A/Prof Lucy Morgan

Transcript

1. A/PROF LUCY MORGAN BMed PhD FRACP
2. Why is good lung health important? What can we do to improve lung health?
3. What makes for good lung health? • Individuals with minimal risk factors for sick lungs • A community with minimal risk factors for sick lungs • Good treatments for sick lungs • Access to treatments for sick lungs
5. What makes up a healthy set of lungs? • Tubes • Sponge • Cling wrap • Cake tin
6. Lungs are like soft fresh bread. Tubes take air in and out of the lungs. Oxygen from the air seeps into the blood via tiny sacks.
7. The lung tissue is covered in 2 layers of very thin pleura
8. the whole lot sits within the chest
9. What makes a set of lungs unhealthy ? • blocked tubes • airspaces full of stuff • scarring and holes • lumps and bumps • weak muscles
10. damage the chest wall Broken ribs Weak muscles Breathlessness pain
11. Blocked tubes Asthma Bronchitis Bronchiectasis Breathlessness Wheeze cough
12. blood Pulmonary embolus Vasculitis Tumour Breathlessness Cough Pain haemoptysis
13. infection Bronchitis Pneumonia empyema Cough Breathlessness Fever pain
14. Scarring or holes or a thickened crust Pulmonary fibrosis Emphysema Pleural thickening Mesothelioma LAM Breathless Chest pain fatigue
15. lumps cancer Cough Fatigue blood
16. Unhealthy lungs leads to • Missed work and school • Less housework • Less homework • Less sleep • More medications • More hospital • Deaths
18. Lung Disease in NZ
19. Respiratory Deaths in NZ in 2013
20. Respiratory DALYs in NZ in 2013 12,000 admissions 50,000 bed days 200,000 GP visits 450,000 scripts 1 DALY= loss of 1 year of healthy life
22. Asthma burden of illness remains high • 20% children • 10% children • 2% of total health care spending • 14% prescribing costs
23. COPD a very high burden of illness for our people • 4th leading cause of death in Australasia • 2nd leading cause of hospital admissions • 1 million bed days per year • >250,000 patients with symptomatic COPD in NSW alone Indigenous Australians with COPD Death rate x5 Admission rate x3 Prevalence rate x2
24. $ 98 billion pa $ 107 million pa
25. Who is at risk for developing unhealthy lungs? • Smokers • Indigenous • Environmental dusts and chemical • Indoor and outdoor air pollutants • Premature birth • Overcrowded living conditions • Wonky genes
26. Chest infections are the commonest reason for Australians to visit the GP • Pneumonia the most likely new problem to require admission to hospital (30% require hospital) • 56,000 hospital separations 2013-14 • Pneumonia carries a heavy burden of illness for people with chronic illness and healthy people
28. What is pneumonia? • Gunk in spongy lung typically caused by infection causing cough, and difficulty breathing • changes in the CXR • Bugs have access to blood stream • Fever, confusion and changes in BP and HR • Potentially life threatening.
29. Pneumonia is an infection in the spongey lung that potentially spreads to the blood stream
30. Why is pneumonia bad? • people die • commonest cause of death for patients with COPD • 20% death rate even with good treatment • high community cost - time off work ,missed school, high medication use • increased rates of other problems getting worse ( falls , fractures, heart attacks…..)
