Engineered stone, a popular choice for countertops, has proven
popular due to its aesthetic appeal, cost, durability, and
versatility. However, in recent years there has been focus on the
serious health concerns linked to engineered stone including
long-term respiratory illness and premature death. In this article,
we will delve into what engineered stone is, the serious
respiratory health problems it poses for workers, and the call for
the ban of its use in Australia.

What is engineered stone?

Engineered stone, often known by but not limited to brand names
like Caesarstone, Silestone, or Quantum Quartz, is a popular
material used for kitchen and bathroom countertops, as well as
other interior surfaces. It is made by combining crushed natural
stone, such as quartz, with polymer resins and pigments to create a
durable and attractive surface. The result is a versatile material
with a wide range of colours and patterns that mimics the look of
natural stone at a much cheaper cost, hence the popularity.

What exactly are the health risks linked to engineered
stone?

While engineered stone offers many advantages, there is a
notable downside associated with its production and fabrication.
Engineered stone contains a high concentration of crystalline
silica, a naturally occurring mineral found in quartz, which poses
a significant respiratory health risk when airborne. The fine dust
produced during the cutting, grinding, and polishing of engineered
stone surfaces can be inhaled by workers and lead to severe health
problems, including:

i. Silicosis
prolonged exposure to respirable crystalline silica dust can lead
to silicosis, an irreversible and often debilitating lung disease.
Silicosis causes scarring of lung tissue, leading to symptoms such
as coughing, breathlessness, and increased susceptibility to
respiratory infections. There is no cure for silicosis and if
developed, life expectancy is diminished.

ii. Lung cancer – inhaling
crystalline silica over an extended period is associated with an
increased risk of lung cancer. Most cases are not curable and
significantly reduce a worker's life expectancy.

iii. Chronic Obstructive Pulmonary Disease
(COPD)
silica exposure can
contribute to the development of COPD, a progressive lung condition
which includes emphysema and chronic bronchitis and is
characterised by breathing difficulties and shortness of
breath.

Silica dust exposure also increases the risk of developing
chronic kidney disease, autoimmune disorders (such as scleroderma
and systemic lupus erythematosus) and other adverse health effects,
including an increased risk of activating latent tuberculosis, eye
irritation and eye damage. The risk posed by engineered stone is
being touted as the new asbestos in terms of the
health ramifications for workers in Australia.

Legislative amendments to the Work Health and Safety Act 2011 (NSW) and
SafeWork Australia's call for a national ban

In response to growing concern over the health risks associated
with engineered stone, the NSW government has previously introduced
amendments to the Work Health and Safety Act 2011 (NSW)
which were designed to safeguard the health and well-being of
workers in the engineered stone industry.

These measures included reduced exposure limits, mandatory
health assessments, improved monitoring, and compliance as well as
education and training, and dust control measures which required
employers to implement effective dust control measures, including
proper ventilation, wet cutting methods, and the use of suitable
personal protective equipment.

To date however, persons conducting a business in this industry,
workers and regulators have failed to ensure the health and safety
of all workers working with engineered stone. In particular, the
lack of effective monitoring and compliance, despite some smaller
and sporadic wins, remains a big issue within the industry.

SafeWork Australia (SWA) has called for a
complete ban of the use of engineered stone in Australia. It has
undertaken significant work since 2018 to improve WHS arrangements
to prevent dust diseases including silicosis. This has included
amendments to NSW WHS legislation, however in February 2023 WHS
ministers agreed to SWA's recommendations to address workplace
exposure to respirable crystalline silica through national
awareness and change in behaviour initiatives, and further
regulation for all materials across all industries (which includes
engineered stone).

SWA undertook extensive analysis and consultation on the impacts
of a prohibition on the use of engineered stone and provided its
decision in a report to WHS Ministers on 16 August 2023 for
their consideration. The expert analysis undertaken shows that dust
from engineered stone poses unique hazards, and there is no
evidence that lower silica engineered stone is safer to work with,
meaning there is no safe level of exposure for workers. SWA has
recommended a prohibition on the use of all engineered stone,
irrespective of the crystalline silica content. There is also a
recommendation of the introduction of a licensing scheme to ensure
appropriate controls are in place to protect worker health when
engineered stone already in place needs to be removed, repaired, or
modified.

Silicosis and dust diseases pose an unacceptable health risk to
workers in Australia, and it is important to note that there are
significant financial and non-financial costs associated with being
diagnosed with silicosis or a dust disease, including significant
physical and emotional harm, the reduced ability to work, reduced
quality of life and ultimately premature death of workers. There
are also significant costs to the public health system and in turn
our economy.

SWA recommends urgent government intervention, due to the
disproportionate number of silicosis cases in engineered stone
workers, the younger age of diagnosis of silicosis and dust related
diseases in engineered stone workers, and the impacts on workers,
their families, and the wider community. The decision to prohibit
the use of some or all engineered stone is a matter for WHS
ministers who will meet later this year. It is clear that while
engineered stone revolutionised interior design, the long-term
health risks for workers involved in its fabrication and
installation outweighs the gain.

The content of this article is intended to provide a general
guide to the subject matter. Specialist advice should be sought
about your specific circumstances.

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With twenty eight percent of tuberculosis cases globally reported from India, it is imperative that we prioritise strengthening our health systems and invest in TB prevention

Persistent coughs are among the early TB symptoms (Photo credit: Pexels)

New Delhi: Tuberculosis (TB) is an infection caused by Mycobacterium Tuberculosis and while the condition primarily affects the lungs, it has the capacity to infect and involve any organs in the body. India has the largest incidence of tuberculosis (TB) worldwide in terms of both cases and fatalities, making it a serious public health concern. With twenty eight percent of tuberculosis cases globally reported from India, it is imperative that we prioritise strengthening our health systems and invest in TB prevention.

Dr Prabhat Ranjan Sinha, Senior Consultant- Internal Medicine, Aakash Healthcare, New Delhi, shared, “The good thing is that it can be cured with proper treatment when diagnosed timely. Besides, improving the standard of living can play a crucial role in controlling the spread of tuberculosis.”

Warning signs of Tuberculosis

The warning signs of TB one should not ignore include:

• Weakness: If you experience unexplained weakness coupled with fever and continuous coughing for a few days, you may have TB.

• Persistent cough – If you have a persistent cough lasting more than two weeks, you should get not ignore it and get yourself evaluated for TB.

• Sputum or blood in the cough: This is another warning sign of tuberculosis (TB) and indicates active existence of this dreaded disease in your lungs.

• Fatigue: A low level of energy and a helplessness feeling are other warning signs of this infectious disease that you should not take it lightly.

• Weight loss: rapid unexplained weight loss in short time is another sign you could be battling with this disease.

• Poor appetite: Patients suffering from TB also report of losing their desire to eat together with a poor appetite.

• Low grade fever: TB patients usually complain of low-grade fever that typically shows up in the evening.

• Night-time sweating: This is another significant warning sign of TB. Along with other symptoms, one should pay attention to night time sweating.

• Breathlessness: Shortness of breath is a typical symptom of several respiratory diseases. as tuberculosis is an ailment of the lungs, this symptom indicates that your lung health is declining due to the disease.

Controlling the spread of TB

“It has been shown that TB may be managed with an improvement in living conditions. Developed nations are better at controlling tuberculosis cases because they have strived to raise their standards of living,” the expert added.

A healthy lifestyle should prioritize eating better foods in order to obtain adequate nutrients that will support the development of immunity. In addition, communities need well-planned infrastructure to prevent unhygienic practices like smoking and spitting.

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Ministers are being urged to roll out a better testing regime for one of the country’s biggest killers, with the most recent figures showing death rates for chronic obstructive pulmonary disease more than three times higher in some of the most deprived areas of the country.

More than 20,000 people a year in England die from chronic obstructive pulmonary disease. The most significant cause of COPD is smoking, but a significant proportion of cases are work-related, triggered by exposure to fumes, chemicals and dust at work.

Figures from the Office for National Statistics reveal that death rates from the disease are significantly higher in more deprived areas of the country including Wolverhampton, Rochdale and Blackpool. Death rates in Salford (82 per 100,000) are 3.9 times higher than in Bath (21 per 100,0000).

The NHS is rolling out targeted lung screening across England for people aged between 55 and 74 who are current or former smokers. The charity Asthma + Lung UK says the checks will identify many people who may have COPD, but there is no established protocol for them to be diagnosed and given appropriate treatment and support.

Dr Samantha Walker, interim chief executive at Asthma + Lung UK, said: “Once targeted lung health checks are fully rolled out, millions of people could be told they have an incurable lung disease like chronic obstructive pulmonary disease, but they won’t be given a firm diagnosis or signposted to the right support, which is simply unacceptable.

An X-ray of a patient’s lungs. Photograph: Douglas Sacha/Getty Images

“What we need to see is a national referral pathway in place for those people who show signs of having other lung conditions as part of this screening process to ensure that people with all suspected lung conditions get the diagnosis and treatments that they deserve. We know that people with lung disease will live better, fuller lives with an earlier diagnosis.”

A survey by the charity published in 2022 found that nearly one in four people with COPD waited more than five years to be diagnosed. About one in eight waited more than 10 years for a diagnosis. There is no cure for COPD, but lifestyle changes and disease management can help slow its progression. A spirometry test which shows how well the lungs are working is used to diagnose COPD. An investigation last year by the BMJ, the medical journal, found that some of the most deprived areas of England had no or limited access for spirometry.

Katy Brown, 66, a former nursery nurse from Portishead, Somerset, said she had suffered from breathlessness since 2019, but had not been diagnosed with COPD until October last year. “It literally takes your breath away,” said Brown. “It’s like someone is sitting on your chest.”

She said that once diagnosed, people could benefit from pulmonary rehabilitation, which provides exercises and advice on managing the condition.

Felicity Payne, 67, a language teacher, from Eastbourne, said exercise played an important role in managing the condition, with regular mile-long swims part of her regime since her diagnosis in 2016. “I never thought I would be able to do that several years on [from the diagnosis],” she said. “It has been a lifeline.”

A Department of Health and Social Care spokesperson said: “We are working to improve services for people with chronic conditions such as COPD so they can live longer, healthier lives.

“The Major Conditions Strategy will look at proposals for the improvement of health outcomes across the six groups of conditions that includes COPD responsible for over 60% of ill health and early death in England.”

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Many people with chronic obstructive pulmonary disease (COPD) experience severe fatigue that can limit their ability to perform daily activities. A 2021 review found fatigue was a symptom of COPD in 17–95% of people, depending on the study.

Researchers don’t know why severe fatigue affects people with COPD, but there’s a significant association with airflow limitation. As COPD can cause you to have less oxygen coming into the body, you might experience greater amounts of fatigue.

If you have COPD, you may need to find new ways to do daily tasks that require less energy. Often, making simple changes consistently can help conserve energy.

There’s research to back that up. A 2020 study found that implementing strategies from a 2-week energy conservation training program reduced the energy expenditure of people with COPD on daily tasks. Assistive devices, good breathing techniques, and ergonomics were all part of the program.

This room-by-room home tour can help you identify ways to modify activities of daily living so you can conserve your energy. For people with COPD, this may mean avoiding reaching, lifting, and bending, as well as finding easier ways to perform tasks.

If you have COPD, performing daily tasks such as dressing or cooking can leave you feeling fatigued and breathless. Finding ways to make these tasks easier can help you conserve your energy.

Getting regular physical activity can also help with fighting fatigue and improving shortness of breath. But it’s important not to overdo it. A pulmonary rehabilitation program can help you find ways to stay active and perform daily tasks with less breathlessness.

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Breathing in clean, fresh air is important for good health and wellbeing yet, around the world, this is far from reality as Indian regions, for instance, occupied six of the top 10 spots for the most polluted cities worldwide in 2022. A report by Air Quality Life Index also found that high levels of pollution or particles in the air (like smoke, dust and more) can reduce an average person’s life span in India by 5.3 years, compared to what they could have had if the air quality met the World Health Organization’s guidelines.

Navigating air pollution and flu season: Expert tips on keeping your respiratory well-being in check (Photo by pngtree)
Navigating air pollution and flu season: Expert tips on keeping your respiratory well-being in check (Photo by pngtree)

In areas with higher concentrations of certain air pollutants, cases of respiratory infections like influenza (or the flu) are most likely observed, too and poor air quality may even make people with conditions like chronic obstructive pulmonary disease more likely to develop viral infections like the flu. It can also cause symptoms like shortness of breath, coughing, wheezing and chest pain.

Hindustan Times - your fastest source for breaking news! Read now.

This is largely because breathing in air pollutants – like gases from vehicles, pollution from burning fuels like coal and oil etc – can harm respiratory systems and irritate airways. The effect of environmental pollution is also seen globally: in the United States, an increase of just one unit on the air quality index was suggested to prompt over 4,000 additional hospitalizations for flu every year.

Ina n interview with HT Lifestyle, Dr Vivek Veerapaneni, Consultant Pulmonary and Allergy Specialist at Swasa Hospital & Clinic in Hyderabad shared, “Poor air quality can greatly affect someone’s health – and I have seen an approximate 40% rise in patients, affected by smog and air pollution in city. Many people are experiencing symptoms like breathlessness and cough – and there’s been a roughly 30% increase in reported cases of influenza-like illnesses over the last 3 months. Polluted air can also make someone feel worse when they have the flu. It’s important for people to protect themselves. They can do this by taking preventive measures like masking up when outdoors or staying indoors when air pollution is high, adopting good hygiene practices like washing one’s face and hands after being outside, and by getting the flu vaccine yearly to avoid infection.”

Flu affects people of all ages – particularly children under five years of age, pregnant women, older adults (65 years of age and older), and people with underlying health conditions. Children are more sensitive to adverse effects of pollutants and viral infections than adults, and studies have shown links between air pollution and a greater risk of upper and lower respiratory infections, particularly flu hence, parents must take extra care to protect their children, starting with immunization.

Pregnant women may also become vulnerable to infections like the flu because of air pollution and this affects them disproportionately. Reducing the pregnant mother’s exposure to air pollution can lower her risk of being affected by an infection and also help safeguard her future child’s health better.

Tips to prevent the flu from spreading

  • It’s important to practice good hygiene whether with handwashing or using a face mask whenever appropriate.
  • By making healthier lifestyle choices, people can also boost their immunity and support their lung health. This includes exercising regularly.
  • However, during peak pollution periods, specially post Diwali, one should try indoor exercises to minimize exposure to air pollution. Wearing a mask when outdoor is always a good practice to follow.
  • Most importantly, one should see a doctor immediately in case of symptoms like fever, cold or cough.

Air pollution causes environmental health issues across seasons, from dust during the summer to smoke and fog in the winter and it is important to take it seriously. With health experts voicing their concerns on the links between poor air quality and rising respiratory issues, it is important to act now and fortunately, there are a few steps people can take.

Dr Jejoe Karankumar, Medical Affairs Director at Abbott India asserted, “Helping people stay healthy at every stage of life is important. Air pollution and respiratory problems, like flu, can come in the way of this. It’s important to raise awareness about the steps people can take to protect themselves against infections like flu, especially at a time when its cases are rising. Preventive care is important, and it’s vital for more people, especially those at risk, to get their yearly flu vaccination for greater protection.”

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Co-authored by Dr. Andrew Potter, Whaddon Medical Centre

Breathing pattern disorder (BPD) is a common sequela of long COVID and has significant functional effects even in the absence of evidence of damage to the lungs or breathing apparatus [1]. Long COVID care facilities have witnessed a surge in patients grappling with breathlessness and fatigue, with BPD emerging as a primary contributory and perpetuating factor. The repercussions of BPD can manifest in various forms, ranging from shortness of breath and chest pains to profound distress and anxiety, impacting an individual's capacity to resume their regular leisure, caregiving, and occupational activities.

At the forefront of our experience within the long COVID clinic, we've encountered a recurring narrative: the oversight of BPD by both primary and secondary healthcare practitioners. Patients often present with persistent and incapacitating breathlessness, yet discussions surrounding the impact of their breathing patterns on these symptoms are frequently absent. Recognizing this gap, our long COVID service has taken proactive steps to integrate a respiratory physiotherapist into a specialized role focused on optimizing breathing function and alleviating these distressing symptoms.

​The outcomes of this approach have been nothing short of remarkable. Many individuals have experienced significant improvements in breathlessness, even in the absence of underlying lung pathology, thanks to intensive physiotherapy interventions and ongoing support. By addressing BPD directly and tailoring interventions to an individual's needs, we've witnessed a profound impact on patient outcomes and overall well-being.

Addressing Breathing Pattern Disorder in Long COVID Recovery

In essence, recognizing and proactively addressing BPD is essential within the comprehensive care continuum for long COVID survivors. By acknowledging the importance of BPD management and prioritizing targeted interventions, we not only enhance patient outcomes but also pave the way towards a brighter and healthier future for those navigating the challenges of long COVID recovery.

To achieve comprehensive recovery, it's vital to expand our range of tools and services, strengthening support for respiratory physiotherapists and enhancing services specifically tailored to address BPD. Additionally by enriching our arsenal of resources and adopting a multifaceted approach, we can effectively guide individuals towards restoring healthy breathing patterns and fostering overall well-being.

