Respiratory Health - Q2 2020

Q2 / 2020 A PROMOTIONAL SUPPLEMENT BY MEDIAPLANET WHO TAKE SOLE RESPONSIBILITY FOR ITS CONTENTS

Respiratory Health

Full campaign on www.healthawareness.co.uk

Dr Andy Whittamore Clinical Lead, British Lung Foundation How technology has helped us manage respiratory conditions in times of crisis.

Page 2 Joe Farrington-Douglas Head of Policy and External Affairs, Asthma UK “Asthma affects 5.4 million people in the UK and the number of people dying from the condition is at the highest level this century.”

Page 6 Larissa Lockwood Head of Health and Air Quality, Global Action Plan Lockdown has helped us to reflect on the importance of clean air more than ever.

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IN THIS ISSUE

04 Kings College London Breathlessness – when to seek help

10 Mums for Lungs The importance of protecting the most vulnerable from air pollution through school streets

Online Allergy UK How indoor allergens are impacting your quality of life Project Manager: Alice Golding Email: alice.golding@ mediaplanet.com Business Development Manager: Kirsty Elliott Content and Production Manager: Kate Jarvis Managing Director: Alex Williams Head of Business Development: Ellie McGregor Digital Manager: Jenny Hyndman Designer: Thomas Kent Content and Social Editor: Harvey O’Donnell Paid Media Strategist: Ella Wiseman Mediaplanet contact information: Phone: +44 (0) 203 642 0737 E-mail: uk.info@mediaplanet.com All images supplied by Gettyimages, unless otherwise specified

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Technology has helped us to cope in times of crisis I’ve heard many people say that we are lucky COVID-19 didn’t happen 10 years ago.

And they are right; technology has been a cornerstone for how many of us have coped throughout this crisis.

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hile my own GP practice in Portsmouth had already been quick to embrace the online healthcare revolution, the outbreak of COVID-19 has forced us to move forward with our digital agenda at rapid pace.

Virtual consultations have helped healthcare services to adapt We’ve had to rethink how to best serve our patients, many of whom we might not be able to see because they are shielding, or in order to protect our staff.

Being able to support people with respiratory conditions is of particular importance, given that they need rapid assessment of their symptoms.

Digital consultations - telephone, video and email - have been key to connecting with respiratory patients and managing their conditions, without the need to come into the GP surgery.

Prioritising patients who are most at risk We prioritise the need for routine checks using data on patients’ prescriptions for reliever inhalers and oral steroids and engaging with the most at-risk patients and symptomatic patients.

These are markers suggesting poor disease control in asthma and COPD. We arrange for a phone call with that patient to assess their condition and can convert that to video consultation if required.

Attitudes are changing to remote management of lung conditions Before the crisis, no video consultations were carried out at my surgery because of lack of demand, but now around 90% of our appointments are done remotely,

including 10% by video.

A recent study by the British Lung Foundation (BLF) found that 77.9% of people with lung conditions would be happy to have their care managed remotely, proving that attitudes are changing.

Being able to attend an appointment without going to your GP surgery saves taking half a day off work, which is important for many patients who need to decide whether to prioritise their health (when they are relatively stable) over employment or school.

Remote consultation is also a bridge to patients who find it difficult to get to their GP surgery.

Addressing the hesitancy around digital technology in healthcare Some of our team were initially sceptical about how they would be able to deliver the best possible healthcare to patients without having them in the room, but have since found it to be a useful tool and can even check inhaler techniques.

A few days ago, one of the nurses ran out of her room and exclaimed that she had just done a video consultation with an elderly patient and it had been “brilliant”. The patient had not only been able to demonstrate inhaler usage clearly but had surprised herself

WRITTEN BY

Dr Andy Whittamore GP in Portsmouth and Clinical Lead, British Lung Foundation and Asthma UK

by being able to use our video calling platform with ease.

The experience has taught me never to make assumptions about different age groups’ abilities to use technology.

I’ve found that many older patients with chronic lung disease already have the technology to hand and there are some younger patients who ‘don’t do’ digital.

Face-to-face consultations are still there for those who need them Of course, some things cannot be done routinely by remote consultation, for example, a breathing test known as spirometry. But there are other digital tools that can improve respiratory patients’ general care.

Use of regular online questionnaires allow healthcare professionals to track patients’ symptoms, while resources like the newly launched BLF tech hub point people to apps that can help them manage their condition themselves.

Asthma UK, where I am also a clinical lead, has just published a report called Digital Asthma: Re-Imagining Primary Care, which highlights how the NHS can better use data to transform asthma management.

While we’ve had the technology for years, it’s taken a crisis to bring down some of the barriers and bring its use into the mainstream.

Moving forward, we must continue to embrace the changes, not to replace, but to enhance our systems of care for better outcomes and better experience.

