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Respiratory health HEALTHAWARENESS.CO.UK
Paula Radcliffe The champion athlete on breaking records with asthma
DR PENNY WOODS
The chief executive of the British Lung Foundation shines a spotlight on lung disease P2
WHY YOU SHOULD BE AWARE OF COPD
Dr Nicholas Hopkinson on the importance of prompt diagnosis P4
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Patient story Read about Sue Townsley’s remarkable journey with pulmonary hypertension P5
Lung disease Dr Lisa Davies on the fight for prompt diagnosis of lung disease and what we can do to help P6
Hear from the experts The European Respiratory Society and the European Lung Foundation on how to turn tide on lung disease
Throwing the spotlight on lung disease
One in five of us in the UK has been diagnosed with a lung disease.1 And millions across the country have the life-limiting lung condition chronic obstructive pulmonary disease (COPD) – but don’t even know it.2 The UK has the fourth highest mortality rate from lung disease in Europe3
O
verall, the burden that lung disease places on our nation’s health and our health services is immense – on a par with non-respiratory cancer and heart disease. Yet the amount of resources and attention invested in tackling lung disease trails behind these other disease areas.4 That’s why we’re calling on the government to set up a respiratory taskforce to develop a five-year strategy to improve lung health.
We’re encouraging doctors to consider COPD as a diagnosis in everyone over 35 who has been, or is a smoker, and has respiratory symptoms. Early diagnosis and treatment is key to providing patients with better outcomes. Correct and timely advice to patients will help empower them to manage their conditions. For example, learning proper inhaler use, taking part in pulmonary rehabilitation and getting help to quit smoking for smokers.
1
The battle for breath – the impact of lung disease in the UK (2016), The British Lung Foundation, p3. https://www.blf.org.uk/what-we-do/our-research/the-battle-forbreath-2016
2
NHS England – Health and high quality care for all, now and for future generations. Section 6.2, Earlier and acute diagnosis of COPD: ‘An estimated 2 million people
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Dr Penny Woods Chief executive, British Lung Foundation (BLF)
We encourage everyone to take their lung health seriously. This involves knowing what symptoms to look for, and understanding the importance of seeking expert medical advice where necessary. For those with longterm respiratory conditions, being active and doing exercise can help improve breathing, fitness and quality of life. It helps in strengthening muscles and coping with breathlessness and in resisting infections,
have undiagnosed and untreated COPD’. https://www.england.nhs.uk/ourwork/futurenhs/deliver-forward-view/sop/red-prem-mort/rd/ 3
The battle for breath – the impact of lung disease in the UK (2016), The British Lung Foundation, p4. https://www.blf.org.uk/what-we-do/our-research/the-battle-forbreath-2016
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as well as boosting wellbeing and confidence. You can check your lung health through online tests such as the one provided by the British Lung Foundation. We want everyone to take the test and if advised to, seek advice from their GP. For advice from the BLF on COPD and other lung conditions: 03000 030 555. Information is also available from: blf.org. uk/COPD & you can take the test here: blf.org.uk/ breathtest
The battle for breath – the impact of lung disease in the UK (2016), The British Lung Foundation, p3. https://www.blf.org.uk/what-we-do/our-research/the-battle-forbreath-2016
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Do you suffer from COPD or Asthma? Would you like access to more promising treatments? Clinical studies are important as they aim to identify new and better ways to treat conditions such as COPD and Asthma There are many benefits to taking part in a Clinical study including: • Close monitoring by the medical team to improve the control of your COPD/Asthma • All medications, health checks & investigations at NO cost
• Reimbursements will be made per visit to cover the cost of travel • We keep your GP fully informed of all test results
If you would like further information about our current studies or to arrange a FREE Respiratory Health Check then please visit our website www.improvingtreatments.co.uk/breathe OR text the word “study” to 85199
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Smiths Medical offers a drug free device to help to manage secretions. The acapella® choice performs effective Oscillating Positive Expiratory Pressure (OPEP) therapy. It helps to mobilise secretions, open airways and optimise medication delivery.
Secretion Management Drug Free Device WHAT DOES SECRETION MANAGEMENT MEAN? Suffering from Chronic Obstructive Pulmonary Disease (COPD), secretions - such as mucus - can build up in the airway and lungs. This can cause breathing problems and can be dangerous, as it means that less oxygen will reach the blood. A lack of adequate oxygen in the blood can lead to severe complications, as it’s needed to enable vital organs to function correctly. The treatment to loosen and remove these excessive secretions, and improve breathing, is called secretion management.
