JOSEPH Carter, the Head of Asthma and Lung UK Scotland, has called for the greater enforcement of the ban on pyrotechnics at sporting events following a spate of alarming incidents this season.

Kick-off in the Edinburgh derby match at Easter Road last Sunday was delayed because smoke bombs had been thrown onto the pitch by both Hibernian and Hearts supporters.

More smoke bombs were then set off by fans of the Tynecastle club after Josh Ginnelly had opened the scoring in the first-half of the Scottish Cup fourth round game.

Exposure to smoke can cause breathing difficulties in people who suffer from medical conditions like asthma, bronchitis and emphysema and Carter is concerned about the worrying trend.

It has been illegal to take a pyrotechnic device into a stadium since the Sporting Events (Control of Alcohol) Act was passed at Westminster in 1985.

READ MOREDisabled Kilmarnock fan, 77, calls for an end to pyro lunacy

Carter wants to see clubs and the football authorities do far more to prevent their use before “something serious” happens at a match in this country. 

“Smoke from flares and smoke canisters can stay in the air for quite a long time, creating areas of air pollution that can trigger asthma attacks or symptoms such as coughing, wheezing and breathlessness,” he said. 

 “With two in five people with asthma surveyed in Scotland saying that poor air quality, including smoke, can trigger their condition, we would like to see better enforcement of the ban of these items at sporting events.

“It is fortunate that no serious incidents have occurred for people with lung condition, such as asthma, so far. The increased use of flares and smoke canisters at games only increases the risk of something serious happening in the future.”

HeraldScotland:

David Hamilton of the Scottish Police Federation this week called on Scotland's clubs to do more to stop supporters using pyrotechnics inside football stadiums and warned they may have their stadium safety certificates taken away from them if they are unable to create a safe environment for spectators. 

"What we really need is for the football clubs themselves to be much, much stricter on the use of pyrotechnics within grounds and search regimes to be much, much tighter," he said. "Sometimes they have not been as tight as they should be.

“I would also really like to see a clear and unambiguous statement from football clubs that pyrotechnics are absolutely unacceptable within grounds and that people found with them will get bans, if not life bans, if they are caught with them.

“We now have the legislation in place, which is helpful, but we need to see a renewed and invigorated response from the clubs. They have to make it clear there is no place for pyrotechnics in football.

READ MOREScotland's clubs told to crack down on pyrotechnics in stadiums

“If the clubs are not going to take responsibility then maybe we need to start looking at their ground safety certificates and asking if they are actually fit and proper organisations to be holding events like that.

“These certificates are there to ensure audiences can watch games in a safe environment. If you have got a proportion of your fans setting off flares and making it unsafe and you are not pursuing them actively enough then I would say there is a real question mark over the ability of clubs to be protecting people.

“That is a last-ditch resort. But our position is that everything should be on the table. What we need to see is clubs dealing very firmly with those who use pyrotechnics. There is a role here for clubs to play.

“People sometimes feel a bit cowed because it is big clubs, big money and a lot of people are involved. But we need to get over that. People cannot be put at risk going to watch a game of football. They need to be able to do that safely.”

 

 



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Lung health

Lung diseases, excluding lung cancer, cause an estimated 235,000 deaths each year

New Delhi: Like other parts of the body, the lungs are an extremely important organ, which needs utmost care.

According to the National Heart, Blood and Lung Insititute, chronic lower respiratory diseases, including obstructive pulmonary disease (COPD) and asthma are the leading causes of death globally, every year.

Lung diseases, excluding lung cancer, cause an estimated 235,000 deaths each year.

Lungs age faster than other parts of the body since we breathe in toxic air, pollution, and dust, involve in smoking, and other things that deteriorate the organ. With time, the lungs lose their strength, which can make it more difficult to breathe.

But by adopting certain healthy habits, you can better maintain the health of your lungs, and keep them working optimally even into your senior years.

Your body relies on your respiratory system to supply the oxygen necessary for your organs to function. And if you struggle to breathe, your body may not get enough oxygen, and without enough oxygen, other critical organs may shut down.

Warning signs of respiratory distress

It is very important to learn to recognise the signs and symptoms of respiratory problems that may help you protect your life. If you notice any of these symptoms, you must contact your doctor immediately.

Breathlessness

Many people suffer from chronic breathlessness which means they are short of breath and the lungs are not able to get enough oxygen to breathe.

Even though it is normal to get breathless occasionally when you exert more than normal, sudden and regular shortness can be a sign of impending danger.

According to health experts, the lungs are involved in transporting oxygen to your tissues and removing carbon dioxide, and problems with either of these processes affect your breathing. Causes of breathlessness can be due to:

  • Asthma
  • Carbon monoxide poisoning
  • Excess fluid in the lungs
  • COPD
  • Covid-19
  • Lung collapse
  • Pulmonary embolism
  • Tuberculosis
  • Pulmonary fibrosis
  • Lung cancer
  • Croup
  • Anaphylaxis

Change in skin colour or Cyanosis

Health experts say that people who have less oxygen in their blood have a bluish colour to their skin. The condition is known as cyanosis, and it develops along with breathlessness and other symptoms. Cyanosis is caused due to lung problems and is a slow-progressing ailment, which needs immediate attention.

Causes of cyanosis in the lungs include:

  • High altitudes
  • Asthma
  • Respiratory tract infection
  • Blood clots in the arteries of the lungs
  • COPD
  • Pulmonary hypertension
  • Pneumonia

Hemoptysis

Hemoptysis is the coughing up of blood from the respiratory tract. Massive hemoptysis can cause the production of more than 600 ml of blood within 24 hours, and lead to lung collapse.

