Respiratory Health - Q2 2022

Q2 2022 | A promotional supplement distributed on behalf of Mediaplanet, which takes sole responsibility for its content

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Respiratory Health

More needs to be done to improve access to pulmonary rehabilitation.

The Government needs to put lung health at the heart of its levelling up agenda.

Essie Mac Eyeson, Pulmonary Rehabilitation Policy lead, Taskforce for Lung Health

Sarah Woolnough, CEO, Asthma + Lung UK

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IN THIS ISSUE

“New treatments are urgently needed to ensure that people with CF can look forward to a brighter future.”

David Ramsden Chief Executive, Cystic Fibrosis Trust

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Increasing access to effective drug-free treatments for patients with lung disease Pulmonary rehabilitation is one of the most effective treatments for people with lung disease and more needs to be done to improve access to this vital service.

“We must ensure the most vulnerable in society are not left behind.”

Dr Hans Bruyninckx Executive Director, European Environment Agency

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“COPD remains a poor relation to other conditions for national recognition and prioritisation.”

Kerry Mills Advanced Respiratory Nurse Practitioner - Primary Care, Co Clinical Director Hereford Medical Group PCN and COPD Lead, ARNS

Online

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P

ulmonary rehabilitation (PR) is an exercise and education programme that helps people with lung disease manage their condition, with patients reporting an improvement in symptoms of breathlessness and being able to enjoy a better quality of life.

The programme includes physical exercises, information on looking after your body and lungs, advice on managing symptoms, nutritional information and stop-smoking advice. PR has been shown to be a highly effective treatment option for many people with lung disease.

Increasing access to PR It is therefore no surprise that demand for PR has increased.

Many services were paused during the pandemic with some PR classes cancelled and referrals stalled. Now, as services try to recover, they are having to meet the needs of an additional group of people with long COVID-related breathlessness.

Yet, investment was needed even before the pandemic to ensure better access. In 2019/2020 only 43% of the eligible chronic obstructive pulmonary disease (COPD) population were referred for PR. Barriers to access can include a lack of local availability, long waiting lists, strict eligibility criteria and a general lack of awareness amongst health care professionals and patients about the benefits of this important service.

The Taskforce for Lung Health believes one solution to increase access is a multi-year investment by the NHS into PR and its workforce.

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Increasing access to PR could save the NHS millions of pounds each year and improve the wellbeing of many patients with lung disease across the country.

Savings for the NHS Increasing access to PR could save the NHS millions of pounds each year and improve the wellbeing of many patients with lung disease across the country. If the eligible COPD population alone had access to pulmonary rehabilitation, the NHS could see a reduction of 150,924 GP appointments and 26,634 fewer hospital admissions per year.

As a treatment which can improve outcomes for many people with respiratory disease, ultimately we want everyone who needs PR to get the chance to participate in it.

WRITTEN BY Essie Mac Eyeson Pulmonary Rehabilitation Policy Lead, Taskforce for Lung Health

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If the eligible COPD population alone had access to pulmonary rehabilitation, the NHS could see a reduction of 150,924 GP appointments and 26,634 fewer hospital admissions per year. ~Essie Mac Eyeson, Pulmonary Rehabilitation Policy Lead, Taskforce for Lung Health

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Lifting the limits of cystic fibrosis Cystic fibrosis (CF) is an incurable life-limiting genetic condition affecting more than 10,800 people in the UK. To mark the end of Cystic Fibrosis Awareness Week, it is important to reflect on life with the condition.

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ystic fibrosis is often thought of as a ‘lung disease’ as people with the condition experience a range of respiratory symptoms, however in reality CF affects many parts of the body. One in 25 people carry the faulty gene that causes CF and half of people who die from CF are aged 36 or under.

The condition causes a build-up of thick sticky mucus in the lungs, digestive system and other organs.

This mucus provides the perfect breeding ground for harmful bacteria, making people with CF at high risk of lung infections.

Managing the condition People with CF undergo a rigorous daily regime of treatments to stay healthy, including taking inhaled and

injected drugs to clear mucus and fight infections, taking dozens of pills to digest food and having gruelling physiotherapy morning and night.

People with CF can never meet each other in person due to the risk of passing on harmful bacteria which could make them very ill. For this reason, the condition can be incredibly isolating.