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Online clinics and at-home treatments are supporting patients with COPD and asthma Times of emergency often breed innovation and adaptation of new technologies. COVID-19 has put enormous strain on health services across the globe. Here in the UK, the NHS has had to make use of new technology and treatments to help patients with respiratory conditions stay away from hospitals and remain in the safety of their own homes.

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ne in five people in the UK develop asthma or COPD (chronic obstructive pulmonary disease) at some stage in their lives, with half of those people requiring regular treatment or medication.1 The crisis has had differing impacts on those living with respiratory conditions, explains Dr Andrea Lever, GSK’s Head of Medical Payer Strategy and Solutions.

This article is sponsored

by GSK

Higher risk patients are asked to shield but they then lose access to face-to-face care “Respiratory patients with COPD and severe asthma have been asked to shield during the outbreak. That obviously sees them protected but also creates barriers to them receiving care and, for some, receiving medicine.

Then there are other respiratory patients who are missing out on their reviews – potentially impacting on the quality of their care long-term.”

The British Medical Association has stated that routine respiratory reviews should continue in cases where patients are having more ‘exacerbations’ – where their condition worsens significantly due to a flare up, sometimes resulting in hospitalisation.

But COVID-19 has made keeping up with demand a far taller task as patients are advised to stay home, and not go into GP practices for their face-to-face consultations. In addition, NICE and professional bodies have advised against non-urgent testing.

Healthcare professionals have had to adapt to what Dr Lever called “a unique situation” – trying to ensure patients are supported safely while also protecting their own safety and ability to remain at work.

Online clinics are replacing face-to-face reviews Virtual consultations and clinics have started to become commonplace to keep patients connected to care, while minimising risk. This is something that’s required a significant change to how HCPs deliver care, according to GSK’s Country Medical Director (UK & Ireland), Dr Karen Mullen.

“The technology already exists for virtual solutions, but it hadn’t been used on the scale nor brought in at the speed that it is now. Having the right skills, to ask the right questions, and have the right dialogue with patients is key to its success and it requires HCPs to have confidence in those skills.”

Prior to the pandemic, 35 centres in the UK offered a homecare service, but that figure has now almost doubled as HCPs strive to meet patients’ needs in the current climate.

Innovative solutions bringing treatment to the patient Patients – and their caregivers – using medicines in the comfort of their own home is another innovation to help patients continue to isolate.

Some patients with severe asthma would usually visit a specialist clinic in hospital for their treatment to be administered, following a GP referral.

These patients incur an obvious risk by attending hospitals where people are being treated for the very virus they are meant to be shielding from.

Prior to the pandemic, 35 centres in the UK offered a homecare service, but

that figure has now almost doubled as HCPs strive to meet patients’ needs in the current climate.

Helping patients and the NHS Organisations, like GSK, are helping to alleviate the strain on GP surgeries and the NHS. The use of homecare is supporting shielding patients, helping them to access the care and medication they need most in a safe environment.

They are also funding pharmacist-led patient review services and equipping HCPs with training to increase their confidence in conducting virtual clinics.2 GSK recently hosted two webinars on virtual clinics. The content covered key areas specific to respiratory reviews, including how to effectively conduct inhaler technique reviews and support patients with inhaler technique training in a remote setting.

At the beginning and end of each webinar, a poll asked “From one to five, how confident do you feel in being able to run a high quality remote respiratory consultation?” On average, there was an increase of 44% from the baseline, which demonstrates real value in providing specialist support.

Dr Mullen concluded: “We have expertise in respiratory management, and we want to use that to support HCPs, the NHS and patient organisations, so they can feel confident in providing the best remote support to patients. It’s a time for us all to work together, for the longterm benefits of our patients and our healthcare system.”

Written by: James Alder

INTERVIEW WITH

Dr Karen Mullen VP, Country Medical Director, UK & Ireland, GSK

INTERVIEW WITH

Dr Andrea Lever Head of Medical Payer Strategy and Solutions, GSK

References 1 British Lung Foundation: https://statistics.blf.org. uk/lung-disease-uk-bigpicture#numbers-livinguk [as of 8 June 2020] 2 The webinar content is available here https:// offyourchest.gsk.com/ webinar-ondemand

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Breathlessness – when to seek help Public Health England advice to “Stay Alert” during the current coronavirus pandemic has heightened the nation’s vigilance for symptoms of respiratory disease. Together with fever and cough, breathlessness is one of the most feared symptoms today as the number of deaths from SARS-CoV2 infection continues to increase worldwide.

Dr Caroline Jolley Senior Lecturer in Human Physiology, Faculty of Life Sciences & Medicine, King’s College London Honorary Consultant in Respiratory Medicine, King’s College Hospital

Professor Surinder Birring Professor of Respiratory Medicine, King’s College Hospital

For most people, getting out of breath from time to time is completely normal Breathlessness, like pain, is a warning that the body’s state of internal balance, or “homeostasis”, is under threat.

