COPD stands for chronic obstructive pulmonary disease. It is the second most common lung disease in the UK. Emphysema is a severe form of COPD. Both conditions can have a significant impact on a person’s quality of life.

According to GOLD (Global Initiative for Obstructive Lung Diseases), the condition is usually caused by pollutants that get into the lungs, initially blocking (obstructing) the airways as well as causing chronic inflammation. Smoking is the main cause of COPD.

People who suffer from emphysema live with severe shortness of breath that often prevents them from doing simple daily activities without pausing to catch their breath or resting. Emphysema cannot be cured; however, treatment may help reduce symptoms, improve quality of life and slow progression of the disease.¹

A patient story – “Getting back to being happy-go-lucky”:

Patricia was diagnosed with COPD in 2004 and it affected everything. Every day was a challenge. After the disease progressed and medication no longer helped, she consulted with her doctor, who did tests to identify further treatment options to improve her quality of life.

It turned out she was a suitable candidate for endobronchial valve treatment, a minimally invasive treatment for patients with severe emphysema that is available on the NHS.² How does her life look like after the procedure? “My life after the treatment completely changed. Recovery was swift and I was able to be my busy self again. I could go into the garden and do weeding. I could walk around the block. I was able to go swimming. I could go up and down stairs again.”

“When Patricia was referred to us for further testing, she had large amounts of trapped air in her lungs and was very breathless despite her inhaler medication”, says Dr Richard Barraclough from Wythenshawe Hospital. “We are very happy for Patricia that her quality of life improved so tremendously after treatment. This treatment is not for everybody, but works very well in a clearly defined subgroup of patients. If you are breathless despite the use of inhalers and have been diagnosed with severe COPD/emphysema, speak with your GP or respiratory doctor to see if you are eligible and can be referred to a treatment centre for consideration of endobronchial valve treatment.”

[1] Criner G et al. Am J Resp Crit Care Med 2018; 198(9): 1151-1164.
[2] http://www.england.nhs.uk/…/lung-volume-reduction-by…/ http://shtg.scot/…/endobronchial-valves-for-lung…/

Results from case studies are not necessarily predictive of results in other cases. Results in other cases may vary.
© 2021 Pulmonx Corporation or its affiliates. All rights reserved. All trademarks are property of their respective owners. EMEA-EN-1217-v1

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New techniques to offer detailed examinations of the lungs are helping offer more personalised care to patients.

Patients are increasingly seeking individualised treatments for their conditions as the healthcare emphasis moves toward personalised medicine.

But in some areas of pulmonology, with diseases such as asthma and COPD that have many phenotypes, it is difficult to adopt an individualised approach as the gold standard for diagnosis – spirometry – cannot differentiate between pulmonary disease phenotypes.

In addition, routine examination of the lungs generally sees a radiologist examine CT scans with the eye, but that only results in larger abnormalities and abnormal patterns being detected.

Detailed diagnosis

Increasingly, clinicians and researchers are looking for new techniques that can deliver the detailed diagnosis and treatments required, and demanded, by patients.

Over the past year, the whole sphere of respiratory conditions and pulmonology has been brought into focus as a result of the ongoing COVID-19 pandemic.

“COVID-19 has made the demand for innovative diagnostic techniques greater than ever. We are having difficulty bringing the pandemic under control, partly because the tools we use to detect and treat the disease are not sufficiently responsive to the situation. Hence there is a substantial need for innovation in the respiratory field,” says Dr Jan De Backer, CEO of Fluidda.

It is very difficult even for a practised eye to see small abnormalities. FRI is a quantitative technique that produces a three-dimensional map of all the clinically-relevant structures in the lungs.

Three-dimensional map

A technique that is offering more detailed assessment of disease is functional respiratory imaging (FRI), which shows small abnormalities and also improves follow-up of diagnostics and treatment selection. It shows the anatomy of the airways and blood vessels in the lungs and the flow of air through them at millimetre-level resolution.

De Backer, who developed FRI in collaboration with his father, Dr Wilfried De Backer, Emeritus Professor of Respiratory Medicine at the University of Antwerp, says: “It is very difficult even for a practised eye to see small abnormalities. FRI is a quantitative technique that produces a three-dimensional map of all the clinically-relevant structures in the lungs.”