​This proactive strategy not only serves to optimize respiratory function but also significantly improves the quality of life for those navigating the complexities of long COVID recovery. By harnessing the specialized expertise of respiratory physiotherapists and offering comprehensive support services, we empower individuals to overcome the challenges posed by BPD and regain control over their respiratory health.

Ultimately, through the prioritization of these interventions and the cultivation of a collaborative approach to care, we can pave a pathway towards a more robust and sustainable journey to recovery for long COVID survivors. Together, by uniting resources, expertise, and support, we can empower individuals to navigate the recovery process with resilience and optimism, facilitating their return to a healthier and fulfilling life.

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Recent research sheds light on an unexpected ally in the quest for improved running performance: yoga breathing techniques. According to a new study published in the International Journal of Exercise Science, integrating yoga breathing practices into a runner’s training regimen can lead to significant enhancements in overall performance.

Researchers discovered that incorporating specific breathing exercises derived from yoga can yield remarkable results. By harnessing the power of controlled breathing techniques, runners can tap into a deeper reservoir of oxygen, improve respiratory efficiency and enhance endurance capacity.

Ihor Verys’s surprising secret weapon: nose breathing

The study

The study had experienced runners of various fitness levels, both male and female, who were enlisted to explore the effects of three specific yoga breathing techniques: Dirgha (breath awareness), Kapalbhati, and Bhastrika (high-frequency yoga breathing). Over three weeks, participants received instruction in these techniques, while a control group received no instructions.

Before and after the instruction period, both groups underwent running tests on a laboratory treadmill, maintaining a prescribed rate of perceived exertion (RPE). Remarkably, after the yoga breathing instruction, participants demonstrated a significant improvement in running pace while maintaining the same RPE as before. In contrast, the control group showed no change in pace.

yoga breathingyoga breathing

Pranayama to power performance

The concept of using yogic breathing isn’t entirely new—past studies have demonstrated the profound impact of pranayama, or yogic breath control, on respiratory muscle function. Through regular practice of pranayama techniques, runners can strengthen the diaphragm and intercostal muscles, leading to more efficient oxygen uptake and utilization during exercise. This translates into better aerobic capacity, reduced breathlessness and prolonged endurance during long-distance runs.

woman doing yogawoman doing yoga

How to get started

Dirgha Pranayama (three-part breath)

Inhale deeply, filling your belly, ribcage and chest with air. Exhale slowly, releasing the breath from your chest, ribcage and belly. Repeat for several rounds, focusing on smooth, controlled breathing.

Kapalabhati

Sit with a straight spine and take a deep inhale. Exhale forcefully through your nose by quickly contracting your lower abdomen. Follow each exhale with a passive inhale. Repeat this rhythmic pattern for several cycles, maintaining focus on the breath.



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The SNS Insider report unfolds a promising future for the Dyspnea Treatment Market, marking its valuation at USD 6.1 billion in 2022. Forecasts indicate a robust expansion, reaching USD 10.2 billion by 2030, with a steady CAGR of 6.7% throughout the forecast period from 2023 to 2030.

The Dyspnea Treatment Market Report provides a comprehensive analysis of the global market landscape, with a focus on current and future trends in dyspnea management. The report encompasses an in-depth examination of key players, market dynamics, opportunities, challenges, and advancements in treatment options for dyspnea sufferers.

Detailed statistics and data-driven insights offer valuable information for stakeholders to make informed decisions regarding product development, marketing strategies, and investment opportunities. The report also highlights emerging technologies, regulatory frameworks, and competitive landscapes shaping the dyspnea treatment market.

Overall, this comprehensive report serves as a crucial resource for healthcare professionals, policymakers, pharmaceutical companies, and investors seeking to understand the evolving landscape of dyspnea treatment worldwide.

Dyspnea Treatment Market Analysis

The dyspnea treatment market is a rapidly expanding sector within the healthcare industry, driven by the increasing prevalence of respiratory diseases and disorders worldwide. As dyspnea, or shortness of breath, can be a symptom of various underlying health conditions such as asthma, chronic obstructive pulmonary disease (COPD), heart failure, and pneumonia, the demand for effective management and treatment options continues to grow.

Market analysis reports indicate that key players in the pharmaceutical and medical device industries are investing heavily in research and development to introduce innovative therapies and devices aimed at improving patient outcomes and quality of life. Additionally, advancements in telemedicine and digital health technologies are expected to revolutionize how dyspnea is diagnosed and managed in the future.

Overall, the dyspnea treatment market shows promising growth potential as healthcare providers strive to address the complex needs of patients experiencing breathing difficulties.

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The  Major Key Players

→Mayne Pharma Group Limited,

→Teva Pharmaceutical Industries Ltd.,

→GlaxoSmithKline plc,

→Bausch Health,

→Hikma Pharmaceuticals plc,

→Lannett Company, Inc.,

→Amneal Pharmaceuticals LLC,

→Mylan N.V., Lupin Limited,

→Akron Incorporated,

→ANI Pharmaceuticals, Inc.,

→Pfizer, Inc.,

→Sun Pharmaceutical Industries Ltd., 

→and Others.

Dyspnea Treatment Market Segmentation Analysis

By Type

→Therapies

→Supplemental Oxygen Therapy

→Relaxation Therapy

→Drugs

→Antianxiety Drugs

→Antibiotics

→Anticholinergic Agents

→Corticosteroids

→Others

By Route of Administration

→Oral

→Inhalation

→Others

By End User

→Hospitals

→Home Care

→Specialty Centres

The segment dominated by chronic respiratory conditions, including COPD and asthma, is expected to lead the Dyspnea Treatment Market. The surge in these conditions amplifies the prevalence of dyspnea, making it a critical segment for treatment solutions.

With a growing aging population and increased awareness of respiratory disorders, this segment holds a substantial market share, driven by the demand for effective therapies.

Dyspnea Treatment Market Key Regional Development

In 2022, North America claimed a significant market share of 48%, propelled by an aging population, increased smoking rates, and environmental degradation. The region experiences a rising prevalence of dyspnea-related respiratory and cardiac disorders, stimulating demand for advanced therapies.

Technological advancements in medical technology and medication development contribute to the creation of novel and more effective dyspnea treatments. Rising awareness of dyspnea's impact on quality of life, coupled with robust healthcare facilities and insurance coverage, further drives the North American dyspnea treatment market.

Europe is poised to witness the fastest market share expansion at 45% during the forecast period. The region's aging population, coupled with the anticipated rise in individuals aged 65 and above, contributes to the growth.

As respiratory disorders become more common with age, the demand for dyspnea treatments is expected to surge. Technological innovations in dyspnea treatment alternatives, such as nebulizers, inhalers, and oxygen therapy, further propel market expansion in Europe.

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Dyspnea Treatment Market Growth Factors

  • Rising levels of air pollution and toxicity exposure globally contribute to the onset of dyspnea symptoms. Ozone and pollutants in the air, especially on hot, sunny days, pose health risks and increase the likelihood of developing dyspnea. The Dyspnea Treatment Market responds to the escalating environmental challenges, offering solutions to address breathlessness caused by exposure to toxic substances. The increasing awareness of the impact of air pollution on respiratory health fuels the market's growth.
  • Innovations in dyspnea treatment alternatives, such as nebulizers, inhalers, and oxygen therapy, play a pivotal role in market expansion. These technological advancements enhance the effectiveness of dyspnea therapies, offering patients more efficient and convenient treatment options. The partnership between Teva Pharmaceutical Industries Ltd and Cipla Limited to develop generic versions of popular inhalers underscores the industry's commitment to advancing treatment modalities.

Dyspnea Treatment Market  Key Takeaways

  • Dyspnea Treatment Market anticipates significant growth, fueled by the escalating prevalence of COPD and asthma.
  • Air pollution, toxicity exposure, and an aging population contribute to the market's expansion, highlighting the urgency for innovative dyspnea treatment options.

Dyspnea Treatment Market Recent Developments

  • Mayne Pharma Group Limited's range of respiratory medications, including inhalers and nebulizers, addresses conditions like asthma and COPD, offering relief from dyspnea symptoms.
  • Teva Pharmaceutical Industries Ltd's partnership with Cipla Limited focuses on developing and marketing a range of respiratory medications in the United States, including generic versions of popular inhalers like Advair and Symbicort, commonly used to treat dyspnea.

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Table of Contents

1. Introduction
1.1 Market Definition
1.2 Scope
1.3 Research Assumptions

2. Research Methodology

3. Market Dynamics
3.1 Drivers
3.2 Restraints
3.3 Opportunities
3.4 Challenges

4. Impact Analysis

5. Value Chain Analysis

6. Porter’s 5 forces model

7. PEST Analysis

8. Dyspnea Treatment Market Segmentation, By Type

9. Dyspnea Treatment Market Segmentation, By Route of Administration
9.1 Oral
9.2 Inhalation
9.3 Others

10. Dyspnea Treatment Market Segmentation, By End User
10.1 Hospitals
10.2 Home Care
10.3 Specialty Centres

11. Regional Analysis

12 Company Profile

13. Competitive Landscape

14. Use Case and Best Practices

15. Conclusion

continued

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The idiopathic pulmonary fibrosis market is anticipated to grow at a CAGR of 11.87% from US$3.459 billion in 2022 to US$7.585 billion by 2029.

The idiopathic pulmonary fibrosis market is anticipated to grow at a CAGR of 11.87% from US$3.459 billion in 2022 to US$7.585 billion by 2029.”

— Knowledge Sourcing Intelligence

NOIDA, UTTAR PARDESH, INDIA, March 19, 2024 /EINPresswire.com/ -- According to a new study published by Knowledge Sourcing Intelligence, the idiopathic pulmonary fibrosis market is projected to grow at a CAGR of 11.87% between 2022 and 2029 to reach US$7.585 billion by 2029.

Older persons are mostly affected by Idiopathic Pulmonary Fibrosis (IPF), a progressive lung disease for which there is no known cause. Breathing becomes more difficult as a result of the lung tissue being thicker and more rigid. Breathlessness, a chronic dry cough, exhaustion, and finally respiratory collapse are some of the symptoms. Although environmental variables and genetic predisposition may play a role, the precise explanation is yet unknown. Lung function examinations and imaging tests are necessary for the diagnosis, which frequently entails ruling out other illnesses. Treatment options include medication, oxygen therapy, pulmonary rehabilitation, and, in extreme circumstances, the possibility of a lung transplant, all of which are intended to manage symptoms and delay the progression of the disease.

The long-term, progressive lung illness known as idiopathic pulmonary fibrosis (IPF) is characterized by lung tissue scarring, which results in decreased oxygen supply and rigidity. It is yet unknown what causes it, which is why it is called "idiopathic." Breathlessness, a chronic cough, and exhaustion are among the symptoms, which usually get worse with time. With a median survival of 2–5 years after diagnosis, IPF primarily affects elderly persons and has a bad prognosis. Treatment includes pulmonary rehabilitation, lung transplant in severe cases, and drugs such as nintedanib and pirfenidone to control symptoms and halt the progression of the disease. To improve patient outcomes, research keeps looking into novel treatments and deepens our understanding of the underlying mechanisms driving the disease.

The market is witnessing multiple collaborations and technological advancements, for instance In January 2023 The US FDA gave Lotus Pharmaceutical's Abbreviated New Drug Application (ANDA) for Nintedanib Capsules, a generic form of Boehringer Ingelheim's OFEV®, preliminary clearance. The generic Nintedanib Capsules will be introduced by the company as soon as possible.

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The idiopathic Pulmonary Fibrosis (IPF) market is expected to have significant growth in the drug class sector. Pharmaceutical companies are constantly developing new medications that target inflammation and fibrotic pathways as a result of continuous research and development activities. This expands the therapy options available to patients. Advances in early diagnosis and personalized therapy also play a part in the growing use of pharmaceutical interventions. The Drug class sector exhibits substantial potential for expansion, driven by innovation and the ongoing pursuit of effective medicines to enhance patient outcomes and quality of life in the management of IPF, despite obstacles such as high treatment costs and restricted therapeutic alternatives.

Based on drug type, the market for idiopathic pulmonary fibrosis (IPF) is expected to rise, with pirfenidone and nintedanib being key players. Because of its effectiveness and tolerability, pirfenidone—which has anti-fibrotic and anti-inflammatory qualities—has become a mainstay treatment. Tyrosine kinase inhibitor nintedanib, on the other hand, provides a unique mechanism that targets the advancement of fibrosis. Although both medications have shown effectiveness in delaying the course of sickness, nitedanib's distinct mechanism might contribute to the growth of its market. Nonetheless, pirfenidone's lengthier clinical history and established commercial presence might help it maintain its relevance. Ultimately, each segment's growth trajectory will be determined by patient preferences, developing clinical evidence, and market factors.

Based on end-users, Due to several factors, the hospital segment in the idiopathic pulmonary fibrosis (IPF) market is expected to increase significantly. Hospitals provide specialized care through interdisciplinary teams and are major centers for the diagnosis, treatment, and management of complicated respiratory disorders like IPF. As treatment options and diagnostic technology progress, hospitals become the main hubs for complete IPF care. The need for IPF-related services is further fueled by the increased need for hospital admissions and treatments brought on by the growing prevalence of IPF. Furthermore, hospitals frequently have access to clinical trials and cutting-edge therapies, which draws individuals looking for the best care possible for their ailments.

Based on geography the idiopathic pulmonary fibrosis (IPF) market in the Asia-Pacific region is expanding significantly due to factors such as escalating healthcare costs, aging populations, and more awareness. Access to cutting-edge therapies and enhanced diagnostic methods both support the growth. Governmental programs to combat respiratory illnesses and improve healthcare facilities also contribute to the market's expansion. Pharmaceutical businesses and academic institutions working together to promote research and development can result in new remedies that are tailored to the unique needs of the area. Notwithstanding obstacles such as inadequate knowledge and problems with reimbursement, the Asia-Pacific IPF market exhibits encouraging growth prospects.

As a part of the report, the major players operating in the Idiopathic Pulmonary Fibrosis (IPF), market that have been covered are Boehringer Ingelheim GMBH, Bristol-Myers Squibb Company, Biogen, Cipla, Hoffman-La Roche AG, Fibrogen Inc, Galapagos NV, Medicinova Inc., Novartis AG, Prometic Life sciences Inc.

The market analytics report segments the Idiopathic Pulmonary Fibrosis (IPF), market on the following basis:

• BY TREATMENT TYPE

o Drug class

o Oxygen Therapy

o Lung Transplant

o Others

• BY DRUG TYPE

o Pirfenidone

o Nintedanib

• BY END-USER

o Hospital

o Clinic

• BY GEOGRAPHY

o North America

• USA

• Canada

• Mexico

o South America

• Brazil

• Argentina

• Others

o Europe

• Germany

• France

• UK

• Others

o Middle East and Africa

• Saudi Arabia

• UAE

• Others

o Asia Pacific

• China

• India

• Japan

• South Korea

• Taiwan

• Thailand

• Indonesia

• Others

Companies Profiled:

• Boehringer Ingelheim GMBH

• Bristol-Myers Squibb Company

• Biogen

• Cipla

• Hoffman-La Roche AG

• Fibrogen, Inc.

• Galapagos NV

• Medicinova, Inc.

• Novartis AG

• Prometic Life sciences Inc.

Explore More Reports:

• Cystic Fibrosis Market: www.knowledge-sourcing.com/report/cystic-fibrosis-market

• Idiopathic Pulmonary Fibrosis Diagnostic And Treatment Market: www.knowledge-sourcing.com/report/idiopathic-pulmonary-fibrosis-diagnostic-and-treatment-market

• Melanoma Treatment Market: www.knowledge-sourcing.com/report/melanoma-treatment-market

Ankit Mishra
Knowledge Sourcing Intelligence LLP
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Introduction

Breathing, a fundamental physiological process that plays a crucial role in overall health and well-being, is often taken for granted.1 According to Nelson et al,2 the core of many breathing exercises is diaphragmatic breathing, which is considered the most fundamental demonstration of core function. These exercises involve retraining the muscles of respiration, improving ventilation, and optimizing gaseous exchange.3

Diaphragmatic breathing is recognized as a key component of many exercise protocols and practices, such as meditation, ancient eastern religions, martial arts, and yoga exercises. Diaphragmatic breathing involves the active engagement of the diaphragm to facilitate deep and efficient inhalation and exhalation. For instance, yogic breathing exercises, which originate from the yoga tradition, play a significant role in promoting relaxation, optimizing lung function, fostering emotional balance, and facilitating self-regulation.4 Many of these exercise practices and protocols not only offer diaphragmatic breathing but also incorporate other techniques such as nasal breathing, slow exhalation with pauses, smoothness, steadiness, and self-observation.

