National Conference On Chronic Lung Disease
20 May 2004
The First National Conference On Copd (Chronic Lung Disease) For Respiratory Health Workers
The first national conference on COPD (a chronic lung disease that includes chronic bronchitis and emphysema) for community respiratory health workers was held in Wellington last week. About 120 respiratory educators and health professionals from around the country attended this foremost and vital conference.
The conference, organised by the Asthma and Respiratory Foundation of New Zealand, provided the latest information on COPD, a condition that affects approximately 200,000 people in New Zealand.
Keynote speakers examined the latest in research, management and treatment of COPD, risks from smoking marijuana, understanding the world of the chronically ill and the carers of the chronically ill and a provocative presentation on how people with a nicotine addiction continue to be killed by the deadly nicotine delivery system - tobacco smoking.
Professor Ian Town, Foundation Medical Director, a keynote speaker at the conference says that being diagnosed with COPD is not a death sentence.
"There is a lot of guilt and negativity involved for the patient because of the cause of their disease - primarily from smoking tobacco.
"COPD is a chronic condition that can be successfully managed, there are new treatments on the horizon and further research is being done. Therefore, people with COPD can have positive and successful outcomes."
Prevention and smoking cessation remain an important focus and tool for reducing the prevalence and severity of the condition says Professor Town.
Robin Taylor, Associate Professor Otago School of Medicine, addressed the risks from smoking cannabis. Cannabis is used by up to 50% of young New Zealanders on a casual basis and of these approximately 10% will be dependent (statistics from the Dunedin Multidisciplinary Health and Development Study).
"The constituents of cannabis smoke are not substantially different from that of tobacco smoke and thus the risks to the respiratory tract from regular cannabis use are similar to that of tobacco smoking," says Associate Professor Taylor.
"Chronic exposure to cannabis smoke leads to inflammation in the lungs - cough, sputum production and changes in exercise tolerance - similar to that caused by tobacco smoking," he says.
"Longitudinal studies suggest that progressive decline in lung function may be increased in cannabis smokers as it is with tobacco."
Furthermore, public health initiatives to minimise the risks of COPD and lung cancer should include reference to the risks of cannabis as well as tobacco smoking says Associate Professor Taylor.
Director of Research at the Wellington Asthma Research Group, Professor Julian Crane says that tobacco is a paradox - its users are addicted to nicotine, which is relatively harmless, but are killed by the delivery vehicle –inhalation of tobacco smoke.
"The failure to recognise and then exploit this paradox is possibly one of the greatest oversights of modern public health," says Professor Crane.
"Funding and exploring alternative nicotine delivery systems, particularly inhaled delivery systems that closely mimic the current delivery system - the cigarette - could have a major impact on reducing the chronic and deadly diseases associated with smoking tobacco."
He wonders why such an important paradox
has been overlooked, or perhaps even ignored, by the public
From Royal College of Physicians, London, UK, 2002: The consumption of non-combustible (smokeless) tobacco is of the order 10-10,000 times less hazardous than smoking, depending on the product.
Professor Crane would like to see alternative nicotine sources made available wherever tobacco is sold and a shift from ‘abstinence’ to 'abstinence OR replacement' with a variety of nicotine sources on offer.
Professor Crane calls for maintaining smoking controls, continuing and extending quit programmes but also adding the concept of permanent nicotine replacement through making gum and patches more widely available at a lower cost as well as looking for newer products which may be more effective.
Finally, the conference had a preview of next years topic (a priority for the Foundation in the coming year) presented by Professor Innes Asher, Department of Paediatrics, University of Auckland and Starship Children's Health. Her keynote address shows the increasing prevalence of many types of childhood respiratory illness, such as bronchiectasis, that are also increasing in their severity.
Professor Asher says she is alarmed by the increase in New Zealand of many of so-called "third world" respiratory diseases that are preventable. She recommends that New Zealand policies need to be addressed in order to rectify the problems of children living in poverty including access to health care, nutrition and immunisations.