Sleep & Respiratory Health June 2017

JUNE 2017

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Sleep & Respiratory Health

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How to use your inhaler correctly: Chair of UK Inhaler Group P4-5 £9.9 BN A YEAR

The cost of respiratory disease to the NHS P2 GLOBAL ACTION NEEDED

to tackle air pollution Professor Prashant Kumar P5

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IN THIS ISSUE

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Living with pulmonary hypertension; Andrew’s story

Obstructive Sleep Apnoea caused Kath Hope depression

Raising awareness of how Obstructive Sleep Apnoea can cause road accidents

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P6

P6-7

Action on respiratory disease is needed now

Respiratory disease is the UK’s third main cause of death, yet is largely neglected.

Dr Penny Woods, Chief Executive of the British Lung Foundation, calls for action

L

ung disease costs the UK a staggering £11bn each year, with £9.9 billion falling directly on the NHS. The UK has Europe’s fourth highest rate of respiratory disease deaths and diagnosis is often poor and late. Respiratory health has been neglected for decades.

For instance, obstructive sleep apnoea (OSA) – a breathing problem that happens when you sleep and your muscles relax – affects about 1.5 million people in the UK, yet fewer than half of these are currently receiving the treatment they need. The resulting disruption to sleep, means sufferers can be drowsy during the

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day, creating a range of dangers, for example, driving accidents.

Treatment is simple, yet waiting times can be up to a year. Investing more in awareness, diagnosis and treatment of OSA could save the NHS up to £28m and prevent up to 40,000 traffic accidents a year.

At the British Lung Foundation, we’re campaigning for greater investment in respiratory care, research into lung disease, and into avoidable causes, such as air pollution. Toxic air, left unchecked, will lead to a rising tide of respiratory disease and other health problems, particularly among those who are most vulnerable. Children, people

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Dr Penny Woods Chief Executive of the British Lung Foundation

@MediaplanetUK

with a pre-existing condition and the elderly will be hit hardest.

During the recent Breathe Easy Week, our lung health support groups were out campaigning, calling for more clean air zones, reduced use of diesel vehicles through an ambitious and fair diesel scrappage scheme, and more air pollution monitoring.

Lung disease is taking a huge financial toll on our health service, businesses, and society. Governments and the NHS in both England and Scotland must take action. We are now leading an independent taskforce for respiratory health to improve outcomes for patients and the nation’s lung health.

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COMMERCIAL FEATURE

Detecting the danger in your home It is a little known fact that one of the deadliest gases to be found in the home, far worse than carbon monoxide, is radon, the leading cause of lung cancer among nonsmokers and the cause of over 1,100 deaths a year in the UK alone

By Virginia Blackburn

It is impossible to see, smell or taste. Radon is a radioactive gas found everywhere.

It is formed by the decay of small amounts of uranium that occur naturally in all rocks and soils, and when trapped inside the home it becomes dangerous. It is generating such concern that in February 2018, legislation is coming into effect across the EU requiring that radon levels in all public spaces must be monitored.

“The amount of radon varies significantly all the time,” says Oyvind Birkenes,

CEO of Airthings, an Oslobased company established in 2008 which develops and manufactures products designed to monitor and identify radon levels in indoor air. The company is led by a team of experienced scientists, engineers and technology professionals who wish to educate people about the prevalence of radon and develop accessible technology solutions to help safeguard their homes and keep themselves and their families healthy. “Until recently, the only way to test for radon

Oyvind Birkenes CEO, Airthings

was to use charcoal or film based canisters, which only take short-term measurements and have to be sent

to a lab for examination,” Birkenes continues. “However, because of the fluctuating nature of the gas, this is not the most effective or efficient method.”

Airthings has now developed a smart radon detector, Airthings Wave, which is an easy-to-use, elegant looking product that can be attached to the wall or ceiling and connects to a smart phone or tablet with a free app. “By using digital sensors and smart home technology, Wave detects real time and long term radon levels and provides

notifications when levels are dangerous,” says Birkenes.

“It is a homeowner product using professional grade technology. Now our goal is to invest in education, and make sure people are aware that there is a simple and effective solution to measuring the air quality within the nation’s family homes.”

