National strategy needed to deal with massive burden of respiratory disease, expert group warns
Leading respiratory experts from the Irish Thoracic Society (ITS) have today warned of the impact of Covid-19 on lung health in Ireland.
The Society has called for urgent action to avert unprecedented rates of excess illness and death from lung disease.
According to the Society, additional resources for the diagnosis, treatment, and ongoing care of people with respiratory conditions were crucial to prevent a lung disease crisis.
The respiratory experts on the Societyâ€™s Covid-19 sub-group had expressed disappointment that the â€˜Programme for Government â€“ Our Shared Futureâ€™ did not include a targeted response to the burden on respiratory healthcare services amidst fears that lung health was set to become one of the biggest casualties of Covid-19.
Dr Aidan Oâ€™Brien, President of the ITS, envisaged a greatly increased demand on respiratory services in the wake of Covid-19. Not only that, but the level of resources currently available was going to be severely curtailed because of restrictions imposed by the ongoing presence of Covid-19 in the society.
He underlined to Irish Medical Times, the massive burden Ireland already faced with existing respiratory disease and added that while strategies were in place for cardiac disease and cancer, there was need for a national strategy for respiratory disease.
In this country between 400,000 and 500,000 people were affected by chronic obstructive pulmonary disease (COPD); 300,000 to 400,000 suffered from asthma with 10 per cent of the population affected by other conditions, such as sleep disorders.
Previous data on Middle East respiratory syndrome (MERS) and the severe acute respiratory syndrome (SARS) had shown that up to 60 per cent of patients appear to have had ongoing respiratory problems, when assessed three months later. â€œWe expect we may be seeing similar numbers with the Covid-19 crisis, which is continuing. It may be an ongoing burden, not to mention the present burden of already incurred cases,â€ said Dr Oâ€™Brien.
â€œAdded to all this, we have all the people who have existing lung disease, and new disease which is occurring that is not being dealt with, because these patients have all been doing the right thing, staying at home, but to the detriment of their lung disease.â€
He said that Covid-19 affected many organs, but the lung had been the primary organ of injury with acute lung disease, and lung presentations, and a long-term potential impact.
It was too early to determine the predominant impact to the lung, but many Covid-19 patients had been suffering acute pneumonia. Anecdotally, there were reports of persistent breathlessness weeks and months later in young healthy people, managed in the community.
He commended the Health Service Executive, and the Health Protection Surveillance Centre, for all the good work they had done to deal with the crisis and Covid-19 to avoid the massive surges seen in other countries.
The Society is pressing for several urgent measures: increased numbers of respiratory specialists; investment and adaptation of infrastructure with availability of isolation rooms, and negative pressure rooms and adequate space. It is also seeking continued development and application of technology and innovation to provide virtual solutions for clinical management, monitoring and self-care of patients.
In addition, rapid implementation of the most recent ITS guidelines in all hospitals was urged.
The Society welcomed accelerated implementation of the SlÃ¡intecare Strategy, as set out in the Programme for Government, but called for this to encompass a targeted response to the specific challenges of respiratory healthcare through a range of measures.
The ITS Covid-19 sub-groupâ€™s members include: Dr Marcus Butler and Prof Tim McDonnell, both of St Vincentâ€™s University Hospital, Prof Sean Gaine and Prof Karen Redmond both of the Mater Misericordiae University Hospital, Prof JJ Gilmartin and Dr Michael Oâ€™Mahony both of Galway University Hospital, Dr Marcus Kennedy of Cork University Hospital, and Prof Eddie Moloney of Tallaght University Hospital.
Other members are Prof Ross Morgan of Beaumont Hospital; Prof Shane Oâ€™Neill, Emeritus Professor of Clinical Medicine Beaumont Hospital, Royal College of Surgeons in Ireland; and Dr Mark Rogan of Waterford University Hospital.
Emma Flood, Midland Regional Hospital Mullingar (Respiratory Physiology); Siobhan Healy, Cork University Hospital (Physiotherapy); and Paula Ryan, University Hospital Limerick (Advance Nurse Practitioner, Respiratory), complete the sub-group.