Are you breathing easy? Statistics suggest that the answer may well be no. More than 12 million people in the UK — about one in five of us — have been diagnosed with asthma, chronic obstructive pulmonary disease (COPD) or another long-standing respiratory condition. And now we are entering the winter months when there is generally an 80 per cent hike in hospital admissions related to severe breathing issues.
According to the Office for National Statistics, more than 1,400 adults and children died from asthma attacks in 2018, with deaths from such severe bouts having risen by a third in England and Wales in a decade. This year may be worse still, owing to chronic lung damage caused by Covid infections. Some experts are warning of a “twindemic” of winter flu and Covid infections striking people at the same time.
For sufferers of one potentially lethal respiratory condition, however, there is good news. A new drug, dupilumab, was last month given the green light for NHS use in England, Wales and Northern Ireland (having already been approved in Scotland) for those with severe asthma whose attacks don’t respond to conventional treatments. That’s an estimated 200,000 people. A monoclonal antibody, or “mab” drug, it targets a blood chemical, immunoglobulin E, that sparks exaggerated allergic responses that can lethally inhibit asthmatics’ breathing. Mab drugs are expensive — the list price is £1,264 for two doses — but the NHS has negotiated a discount.
Dr Samantha Walker, the director of research and innovation at Asthma UK and the British Lung Foundation, calls the new drug a “potential game changer”. She says: “People with severe asthma are currently stuck in a never-ending cycle of hospital visits.” However, she adds that clinical guidelines on diagnosing severe asthma are muddled, leaving three quarters of eligible patients unable to access proper medical support. To try to tackle this, the charity has launched an online tool at asthma.org.uk to help people who think they have severe asthma and may need to press their doctors for help.
Asthma aside, there are manifold reasons why you might be experiencing breathing problems, ranging from COPD to heavy snoring and even stress. Every week about 10,000 people in the UK are newly diagnosed with a lung disease. Many more of us may experience transient symptoms — and not least because we live in stressful times.
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Such difficulties can also bring long-term emotional problems. In June researchers from King’s College London warned in the journal The Lancet Regional Health — Europe that middle-aged people with more than one respiratory problem are three times as likely to suffer depression as they get older, compared with peers who are free of such concerns. The study of more than 150,000 midlife Britons warns this has possible implications for future healthcare services if the coronavirus pandemic brings about increases in long-term respiratory issues. We really do need to protect our breathing gear.
Covid: the new danger
The aftermath of Covid-19 infections is creating an unprecedented swathe of new lung problems, warns Professor Gisli Jenkins, a respiratory physician at Imperial College London.
“Breathing problems represent 60 per cent of the symptoms in long Covid,” he told The Times. “Nearly 15 million people in the UK have been infected, so the numbers of people affected are big — tens of thousands of people will have long-term problems.”
Chronic post-Covid breathing problems are caused primarily by inflammation and scarring of the lungs that inhibits their ability to work, causing debilitating breathlessness, he says.
Jenkins is studying the extent of the problem and says that early data suggests that some 25 to 30 per cent of people whose infections led them to be hospitalised and given lung scans now have long-term problems. “Post-viral lung scarring is not a new phenomenon. We have seen it with flu. What is concerning is the number of people getting Covid all in one go,” he says.
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Jenkins is working to discover whether drugs that are normally prescribed for other conditions — for example metformin for diabetes — but which can also reduce lung scarring will help Covid patients with long-term breathing problems. He and colleagues are also trying to discover why some people develop lung scars after Covid. “It seems they may have a genetic predisposition to developing scarring,” he says. “Having high blood pressure, diabetes or heart disease also seems to increase the risk.”
Looking after our general physical health, getting regular exercise and keeping weight down are therefore crucial in minimising such risk.
Avoiding viruses is another commonsense defence. “I would expect that if you get flu on top of Covid-affected lungs that the problems would be bad,” he says. “Generally, two problems are worse than one. I would recommend that everyone with lung problems gets a flu jab and stays careful about catching Covid.”
