Personal Health - Q1 2021

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Raising awareness of individual health conditions as well as innovations in therapies and treatments.

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Don’t put off speaking to your GP about cancer symptoms

IN THIS ISSUE

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COVID-19 has had a significant impact on the delivery of cancer care in Ireland. However, cancer services are still operational at this time, despite the challenges posed by the pandemic.

HPV continues to be a major cause of several cancers in men and women.

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ancer screening services have been affected and there has been a rise in the number of people with cancer symptoms who are putting off going to their GP due to a fear about catching COVID-19 and not wanting to “burden” the health service.

~ Dr Robert O’Connor, Director of Research, Irish Cancer Society

12 Simple, everyday steps can help to reduce your risk of cancer.

Kevin O’Hagan Cancer Prevention Manager, Irish Cancer Society

~ Helen Forristal, Director of Nursing Services, The Marie Keating Foundation

13 Chickenpox is seen as just a rite of passage for Ireland’s children – yet it is a potentially serious disease. ~ Dr Laura Lenihan, GP, Dr Laura Clinic Project Manager: Scott Bellis scott.bellis@mediaplanet.com Business Development Manager: Josie Mason Managing Director: Alex Williams Head of Business Development: Ellie McGregor Head of Production: Kirsty Elliott Designer: Thomas Kent Digital Manager: Harvey O’Donnell Paid Media Strategist: Jonni Asfaha Production Assistant: Henry Phillips Mediaplanet contact information: P: +44 (0) 203 642 0737 E: uk.info@mediaplanet.com All images supplied

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Patients missing appointments in lockdown Recent research commissioned by the Irish Cancer Society showed that one in four people did not attend a GP or hospital appointment when they needed to during the first lockdown.

Feeling stressed, isolated, anxious or busy home schooling may prevent people from contacting their doctor.

But it’s important to put your health first and if you have any niggling worries about changes to your body, you must contact your GP. Early detection is crucial to successful treatment of cancer. While it can be difficult to spot early stage cancers because often there are very few signs, if any, by detecting tumours at the earliest possible stage, patients have the best possible chance of curative treatment and long-term survival.

Nine out of 10 people who are diagnosed with early stage bowel cancer, (stage one) survive their disease for five years compared with only one out of 10 of those diagnosed at a late stage four. It is important to be aware of your body and if you notice any unusual change in how your body works, talk to your doctor.

The chances are it will not be cancer.

However, getting it checked is not wasting anyone’s time. It could save your life.

We are leading a revolution in Oncology to redefine cancer care IE-2380

Date of preparation: February 2021

It is important to be aware of your body and If you notice any unusual change in how your body works, talk to your doctor.

Some bodily changes that should not be ignored are: • A lump or swelling • Bleeding that is not normal for you • Unexplained weight loss or tiredness • Pain that does not go away after three weeks • A cough, changes in your voice, hoarseness that lasts longer than three weeks or feeling short of breath • A sore or bruise that does not heal • Difficulty swallowing, indigestion or heartburn • Mouth or tongue ulcer for three weeks or more • A change in your bowel or bladder habit, constipation, diarrhoea or problems passing urine for more three weeks • A new mole or change in shape, size or colour to an existing mole • Any change in your breasts If you have difficulties getting through to your GP, call the Irish Cancer Society’s Support Line on 1800 200 700 to speak with a registered nurse.

The Irish Cancer Society are continuing to support cancer patients throughout the pandemic.

These are challenging times for everyone, but particularly for cancer patients.

Visit www.cancer.ie for more information.

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Long-acting reversible contraception, it could be for you If avoiding pregnancy is your priority, a “fit and forget” method, such as the contraceptive coil, is one highly effective option that can last for up to 10 years.

A Dr Caitríona Henchion Medical Director, Irish Family Planning Association (IFPA)

s life changes, your contraceptive needs can change too. Whether you’re thinking of using contraception for the first time, or considering a change of method, understanding what’s available can help you choose an option to suit your needs.

Contraceptive methods include long and short-acting options; hormonal and hormone free coils; barrier methods, including condoms and diaphragms; permanent methods, such as tubal ligation and vasectomy; as well as daily pills and emergency contraception.

Women often are unaware of just how many options they can choose from.

At the IFPA, we provide information about all forms of contraception and we specialise in long-acting methods.

A variety of options available Long-acting reversible contraceptives, sometimes referred to as LARCs, are an option if you are sexually active and wish to avoid pregnancy. Intrauterine devices, also known as coils, are among the most effective fit and forget methods.

The coil is inserted into your uterus and can offer protection for three to 10 years. It can be easily removed by a trained doctor or nurse. Coils are suitable for most people, including younger women, women with no previous pregnancies and women who have had only C-sections.

More reliable than pills or barrier methods, coils can also make your periods lighter or less frequent, or sometimes even stop them altogether.

Most have hormones, but the copper coil is an excellent hormone free option.

Whether you’re thinking of using contraception for the first time, or considering a change of method, understanding what’s available can help you choose an option to suit your needs.

Protecting yourself from STIs It’s important to remember that LARCs don’t offer protection against sexually transmitted infections (STIs). However, they can be used in combination with condoms to protect against STIs. If you’d like to speak to someone about your contraceptive options, talk to your GP or visit your local family planning clinic. You can also find information on all types of contraception on the IFPA website.

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What women need to know about menopause Menopause, while a common fact of life, is still often shrouded in mystery simply because the symptoms can vary so much depending on the individual.

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e’ve all heard about night sweats, brain fog and the end of a woman’s cycle being the key criteria for menopause, but these aren’t the only symptoms women should be aware of.

Dr Conor Harrity Medical Director, The Menopause Hub, Consultant Gynaecologist in Rotunda and Beaumont Hospitals

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Identifying the symptoms of menopause The journey to menopause can actually be a long road, and women should pay attention both to physical and mental symptoms warns Dr Conor Harrity, Consultant Gynaecologist at both The Menopause Hub in Dublin and Beaumont Hospital.

He explains, “Your cycle can offer the first clue that your body is gearing up for menopause, first its length may shorten and then get longer. This can often be accompanied by the more traditional symptoms alongside anxiety, trouble sleeping and low mood.”

Although in the past women have been told they need to wait a year once their periods have stopped before seeking medical help, there are

now HRT alternatives available for women in peri-menopause, such as transdermal creams, patches and gels.

