Respiratory Health - Q4 2020

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Q4 / 2020

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Respiratory Health 02

“COPD can be incredibly life-limiting for people.”

Ian Jarrold

Head of Research and Innovation (Lung Disease), British Lung Foundation

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“If there is more than one inhaler that might be right for you, the greener option may be the one you want to choose.”

Carol Stonham

MBE, RN Queen’s Nurse, The Primary Care Respiratory Society

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“Programmes like pulmonary rehabilitation are being delivered in a virtual way, empowering patients to use their own home and resources to participate.”

Dr Nicola Roberts

Research and Education Sub-Committee, The Association of Respiratory Nurse Specialists

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Identifying those at risk of COPD

A COPD diagnosis is life changing There are 1.2 million people living with diagnosed COPD in the UK, with many more estimated to be waiting for a diagnosis. We need to address this, now.

By studying the very early stages of chronic obstructive pulmonary disease (COPD), researchers across the UK are hoping to be able to identify those at risk of developing the condition, which affects three million people in the UK.

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f you ask the average person in the street what COPD (chronic obstructive pulmonary disease) is, or how life limiting it is, they won’t have a clue. For the most part, COPD continues to be a hidden and ignored condition.

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he British Lung Foundation Early COPD Cohort is a group of young adult smokers between the ages of 30 and 45.

Their lung function is being tracked over time and the study will pick out those whose lung function is beginning to decline and are therefore at risk of developing COPD. Although anyone can develop COPD, people who smoke run a particularly high risk of developing this lung disease. However, 20% of people with the condition have never smoked and not all smokers develop it.

WRITTEN BY

Carol Liddle Patient representative, the Taskforce for Lung Health, British Lung Foundation

Simple tasks become challenging Ian Jarrold, Head of Research and Innovation (Lung Disease) for British Lung Foundation describes the importance of this research: “COPD can be incredibly life-limiting for people. Think about the last time you were out of breath and imagine being in that state just doing everyday tasks like brushing your teeth. There remains an urgent need to provide people with better treatments, but this is dependent on us gaining a better understanding of how the condition develops and progresses. This study will be invaluable in helping us answer these questions.”

I live with COPD My father died as a result of COPD in 1996, so when I started to show the same symptoms in 2004, I knew, deep down, that I had it, too.

COPD is life changing. I don’t think anyone really realises how frightening and isolating it is to not be able to plan ahead. Even something small like a walk to the corner shop can become an impossible task, there are days where I can’t walk more than 20 meters.

The progression of this condition is slow and insidious. You often aren’t aware of your limitations before a lot of damage has been done. But slowly – because of breathlessness – normal life becomes a process of compromise until on some days, some things just aren’t achievable.

Changing the way people talk about COPD This year, I would really like to try and change the conversations around this deadly condition, which is the fourth leading cause of death in the world.

I want COPD to be mentioned every time serious lung conditions are spoken about. It’s so much more than wheezing or being breathless. We need the media

The importance of studying young people During the initial pilot of the study, which has never been done on such a young cohort of individuals, the participants were monitored through the use of CT scans and post bronchodilator spirometry.

Presenting the initial findings at the American Thoracic Society’s annual conference, Andrew Ritchie described the results: “This cross-sectional analysis of 30-45-year-old individuals who are deemed at risk of developing COPD found that a large percentage show CT airway abnormalities. This demonstrates how important it is to study the younger age group to understand the beginnings of the disease.”

This year, I would really like to try and change the conversations around this deadly condition, which is the fourth leading cause of death in the world. to engage more with people like myself to highlight its symptoms and what life with COPD is like. Even when I’ve been to the hospital people have assumed that I have asthma because I’m wheezing and out of breath.

A public lack of awareness, stigma and fear surrounding this long-term condition leads to late diagnosis and life changing interventions being missed and sadly, people dying earlier than they might with the right treatments.

It could happen to anyone There are 1.2 million people living with COPD, and this could happen to you, too. We need you to question any symptoms such as persistent coughs or wheezing. We need your loved ones to say, ‘get it checked out!’.

