Respiratory Health - Q2 2021

A Mediaplanet campaign focused on

Respiratory Health

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“Exposure to air pollution increases the chance of a person dying early, developing lung cancer and cardiovascular disease.” ~ Harriet Edwards, Senior Policy and Projects Manager Air Quality, Asthma UK and the British Lung Foundation

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“During the pandemic, the halting of the lung cancer screening pilots and restricted access to diagnostics contributed to a 75% drop in urgent lung cancer referrals.” ~ Jim Shannon MP, Chair, All-Party Parliamentary Group for Respiratory Health

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IN THIS ISSUE

Pharmacies hold the key to supporting people with lung disease

Urgent action needed to protect the most vulnerable from air pollution

Dr Alison Cook Chair, Taskforce for Lung Health

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A recent report from leading charities reveals that around six million over 65s in England are at risk from asthma attacks and lung damage due to toxic air.

Why we must tackle air pollution for our children Larissa Lockwood Director of Clean Air, Global Action Plan

Page 06

Breathlessness, diagnostics and the challenges of a worldwide pandemic Carol Stonham MBE RN, MSc, QN Executive Chair, PCRS (Primary Care Respiratory Society)

Page 06

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ir pollution is dangerous for everyone, but for the most vulnerable people in society, including older people who are more likely to suffer from lung disease or have weakened lungs from ageing, spikes in air pollution levels can put them at risk of breathing difficulties and having asthma attacks or COPD flare-ups.

In a recent report, ‘The invisible threat: how we can protect people from air pollution and create a fairer, healthier society’, Asthma UK and the British Lung Foundation revealed that 59% of older people are living in areas where fine particulate matter (PM2.5), the most worrying type of pollution that can penetrate deep into the lungs, is above the levels recommended by the World Health Organization (WHO).

Impact of air pollution on quality of life Exposure to air pollution increases the chance of a person dying early, developing lung cancer and cardiovascular disease. Emerging research has even shown links with air pollution and cognitive decline, including dementia.

The research, which used PM2.5 data collected in 2019, shockingly revealed that in 36 local authorities every care home is located in areas with levels of pollution exceeding WHO recommended guidelines. That’s 4,382 care homes that provide critical care and support to older people, located in highly polluted areas across England.

There are pollution black spots across the country affecting 98% of care homes in London, 97% in Epsom and Ewell, 95% in Oxford, 83% in Sandwell, 76% in Northampton, 63.5% in Swindon, 47% in Coventry, 40% in City of Bristol, 37% in Birmingham, 36% in Leicester, 33% in South Gloucestershire and 15% in Liverpool.

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Exposure to air pollution increases the chance of a person dying early, developing lung cancer and cardiovascular disease.

Stronger laws and national health protection plan needed Asthma UK and the British Lung Foundation are urgently calling for the Government to introduce stronger clean air laws that set out targets in line with WHO guidelines, which must be met by 2030.

In addition, charities are also calling for a national health protection plan for England overseen by a newly created air quality minister to safeguard those most at-risk from the effects of toxic air. This plan should include training for health professionals and an alert system that tells the general public when air pollution is going to be high, which directly informs care homes and medical centres so that those most at risk can protect themselves from harm.

Contact information: uk.info@mediaplanet.com or +44 (0) 203 642 0737

WRITTEN BY

Harriet Edwards Senior Policy and Projects Manager - Air Quality, Asthma UK and the British Lung Foundation

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Could a greener inhaler be the right choice for you?

Finding the right inhaler for each patient is crucial, so is considering the environmental impact.

T INTERVIEW WITH Dr Anna Murphy Consultant Respiratory Pharmacist, University Hospitals of Leicester NHS Trust. Respiratory Integrated Care Pharmacist, Leicestershire Partnership Trust (Honorary)

INTERVIEW WITH Beverley Bostock RGN MSc MA QN Advanced Nurse Practitioner in Gloucestershire, Editor in Chief Practice Nurse Journal & Asthma Lead for Association of Respiratory Nurse Specialists

WRITTEN BY Mark Nicholls

he right choice of inhaler for a patient is critical for successful treatment. The decision, in discussion with healthcare professionals, can also consider health economics, environmental impact, inhaler type and medication.

Inhalers are fundamental elements of the treatment for conditions such as asthma or COPD (Chronic Obstructive Pulmonary Disease).

By picking the right inhaler, with the correct medication and an understanding of its usage, there may be increased patient adherence to the treatment, improved outcomes and cost-effective control of a condition.