Finding the best treatment for each individual Dr Harrity continues, “Each clinic should have a GP specialising in women’s health, they will be able to perform a hormone level check and prescribe a treatment plan depending on the patient’s medical history. What’s more, they can even refer to further specialists, from psychologists to dieticians, to help treat individual needs.”

The benefits and variety of applications make hormone therapy one of the easiest ways to regain quality of life during the menopause.

While there are some risks associated with HRT such as breast cancer and

stroke, recent data suggests that these are very low and dependent on a patient’s own medical history. Age is also a factor, so women over the age of 60 may be advised something different.

Osteoporosis is a weakening of the bones which can occur when the bodies supply of oestrogen dips. HRT has been indicated as a prevention for osteoporosis in some cases. For example, it can be used when women are intolerant or contraindicated to other medical products which are approved for the prevention of osteoporosis.

With complications of HRT very small for a healthy woman, the benefits and variety of applications make hormone therapy one of the easiest ways to regain quality of life during the menopause. What’s more, these resources can all be accessed from your GP. Dr Harrity adds, “Even if your periods haven’t stopped yet, feel free to consult your doctor about any physical or psychological changes, there is help available.”

WRITTEN BY: Gina Clarke

For further information on Consilient Health visit consilienthealth.ie

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Preventing age-related disease: ageing better Modern gerontological thinking has moved increasingly from just the treatment of older people to engaging with much younger people, in terms of education and preventative intervention, with a view to ageing better.

M Prof Rónán Collins, Consultant Physician in Geriatric and Stroke Medicine, Tallaght University Hospital, Clinical Lead, National Stroke Programme and Co-Chair, Stroke Prevention and Atrial Fibrillation Ireland (SPAFI)

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any of the more debilitating age-related diseases such as stroke, dementia, blindness, heart failure, atrial fibrillation and kidney disease have origins in cardiovascular disease and in particular blood pressure (hypertension).

Blood pressure is a key component of age-related disease. It is useful to think of our circulation as a closed-circuit system with a pump and pipes. Having high blood pressure is a livelong mechanism by which the heart (pump) and blood vessels (pipes) are put under stress. Continuous high pressure delivered over many years to the organs at the ‘end of the pipeline’(end organs - brain, kidneys, eyes) causes slow accumulative damage to that organ and eventual failure.

Risk of atrial fibrillation Blood pressure is a major risk factor for strokes of all types by damaging the vessels supplying the brain, but also through increasing stress on the heart muscle to cause an irregular rhythm known as atrial fibrillation (AF).

AF results in blood being inadequately mixed within the atrium of the heart (like a faulty food mixer).

Clots can then form along the walls to become dislodged and fall into the main pump of the heart (ventricle) to be ‘fired’ down the blood vessels causing blockage in the brain.

AF causes one in three strokes in

Atrial Fibrillation (AF) is more common the older you get.

Find out more at www.keepthebeat.ie

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Ireland and over two thirds of all stroke patients also have high blood pressure.

The good news is that high blood pressure can be prevented and treated.

The earlier this is done, the better for your heart, blood vessels and the end organs they supply (your brain, kidneys and eyes).

AF causes one in three strokes in Ireland and over two thirds of all stroke patients also have high blood pressure.

Living a healthier life If there is one thing you should do to age better and enjoy a healthier later life it is to know what you can do to prevent high blood pressure and monitor this from your forties onward.

This, coupled with knowing how to check your pulse for the presence of an irregular rhythm (atrial fibrillation) from your sixties onward are important simple measures that may result in an healthier later life.

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Understanding atrial fibrillation ©DRAGANA991

Atrial fibrillation (AF) is the most common cardiac arrhythmia, affecting one in four people over 50 years old.

T Dr Angie Brown Consultant Cardiologist and Medical Director, Irish Heart Foundation

hough some people complain of palpitations, dizziness, breathlessness or chest tightness, 70% of AF is asymptomatic or ‘silent’. This means the actual true prevalence in the community is unknown and probably underestimated. Data collected from pacemakers, loop recorders and Holter monitors show that even short episodes of AF (less than one hour) convey an increased risk of stroke. The difficulty in diagnosing such cases can be improved by screening with regular pulse checks, more prolonged monitoring, or loop recorder insertion.

recognised risks are viral infections, pneumonia, heart failure, lung disease, diabetes, sleep apnoea, thyroid disease and lifestyle factors such as excess alcohol, coffee and cigarettes.

Risk factors for AF The risk of developing AF increases with age, prevalence is also increasing due to better survival post myocardial infarction (MI), congenital and valvular heart disease, and increasing hypertension and obesity. Other

Overweight populations have a higher AF incidence and progression of AF compared with normal weight counterparts. Obese patients with atrial fibrillation who lose at least 10% of their body weight are six times more likely to achieve long-term

In some studies, statin therapy appears to reduce AF and in other studies Beta-blocker use in heart failure also reduces the risk of AF.

freedom from AF compared to those who don’t lose weight.

Finding the right treatment Treatment includes ensuring there are no reversible causes such as thyroid disease and excess alcohol. In some studies, statin therapy appears to reduce AF and in other studies Beta-blocker use in heart failure also reduces the risk of AF. AF significantly increases the risk of stroke, so prevention of stroke with anticoagulants (blood thinners), if appropriate, is crucial.

In some patients we would consider restoration of sinus rhythm with medication, ablation or cardioversion.

In others it’s important to ensure adequate rate control with a variety of medications. The treatment options will vary depending on patient factors and symptoms.

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What is the prostate?

The prostate is a walnut sized gland found in men. It lies between the penis and bladder and wraps around the urethra (the tube that passes urine out of the body).

The steam vapour treatment that can reduce sexual side effects BPH may be common, but as more treatments are developed, concerns over hospital stays and sexual side effects have decreased.

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s patients continue to look for information about benign prostatic hyperplasia (BPH), consultants are finding that many will have a surgical option in mind. Consultants James Forde and Richard Power of Beaumont Hospital in Dublin, have certainly found this to be the case.

Mr Power says, “Common BPH treatments such as the TURP, often come with side effects that can be inconvenient for the patient such as a hospital stay to sexual dysfunction.

So there is demand for minimally invasive treatments as these can be done in just a day.”

What is an enlarged prostate?

An enlarged prostate is a benign, non-cancerous growth of this gland. By increasing in size, it puts pressure on the bladder and makes it difficult to urinate.

Who gets BPH? Only men! An enlarged prostate is associated with ageing. Around 40% of men over 60 have lower urinary tract symptoms (in the bladder and urethra) due to an enlarged prostate.