The Taskforce for Lung Health and the British Lung Foundation work hard to raise awareness of COPD. But we all have a part to play in changing the narrative and raising awareness of the condition, together.

Read more at blf.org.uk

A public lack of awareness, stigma and fear surrounding this long-term condition leads to late diagnosis.

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The study is still looking for volunteers.

Further details available at imperial.ac.uk/ blf-early-copd-partnership/

WRITTEN BY

Ian Jarrold Head of Research and Innovation (Lung Disease), British Lung Foundation

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How toolkits and technology can benefit the patient journey Finding solutions to support patients, doctors and nurses through COVID-19 and beyond.

Identifying the challenges and opportunities During the COVID-19 pandemic, GSK has considered how it can support Completing COPD assessment the NHS to meet the demands and tests remotely the backlog of patients, especially as In addition to identifying patients winter is approaching with additional most at risk, we also found a method pressures to the system. We are to help acquire information on how doing that by asking ‘how’ care is patients are managing their COPD. administered as well as ‘what’ care is Alongside a multi-disciplinary group administered for respiratory patients. of international experts in COPD, The NHS is providing an incredible GSK supported the development of level of care during this time, the COPD Assessment Test (CAT), a demonstrating solutions for patients clinically validated questionnaire. and medical We co-developed professionals. But and sponsored the we’re also aware of delivery of a COPD the demands on time, Florey survey with We’ve seen alternative resources, and the accuRx, which challenge of how to integrates CAT and approaches adopted quickly, identify, prioritise with GPs taking appointments the modified Medical and review patients Research Council on to the phone and online. to ensure respiratory (mMRC) test into the Now it’s time to look at how we survey, built within care can continue across the UK. the existing accuRx can use innovation to improve We’ve seen platform. Sent as respiratory care in these new alternative a text message, circumstances and beyond. approaches adopted patients are able quickly, with to complete the GPs taking appointments on to the assessment and send the results back phone and online. Now it’s time to directly to the GP, allowing them to look at how we can use innovation to review and decide on the next steps improve respiratory care in these new in their care and acquire relevant circumstances and beyond. Whilst information in advance of any patient these cannot replace an in-person review. It has been designed to help review, how can they be evolved to medical professionals quickly identify bring benefits to patients and the how patients with COPD are currently NHS long term? managing their condition remotely.

Identifying the patients most at risk We saw opportunities to share our expertise and sponsor the development of practical tools and solutions to support medical professionals to identify patients and prioritise them.

The co-ordination of annual reviews for patients with asthma and chronic obstructive pulmonary disease (COPD) requires a lot of time and resources but are key to maximising patient care and prioritising limited resources. GSK have sponsored the development and delivery of an Asthma and COPD Audit and Review Toolkit.

Developed in partnership between the Midlands Practice Pharmacy Network and Prescribing Decision Support Ltd at the Centre for Medicines Optimisation team at Keele University,

Looking to the future of respiratory care GSK are investigating future respiratory care. We created the Remote Reviews Resource Hub, a dedicated space for medical professionals that covers considerations for remote reviews.

We also funded two national surveys of patients and medical professionals on remote respiratory care, and sponsored a roundtable facilitated by Wilmington Healthcare to discuss further solutions to support respiratory patients.

We firmly believe the innovation and change we are seeing across healthcare will help the NHS during the pandemic, reducing the demand on medical professional time and resources, and taking us towards a future where health technology can support patient care.

WRITTEN BY

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

Paid for by GSK

Read more at gsk.co.uk

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this free toolkit is a resource designed to help medical professionals identify those patients who are at greater need for a review. It works by tracking a series of avoidable risk factors. Detecting recognised symptoms as warning signs allows doctors and nurses to take pre-emptive action to reduce preventable symptoms.

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y exploring innovative healthcare technology to help identify, prioritise and prepare patients for review, GSK want to support the NHS to address the backlog of respiratory patients caused by the challenges of the pandemic.

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Paid for by Managing Adult Malnutrition in the Community

The role of nutrition in people with COPD

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Factors impacting dietary intake for those with COPD Breathlessness and fatigue can affect the ability to eat, drink and consume a normal sized meal. Individuals with COPD can be left feeling they are ‘gasping for air’ when chewing and swallowing.

