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Hello, and welcome back to i‘s science and tech newsletter. Over the coming weeks there will be a series of guest newsletters that will try and untangle big issues affecting the twinned worlds of science and technology. I’m Chris Stokel-Walker, a freelance journalist and regular contributor to i.

This week, we’re looking at asthma and the environment.

I’ve had asthma since I was a child. When I was young, I remember having to take regular doses of a beclometasone inhaler (the brown, steroidal one), designed to avoid symptoms arriving in the first place, alongside a blue reliever inhaler, to quell symptoms like breathlessness when they arrive.

In my teenage years and twenties, the symptoms largely subsided. But in the last few years – whether because of physical inactivity brought about by my changed way of life post-lockdowns, as I work more from home, or perhaps because of the post-infection impact of the novel coronavirus, I’ve found my asthma symptoms have flared up.

Just last night, for instance, while battling off the tail end of a cold, I became so breathless I needed to use my blue salbutamol inhaler three times overnight.

My inhaler helps make my life more tolerable. But it’s potentially not great for the environment.

Environmental impact

The high use of my inhaler suggests that my asthma is currently poorly controlled. I’m not alone: an analysis of 236,506 people in the UK in a recent study published in BMJ Thorax suggests around 47 per cent of people’s asthma is poorly controlled.

Poor control means overusing the wrong type of inhaler – it’s likely that I should be back on a preventative, rather than relieving, device. It also means I’m more likely to end up in hospital. And combined, those two things are bad for the planet.

Poorly controlled asthma contributes 303,874 tonnes of carbon dioxide equivalent a year – as much excess greenhouse gas emissions as nearly 125,000 UK homes, according to the same study. Greenhouse gas emissions for the average person with poorly-controlled asthma are eight times higher than those who have their asthma under control.

Startlingly, emissions from inhalers account for 3 per cent of the entire NHS’s carbon footprint. Blue inhalers – and inhalers more generally – are harmful to the environment because they deliver their dose alongside a puff of gas, designed to push the medication deep into our lungs, where it can be most effective. That propellant is the main contributor to emissions.

“Inappropriate use” of inhalers is the single largest contributor, the remaining 10 per cent of emissions come from when those inhalers don’t work – or don’t work well enough – and we have to visit the GP or hospital.

So should you ditch the inhaler? Far from it.

Puff, puff and away

Anyone who’s had asthma knows that it can be difficult to think of anything else other than your next breath when you’re struggling to get air into your lungs. And asthma doesn’t just get better with time during your life, or is something you necessarily “grow out of”. “It can come back at any time,” said Dr Andy Whittamore, clinical lead at Asthma + Lung UK, a charity fighting for the rights of asthmatics. “Asthma comes and goes, and actually we need to help to keep away so that they don’t flare up with viruses and things that trigger it off.”

But with the environmental impact weighing on your mind, it might be tempting to not reach for the inhaler. That’d be a mistake, experts say.

“A friend of mine pointed out to me that he’d heard that inhalers were bad for the environment,” said Whittamore. “He started using his inhalers less often. And about six weeks later, he had a flare up which put him in hospital.”

By trying to save the environment, Whittamore’s friend did the opposite: he overused his blue reliever inhaler, which accounts for around 60 per cent of those excess emissions. Then he ended up in hospital, which has its own environmental impact.

“All that together meant actually he was even more an impact on the environment than if he continued to take that preventer inhaler,” said Whittamore. “So that’s the key message here: people need to keep on taking their inhalers as they’ve been prescribed.”

“Targeting improved asthma outcomes by addressing the high burden of poorly controlled asthma, may significantly alleviate asthma care-related carbon emissions,” said Dr John Bell, the study’s author and medical director of biopharmaceuticals medical at AstraZeneca.

An important caveat

These findings aren’t necessarily new. Nor are they necessarily completely, utterly altruistic. Dr Bell works for AstraZeneca, which is developing a zero-carbon inhaler – although the paper has been published in a peer-reviewed journal, and some of his co-authors work in the NHS.

Indeed, a 2022 academic paper by two NHS doctors found roughly the same thing. In an attempt to reduce costs, the UK health sector has turned to metered-dose inhalers, or MDIs, and particularly the blue inhaler, which contains salbutamol, a medication that relaxes the airways to allow more air to flow into the body, to try and treat patients.

Two thirds of asthma patients in the UK’s primary treatment for their problem are those blue inhalers. That’s far higher than other European countries, where on average around 30 per cent of all inhalers are blue.

Overuse of blue inhalers is tackling the symptom, not the underlying problem. “A reliever, the blue one which you take when you get symptoms, is doing nothing to prevent you getting more symptoms,” said Whittamore. “All it’s doing is making you well at that moment.”

What you should do

First of all: keep taking your inhaler when you need it. But if you’re taking your blue one lots perhaps book a GP appointment (like I’m about to do, having spoken to the experts) to see how better to manage your asthma.

Secondly, don’t sacrifice your own health. There are alternatives out there, including powder inhalers and the zero-carbon one currently being developed by AstraZeneca. But they require training to use, and you ought to see a GP first.

And finally, bear in mind that you alone are not the problem. “All healthcare interactions have a carbon footprint,” said Bell. “In the UK, for example, almost a quarter of the total carbon footprint in healthcare is from the delivery of patient care. Chronic respiratory diseases like asthma are complex and difficult to treat.”

Other things I’ve written recently

I tackled a non-science issue this week for i, instead talking about my career – and why shying away from moving to London early on in my working life proved to be the best decision I’ve made, not just for my journey up the career ladder, but in life.

Science link of the week

A new analysis of 46 million people has shown Covid jabs appear to reduce the risk of heart attacks and other conditions.

As the New Scientist puts it: “Many Covid-19 vaccines appear to reduce the risk of heart attacks, strokes and other blood clot conditions for at least six months. This is despite them causing rare side effects that affect the heart and blood clotting system.”

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The global landscape of respiratory health is undergoing a significant transformation, with the Asthma and COPD Drugs Market emerging as a crucial player in combating chronic pulmonary conditions. Valued at $32,988.7 million in 2020, this market is projected to soar to $52,049.54 million by 2030, marking a notable CAGR of 4.64% from 2021 to 2030.

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Asthma, a chronic inflammatory lung disorder, and Chronic Obstructive Pulmonary Disease (COPD), characterized by irreversible airflow limitation, collectively pose a substantial burden on global health. Asthma, often triggered by allergies and environmental factors, manifests as recurrent wheezing, breathlessness, and chest tightness. COPD, primarily linked to tobacco smoking and occupational hazards, presents as a complex interplay of emphysema and chronic bronchitis.

Diagnosis of these conditions relies on a combination of physical examination and specialized tests such as X-rays and sputum analysis. Treatment modalities encompass a range of medications including inhaled corticosteroids, bronchodilators, and combination therapies tailored to manage acute exacerbations and provide long-term symptom control.

The burgeoning prevalence of asthma and COPD, as evidenced by WHO estimates indicating 262 million asthma cases and 46,1000 associated deaths in 2019, propels the growth of this market. Similarly, data from the American Lung Association highlighting 99 million adults with chronic bronchitis and 2 million with emphysema in the US alone in 2018 underscore the pressing need for effective therapeutic interventions.

Significant strides in respiratory disease management and the introduction of innovative pharmaceuticals further buoy market expansion. For instance, AstraZeneca's recent EU approval for 'Trixeo Aerosphere' for COPD maintenance treatment exemplifies the industry's commitment to addressing unmet clinical needs.

However, the market's trajectory is not without challenges. The exorbitant costs associated with asthma treatment serve as a barrier to access, inhibiting market growth during the forecast period.

Segmentation of the Asthma and COPD Drugs Market based on disease, medication class, and region offers valuable insights into market dynamics. While the asthma segment currently dominates due to rising patient numbers, the COPD segment is poised for robust growth fueled by therapeutic advancements.

Among medication classes, combination drugs lead the pack owing to their efficacy and convenience, although inhaled corticosteroids are expected to witness substantial growth driven by therapeutic innovations.

Geographically, North America commands the lion's share of the market, attributed to the high prevalence of asthma, established manufacturing infrastructure, and pervasive tobacco smoking habits. Nonetheless, Asia-Pacific emerges as a hotspot for market expansion, driven by burgeoning healthcare infrastructure and a burgeoning population.

Stakeholders stand to gain manifold from a comprehensive analysis of the Asthma and COPD Drugs Market, leveraging insights to identify investment opportunities and navigate strategic business decisions. Additionally, a thorough examination of key players and their growth strategies illuminates the competitive landscape, aiding stakeholders in charting their course amidst evolving market dynamics.

The Asthma and COPD Drugs Market presents a promising avenue for stakeholders amidst a backdrop of escalating respiratory health challenges. With innovative therapies, expanding markets, and strategic insights, stakeholders are poised to drive meaningful impact in the global fight against asthma and COPD.

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Sponsored Content

Lung Clear Pro is a 7-second ritual that claims to clear stuck mucus and help with breathlessness in just four days.

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What is Lung Clear Pro?

Lung Clear Pro is a liquid nutritional supplement available through

The supplement was specifically formulated to promote respiratory health. By taking drops of the formula daily, you can purportedly help support clearer breathing, flush away mucus, and promote overall respiratory health.

Lung Clear Pro is primarily marketed to people with stuck mucus, breathlessness, low blood oxygen levels, and other respiratory health issues. Some take it because they want to solve their problem without expensive or dangerous medication, while others take it because they want to avoid inhalers and other solutions.

Lung Clear Pro was developed by Mark Silva, a lung rejuvenation specialist based in Arizona. After treating thousands of patients with breathing issues over the years, Mark created Lung Clear Pro as part of a 7-second daily ritual for permanently clearing airways.

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Lung Clear Pro Benefits

Some of the benefits of Lung Clear Pro, according to the official website, include:

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How Does Lung Clear Pro Work?

Lung Clear Pro works by targeting the root cause of respiratory health problems: stubborn, hard mucus that clogs your lungs, making it harder to breathe.

The makers of Lung Clear Pro specifically advertise the formula as an alternative to other respiratory health solutions – like inhalers, prescription medication, and over-the-counter drugs.

Some conventional respiratory health solutions are dangerous, according to the manufacturer, while others only mask symptoms, causing your problems to return time and time again.

Lung Clear Pro doesn’t just target inflammation. Instead, it targets the root cause of that inflammation in the first place: an airborne toxin that causes mucus in your lungs and airways, leading to inflammation.

To activate these benefits, just take one full dropper of Lung Clear Pro daily. Each dropper of Lung Clear Pro contains six active ingredients – including mullein, bromelain, and others – to promote clear breathing.

Who Should Use Lung Clear Pro?

Some people take Lung Clear Pro to help with breathing disorders and respiratory issues. Others take it because they live in polluted cities or are dealing with wildfire smoke.

The manufacturer of Lung Clear Pro specifically recommends it to smokers, people with allergies and asthma, and even those with long COVID, COPD, and other serious medical conditions:

“Lung Clear Pro works if you’ve smoked for 20 years, have asthma, allergies, long COVID, suffer from COPD or just live in polluted cities!”

Some of the people who could benefit from Lung Clear Pro, according to the manufacturer, include:

  1. Smokers and former smokers
  2. Anyone with mucus buildup in the lungs and airways or trouble clearing their throat
  3. People with asthma or allergies
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  5. Patients with COPD
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Whether targeting a medical condition or supporting general respiratory health, Lung Clear Pro aims to be the best respiratory health supplement on the market.

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How to Take Lung Clear Pro

The makers of Lung Clear Pro recommend taking one serving of Lung Clear Pro before meals with a glass of water:

Place 1 full dropper of Lung Clear Pro into a glass of water or the beverage of your choice, then drink as normal

For best results, take Lung Clear Pro 20 minutes before meals

Some customers also take Lung Clear Pro sublingually, holding the liquid under their tongue for maximum absorption before swallowing. You can place the dropper directly in your mouth or add it to the beverage of your choice.

Lung Clear Pro Ingredients

Lung Clear Pro contains six natural, science-backed ingredients to promote the healing of your lungs.

By taking the Lung Clear Pro liquid formula daily, you can allow these ingredients to go to work from the inside out. They enter your bloodstream through the sensitive blood vessels around your mouth, then circulate throughout your body, eventually reaching the blood vessels leading to your lungs and airway.

Here are the six active ingredients in Lung Clear Pro and how they work, according to the manufacturer:


Mullein tea has been used for centuries as a natural solution for respiratory health problems. The makers of Lung Clear Pro condensed the plant extract into a liquefied form, concentrating it for superior absorption and bioavailability. Mullein, according to Mark Silva, “acts like an army of soldiers,” marching to your lungs to clear away toxins, black carbon, and mucus.

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Bromelain is a natural enzyme found in pineapple and certain other foods. It’s typically found in digestive health supplements, but it’s also found in a growing number of respiratory supplements. Studies show bromelain can help clear airways and the mucus within your airways, supporting overall breathing. Bromelain “has a powerful anti-inflammatory effect on lung tissue and cells,” according to Mark Silva, which is why he added it to the formula.


Cordyceps is a mushroom extract used in traditional Chinese medicine for centuries as a general health and wellness aid. Some take it for cognition, while others take it for physical energy. Today, researchers believe cordyceps works because it’s packed with natural antioxidants called beta-glucans, helping to target toxins within your airways and support healthy inflammation. Cordyceps, according to Mark, “goes to work directly in the lungs to break down stuck mucus and quickly and automatically flush it from the lungs.”


Ginger has similar effects to cordyceps: it’s packed with natural antioxidants that could support healthy inflammation throughout your body. And, like cordyceps, ginger has been used in traditional Asian medicine practices for centuries. Mark describes ginger as a powerful superfood” that “has amazing lung health benefits, especially when it comes to stuck mucus.”

Lemon Peel:

Lemon peel is packed with citrus bioflavonoids, or natural molecules linked to healthy inflammation. Instead of eating lemons daily to get these bioflavonoids, you can get a concentrated version in each serving of Lung Clear Pro.

Other Ingredients: The official Lung Clear Pro website discloses five of the six active ingredients in the formula upfront. The company also does not disclose other, inactive ingredients within the formula – like sweeteners, additives, and preservatives that bind the formula together.

The Lung Clear Pro formula is gluten-free, GMO-free, BPA-free, and contains no added chemicals. According to the manufacturer, Lung Clear Pro also contains organic ingredients.

