Respiratory disease - Asthma, COPD, Pneumonia

The Importance Of Screening For Loneliness In COPD & Asthma

Photo Credit: Sinenkiy

Loneliness is a key risk factor for symptom exacerbations and hospitalizations in people with COPD, highlighting the need for targeted interventions.

Loneliness appears to be a more important risk factor for symptom exacerbations and acute health service use among adults with chronic obstructive pulmonary disease (COPD) than asthma, according to study findings published in the Journal of Clinical Psychology in Medical Settings.

"Given the long-term suffering involved among those with COPD, feelings of loneliness may grow more meaningful over time, whereas those with asthma may be less impacted given the acute nature of the symptomology," wrote corresponding author Patric J. Leukel and colleagues.

The study compared the relative association of loneliness and low social support with respiratory health in people with asthma and COPD. Both factors were previously linked with negative outcomes in the population, but researchers were interested in how each impacted patients individually.

"Although social support is correlated with loneliness," they explained, "low social support is neither necessary nor sufficient for the experience of loneliness."

The study included 206 adults with asthma and 308 adults with COPD. Patients reported symptom exacerbations, hospitalizations, and emergency department visits over the previous 12 months. They also completed the three-item version of the UCLA Loneliness Scale and the ENRICHD Social Support Inventory.

Researchers expected to find that loneliness and low social support would each increase the odds of exacerbations and acute care use after controlling for respiratory symptom control and other predictors.

The study showed, however, that in adults with asthma, loneliness but not social support was linked with greater hospitalization odds. Moreover, neither loneliness nor social support was associated with exacerbations or the use of other acute care services.

Among adults with COPD, loneliness was associated with greater odds of hospitalization and symptom exacerbation, as researchers had predicted. Contrary to predictions, however, greater social support also significantly increased the likelihood of symptom exacerbation, hospitalization, and emergency department visits in patients with COPD.

"We suggest two possibilities to explain these seemingly paradoxical findings," the researchers wrote. "First, it is likely that family members and friends provide more support to individuals with more severe respiratory symptoms who are also more likely to experience symptom exacerbations and use acute medical services. Second, these supporters may facilitate their support recipients' use of emergency medical care, which may subsequently increase their likelihood of hospitalizations."

COPD: More Than Just A Health Problem For The Homeless And Uninsured

Early diagnosis is key: cleaning a home is tough when breathing makes movement difficult. Open Airways is concerned about the number of their patients with COPD who are in need of more than just healthcare (Photograph supplied)

Chronic obstructive pulmonary disease is a serious, progressive illness that hits the homeless and underinsured the hardest. It's something Lindsay Bishop is seeing more and more of in her role as COPD educator for Open Airways. COPD is a chronic lung condition characterised by swollen, inflamed airways and excessive mucus which makes it difficult to breathe, especially when exhaling.

In severe cases, it can lead to oxygen dependence or leave people bedridden. It primarily affects smokers, but can also be hereditary or caused by workplace exposure to chemicals or dust.

Helping hand: Open Airways COPD educator Lindsay Bishop demonstrates the proper use of an inhaler (Photograph supplied)

Of real concern to Ms Bishop is that the charity has taken on an unsustainable role: caring not only for people's health needs, but also their entire wellbeing.

"Unfortunately, what I'm seeing more and more in the community, after 35 years of nursing, is more homeless people, more people living in cars, people living in squats, living wherever they can find shelter in town," she said.

Open Airways has typically paid for inhalers, oxygen and doctor's appointments for people that are not employed and not insured. A donor-funded programme gives added help, but only to people in desperate circumstances.

"We're finding more and more people fall into that category, and it almost becomes pointless paying for [medication] when they're sleeping rough and catching lots of colds; they're in dirtier environments, which is affecting the breathing, and they're getting pneumonia from being in contact with viruses and not being able to eat properly, sleep properly and be warm," Ms Bishop said.

"And for [COPD] patients, they're not going to get better and so our role is to educate them, so that they know how not to get worse, how to slow that deterioration down."

COPD health fair this month

Open Airways will host a COPD Health Fair on November 16 at St Paul's Church Hall in Paget.