Read more on airthings.com

COMMERCIAL FEATURE

Lung cancer would never have crossed my mind

By Tree Elven

Jane Holmes was a keen runner with a healthy lifestyle when she was diagnosed with ‘incurable’ lung cancer in 2014. Now, her scans are clear and she’s still running marathons.

“I’d gone to the GP about a pain in my nose – it felt like breathing in cold air. Sinus tests showed nothing and I was lucky that my GP referred me for a chest X-ray which showed a tumour in my right lung. The cancer had spread to the lymph nodes in my neck. I was still running, I was 43, pretty fit.

That’s why I say, if you’ve

got lungs, you can get lung cancer.”

Awareness around lung cancer is improving, but persistent fatigue, shortness of breath, shoulder pains, a persistent cough, and coughing up blood are some of the common symptoms that are often put down to other factors. Jane advises people to ask for more tests if they’re worried. “Lung cancer is a sneaky one. Be your own advocate.

“I associated lung cancer with old men smoking in pubs, but I live a healthy lifestyle, and hadn’t smoked for 20 years. One consultant was very interested because I had none

Jane Holmes Roy Castle Lung Cancer Foundation

of the typical drivers of the disease – I was much more interested in what he was going to do about it!”

People respond in different ways to a scary diagnosis: Jane’s response was to be vocal, get involved in

fundraising, and get herself fit enough for surgery.

The fact that she was physically strong already helped her body deal with the tough treatment, and four months after a lobectomy to remove the tumour, she ran a marathon with her husband, who’s a personal trainer. With help from the community and Roy Castle Lung Cancer Foundation, she has raised £17,000 for the foundation. “Everyone rallied round: we have a friend with a lovely garden where we had an event that raised £5,000 in one weekend. (I don’t think people would have paid to come and see our garden!)”

Participating in digital forums, and getting informed online was part of Jane’s journey. “It’s good to talk to people who’ve ‘been there, done that’ to help you formulate the questions to ask your doctors so that you’re working with them on treatment, not just being told what to do.”

Read more on roycastle.org

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Andrew Hargreaves Pulmonary Hypertension Patient

Sleep struggles and pulmonary hypertension Andrew Hargreaves, 40, was diagnosed with pulmonary hypertension eight years ago. The serious heart and lung disease, which affects just 7,000 people in the UK, has had a big impact on his ability to sleep.

“Last year, I took a turn for the worse and as a result, had a Hickman line fitted. I find myself now with a lot less energy and get fatigued very quickly.

But when I try and sleep, I toss and turn, only managing two to three hours at a time. Concern about my Hickman line getting tangled keeps me awake and it’s become more of an issue over the last six months.

The lack of sleep has affected my quality of life because I find myself needing a ‘power nap’ more often now, and my poor wife’s sleeping pattern has been knocked about as I’m always fidgeting. I can find myself to be very short-fused, too. I was put on a course of sleeping tablets, which I did help a bit, but I only took one course as I didn’t want to have to rely on them.”

For more information about pulmonary hypertension, visit www.phauk.org

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Have an inhaler?

Make sure you use it correctly Over 80 per cent of people – including healthcare professionals – use poor inhaler technique. Here’s how to do it right.

By Linda Whitney

I

nhalers are often prescribed for people with respiratory disorders, such as asthma or chronic obstructive pulmonary disease (COPD).

However, Monica Fletcher, Chief Executive of Education for Health and Chair of the UK Inhaler Group, says: “Studies have shown that as many as 8090 per cent of inhaler users do not use them correctly. This includes healthcare professionals who may be demonstrating their use to patients.

“This is critical because misuse may mean that patients do not receive the correct dose of their medication – or perhaps none, which can affect their health and even increase the risk of death”.

It also means that medicines are wasted, increasing NHS costs unnecessarily.

“The UK Inhaler Group aims to improve the education about correct inhaler technique among patients and health professionals,” says Fletcher.

Monica Fletcher OBE FERS, Fellow QNI, MSc Chair UK Inhaler Group, Chief Executive, Education for Health

The situation is complicated by the increasing number of devices available. “It’s good that there is a wide choice but this also means that doctors, nurses and pharmacists have difficulty keeping up to date with new devices and how to use them properly,” Fletcher says.

