Can breathing exercises and ice baths make you a better, healthier version of yourself? Scientists have found there may be some benefits — but ultimately, the jury is still out.
A new review of research focuses on the "Wim Hof method," a regimen of breath-holding and cold exposure promoted by Dutch athlete Wim Hof, nicknamed "The Iceman" for performing athletic feats in extremely cold temperatures. Hof's website describes this method as having myriad benefits, such as increased willpower; fat loss; a "fortified" immune response; "balanced" hormones; and reduced inflammation.
However, the new review finds there is limited evidence for these purported benefits. Although some research hints that Hof's methods might reduce inflammation, according to the review authors, the studies done to date are simply not high-quality enough to answer the question of whether the Wim Hof method does any good.
"Due to the low methodological quality and small sample sizes, caution is necessary when interpreting the findings," study author Omar Almahayni of Warwick Medical School in the U.K., told Live Science. "While some positive effects are observed, such as attenuation of inflammation, the overall benefits remain uncertain."
Hof's method involves three activities: breathing exercises consisting of 30 deep breaths followed by a period of breath-holding; exposure to cold; and meditation focused on increasing willpower.
Separately, some of these strategies have been shown to have psychological or physiological effects. Mindfulness-based therapy, which incorporates meditation, can reduce anxiety, depression and stress, according to a 2013 review of more than 200 studies. Breathing exercises can have a small-to-medium effect on some people's stress levels, according to a 2023 review of 12 studies.
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The effect of cold exposure is — ironically — hotly debated. Some research suggests taking a polar plunge or open-ocean swimming may improve one's short-term mood and athletic performance, but much of that research has been done on small groups of people. Some studies of cold immersion have tied it to benefits like improved insulin sensitivity — but according to a 2022 review, most of those studies were small and had other limitations, such as including study subjects of only one sex and not having adequate comparison groups.
"We have lots of studies where people have reported perceiving that cold water immersion is 'good for them,' but virtually no properly controlled mechanistic studies," said Mike Tipton, a professor of human and applied physiology at the University of Portsmouth who was not involved in the new review, told Live Science in an email.
"We don't have really good clinical trials, well-controlled, adequately-powered clinical trials on cold stress," agreed Christopher Minson, an environmental physiologist at the University of Oregon who was not involved in the review. "We just don't have it."
But that doesn't necessarily mean there isn't a benefit, Minson noted. Jump into ice-cold water and your blood vessels will constrict, your heart rate will jump, and your breathing may turn into gasping. Experiencing this stress and then recovering from it may have both physical and mental effects, he said.
In a recent study, Minson and colleagues found that people experienced fewer negative emotions several hours after a cold plunge than they did just before it. They also saw declines in the stress hormone cortisol several hours after the plunge.
But overall, research on the Wim Hof method suffers from a lack of comparison to other potentially beneficial activities, Tipton said. The new review, published March 13 in the journal PLOS One, pulled together nine trials that put the method to the test. All of the trials compared Wim Hof's strategies to doing nothing at all. The review authors identified all the trials as having a high chance of returning biased results.
"This methodological approach tells us nothing about the relative benefits against other interventions," such as yoga, walking or swimming in an indoor pool, Tipton said. "Without a sham/alternative active intervention, we can learn very little about the relative value of the [Wim Hof method]."
In studies of cold exposure, a sham intervention might involve participants dousing themselves in lukewarm water for the same amount of time as another group gets the ice-bath treatment, Minson explained.
Two of the reviewed studies that investigated inflammatory responses found that the Wim Hof method was linked to lowered levels of inflammation after people adopted the practice for several days or weeks. However, these preliminary findings were hard to trust, Almahayni said.
"More evidence needs to be synthesized about the Wim Hof Method before being recommended to the public," he said.
It makes sense that the research hints at an effect of the Wim Hof method on inflammation, Minson said, as cold is generally known to reduce inflammation in the short-term. However, whether that's good for one's health depends on the situation.
Exercise triggers a transient inflammatory response that helps build muscle and thus improve performance; reducing that response can reduce the benefits of exercise. However, if someone is experiencing chronic inflammation, turning down that inflammatory response might be desirable, Minson said.
Even if there are benefits, cold immersion comes with some risks. The shock of sudden immersion in cold water can trigger hyperventilation and heart-rate changes that cause people to drown, Tipton said.
People who want to try it should first get a checkup to ensure they don't have any underlying conditions that might make a polar plunge particularly dangerous. When swimming in cold water, Tipton said, make sure that there's a lifeguard nearby. It's better to enter the water slowly rather than all at once, he added, to avoid the automatic gasping response that can cause people to inhale water into their lungs.
More properly controlled studies are needed to know whether the effects of Wim Hof's method are more than a placebo effect, Tipton said. For people who feel that cold-water immersion has improved their lives, "that is great," he said. "I just want to make sure they get these perceived benefits as safely as possible."
This article is for informational purposes only and is not meant to offer medical advice.
A new M Health Fairview clinic is confronting an exhausting disorder that has afflicted more children since the pandemic and caused alarming spikes in heart rate, blood pressure and breathing.
Dr. Matthew Ambrose said it is disheartening to see so many more cases of the condition known as POTS. But the increase at least spurred awareness, and accelerated plans for a clinic in Minneapolis that can better diagnose and treat children who in the past were dismissed.
"Sometimes they're being told outright that they are making it up, that it's all in their head," said Ambrose, a U pediatric cardiologist and the clinic's director. "It's really dispiriting to hear. They can't even be at school because they are too tired."
POTS emerged prior to the pandemic in about one in 500 children and young adults, usually after infectious diseases triggered overly aggressive responses by their immune systems. So doctors weren't shocked when POTS became more of a problem during the pandemic. An estimated 96% of Minnesota children had been infected by the end of 2022 with the coronavirus that causes COVID-19, based on a federal review of pediatric blood samples, creating a huge risk pool for the development of the disorder.
The condition bears similarities to long COVID, the lingering cognitive and physical problems that people experience after coronavirus infections, but with at least one distinguishing characteristic. POTS is short for postural orthostatic tachycardia syndrome, and it is defined by a severe and immediate increase in heart rate whenever people switch positions by sitting or standing up.
Anna Burt, 14, was a bubbly dancer, skier and cheerleader from Sioux Falls, S.D., when she was diagnosed with COVID-19 in October 2020. The resulting exhaustion left her struggling to walk, and often was marked by a pounding heartbeat that raced up to 160 beats per minute.
"Its like a big drum," the girl said.
Burt's mother, Jody, said she felt fortunate to eventually connect with Ambrose, who had observed cases of POTS prior to the pandemic and had taken a clinical and research interest in the condition. Mayo Clinic in Rochester also has specialists who treat POTS, but they didn't have appointments when Anna got sick. Her daughter had developed stomach problems and couldn't sit up, even to ride in the car to the doctor's office, along with episodes of dizziness and pain.
"She really was trapped in the house," her mother said.
Depression and anxiety often occur alongside POTS, so much that they are often mistaken as the causes of children's lethargy, research has shown. Just finding a clinician that believed Anna and her family was vital, her mother said. "We weren't getting that. Most of the time, we were getting, 'its just constipation.'"
Drinking water can reduce POTS flareups, and regular exercise and physical therapy can help patients regain function, Ambrose said. But patients often need poorly understood and even controversial medication regimens. Naltrexone treats opioid addiction but appears to reduce POTS-related fatigue. Steroids regulate water and sodium levels and can prevent or reduce attacks.
Paradoxically, beta blocker drugs that lower blood pressure were thought to worsen POTS, but studies show they help. POTS is related to the autonomic nervous system, or the portion of the nervous system that controls subconscious functions such as heart rate and body temperature.
The drugs temper the body's reaction to signals from that system, Ambrose said. "It's like being at a rock concert but wearing hearing protection."
The clinic's goal is to package together treatments that patients and families often struggled to access separately, and to keep tabs on patients through online check-ups and counseling. By following patients over time, the clinic also hopes to prove which treatments work best and how much progress children with POTS can expect to make.
"When I tell people I think we can get them to a place where they are fully functional, I mean it," Ambrose said. "But it does take work and time and trial and error ... and an Avengers Team of physical therapists."
The clinic sometimes looks for little successes, Ambrose added, giving fluid infusions to one recent patient so she had the energy just to go to prom.
Anna Burt has progressed from a wheelchair to braces to walking on her own, but she still can't run without exhaustion. She has replaced her old pursuits for now with swimming and archery. As a fidgety girl with sensitive skin, she has invented a non-irritating slime toy that she plans to sell under the brand Rainbow Slime.
She said her pain and other symptoms are under better control now, as long as she keeps up with therapy exercises and remembers her medication. She rides a recumbent bicycle at home for exercise and has returned to school for her English and writing classes. Changes day to day are imperceptible, but Anna said she has made long-term improvements and dreams of getting back to old activities.
"Sometimes I get sad. I'm just tired of doing this over and over and over again, but I wouldn't change the experience I had," she said. "Definitely a lot of parts suck, like most of it, 99% sucks. But I wouldn't be who I am now without it."
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MONDAY, March 18, 2024 (HealthDay News) -- Breathing and relaxation techniques may offer relief to some patients battling Long COVID.
In a new, small study of 20 patients, biofeedback therapy relieved both the physical and psychological symptoms of Long COVID, researchers said. Many participants had been dealing with symptoms for more than a year.
"Our biggest hope is that we've identified a way to alleviate chronic physical symptoms that are not successfully treated by standard biomedical approaches, and that we did so with a short-term, non-pharmacological model that is easily scalable," said lead author Natacha Emerson, an assistant clinical professor of psychiatry and behavioral sciences at the University of California, Los Angeles (UCLA).
Biofeedback therapy pairs breathing and relaxation techniques with visual feedback to teach people how to regulate their body temperature, heart rate and other body processes.
After six weeks of treatment, patients in this study reported they were sleeping better and had significant improvements in physical, depression and anxiety symptoms.
Three months later, they were still seeing the benefit, using fewer prescription medicines and having fewer doctor visits, researchers said.
Worldwide, an estimated 65 million people have Long COVID — persistent symptoms that linger long past the actual infection. This constellation of symptoms include depression, anxiety, sleep issues, brain fog, dizziness and heart palpitations.
"It is important to underscore that while this behavioral intervention may help symptoms, patients with Long COVID are not in control of their symptoms and are not faking or exaggerating what they report to their doctors," Emerson said in a UCLA news release.
"Whether it is a racing heart, chronic cough or fatigue, these are real symptoms, just not rooted in a disease process," she added. "Instead, we think the autonomic nervous system is off balance and signaling fight-or-flight mechanisms, similarly to what we see in panic attacks."
Emerson did note that some patients were also receiving other treatments such as acupuncture or psychotherapy, which may have contributed to the observed improvements.
Her team hopes to see similar findings from a randomized, controlled trial. They want to compare biofeedback to other treatments such as psychotherapy or pulmonary rehabilitation.
“What is exciting is that we are restoring hope in people who feared they would be disabled long-term," Emerson said. "And if this tool works, it is one they can practice long term and might apply to future periods of stress.”
More information
The U.S. Centers for Disease Control and Prevention has more about Long COVID.
SOURCE: UCLA Health Sciences, news release, March 13, 2024
Breathing and relaxation techniques may offer relief to some patients battling Long COVID.
In a new, small study of 20 patients, biofeedback therapy relieved both the physical and psychological symptoms of Long COVID, researchers said. Many participants had been dealing with symptoms for more than a year.
"Our biggest hope is that we've identified a way to alleviate chronic physical symptoms that are not successfully treated by standard biomedical approaches, and that we did so with a short-term, non-pharmacological model that is easily scalable," said lead author Natacha Emerson, an assistant clinical professor of psychiatry and behavioral sciences at the University of California, Los Angeles (UCLA).
Biofeedback therapy pairs breathing and relaxation techniques with visual feedback to teach people how to regulate their body temperature, heart rate and other body processes.
After six weeks of treatment, patients in this study reported they were sleeping better and had significant improvements in physical, depression and anxiety symptoms.
Three months later, they were still seeing the benefit, using fewer prescription medicines and having fewer doctor visits, researchers said.
Worldwide, an estimated 65 million people have Long COVID — persistent symptoms that linger long past the actual infection. This constellation of symptoms include depression, anxiety, sleep issues, brain fog, dizziness and heart palpitations.
"It is important to underscore that while this behavioral intervention may help symptoms, patients with Long COVID are not in control of their symptoms and are not faking or exaggerating what they report to their doctors," Emerson said in a UCLA news release.
"Whether it is a racing heart, chronic cough or fatigue, these are real symptoms, just not rooted in a disease process," she added. "Instead, we think the autonomic nervous system is off balance and signaling fight-or-flight mechanisms, similarly to what we see in panic attacks."
Emerson did note that some patients were also receiving other treatments such as acupuncture or psychotherapy, which may have contributed to the observed improvements.
Her team hopes to see similar findings from a randomized, controlled trial. They want to compare biofeedback to other treatments such as psychotherapy or pulmonary rehabilitation.
“What is exciting is that we are restoring hope in people who feared they would be disabled long-term," Emerson said. "And if this tool works, it is one they can practice long term and might apply to future periods of stress.”
Joint pain can be a symptom of many different health conditions, such as arthritis, or it can simply be a sign of ageing.
According to Dr Dawn Harper, an NHS doctor for over 30 years and author of Live Well to 101, joint pain can be "emotionally and physically taxing" and impact the mental health of sufferers.
"Chronic or persistent pain can impact a person's physical capabilities, ability to work and their relationships with loved ones," she says. "Over time, these lifestyle restrictions can also affect sufferers' mental and emotional health. As such, it's important to find self-management strategies that not only support physical health, but also mental and emotional well-being."
Dr Harper has shared her top tips for managing persistent joint pain.
Protect your mental wellbeing
If you suffer from joint pain, remember that you need to look after your mental health as well as your body.
"Almost three-quarters (73%) of joint pain sufferers have experienced anxiety or depression," the expert explains. "To help protect your mental well-being, try implementing relaxation techniques that can support your ability to manage the emotions which may accompany joint pain. Meditation and breathing exercises are great options, or, if you're able, try a gentle yoga flow or walk in nature."
Talk to friends and family
Talking to your loved ones when you are going through a difficult time will help you feel supported and heard.
"It can be difficult for friends and family to feel connected when someone is dealing with chronic or persistent pain, but it's important not to hide your pain from loved ones," Dr Harper notes. "Communicating your symptoms and the way pain affects your life with family and friends can help them understand how to support you."
Try proven treatments
Over-the-counter painkillers and lifestyle changes, such as regular, gentle exercise, are the most common treatments for joint pain.
"One option could be the galactolipid, GOPO, a compound derived from rosehip, with research indicating that it can effectively relieve joint pain," she explains. "The natural anti-inflammatory properties of GOPO make it a viable replacement to pain killers, without the risk of harmful side effects."
In conclusion, Dr Harper advises, "If you do want to try a joint health supplement, always consult your doctor or pharmacist first who can advise on the best treatment for your symptoms."
Asthma is a common and disabling disease, with an estimated cumulative prevalence of 8–10% among adults in Western Europe, including the Nordic countries.1,2 Along with increasing asthma prevalence, a surge in asthma mortality was seen between the 1960s and 1980s. The increased mortality from asthma could later at least partly be attributed to overuse of the β2-agonist fenoterol. The mortality declined substantially following stricter regulations, less use,3 and the introduction of the inhaled corticosteroid (ICS) based asthma treatment approach.4
Today, age-standardized mortality rates for asthma are low in most parts of Europe (0.7–0.9 per 100,000 in 2019 in the Nordic countries).5 Causes of death may be misclassified or incomplete at higher ages,6,7 especially when asthma is one component in a multi-morbid patient. Assessment of all-cause mortality is important to capture the entire burden of this common disease.
The Nordic countries are welfare states with high educational level. Despite similarities in legislation, culture and traditions, there are differences in mortality between and within these countries, partly related to socioeconomic factors.8–10 Although respiratory disease11 and low socioeconomic status (SES) both may be associated with mortality, it is unclear whether and to what extent education may modify mortality among individuals with asthma in these countries. Education by itself might improve health literacy12 and asthma control13 but it is also important to recognize other lifestyle factors that are related to both educational level and asthma control which can act as mediators between these two, such as obesity and smoking.
The Nordic EpiLung Study is a consortium with a remit to catalyze population-based surveys and Nordic registers to understand the contribution of SES to the burden of obstructive airway diseases across the Nordic countries. Within this framework, the large population-based Obstructive Lung Disease in Northern Sweden (OLIN) Studies, the West Sweden Asthma Study (WSAS), and the Trøndelag Health Study (HUNT) in mid-Norway collaborate. The aim here was to study 1) if asthma still is a risk factor for mortality and 2) how educational level influences asthma related mortality.
Materials and Methods
Study Populations
OLIN and WSAS in Sweden
In 2006, a postal questionnaire was sent to 7997 randomly sampled individuals aged 20–69 years residing in Norrbotten, the northernmost county of Sweden, within the framework of the OLIN studies, and n = 6165 (77% of invited) participated.2 In 2008, the same questionnaire was sent to a random sample of n = 30,000 aged 17–74 years in the region of Västra Götaland within the WSAS, and n = 18,087 (60%) responded.14 The questionnaire includes questions on asthma, respiratory symptoms including wheeze and attacks of shortness of breath, asthma medication use, and related factors such as smoking. The questionnaire has been used in several national and international surveys2 and is validated.15 In order to include a working-age sample, data from participants 30–69 years of age from OLIN (n=5224) and WSAS (n = 13,132) were pooled, resulting in a total sample size of 18,356.
HUNT in Norway
During 2006–2008, all residents aged 20 years or older in northern Trøndelag county (located in central Norway) were invited to questionnaires, interview, and clinical examinations in the third survey of HUNT. Totally, 50,807 participated (54% of invited).16 During the HUNT3 Survey, all participants were asked to provide information on having/ever had asthma or attacks of wheeze and/or shortness of breath. In the HUNT3 Lung Study, further detailed data on respiratory symptoms and asthma medication use was obtained. In total, 37,973 participants aged 30–69 years were included in the current study.