The event is in observance of Chronic Obstructive Pulmonary Disease Awareness Month. There will also be a complimentary tea and flu shots and information on any and everything related to COPD.

"For anybody with COPD it would be wonderful if they came along – not just for the tea and the flu shots, there are going to be lots of people there with lots of good information," said Lindsay Bishop, the COPD educator for Open Airways.

Among the speakers will be a pharmacist from CG Pharmacy who will talk about the best medicines there are available in Bermuda; Maureen Ryan, a physiotherapist from Myotherapy Centre, will discuss breathing exercises and how to maximise lung capacity.

Pathways, the addiction rehabilitation centre, will discuss smoking cessation; Open Airways will provide nicotine patches for people who are "very keen to quit" but are not insured and don't have the means to pay.

Also on hand will be medical social workers, nurses from the Department of Health and representatives from Age Concern, who will offer help with any financial issues people might be facing.

Medical House will also be there, to show their supplies of oxygen and related items.

"Oxygen is not for everybody," Ms Bishop said. "It has to be prescribed by a doctor. It can be quite dangerous in COPD, but it also can be very helpful in COPD, so it has to be prescribed properly."

Ms Bishop asked that people who use inhalers bring them along "so we can show them how to best use them and check that they're on the right medications".

The COPD fair will run from 12pm to 3pm on November 16. To attend, RSVP on 536-6060 or nurse@openairways.Com

COPD health fair this month

Open Airways will host a COPD Health Fair on November 16 at St Paul's Church Hall in Paget.

The event is in observance of Chronic Obstructive Pulmonary Disease Awareness Month. There will also be a complimentary tea and flu shots and information on any and everything related to COPD.

"For anybody with COPD it would be wonderful if they came along – not just for the tea and the flu shots, there are going to be lots of people there with lots of good information," said Lindsay Bishop, the COPD educator for Open Airways.

Among the speakers will be a pharmacist from CG Pharmacy who will talk about the best medicines there are available in Bermuda; Maureen Ryan, a physiotherapist from Myotherapy Centre, will discuss breathing exercises and how to maximise lung capacity.

Pathways, the addiction rehabilitation centre, will discuss smoking cessation; Open Airways will provide nicotine patches for people who are "very keen to quit" but are not insured and don't have the means to pay.

Also on hand will be medical social workers, nurses from the Department of Health and representatives from Age Concern, who will offer help with any financial issues people might be facing.

Medical House will also be there, to show their supplies of oxygen and related items.

"Oxygen is not for everybody," Ms Bishop said. "It has to be prescribed by a doctor. It can be quite dangerous in COPD, but it also can be very helpful in COPD, so it has to be prescribed properly."

Ms Bishop asked that people who use inhalers bring them along "so we can show them how to best use them and check that they're on the right medications".

The COPD fair will run from 12pm to 3pm on November 16. To attend, RSVP on 536-6060 or nurse@openairways.Com

Three weeks ago the nurse was contacted by a COPD patient with a chest infection.

The man had been unable to call a doctor for help because he did not have a phone and he was too unwell to make his way to a pharmacy and fill a prescription.

"It was very simple for me to call the doctor and go pick up his meds, but it was going to take a week for that to improve how he was feeling," said Ms Bishop, who is raising the issue to draw attention to COPD Awareness Month observances.

"He'd been quite weak for a very long time and quite tired for a very long time and was on home oxygen.

"Because he lives alone and has no family, his house, you can imagine, was in a terrible state. It was quite dirty through no fault of his own.

"He was unable to push a mop around, unable to scrub the tub, unable to do dishes. He was pretty much bed-bound in the week before I saw him until a neighbour lent him a phone to call."

Another patient of hers lives "in the rough and has been in a squat for a while". Thanks to Open Airways his name is now on a housing list, but in the meantime he relies on others for food.

"We went to all the different helping services. He was a year too young for Ageing and Disability; Age Concern helped a little with a food card," Ms Bishop said.

"He was sleeping in a squat; the squat's now boarded up and locked with his possessions inside. So he's been sleeping outside on a wet porch, and we've been paying for inhalers for him."