Imagine running for a bus. The extra muscle activity demands more oxygen and releases waste products (carbon dioxide and lactic acid) that need to be eliminated. The diaphragm and other respiratory muscles need to work harder to pump more air in and out of the lungs. Once the brain becomes aware that we are needing to breathe more than usual, we feel short of breath, but that breathlessness should subside within a few of minutes of stopping.

Indeed, there are few sensations more terrifying than not being able to breathe.

So if breathlessness can be ‘normal’, when should I worry?

Difficulty with breathing that persists and increases over weeks to months, often termed ‘chronic breathlessness’, can be attributable to a number of important long-term health conditions.

These include lung diseases such as asthma, chronic obstructive pulmonary disease (COPD) and pulmonary fibrosis (lung scarring), but also non-respiratory conditions such as heart failure, obesity, anaemia, and cancer.

Breathlessness is also a common symptom of anxiety, and many people experience a vicious cycle of breathlessness and panic that can be difficult to break. Lifestyle is important.

Cough and breathlessness are more common in smokers even in the absence of smoking-related heart and lung disease.

Exercise improves physical fitness and cardiovascular function, and exercise, along with weight loss, may decrease any contribution to shortness of breath by muscle deconditioning.

New or rapidly increasing breathlessness associated with high temperature, a new, continuous cough, or a loss or change to your sense of smell or taste, is highly suggestive of COVID-19 pneumonia in the context of the current SARS-CoV2 pandemic.

This should prompt urgent medical advice in accordance with current NHS guidance. Please do remember, however, that there are other common respiratory infections, such as bacterial pneumonia, which are potentially serious if left untreated, but readily treatable if diagnosed promptly.

When to seek medical attention Seek medical attention if breathlessness is new, more difficult to control, or is occurring every day at rest or with minimal physical exertion. This is especially important if there are other red flag symptoms such as coughing up blood or chest pain.

Despite the impact that breathlessness has on their daily lives, people often compensate for their breathlessness and normalise it by reducing their physical activity. This can delay reporting their breathlessness to their GP, and thus delay examination, investigation, diagnosis and treatment.

There is good evidence that earlier diagnosis of chronic lung disorders such as COPD can reduce breathlessness and improve quality of life and prognosis.

Lung cancer can be cured completely if diagnosed at an early stage. The initial investigation by the doctor may involve an X-ray of the chest, breathing tests and blood tests.

Don’t delay getting help if you are concerned about new or persistent breathlessness.

However, if breathlessness is the only symptom, without a cough or fever, something other than SARS-CoV2 is likely to be the problem, and it is important to seek medical advice. The key message remains the same: “If you get out of breath doing things you used to be able to do, tell your doctor.” www.nhs.uk/be-clear-on-cancer/symptoms/ out-of-breath © R O L L I N G CA M ER A

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reathlessness, known medically as ‘dyspnoea’, is a common and distressing symptom, often described by patients as ‘difficulty breathing’, ‘chest tightness’, ‘shortness of breath’ or ‘a feeling of suffocation’. Indeed, there are few sensations more terrifying than not being able to breathe.

Breathlessness is one of the most common reasons that patients visit hospital accident and emergency departments but it can also develop gradually and persist, affecting about 10% of the general population.

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This article is sponsored by Breas Medical

Supporting NHS education with online training The COVID-19 outbreak sadly brought the entire world to a standstill, leading to loss of lives and an unprecedented economic recession. Mechanical ventilators can be key to a patient’s recovery.

WRITTEN BY

Raffi Stepanian CEO, Breas Medical

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he government has called upon established manufacturers to build ventilators to support the NHS demand during COVID-19.

Ventilators have been, and will continue to be, distributed centrally by the UK government to the areas of the country that need them most.

Meeting the government’s ‘Ventilator Challenge UK’ Breas, for their part have increased output to supply the NIPPY 4+ and Vivo 65 devices as part of ‘Ventilator Challenge UK’.

Furthermore, there is a drive to find new solutions to shortages of other key items, such as the breathing circuit components and masks, which are required to go with the ventilators.

However, bringing large volumes of newly available equipment into any healthcare system does not come without its challenges, and medical device training is in demand.

Now, in a world of social distancing, people must find new ways of meeting training requirements head on.

Training medical staff online to meet staff shortages Staff shortages were already a big challenge during the UK’s first wave

of COVID-19, with the government requesting retirees to return to the frontline, and also hoping to upskill nursing staff from non-respiratory specialities who will need training to deliver the best possible care.

Digital resources can equip all types of healthcare professionals with the techniques and training to fully understand ventilation, airway clearance, and respiratory care application, monitoring and management.

The Ventilator Training Alliance mobile application is one such example. Here, Breas have collaborated with many other suppliers globally, to help create an excellent base of resources on a whole range of equipment, not just the NIPPY 4+ and the Vivo 65.

Online training needs careful planning for optimum engagement But training resources need to inspire trainees to think differently. Interviews with leading physicians in respiratory management, and technology-led articles, white papers, peer-to-peer discussions and workshops, are a great way to build interactions and engagement.

