The diseases that can take our breath away

The introduction of effective antimicrobial chemotherapy in the 1960s saw the rates decline further.

In the less developed world, TB remains a devastating disease.

However, it has not gone away in this country and many people would be surprised to learn that in the last decade the incidence rate in Britain had started to rise again, to about 8,000 cases per year.

The majority of these cases arise from reactivation of the disease in people who have originally contracted it abroad.

For a while this was particularly worrying because we had begun to relax the public health controls. Fortunately, NHS England and Public Health England have now introduced a new national strategy for TB that focuses on the identification of latent disease in new immigrants and the offer of preventative treatment. The figures already suggest that this strategy is having an effect.

Around 100 years ago, pneumonia was as common as cancer and cardiovascular disease as a cause of death. This was particularly true during influenza epidemics when young people were especially vulnerable.

Although the death rates from pneumonia are no longer of the same epidemic proportions, the condition is still responsible for approximately 35,000 deaths per year. This is a reminder of how important the influenza immunisation campaign is in reducing the risk for the vulnerable categories.

Nevertheless, large numbers of people are still admitted to hospital with pneumonia with a 10 per cent risk of death. Hopefully, these days patients get prompt diagnosis and early antibiotic treatment to reduce the possibility of complications. In the western world the scourge of polio largely ended in the 1950s with the introduction of effective immunisation. Before that, polio killed people by paralysis of the respiratory muscles leaving them to suffocate slowly.

The chances of survival were greatly enhanced with the introduction of artificial ventilation in the form of the tank ventilator known as the iron lung. This device saved many people and there are even people alive today who contracted the disease in the last major epidemic of the 1950s still using this machine.

The lessons learnt from the technology of artificial ventilation have found modern applications. These days the machines which support breathing use positive rather than negative pressure technology, and are much smaller. They are in widespread use for a number of different conditions, particularly when respiratory support is required overnight during sleep.

Examples of conditions that maybe eased by such treatment include scoliosis or other chest deformities, muscular dystrophy, motor neurone disease and sleep apnoea.

It may, however, surprise people to learn that one of the most common reasons for the introduction of artificial ventilation is obesity. Today the most common respiratory diseases are COPD (bronchitis and emphysema) and asthma, with lung cancer the biggest cause of death. Respiratory specialists also look after people with pulmonary fibrosis, bronchiectasis and sleep apnoea among others. Asthma and COPD have some features in common - they both result in airway-narrowing and symptoms of breathlessness. The impact of breathlessness increases with advancing age because lung function naturally declines with age and also because people who avoid exercise because of breathlessness become unfit. Keeping active is a very important factor in keeping well if you have lung disease.

Asthma is thought to affect over five million people and often, though not always, begins in childhood. The basic problem is the development of airway inflammation that is usually allergic and results in episodes of wheezing and breathlessness.

Dealing with the condition has moved on a long way with the introduction of inhaled treatment that can control the inflammation and suppress symptoms.

Sadly, people still die from asthma - albeit a relatively small number - and we do not compare well with other European countries in this respect. This is a complicated area but many of these deaths, especially in younger people, invovle preventable factors.

COPD is a lung condition that results in progressive, irreversible loss of lung function that leads to disabling breathlessness and ultimately respiratory failure. The condition is estimated to affect over three million people in the UK and can be detected by a simple breathing test called spirometry.

Unfortunately, this test is still not widely employed to find people with lung disease and as a result many sufferers may remain undiagnosed until the disease is well established.

Worldwide, the causes of COPD include cigarette smoking as well as exposure to industrial and domestic fuel pollution.

Not everybody who smokes will get COPD so there is also an element of genetic susceptibility. Nevertheless, stopping smoking is the most important way to combat COPD, along with inhalers, flu immunisation, oxygen therapy for respiratory failure and pulmonary rehabilitation.

The latter is effective in helping people who have developed breathlessness that interferes with their daily lives. It includes elements of physical exercise and self- management training that are usually conducted in group settings.

In recent years there has been considerable interest in surgical techniques that can improve lung function in a few patients with pulmonary emphysema.

Known as lung volume reduction surgery, it was found to be effective in carefully selected patients. Recent developments now include the possibility of avoiding open surgery by using endoscopic techniques.

So, respiratory diseases are still important causes of death, disability and hospital attendance. There are still some echoes from the past but todays conditions are more related to older age and frailty. Whatever the nature of your respiratory disease it has never been more important to keep active and learn about condition.

For more details and advice visit the British Lung Foundation at www.blf.org.uk/ and Asthma UK at www.asthma.org.uk.

Professor Mike Morgan is a consultant respiratory physician at the University Hospitals of Leicester NHS Trust and national clinical director, respiratory for NHS England