Most advanced cancers undergo genetic changes that enable them to resist drugs meant to kill them. Scientists like Dr Yinyin Yuan are working to better understand why this happens in lung cancer.

New research, which aims to harness the principles of evolution to stop cancer in its tracks, has transformed our understanding of how lung cancer evolves over time – and has highlighted how big of a role the immune system plays in cancer evolution.

This research is thanks to the TRACERx project; an initiative funded by Cancer Research UK, involving researchers like Dr Yinyin Yuan and the Computational Pathology and Integrative Genomics Team at The Institute of Cancer Research, London.

“Our research has helped us gain insight into how lung cancers can cloak themselves to escape the attention of the immune system. In doing so, it can continue to evolve and develop,” explains Dr Yuan. “Cancer’s ability to evolve and to come back after treatment is one of the biggest challenges facing cancer researchers and doctors today.”

Understanding the immune environment

TRACERx is helping scientists understand the types of immune landscapes that enable tumours to grow.

Tumours’ immune environments can differ. They can be filled with immune cells, or have almost none. Sometimes there is a mixture, with ‘hot’ regions full of immune cells and ‘cold’ regions with sparse immune cells.

This AI tool could be used in the future to pick out lung cancer patients at highest risk of relapse.

As part of the TRACERx initiative, Dr Yuan and her team have applied machine learning to genetic data and pathology images to create an AI tool capable of distinguishing immune cells from cancer cells.

This creates a detailed picture of how lung cancers evolve in response to the immune system in different patients.

The team’s work revealed that cancer cells found in immune cold regions may have evolved more recently than cancer cells found in immune hot regions that are packed with immune cells.

Therefore, areas of the tumour with fewer immune cells may have developed a ‘cloaking’ mechanism under evolutionary pressure from the immune system, allowing them to hide from the body’s natural defences.

Picking out patients at highest risk

The hope is that this AI tool could be used in the future to pick out lung cancer patients at highest risk of relapse, helping inform a more tailored treatment strategy.

“Our research is helping us understand why some lung cancers are so difficult to treat,” says Dr Yuan.

“We’re aiming to get a picture of the complex relationship between lung cancer and the immune system. By improving our understanding, we might be able to target cancer’s ability to evade the immune system – potentially coming up with ways to reactivate immune cells and encourage them to go after sly cancer cells.”

The biggest cancer killer in the UK

While the TRACERx initiative focuses on four cancer types – lung, melanoma, prostate and renal cancer – Dr Yuan’s team specifically studies lung cancer.

Her team’s research is bringing us closer to an era of precision medicine for this cancer type, which remains, by far, the biggest cancer killer in the UK.

“Lung cancer’s high mortality rate is partly due to its ability to evolve, become resistant to treatment and relapse. It is very encouraging to see that we can make progress by trying to understand lung tumours as evolving ecosystems.”

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COVID-19 has reinforced the importance of having healthy, resilient lungs, so why are we taking unnecessary risks with children’s health by exposing them to dangerously high levels of air pollution on the school run?

The invisible killer

Air pollution is a major public health risk, and the biggest environmental threat to human health. Invisible to the naked eye, yet deadly, it is linked with tens of thousands¹ of early deaths every year and has a significant impact on many people’s quality of life.

Alarmingly, new research we commissioned² has found more than a quarter of all schools and colleges in Britain are located in areas with very high levels of fine particulate matter (PM2.5): the most worrying form of air pollution for our health.

In total, 8,549 schools and colleges (27% of all primary and secondary establishments in Britain) were found to have PM2.5 concentrations that exceed those recommended by the World Health Organization (WHO).

It is unfair that children, who are more vulnerable to the effects of toxic air, are forced to breathe it on their way to school

There is no ‘safe’ level of exposure to PM2.5. These tiny particles, which come from a variety of sources such as diesel and petrol engines, tyres and road surfaces, become embedded deep within the lungs where they can cross over to the bloodstream. They carry chemicals which, in the long term, are linked to cancer and other chronic conditions including stroke, heart attack and dementia.³

In children, air pollution can stunt the growth of their lungs, making them less resilient into adulthood and placing them at greater risk of lung disease. Currently 1.1 million children in the UK are receiving treatment for asthma⁴ alone and there’s a growing body of evidence suggesting air pollution might be a cause.

Like other health and environmental inequalities, air pollution disproportionally impacts certain groups, including children with existing respiratory conditions. Lower income families, who are more likely to be living in areas with high volumes of road traffic, are also at greater risk.

On the walk to school, avoiding main roads and busy junctions by taking backstreets can reduce children’s exposure, particularly for younger children who inhale air closer to car exhaust pipes.

The problem could be much worse, post lockdown

Fears over the safety of public transport, due to COVID-19 have likely resulted in more people driving to school and work than before, which means pollution levels could go much higher.

In fact, recent data from the Department of Transport⁵ reveals that, on many days, vehicle usage has returned to pre-lockdown levels and could surpass them as the adverse winter weather begins.

