New treatments bring hope to the hundreds of thousands of people living with severe asthma, but our campaign isn’t over yet.

People living with the severest form of asthma often find themselves stuck in a never-ending cycle of life-threatening asthma attacks, emergency trips to hospital and regular doses of strong steroid tablets. These can be life-saving but can also have nasty side-effects including weight gain, osteoporosis, and mood swings. For the estimated 200,000 people living with this horrible condition, treatment options have traditionally been limited – but now there’s hope on the horizon.

In October, the National Institute for Health and Care Excellence (NICE) recommended dupilumab, a biologic drug that has the potential to transform the lives of people with severe asthma. There are already four other biologics available across the UK, but we know that many tens of thousands of people who would benefit are missing out. Biologic drugs are usually given by injection and are not steroids so don’t have the same side effects as oral steroid tablets traditionally used in severe asthma care.

People living with the severest form of asthma often find themselves stuck in a never-ending cycle of life-threatening asthma attacks.

It’s no overstatement to describe biologics as wonder drugs. We’ve heard from people whose lives have been totally transformed since accessing this treatment. However, we know that four in five people with suspected severe asthma are not being referred to specialists for these treatments that could transform their lives. Recent analysis has also shown that uptake of biologic treatments for severe asthma in England is second from the bottom when compared with similar European countries – this needs to change.

To bring us in line with other European countries we need NICE to take asthma more seriously and develop new, clear guidelines for health professionals to help ensure people eligible for biologic drugs are able to access them. 

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Respiratory syncytial virus (RSV) is the leading cause of respiratory infections in children under five accounting for over one-third of lower respiratory infections.

Globally, RSV causes about 33 million lower respiratory tract infections during early childhood annually and one in 10 RSV cases is hospitalised. RSV is a leading cause of child deaths (with over 120,000 child deaths) worldwide, most of these in the first year of life and in developing countries.

Pressure on health services

In the UK and other developed countries, RSV is the leading cause of hospitalisation, most of which are in infants otherwise healthy and born at term. During the winter months, paediatric respiratory wards are teeming with children with bronchiolitis and these pressures on the healthcare system have an impact on care for other conditions.

In the absence of specific testing for RSV, it is impossible to distinguish RSV infection from the flu. 

Recent studies have shown that RSV infections are as common as influenza in the elderly and are likely to result in a similar number of hospitalisations and deaths each year. In the absence of specific testing for RSV, it is impossible to distinguish RSV infection from the flu.

Preventative solutions needed

There is currently no treatment or preventative option to protect all infants, children and elderly from RSV. With the recognition of RSV as a global health priority over the last decade, including by the WHO, there has been a major push for developing preventative solutions against the virus.

There are currently seven products in phase III clinical trials. Recent data suggest that immunisation against RSV not only protects the infant against the virus but also against other respiratory infections.

New research into RSV

The RSV Consortium in Europe (RESCEU) funded by the Innovative Medicines Initiative (IMI) has been conducting clinical studies and gathering evidence to inform decision-making by WHO, European Medicines Agency and national immunisation technical advisory groups.

A two-year study involving 1,040 participants across Belgium, the Netherlands and the UK showed the incidence of RSV infection was about 5.6% in home-dwelling older adults (varying between 4% in one year and 7% in the next). There are ongoing studies to understand the incidence of RSV infection in infants and identify biomarkers for severe RSV infection and longer-term consequences of RSV.

The work started by RESCEU will now be taken forward by a follow-up IMI project (Preparing for RSV Immunisation and Surveillance in Europe – PROMISE). With clinical societies and patient groups, PROMISE will help us to understand patient perspectives to prepare the ground for introduction of options for RSV prevention in the next five years.

This project has received funding from the Innovative Medicines Initiative 2 Joint Undertaking under grant agreement Nº 116019. This Joint Undertaking receives support from the European Union’s Horizon 2020 research and innovation programme and EFPIA. The article reflects only the author’s view. The JU is not responsible for any use that may be made of the information it contains.

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While there’ i no cure for chronic obstructive pulmonary disease (COPD), early diagnosis is vital to managing the condition.

Around 1.3 million people in the UK live with a diagnosis of chronic obstructive pulmonary disease (COPD), a progressive lung disease which makes it harder to move air in and out of the lungs. In addition, there are thought to be at least another 1.3 million people who live with COPD but have not been diagnosed. As a result, they are not receiving any treatment. 

There is no cure for COPD, but early diagnosis is vital to help people manage their symptoms and live more comfortable lives. Shockingly, our new research exposes totally unacceptable delays which means that half of COPD cases may be undiagnosed. Can you imagine if this was true of cancer cases – it would be a national scandal. 