In the last few years, several new drugs have become available for people with CF – most recently, a triple combination therapy, which targets the underlying cause of CF. Since being approved for use in the UK in 2020, this drug has helped many people with CF breathe more easily, slowing down damage to the lungs and bringing the hope of a longer, healthier life.

Looking to the future It is important to remember that drugs like this are not a cure and don’t work for everyone. New treatments are urgently needed to ensure that every person with CF can look forward to a brighter future.

As we mark the end of CF awareness week, the Cystic Fibrosis Trust renews its commitment to funding groundbreaking research, offering support and advocating for those living with the condition. All those with CF deserve to live a life unlimited, we won’t stop until everyone is physically well, mentally well and living a long and fulfilling life.

WRITTEN BY David Ramsden Chief Executive, Cystic Fibrosis Trust

Important factors to consider when choosing a nebuliser Nebulisers are a vital tool for patients with a range of respiratory health conditions.

N INTERVIEW WITH Mal Apter General Manager, UK & Ireland, PARI Medical

WRITTEN BY Mark Nicholls

Paid for by Nebicorum

ebulisers have the ability to rapidly deliver drugs to the lungs and, following NHS clinical guidelines, can help in conditions such as COPD (chronic obstructive pulmonary disease), cystic fibrosis, bronchiectasis and be used for people with excess mucus in their lungs.

However, experts warn that the design and manufacture of the nebuliser has to be of a high standard to deliver the best quality of life for the patient.

Droplet size A nebuliser is an electric device that turns liquid medicine such as saline, bronchodilators and antibiotics into a fine mist (aerosol) that patients can inhale to help their lungs work more efficiently.

With nebuliser therapy, the amount of medication that quickly and directly reaches the lungs is crucial.

Mal Apter, who has worked in the respiratory device sector for several years, emphasises the importance of correct droplet size.

“Droplets need to be less than five microns, or five onethousandths of a millimetre, in diameter to make it down to the central part of the lung to have the clinical benefit that is intended,” he says. That precision, he adds, requires specialist manufacturing knowledge.

Liquid medication Nebulisers are normally powered by an air compressor. The compressed air forces the liquid medication to form into droplets of the right size to be inhaled by patients.

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Apter, who is general manager of medical device distributor PARI Medical in the UK, explains that most nebulisers use mains power, though smaller portable devices can run off batteries.

The majority of inhaled medications are taken by patients at home. While patients will have a prescription for liquid medication, most will have to buy their own nebuliser.

A nebuliser is an electric device that turns liquid medicine such as saline, bronchodilators and antibiotics into a fine mist (aerosol) .

Main considerations Apter says: “The main considerations for a patient when buying a nebuliser are the amount of aerosol being produced that is less than five microns, the time it takes for nebuliser therapy and the ‘respiratory drug delivery rate’, which describes the amount of aerosol being produced per minute.”

A new webshop has been launched at www.nebicorum.co.uk where patients can buy PARI nebulisers. All devices are made in Germany and go through rigorous user focus group and product testing.

“It is about making sure patients have a device that is convenient, easy to live with and optimises the delivery of the drug so that they have the best quality of life,” adds Apter.

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Creating a healthy and dust-free working environment

ag ep ro vid ed by s Fe to ol

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

Employees expect to be able to operate in a safe and healthy environment when they go to work. Safety equipment is vital to ensure all employees are safe at work.

D WRITTEN BY Andrea Duca National Sales Manager, Festool UK

Paid for by Festool

ust is a common hazard, and depending on the cause of the dust, the air can range from mildly irritating to toxic and dangerous to health in some working environments. Having dust masks and protective glasses can offer some 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” within smaller firms, where there tends to be higher risk of work-related accidents and illnesses.

Dust extraction Rolf Stelzie, who owns a painting company 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.

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

“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. He is looking for ways the company can help improve the health, safety and cleanliness of painters and decorators work to the best standards possible.

Festool provide a range of high-quality dust extractors, with the new range of cordless dust extractors offering more flexibility and mobility around building sites with equipment designed to work alongside power tools.

Festool emphasises on the importance of choosing a dust extractor that is appropriate for the material being worked on and ensuring that it is operating correctly. For example 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 accidents and reduces staff sickness because of injury.

Air pollution remains a problem, but it doesn’t have to be this way A vast majority of people living in European cities continue to be exposed to unsafe levels of air pollution, leaving many exposed to developing a number of health ailments that lead to premature death.