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What to Expect After Taking Lung Clear Pro

According to the makers of Lung Clear Pro, the supplement can promote benefits like:

  • Combat the #1 Lung Destroyer by Flushing Out Mucus-Causing Toxins: The primary goal of Lung Clear Pro is to combat the #1 lung destroyer: stuck mucus in your lungs caused by the toxins in black carbon. According to the team that created Lung Clear Pro, stuck mucus in your lungs is the root cause of breathing problems, respiratory health issues, and other disorders. After taking Lung Clear Pro, “you’ll be able to finally take deep, full breaths again,” according to the manufacturer. The supplement clears away the toxins that cause this mucus to build up in the first place.
  • Better Sleep: People with breathing problems tend to wake up at night because of coughing or low oxygen. According to the official Lung Clear Pro website, “waking up nightly with trouble breathing or coughing will be a thing of the past” after taking Lung Clear Pro.
  • Breathe Easy: People with mucus in their lungs tend to have difficulty breathing. The mucus clogs your airways and lungs, making it harder to get a full breath. According to the official Lung Clear Pro website, the supplement will allow you to “feel powerful, deep, clear breaths every day.”
  • Avoid the Feeling of Breathing Through a Straw: People with respiratory disease, mucus in their lungs, and other breathing disorders often feel like they’re breathing through a straw. According to the makers of Lung Clear Pro, the supplement can help you avoid this feeling, promoting deeper, clearer breaths every day.
  • Enjoy Everyday Activities & Exercise Again: Respiratory diseases and breathing disorders can make it hard to enjoy normal activities – like a walk in the park. Lung Clear Pro can purportedly help you “enjoy everyday activities again like walking without breathing troubles,” according to the manufacturer.
  • Improve Blood Oxygen Levels: Many people who take Lung Clear Pro do so because they have low blood oxygen levels. Generally, your blood oxygen levels should be well above 90%. Levels below 90% can lead to breathlessness, poor stamina, and an increased risk of cognitive and physical health problems. According to the makers of Lung Clear Pro, the supplement can help “improve blood oxygen levels from the comfort of home.”
  • Flush Away Lung Toxins: The makers of Lung Clear Pro developed the formula based on the idea people with breathing problems have a common root problem: toxins in the lungs.
  • Other Benefits – From Sex Drive to Anti-Aging Benefits: According to the makers of Lung Clear Pro, you’ll feel lighter, happier, and more in control after using Lung Clear Pro. The formula can even help with sex drive, anti-aging effects, and more, according to the manufacturer.

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Lung Clear Pro Targets the True Cause of Breathing Problems: A Common Toxin in Your Lungs

Typically, doctors blame breathing problems on age, smoking, genetics, or environmental pollution.

The makers of Lung Clear Pro acknowledge these factors can “contribute” to lung problems. However, they claim all people with lung problems have a common root cause: a toxin within your lungs that causes thick, stuck mucus to accumulate.

Making matters worse, this toxin is particularly common in the United States. The makers of Lung Clear Pro claim it’s more widespread in America “than anywhere else in the world.”

Have you ever wondered why some people smoke two packs a day and live to 100 – while others die from lung cancer in their 40s? This specific toxin is the reason.

Some of the ingredients in Lung Clear Pro are specifically designed to target this toxin, helping to remove it from your body and eliminate the root cause of mucus and inflammation.

Lung Clear Pro Eliminates Black Carbon Toxins

Mark Silva, creator of Lung Clear Pro, found lung health disorders have skyrocketed in the United States over the last century. He wanted to determine why that was the case.

Mark traced the issue to black carbon, which is created when coal and other fuels are burned.

Starting in the 1840s and the Industrial Revolution, black carbon emissions increased dramatically, causing rates of lung cancer to also rise.

By taking Lung Clear Pro daily you can purportedly eliminate the toxin in black carbon that causes inflammation and mucus buildup in your airways.

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Lung Clear Pro is a 7-Second Lung Clearing Ritual

Many people who take Lung Clear Pro have rapidly cleared their lungs and airways using Lung Clear Pro.

Some feel relief immediately after taking Lung Clear Pro for the first time, while others notice dramatic improvements after four to 10 days.

According to the makers of Lung Clear Pro, the 7-second Lung Clear Pro ritual won’t just temporarily help your breathing problems; instead, it will permanently resolve them:

“This simple ritual will free you and your loved ones from coughing and breathing issues for good.”

While doctor-prescribed breathing medication can temporarily help, Lung Clear Pro is marketed as a permanent solution.

Who Created Lung Clear Pro?

Lung Clear Pro was created by a health professional named Mark Silva.

Mark introduces himself as a “lung rejuvenation specialist.” He claims to treat patients with respiratory health problems, breathing disorders, and other serious conditions. Mark doesn’t claim to be a medical doctor, although he does treat patients while wearing a stethoscope and lab coat.

Mark claims that, in 2024, he was voted the “Top Lung Rejuvenation Expert in Arizona.”

Before running a clinic in Arizona, Mark “practiced in Los Angeles, where [he] treated many well-known celebrities and athletes.”

Mark used his medical expertise and firsthand experience treating patients to develop the Lung Clear Pro formula.

Mark was motivated to create a solution to lung problems after witnessing his brother die in a fire at age 10 in his hometown of Toronto. Mark dedicated his life to making a real impact in the world.

Mark has a degree from the University of Toronto. Later, he specialized in “external respiratory factors,” exploring how the airway makes us sick.

Today, Mark uses his medical expertise to solve serious and unique lung problems for people across North America:

“Because of my deep and vast experience with real-world lung issues, I’m known across the US for solving complicated respiratory mysteries.”

To make a long story short, Mark used his experience treating patients with lung problems to develop the ultimate natural solution to respiratory health: Lung Clear Pro.

Place your order right here for the best prices available!

Lung Clear Pro vs. Other Respiratory Health Solutions

Mark Silva claims many doctors recommend “failed solutions” for lung health problems. Mark recommends a different approach: taking Lung Clear Pro instead.

Here are some of the differences between Lung Clear Pro and “failed” respiratory health solutions:

Failed Solution #1: Neti Pots, Essential Oil Diffusers, & Similar Products: Neti pots and diffusers aim to clear out sinuses, lungs, and airways. However, Mark claims there’s almost “zero research” supporting these solutions. Some even make breathing problems worse. They contain harmful fragrances that irritate the lungs of people who didn’t have issues in the first place. Others have chemicals leading to fatigue, brain problems, inflammation, and more. Mark cites one study by researchers showing that 100% of essential oils contained volatile organic compounds (VOCs). Mark recommends “throwing it in the trash” if you have a Neti pot or similar solution at home.

Failed Solution #2: Prescription Medications, Nebulizers, & Albuterol Inhalers: Many doctors prescribe medications – like nebulizers and Alubertol inhalers – to treat breathing disorders. Mark admits these solutions can lower inflammation, but they only provide “temporary” relief. They don’t target the true cause of the inflammation, causing it to return time and time again. Even if a doctor prescribed these solutions to you, Mark seems to advise against it, recommending Lung Clear Pro and his 7-second instead.

Failed Solution #3: Oxygen Therapy & Pulmonary Rehabilitation: Mark describes oxygen therapy as a “last resort option.” It can provide relief, but it’s expensive and requires you to visit a clinic or be tied to a machine for the rest of your life.

Mark even advises against lung transplants because they have a “high risk of complications” while costing over $1 million.

Scientific Evidence for Lung Clear Pro

Can taking a liquid formula daily really solve your respiratory problems? What does science say about Lung Clear Pro? We’ll review some of the scientific evidence for Lung Clear Pro below.

First, Lung Clear Pro was developed by a medical professional Mark Silva, who claims to have firsthand experience treating respiratory health problems in patients. Although Mark doesn’t claim to be a medical doctor, he wears a white lab coat and stethoscope, suggesting he has formal medical or scientific experience and used that experience to develop Lung Clear Pro.

Visit the official website to get discounted prices!

Mark Silva and his team cite 9 studies on the Lung Clear Pro references page, including studies showing the dangers of particulate matter in the air and the benefits of specific ingredients in Lung Clear Pro. Mark cites one study, for example, showing indoor air pollution increased the risk of respiratory health problems in dogs.

The makers of Lung Clear Pro also cite research by the Cleveland Clinic showing how mullein, one of the active ingredients in Lung Clear Pro, “benefits your lungs.” As the Cleveland Clinic explains, people have been drinking mullein tea for respiratory health for centuries, and it’s becoming more popular in the nutritional supplement space today. Verbascum Thapsus, better known as mullein, is generally considered a weed, but studies show it can help with allergies, sore throat, and tonsillitis.

As further proof mullein works, Mark cites a 2012 study published in BMC Complementary and Alternative Medicine. In that study, researchers found mullein was packed with flavonoids, saponins, tannins, and other natural molecules that helped to relax certain cells. Researchers tested mullein on roundworms and tapeworms and found they helped these organisms relax.

Bromelain could also promote anti-inflammatory effects in your lungs and airways. In a 2008 study, for example, researchers found bromelain exerted “anti-inflammatory effects” in mice with allergic airway disease. Bromelain is an enzyme found in pineapple extract and certain other foods. After being treated with bromelain, mice tended to experience a significant improvement in allergic airway disease (AAD). Mark Silva and his team cite a separate study showing bromelain could have potential therapeutic effects in respiratory complications caused by COVID-19.

Overall, Lung Clear Pro contains ingredients shown to help clear airways and promote respiratory health in different ways. However, there’s no evidence these natural ingredients can replace inhalers, doctor-prescribed respiratory medication, and other doctor-recommended solutions for respiratory disease.

Save on Lung Clear Pro when you order now!

Lung Clear Pro Reviews: What Do Customers Say?

Lung Clear Pro seems primarily marketed to people with respiratory health problems, breathing disorders, mucus buildup in the lungs, and similar health issues.

Others, however, have taken it to help with air pollution, wildfire smoke, and other issues not related to chronic health problems.

Here are some of the reviews shared by verified purchasers on the official website and other sources online:

One 72-year-old customer started using Lung Clear Pro to combat wildfire smoke from summer fires in her area, finding it “really loosens up the airways.”

Many customers have been skeptical about Lung Clear Pro after being disappointed with other respiratory health solutions. One customer was “very skeptical” about Lung Clear Pro, for example, only to find the supplement worked as advertised to clear his lungs.

One customer claims he was a “lifelong smoker” and had to use an inhaler “several times a day” before taking Lung Clear Pro, claiming his “lungs felt like hard wet sponges” and it was “very hard to breathe.” After using Lung Clear Pro for just two weeks, however, he found his breathing is “so so much better.” Today, thanks to Lung Clear Pro, he “hardly” uses his inhaler at all and his chest feels “clear, light and airy.”

One 77-year-old customer claims he hadn’t had a clear breath in “years” before taking it. He used to spend four to five hours “hacking and coughing” to clear his airways. Since taking Lung Clear Pro, however, he clears his throat in around an hour with minimal discomfort. Today, thanks to Lung Clear Pro, his “breath is reaching the bottom” of his lungs and he feels “happy and exhilarated.”

One customer claims his breathing issues have “been diminished by about 90%” after taking Lung Clear Pro. He still has to clear his throat, but he finds it “effortless” to do so.

Many Lung Clear Pro customers are former smokers with severe breathing problems later in life – only to rapidly resolve those breathing problems with Lung Clear Pro. One ex-smoker, for example, was having “trouble breathing” before taking Lung Clear Pro and was frequently coughing up mucus. After taking 2mL of Lung Clear Pro daily, she found the problem had “almost completely cleared up.”

Overall, the official Lung Clear Pro website is filled with testimonials from verified purchasers who have resolved everything from serious breathing problems to general respiratory issues using the supplement.

Hear from real people who have used Lung Clear Pro >>>

Lung Clear Pro Pricing

Lung Clear Pro is priced at $79 per bottle or $79 for a one-month supply. All purchases come with free shipping, and you can save money by ordering multiple bottles of Lung Clear Pro per purchase.

Here’s how much you pay when ordering Lung Clear Pro through the official website today:

  • 1 Bottle: $79 + Free Shipping
  • 3 Bottles: $177 ($59 Per Bottle) + Free Shipping
  • 6 Bottles: $294 ($49 Per Bottle) + Free Shipping

Each bottle of Lung Clear Pro contains a one-month supply, or 30 servings (30 full droppers’ worth of liquid formula, or 60mL). You take one full dropper daily to promote clearer breathing.

The ordinary retail price of Lung Clear Pro is $147 per bottle. As part of a 2024 promotion, Mark and his team have lowered the price to $79 per bottle or less.

Act quickly to secure the limited-time discounted price today!

Lung Clear Pro Refund Policy

All Lung Clear Pro purchases have a 180-day money-back guarantee. You have 180 days (6 full months) to try the supplement and request a refund if you’re unhappy for any reason.

About Lung Clear Pro

Lung Clear Pro was created by a group of self-described “health enthusiasts,” including a lung rejuvenation expert named Mark Silva.

You can contact Mark Silva and the Lung Clear Pro customer service team via the following:

Lung Clear Pro is made at a lab in Ohio.

Final Word

Lung Clear Pro is a nutritional supplement marketed to people with respiratory health problems, difficulty breathing, and other lung health disorders.

By taking one full dropper’s worth of Lung Clear Pro daily, you can purportedly resolve these issues permanently, clearing a toxin from your body that causes stuck mucus to build up in your lungs in the first place.

(Flash Sale) Purchase Lung Clear Pro For The Lowest Prices!!

The news and editorial staff of the Santa Cruz Sentinel had no role in this post’s preparation. This is a paid advertisement and does not necessarily reflect the official policy or position of the Santa Cruz Sentinel, its employees, or subsidiaries.

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During the months of January to March, a familiar trend emerges – an increase in viral infections that can leave many feeling under the weather. Common culprits like adenovirus, influenza A, RSV (respiratory syncytial virus), and rhino-enteroviruses are often to blame, bringing along symptoms reminiscent of a cold: runny nose, cough, fever, and fatigue. For some unlucky individuals, these symptoms may also include nausea, vomiting, or diarrhea.

The Rise of Flu Cases

As seasons transition, flu cases tend to surge. Outpatient departments (OPD) become busy hubs as individuals seek relief from symptoms like coughing, fever, breathlessness, and persistent runny noses. Doctors strongly advocate for prioritizing immunity and adopting mask-wearing practices to curtail the spread of infections.

Identifying the Viral Culprits

The spike in infections can be attributed to a variety of viruses, including adenovirus, influenza A, RSV, and rhino-enteroviruses. These viral agents typically manifest in cold-like symptoms such as runny noses, coughs, fevers, and feelings of exhaustion. While most cases are uncomplicated, some individuals may develop complications such as ear infections, wheezing, or pneumonia, although these occurrences are less frequent.

A report from India Today sheds light on the types of viral infections prevalent in OPD visits, which often include influenza/H1N1, respiratory syncytial virus (RSV), Covid-19, and other circulating viruses. The increase in cases during seasonal transitions is expected, with many experiencing common symptoms like body aches, throat pain, runny noses, and dry coughs. However, it is crucial not to overlook severe infections that may require hospitalization, as they can pose serious health risks.

Viral Infections and Allergies

As winter fades between January and March, another health concern arises: seasonal allergies triggered by pollen circulation. Symptoms such as sneezing, blocked noses, watery eyes, and itchy ears become prevalent. Differentiating between allergies and infections becomes crucial during this period.

The fluctuating temperatures and pollen circulation can exacerbate nose and eye allergies, leading to wheezing in asthma patients. It’s important to note that these allergies typically do not come with a fever. Additionally, cases of community-acquired pneumonia (CAP) see an increase during this season, characterized by high fever, dry or productive coughs, and shortness of breath. This type of pneumonia can be caused by viruses, bacteria, or a combination of both.

Seeking Medical Attention

It is imperative to seek medical advice if experiencing symptoms of infection. Consulting a doctor can help determine the type of infection and provide appropriate treatment, which may include anti-allergy, antiviral, or antibiotic medications. It is strongly advised to avoid self-medication and the unnecessary use of antibiotics.

Tips for Maintaining Health

To navigate the challenges of seasonal viral infections and allergies, here are some tips for maintaining good health:

– Take Care of Your Body: Maintain a healthy diet and don’t pack away the warm clothing too soon.