No plan to address the backlog

This alarmingly low rate of diagnosis is down to a combination of factors, including the COVID-19 pandemic. GPs were advised by NHS England in March 2020 to stop using diagnostic breathing tests known as spirometry tests. This, coupled with difficulty in people getting appointments, led to a 51% reduction in COPD diagnoses in England alone last year – that’s around 46,000 people missing out on a diagnosis.

Our research found that one in 10 people with COPD had never smoked before, while one in five had symptoms of the condition under the age of 45.

This is a much larger percentage drop than seen for other conditions such as heart disease, heart failure and diabetes. While rates of cancer diagnosis are already up to, and in some areas better than, pre-pandemic levels, there is no dedicated national plan to address the huge backlog in respiratory care. 

A raw deal for lung conditions

However, while the pandemic has made things worse, it is not entirely to blame. People with lung conditions have for a long time had a raw deal compared to other conditions. Not only is there plenty of unjustified attitudes around lung conditions, which can sadly be seen as ‘dirty’ or ‘people’s own fault’, investment into research and treatment pales in comparison to other conditions. 

It is therefore sad, but not surprising, that there is low awareness and long-standing misconceptions about COPD. One of the most common misunderstandings is that it only affects smokers and older people. This isn’t always the case. Our research found that one in 10 people with COPD had never smoked before, while one in five had symptoms of the condition under the age of 45.

We urge anyone worried about their breathing to contact their GP. They should also visit the British Lung Foundation website to get more information on COPD and to take the BLF Breath Test.

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Lung cancer screening is more important than ever, as more patients present with late stages of the disease as a result of COVID-19 delays.

“Around 75% of lung cancer cases are currently detected at an incurable stage,” explains Dr Samuel Kemp, Consultant Respiratory Physician at Nottingham City Hospital. According to Cancer Research UK, just 3% of patients diagnosed at stage four can expect to live for five or more years, which is why early detection is so vital.

Around 75% of lung cancer cases are currently detected at an incurable stage.

This issue is particularly acute right now. During the early throes of the pandemic, lung health checks were put on hold, staff were redeployed, CT scanners were prioritised for COVID-19 and many patients stayed away from all healthcare settings altogether. The result has been later diagnosis and poorer outcomes, which is why Kemp believes lung cancer screening is so important.

“COVID-19 has been catastrophic,” he explains. “We saw a 75% drop in referrals and are now seeing patients presenting with much later stages of the disease. It will be a while before we get statistics on survival rates, but it could wipe out 10 years of progress.”

CT screening saves lives

Low-dose CT screening has proved to be an extremely effective tool in identifying abnormalities on the lung that could be cancerous. Studies from the NELSON lung cancer trials conducted over a 10 year period showed lung cancer deaths in those who took part in screening fell by about 33% in women and 24% in men, compared to patients who did not undergo screening.

In 2019, the NHS embarked on a four-year pilot to conduct lung health checks, which included low-dose CT screening, for at-risk groups in 14 locations. Early results were promising. In Manchester, the NHS reported the percentage of cancers diagnosed at stage one increased from 18% to 68%, giving patients more options and better outcomes.

Statistics like this are hard to argue with, but as health professionals deal with the fallout from COVID-19 most trials remain on hold, but we can’t pause forever; lives are at risk.

Removing barriers reaps benefits of CT screening 

Samiran Dey

European Business Development Manager, Fujifilm Medical Systems

Lung health checks have proven to be a huge success in removing barriers to healthcare and improving outcomes for patients.

Drawing on evidence from the national lung cancer screening trial in the US, and NELSON study, there have been initiative screening pilots run in the UK, such as the SUMMIT study in North London, that proved a pickup rate in early stage lung cancer detection, leading to curative treatment rather than palliative care.

Another initiative, the Manchester lung health check pilot, has seen the number of cancers diagnosed at stage one increase from 25% to 68%. Delivered everywhere from supermarket car parks to football stadiums, the programme has removed barriers which previously prevented people from coming forward.

A single one-stop community-based unit can screen as many as 60 patients a day, identifying those most at risk as early as possible.

Wider benefits

The improvement in early diagnosis is impressive, but the benefits of the lung health checks are far more wide reaching. The lung health check consultations address which patients require the low-dose CT scan but can also assist with smoking cessation for attendees; helping to reduce their chance of developing cancer and improving long term survival.

It is important to remember that lung cancer screening is more important than ever, as more patients present with late stages of the disease as a result of COVID-19 delays. Lung health checks have proven to be a huge success in removing barriers to healthcare and improving outcomes for patients. Lung cancer screening is needed to reverse COVID-19 damage.