Sources 1. EAU Patient Information, patients.uroweb.org 2. https://www.theurologyfoundation.org/images/2018_Bitesize _Guides/181120_-_Bitesize_Guide_to_Enlarged_Prostate.pdf

Medical professionals who would like to know more about Rezūm, visit bphsolutions.eu

whole procedure only taking around 10-minutes. The patient is discharged later that day with just a urinary catheter that is left in for about four to seven days. One of the goals of the procedure is that a patient will no longer have to take medications for their BPH symptoms which can cause side effects such a difficulty with ejaculation or possibly a reduction in libido.”

Rezūm is just one of a handful of minimally invasive treatments for BPH that has been made available in recent years, and data collected so far puts it on track to compare favourably with the TURP, in that 90% of patients remain satisfied or very satisfied at BPH is such a common issue Enabling patient choice the five-year point in men – around 50% of all He says, “BPH is and almost all over 50s will have some form would recommend such a common of the condition. issue in men – to a friend. What’s around 50% of all more, Mr Power over 50s will have adds, “There’s some some form of the condition. And so feedback to suggest that with Rezūm, when lifestyle choices and medication you wouldn’t require a replacement start to fail, many will search for procedure for up to five years.” a surgical option that suits them.

It’s all about patient choice.”

Long term positive outcomes Rezūm is one such minimally invasive For Mr Forde as a consultant, the treatment where results are seen within choice of treatments such as Rezūm three months. While not available in all means that men have much more to hospital groups at present, interest in choose from than ever before. He says, the procedure is increasing among both “I think in terms of patient choice it patients and urologists. has never been better, we can offer durable treatments which reduce the Reducing time in hospital side effects of both medication and Mr Forde continues, “There are several other surgical methods.” advantages to a minimally invasive “Going forwards, I’m sure we’ll procedure such as Rezūm. It involves continue to see less invasive very short nine second injections of treatments with little side effects and water vapour into the prostate with positive long-term outcomes.”

Mr James Forde Consultant Urologist, Beaumont Hospital

Mr Richard Power Consultant Urologist, Beaumont Hospital

Written by Gina Clarke

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AN URGENT NEED TO URINATE COULD BE A SIGN OF AN ENLARGED PROSTATE. Learn more about Rezūm and find a specialist near you at MyProstateInfo.ie The website MyProstateInfo.ie is sponsored by Boston Scientific.

All cited trademarks are the property of their respective owners. This material is not intended for use in France. URO-974903-AA © 2021 Boston Scientific Corp

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As men age, prostate issues can affect not just how often they need to go to the toilet, but also impact the flow itself. While common, the negative impact should not be ignored.

F James Reynolds BPH Patient

Written by Gina Clarke

or Daniel, 75 from County Dublin, an increased need to go to the toilet was what he first noticed over a decade ago. But as getting up twice a night became six times a night, he realised something needed to be done.

After a number of tests, he was offered a TURP operation (resection of the prostate), which although caused a lot of discomfort at the time, ultimately worked for the next 10 years. But slowly, Daniel realised he was getting up in the night again, so with a nudge from his wife, he went back to his surgeon.

New steam vapour treatments This time, Mr. Richard Power recommended a new type of treatment, Rezūm, that uses water vapour to treat benign prostatic hyperplasia (BPH) – an enlarged prostate. Not only was the treatment known for quick results – a day surgery with minimal recovery time, but the risks of erectile dysfunction and heavy bleeding were much lower, as the treatment uses thermal energy instead of a resection.

Used to trips to the hospital, Daniel wasn’t nervous about the procedure in late 2020, but he was apprehensive about the recovery. He remembered the discomfort he felt previously while still working as a finance officer for a local authority. Only this time, Daniel’s recovery was much quicker.

He says, “The procedure was under anaesthesia and I was warned that I

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The outpatient surgery that stops men getting up in the night

may feel some pain once I woke up but I felt absolutely fine. After some tea and toast and a few hours on the ward I was able to go home. I had to have a catheter for 24-hours and honestly that was the worst part but only because it’s such an unusual feeling.”

Faster recovery times For 64-year-old James Reynolds from Drogheda in County Louth, he had also suffered a decade of discomfort.

Previously he had managed with tablets after making an appointment with his GP after seeing blood in his urine.

He was carefully monitored and saw a consultant every 6-12 months.

But in January 2020, his consultant Mr Power suggested that he might be a candidate for Rezūm. James went home to tell his wife of almost 40 years that he would have his prostate “steamcleaned”, and after several medical checks including an endoscopy, he was given the go-ahead for the procedure.

Like Daniel, James was given an appointment as an outpatient, and was discharged later the same day, returning four days later to have his catheter removed. He says, “I was given some pads after the procedure and warned that it might get worse before it gets better but immediately my problems

But as getting up twice a night became six times a night, he realised something needed to be done. with a slow flow and increased frequency to urinate went away. It was the catheter that felt a bit strange but even knowing what I know, I’d go back and have it done again.”

Removing the stigma around men’s health Both men have seen great results after just a few weeks and were discharged following a six-week check-up. But while James has compared notes with other men who have had similar procedures, Daniel feels that the stigma attached to men’s health makes it hard to talk. “Even when I wanted to talk about my condition, it was just easy to change the conversation to the football or something similar.”

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The challenge of HPV cancers still looms amid the pandemic

People with stable heart disease can exercise safely An increase in sedentary lifestyles makes promoting physical activity more important than ever.

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hysical activity is recommended for everyone with heart disease and can reduce the risk of someone with heart disease dying early, according to international guidelines published last year. According to a report from the European Society of Cardiology (ESC), just like healthy adults of all ages, people with heart disease should exercise on most days, totaling at least 150 minutes per week of moderateintensity exercise.

Moderate intensity means increasing your heart rate and breathing rate but still being able to hold a conversation.

People with long-standing coronary artery disease who wish to take up exercise for the first time should see their doctor first to tailor the intensity of activity according to the patient’s individual risk.

The current pandemic has changed many things, but it has not altered our resolve to eliminate cancers caused by HPV.

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ndeed, if anything, this seismic global health event has proven the power of vaccinations in stopping preventable illness and death.

Another virus, the human papillomavirus (HPV), continues to be a major cause of several cancers in men and women, including those of the throat and cervix.

On average, someone receives a diagnosis of a HPV-caused cancer in Ireland every single day. HPV vaccinations are our best hope at eliminating these cancers in future.