– Consider Vaccines: Consult with your physician about getting influenza and pneumonia vaccines.

– Monitor Children: If children have a fever lasting more than two days, seek medical attention. Look out for signs of difficulty breathing or dehydration.

– Stay Home If Unwell: Prevent the spread of respiratory viruses by staying home when feeling unwell.

– Practice Good Hygiene: Cover your mouth and nose when coughing or sneezing to prevent spreading infectious material.

– Use a Humidifier: Adding moisture to indoor air can ease congestion.

– Get the Flu Vaccine: Especially important for those over 65, pregnant, or with weakened immune systems.

– Wash Hands Regularly: Especially before eating or touching your face.

– Balanced Diet: Include fruits, vegetables, whole grains, and lean proteins to boost immunity.

– Stay Hydrated: Drinking fluids helps flush out toxins and maintain health.

– Adequate Sleep: Ensure you get enough rest to support the immune system.

These proactive measures can go a long way in safeguarding against the seasonal onslaught of viral infections and allergies, promoting overall health and well-being. By staying informed and taking appropriate steps, individuals can navigate these challenges with resilience and vitality.

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Since 2020, the average annual level of PM 10 in the city's air - a measure of large suspended particulate matter, essentially dust - has jumped by more than 50%. That year, the pandemic had struck, lockdowns shut off economic activity and there was little traffic on roads.

dust trap

Focus was on checking Covid infections, but it also presented an opportunity for a civic correction.With no possibility of traffic disruption, engineering changes, landscaping and other measures needed to check pollution could have been undertaken.
More & more dust
That was, however, not to be. From 150 g/m³ in 2020, the annual average of PM 10 rose to 187 g/m³ in 2021, 210 g/m³ in 2022 and 233 g/m³ in 2023. A brown aura that hangs over the city most of the year is its most visible manifestation. Yes, the Thar desert isn't far away and climatic factors do put the city in a dusty spot.
But the dust bowls - construction sites, unpaved roads, broken pavements, burning garbage - are local creations that drive the PM 10 average up. No amount of health warnings seem to work in triggering a civic response on a war footing from govt and the city administration.
Shortening lives
Last year, the Air Quality Life Index released by University of Chicago's Energy Policy Institute said air pollution is shortening lives in Delhi-NCR, the world's most polluted region. Meeting World Health Organisation standards on pollution would, according to the report, add 11.2 years to the life span of a person living in Gurgaon. Also last year, Medanta released a study that concluded around half of the patients diagnosed with lung cancer at its OPD over a 10-year period were non-smokers.
When we breathe in pollutants, we expose our respiratory tracts to tiny, harmful particles that irritate our airways and cause shortness of breath, coughing, wheezing, asthma episodes and chest pain. Over time, exposure to air pollution can lead to other health issues, affecting our heart, brain, skin and other organs.
"There are two basic issues with air quality in NCR - smoke and dust," said Dr Arvind Kumar, chairman of the Institute of Chest Surgery, Chest Onco-Surgery and Lung Transplantation at Medanta. "I have been seeing a lot of patients who have damaged lungs because of the air that surrounds us," he added.
Compounding effect
Air pollution, said Dr Kumar, needs to be treated as a "grave public health emergency". "Air pollution affects everyone and all age groups. Some might not know how it is affecting them because not everyone feels the drastic impacts," he said.
Dr Arunesh Kumar, senior consultant and head (pulmonology and respiratory medicine) at Paras Health, said prolonged exposure to airborne particles can "severely affect the respiratory system". "Inhalation of these particles can lead to acute or chronic inflammation of airways and aggravated symptoms in patients with existing respiratory conditions. These particles can also infiltrate the bloodstream, impacting cardiovascular health, potentially contributing to heart diseases and stroke," he said.
"Pollution affects the whole body. Its musculoskeletal symptoms include muscle pain, fatigue, cramps and irritated bowel. As a respiratory system specialist, I see a rise in cases involving sudden breathlessness, frequent coughing and flu-like symptoms and also an exacerbation of bronchial asthma and COPD episodes," said Dr Kuldeep Kumar Grover, head of critical care, CK Birla Hospital.
More people coughing
Pollution has a significant impact on the eyes as well. Dry eyes, discomfort and irritation are the most common manifestations. Since polluted air often carries a cocktail of environmental toxins, prolonged exposure to these substances can lead to accumulation of toxins in the body.
In OPDs, particularly in the winter months when smoke from farm fires add to toxic pollution, people are experiencing more prolonged coughing episodes that are often triggered by viral infections. The most vulnerable groups, according to doctors, are children and the elderly. Children because their immune and respiratory systems are still developing, putting them at risk of increased respiratory infections. And the elderly because of pre-existing health conditions that are worsened by exposure pollution.
Check construction dust
Rapidly urbanising localities and construction activity generate enormous amounts of dust. A significant portion of construction and demolition waste (C&D) can be recycled and reused but large volumes end up as debris dumps along roadsides. Construction sites need better monitoring of adherence to emission and dust control norms as well as debris management. Also, dust management from C&D activities and greening measures are needed.
Tackle at source
"Govt needs to focus on reducing pollution at source. Vehicular pollution, road dust and industrial residues releases toxic substances into the air, and it needs to be curtailed immediately. There is no quick fix to this situation. We have over the years created this issue and it can be rectified eventually by taking a series of measures," said a senior doctor.

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Consumer Medicine Information (CMI) summary

The full CMI on the next page has more details. If you are worried about using this medicine,
speak to your doctor or pharmacist.

1. Why am I using Symbicort Rapihaler?

Symbicort Rapihaler contains two active ingredients in one inhaler: budesonide and
formoterol (eformoterol) fumarate dihydrate. Symbicort Rapihaler is used for treatment
of asthma in adults and adolescents (12 years and over) or Chronic Obstructive Pulmonary
Disease (COPD) in adults (18 years and over).

2. What should I know before I use Symbicort Rapihaler?

Do not use if you have ever had an allergic reaction to any medicine containing budesonide
or formoterol, or any of the ingredients listed at the end of the CMI.
Talk to your doctor if you have any other medical conditions, take any other medicines,
or are pregnant or plan to become pregnant or are breastfeeding.

For more information, see Section 2. What should I know before I use Symbicort Rapihaler? in the full CMI.

3. What if I am taking other medicines?

4. How do I use Symbicort Rapihaler?

Symbicort Rapihaler should be inhaled into your lungs through the mouth.

Follow all directions given to you by your doctor or pharmacist.

5. What should I know while using Symbicort Rapihaler?

Things you should do

If you have an Asthma Action Plan agreed with your doctor, follow it closely at all

Have your reliever medicine available at all times. As advised by your doctor, this
may be your Symbicort Rapihaler (50/3 or 100/3) or another reliever medicine.

Rinse your mouth out with water after taking your daily morning and/or evening dose
of Symbicort Rapihaler and spit this out.

Remind any doctor, dentist or pharmacist you visit that you are using Symbicort Rapihaler.

Things you should not do

Do not stop using this medicine suddenly without checking with your doctor

Driving or using machines

Symbicort Rapihaler may cause dizziness, light-headedness, tiredness or drowsiness
in some people when they first start using it.

Looking after your medicine

Keep your Symbicort Rapihaler in a cool dry place where the temperature stays below
30oC, with the cover firmly in place.

Dispose your Symbicort Rapihaler 3 months after removal from the foil pouch.

6. Are there any side effects?

All medicines can have side effects. If you do experience any side effects, most of
them are minor and temporary. These include sore, yellowish, raised patches in the
mouth (thrush), hoarse voice, unpleasant taste in your mouth, pounding heart, headache,
trembling or muscle cramps. However, some side effects may need medical attention.
These include severe allergic reactions such as difficulty breathing, swelling of
the face, lips or tongue, severe rash or pneumonia (lung infection), signs include
fever or chills, increased phlegm or a change in colour, increased cough or difficulties
breathing. Serious side effects are rare.
For more information, including what to do if you have any side effects, see Section
6. Are there any side effects? in the full CMI.

Active ingredient(s):
budesonide / formoterol (eformoterol) fumarate dihydrate

Full Consumer Medicine Information (CMI)

This leaflet provides important information about using Symbicort Rapihaler. You should also speak to your doctor or pharmacist if you would like further information
or if you have any concerns or questions about using Symbicort Rapihaler.

Where to find information in this leaflet:

1. Why am I using Symbicort Rapihaler?

Symbicort Rapihaler is a pressurised metered dose inhaler (pMDI) or puffer. It contains
two active ingredients in one inhaler: budesonide and formoterol (as formoterol fumarate
dihydrate, which was previously known as eformoterol fumarate dihydrate).

Budesonide belongs to a group of medicines called corticosteroids. Budesonide acts
directly on your airways to reduce inflammation.

Formoterol belongs to a group of medicines called beta-2-agonists. Formoterol opens
up the airways to help you breathe more easily.

The medicine inside Symbicort Rapihaler is inhaled into the lungs for the treatment
of asthma in adults and adolescents (12 years and over) or Chronic Obstructive Pulmonary
Disease (COPD) in adults (18 years and over).


Asthma is a disease where the airways of the lungs become narrow and inflamed (swollen),
making it difficult to breathe. This may for example be due to exercise, or exposure
to allergens (e.g. an allergy to house dust mites, smoke or air pollution), or other
things that irritate your lungs.

The budesonide in Symbicort Rapihaler helps to improve your condition and to prevent
asthma attacks from occurring.

The formoterol in Symbicort Rapihaler helps you breathe more easily.

Some people can take Symbicort Rapihaler when they need it – they use Symbicort Rapihaler
as an anti-inflammatory reliever to treat their symptoms when their asthma gets worse
and to help prevent asthma attacks, or to help prevent symptoms from happening (eg
before exercise or exposure to other triggers such as allergens).

Some people need to take Symbicort Rapihaler every day – they use their Symbicort
Rapihaler as a daily maintenance preventer to help maintain control of their asthma
symptoms and help prevent asthma attacks.

Chronic Obstructive Pulmonary Disease (COPD)

COPD (which includes chronic bronchitis and emphysema) is a long-term lung disease.
There is often permanent narrowing and persistent inflammation of the airways. Symptoms
may include difficulty in breathing (breathlessness or wheezing), coughing and increased
sputum (phlegm).

Symbicort Rapihaler when used as prescribed will help to control your COPD symptoms
(ie breathing difficulties).

2. What should I know before I use Symbicort Rapihaler


Do not use Symbicort Rapihaler if:

you are allergic to any medicine containing budesonide or formoterol, or any of the
ingredients listed at the end of this leaflet. Always check the ingredients to make
sure you can use this medicine.

Check with your doctor if you:

have any allergies to any other medicines or foods.

have, or have had, any of the following medical conditions, as it may not be safe
for you to take Symbicort Rapihaler:

thyroid problems


heart problems

liver problems

tuberculosis (TB)

low levels of potassium in the blood.

currently have an infection. If you take Symbicort Rapihaler while you have an infection,
the medicine may hide some of the signs of an infection. This may make you think,
mistakenly, that you are better or that it is not serious.

have any other medical conditions.

have any questions about how you should be using your Symbicort Rapihaler.

During treatment, you may be at risk of developing certain side effects. It is important
you understand these risks and how to monitor for them. See additional information
under Section 6. Are there any side effects?

Pregnancy and breastfeeding

Check with your doctor if you are pregnant or intend to become pregnant.

Talk to your doctor if you are breastfeeding or intend to breastfeed.

Your doctor will discuss the possible risks and benefits of using Symbicort Rapihaler
during pregnancy and while breastfeeding.


Do not give Symbicort Rapihaler to a child under 12 years, unless directed to by the
child’s doctor.

Symbicort Rapihaler is not recommended for use in children under 12 years.

Asthma Action Plan

If you have asthma, ask your doctor or pharmacist if you have any questions about
your Asthma Action Plan.

Your healthcare professional should give you a personal Asthma Action Plan to help
manage your asthma. This plan will include what medicines to take as a reliever when
you have symptoms or sudden attacks of asthma, medicines you can take to prevent symptoms
from occurring (eg prior to exercise or allergen exposure) and if you need to take
daily maintenance medicines to help control your asthma. It will also provide advice
on when to seek urgent medical attention such as when your asthma suddenly worsens
or worsens over a period of time.

It is important that you discuss with your doctor both your exposure to triggers and
how often your exercise, as these could impact how your doctor prescribes your Symbicort

3. What if I am taking other medicines?

Some medicines may interfere with Symbicort Rapihaler and affect how it works. These

medicines used to treat heart problems or high blood pressure such as beta-blockers,
diuretics and antiarrhythmics (disopyramide, procainamide and quinidine)

medicines used to treat glaucoma such as beta-blockers

medicines used to treat depression or other mood/mental disorders such as tricyclic
antidepressants, monoamine oxidase inhibitors and phenothiazines

medicines used to treat hayfever, coughs, colds and runny nose such as antihistamines

medicines used to treat fungal infections (eg ketoconazole)

xanthine derivatives (eg theophylline) which are a class of medicines used to treat
asthma and COPD

medicines used to treat Addison’s disease (when there is inadequate production of
a natural steroid hormone by the adrenal gland) or another condition where there is
too much salt lose in the urine (eg fludrocortisone)

These medicines may be affected by Symbicort Rapihaler or may affect how well it works.
You may need different amounts of your medicine, or you may need to use different
medicines. Your doctor or pharmacist will advise you.

Check with your doctor or pharmacist if you are not sure about what medicines, vitamins
or supplements you are taking and if these affect Symbicort Rapihaler.

Your doctor and pharmacist have more information on medicines to be careful with or
avoid while using Symbicort Rapihaler.

4. How do I use Symbicort Rapihaler?

How to use your Rapihaler

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

They may differ from the information contained in this leaflet.

Each pack of Symbicort Rapihaler contains an instruction for use leaflet that tells
you the correct way to use it. Please read this carefully.

If you are not sure how to use the Rapihaler, ask your doctor or pharmacist to show
you how.

How much to take

Asthma (Adults and children 12 years and over)

Your healthcare professional should give you a personal Asthma Action Plan to help
manage your asthma. This plan will include what medicines to take as a reliever when
you have symptoms or sudden attacks of asthma, medicines you take prevent symptoms
from occurring (eg prior to exercise or allergen exposure) and if you need to take
daily maintenance medicines to help control your asthma.

It is important that you discuss with your doctor both your exposure to triggers and
how often you exercise, as these could impact how your doctor prescribes your Symbicort

Your doctor may have prescribed Symbicort Rapihaler for you to use as:

an anti-inflammatory reliever medicine only,

both an anti-inflammatory reliever and daily maintenance preventer medicine or,

as a daily maintenance preventer only, where another medicine is use as a reliever.

If your asthma has been under control for some time, your doctor may tell you to take
less inhalations of Symbicort Rapihaler, prescribe you a lower strength of Symbicort
Rapihaler or recommended that you use Symbicort Rapihaler in a different way.

If you are using more inhalations of your reliever medicine or you are wheezing or
breathless more than usual tell your doctor as your asthma may be getting worse.

Ask your doctor if you have any questions about how you should be using your Symbicort

Anti-inflammatory reliever only (Symbicort Rapihaler 100/3)

For patients aged 12 years and over, Symbicort Rapihaler 100/3 can be used to treat
asthma symptoms when they happen and to help stop asthma symptoms from happening (eg
just before exercise or before you get exposed to other triggers).