Elements of exercise programs in rehabilitation, including the ones mentioned above, have long been recognized for their significant contributions and effectiveness. This type of breathing exercises often encompasses a variety of techniques aimed at improving lung function enhancing oxygenation and strengthening the muscles involved in respiration.5–7 They play a role in helping patients recover from conditions like chronic obstructive pulmonary disease (COPD),8 asthma9 and post-surgical recuperation.10

Breathing exercises aim to improve pulmonary status, increase endurance, and enhance overall function in daily living activities.3 In particular, traditional breathing exercises such as slow breathing, pursed lip breathing, and incentive spirometry have been proven effective in enhancing respiratory capacity and alleviating symptoms associated with these conditions.11–13 However, the success of these exercises can be influenced by factors such as adherence, motivation levels and the perception of routines.14,15

Pulmonary rehabilitation (PR) in specific often involves a range of breathing exercises designed to meet the needs of patients. One example is diaphragmatic breathing exercise, which focuses on improving the efficiency of the diaphragm muscle for inhalation.16 This technique encourages deep, slow breaths to maximize lung expansion and enhance ventilation.17 Pursed lip breathing exercise also helps prevent airway collapse by maintaining positive pressure during exhalation reducing breathlessness in conditions like COPD.18 In addition, incentive spirometry devices guide patients through inhalations to increase lung capacity and clear airways after surgery.19 These exercises are crucial in pulmonary rehabilitation programs as they not only improve lung function but also help individuals regain control over their breathing.

The benefits of incorporating these exercises into rehabilitation are widely recognized. However, some people may face challenges in maintaining timing, frequency or focus on their breath during these exercises.20 Therefore, it is important to provide guidance that helps individuals maintain a breathing rhythm and awareness.

Virtual Reality (VR) technology has made advancements in recent years bringing innovative solutions to various fields, including healthcare.21 With its interactive and immersive features, VR has the potential to revolutionize breathing exercises by making them engaging and enjoyable.22 Patients can be taken to tranquil settings for guided meditation, exciting adventures, or serene landscapes by combining therapeutic breathing exercises with engaging virtual environments and scenarios.23 This combination does not help distract patients from the nature of conventional exercises but also motivates them to actively participate potentially improving their adherence to rehabilitation routines. Furthermore, real time feedback and gamified elements provided by VR enable patients to track their progress and challenge themselves making the process of enhancing function not more effective but also more enjoyable.24

VR offers an experience where patients actively participate in their rehabilitation creating a sense of presence and control. What sets VR apart is its ability to completely immerse users in environments making them feel like they are physically present in that world. This immersive nature of VR can be incredibly helpful in reducing stress and anxiety during breathing exercises.25 Many patients with conditions often feel anxious and uncomfortable due to the limitations imposed by their condition. Through the utilization of VR, patients can be sensory transported to serene and calming environments such as beaches, tranquil forests, or soothing meditation gardens. This immersive experience helps patients mentally escape from their discomforts and anxieties creating an atmosphere for effective breathing exercises and rehabilitation.25

Moreover, the interactivity offered by VR brings a level of engagement.26 This means that patients can actively take part in their rehabilitation routines while immersed in a world often mimicking real life activities. For example, they can follow the instructions of an instructor as they engage in deep breathing exercises while observing how their avatar responds within the virtual environment. The ability to interact with objects and manipulate them within these spaces fosters a sense of control which can be particularly empowering for individuals undergoing rehabilitation.27

In years, there has been a growing trend in utilizing VR to aid breathing exercise. However, there is lack of literature on how these exercises are currently incorporated into VR experiences making it challenging to evaluate their effectiveness. Particularly noteworthy is a scoping review that examines the current state of knowledge on this phenomenon. The only similar study that seems to have exist is Pancini et al study28 on the significance of VR breathing exercise in promoting mental health, while those on pulmonary rehabilitation is very limited. Additionally, it remains uncertain which rehabilitation outcomes have been accessed and whether these interventions yield results.

Literature Review

Virtual reality has grown increasingly common in healthcare intervention, notably in exercise and rehabilitation programs. The use of VR as a feasible tool for breathing exercises in rehabilitation has been examined. Numerous research has investigated the viability and efficiency of adopting VR in diverse contexts. In one study, patients with COPD employed immersive VR headsets as part of a high-intensity interval training (HIIT) exercise program.29 Twelve COPD patients took part in a six-week VR headset-based HIIT training as part of the study. Short bursts of high-intensity activity were alternated with rest or low-intensity exercise as part of the HIIT program. The patients were provided an immersive experience utilizing the VR headset, which lessened their feeling of effort and helped to inspire them. The feasibility and acceptability of VR-HIIT for COPD patients was determined by the authors. Without experiencing any serious side effects, the patients were able to conclude the HIIT program in a safe manner. Additionally, they noted that the VR experience was pleasurable and that it kept them motivated. The study’s findings show that VR-HIIT may be a novel and promising PR technique for COPD patients. Better patient results may arise from VR-HIIT’s capacity to increase desire and adherence to workout routines.

Another study examined the acceptability and safety of a VR-based deep breathing exercise for kids and teenagers getting over a concussion.30 Concussion, categorized as a mild traumatic brain injury, triggers a series of pathophysiological changes and disruptions in brain function. These effects extend to various aspects of respiratory function, such as alterations in breathing rate, mechanics, and the levels of end tidal carbon dioxide.31 Thus, fifteen participants were recruited in the study from a specialty concussion clinic within a tertiary care medical center, aged 11 to 22, who had received a concussion in the previous three months. The participants used a VR headset to pace a 5-minute deep breathing exercise. They were introduced to a serene virtual world and educated in deep breathing strategies by the VR experience. Participants discussed their experiences and any changes in their symptoms following the activity. The outcomes demonstrated that the participants considered the VR-based deep breathing exercise to be both safe and well-tolerated. None of the participants quit the workout or complained of acute discomfort. Three individuals noticed a small increase in headache, nausea, or dizziness; however, these symptoms were simply transient and did not call for medical treatment.

VR gaming and exergaming-based therapies were found to have weak to insignificant effects on heart rate and oxygen saturation in individuals with respiratory difficulties, and to have minor impacts on dyspnea, according to a systematic review and meta-analysis.32 Seventy-nine people with a range of respiratory conditions, such as cystic fibrosis, asthma, and chronic obstructive pulmonary disease (COPD), participated in the evaluation’s 19 trials. The meta-analysis’s findings demonstrated that VR exercise helped people with respiratory disorders improve their quality of life, capacity for activity, and dyspnea. Although the effect sizes were statistically significant, they ranged from low to moderate. The authors concluded that VR exercise is a practical new approach to exercise therapy for those with respiratory issues.

Furthermore, it was discovered that practicing breathing exercises with a VR system that offers multimodal biofeedback-including tactile and visual feedback-was both entertaining and successful.33 Twelve people took part in the study and used the VR equipment to conduct eight sessions of slow breathing exercises. The VR device guided the participants’ respiration with both physical and visual input. When they breathed appropriately, the participants could feel a slight vibration on their abdomen and view a virtual depiction of their own abdomen. The study’s findings demonstrated how well the multimodal VR system guided the participants’ deep, steady breathing. Following the completion of the slow breathing exercises, the participants’ breathing rate dramatically dropped. The VR system, according to the participants, improved the workouts’ motivation and enjoyment. The multimodal VR system is a viable and promising method of delivering slow breathing exercises, according to the research’s conclusion.

The findings of these studies, collectively, demonstrate the immense potential of VR breathing exercises as a cutting-edge method for managing respiratory health and rehabilitation. Further research is required to examine the wider applicability and enduring impacts of VR breathing exercises, as well as to determine the most efficient VR therapies for specific medical conditions and demographics.

Research Question

This paper provides a scoping review of existing knowledge on the possibilities of integrating VR exercise in breathing rehabilitation. Therefore, this paper aim to provide answer to this research question: “Does VR Based Exercise Therapy Offer Significant Improvement in Patients/Participant Breathing rehabilitation/Function?”

Materials and Methods

Methodology

Scoping reviews are undertaken with the purpose of delineating and examining emerging concepts within a particular field of research.34 In contrast to conventional systematic reviews that focus on narrower research issues and have a well-defined pool of relevant studies, scoping reviews are employed to explore emerging research domains and elucidate fundamental concepts.35

Search Strategy and Study Selection

Three electronic databases, including Web of Science, PubMed, and the Cochrane Library, were searched from October 28 to November 10, 2023. The query of the databases involves the use of the keywords “breathing rehabilitation, respiratory rehabilitation, virtual reality exercise, mixed reality exercise, and augmented reality exercise” to search their core collections. Following the search, citations were retrieved by the citation manager for reference management, while duplicate records were automatically excluded.

Inclusion and Exclusion Criteria

For this scoping review, articles were included without considering the specific research design. However, it is important to note that only studies involving human participants were considered, and studies involving animals were excluded from the review. articles published in English were included, and no English articles were excluded to avoid potential limitations associated with non-English papers. Specifically, the focus was on studies related to virtual reality exercise for breathing or respiratory rehabilitation, while studies outside the scope of this review were excluded. There were no restrictions regarding the year of publication or geographic region. However, articles that did not directly address the review question were excluded. Additionally, it is important to note that rehabilitation other than breathing was not within the scope of this review. Conference papers, systematic reviews, notes, secondary studies, and other reviews were excluded, prioritizing primary and original studies. The focus was on studies aimed at breathing functions and exercise, without specific limitations on the patient’s or participant’s condition. The emphasis was on including studies that directly contributed to the enhancement of breathing functions.

Article Selection

Following the retrieval of 236 citations from the databases, 42 duplicate records were removed automatically. The remaining data was then exported to Excel software version 12.0. The title and abstract of the articles were screened, and a total of 173 references were removed. The remaining 18 articles were subjected to full text screening to examine studies in line with the inclusion criteria and studies directly providing answers to the research. In this process, 10 articles not within the context of this research were excluded (Figure 1).

Figure 1 Article screening flowchart.

Quality Assessment

The eight included studies were appraised to examine the methodological and reporting quality of these articles to rate the article’s risk of bias in planning, execution, and result presentation. In doing these, the Jonas Briggs Institute (JBI) checklist36 for randomized trials was utilized since all the studies were randomized trials37 (Appendix 1). The checklist contained 13 appraisal questions, but only applicable 10 questions were utilized. Articles are rated yes if they checked positive, no if they checked native, and unclear if they are unsure of whether they are positive or negative. At the end, overall ratings were based on %yes. Articles were considered high-quality if they scored 80% and above, moderate quality if they scored between 50% and 60%, and those below 50% were low quality and unfit for inclusion in this scoping review.

Noteworthy, following the appraisal of the eight included articles, it was interesting to note that all the studies were of high quality and had a low risk of bias, with none of the papers scoring less than 80% Yes (Table 1). Notably, Rodrigues et al38 was the only study that checked positive for all the checklist questions with 100%. True randomization, allocation concealment, and similarity at baseline were positive across all the studies. Similarly, there was a proper record of follow-up, measures, and reliability, and appropriate statistical analysis was considered by all the included studies.

Table 1 Quality Assessment of the Included Studies

Data Extraction and Synthesis

Information pertinent to this review objective was synthesized into a formulated Excel form, allowing a summary of each article’s information under various headings. The information extracted includes the corresponding author name, year of publication, country, journal, aim of the paper, sample characteristics, ie, demographic data, settings, patients, design, virtual reality system used, description of the system, measures, instrument, method of data collection and analysis, result, and main findings (Appendix 2).

Moreover, the findings of the synthesis indicate that there has been a growing interest in the integration of virtual reality (VR) technology into breathing exercise program in recent years. As shown in Figure 2, there has been an increase in research in this domain.

Figure 2 Article distribution by year.

The publications included in the study came from five distinct countries, with the United States and Brazil emerging as the major contributors. Each of these countries provided two articles, making them the most significant contributors among the eight papers analyzed. Similarly, the Journal of Applied Psychophysiology and Biofeedback exhibited the greatest quantity of publications, whereas the remaining articles were published in the Asian Journal of Nursing, Journal of Physical Medicine and Rehabilitation, Journal of Personalized Medicine, Journal of Applied Psychophysiology and Biofeedback, Journal of Medical Internet Research, and Journal of BMC Psychiatry.

Multiple convenient sample sizes were utilized, with an average sample size of 42 and a total sample size of 296. The sample population consists of individuals of both male and female genders, with a median age range spanning from 21.6 to 63.4 years. The individuals involved in the research were categorized as either in-patients or out-patients across the several investigations. The research involved patients or participants who shown a need to enhance their breathing functionality. All participants were randomly assigned to receive the VR-based intervention, and this assignment was conducted in accordance with relevant ethical consent procedures.

Narrative Synthesis

The study conducted by Kang et al39 in 2020 is the initial study included in the analysis, achieving a quality assessment score of 80%. The research utilized virtual reality technology to create an innovative breathing exercise solution that does not require contact with the mouth. Additionally, the study assessed the feasibility and effectiveness of this exercise technique. The proposed system is a virtual reality-based breathing exercise system, referred to as VR-BRES. The developers have integrated gaming features and a soft stretch sensor into their virtual reality-based self-regulatory biofeedback breathing workout system. The study assessed the feasibility and effectiveness of the system in comparison to the standard deep breathing (CDB) exercise. A total of 50 healthy participants (23 males and 27 females) with an average age of 42.52 ± 15.76 years were included in the analysis. The study involved individuals who were admitted as inpatients. Various respiratory parameters, such as forced vital capacity, forced expiratory volume in one second (FEV1), and peak expiratory flow (PEF), were assessed using a portable spirometry device called Pony FX (COSMED, USA). The utilization of the Virtual Reality-based Breathing Rehabilitation System (VR-BRES) yielded notable improvements in the parameters during the breathing rehabilitation program. Significantly, the outcomes of participants’ evaluations indicate that, in comparison to the standard deep breathing CDB exercise system, users regarded the breathing exercise with VR-BRES as more engaging, effective, and with a higher intention to utilize. Despite the lack of major differences in convenience across the various exercise approaches, However, the findings of the study indicate that virtual reality can serve as an effective training system for the purpose of respiratory rehabilitation.

Blum et al study20 assessed the feasibility of utilizing a virtual reality exercise system for diaphragmatic breathing with the incorporation of biofeedback algorithms. The VR-based system also employs a respiratory biofeedback method. To assess the effectiveness of this system, a total of 72 participants, with a majority of 56 females and 16 males, were randomly assigned to engage in a brief VR-based breathing exercise. The average age of the participants was 21.6 years. The study involved a group of outpatients, and the variables assessed included participants’ post-exercise experience, subjective breath awareness after exercising, respiratory-induced abdomen motions during the exercise, and heart rate variability throughout the exercise. These measurements were obtained using the Oculus Rift CV1. In comparison to a control group engaging in focused breathing exercises, the findings of the study suggest that a VR-based breathing exercise system, when integrated with biofeedback, enhances respiratory sinus arrhythmias with a particular emphasis on slow diaphragmatic breathing. Similarly, enhancing breathing awareness and achieving an elevated level of user satisfaction.

The study conducted by Betka et al40 focused on leveraging VR as a potential solution for addressing the issue of persistent dyspnea, often known as shortness of breath, among individuals in the recovery phase of COVID-19. The VR-based breathing workout system was utilized to construct a visual respiratory feedback function. The randomized experiment included a cohort of 26 participants, the majority of whom were male, with a median age of 55. The study involved individuals who were admitted as inpatients. The respiratory rate and respiratory rate variability were assessed as progression indicators of pulmonary rehabilitation. These parameters were recorded using the Go Direct® Respiration Belt, manufactured by Vernier, Beaverton, OR, USA. The intervention group was provided with synchronous feedback regarding their breathing, while the control group received asynchronous feedback. The assessment of the results was conducted using a combination of breathing recordings and questionnaires. The results of the trials suggest that the implementation of the Individual VR exercise system led to enhanced breathing comfort among participants in the intervention group, whereas no statistically significant improvements were observed in the control group. Although no negative effects were noted by the subjects, the research documented an increased level of user satisfaction and perception.

Cruz and collaborators conducted a study41 in which various parameters were measured, including blood pressure, heart rate, respiratory rate (RR), peripheral oxygen saturation (SpO2), and rating of perceived exertion (RPE). These measurements were obtained utilizing the Epson PowerLite H309A and Xbox One Kinect devices. However, the study discovered that virtual reality-based therapy (VRBT) significantly enhances breathing rehabilitation by influencing various physiological parameters such as heart rate, respiratory rate, and rate of perceived exertion. These effects were observed during the execution of VRBT as well as during moments of rest and at 1, 3, and 5 minutes of recovery. The present study involved a cluster trail done at an outpatient rehabilitation center in Brazil, with a sample of 27 individuals with a mean age of 63.4 years.

In a trial conducted by Ruzicky et al42 in which a pulmonary rehabilitation program, utilizing virtual reality technology to perform exercises, was provided to a group of 32 inpatient individuals diagnosed with COVID-19. The assessment included criteria such as breathing exercise tolerance and other factors. The findings from the trials indicate that the analysis of the initial data shown that a hospital-based pulmonary rehabilitation program lasting for a duration of three weeks resulted in enhanced exercise tolerance among those affected by COVID-19. Additionally, this program was associated with a decrease in symptoms related to depression and anxiety.

