Respiratory disorders are among the most common conditions underwriters see disclosed on application forms for life and health cover. Nicola Wharrier examines the facts
In Britain, asthma is the most common childhood disease and Britain has one of the highest prevalences of asthma in the world. Its prevalence is rising, and to date no satisfactory reason has been found for this increase. At least one child in 10 and about one adult in 20 suffer from asthma. In 1996, about 6.6% of males and 6.8% of females in the UK were known to be receiving treatment for asthma. Asthma is not a trivial disease. Over 2,000 people die from it each year in the UK. Most of these deaths can be avoided if those at risk know enough about the disease and can recognise the danger signs. Asthma can be so mild that it is hardly noticeable, or it can come on suddenly and be so severe that the affected person can be at serious risk. Most cases are somewhere in between.
Asthma symptoms
Asthma is a long-term inflammatory condition of the airways, which narrow easily in response to a range of causes. This narrowing makes it more difficult for air to flow and this is made worse by the swelling of the lung lining and by an increased production of mucus. In nearly all cases there is wheezy breathing, but coughing is also very common.
During an attack there is a feeling of tightness of the chest and the heart may be beating more quickly than usual. The severity and duration of symptoms are highly variable and unpredictable. Attacks may last for hours or they may persist for weeks. Long-term asthmatics may suffer lung changes that result in permanent symptoms.
The forms of asthma can be divided into two groups ' those with a known cause and those without. The first group mainly affects people with a general condition called atopy. This is a genetic condition which makes people allergic to various substances (allergens). It also increases the likelihood of eczema and hay fever and there is often a family history of these conditions. The second group is more likely to have developed asthma as a result of exposure to industrial or atmospheric pollution, drugs such as NSAIDS (anti-inflammatory drugs) and beta-blockers, commonly used for heart disease and hypertension. Over 200 industrial substances are known to aggravate asthma. Other triggers include cigarette smoke, cold air, exercise, chest infections and strong perfumes. Treatment when required is in the form of an inhaled steroid. There are five groups of commonly-used drugs. They act in several different ways and are prescribed for certain symptoms. The most commonly used are treatments that widen the air passages and reduce inflammation. In addition to inhaled steroid therapy the patient may need a course of oral steroids ' usually prednisolone. The underwriter pays particular attention to cases that require oral steroids to control the condition. Frequent use of prednisolone is indicative of moderate or severe asthma and this feature would be viewed less favourably.
The most serious complication of asthma is a condition called status asthmaticus. This is a severe continuous attack that does not respond to treatment. This condition can lead to death and requires urgent hospital treatment. Some risk factors for asthma-related death include abrupt development of symptoms that respond poorly to treatment, poor understanding of asthma by the patient and frequent hospital admissions.
Mild asthma can be classified as infrequent attacks that respond well to self-administered treatment, no tightness or wheezing on examination and no time off work.
Moderate cases include cases where the individual has had two or three attacks in the last two years. These may have required oral steroid treatment to control the attack and the proposer may have had to take time off work while on treatment.
A severe classification would indicate more frequent or even continuous use of oral steroids, a history of hospital admissions or status asthmaticus.
Bronchitis
Bronchitis can either be acute or chronic. Acute bronchitis is an inflammation and irritation of the bronchial tubes (airways) and usually follows a cold, a sore throat or influenza, usually in winter. For non-smokers, most cases will settle within a week or two. However, there is always a risk, especially in cigarette smokers, that the condition may progress to chronic bronchitis with inevitable winter flare-ups.
Chronic bronchitis is one of the forms of chronic obstructive pulmonary disease (COPD). COPD is liable to become permanent with age and lead to progressive disablement.
Most heavy smokers have chronic bronchitis, usually called a'smoker's cough.' Chronic bronchitis and other forms of COPD affect 18% of male smokers and 14% of female smokers.
In the Western world, COPD is probably the fourth most common cause of death in middle-aged to elderly men after heart disease, lung cancer and stroke. In the UK, respiratory conditions are the third most common cause of chronic sickness in working-aged people.
People with chronic bronchitis cough up sputum on most days for at least three months of each year. In the early stages, chronic bronchitis is a comparatively mild disease. But with time and continued abuse the condition can worsen and the delicate lung tissue becomes damaged.
There are two stages of bronchitis, reversible and irreversible. In the reversible phase the symptoms are not severe enough to take time-off work. At this stage if the lung irritant is completely withdrawn, for example smoking, the changes in lung tissue will resolve and mucus production will reduce. In irreversible chronic bronchitis, there is a continuous presence of the irritant and a widespread narrowing of the airways. There is sometimes an inherited predisposition to disease of the respiratory tract. Irreversible chronic bronchitis can be classified as mild, moderate or severe.
Mild conditions are classified by regular attacks of winter bronchitis with prolonged cough and wheeze. Abnormal lung signs are apparent in winter, but are usually gone during the summer and taking no more than one week off work per year. Moderate cases show frequent acute flare-ups of the condition not always confined to the winter months, persistent chest signs throughout the year and shortness of breath on physical activity. Severe cases show continuous symptoms with a chronic productive cough. Patients are breathless with minimal effort and have frequent time off due to acute attacks.
Nicola Wharrier is a life and disability underwriter at Scottish Equitable Protect