FRI utilises computational fluid dynamics (CFD) and came after Wilfried De Backer began to think about an alternative to spirometry, with the computer technology adapted to give an accurate, personal representation of the lungs.

Sensitive technique

FRI analysis involves two CT scans that are transmitted to Fluidda for analysis via Artificial Intelligence (AI) algorithms.

De Backer explains: “We analyse and model the images using a range of computer methods including computational fluid dynamics, a flow simulation system that has its origins in the aerospace industry. That yields a three-dimensional image of the lungs, showing the flow of air and revealing areas of increased air resistance or places where inhaled particles have been deposited.”

An example of how sensitive the technique is can be highlighted with pulmonary hypertension which can be due to constriction of the smallest blood vessels in the lungs.

“We can see abnormalities even in blood vessels with a diameter of only one millimetre,” says De Backer. “That makes FRI a very patient-friendly option for diagnosing and monitoring pulmonary hypertension, which at present is done using invasive pressure measurement in the pulmonary artery.”

Personalised picture

Compared to spirometry, which gives a general idea of lung function, FRI gives a detailed, personalised picture which can form the basis for targeted, individual therapy. It offers the advantage to rapidly review expensive treatments and is also cost effective when compared to cardiac catheterisation to diagnose pulmonary hypertension.

FRI – which has FDA approval as a diagnostic tool for pulmonary disease in American hospitals with European approval expected this year – has a role in pharmaceutical research, providing stable parameters for clinical trials, lends itself to predicting clinical outcomes, such as in COVID-19 patients and for assessing treatment progress.

In conclusion, De Backer notes that the pandemic is showing the world the need for innovations in pulmonary medicine.

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Beverly Bostock

Asthma Lead, The Association of Respiratory nurse Specialists (ARNS)

Spirometry testing was stopped in general practice clinics during the pandemic because of the risk of spreading COVID-19. Safety considerations are now needed for recommencing services.

Spirometry is a procedure that measures lung volumes and serves as a diagnostic tool to confirm or rule out a clinical diagnosis of conditions such as asthma and chronic obstructive pulmonary disease (COPD). It can also measure the effect of disease on lung function, screen individuals at risk of having respiratory diseases and aid further assessment (Welch, 2016).

Respiratory assessments need to be performed at the onset of any new respiratory symptoms, to acquire objective diagnosis and during annual checks to monitor disease progression.

Risks to practitioners

Spirometry testing was stopped in general practice clinics during the pandemic because of the risk of spreading the virus during the procedure, which requires people to blow hard and repeatedly into the spirometer. The COVID-19 infection is transmitted through respiratory droplets, coughing, sneezing and expiration.

Respiratory assessments need to be performed at the onset of any new respiratory symptoms, to acquire objective diagnosis and during annual checks to monitor disease progression.

The World Health Organization has recommended a range of infection control procedures to minimise this risk but community and primary care infrastructures are not designed to accommodate this increased level of infection control precautions. Surgeries are often based in older houses, with no extra ventilation and limited space to conduct clinical procedures.

Rethinking community respiratory care

Nonetheless, plans are in place to reinstate safe and effective lung function testing and assessment in the community as soon as possible. Primary care networks are working towards providing centralised diagnostic hubs, where expert nursing staff lead on accurate and proficient assessment, diagnosis and identification of treatment goals, promoting nurse led respiratory diagnostics and yearly respiratory assessment in a safe, dignified and sustainable way.

Chris Loveridge, an experienced general practice nurse who has working in this field for many years is currently developing a Primary Care Diagnostic Hub in Coventry. She says:

“This is an exciting opportunity to transform respiratory care and do things differently and more effectively on every level. Our hub will ensure that holistic assessments are carried out by fully trained nurses and healthcare professionals who are experts in respiratory care. As well as being able to provide a full assessment of people presenting with respiratory symptoms, the hub will also ensure ongoing education and support for clinicians and patients alike.” 

Nurses are also at the forefront of developing and implementing technology to enhance assessments, including remote inhaler checks as ensuring people can use and inhale their medications correctly is so important as is exploring and improving inhaler device selection.

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The impact of COVID-19 on lung cancer outcomes is potentially devasting for patients and their families.

Hard pressed clinicians and staff are doing everything they can to diagnose and treat as many patients as possible and the aim must be to increase screening and treatment levels beyond pre-COVID levels.

