In the early decades of the 21st century, the life expectations of the ageing population of this world will be different from those in the past decades. One of the major reasons for this is improved quality of life, which leads to a longer life expectancy.


This generation has enjoyed better prenatal care, nutrition, lower childhood accident rates, healthier work environments and greater attention to preventative measures relevant to many chronic diseases. They expect to be healthier than their predecessors and to have a higher level of function and independence in later life. This group, the size of which is predicted to double by 2050, will also dominate the world\\$quot;s population if the worldwide birth rates keep declining.

However, as the number of older citizens grows, so will the number of patients that will need medical attention to treat chronic diseases caused by major lifestyle factors such as smoking, poor diet, lack of physical exercise, high blood pressure, excessive alcohol consumption and excessive stress.


All of these factors contribute towards respiratory diseases such as Chronic Obstructive Pulmonary Disease (COPD), Obstructive Sleep Apnea (OSA) or asthma. These diseases could be treated at home, which is the preference of most patients, but they are still often cared for in hospitals. This takes up valuable bed space and is very expensive to national healthcare systems.


COPD - top cause of death
An average patient in Germany receiving long term oxygen therapy (LTOT) to treat COPD in hospital costs the national healthcare system approximately €1944 a year, whilst the figure in France is €1785 and in Spain €2273 a year. In Germany 64 per cent of the total cost is reimbursed by the Statutory Health Insurance, which lays an enormous financial burden on the healthcare system.



Since the number of people suffering from COPD is believed to be underestimated, the potential cost to national healthcare systems is huge. According to the World Health Organization (WHO) COPD sufferers in the five major Western European countries \\$quot;“ Spain, UK, Germany, Italy and France \\$quot;“ currently amount to 12 million people.

At the moment the number of adult men suffering from the disease in Germany for example is between 3.3 and 5 per cent compared 4 to 6 per cent in the US.


WHO also reports that COPD is one of the major causes for morbidity and mortality, currently causing 2.74 million deaths worldwide each year. By 2025 COPD is expected to surpass strokes to become the third leading cause of death in the world. At the moment COPD ranks fourth in the US, trailing only cardiovascular disease, pneumonia and strokes.


On a national level Hungary has the highest mortality rate amongst men; approximate 75 men out of 100,000 die each year to the disease. Ireland is second with 65, and Romania third with 60. Amongst women, Scotland has the highest figure of 40 annual deaths out of 100,000 people followed by the USA and New Zealand both of which have 30.

Common causes of COPD are heredity, passive smoking, air pollution and childhood respiratory infections///

Opportunity for gas companies
Ironically the ageing and unhealthier population provides the industrial gas companies with enormous growth opportunities and prospects. The shift is undoubtedly toward home-based healthcare, which doesn\\$quot;t only dehospitalize patients and improve their quality of life but is increasingly the most cost effective option for the national healthcare systems.


A COPD study sponsored by Boehringer Ingelheim Pharma and Pfitzer in 2001 supports this, revealing that 40 per cent of the cost for a patient derives from hospital costs, 30 per cent from medicine, 11 per cent from physician visits, seven per cent from oxygen therapy and the rest from factors such as care, rehabilitation, aids and cost related to unfitness for work.


According to industrial gas consultant Josef David, clinical studies have shown that supplemental oxygen can have a beneficial effect and prolong the lives of patients. He said: "For more than 50 years oxygen therapy has been used to treat COPD patients successfully and safely in their homes.


"As a therapy it is far more cost effective; the cost of hospital care is just over 40 per cent whereas the cost of treating patients at home is approximately three to ten per cent of the total cost."


According to him the maximum cost saving potential in Germany could be about €1,442bn annually.


He continued: "COPD is a candidate for a disease and care management program because of the high cost potential, the number of affected people and necessity of early diagnoses.


"It is important to investigate the prevention of COPD and its effective treatment. In my opinion the primary task must be delaying the progression of the disease and avoiding treatment especially in hospitals, which represents the main part of the overall cost."


David says the homecare providers, possibly the industrial gases companies, could adopt the role of disease and care manager through their qualified respiratory homecare specialists. "These specialists would focus on the needs of patients and managing institutions such as physicians, rehabilitation centres, care and nursing homes that are involved in the COPD treatment process."