If you get asthma symptoms, take 2 inhalations and wait a few minutes. If you do not
feel better, take 2 more inhalations.

Your doctor will tell you how many inhalations to take before exercising or exposure
to other triggers to help stop symptoms from happening.

Do not use more than 12 inhalations on a single occasion or more than 24 inhalations
in any day. If your symptoms continue to worsen over 3 days, despite using additional
inhalations, tell your doctor.

Have your Symbicort Rapihaler reliever with you at all times.

Anti-inflammatory reliever plus maintenance therapy (Symbicort Rapihaler 50/3 and

For patients aged 12 years and over, Symbicort Rapihaler 50/3 and 100/3 can be used
to treat asthma symptoms when they happen. Symbicort Rapihaler 100/3 can also be used
to help stop asthma symptoms from happening (eg just before exercise or before you
get exposed to other triggers).

If you get asthma symptoms, take 2 inhalations of Symbicort Rapihaler 50/3 or 100/3
and wait a few minutes. If you do not feel better, take 2 more inhalations.

Your doctor will tell you how many inhalations of Symbicort Rapihaler 100/3 to take
before exercising or exposure to other triggers to help stop symptoms from happening.

Have your Symbicort Rapihaler 50/3 or 100/3 reliever with you at all times.

You also need to take your Symbicort Rapihaler (50/3 or 100/3) daily as your maintenance
preventer. The usual maintenance dose is 4 inhalations per day (given either as 2
inhalations in the morning and evening or as 4 inhalations in either the morning or
evening). Your doctor may prescribe a maintenance dose of Symbicort Rapihaler 100/3,
4 inhalations twice a day.

Do not use more than 12 inhalations on a single occasion or more than 24 inhalations
of Symbicort Rapihaler (as needed and daily dose) in any day. If your symptoms continue
to worsen over 3 days, despite using additional inhalations, tell your doctor.

NOTE: Symbicort Rapihaler 200/6 is not recommended to be used as anti-inflammatory
reliever medicine.

Daily fixed dose maintenance therapy (Symbicort Rapihaler 50/3, 100/3 and 200/6)

For patients aged 12 years and over, Symbicort Rapihaler 50/3, 100/3 and 200/6 can
be used as a daily fixed-dose maintenance preventer.

The usual dose of Symbicort Rapihaler 50/3 and 100/3 is 2 or 4 inhalations twice a
day. Do not take more than 8 inhalations a day.

The usual dose of Symbicort Rapihaler 200/6 is 2 inhalations twice a day. Do not take
more than 4 inhalations a day.

Symbicort Rapihaler 200/6 can also be given as a higher dose in patients aged 18 years
and over. The usual dose is 4 inhalations twice a day. Do not take more than 8 inhalations
per day.

Have your separate reliever with you at all times.

COPD (Adults)

The usual dose (also maximum recommended dose) is 2 inhalations of Symbicort Rapihaler
200/6 twice a day.

Your doctor should tell you the best way to manage your symptoms and any flare ups.
This may include additional medicines (such as reliever medicines) to use when you
have sudden attacks of breathlessness.

If you are using more inhalations of your reliever medicine or you are wheezing or
breathless more than usual tell your doctor.

If your COPD gets worse, your doctor may give you some additional medicines (such
as oral corticosteroids or antibiotics).

How long to use your Symbicort Rapihaler

If your doctor has told you to take Symbicort Rapihaler daily, it is important that
you use it every day even if you feel well.

Symbicort Rapihaler helps control your asthma or COPD but does not cure it.

Keep using it for as long as your doctor tells you to. Do not stop using it unless
your doctor tells you to.

If you forget to use Symbicort Rapihaler

If you miss a dose of Symbicort Rapihaler, take your dose as soon as you remember.

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

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

If you are using Symbicort Rapihaler as a reliever medicine, consult your doctor on
the correct use of the product.

If you are not sure what to do, ask your doctor or pharmacist.

If you have trouble remembering to use your medicine, ask your pharmacist for some

If you use too much Symbicort Rapihaler

If you think that you have used too much Symbicort Rapihaler, you may need urgent
medical attention.

You should immediately:

phone the Poisons Information Centre
(by calling
13 11 26), or

contact your doctor, or

go to the Emergency Department at your nearest hospital.

You should do this even if there are no signs of discomfort or poisoning.

If you use too much Symbicort Rapihaler, you may feel sick or vomit, have a fast or
irregular heartbeat, a headache, tremble, feel shaky, agitated, anxious, tense, restless,
excited or be unable to sleep.

5. What should I know while using Symbicort Rapihaler?

Things you should do

If you have an Asthma Action Plan that you have agreed with your doctor, follow it
closely at all times

Keep using Symbicort Rapihaler for as long as your doctor tells you to, even if you
are feeling well.

See your doctor regularly to make sure that your asthma or COPD is not getting worse.

Have your reliever medicine available at all times. As advised by your doctor, this may be your Symbicort Rapihaler (50/3 or 100/3) or
another reliever medicine.

If you become pregnant while using Symbicort Rapihaler, tell your doctor.

Rinse your mouth out with water after taking your daily morning and/or evening dose
of Symbicort Rapihaler and spit this out.
If you don’t rinse your mouth, you are more likely to develop thrush in your mouth.
You do not have to rinse mouth if you have to take occasional doses of Symbicort Rapihaler
for relief of asthma symptoms (ie as an anti-inflammatory reliever).

Call your doctor straight away if you:

are taking Symbicort Rapihaler for COPD and you notice any signs of pneumonia (infection
of the lung). Signs include fever or chills, increased phlegm/sputum production or
change in colour, increased cough or increased breathing difficulties. Pneumonia is
a serious medical condition and will require urgent medical attention.

Remind any doctor, dentist or pharmacist you visit that you are using Symbicort Rapihaler.

Things you should not do

Do not stop using this medicine suddenly without checking with your doctor.

Do not take any other medicines for your asthma or COPD without checking with your

Do not give Symbicort Rapihaler to anyone else, even if they have the same condition
as you.

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

Driving or using machines

Be careful before you drive or use any machines or tools until you know how Symbicort
Rapihaler affects you.

Symbicort Rapihaler may cause dizziness, light-headedness, tiredness or drowsiness
in some people when they first start using it.

Looking after your medicine

Follow the instructions in the carton on how to take care of your medicine properly.


Keep your Symbicort Rapihaler in a cool dry place where the temperature stays below

Always replace the mouthpiece cover after using Symbicort Rapihaler.

Discard Symbicort Rapihaler within 3 months after removal from the foil pouch.

Store it in a cool dry place away from moisture, heat or sunlight; for example, do
not store it:

in the bathroom or near a sink, or

in the car or on window sills.

Keep it where young children cannot reach it.


The canister in Symbicort Rapihaler contains a pressurised liquid. Do not expose to
temperatures higher than 50oC. Do not pierce the canister. The canister should not be broken, punctured or burnt,
even when it seems empty.


The Rapihaler mouthpiece must be wiped with a clean dry cloth/tissue and must never
get wet.

Full instructions on the right way to use and clean Symbicort Rapihaler are inside
each pack.

Getting rid of any unwanted medicine

Since some medicine may remain inside your Symbicort Rapihaler you should always return
it to your pharmacist for disposal including:

when you have taken all your doses and the dose counter is on zero (‘0’ – see instructions
in the pack), or

3 months after removal from the foil pouch, or

it is damaged or past its expiry date, or

your doctor/pharmacist has told you to stop using it.

6. Are there any side effects?

All medicines can have side effects. If you do experience any side effects, most of
them are minor and temporary. However, some side effects may need medical attention.

Tell your doctor or pharmacist as soon as possible if you do not feel well while you
are using Symbicort Rapihaler.

If you get any side effects, do not stop using Symbicort Rapihaler without first talking
to your doctor or pharmacist.

See the information below and, if you need to, ask your doctor or pharmacist if you
have any further questions about side effects.

Less serious side effects

Less serious side effects

What to do


sore, yellowish, raised patches in the mouth (thrush)

hoarse voice

irritation of the tongue and mouth


These are less likely to happen if you rinse your mouth out after every time you use
your usual morning and/or evening dose of Symbicort Rapihaler.

Speak to your doctor if you have any of these less serious side effects and they worry


fast or irregular heart rate or pounding heart

chest pain

Nervous system-related:

feeling anxious, nervous, restless or upset


trembling or shakiness

feeling light-headed or dizzy


unpleasant taste in your mouth



nausea (feeling sick)



skin rash

skin bruising


difficulty sleeping

muscle twitching or cramps

weight gain

Speak to your doctor if you have any of these less serious side effects and they worry

mood changes

Speak to your doctor if you notice any of these.

You may need urgent medical attention.

Serious side effects

Serious side effects

What to do

Allergic Reaction:

difficulty breathing or worsening of your breathing problems

swelling of the face, lips, tongue or other parts of the body

severe rash

Pneumonia (lung infection):

signs include fever or chills, increased phlegm/sputum production or a change in colour,
increased cough or difficulties breathing

Call your doctor straight away, or go straight to the Emergency Department at your
nearest hospital if you notice any of these serious side effects.
You may need urgent medical attention. Serious side effects are rare.

Potential eye problem:

Any issues with your eyes such as blurred vision or other problems with your eyesight.

Speak to your doctor if you notice any of these.

Your doctor may need to send you to an ophthalmologist (eye doctor) to check that
you don't have eye problems such as cataracts (clouding of the eye lens), glaucoma
(increased pressure in your eyeballs) or other rare eye conditions reported with corticosteroids

Other side effects


Corticosteroids taken into the lungs for long periods (eg 12 months) may affect how
children/adolescents grow. In rare cases, some children/adolescents may be sensitive
to the growth effects of corticosteroids, so the doctor may monitor a child's/adolescent's

Tell your doctor or pharmacist if you notice anything else that may be making you
feel unwell.

Other side effects not listed here may occur in some people.

Some of these side effects (for example, changes in blood sugars) can only be found
when your doctor does test from time to time to check your progress.

Reporting side effects

After you have received medical advice for any side effects you experience, you can
report side effects to the Therapeutic Goods Administration online at
By reporting side effects, you can help provide more information on the safety of
this medicine.

Always make sure you speak to your doctor or pharmacist before you decide to stop
taking any of your medicines.

7. Product details

This medicine is only available with a doctor's prescription.

What Symbicort Rapihaler contains

Active ingredients

(main ingredient)


formoterol (eformoterol) fumarate dihydrate

Other ingredients

(inactive ingredients)

apaflurane (HFA-227)

macrogol 1000


Do not take this medicine if you are allergic to any of these ingredients.

Symbicort Rapihaler does not contain lactose, sucrose, gluten, tartrazine or any other
azo dyes.

What Symbicort Rapihaler looks like

Symbicort Rapihaler is a pressurised metered dose inhaler with a dose counter. The
inhaler is comprised of a pressurised aluminum canister with an attached dose counter,
a red plastic casing body with a white mouthpiece and attached grey mouthpiece cover.
Each inhaler is individually wrapped in a foil laminate pouch (containing a sachet
of drying agent).

Symbicort Rapihaler is available in the following presentations*:

50/3: Each pack contains 1 inhaler of 120 inhalations of the medicine. [AUST R 158898]

100/3: Each pack contains 1 inhaler of 120 inhalations of the medicine. [AUST R 158899]

200/6: Each pack contains 1 inhaler of 60 (sample) or 120 inhalations of the medicine.
[AUST R 115555]

*not all presentations might be available in Australia

Who distributes Symbicort Rapihaler

AstraZeneca Pty Ltd
ABN 54 009 682 311
66 Talavera Road

Telephone:- 1800 805 342

This leaflet was prepared on 11 Aug 2022.

® Symbicort Rapihaler is a registered trade mark of the AstraZeneca group of companies.

© AstraZeneca 2022

Doc ID-000374359 v9

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CHENNAI: With several construction works, developmental projects and increasing pollution, the risk of pulmonary issues and respiratory problems are worsening. Various cases of fever and influenza like illnesses are increasing at the city hospitals, which is why the health experts are emphasizing on staying cautious against environmental factors to prevent the same. The areas with higher concentrations of certain air pollutants are also seeing a surge in cases of respiratory infections, especially among children.

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.

Dr V Vilvanathan, Senior Consultant, Paediatric Medicine, Sri Ramachandra Research Centre says, “Poor air quality can greatly affect someone’s health and I have seen an approximate 12 percent rise in patients, affected by smog and air pollution in Chennai. Many people especially, under 5 children are experiencing symptoms like breathlessness and cough – and there’s been a roughly eight percent increase in reported cases of influenza-like illnesses over the last six months. Doctors say that polluted air can not only worsen the people with Asthma and COPD but also make someone feel worse when they have the flu.

Pollutants such as gases from vehicles, pollution from burning fuels like coal and oil, construction activities and more – can harm respiratory systems and irritate airways. 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.

Senior consultant pediatrician Dr Mohan Kumar says that the bacteria and viruses are already present in the environment and air pollution is worsening in the urban areas with several construction works and projects, an increase in the vehicular pollution and other expansion projects. With multiple factors contributing to these issues, past three months we have seen an increase in the sale of inhalers for people with Asthma.

Dr Jejoe Karankumar, Medical Affairs Director, Abbott India says that its 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.”

Doctors also emphasize on 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.

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And the steeper the stairs, the harder they’re going to have to work, Hart says, since taking bigger steps requires you to recruit a greater number of muscle fibers. Like we mentioned, your body needs oxygen to supply your muscles with energy; the more in play, the more oxygen you’ll need to sustain that effort—hence the increased breathing you may notice when tackling stairs.

3. You’re tapping into different types of muscle fibers.

Speaking of muscle fibers: When you’re doing easy aerobic activity, like walking on even ground, your type 1 fibers, or endurance-based slow-twitch ones, help you along. But when you start climbing stairs, you engage your type 2 fibers—aka, your fast-twitch ones, which support powerful movements like lifting heavy weights or sprinting.

This can lead to the buildup of hydrogen ions and carbon dioxide in your muscles and blood; you need oxygen to clear that out to help stop fatigue from creeping in. This higher demand forces your body to respond by increasing your heart rate and breathing rate, which is why you may arrive at the top of the staircase huffing and puffing, Hart explains.

If your workout routine is heavily focused in the endurance space—like steady-state running, biking, walking, or swimming, which trains type 1 muscle fibers—your body might not be as used to engaging type 2 fibers as, says, someone who lifts heavy weights or does explosive exercises like sprints or plyometrics. So when it comes time to use them to climb a flight of stairs, it’s going to be that much more taxing on your body.

4. The effects of gravity are real.

Stair climbing may seem easy since it’s essentially just walking, right? Well, the key difference is gravity. When you’re strolling on flat ground, you’re propelling your body forward. But when you’re walking up stairs, you’re moving forward and up. Most people take bigger steps—and lift their hips higher—to do this, which engages more muscle fibers, says Hart. At the same time, gravity is doing its best to pull you back down, and your muscles have to work overtime to surmount that resistance, as SELF previously explained.

All this increases the amount of work your heart needs to do, Dr. Lala explains. As Hart puts it, your heart rate and breathing rate will then amp up to supply your body with the oxygen to complete that extra work.