Doctors say in hemoptysis, the blood arises from this bronchial circulation when there is a trauma causing damage to pulmonary arteries because of a tumour caused by lung cancer. Hemoptysis is also caused by:

  • Severe pneumonia
  • Tuberculosis
  • Severe respiratory tract infection
  • Bronchitis

Wheezing

If you are constantly wheezing or breathing noisily, it could be an indication that your airways have become obstructed and there is a problem with the functioning of the lungs.

Doctors say it is important to report the first sign of experiencing wheezing. It is a result of inflammation and narrowing of the airway in any location from your throat to the lungs.

The most common causes of wheezing are:

Chest pain

If you suffer from lingering chest pain, you must contact your doctor immediately, as it can be due to:

  • A blood clot in the lung is known as a pulmonary embolism, where the artery can block blood flow to lung tissue.
  • Inflammation of the membrane covering the lungs, known as pleurisy in which chest pain, worsens when you inhale or cough.
  • A collapsed lung when air leaks into the space between the lung and the ribs.
  • High blood pressure in the lung arteries is known as pulmonary hypertension. This condition affects the arteries carrying blood to the lungs and can produce chest pain.

Disclaimer: Tips and suggestions mentioned in the article are for general information purposes only and should not be construed as professional medical advice. Always consult your doctor or a dietician before starting any fitness programme or making any changes to your diet.

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Chairman of Reliance Industries Mukesh Ambani youngest son of Anant Ambani Recently got engaged to his girlfriend Radhika Merchant. The engagement took place at the house ‘Antilia’ located in Mumbai. Many celebrities were also involved in this ceremony. But only the beautiful couple of Anant Ambani and Radhika Merchant is being talked about everywhere. Along with this, many types of discussions have started happening again on the internet regarding the weight of Anant Ambani.

Actually, after 108 kg weight loss in 2016, Anant became a motivation for obese people. But now his weight has increased again. People are even searching on Google to know the reason behind it. here you Anant Ambani’s Weight Loss Journey From to back, you can know the reason for weight gain in detail.

Nita Ambani told how son Anant’s weight increased

TOI During an interview in 2017, Nita Ambani also spoke openly about son Anant’s obesity. He told that Anant has to take steroids due to asthma. Due to which he is suffering from obesity. According to the reports, earlier the weight of Anant used to be around 208 kg.

(Photo credit- yogen shah)

Big bang entry of ‘Tiger’ to save Shahrukh, fans go crazy after seeing Salman Khan in ‘Pathan’

How do steroids help to treat asthma?

In case of worsening of asthma symptoms (asthma attack), the doctor may prescribe steroid medicine. This medicine helps in reducing the inflammation in the airways due to asthma, due to which the problem of breathlessness is negligible.

how to gain weight with steroids

According to the Asthma and Lungs Organization UK, If you have asthma, it may be more difficult to exercise or stay active as your symptoms worsen. Along with this, taking steroids for a long time can also cause more appetite than normal, due to which the risk of weight gain can increase manifold. There is also a risk of swelling due to water accumulation due to steroid medication, which can cause weight gain.

Anant Ambani did weight loss with this exercise routine

In 2016, Anant Ambani’s weight loss transformation took the internet by storm. It is said that Anant had lost 108 kilos naturally in just 18 months. For this, he used to exercise for 5-6 hours daily. It included 21km walk, yoga, weight training, functional training, cardio.

Followed this diet to lose weight

Anant followed a zero-sugar, high-protein and low-fat, low-carb diet for weight loss. He was consuming 1200-1400 calories every day.

Also his included fresh green vegetables, pulses, sprouts, and dairy products such as cheese and milk. Along with this, he had also completely avoided junk food during this period.

Disclaimer: This article is for general information only. It cannot be a substitute for any medicine or treatment in any way. Always consult your doctor for more details.

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A 33-year-old Seychelles woman, who was on oxygen therapy for the last five years due to cystic fibrosis and pulmonary hypertension, got a new lease of life after Mumbai doctors performed a complicated and complex bilateral lung transplantation.

The patient had a very rare congenital variation, where a single vein in her blood vessels connected her lungs to the heart. She experienced breathlessness and was rushed to a local hospital back in 2018 and had been on oxygen therapy since then. She was diagnosed to have cystic fibrosis, a condition which affects the lungs the most. As the disease progresses, people have shortness of breath, chronic cough, wheezing, digital clubbing, cyanosis and end up coughing up blood. Then they develop pulmonary heart disease that ultimately leads to a collapsed lung. To complicate matters, she was also detected with pulmonary hypertension (a type of high blood pressure impacting the arteries in the lungs and the right side of the heart). In such cases, one needs both heart and lung transplant as both organs are dysfunctional.

The woman was referred to the team at Global Hospitals, Mumbai, where she was registered for a bilateral lung transplant after undergoing several tests. Her treating doctor, Dr Samir Garde, Director of Pulmonology, Interventional Pulmonology and Lung Transplant said, “She came to us with severe breathlessness. At a young age, she was unable to do anything because of her clinical condition. Lung transplantation in such cases not only is life-saving but improves the quality of life dramatically. Lung transplantation is the most challenging transplant to manage as the organ is exposed to an external environment immediately after the surgery. Additionally, as the patient is of African origin, transplanting Indian lungs posed an additional immunological challenge.”

Dr Chandrashekhar Kulkarni, Senior Consultant CVTS and Lead Lung Transplant Surgeon at Global Hospital, mentioned that the transplant performed on December 18, 2022 was challenging as the patient had a congenital variation in her blood vessels connecting the lungs to the heart. “Normally each lung is connected to the upper chamber of the heart by two veins which are each around 1 to 1.5 cm in size. In our patient, we had a single vein of approximately 2 cm placed in an abnormal position, a congenital variation. The donor had standard two veins and the main challenge of the surgery was to conform the two veins to the single vein in such a way that the flow was not obstructed. A slight aberration and it could have led to immediate graft failure as both the site and size were a major deviation from the normal.”

