Experts are hoping this summer's public space smoking ban will result in lower levels of a little known lung disease. Health Editor Barry Nelson investigates.

IT'S frightening. Nearly nine out of ten people in the region have never heard of a disease which killed more women than breast cancer in the North-East in 2005.

And nine out of ten cases of the disease are directly caused by smoking, a fact which suggests this summer's public space smoking ban should eventually have an impact on death rates.

The shocking results were unearthed by a survey carried out by the British Lung Foundation in the North-East last year. They wanted to find out how many people had heard of Chronic Obstructive Pulmonary Disease, usually referred to as COPD.

But despite COPD being the fifth biggest killer in the UK - claiming the lives of around 30,000 people in England and Wales - a staggering 86 per cent of North-Easterners surveyed had never heard of it.

Dr Chris Stenton, a chest specialist at Newcastle's Royal Victoria Infirmary, thinks it is time we woke up to the healthcare threat posed by smoking-related COPD.

Countless lives are ruined and shortened in the North-East due to the impact of COPD on delicate lung tissue. Many sufferers have to rely on home oxygen to have any quality of life and a small number are put on the list to have a lung transplant.

Women are more vulnerable to the illness because their lungs are damaged more easily than men, and far from being purely an older person's ailment, specialists are increasingly seeing younger sufferers, including people in their 30s whose illness has been triggered by smoking cannabis.

In a nutshell, COPD is medical shorthand for a group of lung diseases, which includes chronic bronchitis, emphysema and small airways disease.

The great majority of cases are caused by smoking, with the rest mostly made up of people exposed to airborne pollution at work.

In the case of chronic bronchitis, the large airways, or bronchi, become inflamed, producing phlegm which makes sufferers cough.

With small airways disease, these passages become narrower, making it harder for air to get in and out of the lungs and leading to shortness of breath. In the case of emphysema, the alveoli, or air sacs, in the lungs are gradually destroyed, reducing the oxygen supply and causing shortness of breath.

It is ironic that in an area which has some of the highest smoking rates in the country, so few people in this region have heard of COPD when it is mainly caused by inhaling cigarette smoke.

That's why Dr Stenton, who chairs the regional branch of the British Lung Foundation, is such a strong supporter of this summer's public space smoking ban.

By now most people in the region must be aware that come 6am on July 1, smoking will be outlawed in all workplaces and in substantially enclosed public spaces. Dr Stenton, who sees hundreds of COPD sufferers every year at his clinic, is particularly pleased that pubs and bars will ban smoking. "The ban is really going to help in two ways. It will reduce passive smoking, which causes lung disease. It will also help people to successfully stop smoking. Every survey suggests that most smokers actually want to give up."

Dr Stenton said the evidence from Ireland and Scotland, which have already introduced workplace smoking bans, suggests that it is already improving the health of bar staff. "Overall, the evidence is that people will tend to smoke less once a public space smoking ban is in place," he says.

The sheer scale of the problem in the North-East almost beggars belief.

At the RVI alone, around 1,400 people a year from Tyneside, North Durham and Northumberland are admitted as emergency COPD cases, making it the commonest cause of people being admitted to hospital with an acute illness.

On top of this, Dr Stenton sees around 30 patients a week, mostly new cases who have to be assessed and then given a treatment plan. The first thing he tells patients with COPD is to stop smoking, immediately.

"The more you smoke, the bigger the risk of COPD. It is very common among middle-aged people. More than ten per cent of those aged 45 to 70 will have COPD. Of those who smoke, it is probably more than one in five," the consultant adds.

COPD is bad enough, but smokers also run a significantly increased risk of heart disease and cancer as well. "We reckon that the life expectancy of the average smoker is about ten years less than the non-smoker. Sometimes smokers get a combination of COPD, heart disease and cancer," says Dr Stenton.

Because the lung is an internal organ, few people consider the impact of repeatedly inhaling a toxic combination of chemicals.

"The lung is a very delicate organ which has fine membranes to allow oxygen to be absorbed. Smoking means the tissue gets inflamed and damaged," says Dr Stenton.

The impact of COPD can be devastating. Some sufferers are so fearful of becoming breathless that they become virtually housebound. "Being breathless has a lot of scary effects. If people feel they can't leave the house, they become isolated from friends and family," says Dr Stenton.

A combination of much improved medication and oxgyen at home for the worst affected has improved the management of this condition, but the illness remains debilitating.

One danger is that patients will lose confidence in their ability to go for a walk or do any exercise. Exercise clubs run by specially trained physiotherapists can help COPD patients regain their confidence and become more adventurous.

Dr Stenton has fingers firmly crossed the smoking ban will have an impact on disease rates. "Lung cancer is already becoming less common as smoking rates reduce," he says. "It will take longer for COPD levels to come down but I expect this to happen."