Today is World Lung Day

Today is World Lung Day (September 25th)

This important day was first conceived and created during the 2016 Assembly of the Forum of International Respiratory Societies by its then President Michiaki Mishima and is intended to raise awareness of lung health, something that we have all become more sensitive to courtesy of the SARS- CoV-2 coronavirus, and so it is unquestionably a big deal day.

The theme of this World Lung Day for 2023 is ‘Access to prevention and treatment for all. Leave no one behind’ - noble aspirations for sure.

Lung disease comes in many treacherous forms: COPD, lung cancer, asthma, pneumonia, whooping cough, ‘flu, etc. And of course, lung health is also very seriously adversely affected by tobacco smoking, by pollution, and by the pernicious effects of climate change. It's an enormous issue.

But also it comes in the form of pulmonary tuberculosis.

Some sobering facts about lung disease as identified by FIRS

- Around 200 million people are living with COPD

- Around 3 million are reckoned to die from COPD each year making it the third highest cause of death

- Lung cancer causes a quarter of all deaths from cancer

- Pneumonia is a leading cause of death for children up to the age of five

- Asthma is one of the most common types of non-communicable disease

- After COVID the number of deaths caused by TB has risen drastically.

This last issue (as identified by FIRS) naturally caught our attention because so surprisingly little has been mentioned about TB in today's publicity. This silence about TB continually surprises us because tuberculosis is (as we have recorded many times before in these blogs) humanity’s most lethal infectious disease, and it most frequently infects the lungs (though it can infect other organs).

Some facts about TB

- Despite a hundred year-old (largely ineffective) vaccine ..

- despite for over seventy years there having been effective cheap drugs that can cure TB in the vast majority of cases of drug-susceptible disease ..

- despite there being effective cheap preventative treatment..

- and despite TB being officially declared a ‘Global Emergency’ by the World Health Assembly in 1993 (thirty years ago)..

- TB is STILL today humanity’s most lethal infectious disease.

So today’s theme (Access to prevention and treatment for all; leave no one behind) is super relevant in respect of TB because the list immediately above testifies to a secondary issue – that, given the scale of its devastation, it is also humanity’s most neglected.

Let’s look at ‘Prevention’ of TB for instance

Prevention, as mentioned above, is one of the aspirational aspects of today's 'Lung Day' theme.

Targets for prevention of TB among high risk or vulnerable people were set in New York in 2018 at a special High Level Meeting for TB, unanimously agreed and committed to by all 192 member states. These targets have since been being missed catastrophically (to the extent that it looks like those high risk and/or vulnerable people simply don’t really matter). The roll-out of preventative therapy for household contacts of infectious cases, for example, (self evidently high risk individuals) was last reported as matching so far just 3% of the agreed cumulative target. The latest data for the total preventative treatment roll-out for 2022 was recently published by the Global Fund - that 1.5 million people exposed to TB received preventive therapy in 2022. This may sound a lot (in fact it was reported as such by the Fund in its Report), but this number needed to have been 17.5 million if the cumulative target were to have been met!

By coincidence, this target, along with all of the others should be being reviewed this very week at the second HLM for TB which started two days ago. We are watching this space to see how these sorts of failures are presented to the world.

We repeat our judgement that with regard to TB this is a catastrophic failure.

And what about today's second aspiration of ‘Treatment for All’?

This has always been an issue for ‘all TB’ because, a full thirty years into a Global Emergency,, around one in three of the 10 million estimated new TB cases are reckoned to still be being missed each year by national TB programmes (we repeat: a full thirty years into a ‘Global Emergency’).

But tucked away within this malingering malevolent plague lies an even more sinister one – MDR-TB. This is basically when the standard first line drugs (which are cheap and widely available) fail to work. For drug-resistant cases there has actually never even been a sniff of any serious ‘treatment for all’ because second-line drugs are too expensive and difficult to manage for most TB endemic countries. So almost all of these cases, largely invisibly, are still being 'left behind'.

Most will die, but will do so slowly because that's how TB works - and all these cases should be being considered to remain infectious. Furthermore, we should remind ourselves that DR-TB is the only anti-microbial resistant (AMR) disease that is infectious simply be being airborne. In this sense it is a public health threat all of its own, and what makes this so tragic is that we have created this threat by neglect and by mismanagement.

In every respect, a further catastrophe within a catastrophe.

Happy World Lung Health Day... and let's hope for better days ahead when these noble aspirations will indeed be being met instead of pontificated upon.