Introduction

Respiratory diseases (e.g., Chronic Obstructive Pulmonary Disease (COPD), and lung
cancer) are a major health burden worldwide. For example, COPD affects more than 200
million people and is the fourth leading cause of death. The World Health Organization
predicts that by 2030, COPD will have risen to the third most common cause of death,
accounting for 8.6% of all deaths worldwide.
Smoking is the most important factor contributing to the development of respiratory
disorders. In England alone, one-third of all deaths from respiratory disorders are attributable
to cigarette consumption, while current smokers are 25 times more likely to die from lung
cancer compared to those who have never smoked.
A. Lung Cancer
Lung cancers can start in the cells lining the bronchi and parts of the lung such
as the bronchioles or alveoli. Lung cancers are thought to start as areas of precancerous changes in the lung. The first changes in the genes (DNA) inside the lung
cells may cause the cells to grow faster. These cells may look a bit abnormal if seen
under a microscope, but at this point they do not form a mass or tumor. They cannot
be seen on an x-ray and they do not cause symptoms.
Over time, the abnormal cells may acquire other gene changes, which
causethem to progress to true cancer. As a cancer develops, the cancer cells may make
chemicals that cause new blood vessels to form nearby. These blood vessels nourish
the cancer cells, which can continue to grow and form a tumor large enough to be
seen on imaging tests such as x-rays. At some point, cells from the cancer may break
away from the original tumor and spread (metastasize) to other parts of the body.
Lung cancer is often a life-threatening disease because it tends to spread in this way
even before it can be detected on an imagingtest such as a chest x-ray.
Sometimes lung cancer can spread to other parts of your body. Cancer cells
can break away from the tumour in your lung and travel around your body in your
blood or lymphatic system. The cancer cells can travel to other organs and grow
into what are called secondary cancers.

The symptoms of lung cancer can include:

coughing up blood;
a persistent cough;

breathlessness;
wheezing;
hoarseness;
chest or shoulder pain;
tiredness; and
weight loss

Types of lung cancer

There are 2 main types of lung cancer:
Small cell lung cancer (SCLC)
This kind of lung cancer tends to spread quickly. About 10% to 15% of
all lung cancers are small cell lung cancer (SCLC), named for the size of the
cancer cells when seen under a microscope. Other names for SCLC are oat cell
cancer, oat cell carcinoma, and small cell undifferentiated carcinoma. It is very
rare for someone who has never smoked to have small cell lung cancer. SCLC
often starts in the bronchi near the center of the chest, and it tends to spread
widely through the body early in the course of the disease.

Non-small cell lung cancer (NSCLC)

This is a term for several types of lung cancers that act in a similar
way. Most lung cancers are non-small cell. This kind of lung cancer tends to
spread more slowly than small cell lung cancer.About 85% to 90% of lung
cancers are non-small cell lung cancer (NSCLC). There are 3 main subtypes of
NSCLC. The cells in these subtypes differ in size, shape, and chemical makeup. But they are grouped together because the approach to treatment and
prognosis (outlook) are often very similar.

Treatment for lung cancer

Surgery
If you have stage 1 or 2 non-small cell lung cancer, surgery may be
the best option for you. Surgery offers you the highest chance of living
longer. Surgery is not for everyone. Your doctor will decide whether you are
suitable for this. For example, you may have another medical condition
which makes having surgery dangerous. Your doctor will discuss this with

you. During your operation, the surgeon will try to remove all of the cancer.
The surgeon will either remove part of your lung (lobectomy) or remove all of
one lung (pneumonectomy). This depends on where your cancer is. Your
operation may be done by open surgery (where the surgeon will make a large
cut in your chest) or video-assisted thoracic surgery. This is when the surgeon
makes a small cut in your chest and uses a camera to guide the operation.

Chemotherapy uses anti-cancer drugs to kill cancer cells.

You will not be given chemotherapy or

chemoradiation

(chemotherapy and radiotherapy given together) before your surgery unless

you have chosen to take part in a clinical trial. Your doctor will discuss this
with you. After you have the operation to remove the cancer you may be
considered for chemotherapy. This may be given to reduce the chance of the
cancer coming back and your doctor should discuss whether or not having
chemotherapy is right for you.If all of your tumour has been removed by
surgery, you will not need radiotherapy. Your doctors may consider giving you
radiotherapy if surgeons have not been able to remove all of the tumour during
your operation.

Radiotherapy
If you have stage or non-small cell lung cancer and are not well
enough to have an operation you may be offered radiotherapy

instead.

Radiotherapy uses X-rays or other forms of radiation to kill the cancer

cells.If you have stage 3A or 3B non-small cell lung cancer and your
tumour is growing, you should also be offered radiotherapy.If possible, you
should be offered a radiotherapy treatment called

CHART

(continuous

hyperfractioned accelerated radiotherapy). With CHART you will be

asked to stay in hospital to get radiotherapy three times a day over days.
CHART is not available everywhere in Scotland but your doctor may be
able to refer you to a centre that offers it. If you cannot be offered CHART,
your doctor will discuss the other options with you.3 Radiotherapy on its own,
or along with chemotherapy may cure some patients. It can be helpful in
improving symptoms in all patients, even if a cure is not possible.

