Respiratory Health - Q4 2021 by Mediaplanet UK&IE

Q4 2021 | A promotional supplement distributed on behalf of Mediaplanet, which takes sole responsibility for its content

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Improving air quality to protect future generations and level-up our communities

Our report found 85% of people living in areas with illegal levels of air pollution make up the poorest 20% of the UK population.

Urgent action is needed to protect millions of children who face a lifetime of poor health because air pollution levels in many parts of the UK are dangerously high.

WRITTEN BY Tim Dexter Campaigns Manager, Air Quality, Asthma UK and the British Lung Foundation

For more information please visit: ClearTheAir.org.uk

ublished just ahead of A national scandal COP26, our latest report It is a national scandal that 36,000 found more than a quarter premature deaths a year are of a million babies each attributed to long-term exposure year are being born in to air pollution in the UK. It parts of the UK where can worsen or “trigger” existing levels of air pollution fail to meet respiratory conditions, such as the World Health Organization’s asthma and COPD, resulting in previous air quality guidelines for fine potentially life-threatening asthma particulate matter (PM2.5) set in 2005. and exacerbations. It can also lead It also revealed over a third (35%) to the development of new lung of maternity units and over a quarter conditions. Over a million children (27%) of schools across Britain are in are receiving treatment for asthma areas that have unsafe levels of in the UK. air pollution. Much of this harmful Levelling-up pollution stems from commitments vehicle emissions Access to clean which are also fuelling air should not be the UK’s contribution dependent on where It is a national to the climate crisis. people are born or scandal that 36,000 live, which is why Health inequalities that we are calling on premature deaths a can last a lifetime the Government to year are attributed to embrace the COP26 Children growing up in deprived and by ensuring long-term exposure to legacy ethnic minority tackling air pollution is communities are more air pollution in the UK. an integral part of the likely to experience levelling-up agenda. the devastating and We are pressing the potentially life-long health effects of Government to set ambitious legally air pollution compared to children binding clean air targets in line born in areas with cleaner air – this is with the WHO’s 2005 recommended cruelly unequal. guidelines, with commitments Our report found 85% of people to meet these targets by 2030, living in areas with illegal levels of at the latest. air pollution make up the poorest By sharing the stories of the people 20% of the UK population. Children whose lives are most impacted and babies, including those in by toxic air, we hope to harness the womb, are more vulnerable political ambition to clear the UK’s to polluted air than many adults air for future generations, creating because their airways are smaller a fairer and healthier society. and still developing. Prolonged exposure can also stunt the growth of children’s lungs; in turn, this can reduce their resilience to respiratory illnesses throughout life.

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Long COVID clinics one year on In November 2020, NHS England announced new clinics dedicated to helping people living with the long-term impacts of COVID-19.

O WRITTEN BY Sarah Woolnough CEO, Asthma UK and the British Lung Foundation

ne year later, people are still battling long COVID alone as they struggle to get the support and care they so desperately need. Long COVID is new and unpredictable. There is still a lot that we do not understand about it. But what we do know is that life is not the same for the one million people living with the condition. People using the British Lung Foundation’s support services tell us they are battling multiple, often disabling, symptoms, most commonly breathlessness, which in some cases have totally turned their life upside down. One person living with long COVID told us they are now too breathless and weary to do everyday tasks like cleaning and the weekly shop. Another said they are grieving the life they lost and see no hope of returning to it.

Our analysis shows many people with long COVID, especially those who managed the acute phase of COVID-19 at home, feel like the forgotten patients of the pandemic Challenges accessing support The introduction of long COVID clinics in November 2020 offered a beacon of hope. NHS England announced that patients would be able to get specialist help at 60 sites across the country. But one year on, although the number of clinics has increased, people are still struggling to access the support they so desperately need. Our analysis shows many people with long COVID, especially those who managed the acute phase of COVID-19 at home, feel like the forgotten patients of the pandemic. People told us that they feel deserted and abandoned, with their doctors dismissing their symptoms as anxiety or stress.