5. You haven’t actually trained for stair-climbing.

There’s a principle in exercise called “specificity,” which basically just means your body adapts to the very particular demands you place on it, Hart explains. This means that if you want to become a better runner, you need to run regularly; spending hours on other forms of endurance exercise—like riding your bike or logging laps in the pool—just won’t be as effective.

Same goes for stair climbing: Even if you’re doing movements that train those type 2 muscle fibers—like squats, deadlifts, and leg presses—those exercises are still not the exact movement and probably won’t carry over as well as actually climbing stairs would, Hart says. So unless your workout or daily life includes ascending a whole bunch of steps, it’s no wonder tackling a staircase will feel hard and fatiguing when you have to do it.

But there are some cases where breathlessness can hint at a problem.

In general, feeling tired and breathless at the top of a staircase can be totally normal and not a sign of anything concerning. But there are a few instances in which stair climbing fatigue does warrant a check in with your doctor:

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Will I die because of stress?

No. There is no direct link between stress and death. Stress is the body’s response to threats. There is an increase in stress hormones – cortisol, adrenaline, and noradrenaline. Chronic stress can cause diabetes, irregular heart rhythms, and changes in the brain structure. It can also lead to mental health disorders, weak immunity, and chronic inflammation.

You can live without anything but stress in today’s world. With a honking car on the road or the death of a loved one, we encounter many stressors. Stress is our body’s response to a worrisome situation. Everyone faces stress, but the degree of stress may vary. It depends on how well a person can cope with stress. It may sometimes lead to certain unpleasant and adverse impacts on our health. In this article, we explore whether stress is capable of killing us.

What happens during stress?

When the body faces an actual or perceived threat, it undergoes three stages of the stress response:

Alarm stage

The first stage of the stress response is the alarm stage. In this stage, the body prepares to fight the stressor or escape it. It releases stress hormones, which include cortisol, noradrenaline and adrenaline. 

Cortisol increases the blood glucose level. It allows the brain to take up more glucose. It reduces bodily functions, like digestion, that are unimportant in fighting the stressor. Adrenaline increases the heartbeat and blood pressure. It makes the blood rush to muscles, the heart and vital organs. It promotes rapid breathing. Noradrenaline releases glucose from fat stores in the body.

In short, these hormones increase the body’s energy so that it can deal with the threat. 

Adaptation stage

The second stage of the stress response is called the adaption stage. If the stressor is gone, the body returns to normal functioning. However, if it continues to face the stressor, in the adaption stage, the body uses all its resources to adapt to the threat. For example, there is a continuous release of stress hormones. In this state of facing chronic stress, physical, mental, emotional, or behavioural problems arise. 

Exhaustion or recovery stage

The third stage of the stress response is the exhaustion or recovery stage. If the body is successful in overcoming the stressor, it enters recovery mode. But if it cannot overcome the stressor and has used its resources, it enters the exhaustion stage. During this, the body is unable to maintain normal functioning. Serious health illnesses such as depression, high blood pressure, and heart disease become common at this stage. 

What are the signs of stress?

When we face a stressful situation, our body reacts in a specific manner. Signs that the body is experiencing stress are:

  • Difficulty to relax, reduced concentration
  • Varied emotions like anxiety, irritability, anger, and sadness
  • Body aches like headaches 
  • Disturbed sleep pattern
  • Chest pain, increased heartbeat and blood pressure
  • Breathlessness and choking sensation
  • Stomach troubles like diarrhoea, nausea, and vomiting

Can stress cause death?

Stress may be a contributor to health conditions, but there is no possibility of stress killing you. Different studies point to this fact.

Researchers studied whether stress can lead to sudden cardiac arrest (SCA). They found that stress can impact the ion channels in the heart disrupting the heart rhythm. Irregular heart rhythms can cause sudden heart attacks. However, there is a need for more specific studies to establish a direct linkage. 

Another study in 2021 suggests that chronic stress increases the risk of SCA in healthy individuals. However, it still requires more research to understand the exact role of stress in SCA. Chronic stress may also cause angina. A 2021 study done in Finland states that higher stress can reduce life expectancy by 2.8 years. Nonetheless, there is no established link as to whether stress causes death.

How does chronic stress impact our health?

Stress cannot kill you. However, long-lasting stress can impact the body in many ways. The body remains stuck in the alarm stage and continually tries to cope. Eventually, it enters the exhaustion stage and develops diseases. 

One study (2022) found that lifelong stress can change the brain structure. Changes in brain structure impair thinking capability. They also increase the chances of mental health issues. Long-term stress may cause depression in certain individuals.

There is evidence that lifelong stress exposure causes changes at the DNA level. As a result, there is consistent inflammation in the body. In addition, DNA changes reduce the virus-fighting capacity of the body.

During the stress response, cortisol reduces the immune function of the body. In the case of persistent stress, cortisol levels remain high. Thus, over some time, the body can become incapable of initiating an immune response. Chronic stress also reduces the size of the immune system’s organ, the thymus. The whole purpose of the stress response is to increase the body’s energy level. As a result, stress hormones increase glucose concentration in the blood. However, when stress persists, high glucose levels cause insulin resistance. Thus, chronic stress can lead to diabetes.

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A recent study conducted by the Christian Medical College, Vellore, suggests that Indians recovering from COVID-19 encounter more severe lung issues compared to their European and Chinese counterparts. The study indicates that these persistent symptoms might endure for up to a year in certain cases, while others may face lasting impairment in lung function.

As reported by India Times, Dr. Suranjit Chaterjee, senior consultant of internal medicine at Indraprastha Apollo Hospital, New Delhi, (not affiliated with the study) said, "Based on the available evidence, long Covid may manifest even in individuals who experienced mild COVID-19 episodes. Symptoms tend to improve with appropriate therapy and medications."

Regarded as the first of its kind study for Indians

This research underscores that Indian patients in the study showed a higher prevalence of underlying health conditions and greater lung damage compared to Europeans and Chinese individuals. Regarded as the first of its kind for Indians, this study sheds light on the prolonged consequences of COVID-19 on lung health and overall well-being.

Another ICMR study analyzed data from 14,419 patients across 31 hospitals

According to another study conducted by the Indian Council of Medical Research (ICMR) in 2023, approximately 6.5% of hospitalized COVID-19 patients succumbed to the disease within the subsequent year. This mortality rate aligns with global data trends. The study analyzed data from 14,419 patients across 31 hospitals, spanning those hospitalized since September 2020.

These cases involved infections presumed to be caused by various coronavirus variants, including the original strain, delta, or omicron. Moreover, the study focused on outcomes among patients with moderate to severe disease, revealing that 17.1% experienced post-COVID-19 conditions such as fatigue, breathlessness, and cognitive abnormalities like brain fog and difficulty concentrating. Notably, individuals with these post-COVID-19 conditions were nearly three times more likely to succumb to the disease.

Here are 5 effective ways to take care of your lungs:

Quit Smoke: Smoking is one of the most significant risk factors for lung disease. If you smoke, quitting is the single best thing you can do for your lung health. Avoiding exposure to secondhand smoke is also crucial.

Exercise Regularly: Engaging in regular physical activity can improve lung function and capacity. Aerobic exercises like walking, swimming, and cycling are particularly beneficial for lung health.

Practice Good Posture and Breathing Techniques: Maintaining proper posture and practicing deep breathing exercises can help optimize lung function. Diaphragmatic breathing techniques, also known as belly breathing, can help strengthen the diaphragm and improve lung capacity.

Take steam and wear masks: Minimize exposure to air pollutants which can irritate the lungs and exacerbate respiratory conditions. Wear masks whenever you step outside. Practice taking steam atleast twice a day to heal your lungs from pollution or external infection.

Eat a Healthy Diet: Consuming a diet rich in fruits, vegetables, whole grains, and lean proteins can provide essential nutrients that support lung health. Foods high in antioxidants, such as berries, leafy greens, and nuts, may help protect the lungs from oxidative stress and inflammation.

Also watch: Death risk lingers till 3 months post Chikungunya infection according to Lancet study

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In an unprecedented global health crisis, the long-term effects of COVID-19 continue to puzzle scientists and physicians alike. A recent large-scale immunological screening of over 1,000 confirmed COVID-19 patients has now thrown light on potential diagnostic markers for Long COVID, a condition characterized by persistent symptoms following recovery from the initial virus infection. This study, revealing the crucial role of memory CD8 T cell clonal expansion, marks a significant stride in understanding and possibly treating Long COVID.

Decoding Long COVID's Immunological Footprint

At the heart of this groundbreaking research lies the discovery that memory CD8 T cell clonal expansion serves as a more reliable marker of Long COVID than traditional antigen detection methods. This finding challenges previous diagnostic approaches and opens new avenues for identifying and managing Long COVID cases. The study also highlighted that elevated serologic responses were inversely correlated with expanding CD8 T cell populations in Long COVID patients. This inverse relationship underscores the importance of a restrained antiviral T cell response in the pathology of Long COVID, providing a new perspective on the immune system's role in the persistence of this condition.

Unraveling the Mystery of Dysregulated Breathing

Further illuminating the complex nature of Long COVID, the study uncovered that non-hospitalized patients experience increased sensitivity of the carotid chemoreflex, leading to excessive hyperventilation and breathlessness during exercise. This suggests that the carotid chemoreflex, a key regulator of breathing in response to changes in blood chemistry, may be a pivotal factor in the dysregulated breathing patterns and exercise intolerance observed in Long COVID patients. The implications of this discovery are profound, offering potential treatment targets that could alleviate some of the most debilitating symptoms of Long COVID.

Comparative Analysis with Healthy Controls

In a comparative study involving 14 Long COVID participants and a control group of 8 individuals who recovered from the initial viral infection without ongoing symptoms, alongside data sets from six healthy participants from a previous study, researchers sought to identify any cardiovascular or pulmonary abnormalities. Despite similar demographics and baseline health metrics, Long COVID participants reported at least three persistent symptoms, including dyspnea, extreme fatigue, brain fog, and chest pain. Notably, spirometry data revealed no significant differences between the two groups, suggesting that the observed impairments in Long COVID patients may not be attributable to lung function alone. However, cardiopulmonary exercise testing unveiled a lower peak oxygen uptake (VO2 peak) in Long COVID participants, pointing to a cardiovascular limitation to exercise that could explain the pervasive fatigue and exercise intolerance reported by many sufferers.

As the world grapples with the aftermath of the COVID-19 pandemic, these insights into the immunological and physiological underpinnings of Long COVID illuminate a path forward. By identifying specific diagnostic markers and understanding the mechanisms driving persistent symptoms, researchers can pave the way for targeted therapies and interventions. This study not only advances our knowledge of Long COVID but also exemplifies the power of scientific inquiry in addressing some of the most pressing health challenges of our time.

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Respiratory diseases encompass a broad spectrum of conditions affecting the airways and lungs, significantly impacting human respiration. These ailments may stem from infections, tobacco smoking, exposure to secondhand smoke, environmental pollutants such as radon and asbestos, among other factors. With diverse manifestations ranging from asthma to chronic obstructive pulmonary disease (COPD), understanding the intricacies of these disorders is crucial for effective management and prevention.

Causes and Pathophysiology

Respiratory diseases arise from various triggers, including environmental pollutants and genetic predispositions. Chronic exposure to tobacco smoke, both directly and indirectly, stands as a prominent risk factor, contributing significantly to the prevalence of conditions like COPD and lung cancer. Additionally, occupational hazards, such as exposure to dust and chemicals, pose substantial threats to respiratory health.

The respiratory system's vulnerability to diseases can be attributed to its direct interface with the external environment and its extensive capillary network, making it susceptible to inhaled pathogens and toxins. Moreover, allergic reactions and sensitivities further complicate respiratory function, underscoring the multifactorial nature of these disorders.

Common Respiratory Diseases

Among the myriad respiratory ailments, asthma and COPD emerge as prevalent and debilitating conditions worldwide. Asthma is characterized by recurrent episodes of breathlessness, wheezing, and chest tightness, often triggered by allergens or environmental irritants. In contrast, COPD, primarily caused by long-term exposure to harmful gases or particles, manifests as progressive airflow limitation and persistent respiratory symptoms.

Emphysema, a hallmark of COPD, involves the destruction of alveolar walls, diminishing the lungs' capacity for efficient gas exchange. This results in symptoms like shortness of breath, chronic cough, and wheezing, significantly impairing respiratory function and quality of life.

Signs and Symptoms

Recognizing the signs and symptoms of respiratory diseases is pivotal for timely intervention and management. Persistent cough, especially when accompanied by sputum production or hemoptysis, warrants thorough evaluation, as it may signify underlying inflammatory or malignant conditions. Dyspnea, or shortness of breath, serves as another cardinal symptom, reflecting the progressive nature of respiratory ailments like emphysema and fibrosis.

Individuals experiencing exacerbations of asthma or COPD may present with acute episodes of wheezing, chest tightness, and increased respiratory effort, necessitating prompt medical attention. Moreover, awareness of environmental triggers and lifestyle factors is crucial for minimizing symptom exacerbation and optimizing respiratory health.

Management and Prevention

While chronic respiratory diseases pose significant challenges, effective management strategies can alleviate symptoms and enhance patients' quality of life. Pharmacological interventions, including bronchodilators and inhaled corticosteroids, play a central role in controlling airway inflammation and improving respiratory function. Moreover, lifestyle modifications, such as smoking cessation and environmental mitigation, are integral components of disease management and prevention.

Preventive measures, including vaccination against respiratory infections and avoidance of known triggers, are paramount for reducing disease burden and mitigating complications. Additionally, public health initiatives aimed at promoting respiratory health awareness and improving access to care are essential for combating the global prevalence of respiratory diseases.

Respiratory diseases encompass a diverse array of conditions with significant implications for public health and individual well-being. By elucidating the underlying causes, signs, and symptoms of these ailments, healthcare professionals can facilitate early diagnosis and implement targeted interventions to optimize patient outcomes. Through collaborative efforts in research, education, and policy advocacy, strides can be made towards achieving a world where respiratory health is prioritized, and all individuals can breathe freely.

1.    National Cancer Institute. (n.d.). Respiratory Disease. Retrieved from
2.    Britannica. (n.d.). Respiratory Disease. Retrieved from
3.    World Health Organization. (n.d.). Chronic Respiratory Diseases. Retrieved from

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ByZarafshan Shiraz, New Delhi

The end of winters are here and as much as we enjoy the last of the cold weather, there are people who get sick due to the weather change which includes flu, sinuses, cold and cough etc. On the other hand, people with known respiratory illness face a lot of challenges with regular breathing function especially in cities but sweat not as we got an expert on board to discuss more about pulmonary function, respiratory health and how breathing exercises can be an aid.

12 ways and exercises to manage your respiratory health during end of winters (Photo by Freepik)
12 ways and exercises to manage your respiratory health during end of winters (Photo by Freepik)

In an interview with HT Lifestyle, Priya Singh, Women’s Health Physiotherapist and Lactation Consultant at Cloudnine Group of Hospitals, in Navi Mumbai's Vashi, highlighted the common concerns people face with most of the respiratory illness when combined -

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  • Breathlessness ( Dyspnea )
  • Cough, sputum secretions
  • Weight loss
  • Generalised fatigue
  • Chest pain
  • Fever followed by an infection
  • Noisy breathing (wheezes), most common in patients with Obstructive lung disease and Asthma.

