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23 September 2020
Asthma , COPD
CARE, - Healthcare

Although this year it was particularly difficult to choose among the variety and intense 4 full days programme at the 2020 European Respiratory Society Congress,  EFA delegation of 8 people attended a selection of interesting sessions. We followed those discussing the latest findings on research, disease prevention and management to Inform, Prevent, Care for allergy and airways diseases such as asthma and chronic obstructive pulmonary disease. Here are our highlights!

Congratulations to ERS for such a quality gathering both in terms of content and in format. We especially appreciated your effort to allow patient advocates access the scientific sessions. That’s #ShowLeadership!



Sars-CoV-2 COVID-19 pandemic

With a full day on COVID-19 the ERS Congress highlighted that Sars-CoV-2 is, above all, a respiratory disease. It was interesting and relieving to learn from world top lung clinicians that:

  • Asthma per se does not lead to a severe COVID-19 infection requiring hospitalisation. Certainly, asthma patients are more fragile against the virus if they get it than healthy individuals but research shows that mortality rates due to coronavirus are not higher among asthma patients.
  • However, patients under oral corticosteroids are more vulnerable if infected by COVID-19 because of their disease severity and control is worse and also because of the secondary effects of thistreatment.
  • COPD and smoking are associated with a higher increase of COVID-19 severity and mortality, while the proportion of patients with COPD or smokers has been low among all patients.
  • It seems that as a consequence of a COVID-19 infection, some patients develop post-pulmonary fibrosis. More research is needed to see the prevalence and to support these patients.
  • The World Health Organisation informed they do not consider COVID-19 to come in waves, the virus is not seasonal, but rather the same strain has been continuously present, and the decrease of incidence during the summer was a consequence of the control measures adopted by countries.



Origins of respiratory diseases: early-life  

Several environmental risk factors occurring in early life (or even pre-natal, before birth) have been linked with lung function decline such as smoking parents and exposure to tobacco smoke and air pollution. Early life is important for lung health:

  • Exposures of previous generations to dangerous substances e.g. certain disinfectants may impact the development of asthma in children, while exposures in pregnancy may impact several generations. Meanwhile, exposures during early puberty seems also key.
  • Indoor air particulate matter (in moisture-damaged houses) impact the genes of the airways, leading to the activation of immune-defence related genes in human airways, which can lead to the person developing health conditions relating to their airways.
  • Other medical history aspects such as parents with asthma, respiratory infections during childhood, and prematurity are found to increase the risk of chronic pulmonary disease in terms of cause, timing and severity. Paediatricians have a key role to mitigate the risks children face and that might impact developing asthma or COPD later on.
  • We should help people to reach maximum lung capacity early in life. In fact when people with lung disease are asked whether they were born pre-term, surprisingly many have.
  • Stopping asthma treatment during pregnancy can lead severe exacerbations and among others a lower birth rate for the child.

Exposure in the workplace and respiratory disease

  • COPD and bronchitis have strong indications that workplace inhalational of hazardous substances contribute substantially to the burden of COPD. Occupational asthma bears a heavy burden too, with more than 400 risk agents identified. Exposome research can help better understand the full scale of this preventable burden.
  • There is a possible connection between the exposure of foetuses to heavy metals and the risk of developing asthma and allergic diseases early on. The results mainly referred to cadmium, which is present in batteries and tobacco. There is also a relationship between platinum salt and respiratory sensitisation in refinery workers.
  • The European Lung Foundation and the European Respiratory Society have developed an online tool allowing workers to assess whether their work poses a risk for their lung function.


Advancing tobacco control and cessation

Tobacco and vaping are harmful to health, and yet they are addictive. People wishing to quit, especially if they live with a respiratory disease, should be able to receive expert guidance and medical support.