“I am happy to stand on my feet again, walk and breathe freely now. Organ donation is a noble act and everyone should donate organs. I thank the family of the donor for saving my life,” said the patient.



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How to deal with panic attacks: First of all, it is important to understand what a panic attack is. Panic attacks can happen suddenly and without warning. It can be a sudden fear about something. Why these panic attacks happen, there can be many reasons for this. Here in this article, know everything about panic attack. What are the signs or symptoms of a panic attack? What to do if someone is having a panic attack. It is important to understand that panic attacks can be related to anxiety. Often it can be seen in diabetes, blood pressure, heart patients. Green Peas: Don’t consider peas as such, you get these amazing benefits by eating them every day

Symptoms of Panic Attack | Symptoms of Panic Attack

First of all understand its symptoms. It is important to know what kind of symptoms appear when a panic attack occurs.

1. Shivering. It can be experienced all over the body.
2. Rapid and short breathing.
3. Feeling of shivering in the body. Feeling like a heart attack is about to come.
4. Suddenly breathlessness starts. Suffocation can also be felt in this.
5. Being of fear. It may be that the reason for the fear is not known, but still there is an unknown fear of something.
6. Restlessness.
7. Trembling of legs
8. Chest pain and discomfort
9. Vomiting and upset stomach
10. Rapid heartbeat and heart palpitations
11. Feeling hot
12. Fainting.

If such symptoms are seen then it can be a panic attack.

Why panic attack can come, what can be the reasons behind panic attack-

Firstly, the reason behind this could be genetics. In many cases it has been observed that panic attacks are due to genetic reasons.
– Suddenly something happens that dominates the fear.
– Increased heartbeat due to excessive stress and fear.
People who are very sensitive by nature. Cases of his panic attacks can often be seen.
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How You Can Help A Person Having A Panic Attack

The chances of anything bad happening in the event of a panic attack are slim. If you have a panic attack, convince yourself that it is not dangerous. Start talking to yourself or those who have problems. Explain that this situation is a temporary anxiety. You can stop it.

– Breathe in slowly, deeply and slowly through the nose as much as possible.
Exhale slowly and deeply through the mouth.
If this is the case, then counting from 1 to 5 while breathing can be helpful.
Close your eyes and focus on your breath.

By doing this the person facing the attack can feel better.

People with panic disorder often ignore situations that can trigger panic attacks in them. Such people often feel hesitant or afraid to meet people. Underactive Thyroid Signs: These 5 changes in the body indicate that you have hypothyroidism.

when to go to the doctor

If you constantly feel stressed and anxious, especially about when your next panic attack might happen, you may have panic disorder. See a doctor as soon as possible. and better understand your situation.

Disclaimer: This content provides general information only including advice. It is in no way a substitute for qualified medical opinion. Always consult an expert or your doctor for more details. NDTV does not claim responsibility for this information.

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Is COVID-19 Pneumonia Make A Comeback? 7 Signs COVID Is Causing Fluid Buildup In Your Lungs

David Strain, a senior clinical lecturer at the University of Exeter Medical School said that although not as serious as the first one, the world is seeing a rise in the number of patients developing COVID-19 pneumonia.

In 2021, India was hit by the worst COVID-19 wave, triggered by the highly lethal Delta variant. The ferocious second wave of coronavirus had left lakhs infected in the country, and many hospitalized with severe respiratory illnesses. The grim pictures from the deadly second wave were not even out from the memories of the people when experts warned about the re-emergence of the worst symptom that dominated the deadly 2021 surge in India -- COVID-induced pneumonia, or COVID-19 pneumonia.

COVID-19 Pneumonia Is Reappearing: Experts

In a recent statement, experts warned that respiratory illness is making a comeback with either of 2 Omicron variants - BA.4 and BA.5. With the current trend of the virus spread in China, the United States, and Japan, experts are predicting that the virus is making its way back into the environment with a different set of new and old symptoms. Some of these symptoms can be a sore throat and nasal congestion --- falling under the category of new signs of COVID infection. And some can be breathlessness or trouble breathing, and severe lung infection (like COVID pneumonia), falling under the old signs of COVID infection category.

Speaking to the media, David Strain, a senior clinical lecturer at the University of Exeter Medical School said that although not as serious as the first one, the world is seeing a rise in the number of patients developing COVID-19 pneumonia. What is this condition? How can a patient develop COVID-19 pneumonia and what symptoms may show up in the body? Here is what doctors want you to know.

What Is COVID-19 Pneumonia?

Pneumonia, also known as lower respiratory tract disease is an infection in the lungs that leads to fluid buildup inside the air sacs present in the lungs. The COVID virus enters the body through the nose and throat, then it travels down the respiratory tract to reach the lungs. This is the time when an infected patient develops symptoms such as a cough and shortness of breath. However, in some cases, the virus doesn't stop there and goes deep into the lungs. This is when it causes pneumonia. This is when the infection causes a large buildup of inflammatory fluid or even pus. When this happens, the fluid makes it difficult for the oxygen you breathe to get into your blood. And symptoms tend to worsen.

Below we have listed 7 such symptoms that a patient who has developed COVID-19 pneumonia may experience.

Signs COVID Is Causing Severe Lung Infection

It can be challenging to know if someone is developing COVID pneumonia, just on the basis of symptoms. This is mainly because the first symptoms that appear when a person gets infected with COVID-19 are very much similar to pneumonia -- fever accompanied by chills, trouble breathing, chest pain, etc. However, a COVID pneumonia causes much more severe symptoms than just a COVID-19 infection. Here is a list of a few signs of COVID pneumonia:

  1. Fever
  2. A dry cough
  3. Shortness of breath
  4. Change in skin colour
  5. Rapid heart rate
  6. Chest pain
  7. Extreme fatigue

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SHOPPERS raised money for a good cause that helps people improve their lung health through singing. 