Priya Singh said, “Breathing is one of the automated function for humans for living but no one has ever thought about the numerous benefit breathing consciously would have on lungs and over all respiratory health.” She explained:

  1. Breathing exercise helps with generalized fatigue
  2. Provides relief from Breathlessness ( Dyspnea) by improving oxygenation
  3. Improves respiratory muscle function and strength
  4. Helps in clearing out secretions and sputum
  5. Relaxes body through reducing elevated blood pressure and heart rate

Asserting that maintaining respiratory health during winter is important since cold and dry air can have an impact on the respiratory system, Priya Singh suggested some tips to help you manage your respiratory health -

  1. Stay Warm and Layered: Dress warmly to protect yourself from the cold air. Use layers to trap heat and prevent your body temperature from dropping too much.
  2. Stay Hydrated: Cold air can be drying to the respiratory passages. Drink plenty of water to stay hydrated and keep your mucous membranes moist.
  3. Use Humidifiers: Humidifiers add moisture to the air, which can be beneficial, especially in heated indoor environments. This helps prevent the airways from becoming too dry.
  4. Practice Good Hand Hygiene: Wash your hands regularly to reduce the risk of respiratory infections. Viruses that cause respiratory illnesses are more prevalent during the winter months.
  5. Avoid Smoke and Pollutants: Stay away from tobacco smoke and other pollutants, as they can irritate the respiratory system and worsen respiratory conditions.
  6. Exercise Regularly: Regular physical activity can help strengthen your respiratory muscles and improve lung function. However, if you have respiratory conditions, consult your healthcare provider before starting a new exercise program.
  7. Practice Deep Breathing Exercises: Engage in deep breathing exercises to improve lung capacity and promote better respiratory function.
  8. Maintain Indoor Air Quality: Ensure good ventilation in your home and avoid the use of strong chemicals or cleaning products that may irritate the respiratory system.
  9. Get Vaccinated: Consider getting vaccinated against respiratory infections, such as the flu. Consult with your healthcare provider for advice on vaccines that are appropriate for you.
  10. Eat a Balanced Diet: Consume a diet rich in fruits, vegetables, and whole grains. These foods provide essential nutrients that support overall health, including respiratory health.
  11. Manage Respiratory Conditions: If you have pre-existing respiratory conditions such as asthma or chronic obstructive pulmonary disease (COPD), work closely with your healthcare provider to manage and control your symptoms. Ensure that you have an action plan in place.
  12. Stay Informed: Be aware of air quality levels and weather conditions, especially if you have respiratory conditions that may be affected by changes in temperature and air quality.

Talking about the types of breathing exercises that are available to us to manage respiratory illness, Priya Singh explained -

  1. Diaphragmatic Breathing exercise - This breathing involves filling air in your lungs while you allow your abdomen to expand and gradually breath out and engage your abdomen inwards. This breathing exercise helps particularly with releasing tension around the intercostal muscles, relaxes he body by lowering blood pressure, provides energy to continue with activity of daily living.
  2. Pursed lip breathing - In this type of breathing you have to inhale deep and exhale gradually through your mouth, note that your exhalation time has to be more than inhalation. This breathing particularly with breathlessness, calms down the system. Mostly helpful in cases of asthma and COPD.
  3. Segmental expansion breathing exercise – This exercise as the name suggests is perform at particular segment, helps in conditions where there is accumulation of fluid around the segment of the lung like in pneumonia, improves chest wall movement, the aim remains to improve oxygenation and ventilation followed by underlying respiratory illness.

She revealed an another pulmonary rehabilitation program that includes the below breathing techniques -

  • Forced Expiratory Technique – also known as FET technique: As we can understand by the name of the technique this pattern of breathing is focusing on force full exhalation across the lung volumes, this technique of breathing helps with effective coughing and clearance of collected mucus.
  • Active Cycle of Breathing Technique – also known as ACBT technique: This pattern of breathing involves cyclic pattern breathing combining FET that is breathing for 5 times and controlling the same followed by again active cycle of 5 breaths and 2-3 FET Breathing ending with breath control , when performed in cyclic manner helps with mobilizing the mucus, improves lung volume and capacity.
  • Autogenic drainage: This technique of breathing is when you are breathing deeply through your nose keeping the rate and depth of it in mind during inspiration, which starts from the lowest segment of lung and moves towards apical segment. This technique has stages where it helps in providing great relief with chest congestion by mobilising the secretions.

Priya Singh concluded, “The above exercise are beneficial not only during winters but when practiced under guidance of a Physiotherapist can bring improvement in ones respiratory health. The atmosphere where you are practicing breathing exercise is equally important, so while you start performing make sure that you have good source of ventilation.”

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Lorraine Hewitt, a retired nurse from Ruabon, has allergic asthma. After attending a meeting at a mouldy village hall, her health quickly detreated. Breathing in mould spores left her struggling to breathe, she was hospitalised, and it took her 12 months to recover.

“I attended a work meeting at a village hall and had a reaction to breathing in mould," the 64-year-old said. 

"Three days later I was hospitalised and it took me over 12 months to recover. Despite six months of steroids, my lungs have never returned to how they were. I had no idea that breathing in mould spores could do that.

“There needs to be more awareness of the dangers of mould, especially to those who live with a lung condition like me. That one meeting in a mouldy village hall, left me struggling to eat or walk up the stairs."

The Leader: Lorraine Hewitt was left struggling to breathe due to a reaction to mould. Lorraine Hewitt was left struggling to breathe due to a reaction to mould. (Image: Asthma + Lung UK Cymru)

Mould can be very harmful to health, especially for babies, small children, older people and people with allergies because it produces spores, which can be breathed in and can cause health problems in those who are sensitive or allergic to them.

Mould usually appears as fuzzy black, white, or green patches on the walls, ceiling or tiles. It might also smell damp and musty. If you are allergic to mould it can cause symptoms like coughing, wheezing, sneezing and watery eyes or cause symptoms of a lung condition like asthma or COPD to worsen.   

Keeping your home well aired and warm to at least 18°C in colder months helps reduce condensation, which leads to mould. But the rising cost of living has made this increasingly harder for those with lung conditions who live in socially deprived areas and are already struggling to pay bills.  


​In a recent survey conducted by leading lung charity Asthma + Lung UK Cymru, 39 per cent of people surveyed with a lung condition in Wales said mould was a trigger for their condition, prompting symptoms such as breathlessness, coughing and wheezing or bringing on potentially life-threatening asthma attacks.

The charity says the numbers are worrying and is urging anyone with a lung condition to take precautions to protect their health.

Joseph Carter, head of Asthma + Lung UK Cymru, said:  “Mould is a serious issue. If you have a lung condition, your symptoms may get worse, and if you have asthma, mould could cause an asthma attack. Babies, small children, older people and people with allergies are more likely to be affected by mould. 

"Asthma + Lung UK Cymru believes no one should have to suffer worse health because of where they live, or how much money they have. There is a link between poor housing and asthma, because of things like mould and damp.

“If you think your home is damp or you’ve noticed mould, it’s best to act quickly before it gets worse. For those in rented accommodation, landlords have a responsibility to their tenants and to fully support them to make sure that the housing is up to scratch. They should not just paint over the problem."

Further advice is available at

To help protect yourself and your home against the potentially harmful effects of mould this winter, Asthma + Lung UK Cymru has the following tips:  

1. Take all your medicines as prescribed to reduce your risk of mould affecting your lung condition.  

2. Keep rooms well-aired. Open your windows for 5 to 10 minutes several times a day if you can, especially if you’re cooking or using the shower. If you live in a highly polluted area, check the air pollution levels before opening windows.  

3. If you can, dry washing in a tumble dryer. If you can’t do that, try a well-aired room or airing cupboard.  

4. Fix any leaks or water damage, as this will help to prevent humidity that causes condensation.  

5. Try to keep your home at a good background temperature so it never gets too cold - ideally at least 18 degrees when it’s cold outside. 

6. Use extractor fans in the kitchen and bathroom or open a window when cooking or after a shower to get rid of moisture in the air. 

7. Close the door of the room you are in if you’re cooking or showering - to prevent condensation in other rooms. 

 8. Some people find that de-humidifiers help to dry the air and prevent damp and mould. But make sure you get the setting right as leaving the air too dry might make you cough.

9. And remember mould spores can be outside too, so make sure you carry your reliever (or rescue) inhaler wherever you go to deal with any symptoms quickly.  

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(MENAFN- IANS) New Delhi, Feb 15 (IANS) Even as the national Capital's air quality continues to dip, doctors on Thursday reported a rise in respiratory and cardiac issues.

As per data by the Central Pollution Control Board (CPCB), Delhi's overall Air Quality Index (AQI) showed no sign of improvement as it was recorded at 294 on Thursday at 9 am. The AQI was 341 on Wednesday and 342 a day earlier.

“We have noticed a significant increase in the number of patients seeking medical attention for various health issues, ranging from respiratory problems to cardiac conditions. Many individuals are experiencing worsened symptoms of respiratory ailments such as asthma, persistent cough, colds, and viral infections, including cases of H1N1,” Dr. Sushila Kataria, Senior Director, Internal Medicine, Medanta, Gurugram, told IANS.

“The primary contributing factor to these health issues is the presence of smog, which directly irritates the lungs and throat, particularly affecting those with pre-existing respiratory conditions,” she explained.

A recent analysis done by the Centre for Research on Energy and Clean Air (CREA) showed that Delhi was ranked first on the list of the country's most polluted cities in January.

Of the 254 cities, Delhi's pollution levels were recorded at the highest with the average PM2.5 concentration at 206 micrograms per cubic metre.

The city exceeded the National Ambient Air Quality Standards (NAAQS) every day of the month.

“In the face of escalating air pollution, especially evident in cities like Delhi, the impact on respiratory health, is significant. People suffering from asthma as well as COPD (Chronic Obstructive Pulmonary disease) -- both chronic respiratory ailments -- experience considerable aggravation due to air pollutants, resulting in symptoms like shortness of breath and exacerbations. Therefore taking precautionary measures becomes paramount,” said Dr Anshum Aneja Arora, a Delhi-based Pulmonologist.

Dr. Puneet Khanna, HOD and Consultant Respiratory Medicine, Manipal Hospital, Dwarka told IANS that children are also getting mild respiratory tract infections, and are also coming with lots of complaints of coughing, sneezing, and cold.

“The major complaints are upper airway conditions, nose blockage, coughing, wheezing, breathlessness, and a sore throat. Sometimes it is accompanied by chest pain and fever, but most of these symptoms are mild and self-limiting, and usually they recover after three to five days of medication,” he said.

According to the Air Quality Early Warning System for Delhi, the air quality is likely to remain "very poor" from February 15-17.

The outlook for subsequent six days from February 17 is that the air quality is likely to be "poor."

Dr Anshum said utilising masks to reduce inhalation of pollutants is a simple yet effective practice.

The doctor stressed on adequate hydration to counteract air pollution-induced dehydration which can cause the lining of the airways and sinuses to become dry, causing asthma symptoms or other symptoms like headache and nausea.




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Understanding the Connection

Recent research has sought to uncover the connection between female reproductive factors and Chronic Obstructive Pulmonary Disorder (COPD), a group of lung diseases characterized by breathlessness, persistent cough, and mucus production. In a study published in Thorax, health scientists have shone a light on the association between female reproductive history and the risk of COPD. This research included an impressive number of 283,070 women, with a median follow-up of 11 years. The findings revealed that 3.8 percent of the participants developed COPD during this time, with several reproductive factors associated with the increased risk of COPD.

Unveiling the Contributing Factors

The study found that the age at menarche, number of children, miscarriage, stillbirth, and age at natural menopause were all associated with an increased risk for COPD. These findings suggest that clinicians should consider these potential risk factors when assessing women’s health. More specifically, the study found a U-shaped association between age at menarche and COPD, indicating that early menarche can be linked to insufficient lung growth, potentially predisposing women to COPD later in life.

Further, giving birth to multiple children, experiencing miscarriages, and early natural menopause were also linked to an increased risk of COPD. Specifically, women who went through menopause before the age of 40 were found to have a 69% higher risk of developing COPD compared with those who experienced it naturally at the age of 50-51. On the other hand, the risk was 21% lower for those who entered menopause at or after the age of 54.

The Role of Estrogen and Other Factors

The researchers suggest that the female hormone estrogen may play a key role in COPD risk in women. This hormone, which plays a significant role in female reproductive health, may also influence lung development and COPD development. However, it’s important to note that other factors, including autoimmune disease, social and environmental factors, and being underweight, might also contribute to COPD risk.

Implications and Future Directions

This pioneering study underscores the need for further research to better understand the mechanisms linking female reproductive factors and COPD. The findings suggest a complex relationship between female reproductive health and COPD risk, urging health professionals to consider these factors in the prevention and management of COPD. As this is an observational study, it doesn’t establish cause and effect. Nevertheless, it highlights the crucial role of collecting comprehensive female reproductive history to assess future health risks and develop personalized care plans for women.

Further research is essential to confirm these findings and develop strategies to reduce COPD risk in women. As we strive to understand and combat COPD, acknowledging and investigating the role of female reproductive factors can be a crucial step towards more effective prevention, early detection, and management of this chronic lung disease.

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Despite the significant morbidity and mortality associated with chronic obstructive pulmonary disease (COPD), few trials have investigated the impact of screening. The US Preventive Services Taskforce (USPSTF) updated (May 2022) their COPD screening guidance (following a systematic review) and recommended against screening in asymptomatic adults.1 This recommendation was based on the current lack of supportive evidence for intervention(s) in those who did not recognise their respiratory symptoms at a level that would prompt them to seek consultation with a doctor.1,2 The USPSTF specifically stated, “do not screen for COPD in patients with no symptoms”, but this “does not apply to populations at very high risk for COPD, such as persons with α1-antitrypsin deficiency or workers exposed to certain toxins at their work” as these high-risk populations were not specifically included in the review.1 The recommendation in support of screening did not extend to those with a history of smoking and, therefore, the USPSTF recommended that those with a history of smoking should be symptomatic prior to screening for COPD.1

An earlier diagnosis of COPD could reduce the burden of COPD through earlier access to pharmacological and non-pharmacological treatments.3 There is also an increasing focus on a “pre-COPD” population who are at-risk of COPD but may have risk factor(s) with preserved lung function.3 Therefore, despite the USPSTF recommendations, the Global initiative for Obstructive Lung Disease (GOLD) and Australian COPD-X guidelines recommend a case-finding approach (targeted screening) where those at risk of COPD, including those with a smoking history, are screened using a COPD screening device, irrespective of symptoms.4,5 The diagnosis of COPD itself may evoke some response from a patient.6,7 To the best of our knowledge, there has been no trial that has specifically aimed to investigate the impact of COPD screening (or case-finding) on outcomes including respiratory symptoms and behavioural changes such as smoking cessation.

However, a Cochrane review investigated the potential impact of biomedical risk assessment(s), including spirometry, to aid smoking cessation.8 This review found little supportive evidence for biomedical risk assessment as smoking cessation aids, with spirometry showing some positive benefit once high risk of bias studies were excluded from analyses.8 To address the impact of a diagnosis via case-finding (or screening) and early treatments more conclusively, future studies need to be conducted that specifically recruit those who are at-risk of COPD or sub-group analyses need to be conducted so that the outcomes in those diagnosed via case-finding and/or asymptomatic or minimally symptomatic could be systematically reviewed and meta analysed.