If you have long COVID and want support and advice, you can visit blf.org.uk/long-covid

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Delays in treatment and support When referrals are made into these dedicated clinics, over a third of people are waiting more than 15 weeks for their initial specialist appointment. It simply cannot be right that so many seriously unwell people are left to languish on long waiting lists like this or are not referred to specialist services at all. People deserve rapid access to support services, and NHS England needs to support clinicians to either refer patients into existing pathways or guide them to self-manage if clinically appropriate.

Detecting lung cancer early is crucial in the recovery process As we continue the fight to recover from the impact of COVID, one thing remains clearer than ever – our desperate need for a national lung cancer screening programme.

month after lung cancer surgery, Tracy went on holiday to Fuerteventura. This may sound like the start of a fairy tale, but it is not fiction; Tracy’s story shows how quickly people can recover from lung cancer when it is found early. Tracy was diagnosed with lung cancer in 2019 after suffering from two chest infections in short succession. Recognising this was unusual for her, the GP sent her for an X-ray which led to her early diagnosis. That is the morale of the story; the earlier lung cancer is caught, the easier it is to treat. The difficulty is catching it early. Impact on progress COVID has set lung cancer back decades. Speaking to the Health and Social Care Committee earlier this month, Professor David Baldwin, says: “No. 10’s guidance has discouraged people with a hallmark symptom of the disease from seeking medical help.” As a result, the Lung Cancer Clinical Expert Group chair likened the situation to that of “25 years ago, with late-stage disease, horrible presentations, all sorts of things that we’d actually forgotten about because we’d made so much progress on the early diagnoses pathway.”

Road to recovery The relaunch of targeted lung health checks is imperative in the recovery of lung cancer. People aged 55-74 in selected areas of England who have ever smoked are being invited for a check-up. We urge them to take up the opportunity. However, what is desperately needed, and what we continue to campaign for, is a national lung cancer screening programme. A way to finally get ahead of the disease and diagnose people at the earliest stage before symptoms even start to show. We have seen the devastation that delay has on lung cancer and we cannot wait any longer, we need screening and we need it now. Until then, we need people to spot any differences in their health such as a persistent cough, breathlessness, fatigue, weight loss or repeat chest infections like Tracy. Push to see a GP, push for a referral and give yourself the chance to live happily ever after.

WRITTEN BY Paula Chadwick Chief Executive, Roy Castle Lung Cancer Foundation

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Lung cancer screening is needed to reverse COVID-19 damage Lung cancer screening is more important than ever, as more patients present with late stages of the disease as a result of COVID-19 delays.

A INTERVIEW WITH

Dr Samuel Kemp Consultant Respiratory Physician, Nottingham City Hospital PAGE WRITTEN BY

Kate Sharma

round 75% of lung cancer cases are currently CT screening saves lives detected at an incurable stage,” explains Dr Low-dose CT screening has proved to be an extremely Samuel Kemp, Consultant Respiratory Physician effective tool in identifying abnormalities on the lung that at Nottingham City Hospital. According to Cancer could be cancerous. Studies from the NELSON lung cancer Research UK, just 3% of patients diagnosed at stage four trials conducted over a 10 year period showed lung can expect to live for five or more years, which is cancer deaths in those who took part in screening why early detection is so vital. fell by about 33% in women and 24% in men, This issue is particularly acute right now. compared to patients who did not undergo Low-dose CT During the early throes of the pandemic, screening. lung health checks were put on hold, In 2019, the NHS embarked on a fourscreening has proved staff were redeployed, CT scanners were year pilot to conduct lung health checks, to be an extremely prioritised for COVID-19 and many which included low-dose CT screening, effective tool in patients stayed away from all healthcare for at-risk groups in 14 locations. Early settings altogether. The result has been identifying abnormalities results were promising. In Manchester, the later diagnosis and poorer outcomes, which NHS reported the percentage of cancers on the lung that could is why Kemp believes lung cancer screening diagnosed at stage one increased from 18% be cancerous. is so important. to 68%, giving patients more options and “COVID-19 has been catastrophic,” he better outcomes. explains. “We saw a 75% drop in referrals and are Statistics like this are hard to argue with, but as now seeing patients presenting with much later stages health professionals deal with the fallout from COVID-19 of the disease. It will be a while before we get statistics on most trials remain on hold, but we can’t pause forever; lives survival rates, but it could wipe out 10 years of progress.” are at risk.