Ethical Approvals
All participants provided written informed consent, and the Swedish Ethical Review Authority (2023-00773-01) and The Regional Committee for Medical and Health Research Ethics in Norway (2017/2364/REK midt) approved the studies. The study complied with the declaration of Helsinki.
Asthma
Current asthma was defined as self- reported ever having had asthma in combination with at least one of the following during the last 12 months: a) any wheeze, b) shortness of breath or c) use of asthma medication.
Smoking and Educational Level
Smoking habits were categorized as non-smokers, ex-smokers (having quit more than one year earlier), or smokers. Smokers were further divided by the average number of cigarettes smoked daily into three groups: a) <5, b) 5–14, or c) >14 cigarettes/day. A dichotomized variable including ever smokers (current and ex-smokers) and never smokers was also created.
Educational level was linked from the national LISA database in Sweden and Statistics Norway in Norway as a proxy measure of SES and grouped into primary (<12 years), upper secondary (12–13 years), and tertiary (ie, university) education.
Mortality
Data on 10-year all-cause mortality was linked from the Swedish and Norwegian Cause of Death Registers. In WSAS, the number of person-years in the study was available as whole years only, in contrast to person-years with one decimal point in OLIN and HUNT.
Statistical Analysis
SPSS version 26 (IBM), Stata version 15.1 (StataCorp., College Station, Texas) and R 4.2.1 software (www.r-project.org) were used for statistical calculations. All statistics were calculated separately for Sweden and Norway. Chi-square tests were performed to compare proportions across groups, and t-test or ANOVA, as appropriate, to compare means. Mortality incidence curves were computed. P-values <0.05 were considered statistically significant.
Cox proportional hazards regression models were used to estimate hazard ratios (HR) with 95% confidence intervals (CI) for the association between current asthma and mortality. The regression analyses were performed crude and adjusted, with age, sex and smoking as covariates in the models. The smoking covariate included the following five categories: non-smokers, former smokers, and current smokers divided into three groups: a) <5, b) 5–14, or c) >14 cigarettes/day. The models based on Swedish data were additionally adjusted for cohort (WSAS/OLIN). These analyses were performed among all and also stratified by educational level, smoking habits and sex. Schoenfeld’s global test to test the proportional hazards assumption in the Cox proportional hazards model was applied.
Meta-analysis with fixed effect was used to pool estimates from the regression models from both countries, using the metafor package in R. The proportion (%) of mortality risk attributable to current asthma, ie, the attributable risk, was calculated according to Levin’s formula, as follows (based on crude HR): , where Pa is the prevalence of asthma.
Supplementary Analysis
The regression analyses were also performed without smoking as covariate in the models, as smoking can be considered downstream in the causal pathway from educational level. As data on body mass index (BMI), physical activity and comorbidity (cardiovascular disease, blood pressure medication, diabetes, anxiety, and depression) were available in HUNT, we additionally adjusted for these variables in the Norwegian sample. As further supplementary materials, Cox proportional hazards regression models were used to estimate HR with 95% CI for the association between educational level (with tertiary education as reference category) and mortality among participants with and without current asthma. These models were performed crude, as well as adjusted for age, sex and smoking. The models based on Swedish data were additionally adjusted for cohort (WSAS/OLIN). The statistical interaction between current asthma and educational level was evaluated by including current asthma, educational level and an interaction term for these two variables as covariates in the Cox regression models among all participants described above.
Results
Characteristics at Baseline
In Sweden, the proportion of women was 53.1 and the mean age 49.9 years, with corresponding figures of 54.0% and 50.9 years in Norway. In Sweden, 16.7% were current smokers and 15.7% had primary educational level, compared to 27.6% and 21.0% in Norway. In Norway, the proportion with primary educational level was 20.6% in participants without current asthma and 26.1% in those with current asthma, while it was 15.7% regardless of having current asthma or not in Sweden (Table 1).
Table 1 Baseline Characteristics in Sweden and Norway, Among Participants with and without Asthma, and Among All
Low Educational Level as Risk Factor for Mortality
Persons with primary compared to tertiary education had higher mortality in both countries independent of having asthma or not (Table 2, Supplemental Table 1), also when stratified for smoking (Supplemental Tables 2 and 3).
Table 2 10-Year Mortality and Attributable Mortality Risk Due to Asthma, Stratified by Educational Level and Among All
Asthma as Risk Factor for Mortality
Current asthma was significantly associated with higher all-cause 10-year mortality in both countries (Figure 1), in Sweden with 6.7 vs 5.0 deaths/1000 person-years in individuals with vs without asthma, and with corresponding figures of 7.6 vs 3.8 in Norway (Table 2). When pooled, 5.5% of deaths were attributable to current asthma. The hazard ratios (HR) for current asthma were 1.58 (95% CI 1.28–1.95) in Sweden, 1.78 (1.54–2.06) in Norway, and a pooled adjusted estimate of 1.71 (1.52–1.93) when adjusted for age, sex and smoking (Figure 2). The association between current asthma and mortality was slightly stronger in women than men with HR 1.84 (95% CI 1.56–2.19) in women and 1.61 (1.36–1.90) in men, and in ever-smokers compared to non-smokers (HR 1.79 (1.56–2.05) vs 1.48 (95% CI 1.14–1.92)) (Figure 3).
Figure 1 Mortality incidence curves among adults with asthma (red) compared to without asthma (black) and stratified by education.
Figure 2 Asthma as a risk factor for 10-year mortality, among all participants and stratified by educational levels. Results are expressed as Hazard ratios with 95% Confidence intervals (CI) from crude Cox proportional hazard models, and from models adjusted for age, sex and smoking.
Figure 3 Asthma as a risk factor for 10-year mortality, among men, women, non-smokers, and ever-smokers, in all and stratified by educational levels. Results are expressed as Hazard ratios with 95% Confidence intervals (CI) from crude Cox proportional hazard models, and from models adjusted for age, sex and smoking.
Influence of Educational Level on Mortality Associated to Asthma
Stratification by level of education showed higher hazard for death related to current asthma by lower education with pooled adjusted HR 1.80 (1.48–2.18), HR 1.70 (1.43–2.02) and HR 1.39 (0.99–1.95) in those with primary school, upper secondary and tertiary education, respectively. This gradient was slightly clearer in Norway than in Sweden, but in both countries, the risk was lowest in those with tertiary education (Figure 2). The analysis on interaction between asthma and educational level yielded a pooled crude HR of 1.16 (95% CI 0.97–1.39) and adjusted HR of 1.12 (95% CI 0.94–1.34). Similar estimates were found in both sexes and in both countries (Figure 3), and inclusion of BMI, physical activity and comorbidity as covariates in the Norwegian data did not alter the results (Supplemental Table 4). Further, adjusting for age and sex only and not for smoking or BMI also yielded similar findings (Supplemental Table 5). Stratifying for smoking yielded wider confidence intervals and slightly less clear associations in non-smokers than in ever-smokers, but the association between current asthma and mortality was consistently weakest among those with tertiary education, regardless of smoking habits (Figure 3).
Discussion
In summary, this study of >56,000 working-age adults from two affluent Nordic countries showed that current asthma was associated with about 71% increased risk for all-cause mortality, and that 5.5% of all deaths could be attributed to asthma. Asthma was associated with increased all-cause mortality in both sexes and in ever-smokers as well as in non-smokers. When comparing the hazard of all-cause mortality related to current asthma by level of education, the risk was most increased in individuals with primary educational level and lowest in individuals with tertiary educational level.
We found a substantially increased mortality related to asthma. Ours is one of the first population-based studies reporting an increased all-cause mortality among adults with asthma vs those without asthma in the high income countries Norway and Sweden. In line with our findings of a substantially increased mortality, one Swedish register-based study on children and young adults found an increase in all-cause mortality related to asthma,17 and population-based studies from the 1990s on adults in the neighboring Finland18,19 and Denmark20–22 have yielded similar results. There is also one Finnish study with data from early 2000s,23 and results from both the US11 and other European countries24,25 that support an increased risk for all-cause mortality related to having asthma in adulthood, although there are also a few studies showing no such increased risk.25,26
In low-income countries, overuse of short-acting beta2-agonists is a potential explanation for increased mortality in individuals with asthma as patients cannot afford to buy costly asthma medication such as ICS. In Norway and Sweden, such treatment is reimbursed, and costs should have less influence on purchased treatment.10 However, lack of adherence is a problem in all countries. New guidelines27 recommend use of ICS whenever the patient uses SABA, and specifically ICS-formoterol both as maintenance and reliever medication. This reduces the risk of severe exacerbations and hospitalizations28 and could be expected to decrease mortality29 when this change is implemented in health care. This treatment approach is recommended in Norway from 2022 and in Sweden from 2023.
Some individuals with asthma develop chronic airway obstruction and COPD, mainly due to tobacco smoking but also due to more severe disease with ongoing inflammation. For some years the co-existence of asthma and COPD has been labelled Asthma COPD Overlap (ACO), and it has been shown that these patients have more respiratory symptoms, more exacerbations, poor quality of life, more rapid decline in lung function, higher mortality than patients with asthma or COPD alone.30,31 In contrast to our findings, a large population-based Danish study found an increased asthma-related risk for all-cause mortality among smokers but not among never-smokers.32 We found associations between asthma and mortality both in non-smokers and in ever-smokers, even though the risk was slightly more increased in ever-smokers, indicating an independent association.
Level of education influenced mortality related to asthma in our study, as we found the highest risk in those with primary education, while the risk was lowest in those with tertiary education, although no significant statistical interaction was found. Several studies have found that individuals with lower levels of education are more likely to have asthma than those with higher levels of education,33,34 and there are several potential explanations for this relationship. Individuals with lower levels of education may, eg, be more likely to work in jobs that expose them to environmental triggers for asthma, such as air pollution or irritants in the workplace.27,35 They may also have less access to healthcare and be less likely to afford or seek medical treatment for their symptoms, which could lead to worse asthma control and clinical outcomes.13
Additionally, low educational level increases the risk for life style factors related to poorer health outcomes,9 such as smoking, less healthy diet or lack of exercise, which can contribute to the development of asthma.34 Low education can also relate to low asthma control,13 level of health literacy12 and less knowledge and understanding about asthma and how to effectively manage the disease, including adherence to medications and improper inhaler technique.36 Further, individuals with lower levels of education may be more likely to experience anxiety, which can worsen asthma symptoms.37 Additionally, they may not have access to resources to manage their stress or mental health, which potentially can further exacerbate their asthma.
It is important to note that the relationship between SES and asthma is complex and likely influenced by multiple factors. As these are mainly downstream from educational level in the pathway to asthma, they should not be adjusted for when analyzing relationships with SES, but are certainly of utmost importance for enabling preventive measures. Nevertheless, to enable comparisons with another studies, we performed our analyses crude and also adjusted for smoking and BMI which are risk factors for a plethora of adverse health outcomes. However, adjustment meant only minor changes of our estimates. however. More research is needed to fully understand the mechanisms mediating this relationship and to develop effective interventions to reduce the burden of asthma in individuals with low educational attainment. Addressing educational disparities and increasing access to healthcare and resources has the potential to reduce asthma disparities and improve health on a population level.
Regarding limitations of the current study, we cannot exclude residual confounding, eg, by tobacco smoking. In attempt to investigate this, we stratified the analyses for sex and smoking habits and found associations between asthma and mortality in both men and women and never- and ever smokers, which is supportive of our findings of increased all-cause mortality among individuals with asthma. Another limitation in the stratified analyses was that we combined current and former smokers into one ever smoker category, which was necessary to keep statistical power. Current asthma was further defined by self-report instead of clinical examinations including spirometry, and thus the validity could be questioned. In Sweden, clinical validation studies on the survey question about physician-diagnosed asthma in adults with incident asthma have, however, shown a positive predictive value of >90%.38 Those with well-controlled asthma may not be included in our definition of current asthma, and one could speculate that misclassification of these people may have attenuated the results. Regarding strengths, large population samples from two countries were included, yielding a total sample size of >56,000. Valid data on educational level and all-cause mortality were linked from national registries in Sweden and Norway and none or only limited selection bias has been found in the epidemiological surveys.14,16,39
Conclusion
In conclusion, asthma associated with a 71% increased risk for all-cause mortality and about 5.5% of deaths from all causes can be attributed to asthma. Educational level modified the risk of mortality associated with asthma, as the risk was highest in individuals with primary educational level and lowest in individuals with tertiary educational level.
Abbreviations
ATS, American Thoracic Society; BMI, Body Mass Index; COPD, Chronic Obstructive Pulmonary Disease; CI, Confidence Interval; ERS, European Respiratory Society; HR, Hazard Ratio; HUNT, Trøndelag Health Study; SES, Socioeconomic status; ICS, Inhaled Corticosteroids; OLIN, Obstructive Lung Disease in Northern Sweden; WSAS, West Sweden Asthma Study.
Acknowledgments
Helena Backman and Laxmi Bhatta are co-first authors of this study. Eva Rönmark and Arnulf Langhammer are co-senior authors of this study. We would especially like to acknowledge the participants in the OLIN, WSAS and HUNT studies. Also, the late Bo Lundbäck, founder of the OLIN and WSAS studies, and the research staff is acknowledged for their excellent work.
The Trøndelag Health Study (HUNT) is a collaboration between HUNT Research Centre (Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology NTNU), Trøndelag County Council, Central Norway Regional Health Authority, and the Norwegian Institute of Public Health.
Funding
Financial support was provided by the Nordic Council, the Swedish Research Council for Health, Working Life and Welfare (FORTE, Dnr 2022-00381), the Swedish Research Council, the Swedish Heart-Lung foundation, Northern County Councils’ Regional Federation, a regional agreement between Umeå University and Västerbotten County Council (ALF), Region Norrbotten, the VBG Group Herman Krefting Foundation for Asthma and Allergy Research, Sweden, the Swedish Asthma and Allergy Foundation, and ALF agreement (Grants from the Swedish state under the agreement between the Swedish Government and the county councils). LB and BB received support from the K.G. Jebsen Center for Genetic Epidemiology funded by Stiftelsen Kristian Gerhard Jebsen; Faculty of Medicine and Health Sciences, NTNU; The Liaison Committee for education, research and innovation in Central Norway; and the Joint Research Committee between St Olavs Hospital and the Faculty of Medicine and Health Sciences, NTNU.
Disclosure
HB reports personal fees from AstraZeneca, Boehringer Ingelheim and GSK, outside the submitted work. SAAV reports personal fees from AstraZeneca, outside the submitted work. ALi reports personal fees from AstraZeneca, Boehringer Ingelheim, GSK and Novartis, outside the submitted work. HK reports personal fees from GSK, Boehringer Ingelheim, AstraZeneca, MSD, Novartis, Orion Pharma and SanofiGenzyme, outside the submitted work. ALa reports personal fees from SanofiGenzyme, outside the submitted work. The authors report no other conflicts of interest in this work.
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Expanded savings programs build on company’s longstanding commitment to addressing barriers to access and affordability for patients
AstraZeneca announced it will expand the savings programs for its entire US inhaled respiratory portfolio, helping eligible patients pay no more than $35 per month for their medicine.* Expanding the savings programs will help make its inhalers more affordable to the most vulnerable patients living with asthma and chronic obstructive pulmonary disease (COPD), including those who are uninsured and underinsured.
Pascal Soriot, Chief Executive Officer, AstraZeneca, said: “AstraZeneca’s expanded savings programs build on our longstanding commitment to addressing barriers to access and affordability for patients living with respiratory diseases to ultimately help patients lead healthier lives. We remain dedicated to addressing the need for affordability of our medicines, but the system is complex and we cannot do it alone. It is critical that Congress bring together key stakeholders to help reform the healthcare system so patients can afford the medicines they need, not just today, but for the future.”
Starting June 1, 2024, eligible patients will pay no more than $35 per month for all AstraZeneca US inhaled respiratory medicines, including:
AIRSUPRA® (albuterol and budesonide)
BEVESPI AEROSPHERE® (glycopyrrolate and formoterol fumarate) Inhalation Aerosol
BREZTRI AEROSPHERE® (budesonide, glycopyrrolate, and formoterol fumarate) Inhalation Aerosol
SYMBICORT® (budesonide and formoterol fumarate dihydrate) Inhalation Aerosol
In addition, AstraZeneca substantially reduced the list price of SYMBICORTon January 1, 2024. The Company will continue to provide discounts and rebates off the list price to help patients afford its inhaled respiratory medicines.
For more than 50 years, AstraZeneca has served respiratory patients by investing in the research and development of new drug-device combinations, as well as next-generation biologics and novel mechanisms to address the vast unmet needs of these chronic, often debilitating diseases. AstraZeneca remains dedicated to transforming patient outcomes, while ensuring access and affordability of our innovative medicines.
*Terms and conditions apply. Government restrictions exclude people enrolled in federal government insurance programs from co-pay support.