Sounds Better CIC collected money at the Salisbury Co-op as part of the shop’s community fund initiative.

The £1714.55 raised will help Sounds Better to run its singing courses to improve lung health.

The courses have been available in Salisbury since 2017 following training with the British Lung Foundation and are now offering face-to-face and online attendance options.

Salisbury Journal: Sounds Better CICSounds Better CIC (Image: Sounds Better CIC)

The co-director of Sounds Better Liv McLennan celebrated alongside other good causes at the Castle Road store before Christmas.

Read more: Serving soldier in Larkhill frustrated with the military house of mould

She said: “We are so grateful to Salisbury Co-op shoppers for raising this significant amount of money. We will be supporting people living with breathlessness, lung conditions and long-covid through our introductory course, which we deliver alongside local Parish Nurse, Rose Maylin.”

Salisbury Journal: Sounds Better CICSounds Better CIC (Image: Sounds Better CIC)

One of the participants who attended a previous course, Hayley said: “Before the course, I couldn’t walk up a small nearby slop within having to stop to recover. I can now. I can certainly hold a note for much longer than I could at the start. Highly recommended.”

Read more: Woman thanks donators after launching Go Fund Me page for her mother

A six-week introductory course to singing for better breathing is due to start on Wednesday, February 22 at the Bemerton Heath Centre and will run until Wednesday, March 29.

The course offers a fun approach to breathing techniques.

For more, go to soundsbettercic.org

 

 



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The Current23:26How the English National Opera is helping long COVID patients breathe a little easier

Read Transcribed Audio

Joanna Herman is finding solace through the power of lullabies.

She has been struggling with the effects of long COVID since she contracted it nearly three years ago, but she joined a program that is making a difference.

The English National Opera in London teamed up with experts from Imperial College London to create The Breathe Programme, which uses singing and breathing techniques to help people with long COVID.

"[It was] an hour of sort of pure joy and fun, and extraordinary exercises that really [were] so beneficial in so many ways," said Herman, who was able to perform her favourite lullaby at one of the U.K.'s most famous theatres last month.

"Having that bit of joy and fun burst on to your screens for an hour a week has been really important and really uplifting and energizing." 

A recent study in The Lancet says it's showing promising results, as participants are reporting a better quality of life and reduced breathlessness.

The ongoing program lasts six weeks, with six one-hour classes online. Suzi Zumpe, creative director of The Breathe Programme, says there are no tests at the end. People learn breathing exercises and sing.

"We perhaps approach things as musicians in a different way than a medic or a physician would. So what's been exciting has been working together with a multi-disciplinary team of people with lots of different expertise and exploring what we might offer together," said Zumpe. 

The power of the lullaby

Zumpe says that when you breathe to sing, you're not thinking about the breath; instead, it happens naturally.

"When you breathe to sing, you breathe in a way that is emotionally connected with the music that you're about to engage with. And when that happens, you're not focused on the minutia of different bits of physiology," said Zumpe. 

Participants aren't belting out lyrics from today's top hits. Zumpe says they very specifically focus on lullabies. 

"Wherever you drop down in the world, people would know what a lullaby is and what it's for. And in fact, if you were to travel back in time, the same is true. They are just in the very fabric of our humanity," she said. 

LISTEN | Hear one of the lullabies that's helping long-COVID sufferer

The tunes are often simple to sing, even for people who aren't professional singers. And, Zumpe added, there's an emotional power to singing a lullaby. 

"Everything that we want to do around this program is connected to calming and soothing, in terms of what's happening with people's breath. And that's what's happening here, really."

A suspended life

Herman says she didn't know what she was getting into when she signed up to participate in the program. At first, it just felt good to be part of a group that shared her experience living with long COVID, and understood what she was going through.

She says it's been both a physical and emotional roller coaster. While it varies day to day, she can struggle to do everyday tasks, and hasn't been able to return to work as a consultant in infectious diseases. She also has to limit her social engagements. 

"I still really feel life is very much suspended. But at the same time, when I look back and think what I could manage, say, a year ago or even a few months ago, I'm making steady progress. But it's painstakingly slow," said Herman. 

She credits that progress in part to the program. What she thought would be weekly sessions of breathing exercises and some singing ended up being much more than that.

Despite finishing her program with the opera, Herman still talks regularly with members of her group.

A woman posing for a portrait.
Joanna Herman has been struggling with the varying day-to-day impact of long COVID, but she says The Breathe Program has helped. (Submitted by the English National Opera. )

"[I've] been part of a group who have really a silent understanding of each other's illness. We don't need to explain ourselves. We don't need to excuse ourselves," she said.

Recently, Herman and the other participants travelled to the London Coliseum, got on stage overlooking a theatre of empty seats, and performed the South African lullaby Abiyoyo, made famous by Pete Seeger. 

"Oh, it was magical. It was exhilarating," she said.

"We had people came in wheelchairs, some were struggling to walk, some were struggling to breathe. But it was that sense of community. It was just the realization of something that was really, really, really wonderful."