This is exactly the type of content that has been developed and shared

on the Education by Breas website, an exciting new initiative which was launched in 2019.

Set up before the COVID-19 crisis, this website has now become a popular hub for a wealth of free information at this time, and not just for users of Breas equipment.

While some product information makes up a part of the website, sections around COVID-19, ventilation, airway clearance and patient monitoring are aimed at challenging current thinking and practice.

This level of training support can help medical staff upskill – and at pace – in order to help more COVID-19 patients overcome this tragic, global pandemic.

In the meantime, we must continually ask, can we do better by the ventilated patients from all walks of life, not just those that are presenting during these difficult times in a global pandemic?

Patients requiring long-term home ventilation are the ones whom Breas have aimed to support since their inception. Improving the quality of these lives in any and every way possible will remain firmly at the forefront of their focus, not just in the present, but beyond the pandemic, and long into the future.

Breas Medical are a respiratory company who design and manufacture ventilation and airway clearance products. They strive to deliver unique therapy solutions, that keep both the patient’s and the clinicians’ needs at the focus. They have collaborated closely with the UK government’s needs to supply large numbers of the NIPPY 4+ and Vivo 65 ventilators to the NHS. Read more at educationbybreas.com

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5.4 million

Asthma affects 5.4 million people in the UK and the number of people dying from the condition is at the highest level this century.

Can your income make your asthma worse?

COVID-19 has left deep scars on the poorest parts of our society. The high death rates in the most deprived areas of the country highlight the need for urgent action to address health inequalities.1

U WRITTEN BY

Joe Farrington-Douglas Head of Policy and External Affairs, Asthma UK

nfortunately, COVID-19 is not the only respiratory condition where your wealth makes a difference to your health.

Asthma affects 5.4 million people in the UK and the number of people dying from the condition is at the highest level this century.2 Anyone from any walk of life can have asthma but those on lower incomes are more likely to suffer the worst effects of the condition.

Asthma is often worse and more frequent in lower income homes Asthma UK recently released a report called 'The Great Asthma Divide', which revealed that poorer people were more likely to have uncontrolled asthma, resulting in life-threatening asthma attacks.

A 2019 study found 47% of people, with an annual household income of under £20,000, had suffered more than two asthma attacks in the past 12 months. This was almost double that of households with an income of more than £70,000.3 Our report revealed that the quality of care people on low incomes receive is less than those on higher incomes.

Asthma patients on lower incomes are less likely to be asked about their symptoms in an annual asthma review,

their inhaler usage is not assessed and their adherence to their preventer inhaler is not discussed as often.4 An annual review is paramount to preventing asthma attacks and, if key parts are missed out, this leads to people with asthma suffering unnecessarily.

Campaigning to remove asthma prescription costs We know that costs like prescription charges also fuel health inequalities, as they are often a barrier to people accessing their medication, leading to uncontrolled asthma.

Asthma UK is campaigning to get these removed for asthma patients in England.5 A full investigation into the complex causes of health inequalities is vital to understanding what action needs to be taken.

Meanwhile, improving the quality of basic asthma care for all is a good place to start, with time and training for GPs and nurses to carry out high quality asthma reviews.

We need more investment in asthma training for GPs and nurses Investing in resources such as data analysis, which allow GPs and nurses to intervene if patients are at risk of an

asthma attack, will help the NHS in the long run, especially at a time when the health service is under financial strain.

Hospital admissions because of asthma attacks are costly, both to patients’ care and the public purse.

COVID-19 has made more people aware of their asthma management.

It shouldn’t have taken a pandemic for this to happen.

It’s important that the one in 12 adults and one in 11 children in the UK who have asthma, know that they have a right to the best quality NHS care.

We must position asthma at the heart of efforts to address health inequalities if we are to start to close the wealth gap in health that COVID-19 has exposed.

No-one should be at more risk of a life-threatening asthma attack because of who they are or where they live.

Reference 1: https://www.theguardian.com/world/2020/ may/01/covid-19-deaths-twice-as-high-in-poorest-areasin-england-and-wales Reference 2: The Great Asthma Divide, p. 3 https://www. asthma.org.uk/58a0ecb9/globalassets/campaigns/ publications/The-Great-Asthma-Divide.pdf Reference 3: Asthma UK conducted a survey of over 12,000 people in summer 2019, results were presented in The Great Asthma Divide, p. 8 Reference 4: In the same report, p. 11 Reference 5: https://www.asthma.org.uk/support-us/ campaigns/our-policy-work/prescription-charges/ Read more at healthawareness.co.uk

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One person dies every hour of pulmonary fibrosis Imagine that every breath you take is an effort. This is what it’s like for around 70,000 people in the UK living with the devastating lung disease, pulmonary fibrosis.

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ulmonary fibrosis is a littleknown condition that causes scarring or stiffening of the lungs, making it hard for oxygen to pass from the lungs to the body.

Over time, people living with pulmonary fibrosis find it increasingly difficult to breathe – even becoming breathless when eating or talking.