IMPORTANT SAFETY INFORMATION
AIRSUPRA® (albuterol and budesonide)
Contraindications: Hypersensitivity to albuterol, budesonide, or to any of the excipients
Deterioration of Asthma: Asthma may deteriorate acutely over a period of hours or chronically over several days or longer. If the patient continues to experience symptoms after using AIRSUPRA or requires more doses of AIRSUPRA than usual, it may be a marker of destabilization of asthma and requires evaluation of the patient and their treatment regimen
Paradoxical Bronchospasm: AIRSUPRA can produce paradoxical bronchospasm, which may be life threatening. Discontinue AIRSUPRA immediately and institute alternative therapy if paradoxical bronchospasm occurs. It should be recognized that paradoxical bronchospasm, when associated with inhaled formulations, frequently occurs with the first use of a new canister
Cardiovascular Effects: AIRSUPRA, like other drugs containing beta2-adrenergic agonists, can produce clinically significant cardiovascular effects in some patients, as measured by pulse rate, blood pressure, and/or other symptoms. If such effects occur, AIRSUPRA may need to be discontinued. In addition, beta-agonists have been reported to produce electrocardiogram (ECG) changes, such as flattening of the T wave, prolongation of the QTc interval, and ST-segment depression. Therefore, AIRSUPRA, like all sympathomimetic amines, should be used with caution in patients with cardiovascular disorders, especially coronary insufficiency, cardiac arrhythmias, and hypertension
Do Not Exceed Recommended Dose: Clinically significant cardiovascular effects and fatalities have been reported in association with excessive use of inhaled sympathomimetic drugs
Hypersensitivity Reactions, Including Anaphylaxis: Can occur after administration of albuterol sulfate and budesonide, components of AIRSUPRA, as demonstrated by cases of anaphylaxis, angioedema, bronchospasm, oropharyngeal edema, rash, and urticaria. Discontinue AIRSUPRA if such reactions occur
Risk of Sympathomimetic Amines with Certain Coexisting Conditions: AIRSUPRA, like all therapies containing sympathomimetic amines, should be used with caution in patients with convulsive disorders, hyperthyroidism, or diabetes mellitus and in patients who are unusually responsive to sympathomimetic amines
Hypokalemia: Beta-adrenergic agonist medicines may produce significant hypokalemia in some patients. The decrease in serum potassium is usually transient, not requiring supplementation
Immunosuppression and Risk of Infections: Due to possible immunosuppression from the use of inhaled corticosteroids (ICS), potential worsening of infections could occur. Use with caution. A more serious or fatal course of chickenpox or measles can occur in susceptible patients
Oropharyngeal Candidiasis: Has occurred in patients treated with ICS agents. Monitor patients periodically. Advise patients to rinse his/her mouth with water, if available, without swallowing after inhalation
Hypercorticism and Adrenal Suppression: May occur with very high doses in susceptible individuals. If such changes occur, consider appropriate therapy
Reduction in Bone Mineral Density: Decreases in bone mineral density have been observed with long-term administration of ICS. For patients at high risk for decreased bone mineral density, assess initially and periodically thereafter
Glaucoma and Cataracts: Have been reported following the long-term administration of ICS, including budesonide, a component of AIRSUPRA
Effects on Growth: Orally inhaled corticosteroids, including budesonide, may cause a reduction in growth velocity when administered to pediatric patients. The safety and effectiveness of AIRSUPRA have not been established in pediatric patients, and AIRSUPRA is not indicated for use in this population
Most common adverse reactions (incidence ≥ 1%) are headache, oral candidiasis, cough, and dysphonia
Drug Interactions: AIRSUPRA should be administered with caution to patients being treated with:
Strong cytochrome P450 3A4 inhibitors (may cause systemic corticosteroid effects)
Short-acting bronchodilators (concomitant use of additional beta-agonists with AIRSUPRA should be used judiciously to prevent beta-agonist overdose)
Beta-blockers (may block pulmonary effects of beta-agonists and produce severe bronchospasm)
Diuretics or non-potassium-sparing diuretics (may potentiate hypokalemia or ECG changes). Consider monitoring potassium levels
Monoamine oxidase inhibitors (MAOI) or tricyclic antidepressants (Use AIRSUPRA with extreme caution; may potentiate effect of albuterol on the cardiovascular system)
Use AIRSUPRA with caution in patients with hepatic impairment, as budesonide systemic exposure may increase. Monitor patients with hepatic disease
BEVESPI AEROSPHERE® (glycopyrrolate and formoterol fumarate) Inhalation Aerosol
CONTRAINDICATIONS
All long-acting beta2-adrenergic agonists (LABAs), including formoterol fumarate, are contraindicated in patients with asthma without use of an inhaled corticosteroid. BEVESPI is not indicated for the treatment of asthma. BEVESPI is contraindicated in patients with hypersensitivity to glycopyrrolate, formoterol fumarate, or to any component of the product.
WARNINGS AND PRECAUTIONS
The safety and efficacy of BEVESPI AEROSPHERE in patients with asthma have not been established. BEVESPI AEROSPHERE is not indicated for the treatment of asthma
Use of LABAs as monotherapy (without inhaled corticosteroids [ICS]) for asthma is associated with an increased risk of asthma-related death. These findings are considered a class effect of LABA monotherapy. When LABAs are used in fixed-dose combination with ICS, data from large clinical trials do not show a significant increase in the risk of serious asthma-related events (hospitalizations, intubations, death) compared to ICS alone. Available data do not suggest an increased risk of death with use of LABAs in patients with chronic obstructive pulmonary disease (COPD)
BEVESPI should not be initiated in patients with acutely deteriorating COPD, which may be a life-threatening condition
BEVESPI should not be used for the relief of acute symptoms (ie, as rescue therapy for the treatment of acute episodes of bronchospasm). Acute symptoms should be treated with an inhaled short-acting beta2-agonist (SABA)
BEVESPI should not be used more often or at higher doses than recommended, or with other LABAs, as an overdose may result
If paradoxical bronchospasm occurs, discontinue BEVESPI immediately and institute alternative therapy
If immediate hypersensitivity reactions occur, in particular, angioedema, urticaria, or skin rash, discontinue BEVESPI at once and consider alternative treatment
BEVESPI can produce a clinically significant cardiovascular effect in some patients, as measured by increases in pulse rate, blood pressure, or symptoms. If such effects occur, BEVESPI may need to be discontinued
Use with caution in patients with convulsive disorders, thyrotoxicosis, diabetes mellitus, ketoacidosis, and in patients who are unusually responsive to sympathomimetic amines
Be alert to hypokalemia and hyperglycemia
Worsening of narrow-angle glaucoma or urinary retention may occur. Use with caution in patients with narrow-angle glaucoma, prostatic hyperplasia, or bladder-neck obstruction, and instruct patients to contact a physician immediately if symptoms occur
ADVERSE REACTIONS
The most common adverse reactions with BEVESPI (≥2% and more common than placebo) were cough, 4.0% (2.7%) and urinary tract infection, 2.6% (2.3%).
DRUG INTERACTIONS
Use caution if administering additional adrenergic drugs because the sympathetic effects of formoterol may be potentiated
Concomitant treatment with xanthine derivatives, steroids, or diuretics may potentiate any hypokalemic effect of formoterol
Use with caution in patients taking non-potassium-sparing diuretics, as the ECG changes and/or hypokalemia may worsen with concomitant beta2-agonists
The action of adrenergic agonists on the cardiovascular system may be potentiated by monoamine oxidase inhibitors, tricyclic antidepressants, or other drugs known to prolong the QTc interval. Therefore, BEVESPI should be used with extreme caution in patients being treated with these agents
Use beta-blockers with caution as they not only block the therapeutic effects of beta-agonists, but may produce severe bronchospasm in patients with COPD
Avoid co-administration of BEVESPI with other anticholinergic-containing drugs as this may lead to an increase in anticholinergic adverse effects
INDICATION
BEVESPI AEROSPHERE is a combination of glycopyrrolate, an anticholinergic, and formoterol fumarate, a long-acting beta2-adrenergic agonist (LABA), indicated for the maintenance treatment of patients with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and/or emphysema.
LIMITATION OF USE
Not indicated for the relief of acute bronchospasm or for the treatment of asthma.
BREZTRI AEROSPHERE® (budesonide, glycopyrrolate, and formoterol fumarate) Inhalation Aerosol
BREZTRI is contraindicated in patients who have a hypersensitivity to budesonide, glycopyrrolate, formoterol fumarate, or product excipients
BREZTRI is not indicated for treatment of asthma. Long-acting beta2-adrenergic agonist (LABA) monotherapy for asthma is associated with an increased risk of asthma-related death. These findings are considered a class effect of LABA monotherapy. When a LABA is used in fixed-dose combination with ICS, data from large clinical trials do not show a significant increase in the risk of serious asthma-related events (hospitalizations, intubations, death) compared with ICS alone. Available data do not suggest an increased risk of death with use of LABA in patients with COPD
BREZTRI should not be initiated in patients with acutely deteriorating COPD, which may be a life-threatening condition
BREZTRI is NOT a rescue inhaler. Do NOT use to relieve acute symptoms; treat with an inhaled short-acting beta2-agonist
BREZTRI should not be used more often than recommended; at higher doses than recommended; or in combination with LABA-containing medicines, due to risk of overdose. Clinically significant cardiovascular effects and fatalities have been reported in association with excessive use of inhaled sympathomimetic drugs
Oropharyngeal candidiasis has occurred in patients treated with orally inhaled drug products containing budesonide. Advise patients to rinse their mouths with water without swallowing after inhalation
Lower respiratory tract infections, including pneumonia, have been reported following ICS. Physicians should remain vigilant for the possible development of pneumonia in patients with COPD as the clinical features of pneumonia and exacerbations frequently overlap
Due to possible immunosuppression, potential worsening of infections could occur. Use with caution. A more serious or fatal course of chickenpox or measles can occur in susceptible patients
Particular care is needed for patients transferred from systemic corticosteroids to ICS because deaths due to adrenal insufficiency have occurred in patients during and after transfer. Taper patients slowly from systemic corticosteroids if transferring to BREZTRI
Hypercorticism and adrenal suppression may occur with regular or very high dosage in susceptible individuals. If such changes occur, consider appropriate therapy
Caution should be exercised when considering the coadministration of BREZTRI with long-term ketoconazole and other known strong CYP3A4 Inhibitors. Adverse effects related to increased systemic exposure to budesonide may occur
If paradoxical bronchospasm occurs, discontinue BREZTRI immediately and institute alternative therapy
Anaphylaxis and other hypersensitivity reactions (eg, angioedema, urticaria or rash) have been reported. Discontinue and consider alternative therapy
Use caution in patients with cardiovascular disorders, especially coronary insufficiency, as formoterol fumarate can produce a clinically significant cardiovascular effect in some patients as measured by increases in pulse rate, systolic or diastolic blood pressure, and also cardiac arrhythmias, such as supraventricular tachycardia and extrasystoles
Decreases in bone mineral density have been observed with long-term administration of ICS. Assess initially and periodically thereafter in patients at high risk for decreased bone mineral content
Glaucoma and cataracts may occur with long-term use of ICS. Worsening of narrow-angle glaucoma may occur, so use with caution. Consider referral to an ophthalmologist in patients who develop ocular symptoms or use BREZTRI long term. Instruct patients to contact a healthcare provider immediately if symptoms occur
Worsening of urinary retention may occur. Use with caution in patients with prostatic hyperplasia or bladder-neck obstruction. Instruct patients to contact a healthcare provider immediately if symptoms occur
Use caution in patients with convulsive disorders, thyrotoxicosis, diabetes mellitus, and ketoacidosis or unusually responsive to sympathomimetic amines
Be alert to hypokalemia or hyperglycemia
Most common adverse reactions in a 52-week trial (incidence ≥ 2%) were upper respiratory tract infection (5.7%), pneumonia (4.6%), back pain (3.1%), oral candidiasis (3.0%), influenza (2.9%), muscle spasms (2.8%), urinary tract infection (2.7%), cough (2.7%), sinusitis (2.6%), and diarrhea (2.1%). In a 24-week trial, adverse reactions (incidence ≥ 2%) were dysphonia (3.3%) and muscle spasms (3.3%)
BREZTRI should be administered with extreme caution to patients being treated with monoamine oxidase inhibitors and tricyclic antidepressants, as these may potentiate the effect of formoterol fumarate on the cardiovascular system
BREZTRI should be administered with caution to patients being treated with:
Strong cytochrome P450 3A4 inhibitors (may cause systemic corticosteroid effects)
Adrenergic drugs (may potentiate effects of formoterol fumarate)
Beta-blockers (may block bronchodilatory effects of beta-agonists and produce severe bronchospasm)
Anticholinergic-containing drugs (may interact additively). Avoid use with BREZTRI
Use BREZTRI with caution in patients with hepatic impairment, as budesonide and formoterol fumarate systemic exposure may increase. Patients with severe hepatic disease should be closely monitored
INDICATION
BREZTRI AEROSPHERE is indicated for the maintenance treatment of patients with chronic obstructive pulmonary disease (COPD).
LIMITATIONS OF USE
Not indicated for the relief of acute bronchospasm or for the treatment of asthma.
SYMBICORT® (budesonide and formoterol fumarate dihydrate) Inhalation Aerosol
Use of long-acting beta2-adrenergic agonists (LABA) as monotherapy (without inhaled corticosteroids [ICS]) for asthma is associated with an increased risk of asthma-related death. Available data from controlled clinical trials also suggest that use of LABA as monotherapy increases the risk of asthma-related hospitalization in pediatric and adolescent patients. These findings are considered a class effect of LABA. When LABA are used in fixed dose combination with ICS, data from large clinical trials do not show a significant increase in the risk of serious asthma-related events (hospitalizations, intubations, death) compared to ICS alone
SYMBICORT is NOT a rescue medication and does NOT replace fast-acting inhalers to treat acute symptoms
SYMBICORT should not be initiated in patients during rapidly deteriorating episodes of asthma or COPD
Patients who are receiving SYMBICORT should not use additional formoterol or other LABA for any reason
Localized infections of the mouth and pharynx with Candida albicans has occurred in patients treated with SYMBICORT. Patients should rinse the mouth after inhalation of SYMBICORT
Lower respiratory tract infections, including pneumonia, have been reported following the administration of ICS
Due to possible immunosuppression, potential worsening of infections could occur. A more serious or even fatal course of chickenpox or measles can occur in susceptible patients
It is possible that systemic corticosteroid effects such as hypercorticism and adrenal suppression may occur, particularly at higher doses. Particular care is needed for patients who are transferred from systemically active corticosteroids to ICS. Deaths due to adrenal insufficiency have occurred in asthmatic patients during and after transfer from systemic corticosteroids to less systemically available ICS
Caution should be exercised when considering administration of SYMBICORT in patients on long-term ketoconazole and other known potent CYP3A4 inhibitors
As with other inhaled medications, paradoxical bronchospasm may occur with SYMBICORT
Immediate hypersensitivity reactions may occur, as demonstrated by cases of urticaria, angioedema, rash, and bronchospasm
Excessive beta-adrenergic stimulation has been associated with central nervous system and cardiovascular effects. SYMBICORT should be used with caution in patients with cardiovascular disorders, especially coronary insufficiency, cardiac arrhythmias, and hypertension
Long-term use of ICS may result in a decrease in bone mineral density (BMD). Since patients with COPD often have multiple risk factors for reduced BMD, assessment of BMD is recommended prior to initiating SYMBICORT and periodically thereafter
ICS may result in a reduction in growth velocity when administered to pediatric patients
Glaucoma, increased intraocular pressure, and cataracts have been reported following the administration of ICS, including budesonide, a component of SYMBICORT. Close monitoring is warranted in patients with a change in vision or history of increased intraocular pressure, glaucoma, or cataracts
In rare cases, patients on ICS may present with systemic eosinophilic conditions
SYMBICORT should be used with caution in patients with convulsive disorders, thyrotoxicosis, diabetes mellitus, ketoacidosis, and in patients who are unusually responsive to sympathomimetic amines
Beta-adrenergic agonist medications may produce hypokalemia and hyperglycemia in some patients
The most common adverse reactions ≥3% reported in asthma clinical trials included nasopharyngitis, headache, upper respiratory tract infection, pharyngolaryngeal pain, sinusitis, pharyngitis, rhinitis, influenza, back pain, nasal congestion, stomach discomfort, vomiting, and oral candidiasis
The most common adverse reactions ≥3% reported in COPD clinical trials included nasopharyngitis, oral candidiasis, bronchitis, sinusitis, and upper respiratory tract infection
SYMBICORT should be administered with caution to patients being treated with MAO inhibitors or tricyclic antidepressants, or within 2 weeks of discontinuation of such agents
Beta-blockers may not only block the pulmonary effect of beta-agonists, such as formoterol, but may produce severe bronchospasm in patients with asthma
ECG changes and/or hypokalemia associated with nonpotassium-sparing diuretics may worsen with concomitant beta-agonists. Use caution with the coadministration of SYMBICORT
INDICATIONS
SYMBICORT is indicated for the treatment of asthma in patients 6 years and older not adequately controlled on a long-term asthma-control medication such as an ICS or whose disease warrants initiation of treatment with both an ICS and LABA (also see DOSAGE AND ADMINISTRATION).
SYMBICORT 160/4.5 is indicated for the maintenance treatment of airflow obstruction in patients with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and/or emphysema, and to reduce COPD exacerbations.
SYMBICORT is NOT indicated for the relief of acute bronchospasm.
Asthma is a chronic, inflammatory respiratory disease with variable symptoms that affects as many as 262 million people worldwide,1 including approximately 25 million in the US.2
Patients with asthma experience recurrent breathlessness and wheezing, which varies over time, and in severity and frequency.3 These patients are at risk of severe exacerbations regardless of their disease severity, adherence to treatment or level of control.4-5
There are an estimated 136 million asthma exacerbations globally per year,6 including approximately 10 million in the US2; these are physically threatening and emotionally significant for many patients7 and can be fatal.3,8
Inflammation is central to both asthma symptoms4 and exacerbations.9 Many patients experiencing asthma symptoms use a SABA (e.g., albuterol) as a rescue medicine10-12; however, taking a SABA alone does not address inflammation, leaving patients at risk of severe exacerbations,13 which can result in impaired quality of life,14 hospitalization15 and frequent oral corticosteroid (OCS) use.15 Treatment of exacerbations with as few as 1-3 short courses of OCS are associated with an increased risk of adverse health conditions including type 2 diabetes, depression/anxiety, renal impairment, cataracts, cardiovascular disease, pneumonia and fracture.16 International recommendations from the GINA no longer recommend SABA alone as the preferred rescue therapy.3
About COPD
COPD refers to a group of lung diseases, including chronic bronchitis and emphysema, that cause airflow blockage and breathing-related problems.17 Affecting an estimated 16 million Americans, COPD is the third leading cause of death due to chronic disease and the sixth overall leading cause of death in the US.18-19
About AIRSUPRA®
AIRSUPRA (albuterol and budesonide), formerly known as PT027, is a first-in-class SABA/ICS rescue treatment for asthma in the US, to be taken as needed. It is an inhaled, fixed-dose combination rescue medication containing albuterol (also known as salbutamol), a SABA, and budesonide, a corticosteroid, and has been developed in a pMDI using AstraZeneca’s Aerospheredelivery technology.