Find out more at fujifilm-endoscopy. com/contact

Removing barriers reaps benefits of CT screening Lung health checks have proven to be a huge success in removing barriers to healthcare and improving outcomes for patients.

D INTERVIEW WITH

Samiran Dey European Business Development Manager, Fujifilm Medical Systems

rawing on evidence from the national lung cancer screening trial in the US, and NELSON study, there have been initiative screening pilots run in the UK, such as the SUMMIT study in North London, that proved a pickup rate in early stage lung cancer detection, leading to curative treatment rather than palliative care. Another initiative, the Manchester lung health check pilot, has seen the number of cancers diagnosed at stage one increase from 25% to 68%. Delivered everywhere from supermarket car parks to football stadiums, the programme has removed barriers which previously prevented people from coming forward. A single one-stop community-based unit can screen as many as 60 patients a day identifying those most at risk as early as possible. Wider benefits The improvement in early diagnosis is impressive, but the benefits of the lung health checks are far more wide reaching. The lung health check

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consultations address which patients require the low-dose CT scan but can also assist with smoking cessation for attendees; helping to reduce their chance of developing cancer and improving long term survival. It is important to remember that lung cancer screening is more important than ever, as more patients present with late stages of the disease as a result of COVID-19 delays. Lung health checks have proven to be a huge success in removing barriers to healthcare and improving outcomes for patients. Lung cancer screening is needed to reverse COVID-19 damage. Removing barriers to access Removing barriers to reap the benefits of low-dose CT screening, early diagnosis is just the start. If it is not followed up swiftly with further tests and treatment, opportunities will be wasted and lives will be lost. One in five patients sees their cancer stage change while they are waiting for treatment. As the rollout of the programme is considered in a further

20 locations, connected working and a continued commitment to removing barriers are vital. The uptake of lung health checks will require a greater need for the NHS to deliver the post-screening diagnostic confirmations leading to referrals of treatment options in order for the screening programmes to remain within, if not shorten, the lung cancer diagnostic pathway. This will require increased capacity and funding for infrastructure in order to develop a successful nationwide programme. The first step in battling lung cancer is to establish an effective screening programme.

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Lung function, long COVID and the road to recovery Behind the images of “donned” healthcare professionals has been an army of inspiring respiratory physiologists who have changed their roles to fight COVID-19 on the front line.

WRITTEN BY Carol Stonham MBE Executive Chair, Primary Care Respiratory Society

Why inactivity is causing long term health consequences

After months of inactivity, many people who have been shielding are now less active because of COVID-19 restrictions and are finding it more difficult to look after themselves.

legacy of the COVID-19 pandemic, which is rarely discussed, is deconditioning – the decline in physical function of the body as a result of physical inactivity and/ or an extremely sedentary lifestyle. Alongside those who have suffered acute COVID-19 and long COVID, many older people often with chronic conditions have been significantly more inactive over the last 12 months. This has resulted in what is known as deconditioning.

Deconditioning increases the risk of disability, frailty and dementia, all of which can have a significant impact on healthcare and social care services. The consequences of deconditioning Deconditioning increases the risk of disability, frailty and dementia, all of which can have a significant impact on healthcare and social care services. Quality of life can also be significantly impacted, people with long term conditions such as COPD and asthma that were previously able to care for themselves are now less able to undertake simple tasks such as walking to the post office, gardening and other activities. A common presentation of deconditioning is increased breathlessness. There has been a great deal of media attention on managing the symptoms

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of long COVID and mental health issues. However, there remain huge health consequences for those people who have been shielding and those with a chronic illness who have been unable to be as active as they were previously. Improving health after deconditioning The effects of deconditioning can be reversed over time given appropriate support and guidance. Alongside the excellent support by our primary care services, there needs to be a new attitude in support of social prescribing and exercise/movement programmes as a prescription for health. We need to support and help people to do more for themselves and help boost confidence, self-esteem and quality of life. Exercise and movement programmes should be tailored to the needs of the individual with achievable goals that can be easily adapted into the person’s lifestyle such as, walking to the end of the garden or participating in a pulmonary rehabilitation group. Medicalisation of treatment isn’t necessary and a joint approach of health, social and activity services will enable people to reverse the effects of deconditioning and improve physical and mental symptoms.