Different inhalers Not all inhalers are the same, with different techniques regarding the type of breath required, process to prepare the inhaler and also the carbon footprint. Engaging with patients and helping them make an informed choice about these factors is important.

Murphy says: “With over 20 different inhaler devices on the UK market, this process has become complicated for us as healthcare professionals and for patients.”

“Getting patients to use their device correctly will also reduce unnecessary escalation of treatments.”

“From an NHS perspective, this cuts down unnecessary drug usage with some £300 million worth of medicines being wasted each year.”

Green inhalers Opting for a ‘green’ inhaler could The most commonly used inhalers, be a factor in the patient choice, pressurised metered dose inhalers though health professionals (pMDIs), still use greenhouse gases From an NHS perspective this underline the importance that called hydrofluoroalkane, which clinical need must come first. “The cuts down unnecessary drug contain HFCs (hydrofluorocarbons) green agenda is something we need usage, with some £300 million to take on board, but we should see as a propellant to push the medication out of the inhaler. Five it as an opportunity to also improve worth of medicines being doses from a pMDI have a global inhaled treatment to make sure we wasted each year. warming potential equivalent to a have the right device for the patient nine-mile car trip, with each dose at the right time” says Murphy. having an estimated carbon footprint of up to 500g of carbon dioxide and emitting up to 36kg of CO2 Working with patients in its lifetime.

There has been a 17% increase in the age standardised Propellant-free inhaler models, which have been asthma death rate in the last six years in the UK. available since the 1990s, are dry powder inhalers There are many reasons for this that include patients (DPIs) that deliver powdered medication, with the missing asthma reviews and not taking their active ingredient expressed without a propellant. medication as prescribed. Engaging with patients and DPIs can significantly diminish the climate impact, asking questions to understand their knowledge of with lifecycle emissions 10-37 times lower than pMDIs. their condition and treatments could help.

As part of a drive to be net carbon zero by 2040, NHS “As clinicians, we need to discover what a patient England is supporting a move from MDI to DPI. knows about asthma and inhalers. If we started our Anna Murphy, a consultant respiratory pharmacist consultations with these types of questions, we’d at University Hospitals of Leicester NHS Trust get far better outcomes, as we know adherence to says: “There seems to be a great benefit to the treatment is a major issue with asthma care” says environment by switching to a dry powder and nurse practitioner Bev Bostock, who is also asthma potentially cost savings for the NHS, but we can’t lead for the Association of Respiratory Nurse just blanket switch patients to DPIs because we need Specialists. Furthermore, a patient being trained to to make sure patients are aware of what we’re doing use their inhaler properly is vital. and that they’re happy to make that switch.”

“If we don’t get that right, it doesn’t matter what drug we’re trying to deliver as it won’t get to the right area to make an impact.”

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Exploring the impact of COVID-19 on lung patients A study is underway to assess the impact of COVID-19 on lung fibrosis development.

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nterstitial lung disease (ILD), or lung fibrosis, diagnosed by CT scan, causes difficulty breathing by affecting the delicate membrane separating the blood and air in the lungs.

Joanna Porter, Professor of Respiratory Medicine at University College London, says there are more than 200 causes of ILD, including asbestos, mould, feathers, underlying conditions such as rheumatoid arthritis, and infection.

COVID-19 infection may be the latest contributor to ILD development.

COVID-19 impact Dividing her research role with clinical work as head of the national NHS centre for ILD at University College London Hospitals, Professor Porter says there are an estimated 16,000 new ILD cases per year but this could be an underestimate as some people may not know they have the disease.

Specialists agree that current evidence is limited, however there is concern regarding the impact of COVID-19 on ILD and lung fibrosis patients. What is known is that patients with the most severe form of ILD - idiopathic pulmonary fibrosis (IPF) – do less well if they catch the virus.

The UK ILD Post-COVID Study is now following up hospitalised and nonhospitalised post-COVID patients to see how many develop a new ILD as a result of SARS-CoV-2 infection.

This UKRI funded multicentre study will look at patients in the PHOSP study who had a CT scan three months after their initial infection and compare that with their 12-month follow-up scan to identify ongoing and resolved issues.

Although we do not know the final figures, unpublished preliminary data from UCLH suggest around 4% of patients may be affected.