Chemotherapy

If you are not able to have surgery or radiotherapy, you have the option
to have chemotherapy instead. Chemotherapy uses anti-cancer drugs which
kill the cancer cells that have spread beyond the lung.If you have stage 3B or
non-small cell lung cancer, you may be considered for chemotherapy with
a medicine containing platinum. This can help control your symptoms and
improve your chances of living longer.The number of chemotherapy cycles
you have should be no more than four if you have advanced non-small cell
lung cancer. If you had chemotherapy and it worked, you may be
considered for more chemotherapy with a medicine called docetaxel if the
cancer starts to grow again. This is given to help you live longer and improve
your quality of life. Your doctor will check to see if you are well enough to
have this.
B. Chronic Obstructive Pulmonary Disease (COPD)
The Global Initiative for Chronic Obstructive Lung Disease (GOLD) has
defined COPD as a progressively disabling disease characterised by airflow
obstruction that interferes with normal breathing. Typical symptoms include increased
breathlessness, a persistent phlegm based cough and frequent chest infections. Latest
statistics suggest that 64 million people have COPD worldwide, and that 5% of all
deaths globally are attributable to the disease.27,28 COPD is more common in men
than women and is associated with socioeconomic deprivation. Individuals of low
socio-economic status are more likely to be diagnosed and to die from COPD than
those of higher socio-economic status. It is estimated that more than 3 million
individuals are living with COPD in the UK alone, of which only 900,000 have been
diagnosed. This is partially due to individuals dismissing the symptoms as a common
cough. COPD is also one of the most common causes of emergency admission and
readmission to hospital. The National Institute for Health and Care Excellence (NICE)
reports that COPD accounts for 30,000 UK deaths every year. This is almost double
the European average.The two main types of COPD are chronic bronchitis and
emphysema. People with chronic bronchitis have intermittent attacks of obstructed
breathing during which their airways become inflamed, narrowed and clogged with
mucus. Chronic bronchitis is the swelling of the lining of your bronchial tubes. When
this happens, you have less air flow to and from your lungs. You cough up heavy
mucus with chronic bronchitis
Emphysema refers to the destruction of the alveoli (air sacs) in the lungs.
Alveoli are essential for the exchange of oxygen in the blood: when they break down

the lung loses its elasticity and there is less surface area of the lung to absorb oxygen.
The onset of the disease is very gradual and breathlessness only becomes troublesome
when about half of the lung has been destroyed. Emphysema causes the walls between
the air sacs in your lungs to lose their ability to stretch and shrink back. The air sacs
become weaker and wider. Air gets trapped in your lungs. You have trouble breathing
in oxygen and breathing out carbon dioxide. If you keep smoking, normal breathing
may become harder as emphysema develops. With emphysema, lung tissue is
destroyed, making it very hard to get enough oxygen.
Although COPD can be the result of exposure to occupational hazards and air
pollution, across the world, smoking (active and passive) is the most commonly cited
risk factor. Cigarette smokers not only have a higher prevalence of respiratory
symptoms and lung function ASH Fact Sheet on Smoking and respiratory disease
abnormalities, but also a higher mortality rate. Other forms of tobacco (e.g., cigars
and water pipes) also increase the risk of COPD. Smoking causes COPD through its
irritant and inflammatory effects on the lungs. Subsequently, the inflammation causes
the airways to thicken and narrow and larger amounts of mucus to be produced.
Evidence shows that: About half the number of cigarette smokers develops some
airflow obstruction and 10-20% develop clinically significant COPD. The risk of
developing COPD is increased if a person smokes from a young age. The findings of
a retrospective cohort study of adult smokers suggest that women are particularly at
risk of COPD if they start to smoke before the age of 16.80% of COPD deaths are
caused by smoking. Secondhand smoking is also a major independent risk factor for
COPD. Evidence published in 2009 found an association between childhood exposure
to secondhand smoke and the development of emphysema in adulthood. The findings
suggest that the lungs may not recover completely from the effects of early-life
exposure to second-hand smoke. Data from the Health Survey for England show that
smokers with COPD tend to be more addicted to cigarettes but show no greater desire
to stop smoking than other smokers. Quitting smoking when COPD is already
developed cannot reverse the disease but can help to decelerate its worsening.
Smoking cessation is more effective than all known pharmacological treatments for
COPD and can also reduce the severity of COPD symptoms. However, the best way
to prevent COPD is to have never started smoking. The most effective way to quit
smoking is by using a combination of treatment, which includes both behavioural
therapy and pharmacotherapy. Recent evidence suggests that when using medication

and counselling, people with COPD can achieve quit rates which are comparable to
those observed in the general population.

References
Action on Smoking and Health. 2015. Smoking and Respiratory Disease. United Kingdom:
Action on Smoking and Health.
American Cancer Society. 2015. Lung Cancer Prevention and Detection. Atlanta: American
Cancer Society.
Department of Health and Human Service. 2010. A Report of Surgeon General: How
Tobacco Smoke Causes Disease. USA: Department of Health and Human Service.
Department of Health and Human Service. 2010. Lung Diseases. USA: Department of Health
and Human Service.
World Health Organization. 2009. Fact Sheet Tobacco.