Dr Angie Brown Consultant Cardiologist and Medical Director, Irish Heart Foundation

Encouraging more physical activity For people living with obesity or those with high blood pressure or diabetes, the guidelines recommend strengthbuilding exercise (for example, lifting light weights) at least three times a week plus moderate or vigorous aerobic exercise, such as cycling, running or swimming.

Coronary artery disease is the most common type of heart disease and is caused by build-up of fatty deposits on the inner walls of the arteries. If the arteries become completely blocked this can cause a heart attack. Most people with stable coronary artery disease can play sports according to their fitness and condition. People who are completely inactive and those with advanced heart disease need to consult their doctor before taking up sports.

On average, someone receives a diagnosis of a HPV-caused cancer in Ireland every single day.

School-based vaccination In 2020, uptake among those eligible to receive the vaccine was initially expected to top 80%. This is following on from the important milestone of extending its availability to boys of secondary school age prior to the curtailment of the school-based vaccination programme last year due to the pandemic.

Safety must always come first in considering how and when people are vaccinated, but it is clear that we must all redouble our efforts to ensure an effective rollout of the HPV vaccine so we can pick back up on the good work done over the last few years.

At the Irish Cancer Society, we are doing our best to ensure that cancer does not become the forgotten C in the time of COVID-19.

©LORDN

Dr Robert O’Connor Director of Research, Irish Cancer Society

Regular, moderate physical activity is recommended to prevent the most common heart rhythm disorder – called atrial fibrillation. People with atrial fibrillation who are taking anticoagulants to prevent stroke should avoid contact sports due to the risks of bleeding.

People with pacemakers should not be discouraged from playing sports (except collision sports) because of the device. However, they need to tailor their choice according to the underlying disease.

Breaking up sedentary time The Irish Heart Foundation welcomed the ESC recommendations and said they provided reassurance for patients with cardiovascular disease.

With rising levels of obesity and sedentary lifestyles – which have been exacerbated by the COVID-19 pandemic - promoting physical activity is more crucial now than ever before.

Regular exercise not only prevents heart disease, but also reduces premature death in people with established heart disease. This is one reason we launched our Escape Your Chair campaign last September to highlight the importance of reducing sitting times with frequent daily activities, this is particularly important as we have found sitting times to be significantly increased with so many people are working from home.

Sitting for long periods of time can increase your risk of heart disease and stroke. Therefore, it is important that everyone, particularly those living with heart disease, try to reduce their sitting time.

The Irish Heart Foundation’s Escape Your Chair campaign, urges everyone to get up and move for a minute each hour during the day as a way to kick-start their daily exercise. irishheart.ie/campaigns/ escape-your-chair/

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How an innovative heart procedure saved my life

For more information on Aortic Stenosis contact us to receive a free information kit.

Text +44(0)7864 299093 Visit newheartvalve.com/UK If you are experiencing any symptoms, do go and ask your GP for a stethoscope check.

Rosemary Reilly’s breathlessness and swollen legs were symptoms of aortic stenosis - a potentially fatal heart condition. A minimally invasive valve replacement procedure saved her life.

Professor Ivan Casserly Consultant Interventional Cardiologist, Mater Hospitals, Dublin

Rosemary Reilly Patient

Sheena Rock Rosemary’s daughter

WRITTEN BY Tony Greenway

Know the symptoms of aortic stenosis Now, however, other symptoms started to appear, Rosemary’s breathlessness was so bad that Sheena and her brothers called the doctor. “We were concerned about mum going into hospital because of the pandemic,” admits Sheena. “But the doctor explained that they couldn’t do anything for her at home.”

After arriving at the A&E in Navan, Rosemary underwent various tests. By this time her condition had worsened, and she was admitted to the ICU and put on oxygen. Later, after stabilising, Rosemary was transferred to a ward and told that she was experiencing the symptoms of aortic stenosis (AS), a potentially fatal heart valve condition.

In a minority of people, the aortic valve can progressively degenerate, calcify and narrow with advancing age, explains Professor Ivan Casserly, Consultant Interventional Cardiologist at Mater Hospitals, Dublin. “This impairs blood from flowing out of the main pumping chamber of the heart and being delivered around the body,” he says. “The obstruction caused by the severely narrowed aortic valve caused fluid to back up into her lungs and swelling in her legs. Her presentation was dramatic: she was even experiencing shortness of breath in bed at night.”

©WAVEBREAKMEDIA LTD

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osemary Reilly, at 88 years old, just gets on with life and doesn’t like to complain.

So her children were extremely concerned in January when she admitted that she was having trouble breathing.

“It was a frightening feeling,” remembers Rosemary, who lives with her daughter, Sheena Rock, and Sheena’s husband, David.

“It was the first time my breathing had been affected that badly. I was in a terrible state.”

There were subtle clues that Rosemary’s health had been deteriorating. When admitted for a hip operation, doctors found then, that she had a heart murmur. However, due to a lack of other symptoms, no further diagnosis was pursued. “But her legs had been giving her an awful lot of trouble” says Sheena. “She’d been taking painkillers because her legs were extremely swollen and hard due to a build-up of fluid, and she wasn’t sleeping well.”

So, if you experience symptoms of breathlessness, it is important to see your GP for an assessment that includes listening to your heart with a stethoscope.

Finding the best treatment It was decided that the best course of treatment for Rosemary would be transcatheter aortic valve implantation (TAVI), a minimally invasive procedure to replace the valve.

“The alternative to TAVI would be open heart surgery,” says Professor Casserly. “But at Rosemary’s age, the risks of that sort of operation would be high. There is still a small risk of serious complications with the TAVI procedure, but it’s minimally invasive and recovery is usually very quick.

So, if you experience symptoms of breathlessness, it is important to see your GP for an assessment that includes listening to your heart with a stethoscope. The murmur that is heard with the stethoscope is a clue that you might have aortic stenosis as a cause of your symptoms.”

Rosemary had the procedure at the Mater Private Hospital in Dublin. “If I’d been the Queen Mother I couldn’t have been looked after better!” she

says. “Everybody was wonderful to me, explained exactly what was happening and kept my family in constant contact.” With COVID-secure procedures in place, she also felt extremely safe.

Rosemary returned home a couple of days later and is now back to her usual self. “I’ve had no pain in my legs and no breathlessness,” she says. “I haven’t even had to take a painkiller. I feel absolutely wonderful, all thanks to the doctors and staff.”