The FDA approval of AIRSUPRA was based on MANDALA and DENALI Phase III trials (Approval press release). In MANDALA, AIRSUPRA significantly reduced the risk of severe exacerbations compared to albuterol in patients with moderate-to-severe asthma when used as an as-needed rescue medication in response to symptoms. For patients treated with AIRSUPRA 180 mcg/160 mcg the annualized total systemic corticosteroids dose when compared with albuterol 180 mcg was statistically significantly different, with a reduction in mean annualized dose of 40 mg per patient. In DENALI, AIRSUPRA significantly improved lung function compared to the individual components albuterol and budesonide in patients with mild to moderate asthma.
About BEVESPI AEROSPHERE®
BEVESPI AEROSPHERE (glycopyrronium and formoterol fumarate) is a fixed-dose dual bronchodilator in a pMDI, combining glycopyrronium, a long-acting muscarinic antagonist (LAMA), and formoterol fumarate, a long-acting beta2-agonist (LABA). PMDIs are an important choice for COPD patients where limited lung function, advanced age and reduced dexterity or cognition are significant considerations for patients to achieve therapeutic benefits from their medicines. BEVESPI AEROSPHERE is the only LABA/LAMA with Aerosphere delivery technology. Results from an imaging trial have shown that BEVESPI AEROSPHERE effectively delivers medicine to both the large and small airways.
About BREZTRI AEROSPHERE®
BREZTRI AEROSPHERE (budesonide, glycopyrrolate, and formoterol fumarate) is a single-inhaler, fixed-dose triple-combination of formoterol fumarate, a LABA, glycopyrronium bromide, a LAMA, with budesonide, an ICS, and delivered in a pressurized metered-dose inhaler. BREZTRI AEROSPHEREis approved to treat COPD in more than 50 countries worldwide including the US, EU, China and Japan, and is currently being studied in Phase III trials for asthma.
About SYMBICORT®
Symbicort (budesonide and formoterol fumarate dihydrate) is the number one ICS/LABA combination therapy in asthma and chronic obstructive pulmonary disease (COPD) in China. It is a combination formulation containing budesonide, an ICS that treats underlying inflammation, and formoterol, a LABA with a fast onset of action, in a single inhaler. Symbicort was launched in 2000 and is approved in approximately 120 countries to treat asthma and/or COPD either as Symbicort Turbuhaler or Symbicort pMDI (pressurised metered-dose inhaler).
About AstraZeneca in Respiratory & Immunology
Respiratory & Immunology, part of BioPharmaceuticals, is one of AstraZeneca’s main disease areas and is a key growth driver for the Company.
AstraZeneca is an established leader in respiratory care with a 50-year heritage. The Company aims to transform the treatment of asthma and COPD by focusing on earlier biology-led treatment, eliminating preventable asthma attacks, and removing COPD as a top-three leading cause of death. The Company’s early respiratory research is focused on emerging science involving immune mechanisms, lung damage and abnormal cell-repair processes in disease and neuronal dysfunction.
With common pathways and underlying disease drivers across respiratory and immunology, AstraZeneca is following the science from chronic lung diseases to immunology-driven disease areas. The Company’s growing presence in immunology is focused on five mid- to late-stage franchises with multi-disease potential, in areas including rheumatology (including systemic lupus erythematosus), dermatology, gastroenterology, and systemic eosinophilic-driven diseases. AstraZeneca’s ambition in Respiratory & Immunology is to achieve disease modification and durable remission for millions of patients worldwide.
AstraZeneca
AstraZeneca is a global, science-led biopharmaceutical company that focuses on the discovery, development, and commercialization of prescription medicines in Oncology, Rare Diseases, and BioPharmaceuticals, including Cardiovascular, Renal & Metabolism, and Respiratory & Immunology. Based in Cambridge, UK, AstraZeneca operates in over 100 countries and its innovative medicines are used by millions of patients worldwide. Please visit www.astrazeneca-us.com and follow us on social media @AstraZeneca.
About AZ&Me™
AstraZeneca’s patient assistance program, AZ&Me Prescription Savings Program (AZ&Me), is part of the Company’s commitment to addressing barriers to access and affordability to improve medication adherence, enhance patient care, and help patients lead healthier lives. AZ&Me is just one of the ways that AstraZeneca makes its life-changing medicines widely available, accessible, and affordable.
For over 40 years, AstraZeneca has offered a patient assistance program through AZ&Me and prior legacy free drug programs, making it one of the longest standing patient assistance programs in the country. Since 2007, over five million people have benefited from this program. In addition to its patient assistance programs, AstraZeneca offers other affordability programs and resources to help increase patients’ access to medicines and reduce their out-of-pocket costs including a co-pay savings program for commercially-insured patients and additional affordability resources. Each of these programs offer financial support to particular patient populations, consistent with applicable legal requirements.
The goal of AZ&Me is to help patients who have been prescribed an AstraZeneca medication and are having difficulty affording it. Patients enrolled in AZ&Me receive their AstraZeneca medicine for free. To learn more, visit AZ&Me.com.
Global Initiative for Asthma. Updated May 2023. Accessed: March 2024. www.ginasthma.org
Price D, et al. Asthma control and management in 8,000 European patients: the REcognise Asthma and LInk to Symptoms and Experience (REALISE) survey. NPJ Prim Care Respir Med. 2014;24:14009.
Papi A, et al. Relationship of inhaled corticosteroid adherence to asthma exacerbations in patients with moderate-to-severe asthma. J Allergy Clin Immunol Pract. 2018;6(6): 1989-1998.e3.
Data on File. REF-173201. AstraZeneca Pharmaceuticals LP.
Sastre J, et al. Insights, attitudes, and perceptions about asthma and its treatment: a multinational survey of patients from Europe and Canada. World Allergy Organ J. 2016;9:13.
Fernandes AG, et al. Risk factors for death in patients with severe asthma. J Bras Pneumol. 2014;40(4):364-372.
Wark PA, et al. Asthma exacerbations. 3: Pathogenesis. Thorax. 2006;61(10):909-915.
Johnson DB, et al. Albuterol. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2024 Jan 10.
Montemayor T, et al. Albuterol: Often Used and Heavily Abused. Respiratory Care. November 2021, 66 (Suppl 10) 3603775.
Nwaru BI, et al. Overuse of short-acting β2-agonists in asthma is associated with increased risk of exacerbation and mortality: a nationwide cohort study of the global SABINA programme. Eur Respir J. 2020;55(4):1901872.
Lloyd A, et al. The impact of asthma exacerbations on health-related quality of life in moderate to severe asthma patients in the UK. Prim Care Respir J. 2007;16(1):22-27.
Bourdin A, et al. ERS/EAACI statement on severe exacerbations in asthma in adults: facts, priorities and key research questions. Eur Respir J. 2019;54(3):1900900.
Price DB, et al. Adverse outcomes from initiation of systemic corticosteroids for asthma: long-term observational study. J Asthma Allergy. 2018;11:193-204.
GOLD. Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2024. [Online]. Accessed: March 2024. goldcopd.org/2024-gold-report/
Sleep apnea can negatively impact health and well-being, but treatment is limited to poorly tolerated positive pressure masks (CPAP) and, in the worst cases, surgery. However, in a recent trial, a nasal spray showed promise as a treatment for the most common sleep-related breathing disorder.
Obstructive sleep apnea (OSA) occurs when the upper airway collapses during sleep, reducing or completely blocking airflow. It’s primarily caused by a combination of impaired throat anatomy and inadequate muscle function during sleep. This leads to a drop in oxygen intake and arousal from sleep, which can have negative health and safety consequences, including daytime tiredness, difficulty focusing, and high blood pressure.
OSA treatment is limited. First-line treatment is a machine that provides continuous positive airway pressure (CPAP) to keep the airway from collapsing. Unfortunately, around half of people who use CPAP machines find them difficult to tolerate. In these cases, surgery to fix the anatomical obstruction may be considered.
Researchers from Flinders University in Australia conducted a small trial using a nasal spray to treat OSA and found it produced promising results.
“Obstructive sleep apnea (OSA) is a sleep disorder where the muscles in the back of the throat relax, and the upper airway narrows or collapses, restricting oxygen intake and causing people to wake repeatedly throughout the night,” said Danny Eckert, a professor at Flinders University’s College and Medicine and Public Health and one of the study’s co-authors. “It has been linked to a variety of medical conditions including cardiovascular disease, stroke, obesity, diabetes, anxiety and depression.”
The researchers tested a nasal spray to deliver a potassium channel blocker topically to the airway muscles to see if it reduced the severity of OSA symptoms.
“Potassium channel blockers are a class of drugs that block the potassium channel in the central nervous system,” said Amal Osman, the lead and corresponding author of the study. “When used in a nasal spray, the blockers have the potential to increase the activity of the muscles that keep the upper airway open and reduce the likelihood of the throat collapsing during sleep.”
Ten people (five women, five men; mean age 55) with OSA randomly received one of three treatments: a placebo nasal spray, a nasal spray containing a potassium channel blocker, or the blocker nasal spray with breathing restricted to ‘nasal only,' which involved the use of mouth tape or a chin strap. On average, participants were obese, had severe OSA, were not overly sleepy and did not have insomnia.
Participants completed three overnight sleep studies with a break of about a week between visits. The researchers found that seven of the 10 study participants showed a modest reduction in OSA severity when the nasal spray was combined with unrestricted breathing versus the placebo. Total oxygen saturation levels were higher with the unrestricted breathing nasal spray treatment than in the placebo group. Morning blood pressure measurements were also lower with the unrestricted breathing spray treatment.
Participants restricted to nose-only breathing did not show improvements despite receiving the potassium channel blocker via nasal spray. Instead, the researchers found that breathing and upper airway muscle function tended to worsen when a chin strap was used.
“What we have discovered is that the nasal spray application of the potassium channel blocker that we tested is safe, well tolerated,” Osman said. “Those who had a physiological improvement in their airway function during sleep also had between 25–45% reductions in markers of their OSA severity, including improved oxygen levels as well as a reduction in their blood pressure the next day.”
The study’s findings offer a new way of expanding treatment options for people with OSA.
“These insights provide a potential pathway for [the] development of new therapeutic solutions for those people with OSA who are unable to tolerate CPAP machines and/or upper airway surgery, and those with a desire for alternatives to existing therapies,” said Eckert. “Right now, there are no approved drugs for treating OSA, but through these findings and future research, we are getting closer to developing new and effective drugs that are safe and easy to use.”
The researchers plan to conduct larger studies to explore their initial findings further.
Keeping your furry friend safe and comfortable during cold weather is essential, especially certain breeds. There are many reasons why some breeds dislike winter, from anxiety issues to reasons involving their age and health. Many dog breeds hate the cold, but what makes this group stand out is their genetic need to keep themselves warm and toasty. With that being said, the dogs on our list are the top seven worst dogs for cold climates that simply cannot stand chilly temperatures.
Which pups should you avoid if you live in a cold climate? To help you out, StudyFinds researched across eight expert sources to find seven of the worst dog breeds for cold climates that were mentioned most. If you have a dog we missed, please let us know in the comments below.
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The List: Worst Dog Breeds For Cold Climates, According To Canine Experts
1. Chihuahua
Are you surprised? These little guys have close to no fur to keep them warm. They are from Mexico, so they are definitely used to the warmth. They will not stand for cold weather, but can you blame them for their small stature? Treat Your Dogs tells us that Chihuahuas were the inspiration behind waterproof dog coats. How cute!
If you have been around a Chihuahua, you may have noticed how they shake. Most people assume it is because they are scared. Most of the time, they shake because they are cold, according to Greenfield Puppies.
A Chihuahua’s playful spirit may have them playing in the snow for a little bit, but you can bet they’ll get cold soon and seek warmth. They are many things, but weatherproof is not one of them. A-Z Animals says, “forget just one sweater, Chihuahua’s might need multiple layers to actually enjoy outdoor time in the winter.
2. French Bulldog
The French Bulldog is a brachycephalic breed, so they require layers to regulate their body temperature. Like Chihuahuas, they benefit from wearing a cute little doggy coat. Treat Your Dogs suggests even a hoodie or padded waterproof coat along with it.
These little sweeties have trouble breathing in the heat due to their short snout, but it also affects their breathing in the cold. Future owners should be aware that they are sensitive to respiratory problems. According to Greenfield Puppies, the common cold can escalate into something dangerous for Frenchies.
Keep your Frenchie’s sleeping space away from a draft. Additional tips to keep Bulldogs safe in the cold is to keep their walks short and watch for signs of discomfort. Bark makes sure readers know that they prefer to run around in your warm home than romp around in chilly winter weather.
3. Greyhound
Because Greyhounds are thin with short coats, they can really feel the cold. They should wear outer wear from fall until spring. Treat Your Dogs says owners should even up it with a waterproof coat when it is extreme weather.
Greyhounds are great racing dogs, but racing is typically done in warmer weather. They do love to run around and play, but because of their low body fat, they easily get the chilly willies. A-Z Animals says Greyhounds are a magnet for hypothermia.
4. Yorkshire Terriers
Terriers can typically deal with temperatures between 50 and 60 degrees, but anything below that and they’ll need to be protected. Treat Your Dogs agrees they need warmth from dog coats and clothing. These terriers have only one coat, which doesn’t give them the protection they need for warmth. If it is cold out, their classic playfulness tends not to last long. Greenfield Puppies claims that they would rather be inside cuddling with their human.
Besides companionship, this breed was designed for eliminating rodents in Victorian England. Unlike most dog hair, the Yorkie’s coat is hypoallergenic, but doesn’t provide much insulation (SheKnows). It’s the owner’s responsibility to keep these little fluff balls warm in the winter.
5. Whippets
Just Food For Dogs brings up that although Whippets are much smaller than Greyhounds, they share many of the same physical attributes. See where we are going here? Their low body fat can’t handle the cold weather. They also have short and dense fur which does not hold in a lot of heat. This is because they were bred to race at 57 kms per hour (Bark).
Did we mention that the Whippet is related to the Greyhound? Looks like misery loves company in the cold. Bred in England, Whippets are more tolerant to the cold than Greyhounds, but still do not like it. Front of the Pack advises to equip them in warm clothes because they aren’t complainers.
6. Chinese Crested Dog
The Chinese Crested is the silly looking breed with hair around their heads and tails, but nothing on the body. That explains why they get the chills in the cold weather. Just Food For Dogs agrees they are yet another breed that needs a thick sweater to be in the snow or cold.
It really is a no brainer with this breed. With such a lack of fur on their bodies, it makes for plenty of reason to “limit their time outdoors when there are inclement weather conditions,” according to A-Z Animals.
The Chinese Crested surprisingly gives as much heat as he gets, radiating off of his exposed skin. Bark jokes, “if you walked around naked all the time, you’d be cold, too.”
7. Basset Hounds
Basset Hounds are stocky, but they have have short legs and long ears which contribute to their difficulty getting around in the snow. They get cold easier due to this. Greenfield Puppies says it means “they tend to have more of their body in the snow because their bellies are often low enough to be in it!”
A Basset’s tummy also poses a problem as it is exposed to the cold wind. That said, they can handle mildly cold weather, but not bitter cold. Front of the Pack tells us that “the breed comes from Europe, where colder temperatures have always been normal.”
Their trademark floppy ears are partially to blame here when it comes to susceptibility to the chills. They hang so low they often brush against the ground as they sniff around. So, it’s important that you keep those ears protected, according to A-Z Animals.
Winter Care Tips for Sensitive Dogs:
If you are the proud owner of one of the dogs on this list, these are a few tips you can implement into your care routine in the winter or when your pooch is exposed to cold temperatures.
Limiting Outdoor Exposure:
Adjust Walk Times: During extremely cold weather, shorten walks or skip them altogether if temperatures plummet or wind chills reach dangerous levels.
Quick Potty Breaks: If walks are necessary, keep them brief, focusing on potty breaks rather than extended playtime.
Proper Gear for Walks:
Protective Coat or Sweater: Invest in a well-fitting coat or sweater for your dog, especially if they have short fur. Consider factors like breed, size, and fur length when choosing the right gear.
Booties for Paws: Protect your dog’s paws from the cold, ice, and salt/chemicals on the ground with booties. Choose a secure and comfortable fit that stays on during walks.
Post-Walk Care:
Wipe Down Paws: After walks, thoroughly wipe down your dog’s paws with a damp towel to remove ice, snow, salt, or chemicals that can irritate their skin. You can even use a dog-safe paw balm for additional protection.
Dry Wet Fur: If your dog gets wet from snow or rain, use a towel to dry them off as much as possible to prevent them from getting chilled.
You might also be interested in:
Sources:
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“Open your eyes, and observe all the objects of your surroundings,” said the voice of Gwyneth Paltrow, live, from LA. “now become aware of the empty space around your objects, and how the space allows everything to exist within it.”
It was odd to do a meditation breathing exercise with another person on Zoom. I was staring out the window at nothing in particular, picking a water spot on the glass as a focal point while the Iron Man franchise star and Goop owner talked me through the exercise. I was used to closing my eyes and sitting on a chair or cushion while I practiced mindfulness, but as my eyes glazed over, I could see how taking your practice anywhere could be very useful.
I was lucky enough to be part of a video call presentation and discussion from Gwyneth Paltrow about Moments of Space, a new meditation app co-owned by Paltrow, and moderated by the app’s creator, Kim Little.