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Global Asthma Disease Market - Industry Trends and Forecast

Global Asthma Disease Market - Industry Trends and Forecast to 2028
Data Bridge Market Research analyses that the asthma disease will exhibit a CAGR of around 4.2% for the forecast period of 2021-2028. Rising prevalence of air pollution, cancer, consumption of tobacco and smoking will drive the growth of asthma disease market.
Asthma is a respiratory disease that results in narrowing the airways which leads to difficulty in breathing. Asthma leads to excessive development of mucous in the windpipe which results in period but repetitive attack of breathlessness. Asthma also brings along chest pain, coughing and congestion. Asthma results in lung inflammation and tightens the muscles.
Rising consumption of tobacco and increased smoking are propelling to the growth of asthma disease market. Worsening air quality and increasing air pollution levels will further induce growth of asthma disease market. Increasing prevalence of indoor and outdoor allergens will further promote the number of patients suffering from asthma disease. Increased exposure to certain toxins in the chemical laboratory will again lead to rise in the population suffering from asthma disease.
High costs associated with the treatment will derail the asthma disease treatment market growth rate. Lack of awareness about various novel treatment and drugs available in the market will again derail the asthma disease treatment market growth rate. Under diagnosis of asthma disease in low and middle class economies will pose as a challenge for the market.
This asthma disease market report provides details of new recent developments, trade regulations, import export analysis, production analysis, value chain optimization, market share, impact of domestic and localised market players, analyses opportunities in terms of emerging revenue pockets, changes in market regulations, strategic market growth analysis, market size, category market growths, application niches and dominance, product approvals, product launches, geographic expansions, technological innovations in the market. To gain more info on Data Bridge Market Research asthma disease market contact us for an Analyst Brief, our team will help you take an informed market decision to achieve market growth.
Global Asthma Disease Market Scope and Market Size
The asthma disease market is segmented on the basis of classification type, duration of action type, route of administration and end users. The growth amongst these segments will help you analyse meagre growth segments in the industries, and provide the users with valuable market overview and market insights to help them in making strategic decisions for identification of core market applications.

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Introduction

Approximately one in five people with COPD are also living with frailty.1 Frailty is a multidimensional syndrome, characterised by decreased reserve and diminished resistance to stressors.2 It is relevant across diagnoses, including multimorbidity, and can provide a holistic measure of a person’s health and risk of adverse outcomes. People with both COPD and frailty experience poorer physical and mental health,3 higher risk of readmission4 and mortality,5 and are at higher risk of not receiving disease modifying treatments3,6 compared to those with COPD without frailty. Identifying frailty in respiratory research and practice has been recognised as important by public and professional stakeholders.7

Several measures have been used to identify frailty in people with COPD, and there is no universal agreement on which frailty measure should be used.8 While comprehensive geriatric assessment is the gold-standard approach to identify this syndrome and direct appropriate clinical care,9 brief tools to approximate frailty are essential to identify potential candidates for additional support, and measure frailty as a clinical or research outcome. The Fried Frailty Phenotype (FFP) is one of the most well-established measures of frailty,8 comprising five characteristics: unintentional weight loss, exhaustion, low physical activity, slowness and weakness.10 The Short Physical Performance Battery (SPPB)11 incorporates static balance tests, four-metre gait speed (4MGS), and the five sit-to-stand test, and has recently been recommended by the European Medicines Agency for baseline characterisation of physical frailty in people aged ≥65 years enrolled in clinical trials. Both measures are responsive to change following pulmonary rehabilitation3,12 and predictive of adverse events,13,14 including mortality.14 Using the FFP, people with COPD and frailty have been found to have higher risk of mortality compared to people with COPD without frailty (adjusted HR 1.4; 95% CI 0.97 to 2.0);15 and compared to people with neither COPD nor frailty (adjusted HR 2.7, 95% CI 1.07–6.94).16 While SPPB scores are predictive of mortality in COPD,14 this has not been explored with SPPB scores dichotomised by thresholds for frail versus not frail.

Although both the FFP and SPPB measures have been used to identify people living with frailty, little is known about the comparative characteristics of these measures when used with people with COPD. One study with 395 lung transplant candidates measured frailty using both measures to assess their construct and predictive validity.6 Despite more people being categorised as frail using FFP versus SPPB (28% vs 10%), both measures were associated with physiological and functional baseline characteristics and outcomes. However, only 30% of participants had COPD, and this study did not explore associations between the frailty measures and broader domains of health (eg, psychological, quality of life). Moreover, the multivariate modelling did not control for any widely used and validated prognostic index (eg, Age Dyspnoea Obstruction [ADO] or Body mass index, Obstruction, Dyspnoea, Exercise performance [BODE]).17

How the FFP and SPPB identify people living with frailty, and their varying predictive properties, may have important implications for their use and interpretation. Yet, these measures have not been directly compared in people living with COPD. Differences in the frailty definitions selected may modify the target population and interventional response and/or inform how evidence relating to frailty is synthesised. To support data-driven decision-making in clinical practice and research, this study aimed to compare the FFP and SPPB measures of frailty in people with stable COPD. Objectives were to (a) describe prevalence of, and overlap in, identification of frailty using the two measures; (b) compare disease and health characteristics in those identified as living with frailty using the two measures, and (c) compare the predictive value of the two frailty measures in relation to survival time.

Methods

Design

Cohort study.

Setting

Hillingdon Borough, North West London, United Kingdom.

Participants

Participants were consecutively identified and recruited from community respiratory and pulmonary rehabilitation assessment clinics, between November 2011 and January 2015. Eligible participants included people aged 35 years or over with a physician diagnosis of COPD (consistent with GOLD criteria18), and appropriate for pulmonary rehabilitation referral in line with British Thoracic Society Guidance: able to walk at least five metres, experiencing functional impairment due to breathlessness, and no previous supervised pulmonary rehabilitation in the previous 12 months. Exclusions included exacerbation of their COPD within the past four weeks that required a change in medication, or if moderate-intensity exercise was deemed unsafe (eg, due to unstable cardiac condition). Data from this ongoing research cohort have been published previously.3,19 The current study includes those with complete data for both frailty measures. Where people were assessed for pulmonary rehabilitation more than once during the study period, only their first assessment was included.

