Respiratory conditions

On average, at least one person per family is affected by lung disease.

A huge number of people live with the debilitating effects of the disease and it is also a major killer.

From an underwriting point of view any current lung condition can have an impact on the terms offered for both life and disability benefits.

Some of the more prevalent conditions are covered here but this is by no means exhaustive.

Asthma - This is usually triggered by spasms of the bronchial tubes.

The cause is often external such as pollen, dust and food allergies.

Infections, change in body temperature and emotional upset may also cause an attack.

There are two types:

• Extrinsic - Usually appears in childhood, is mild and related to external factors.

Symptoms include wheezing and a tight chest.

Sufferers will usually be symptom-free between attacks and often out-grow the condition.

There is no significant impact on mortality.

• Intrinsic (late-onset) - Appears in adulthood and is less common than extrinsic.

Attacks are usually severe and respond poorly to treatment, with symptoms continuing in between acute attacks.

There is higher than average mortality.

Treatment is with antibiotics (for acute infection), inhalers and steroids.

Oral steroids indicate more serious disease.

Symptoms are relieved, not cured.

Bronchitis - Acute bronchitis is inflammation of the mucosal lining of the bronchi, secondary bronchi and bronchioles.

It is generally due to viral infection.

If the lungs are otherwise healthy, an attack should be brief and leave no residual damage.

Chronic bronchitis starts as excess secretion of mucus by the glands in the lining of the bronchi.

In the later stages of disease there is structural damage to the bronchi, causing irreversible narrowing of the airways.

The two conditions necessary for the development of the irreversible stage are:

• Constitutional or inherited predisposition to disease of the respiratory tract.

• Continuous presence of an irritant to the bronchial mucosa.

The major cause is tobacco smoke from cigarettes.

There is no cure for chronic bronchitis, treatment is aimed at stopping progression and relieving symptoms.

These include inhalers and antibiotics for acute infection.

Bronchiectasis - Broncheictasis can be congenital or acquired.

It is characterised by dilation (widening) of the smaller bronchial tubes and bronchi.

One (unilateral) or both (bilateral) lungs may be affected.

Symptoms are a chronic persistent cough and respiratory infections.

Sufferers are vulnerable to other lung disorders.

Recurrent infection and continued smoking can lead to chronic bronchitis.

There is an effect on mortality.

Treatment is antibiotics for infection, postural drainage - the patient lies head down to cough up secretions from the lungs - or surgery (to remove a part or whole damaged lung).

Impaired immunity Emphysema - This is a chronic incurable disease caused by distention of the alveoli and is often associated with advanced chronic bronchitis and due to cigarette smoking.

Usually a disease of old age, particularly for men, although this is changing as more women have started smoking in recent years.

Symptoms include cough, increase in shortness of breath on exertion, wheezing, tachycardia (fast heartbeat), barrel chest and hyperinflated lungs.

This is an incurable disease so treatments are aimed at relief, antibiotics for infection and bronchiodilators to aid breathing.

Cigarette smoking must be stopped.

This disease has a significant impact on mortality.

Chronic Obstructive Airways Disease (COPD) - This is a generic term covering both chronic bronchitis and emphysema.

It is characterised by significant irreversible airways obstruction.

Pneumonia - Also known as pneumonitis, is an acute infectious disease characterised by inflammation of the lung(s).

It can be caused by bacteria, viruses, parasites and other organisms.

It can occur in association with other diseases such as tuberculosis, alcoholism, diabetes, cardiovascular disease and HIV/Aids.

It is treated with antibiotics to clear the infection.

Tuberculosis (TB) - This is an infection caused by bacteria.

As it is breathed in, it is usually the lungs that are affected but it can spread to any part of the body including bones, kidneys and the brain.

This is known as extra or non-pulmonary TB.

The bacteria is very unusual in that it can remain dormant for many years in the lungs.

For this reason, when someone becomes ill, it can be impossible to determine when they were infected.

Someone with impaired immunity is more likely to become ill after infection.

Initial symptoms include coughing but may lead to breathlessness as lung damage progresses.

Treatment should be with a combination of at least three drugs and last for at least six to nine months.

Lung cancer - Small cell lung cancer is entirely smokingrelated.