WRITTEN BY Professor Brendan Cooper Consultant Clinical Scientist at the University Hospitals Birmingham on behalf of the Association for Respiratory Technology and Physiology (ARTP)

’d like you to take a deep breath in…right in and…blow! Keep blowing…keep blowing, keep going, right out…just a little bit more…and…relax!” These words are uttered by respiratory physiologists thousands of times daily in the

UK. This is spirometry, the basic lung function test that indicates normality from abnormality, detecting asthma, COPD or lung fibrosis and is the gateway measurement to many lung disorders.

There is something in the air The 3,000 respiratory physiologists, trained from degree to doctorate level, provide most breathing tests investigating the state of the airways, lung size and the efficiency of gas exchange by testing the breathing system during rest, sleep and exercise. Largely unknown to the public, they mainly work in hospital outpatient departments. However, they have undergone a meteoric change in their roles as the result of COVID-19. One consequence of the pandemic was the reduction of routine diagnostic services and outpatient activity, but respiratory physiologists weren’t idle. Firstly, a skeleton service was continued under stringent infection control procedures. This is because COVID-19 is an airborne vector and lung function testing is effectively an aerosol-generating procedure often inducing coughing and mass viral spread. Many services continued pre-operative testing for urgent requests such as lung cancer and fibrosis. A blow out in the car park Secondly, because of decreased outpatients, innovative delivery included car spirometry, home remote monitoring and rapid room ventilation to clear the diagnostic backlogs. Physiologists, in full PPE in hospital car parks, performed testing through the windows of family hatchbacks. Some services used smart disposable spirometers to enable selftesting at home using smartphones. Critical caring Finally, COVID-19 is a respiratory disease, so senior physiologists were deployed to COVID-19 wards/ITUs to deliver ventilation and oxygen 24/7. Inpatients had no visitors; physiologists provided kindness, caring and moral support to sick and lonely patients. They are now established as “clinical reinforcements” in hospitals during “winter pressures.” Innovative diagnostics are now embedded into routine services, enabling more communitybased diagnostics and reducing the huge diagnostics backlog, using these incredibly hard-working teams. “Taking a deep breath” after the pandemic has a whole new meaning for respiratory physiologists.

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A WRITTEN BY Scott Lawson Country Manager UK, Pulmonx

ccording to GOLD (Global Initiative for Obstructive Lung Diseases), the condition is usually caused by pollutants that get into the lungs, initially blocking (obstructing) the airways as well as causing chronic inflammation. Smoking is the main cause of COPD. People who suffer from emphysema live with severe shortness of breath that often prevents them from doing simple daily activities without pausing to catch their breath or resting. Emphysema cannot be cured; however, treatment may help reduce symptoms, improve quality of life and slow progression of the disease.1

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COPD stands for chronic obstructive pulmonary disease. It is the second most common lung disease in the UK. Emphysema is a severe form of COPD. Both conditions can have a significant impact on a person’s quality of life.

Severe COPD and emphysema: when breathing becomes hard work

A patient story – “Getting back to being happy-go-lucky”: Patricia was diagnosed with COPD in 2004 and it affected everything. Every day was a challenge. After the disease progressed and medication no longer helped, she consulted with her doctor, who did tests to identify further treatment options to improve her quality of life. It turned out she was a suitable candidate for endobronchial valve treatment, a minimally invasive treatment for patients with severe emphysema that is available on the NHS.2 How does her life look like after the procedure? “My life after the treatment completely changed.

People are being urged to get a flu jab this winter With the onset of winter, people are being urged to get vaccinated against respiratory conditions such as flu and pneumonia.

harmacists are keen to stress that vaccination is more important than ever this year as many people’s immune systems have been weakened through reduced contact because of social distancing measures introduced during the COVID-19 pandemic. Both flu and pneumonia are potentially serious - particularly for vulnerable groups such as the elderly, children, pregnant women and those with weak immune systems. However, they can be less severe if people have a flu jab, and where possible, vaccination against pneumonia.