Frailty Measures

We compared the FFP and the SPPB, collected at baseline assessments.

The five characteristics of the FFP were assessed, respectively, using self-report unintentional weight loss history, two self-report questions on exhaustion from the Centre for Epidemiological Studies Depression (CES-D) questionnaire, self-reported physical activity from the modified Minnesota Leisure-Time physical activity questionnaire, handgrip dynamometry (weakness), and 4MGS (slowness). The 4MGS was completed using processes validated in COPD20 on a flat, unobstructed course, following a demonstration by the assessor. Participants were able to use their usual walking aids if applicable, and the faster of two attempts completed sequentially without rest was used. Presence or absence of each FFP characteristic was assessed and scored based on standardised criteria, described in detail previously.3 People meeting three or more criteria were considered to be living with frailty;10 those meeting 1–2 (prefrail) or 0 criteria (robust) were considered not to be living with frailty.

For the SPPB,11,21 performance in static balance, 4MGS, and five sit-to-stand tests were each assessed following a standardised protocol from the National Institute of Ageing, and scored from 0 to 4. The sit-to-stand component followed processes validated in COPD,22 including the use of a straight-backed armless chair with a floor-to-seat height of 48cm. Participants began with an initial stand and sit: those completing this successfully completed the five sit-to-stands, while the test was terminated for those unable to complete this initial manoeuvre. Each SPPB component contributes to a total score from 0 to 12, with higher scores indicating robustness. People scoring ≤7 were considered to be living with frailty,21 in line with European Medicines Agency guidance. As there is no consensus over optimal cut-offs when using the SPPB, we also conducted sensitivity analyses using alternative cut-off values of ≤823 and ≤9.24

Analysis

Prevalence and Overlap in Identification of Frailty

The prevalence of participants identified as living with frailty using each measure were described as percentages, and agreement described using Cohen’s Kappa. Agreement was categorised: slight ≤0.20, fair 0.21–0.40, moderate 0.41–0.60, substantial 0.61–0.80, almost perfect 0.81–1.00.25 Overlap in frailty categorisation between the two measures was illustrated using a Venn diagram. Post-hoc analysis explored areas of convergence and divergence between the measures through tabulating and examining inter-item correlations.

Comparison of Population Characteristics

The following characteristics (scale, ranges if applicable) from participants’ baseline assessment were described for those identified as living with or without frailty by each measure: age (years); forced expiratory volume in one second percent-predicted (FEV1% predicted); breathlessness (Medical Research Council [MRC] Dyspnoea, 1–5); Age Dyspnoea Obstruction (ADO) Index (0–14); Body Mass Index (BMI); comorbidities (age-adjusted Charlson comorbidity index); exercise capacity (Incremental Shuttle Walk Test [ISWT] distance in metres); anxiety symptoms (Hospital Anxiety and Depression Scale [HADS], 0–21); depression symptoms (HADS, 0–21); health-related quality of life (Chronic Respiratory Questionnaire Dyspnoea [5–35], Emotion [7–49], Fatigue [4–28] and Mastery [4–28] domains); and independence in basic activities of daily living (Katz questionnaire, scores 1–6 dichotomised some dependence [scores 1–5] and independent [score 6]). Questionnaires and physical measures were collected during their assessment in an outpatient consultation room. Additional information about these measures can be found within the Supplementary Material Table S1.

Following distribution checks for normality, characteristics were described using mean/medians and standard deviations/interquartile ranges (as appropriate) for continuous variables, and using frequencies and percentages for categorical variables. Independent t-tests/Mann Whitney U-tests and chi squared tests (as appropriate) were used to compare those identified as living with and not living with frailty within each measure. A p-value of less than 0.01 was used as the threshold for statistical significance to reduce risk of type 1 error due to multiple testing.26

Predictive Value for Mortality

It is recommended that, in survival analysis, there should be a minimum of 10 events per independent variable included in the model.27 As there were 376 deaths, there were sufficient cases for multivariable modelling.

Participants were followed up prospectively, and date of death was identified from hospital records and/or central National Health Service databases. Time to death in days was calculated from the date of assessment until date of death. Participants who survived were censored on 29th January 2021.

Kaplan–Meier plots and log rank tests were used to assess whether each frailty measure identified groups with different survival curves. The following disease and health characteristics were also assessed for associations with mortality using univariate Cox regression (or appropriate alternatives if proportional hazard assumption was violated), to inform subsequent adjusted analysis: Body Mass Index, comorbidity index, exercise capacity, anxiety, depression, independence in activities of daily living, and pulmonary rehabilitation completion. In separate models for each frailty measure, variables associated with mortality in univariable analyses (p < 0.05) were included in multivariable Cox Regression analysis (or appropriate alternatives if proportional hazard assumption was violated). In all cases, the multivariable analyses included checking for collinearity (r < 0.75), and controlling for sex and the ADO index: the former to account for known sex differences in mortality,28 the latter to determine the prognostic value of the FFP and SPPB over and above an established validated prognostic indicator.29 Analyses were undertaken using IBM SPSS Statistics 27.30

Ethical Approval

Study procedures complied with the Declaration of Helsinki. All participants gave informed consent. The recruitment and follow-up of the cohort received ethical approval from the West London (11/H0707/2) and London Camberwell St Giles (11/LO/1780) research ethics committees.

Results

Participant Characteristics

Of 1084 unique referrals for people with COPD during the study period, 1019 attended their assessment. Of these, 716 (70%) were eligible to be included in the research cohort. Of 716 individual participant assessments during the study period, SPPB scores were missing for 2 participants and the remaining 714 had data for both frailty measures. Four-hundred and twenty-one (59%) were male, and the mean (SD) age was 69.9 (9.7) years. Participant characteristics are shown in Table 1.