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e are currently facing a number of challenges including a rebound in transport, aviation and industry emissions after the COVID-19 lockdowns as well as the possible increased use of more polluting fuels like coal or wood due to the energy crisis and war in Ukraine. However, we cannot afford to lower our ambitions or slow down our efforts to cut air pollution.

Delayed action is very likely to result in higher social and health costs in the long run. Despite reductions in emissions over past years, most of the European Union’s urban population (96%) was exposed to levels of key air

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pollutants that are damaging to health.

Breaches of European air quality standards remain common across the EU, according to our most recent European Environment Agency analyses.

Cleaner air is possible Progress in climate and environment efforts can result in concrete gains.

For example, cleaner air helped save hundreds of thousands of lives in Europe. The implementation of EU, national and local policies and measures across Europe has led to reduction in emissions of all air pollutants, which in turn has led to a reduction of the population’s exposure

to health impacts.

In 2019, air pollution continued to drive a significant burden of premature death and disease in Europe. In the EU, 307,000 premature deaths were linked to exposure to fine particulate matter in 2019, a decrease of 33% on 2005.

Delivering clean and safe air for Europe will require additional reductions in emissions by national and local authorities and linking clean air with economic recovery. We must also ensure the most vulnerable in society are not left behind.

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WRITTEN BY Dr Hans Bruyninckx Executive Director, European Environment Agency

Reducing premature deaths Under the European Green Deal’s Zero Pollution Action Plan, the European Commission set the 2030 goal of reducing the number of premature deaths caused by fine particulate matter by at least 55% compared with 2005 levels.

The Commission has also started a revision of the ambient air quality directives, aiming, among other things, to align the air quality standards more closely with WHO recommendations.

In parallel, stricter requirements are also foreseen to tackle air pollution at source, such as pollution from agriculture, industry, transport, buildings and energy supply.

With such action we can make the threat posed by air pollution to our health a much lower one in the decades ahead.

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The importance of establishing good inhaler technique Many respiratory conditions such as asthma or chronic obstructive pulmonary disease require inhaled therapy.

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nhalers are convenient and enable the medicine to be delivered exactly where it needs to go. But research suggests that up to 90% of people don’t use their inhalers correctly.

This can be due to a number of factors such as the design of the inhaler, how well the patient is able to physically handle the inhaler and whether they are able to coordinate inhaling at the same time as operating the inhaler.

Good inhaler technique is vital to ensure that as much of the medicine as possible is delivered to the lungs. Less than optimal technique can lead to poor disease control and quality of life, increased potential for side effects, more hospital admissions and increased costs of healthcare treatment.

Different inhalers require different techniques There are many types of inhalers available.

These mainly fall into two categories: aerosol metered dose inhalers (MDI) or dry powder inhalers (DPI). The technique required varies for different devices.

MDIs are commonly prescribed and they require slow, steady inhalation. But many patients aren’t taught how to use the device properly, or they struggle to use it (although this is improved by using a spacer device). This means that the medicine can’t reach where it needs to work and is therefore ineffective.

Conversely, DPIs require a fast, deep inhalation. They also don’t contain propellant gases (which contribute to global warming) and may be a more suitable option. However, it is important to discuss with the patient and prescribe the device which is most suitable.

Training from healthcare professionals Patients may not have been instructed on correct inhaler use or, despite this, may still be unable to use them. Almost everyone can learn good technique with adequate training and practice. Training from healthcare professionals (HCPs) should be repeated regularly to ensure that the patient continues to use the inhaler correctly in order to remain well.

Support and resources are available to help with this. Technique can be checked by asking the patient to demonstrate at treatment initiation and as part of their regular review.

WRITTEN BY

Ravijyot Saggu Chair, UK Clinical Pharmacy Association Respiratory Committee Clinical pharmacist, University College London Hospital NHS Foundation Trust

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Levelling up the nation’s dismal lung health for lasting change It’s no exaggeration to describe the UK’s record on lung health as shameful. There has never been a better time to give respiratory health the investment and attention it deserves.

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he UK has the worst death rate for lung conditions such as asthma and chronic obstructive pulmonary disease (COPD) in western Europe. Lung disease is the third biggest killer in the UK, and the numbers of people admitted to hospital for lung conditions in England and Wales have doubled in the past two decades.