Meditation apps have been around for a very long time: most of the best fitness apps offer some sort of mindfulness or breathing exercise element, while dedicated apps like Headspace and Calm offer audio experiences for short mindfulness sessions, long meditations, sleeping, naps, and everything in between.
Moments of Space has its own unique selling point (other than Paltrow’s involvement, that is): a focus on open-eye techniques, encouraging you to experience the world around you while you meditate, not just sitting on the floor with your eyes closed.
During the call, Paltrow said: “Eyes-open meditation has changed my life because I find that all-day-every-day, I can just steal a few minutes here and there. I can be at my desk, walking down a hall, on a zoom (no offense) and I can meditate!
“I find it’s really deepened the results of what meditation does.”
The other unique bit is that rather than remain carefully secular, like Headspace and Calm, it’s unashamedly rooted in Dzogchen Buddhist teachings while embracing modern tech advancements, like artificial intelligence. The app’s AI is said to identify your personality traits and put you on structured paths of content (for example, a particular course of meditations designed to soothe anxiety), but it will also identify ‘transient’ states and recommend standalone meditations called ‘Moments’ to match. “The more you use the app,” said founder Kim Little, “the better it will get to understanding your needs in the moment.
“With the advent of AI, it’s all going to be about hyper-personalization. Everything will become personalized to the user, completely customized and dynamic, and I know in our app we’re trying to solve this problem of giving the user the right content. That’s the potential impact of tech in wellness… everything becoming unique to that user.”
Identifying your personality traits puts you on structured paths of content, but it will also identify transient states and recommend standalone meditations called “Moments” to match. The more you use the app, the better it will understand your needs in the moment.
Gwyneth Paltrow is a bona fide wellness guru, promoting alternative (and occasionally controversial) approaches to the norm. It stands to reason that as the industry moves on, she’s investing in products like Moments of Space that are making use of the vast suite of health metrics your phone and wearables can collect.
“I think we’re living in the most amazing time where technology is moving at an incredible pace,” said Paltrow. “There will be a lot of opportunity with technology to provide us data and roadmaps to help further our own wellness. For example, I have an Oura Ring which I wear and it uses technology and hardware to help me track certain wellness markers which are important to me.
“I can set up my Oura Ring before I meditate and it will tell me what my heart rate was before and after my meditation, body temperature, and so on. It’s predictive, so I think technology being able to help us pull data lets us go further. I can make adjustments based on that data in terms of how I drink alcohol or don’t drink alcohol, for example, which impacts my sleep.”
The best smart rings are fantastic for recording these kinds of passive experiences, as they don’t have a screen to interact with. This places the emphasis less on fitness and more on holistic well-being, so it’s no surprise Paltrow prefers rings to the best smartwatches.
Moments of Space sounds like it’s got enough going for it to distinguish itself from the rest of the meditation app pack, not the least of which is wellness guru’s Paltrow involvement. Even her brief presentation has me second-guessing what I thought I knew about mindfulness.
Dr Neena Sharma Physiology is an essential field in the realm of public health, providing critical insights into the functioning of the human body at various levels, from cellular mechanism to the organ systems. Understanding the physiological processes is foundational to address public health challenges, as it elucidates the mechanism underlying health and disease states. In this article, we will delve into the public health relevance of physiology across different domains, including cardiovascular health, respiratory health, metabolic disorders, and the impact of environmental factors on human physiology. Introduction to Physiology and Public Health Physiology is the study of how living organism function, encompassing the intricate connections between cells, tissues, organs and systems,that maintain homeostatsis and adapt to environmental changes. Public health focuses on improving and protecting the health of populations, emphasizing prevention, promotion, and policy interventions. The interaction of physiology and public health is crucial for addressing health disparities, preventing diseases, and promoting overall well-being. Cardiovascular Physiology and Public Health The cardiovascular system plays a central role in supplying oxygen and nutrients to tissues and removing waste products from the body. Understanding cardiovascular physiology is essential for preventing and managing various cardiovascular diseases, including hypertension, coronary artery disease, and heart failure, which are leading causes of mortality and morbidity worldwide.Public health efforts targeting cardiovascular health involve strategies such as promoting healthy lifestyles, reducing tobacco use, improving access to healthcare services, and implementing policies to address risk factors like high blood pressure, cholesterol levels and obesity. Respiratory Physiology and Public Health Respiratory physiology focuses on the mechanism of breathing, gas exchange in the lungs, and regulation of respiratory functions. Respiratorydiseases such as asthma, chronic obstructive pulmonary disease (COPD) and respiratory infections pose significant public health challenges, impacting millions of people globally. Public health initiatives aimed at respiratory health include smoking cessation programs, air quality regulations, vaccination campaigns and educational efforts to promote respiratory hygiene and disease prevention. Metabolic Physiology and Public Health Metabolic physiology encompasses the processes involved in energy production, storage, and utilization within the body. Dysregulation of metabolic pathways can lead to metabolic disorders such as diabetes, obesity, and metabolic syndrome, which have reached epidemic proportions worldwide. Public health interventions targeting metabolic health focus on promoting healthy dietary habits, physical activity, weight management, and early detection and management of metabolic disorders through screening programs and access to health care services. Neurophysiology and Mental Health Neurophysiology explores the structure and function of the nervous system, including the brain, spinal cord, and peripheral nerves. Mental health disorders, including depression, anxiety, and schizophrenia,are major public health concerns with significant social and economic implications. Understanding the neurobiological basis of mental health disorders is crucial for developing effective prevention and treatment strategies, which may include psychotherapy, pharmacotherapy, community support programs, and policies to reduce stigma and improve access to mental health services. Environmental Physiology and Public Health Environmental physiology examines the interactions between organisms and their environment, including the effects of temperature, altitude, pollution and other environmental factors on physiological processes. Environmental exposures can impact health outcomes, contributing to diseases such as heat-related illnesses, respiratory problems, and vector-borne diseases. Public health efforts to address environmental health risks involve monitoring air and water quality, implementing regulations to reduce pollution, promoting sustainable practices and developing resilience strategies to mitigate the impacts of climate change on human health. Developmental Physiology and Maternal-Child Health Developmental physiology investigates the physiological changes that occur throughout the lifespan, from fetal development to aging. Maternal and child health is a priority area within public health, focussing on promoting the health and well-being of mothers, infants, and children. Understanding developmentalphysiology is essential for ensuring healthy pregnancies, early childhood development, and the prevention of birth defects, preterm birth, and infant mortality. Public health Interventions in this domain include prenatal care, breastfeeding support, immunization programs and initiatives to reduce maternal and child mortality and morbidity. Genomic medicine Advances in genomic medicine and personalized healthcare have revolutionized the field of physiology and public health by providing insights into individual patients based on their genetic makeup, lifestyle factors and environmental influences, leading to more targeted and effective healthcare interventions. In conclusion, physiology is inherently linked to public health, providing the foundational knowledge necessary for understanding health and disease states and informing evidence-based interventions to improve population health outcomes. By elucidating the mechanism underlying physiological processes, researchers, healthcare professionals, and policymakers can develop and implement strategies to prevent diseases, promote health equity, and enhance the overall well-being of communities worldwide. As we continue to advance our understanding of physiology and its implications for public health, interdisciplinary collaboration and a holistic approach to health promotion and disease prevention will be essential in addressing the complex challenges facing global health today and in the future. (The author is Associate Professor, Department of Physiology, AIIMS Jammu.)
54% Indian respondents have not consulted with a medical professional about their sleep difficulties.
Work related stress is the top cause of disrupted sleep in India, with 42% Indians stating it keeps them up at night.
ResMed, a global leader in digital health, sleep, and respiratory care, marked this World Sleep Day 2024 by releasing insights from its annual sleep survey, emphasizing the global issue of insufficient sleep, averaging 6.8 hours. The findings underscore the critical need to address sleep health for improved well-being.
The 2024 ResMed Sleep Survey, an annual ResMed property that brings insightful narratives around sleep health, was the largest and most in-depth undertaken by the company with 36,000 respondents across 17 markets surveyed this year. The survey shed insight into perspectives, habits, and behaviors when it comes to sleep health.
A Country Neglecting its Sleep Hygiene
In 2023, 84% of Indian respondents were the most satisfied with the quantity and quality of their sleep, however, alarmingly in 2024, we noted that only 27% of the Indian respondents are getting a good nights sleep across both quality and quantity every day of the week highlighting the need to educate the public about sleep hygiene.
And it’s not just about the quality of sleep – out of 5,000 Indian respondents, the survey found that while 44% consider 8-8.99 hours of sleep are a good night’s sleep, only 29% actually sleep for 8-8.99 hours a night, revealing a country that is deprived of good sleep and yet not making it a priority.
There is a need to highlight how sleep is a crucial pillar of health and chronic sleep deprivation can have an impact on the everyday functioning of individuals.
“It is crucial to discuss the unrecognized crisis of sleep health and how the lack of sleep is contributing to the healthcare burden in India. ResMed continues to lead the charge in advancing sleep awareness across India while empowering individuals and the medical fraternity with innovative digital health solutions. Our commitment to developing cloud-connected tools remains unwavering as we strive to provide comprehensive sleep care to those suffering from conditions like sleep apnea and COPD,” said Sandeep Gulati, General Manager, South Asia, ResMed. “We believe everyone deserves the opportunity to sleep, breathe, and live better.”
Clocking Out but Not Switching Off
The top cause of disrupted sleep in India is work-related stress, with 42% of citing it as what keeps them up at night. This is prevalent across the various regions with 42% from North India, 45% from the Northeast, 49% from Central India, 42% from East India, 43% from the West and 38% from South India indicating work stress as the reason they struggle to fall asleep. Almost 90% of respondents (with a history of sleep apnea) agree that good sleep impacts your ability to be productive at work highlighting how adequate sleep is fundamental to general wellbeing, favorably impacting productivity.
ResMed Sleep Survey 2024 also indicated the following data points:
Sleep Tracking: 68% of individuals in India actively monitoring their sleep patterns, with 47% using an application on their phones to track their sleep.
Breathing difficulties affect 22% of Indians who have a history of sleep apnea when it comes to their ability to sleep.
Diagnosed with sleep apnea:
48% started or are due to start treatment 18% have not started the treatment 20% began the recommended treatment but did not continue it 14% decided to trial my own methods to combat sleep difficulties.
Consult Doctors and Not Screens for Sleep Health
The survey indicates that 49% of Indians are very likely to look up information regarding symptoms they are experiencing if they interfere with their ability to sleep. Remarkably, even though 69% of Indians think that doctors are a reliable source of information about sleep health, a substantial 54% have not sought consultation with a physician.
“Long-term sleep deprivation could result in an increased risk of cardiovascular events, compromised immune system, and even road traffic accidents.” said Dr Sibasish Dey, Head, Medical Affairs, South Asia, ResMed. “Our survey results underscore a pressing demand for more awareness and education on comprehensive sleep health.As a member of the medical fraternity witnessing the impact of sleep disorders on individuals, we recommend a greater focus on creating awareness and testing for sleep disorders, as it would lead to better health outcomes. As an additional course of action, sleep health should be advocated for and included in policies to provide it the importance and due consideration it requires in Indian healthcare.”
Discovering your sleep superpower
ResMed is embarking on a mission to unlock the sleep superpowers of people across the globe with its campaign ‘Discover Your Sleep Superpowers’. With the launch of the campaign on World Sleep Day, the aim is to inspire people with the benefits of good sleep while empowering them with the information they need to prioritize their own sleep health.
In India, around 104 million people potentially suffer from Obstructive Sleep Apnea (OSA), a chronic disease in which the muscles of the throat relax to the point of collapse, restricting airflow and casing the sufferer to stop breathing repeatedly throughout the night. Despite the prevalence of the condition, there is still a significant challenge around the lack of awareness. This results in prolonged suffering without proper diagnosis and treatment. ResMed, a global provider of sleep apnea treatment devices, strives to enhance awareness and understanding of sleep health through market insights, fostering better therapeutic outcomes.
To learn more about ResMed’s 2024 Global Sleep Survey or for help identifying if you have symptoms that could indicate poor sleep health, visit www.resmed.com/sleepassessment
Survey Methodology
The 2024 ResMed Global Sleep Survey included a total of 36,000 across 17 markets including Australia, Brazil, China, France, Germany, Hong Kong, India, Ireland, Japan, Korea, Mexico, New Zealand, Singapore, Taiwan, Thailand, UK and USA, between December 2023 and January 2024.
About ResMed
At ResMed we pioneer innovative solutions that treat and keep people out of the hospital, empowering them to live healthier, higher-quality lives. Our digital health technologies” and cloud-connected medical devices transform care for people with sleep apnea, COPD, and other chronic diseases. Our comprehensive out-of-hospital software platforms support the professionals and caregivers who help people stay healthy in the home or care setting of their choice. By enabling better care, we improve quality of life, reduce the impact of chronic disease, and lower costs for consumers and healthcare systems in more than 140 countries.
To learn more, visit ResMed.com and follow @ResMed.
Within weeks of stopping, you will experience the health benefits of breathing easier and feeling fitter.
Quitting for at least six weeks is also proven to boost mental health and wellbeing, by relieving stress, anxiety, and depression.
However, it’s notoriously difficult to stop, because nicotine is a highly addictive drug.
One way to tackle it is to be surrounded by others attempting to do the same - which is where No Smoking Day comes in.
Here’s everything you need to know about how to get involved.
What is No Smoking Day?
No Smoking Day is an annual awareness day that encourages smokers to attempt to quit the habit.
This year’s theme is “stopping smoking protects your brain health”.
People over the age of 55 most fear getting dementia, more than any other life-threatening disease, such as cancer or diabetes, according to Alzheimer’s Research UK.
However, YouGov data commissioned by Action on Smoking and Health (ASH) revealed that fewer than one in five (17 per cent) of people in London who smoke understand that smoking increases the risk of dementia, compared to 77 per cent who know that smoking causes lung disease or cancer.
Smoking raises the risk of developing dementia, particularly Alzheimer’s disease and vascular dementia.
If you smoke, quitting is perhaps the most important step you can take to protect both your heart and your brain
Dr Chi Udeh-Momoh, a neuroscientist and dementia-prevention expert
This is because it harms the vascular system (heart and blood vessels) and the brain.
Studies also suggest that quitting smoking reduces this risk substantially, and smoking has been identified as one of 12 risk factors that, if eliminated entirely, could collectively prevent or delay up to 40 per cent of dementia cases.
Yet data from Alzheimer’s Research UK shows only a third of UK adults know there are things they can do to help reduce their risk of dementia, and stopping smoking is one of them.
When is No Smoking Day?
No Smoking Day will be on Wednesday, March 13.
How can No Smoking Day help Londoners quit?
Tracy Parr, programme director of London Tobacco Alliance and Stop Smoking London, said: “Free help is available for anyone in London who wants to stop smoking.
“We know it is much easier to overcome tobacco dependence with expert support – you’re three times as likely to stop smoking successfully with help from your free service.
“For smokers thinking ‘Today is the day’, London’s dedicated digital and free telephone programme Stop Smoking London can also help you find local face-to-face services to help you achieve your goal of being smoke-free.”
Dr Chi Udeh-Momoh, a neuroscientist and dementia-prevention expert based at Imperial College London, said: “If you smoke, quitting is perhaps the most important step you can take to protect both your heart and your brain. It really can be life-changing.
“Many people know that smoking affects the heart and blood vessels, increasing the risk of conditions like high blood pressure and stroke. But fewer realise that these conditions, in turn, increase the risk of dementia, or that the chemicals in cigarette smoke can speed up the natural aging of the brain.
“It’s fantastic that brain health is the theme of No Smoking Day 2023. Initiatives like this are so important in raising awareness of the steps we can take to help keep the brain healthy.”
Deborah Arnott, chief executive of Action on Smoking and Health, who is helping to co-ordinate this year’s No Smoking Day, explained that: “No Smoking Day is the perfect time to quit smoking when thousands of other people are stopping, too.
“There are many ways to stop, from nicotine-replacement therapy to vaping and free local support to stop smoking. Smokers are three times more likely to succeed in quitting with help from a trained professional than with willpower alone.”
Hilary Evans, chief executive of Alzheimer’s Research UK, added: “Just a third of people realise that we can take steps to help reduce our risk of developing dementia in later life.
“This has to change, which is why improving people’s understanding of the things that they can do to shape their brain health is a real priority for Alzheimer’s Research UK.
“We’re delighted to be working alongside ASH to shine a light on the link between smoking and brain health. We hope the positive message that quitting smoking at any point can help reduce your dementia risk gives people who smoke fresh motivation to quit this No Smoking Day.”
From antidepressants to breathwork, here's how this performance coach overcame depression and is channeling his learnings to help others.
When you were 25, you left your career and hauled your entire life from London to Sydney to teach people how to breathe. What was the impetus for this massive move?
In London, I was working a nine-to-five corporate job and I was so miserable. I was diagnosed with depression and anxiety and prescribed antidepressants, but I wanted to find holistic ways to improve my health. I’d never heard of breathwork, but I loved the connection that came with yoga and breath. I went to my first session in 2018 and, without sounding too clichéd, it transformed my life. I was hooked on the euphoric feeling it gave me, something I hadn’t felt in years. So I started to think of other ways to make myself happier. Blue skies promote happiness, and the darkness of London is not very conducive to that, so I moved to Sydney.
You arrived in Australia just before the pandemic and our lockdowns were harsh. How did you safeguard your mental health during that time?
Yeah, I battened down the hatches and I sat it out in Sydney. I was also building a business around breathing and breathwork during a global respiration pandemic, which was incredibly challenging. But in a strange way, a lot of people were looking for tools to improve mental health so I grew my business online. I would host free sessions, which started off with my friends and family back in the UK and then it grew to having 500 people join these Zoom sessions. It was lonely, don’t get me wrong. But equally, I had so much excitement in what I was doing. I love to be able to help people and I could see the difference this was making. I hated that there was a reason for my service, but I was joyful that it could provide people with some value and benefit during a pretty challenging time. And what I do is still slightly different: it's niche. It's not yoga, it's not running, it's not strength training. It’s breathing.