Sheena, David, Tony and Sean have been delighted to see the change in their mum. “She’s getting better every day,” says Sheena. “Previously, she was out of bed by 5.30am because she couldn’t bear the pain in her legs, but now she doesn’t get up until 7.30am. She looks great and she’s sleeping. She likes to sit outside in the summer, so when the better weather comes, she’ll be able to do that. She’s a different person, which is so brilliant to see.”

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©Alessandro Biascioli

If a parent is concerned their school-aged child is drooling excessively, they should have it checked out by a Speech and Language therapist, GP or a paediatrician.

Helping to combat drooling in children Drooling or dribbling is sometimes a problem for children who have a neurodisability such as cerebral palsy.

Dr Louise Baker Consultant Paediatrician S.I. Neurodisability, Department of Paediatrics, Children’s Health Ireland

Written by: Mark Nicholls

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it can cause recurrent respiratory tract infections. Cough, reduced speech clarity or choking episodes can also be common in this group of children and adults.

Risk of infection Drooling can impact on many aspects of life depending on its nature and severity. It can occur in more than 40% of children with cerebral palsy and can vary from mild to severe.

As saliva contains bacteria and yeast,

Management of drooling Treatment, via a multi-disciplinary team, is recommended as best practice in assessment and management says Dr Baker. “When the drooling is defined as a behavioural problem with too little swallowing and wiping, a goal would be to increase the frequency of swallowing and/or wiping.” Management options vary from conservative methods with input from a speech and language therapist to medications or surgical intervention.

“If children are having recurrent respiratory infections, it is important to treat them urgently with suitable medication. We know from the studies that medication can give a very good outcome, but these children need to be monitored regularly and the adjustment of the dose according to the size of the child is important,” she says.

Treatment for more serious cases can mean injecting Botulinum toxin into the salivary glands, or surgery on the salivary gland ducts.

Dr Baker says: “There is a huge spectrum of children who can have saliva control and drooling issues.

Some children have a lot of secretions that can have an unpleasant odour, it can damage books and equipment and impede their successful integration into school and the community.”

However, while drooling can

aliva is important as it protects teeth, gums, prepares food for chewing and swallowing and supports oral hygiene.

Excessive Drooling is the inability to manage saliva flow. Consultant Paediatrician Dr Louise Baker explains that anterior drooling, where saliva comes out of the mouth and onto the face or clothes, can be distressing for a child. Posterior drooling, where saliva can trickle into the lungs, can lead to serious medical issues for vulnerable children.

Dr Baker explains that most people produce 0.5-1.5 litres of saliva and swallow 1200 times a day and for toddlers drooling is part of their typical development. Drooling beyond the age of four is abnormal and may need management. For children with any type of a neurological impairment, drooling can worsen and cause significant difficulties for the child and their family.

Drooling can be stigmatising, distressing and lead to a child being socially rejected, isolated and lacking self-confidence.

However, interventions and therapies are available to treat drooling, which is generally defined as an inability to efficiently and safely manage saliva.

be controlled or managed, she emphasises that the treatment goals can vary according to the severity of the condition.

It may range from cutting the number of times wet clothes or bibs need to be changed to reducing admissions to hospital for recurrent serious respiratory conditions caused by poor saliva control.

Stressing the importance of assessing why a child may be drooling she says: “If a parent is concerned their child is drooling more than they should, they should be checked out by a speech and language therapist, GP or paediatrician.”

Finding the right support Dr Baker practices in Dublin at Children’s Health Ireland, the country’s largest paediatric hospital, and the Central Remedial Clinic in Clontarf, where she runs specialist clinics for children with neuro-disabilities.

Her goal is to establish a drooling service in Ireland with a multidisciplinary approach in a clinical setting with speech therapists, paediatricians, dentists and nurse specialists to assess children and offer treatment.

“Drooling is a long-standing chronic condition that we should be treating especially in children who have a neurodisability,” she says. “We do need to set this service up in Ireland because drooling can cause such difficulties for children and their families.”

Read more at healthnews.ie

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Urgent need for more child-specific medicines

RoI-PRO-2021-005 Created March 2021

A lack of medicines designed specifically for children is leaving serious gaps in children’s healthcare provision.

Dr Simon Bryson Chief Executive Officer and Co-Founder, Proveca

Dr Helen Shaw Medical Director and Co-Founder, Proveca

WRITTEN BY Mark Nicholls

Paid for by Proveca

Adverse effects Using adult medicines for children carries risks; there may be limited evidence that a reduced adult dose is safe and effective. Children may also resist taking adult medication because of the taste or dose format such as large tablet size.

Excipients (additives to medicines for taste and other characteristics) are also an area of real concern, as certain additives can have an adverse effect on a child and need to be evaluated fully during the drug licensing process.

Proveca is working hard to address these gaps by taking medicines previously developed for adults and redesigning them for the paediatric population, through extensive clinical trials and a European licensing process specifically for children’s medicines.

Effective drugs that are well accepted The company creates medicines that have the correct package of information to demonstrate safety and efficacy in children, as well as in doses and formats more acceptable to children in terms of taste, smell, touch, colour and sensation on the palate.

They do this by designing innovative medicine formats, such as mini tablets that will dissolve rapidly on the tongue, or syrups with more children friendly flavours.

Dr Bryson says: “Presentation of a medicine in an ideal format is really important. If it is not acceptable to a child, then adherence to that medication is going to be inhibited.”

“While sometimes adapting an adult medicine may be the only available

©Image provided by Proveca

M

any medications taken by children continue to be adapted from adult drugs, leaving young people potentially at risk from uncertain dose measurements.

While major pharmaceutical companies cater for child patients in areas such as diabetes or asthma, the less common conditions of heart failure, epilepsy, cerebral palsy and other rare diseases are often overlooked, according to Dr Simon Bryson, Chief Executive Officer of pharmaceutical company Proveca.

At present, 50-90% of medicines prescribed for children are not licensed for use in young people, so there is clear need for customised design and innovation in this “poorly-served” area of children’s healthcare.

At present, 50-90% of medicines prescribed for children are not licensed for use in young people, so there is clear need for customised design and innovation in this “poorlyserved” area of children’s healthcare. option, it can lead to a child not receiving the appropriate dose, with the risks of over, or under, dosing.

Both doctors and pharmacists tell us that they are keen to have a children specific, licenced medicine available for every child” he says.

Focussing on children’s medicines Proveca’s Medical Director, Dr Helen Shaw, says “adaptation of adult medicines for children is widespread and accepted as the only option for many childhood diseases.” She acknowledged that “until there are more medicines specifically designed and licensed for children, doctors have little alternative but to use adult medicines to enable them to treat a child.”