To address the lack of trials that have aimed to investigate the impact of COPD case-finding (or screening) on outcomes, we aimed to examine the: a) distribution of demographic and clinical characteristics by time of COPD diagnosis and b) effectiveness of early treatment versus usual care in those who were diagnosed via case-finding, and in those with or without symptoms.


Study Design and Population

Detailed study methods including study design and population have been published.9 In brief, Review of Airway Dysfunction and Interdisciplinary Community-Based Care of Adult Long-Term Smokers (RADICALS) was a randomised controlled trial (RCT) that evaluated the effectiveness of an interdisciplinary community-based program against usual care at improving HR-QoL.9,10 The study followed up participants at 6- and 12-months and was undertaken between 2015 and 2018 in Melbourne, Australia.9,10 Current or former smokers ≥40 years of age with at least a 10-pack-year history of smoking were identified from 40 recruited and randomised general practice clinics and invited to participate.9,10 Those with an expected survival of <12-months, unable to provide consent, less than two visits to the practice in 12-months, interstitial lung disease, comorbidities preventing participation in pulmonary rehabilitation or a contraindication to spirometry were excluded.9

Participants underwent case-finding following the Australian COPD-X plan using a handheld COPD-6 (Vitalograph Inc., Ennis, Ireland) screening device and completed the RADICALS baseline questionnaire (demographics, smoking history, outcomes).9 Those with a forced expiratory volume in 1 s (FEV1) and a forced expiratory volume in 6 s (FEV6) ratio of ≤0.75 were further tested using spirometry and completed a COPD Assessment Test (CAT) and modified Medical Research Council (mMRC) breathlessness questionnaire.9 A diagnosis of COPD was made following recommendations in the COPD-X plan.9,11 The fixed cut-off approach (post-bronchodilator FEV1/FVC <0.70) was used with clinical correlation, including CAT and mMRC questionnaire scores. Participants with a pre-existing diagnosis of COPD were also invited to participate after being identified in practice databases.

Study Arms

RADICALS was a two-arm, cluster RCT, with the intervention group receiving an interdisciplinary model of care that included collaborative support from their regular general practitioner (GP) and practice staff and a study-specific pharmacist and physiotherapist.9,10,12 The intervention group received integrated disease management, from a multidisciplinary team, that included active smoking cessation support, home medicines review (HMR) and home-based pulmonary rehabilitation (HomeBase), and the control group received usual care, referral to Quitline® and a copy of the Lung Foundation Australia publication “Better Living with COPD – A Patient Guide”.13

Outcome Measures

Outcome data were collected from participants using validated tools at baseline, and at both 6- and 12-months post-baseline. Outcomes included in this analysis were those that were likely to demonstrate emotional or behavioural change post-diagnosis and/or used to demonstrate the impact of treatments.

The primary outcome was HR-QoL as measured using the St George’s Respiratory Questionnaire (SGRQ).14 Secondary outcomes included smoking related: carbon monoxide (CO)-verified 7-day point prevalence smoking abstinence,15 heaviness of smoking index (HSI),16 readiness-to-quit ladder (adapted) (RTQ),17,18 smoking self-efficacy scale,19 visual analogue scale (VAS) for confidence and motivation to give up smoking.9 Symptom-related outcomes were as follows: COPD Assessment Test (CAT) score20 and mMRC grade.21,22 Behavioural outcomes were as follows: anxiety and depression measured using the Hospital Anxiety and Depression Scale (HADS)23 and body mass index (BMI).

Statistical Analyses

The distributions of participant characteristics were examined by time of diagnosis (and symptoms in those newly diagnosed with COPD). Symptomatic COPD was defined as those with a CAT score of ≥10 and asymptomatic/minimally symptomatic as those with a CAT score of <10.24,25 For the majority of outcomes, higher scores indicated negative/worse impacts on health eg the higher the SGRQ (scores range from 0 to 100) the worse the HR-QoL.14 Whereas for some outcomes, higher scores indicated positive/better impact on health (RTQ, VAS-confidence, and VAS-motivation).

The within-group change or difference was determined using the outcome at follow-up minus the outcome at baseline. Controlled before and after analysis used linear regression for continuous outcomes and logistic regression for binary outcomes. All regression analyses were adjusted for age at baseline, gender, highest education, income, current smoker status and standard errors accounted for clustering at the practice level based on previously published methods.9 Analysis followed an intention to treat (ITT) principle and a secondary per-protocol analysis (PPA) was performed (Supplementary Tables S2 and S4). All analyses were performed using STATA version 16.1.26

The RADICALS trial and subsequent analyses were approved by the Monash University Human Research Ethics Committee (Project ID: 4899). All participants provided informed consent at the time of enrolment in the RADICALS trial.10 The RADICALS trial was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12614001155684) in compliance with the Declaration of Helsinki.10


Distribution of Characteristics

The RADICALS trial included 272 participants of whom 130 had a pre-existing COPD diagnosis and 142 had an incident diagnosis post case-finding. Of the 142 newly diagnosed participants, 75 (52.8%) were symptomatic (CAT score ≥10),24,25 66 (46.5%) were asymptomatic or minimally symptomatic and one (0.7%) was excluded due to a missing CAT score at baseline. Those in the pre-existing diagnosis group were older and less likely to be current smokers compared to those newly diagnosed. The baseline participant characteristics at the time of COPD diagnosis are presented in Table 1.

Table 1 Baseline Participant Characteristics by Time of COPD Diagnosis

Effectiveness of Early Treatment in Sub-Groups


There were non-significant improvements between baseline and 6-month follow-up SGRQ scores within both the control and intervention groups (Table 2). However, there were significant improvements between baseline and 12-month follow-up SGRQ scores within both groups (Table 2). For other outcomes, significant improvements were seen in HADS-anxiety, depression and CAT scores in the intervention group, and in VAS-motivation, HADS-anxiety and depression in the control group (Supplementary Table S1). A significant worsening of VAS-confidence was seen between 6-/12-months and baseline in the intervention group. Most of the within-group differences at 6-months persisted, or strengthened, at 12-months (Supplementary Table S1).

Table 2 Effectiveness of Early Treatment in Those with an Incident Diagnosis: Change in SGRQ from Baseline to 6- and 12-Months

The between-group differences (intervention versus control) in SGRQ at both 6- and 12-months follow-up favoured the intervention group, indicating a greater non-significant improvement in HR-QoL in the intervention group compared to the control group (Table 2). The between-group differences were non-significant for all other outcomes (Supplementary Table S1).

In the PPA, there was a significant between-group difference (treatment effects) in SGRQ at 12-months follow-up in favour of the intervention group, indicating a greater improvement in HR-QoL in the intervention group compared to the control group (Supplementary Table S2).

Symptomatic, Asymptomatic or Minimally Symptomatic

The improvement in SGRQ scores (between 6- and 12-months to baseline) was greater in the treatment than the control group for those with a pre-existing diagnosis and symptomatic with a new diagnosis (Supplementary Table S3). Within-group significant improvements were seen in the symptomatic incident diagnosis intervention group at 6-months (adjusted mean difference: 4.9, 95% CI: 0.5 to 9.2), symptomatic incident diagnosis control group at 12-months (6.3, 0.6 to 12.1) and symptomatic incident diagnosis intervention group at 12-months (9.2, 3.9 to 14.5) (Supplementary Table S3-ii, iii and iv). Differences in treatment effects between groups were not significant (Table 3). However, at 6-months, the point estimate favoured pre-existing compared to either incident diagnosis group, and favoured symptomatic compared to the asymptomatic incident group. At 12-months, the point estimated favoured the symptomatic incident diagnosis group compared to the pre-existing group and favoured the pre-existing and symptomatic groups when compared to the asymptomatic incident group (Table 3).

Table 3 Effectiveness of Early Treatment in Those with a) Symptomatic or b) Asymptomatic or Minimally Symptomatic Incident Diagnosis versus a Pre-Existing Diagnosis of COPD: Difference in Estimated Treatment at 6- and 12-Months

In the PPA, the differences in treatment effects between groups were not significant (Supplementary Table S4). For completeness and potential future meta-analyses purposes, the differences in other outcome measures are presented in Supplementary Table S5.


The RADICALS study included participants who had either a pre-existing diagnosis of COPD (48%) or those newly diagnosed via case-finding (52%). Of those who were diagnosed via case-finding, 53% were already symptomatic (CAT score ≥10) and 47% were asymptomatic or minimally symptomatic (CAT score <10). Early treatment with RADICALS intervention in those with an incident diagnosis had a positive but non-significant impact on HR-QoL (as measured by SGRQ). The difference in treatment effects generally favoured the pre-existing diagnosis group when compared to either incident diagnosis groups, and favoured the symptomatic group when compared to the asymptomatic or minimally symptomatic group. These findings suggest that early treatment may have a greater positive impact in those who are symptomatic compared to those who are asymptomatic or minimally symptomatic.

The RADICALS trial was not powered to detect significant differences in outcomes in incident diagnosis versus pre-existing diagnosis sub-groups, meaning that uncertainty remains. These initial findings provide useful insights into the potential impact of screening or case-finding for COPD. COPD intervention trials often exclude either those who were newly diagnosed post screen-detection (or case-finding) and/or those with minimal or asymptomatic disease, creating a treatment effect bias towards those with more severe disease. A large European study found that, when comparing characteristics of COPD intervention trial participants to those treated with COPD in primary care, trial participants had significantly worse lung function and quality of life than those treated in primary care.27 Our results are important and could be used, along with similar subgroup analyses, as part of a meta-analysis to provide stronger evidence on the impact of screening (or case-finding) and the impact of early treatments. To the best of our knowledge, no trial has specifically considered outcomes in those screen-detected (or diagnosed via case-finding) and the USPSTF recommends against screening for COPD.1

Despite this USPSTF recommendation against asymptomatic screening, we found that approximately half of those diagnosed via case-finding were symptomatic. This suggests that there is still no strong public awareness of the symptoms of COPD, as those with respiratory symptoms were not prompted to seek consultation with a doctor and undergo COPD case-finding. A 2014 study interviewed people who were newly diagnosed with COPD and found that those with multi-morbidity had difficulty understanding the significance and long-term impact of COPD.7 These newly diagnosed patients did not place much importance on their new COPD diagnosis, with many prioritising other comorbidities such as diabetes.7 A later qualitative study found that people newly diagnosed with COPD had difficulty understanding the importance of the diagnosis and delayed quit attempts.6 Our study supports the ongoing need for COPD education and raises public awareness on risk reduction, particularly in those with a history of smoking.

Our study had several strengths. These included the pragmatic nature, broad recruitment criteria enabling comparisons between newly diagnosed via case-finding, and pre-existing diagnosis groups. The diversity of GP practices recruited in terms of size, location, socioeconomic status of patients and availability of respiratory services increased the generalisability of the findings. The intervention was designed to incorporate services that were available in primary care to ensure that the intervention could be implemented in a real-world setting.

Our study had some limitations. These included the partial uptake of the multifaceted intervention, the length of follow-up and the comparison group and the fact that this sub-group analysis was not pre-specified. There was limited uptake of full intervention, with some participants only receiving smoking cessation support. The maximum follow-up was 12 months and therefore we were unable to capture the potential longer-term impact of screening and effects of early treatment. Although we were able to make comparisons between the pre-existing diagnosis and the incident diagnosis groups, the recruitment did not include a comparison group that was not screened and therefore any potential differences in outcomes between the non-screened and screened could not be determined. The RADICALS study was not designed with this sub-group analysis in mind and therefore was not powered to measure meaningful differences in outcomes between these sub-groups. Given the significant improvements in SGRQ at 12-months, in both the intervention and control groups, usual care may be effective and/or trial participation may have positively impacted on HR-QoL.


Approximately half of those diagnosed with COPD via case-finding were already symptomatic. Case-finding appeared to have a positive impact on HR-QoL in the newly diagnosed group. Early treatment with RADICALS intervention in those screen-detected had a positive non-significant impact on HR-QoL. The difference in treatment effects generally favoured the pre-existing diagnosis group when compared to either incident diagnosis group and favoured the symptomatic group when compared to the asymptomatic group. Larger studies or meta-analyses of sub-group analyses are required.


AUD, Australia dollars; BD, bronchodilator; BMI, Body mass index; CAT, COPD Assessment Test; CI, confidence interval(s); CO, carbon monoxide; COPD, chronic obstructive lung disease; FEV1, forced expiratory volume in 1 s; FEV6, forced expiratory volume in 6 s; FVC, forced vital capacity; GOLD, Global initiative for Chronic Obstructive Lung Disease; GP, general practitioner; HADS, Hospital Anxiety and Depression Scale; HMR, home medicines review; HR-QoL, health-related quality of life; HSI, heaviness of smoking index; ITT, intention to treat; mMRC, modified Medical Research Council dyspnoea scale; N/A, not applicable; OD, odds ratio(s); PPA, per protocol analysis; RADICALS, Review of Airway Dysfunction and Interdisciplinary Community-Based Care of Adult Long-Term Smokers; RCT, randomised controlled trial; RTQ, readiness-to-quit; SD, standard deviation; SGRQ, St George’s Respiratory Questionnaire; USPSTF, US Preventive Services Task Force; VAS, visual analogue scale.

Data Sharing Statement

If interested, reasonable requests for data can be made to the corresponding author ([email protected]) and will be considered in line with the requirements of Monash University Human Research Ethics Committee approval (Project ID: 4899).


We wish to acknowledge and thank the RADICALS: chief investigators (Nicholas Zwar, Grant Russell, Billie Bonevski, Anne Holland, Eldho Paul, Sally Wilson and Ajay Mahal), the Data Safety and Monitoring Board members, the research staff and students, clinic staff and participants, and Brigitte Borg and The Alfred Respiratory Laboratory. We also acknowledge the RADICALS trial funders and partners (Boehringer Ingelheim, Eastern Melbourne PHN, Lung Foundation Australia and National Health & Medical Research Council). KP acknowledges the support of the Australian Government’s research training program.


KP was supported by an Australian Government Research Training Program (RTP) Scholarship. MJA holds investigator-initiated grants for unrelated research from Pfizer, Boehringer Ingelheim, Sanofi and GSK. He has also undertaken an unrelated consultancy (paid to his employer) for Sanofi and received a speaker’s fee from GSK. JG holds investigator-initiated grants for unrelated research from Pfizer, GSK and Boehringer Ingelheim. He has received honoraria (paid to his employer) from a consultancy for GSK, AZ and for invited presentations at a continuing education event organised by Pfizer. The authors report no other conflicts of interest in this work.


1. Mangione CM, Barry MJ, Nicholson WK.; US Preventive Services Task Force. Screening for chronic obstructive pulmonary disease: US preventive services task force reaffirmation recommendation statement. JAMA. 2022;327(18):1806–1811. doi:10.1001/jama.2022.5692

2. Guirguis-Blake JM, Senger CA, Webber EM, Mularski RA, Whitlock EP. Screening for chronic obstructive pulmonary disease. JAMA. 2016;315(13):1378. doi:10.1001/jama.2016.2654

3. Han MK, Agusti A, Celli BR, et al. From GOLD 0 to Pre-COPD. Am J Respir Crit Care Med. 2021;203(4):414–423. doi:10.1164/rccm.202008-3328PP

4. Yang I, George J, McDonald C, et al. The COPD-X plan: Australian and New Zealand Guidelines for the management of chronic obstructive pulmonary disease. TSANZ [Internet]; Version 2; 2022. Available from: Accessed January 26, 2024.