Prioritising lung health While these figures are shocking, they stand to get worse unless the Government puts lung health at the heart of its levelling up agenda and gives respiratory research, care and disease prevention the boost it so desperately needs.

The lack of research investment is hindering the creation of more effective diagnostic tests and treatments for lung disease. Though more than 12 million people in the UK will get a lung condition during their lifetime, only 2% of public spend on medical research is on lung conditions. We think this is an injustice.

Lack of basic care Even before COVID-19 hit and shined a light on how terrifying it can be when things go wrong with our lungs, life for the millions of people living with chronic lung disease was getting harder. Many people with asthma and COPD weren’t getting basic care from their GP, nurse or other healthcare professional.

Over the past two years, many people have watched their health deteriorate while they wait for care and diagnosis rates for conditions like COPD have plummeted.

The Government has made clear its intentions to ‘level up’ the country and tackling the huge health inequalities caused by poor lung health is the perfect place to start. Currently, people in the poorest neighbourhoods are seven times more likely to die of

a lung condition than those in the richest. This could be because they are more likely to be more exposed to air pollution, which is linked to 36,000 premature deaths each year, as well as live in poor-quality housing and be exposed to cigarette smoke.

Though more than 12 million people in the UK will get a lung condition during their lifetime, only 2% of public spend on medical research is on lung conditions.

Creating meaningful change We don’t want ‘levelling up’ to become a catch-all phrase – it needs to deliver meaningful change by focusing on the key drivers of health inequality.

We are urging government to triple funding for respiratory research to identify new ways of diagnosing and treating people with lung conditions, tackle air pollution and ensure better diagnosis and care for everyone with a lung condition.

WRITTEN BY Sarah Woolnough CEO, Asthma + Lung UK

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Supporting patients and HCPs with new digital technology Chronic respiratory diseases present a huge burden on society but advancing technology can help patients to better manage their condition with the help of their healthcare professionals.

C WRITTEN BY Marcus Bates Vice President of Digital Healthcare Business Development, Aptar Pharma

Paid for by Aptar Pharma

hronic respiratory diseases (CRD) such as asthma or chronic obstructive pulmonary disease (COPD) impact over half a billion people globally, with COPD alone accounting for 3.2 million deaths worldwide in 2019. In the UK, the total annual cost of managing respiratory conditions is £11 billion, of which almost £5 billion relates to COPD and asthma.

Driven by harmful environmental, occupational and behavioural exposures, these numbers will continue to increase if measures to improve respiratory health are not implemented. In parallel, giving patients and care teams tools to better control disease and disease progression is paramount to reducing the CRD impact on quality of life, and improving clinical and medico-economic outcomes.

Despite the availability of inexpensive inhaled therapeutics for CRD, poor disease control is currently commonplace, notably for asthma.

With this in mind, Aptar Pharma has launched HeroTracker® Sense, a novel smart device that transforms a standard metered dose inhaler into a smart connected healthcare device. The device provides feedback to help patients use medications as intended by prescribing healthcare providers (HCPs). By supporting inhalation technique and adherence, it can improve disease control and patient outcomes.

Empowering patients HeroTracker® Sense is a patient-centric product that aligns trusted inhalers with modern lifestyles. It utilises sensors to support the coordination of inspiration with actuation, and to monitor flow rate and inhalation duration. The BreatheSmart® mobile app stores this data and also features date and time stamps to indicate when the patient should take their medication, environmental monitoring alerts on temperature and humidity issues.

Facilitate care delivery This kind of technology is an innovation with parallel potential to reduce the burden that CRD imposes on HCPs and nurse practitioners. By providing valuable analytics, the device delivers insights into patient training, onboarding and performance. Teams can also better understand real-life situations and use and adapt treatment plans accordingly.

Build the future of care Via systematic acquisitions and partnerships, the company is now working towards solutions for end-to-end integrated healthcare that efficiently combine therapies, drug delivery devices and digital services.

As summarised by Marcus Bates, Vice President of Digital Healthcare Business Development at Aptar Pharma: “Our ultimate goal is to leverage digital solutions to give patients more control over their disease and to cost-efficiently improve health outcomes.”

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HeroTracker® Sense – A Smart Healthcare Solution for Digital Respiratory Medicine Designed for patients, Aptar Pharma’s HeroTracker® Sense is a digital health solution that transforms a metered dose inhaler (pMDI) into a connected healthcare device. HeroTracker® Sense helps improve patient compliance and adherence. The insights from the healthcare analytics, collected by the smart sensors, can help doctors and healthcare providers offer improved care for their patients.