As we live through the COVID-19 pandemic, people with pulmonary fibrosis perhaps understand better than most what COVID-19 might feel like.

Early symptoms include a persistent cough and breathlessness. Everyday tasks and activities many take for granted become increasingly hard.

In time, patients become more and more dependent on oxygen, ultimately dying from respiratory failure.

One person dies every hour of pulmonary fibrosis

This article is sponsored by Action for Pulmonary Fibrosis

There is hope for patients with pulmonary fibrosis Today, we are acutely aware of our lungs.

We are determined to raise awareness of pulmonary fibrosis and, more importantly, what can be done to help.

Action for Pulmonary Fibrosis is giving hope to patients. We are spearheading ground-breaking research programmes and have a network of 80 support groups across the UK providing practical support.

We are upscaling our online support alongside our telephone support line staffed by a specialist nurse.

We are working hard to reduce the isolation and anxiety and signpost to local services. We have also made a series of videos on topics like nutrition and exercise for people isolating.

While we understand the causes of some types of pulmonary fibrosis, others we do not.

Written by: Steve Jones Chair of Trustees, Action for Pulmonary Fibrosis

One of the most aggressive is idiopathic pulmonary fibrosis (IPF), which affects around 32,500 people.

There are limited treatments, no cure and it has no known cause.

Life expectancy can be between three to five years following diagnosis and it has a worse prognosis that most cancers.

Despite this, awareness is low, and it can take over a year to receive the correct diagnosis (the average is 7-8 months).

Pulmonary fibrosis normally affects people over 50 and more men than women. The diagnosis cruelly strikes as they are looking forward to a new phase in their lives – making plans for their retirement or travelling overseas.

As we face the ‘new normal’, support for charities like Action for Pulmonary Fibrosis is crucial and will be needed more than ever.

About Action for Pulmonary Fibrosis: Action for Pulmonary Fibrosis (APF) is a growing community of patients, families, researchers, and healthcare professionals striving to find a cure for pulmonary fibrosis so that everyone affected by the disease has a better future. We provide personalised support to patients and families and raise awareness of pulmonary fibrosis through campaigning, fundraising and education. We are also committed to funding research to improve quality of life for people living with pulmonary fibrosis today and tomorrow. www.actionpf.org

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*Feedback from a recent Rafi-Tone survey.

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COVID-19 and clean air Clean Air Day 2020 has not gone ahead as planned. Due to COVID-19, it has been postponed to 8 October 2020.

WRITTEN BY

Larissa Lockwood Head of Health and Air Quality, Global Action Plan

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his coronavirus-induced pause on what should have been Clean Air Day 2020 provides a moment to reflect. What would make this a clean air day? Would we like this, and every day, to be a clean air day?

It seems few of us want to go back to what was ‘normal’ before.1 The improvement in air quality is one of the aspects of the crisis that people want to hang on to.

Benefits of lockdown Most of us have experienced some benefits during lockdown. Most notably: less noise pollution, the air feeling cleaner, more appreciation of the natural world and outdoor space, and the roads feeling safer for walking and cycling.

Many of these benefits stem from one source: fewer vehicles on the road.

To help make clean air everyday, we urgently need to reconsider why and how we travel around.

During lockdown we have seen some dramatic reductions in the level of the air pollutant, nitrogen dioxide, which primarily comes from road vehicles. Nitrogen dioxide levels have even halved in some central London locations.

Clean air and COVID-19 We know that health conditions that are caused or worsened by air pollution - such as asthma, heart disease and COPD - make a person more vulnerable to complications if they contract COVID-19.

If any person contracts COVID-19, which is principally a respiratory illness, they can become short of breath. It is therefore imperative that those recovering from and managing respiratory illnesses have access to clean air.

As lockdown eases, we must avoid a sudden surge in air pollution exposing the UK public – and those who are particularly vulnerable to COVID-19 – to dirty air. We must build back cleaner air by keeping levels of traffic low.

Change in attitudes since COVID-19 We know that nearly half of the population would like to walk more when lockdown is lifted, almost a quarter would like to cycle more and over a quarter of people want to drive less.

It seems that the place many of us want to drive to less is the workplace: 87% of those who are homeworking under lockdown want to continue working from home to some extent,

with this figure rising to 91% among people with asthma.

We call on business to confirm that all those who are able to work from home can consider it as an option for the long term.

And for those who do have to travel to work, let’s lose the stressful commute and instead encourage active travel, to promote health, reduce air pollution and protect those most vulnerable to COVID-19.

We all have a role to play in creating this clean air future. We need local and national government to create safer walking and cycling infrastructure, schools to implement school streets, businesses to encourage virtual working, and all of us to leave the car at home more often.

Research by Opinium tells us that 72% of people think that clean air is even more important now because COVID-19 can affect people’s lungs.