“What we are developing,” continues Dr Shaw, “is a child specific, patientcentred medicine, that is easy to deliver at the correct dose in a simple and child friendly way.”

Clinical trials disrupted Over the last few months, the coronavirus pandemic has disrupted ongoing and new clinical trials, slowing development and licensing of new drugs, with the emphasis and funding concentrating on research into COVID-19.

The pandemic has also hampered clinical programmes and reduced faceto-face interaction with patients and clinicians, but Dr Shaw does draw some positives from the situation.

Educational programmes delivered virtually are reaching a wider audience, and events over the last year have shown how quickly clinical trials can be set up and medicines developed and licensed if people work together in new and collaborative ways.

“There are some really important lessons to take out of that as a way of working that we should not lose,” she says.

Post-Brexit, Proveca has worked to maintain its Europe-wide reach in terms of developing, distributing and licensing products, and clinical trial collaboration, by establishing a hub in Dublin to deliver its European programme of work from Ireland. It is still retaining a footprint in the UK in Manchester. See more at proveca.com

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Simple, everyday steps can help to reduce your risk of cancer Many people underestimate the impact our daily choices could have on our health, and specifically on our risk of developing cancer in the future.

B

y introducing small but significant changes to seven areas of your life, and making the conscious effort to create healthy habits, you can significantly reduce your risk of some of Ireland’s most common cancers, such as breast, skin and bowel cancer. Some of the ways you can do this are:

Helen Forristal Director of Nursing Services, The Marie Keating Foundation

Exercise and activity To keep your body fit and healthy, it is recommended that everyone take 30 minutes of moderate to rigorous activity each day. Anything that elevates your heart rate is considered to be activity and the more regularly you do it, the easier it becomes.

Maintaining a healthy diet Eating a well-balanced diet with plenty of fruits and vegetables is an essential step in cancer prevention.

Research shows that people who follow a healthy lifestyle and eat a balanced diet have an 18% lower risk of cancer compared with people whose

lifestyle and body weight do not meet the recommendations.

and ensure you do not exceed the recommended alcohol units per week.

Staying safe in the sun Skin cancer is the most common cancer in Ireland, but it is also the most preventable. By following the SunSmart code, applying SPF 30+ sunscreen regularly and avoiding time spent outdoors without proper protection, you can drastically reduce your risk of skin cancer.

Attending your cancer screening: Cancer screening is the process of testing people with no symptoms for the early indicators of cancer. Ireland currently has a national screening programme for bowel, breast and cervical cancer. By taking up your invitation to attend screening when it arrives, it can detect cancer in its earliest stages and help to reduce your risk of developing cancer.

Smoking cessation: Smoking accounts for 30% of the cancer cases diagnosed each year in Ireland. By not smoking, or quitting if you do, you can help to reduce your risk of cancer and improve your overall health.

Monitoring alcohol consumption: Did you know that each year in Ireland over 500 people die from an alcohol related cancer? To help reduce your risk, follow the “less is best, none is better” motto when it comes to alcohol

The HPV vaccine: Around 99% of the worlds cervical cancer diagnosis can be linked back to the HPV virus. The HPV virus is also linked to other cancers such as head and neck. By vaccinating boys and girls before they become sexually active, we can effectively eradicate the spread of HPV and help to reduce the instances of HPV related cancers.

The Marie Keating Foundation’s Your Health, Your Choice campaign is designed to give everyone the tools they need to make healthy lifestyle choices and reduce their risk of cancer in the future.

For more information, advice and resources visit mariekeating.Ie/yourhealth-your-choice/

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How children can be protected from chickenpox A simple vaccination could protect children and adults from chickenpox, a potentially serious disease – but many parents don’t know.

C Dr Laura Lenihan GP, Dr Laura Clinic

WRITTEN BY: Linda Whitney

hickenpox is seen as just a rite of passage for Ireland’s children – yet it is a potentially serious disease.

Galway GP Dr Laura Lenihan says: “Chickenpox is extremely contagious.

For most children it is not serious but there can be complications, including bacterial infections, pneumonia, encephalitis and strokes.”

Catching chickenpox increases the likelihood of later developing shingles – a very painful rash. Adults who catch chickenpox are usually more seriously affected. While the fatality rate among children aged one to 14 in Ireland is 1/100,000 cases, among 30–49-year-olds it is 25.2/100,000. In 2017, 105 people were hospitalised with chickenpox.

Early symptoms can include a high fever, coughs, sneezing, aches and pains and loss of appetite. Crops of three to four itchy blisters start appearing after about 48 hours, often on the abdomen, before spreading across the body.

ARE YOU CHICKENPOX AWARE?

Tackling the spread Children with chickenpox should be kept away from school or childcare, so a parent or carer will have to look after them. Dr Lenihan adds: “It is highly contagious especially before the blisters appear, so it’s easily passed on to the whole family before being recognised.”

Early symptoms can include a high fever, coughs, sneezing, aches and pains and loss of appetite. Crops of three to four itchy blisters start appearing after about 48 hours, often on the abdomen, before spreading across the body. The child is infectious from one to two days before the rash appears until after the blisters have all crusted over.

Infected children should be kept away from babies, people with serious health conditions and pregnant women who have not had chickenpox, as catching it can lead to problems for mother and foetus. “Women intending to get pregnant can take a blood test to check immunity and if necessary, get vaccinated,” says Dr Lenihan.

Vaccination is available There is no herd immunity to chickenpox in Ireland, and spotting early infection is hard, so the best prevention is vaccination, says Dr Lenihan – yet many parents do not realise

There is no herd immunity to chickenpox in Ireland, and spotting early infection is hard, so the best prevention is vaccination. that there is a vaccine. This is partly because chickenpox jabs are currently not part of Ireland’s childhood vaccination schedule. However, you can pay to get a vaccine from your GP. Dr Lenihan advises: “It is best done at about 14 months, after the nationally-recommended childhood vaccination programme.” She does not recommend sending children to ‘chickenpox parties’”.

She says: “As a GP I have seen some complex cases of chickenpox, including a young baby with chickenpox in the genital area. She was in so much pain. Having seen what chickenpox can do, I vaccinated my own two daughters that are eligible.”

Read more at healthnews.ie

Chickenpox can be unpleasant for your child, but there may be ways you can help them feel better.