The condition can lead to a reduction in the body’s ability to maintain muscle, resulting in gradual muscle loss. This reduces the ability to breathe well and keep active.

The effort of laboured breathing increases the amount of energy the body requires.

Oxygen, nebulisers and inhalers, often used in COPD treatment, can cause dry mouth and taste changes which may affect appetite.

Depression, social isolation and living conditions can also interfere with the ability to shop, purchase, and prepare food.

All these factors can result in less nutrients being consumed than required with subsequent unplanned weight loss, muscle loss, increased susceptibility to infections and the need for hospital care.

How do I know if I am undernourished?

A self-screening website is available for people who are concerned about their diet and weight, it helps calculate the risk of malnutrition and advises on next steps: malnutritionselfscreening.org/ What can I do to keep well nourished?

The Malnutrition Pathway has developed free leaflets for people with COPD; containing advice on diet and the importance of protein rich foods combined with physical activity to increase the strength of the lungs and body, along with tips for coping with common symptoms: malnutritionpathway.co.uk/copd Disclaimer: ‘The Malnutrition Pathway is supported by an unrestricted educational grant from Nutricia.’

WRITTEN BY Dr Anne Holdoway Consultant Dietitian, Chair, Malnutrition Pathway Community and COPD Panels

Similar eating and drinking difficulties can occur with COVID-19 infection and advice is also available: malnutritionpathway.co.uk/covid19

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hronic obstructive pulmonary disease (COPD) is a lung condition where the airways have become narrow, making it hard to get air in and out of the lungs.

People with COPD are at particular risk of undernutrition (malnutrition).

This can develop over several years or might occur following a flare up of symptoms.

Clean air is essential for respiratory health Focusing on reducing the environmental impact of respiratory healthcare is a priority we cannot ignore.

I WRITTEN BY

Carol Stonham MBE RN Queen’s Nurse, The Primary Care Respiratory Society

n 2020, the Primary Care Respiratory Society (PCRS) launched the Greener Respiratory Healthcare Initiative. Healthcare accounts for 4% of carbon emissions in England and minimising the environmental impact of healthcare in general is a key goal for the NHS.1 Environmental pollution also contributes to the burden of lung disease. Around one in five people in the UK are living with a lung disease and a further 10,000 people are diagnosed every week.2 For many of these people, air pollution is both a cause and an aggravating factor, making their symptoms worse and their lives more difficult.

Early and accurate diagnosis is key We believe that a key to greener respiratory healthcare is to ensure patients receive an early and accurate diagnosis. This is critical so that patients can receive the treatment that’s right for them. Accurately diagnosed and well controlled respiratory disease is already greener as it avoids wasted medications and additional hospital visits.

Greener medications must be fit for purpose Many of the medications prescribed for respiratory disease come in inhalers, delivering medicines straight to the lungs. The choice of inhaler should be made based first and foremost on what best controls a patient’s condition and that the patient is able to use effectively.

As a patient you can do your part by making sure you can use your inhaler correctly every time and letting your

Accurately diagnosed and well controlled respiratory disease is already greener as it avoids wasted medications and additional hospital visits. doctor or respiratory nurse know as soon as your COPD starts to flare up.

After that, if there is more than one inhaler that might be right for you, the greener option may be the one you want to choose. In the future we hope that all inhalers will be kind to the environment. For now, we need to make sure they are used correctly, used until they are empty and are safely disposed of or recycled where possible.

Greener respiratory health care We need to work collaboratively to ensure optimal respiratory health for all. We can do this by raising awareness, providing education, and advocating for proactive strategies to reduce the impact of respiratory healthcare on the environment. This is at the heart of the PCRS Greener Respiratory Healthcare Initiative, as we enable our members to deliver healthcare that is kinder to environment.

References: 1. NHS England. Delivering a ‘Net Zero’ National Health Service. Available at: https://www.england.nhs.uk/greenernhs/ wp-content/uploads/sites/51/2020/10/delivering-a-net-zero-national-health-service.pdf.

