‘Dickensian’ lung disease rates on the rise in UK pensioners 

05/11/2015 00:00 
The number of people diagnosed with bronchiectasis, a lung condition thought to be a ‘disease of the past’, has risen considerably in the past decade and now affects more than 1% of UK pensioners.

This was the finding in a new study by UCLH, UCL, Imperial College London and the London School of Hygiene and Tropical Medicine.

Bronchiectasis is a disease in which the airways taking air into the lungs are damaged. It can be caused by a previous chest infection, weaknesses of the immune system and by conditions that cause inflammation of the airways such as rheumatoid arthritis.

The damaged airways are less able to clear mucus and bacteria away, causing recurrent chest infections. The patients cough up mucus and blood, and develop shortness of breath and sometimes respiratory failure.

The disease is incurable and although the resulting infections can be treated with antibiotics, resistant bacteria are becoming an increasing problem.

The new research, published in the European Respiratory Journal, used anonymised GP records covering 14 million patients from across the UK to identify those with a diagnosis of bronchiectasis.

The research found that bronchiectasis is surprisingly common and becoming commoner, especially in older people. The disease affected approximately 0.6% of people aged 70 or over in 2004, but this increased to 1.2% in 2013.

The condition was more common in women and among people with higher socio-economic status. Furthermore, the mortality rates in people with bronchiectasis are twice as high as mortality rates in the general population.

“Bronchiectasis is historically associated with untreated chest infections when antibiotics were not readily available,” explains senior author Jeremy Brown, Professor of Respiratory Infection at UCL and consultant at UCLH where he runs a bronchiectasis clinic. “We found that the disease has had a resurgence in recent years, particularly among more well-off members of society. This could be partly down to improved diagnosis in these groups, but whatever the reason we need better treatment options for patients.”

The study found that 42% of people with bronchiectasis also had asthma and 36% had chronic obstructive pulmonary disease (COPD). 6.9% of bronchiectasis patients also had HIV, a much higher proportion than expected.

“The high prevalence of bronchiectasis in people with asthma and COPD is an important finding,” explains lead author Dr Jennifer Quint, who carried out the study while at the London School of Hygiene and Tropical Medicine and UCLH, and now works at Imperial College London. “Whether the diagnosis of bronchiectasis precedes or follows the diagnosis of asthma or COPD is important to investigate next as it may help to guide longer term management in these patients.”

The incurable condition can make life extremely difficult for patients such as Clare Dawson, a 35-year-old lawyer from London, who cannot work full-time because "i would have to take so much time off that it would become untenable."

Clare Dawson

Clare was diagnosed with an osteosarcoma in her chest wall near her left lung when she was 17. "I had a lot of treatment for it: surgery, radiotherapy and chemotherapy and I went into remission and have been clear ever since.

"But the treatment caused a lot of damage to my left lung, and my immunity was compromised, so I started getting a lot of chest infections about a year into treatment, and for about a year after that I was in an out of hospital with chest infections.

"By the time I was 19, my immune system got stronger, and my chest infections were under control but I was referred to a respiratory physician to manage my condition. I don’t think anyone had mentioned bronchiectasis or knew that that’s what it was.

"I recovered, went back to school and finished my law degree at university. I managed to get on with things, but once a year I was being admitted to hospital with a chest infection because it just wouldn’t quit. Over time my bouts became more frequent and I was referred to Prof Brown. I think by that time the consultant I was seeing was probably aware it was bronchiectasis and that is why I was referred to him.

"I wish I’d known then what I know now. I know that I didn’t get the chest infections treated early enough and aggressively enough because we didn’t know I had bronchiectasis. My left lung had originally been damaged by the cancer treatment but the infections in the left lung started compromising my right lung. Bronchiectasis is not easy to pick up and even when I was told about it, I’m not sure I realised the long term implications of it.

"But with diagnosis, I had a proper treatment plan and knew I had to react quite quickly to the first sign of infection. For the first eight or nine years, I managed quite well, but in the past seven years or so it has been interfering quite a bit with my life. I have not been able to start my job in law because every time I had a start date I had to go to hospital and bronchiectasis has contributed significantly to this.

At my last appointment I was told that my lung capacity was down to 40 per cent and in practical terms I know I have to be careful. I cannot exercise and I walk around much slower because I get breathless really quickly.

On a good day, I don’t look like I’m unwell, but on a bad day it can be a struggle to get up the stairs at home. Over time, what is happening is that I am getting more bad days. Last winter I was constantly ill for five months.

"I’ve had a few scary complications. Two years ago I was in intensive care because I started coughing up a lot of blood. My blood vessel walls have become weaker and rupture more easily when I cough so it can get quite dangerous.

"I cannot work full time because I would have to take so much time off that it would become untenable. I do lots of little part time things that I can get in and out of, and I do manage to keep busy but it does mean that I’m still dependent on benefits.

"I know that the reality is going to get a lot worse, but I’m not too keen to think about the long term. The medium term is enough for now, I just want to know enough to be able to manage my day to day."


Photo credit: (Lung image on news section and website home page, Anatomy of the lungs and heart (courtesy of University of Liverpool via Flickr: https://www.flickr.com/photos/liverpoolhls/10826115733/)

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