SPACE FOR COPD® is a ‘self-management programme of activity, coping and education’ which empowers individuals with COPD (chronic lung disease) to manage their disease.

The programme was developed by healthcare professionals at the University Hospitals of Leicester (UHL) NHS Trust and approved by the Plain English Campaign. It is a structured programme of exercise, education and psychosocial support for individuals with COPD and can be delivered in online or textbook formats. SPACE FOR COPD® is interactive and delivered to patients by a health professional with in-depth knowledge of COPD, exercise and motivational interviewing.

For further information see: www.spaceforcopd.co.uk

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Professor Prashant Kumar Professor and Chair in Air Quality and Health, University of Surrey

Air pollution and what we can do about it

Correct inhaler use It is important to note that there are two broad types of inhalers. Pressurised, metered dose inhalers (pMDI), which deliver medicines in a spray form, while dry powder inhalers contain powdered medicine in a reservoir or a capsule inside the device.

So what is the right inhaler technique?

First, before using any inhaler, empty the lungs as much as you can, so that when you inhale, you ‘suck down’ the medication as far as possible.

Fletcher says: “Breathing out fully can be hard for some people, particularly those with COPD, so there are additional devices called ‘spacers’ that can be prescribed, which means this is not necessary For many inhalers it is important to get the hand/breath coordination

right, so you breathe in as you press the inhaler.

When inhaling from pMDI’s, the breath should be slow and steady.

With dry powder inhalers, the inhalation should be quick and deep.

Once you have inhaled, hold your breath for a little while for the medicine to stay in the lungs.

Fletcher says: “Even assuming patients have been taught effective inhaler technique it is easy for users to become complacent. So you should have your inhaler technique checked regularly.”

She advises: “Remember, inhalers deliver effective medicines so it is important to take inhaler technique seriously.”

There are video demonstrations of correct use of some inhalers at www. asthma.org.uk and in early 2018 these will be updated with a complete range of currently available devices.

Air pollution causes respiratory illness and death across the world. What’s needed is global action to tackle it.

Meanwhile here’s what you can do to help protect yourself.

World Health Organisation figures link air pollution and respiratory deaths.

“Air pollution, a mix of gaseous and particulate matter such as nitrates, sulphates, silica, iron and black carbon, is linked to heart disease, strokes, lung cancer, chronic obstructive pulmonary disease and respiratory infections. Children and the elderly are most at risk,” says Professor Prashant Kumar, Chair in Air Quality and Health and the founding Director of the Global Centre for Clean Air Research (GCARE) at the University of Surrey.

Sources include road dust, vehicle emissions, industry and barbeques.

Household air pollution from sources such as cooking with solid fuels claims 4.3 million lives annually.

What can be done?

“We can use more low-emission or electric vehicles and more mass transport. Motorists should close windows and set the AC to ‘recirculate’ while at the lights. Flagging up high pollution areas means pedestrians could choose safer routes.

“Hedges planted beside busy open roads also help,” says Kumar, who is researching green barriers under the iSCAPE project.

He adds: “Air pollution affects us all. We need global collaboration to tackle it.”

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say that it can improve the health of sufferers of debilitating respiratory issues including Asthma, Chronic Obstructive Pulmonary Disease (COPD), Cystic Fibrosis, Asthma, Bronchitis, Sinusitis, Rhinitis (hay fever), Allergies, Snoring and Sleep Apnoea. toms have improved considerably. Enda said that she could New Lease of Life for not recommend Salin® Plus COPD Sufferer highly enough for those with Enda Veale (pictured) suffers COPD or respiratory problems. from COPD. Her daughter purchased the Salin® Plus natural Helped My Asthmatic Son salt therapy air purifier for her David Coyne, father of 5 year and since she started to use it her old Ryker said, “Ryker has had breathing and her COPD symp-

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The hidden toll of obstructive sleep apnoea (OSA)

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Kath Hope Founder, Hope2Sleep Charity

Think you have Sleep Apnoea?