2. British Lung Foundation. Lung disease In the UK - big picture statistics. Available at: https://statistics.blf.org.uk/ lung-disease-uk-big-picture#numbers-developed-lungdisease-uk. Accessed November 2020.

The Primary Care Respiratory Society (PCRS) is a UK-wide professional society for respiratory health care professionals. The PCRS launched the Greener Respiratory Healthcare Initiative in 2020 to ensure #NoWasteNoHarm.

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Cutting the toll of COPD with a new way forward

Paid for by AstraZeneca

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OPD is the fifth leading cause of death in the UK, causing 30,000 deaths every year.1 More needs to be done to increase awareness.

INTERVIEW WITH

With early diagnosis and proactive treatment, the burden can potentially be reduced.

Why is reform needed?

“In the 20 years since I became interested in chronic obstructive pulmonary disease (COPD), it remains a Cinderella disease. The main, but by no means only, cause is smoking, leading to a stigma associated with COPD,” says Dr Kevin Gruffydd-Jones, a GP who co-authored the Patient Charter.

COPD affects 1.2 million people in the UK,2 is the second largest cause of emergency admission,1 and costs the NHS £1.9 billion a year.3 One in eight emergency hospital admissions is for COPD and ~30% patients are readmitted within 90 days.1 With early diagnosis and proactive treatment, the burden can potentially be reduced.

example patients admitted to hospital with COPD are 14% more likely to die than those not reviewed by a respiratory specialist within 24 hours.”5 The principles of the Patient Charter include: 1. Timely diagnosis and assessment of COPD 2. Understanding what a COPD diagnosis means 3. Access to personalised treatment 4. Review management plans to prevent exacerbations 5. Access to specialist care 6. Reducing stigma

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New Patient Charter outlines action needed to tackle COPD, the Cinderella disease that claims 30,000 lives a year.1

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COPD affects 1.2 million people in the UK,2 is the second largest cause of emergency admission,1 and costs the NHS £1.9 billion a year.3

Barriers to optimal care The name. “People do not know what COPD stands for, let alone what it is.

Many assume they have a smoker’s cough and nothing can be done.”

The stigma is a barrier to reporting and treatment. “Many patients believe their condition will be perceived as “their own fault” leading to low treatment expectations. People delay seeking a diagnosis, resulting in hospital admissions after experiencing an exacerbation (also called ‘flare ups’).”

Adherence to guidelines: “We have pretty good treatment guidelines, but lack of awareness and confusion means they are not always followed” he says.

“Many practitioners treat patients’ symptoms but are less aware of the need to prevent harmful exacerbations.”

Access to therapy. “Pulmonary rehabilitation is not available everywhere, even though it is known to reduce hospital admissions.”4 Expertise: “Often patients are reviewed by clinicians without specialist respiratory expertise. For

“This is all particularly important now,” he says. “People with COPD are three times more likely to die if they are hospitalised with COVID-19.”6 Professor John Hurst, at the Royal Free highlights: “At a time when the NHS is experiencing increased pressure, it has never been more important to optimise the care of people living with COPD helping them to stay out of hospital and living well.”

Dr Kevin Gruffydd-Jones GP in Box with a specialist interest in Respiratory, Joint Clinical Policy Lead, Primary Care Respiratory Society

Professor John Hurst Professor of Respiratory Medicine, University College London and Consultant Physician, Royal Free Hospital

Written by: Linda Whitney

The future of COPD care Hurst says: “The Charter will empower people to know what good care looks like, to know what to ask for when care falls short.” Gruffydd-Jones adds: “Collaboration between patients, practitioners and policymakers will prevent needless suffering, hospitalisation and deaths. Working together, we can transform COPD care.”

The Charter was created and funded by AstraZeneca in partnership with GAAPP .

References 1. NICE. QS10. Health and social care directorate. Quality standards and indicators - Chronic obstructive pulmonary disease (COPD) update. May 2015. Available at: https:// www.nice.org.uk/guidance/qs10/documents/briefing-paper (accessed November 2020) 2. British Lung Foundation. Chronic Obstructive Pulmonary Disease (COPD) Statistics. Available at: https:// statistics.blf.org.uk/copd (accessed November 2020) 3. British Lung Foundation. The battle for breath – Estimating the economic burden of respiratory illness in the UK. Available at: https://www.blf.org.uk/policy/economicburden (accessed November 2020) 4. Kjaergaard J et al. Chronic obstructive pulmonary disease.