By coming together to build back cleaner air we can create positive change out of this COVID-19 tragedy and ensure that every day is a clean air day. https://www.thersa.org/about-us/media/2019/brits-seecleaner-air-stronger-social-bonds-and-changing-foodhabits-amid-lockdow 1

Read more at healthawareness.co.uk

MEDIAPLANET | A promotional supplement distributed on behalf of Mediaplanet, which take sole responsibility for its contents This article is sponsored by Airlite

This article is sponsored by Roy Castle Lung Cancer Foundation

Because lung cancer won’t wait

Airlite is an air purifying, anti-bacterial paint made with 100% natural materials. Airlite requires no electricity, makes no noise and works for as long as the paint is on the walls Used by IKEA, Grosvenor Estate, Bouygues, MercedesBenz and Kensington Palace; AirliteHome launches this summer.

COVID-19 may dominate our headlines, our hospitals, our minds, but our priority remains the same – lung cancer and supporting the people who are living with it.

Airlite: Cleaner Air, Safer Surfaces, Greener Planet www.airlite.com

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hey say, when we’re faced with adversity, we find out who we really are.

This year marks the 30th anniversary of Roy Castle Lung Cancer Foundation. During those three decades, we have encountered many forms of adversity.

Our charity was founded in the face of opposition, the face of negativity, the face of hopelessness. Thirty years ago, only 17% of people with lung cancer survived for a year or more. If there was a suspicion that a patient had lung cancer, they were not referred to hospital. They were denied investigation.

Our founder, Professor Ray Donnelly, recalls speaking to a GP and member of the Parliamentary Health Committee at a Labour party conference who questioned why we needed more emphasis on lung cancer. ‘They all die, don’t they?’ was his retort.

But, as everyone else disregarded lung cancer and the people it affected, we prioritised it and them. And the same can be said now.

Improve your quality of life with cleaner indoor air In the UK, we spend on average 90% of our time indoors, where air pollution is typically 2-5x worse than outdoors.

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After you read this article, the first thing you should do is open a window.

The main reason air quality is worse indoors is poor ventilation.

So, while air pollution is at its lowest level in a decade, you should make the most of it and get some good clean air flowing through your home.

Air pollution affects us all, slowly but surely degrading our respiratory system, and reducing our ability to fight infection and illness.

In the short-term, poor air quality results in reduced energy levels, nasal congestion, headaches and dizziness and is the leading cause of the rapid rise in asthma rates.

WRITTEN BY

Tom Faggionato Chief Operating Office Airlite

poor air quality found that by painting a classroom with air purifying paint it had a 95% lower NO2 concentration than the classroom next door.

Poor air quality will return after lockdown As we emerge from lockdown, many of us will treasure memories of skies blissfully free from aeroplanes, the dawn chorus uninterrupted by the roar of cars and walks in noticeably fresher and cleaner air.

Sadly, as already seen in China, the high levels of air pollution will return.

Legislation and responsible corporations have begun the seismic shift needed to clean the atmosphere.

Meanwhile, we must look at limiting indoor sources of air pollution and start employing ways of actively cleaning the air in our homes and workplaces.

Opening the windows will soon not be an attractive option so active air purification, especially for the most vulnerable, is critical.

NASA has published a list of the best air cleaning plants, there are a multitude of electric air purifiers on the market and now even the possibility of having air purifying paint on your walls.

Our one and only focus While everyone’s attention is firmly fixed on COVID-19, ours remains on lung cancer. It remains set on supporting those living with the disease. Because lung cancer does not care about COVID-19. It will not wait patiently for the pandemic to be over before striking or spreading. Just ask Vicky.

Vicky has been receiving treatment

©CHINNAPONG

WRITTEN BY

Paula Chadwick Chief Executive, Roy Castle Lung Cancer Foundation

for incurable lung cancer for the last three years. She recently found out her disease had spread, but she couldn’t access the only remaining treatment that might help.

Her sister, Alison, called our nurseled helpline for advice. Armed with the necessary information, Vicky has now been given access to a new treatment, which could give her more time with her three children.

Thankfully, many of us will never hear those terrifying words – “You have lung cancer”. For those, like Vicky, who do – over 46,000 in the UK every year – life will never be the same again.

Easing anxiety Living with lung cancer means constantly living in fear of the unknown. You are in constant fear that it might spread, your treatment has stopped working or the disease may come back. COVID-19 has magnified this fear but we’re here to help mitigate these anxieties as much as we can – emotionally, financially and practically.

We have come a long way in the last 30 years. One-year survival rates have more than doubled. Lung cancer now receives the second highest amount of research funding. We are on the cusp of a national screening programme, with several lung health check pilots poised to launch across England. There is a momentum behind lung cancer, and we must not lose focus. We will not lose focus. Too many lives depend on it.”

If you are living with lung cancer, or are concerned in any way, please visit www.roycastle.org

800,000 deaths per year in Europe are caused by air pollution – more than smoking.

Children’s bedrooms often have the poorest air quality Shockingly, research has shown the worst air quality in the home is usually found in children’s bedrooms.

