP) is the main therapy for those with moderate or severe forms of the condition, where a continuous supply of compressed air delivered by a face or nasal mask prevents the throat from closing. “The benefits of CPAP are a dramatic improvement in quality of life and significant reduction in the risk of stroke, hypertension and heart disease,” says Gilmartin. “The outlook for sufferers, even with severe forms of sleep apnoea, is very good if they receive appropriate treatment.”

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Chronic Obstructive Pulmonary Disease affects up to

440,000

PEOPLE in Ireland

COPD is the fourth leading cause of death in the world but most people don’t even know what it is.3

83%

46%

of Irish sufferers have less energy to live their daily lives4

had to make an urgent or unplanned visit to their GP as 4 a consequence of their COPD4 Smoking is the leading cause3, YET OVER THREE QUARTERS

(77%)

of Irish people don’t know this4 References 1. http://www.livingwithcopd.ie/ accessed 5th November 2012 2. Mathers CD, Loncar D (November 2006). “Projections of Global Mortality and Burden of Disease from 2002 to 2030” 3. Celli BR, MacNee W, et al. Standards for the Diagnosis and Treatment of Patients with COPD: A Summary of the ATS/ERS Position Paper. European Respiratory Journal. 2004; 23:932-46.

4. Empathy Research: COPD Awareness and Patient Research 2012

Read more on healthnews.ie

COPD: see your GP for important early diagnosis

By Tony Greenway

Early diagnosis of chronic obstructive pulmonary disease (COPD) is vital so that patients can prevent the condition from getting worse, says consultant respiratory physician, Dr Aidan O’Brien.

It’s well-documented that smoking is a major cause of cancer and heart disease; but, it’s less well known that it’s also the main cause of chronic obstructive pulmonary disease (COPD), the name for a collection of lung diseases which include emphysema and chronic bronchitis. COPD is progressive, limits life expectancy, reduces quality of life, leads to disability and, in severe cases, can be fatal.

This is why Dr Aidan O’Brien, Consultant Respiratory Physician, University Hospital Limerick, is surprised that so many people in Ireland are still lighting up. “We are an intelligent and informed population, but approximately 25 per cent of us are still smoking, despite being well aware of the risks to our health. Cancer and heart disease deserve the media attention they get, of course — but COPD should have a higher profile than it does because 10 per cent of the population or more are affected by it.”

Making a diagnosis When it comes to treating COPD, early diagnosis is critically important, says O’Brien. “The sooner the disease is diagnosed, the quicker the patient is able to adjust their lifestyle and risk factors to prevent it progressing — which means including stopping smoking, for example, or avoiding dusty environments. Also, many interventions are available for reducing the risk of exacerbations and infections.”

Medications may not affect the progression

of the disease, but they do help reduce symptoms and improve quality of life. And while COPD is incurable, it can be partially reversible. In its advanced stages, however, it is irreversible, which is another reason to seek early diagnosis, says O’Brien. “If a patient has lost some of their lung function — and with COPD that can often be as much as 30 per cent to 40 per cent by the time of presentation — this may not be reversible.

As a result, they are more likely to be at risk of subsequent infections and the need for oxygen and hospitalisation, as well as limiting their lifespans, reducing quality of life and exercise capacity.”

Measuring lung function Healthcare professionals diagnose COPD by first assessing the patient’s symptoms. These include persistent breathlessness or wheeziness (when either resting or after moderate exercise) and a chronic productive cough.

Genetics also play a part, so your GP will also want to know if there is a history of lung conditions in your family. Patients will also be asked to carry out a breathing test called spirometry as well as undergo a physical exam.

“The spirometry test measures an individual’s lung function,” explains O’Brien.

“This involves blowing into a machine which records different measurements of lung function. It’s then possible for the healthcare professional to estimate if disease is present in the lung and how severe it is.” After the test, and taking symptoms into account, an immediate diagnosis should be available. However, occasionally further tests may be needed and include Arterial Blood Gas (ABG) — a blood test that gives more information about oxygen and carbon dioxide levels — X-rays, or more detailed lung function tests.

Dr Aidan O’Brien Consultant respiratory physician

Major COPD breakthroughs There have been many advances in the understanding of COPD, and of how COPD develops, in the last two decades. This has subsequently affected the way the disease is treated. “But these advances haven’t changed how COPD is diagnosed in any major way,” says O’Brien. “Diagnosis of COPD is still based on an assessment of classical symptoms, physical exam and the results of a spirometry test. More sophisticated testing, such as Computerised tomography (CAT Scan) of the chest, can help with the diagnosis of COPD — but no new blood tests or other radiological tests have yet been developed that significantly aid diagnosis.”