Adherence to early pulmonary rehabilitation after COPD exacerbation and risk of hospital readmission: a secondary analysis of the COPD-EXA-REHAB study. BMJ Open Respiratory Research. Chronic obstructive pulmonary disease 2020. Available at: http://dx.doi.org/10.1136/ bmjresp-2020-000582 (accessed November 2020) 5. Royal College of Physicians. National Asthma and COPD Audit Programme (NACAP): COPD Clinical Audit 2017/2018. May 2019. Available at: https://www.rcplondon. ac.uk/projects/outputs/national-asthma-and-copd-auditprogramme-nacap-copd-clinical-audit-201718 (accessed November 2020) 6. Venkata V and Kiernan G. Covid-19 and COPD: pooled analysis of observational studies. J Chest. October 2020.

V158:4. PA2469. Available at: https://doi.org/10.1016/j. chest.2020.09.046 (accessed November 2020) GB-25049 | November 2020

Read more at healthawareness .co.uk/respiratory Scan the QR code to read the Patient Charter manuscript This article has been developed and written

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Paid for by Roy Castle Lung Cancer Foundation WRITTEN BY

Doreen McGinley Lung cancer patient

Prevent the crash: the importance of detecting lung cancer early In a world where tiredness comes as standard, weight loss is welcomed and a cough is COVID-19, how do we diagnose lung cancer earlier?

W Paula Chadwick Chief Executive, Roy Castle Lung Cancer Foundation

For more information about the signs and symptoms of lung cancer, visit roycastle. org/symptoms

©Image provided by Institute of Cancer Resreach

WRITTEN BY

ith a disease as serious as lung cancer, you would expect symptoms to match the severity. You would expect a clear or obvious warning light – gasping for breath, a violent and unshakable cough, intense chest pains. How could something so acute not send out an adequate alert?

However, the reality is when it comes to lung cancer, it’s less about the tyre blow out at 70mph down the M6 and more about the slow puncture.

Recognising the signs Lung cancer symptoms can be subtle and easily dismissed as something else. A bit of breathlessness is because you’re a bit out of shape. Lack of energy can be down to anything from poor diet to low mood. A persistent cough? Well, we all know how our perceptions of hearing someone cough have changed.

For Keshu, one of the patients featured in our ‘Still Here’ awareness campaign, the first symptom was weight loss.

Instead of seeing this as a warning, Keshu was happy to have lost a few kilos. Even when the cough started, alarm bells still didn’t ring.

It was only when the third set of antibiotics failed to work that questions were finally asked. But by then it was too late.

The tire had blown. It was lung cancer and it had spread.

“Cancer is just part of my life now” Doreen shares her story of her lung cancer diagnosis and why she is taking it in her stride.

Acting on instinct Ruthra’s story starts in similar fashion. She put her symptoms - recurrent chest infections - down to her child bringing bugs home from nursery.

However, Ruthra soon noticed that she was getting these infections far more regularly than her husband and was even succumbing to them in the summer months. As a fit and healthy 37-year-old, Ruthra recognised something wasn’t right. Even though lung cancer was not even a passing thought, she asked to see a respiratory specialist.

It was a decision that may have saved her life because, as unlikely as it was, Ruthra was diagnosed with early-stage lung cancer.

Finding lung cancer early, like Ruthra, is key. To do that, we have to take notice of the little differences in our health and be our own advocate. They might be small. They are probably something far less serious. Why take that risk? Get the slow puncture checked. Avoid the tire blow out. Prevent the crash.

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ive years ago, I went to see my GP about a cough I’d been living with for over 12 months. There didn’t seem to be anything wrong, but I was referred to a chest specialist anyway – just in case.

The lesion in my lower right lung was discovered after I had a CT scan, and further tests confirmed it was cancer. They also confirmed that the disease had already spread from my lung to my brain.