WHAT DOES OSCILLATING POSITIVE EXPIRATORY PRESSURE (OPEP) MEAN? OPEP therapy is one form of secretion management and works by breathing through an OPEP device - like the acapella® choice system. The acapella® choice system loosens and mobilises secretions in patients with varied types of respiratory problems like COPD.
HOW DOES THE ACAPELLA® CHOICE SYSTEM WORK? When a person breathes out with moderate force through the device, their breath will meet resistance. This resistance produces ‘positive pressure’, which helps to keep the airways open. The positive pressure allows airflow to get beneath secretions, forcing them away from airway surfaces. The same breath creates a vibration in the acapella® choice system, which further helps to loosen sticky mucus and secretions. This allows the mucus to move upwards towards the larger airways where it can be coughed out through a technique called ‘huff coughing’. The acapella® choice OPEP therapy system is convenient and can be used in hospital, at home or wherever treatment is needed. The device is easy to use and does not require electricity or medical gas to operate. OPEP therapy can be used for patients suffering from COPD and is recommended
within the British Thoracic Society Guidelines for physiotherapy management of adult spontaneously breathing patients1. The acapella® choice OPEP therapy system is now available on prescription. The simplicity and ease of use of the acapella® choice system can be seen in a number of educational videos, which can be found on the Smiths Medical website: www.smiths-medical.com. To summarise, the main characteristics of our acapella® choice system to improve patients experience and enhance compliance: Easy to perform – works in any position, can be used anywhere. Easy to learn - techniques are intuitive, do not depend on others and are time-efficient. Adaptable – our acapella® choice system can be combined with a nebuliser. This allows you to combine two therapies into one. 1. Thorax 2009;64(Suppl I):i1–i51. doi:10.1136/thx.2008.110726
For further information please call Cliff Pool at 07812 151 829 or email cliff.pool@smiths-medical.com Alternatively, contact 0845 850 0445, ukcs@smiths-medical.com or visit www.smiths-medical.com acapella, Portex and the Smiths Medical design mark are trademarks of Smiths Medical. ©2016 Smiths Medical. All rights reserved. MPAUCA-1479
COMMERCIAL FEATURE
The tiny coils which can help treat emphysema By Linda Whitney
A new treatment could bring a better quality of life to more emphysema patients. Tiny coils inserted into the lungs of those with chest hyperinflation can allow them to breathe more easily.
“In the past the main surgical option for emphysema patients where damage was limited to certain areas of the lung was to remove the damaged sections. This required open surgery and at least a week’s hospital stay. It is a high-risk procedure only suitable for limited numbers of fit patients,” says Mr Aiman Alzetani, consultant thoracic surgeon at University Hospital Southampton. Non-invasive alternative “The coils, however, can be inserted
into the lungs down the throat using a bronchoscope guided by a tiny camera to the damaged areas. No incision is required. The procedure is done under sedation and the patient generally goes home the following day. Whereas lung reduction surgery was only suitable for people with localised lung damage, the coils are suitable where lung damage is more widespread, so more patients can be treated. They are however most effective in patients with hyperinflation where damage to the air sacs has enlarged the lungs so that pressure on the chest cavity hampers normal breathing. The PneumRx-manufactured shape-memory alloy coils are straightened for insertion and then regain their original shape. They create tension in the airways
having a hyperinflation of 200 per cent or more compared to normal. Many patients report improved quality of life. Alzetani says: “Some of my patients have been able to stop using oxygen, can walk rather than using a wheelchair or can exercise more.”
Mr Aiman Alzetani Consultant Thoracic Surgeon, University Hospital Southampton
which reduces air-trapping and hyperinflation, and help keep the airways open. Success story Around 5,000 patients have been treated with the coils worldwide and studies have shown that they are most effective for patients
Building momentum There are centres already doing this procedure within the NHS such as Preston, Bristol, Birmingham and ourselves, 3-4 centres will additionally be operating before the end of 2016. Studies are continuing, and a patient register has been established to collect data to ensure the treatment targets those most likely to benefit.