A combination of cleaning products, new furniture, fresh paint and plastic toys, release potentially damaging toxins into the air, to be breathed in by the most vulnerable and precious members of our families.

Importantly, schools are also now trying to improve their indoor air. A central London school with extremely

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Improving air quality around schools to protect children The coronavirus pandemic has highlighted the need for school streets. Closing streets to traffic at school times and reallocating space to walking and cycling can help maintain physical distance amongst parents and children and improve air quality.

WRITTEN BY

Frances Buckingham Campaign Volunteer, Mums For Lungs

Making roads around schools pedestrian only The idea of ‘School Streets’ is to transform the roads outside schools so that only pedestrians and cyclists can use them at school drop off and pick up times. At these times each day, the streets around schools are closed to vehicles. Signs are put up to inform drivers of the road closure, and barriers or cameras can be used to enforce it. Residents, local businesses, and blue badge holders can apply for an exemption.

Implementing the new initiative across the UK Twenty London boroughs have successfully implemented School Streets with the greatest number in Islington and Hackney. In Cardiff, cars have been banned from streets outside five schools to improve road safety and air quality. A project in Levenshulme, Greater Manchester, aims to create an entire active neighbourhood that prioritises people over cars. This would create safer, healthier and more sociable streets where children and residents can walk or cycle to the schools and the suburb’s centre.

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The new normal for schools after coronavirus As children return to school following the coronavirus pandemic, there is an even more urgent need for school streets and cleaner air. Maintaining social distancing will require more space around schools with the risk

© M O N K E Y B U S I N ES S I M AG ES

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reduction in air pollution is critical given the emerging evidence that poor air quality, already particularly harmful to young lungs, can worsen coronavirus symptoms in the most vulnerable.

Over the last few years, ‘School Streets’ have emerged as an important initiative for improving air quality and road safety around schools. Children and babies are particularly vulnerable to air pollution as their lungs are still growing and developing. Research1 has linked exposure to toxic air with a number of health conditions including low birth weight, abnormal lung growth, cot death and mental health problems in children and teenagers.

Mums for Lungs Mums for Lungs was established in Brixton in 2017 when a group of mums on maternity leave became acutely aware of the toxic levels of air pollution on London’s streets. Support for the grassroots has grown rapidly and many more mums, dads and carers with children of all ages have joined. Two more branches in East Sheen and Walthamstow have been established.

Mums for Lungs wants to make it as easy as possible for parents to make a difference and has created two templates for School Streets or a filtered street (shut to through traffic, but accessible to residents, pedestrians and cyclists) to download, adapt and send to the council. For more information join the Mums for Lungs School Streets Facebook group.

of children or parents, especially at larger schools, needing to step into busy roads to avoid close contact.

Public transport operating at reduced capacity could lead to an increase in car use and a rapid rise in pollution levels around schools.

Research by Global Action Plan finds that six out of ten parents are worried about increased levels of traffic when lockdown ends.2 Street space around schools needs to move away from motorists and towards walking and cycling as the safest and healthiest ways to travel.

New guidance from the government The government has announced new statutory guidance, which includes School Streets as a measure to assist with reallocating road space safely as lockdown eases.3 The Mayor of London has also published Streetspace for London,4 which aims to create more space for walking and cycling. The plan goes so far as to recommend that “School Streets should be considered outside of all primary schools in London.”5 For the first time, clean air campaigners can say to schools and councils: the government wants you to do this.

Lockdown has helped us to see changes more clearly Before the pandemic, School Streets were gaining momentum, but implementation can be slow and they are not without

detractors.

Lockdown, while a challenge for so many, has brought the benefits of cleaner air and quieter streets.

Cycling and walking have taken up a new place in people’s lives and communities have flourished in the absence of traffic. We expect more people will want to retain this ‘cleaner air’ approach to life where they can – especially for their children.

Research by Global Action Plan finds that six out of ten parents are worried about increased levels of traffic when lockdown ends.

Campaigning for cleaner air together The cleaner air that has resulted from fewer cars on the roads is what Mums for Lungs has long been campaigning for. We have joined nine other NGOs to put pressure on councils to commit funding to School Streets. Every child in the country has the right to clean air and to be able to walk safely to school. It shouldn’t have taken a pandemic and so many tragic deaths to make this happen.

References 1 https://www.thelancet.com/journals/lanpub/article/PIIS24682667(18)30202-0/fulltext 2 https://www.cleanairhub.org.uk/news-stories/school-streets-needed-to-ensure-child-safety-post-lockdown-say-parents-and-ngos-in-new-research 3 https://www.gov.uk/government/publications/reallocating-road-space-in-response-to-covid-19-statutory-guidance-for-local-authorities/ traffic-management-act-2004-network-management-in-response-to-covid-19?fbclid=IwAR1bJVQWvp-owp5bp0Odv1lY6Bs1pe8qU8G3Sen8M4QEvapAhE_sU2oB7dM#reallocating-road-space-measures 4 https://tfl.gov.uk/travel-information/improvements-and-projects/streetspace-for-london 5 content.tfl.gov.uk/lsp-interim-borough-guidance-main-doc.pdf?fbclid=IwAR0d3hZEVO6s7i6O0eEhG-U2SAJ_3X6bE2pVD9pF8ap_92Nzqb6X285d7ug

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What should people with a lung condition do now?