Win - Win solution
COPD has five severity levels; at risk, mild, moderate, severe and very severe, but only patients with the latter diagnosis and low levels of oxygen in blood can be treated with oxygen therapy.

For some people with severe COPD, using extra oxygen for more than 15 hours a day can help them to do tasks or activities with less shortness of breath, protect the heart and other organs from damage, sleep more during the night, improve alertness during the day and live longer.


Oxygen therapy and home treatment are of interest for gas companies and homecare is identified as one of the fastest growing segments for industrial gas suppliers. Kenth Drott, head of marketing and development at Linde Homecare says that they do not only offer gases and equipment but increasingly develop innovative solutions for certain patient groups. "Our recently launched REMEO® integrated care concept treating ventilated patients outside ICUs is an example of how we see the future of the homecare business. Not only do we provide the equipment, but we also offer advanced nursing, patient education and carer training in the home or in our dedicated REMEO® care centres.


"Patients can stay outside the hospital setting even with such a severe disease while the healthcare payers benefit from significant cost savings. The solutions of the future have to focus more on improved outcome, which means better care and better quality of life at a lower cost."


How big a part does the homecare sector really play in the life of industrial gas companies? At the moment the sector, according to most major gas companies, is estimated to grow up to 10 per cent per annum in Europe alone.


But the potential could be much more. Drott estimates that the global homecare market relevant to industrial gas companies is up to $10bn, which currently represents approximately a fifth of the value of the whole industrial gases business globally.


"If we look at COPD for example, it is already today the fourth leading cause of death and the prevalence and mortality is expected to continue to increase in the years to come.

"However, it must be noted that a certain product may be applicable only for a subset of the total population, i.e. long-term oxygen therapy is only recommended for the most severe patients, which represent a fraction of the total COPD population.


"Nevertheless the market growth expectations are good. We are expecting the developing countries to grow more than 10 per cent because their homecare structures are still underdeveloped. But also mature markets and certain therapies keep growing between five and ten per cent despite increasing price pressure."


Naturally new opportunities attract new players in the field. The majors are already there but the list is expanding daily. Also Drott thinks that competition will be intensified as many players see the opportunity to leverage the healthcare transformation that has already started and will continue with increasing speed.


"As the new competitive field emerges, industrial gas companies as well as homecare providers, sanitary houses and a number of others such as device companies, hospital groups and nursing home companies will be there."


So the race is on for grasping market shares and developing new technologies to serve the market more efficiently. And it\\$quot;s all for the benefit of the patient, as the aim is to improve patient\\$quot;s quality of life - isn\\$quot;t it?

COPD - Chronic Obstructive Pulmonary Disease
Chronic Obstructive Pulmonary Disease (COPD) is a term referring to two lung diseases, chronic bronchitis and emphysema. It is characterised by reduced maximal expiratory flow and slow, forced emptying of the lungs.

Chronic bronchitis is the inflammation and eventual scarring of the lining of the bronchial tubes. When the bronchi are inflamed or infected, less air is able to flow to and from the lungs and a heavy mucus or phlegm is coughed up.


Emphysema begins with the destruction of air sacs (alveoli) in the lungs where oxygen from the air is exchanged for carbon dioxide in the blood. As air sacs are destroyed, the lungs are able to transfer less and less oxygen to the bloodstream, causing shortness of breath.

Common causes and symptoms of COPD
Long-term smoking is responsible for 80-90 per cent of all COPD cases. Other risk factors are heredity, passive smoking, air pollution, and a history of frequent childhood respiratory infections.


Symptoms include shortness of breath, chronic coughing, chest tightness, greater effort to breathe, increased mucus production and frequent clearing of the throat.


COPD is progressive and irreversible; there is no cure. As it progresses, the lungs\\$quot; small airways and alveoli (air sacs) lose their elasticity. The airway walls collapse, closing off some of the smaller air passages and narrowing larger ones. Airways become clogged with mucus and \\$quot;˜stale\\$quot; air gets trapped in the lungs.


People with COPD may eventually require supplemental oxygen and may have to rely on mechanical respiratory assistance.

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The Homecare Market