Rodrigues et al38 similarly examine the potential impact of VR on the experience of dyspnea, as well as other factors including pain symptom management, well-being perception, anxiety, and depression, in a sample of 44 hospitalized individuals with COVID-19. The average age of the participants is 48.9, and the distribution of samples is equal between genders. A novel biofeedback VR breathing exercise, incorporating gaming elements and a lens, was created for the purpose of assessing dyspnea as the major outcome. Additionally, the secondary outcomes of arterial hypertension, heart rate, respiratory rate, and SpO2 were also evaluated. Upon completion of the studies, it is evident that exercise therapy utilizing VR has a substantial impact on reducing symptoms of dyspnea as well as other measurable secondary outcomes.

A previous investigation conducted by Russell et al43 centered on the utilization of virtual reality to facilitate paced diaphragmatic breathing (DB) training. The study involved a randomized trial of 60 female outpatients who were assigned to receive a treatment consisting of VR-based breathing exercises. The study examined many outcomes, including heart rate variability, breathing rate, and assessments of motion nausea. It is important to note that heart rate variability is a controversial outcome measure herein. Heart rate variability is often used as an indicator of autonomic nervous system activity, specifically reflecting the balance between sympathetic and parasympathetic influences on heart rate. However, its interpretation as a direct measure of parasympathetic drive is subject to debate and caution. The study’s results indicate that the implementation of VR-based timed DB exercises leads to a notable enhancement in breathing functions and the activation of the parasympathetic nervous system (PNS). This activation of the PNS effectively mitigates physiological responses linked to motion sickness.

In a study conducted by Shiban et al,44 the researchers examined the use of diaphragmatic breathing as a coping strategy in the context of virtual reality exposure therapy for aviophobia. The trial comprised a cohort of 29 individuals, with a significant majority being female. The measurement of both heart rate and respiration rate was conducted after the VR-exposure treatment. The findings indicate that the incorporation of VR technology into diaphragmatic breathing exercises yields enhancements in respiratory functions and aids in the alleviation of aviophobia.

Discussion

This research presents a scoping review that investigates the significance of integrating virtual reality exercise into breathing rehabilitation. Although different breathing techniques like mindful breathing, focused breathing, diaphragmatic breathing, and abdominal breathing are commonly used in clinical settings, there is a growing interest in exploring how emerging virtual reality technology could help with slow and controlled breathing, which could help with relaxation and improve respiratory functions.

Based on the review of eight high-quality studies in this research, it is clear that VR technology has the potential to boost breathing function even more than traditional breathing exercises. This finding was corroborated by all of the trials included in the study. Of note, the majority of the reviewed papers relied on pilot studies or control studies as the basis for their research. Additionally, a subset of the papers focused solely on describing the design and development processes of their systems.

Blum et al20 showed that a VR-based tool can work and be useful for encouraging slow diaphragmatic breathing through biofeedback of the respiratory system. The research conducted involved the development of a VR system for conducting breathing exercises. The study revealed how well a respiratory biofeedback method used in virtual reality could teach people how to control their breathing patterns and improve their overall respiratory health. It was quite interesting that the VR system developed in their paper facilitates the regulation of participants’ respiration through the utilization of visual stimuli. Showing each participant, a virtual representation of their chest cavity, wherein the color of the cavity changed in accordance with the depth of their breath further enhance participant breathing awareness. Upon the conclusion of multiple virtual reality training sessions, the participants acquired the ability to regulate their breathing patterns in a consistent and profound manner. This, however, facilitate the acquisition of improved breathing management skills, as a result of the biofeedback on their respiratory patterns. The findings of this study proved the feasibility and acceptability of utilizing VR for breathing rehabilitation and respiratory biofeedback.

In contrast to different methods for breathing exercises, growing evidence and reports have consistently demonstrated the efficacy of the VR exercise system in enhancing breathing rehabilitation. This improvement is achieved through the utilization of the VR respiratory biofeedback technique, which not only offers participants an enjoyable and motivating experience but also provides them with valuable feedback on their breathing patterns. The observation of a notable rise in forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) after the VR-based breathing exercise training indicates the presence of this phenomenon. The integration of respiratory biofeedback techniques into the VR system in Blum study may presents a promising avenue for breathing rehabilitation, offering potential benefits offering potential benefits for individuals seeking to enhance their breathing capabilities. It was further underlined by the study that the advantages of VR can also be taken into account for several respiratory disorders, such as cystic fibrosis, COPD, and asthma, which may benefit from the technology.The link between success and the swift growth of VR breathing techniques may be attributed to the provision of a very engaging and immersive workout experience. All of the evaluated research consistently placed focus on these features. One of the studies,39 compared the efficacy and usefulness of a VR breathing exercise system to conventional deep breathing exercises. The findings of their trial indicated that although individual variations in breathing function exist, the use of a VR-based exercise system resulted in a noteworthy enhancement of breathing parameters. In-addition, their user reviews indicated that these training routines are highly captivating, enjoyable, and high intention to use.

Similar to Blum’s findings, the fact that biofeedback and self-regulation are part of the virtual reality exercise system may explain the success of the breathing exercise system. This finding aligns with assertions made by other scholars, as its distinctiveness correlates to the visualization of respiratory signals that offers respiratory feedback. This was also emphasized by Kang et al VR-based breathing exercise system,39 which provides biofeedback through breathing signal visualization, such as the avatar rabbit jump. The importance of this biofeedback was also underscored in a prior study, which demonstrated that women with limited thoracic movement experienced notable changes in respiratory parameters when incorporating visual feedback of diaphragmatic motion through ultrasound imaging into their VR breathing exercise regimen. Significantly, the transformation of the physical expansion of the chest or abdomen during inhalation into visual cues that are promptly relayed to the participants was effectively augment and engagement in breathing exercises was heightened.

The integration of bio-respiratory visual feedback into virtual reality exercise can also be utilized in addressing dyspnea38,40. In line with the findings of these authors, the inclusion of visual-respiratory feedback or self-regulating biofeedback in VR interventions may enhance the breathing comfort of patients in the recovery phase of COVID-19 pneumonia, particularly those who are experiencing persistent dyspnea. Betka et al further confirmed these through their clinical experiment, including patients who are undergoing recovery from COVID-19 and are persistently affected by dyspnea.40 The authors posited that in cases where alternative respiratory treatments or interventions prove ineffective and potentially result in serious complications such as cognitive impairments, mental health disorders, and motor impairments, the implementation of a virtual reality-based breathing exercise intervention could yield substantial success in addressing the issue of persistent dyspnea. This observation aligns with the findings of the Rodrigues et al study, wherein a significant decrease in dyspnea and fatigue was seen among those affected by COVID-19 following VR-based exercise intervention.38

Virtual reality breathing exercise intervention demonstrates a broader impact beyond its application to COVID-19 patients. This claim was similarly supported by a recent study which indicated that VR tool can also effectively reduce tiredness and dyspnea in obstructive pulmonary patients via administering virtual reality-based pulmonary rehabilitation.45

Additionally, a recent randomized control study conducted in Saudi Arabia (42) focused on children with repaired congenital diaphragmatic hernia (CDH), who are known to continue living with chronic lung issues and demonstrate lower cardiorespiratory fitness compared to their healthy counterparts. Consequently, there is a risk of declining functional performance and physical ability in these children due to reduced cardiopulmonary fitness. However, the study highlighted that when VR-based exercises are combined with traditional physical therapy, these children with repaired CDH experienced more significant improvements in their pulmonary functions, cardiopulmonary capacity, functional performance, and quality of life compared to those who received traditional physical therapy alone46. However, without a detailed explanation of the underlying mechanism of action, it is challenging to fully understand how VR-based exercises contribute to these positive outcomes. The absence of a conceptualized framework in several studies limits our ability to contextualize and interpret the study findings within a theoretical framework.

This growing evidence among adults and kids supports the assertion that a VR-based breathing exercise system can be considered as a potential alternative approach which is non-invasive and has no pharmacological features for promoting the rapid recuperation of patients.

This scoping review founds VR breathing exercise therapy to be a promising tool in terms of patient satisfaction and the potential to alleviate the breathing issues and persistent dyspnea commonly observed in individuals recovering from severe conditions like Covid-19. Clinical improvements were observed in various aspects as a result of the VR biofeedback breathing intervention. Participants demonstrated noteworthy improvements in fatigue levels, and overall comfort during breathing exercises. Moreover, positive alterations were observed in vital signs, encompassing heart rate and other cardiopulmonary parameters as reported by Betka et al.

To show how fast these rehabilitation techniques can be, limited exposure of people having breathing problems to short synchronous VR interventions incorporating visuo-respiratory features may improve breathing comfort. The uniqueness of the Immersive VR developed by Betka and associates and the VR-assisted therapeutic breathing exercise system developed by Rodrigues et al underscores the importance of cardiac or respiratory synchrony and self-regulating biofeedback.38,40 This synchrony creates a system that offers a better outcome. For example, the utilization of a “virtual body that is animated by the patient’s own respiratory movements”, a “complete duration of the breathing sequence”, and a comparable “three-dimensional virtual environment” contribute to enhanced involvement in breathing exercises.

The provision of synchronous feedback has been found to significantly enhance the perception of control among patients with respect to their respiratory function, as reported in multiple studies20,39,40. Consequently, this heightened sense of control contributes to the enhancement of breathing self-regulation and awareness. Although the initial stage of Betka’s study did not show a statistically significant decrease in breathing discomfort, it did reveal a notable improvement in overall breathing comfort when utilizing synchronous visuo-respiratory stimulation. The insignificant initial phase result may be attributed to semantics or subjective discomfort ratings. This claim is consistent with the findings of a study conducted recently on the effects of a virtual reality-based breathing therapy on physiological responses in breathing rehabilitation.41 Specifically, their findings indicated that this therapy is effective in conditioning the participants during the execution phase. However, it was noted that elevated levels of respiratory rate and other cardiac parameters may be achieved during the recovery phase, and these effects can persist for up to 5 minutes. It is not surprising that such interventions can have an impact on various hemodynamic functions during the recovery phase, even up to a few minutes after the activity has ended. Nevertheless, the diverse effects observed in their virtual reality breathing therapy may be attributed to the differential levels of effort and intensity applied during the treatment. These, however, raise the importance of exercising caution throughout the administration of the virtual reality intervention, particularly in terms of closely monitoring the level of virtual reality exertion.

Betka40 and Cruz41 successfully demonstrated the safety and cost-effectiveness of immersive VR-based digital therapeutics and virtual reality breathing therapy. They posited that VR-based interventions can be utilized as alternative cardiovascular interventions for individuals who are either in-patients or out-patients and are facing respiratory or breathing challenges. This tool can offer a supplementary approach for treatment and assessment, thereby reducing the potential for transmission and mitigating the established adverse effects linked to opioid therapy.

Additionally, this scoping review identified exercise tolerance; a key indicator of cardiovascular endurance during breathing rehabilitation, and the implications of optimal lung function as another important area in which VR can be leveraged. This was supported by Ruzicky et al investigation on the importance of VR in enhancing exercise tolerance.42 They emphasize incorporation of VR-breathing exercise rehabilitation into COVID-19 rehabilitation therapy due to its numerous advantages in enhancing respiratory problems. Their three-week VR pulmonary rehabilitation program for COVID-19 inpatients demonstrated a noteworthy effect, as patients exhibited notable improvements in exercise tolerance subsequent to exposure to VR breathing exercise. While there was a gain in functional ability, the improvement in quality of life was not found to be significant, and no notable advantage over conventional treatments was noted. This observation is in contrast with the conclusions drawn by previous researchers, who discovered a notable and distinct advantage of VR breathing exercises over traditional rehabilitation interventions.

The preliminary nature of the data analysis in the their study42 and brief duration of the VR exposure may be attributed to the insignificance findings. Therefore, possibly conducting a re-evaluation with a more extensive sample size over long period of exposure could potentially yield a positive outcome. Despite these findings, the author asserts, in alignment with prior research, that the integration of VR into breathing rehabilitation therapy presents a viable approach for mitigating the long-term consequences of COVID-19 and other respiratory ailments.

This review synthesizes evidence suggesting that VR breathing exercise interventions have the potential to yield more favorable outcomes compared to conventional interventions. Specifically, these interventions can effectively promote increased awareness of patients’ breathing status and facilitate the maintenance of a balanced pulmonary function. Moreover, VR exercise tool’s ability to provide entertainment, engagement, and interactivity aligns with its distinct advantage over usual exercise methods that entail passive exercise participation. This, however, leads users to see exercise, typically seen as a highly demanding activity, as an enjoyable and immersive experience owing to its interactive characteristics.

In comparison to traditional breathing exercise interventions, a study conducted by Russell et al demonstrated that the diaphragmatic breathing protocol resulted in a drop-in respiration rate, an increase in parasympathetic nervous system tone, and a reduction in the occurrence of motion sickness symptoms.43 The objective of activating the parasympathetic nervous system, as indicated by an increase in heart rate variability, was successfully accomplished, potentially resulting in the prevention of symptoms associated with motion sickness. Furthermore, these findings provide additional support for the assertion that the utilization of VR breathing exercises might effectively mitigate the progression of symptoms associated with motion sickness resulting from breathing control. The confluence of diaphragmatic breathing mechanisms and reduced respiratory rate suggests that these methods have the potential to enhance parasympathetic tone and provide a safeguard against motion sickness when individuals are exposed to stimuli that induce motion sickness. Despite concerns regarding potential risks associated with diaphragmatic breathing exposure during VR exercise therapy, evidence suggests that diaphragmatic breathing during VR intervention does not moderate negative outcomes.44 On the contrary, it has been found to enhance the effectiveness of VR breathing exercise rehabilitation and alleviate conditions such as aviophobia, which involves a fear of flying.

Considering the long-term effects is crucial for understanding the true potential and effectiveness of VR-based exercise interventions in the context of respiratory conditions. Future studies should address this limitation by incorporating follow-up evaluations to provide a more comprehensive understanding of the treatment’s lasting impact.

Limitation and Conclusion

Limitation

The heterogeneous nature of the VR system and the biofeedback mechanisms and techniques employed by the different included studies may be considered the main limitations of this scoping review. Since the primary objective of each respective study varies, the outcome may vary with studies. Limited numbers of trials may also be a potential limitation, as it is difficult to conclude with limited evidence. Nonetheless, the scoping review of eight quality studies in these current papers confirmed the significance of taking advantage of VR in breathing exercise rehabilitation.

It is noteworthy that the findings of some reported studies exhibit variability due to factors such as constraints in experimental design methodology, inadequate availability of objective measurable breathing outcomes, and limited sample sizes. We encourage readers to conduct a more critical appraisal of the article/topic(s) of interest to form an independent and informed judgment regarding the effectiveness and implications of breath training with/without the VR in the context of their specific clinical population.

Conclusion

The effectiveness and rapid growth of VR breathing techniques are attributed to their engaging and immersive experience. The integration of biofeedback and self-regulation in VR exercise systems was also found to contribute to the significant outcome of the breathing exercise system. This is because the use of visual feedback in VR breathing exercises enhances user interest in breathing exercises.

In addition, this scoping review highlights the effectiveness of VR exercise in improving dyspnea, a breathing condition. The unique aspect of VR-assisted breathing exercise systems lies in their emphasis on cardiac or respiratory synchrony and self-regulating biofeedback. The inclusion of a “virtual body animated by the patient’s own breathing” and a 3D virtual environment enhances engagement, self-regulation, and awareness during breathing exercises. However, the review also indicates that the outcomes of VR rehabilitation can vary depending on the effort and intensity exerted. Therefore, careful monitoring of VR effort intensity is necessary. Overall, VR breathing exercises are considered safe and cost-friendly rehabilitation tools for both in-patients and out-patients with respiratory difficulties.

Additionally, the paper suggests that VR breathing exercise interventions offer preventive measures against the prolonged effects of conditions such as COVID-19 and other respiratory conditions. These interventions motivate patients to be mindful of their breathing condition and maintain balanced pulmonary function. The entertaining, engaging, and interactive nature of VR exercise therapy adds a fun and immersive element to the overall exercise experience for users.

Abbreviations

COPD, chronic obstructive pulmonary disease; CDH, congenital diaphragmatic hernia; DB, diaphragmatic breathing; FEV1, forced expiratory volume in one second; HIIT, high-intensity interval training; JBI, Jonna Briggs Institute; VR, virtual reality; VRBT, virtual reality-based therapy; PNS, parasympathetic nervous system; PR, Pulmonary rehabilitation.

Acknowledgments

The author would like to thank the College of Applied Medical Sciences Research Center and the Deanship of Scientific Research at King Saud University.

Disclosure

The author reports no conflicts of interest in this work.

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diclofenac sodium

CONSUMER MEDICINE INFORMATION

What is in this leaflet

This leaflet answers some common questions about FENAC EC.

It does not contain all of the available information. It does not take the place of
talking to your doctor or pharmacist.

All medicines have benefits and risks. Your doctor has weighed the risks of you taking
FENAC EC against the benefits they expect it will have for you.

If you have any concerns about taking this medicine, talk to your doctor or pharmacist.

Keep this leaflet with your medicine.

You may need to read it again.