To find out more, visit chickenpoxaware.ie This is an MSD website with more information on chickenpox.

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Don’t take your eyesight for granted It is all too easy to take good vision for granted. As we grow older our eye health can become under increasing pressure and in particular the macula.

F

igures reveal that over 100,000 people in Ireland are affected by age-related macular disease, with 7,000 new cases a year.

Men are taking ownership of their mental health The pandemic has posed significant challenges to our mental health. It is also a timely reminder for men, in particular, to pay more attention to their mental health.

Layers of protection Lutein and zeaxanthin are important nutrients that the body naturally deposits in the macula, to create a protective layer known as macular pigment. They are powerful antioxidants that work like internal sunglasses, protecting the macula from the damaging effects of blue light and oxidative stress.

What is age-related macular degeneration?

Age-related macular degeneration (AMD) is a progressive eye disease that affects the macula. It is responsible for central vision and allows you to see detail. It does not cause total blindness, but it makes everyday tasks such as reading, watching TV, driving, or using computers more difficult. Research reveals that people as young as 37 years of age are being diagnosed with AMD. The macula pigment comprises of three carotenoids, lutein, meso-zeaxanthin and zeaxanthin. The body does not produce lutein and zeaxanthin. The macular pigment can therefore become severely depleted in those with a poor diet lacking in the right foods.

Why MACU-SAVE? MACU-SAVE is a one-a-day, easy to swallow food supplement which provides advanced nutrition for the eyes. It is suitable for people living with diabetes, it is gluten free, yeast free, lactose free and contains no artificial preservatives or sweeteners. MACU-SAVE contains FloraGLO lutein and OPTISHARP national zeaxanthin, clinically proven ingredients to enhance the quality of vision and visual performance. FloraGLO® lutein is the most clinically researched lutein brand worldwide with over 90 human clinical trials published.

C Noel Richardson Director, National Centre for Men’s Health, IT Carlow

OVID-19 has brought unprecedented disruption, upheaval and uncertainty to our lives. The search for a chink of light in the midst of the darkness cast by a pandemic might seem futile.

Or maybe not? The pandemic has forced many - men in particular - to take stock: to reconfigure their work/life balance and to search for value, meaning and purpose beyond paid employment roles.

As a potential catalyst for positive change in men’s lives, COVID-19 is a timely reminder of what other steps men can take to safeguard their mental health.

‘Real’ men ask for help: Everyone goes through peaks and troughs in life – even men! Many of the messages that we pick up as boys tell us that ‘real men’ sort out their own problems. Thankfully, this is changing. More and more men are realising that it takes courage and strength to be vulnerable and to reach out to someone you trust to ask for help. This is particularly important when we face difficult transition points in our lives.

Remember, small things can make a big difference. For more tips on minding your mental health, check out the HSE’s ‘Keep Well’ campaign gov.ie/en/campaigns/ healthy-ireland/#

Be happy in your own skin: We’re all different and none of us are perfect! Yet we are bombarded by endless messages telling us how we can be and do ‘better’. Accepting yourself for who you are is fundamentally important for your mental health.

Being happy in your own skin is the cornerstone to good self-confidence and self-esteem.

No man is an island: We know that men who become isolated and disconnected from their families and

Strong social networks – with family, friends, colleagues – help us deal with the stresses of life. communities are much more likely to struggle with mental health issues. Strong social networks – with family, friends, colleagues – help us deal with the stresses of life. They enable us to feel included and cared for. They protect us from being overwhelmed during challenging times. So, we all have a role to play to reach out and connect.

Healthy body, healthy mind: Looking after our physical health is key to enjoying good mental health. Regular physical activity that you enjoy can really give your mental health a boost. Eating a balanced diet will help you feel better and think straighter. Using alcohol, smoking or drug use as a coping strategy or to change our mood is never a long-term solution to our problems.

Work, play and sleep: Hectic work schedules can leave little time to unwind and relax, causing many of us to feel exhausted. Make room for other activities and hobbies that help you rediscover your mojo. Try to set a good routine to get the best quality sleep.

Treating AMD Experts recommend early diagnosis to help manage the disease. There is no cure for AMD. While there is medical treatment for wet AMD, there is currently none for dry AMD. However, experts recommend taking eye health supplements. MACU-SAVE is a supplement which contains all three macular carotenoids which are essential for macular health.

Available in independent pharmacies, Allcare, Life, Careplus and Hickey’s Pharmacies nationwide.

Visit www.macu-save.ie for more information.

Emma Heduan Brand Manager, MACU-SAVE

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Why all CBD oils are not the same What are CBD products, how are they made and are they all the same? An Irish grower and producer explains the differences.

C Mark Canavan Co-founder, Greenheart CBD

Paid for by GreenHeart CBD

annabidiol (CBD) oil or hemp oil all come from the hemp plant which has drawn a great deal of attention over the past few years. The hemp plant is extremely versatile and useful in a number of sectors including textiles and personal health. The plant naturally contains more than 100 cannabinoids, notably cannabidiol (CBD), but despite this, not all oils are the same.

Mark Canavan, co-founder of Co.Meath-based Greenheart CBD explains: “Most oils on the market are produced using chemical extraction or made up from concentrates but at Greenheart we keep our product fully natural and extract in a natural process known as cold pressed extraction.”

How the process works The company uses a ‘seed to shelf’ production process that starts in the fields and provides full traceability to

the end consumer.

“We grow hemp under licence, using strains permitted in the EU and scan the fields daily using AI-enhanced drones, which relay details about the health and stage of growth, so we can identify any problems and harvest crops at the optimum time,” says Canavan. The company plans to introduce larger drones that allow for soil testing, weeding and the spray application of organic fertiliser or plant nutritional products.

“Some people use CBD oils to help with anxiety, depression, muscle relaxation and arthritic issues to name a few. We also do a great deal of work with the autistic community” says Canavan.

A new cryptocurrency ‘PUNT’ Canavan also shares his experiences of a new venture they are currently working on: “We are a very forward-thinking company and due to the evolution

Some people use CBD oils to help with anxiety, depression, muscle relaxation and arthritic issues to name a few. that is occurring in the finance sector we decided to get involved in the crypto currency space using our oil as a commodity to give our new currency ‘PUNT’ a floor price. We embarked on this project in September of 2020 and got our token listed with a number of crypto currency exchanges. Our next listing will be with Uniswap which is a decentalised exchange that holds great credit and liquidity.”