Get tested, urges Kath Kath Hope rejected the idea that obstructive sleep apnoea (OSA) caused her depression and exhaustion – but a diagnosis changed her life.

Now she helps others tackle OSA.

“I refused to believe I could have OSA,” says Kath Hope.

For years, she suffered with sleepiness and was on anti-depressants for mental exhaustion but put it down to running a busy music school. Then, an ENT consultant investigating her hearing problems suggested OSA and ordered a sleep study.

“I was sure he was wrong, but I proved to have severe OSA,” says Kath. “My body was waking me 30 times an hour, without my knowledge. I was only really sleeping two hours a night. My problems were caused by sleep deprivation.”

Kath’s mother died young of a heart attack. “Now I realise it was indirectly caused by OSA, because it runs in families,” she says.

Kath now uses a continuous positive airway pressure (CPAP) device nightly to ensure her airway no longer collapses, preventing her body waking her to restore breathing.

Determined to raise awareness of Sleep Apnoea and support existing sufferers, Kath founded the Hope2Sleep charity, www.hope2sleep.co.uk, “This a hidden epidemic,” says Kath. “If you suspect you have Sleep Apnoea ask your GP for a sleep study.”

Daytime sleepiness caused by obstructive sleep apnoea leads to accidents. It’s time to tackle the issues that stop workers and professional drivers from coming forward to be tested.

By Linda Whitney

S

noring is often treated as a joke, but it can be the sign of a condition that results in many accidents due to excessive daytime sleepiness.

“Snoring is a major indicator of obstructive sleep apnoea (OSA), which can cause disturbed sleep and, in some cases, daytime sleepiness. This is a potential health and safety issue for everyone, but particularly when it happens to lorry and coach drivers,” says John Stradling, Emeritus Professor of Respiratory Medicine at Oxford University.

“Many lorry drivers – and others – have died because OSA often goes unrecognised or untreated and the current system actively discourages drivers who may have OSA from coming forward,” he says.

OSA not taken seriously People consulting their GP about daytime sleepiness are often not taken seriously or are tested for other conditions that present with tiredness or fatigue. If they are referred to a sleep clinic – the essential first step in diagnosing and treating OSA – it can take months to get an appointment.

Meanwhile they are likely to be forbidden to drive.

“For a professional driver, this can mean losing their job,” says Stradling. “As a result, professional drivers are reluctant to request testing, especially if they are selfemployed.”

Stradling is part of a group battling to change the situation. “Through the OSA Partnership Group, which includes

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Stradling: “Typical accidents caused by sleepiness include running off the road and ploughing into slow or stationary vehicles in front”

physicians, haulage contractors and motorists’ associations, we are pushing to raise awareness of the OSA problem and institute a nationwide ‘fast track’ system for professional drivers, which takes them from initial GP consultation through to a sleep clinic test and, if necessary, to treatment within four weeks – a period that the road haulage groups have said would be acceptable to most haulage companies.’

“This can be done,” says Stradling. “Some clinics, such as in Newcastle and Oxford already offer this, but many cannot. It requires no extra money, just a bit of reorganisation.”

Dispelling the OSA myths

John Stradling Emeritus Professor of Respiratory Medicine Oxford University

Read more on healthawareness.co.uk

Getting action on the OSA health and safety issue also requires dispelling myths about OSA. “OSA does not just affect overweight people – a third of OSA patients would not be classified as obese – though it can be exacerbated by extra weight. It is not an issue confined to overweight individuals, though with an average BMI of 32, lorry drivers are at greater risk,” he says.

The typical OSA patient is male, 55 and with a long history of snoring and recent daytime sleepiness. While not all people who snore have OSA, almost all people with OSA snore.

There are no exact figures for the

number of road accidents caused

by OSA-linked daytime sleepiness but, Stradling says: “Typical accidents caused by sleepiness include running off the road and ploughing into slowing or stationary vehicles in front. When lorries jack-knife, it is often because the driver has braked and over-corrected his steering after nodding off.”

Stradling adds: “GPs also need to be aware of OSA, and should ask specifically about daytime sleepiness, not just general tiredness. All these things can be done and we must do them to encourage professional drivers to come forward so they – and the public – are safer on the roads.”

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