What FENAC EC is used for

FENAC EC belongs to a group of medicines called Non-Steroidal Anti-Inflammatory Drugs
(NSAIDs), which are used to treat pain and reduce inflammation (swelling and redness).

FENAC EC is used to treat:

different types of arthritis including rheumatoid arthritis and osteoarthritis

other painful conditions where swelling is a problem such as back pain, rheumatism,
muscle strains, sprains and tendonitis (e.g. tennis elbow)

menstrual cramps (period pain)

relieve pain in children after they have had an operation.

It can relieve the symptoms of pain and inflammation, but it will not cure your condition.

Ask your doctor if you have any questions about why FENAC EC has been prescribed for
you.

Your doctor may have prescribed it for another purpose.

FENAC EC is only available with a doctor's prescription. It is not addictive.

There is not enough information to recommend the use of FENAC EC tablets in children.

Before you take FENAC EC

When you must not take it

Do not take FENAC EC if you are allergic (hypersensitive) to:

diclofenac (the active ingredient in FENAC EC) or any of the other ingredients listed
at the end of this leaflet

other medicines containing diclofenac

aspirin

ibuprofen

any other NSAID

If you are not sure if you are taking any of the above medicines, ask your doctor
or pharmacist.

Symptoms of an allergic reaction to these medicines may include:

shortness of breath

wheezing or difficulty breathing

swelling of the face, lips, tongue, throat, and/or extremities (signs of angioedema)

rash, itching or hives on the skin.

Many medicines used to treat headache, period pain and other aches and pains contain
aspirin or

NSAID medicines.

If you are allergic to aspirin or NSAID medicines and you use FENAC EC, these symptoms
may be severe.

Do not take FENAC EC if you have had any of the following medical conditions:

a stomach or intestinal ulcer

bleeding from the stomach or bowel (symptoms of which may include blood in your stools
or black stools)

kidney or liver problems

severe heart failure

heart bypass surgery

Do not take FENAC EC during the first 6 months of pregnancy, except on doctor's advice.
Do not take this medicine during the last three months of pregnancy.

Use of this medicine during the last 3 months of pregnancy may affect your baby and
may delay labour and birth.

Use of non-aspirin NSAIDs can increase the risk of miscarriage, particularly when
taken close to the time of conception.

Do not take this medicine after the expiry date printed on the pack or if the packaging
is torn or shows signs of tampering.

If it has expired or is damaged, return it to your pharmacist for disposal.

Before you start to take it

Tell your doctor if you have allergies to any other medicines, foods, preservatives
or dyes.

Your doctor will want to know if you are prone to allergies, especially if you get
skin reactions with redness, itching or rash.

Tell your doctor if you have, or have had, any of the following medical conditions:

established disease of the heart or blood vessels (also called cardiovascular disease,
including uncontrolled high blood pressure, congestive heart failure, established
ischemic heart disease, or peripheral arterial disease, or atherosclerotic cardiovascular
disease) as treatment with FENAC EC is generally not recommended

established cardiovascular disease (see above) or significant risk factors such as
high blood pressure, abnormally high levels of fat (cholesterol, triglycerides) in
your blood, diabetes, or if you smoke, and your doctor decides to prescribe FENAC
EC, you must not increase the dose above 100 mg per day if you are treated for more
than 4 weeks.

current or past history of gastrointestinal problems such as stomach or intestinal
ulceration, bleeding or black stools, and/or stomach discomfort or heartburn after
taking anti-inflammatory medicines in the past

diseases of the bowel or inflammation of the intestinal tract (Crohn's disease) or
colon (ulcerative or ischemic colitis)

past history of haemorrhoids (piles) or irritation of the rectum (back passage)

liver or kidney problems

a rare liver condition called porphyria

bleeding disorders or other blood disorders (e.g. anaemia)

asthma or any other chronic lung disease that causes difficulty in breathing

hay fever (seasonal allergic rhinitis)

repeated chest infections

polyps in the nose

diabetes

dehydration (e.g. by sickness, diarrhoea, before or after recent major surgery)

swollen feet

Your doctor may want to take special precautions if you have any of the above conditions.

It is generally important to take the lowest dose of FENAC EC that relieves your pain
and/or swelling and for the shortest time possible in order to keep your risk for
cardiovascular side effects as small as possible.

Tell your doctor if you are pregnant or trying to become pregnant.

There is not enough information to recommend the use of FENAC EC during the first
6 months of pregnancy and it must not be used during the last 3 months. FENAC EC may
also reduce fertility and affect your chances of becoming pregnant. Your doctor can
discuss the risks and benefits involved.

Tell your doctor if you currently have an infection.

If you take FENAC EC while you have an infection, some of the signs of the infection
such as pain, fever, swelling and redness may be hidden. You may think, mistakenly,
that you are better or that the infection is not serious.

Tell your doctor if you are breastfeeding or plan to breastfeed.

Breast feeding is not recommended while taking FENAC EC. The active ingredient, diclofenac,
passes into breast milk and may affect your baby. Your doctor will discuss the risks
and benefits of taking FENAC EC when breastfeeding.

Tell your doctor if you are lactose intolerant.

FENAC EC tablets contain lactose.

Tell your doctor if you are planning to give this medicine to a child.

Safety and effectiveness in children have not been established.

If you have not told your doctor about any of the above, tell them before you start
taking FENAC EC.

Taking other medicines

Tell your doctor if you are taking any other medicines, including any that you buy
without a prescription from a pharmacy, supermarket or health food shop.

Some medicines and FENAC EC may interfere with each other. These include:

other anti-inflammatory medicines e.g. aspirin, salicylates or ibuprofen

warfarin or other "blood thinners" (medicines used to prevent blood clotting)

digoxin (a medicine for heart problems)

lithium or selective serotonin- reuptake inhibitors (SSRIs), a medicine used to treat
some types of depression

diuretics (medicines used to increase the amount of urine)

ACE inhibitors or beta-blockers (medicines used to treat high blood pressure, heart
conditions, glaucoma and migraine)

prednisone, cortisone, or other corticosteroids (medicines used to provide relief
for inflamed areas of the body)

medicines (such as metformin) used to treat diabetes, except insulin

methotrexate (a medicine used to treat arthritis and some cancers)

ciclosporin, tacrolimus (a medicine used in patients who have received organ transplants)

trimethoprim (a medicine used to prevent or treat urinary tract infections)

some medicines used to treat infection (quinolone antibacterials)

glucocorticoid medicines, used to treat arthritis

sulfinpyrazone (a medicine used to treat gout)

voriconazole (a medicine used to treat fungal infections)

phenytoin (a medicine used to treat seizures)

rifampicin (an antibiotic medicine used to treat bacterial infections)

You may need to take different amounts of your medicines or to take different medicines
while you are using FENAC EC. Your doctor and pharmacist have more information.

If you have not told your doctor about any of these things, tell him/ her before you
start using this medicine.

How to take FENAC EC

When to take it

It is recommended to take the tablets before meals or on an empty stomach. If they
upset your stomach, you can take them with food or immediately after food.

They will work more quickly if you take them on an empty stomach but they will still
work if you have to take them with food to prevent stomach upset.

How much to take

Follow all directions given to you by your doctor and pharmacist carefully.

These instructions may differ from the information contained in this leaflet.

If you do not understand the instructions, ask your doctor or pharmacist for help.

There are different ways to take FENAC EC tablets depending on your condition. Your
doctor will tell you exactly how many tablets to take.

Do not exceed the recommended dose.

To treat arthritis or other painful conditions

The usual starting dose of FENAC EC tablets is 75 mg to 150 mg each day. After the
early stages of treatment, it is usually possible to reduce the dose to 75 mg to 100
mg each day.

To treat menstrual cramps (period pain)

The tablets are usually taken during each period as soon as cramps begin and continued
for a few days until the pain goes away.

The usual starting dose of FENAC EC tablets is 50 mg to 100mg each day, beginning
as soon as cramps begin and continuing until the pain goes away, but for no longer
than 3 days.

If necessary, the dose can be raised over several menstrual periods to a maximum of
200 mg each day.

How to take it

FENAC EC tablets are usually taken in 2 or 3 doses during the day.

Swallow the tablets whole with a full glass of water or other liquid. Do not chew
them.

The tablets have a special coating to keep them from dissolving until they have passed
through the stomach into the bowel. Chewing the tablets would destroy the coating.

How long to take it for

Do not use FENAC EC for longer than your doctor says.

If you are using FENAC EC for arthritis, it will not cure your disease but it should
help to control pain and inflammation. It usually begins to work within a few hours
but several weeks may pass before you feel the full effects of the medicine.

If you forget to take it

If it is almost time for your next dose (e.g. within 2 or 3 hours), skip the dose
you missed and take your next dose when you are meant to.

Otherwise, take it as soon as you remember, and then go back to taking it as you would
normally.

Do not take a double dose to make up for the dose you missed.

This may increase the chance of you getting an unwanted side effect.

If you have trouble remembering when to take your medicine, ask your pharmacist for
some hints.

If you take too much (overdose)

Immediately telephone your doctor, or the Poisons Information Centre (telephone 13
11 26) for advice, or go to Accident and Emergency at the nearest hospital, if you
think you or anyone else may have taken too much FENAC EC. Do this even if there are
no signs of discomfort or poisoning.

You may need urgent medical attention.

Symptoms of an overdose may include vomiting, bleeding from the stomach or bowel,
diarrhoea, dizziness, ringing in the ears or convulsions (fits).

While you are taking FENAC EC

Things you must do

If you take FENAC EC for more than a few weeks, you should make sure to visit your
doctor for regular check-ups to ensure that you are not suffering from unnoticed undesirable
effects.

If you become pregnant while taking this medicine, tell your doctor immediately.

Your doctor can discuss with you the risks of taking FENAC EC while you are pregnant.

Be sure to keep all of your doctor's appointments so that your progress can be checked.

Your doctor will periodically re-evaluate whether you should continue treatment with
FENAC EC, if you have established heart disease or significant risks for heart disease,
especially in case you are treated for more than 4 weeks.

Your doctor may want to check your kidneys, liver and blood from time to time to help
prevent unwanted side effects.

If, at any time while taking FENAC EC you experience any signs or symptoms of problems
with your heart or blood vessels such as chest pain, shortness of breath, weakness,
or slurring of speech, contact your doctor immediately. These may be signs of cardiovascular
toxicity.

If you are going to have surgery, tell the surgeon or anaesthetist that you are taking
FENAC EC.

NSAID medicines can slow down blood clotting and affect kidney function.

If you get an infection while taking FENAC EC, tell your doctor.

This medicine may hide some of the signs of an infection (pain, fever, swelling, redness).
You may think, mistakenly, that you are better or that the infection is not serious.

If you are about to be started on any new medicine, remind your doctor and pharmacist
that you are taking FENAC EC.

Tell any other doctors, dentists and pharmacists who treat you that you are taking
FENAC EC.

Things you must not do

Do not take any of the following medicines while you are taking FENAC EC without first
checking with your doctor or pharmacist:

aspirin (also called ASA or acetylsalicylic acid)

other salicylates

other medicines containing diclofenac

ibuprofen

any other NSAID medicines.

If you take these medicines together with FENAC EC, they may cause unwanted side effects.

If you need to take something for headache or fever, it is recommended that you take
paracetamol. If you are not sure, your doctor or pharmacist can advise you.

Do not stop any other forms of treatment for arthritis that your doctor has told you
to follow.

This medicine does not replace exercise or rest programs or the use of heat/cold treatments.

Do not give this medicine to anyone else, even if their condition seems similar to
yours.

Do not use it to treat any other complaints unless your doctor tells you to.

Things to be careful of

Be careful driving, operating machinery or doing jobs that require you to be alert
until you know how FENAC EC affects you.

This medicine may cause dizziness, drowsiness, spinning sensation (vertigo) or blurred
vision in some people. If any of these occur, do not drive, use machine or do anything
else that could be dangerous.

Elderly patients should take the minimum number of tablets that provides relief of
symptoms.

Elderly patients, especially those with a low body weight, may be more sensitive to
the effects of FENAC EC than other adults.

Side effects

Tell your doctor or pharmacist as soon as possible if you do not feel well while you
are taking FENAC EC.

All medicines can have side effects. Sometimes they are serious, most of the time
they are not. You may need medical treatment if you get some of the side effects.

If you are over 65 years of age, you should be especially careful while taking this
medicine. Report any side effects promptly to your doctor.

Do not be alarmed by this list of possible side effects. You may not experience any
of them.

Ask your doctor or pharmacist to answer any questions you may have.

Tell your doctor or pharmacist if you notice any of the following and they worry you:

stomach upset including nausea (feeling sick), vomiting, indigestion, cramps, loss
of appetite, wind

heartburn or pain behind or below the breastbone (possible symptoms of an ulcer in
the tube that carries food from the throat to the stomach)

stomach or abdominal pain

constipation, diarrhoea

sore mouth or tongue

altered taste sensation

headache

dizziness, spinning sensation

drowsiness, disorientation, forgetfulness

feeling depressed, anxious or irritable

strange or disturbing thoughts or moods

shakiness, sleeplessness, nightmares

tingling or numbness of the hands or feet

feeling of fast or irregular heart beat

unusual weight gain or swelling of arms, hands, feet, ankles or legs due to fluid
build-up

symptoms of sunburn (such as redness, itching, swelling, blistering of the lips, eyes,
mouth, and/or skin) that happen more quickly than normal

skin inflammation with flaking or peeling

vision disorders *(e.g. blurred or double vision)

buzzing or ringing in the ears, difficulty hearing

hypertension (high blood pressure)

hair loss or thinning

NSAIDs, including diclofenac, may be associated with increased risk of gastro-intestinal
anastomotic leak. Close medical surveillance and caution are recommended when using
this medicine after gastrointestinal surgery.

*If symptoms of vision disorders occur during treatment with FENAC EC, contact your
doctor as an eye examination may be considered to exclude other causes.

If any of the following signs appear, tell your doctor immediately, or go to Accident
and Emergency at the nearest hospital:

red or purple skin (possible signs of blood vessel inflammation)

severe pain or tenderness in the stomach, vomiting blood or material that looks like
coffee grounds, bleeding from the back passage, black sticky bowel motions (stools)
or bloody diarrhoea (possible stomach problems)

rash, skin rash with blisters, itching or hives on the skin; swelling of the face,
lips, mouth, tongue, throat, or other part of the body which may cause difficulty
to swallow, low blood pressure (hypotension), fainting, shortness of breath (possible
allergic reaction)

wheezing, troubled breathing, or feelings of tightness in the chest (signs of asthma)

yellowing of the skin and/or eyes (signs of hepatitis/liver failure)

persistent nausea, loss of appetite, unusual tiredness, vomiting, pain in the upper
right abdomen, dark urine or pale bowel motions (possible liver problems)

constant "flu-like" symptoms including chills, fever, sore throat, aching joints,
swollen glands, tiredness or lack of energy, bleeding or bruising more easily than
normal (possible blood problem)

painful red areas, large blisters, peeling of layers of skin, bleeding in the lips,
eyes, mouth, nose or genitals, which may be accompanied by fever and chills, aching
muscles and feeling generally unwell (possible serious skin reaction)

signs of a possible effect on the brain, such as sudden and severe headache, stiff
neck (signs of viral meningitis), severe nausea, dizziness, numbness, difficulty in
speaking, paralysis (signs of cerebral attack), convulsions (fits)

change in the colour or amount of urine passed, frequent need to urinate, burning
feeling when passing urine, blood or excess of protein in the urine (possible kidney
disorders)

sudden and oppressive chest pain (which may be a sign of myocardial infarction or
a heart attack)

breathlessness, difficulty breathing when lying down, swelling of the feet or legs
(signs of cardiac failure)

Coincidental occurrence of chest pain and allergic reactions (signs of Kounis syndrome)

Tell your doctor or pharmacist if you notice anything that is making you feel unwell.

Some people may have other side effects not yet known or mentioned in this leaflet.

After taking FENAC EC

Storage

Keep your medicine in the original container until it is time to take it.

If you take the tablets out of the pack they may not keep well.

Keep your tablets in a cool dry place where the temperature stays below 25°C.

Do not store FENAC EC or any other medicine in the bathroom or near a sink.

Do not leave FENAC EC in the car or on window sills.

Heat and dampness can destroy some medicines.

Keep FENAC EC where children cannot reach it.

A locked cupboard at least one-and-a-half metres above the ground is a good place
to store medicines.

Disposal

If your doctor tells you to stop taking FENAC EC, or your tablets have passed their
expiry date, ask your pharmacist what to do with any that are left over.

Product description

What it looks like

FENAC EC 25 mg tablets are round, pale yellow, enteric coated tablets plain on both
sides. Available in blister packs of 50 tablets.

FENAC EC 50 mg tablets are round, pale brown, enteric coated tablets plain on both
sides. Available in blister packs of 50 tablets.

Ingredients

FENAC EC contains 25 mg or 50 mg of diclofenac sodium as the active ingredient.