Non-small cell lung cancer comprises large cell and squamous cell, which are almost entirely smokingrelated; and adenocarcinoma, which is the only nonsmoking- related lung cancer.

Treatment consists of surgery, chemotherapy and radiotherapy.

However, small cell cancer is very aggressive and surgery is rarely an option.

Overall surgery is only appropriate for 10% of patients.

Other less common lung conditions include sarcoidosis, sleep apnoea, asbestosis and mesothelioma.

All of which would require information from the patients GP.

With worldwide travel now commonplace we are open to diseases that were once virtually eradicated in the UK.

Among these is TB.

In the UK we have had an immunisation programme for many years but around the world one third of all people are infected.

New diseases and viruses are also able to spread much more quickly.

Severe Acute Respiratory Syndrome (SARS) caused 800 deaths worldwide in just a few weeks in 2003.

Without the screening and containment procedures that came into effect things could have been much worse.

SARS was an example of a new strain of disease with a massive immediate threat to public health, one that required an immediate response from insurance companies.

Smoking is undoubtedly a huge factor in many common respiratory conditions and although overall the numbers of smokers in the UK has been falling in recent years, there is a worrying trend in young people.

In particular more women are now smoking than men.

Cannabis is up to 50% more carcinogenic than cigarettes - three joints a day can cause the same damage as 20 cigarettes.

It has been estimated that in 2002 nearly one third of 15 year olds used cannabis.

So with laws on cannabis use now being relaxed this could become as important to underwriters in the future as cigarette smoking is now.

Cannabis use is currently covered under a question about drug use but perhaps we may eventually see a separate question, as with alcohol and tobacco use.

Sources: www.britishlungfoundation.org; Swiss Re underwriting manual Debra Bradley is life & disability underwriter for Scottish Equitable Protect Each year 120,000 people die as a direct result of smoking.

• 28% of adults are smokers.

• Up to 45% of children under 16 have tried smoking and about 20% claim to be regular smokers.

• In the UK it is estimated that 17,000 under-fives are hospitalised each year as a result of passive smoking and that 1,000 people each year die from exposure to other people's tobacco smoke.

• 12% of people are affected by asthma and 1,500 people die each year.

• It is estimated that about 1.

5% of the population have been diagnosed with COPD, around 900,000 people.

• 7% of men over 75 have been diagnosed with COPD.

• COPD and related conditions cause 27,000 deaths each year.

• In the UK, more men die of lung cancer than any other cancer.

• Lung cancer affects as many British women as breast cancer.

• 90% of lung cancers occur in people who smoke.

Source: British Lung Foundation Facts and figures An application disclosing mild asthma, an acute attack of bronchitis or single episode of pneumonia may be accepted on standard terms from the proposal only.

However, most conditions will require further evidence from the client's GP, particularly if any disability benefits are required or any period of hospitalisation is disclosed.

It should also be noted that many conditions will attract harsher terms for a smoker, even where the policy has smoker/non-smoker rates.

Asthma - may be accepted at ordinary rates if disclosed as mild.

However, recent or frequent oral steroid use, hospital admissions or smoking are likely to incur a rating.

Bronchitis - acute episodes under three weeks with full recovery can be standard rates.

Chronic bronchitis - described as a chronic with sputum most days of the month, three months of the year for two successive years, with no underlying cause - will not be standard terms.

Reversible stage could be a minimal rating but irreversible stage can be heavily rated or declined for life cover and other benefits are likely to be declined.

Bronchiectasis and emphysema - terms will normally be offered for most benefits.

However, if the condition is severe income protection is likely to be declined.

Pneumonia and tuberculosis - generally ordinary rates if treatment is complete and the client is now fully recovered.

Lung cancer - As with most cancers the terms will depend on the type and extent of tumour, success of the treatment and length of time since initial treatment was completed.

Initial treatment may combine surgery, chemotherapy and radiotherapy.

Critical illness will be declined in all cases.

For other benefits, a completely removed Carcinoid may be offered standard terms after around six years (declined if not completely removed).

Carcinoma may not be offered terms in the first few years after treatment but then may incur a temporary rating.

After 10 years it could be ordinary rates or still incur a minimal permanent rating.

Underwriting implications