Table 1 Participant Characteristics (n = 714)

Prevalence and Overlap in Frailty Identification

Similar proportions of the sample were identified as living with frailty using the FFP (26.2%, n = 187) and SPPB (23.7%, n = 169) measure. There was moderate agreement between the measures (K = 0.469, SE = 0.038, p = <0.001), with matching classifications of frail or not frail in 572 (80.1%) of cases (Figure 1). Sensitivity analysis using SPPB cut-offs of ≤8 and ≤9 led to higher proportions of the sample being identified as frail (33.6% [n = 240] and 46.1% [n = 329], respectively), but lower proportions of matching classifications (76.9% [n = 549] and 70.0% [n = 500], respectively) and lower kappa agreement scores with the FFP (0.452 and 0.377, respectively).

Figure 1 Venn diagram of frailty classification using Fried Frailty Phenotype (FFP) and Short Physical Performance Battery (SPPB) measures (n = 714).

Post-hoc analyses of inter-item correlations (Table 2) suggest that classification discrepancies may have arisen particularly from the weight loss and exhaustion components of the FFP, both of which show the lowest correlations with each SPPB item. Balance was the SPPB item least correlated with the FFP items.

Table 2 Inter-Item Correlation Between Fried Frailty Phenotype and Short Physical Performance Battery Components

Disease and Health Characteristics by Frailty Measure

Participants identified as living with frailty using either the FFP or SPPB were significantly older and had more comorbid conditions but did not show substantial differences in FEV1% predicted or BMI (Table 3). Participants with frailty identified using either measure scored lower on functional exercise capacity and reported more breathlessness and dependence in activities of daily living, higher depression symptoms, and poorer quality of life on the CRQ domains of fatigue, emotion, and mastery. Only participants identified as living with frailty using the FFP (not SPPB) reported significantly poorer anxiety and worse CRQ dyspnoea. Sensitivity analysis using cut-offs of ≤8 and ≤9 for SPPB found similar patterns, but as the cut-off score increased the SPPB showed significant differences in anxiety (≤8 only) and CRQ dyspnoea (≤8 and ≤9) between those with and without frailty.

Table 3 Comparison of People Identified as Living with Frailty versus without Frailty Using the Fried Frailty Phenotype and Short Physical Performance Battery (n = 714)

Predictive Value in Relation to Survival

Of the 714 participants, 376 (52.7%) had died by 29th January 2021. Mean survival time was 2270 days (95% CI 2185–2355); approximately 6 years. For both the FFP and SPPB measure, a higher proportion of people with frailty had died by end of the study period than the non-frail groups: FFP 71.7% (n = 134) with frailty vs 45.9% (n = 242) without frailty died; SPPB 72.2% (n = 122) with frailty vs 46.6% (n = 254) without frailty died.

Survival time was approximately 2 years shorter for those with frailty versus without frailty, using either the FFP (mean 1795 days [95% CI 1629–1961] vs mean 2439 days [95% CI 2344–2533]) or SPPB (mean 1698 days [95% CI 1530–1866] vs 2435 days [95% CI 2342–2527]). As illustrated in the Kaplan–Meier plots in Figure 2, both measures identified a frail group with significantly shorter survival than the group who were not frail.

Figure 2 Kaplan–Meier plots showing survival of frail vs non-frail groups using the Fried Frailty Phenotype and Short Physical Performance Battery.

Univariate Cox regression analysis found that BMI, comorbidities, and exercise capacity were also significantly related to survival, while activities of daily living, anxiety, depression, and pulmonary rehabilitation completion were not. The final multivariable models for each frailty measure and survival included ADO and sex (as forced variables) as well as comorbidities, exercise capacity and BMI. When controlling for these variables, frailty measured using the FFP measure remained a significant independent predictor of survival, while frailty measured using the SPPB did not. However, both showed comparable point estimates, suggesting in either case an increase in mortality risk for those with frailty (Table 4). Sensitivity analysis using the alternative SPPB cut-offs of ≤8 and ≤9 found similar results (≤8 cut-off HR = 1.73, 95% CI 1.41–2.12 and aHR = 1.00, 95% CI 0.77–1.29; ≤9 cut-off HR = 1.78, 95% CI 1.45–2.18 and aHR = 1.04, 95% CI 0.81–1.33).

Table 4 Univariable and Multivariable Prediction of Mortality Comparing the Fried Frailty Phenotype and Short Physical Performance Battery

Discussion

This study compared the properties of the FFP and SPPB measures in people with COPD. We found moderate agreement in frailty classification, including matching classification of frail or not frail in 80% cases. Participants identified as living with frailty using either measure differed significantly from non-frail participants in similar ways: they were older, had more comorbidities and lower functional exercise capacity, and reported more dependence in activities of daily living, higher depression symptoms, and poorer health-related quality of life. People identified as frail using the FFP also reported significantly worse anxiety symptoms. Both measures showed predictive value in relation to survival. While the FFP provided slightly higher independent predictive value than the SPPB when used alongside other measures, including the ADO Index, this difference was marginal and trivial.