The tablets also contain the following inactive ingredients:

colloidal anhydrous silica

microcrystalline cellulose

lactose monohydrate

magnesium stearate

maize starch

povidone

hypromellose

iron oxide yellow

iron oxide red (50 mg tablet only)

titanium dioxide

sodium starch glycollate type A

purified talc

PEG-40 hydrogenated castor oil

methacrylic acid - ethyl acrylate copolymer (1:1)

triethyl citrate

The tablets also contain sugars as lactose.

Supplier

FENAC EC is supplied in Australia by:

Alphapharm Pty Ltd trading as Viatris

Level 1, 30 The Bond

30-34 Hickson Road

Millers Point NSW 2000

www.viatris.com.au

Phone: 1800 274 276

This leaflet was prepared in January 2024.

Australian registration numbers:

AUST R 272882 - FENAC EC diclofenac sodium 25 mg enteric coated tablet blister pack

AUST R 272871 - FENAC EC diclofenac sodium 50 mg enteric coated tablet blister pack

FENAC® is a Viatris company trade mark

FFENAC EC_cmi\Jan24/00 

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Credit - Karl Tapales—Getty Images

The Global Initiative for Chronic Obstructive Lung Disease, or GOLD, is the world’s preeminent COPD research and advocacy organization. Founded in 1997 in collaboration with the U.S. National Institutes of Health and the World Health Organization, one of GOLD’s stated aims is to “improve prevention and treatment of this lung disease.”

In its 2023 global strategy report, GOLD changed its definition of COPD—which many in the profession viewed as overdue. Specifically, the new definition emphasized the heterogeneity of COPD in terms of its underlying drivers and long-term disease course.

“If you look at the new GOLD guidelines, they’re really acknowledging that there’s more of an inflammatory component to COPD than we initially thought,” says Dr. Laren Tan, a pulmonary disease and critical care specialist and chair of the Department of Medicine at Loma Linda University Health in California.

Tan says the recognition that COPD can take unconventional forms is crucial to tailoring appropriate care to the individual patient. “We’re now approaching COPD in terms of trying to identify subgroups of patients that have this underlying inflammatory state,” he says. “If we don’t uncover this inflammatory component, that can lead to worse outcomes.”

Here, Tan and other experts in the field describe how this new understanding of inflammation is informing treatment. And it's just one of several recent advances in COPD care and management. From innovative new lung valves to refinements in the deployment of inhaled therapies and vaccines, the landscape of COPD care and treatment is changing.

The newest drug therapies

Arguably the most buzzed about advancement in the COPD treatment landscape is the emergence of new biologic therapies, says Dr. Meilan Han, a professor of medicine in the Division of Pulmonary and Critical Care at the University of Michigan. Biologics are injected medications derived from living cells or other biologic material that are able “to target very specific immune pathways,” Han explains.

Essentially, these drugs are intended to narrowly shift or block the operation of the immune system, thereby switching off or moderating the types of inflammation or other immune reactions that drive some COPD exacerbations while simultaneously leaving the remainder of the immune system unaffected. The drugs are already used to treat related pulmonary conditions, like asthma, and there’s reason to believe they’re about to enter the COPD arena.

“The exciting news is that there is a drug that looks like it will work for COPD, and that may soon have [U.S. Food and Drug Administration] approval,” Han says. That medication, dupilumab, is already approved for the treatment of asthma. In July 2023, a study published in the New England Journal of Medicine found that patients with so-called Type 2 inflammation—defined by the elevated presence of blood eosinophils—benefited from dupilumab. The patients experienced “fewer exacerbations, better lung function and quality of life, and less severe respiratory symptoms than those who received placebo,” the study found.

“What we’d seen in the last few years prior to this was that companies were fleeing respiratory drug development because a lot of studies had failed,” Han explains. “Dupilumab is just one drug, but it opens up the door for a lot more research and exploration of biologics for the treatment of COPD.” She notes that there are multiple trials examining additional biologics that target new pathways. “I’m hoping this is just the tip of the iceberg, and soon we’ll have many more new therapies,” she adds.

While biologics are garnering the most attention, experts say that smaller, more incremental improvements in care are having a greater impact on the day-to-day lives of COPD patients.

For example, phosphodiesterase inhibitors have long been used to help treat the mucous production and accumulation that so many COPD patients experience, Tan says. “The new phosphodiesterase inhibitors help relax airway smooth muscle and also help to clear out mucus from airways,” he says. “But patients take this as a tablet, which unfortunately comes with a lot of side effects, such as GI issues.” To prevent these side effects and improve the drug’s efficacy, researchers have looked into the development of inhalable forms of these drugs, and Tan says there’s promising data that these work.

Staying in the inhaler space, one of the greatest challenges in COPD care—and, for that matter, in the care of asthma and other lung conditions—is the problem of poor patient adherence to medications. Inhalers are often a mainstay of symptom management, but it can be a struggle for people to use an inhaler consistently, especially when treatment involves more than one type of inhaled drug.

This problem of adherence led to the development of combination inhalers—a single device that allows a patient to take two or even three medications simultaneously. “They’ve taken all these inhalers and put them into one device,” Han says. “This makes it easier for patients to take their medications, and this has led to a reduced frequency of exacerbations.”

In parallel with the emergence of combination inhalers, research has revealed that, for some COPD patients, the blend of three inhaled medicines may be superior to the old two-drug approach. “For most patients, we prescribe two long-acting bronchodilators,” says Dr. Peter Barnes, a professor of thoracic medicine at the National Heart and Lung Institute in the U.K. These are a long-acting muscarinic antagonist, or LAMA, coupled with a long-acting β2-agonist, or LABA. While this LABA/LAMA combination is nothing new, Barnes says that adding a third medicine—an inhaled corticosteroid—has proven helpful in patients with high blood levels of eosinophils. “These three can now be combined in single inhaler, called a triple inhaler,” he says.

Plus, some of the first research studies on the long-term benefits of these triple inhalers have found that they may reduce mortality among patients who use them. “When used appropriately in combination, these drugs can save lives,” Han says.

Read More: Severe Asthma Patients on Ways Their Doctors Could Improve Treatment

Valves, telemedicine, and other advances

Lung volume reduction surgery, or LVRS, is one of the most common surgical procedures for the treatment of COPD. The procedure, which has been around since the 1950s, involves the removal of the most diseased parts of lung tissue in order to allow better, less-restricted lung expansion during breathing. “When you take that diseased part out, that helps to restore the lung’s natural mechanics,” Han says.

But this surgery comes with downsides. “It’s a major surgery with a long recovery time, and the risk for complications is high,” Tan says. These complications include unintended air leakages, pneumonia, and heart issues such as arrhythmias.

In just the past few years, a new and milder intervention has emerged. Two different companies have developed valves that can be placed in the airway using a minimally invasive procedure, and that allow trapped air to escape the damaged lung. “These are essentially a one-way valve that allows air to go out of the affected areas of the lungs,” Tan explains. “This helps improve ventilation and breathlessness.” The procedure, known as bronchoscopic lung volume reduction, mimics the effects of the older surgery, but is reversable.

Aside from new drugs and surgical procedures, vaccines are another area that should lead to better symptom management. “With COPD, a lot of common viruses—things like respiratory viruses—can contribute to periodic flare-ups or exacerbations,” Han says. Vaccines can help prevent these viral infections, and more are becoming available all the time. “The ramp-up of vaccine development we saw during the pandemic—I’m hopeful we’ll continue to see new vaccines for things like rhinovirus that have a major impact on COPD,” she says.

Experts say there have also been helpful advances in the way COPD patients and their care providers interact.

“Pulmonary rehab doesn’t get much buzz, but we know it’s critical for a patient’s daily functioning,” Tan says. Pulmonary rehab often involves group education courses that teach people with COPD how to adjust their lifestyles—for example, by incorporating safe forms of exercise, or learning to prepare healthier meals—in order to improve their symptoms and functionality.

Unfortunately, reimbursement and insurance coverage for pulmonary rehab is poor. Plus, attending the group sessions can be difficult or inconvenient for people who don’t live close to their center of care. “But during the pandemic, we found that we can offer pulmonary rehab remotely through telehealth, and I think that’s been a gamechanger,” Tan says. While many of those pandemic-era telehealth programs have since been suspended, they acted as a proof-of-concept—a demonstration that pulmonary rehab courses can be offered virtually—that Tan hopes will eventually increase access and reduce costs for people with COPD.

Smoking cessation is another area that has witnessed some noteworthy advancements, Tan says. A majority of COPD patients are current or former smokers, and a lot have trouble quitting despite the help of medications and patches or other nicotine-replacement aids. “Now we’re starting to see people using an AI-powered app to help them quit,” he says.

Earlier this year, the Fred Hutchinson Cancer Center launched a free QuitBot AI app. The app offers personalized smoking cessation support—answering questions and providing evidence-based pre- and post-quit-date education materials—that can help people stick with it.

Meanwhile, researchers at Johns Hopkins University have found that combining psychedelics with cognitive behavioral treatments can lead to remarkable cessation rates. One study found that 80% of people were able to stay cigarette-free six months after the treatment—an unheard-of success rate for smoking cessation therapies.

Read More: How Alternative Medicine Can Help People With Asthma

What’s next?

In many branches of medicine, researchers and providers have turned their attention to better, more comprehensive diagnostics. With the help of advanced genetic testing, blood analyses, and other cutting-edge assessment tools, doctors can get a clearer picture of a patient’s underlying disease state, which can guide them toward the most efficacious and precise treatments—and, as a result, improving outcomes and reducing side-effects or other quality-of-life challenges.

This, experts say, is where COPD care is headed. “We know now there are multiple subtypes of COPD—that the inflammatory sub-profile differs from patient to patient,” Tan says. “But the inflammatory process is extremely complex.” It will take time to map the different inflammatory pathways and processes at play, and years of work to identify or develop new medicines that treat those specific instigators of inflammation. But all of this is underway. And, as the latest research on biologics suggests, this form of precision medicine is going to be part of the COPD conversation for a long time to come.

“I’ve been doing this for 20 years, and this is the first time I feel like we’re at an inflection point where I’m anticipating a lot of new therapies within the next five years,” Han says.

For people with COPD—and their care providers—the future looks bright.

Contact us at [email protected].

Source link

The Global Initiative for Chronic Obstructive Lung Disease, or GOLD, is the world’s preeminent COPD research and advocacy organization. Founded in 1997 in collaboration with the U.S. National Institutes of Health and the World Health Organization, one of GOLD’s stated aims is to “improve prevention and treatment of this lung disease.”

In its 2023 global strategy report, GOLD changed its definition of COPD—which many in the profession viewed as overdue. Specifically, the new definition emphasized the heterogeneity of COPD in terms of its underlying drivers and long-term disease course.

“If you look at the new GOLD guidelines, they’re really acknowledging that there’s more of an inflammatory component to COPD than we initially thought,” says Dr. Laren Tan, a pulmonary disease and critical care specialist and chair of the Department of Medicine at Loma Linda University Health in California.

Tan says the recognition that COPD can take unconventional forms is crucial to tailoring appropriate care to the individual patient. “We’re now approaching COPD in terms of trying to identify subgroups of patients that have this underlying inflammatory state,” he says. “If we don’t uncover this inflammatory component, that can lead to worse outcomes.”

Here, Tan and other experts in the field describe how this new understanding of inflammation is informing treatment. And it's just one of several recent advances in COPD care and management. From innovative new lung valves to refinements in the deployment of inhaled therapies and vaccines, the landscape of COPD care and treatment is changing.

The newest drug therapies

Arguably the most buzzed about advancement in the COPD treatment landscape is the emergence of new biologic therapies, says Dr. Meilan Han, a professor of medicine in the Division of Pulmonary and Critical Care at the University of Michigan. Biologics are injected medications derived from living cells or other biologic material that are able “to target very specific immune pathways,” Han explains.

Essentially, these drugs are intended to narrowly shift or block the operation of the immune system, thereby switching off or moderating the types of inflammation or other immune reactions that drive some COPD exacerbations while simultaneously leaving the remainder of the immune system unaffected. The drugs are already used to treat related pulmonary conditions, like asthma, and there’s reason to believe they’re about to enter the COPD arena.

“The exciting news is that there is a drug that looks like it will work for COPD, and that may soon have [U.S. Food and Drug Administration] approval,” Han says. That medication, dupilumab, is already approved for the treatment of asthma. In July 2023, a study published in the New England Journal of Medicine found that patients with so-called Type 2 inflammation—defined by the elevated presence of blood eosinophils—benefited from dupilumab. The patients experienced “fewer exacerbations, better lung function and quality of life, and less severe respiratory symptoms than those who received placebo,” the study found.

“What we’d seen in the last few years prior to this was that companies were fleeing respiratory drug development because a lot of studies had failed,” Han explains. “Dupilumab is just one drug, but it opens up the door for a lot more research and exploration of biologics for the treatment of COPD.” She notes that there are multiple trials examining additional biologics that target new pathways. “I’m hoping this is just the tip of the iceberg, and soon we’ll have many more new therapies,” she adds.

While biologics are garnering the most attention, experts say that smaller, more incremental improvements in care are having a greater impact on the day-to-day lives of COPD patients.

For example, phosphodiesterase inhibitors have long been used to help treat the mucous production and accumulation that so many COPD patients experience, Tan says. “The new phosphodiesterase inhibitors help relax airway smooth muscle and also help to clear out mucus from airways,” he says. “But patients take this as a tablet, which unfortunately comes with a lot of side effects, such as GI issues.” To prevent these side effects and improve the drug’s efficacy, researchers have looked into the development of inhalable forms of these drugs, and Tan says there’s promising data that these work.

Staying in the inhaler space, one of the greatest challenges in COPD care—and, for that matter, in the care of asthma and other lung conditions—is the problem of poor patient adherence to medications. Inhalers are often a mainstay of symptom management, but it can be a struggle for people to use an inhaler consistently, especially when treatment involves more than one type of inhaled drug.

This problem of adherence led to the development of combination inhalers—a single device that allows a patient to take two or even three medications simultaneously. “They’ve taken all these inhalers and put them into one device,” Han says. “This makes it easier for patients to take their medications, and this has led to a reduced frequency of exacerbations.”

In parallel with the emergence of combination inhalers, research has revealed that, for some COPD patients, the blend of three inhaled medicines may be superior to the old two-drug approach. “For most patients, we prescribe two long-acting bronchodilators,” says Dr. Peter Barnes, a professor of thoracic medicine at the National Heart and Lung Institute in the U.K. These are a long-acting muscarinic antagonist, or LAMA, coupled with a long-acting β2-agonist, or LABA. While this LABA/LAMA combination is nothing new, Barnes says that adding a third medicine—an inhaled corticosteroid—has proven helpful in patients with high blood levels of eosinophils. “These three can now be combined in single inhaler, called a triple inhaler,” he says.

Plus, some of the first research studies on the long-term benefits of these triple inhalers have found that they may reduce mortality among patients who use them. “When used appropriately in combination, these drugs can save lives,” Han says.

Read More: Severe Asthma Patients on Ways Their Doctors Could Improve Treatment

Valves, telemedicine, and other advances

Lung volume reduction surgery, or LVRS, is one of the most common surgical procedures for the treatment of COPD. The procedure, which has been around since the 1950s, involves the removal of the most diseased parts of lung tissue in order to allow better, less-restricted lung expansion during breathing. “When you take that diseased part out, that helps to restore the lung’s natural mechanics,” Han says.

But this surgery comes with downsides. “It’s a major surgery with a long recovery time, and the risk for complications is high,” Tan says. These complications include unintended air leakages, pneumonia, and heart issues such as arrhythmias.

In just the past few years, a new and milder intervention has emerged. Two different companies have developed valves that can be placed in the airway using a minimally invasive procedure, and that allow trapped air to escape the damaged lung. “These are essentially a one-way valve that allows air to go out of the affected areas of the lungs,” Tan explains. “This helps improve ventilation and breathlessness.” The procedure, known as bronchoscopic lung volume reduction, mimics the effects of the older surgery, but is reversable.

Aside from new drugs and surgical procedures, vaccines are another area that should lead to better symptom management. “With COPD, a lot of common viruses—things like respiratory viruses—can contribute to periodic flare-ups or exacerbations,” Han says. Vaccines can help prevent these viral infections, and more are becoming available all the time. “The ramp-up of vaccine development we saw during the pandemic—I’m hopeful we’ll continue to see new vaccines for things like rhinovirus that have a major impact on COPD,” she says.

Experts say there have also been helpful advances in the way COPD patients and their care providers interact. 

“Pulmonary rehab doesn’t get much buzz, but we know it’s critical for a patient’s daily functioning,” Tan says. Pulmonary rehab often involves group education courses that teach people with COPD how to adjust their lifestyles—for example, by incorporating safe forms of exercise, or learning to prepare healthier meals—in order to improve their symptoms and functionality.

Unfortunately, reimbursement and insurance coverage for pulmonary rehab is poor. Plus, attending the group sessions can be difficult or inconvenient for people who don’t live close to their center of care. “But during the pandemic, we found that we can offer pulmonary rehab remotely through telehealth, and I think that’s been a gamechanger,” Tan says. While many of those pandemic-era telehealth programs have since been suspended, they acted as a proof-of-concept—a demonstration that pulmonary rehab courses can be offered virtually—that Tan hopes will eventually increase access and reduce costs for people with COPD.