Removing barriers to access

Removing barriers to reap the benefits of low-dose CT screening, early diagnosis is just the start. If it is not followed up swiftly with further tests and treatment, opportunities will be wasted and lives will be lost. One in five patients sees their cancer stage change while they are waiting for treatment. As the rollout of the programme is considered in a further 20 locations, connected working and a continued commitment to removing barriers are vital.

The uptake of lung health checks will require a greater need for the NHS to deliver the post-screening diagnostic confirmations leading to referrals of treatment options in order for the screening programmes to remain within, if not shorten, the lung cancer diagnostic pathway. This will require increased capacity and funding for infrastructure in order to develop a successful nationwide programme. The first step in battling lung cancer is to establish an effective screening programme.

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Tracy Roughley

Clinical Nurse Advisor, Superdrug

With the onset of winter, people are being urged to get vaccinated against respiratory conditions such as flu and pneumonia.

Pharmacists are keen to stress that vaccination is more important than ever this year as many people’s immune systems have been weakened through reduced contact because of social distancing measures introduced during the COVID-19 pandemic.

Both flu and pneumonia are potentially serious – particularly for vulnerable groups such as the elderly, children, pregnant women and those with weak immune systems. However, they can be less severe if people have a flu jab, and where possible, vaccination against pneumonia.

Preventing potential complications

Pharmacist Aminah Mirza, an NHS services manager for Superdrug, says the flu jab will help prevent people from getting flu, or developing complications from flu, such as pneumonia.

Flu symptoms can include fever, headache, tiredness, muscle aches, sore throat, nasal congestion, stomach pain, digestive problems, weakness, difficulty sleeping, loss of appetite, shivering, cough, nausea and vomiting.

The big concern is that anyone who contracts flu will be at increased risk of a serious case COVID-19.

Some people may experience flu-like symptoms after the vaccination, though they are unlikely to be severe. The big concern is that anyone who contracts flu will be at increased risk of a serious case COVID-19 because their immune system will be compromised.¹

“To protect yourself from worse symptoms of COVID, it would be beneficial to get a flu jab,” adds Aminah Mirza. “The emphasis on the flu jab is because flu is a big killer every single year and this year it is predicted to be even worse.”

The free NHS flu jab, for at-risk groups including the over-50s, is available at Superdrug. For other groups it costs £9.99.

Protection against pneumonia

Pneumonia vaccinations are also available and can protect against a range of bacterial infections.

Clinical Nurse Advisor Tracy Roughley, who works at the Superdrug nurse clinic in Corporation Street, Birmingham, says: “While it is often referred to as the pneumonia vaccine, it also protects against other pneumococcal bacteria, such as forms of meningitis.”

A one-off vaccine, it is free to at-risk groups on the NHS, or available to other groups through nurse clinics such as Superdrug for anybody aged two and above. Two types of pneumonia vaccines are available, offering different ranges of protection.

Tracy Roughley stresses the importance of protection as there are currently many respiratory viruses and bacteria circulating. “Flu and pneumonia vaccines are not going to protect against COVID-19,” she adds, “but they will help boost the immune system and give some protection against other respiratory infections, it will also help to protect the NHS and keep people out of hospital and at work.”

[1] https://www.theguardian.com/world/2021/oct/10/getting-flu-with-covid-makes-you-twice-as-likely-to-die-says-uk-health-chief

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In November 2020, NHS England announced new clinics dedicated to helping people living with the long-term impacts of COVID-19. One year later, people are still battling long COVID alone as they struggle to get the support and care they so desperately need.

Long COVID is new and unpredictable. There is still a lot that we do not understand about it. But what we do know is that life is not the same for the one million people living with the condition. People using the British Lung Foundation’s support services tell us they are battling multiple, often disabling, symptoms, most commonly breathlessness, which in some cases have totally turned their life upside down. One person living with long COVID told us they are now too breathless and weary to do everyday tasks like cleaning and the weekly shop. Another said they are grieving the life they lost and see no hope of returning to it.

One person living with long COVID told us they are now too breathless and weary to do everyday tasks like cleaning and the weekly shop.

Challenges accessing support

The introduction of long COVID clinics in November 2020 offered a beacon of hope. NHS England announced that patients would be able to get specialist help at 60 sites across the country. But one year on, although the number of clinics has increased, people are still struggling to access the support they so desperately need. 

Our analysis shows many people with long COVID, especially those who managed the acute phase of COVID-19 at home, feel like the forgotten patients of the pandemic. People told us that they feel deserted and abandoned, with their doctors dismissing their symptoms as anxiety or stress.