32. Who is at risk for developing pneumonia? • All of us, especially: • Chronic lung disease • Chronic heart disease • Chronic kidney disease • Chronic liver disease • Cancer • Diabetes • Increasing age • Alcohol and smoking Risk Stacking makes everything worse
33. What is Risk Stacking? • Multiple comorbidity also associated with • poor prognosis • poor tolerability of treatment • more likely to be admitted to hospital • Hence an important group to address re prevention
35. Common causes of pneumonia • Bacteria • Streptococcus pneumoniae (pneumococcus) • Mycoplasma pneumoniae • Haemophilus influenzae • Chlamydophila pneumoniae • Legionella spp • Viruses • Influenza • RSV • HPNV • RV
36. CASE 1: Male, 48-year-old
37. CASE 2: Male, 73-year-old
38. CASE 3: Male, 91-year-old
39. CASE 4: Male, 42-year-old
40. CASE 4: Male, 42-year-old
41. Strep. Pneumoniae causes pneumococcal disease • Healthy people carry the bacteria in the nose and throat • Doesn’t make them sick until another illness (e.g. flu) allows for invasion
42. t3rd ~30,000 in NZ admissions p/a
43. What can we do to reduce pneumonia for these patients with high risk ? • QUIT smoking • Good evidence of benefit • Public health policy very important • Hand hygiene • Good evidence of benefit • Hospital infection control policy very important • Vaccinations • Good evidence of benefit • NIP and PBS support
44. Pneumococcal vaccination reduces risk of developing pneumonia • reduces invasive pneumococcal disease (IPD) • Recently confirmed to protect against non-bacteraemic pneumococcal pneumonia 45% reduction in risk
45. Influenza vaccination reduced the risk of developing pneumonia • Reduces the risk of acquiring Flu when the vaccine and circulating strain of virus are well matched • Reduces community Flu burden • Reduces viral pneumonia and post viral bacterial pneumonia • For people > 65 years old and those with chronic health issues reduces hospital admission and death from pneumonia
46. Viral pneumonia • second most common cause of pneumonia requiring hospitalisation • mostly Influenza **** • respiratory syncytial virus (RSV), parainfluenza virus, human metapneumovirus and coronavirus. • Bacterial/viral co-infection up to 26% – S. pneumonia and Staphylococcus aureus
47. Influenza • Common (10,000 cases notified in Aust 2015) • Associated with high rates of complications • Especially for people with other medical problems • 30% <15 yrs • Peaks 5-9 yrs, 35-44 yrs, >85 yrs • Vaccine preventable
50. LUNG FOUNDATION AUSTRALIA  Advocacy  Education  Support  Policy
51. Lung Foundation Australia
54. Burden of respiratory disease is not equal in NZ
57. LFA in NSW • 30% of LFA activity in NSW • Patient enquiries (6,400 per year) • Lungs in Action – 30 programs • Pulmonary Rehabilitation – 100 programs • 2,368 registered users of COPDX Guidelines • Seminars in Sydney, Port Macquarie, Lismore, Campbelltown
58. Cost vs Benefit • The costs of activities such as pulmonary rehabilitation for patients with COPD is relatively small • Same $ model for setting up a lungs in action group. • The benefits are huge
59. Patient Self-Management • Numbers needed to treat to prevent 1 respiratory related admission = 20 • Pulmonary rehabilitation • Action planning • Medication adherence/device usage • Immunisation • Lifestyle and maintenance of physical activity
60. Wider access to Rehabilitation • Numbers needed to treat to avoid re- admission = 4 • Low access outside metro centres • Long waiting lists in metropolitan areas • Transport issues a barrier to access hospital based programs • Inequitable access • LFA advocating for MBS rebate
61. Compare Rehabilitation to the cost of Statins • Cost to community via PBS in Australia • NNT= 28 to save one life in patients who already have heart disease A$284 million for 76 million prescriptions A$53 million for 90,000 prescriptions
62. Mortality from Lung Disease • 14 % of all Deaths in Australia • Caused by lung disease including • COPD • Asthma • Bronchiectasis • Lung Cancer • Influenza • Pneumonia
63. Other vital activities for LFA • Clinical Disease Registries • Interstitial Pulmonary Fibrosis (IPF) • Australian Bronchiectasis Registry (ABR) • Orphan Lung Diseases • Bring together patients, clinicians and researchers • National high quality data sets • International collaborations • Platforms for clinical trials
65. Courtney Barnett from the Avant Gardener Courtney Barnett from the Avant Gardener