Sometime ago I made mention of a new initiative of the National Heart, Lung, and Blood Institute known as the National Lung Health Education Program, (NLHEP). NLHEP promises to become a new major health initiative in this country. It is designed to develop a program which will identify an estimated 15 million people who have various early stages of chronic obstructive pulmonary disease (COPD). The known cases of COPD have now risen to be the fourth most common cause of death in this country today. In fact, COPD is the only major disease process that is on the rise, because, of course, of the continued use of tobacco. It is interesting that the most common fatal malignancy in both men and women, lung cancer, is also the only major cancer on the rise. Our studies and those of many others have shown a clear linkage between the presence of early stages of COPD and lung cancer. When lung cancer can be found in its early asymptomatic stages, cures are the rule rather than the exception.
The NLHEP is patterned somewhat after the National Hypertension Program, which began nearly 25 years ago, followed by the National Cholesterol Education Program. Both of these programs had a favorable impact on health because they encourage patients and their primary care physicians to get the necessary tests to find out if hypertension, high cholesterol, or both were present. If found, both could be readily treated and the risk of heart attack and stroke was accordingly dramatically reduced. Another more recent program, the National Asthma Education Program now six years old, is beginning to change how physicians treat asthma by focusing on the reduction of inflammation as the mainstay of management and using bronchodilators only for breakthrough symptomatic attacks.
The NLHEP will soon be announced nationally through press conferences, public presentations, and the lay and professional press. The aim of the NLHEP is to have all primary care physicians do simple lung function tests in their offices to measure flow, i.e., the well known forced expiratory volume in one second (FEV1 ), and volume known as FVC. “Test Your Lungs/Know Your Numbers” is the motto. Already some evidence shows that if people know that early abnormalities are present, that smoking cessation is more likely to be successful than when airflow is normal. Even patients with normal airflow can be encouraged to stop smoking and often do so on the basis that their smoking has not done irreparable lung damage.
NLHEP will usher in a new major health initiative in this country and ultimately it will be expanded globally, as the asthma program was. Finding and treating lung and associated diseases early should also be appealing to health management organizations that pay the bill in advanced stages of COPD, when oxygen, mechanical ventilation, and pulmonary rehabilitation are required to save lives or to palliate disease. Surgery for lung cancer, radiotherapy, and cancer chemotherapy are also extremely expensive. Thus, finding patients with early airflow obstruction will identify patients at risk of premature losses of lung function and those most likely to have lung cancer, heart attack, stroke and other cancers related to tobacco.
NLHEP is an ambitious project which I have the privilege of chairing. I hope that everyone will join with me in supporting this program and hoping for its success.
I’ll be in touch next month.
Thomas Petty, MD