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COPD: the disease that too often goes undetected Breathlessness or a ‘smokers cough’ could be signs of chronic obstructive pulmonary disease (COPD). Prompt diagnosis could save you from the worst effects By Linda Whitney
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round 1.2 million people in the UK have been diagnosed with COPD, a combination of chronic bronchitis and emphysema, and many more are unaware they have it. This is a concern, as left untreated, the condition worsens. COPD is a largely preventable disease. The most common cause is smoking, but it can also be a result of inhaling smoke from other sources such as cooking and heating, industrial fumes and pollution. People with COPD are prone to exacerbations when the symptoms worsen, perhaps from a viral infection, high pollution levels or sudden cold weather. These can be very frightening for patients and are one of the biggest causes of hospital admissions. “Newly-diagnosed patients often describe symptoms going back 10 to 15 years, but assumed that breathlessness was just a sign of ageing and their cough was just a ‘smokers cough’, not a sign of a serious
lung condition”, says Dr Nicholas Hopkinson, clinical lead for COPD at Royal Brompton Hospital and reader in respiratory medicine at Imperial College London. “People with symptoms of cough, sputum and breathlessness, especially if they have a history of smoking should have a simple test to check their lung function.” Untreated, COPD gets worse. This can also increase the risk of getting multiple long term medical conditions. “The breathlessness brought on by COPD can mean people stop exercising, so they become more prone to other medical problems like high blood pressure, heart disease, obesity and diabetes,” says Hopkinson. Patients are helped to identify the cause, recognise the symptoms, and work out preventive strategies, such as stopping smoking and exercising more – which is proven to help. Pulmonary rehabilitation, which combines aerobic exercises and
Dr Nicholas Hopkinson Clinical lead for COPD at Royal Brompton Hospital and reader in respiratory medicine, Imperial College London
strength training, alongside other patients, guided by a physiotherapist is a key treatment. “Rehabilitation reverses the loss of fitness. Patients make themselves breathless, in a safe environment, making them more confident about exercising,” says Hopkinson. “A key message is that it’s not dangerous to make yourself breathless”. Patients also learn more about
their condition and how to manage it, and are taught relaxation techniques. “Pulmonary rehabilitation is one of the most effective and high value treatments for COPD” says Hopkinson. He also recommends the Breathe Easy groups run by the British Lung Foundation. People with COPD are commonly prescribed inhalers to open up their airways or reduce inflammation and the risk of chest infections. “It’s important that patients learn to use their inhalers properly to get the most benefit,” says Hopkinson. In serious cases, where damage is limited to certain areas of the lung, surgical treatment to remove the most damaged parts can be very effective, but it is only suitable for a small proportion of patients. “A newer approach we have been investigating, placing valves to block off the worst areas of lung, shows promise and may become available on the NHS within the next few years, as studies have shown significant benefits.”
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Paula Radcliffe: the champion athlete with asthma By Linda Whitney
Paula Radcliffe is the fastest female marathon runner ever – and she has asthma.
Paula Radcliffe Champion athlete
“I started blacking out in training at 14 and was diagnosed with exercised-induced asthma [EIA]. An attack reduces your lung capacity which affects your performance unless it’s treated and controlled,” says Paula. “Some people with asthma are afraid that taking part in sport could damage their lungs but exercise makes your lungs bigger, stronger and better able to cope,” she says. Like Paula many top athletes have EIA.
She controls the condition by forward thinking and inhalers. “I use a preventer inhaler morning and night and a blue ventolin inhaler if I’m likely to be faced with my triggers - pollution, extreme temperatures, cigarette smoke, some pollens and oil seed rape.” Paula advises: “Don’t be afraid of asthma. You can control it. If you have asthma of any kind, get the best support to control it. Kept under control my asthma has not held me back at all.” And she has the records to prove it.
Pulmonary hypertension: Sue’s remarkable journey By Linda Whitney
At 32, Sue Townsley was diagnosed with pulmonary hypertension – an incurable disease with a poor prognosis. Medical advances and determination have helped her reach 49.
Sue Townsley Patient and PHA UK (The Pulmonary Hypertension Association) Trustee
“When I learnt I had pulmonary hypertension at 32 I was told my only hope was a heart and lung transplant,” says Sue Townsley, from Coventry. In pulmonary hypertension the walls of the arteries supplying the lungs thicken and stiffen or are blocked by blood clots causing breathlessness, fatigue, blackouts and heart disease. Life expectancy is around seven years.
“Just getting off a chair left me breathless but I refused to accept that I would not see my children grow up,” says Sue. Sue was treated with Warfarin while awaiting a transplant, but got on to a trial that involved taking the vasodilator Iloprost as an inhaled vapour. “I could go back to parttime work,” she says. After five years she started on Sildenafil too. Finally exhaustion forced her to leave and she started taking Iloprost intravenously. “Now I can do housework and cook – slowly,” she says. “In the 17 years since I was diagnosed PH treatment options have grown. I thought I was doomed. Now I look forward to my 50th birthday.”