Smoking cessation is another area that has witnessed some noteworthy advancements, Tan says. A majority of COPD patients are current or former smokers, and a lot have trouble quitting despite the help of medications and patches or other nicotine-replacement aids. “Now we’re starting to see people using an AI-powered app to help them quit,” he says. 

Earlier this year, the Fred Hutchinson Cancer Center launched a free QuitBot AI app. The app offers personalized smoking cessation support—answering questions and providing evidence-based pre- and post-quit-date education materials—that can help people stick with it.

Meanwhile, researchers at Johns Hopkins University have found that combining psychedelics with cognitive behavioral treatments can lead to remarkable cessation rates. One study found that 80% of people were able to stay cigarette-free six months after the treatment—an unheard-of success rate for smoking cessation therapies.

Read More: How Alternative Medicine Can Help People With Asthma

What’s next?

In many branches of medicine, researchers and providers have turned their attention to better, more comprehensive diagnostics. With the help of advanced genetic testing, blood analyses, and other cutting-edge assessment tools, doctors can get a clearer picture of a patient’s underlying disease state, which can guide them toward the most efficacious and precise treatments—and, as a result, improving outcomes and reducing side-effects or other quality-of-life challenges.

This, experts say, is where COPD care is headed. “We know now there are multiple subtypes of COPD—that the inflammatory sub-profile differs from patient to patient,” Tan says. “But the inflammatory process is extremely complex.” It will take time to map the different inflammatory pathways and processes at play, and years of work to identify or develop new medicines that treat those specific instigators of inflammation. But all of this is underway. And, as the latest research on biologics suggests, this form of precision medicine is going to be part of the COPD conversation for a long time to come.

“I’ve been doing this for 20 years, and this is the first time I feel like we’re at an inflection point where I’m anticipating a lot of new therapies within the next five years,” Han says. 

For people with COPD—and their care providers—the future looks bright.

Source link

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 SYMBICORT on 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
    • Digoxin (may decrease serum digoxin levels). Consider monitoring digoxin 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

Please see full Prescribing Information, including Patient Information.

You may report side effects related to AstraZeneca products.

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.

Please read full Prescribing Information, including Patient Information.

You may report side effects related to AstraZeneca products.

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)
    • Xanthine derivatives, steroids, or non-potassium sparing diuretics (may potentiate hypokalemia and/or ECG changes)
    • 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.

Please see full BREZTRI Prescribing Information, including Patient Information.

You may report side effects related to AstraZeneca products.

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.

Please see full Prescribing Information, including Patient Information.

You may report side effects related to AstraZeneca products.

Notes

About Asthma

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 Aerosphere delivery 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 AEROSPHERE is 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.

Contacts

Brendan McEvoy        +1 302 885 2677
Jillian Gonzales          +1 302 885 2677       

US Media Mailbox: [email protected]

###

References

  1. The Global Asthma Report 2022. Accessed: March 2024.  globalasthmareport.org/index.html
  2. Centers for Disease Control and Prevention (CDC). Most Recent National Asthma Data. Accessed: March 2024.  www.cdc.gov/asthma/most_recent_national_asthma_data.htm
  3. Global Initiative for Asthma. Updated May 2023. Accessed: March 2024. www.ginasthma.org
  4. 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.
  5. 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.
  6. Data on File. REF-173201. AstraZeneca Pharmaceuticals LP.
  7. 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.
  8. Fernandes AG, et al. Risk factors for death in patients with severe asthma. J Bras Pneumol. 2014;40(4):364-372.
  9. Wark PA, et al. Asthma exacerbations. 3: Pathogenesis. Thorax. 2006;61(10):909-915.
  10. Johnson DB, et al. Albuterol. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2024 Jan 10.
  11. Montemayor T, et al. Albuterol: Often Used and Heavily Abused. Respiratory Care. November 2021, 66 (Suppl 10) 3603775.
  12. ClinCalc.com. Albuterol Drug Usage Statistics, United States, 2013-2020. Accessed: March 2024. clincalc.com/DrugStats/Drugs/Albuterol
  13. 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.
  14. 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.
  15. 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.
  16. Price DB, et al. Adverse outcomes from initiation of systemic corticosteroids for asthma: long-term observational study. J Asthma Allergy. 2018;11:193-204.
  17. 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/
  18. National Heart, Lung, and Blood Institute. What is COPD? Accessed: March 2024. www.nhlbi.nih.gov/health/copd
  19. Centers for Disease Control and Prevention. Leading Causes of Death. Accessed: March 2024. www.cdc.gov/nchs/fastats/leading-causes-of-death.htm

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The effect of long Covid on 3 Lancashire women

The effect of long Covid on 3 Lancashire women

Long Covid sufferers in Lancashire have called for better co-ordination of their care and more compassion from society as they fight a daily battle against a condition that has blighted their lives.

They say improvements to some elements of the NHS’s post-Covid services and increased support from their fellow citizens would make a big difference in helping them to cope with what remains a poorly understood condition, whose symptoms number more than 200 and can continue indefinitely after an initial Covid infection.

That list of post-viral problems is regularly topped by debilitating physical fatigue and a lack of concentration and memory characterised as ‘brain fog’. However, it can include a plethora of other complaints – including shortness of breath, joint pain and headaches.

The only truly unifying feature of the 1.9 million estimated cases of Long Covid in the UK last year is its ability to ruin the lives of those who catch the virus – but never recover.

The head of the World Health Organisation, Tedros Adhanom Ghebreyesus, warned 12 months ago that the1 in 10 infections believed to lead to Long Covid suggests “hundreds of millions of people will need longer-term care” across the globe in the years to come.

While the number of lives being ended by Covid has significantly reduced – although not been eliminated – compared to the earlier part of the pandemic, its capacity to upend life seemingly knows no bounds.

Now, a trio of Lancashire patients have spoken to the Local Democracy Reporting Service (LDRS) to mark Long Covid Awareness Day, explaining what the condition has stolen from them – and outlining the support they need to make the best of the lives they have been left with.

MIRIAM, Preston 

Lancashire Telegraph: Miriam, Long Covid Sufferer, PrestonLancashire Telegraph: Miriam, Long Covid Sufferer, Preston

Lancashire Telegraph: Miriam, Long Covid Sufferer, Preston

Miriam, who did not want to give her full name, was a frontline NHS worker before the onset of the pandemic and fell pregnant shortly before it struck.  Early fears about how Covid might affect pregnant women and their unborn children resulted in her spending most of her pregnancy in isolation.

Not long after her daughter turned one – and at the height of the first Omicron wave in January 2022, the new mum caught Covid.

Her recovery from the initial infection was far from complete when she returned to work, leaving her particularly vulnerable to the effects of contracting it again – which she unfortunately did just five months later, after a single day back in her hospital job.

Two years on, and her second brush with Covid has left her unable to work and in need of a walking stick – at the age of just 35.

“We went to the zoo just before Christmas and I ended up having to rent a scooter because I couldn’t walk.  And that’s what I’m having to look at now as a permanent thing – if I am going to go out, I might need to hire a scooter to get about.

“As well as my mobility and breathlessness, it has been the fatigue, more than anything.

"That’s terrible because you want to do stuff, but you just physically can’t move to do it,” Miriam explained.

As well as the practical problems that poses, it has also robbed her of something particularly precious – and irretrievable.

“There have been many times when my baby girl has been poorly and I could hear her crying, but couldn’t get up to get to her.

“I actually don’t remember much of my daughter being a toddler – and I’m never going to get that back. Plus, we didn’t go and do half of what I’d love to have been able to do with her.

“My husband has been a Godsend – he’s a daddy and has also [basically] been my carer at times, when I have been unable [to look after myself].

“I’m not as bad as I was, but still nowhere near [normal] – and I might never be that way again because of damage to my organs. So it’s just taking one day at a time – and you can’t really look forward to many things, because if you have a flare-up, you’re in trouble,” Miriam says.

For that reason, she says, the most important thing for people with Long Covid is getting access to the health services that are on offer.

While she has enjoyed the support of her GP, she knows many Long Covid sufferers are not so fortunate.

“A lot of people struggle even getting to that point – they are not listened to and are dismissed, so you are up against a massive hill from the start.”

Miriam says that the physio team who have looked after her at a Long Covid clinic has been “fantastic” – and even arranged mobility aids for her home.  But she says continued investment in research for the best way to help people in her situation is vital – as well as the support of society at large.

“People want to have normality and ignore problems unless it affects them directly – and that’s normal human behaviour. But that’s why I think it’s really important to have the awareness day for Long Covid.

“Just remember that everyone’s got their own story and everyone is struggling with their own stuff – so if you see someone struggling, help. And just be kind.”

MELANIE, Ormskirk

Lancashire Telegraph: Melanie, Long Covid sufferer, Ormskirk Lancashire Telegraph: Melanie, Long Covid sufferer, Ormskirk

Lancashire Telegraph: Melanie, Long Covid sufferer, Ormskirk

Fifty-three-year old Melanie had to give up her job as a part-time church administrator after contracting Covid more than three years ago. She never recovered and although she initially tried to recapture the life she had previously lived, her condition has steadily deteriorated – to the point at which she was left largely housebound.

“My life has literally just stopped,” Melanie told the LDRS.

“It sounds very dramatic [to say], but it feels like you’re slowly dying.

“Before Covid I was, like most people, running [at] 110 percent.  I pushed myself and pushed myself after the first infection – and then I can only describe it as my body just crashing.

“I can remember saying to my boss I was going to have to leave work early – it felt like I was drunk, I was staggering and really scared.

“A year later I started to develop neurological symptoms – and I have gone further downhill since.

“But last October, I caught Covid again and I was really frightened, because I couldn’t find my baseline.  If I got in the shower. I would just have to lie in bed and have a sleep afterwards.

“I emailed my physio at the Long Covid clinic and my GP and I said, ‘I’m housebound, my next step back [is being] bedbound – [and] you need to help stop me getting there.”

Melanie says the main thing she feels has been missing from her care is a single doctor overseeing it.  NHS England commissioning guidance for post-Covid services states that they should be centred around multi-disciplinary teams (MDTs), which bring together specialist medical, nursing and other health professionals, with “clinical leadership from a doctor with the relevant skills and experience”.

“I have been really lucky – I’m still under a Long Covid clinic and when I first was diagnosed, [they arranged] cognitive behavioural therapy and I went on an online course for how to live with a long term disability.  That does help, because you have had your world turned upside down.

“They’re doing as much as they can, but at the end of the day, [they] phone me every couple of months and ask if there is anything [they] can do.   I did ask if they could refer me to a multidisciplinary team that was led by a doctor, but they weren’t any.

“Now I’m waiting to be seen privately by a doctor in Liverpool,” Melanie said.

ALISSA NEHRLICH, Preston

Lancashire Telegraph: Alissa Nehrlich, Long Covid sufferer, PrestonLancashire Telegraph: Alissa Nehrlich, Long Covid sufferer, Preston

Lancashire Telegraph: Alissa Nehrlich, Long Covid sufferer, Preston

Before catching Covid in January 2022, Alissa was what she describes as “the perfect example of someone young, fit and healthy”.

Sadly, the virus changed all that – just two weeks before she was due to start a new job in an events team.

Now just 24, Alissa – who did manage to take up her job, which she is still doing four days a week – says she developed Long Covid “and it just never went away”.

“For me, it’s the fatigue – if I do too much, my body just crashes . There is also muscle pain, joint pain, dizziness and a lot of cognitive [issues] – brain fog being the main one and concentration [problems].

“Last year, I did have a big crash [when] everything caught up [with] me – [and] my mobility and cognitive function have definitely plummeted since.

“Pushing through has had an effect and made things worse than – but I didn’t know any better,” Alissa added.

Apart from her ongoing condition, her biggest frustration is the way in which the therapeutic support she is receiving is all under one roof – but any medical help she needs is fragmented and often delayed.

“Within the Long Covid clinic in Preston, it’s nice, because they have a physio, dietitian, occupational therapist – and they all talk to each other [about you].

“But if there is a problem that requires a doctor, you get referred back to your GP – and that’s where it gets [complicated].   There was one point at which I was on four different waiting lists for four different specialists – [who] don’t talk to each other.

“I had an initial cardiology appointment last summer and testing done in September, but I’m still waiting for an actual treatment plan, because I can’t get a follow-up appointment,” Alissa explained.

WHAT DOES THE NHS SAY?

Responsibility for post-Covid services will have shifted from a national level to the NHS’s regional integrated care boards (ICBs) by the end of the month.

A spokesperson for the Lancashire and South Cumbria ICB said:  ““The Long Covid clinics are provided by multi-disciplinary teams, which include nursing, physiotherapy, occupational therapy, respiratory support [and]  psychological support – and cover the full ICB area.

“The teams cover: Morecambe Bay, including south Lakeland, the Fylde Coast, Central Lancashire, East Lancashire, including Blackburn with Darwen, and West Lancashire.  All can be accessed by referral by GP.”

NHS England referred the LDRS to the ICB when approached for comment.

WHAT DOES THE GOVERNMENT SAY?

A Department of Health and Social Care spokesperson said: “Long Covid can have a debilitating impact on people’s physical and mental health, that’s why we have backed our world-leading scientists with over £50 million to better understand it and identify new treatments.

“NHS England has also invested £314 million to expand treatment and rehabilitation services, establishing 100 long Covid services for adults and 13 specialist paediatric hubs for children and young people.”

HOW TO GET HELP

Anyone who is concerned about long-lasting symptoms after having had Covid should contact their GP.

The Long Covid Support group website also has advice and information – www.longcovid.org

Other support is available in Lancashire via Brain Health Breakthrough CIC.

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Dyspnea, also known as shortness of breath or breathlessness, is a subjective sensation that refers to the discomfort or difficulty in breathing.

Market Overview:  

The dyspnea market is expected to exhibit a CAGR of 5.24% during 2024-2034. The report offers a comprehensive analysis of the dyspnea market in the United States, EU5 (including Germany, Spain, Italy, France, and the United Kingdom), and Japan.

It covers aspects such as treatment methods, drugs available in the market, drugs in development, the proportion of various therapies, and the market’s performance in the seven major regions. Additionally, the report evaluates the performance of leading companies and their pharmaceutical products.

Current and projected patient numbers across these key markets are also detailed in the report. This study is essential for manufacturers, investors, business planners, researchers, consultants, and anyone interested or involved in the dyspnea market.

Request for a Sample of this Report : www.imarcgroup.com/dyspnea…uestsample

Dyspnea Market Trends:

The dyspnea market is experiencing significant growth, influenced by several key factors. Primarily, the increasing incidence of respiratory diseases such as asthma, chronic obstructive pulmonary disease (COPD), and pulmonary hypertension contributes to the rising prevalence of dyspnea.

These respiratory conditions are becoming widespread due to factors like air pollution, smoking, and lifestyle changes, driving the demand for effective dyspnea management solutions. Additionally, the aging population, which is more susceptible to respiratory disorders, is another vital factor propelling the growth of the dyspnea market.

Advances in medical technology have led to the development of innovative diagnostic tools and treatment methods for respiratory ailments, further fueling market expansion. The growing awareness of respiratory health and early diagnosis techniques has also resulted in more people seeking treatment for dyspnea, thereby boosting the market.

The pharmaceutical and healthcare sectors are increasingly focusing on the research and development of new drugs and therapies, offering effective and targeted treatments for dyspnea. Furthermore, the adoption of digital health solutions, such as telemedicine and remote patient monitoring, has been accelerated by the COVID-19 pandemic, offering new avenues for managing dyspnea effectively.

This trend is expected to continue, significantly influencing dyspnea market dynamics in the foreseeable future.

Countries Covered:

  • United States
  • Germany
  • France
  • United Kingdom
  • Italy
  • Spain
  • Japan

Analysis Covered Across Each Country:

• Historical, current, and future epidemiology scenario
• Historical, current, and future performance of the dyspnea market
• Historical, current, and future performance of various therapeutic categories in the market
• Sales of various drugs across the dyspnea market
• Reimbursement scenario in the market
• In-market and pipeline drugs

This report also provides a detailed analysis of the current dyspnea marketed drugs and late-stage pipeline drugs.

In-Market Drugs

  • Drug Overview
  • Mechanism of Action
  • Regulatory Status
  • Clinical Trial Results
  • Drug Uptake and Market Performance

Late-Stage Pipeline Drugs

  • Drug Overview
  • Mechanism of Action
  • Regulatory Status
  • Clinical Trial Results
  • Regulatory Status

Competitive Landscape:

The competitive landscape of the dyspnea market has been studied in the report with the detailed profiles of the key players operating in the market.

Ask Analyst for Customization and Explore Full Report With TOC & List of Figures: www.imarcgroup.com/request…amp;flag=C

If you need specific information that is not currently within the scope of the report, we will provide it to you as a part of the customization.