I was amazed. Even though I felt so well and have never even smoked before, I was being told I had stage 4 lung cancer.

©RollingCamera

The reality is when it comes to lung cancer, it’s less about the tyre blow out at 70mph down the M6 and more about the slow puncture.

Nothing much has changed After radiotherapy, to tackle the tumours in my brain, I was put on a targeted cancer drug which I’ve been on ever since.

Strangely, my father had also been diagnosed with lung cancer when I was younger. This was in the ‘70s and he’d lived for ten years, so I was hopeful treatment would have greatly advanced since then – and it has!

My current treatment is brilliant.

Nothing much has changed since my diagnosis. I have always felt well, and I still do.

Being on targeted treatment has kept me fit, healthy and symptom-free for which I am so grateful. Cancer is just part of my life now.

Being on targeted treatment has kept me fit, healthy and symptom-free for which I am so grateful.

Cancer is just part of my life now.

I take cancer in my stride I can still go out walking all the time.

I’m lucky that my treatment lets me, quite literally, take cancer in my stride.

Since being diagnosed, I’ve walked three Caminos, the Hadrian’s Wall Path and the Cleveland Way, and I am continuing to complete other longdistance walks in stages.

My disease will eventually progress – I know that – but I don’t tend to dwell on it. Charities like The Institute of Cancer Research, London, are working hard to stop cancer developing resistance to drugs, and I hope that they will find a way to outsmart it.

At the moment, I’m just enjoying feeling healthy and well, and I’m very much living in the present.

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Adapting to delivering respiratory care during a pandemic Since the start of the pandemic the NHS has had to adapt at lightning speed, this has meant fast innovation in the way we deliver care to replace face to face consultations.

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Is home monitoring the future for severe asthma?

Validated technology allows patients to monitor respiratory health from home.

WRITTEN BY

Dr Nicola Roberts Research and Education Sub-Committee, The Association of Respiratory Nurse Specialists (ARNS)

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efore COVID-19 there was Maria Parsonage, a respiratory a steady increase in the use consultant nurse states “Some people of virtual and telephone with COVID-19 are at greater risk of consultations in healthcare. becoming rapidly unwell and using This has rapidly evolved further since community pulse oximetry in those the start of the pandemic. For those assessed at risk of deterioration can working with respiratory patients, like often be life-saving”. asthma and COPD, this has included changing to email, video and telephone Face to face support is still available consultations.

It is important to highlight where Programmes like pulmonary needed, face-to-face care with a rehabilitation are being delivered in healthcare practitioner is still available, a virtual way, empowering patients these digital and virtual innovations are to use their own home and resources not appropriate for everyone. Joanna to participate. Alison Hughes, a King, a respiratory nurse consultant, respiratory nurse specialist and ARNS says: “Remote consultations are Vice Chair adds: “More than 80% valuable, helping to keep close contact of participants felt to a minimum, more confident with recognised exercising at home benefits such as after the course, only speed of access, More than 80% of participants 30% of participants more flexibility in felt more confident exercising had accessed appointment times at home after the course, healthcare virtually and less travel. only 30% of participants had prior to attending However, it’s not the classes”. suitable for all, I had accessed healthcare virtually one patient who hung prior to attending the classes.

Implementing up accidently three virtual wards times and another Schemes such as “virtual wards” are who had hearing difficulties, making playing an important role. These it challenging for some.” projects have reduced the time spent There are also issues around in hospital for those with COVID-19, training and confidence as healthcare allowing them to be monitored professionals learn to use these new at home.1 The Academic Health technologies. This way of working is Science Networks and Patient Safety very new and different. It is important Collaboratives are supporting the that changes to delivery of care made implementation of COVID-19 virtual during this pandemic are evaluated to wards and the widespread use of pulse ensure that healthcare professionals are oximeters (oximetry measures oxygen supported to adopt new ways. in the blood using a small fingertip References: monitoring device) within our local 1. Thorton J. The “virtual wards” supporting patients with health and care systems. covid-19 in the community BMJ 2020; 369 doi: https://doi.