O’Brien’s message is: if you think you have symptoms of COPD, don’t wait — see your GP. And, crucially, stop smoking. “I’m very optimistic about the future when it comes to finding new ways to treat COPD but we have to emphasise that prevention is better than treatment,” he says. “It’s so important that people don’t smoke. And if they are smokers, then their number one priority is to quit immediately. Nothing else will be as effective.

COMMERCIAL FEATURE

Treatments for COPD ‘improving the lives of patients’ Treatment for patients with chronic obstructive pulmonary disease has improved greatly in recent years, says Professor Tim McDonnell, consultant respiratory physician at St. Vincent’s Private Hospital

I

t is the commonest disease-specific cause of edisease-specific cause of emergency admission of adults to our hospitals — with 15,000 patients admitted annually — yet it is a condition that many people know nothing about: chronic obstructive pulmonary disease (COPD). Worryingly, incidences of the disease are on the increase.

COPD is a disease of the lungs which obstructs airflow and includes the conditions chronic bronchitis and emphysema and many people diagnosed with it are either smokers or ex-smokers..

COPD is progressive. It is, however, usually partially reversible — and treatment has improved over the last few years. “While COPD can’t be cured, it can be managed,” says McDonnell. “We now have an

increasing number of inhalers and we know how to use them for optimum results. Today’s treatments are very good at slowing the disease and improving the lives of patients who have it.”

Inhaled medication called bronchodilators (either short acting or long acting) relax the muscles in the lungs and widen the airways and are the cornerstones for treating COPD. A small minority of patients with advanced cases of the disease and exacerbations can use inhaled steroid medication to reduce swelling and inflammation.

Pulmonary rehabilitation is another treatment option: a comprehensive programme of supervised exercise. “We know that people who exercise more are less likely to have exacerbations (or infections) and do better in the long term than

Professor Tim McDonnell Consultant respiratory physician, St. Vincent’s Private Hospital

patients with COPD who exercise less,” says McDonnell. “Vigorous walking for at least 30 minutes a day opens up the airways, helps clear secretions from the lungs and improves lung function.”

Recovery Non-invasive

ventilation

(a

breathing machine) is used to treat a small minority of patients who are admitted to hospital while they recover from an acute exacerbation; while oxygen therapy and surgery is also used for the small minority of patients with severe cases of the disease. In years to come we may also see coils and valves being more routinely implanted into the lungs to improve elasticity to expel air, says McDonnell — although this is currently in the experimental stage.

St Vincent’s Private Hospital has its own state of the art pulmonary function laboratory for assessing patients together with one of the largest sleep laboratories in the country for assessing sleep disordered breathing which is common in patients with COPD. There are also ancillary physiotherapy services and the St Vincent’s Health-

care Group was the first in the county to have a pulmonary rehabilitation department and one of the first to have a COPD Outreach service. Thoracic surgery is a major strength of St. Vincent’s Private Hospital and is supported by an integrated High Dependency Unit. “Patients with COPD have access to a comprehensive range of resources and treatments at St. Vincent’s Private Hospital, delivered by nine highly trained respiratory consultants,” says McDonnell. “Twenty years ago, wherever they were treated, the advice to patients was ‘stop smoking’. That’s still vital of course; and, these days, treatments are more extensive — and the range of inhalers and exercise programmes, etc, can be tailored to an individual’s specific needs.

Address: St. Vincent’s Private Hospital Merrion Road Phone: 01 263 8000 / 01 260 9200 Fax: 01 260 9249 Email: info@svph.ie Website: www.svph.ie

St. Vincent’s Private Hospital is accredited by Joint Commission International

What is COPD?

Chronic means won’t go away. Obstructive means partly blocked.

Pulmonary means in the lungs. Disease means sickness.

COPD is a disease that blocks up the lungs, causing less air to flow in and out and leading to shortness of breath and difficulty breathing. COPD gets worse over time if untreated and has a major impact on the lives of patients and their families. There are two major conditions for people with COPD:

Emphysema

Bronchitis

This is where the alveoli, or air sacs in the lungs that exchange oxygen with carbon dioxide with the blood, are damaged. This causes the lungs to be hyper-inflated, or pumped with too much air.

Risk Factors

This is where the bronchi, or the airways in the lungs, are damaged. This causes scarring and results in excess mucus, making it easy for germs to infect the lungs.

Signs & Symptoms

Smoking

Air pollution

Difficulty breathing and breathlessness

Being over age 35

Family history of COPD

Coughing with thick mucus

If you are worried about COPD you can now free phone the COPD adviceline on 1800

Extreme tiredness (fatigue)

83 21 46 to speak to a Respiratory Nurse Specialist.

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Asthma: innovative treatments ‘tailored to the individual’ Treatments for asthma have improved significantly over the last few years, which means that more options are available to people whose condition is poorly controlled

T

By Tony Greenway

wenty years ago, the main treatment options for asthma patients were blue ’reliever’ inhalers (containing the medication salbutamol or an adrenergic receptor agonist called terbutaline) and brown ‘preventer’ inhalers (which contain a low dose of corticosteroids).