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EXETER, N.H., March 6, 2024 /PRNewswire/ -- Vapotherm, Inc. (OTCQX: VAPO), ("Vapotherm" or the "Company") today announced that David Yamane, MD was awarded the Star Research Award by the Society for Critical Care Medicine (SCCM) at the 2024 Critical Care Congress. The award is in recognition of the HYPERACT study – a new multi-center, randomized controlled trial which offers high velocity therapy as an additional, more comfortable, option for clinicians treating acute exacerbations of moderate-severe COPD.

 (journals.lww.com/ccmjournal/citation/2024/01001/42__high_velocity_nasal_insufflation_vs.43.aspx)

This study compared non-invasive positive pressure ventilation (NiPPV) to Vapotherm high velocity therapy by measuring relief of dyspnea (breathlessness) as well as blood chemistry values and patient response.

Dr. Yamane shared his sentiments, stating, "I am deeply honored by this recognition and genuinely excited about the potential impact of the HYPERACT study on health care. Offering an alternative to mask-based therapies that is both effective and comfortable for patients marks a significant advancement in our approach to COPD treatment."

Acute exacerbations of COPD contribute to over 600K emergency room (ER) visits and 140K deaths annually in the US alone. The cost is approximately $50 billion per year. (1,2)

This is the first multi-center, randomized, controlled trial focused on patients with moderate to severe exacerbations of COPD, showing similar improvement in pH and pCO2 comparing high velocity therapy and NiPPV.

"When patients present to the emergency department out of breath, they're often placed on a mask-based therapy that uses pressure to open their airways. It can be even more distressing when you can't breathe to have a mask on your face, forcing air down your lungs" said Vapotherm's Chief Medical Officer, Jessica Whittle, MD, PhD. "This study concludes that high velocity therapy provides similar clinical results and statistically superior patient reported comfort compared to mask-based therapies."

Over time, patients reported improved comfort on high velocity therapy while patients on NiPPV reported more discomfort from baseline. 19% of NiPPV patients failed therapy compared to 11% of high velocity therapy patients.

Joe Army, Vapotherm's President and Chief Executive Officer expressed his enthusiasm, stating, "11% of patients on high velocity therapy in HYPERACT were effectively treated in the ED and were discharged home, whereas 0% of patients treated with NiPPV were discharged directly home – that's a huge cost savings for hospitals." Mr. Army continues, "This is a win-win-win scenario: a win for the clinician to use a simple, evidence-based therapy, a win for the patient regarding comfort, and a win for the hospital because mask-based complications add costs." (3)

Dr. Yamane was presented with the award at the 2024 Critical Care Congress on January 23rd, 2024, in Phoenix, AZ. He also presented the HYPERACT findings at the conference.

  1. Sullivan J, Pravosud V, Mannino DM, Siegel K, Choate R, Sullivan T. National and state estimates of COPD morbidity and mortality - united states, 2014-2015. Chronic Obstr Pulm Dis. 2018;5(4):324-333. doi: 10.15326/jcopdf.5.4.2018.0157.
  2. Nguyen PL, Uddin MM, Mir T, et al. Trends in incidence, and mortality of acute exacerbation of chronic obstructive pulmonary disease in the United States emergency department (2010–2018). COPD: Journal of Chronic Obstructive Pulmonary Disease. 2021;18(5):567-575. doi.org/10.1080/15412555.2021.1979500. doi: 10.1080/15412555.2021.1979500.
  3. Carron M. et al. Complications of non-invasive ventilation techniques: a comprehensive qualitative review of randomized trials. British Journal of Anaesthesia. 110(6):896-914. (2013) www.ncbi.nlm.nih.gov/pubmed/23562934

About Vapotherm

Vapotherm, Inc. (OTCQX: VAPO) is a publicly traded developer and manufacturer of advanced respiratory technology based in Exeter, New Hampshire, USA. The Company develops innovative, comfortable, non-invasive technologies for respiratory support of patients with chronic or acute breathing disorders. Over 4.2 million patients have been treated with the use of Vapotherm high velocity therapy® systems. For more information, visit www.vapotherm.com.

Vapotherm high velocity therapy is mask-free non-invasive respiratory support and is a front-line tool for relieving respiratory distress—including hypercapnia, hypoxemia, and dyspnea. It allows for the fast, safe treatment of undifferentiated respiratory distress with one tool. The HVT 2.0 and Precision Flow systems' mask-free interface delivers optimally conditioned breathing gases, making it comfortable for patients and reducing the risks and care complexities associated with mask therapies. While being treated, patients can talk, eat, drink and take oral medication.

Legal Notice Regarding Forward-Looking Statements

This press release contains forward-looking statements under the Private Securities Litigation Reform Act of 1995, including statements about the Company's business and growth prospects in Brazil. In some cases, you can identify forward-looking statements by terms such as "expect," "anticipate," "continue," "plan," "intend," "will," or "typically," or the negative of these terms or other similar expressions, although not all forward-looking statements contain these words, and the use of future dates. Each forward-looking statement is subject to risks and uncertainties that could cause actual results to differ materially from those expressed or implied in such statement. Other risks and uncertainties included under the heading "Risk Factors" in Vapotherm's Annual Report on Form 10-K for the fiscal year ended December 31, 2023, as filed with the SEC on February 22, 2024, and in its subsequent filings with the SEC. The forward-looking statements contained in this press release reflect Vapotherm's views as of the date hereof, and Vapotherm does not assume and specifically disclaims any obligation to update any forward-looking statements whether as a result of new information, future events or otherwise, except as required by law.

Investor Contact:John Landry, SVP and CFO

investors.vapotherm.com/

Cision View original content to download multimedia:www.prnewswire.com/news-releases/dr-david-yamane-was-awarded-the-star-research-award-at-the-2024-critical-care-congress-for-the-presentation-of-the-hyperact-study--a-randomized-controlled-trial-demonstrating-vapotherms-high-velocity-therapy-effectively-treats--302078568.html

SOURCE Vapotherm, Inc.



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There is a link between depressive disorders and respiratory disorders among those with self-reported chronic obstructive pulmonary disease (COPD) and asthma, according to new findings, though this is not seen in objective diagnoses based upon spirometry.1

These new data resulted from a study conducted to assess potential links between ventilatory disorders, spirometric indices, and self-reported diseases of the respiratory system to psychiatric conditions. The team ensured that confounding variables were included in their assessment.

The research was led by Brice Touilloux, from Lausanne University Hospital’s respiratory medicine department at the University of Lausanne in Switzerland. Touilloux and colleagues noted that individuals with depressive symptoms often show elevated inflammation cytokines, some of which are connected to weakened bronchodilation responses and airway neutrophilia.2

“Using data from a population-based cohort, the purpose of the present paper is to evaluate the association between lung volumes, spirometric ventilatory disorders and self-reported respiratory diseases and major depressive episode (MDE) and anxiety disorders, controlling for potential confounders,” Touilloux and colleagues wrote.

Background and Methods

The investigators’ data was drawn from the prospective CoLaus/PsyCoLaus cohort study, investigating the link between mental disorders and cardiovascular risk factors within a community setting. The cohort was made up of 6734 individuals within the age range of 35 - 75 years who had been recruited from Lausanne, Switzerland in the period between 2003 - 2006.

Evaluations during follow-up meetings had been carried out about 5 (labeled ‘FU1,’ 5064 subjects), 9 (FU2, 4881 subjects), and 13 years (FU3) following the point of baseline. The PneumoLaus spirometry research was done from June 2014 - August 2017, coinciding with the FU2 physical assessment and taking place a single year prior to the FU2 psychiatric evaluation.

Among the 3351 individuals taking part in PneumoLaus and the 3493 individuals in the FU2 psychiatric assessment, the investigators’ analysis aimed at the 2774 subjects who finished both assessments. The methodology used in Pneumolaus had been previously disclosed in detail.3

The research team defined ventilatory disorders through GLI-2012 references, whereas major depressive episodes and anxiety disorders were defined by the team according to DSM-IV criteria.

Using face-to-face interviews, the investigators evaluated respiratory symptoms, risk factors, and prior diagnoses, involving respiratory practitioners on the day of subjects’ spirometry. Cough, sputum production, and breathlessness were symptoms that were recorded and identified through the use of the modified Medical Research Council (mMRC) dyspnea scale.

Findings

Overall, 22.7% of the study subjects ended up presenting with a recent major depressive episode (MDE), the investigators found. They also noted that reversible cases of obstructive ventilatory disorders had associations with recent episodes (OR=1.94, 95% CI, 1.10-3.43) and recent anxiety disorders (2.21 [1.16-4.22]) only within the team’s unadjusted model.

The research team noted that self-reported cases of asthma and COPD were found to be linked to major depressive episodes, with adjusted ORs of 1.56 (95% CI, 1.04-2.35) and 2.49 (95% CI, 1.19-5.27), respectively. The team also reported that potential restrictive ventilatory impairment had a positive correlation with anxiety disorders occurring recently (OR=2.46, 1.10-5.51).

Despite these findings, the investigators found that the Z-scores of FEV1, FVC, and maximum mid-expiratory flow (MMEF) ended up having no associations to psychiatric conditions. In the adjusted models used by the team, they identified no association between ventilatory disorders and major depressive episodes.

“People with low spirometry values might not have participated in our cohort due to their symptom burden,” they wrote. “Moreover, this was a cross-sectional study, therefore it was only possible to confirm a temporal association between mental disorders and airways impairment, without being able to analyse a potential causality due to a period of only one year between the spirometry and the psychiatric assessment.”

Nevertheless, the team’s research represents the first population-based study focused on the connection between ventilatory disorders, spirometry indices, and psychiatric conditions through the use of a semi-structured interview.

References

  1. Brice Touilloux, Alessio Casutt, Marie-Pierre F. Strippoli, et al. Associations of depressive and anxiety disorders with pulmonary disorders in the community – the PneumoLaus and PsyCoLaus studies. Respiration 2024; doi.org/10.1159/000537918.
  2. Zhang L, Zhang X, Zheng J, Liu Y, Wang J, Wang G, et al. Depressive symptom-associated IL-1beta and TNFalpha release correlates with impaired bronchodilator response and neutrophilic airway inflammation in asthma. Clin Exp Allergy. 2019 Jun;49(6):770-80.
  3. Lenoir A, Fitting JW, Marques-Vidal PM, Vollenweider P, Nicod LP. GLI 2012 equations define few spirometric anomalies in the general population: the PneumoLaus study. Respir Res. 2018 Dec 13;19(1):250.

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(MENAFN- Pressat)
Voices of Hope , the Kingston upon Thames based charity, today announced the launch of its informative Active Breathing Course (ABC) website.

The six-week online course, launched in 2021, is designed to help people recover from long-term respiratory conditions and manage their fatigue, stress and anxiety levels. It is NHS approved and is guided by specialist professional tutors.

Having run more than 60 courses, in the three years since its inception, ABC has 9 expert tutors and has impacted over 600 lives.

  • 89% of participants found the course very helpful/helpful

  • more than 60% said that they had seen a great or good improvement in their overall breathing capacity.

Whilst the course came about in response to the devastating symptoms of long-Covid, the courses now help people with a range of ongoing respiratory illnesses, as well as benefitting those struggling with anxiety disorders[i] .

Voices of Hope CEO, Sarah Clay, BEM explains:

“Respiratory disease affects one in five people and is the third biggest cause of death in England. Not only does it have a distressing impact on the lives of the people involved, but it also puts a huge economic burden on the NHS, with the cost of asthma and COPD treatment alone standing at an estimated £4.9 billion annually.[ii]

Through our Active Breathing Course, we aim to help people manage their symptoms through a range of techniques, including the teaching of Diaphragmatic Breathing, controlled breathwork and singing exercises that help to strengthen intercostal muscle; all done in a creative, inspiring and empowering way.

The course has been shown to have a positive impact on our participants and we partner extensively with charities, healthcare providers (including hospitals, GPs and social prescribers) and businesses. As a charity we can offer individuals a cost-effective way of improving their breathing and quality of life.”

Sarah Clay continued:

“ABC can also offer great benefits for businesses. With bespoke courses available, we support businesses in improving staff well-being. Benefits can include higher energy and creativity levels; a reduction in stress and anxiety levels in the workplace; improved posture and the positive release of endorphins.”

For more information about the Active Breathing course visit our website

-ENDS-

Contacts:

Sarah Clay, CEO, Voices of Hope
...
Charity No. 1187454

Notes to Editors:

About Voices of Hope
Voices of Hope is a locally founded charity in Kingston Upon Thames with a focused reach into SW London. We are dedicated to bringing hope to individuals and the wider community, improving physical and mental health through community-based projects.

Our mission is to restore people, give them hope to rebuild their lives, and to equip them both practically and emotionally. We aim to achieve this through creative and inspiring projects focused in the 3 areas of Creative Arts, Food, and Women's projects.

We work with people struggling with complex physical and/or mental health issues, families experiencing food insecurity, women who have experienced abuse/domestic violence, and the elderly. We see those we reach as people who need support, encouragement and empowerment – not as problems which need solving.

Due to the impact of our work locally and our collaborative partnership approach, we are having a growing national reach through several of our projects.

About Active Breathing Course (ABC)
The Active Breathing Course is a six week, NHS approved, online and in-person course. Through controlled breath work and creative exercises, ABC is tailored to support recovery and long-term wellbeing with the help and guidance of our specialist tutors.

ABC is now accessible across the UK and is particularly, though not exclusively, focused on reaching those who are suffering from a long-term, ongoing respiratory condition, breathlessness, disordered breathing, anxiety or fatigue.

/active-breathing-course/

[i] 8 million people are experiencing anxiety disorder at any one time in the UK according to Mental Health UK

[ii] NHS England statistics 2023

MENAFN05032024004644010603ID1107935454


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Kingston upon Thames based charity Voices of Hope has announced the launch of their new Active Breathing Course (ABC) website. The six-week online course, which was launched in 2021, aims to help individuals recover from long-term respiratory conditions and manage fatigue, stress, and anxiety levels. The course is NHS approved and is led by expert professional tutors.

Since its inception three years ago, ABC has helped over 600 individuals through more than 60 courses. According to the charity, 89% of participants have found the course to be very helpful or helpful, and more than 60% have reported significant improvements in their overall breathing capacity.

While the course was originally created in response to the devastating symptoms of long-Covid, it has since expanded to aid those with a variety of ongoing respiratory illnesses and to benefit individuals struggling with anxiety disorders.

Speaking about the launch of the new website, Voices of Hope CEO Sarah Clay, BEM, said, “Respiratory disease affects one in five people and is the third biggest cause of death in England. Not only does it have a distressing impact on the lives of the people involved, but it also puts a huge economic burden on the NHS, with the cost of asthma and COPD treatment alone standing at an estimated £4.9 billion annually.”

Through the Active Breathing Course, participants are taught a range of techniques, including Diaphragmatic Breathing, controlled breathwork, and singing exercises to strengthen intercostal muscles, all in a creative, inspiring, and empowering way. The course has shown positive results for participants, and the charity partners with organizations such as charities, healthcare providers, and businesses to offer cost-effective ways for individuals to improve their breathing and quality of life.

Clay also highlighted the benefits of the Active Breathing Course for businesses, stating, “With bespoke courses available, we support businesses in improving staff well-being. Benefits can include higher energy and creativity levels, a reduction in stress and anxiety levels in the workplace, improved posture, and the positive release of endorphins.”

For more information about the Active Breathing Course, interested individuals can visit Voices of Hope’s website at www.voh.org.uk/abc.

-ENDS-

Contacts:

Sarah Clay, CEO, Voices of Hope

[email protected]

Charity No. 1187454

Notes to Editors:

– Voices of Hope is a locally founded charity in Kingston Upon Thames with a focused reach into SW London. The organization is dedicated to bringing hope to individuals and the wider community and improving physical and mental health through community-based projects.

– Their mission is to restore people, give them hope to rebuild their lives, and equip them both practically and emotionally. The charity’s work is centered around creative and inspiring projects in the areas of Creative Arts, Food, and Women’s projects.

– Voices of Hope works with individuals struggling with complex physical and/or mental health issues, families experiencing food insecurity, women who have experienced abuse/domestic violence, and the elderly. They see those they reach as people who need support, encouragement, and empowerment, rather than problems that need solving.

– Due to the impact of their work locally and their collaborative partnership approach, Voices of Hope is gaining a growing national reach through several of their projects.

– For more information about the organization, individuals can visit their website at www.voh.org.uk.

– About the Active Breathing Course (ABC): The ABC is a six-week, NHS approved, online and in-person course designed to aid recovery and long-term well-being through controlled breathwork and creative exercises. The course is accessible across the UK and is focused on reaching those suffering from a long-term, ongoing respiratory condition, breathlessness, disordered breathing, anxiety, or fatigue.

– For more information about the ABC, individuals can visit the Voices of Hope’s website at www.voh.org.uk/active-breathing-course/.

– Mental Health UK reports that 8 million people in the UK are experiencing an anxiety disorder at any one time.

– According to NHS England statistics, respiratory disease is the third leading cause of death in England, affecting one in five people and costing the NHS an estimated £4.9 billion annually.

Derick is an experienced reporter having held multiple senior roles for large publishers across Europe. Specialist subjects include small business and financial emerging markets.

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