The man was referred to Open Airways by the Emergency Department at King Edward VII Memorial Services after he had been admitted for treatment three times.

"We have managed to get him a card to help with some of his medications, not all, and he eats three times a week at a church. They would kindly give him more food, but he has nowhere to store it."

Open Airways is to host a mini health fair for people with COPD on November 16, between Noon and 3pm, at St Paul's Anglican Church, Paget (Photograph supplied)

An effort to get the man on financial assistance has "been a long process" because he didn't have the money to open a bank account or pay for the birth certificate he needed as proof of ID.

"So while I'd like to say that we were just helping with people's health, I'm finding more and more that this job is social work as well because we have to take care of the whole patient, not just the inhalers.

"Telling them how to use their inhaler properly is of no benefit if they can't eat or sleep," Ms Bishop said.

Also alarming to her is the rising number of individuals who are homeless because illness prevents them from working. It's a contrast with past decades, when most people were sleeping in the rough because of "alcohol, mental health, or drug issues".

"Often with COPD, patients get breathless. So if they were in a job painting or mowing grass, or doing something that required a lot of exertion, they can no longer do that job," Ms Bishop said.

Of the five patients she saw with COPD last week, three were new. It's a definite increase over what she has seen in her 30-odd years of nursing.

"The World Health Organisation says that COPD is the third leading cause of death in the world. It's a common umbrella term for diseases such as chronic bronchitis and emphysema. It's treatable, but it's not curable," she said.

Open Airways follows guidelines set by the Gold Initiative for Lung Disease and the medication that is available here is of a good quality however it's up to the patient to ensure a successful outcome.

"Best practice is that people need physio. Best practice is that people need to exercise, take the medicines properly and take care of themselves.

"Generally, it's hard to get people to increase their exercise. When they're short of breath they're very frightened [about doing that] so it's important to do that with an expert helping them, so they know how far to push themselves," Ms Bishop said.

Early diagnosis is key. Smokers and former smokers over the age of 40 should have a lung function test, which is free to anyone with insurance.

"We've got patients with COPD that are runners; we've got patients that are homebound and palliative, very end-stage and soon to die.

"So it runs the whole gamut, and not everybody reaches that oxygen homebound stage, but even for people that do, we can make sure they're very comfortable," she said.

"But it's also a case of knowing how to use the inhalers properly. And that's one of the things that our free home visits and consults do, teach you how to use these things properly."

• For more information on COPD, visitopenairways.Com

TIME100 Climate 2024: Pam Cheng

Credit - Photo-Illustration by TIME (Source Image: Paulo Nunes dos Santos—Bloomberg/Getty Images)

There are few experiences quite so frightful as the inability to draw a simple breath—something the nearly 500 million people worldwide with chronic obstructive pulmonary disease (COPD) could tell you. That's why pocket-sized, pressurized inhalers have been such a life-saving boon to this large and growing population. But the very same puffs that clear struggling lungs make a surprisingly big contribution to fouling the air around us, releasing hydrofluorocarbon propellant—a powerful greenhouse gas—into the atmosphere. Now, AstraZeneca, the maker of the Breztri inhaler, is doing something about it.

Under the leadership of Pam Cheng, the company's chief sustainability officer, Breztri may soon be released in a new package with a new propellant that has 99.9% less global warming potential than the hydrofluorocarbons now in use. The company plans to submit its regulatory filings in Europe, the U.K., and China by the end of the year. Currently, the use of AstraZeneca's consumer products contributes to the release of 6.7 million tons of greenhouse emissions per year worldwide. The new Breztri would slash that total by 1.3 million tons.

And that's not all. As part of its Ambition Carbon Zero program, the company is seeking to decarbonize its clinical trials, implementing such straightforward changes as minimizing participants' travel to their trial sites and consolidating shipments of lab kits and sample-collection materials. All of this is part of Cheng's and AstraZeneca's goal of halving the company's overall emissions—including factory output—by 2030, and cutting it by 90% by 2045. A company that is helping to give close to half a billion COPD patients their breath is taking steps to ensure that the rest of the human population benefits too.

Write to Jeffrey Kluger at jeffrey.Kluger@time.Com.

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