Now, however, while these devices are still used in frontline asthma control, they aren’t the only answer for sufferers of the condition. Various innovative treatments from multiple drug companies are currently available and have made a big difference to people with asthma notes Dr Desmond Murphy, consultant respiratory physician at Cork University Hospital.

Asthma is an inflammation of the lining of the airways — the tubes which carry air to the lungs.

During an asthma attack, these tubes become narrow and so make it difficult for air to flow in and out, which affects an individual’s breathing. Symptoms can include breathlessness, wheezing, coughing and tightness of the chest which, depending on the severity of the attack, can be frightening and occasionally even life-threatening. Yet asthma is a common condition affecting an estimated 10 to 15 per cent of the Irish population.

Typically it presents in childhood

Hi-tech novel treatments

and teenage years, says Murphy, but it can start at any age with some patients only displaying symptoms in their late 40s or 50s.

Understand your trigger “People have their own asthma ‘triggers’,” explains Murphy. “This might be a chest infection, cold air, pollen, or all of the above. That’s why it’s such a complex condition — one which depends on environmental factors as well as an individual’s genetic make-up.” Understanding your personal trigger is an essential part of controlling your asthma.

When it comes to treatment, inhalers reduce inflammation, open up the airways and increase lung capacity. “Providing someone has normal lung function, initial treatment for asthma is a blue salbutamol ‘reliever’ inhaler,” says Murphy. “However, if an individual is increasingly having to take their blue inhaler, they might need to use it in conjunction with the brown steroid ‘preventer’ inhaler. After that, if they are still having to use their blue inhaler three or four times a week, their healthcare professional might need to escalate therapy with a combination inhaler.” This is a device which includes a long-acting reliever to relieve symptoms, and a corticosteroid preventer to help prevent airway inflammation.

Dr Desmond Murphy Consultant respiratory physician, Cork University Hospital

Exercise-induced bronchoconstriction Anyone taking exercise should ensure they have their inhalers with them at all times as some attacks can be exercise-induced. “Ninety per cent of people with asthma will experience exercise-induced symptoms,” says Murphy, “although narrowing of the airways can happen during exercise in a small number of people without asthma.

“But it should be noted that many athletes have asthma — Paula Radcliffe, David Beckham, Paul Scholes, Ronan O’Gara and John O’Shea, for example — and it hasn’t impaired their performance. So the message to parents of a child with asthma is that, in the vast majority of cases, the condition shouldn’t be an impediment to achievement in sport.”

The majority of asthma cases will be well-controlled with inhaler therapy, says Murphy. But if these treatments have been tried and an individual’s asthma is still difficult to control, then this could indicate a severe, persistent case which might require more hitech, novel treatments.

This might include an injection every 2-4 weeks with a humanised antibody called omalizumab, which blocks immunoglobulin E, a substance in the body that is one of the main causes of inflammation in allergic asthma. “Newer drugs are expected to come through in the next 12 – 24 months,” says Murphy. “These include an anti-IL5 compound which would target hard-tocontrol asthma.”

Bronchial thermoplasty is another relatively new treatment for those with severe asthma — one which has made headlines in the last few years. “Thermoplasty is a procedure which heats the airwaves to between 60 and 70 degrees Celsius, killing off the abnormal muscle cells,” says Murphy. “The evidence for this is still emerging but initial trials were positive — although it isn’t being used on a widespread basis just yet.”

Regular asthma review It’s an exciting time for anyone

involved in asthma healthcare says Murphy. “There are a plethora of inhalers available,” he says. “There are MDIs (metered-dose inhalers) and different types of powder inhalers (which give the medicine in a dry powder instead of a spray). There is also an inhaler called tiotropium, which was traditionally used for patients with emphysema but is now shown to be useful in patients with asthma, too. Plus, there is a drug in tablet form that is well-tolerated by around 30 per cent to 40 per cent of patients and is a safe second line therapy. And, apart from new medications coming to market, thermoplasty could have an increasing role over the coming years. All of this means that healthcare professionals can now tailor specific treatments to their patients and have more options when treating more difficult cases, rather than simply putting them on steroids which have multiple potential side-effects.”

To ensure your asthma is wellcontrolled, Murphy recommends that you have a regular asthma review with your healthcare professional. “Patients should have a review every year to assess their inhaler technique and check if they need to increase or decrease their inhaled corticosteroid,” he says. “If their condition is not well-controlled they should obviously be seen by their GP as soon as possible.”

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Professor Sean Gaine Director, National Pulmonary Hypertension Unit, Mater Hospital

What is pulmonary hypertension (PH)?