  • From a product perspective, e-cigarette liquids were shown to be chemically unstable and to generate potent irritants for the user.
  • Evidence shows that passive vaping can trigger acute inflammatory responses in the lungs of COPD patients, which suggests that e-cigarette emissions are not merely harmless vapour but may have an actual impact on health.
  • An analysis of the flavour content of a certain e-cigarette brand across the US, the EU and Canada confirmed that menthol facilitates smoking initiation and continuation. Researchers advanced that it is important to include synthetic coolants in legislation, as they have the same effect as menthol, which is now banned in the EU Tobacco Products Directive.
  • The immediate past Chair of the European Lung Foundation and EFA Member delegate Isabel Saraiva offered compelling details of her personal story with smoking cessation. It only became possible for her through the life-saving and timely consultations with medical professionals. She lives with COPD.
  • Monica Fletcher from the Asthma UK Centre for Applied Research made a strong case for patient engagement at all levels, including in the planning of smoking cessation services, writing of guidelines and strategies, developing public health initiatives, and educating healthcare professionals and policymakers.
  • Smoking cessation training should be integral in medical curriculum at all levels. Doctors can offer valuable services through new types of interventions based on brief advice, support and treatment.
  • Heated tobacco releases compounds found in conventional tobacco cigarettes. These include carbon monoxide (CO), polycyclic aromatic hydrocarbons (PAHs) and volatile organic compounds (VOCs). Therefore, claims by the industry that these are smokeless products, aside from being false, may also undermine indoor-smoking bans.
  • There is insufficient evidence that e-cigarettes are more effective than existing smoking cessation medication. Pragmatic trials on e-cigarette use showed low quit rates. While this indicates that it can even undermine smoking cessation, many users seem to use e-cigarettes as a supplement, rather than a replacement, to conventional cigarettes.



Diagnosis, management, adherence and digital health  

  • Primary care is at the forefront of early diagnosis, which matters in order to preserve lung function, preserve quality of life, encourage smoking cessation, earlier interventions to prevent exacerbations, reducing cost and decrease mortality
  • There are large differences in the ease of use of inhalers among COPD patients and an absolute need for counselling from healthcare professionals when some inhalers are prescribed for the first time. The problem arises when in fact doctors are not trained themselves
  • Evidence shows that while intensive training on inhaler use increases adherence, after this follow up is terminated, the technique is not maintained and patients often go back to their old habits indicating the need for new patient centred strategies for self-management
  • The right inhaler technique improves patient condition and quality of life. Poor adherence to treatment and poor technique is linked to increased mortality
  • Overuse and reliance on short acting medication (SABA) in asthma, instead of the maintenance treatment can lead to increased exacerbations and mortality regardless of whether it is combined with long acting inhaled corticosteroids (ICS). There is a need to study the impact of this overuse in asthma control. The newest update of the GINA, Global Initiative for Asthma guidelines help to clarify the use of SABA.
  • Evidence from the use of an electronic application had positive results in early detection of symptom worsening. This can help prevent exacerbations and hospitalisations. A model developed to predict asthma exacerbations highlighted the importance of comorbidities in the prognosis of asthma.
  • One study explored the nurse service developed by Asthma UK and British Lung Foundation which uses Whatsapp instant advice for patients living with asthma. Users in the UK gave very positive feedback, as it improved their confidence in managing their asthma. These outcomes have significant implications for future care delivery, with virtual consultations proving a popular and effective tool to reach younger patients.
  • Chronic cough can be linked to lung diseases, nasal/throat or gastro-intestinal diseases, smoking, occupational or environmental risk factors, but it also exists without. While it is important to look at the different treatable traits, the current treatment is focusing on testing different medicines that may help. The nomenclature, the definitions and what a chronic caught or refractory cough is called is unclear and new diagnostis methods are needed, and novel methods such as cough monitoring systems can be used
  • The evidence on the usefulness of targeted digital COPD patient exercise support programmes is increasing. COPD diagnosis and the use of spirometry remain problems and while it is important to promote existing tools, new innovation is needed. During COVID-19, spirometry was scaled down because of risk of infection.
  • The future to improve lung care is a person-centered, personalized approach, supported by digital technology