Part of the digital health portfolio from Aptar Pharma.

For more information visit: https://www.aptar.com/pharmaceutical/digital-healthcare-solutions/

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How efficient lung disease diagnosis can help improve treatment Taking this innovative technology to market, Dr Moschos has worked with Northumbria’s IP Commercialisation team to launch the medtech spinout company PulmoBioMed Ltd. The process of taking the technology from academic research to a spinout company was facilitated with support from the Innovate UK NxNW ICURe program and Northern Accelerator, a collaboration between Northumbria, Durham, Newcastle, Sunderland and Teesside Universities to commercialise research and boost the region’s economy.

Dr Sterghios Moschos (right) pictured with design engineer Saqib Ali working on PulmoBioMed’s innovative breath collecting device, PBM-Hale™.

Leading scientists are developing pioneering solutions to help diagnose those with respiratory disease and reduce the costs of treating and rehabilitating sufferers.

S INTERVIEW WITH Dr Sterghios Moschos Associate Professor, Department of Applied Sciences

INTERVIEW WITH Professor Ioannis Vogiatzis Professor of Rehabilitation Sciences, Department of Sport, Exercise and Rehabilitation

WRITTEN BY Sheree Hanna

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ince the start of the COVID-19 pandemic, respiratory diseases have gained increased focus, highlighting the importance of early diagnosis, correct treatment and patient rehabilitation.

Northumbria University is undertaking ground-breaking work for patients with a variety of lung diseases, including chronic obstructive pulmonary disease (COPD) and asthma.

Diagnosing lung conditions from breath Dr Sterghios Moschos, Associate Professor, Department of Applied Sciences and his team have developed a device to collect a breath sample which can then be analysed for disease.

It has been used during the pandemic to understand how the COVID virus transmits and he hopes soon to be able to share the understanding and knowledge gained from this work.

However, the non-invasive device is also set to play an instrumental role in the diagnosis of lung conditions, particularly in the over 65s and young children.

A third of all children under the age

of three will present to GPs and A&E at some point with a wheeze. They use up 75% of all childhood NHS appointments, a total of 217,000 visits per year.

Before the pandemic, more than 120,000 patients over the age of 65 were admitted to UK hospitals with a respiratory condition every year and were likely treated with antibiotics and steroids without confirming the cause of infection, with the hope this would resolve the problem.

Correct treatment and management Moschos says: “Our innovation can sample breath exclusively from the deep lung, entirely non-invasively and without anaesthesia to detect bacteria, viruses and fungi, as well as materials from the body that could be tell-tale signs of other diseases, like lung cancers and lung fibrosis.

“It will provide an effective diagnosis giving doctors specific, effective treatment options; if you have patients not coming back with recurring problems or unresolved disease, then the cost to the NHS could be massively reduced.”

Paid for by Northumbria University

Providing the right exercise programme Professor Ioannis Vogiatzis, Professor of Rehabilitation Sciences, Department of Sport, Exercise and Rehabilitation brings his 25 years of expertise in rehabilitation innovations mostly for COPD but has also worked with people who have cystic fibrosis, asthma and pulmonary hypertension.

Interval or intermittent exercise – a style of training which prescribes very short, intense, bursts of exercise followed by the same amount of rest before repeating – has grown in popularity with elite athletes worldwide. Professor Vogiatzis used this approach to devise an adapted exercise routine for people with lung disease.

“My work has informed the American, European and British Thoracic Societies’ pulmonary rehabilitation guidelines and has proven to work well with those who suffer from lung diseases. For those who are already breathless, doing long continuous exercise activity is not helpful,” Vogiatzis explains.

“There is good evidence now that this type of exercising works well for COPD and other lung disease sufferers.”

His exercise programme is now delivered by physiotherapists in hospital and community-based rehabilitation centres across the UK and around the world.

He concludes: “Patients who undertake this kind of programme may have a higher quality of life and are less anxious or depressed. They require fewer GP visits, less medication and hospital admissions decrease.”

Northumbria University has recently gained reinforcement of its already outstanding reputation for excellence in research, having been ranked 8th in the UK for research power for professions allied to health, such as biomedical science, in the latest Research Excellence Framework (REF2021).

Find out more at northumbria. ac.uk/research

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