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Preventing potential complications Pharmacist Aminah Mirza, an NHS services manager for Superdrug, says the flu jab will help prevent people from getting flu, or developing complications

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from flu, such as pneumonia. Flu symptoms can include fever, headache, tiredness, muscle aches, sore throat, nasal congestion, stomach pain, digestive problems, weakness, difficulty sleeping, loss of appetite, shivering, cough, nausea and vomiting. Some people may experience flulike symptoms after the vaccination, though they are unlikely to be severe. The big concern is that anyone who contracts flu will be at increased risk of a serious case COVID-19 because their immune system will be compromised.1 “To protect yourself from worse symptoms of COVID, it would be beneficial to get a flu jab,” adds Aminah Mirza. “The emphasis on the flu jab is because flu is a big killer every single year and this year it is predicted to be even worse.”

Recovery was swift and I was able to be my busy self again. I could go into the garden and do weeding. I could walk around the block. I was able to go swimming. I could go up and down stairs again.” “When Patricia was referred to us for further testing, she had large amounts of trapped air in her lungs and was very breathless despite her inhaler medication”, says Dr Richard Barraclough from Wythenshawe Hospital. “We are very happy for Patricia that her quality of life improved so tremendously after treatment. This treatment is not for everybody, but works very well in a clearly defined subgroup of patients. If you are breathless despite the use of inhalers and have been diagnosed with severe COPD/emphysema, speak with your GP or respiratory doctor to see if you are eligible and can be referred to a treatment centre for consideration of endobronchial valve treatment.”

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References 1. Criner G et al. Am J Resp Crit Care Med 2018; 198(9): 1151-1164. 2. http://www.england.nhs.uk/.../lung-volume-reduction-by.../ http://shtg.scot/.../endobronchial-valves-for-lung.../ Results from case studies are not necessarily predictive of results in other cases. Results in other cases may vary. © 2021 Pulmonx Corporation or its affiliates. All rights reserved. All trademarks are property of their respective owners. EMEA-EN-1217-v1

Do you want to find out more about severe COPD/ emphysema? Visit:

The free NHS flu jab, for at-risk groups including the over-50s, is available at Superdrug. For other groups it costs £13.99. Protection against pneumonia Pneumonia vaccinations are also available and can protect against a range of bacterial infections. Clinical Nurse Advisor Tracy Roughley, who works at the Superdrug nurse clinic in Corporation Street, Birmingham, says: “While it is often referred to as the pneumonia vaccine, it also protects against other pneumococcal bacteria, such as forms of meningitis.” A one-off vaccine, it is free to at-risk groups on the NHS, or available to other groups through nurse clinics such as Superdrug for anybody aged two and above. Two types of pneumonia vaccines are available, offering different ranges of protection. Tracy Roughley stresses the importance of protection as there are currently many respiratory viruses and bacteria circulating. “Flu and pneumonia vaccines are not going to protect against COVID-19,” she adds, “but they will help boost the immune system and give some protection against other respiratory infections, it will also help to protect the NHS and keep people out of hospital and at work.” Reference 1. https://www.theguardian.com/world/2021/oct/10/gettingflu-with-covid-makes-you-twice-as-likely-to-die-says-ukhealth-chief)

INTERVIEW WITH

Aminah Mirza NHS Services Manager, Superdrug

INTERVIEW WITH

Tracy Roughley Clinical Nurse, Superdrug WRITTEN BY

Mark Nicholls

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New research is needed to help prevent RSV in children Respiratory syncytial virus (RSV) is the leading cause of respiratory infections in children under five accounting for over one-third of lower respiratory infections.

lobally, RSV causes about 33 million lower respiratory tract infections during early childhood annually and one in 10 RSV cases is hospitalised. RSV is a leading cause of child deaths (with over 120,000 child deaths) worldwide, most of these in the first year of life and in developing countries.