Delays in treatment and support

When referrals are made into these dedicated clinics, over a third of people are waiting more than 15 weeks for their initial specialist appointment. It simply cannot be right that so many seriously unwell people are left to languish on long waiting lists like this or are not referred to specialist services at all. People deserve rapid access to support services, and NHS England needs to support clinicians to either refer patients into existing pathways or guide them to self-manage if clinically appropriate.

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As we continue the fight to recover from the impact of COVID, one thing remains clearer than ever – our desperate need for a national lung cancer screening programme.

A month after lung cancer surgery, Tracy went on holiday to Fuerteventura. This may sound like the start of a fairy tale, but it is not fiction; Tracy’s story shows how quickly people can recover from lung cancer when it is found early. 

Tracy was diagnosed with lung cancer in 2019 after suffering from two chest infections in short succession. Recognising this was unusual for her, the GP sent her for an X-ray which led to her early diagnosis. That is the morale of the story; the earlier lung cancer is caught, the easier it is to treat. The difficulty is catching it early.

We have seen the devastation that delay has on lung cancer and we cannot wait any longer, we need screening and we need it now.

Impact on progress 

COVID has set lung cancer back decades. Speaking to the Health and Social Care Committee earlier this month, Professor David Baldwin, says: “No. 10’s guidance has discouraged people with a hallmark symptom of the disease from seeking medical help.” 

As a result, the Lung Cancer Clinical Expert Group chair likened the situation to that of “25 years ago, with late-stage disease, horrible presentations, all sorts of things that we’d actually forgotten about because we’d made so much progress on the early diagnoses pathway.”

Road to recovery

The relaunch of targeted lung health checks is imperative in the recovery of lung cancer. People aged 55-74 in selected areas of England who have ever smoked are being invited for a check-up. We urge them to take up the opportunity.

However, what is desperately needed, and what we continue to campaign for, is a national lung cancer screening programme. A way to finally get ahead of the disease and diagnose people at the earliest stage before symptoms even start to show. 

We have seen the devastation that delay has on lung cancer and we cannot wait any longer, we need screening and we need it now. Until then, we need people to spot any differences in their health such as a persistent cough, breathlessness, fatigue, weight loss or repeat chest infections like Tracy. Push to see a GP, push for a referral and give yourself the chance to live happily ever after.

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Urgent action is needed to protect millions of children who face a lifetime of poor health because air pollution levels in many parts of the UK are dangerously high.

Published just ahead of COP26, our latest report found more than a quarter of a million babies each year are being born in parts of the UK where levels of air pollution fail to meet the World Health Organization’s previous air quality guidelines for fine particulate matter (PM2.5) set in 2005.

It also revealed over a third (35%) of maternity units and over a quarter (27%) of schools across Britain are in areas that have unsafe levels of air pollution. 

Much of this harmful pollution stems from vehicle emissions which are also fuelling the UK’s contribution to the climate crisis.

Health inequalities that can last a lifetime

Children growing up in deprived and ethnic minority communities are more likely to experience the devastating and potentially life-long health effects of air pollution compared to children born in areas with cleaner air – this is cruelly unequal.

Our report found 85% of people living in areas with illegal levels of air pollution make up the poorest 20% of the UK population. Children and babies, including those in the womb, are more vulnerable to polluted air than many adults because their airways are smaller and still developing. 

Prolonged exposure can also stunt the growth of children’s lungs; in turn, this can reduce their resilience to respiratory illnesses throughout life.

It is a national scandal that 36,000 premature deaths a year are attributed to long-term exposure to air pollution in the UK.

A national scandal 

It is a national scandal that 36,000 premature deaths a year are attributed to long-term exposure to air pollution in the UK. It can worsen or “trigger” existing respiratory conditions, such as asthma and COPD, resulting in potentially life-threatening asthma and exacerbations. It can also lead to the development of new lung conditions. Over a million children are receiving treatment for asthma in the UK. 

Levelling-up commitments 

Access to clean air should not be dependent on where people are born or live, which is why we are calling on the Government to embrace the COP26 legacy by ensuring tackling air pollution is an integral part of the levelling-up agenda.

We are pressing the Government to set ambitious legally binding clean air targets in line with the WHO’s 2005 recommended guidelines, with commitments to meet these targets by 2030, at the latest. 

By sharing the stories of the people whose lives are most impacted by toxic air, we hope to harness political ambition to clear the UK’s air for future generations, creating a fairer and healthier society.