There’s a close relationship between the heart and lungs. The right side of the heart pumps blood through the lungs into the left side of the heart. Pulmonary hypertension occurs when the flow of blood through the lungs is restricted, leading to an increase in the pressure on the right side of the heart.

What causes it and who does it affect?

There are many causes. It can be something as simple as low oxygen which can restrict lung blood vessels when people go to high altitudes; or DVT (deep vein thrombosis) which leads to clots in the lung leading to obstruction to blood flow; or it develops because of other lung problems, such as emphysema, or chronic bronchitis over many years. However, it can also develop out of the blue for no good reason in some people, and can run in families. It’s a condition that is twice as common in women as in men, and it tends to be younger women who develop it.

What are the symptoms?

Shortness of breath, particularly when walking up an incline or a second flight of stairs; tightness of the chest, because there’s a strain on the right side of the heart; swelling of the ankles; plus dizziness, because if you can’t get enough blood to go from the right side of the heart to the left side, then there’s a good chance your brain won’t be getting enough oxygen.

Can it be cured?

There’s no cure — apart from having a lung transplant — but it can be managed. New treatments open up blood flow through the lungs: one of the drugs we use which works remarkably well is Sildenafil. In fact, there have probably been more new developments in treatment for PH in the last decade than in any other area of heart or lung disease. A decade ago, if you had severe pulmonary hypertension, your life expectancy was two years. Now it’s much closer to a decade or more.

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New innovations offer “improvements” in lung cancer treatment Mortality rates among lung cancer patients are high — but new innovations offer hope to those in the early stages of the disease, and better management for patients with more advanced cases

By Tony Greenway

T

he most common cancer killer in Ireland isn’t bowel or breast cancer. It’s lung cancer. In fact, lung cancer kills more people every year than bowel and breast cancer combined.

“There are approximately 2,500 new cases of lung cancer every year in Ireland,” says Dr Ross Morgan, Consultant Respiratory Physician at Beaumont

Hospital, Dublin. “It’s the cause of one in 5 of all cancer-related deaths. Only one in eight people with lung cancer survive it.”

The reason for this high mortality rate is that symptoms are sometimes hard to spot, and many patients are only diagnosed in advanced stages. “Unlike other cancers where patients present with a lump, lung cancer tumours can be large before the disease becomes apparent,” says Morgan. “And many symptoms — such as a cough

that doesn’t go away — are common to other ailments.”

Optimistic That said, Morgan insists the lung cancer community is optimistic about the future of treatment. “In the past it’s a disease which has been difficult to treat,” he says. “But we now understand much more about different types of lung cancer, and many new innovations are now available when it comes to diagnosis and treatment.”

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One area of innovation is lung cancer screening for those who are considered at risk of developing the disease, although this is expensive and hasn’t yet arrived in Ireland. “However,” says Morgan, “I would expect it to be available in Ireland and the UK in the next four to five years.”

There has also been a vast improvement in rapid organisation of lung cancer care. “Individuals with suspected lung cancer can now be referred to a Rapid Access clinic for quick assessment,” says Morgan. “About

half of all lung cancers are detected through these clinics. Also, new minimally invasive procedures and scope tests are available, including Endobronchial ultrasound (EBUS), to help with diagnosis.” And rather than seeing one specialist, lung cancer patients can now expect a multidisciplinary approach to their illness, which gives better outcomes.

Improvements In early stage cases, lung cancer may be operable (and potentially

Dr Ross Morgan Consultant respiratory physician, Beaumont Hospital, Dublin

curable). “Approximately 20 per cent of cases are operable,” says Morgan.

“Surgical techniques have improved and are now less invasive, and offer less time in hospital for the patient and better chances of cure.” Radiation techniques have also improved for those with early stage cancer, which means tumours can be targeted more precisely.

For those with late stage cancers, where surgery is not an option, treatment has become far more personalised. “We now better understand

the biology of different lung cancer tumours,” says Morgan. “This means we can offer targeted treatments which have helped in the management of advanced stage cases.”

However, Morgan stresses that prevention is better than cure — and highlights that the number one cause of lung cancer is smoking. His advice, therefore: don’t smoke, or quit if you do. And exercise, too. “Use your lungs,” he says.

“You can do that by keeping yourself active.”

Lung cancer.

Know the symptoms and catch it early.

1. A cough that doesn’t go away or a change in a long-term cough.

2. Feeling short of breath or wheezing.

3. Repeated chest infections that won’t go away even after antibiotics.

4. Coughing up blood.

5. Pain in your chest, especially when you cough or breathe in.

6. Feeling more tired than usual and/or unexplained weight loss.

7. Hoarse voice, problems swallowing or swelling in the face or neck.

How healthy are your lungs? Take the online lung health checker at www.cancer.ie/lung to find out.

For further information on lung cancer, call our Cancer Nurseline on Freephone 1800 200 700

Irish Cancer Society