WRITTEN BY: Linda Whitney

You can find out more information regarding our crypto currency on www.coinmarketcap.com or www.coingecko.com Greenheart CBD is an award-winning company winning a place in the Sunday Independents ‘30 under 30’ in 2019 and winning a Business All-Star Award for the company in 2020.

Paul Walsh, the co-founder has been awarded as a ‘Thought Leader in Innovation, Technology and Sustainability’.

8 WAYS TO IMPROVE YOUR MENTAL HEALTH THIS SUMMER Talk about it Problems feel smaller when they are shared with others. Talking about feelings is a good way to deal with a problem.

Keep active Regular exercise can really give your mental health a boost.

Drink less alcohol Avoiding too much alcohol is important, especially if you’re feeling down or worried.

Stay in touch Trusted friends and family are important,

Ask for help Asking for help is not a weakness but a sign of personal strength.

Everyone needs help from time to time and there’s nothing wrong with asking for it.

Eat and sleep well Having a balanced diet and a good sleep pattern will not only help the way you feel, but it will also help the way you think.

Accept yourself

Do something you enjoy Setting aside some time to do something you enjoy, especially if you are not feeling great, will help you feel better.

and is entitled to things, including your background, race, religion and sexual identity, make you who you are.

times. You do not have to face things on your own.

visit yourmentalhealth.ie or Freephone the YourMentalHealth Information Line on 1800 111 888 any time.

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Overactive bladder what you need to know Overactive bladder (OAB) is a very common condition affecting an estimated 350,000 people over the age of 40 in Ireland.

O Professor Barry O’Reilly Consultant in Obstetrics and Gynaecology, Cork University Maternity Hospital

Paid for by Astellas

AB is a condition that causes symptoms such as needing to run to the toilet to pass urine (urinary urgency) and, possibly, urinary leakage before getting there (urinary urge incontinence). It also causes an increase in the number of visits to the toilet during the day and at night (urinary frequency). OAB is still largely a ‘hidden’ condition. Patients do not readily admit to symptoms because they feel embarrassed or attribute them to the process of ageing.

More than two-thirds of people with OAB report a negative effect on daily life. OAB has been associated with many other problems including depression, falls and fractures in the elderly (as a consequence of rushing and frequent visits to toilet at night) and, as a result, increased admission to hospitals and nursing homes.

Diagnosis and treatment options The cause of OAB is still unknown.

A diagnosis of OAB is made based on the person’s symptoms and by ruling out other causes like neurological

diseases or, more commonly, infections. Investigations that the doctor may order include a bladder diary and urine analysis. Secondary investigations include urodynamic testing, a cystoscopy and imaging of the upper urinary tract.

Once the diagnosis has been made, treatment includes lifestyle modifications like adjusting the volume, timing and types of fluid intake. In addition to lifestyle modification, exercises aimed at strengthening the pelvic floor musculature are a key part of managing OAB. Patients are also taught bladder training, which aims at increasing bladder capacity and subsequently increasing the interval between toilet visits, thus decreasing the symptoms or urgency.

The importance of seeking medical attention Medical management is an important part of controlling the symptoms of OAB. The choice of therapy should be guided by the individual’s other medical conditions or other drug

It is imperative that we encourage people to not endure these symptoms and instead to seek medical attention.

therapies, as not all the drug options are the same. It is often useful to consider combination therapy if the symptoms are difficult to control.

If medical management fails, other treatment options include Botox injections into the bladder, or stimulation of the nerves responsible for bladder control, which can be performed in an outpatient setting.

Other options would include major surgery to increase bladder capacity.

OAB is a prevalent and debilitating condition with a significant impact on the quality of life of the patient.

It is imperative that we encourage people to not endure these symptoms and instead to seek medical attention.

It is also as important to enforce preventative measure on a national basis including raising bladder awareness, good toileting habits and pelvic floor exercises.

Sources: Source: Milsom et al. How Widespread are the Symptoms of OAB? BJU Intl. 2001; 87: 760-766.

Read more at OAB.ie

COPD patients need to be empowered to take responsibility for their health People living with COPD are being urged to work together with their GPs to learn how to manage their condition. Taking such steps will help them live longer healthier lives.

C Prof. Tim McDonnell Consultant Respiratory Physician

WRITTEN BY Janet Fricker

Paid for by AstraZeneca

hronic obstructive pulmonary disease (COPD) is a lung condition where airways become inflammed and blocked and airsacs (alveoli) become damaged.

Serious consequences resulting from it are difficulty breathing, air exchange becoming less efficient and resulting in symptoms including breathlessness, cough and phlegm.

Whilst smoking is the main cause, between one third and one quarter of COPD sufferers are non smokers, with other risk factors including genetics, low birth weight and air pollution.

Patients going undiagnosed In Ireland, it is estimated 380,000 people are living with COPD, yet only 110,000 have been diagnosed. “People often think shortness of breath is part of natural ageing and don’t get checked out,” explains Professor Tim McDonnell, a respiratory consultant from St Vincent’s University Hospital, Dublin. Not getting a diagnosis means people don’t get access to treatments (such as short acting and long-acting

bronchodilators) that open up the airways and delay progression of COPD.

“Exacerbations (or ‘flare ups’) of COPD reduce patient’s quality of life making them feel short of breath and acutely unwell. But what’s more serious is they lead to further lung damage and increase their risk of dying,” says Professor McDonnell. One recent study, he adds, showed one in five people hospitalised for COPD exacerbations die within a year.

Empowering people to manage COPD

The large number of hospitalisations points to the fact COPD patients need to be empowered to take ownership of their own health.

One approach starting to be used more widely, which works well for asthma, is self-management COPD plans. Here GPs work in partnership with COPD patients to produce personalised records of when to take medications, actions to take when symptoms flare and when to call an ambulance.

People with COPD should learn how to reduce their risk of their condition worsening, otherwise known as exacerbations, including the following: • Having annual flu and one-off pneumonia vaccines (to reduce risk of infections which are the most common trigger for exacerbations).

• Keep ‘rescue packs’ of medications (including steroids to reduce inflammation and antibiotics to fight infection) on hand at home to tackle the first sign of exacerbations.

• Taking regular exercise. “Exercise has multiple benefits – it helps patient to use the lung capacity they have and clear their lungs of secretions,” explains Professor McDonnell. People can also consider joining pulmonary rehabilitation programmes which train them to use their lungs more efficiently.

• Discuss with their GP whether they are on the correct inhalers.

Advice on managing COPD is available from COPD Support Ireland - www. copd.ie