During the pandemic, the halting of lung cancer screening pilots and restricted access to diagnostics contributed to a 75% drop in urgent lung cancer referrals.¹

The Public Health Minister confirmed in the House of Commons that these figures have not yet recovered by stating: “sustained fall in people coming forward for lung checks, with the number of people seeking checks at only 76% of pre-pandemic levels.²“

Impact of delayed treatment

Any further delays to referrals or treatment will have a devastating impact on patients. The Annals of Oncology reported that the greatest rates of death arise following even modest delays to surgery in aggressive cancers, with >30% reduction in survival at six months and >17% reduction in survival at three months for patients with stage two or three lung cancer.³

During the pandemic, the halting of lung cancer screening pilots and restricted access to diagnostics contributed to a 75% drop in urgent lung cancer referrals.

This doesn’t consider the impact of delays on functional outcomes – quality of life, complications due to progression, greater economic burden and premature mortality and morbidity. The impact of treatment delay is probably far greater for patients and society than we are currently seeing.

The NHS Long Term Plan and other government initiatives contain ambitions to reduce the number of lung cancer deaths. The All-Party Parliament Group for Respiratory Health has launched an inquiry into lung cancer outcomes, but it will take a collaborative effort to accelerate lung cancer treatment and management to improve lung cancer outcomes.

^[1] Elizabeth Gourd, “Lung cancer control in the UK hit badly by COVID-19 pandemic”, The Lancet, Volume 21, Issue 12, P1559, December 1st, 2020. Last accessed January 2021
^[2] Official Report, “COVID-19 Lung Cancer Pathway” WH 2nd December, 2020
^[3] A Sud, ME Jones, J Broggio, et al, “Collateral damage: the impact on outcomes from cancer surgery of the COVID-19 pandemic”, Annals of Oncology, ESMO, Volume 31, Issue 8, P1065-1074, August 1st, 2020, Last accessed January 2021

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

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

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

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

Why children are at risk 

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

Clean Air Day 2021

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

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

We have a once in a lifetime opportunity for change. We must use it. 

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

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

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

Breathlessness – is it deconditioning?

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

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

The ‘hospital at home’ technology and digital solutions to healthcare became essential for the safety of patients and staff.

When we reduce our activity and in particular our load bearing muscles, they become less able to cope with the daily demand they used to manage with ease. Add to that a change in diet, and potentially a few extra lockdown pounds in weight gain and you can easily see how deconditioning can occur.

In an otherwise fit, healthy person this might be perceived as being a little unfit and easily corrected by eating healthily and getting back to the gym. In more vulnerable people, it can cause breathlessness and fatigue that is akin to other physical illness. All is not lost though. A tailored programme of rehab with the right therapists can get you back on to the road to recovery.

Learning from adversity

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

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

We must remember that there is no one size fits all. There are times when we still need to offer to see patients the traditional way, face to face.

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

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

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

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

It’s clear that there is work to do

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

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

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

On top of the benefits to people living with lung disease, making sure that local pharmacies are more integrated into the way the NHS works could ensure that the pressures our doctors, hospitals and healthcare staff are under are greatly eased, in the pandemic and for the foreseeable future.

Pharmacies need to be a part of the way the NHS operates

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

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

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

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

Impact of air pollution on quality of life

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

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

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

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

Stronger laws and national health protection plan needed

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

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

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Health and safety within the workplace is of paramount importance in protecting personnel.

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

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

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

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

Health and safety

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

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

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

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

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

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

Dust extraction

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

“Our employees greatly value healthy work. They don’t sand without dust masks. They never leave the building without a dust extraction system. They always strap up when working at dangerous heights. And they are proactive about talking to me when they need something.”

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

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

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

High-quality system

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

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

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

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

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

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

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Figures show that many parents of children with asthma are still failing to identify the most common symptom associated with a potential attack.

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

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

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

Asthmatic symptoms

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

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

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

Addressing lack of clarity

Building on decades of expertise in technology for respiratory treatment, OMRON has worked closely with parents to gain an insight into their levels of confidence in detecting wheezing symptoms in their children. At least 60% of surveyed parents need some sort of reassurance when managing asthmatic symptoms in their children at home.

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

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

Early detection

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

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

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

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

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

Providing support

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

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

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