Professor Porter is also Medical Director of Breathing Matters, a UCLH charity, dedicated to finding a cure for all forms of ILD/pulmonary fibrosis. She points out that anything we learn from post-COVID ILD will almost certainly help other patients with lung fibrosis. Breathing Matters has continued vital research throughout the pandemic to address these critical questions.

INTERVIEW WITH

Professor Joanna Porter Medical Director and Clinical Lead of Lung Fibrosis, Breathing Matters WRITTEN BY

Mark Nicholls

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Pharmacies hold the key to supporting people with lung disease

If we really want to reduce the strain on the NHS, community pharmacies need to be better utilised for people with lung conditions in the pandemic and beyond.

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ore than 1.6 million people visit a community pharmacy each day, providing a huge opportunity to pick up on warning signs for lung disease, support people living with lung conditions and make sure that the care people receive is right for them.

Pharmacies are often just at the end of the street and easier to access than doctors’ surgeries, which require an appointment. It’s therefore unsurprising that a Taskforce for Lung Health survey of over 2,000 people living with lung conditions found that 95% of respondents saw the services on offer as valuable and essential, or something they could not live without.

What was surprising is the fact that despite this recognition of how vital local chemists are for lung health care, many patients were not aware of the range of services on offer or were not using them.

It’s clear that there is work to do Despite inhaler technique checks being a crucial part of basic care for people with lung disease, nearly half (48%) of people were not using inhaler technique check services, with a quarter of these unaware they were available. These checks help to prevent life threatening asthma attacks from incorrect inhaler use.

By raising more awareness of the range of services that local pharmacies offer, and encouraging people with lung disease to use them, we could see a huge change in the way lung disease care is approached.

For example, according to the survey, only one in four respondents got their flu jab at their local pharmacy. Increasing uptake could really help protect people with lung disease, who are seven times more likely to die if they catch flu than someone who is not in an at-risk group.

On top of the benefits to people living with lung disease, making sure that local pharmacies are more integrated into the way the NHS works could

ensure that the pressures our doctors, hospitals and healthcare staff are under are greatly eased, in the pandemic and for the foreseeable future.

By raising more awareness of the range of services that local pharmacies offer, and encouraging people with lung disease to use them, we could see a huge step change in the way lung disease care is approached.

Pharmacies need to be a part of the way the NHS operates People with lung conditions have told us that community pharmacies act as a lifeline for their care, but there is clearly still work to do in making sure that the NHS starts to integrate these services into the way care is delivered so that pharmacists can help refer patients to the treatments they need. The level of training pharmacists receive means that they are a vastly untapped and underused NHS resource for improving lung health care.

WRITTEN BY Dr Alison Cook Chair, Taskforce for Lung Health

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Helping parents identify signs of an asthma attack Figures show that many parents of young children with asthma are still challenged with identifying the most common symptom associated with a potential attack.

Wheezing, the most common symptom associated with asthma in children under five, can be a precursor of an asthma attack.

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heezing, the most common symptom associated with asthma in children under five, can be a precursor of an asthma attack.

But recognising the continuous, coarse, whistling sound produced in the respiratory airways during breathing as a wheeze without proper clinical training is not always straightforward. This is especially worrisome for children in this age group, who are too young to speak or articulate what they’re feeling.

In addition, what parents and doctors mean by “wheezing” is often very different. This is problematic, since proper asthma management depends on accurate and early identification of a wheeze.

Asthmatic symptoms Jean-Paul Eekhout, Respiratory Development Group Manager at OMRON Healthcare Europe, says: “Wheezing is one of the symptoms that children diagnosed with asthmatic symptoms will have as a warning for an upcoming exacerbation. What is happening is that the airways are contracting and this results in the whistling sound”.

By using medication that has been prescribed as part of the treatment plan, a child would receive the necessary support to relax the airways again and avoid having a serious asthma attack. However, most parents want to be certain their child is having an asthma attack before exposing them to particular medications and potential side effects. Unfortunately, this approach risks missing early action that could prevent attacks.

Addressing lack of clarity Building on decades of expertise in technology for respiratory treatment, OMRON has worked closely with parents to gain an insight into their levels of confidence in detecting

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wheezing symptoms in their children.

At least 60% of surveyed parents need some sort of reassurance when managing asthmatic symptoms in their children at home.

“In addition to consumers, we also collaborate with key respiratory experts to understand their own challenges when providing all the help they can to reduce harm in children,” says Eekhout. “Healthcare professionals are stating that there often is a misinterpretation of wheezing sounds as they are perceived by a doctor and the caregiver. That leads to confusion and potentially to administering the wrong medication or too much or too little”.

