35. Respiratory Diseases of Adults


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Richard Lord, www.rlordphoto.com

Adult respiratory diseases, particularly chronic respiratory disease, constitute a major burden in terms of morbidity and mortality in the developing world. They contribute to work–limiting health problems, lost work days, and premature death resulting from delayed diagnosis and treatment. The potential for worldwide epidemics of influenza, for example, highlights the importance of improving infection control practices. A strong case can also be made for moving resources in developing countries from expensive curative interventions to more cost–effective preventive interventions.

The burden of acute and chronic adult respiratory diseases has been rising throughout the world, now including not only tuberculosis but also pneumonia and influenza, chronic obstructive pulmonary disease (COPD) and asthma, and occupational lung diseases. Some diseases, like influenza, are triggered by viral transmission, whereas others, like COPD, are often caused by environmental exposure to tobacco smoke or unvented coal–fired cook stoves. Since the bulk of mining and manufacturing activities have transferred to the developing world?where controls on risky exposure are conspicuously lacking?occupational lung diseases, including asbestosis, present a particular problem.

Although various interventions are indicated for each of these disease categories, they can be costly and of limited efficacy in lowering premature mortality. In the developing world, preventive and therapeutic strategies may have greater societal effect than managing the diseases after they arise. Cost–effective interventions include vaccination schemes to reduce the burden of influenza, and smoking prevention and reduction programs to tackle both asthma and COPD. When disease strikes, educating local healers on the importance of initiating treatment early could translate into savings with respect to worker productivity and medical costs and also reduce fatalities.