You do a lot of work with athletes. Can you explain the link between our breath and physical performance?
Breath is vastly overlooked. If you’re not breathing correctly, you won’t sleep well, you’re likely to make poorer decisions and it’s linked to increased stress. I’ve worked with the Sydney Swans over the last three AFL seasons… supporting the players to perform at a high ability for as long as possible. Panting out of the mouth too fast and too shallow spikes your heart rate and causes a faster fatigue rate. Breathing through the nose brings more oxygen into the working tissues so the rate of fatigue is a lot lower. On top of this, deep breathing has also been directly correlated to decision making. So if athletes can breathe better, they’ll reduce the amount of unforced errors.
You’re also an ultramarathon runner, which means that you run 60-plus kilometres in one go. Tell us, does the ‘runner’s high’ really exist?
Long-distance running is a roller-coaster. When I’m running that far, there are so many highs and so many lows. For me, the runner’s high shows in tears, and it can happen anywhere between 20 to 100 kilometres. I’ll go through periods of laughter, then crying, then euphoria, then sadness. And these emotions make me think about what I am running for. Am I running away from my demons or into euphoria? Most of the time I’m not battling against anyone else. I’m battling against myself. My biggest demon is my own brain.
How do you fuel yourself before and after an ultramarathon? And any recovery hacks you can share with us?
It’s very much about carbs and volume. I’ll eat pasta the night before a race with a high-carb ‘dessert’, usually Weet-Bix. And then carbs again in the morning. Liquid sodium and electrolytes are also key. And I fuel every half hour during the race with gels, bars and more hydration drinks to make sure that I’m getting what my body needs to keep going. I’ll also have various mushroom supplements, too. My recovery starts the minute the race is over in the form of food, because the body’s pretty depleted in, well, everything. And then, a big focus is sleep. I also love saunas and ice baths.
A lot of people associate breathwork with a monk-like Zen mentality. What do you do for fun or to blow off steam?
I don’t really drink anymore, to be honest, but I love music, so I’ll go to music events with my mates and blow off steam by dancing. I also get so much joy from running and feel so free when I’m out there. If I’m having a bad day or a bad week, I’ll go for a run and come back as a new human.
You do a lot of work with large scale companies. What have you seen to be the biggest reward out of working with that kind of demographic where not many people in that field would be thinking about their breath, are they?
Breathing is vastly overlooked and undervalued in general, but I think of breathing and breathwork as the foundation of all human development. If you're not breathing correctly, you won't be sleeping well, you’re likely to make poorer decisions, and it’s also linked to increased stress. So breath is the foundation to all human performance. I think post-pandemic these corporate companies are giving a lot more attention to evidence-based practices, and there's an incredible amount of science in breathwork not only for mental health but for productivity too. After these sessions, I'll often ask people to tell me one word to describe how they feel, and the most common response is ‘empowered’ and ‘clear’. And then when the company sees this, they realise that their employees are finding the value in it.
Rapid-fire round
Guilty pleasure: Listening to Justin Bieber
Fave book: Man’s Search For Meaning by Viktor E Frankl
Go-to post-training meal: Burger and a chocolate milkshake
I can’t start my morning without: Cuddles with my dog Albert
Best running shoes: On Eclipse
My go-to podcast: Modern Wisdom with Chris Williamson
Four years ago, a virus brought everyday life in the United States to a screeching halt. On March 15, 2020, officials in places like New York City and Ohio announced some of the first shutdowns and stay-at-home orders in a century, which soon spread across the country like the novel coronavirus itself.
Basically, this means that people experiencing symptoms of a respiratory virus (like fatigue, a fever, the chills, or a cough) can resume their normal activities after they’ve been feeling “better overall” or fever-free for 24 hours. It’s a return to the halcyon days of ignoring the possibility of being contagious, and not thinking about who might be exposed to what otherwise healthy people perceive as a mild illness, or the potential long-term consequences of an infection.
For some people, the CDC’s announcement effectively marked the end of the pandemic, freeing them from the final vestige of Covid-era restrictions: their obligation to avoid infecting others with Covid or other respiratory viral illnesses. But the millions of Americans living with Long Covid, including myself, don’t have the luxury of being able to move on.
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We’re stuck in broken bodies that can still be difficult to recognize as our own, even after inhabiting them for four years. Many of us are immunocompromised: some, for the first time, and others after years of living with other chronic conditions. It has cost us careers, sources of income, homes, relationships, and in some cases, our identity. And now, as more people think of Covid as a problem of the past, those of us with Long Covid are concerned about our uncertain future.
By all accounts, I should have been hospitalized during my first acute Covid-19 infection. But it was the first week of April 2020, and I wasn’t the only person in Queens spending hours each day choking down shallow breaths, taking in just enough air to survive.
With patients spilling out into hallways and tents at my local hospitals, the empathetic but exhausted clinicians on the other end of the city’s Covid hotline told me to stay home — unless I stopped breathing completely — and that while I wasn’t eligible for testing, I was considered a “presumed positive” case. When I called back a month later because my symptoms hadn’t gone away, I was dismissed for the first of what would turn out to be many times: told that Covid-19 infections only lasted two weeks, so I must not have contracted the novel coronavirus after all.
As a bioethicist, I went into the pandemic familiar with the ethical challenges that can arise during public health emergencies, but hadn’t anticipated the hypothetical case studies I taught in class to play out in real life. I began covering them in February 2020, and by June, I was working on my first assignment on what would come to be known as Long Covid.
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Over several months of reporting, I spoke with other people who had Covid in early spring, sought medical attention after at least a month of new or lingering symptoms, and were informed that they were simply the result of aging, anxiety, obesity, or all in our heads. (Physicians and other healthcare workers living with Long Covid didn’t necessarily fare any better, reporting that they “felt dismissed or not taken seriously by their doctors,” according to the authors of a review of 30 studies evaluating their experiences, published March 5, 2024 in the journal PLOS One.)
Remarkably, four years later, it can still be difficult to find doctors who have even a basic — let alone comprehensive — understanding of Long Covid and the myriad ways it can affect the body and brain. While there are clinics dedicated to treating Long Covid patients in hospitals across the country, it’s not unusual for it to take several months to get an appointment.
“There are not enough clinics to serve all those in need — especially vulnerable patients,” says Linda Geng, MD, PhD, co-director of the Stanford Post-Acute Covid-19 Syndrome Clinic, and clinical assistant professor of medicine and population health at Stanford University.
While some existing clinics, like the one at Stanford, have partnered with community health initiatives and primary care providers to expand services and support for Long Covid patients, other programs across the country have lost crucial funding, forcing them to place restrictions on the new patients they accept and the services they offer, or shut their doors completely.
According to Geng, another major challenge for providers trying to care for patients with Long Covid is that there still isn’t a single FDA-approved therapy for the constellation of symptoms and conditions. “We are lacking good tools to treat our patients,” Geng tells Rolling Stone. “While research is advancing, there is an urgent need to find effective and safe therapies for Long Covid.”
Take, for example, neurological symptoms of Long Covid — including cognitive dysfunction, fatigue, dizziness, and headaches — which can be among the most disruptive and destructive to our careers, relationships, and other aspects of our lives. At this point, researchers partially understand what causes post-Covid “brain fog,” and that the virus “leaves an inflammatory footprint on the brain, its cells, vessels, and other structures,” says Anna Nordvig, MD, a neurologist at Weill Cornell Medicine, whose research group is currently studying biomarkers that can be used in future diagnoses and treatments.
In the meantime, doctors have been trying to help people living with Long Covid manage their symptoms using what’s available. “These past four years have been about repurposing all the drugs and treatments we can, from many fields of medicine,” Nordvig tells Rolling Stone.
But having effective treatments and comprehensive care for people living with Long Covid is one thing; being able to afford them is another. On top of the high cost of healthcare in the United States, many people with Long Covid have developed physical and neurological conditions that left them unable to work — at least to the extent they did before getting Covid.
Technically, Long Covid has qualified as a disability under the Americans with Disabilities Act (ADA) since July 2021, but, as I reported that October, it’s up to a person’s employer to determine whether the law and its protections apply to them. Although the extent of the impact on the U.S. labor force and economy isn’t yet known, at least twostudies have estimated that roughly four million people are out of work because of Long Covid, resulting in around $200 billion each year in lost wages. Yet the economic burden of Long Covid continues to be widely overlooked.
“There’s been so much discussion about supply chains, worker shortages, and defaulting on debts, but no one wants to talk about the fact that a significant portion of the workforce has been killed or disabled by Covid,” says Froglet Taylor, who first contracted Covid in March 2020, and in addition to their job, also lost their home.
I first interviewed Taylor for a February 2022 article on Long Covid and housing insecurity, and now, more than two years later, they’re “still living in a cabin made of tarps, miraculously, under the same tree” on a dead-end street near the Astrodome in Houston, Texas. Last summer, they changed their first name to Froglet in order to process the way Covid “forever altered” their life and identity. “I needed that division between who I used to be — a person I barely recognize anymore — and who I am now,” Taylor explains.
Since then, their attempts to access government services have continued to fail. “There is still no help for most of us, largely owing to the fact that there is not a test for Long Covid, or even established diagnostic criteria,” Taylor tells Rolling Stone. “Without that, it’s impossible to claim disability assistance unless you happen to have a qualifying secondary diagnosis.”
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Lacking that assistance, and financial support from partners, family members, or friends, many people with Long Covid, including Taylor, turn to crowdfunding in order to cover medical bills, as well as basics like food and housing. This also includes Gwen Bishop, who has been living with Long Covid since January 2022, and manages @LongCovidAidBot, an automated account on X (formerly Twitter) that shares crowdfunding campaigns and mutual aid requests.
“Long Covid is expensive and debilitating, and especially hard on those who were underpaid or exploited gig workers prior to becoming disabled,” Bishop tells Rolling Stone. “We have no viable social support in the U.S., so the workers whose health has been sacrificed are left to rot, and are dying. It’s becoming heartbreakingly common for people in my community to die with their last tweet being a crowdfunding request that never gets fulfilled.”
On March 11, 2020, the World Health Organization officially declared the novel coronavirus a pandemic. The decision would change the world as we know it — how we live, work, interact with each other — and mark the beginning of a new era in which we coexist with COVID-19.
The pandemic has since been declared over, but the SARS-CoV-2 virus, which causes COVID-19, continues to circulate, mutate and infect people around the globe.
Although many people who have gotten COVID-19 have recovered and gone on with their lives, some have been left with persistent symptoms and debilitating health problems for which there is no cure — which we now know as long COVID.
It goes by several different names, including post-COVID conditions (PCC), long-haul COVID, and post-acute sequelae of COVID-19 (PASC).
Long COVID is not one illness, but rather an umbrella term to describe a wide range of symptoms, conditions and diseases, which can vary from person to person.
Long COVID symptoms commonly include fatigue, brain fog, dizziness, headaches, shortness of breath, joint pain, nerve issues, gastrointestinal problems and many more.
The constellation of long-term health effects can affect every organ system in the body, Dr. Ziyad Al-Aly, chief of research and development at the VA St. Louis Health Care System, tells TODAY.com. “Symptoms are on a spectrum from mild to severe and profoundly disabling,” says Al-Aly.
The cognitive deficits associated with long COVID, such as decreased attention and memory, can be especially debilitating.
Some patients experience slower processing speeds and diminished executive functioning, which means they may struggle to synthesize information or make decisions, James Jackson, Psy.D., neuropsychologist at Vanderbilt University and author of the book “Clearing the Fog,” tells TODAY.com.
“Executive functioning impairment is a big reason why we see so many people with long COVID who are no longer in the workplace,” Jackson adds.
A recent study in the New England Journal of Medicine found that people with long COVID have IQs that are six points lower on average than people who have never had COVID. The cognitive deficits can contribute to worsened mental health outcomes, and vice versa, says Jackson.
How long does long COVID last?
Long COVID symptoms can last "weeks, months or years," according to the CDC, and may persist or go away and come back again.
Akiko Iwasaki, Ph.D., director of the Center for Infection & Immunity at the Yale School of Medicine, tells TODAY.com long COVID symptoms tend to last for two months or more.
Is there a long COVID test?
There are no laboratory tests to diagnose long COVID, the experts note. Due to the multitude of symptoms, there is no universally agreed-upon set of diagnostic criteria either, says Al-Aly.
“A lot of it is patient history and a process of (elimination) of other possible causes, so doctors might perform multiple different tests to exclude other diseases that could be resulting in similar outcomes,” says Iwasaki.
While many people with long COVID have evidence of their acute infection, such as a previous PCR or antibody test, some may have never tested positive or not know they were infected, per the CDC.
A 2023 study published in the journal Nature showed people with long COVID may have certain blood biomarkers, signs of the condition in the body, which could be promising for developing diagnostic tests.
However, as of now, diagnosing long COVID remains a complex and often challenging process. “A lot of times, people are being dismissed, and (told) it’s in their head or this doesn’t exist. … We know it exists, we know it’s a big deal,” says Al-Aly.
How common is long COVID?
In 2022, nearly 7% of adults in the U.S. reported ever having long COVID, according to a report from the CDC. However, the true number of people affected may be higher, the experts note.
“We see a good amount of variation in terms of incidence rates. I’ve seen those numbers range from 5-20% of patients,” Dr. Rainu Kaushal, chair of the department of population health sciences at Weill Cornell Medicine, tells TODAY.com. “Depending on how you define long COVID, it can also affect the rates you’re seeing."
There is an ICD-10 diagnostic code for long COVID (which is used for medical records or death certificates, for example), but this code is not uniformly used, Kaushal adds. This can also impact statistics.
Who gets long COVID?
Anyone who gets COVID can develop long COVID — regardless of age, race, gender, severity of infection, vaccination status or underlying health conditions.
“We have kids with long COVID, (and) we have people who are 100 years old with long COVID,” says Al-Aly.
Many people also get long COVID even if they didn't feel sick. “The vast majority of people develop long COVID after a mild infection,” says Iwasaki. Even if you recover fully from the first infection, it’s possible to develop long COVID after each subsequent reinfection.
However, some data indicates that certain groups may be at increased risk.
According to CDC data from 2022, adults between the ages of 35 and 49 were most likely to experience long COVID, and women were more likely than men to have had or currently have long COVID.
People who had a severe acute infection, especially those who needed to be hospitalized or treated in the intensive care unit may also be at higher risk, says Iwasaki, as well as people who have underlying health conditions and those who are unvaccinated.
Health inequities may also put people from certain racial or ethnic minority groups at greater risk, per the CDC.
Studies have shown that compared to white adults, Black and Hispanic adults who had severe COVID-19 were more likely to develop symptoms associated with long COVID, but also less likely to be diagnosed, according to the National Institutes of Health.
Additionally, certain groups may face greater barriers to health care, and a long COVID diagnosis, including those who are low-income.
Vaccination and the antiviral paxlovid can reduce the risk of developing long COVID, says Al-Aly, but the only way to completely prevent it is to not get COVID-19 in the first place.
What causes long COVID?
Scientists do not know exactly what causes long COVID, but there are several theories. One of the main ones is called viral persistence. “Whether the virus is replicating or remnants of viral products are persisting, that can be stimulating the immune responses which results in these symptoms,” says Iwasaki.
The idea is that some individuals do not fully clear SARS-CoV-2 after infection, and the virus or its remnants remain in “reservoirs” in the body, says Kaushal.
A 2023 study published in Cell showed that the gastrointestinal tract may be a reservoir for the virus, and that these reservoirs could impair serotonin production in the body, for example, which can lead to cognition-related symptoms, Al-Aly explains.
Another theory is that the infection with SARS-CoV-2 triggers a type of persistent, systemic inflammation that takes time to resolve or in some cases does not resolve at all, the experts note.
Scientists are also exploring the link between long COVID and autoimmune conditions. “We know that a lot of different types of infections can trigger autoimmune diseases," says Iwasaki. One example is the Epstein-Barr virus, which is linked to multiple sclerosis, according to a 2019 review on published in Viruses.
"I think some people are suffering from autoimmunity caused by SARS-CoV-2 infection,” says Iwasaki.
Finally, some hypothesize that SARS-CoV-2 may be reactivating other, latent viruses in the body. “We all carry multiple latent viruses, particularly in the herpes family, such as Epstein-Barr and the Varicella Zoster virus. The theory is that these can reactivate after an acute infection with SARS-CoV-2 and cause symptoms associated with long COVID,” says Iwasaki.
Is there a treatment for long COVID?
“We don’t have a cure,” says Al-Aly. Although this is a very active area of research, there are still no specific treatments or FDA- approved medications for long COVID, Al-Aly adds.
Instead, treatment is largely focused on managing the different symptoms or conditions, which may involve various specialists and therapies.
“That really represents a collective failure to find treatments for long COVID so far, going into the fifth year of the pandemic,” says Al-Aly. However, there are a number of long COVID clinics that aim to address the needs of patients. Clinical trials are underway, such as the NIH RECOVER Initiative, to evaluate treatments and find answers about long COVID.
In the meantime, what is known is that many people are suffering, and long COVID can affect the whole body. TODAY.com spoke with six patients, who shared how their lives have changed months to years later. Read on for their stories and an in-depth look at the long COVID symptoms that they fight every day.
Charlie McCone, 34, San Francisco
At the start of 2020, Charlie McCone had just turned 30, started a new nonprofit job, and moved in with his girlfriend in San Francisco. McCone was healthy and active, but after getting COVID-19 in March 2020, he developed severe cardiorespiratory symptoms, which limited his physical activity. When McCone was reinfected in 2021, he became house-bound and lost his job. McCone now suffers from extreme fatigue, cognitive issues, migraines and postural orthostatic tachycardia syndrome (POTS).