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This article is sponsored by Trudell Medical UK Limited

About Aerobika® OPEP device

Drug-free Aerobika® OPEP device from Trudell Medical UK, opens airways, helps to thin and loosen mucus for easier expectoration which means inhaled medications may work better.1-3 A real-world study indicated that, for patients with moderate to severe COPD, Aerobika® OPEP device can help reduce exacerbations.4

Airways clearance therapy may improve COPD patient quality of life Quality of life is hugely important to any COPD patient. Research into Airways Clearance Therapy suggests that mucus clearance is just the tip of the iceberg in terms of its benefits to patients.

INTERVIEW WITH

Dr Jason Suggett Group Director, Science and Technology, Trudell Medical International

INTERVIEW WITH

Glenn Leemans Respiratory Physiotherapist, Clinical Researcher, Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp

Written by: James Alder

S

ome 1.2 million people in the UK1 live with Chronic Obstructive Pulmonary Disease (COPD).

The disease can have a drastic effect on a patient’s quality of life and worsens over time, with the patients slowly losing lung functionality.

Symptoms like chronic shortness of breath (dyspnoea), constant coughing and producing excessive quantities of mucus, each provide challenges for patients.

A new, ground-breaking study, into what effect clearing mucus can have when combined with effective inhaled drugs on the patient’s airways and medication delivery in the lung, has positive future implications for clinical outcomes.

Loosening mucus by pulsing pressure through the airways The study2 saw 10 patients treated with a hand-held oscillating positive expiratory pressure device (OPEP), which is designed to aid mucus clearance in the lungs by generating pressure pulses in the airways. The mucus became less sticky and easier to shift, while opening smaller airways in the lungs for longer during exhalation.

Glenn Leemans is a respiratory physiotherapist and clinical researcher at the University of Antwerp. He is also the first author of this study.

Leemans believes, focussing on mucus clearance in patients with moderate to extremely severe COPD can benefit them in terms of their overall quality of life, while also helping to prevent ‘exacerbations’ – instances where symptoms flare up and require medical attention.

Excess mucus can seriously impact physical and emotional quality of life “Living with this excess mucus has a tremendous effect on a patient’s quality of life. Coughing it up can be terrible.

“Mucus is also harmful to the patient medically, given it is a breeding ground for infections and a catalyst for the type of exacerbations that require hospital treatment.”

“There’s also the stigma and the mental effect of that. If you’re coughing up a lot, with friends or with other people, it draws attention to you.

“There’s a psychological effect, which is hard to bury for a lot of patients.”

Improved lung ventilation also improves inhalation of medicines Leemans’ study found that patients who used the OPEP device expanded their airway volume, meaning there is more place for air to pass easily during exhalation.

Leemans also saw lung ventilation improve, resulting in a better deposition of the patient’s inhaled medicines – an observation that may spark further research into the positive effect of OPEP devices on the efficacy of inhaled drug therapies.

“The evidence base we have already is more than enough to suggest that those who work in this field should be prescribing use of OPEP devices more often than they are currently. We don’t, as a community, need to wait for the guidelines to change.”

That OPEP devices should increasingly form part of COPD patient’s treatment plans is a notion shared by Dr Jason Suggett, Group

Director, Science and Technology at Trudell Medical International.

Many patients are now using this mucus-clearing device “The device is already being used by a lot of patients,” says Dr Suggett.

“We’re getting to a tipping point in terms of how big the body of evidence is now. With more, high quality, evidence being produced, then hopefully use of the devices will become part of COPD guidelines.”

Dr Suggett continues: “We have already seen that combining this nondrug therapy with their existing drug therapy is likely to help the patient have a better quality of life.”

With exacerbation triggered hospitilisations often lasting several days, the cost to the NHS of one hospital visit could be in the thousands.

Reducing the likelihood of patients having those exacerbations and requiring hospital treatment – whilst also doing much to improve their experience of the disease – is a win/win for both.

British Lung Foundation, 2019 www.dovepress.com/a-functional-respiratory-imaging-approachto-the-effect-of-an-oscillat-peer-reviewed-fulltext-article-COPD# 1

2

UK AB 078 0620 | Date of preparation June 2020 About Aerobika® OPEP device References 1. Wolkove N, et al. CHEST, 2002 2. Leemans G, et al. Int J COPD, 2020 3. Mussche C, et al. ATS Conference, 2018 4. Burudpakdee C, et al. Pulm Ther., 2017

For more details visit trudellmedical.co.uk/ aerobika or contact info@trudellmedical.co.uk