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Emma Rickards

Acute Care Lead, The Association of Respiratory Nurse Specialists (ARNS)

With the winter pressures looming on the NHS, new innovations are helping to ensure continuity of care, finding new ways to avoid unnecessary hospital admissions and supporting patients back into the community.

In a normal year, respiratory disease is a major factor in ‘winter pressures’ within the NHS, with twice as many respiratory admissions usually occurring in December compared to August. This winter will be difficult with the continuing impact of COVID. New innovations are being developed to help support all areas of primary care.

Improving self-management for respiratory conditions

In general practice, the pressure has been on to get people living with respiratory conditions seen and supported. This is achieved by assessing their current control, symptoms and fine-tuning their treatment (best drug through the best inhaler device). In addition, it is important to ensure they have a self-management plan, so they know how to recognise if their symptoms increase and, importantly, what to do about it.

In general practice, the pressure has been on to get people living with respiratory conditions seen and supported.

Many respiratory reviews have taken place remotely. It is perfectly possible to do this with the right approach – a questionnaire sent out first, a telephone review to discuss the results and a video consultation (where possible) to check inhaler technique. These are usually followed up with a message sent to a mobile phone with the updated action plan and a video of the correct inhaler technique.

Many people have found this ‘remote’ option very useful, although for those who don’t have access to technology or who prefer a face-to-face appointment, general practice is well and truly open!

Avoiding unnecessary admissions

Due to the increasing volume of patients attending emergency departments, innovative ideas, such as having a respiratory nurse specialist within an emergency department (ED) for those turning up with a respiratory complaint, have prevented people being admitted unnecessarily (preventing 220 admissions).¹

Similarly, an admission avoidance respiratory car working with ambulance services provided ‘hospital expertise’ at home which has avoided 231 admissions.² Partnership working can provide improved services for patients with respiratory disease and prevent unnecessary hospital admissions.

The COVID pandemic has encouraged nurses and other healthcare professionals to adapt and improve the way that care is being delivered. Many of these innovations will continue to improve care in the future.

[1] Rickards, E, et al (2021). The SWISS Nurse; respiratory nursing care without any borders. An admission avoidance winter pressure initiative. European Respiratory Society Abstract.
[2] Rickards, E, et al (2021). The impact of an admission avoidance rapid response respiratory car in collaboration with the Northwest Ambulance Service. European Respiratory Society Abstract

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Behind the images of “donned” healthcare professionals has been an army of inspiring respiratory physiologists who have changed their roles to fight COVID-19 on the front line.

“I’d like you to take a deep breath in… right in and…blow! Keep blowing… keep blowing, keep going, right out… just a little bit more… and… relax!” These words are uttered by respiratory physiologists thousands of times daily in the UK.  

This is spirometry, the basic lung function test that indicates normality from abnormality, detecting asthma, COPD or lung fibrosis and is the gateway measurement to many lung disorders. 

There is something in the air

The 3,000 respiratory physiologists, trained from degree to doctorate level, provide most breathing tests investigating the state of the airways, lung size and the efficiency of gas exchange by testing the breathing system during rest, sleep and exercise. Largely unknown to the public, they mainly work in hospital outpatient departments. However, they have undergone a meteoric change in their roles as the result of COVID-19. 

One consequence of the pandemic was the reduction of routine diagnostic services and outpatient activity, but respiratory physiologists weren’t idle.

Firstly, a skeleton service was continued under stringent infection control procedures. This is because COVID-19 is an airborne vector and lung function testing is effectively an aerosol-generating procedure often inducing coughing and mass viral spread. Many services continued pre-operative testing for urgent requests such as lung cancer and fibrosis.

One consequence of COVID-19 was the reduction of routine diagnostic services and outpatient activity, but respiratory physiologists weren’t idle.

A blow out in the car park

Secondly, because of decreased outpatients, innovative delivery included car spirometry, home remote monitoring and rapid room ventilation to clear the diagnostic backlogs. Physiologists, in full PPE in hospital car parks, performed testing through the windows of family hatchbacks. Some services used smart disposable spirometers to enable self-testing at home using smartphones. 

Critical caring

Finally, COVID-19 is a respiratory disease, so senior physiologists were deployed to COVID-19 wards/ITUs to deliver ventilation and oxygen 24/7. Inpatients had no visitors; physiologists provided kindness, caring and moral support to sick and lonely patients. They are now established as “clinical reinforcements” in hospitals during “winter pressures.” Innovative diagnostics are now embedded into routine services, enabling more community-based diagnostics and reducing the huge diagnostics backlog, using these incredibly hard-working teams.“Taking a deep breath” after the pandemic has a whole new meaning for respiratory physiologists.

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