Chimére L. Sweeney, 42, Baltimore
Four years ago, Chimére L. Sweeney was a healthy 37-year-old working as a middle school teacher in Baltimore. But then Sweeney got COVID-19 in March 2020. In the months that followed, Sweeney developed debilitating headaches, fatigue, spinal pain, dizziness, vision loss, gastrointestinal issues, and her mental health declined, among other problems. Sweeney was repeatedly dismissed and discriminated against by doctors, and now advocates for Black women living with long COVID.
Cynthia Adinig, 38, Virginia
Cynthia Adinig is a mother and marketing specialist turned long-COVID advocate from Northern Virginia. After a mild case of COVID-19 in March 2020, Adinig developed a rapid heart rate; intermittent paralysis and weakness in her legs, which put her in a wheelchair for several months; esophageal spasms and tears; severe reactions to certain foods, and more. Adinig also suffers from Mast Cell Activation Syndrome (MCAS), which causes repeated allergic reactions or symptoms of anaphylaxis. After being repeatedly denied care, Adinig founded the BIPOC Equity Agency.
Dr. Sue Miller, 50, South Carolina
Dr. Sue Miller, 50, served as medical director of the neonatology intensive care unit (NICU) and chair of pediatrics at a hospital in South Carolina before leaving medicine because of her long COVID. While she avoided getting COVID-19 early on, she caught it for the first and only time at a conference in May 2022. About a month later, Miller noticed she new symptoms, including exhaustion, cognitive impairment, gastrointestinal troubles and pain.
Joel Fram, 57, New York
Broadway conductor Joel Fram was part of the early wave of New Yorkers who contracted COVID-19 in March 2020. As he was recovering during lockdown, he noticed he became exhausted when he tried exercising and often felt so tired he fell asleep in the middle of a tasks, such as eating. He’s had COVID-19 four times but does not believe the reinfections worsened his long COVID symptoms.
Tony Marks, 56, North Carolina
Tony Marks has been living with long COVID for over three years. The father of two and former software executive was once healthy, active and regularly coached hockey. When Marks first contracted COVID-19 in February 2021, he had to be hospitalized for a week with pneumonia in both lungs. Marks and his doctors were initially confident that he’d recover, but he never did. The worst of his long COVID symptoms include debilitating fatigue, muscle pain and spasms, and neuropathy, or nerve damage that can lead to pain, numbness and weakness, per the Mayo Clinic.
Brain Fog
"Brain fog" is used to describe the collection of neurological and cognitive symptoms associated with COVID-19 and long COVID. These include issues with memory, attention and executive functioning. They can range from mild to severe and impair a person's ability to work or socialize.
Tony Marks was the director of a software company before his brain fog and other long COVID symptoms, forced him to resign. "Mid-sentence, during a conversation, I'll just stop because I have no idea what I just told you or where I was going. ... (Sometimes) I won't recall the conversation at all, it's like complete amnesia," Marks tells TODAY.com.
Once, while driving, Marks ended up in a random location with no recollection of how he got there. "I got in the car and my brain just entered into this mode. ... I don't remember going through stop lights or stop signs. ... (Another time) I wound up so far away from where I was supposed to be, I got out and checked my truck for dents and to make sure that I hadn't hit anything," says Marks.
Dr. Sue Miller, a former NICU director, realized soon after she had COVID-19 she could no longer multitask. “I don’t like to call it brain fog because I think that underestimates what I have,” Miller tells TODAY.com. “It’s a brain injury. It is an infection-caused brain injury.”
At work, Miller couldn’t complete paperwork with the door open because the hallway noise distracted her too much. She forgot nurses’ names. “I was having word-finding issues,” Miller says. “I speak much slower now.”
With much sadness, Miller realized she needed to stop practicing medicine. “I was worried I would make a mistake,” Miller says. “I save lives. You have to be able to think fast and not be tired and not make a mistake — because seconds matter.”
Studies have shown COVID-19 can damage the brain, and people who recover from an infection tend to have less grey matter in the brain — crucial for information-processing, per Cleveland Clinic — than those who didn’t get COVID-19.
Dizziness
Dizziness and lightheadedness are some of the most common symptoms reported among long COVID patients, per the CDC.
It was one of Chimére L. Sweeney's early long COVID symptoms in March 2020. "When I was standing up, I would feel extremely dizzy," Sweeney tells TODAY.com. It soon became difficult to walk, and showering was a monumental effort. “I was fainting in my bathroom and waking up and not knowing where I was,” says Sweeney.
Some long COVID patients also report experiencing a type of dizziness called vertigo and impairments to the vestibular system, which controls balance.
Vision disturbances
Miller, the former NICU physician, says her ongoing visual disturbances trouble her.
“It’s called imprinting. What happens is light will stay in my eyes,” she says. “Mine lasts for a really long time.”
Sweeney, too, noticed her vision started to change after she got COVID. “By mid-April, I lost vision in my left eye,” she says. “It had been about six months of going to the hospital trying to seek care. I was sent home with lost vision — they could see my vision was blurry, but nobody was telling me why,” says Sweeney.
After months of her vision loss being brushed off, doctors discovered Sweeney had dense cataracts. “I had two of them, one in each eye because of the infection, the inflammation,” says Sweeney. It took another few months for doctors to agree she needed surgery. “Now I have these dark black floaters in my eyes that impair my vision a lot,” she adds.
Rapid heart rate, trouble breathing
In the first few months after developing long COVID symptoms, Cynthia Adinig would notice her heart racing often "to the point where I feared I was having a heart attack,” she says. Her heart symptoms were often brushed off by doctors as anxiety, she says.
Joel Fram says he experiences chest pain, but trying to treat his rapid heartbeat has been frustrating.
“The cardiologist was like, ‘Well your heart rate is quite high. But your ECG is coming back normal. Your ultrasounds are coming back normal,’” Fram, a Broadway conductor, tells TODAY.com. “I was like, ‘OK, but something’s happening.”
Fram's heart rate often skyrockets after physical activity, so he's slowly building up his activity levels through physical therapy.
Before the pandemic, Charlie McCone used to regularly bike 10 miles to work and back. “I got sick in March 2020, and I’ve never been the same,” McCone tells TODAY.com. After his first infection, he developedsevere shortness of breath, chest pain and a rapid heartbeat.
“I felt like I couldn’t take a breath. It was agonizing,” says McCone, adding that he could walk at most for five or 10 minutes. When he was reinfected a year and a half later, COVID-19 took a toll on his lungs and heart once again.
"I ended up getting pneumonia, and I was hospitalized for a night. ... It was a total nightmare,” says McCone. Although his respiratory symptoms have improved slightly, McCone can only engage in limited physical activity, such as walking to another room.
Fatigue
Before getting COVID-19, Tony Marks was a healthy, active individual who could "do whatever he wanted to do," he says. The extreme fatigue has stripped that away from him.
"Now, I fall asleep all the time, for no reason. I’ll be sitting visiting with people, at the pool, and I fall asleep, and nobody can wake me up," says Marks. "Next thing I know I’m waking up in the hospital because I had fallen into such a deep state of sleep (and) it was impossible to wake me," Marks adds.
After being reinfected with COVID in 2021, Charlie McCone’s fatigue rendered him bed-bound. “I couldn’t even sit at a computer for 30 minutes,” says McCone. The once athletic, outgoing young man now rarely leaves his home except to seek medical care.
“I have been severely housebound.I lost my job, am no longer able to work, and I rely on my partner as a full-time caretaker,” says McCone, adding that he’s seen little improvement in three years. “Now I am only really able to function for one to two hours a day to do computer work or stuff around the house,” says McCone.
Fram, the Broadway conductor, says the fatigue felt “really debilitating. ... It’s just not something as a human being you really expect. You’re having lunch with someone and you’re literally falling asleep on them. That’s really hard to fight.”
Fram also experiences post-exertional malaise (PEM), the worsening of symptoms 12 to 48 hours after little physical or mental activity, which can last for weeks, per the CDC.
Fram is now trying a type of physical therapy where he does a few small movements followed by intentional breathing to try to combat his PEM. “You’re retraining your body,” Fram says. “It’s to remind your body to lower your heart rate when you’re finished exercising … but not trigger a fatigue attack with too much exertion.”
Tremors and spasms
Shaking, buzzing and abnormal movements can also be symptoms of long COVID. Adinig has experienced internal vibrations and tremors that occasionally wake her up at night.
“I’ll be waking up choking on my air, having violent tremors in my sleep, and then once I am awake, the tremors don’t stop,” she says. Although she now takes a medication that helps with her tremors, they still come and go during symptom flare-ups.
Marks says that long COVID has left him with "thousands of muscle spasms a minute," mostly in his arms and legs. "Most of that is internal spasms but when they get really bad, I have an external shake or twitch," says Marks.
"One time, I was at work, and out of the blue I had one in my arm. I just happened to have the (computer) mouse in my hand and it goes flying against the wall because the jerk was so bad," he recalls. Three years later, the spasms and twitching have not improved.
In a 2023 study of 423 adults with long COVID, which Iwasaki co-authored, about 37% reported having “internal tremors, or buzzing and vibrations." This cohort also reported having a worse quality of life, more financial difficulties, and “higher rates of new-onset mast cell disorders and neurologic conditions,” compared with long COVID patients without tremors.
Chronic pain
Paint throughout the body, especially in the joints and muscles, is one of the main long COVID symptoms that prevents patients from returning to their old lives.
Fram keeps a bottle of ibuprofen at the ready to help ease his swollen, tender joints, which make his work as a conductor and pianist much harder.
“(It) requires a lot more practice to play the piano as dexterously and accurately as I used to,” he says. “When I conduct, I have always used my hands instead of a baton, but the swelling and stiffness in my joints means I have to manage a fair amount of pain.”
He has discomfort in his feet and legs, too: “It is very similar to restless leg syndrome, where I get uncomfortable tingling in them, and I can’t keep my feet still. My body keeps trying to shake it out.”
One of Sweeney’s early long COVID symptoms felt like a searing migraine. “I felt this fiery pain move from the base of my skull to the bottom of my spine. It felt like someone had poured acid, (or) lit a match down my spine. I knew that something was very wrong,” she says.
By April, the pain moved to the left side of her face. “It felt like someone had hit me with concrete,” she adds.
It took months for Sweeney to get a diagnosis of occipital and trigeminal neuralgia, a type of shocking or shooting pain that follows the path of a nerve due to irritation or damage, per the National Library of Medicine.
"I have never felt anything like the pain that I felt in my skull (with long COVID),” says Sweeney. "Every second of the day, my head is hurting."
Marks describes the pain in the muscles of his legs as "feeling like I was being beat with a baseball bat. ... It can be a dull pain or deep. I have woken up at night feeling like I've been stabbed in the legs."
The neuropathy has also caused severe weakness in his legs. "It almost feels like I'm trying to balance on jello, the muscles in my legs are so weak and they just can't support me," says Marks. The former hockey coach often wakes up wondering whether it will be the last day he can walk on his own.
Digestive problems
Long COVID can infiltrate the digestive tract, leading to symptoms such as diarrhea and abdominal pain.
Long-hauler Chimére L. Sweeney initially had diarrhea during her acute COVID-19 infection, but she now deals with chronic and severe constipation with no relief.
"I am still so constipated that when I had a colonoscopy (recently), they could not complete the process because my body was not even adhering to the prep, after the laxatives and the fasting," says Sweeney. "I suffered and still suffer today."
On Mother's Day in 2020, Cynthia Adinig suffered a reaction while eating one of her favorite foods, shrimp. “I felt strange, my jaw felt tight,I couldn’t swallow, my heart raced,” says Adinig. "I went to the ER and tests showed nothing alarming to the medical staff."
In the following months, Adinig suffered from similar reactions to more foods, as well as gastric reflux and other gastrointestinal issues, but was repeatedly dismissed by doctors.
By September, Adinig had lost 50 pounds and had to be hospitalized multiple times for starvation and dehydration, where doctors discovered an esophageal tear. "I developed esophageal spasms and I've had issues with swallowing and choking since, even on small amounts of food and water," she says.
Although she started to recover in 2021, Adinig is dependent on antihistamines and can only eat a handful of bland foods that won’t cause a reaction. "Even like a sprinkle of pepper will trigger my reflux so badly that it's not worth it," says Adinig.
Grief and gaslighting
Many people with long COVID mourn who they once were.
In 2021, Fram, the Broadway conductor, “went down a terrible mental spiral,” including suicidal thoughts, he says. “I was getting anxious and incredibly depressed. I could no longer manage it on my own.”
He remembers crying after visiting the Center for Post-COVID Care at Mount Sinai in New York City because he "finally found" health care providers who believed him, and he could see a path forward.
Due to her long COVID, Miller says she's had to confront "a loss of identity, the loss of my health, getting old."
“You start to think you’re losing your mind, like this isn’t real,” she adds. “I’m not clinically depressed, but ... I’m crying because this has taken over my life. … People will say it’s anxiety. No. I’m anxious but because I don’t know what this is going to turn into.”
A former middle school teacher, Sweeney, too, "(grieves) over how much I lost. ... I’m now retired due to being medically disabled. It's been one of the most disappointing and hurtful things in my life."
Severe depression and suicidal ideation, which Sweeney manages with medication and therapy, are common for long COVID patients, often due to the burden of their other symptoms, Jackson explains.
And part of this struggle may require convincing health care providers to believe you have long COVID at all.
“I experienced nothing short of humiliation, a lot of sexism and even racial profiling and discrimination,” Sweeney recalls of being hospitalized due to her long COVID symptoms in July 2020.
Adinig testified in front of Congress in 2022 about being dismissed: She sought emergency medical care for a dangerously high heart rate and low oxygen levels, and emergency room staff drug tested her without her consent and threatened to arrest her.
When Miller told her primary care doctor about her long COVID diagnosis, all she offered was a hug, "which is not anything anyone wants to hear from a physician,” Miller recalls.
Although the research on long COVID has advanced rapidly, many patients feel that these these scientific leaps have yet to translate into tangible steps for treatment.
"It's debilitating, devastating and demoralizing ... and you deal with that every single day," says Marks.
The 4 7 8 sleep method is a breathing technique that can help you quickly drop into a state of relaxation, which in turn will help you fall asleep faster. It works especially well for combatting sleep anxiety and easing a stressed out mind at bedtime, but it can be used to help you fall asleep more easily during a daytime nap too,
Developed by Dr Andrew Weil, Founder and Director of the University of Arizona Center for Integrative Medicine, the 4 7 8 sleep method is a form of conscious breathing and a simple yet effective technique for feeling calmer before sleep.
Dr Weil described the 4 7 8 sleep method as “a natural tranquilliser for the nervous system”. As part of Sleep Awareness Week 2024, here's what you need to know about this popular breathing technique, how it works and how to use it to fall asleep fast tonight...
What is the 4 7 8 sleep method breathing technique?
According to Dr Andrew Weil, creator of this breathing technique, the 4 7 8 sleep method is a form of 'conscious breathing'. It encourages you to let go of anxiety, stress and other negative feelings, and replace them with a state of calm that's better suited to falling asleep fast.
Also known as the Relaxing Breath, the 4 7 8 sleep method is very popular with people dealing with sleep anxiety or who are too wired, worried and stressed to switch off for sleep. That makes it harder to fall asleep, and can lead to wake-ups in the night.
The 4 7 8 sleep method aims to reduce all of that at bedtime so that you have a better chance of falling asleep fast and sleep through the night.
How does the 4 7 8 sleep method work?
When talking about the 4 7 8 breathing technique, Dr Weil explained how, “this exercise is subtle when you first try it, but gains in power with repetition and practice.”
The 4 7 8 sleep method works by activating your parasympathetic nervous system (PSNS). Psychologists describe the PSNS as the system responsible for rest and relaxation, and for switching off the sympathetic nervous system (SNS) – the one that kick-starts your stress response and ‘fight or flight’ mode.
Through deep, rhythmic breathing, this powerful technique helps you fall asleep faster while reducing any anxiety and stress you might be feeling. Here’s how to use it tonight…
How to use the 4 7 8 sleep method
First things first, you need to practice this breathing technique twice a day every day. Just like the military sleep method, the 4 7 8 sleep method increases in power the more you use it.
Secondly, if you have asthma or a respiratory condition, speak to your doctor first to make sure this breathing technique is safe for you to use. Ready to start? Then here’s how to use the 4 7 8 sleep method tonight…
1. Get into a comfortable position and relax your body.
2. Place the tip of your tongue against the tissue behind your upper front teeth.
3. Exhale through your mouth, making a whooshing sound.
4. Close your mouth and inhale through your nose for 4 seconds.
5. Now hold your breath for 7 seconds.
6. Exhale fully through your mouth for 8 seconds, making a whooshing sound as you breathe out.
7. That counts as one cycle of breath. Repeat this cycle 3-4 times, twice a day.
If you find it hard to hold your breath for that long to begin with, you can speed up the count in the beginning as long as you stick to the 4:7:8 ratio per breath.
It may take four to six weeks to notice any big changes, but with twice-daily practice you’ll soon be falling asleep faster and feeling more peaceful when drifting off.
And if you wake up often at night, you can also use the 4 7 8 sleep method to get back to sleep quickly. Here’s Dr Weil on how to use this breathing technique and what it sounds like when you do it right:
How does it compare to the Military Sleep Method?
While both the 4 7 8 sleep method and the Military Sleep Method involve breathwork, the 478 sleep method is essentially a breathing technique while the Military Sleep Method is a visualization technique based on Cognitive Behavioral Therapy (CBT).
Both can be powerful ways to calm your sleep anxiety and stressed out mind to fall asleep faster at night, but we usually find that most people gravitate towards one or the other. If you're very stressed and anxious, try the 4 7 8 Sleep Method as it will quickly regulate your breathing and drop you into a place of calm.
You feel too stressed out otherwise to work through the imagery laid out in the Military Sleep Method, which has some similar elements to a guided sleep meditation or body scan technique.
How does deep breathing help us fall asleep fast?