WRITTEN BY Harish Nair Professor of Paediatric Infectious Diseases and Global Health at University of Edinburgh (UEDIN), RESCEU Project Scientific Coordinator

Pressure on health services In the UK and other developed countries, RSV is the leading cause of hospitalisation, most of which are in infants otherwise healthy and born at term. During the winter months, paediatric respiratory wards are teeming with children with bronchiolitis and these pressures on the healthcare system have an impact on care for other conditions. Recent studies have shown that RSV infections are as common as influenza in the elderly and are likely to result in a similar number of hospitalisations and deaths each year. In the absence of specific testing for RSV, it is impossible to distinguish RSV infection from the flu. Preventative solutions needed There is currently no treatment or preventative option to protect all infants, children and elderly from RSV. With the recognition of RSV as a global health priority over the last decade, including by the WHO, there has been a major push for developing preventative solutions against the virus. There are currently seven products in phase III clinical

trials. Recent data suggest that immunisation against RSV not only protects the infant against the virus but also against other respiratory infections.

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New research into RSV The RSV Consortium in Europe (RESCEU) funded by the Innovative Medicines Initiative (IMI) has been conducting clinical studies and gathering evidence to inform decisionmaking by WHO, European Medicines Agency and national immunisation technical advisory groups. A two-year study involving 1,040 participants across Belgium, the Netherlands and the UK showed the incidence of RSV infection was about 5.6% in home-dwelling older adults (varying between 4% in one year and 7% in the next). There are ongoing studies to understand the incidence of RSV infection in infants and identify biomarkers for severe RSV infection and longer-term consequences of RSV. The work started by RESCEU will now be taken forward by a follow-up IMI project (Preparing for RSV Immunisation and Surveillance in Europe - PROMISE). With clinical societies and patient groups, PROMISE will help us to understand patient perspectives to prepare the ground for introduction of options for RSV prevention in the next five years. This project has received funding from the Innovative Medicines Initiative 2 Joint Undertaking under grant agreement Nº 116019. This Joint Undertaking receives support from the European Union’s Horizon 2020 research and innovation programme and EFPIA. The article reflects only the author’s view. The JU is not responsible for any use that may be made of the information it contains.

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We must tackle COPD diagnosis rates to improve lives While there is no cure for chronic obstructive pulmonary disease (COPD), early diagnosis is vital to managing the condition.

A WRITTEN BY Jon Foster Senior Policy Officer, Asthma UK and the British Lung Foundation

round 1.3 million people in the UK live with a diagnosis of chronic obstructive pulmonary disease (COPD), a progressive lung disease which makes it harder to move air in and out of the lungs. In addition, there are thought to be at least another 1.3 million people who live with COPD but have not been diagnosed. As a result, they are not receiving any treatment. There is no cure for COPD, but early diagnosis is vital to help people manage their symptoms and live more comfortable lives. Shockingly, our new research exposes totally unacceptable delays which means that half of COPD cases may be undiagnosed. Can you imagine if this was true of cancer cases – it would be a national scandal. No plan to address the backlog This alarmingly low rate of diagnosis is down to a combination of factors, including the COVID-19 pandemic. GPs were advised by NHS England in March 2020 to stop using diagnostic breathing tests known as spirometry

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tests. This, coupled with difficulty in people getting appointments, led to a 51% reduction in COPD diagnoses in England alone last year – that’s around 46,000 people missing out on a diagnosis. This is a much larger percentage  drop than seen for other conditions such as heart disease, heart failure and diabetes. While rates of cancer diagnosis are already up to, and in some areas better than, prepandemic levels, there is no dedicated national plan to address the huge backlog in respiratory care. A raw deal for lung conditions However, while the pandemic has made things worse, it is not entirely to blame. People with lung conditions have for a long time had a raw deal compared to other conditions. Not only is there plenty of unjustified attitudes around lung conditions, which can sadly be seen as ‘dirty’ or ‘people’s own fault’, investment into research and treatment pales in comparison to other conditions. It is therefore sad, but not

surprising, that there is low awareness and long-standing misconceptions about COPD. One of the most common misunderstandings is that it only affects smokers and older people. This isn’t always the case. Our research found that one in 10 people with COPD had never smoked before, while one in five had symptoms of the condition under the age of 45. We urge anyone worried about their breathing to contact their GP. They should also visit the British Lung Foundation website to get more information on COPD and to take the BLF Breath Test. READ MORE AT HEALTHAWARENESS.CO.UK