“If an asthma attack is looming, the earlier you are there, the faster you can respond and you can avoid it. But if no action is taken, by the time you will realise the severity of the situation, it is too late” he says.

INTERVIEW WITH Jean-Paul Eekhout Respiratory Development Group Manager at OMRON Healthcare Europe WRITTEN BY Mark Nicholls

Early detection With the increasing burden of asthma as the bedrock for removing guesswork during an exacerbation, OMRON Healthcare developed WheezeScan, a new device designed for early detection of wheezing to alert parents or caregivers that an asthma episode may be imminent.

Created for use in children aged from four months to seven years, it is “essentially a digital stethoscope,” explains Eekhout.

“It has a very powerful microphone combined with noise cancellation circuitry that is placed on a child’s chest to tell the parent or caregiver whether the child is wheezing or not in 30 seconds,” he adds.

An algorithm has been trained to detect the wheeze “signature”, which is analysed and highlights if a wheeze is detected facilitating earlier intervention, or whether there is no wheeze.

Because asthma has a better prognosis when the symptoms are tackled earlier, OMRON expects that the WheezeScan will contribute to improve asthma management, reduce hospital admissions and achieve better patient care outcomes.

Providing support “This device is also not about detecting asthma from a diagnostics point of view; this is a device that goes to parents or caregivers of children that have been diagnosed with asthma by their GP to provide support, enabling parents to follow the recommended treatment plan in the presence of a wheeze.”

Additionally, during the COVID-19 pandemic, patients may have missed seeing their doctor as often as required, meaning they may have required extra support from such a device.

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Breathlessness, diagnostics and the challenges of a worldwide pandemic The global pandemic, repeated lockdowns and the way we now deliver healthcare has had an impact on the respiratory health of the population.

F WRITTEN BY Carol Stonham MBE RN, MSc, QN. Executive Chair, (PCRS) Primary Care Respiratory Society

or over a year many tests that are considered routine or not urgent have been put on hold, amongst them, lung function tests which help to confirm or rule out conditions such as asthma and COPD. The result has been a backlog of people with respiratory symptoms waiting for the tests to confirm which condition they might have. As well as those who have not yet presented to their doctor.

Those with symptoms of more urgent conditions, such as lung cancer, should and must be prioritised. They must also see their doctor if they have a prolonged cough or other unexplained symptoms.

Breathlessness - is it deconditioning?

When patients consult with breathlessness there are a number of underlying conditions that can be at the root of the problem. Breathlessness can be complicated, it can relate to a number of organs in the body, medication or a combination of factors.

One thing that can be overlooked, yet is likely to be an increasing problem following the prolonged periods of lockdown we have just experienced, is deconditioning.

When we reduce our activity and in particular our load bearing muscles, they become less able to cope with the daily demand they used to manage with ease. Add to that

a change in diet, and potentially a few extra lockdown pounds in weight gain and you can easily see how deconditioning can occur.

In an otherwise fit, healthy person this might be perceived as being a little unfit and easily corrected by eating healthily and getting back to the gym. In more vulnerable people, it can cause breathlessness and fatigue that is akin to other physical illness. All is not lost though.

A tailored programme of rehab with the right therapists can get you back on to the road to recovery.

Learning from adversity So, what has the pandemic taught us? What will the ‘new normal’ for healthcare look like? We moved very quickly to an environment using video consultation which is likely to be here to stay.

The ‘hospital at home’ technology and digital solutions to healthcare became essential for the safety of patients and staff. It has shown us we can and should incorporate it into everyday healthcare, but in a way that considers what patients need.

We must remember that there is no one size fits all.

There are times when we still need to offer to see patients the traditional way, face to face.

Why we must tackle air pollution for our children

Clean Air Day 2021 We have seen the power of Clean Air Day to unite a movement, to bring confidence to talk about the importance of tackling air pollution even in trying times and to push for change. Which is why this year on 17 June, we themed the campaign “protect our children’s health from air pollution” and we are encouraging individuals and organisations to do something to tackle air pollution and to support and call for wider action.

As we emerge from a global pandemic, we must now look to protect our children’s health from air pollution.

T WRITTEN BY Larissa Lockwood Director of Clean Air, Global Action Plan

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he last year has been a wakeup call for many reasons – our health has been front of mind and we have become much more interested in the air we breathe. Now we need to make the connection from pathogens in the air to pollutants in the air, as both can cause disease. In the same way that we have protected and supported the most vulnerable from COVID-19, we must now protect children from air pollution as they are some of the most at risk to its life limiting impacts.