5. Lung Foundation of Australia. COPD case finding position paper; 2019; Available from: Accessed January 26, 2024.

6. Bragadottir GH, Halldorsdottir BS, Ingadottir TS, Jonsdottir H. Patients and families realising their future with chronic obstructive pulmonary disease—A qualitative study. J Clin Nurs. 2018;27(1–2):57–64. doi:10.1111/jocn.13843

7. Ansari S, Hosseinzadeh H, Dennis S, Zwar N. Patients’ perspectives on the impact of a new COPD diagnosis in the face of multimorbidity: a qualitative study. NPJ Prim Care Respir Med. 2014;24(1):14036. doi:10.1038/npjpcrm.2014.36

8. Clair C, Mueller Y, Livingstone-Banks J, et al. Biomedical risk assessment as an aid for smoking cessation. Cochrane Database Syst Rev. 2019;3(3):CD004705. doi:10.1002/14651858.CD004705.pub5

9. Liang J, Abramson MJ, Zwar N, et al. Interdisciplinary model of care (RADICALS) for early detection and management of chronic obstructive pulmonary disease (COPD) in Australian primary care: study protocol for a cluster randomised controlled trial. BMJ Open. 2017;7(9):e016985. doi:10.1136/bmjopen-2017-016985

10. Liang J, Abramson MJ, Russell G, et al. Interdisciplinary COPD intervention in primary care: a cluster randomised controlled trial. Eur Respir J. 2019;53(4):1801530. doi:10.1183/13993003.01530-2018

11. Yang IA, Brown JL, George J, et al. COPD‐X Australian and New Zealand guidelines for the diagnosis and management of chronic obstructive pulmonary disease: 2017 update. Med J Aust. 2017;207(10):436–442. doi:10.5694/mja17.00686

12. Jessup RL. Interdisciplinary versus multidisciplinary care teams: do we understand the difference? Aust Heal Rev. 2007;31(3):330–331.

13. Schrijvers G. Disease management: a proposal for a new definition. Int J Integr Care. 2009;9(1). doi:10.5334/ijic.301

14. Jones PW, Quirk FH, Baveystock CM, Littlejohns P. A self-complete measure of health status for chronic airflow limitation: the St. George’s Respiratory Questionnaire. Am Rev Respir Dis. 1992;145(6):1321–1327. doi:10.1164/ajrccm/145.6.1321

15. Benowitz NL, Jacob P, Ahijevych K; SRNT Subcommittee on Biochemical Verification. Biochemical verification of tobacco use and cessation. Nicotine Tob Res. 2002;4(2):149–159. doi:10.1080/14622200210123581

16. Borland R, Yong -H-H, O’Connor RJ, Hyland A, Thompson ME. The reliability and predictive validity of the Heaviness of Smoking Index and its two components: findings from the International Tobacco Control Four Country study. Nicotine Tob Res. 2010;12(suppl_1):S45–S50. doi:10.1093/ntr/ntq038

17. Biener L, Abrams DB. The Contemplation Ladder: validation of a measure of readiness to consider smoking cessation. Heal Psychol. 1991;10(5):360. doi:10.1037/0278-6133.10.5.360

18. Niaura R, Shadel WG. Assessment to Inform Smoking Cessation Treatment. In: The Tobacco Dependence Treatment Handbook: A Guide to Best Practices. Guilford Press; 2003.

19. Velicer WF, Diclemente CC, Rossi JS, Prochaska JO. Relapse situations and self-efficacy: an integrative model. Addict Behav. 1990;15(3):271–283. doi:10.1016/0306-4603(90)90070-E

20. Jones PW, Harding G, Berry P, Wiklund I, Chen WH, Leidy NK. Development and first validation of the COPD assessment test. Eur Respir J. 2009;34(3):648–654. doi:10.1183/09031936.00102509

21. Mahler DA, Wells CK. Evaluation of clinical methods for rating dyspnea. Chest. 1988;93(3):580–586. doi:10.1378/chest.93.3.580

22. Celli BR, Cote CG, Marin JM, et al. The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. N Engl J Med. 2004;350(10):1005–1012. doi:10.1056/NEJMoa021322

23. Zigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand. 1983;67(6):361–370. doi:10.1111/j.1600-0447.1983.tb09716.x

24. Jones PW, Tabberer M, Chen W-H. Creating scenarios of the impact of COPD and their relationship to COPD assessment test (CATTM) scores. BMC Pulm Med. 2011;11(1):42. doi:10.1186/1471-2466-11-42

25. Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease [Internet]; 2023. Available from: Accessed January 26, 2024.

26. StataCorp. Stata Statistical Software: Release 16.1. College Station, TX: StataCorp LLC; 2019.

27. Kruis AL, Ställberg B, Jones RCM, et al. Primary care COPD patients compared with large pharmaceutically-sponsored COPD studies: an UNLOCK validation study. PLoS One. 2014;9(3):e90145. doi:10.1371/journal.pone.0090145

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February 13, 2024

2 min read

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Key takeaways:

  • There is a lack of data describing the demographics and impact of inducible laryngeal obstruction.
  • Data from this study will guide clinicians in health care resource management and research priorities.

Researchers identified inducible laryngeal obstruction as associated with a high burden of morbidity and health care utilization, according to study results published in The Journal of Allergy and Clinical Immunology: In Practice.

“The lack of robust prospective characterization of [inducible laryngeal obstruction (ILO)] impedes understanding of the condition and consequently limits advances in research and optimization of management strategies,” Jemma Haines, BSc (Hons), PhD student in Manchester Biomedical Research Center’s respiratory theme, and colleagues wrote. “To address this deficiency, we established a U.K. national registry, with standardized data entry from tertiary ILO treatment centers, with the aim of comprehensively describing the clinical and demographic features of ILO.”

The most common comorbidities with inducible laryngeal obstruction included asthma (68%), reflux (57%) and breathing pattern disorder (23%).

To achieve that aim, Haines and colleagues conducted a multicenter prospective characterization of 137 individuals (80% female; mean age, 47 years; 82% white) with endoscopically diagnosed ILO included within their registry. The four included centers received referrals for patients with difficult-to-treat asthma, unexplained breathlessness or suspected upper airway difficulties.

The registry included data on demographics, comorbidities — such as asthma, reflux, nasal disease and breathing pattern disorder — health care utilization, physiological data, questionnaire scores and imaging information.

Of the 137 participants included in the analysis, 87% had inspiratory ILO and 82% required provocation to induce ILO. The most common comorbidities were asthma (68%), reflux (57%) and breathing pattern disorder (23%).

Health care utilization was high, with 69% having an emergency visit to a health care setting at least once in the previous 12 months, close to half (44%) being admitted to the hospital and 18% being admitted to intensive care.

The researchers also used the validated MRC Dyspnoea Scale (graded 1 to 5, with 5 being most severe) to assess patients’ symptom and functional burden.

The median of functional impairment was grade 3 (interquartile range, 2-4), with 64% overall reporting impaired functional capacity (grade 3).

Only 12% felt untroubled by breathlessness except during strenuous exercise (grade 1), whereas another 12% felt too breathless to leave the house (grade 5).

Based on the Hospital Anxiety and Depression Scale, researchers also observed that 29% of patients indicated anxiety and 26% depression based on scores of 11 or higher.

“Our findings highlight the urgent need for robust research to better understand ILO management toward reducing both the individual and health economic burden of the condition,” Haines and colleagues wrote.

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THE King’s cancer diagnosis serves to highlight the benefit of early detection.

Symptoms can alert you to changes in the body, but it’s important to take note of what is normal for you.

Dr Zoe Williams helps a reader with shortness of breath after having an angioplasty


Dr Zoe Williams helps a reader with shortness of breath after having an angioplasty
The King’s cancer diagnosis serves to highlight the benefit of early detection.


The King’s cancer diagnosis serves to highlight the benefit of early detection.Credit: Getty

What are your typical toilet habits? How much do you weigh? Do you know what your moles look like?

Knowing your “normal” is also helpful for spotting any clues when doing at-home health checks, which I urge all readers to do.

Once a month, women should check their breasts (and armpits and collarbone area) for changes, while men should check their testicles.

Always take up NHS invitations for mammograms, smear tests and abdominal aortic aneurysm screening.

And do your bowel cancer test when the kit comes through the letterbox – it could save your life.

If you’re aged between 40 and 74 and have no pre-existing conditions, you will be invited for an NHS Health Check every five years to assess your risk of serious health conditions.

Here’s what readers have been asking me this week . . . 

Q) I RECENTLY had an angioplasty as I had angina pain and a history of heart disease.

My arteries are now clear. However, I am still getting quite bad shortness of breath on lifting.

An endoscopy was clear and so was a chest X-ray. It’s not asthma either.

Diabetes symptoms and the signs of all types of diabetes

But I regularly get pain in the ­sternum. It feels like something pressing around my ribs.

 It has stopped me working, walking and doing anything physical. I’m 61 and diabetic. The symptoms started eight weeks ago.

A reader suffering from angina pain with a history of heart disease has contacted Dr Zoe with his concerns


A reader suffering from angina pain with a history of heart disease has contacted Dr Zoe with his concernsCredit: Getty

A) Your symptoms sound severe if you can’t work or walk, so definitely need to be looked into further.

Angioplasty is a procedure to open the inner tube of the arteries so oxygenated blood can flow properly to supply the heart muscle.

The heart pumps blood around the body without ever having a break, which is quite amazing really.

Unfortunately, it only takes one of those arteries to be significantly blocked to cause angina symptoms, which can cause pain and/or shortness of breath.

There are lots of heart conditions that can cause breathlessness and/or pain, including myocarditis, pericarditis, auto­immune conditions such as sarcoidosis and heart failure.

Anaemia, or other types of chronic disease, can also cause breathlessness.

I expect you are due to be followed up by the cardiology team, but I wouldn’t wait for your appointment.

You could contact your cardiologist’s secretary to see if the team think they should see you sooner.

Failing that, ask your GP to check you over and get some blood tests and an ECG in addition to the chest X-ray you already had.

Frozen shoulder’s got me screaming

Q) I’VE just been diagnosed with a frozen shoulder, but the pain is mainly in my bicep area, not so much in my shoulder. What causes it? Would a cortisone injection help? The pain is so bad I scream.

A) Adhesive capsulitis – or ­frozen shoulder – is a ­condition where the shoulder becomes painful and stiff, often for no particular reason.

It affects about three in 100 adults at some stage, but usually between ages 40 and 60 and is more common in women. People with diabetes are slightly more likely to get it.

The range of movement can significantly reduce, often so much that the shoulder can become completely “frozen”.

 It most often affects only one shoulder, but it can affect both. Without treatment, symptoms usually go away naturally but that can take up to three years.

The pain is often over the front of the shoulder, around the bicep, or down the outside of the arm, so this fits your symptoms.

Another cause of pain is biceps tendonitis, or an inflamed biceps tendon. It can happen in isolation or with a frozen shoulder so I would suggest an ultrasound to see exactly where the problem is.

The good news is that a ­steroid injection can treat both conditions, but it must go into the site where the problem is, so have an ultrasound first.

Meanwhile, try ice packs and anti-inflammatory medication. You can do rehabilitation exercises, but your GP or physio can advise on how often and when to start.


OMEGA-3 fatty acids are important for the functioning of your body, particularly your brain and eyes, and may be able to reduce the risk of heart disease, blood clots, dementia and death.

But your body can’t produce the amount of omega-3s you need to survive, therefore you need to eat it.

 Include salmon, sardines, mackerel, walnuts, flaxseeds and chia seeds in your weekly diet.

Q) IN the past six months I’ve lost a lot of weight, and I have painful joints, breathlessness and digestive problems.

I have bronchiectasis and one cystic fibrosis gene. I have been told I am a CF carrier. I went to my GP, who thought I might have diabetes, but my blood tests didn’t show anything.

However, I’ve never had a glucose diabetes test for people with the CF gene. Do you think I should ask the doctor for one?

Another reader is concerned about  painful joints, breathlessness and digestive problems


Another reader is concerned about painful joints, breathlessness and digestive problemsCredit: Getty

 A) Your case is fairly complex and it is important to get to the bottom of it, especially as your symptoms are progressively getting worse.

You’ve been diagnosed with bronchiectasis, which is a condition where the airways of the lungs become widened. This can lead to excess mucus in the lungs, leaving them more vulnerable to infection. It’s a condition that often affects people who have CF, but it can occur for other ­reasons too.

If you have bronchiectasis that is not well managed, you should be referred to a respiratory specialist doctor. It’s also important for your GP to examine you and do a full set of investigations looking for other causes of this rapid unintentional weight loss and your other symptoms.

These should include a full set of bloods and a chest X-ray as a minimum, and potentially other tests depending on your symptoms and examination findings.

For a diagnosis of cystic fibrosis, you need two mutated copies of a particular gene. If you have one normal copy and one mutated copy – as in your case – then you’re a carrier. You do not have CF, but could pass it to your children if their other biological parent is also a carrier. Most CF carriers don’t have symptoms, but some can have symptoms associated with CF.

New research suggests carriers have a higher risk for CF-related issues such as bronchiectasis. The 2020 study from the US compared 19,802 CF carriers to 99,010 people who had no mutations at all.

They assessed the risk of getting 59 health conditions. CF carriers were found to have a higher risk for 57 of the 59.

You and your GP need to be aware that you could be vulnerable to other conditions. It’s new research that will not be well known, so it may help to share the study with your GP and then discuss next steps.

One of the more likely conditions in a CF carrier is diabetes, so an oral glucose ­tolerance test may be a good idea.

Do let me know how you get on.

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Delivered in partnership with NHS Wales Health Boards, Wellness with WNO is a singing and breathing programme for people with Long COVID in Wales.

This six-week online programme was developed with NHS medical professionals and is designed to support people experiencing feelings of breathlessness and anxiety that have continued longer term after the initial symptoms of the COVID-19 virus.

Launched in November 2021, the programme is delivered in a relaxed, informal setting where participants are invited to explore singing and performing techniques used at Welsh National Opera, with the aim to support improved breath control, lung function, circulation, and posture. Over 100 participants have completed the programme so far, with many also engaging with the Company longer-term at drop-in sessions to continue their progress. 

We accept direct referrals from NHS Long COVID Services from all Health Boards in Wales:

  • Aneurin Bevan University Health Board
  • Betsi Cadwaladr University Health Board
  • Cardiff and Vale University Health Board
  • Cwm Taf Morgannwg University Health Board
  • Hywel Dda University Health Board
  • Powys Teaching Health Board
  • Swansea Bay University Health Board

For more information, please contact WNO Producer April Heade on [email protected]

Wellness with WNO is supported by Arts Council Wales via the Arts, Health and Wellbeing Lottery Fund and has been devised in consultation with English National Opera and based on their original ENO Breathe project. The pilot programme was developed by Betsi Cadwaladr University Health Board, Cardiff and Vale University Health Board, Cwm Taf Morgannwg University Health Board and Welsh National Opera.

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