This editorial has been supported with funding from Actelion Pharmaceuticals UK who had no input to the content
DRIVEN BY THE NEEDS OF PATIENTS. Actelion cares about rare diseases. We believe that by working together with healthcare professionals and patient organisations we can transform patients’ lives by redefining what is possible and delivering against unmet medical needs. ACTELION PHARMACEUTICALS UK LTD Chiswick Tower 13th Floor . 389 Chiswick High Road . London W4 4AL UK Phone +44 (0) 208 987 3333 . Fax +44 (0) 208 987 3322 . www.actelion.co.uk Date of preparation: Nov 2016; NOP 16/0260
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Professor Guy Joos President, European Respiratory Society Dan Smyth Chair, European Lung Foundation
Turning the tide on the burden of lung disease
L
ung disease is one of the world’s biggest health concerns. The impact remains as large today as it was at the turn of the century and is likely to remain so for several decades. Funding and support for lung disease is often lacking as smoking if often viewed as the cause of all lung disease. However, there are many more risk factors and, recently, a global spotlight has been put on the lung health implications of both poor air quality and physical inactivity, and how addressing this can help maintain healthy lungs for life. Poor air quality, both outdoors and in the home and workplace, is a significant risk factor for lung disease. We all have little control over ambient air quality, but learning more about the quality of air locally and its impact can help people understand how to reduce risks of exposure. Individuals should be aware of the quality of air they are breathing by checking pollution alerts, avoiding busy streets, ensuring homes and offices are well ventilated and being aware of the early symptoms of lung disease so that these can be managed from an early stage. There is also a growing body of evidence supporting the importance of exercise for lung health, both for the population in general, and people living with chronic lung conditions. Regular physical activity has been shown to improve quality of life and fitness in healthy individuals and to reduce the risk of chronic conditions. There is a level of exercise or physical activity that is suitable for everyone and lack of physical activity is known to make breathlessness worse in conditions such as chronic obstructive pulmonary disease (COPD) and asthma. It should be noted that smoking is still a key factor and should be the first action for any person worried about ensuring their lungs remain healthy for their life time. Read more on healthawareness.co.uk
Awareness-raising campaigns on lung disease must be sustained to make a difference
The fight for early diagnosis of lung disease By Lisa Davies
Lung disease inflicts a huge health and economic burden on UK society and the NHS. Yet early diagnosis of conditions such as lung cancer and chronic obstructive pulmonary disease (COPD) could have a huge impact, preventing unnecessary deaths and improving quality of life.
I love my work but something which is always difficult is having to tell someone they have a life-limiting lung condition and knowing that better treatment may have been possible if they had been diagnosed sooner. Early and accurate diagnosis of lung disease is critical to achieving better outcomes for patients. Sadly, research shows that over a third of lung cancer patients are only diagnosed following an emergency hospital admission, by which stage the disease can be too advanced to be cured. The statistics make for grim reading. Alongside heart disease and non-respiratory cancer, lung disease is one of the UK’s three biggest killers, with one person dying every five minutes from a respirato-
Dr Lisa Davies Consultant respiratory physician, Aintree University Hospital and Chair, British Thoracic Society Board
ry condition. Only three European countries – Denmark, Romania and Hungary, have a higher lung disease death rate than the UK. Things are improving gradually, but we must do better and accelerate the pace of change. To really drive things forward, it is vital we have an overall NHS strategy to diagnose and treat lung disease earlier. There have been similar effective initiatives for cancer and diabetes. A respiratory strategy would reap huge health and economic benefits. A centre-piece activity within an early diagnosis strategy must be continued public education. Whilst 1 in 5 have been diagnosed with a lung condition, many people
have never heard of common respiratory diseases such as COPD. Recent national awareness campaigns have been very welcome, but must be sustained to make a real difference. The NHS Health Check, which reviews the health of 40-74 year olds for signs of heart disease and diabetes, should also include a check on lung health. This relatively simple change could achieve a great deal in detecting problems at an early stage. The NHS should also review and recommend the best tools to help GP practices identify those most at risk in order to pick up people with lung disease much earlier. Finally, we must adequately fund and roll out the new national initiative to ensure health professionals who deliver and interpret spirometry (a key breathing test in diagnosing many lung diseases) are appropriately trained and quality assured. We can improve and save lives if we diagnose and treat lung disease earlier. Many other countries do it and we can too. As respiratory specialists, we need to work across the NHS, with our patients and in partnership with Government to tackle the issue head on.