In 2020 and 2021, we saw our children bear the burden of the pandemic, compromising their freedom, education and mental wellbeing. Now as we return to our

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lives, we owe it to our children to provide a healthy environment where they can learn and play safely.

Why children are at risk Children are particularly vulnerable to the impacts of air pollution because their bodies and brains are still developing. Air pollution not only affects their physical health - impacting lung function development, triggering asthma and causing asthma in some - but also their ability to learn. We need to focus on cleaning up the air as part of our recovery from the pandemic, to help ‘level-up’ and secure the health and educational potential of these future generations.

Air pollution is not a fact of life and can be solved with collaborative action and education.

Air pollution is not a fact of life and can be solved with collaborative action and education. We must all come together - individuals, schools, businesses, local authorities across the UK to collectively take action and seize this moment to create and support change, for good. We have a once in a lifetime opportunity for change. We must use it.

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Creating a safe working environment for all Health and safety within the workplace is of paramount importance in protecting personnel.

E INTERVIEW WITH Andrea Duca National Sales Manager, Festool UK WRITTEN BY Mark Nicholls

mployees expect to be able to operate in a safe and healthy environment when they go to work.

But some employment sectors have differing perceptions of risk, while other occupations are more hazardous simply because of the nature of the work.

That means that it is even more important for companies to ensure that they create a safe and healthy working environment with relevant protective equipment, and also comply with all health and safety regulations.

Dust is a common hazard, and depending on the cause of the dust, the substances thrown up into the air can range from mildly irritating to toxic and dangerous to health.

Health and safety Having dust masks and protective glasses can offer protection, but ventilation and dust extraction systems are also a pivotal part of the process.

According to the European Agency for Safety and Health at Work (EU-OSHA), health and safety approaches in the workplace are “often inadequate” and place staff in smaller firms at a higher risk of work-related accidents and illnesses.

The consequences of an incident can be farreaching, even bringing the entire business to a standstill.

Occupational health and safety expert, Alexander Hoste, regularly visits businesses and is acutely aware of the importance of workforce wellbeing.

“Every pound invested in health and safety in the workplace pays off double. In small companies in particular, injuries and illnesses can represent existential threats,” he says.

Dust extraction Rolf Stelzle, who owns a painting company that employs 10 people, says: “Having healthy employees is the basic prerequisite for running a healthy business. That’s why health and safety in the workplace should be simply a matter of course, so much a part of the standard operating procedure that you don’t even have to think about it.

“Our employees greatly value healthy work. They don’t sand without dust masks. They never leave the building without a dust extraction system. They always strap up when working at dangerous heights.

Health and safety in the workplace should be simply a matter of course, so much a part of the standard operating procedure that you don’t even have to think about it.

And they are proactive about talking to me when they need something.”

Workers in the construction industry are one of the groups most at risk, but there has to be a constant awareness of the dangers of the environment they work in.

But as Stelzle explains, the rules and regulations that are in place are about the safety of the people.

“My employees are my most important asset,” he adds. “Without them, I would have to shut down operations. That’s why it’s important to me that they work healthy and stay healthy in the long term.”

High-quality system As a hazard, dust can create numerous problems: it affects visibility, clogs tools and machinery, but can also be a serious health hazard for workers if it gets into an individual’s airway.

Philipp Stahl is a master painter, who works as an application technician at Festool, is looking for ways the company can help painters improve the health, safety and cleanliness of their work as best as possible.

An important element, he says, is a high-quality dust extraction system that sucks up the dust and stores it until it can be safely disposed of.

Festool offer a range of dust-extractors for building sites or wood dust from sanding with the equipment designed to work alongside power tools.

It emphasises the importance of choosing a dust extractor that is appropriate for the material being worked on and ensuring that it is operating correctly, such as seeing that the connection between the hose and the extractor is secure and has the correct filtration for the type of dust involved.

The correct equipment helps ensure a healthy workforce, cuts the risk of accident, and reduces staff sickness as a result of injury.

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In 2020 and 2021, we saw our children bear the burden of the pandemic, compromising their freedom, education and mental wellbeing. Now as we return to our lives, we owe it to our children to provide a healthy environment where they can learn and play safely. ~ Larissa Lockwood, Director of Clean Air, Global Action Plan

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