Current laws are not fit for purpose

Alarmingly, current legal limits for concentrations of PM2.5 are double the limit recommended by the WHO.

To protect future generations from toxic air, the government must listen to the science and, this year, commit to setting new legally binding targets on PM2.5 concentrations within the Environment Bill, which must be met by 2030 and backed by robust plans to reduce levels as quickly as possible.

Why should our children have to wait 10 years? What can be done now?

Ultimately, the best way to protect all our lungs is to clean up and reduce the number of vehicles on our roads. The government’s own evidence shows the quickest way to do this is by establishing clean air zones in our major cities that reduce access for polluting vehicles.

Traffic should be reduced by walking children to school or encouraging and facilitating other forms of active transport such as scooting or cycling.

For those having to travel a greater distance, using public transport in accordance with the latest COVID-19 “Hands, Face, Space” measures is recommended.

On the walk to school, avoiding main roads and busy junctions by taking backstreets can reduce children’s exposure, particularly for younger children who inhale air closer to car exhaust pipes.

We’ve been working with parents across the UK to demand change and in some areas, parents and schools have been campaigning for local authorities to introduce measures like ‘school streets’, but we need to go further.

Without bold new clean-air laws and a clear government plan to protect children from toxic air, children’s health will continue to be put at risk for years to come.

[1] NHS – https://www.nhs.uk/news/heart-and-lungs/air-pollution-kills-40000-a-year-in-the-uk-says-report/ | [2] School analysis for PM2.5 – The research covers England, Scotland and Wales. Postcodes for schools were extracted from the Scottish government school statistics and the English and Welsh government register of schools and colleges.  In total, 31,979 schools and colleges were included. CERC used existing modelled PM2.5 data published by the UK Government as part of their responsibilities under the Environment Act 1995. CERC used predicted annual average PM2.5 data for 2019. These data have a spatial resolution of 1 km x 1 km, and therefore represent ‘background’ levels of PM2.5. These data give a representative indication of expected PM2.5 levels across the whole of the UK at sufficient resolution to provide good evidence. | [3] British Lung Foundation – Air Pollution – https://www.blf.org.uk/support-for-you/air-pollution | [4] Asthma UK – Facts and Statistics – https://www.asthma.org.uk/about/media/facts-and-statistics/ | [5] The Department of Transport data source – https://www.gov.uk/government/statistics/transport-use-during-the-coronavirus-covid-19-pandemic#history

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Dr Jason Suggett

Group Director, Science and Technology, Trudell Medical International

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

Some 1.2 million people in the UK[1] live with chronic pulmonary obstruction 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 study 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 Jason Suggett, Group Medical Director at Trudell. “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 non-drug 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.

[1] British Lung Foundation, 2019

[1] Wolkove N, et al. Use of a Mucus Clearance Device Enhances the Bronchodilator Response in Patients With Stable COPD. CHEST 2002;121(3):702-707. | [2] Leemans G, et al. A Functional Respiratory Imaging Approach to the Effect of an Oscillating Positive Expiratory Pressure Device in Chronic Obstructive Pulmonary Disease. International Journal of COPD 2020;15 1261-1268. | [3] Mussche C, et al. Poster presented at: American Thoracic Society Annual Conference. May 18-23, 2018. San Diego, United States. | [4] Burudpakdee C, et al. A Real-World Study of 30-Day Exacerbation Outcomes in Chronic Obstructive Pulmonary Disease (COPD) Patients Managed with Aerobika* OPEP Pulm Ther 2017;3(1):163-171.

UK AB 078 0620 | Date of preparation June 2020

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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.

A 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. Researchhas 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.

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.

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 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. 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. The Mayor of London has also published Streetspace for London, 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.”^[ 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.

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.

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Professor Surinder Birring

Professor of Respiratory Medicine, King’s College Hospital

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-CoV-2 infection continues to increase worldwide.

Breathlessness, 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.

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.

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.

The key message remains the same: If you get out of breath doing things you used to be able to do, tell your doctor.

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-CoV-2 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-CoV-2 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.”

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In the UK, we spend on average 90% of our time indoors, where air pollution is typically 2-5x worse than outdoors.

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.

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

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.

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 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.

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Dr Andrea Lever

Head Of Medical Payer Strategy And Solutions, GSK

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

One 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.  The current crisis has had differing impacts on those living with respiratory conditions, explains Dr Andrea Lever, GSK’s Head of Medical Payer Strategy and Solutions.

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.”

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.  

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 long-term benefits of our patients and our healthcare system.”

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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.

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

This year marks the 30^th 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.

There is a momentum behind lung cancer, and we must not lose focus. We will not lose focus. Too many lives depend on it.

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.

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 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 nurse-led 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

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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].

Unfortunately, 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.

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

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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.

The 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.

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?

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?

People like David Kirby, the kind of patient Breas have aimed to support since their inception, will remain at the forefront of their focus, not just in the present, but long into the future.

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