Asthma
Asthma attacks and fatalities double during the winter months, according to survey evidence by the charity Asthma UK. Seasonal triggers include cold weather, chest infections, damp and mould, dust mites, central heating, open fires and wood-burning stoves.
The charity’s research evidence from surveys of nearly 13,000 asthmatics shows that six in ten say that cold, dry air triggers attacks. This is because it can irritate sensitive airways. It leads many to avoid the outdoors and thus miss out on vital exercise.
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As Emma Rubach, Asthma UK’s head of health advice, says: “Regular exercise boosts asthmatics’ lung power and supports their immune systems, helping to fight colds and viruses.”
She recommends that susceptible people take exercise indoors, such as playing badminton or practising yoga. “When outside, ensure your chest and throat are covered and keep a scarf around your nose — this helps warm up the air, so it’s less likely to set off your symptoms.”
Jenkins says that the risk of Covid-19 complications among younger people with mild asthma are about the same as for the general population. But he warns: “If you have severe asthma then your consequences of getting Covid are much worse.”
COPD
COPD is used to describe a number of conditions, including emphysema and chronic bronchitis. The condition affects 1.2 million people in the UK, yet doctors believe that millions more have COPD but don’t know about it.
With COPD, airways become inflamed and air sacs in the lungs are damaged. This causes airways to narrow. Symptoms of COPD include being out of breath when exercising or moving around, a persistent cough with phlegm that never goes away, wheezing and frequent chest infections.
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NHS figures show COPD to be one of the most common reasons for people being admitted to hospital during the winter months. Cold air causes sufferers’ airways to narrow even further, making breathing still more difficult. Add to this the risk of winter lung infections.
Dr David Crichton, the chairman of NHS Doncaster Clinical Commissioning Group, says: “Those with a diagnosis of COPD are at a higher risk of cold, flu and pneumonia leading to more breathing difficulties. It’s absolutely vital that patients take up their free flu and anti-pneumonia vaccinations.”
The biggest risk factor for COPD is smoking, which is believed to cause up to 90 per cent of cases. Additional risk factors for COPD may include a history of lung infections, as well as breathing in chemicals, fumes and dust.
Regular exercise is recommended to strengthen the heart and improve cardiovascular function in those with COPD, although again exercising only indoors during winter is a commonsense precaution.
Snoring
Severe snoring — called obstructive sleep apnoea (OSA) — affects an estimated 1.5 million adults in the UK. Thanks to rising obesity numbers, however, this could rise to about 8 million soon, international researchers warned in the The Lancet Respiratory Medicine last year.
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OSA occurs when the tissues at the back of the throat collapse and partly or fully block the upper airways. Even though you are still trying to breathe, there is very little or no air getting into the lungs, which causes strain on the cardiovascular system that may raise the risk of dying from heart disease by up to five times, according to evidence cited by Harvard Medical School.
Attacks of OSA worsen in winter, according to researchers in the journal Chest in 2012. The ten-year study of 7,500 sufferers says this may be due to winter-related upper-airway problems, such as infections that intensify the severity of symptoms, and a drop in indoor air quality in stuffily heated homes.
The British Lung Foundation says that for most people the best way to treat OSA is to lose weight, as more than 60 per cent of sufferers are overweight, which strains the upper airways and chest.
Improving the airflow in your bedroom by keeping a door or window open can help, according to Dutch investigators in the journal Indoor Air in 2017. Just convince yourself that it’s not a draught — it’s healthy ventilation.
Stress
Ironically, given all these health perils, stressing too much about your breathing can itself spark breathing problems. As Jenkins explains, “Many cases of breathlessness, particularly among young people, occur when they become conscious of their breathing. They start to think about it obsessively and then that starts to make them feel anxious.”
Matters can then spiral, when their anxiety makes them feel more breathless, they breathe harder and they get even more anxious. Jenkins says there is a physical cause for this: “If you hyperventilate then your levels of CO2 rise, and anxiety is a huge consequence of rising CO2.”
So this winter, we should try to do everything we can to live and breathe healthily — and breathe easily.