WRITTEN BY

Helen Parrott Clinical Lead, NuvoAir

round 200,000 people in the UK have severe asthma, a serious and often debilitating form of asthma that’s not easy to manage, as patients are often unresponsive to conventional treatments.

Coughing, wheezing and breathlessness can affect everyday life such as work, study and relationships. People with severe asthma often spend their lives in and out of hospitals.

Regular monitoring of lung function, symptoms and treatment is key to finding the right management course for each individual. A visit to a specialist asthma centre or clinic for tests such as spirometry can be required several times a year.

With COVID-19 affecting healthcare’s ability to maintain check-up appointments, and people less willing to attend, wouldn’t it be faster, safer and more efficient if patients could effectively monitor their health at home?

Technology enables patient home monitoring There is a rise in new medical device technology that gathers health data remotely. This means people can self-monitor from home and share data with their care teams for timely decision-making.

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For more information, visit nuvoair.com

©IMAGE PROVIDED BY NUVOAIR

org/10.1136/bmj.m2119 (Published 05 June 2020)

New possibilities for clinicians Is there technology that can be trusted? NuvoAir has developed a respiratory platform which includes a home spirometer and app that provides coaching to achieve quality results. Peer-reviewed studies and clinical evidence have proven the validity of the technology and show that unsupervised home spirometry with NuvoAir is equivalent to in-clinic spirometry, with high adherence and engagement.

Clinicians can review data in real time, allowing swift interventions and therapy changes, without waiting months for an appointment. For people with severe asthma, this brings potential for substantially improved quality of life.

Having real-time access to respiratory health data means clinicians can identify patients that might benefit from new biologic treatments sooner. Being data driven helps to measure the effectiveness of interventions and new treatments. Symptoms and quality of life data help clinicians to get a holistic view.

There are also benefits for transforming clinical services. A study involving cystic fibrosis patients at the Royal Brompton Hospital showed a 39% reduction in urgent face-to-face visits and 31% reduction in booked face-to-face visits with virtual consultations supported by NuvoAir before COVID-19.

The NuvoAir Home platform contains a toolkit of devices and features that enables home monitoring and optimal care for people with severe respiratory conditions. The platform is used by hundreds of clinicians and thousands of patients in the UK alone and can benefit patients with severe asthma, cystic fibrosis, COPD and other respiratory conditions.

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Could more use of spacers improve outcomes?

Inhaler technique is more important now than ever, but when good technique cannot be confirmed, a spacer can help those using a pMDI inhaler when taught by a trained HCP.

INTERVIEW WITH

Dr Michael D Smith General Practitioner

INTERVIEW WITH

Dr Omar Usmani Reader in Respiratory Medicine & Consultant Physician, National Heart and Lung Institute (NHLI), Imperial College London & Royal Brompton Hospital

INTERVIEW WITH

Carol Stonham Senior Nurse Practitioner Respiratory, NHS Gloucestershire CCG, Executive Chair PCRS

INTERVIEW WITH

Dr Richard Iles Consultant in Respiratory Paediatrics, Evelina London Children’s Hospital

WRITTEN BY

Linda Whitney

The importance of inhaler technique “Inhaler technique is 50% of the prescription, alongside the right drugs,” says Dr Omar Usmani, consultant chest physician and Chair of the UK Inhaler Group. “But systematic reviews have shown that health care practitioners themselves are poor at understanding the devices and often relay poor techniques to patients.”

Many practitioners have turned to online or telephone consultations during the pandemic, but it is almost impossible to check inhaler technique over the phone. Even video consultations have limits,

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ontrolling chronic respiratory diseases has never been more important.

The COVID-19 pandemic and the winter cold and flu season is here. Therefore, it is even more vital that people with respiratory diseases such as asthma and chronic obstructive pulmonary disease (COPD) control their conditions effectively.

That means persistence in using inhaler-delivered medicines as often as prescribed and using the correct inhaler technique.

Sticking to the right routines and techniques can be challenging at the best of times - figures show that eight out of 10 people’s inhaler techniques are incorrect.1 The best way to learn the right techniques is face-to-face, from a healthcare practitioner skilled in their use. Digital services, such as video appointments or website selfassessments, have provided utility in helping enhance asthma care with guides and resources, but they do not replace face-to-face services. Due to the pandemic, many regular face-toface consultations are not taking place, which means basic levels of asthma care are not provided and will result in declining asthma care. Lives could be at risk.

