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In a report covered by PGVG magazine it was revealed that in Belgium a drug administered to patients with pulmonary fibrosis in order to stabilise the condition will no longer be reimbursed* by INAMI (the Belgian statutory national medical insurance association) to those who have smoked in the last 6 months.

However it doesn't stop there. It appears that the Belgian health authorities intend to test whether or not a potential recipient of the drug has smoked via a urine test which will detect cotanine, a metabolite of nicotine, which will also be found in raised quantities in all users of nicotine including smokeless tobacco users, NRT users and vapers.

Pulmonary fibrosis is a lung disease which causes scarring to the lung tissue and specifically the small air sacs or alveoli. The scarred areas are less able, or completely unable, to transfer oxygen to the bloodstream. This leads to a dry cough and shortness of breath. The condition is progressive and irreversible and is very often fatal. Life expectancy after diagnosis untreated is just 3-5 years.

In most cases pulmonary fibrosis is idiopathic, i.e. the actual cause is unknown. Smoking does seem to be a significant risk factor but it is far from the only one. Others include persistant acid reflux, environmental polution and certain viral infections.

Living with pulmonary fibrosis is difficult and the knowledge that it is incurable makes for a grim outlook. The shortness of breath gradually erodes the sufferer's ability to tolerate any exertion, and as it advances people become reliant on aids such as wheelchairs and medical oxygen and will eventually need carers. Smoking becomes almost impossible and only the most dependant smokers will continue to try.

The drug, Nintedanib, does not cure pulmonary fibrosis - nothing does short of lung transplantation, which is a procedure which carries huge risks of its own (if you are lucky enough to get one) and still only offers post operative survival rates of about 5 years. The drug has been shown to slow the progression of the disease and to reduce the rate of decline in lung function which it causes. It means people remain fitter, retain their independance and can actively participate in life for longer before this debilitating disease takes it toll. In other words, it buys people time.

No doubt there is a school of thought which will assert that state funds should not be expended on improving the lives of those who will not help themselves by quitting smoking. However, denying this treatment to anyone, including smokers,  does actual physical harm in that it allows the disease to progress unchecked. Have we really got to the stage where in an otherwise civilised country, smokers are so vilified that they not only condone harming them, but also deny them the option of harm reduced nicotine containing products?

This policy is literally 'quit or die'. Fortunately NICE, which has just approved Nintedanib for use by the NHS in the UK, has applied no such restriction. Smokers with serious lung diseases should be given every assistance possible in order to beat the habit but holding a gun to their head should not be one of them.


* In Belgium patients generally pay costs upfront and are reimbursed a proportion of the charges for medical and dental fees, hospital care and treatment, maternity costs and prescriptions through their health insurance fund.