Deep breathing is a natural sleep aid and, best of all, it’s completely free and easy to do. Research has shown that it can be effective for people with insomnia, and how slow, deep breathing – especially when used with sleep hygiene techniques – can help people initiate sleep faster.
Deep breathing is also one of the best ways to quickly lower stress in the body as, according to guidance shared by the University of Michigan Health, ‘it sends a message to your brain to calm down and relax. The brain then sends this message to your body.’
The 4 7 8 sleep method takes no time to practice, so try it twice a day for the next four to six weeks and see how it benefits your sleep. If you have any concerns about your quality of sleep though, speak to your healthcare professional to see what help is available to you.
Also, don’t forget that your bed can impact how well you sleep, so make sure you have the best mattress for your body. If you aren’t ready for a new mattress just yet but your bed needs a big comfort boost, try a thick mattress topper instead. Both are seeing price cuts thanks to the incoming Presidents’ Day mattress sales.
Experts provide insights into the importance of sleep for our health and well-being. (LaylaBird / Getty Images)
Sleep is as essential to our health as food and water.
It is important to a number of brain functions, including how nerve cells communicate with each other.
We sleep for a third of our lives and there are many restorative processes going on during sleep that are needed to stay healthy.
Why do we usually sleep at night? What happens when we don't sleep? On World Sleep Day, Nadine Dreyer asks a group of experts to tell us more about this essential part of our lives.
Why do we need sleep and why do we sleep better at night?
We sleep for a third of our lives, yet it is only when we cannot sleep or when we experience poor-quality sleep that we really start noticing it.
During sleep, our muscle activity drops, our breathing slows down, and our heart rate and blood pressure decrease. At the same time, our brain actively clears toxins, which cause neurodegenerative diseases.
It also consolidates memories, wiping out "useless" ones during deep sleep, known as slow wave sleep.
All this allows us to start afresh the following day.
Our lives are organised around our sleep-wake schedule. As we're a diurnal species, our master clock in the brain, which maintains many of our 24-hour rhythms, schedules our period of activity with daylight, and our period of rest with the night.
In some other animals, like rodents, evolutionary pressure has pushed those species to become nocturnal, which allows them to scurry and feed outside the view of their diurnal (daytime) or crepuscular (twilight) predators.
Not sleeping at the right time has been associated with poor health. Some of the side effects are poorer cognitive performance, lower energy and worse mental health.
There's also a higher risk of developing neurodegenerative diseases such as Alzheimer's and a higher risk of developing high blood pressure and diabetes.
After a poor night's sleep, we try to get on with our lives but research has shown this is not so easy. During the Covid-19 pandemic and the strictest lockdown, South Africans rated their sleep quality as poorer, with more insomnia symptoms. These were both, in turn, associated with worse levels of depression and anxiety.
What happens when we don't sleep?
Sleep is a state of vulnerability where a "rest and digest" state dominates over the "fight and flight" state when we are awake.
Our early sleep "scans" the environment before allowing us to dive into deeper stages of sleep.
When a rupture in this consolidated bout of sleep happens, we will start complaining "I haven’t slept enough" or "I slept really badly last night".
Such ruptures include those induced by specific sleep disorders like sleep apnoea or insomnia.
Sleep apnoea leads to unconscious sleep interruptions due to upper airways obstruction and can lead to hypertension and increased risk of diabetes.
Research in rural Mpumalanga province in South Africa found one out of three older adults had moderate to severe sleep apnoea and this was associated with a higher risk of cardiovascular disease. Yet, there is no treatment in the public health system for this common sleep disorder.
Certain situations disrupt sleep: parents tending to their young children, doctors being awake while on call, loud generator noises during night-time electricity cuts, mosquitoes, or worse, gunshots or sounds of violence waking us up from our slumber, signalling danger.
Sleep health inequity in South Africa is also driven by socioeconomic status.
A recent study on sleep in men and women living in the urban township of Khayelitsha in South Africa's Western Cape province showed that poor sleep quality was associated with fear of falling asleep in a violent environment. Sleep was disturbed by strange noises, fear of attacks and dreams about past traumatic experiences.
Electronic devices make it difficult to sleep. Why?
Even though our biology is meant to make us sleep at night, several societal and technological changes have progressively decreased our sleep opportunities.
Our sleep timing is controlled by our master circadian clock. This clock is exquisitely sensitive to light, so exposure to bright light and blue light, such as that emitted from electronic devices such as smartphones, shifts our bedtime to a later time.
In our recently published study of adolescent sleep in Nigeria, adolescents in urban areas slept less and sleep quality was worse.
Sleep duration was shorter due to bedtimes being later, but waking times in the morning were similar to those of adolescents in rural areas. The use of electronic devices at night by urban Nigerian adolescents was associated with shorter sleep duration.
This is one example of a growing body of research that highlights the negative consequences of nocturnal tech use on sleep, even in African societies.
What are key habits to help people sleep better?
The most important habit is to take sleep as seriously as a healthy diet and regular exercise.
We advise the following:
Keep regular wake times and bedtimes. This helps us sleep at the best time with respect to our master clock’s rhythm. This in turn helps ensure a consolidated bout of sleep.
Aim for an average of 7 to 9 hours of sleep each night.
Avoid watching screens one hour before normal bedtime. If this is unavoidable, choose the lowest brightness and add the orange night screen setting. Rather read a book under a bedside light.
Get outdoor light during the day to strengthen the master clock’s circadian (near 24-hour) rhythm.
Do some form of physical activity once a day. This helps build sleep pressure and also strengthens the master clock’s rhythms.
Avoid alcohol before bedtime as this is associated with disrupted sleep.
Avoid caffeine and stimulants after noon.
Try to sleep in a quiet, cool and dark or dimly lit environment.
Any links to online stores should be assumed to be affiliates. The company or PR agency provides all or most review samples. They have no control over my content, and I provide my honest opinion.
I have reviewed a few health tech products that aim to improve well-being, including the popular Sensate relaxation device.
While I love the idea of using devices to improve mental health, sleep or general well-being, I haven’t had much luck with the devices I have used.
In my case, I have ADHD, I am likely ASD, and I have terrible anxiety and sleep problems.
I have tried pretty much everything to help with sleep and anxiety, but I have always struggled to get into meditation/mindfulness.
Moonbird is another product that is supposed to help with breathing and meditation exercises, so I was eager to try it out. But, based on past experiences, I was somewhat sceptical of its effectiveness.
However, my experience with this product has been much more positive than other devices I have reviewed.
What is Moodbird?
Moonbird is a handheld device that expands and contracts slowly, guiding you through breathing exercises and providing feedback using your heart rate or HRV.
By holding Moonbird in your hand, you can effortlessly sync your breathing with its gentle rhythm, embarking on calming breathing exercises. This simple yet effective ritual helps you find the precious serenity that often seems out of reach in our busy modern lives.
Therapists and respected medical professionals recommend Moonbird as a supportive treatment tool for those dealing with stress, anxiety, and sleep issues. By integrating Moonbird into your daily routine, you can create a sanctuary from the demands of the world, finding moments of respite and tranquillity.
The Moonbird package includes everything you need to begin your journey towards greater well-being: the Moonbird device, a convenient charging cable, a protective pouch, and exclusive access to the Moonbird app. The app not only allows you to connect with your Moonbird but also provides a wealth of guided breathing exercises and audio guides to support and enhance your wellness practice.
As a physical breathing guide, Moonbird expands and contracts in your hand, encouraging you to match its rhythm by inhaling as it expands and exhaling as it contracts. The app offers real-time biofeedback on heart rate, heart rate variability, and coherence while also allowing you to customise your breathing exercises and rhythm. Moonbird can be used in various situations, such as between meetings, in traffic, or before bed. You have the freedom to decide when and where to take a break and focus on your well-being. To experience the most benefits and become accustomed to breathing with Moonbird, it is recommended to start with short, 4–6-minute exercises, 2-3 times a day.
Design
The Moonbird is an ergonomically designed device that sits comfortably in your hand and is coated in soft-touch plastic.
Within the dimple of the Moodbird is an optical heart rate monitor similar to the HRM found on most wearables, such as Garmin and Xiaomi.
Then, the body of the device can expand and contract to replicate the slow rhythm of breathing required for the exercise.
It then uses Bluetooth, allowing you to pair it to your phone and synchronise it with the guided exercise.
Set-Up
There is not much setup required; you will need the Moonbird App (Android link). You activate the Moonbird when you pick it up, and you need to pair your phone to the device. That’s about it!
Performance: How effective is it for anxiety and sleep?
With the Moonbird connected, you have four predefined exercises consisting of:
Balanced Breathing Exercise
Falling Asleep
Box Breathing
Curb Anxiety
You can then customise the time of each exercise and optionally mute the audio. Alternatively, you can create your own breathing exercise.
When you start the exercise, you can choose to monitor your HRM, HRV or Heart Coherence.
Heart coherence was something new to me. This is a state of synchronisation between various physiological systems in the body, particularly the heart and brain, resulting in optimal physical, emotional, and mental functioning. It is characterised by a highly ordered, smooth, and sine wave-like heart rhythm pattern, indicating harmony between the sympathetic and parasympathetic branches of the autonomic nervous system.
Basically, your heart rate synchronises with your breathing, speeding up when you inhale and slowing down when you exhale.
Heart Rate Variability has been a popular metric used with Garmin watches over the past few years. This refers to the variation in the time interval between consecutive heartbeats in milliseconds. Contrary to the common perception that a healthy heart beats with a consistent rhythm, a healthy heart actually beats with slight variations in time intervals between beats. These variations are influenced by the autonomic nervous system (ANS), which regulates many unconscious bodily functions, including heart rate.
HRV is a significant indicator of the autonomic nervous system’s balance and flexibility. It reflects the body’s ability to adapt to stress, physical activity, and environmental demands. A higher HRV indicates more variability between heartbeats, signifying better cardiovascular health, resilience, and adaptive capacity of the ANS. Conversely, lower HRV is associated with stress, fatigue, or underlying health issues, suggesting less adaptability and potentially poorer health.
When you begin a breathing exercise with the audio on, a woman with a pleasant, relaxing voice will guide you through the exercise, with the Moonbird slowly pulsating in the rhythm you should breathe.
I like the pulsating rhythm; it is comforting to hold in my hand, and I don’t need to concentrate on what the person is saying. This is particularly useful for someone like me, as I have terrible concentration and am easily distracted. I can use it to relax while watching TV, or when I go to bed, I can use it while attempting to go to sleep without getting annoyed at the vocal coaching.
It is too early to say if it has had a significant impact on my anxiety or sleep, but I would say this is my most successful attempt at committing to breathing exercises and meditation.
My therapist has attempted to get me to do similar timed breathing exercises, but it has never really stuck before. I also demonstrated the Moonbird to her, and she was impressed and felt it would be a good device for people with ADHD.
Price and Alternative Options
The Moonbird Breathing & Meditation Device is available from Amazon for £169.
If you buy from Moonbird directly, they have a 30-day 100% money-back guarantee.
There is the TheaWellbeing Melo, which is a concept similar to guided breathing. This uses light rings and vibration to guide you but lacks the HRM sensor. Reviews on Amazon are not overly positive but it is more affordable at £70.
Mindplace has the Kasina or Limina Light & Sound Meditation System, which requires you to wear glasses to aid in the meditation. These are very expensive, at £360 and £280, respectively.
The Muse 2 is a brain-sensing headband that gives real-time feedback on your meditation. It is an interesting concept, not dissimilar to what Moonbird has done by using a heart rate sensor and EEG to provide feedback. However, it also has a premium price of £240.
The Sensate was another interesting meditation device that uses a mix of infrasonic frequencies and sound which claims to do vagal nerve toning. This appears to be one of the best-reviewed meditation devices. I found that it did help with meditation but at £300 for the Sensate and £49 per year subscription it felt like poor value for money.
I previously reviewed the Modius Slim, which was supposed to be an innovative weight loss device that used vestibular stimulation. I didn’t see any positive results, and they have now pivoted and market the devices as sleep and stress aids, with the headset being worn for 30 minutes each evening prior to going to bed. At the moment, the Modius website seems only to be working for China, but they can ship internationally, and it costs 4,999 Chinese Yuan or £544.
Overall
From my past experience with health tech such as this, I know that the effectiveness of the product is much more subjective than normal consumer technology, and what works well for one person may not work well for another.
I was sceptical of both Sensate and Modius due to some of the questionable scientific claims. I did like the Modius, and it certainly aided meditation, but £300 for a vibrating plastic pebble felt excessive, to say the least.
For Moonbird, they are not using any fancy technologies which claim to aid meditation. It is just a device that provides guided breathing exercises that use heart rate and HRV to monitor progress. Meditation, mindfulness, and breathing exercises are all well-established as effective for anxiety, sleep, and general mental health. So, there is nothing to criticise here.
Personally, I liked the Moonbird. I like the fact I can just hold it in my hand and follow the breathing exercise with no audio on allowing me to try and fall asleep while using it or just relax and watch TV. I found the pulsating nature of the Moodbird quite relaxing too.
I have not used it for a very long time, but I am hoping that this will be the first device that helps me stick to regular breathing/meditation exercises and that would make it good value for money for me.
On the flip side, I can imagine many people won’t get as much value for money from it. It may be more affordable than competing systems, but £170 for a device that pulsates and measures your heart rate seems steep for what it is. The guided exercises are somewhat limited, but at least you don’t have to pay for a subscription. Then. there are plenty of apps available that do guided breathing exercises for free, and I would say that is the best place to start if you want to get into some form of meditation. But, many people, including myself fine committing to using these apps regularly and not getting distracted is frustratingly difficult, and this is where Moonbird may help.
Overall, if you are like me and realise that meditation would be beneficial to you but have struggled to get into a regular habit, I think the Moonbird is well worth considering. You can also try it out for 30 days if you are unsure how effective it may be.
Moonbird Breathing & Meditation Device Review
Summary
If you are like me and realise that meditation would be beneficial to you but have struggled to get into a regular habit, I think the Moonbird is well worth considering. You can also try it out for 30 days if you are unsure how effective it may be.
Pros
No pseudoscience – breathing exercises and meditation are well-established treatments for anxiety
The breathing rhythm of the Moonbird allows you to use this without any vocal guidance which I found particularly useful.
Cons
Quite expensive for what it is
I am James, a UK-based tech enthusiast and the Editor and Owner of Mighty Gadget, which I’ve proudly run since 2007. Passionate about all things technology, my expertise spans from computers and networking to mobile, wearables, and smart home devices.
As a fitness fanatic who loves running and cycling, I also have a keen interest in fitness-related technology, and I take every opportunity to cover this niche on my blog. My diverse interests allow me to bring a unique perspective to tech blogging, merging lifestyle, fitness, and the latest tech trends.
In my academic pursuits, I earned a BSc in Information Systems Design from UCLAN, before advancing my learning with a Master’s Degree in Computing. This advanced study also included Cisco CCNA accreditation, further demonstrating my commitment to understanding and staying ahead of the technology curve.
I’m proud to share that Vuelio has consistently ranked Mighty Gadget as one of the top technology blogs in the UK. With my dedication to technology and drive to share my insights, I aim to continue providing my readers with engaging and informative content.
Breathing+ by Breathing Labs has passed peer review in a randomized controlled clinical trial that was recently published in SCI Q2 journal Pediatric Pulmonology. Research done by @bezmialem Full text is available in a link here: https://www.breathinglabs.com/clinical-trials/research-breathing-labs-and-nintendo-clinical-trial-is-published-in-journal-pediatric-pulmonology-sci-q2-impact-factor-3/?fbclid=IwAR2wNhSgurdbrrf3gzOOkHthgiWfXJ1x8RWvnMhkSo6fi33QPZEGzxzd6jM
BREAKING: @breathinglabs and @Nintendo clinical trial is published in journal Pediatric Pulmonology (SCI Q2, Impact Factor > 3), full text: https://breathinglabs.com/Nintendo%20&%20Breathing%20Labs%202022 #telemedicine #telehealth #mhealth
Clinical mouthpieces 10pcs packages are now available at 45€/50USD (shipping cost not included). Learn more: https://www.breathinglabs.com/latest-news/announcement-breathing-mouthpieces-for-clinical-and-professional-use-are-now-available/
BREATHING VR: Lately we are sourcing this VR headset for use in Breathing VR application. It allows easiest installation of both breathing+ headset cable, and USB charging cables, which is essential in professional use: https://www.banggood.com/VR-SHINECON-G5-VR-Glasses-3D-Virtual-Reality-Glasses-VR-Headset-For-iPhone-XS-11Pro-Mi10-p-1679808.html?rmmds=myorder&cur_warehouse=CN
Update: Each purchase of Breathing+ will now include three machine washable mouthpieces. Previous buyers will be supplied with those by their country representatives but will have to cover shipping costs. Please be patient while we arrange distribution. https://www.breathinglabs.com/latest-news/announcement-breathing-mouthpieces-for-clinical-and-professional-use-are-now-available/
Update: We moved servers + relocated all our games to our servers, please be patient while google reviews all that (showing unsafe website atm). Use duckduckgo or non-chromium browsers to reach our pages in the meantime. Everything ok + new product addons coming out in a month!
Registration and all functionalities at http://breathinglabs.com (and in our iOS and Android games) are fixed and fully working. If you find any issues -> [email protected]
We are back in stock with Breathing+, currently searching for VR supplier, and setting up mass production for toys and tens stimulation + in November we will be signing up new erasmus traineeships, research projects, bilateral, FP(eu), and asia-pacific ->[email protected]
BREAKING: Nintendo Co. Ltd (Japan) is implementing Breathing Games by @breathinglabs in FDA approved clinical trial for children with bronchiectasis: https://clinicaltrials.gov/ct2/show/NCT04038892
Notice to b2b partners: we are running late with some minor upgrade-> briefly running out of stock -> retail and b2b sale is closed until early october. To get a list of partners with stock to sell contact us at [email protected] Thanks, we'll go strong again in winter 💪