“A July 2020 survey of 8,268 asthma patients by Asthma UK2 showed that one in three asthma patients had delayed or avoided visiting their GP or hospital when unwell. This was because they didn’t feel safe or didn’t want to overburden the health service – even if it meant that their condition worsened. Around four out of 10 people with respiratory conditions had had an asthma attack or worsening of their lung disease since the start of the pandemic, but most did not seek help” says GP Dr Michael D Smith.

says respiratory nurse consultant Carol Stonham.

“Video consultations risk increasing health inequalities,” she says. “What if you cannot afford the necessary technology, cannot operate it or have a poor internet connection? Inability to access your GP face-to-face means missed opportunities to pick up problems with inhaler techniques.”

What could help with better inhaler use?

Better education in inhaler use for practitioners and patients is essential.

But if an effective inhalation technique cannot be confirmed, the prescription of a spacer should be considered as a risk mitigation approach.

Spacers – valved holding chambers that attach to inhalers – have been typically prescribed for use by children, or adults who find it hard to co-ordinate their actions consistently.

However, they could be used to help many more people.

Dr Richard Iles, a consultant in respiratory paediatrics, says: “To stand the best chance of using an inhaler with the kind of co-ordination that ensures the majority of the drug gets into your airway, you need to be fit and healthy (i.e. not having an acute exacerbation) and ideally aged 14 to 35 (without any co-morbidities). If you are not in that group, a spacer will help. It holds the gaseous drug so you can breathe it into your lower airways and removes the need for masterful coordination between actuation and inhalation.”

Recommended in guidelines for general use GINA Report, Global Strategy for Asthma Management and Prevention (2020) and the UK BTS/SIGN Asthma Guidelines recommend the use of

Due to the pandemic, many regular face-to-face consultations are not taking place, which means basic levels of asthma care are not provided and will result in declining asthma care. valved holding chambers to improve drug delivery.

Despite this, prescriptions for spacers have dropped dramatically during the pandemic, even though the guidelines recommend spacers.

Doctors also say spacers should be used more widely as they can only help in monitoring disease control and avoiding exacerbations.

Dr Smith says: “In the present circumstances in particular I am reconsidering which patients I prescribe a spacer device to and will have a low threshold for doing so, especially if it means reducing the risk of poor inhaler technique. To those asthma patients with a pMDI/puffer inhaler reading this, who think that a spacer may help them; please talk to a qualified HCP for appropriate advice.”

UK AC 054 1120 Date of preparation: November 2020 References: 1. GINA Report, Global Strategy for Asthma Management and Prevention (2020) 2. Asthma UK: Five Headlines from our summer COVID-19 survey. August 2020 https://www.asthma.org.uk/ support-us/campaigns/campaigns-blog/five-survey-headlines/ Accessed Nov. 2020

Paid for by Trudell Medical UK Limited

This article is sponsored by Trudell Medical UK Limited (TM-UK). All interviewees are members of TM-UK’s ActOnAsthma advisory board. Members of the ActOnAsthma advisory board will receive an appropriate honorarium for their time dedicated to the project.

For more information visit trudellmedical.co.uk/ pmdi-and-spacerinhaler-technique or contact info@ trudellmedical.co.uk For additional information on AeroChamber Plus® Flow-Vu® Anti-Static Valved Holding Chamber please visit: trudellmedical.co.uk/ products/aerochamberflow-vu-chamber

Using an AeroChamber Plus® Flow-Vu® Anti-Static Valved Holding Chamber with a pMDI (puffer) inhaler ensures medicine is delivered to the lungs1 and can help to reduce exacerbations, A&E visits and hospitalisations.2 Please consult a qualified HCP before beginning a new treatment or therapy, to ensure the treatment or therapy is appropriate for you.

References: 1. Suggett J et al Am J Respir Crit Care Med 2020;201:A5689 2. Burudpakdee C et al. Pulmonary Therapy 2017; 3(2):283–296.