This study is the largest to date to use either the validated version of the FFP measure or the SPPB to predict mortality in people with COPD. Building on prior work by Singer et al that compared these measures in 395 candidates for lung transplant,6 we also found approximately 80% matching classifications between the two measures. Moreover, our adjusted hazard ratios for mortality were similar to those for delisting or death before lung transplant (FFP aHR 1.30, 95% CI 1.01–1.67; SPPB aHR 1.53, 95% CI 1.19–1.59).6 Together with smaller studies of the FFP13,16 and SPPB14 measures in people with COPD, there is growing evidence that each measure provides additional prognostic information when predicting mortality in this population, even when including established indexes such as ADO, in the current study, and BODE in the study by Fermont et al14

The FFP and SPPB both identified a group with multidimensional health challenges. Corroborating previous work, we found that around 1 in 4 people with COPD attending pulmonary rehabilitation were living with frailty31,32 and that those with frailty on either measure had lower exercise capacity,6,12 poorer physical function33,34 and increased breathlessness,12,13,33,34 but little difference in lung function.6,12,33 We extend these findings by illustrating associations of frailty, on either measure, with other dimensions of health, including higher depression symptoms, increased dependence in activities of daily living, and lower health-related quality of life. These differences tended to not only be significant but clinically meaningful.35,36 These wider correlates of frailty are in line with qualitative descriptions of the multidimensional losses experienced by people living with both COPD and frailty.37 The FFP measure additionally discriminated between people with different levels of anxiety and CRQ dyspnoea where the SPPB did not. This may reflect closer links between these broader self-reported aspects of health and the self-reported components of the FFP, such as exhaustion.

Measurement of frailty in respiratory research and care is increasingly recognised as important.7,38 Given varying resources and equipment available across settings (eg, handgrip dynamometers), it is helpful to know that there is substantial overlap between those identified as frail using the FFP or SPPB measure and that both measures identify people experiencing multidimensional health challenges. Decisions driven by pragmatic considerations can now be made with an understanding of the different emphases of each measure. For example, the FFP may identify people with more psychological symptoms and be less discriminant in relation to the presence of balance difficulties, while the SPPB may be less discriminant in relation to presence of exhaustion and weight loss. Moreover, this knowledge may inform more purposive use of either measure, for example, depending on the theorised mechanisms and targets of a particular intervention. Importantly, it should be acknowledged that both the FFP and SPPB are only surrogate markers of frailty: a comprehensive geriatric assessment remains the gold-standard approach to identify this syndrome and direct appropriate clinical care.9

Our data show that those identified as frail using the FFP or SPPB are twice as likely to die in the subsequent six years or so than their non-frail counterparts. Although there are limited trial data, growing evidence supports the potential of pulmonary rehabilitation in reversing frailty,3,32 but also of the difficulties those with frailty face in completing this intervention.3,37 Adapted pulmonary rehabilitation approaches for this group that integrate comprehensive geriatric assessment may have a role here,39 and work in this area is ongoing.40 Alongside this, the increased risk of mortality and poorer multidimensional health in those with COPD and frailty should also prompt thinking around the information and support needs of this group, which might include a role for integrated working with palliative care specialists and advance care planning.41

Although the single centre design and restriction to people attending an initial pulmonary rehabilitation assessment may reduce external validity, the large sample size and consecutive recruitment may support some generalisability to other outpatient cohorts. The focus on baseline data (with only survival as follow-up data) also meant little frailty data was missing for this cohort. This analysis included relevant disease characteristics, physical tests and self-reported health across multiple dimensions, including physical and psychological symptoms, activities of daily living and quality of life. This allowed us to comprehensively characterise those with frailty, but also adjust for several important confounders. These measures are routinely collected by skilled professionals during clinical assessments, supporting internal validity. It is important to acknowledge that including the separate component variables for Age, Dyspnoea and Obstruction may have accounted for more variance in the multivariate modelling than the composite ADO index, however it was deemed valuable to understand the prognostic value of the FFP and SPPB over and above an established prognostic indicator. Our long-term mortality follow-up helps demonstrate the value of two common frailty measures over an extended duration, but future work exploring comparative predictive value in relation to hospitalisation and readmission may also be useful. Importantly, this comparison only included two measures of frailty, both of which require physical tests which are not always feasible or practical. Further comparative work exploring the properties of other types of frailty measure including self-report screening tools (eg, FRAIL Scale42) and clinical-judgement-based approaches (eg, the Clinical Frailty Scale43) in COPD is needed. In addition, applicability across different ethnicities is unknown due to lack of data on this characteristic.

In conclusion, we found that in stable COPD, both the FFP and SPPB measures identify people with multidimensional health challenges and increased mortality risk. When used alongside other established measures, including the ADO index, both the FFP and SPPB frailty measures offer added value in predicting mortality.

Data Sharing Statement

All data requests should be submitted to Dr William D-C Man ([email protected]) for consideration. Access to anonymised data might be granted following investigator review.

Acknowledgments

Thank you to the participants for contributing their time to this research, and to Jane Canavan, Sarah Jones, and the clinical teams for supporting data collection. Matthew Maddocks and William DC Man are co-senior authors for this study.

Funding

This study was funded by a Medical Research Council New Investigator Research Grant and a National Institute for Health and Care Research (NIHR) Clinician Scientist Award (DHCS/07/07/009) held by WDCM and a NIHR Career Development Fellowship (CDF-2017-10-009) held by MM. RB is funded an NIHR Clinical Doctoral Research Fellowship (ICA-CDRF-2017-03-018). CE is funded by a Health Education England/National Institute of Health Research Senior Clinical Lectureship (ICA-SCL-2015-01-001). This research was supported by the NIHR Collaboration for Leadership in Applied Health Research and Care South London, now recommissioned as NIHR Applied Research Collaboration South London. This publication presents independent research funded by the NIHR. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, NIHR or the Department of Health and Social Care.

Disclosure

LJB, REB, SP, JAW, OP, SSCK, WG, CJE, and MM have no conflicts to declare. CMN reports personal fees from Novartis, outside the submitted work. WDCM reports grants from Medical Research Council, National Institute for Health and Care Research, and British Lung Foundation, during the conduct of the study. WDCM also involved in educational activities with Mundipharma, Novartis, and European Conference and Incentive Services DMC; and is also part of the advisory board for Jazz Pharmaceuticals, outside the submitted work. The authors report no other conflicts of interest in this work.

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24. Pavasini R, Guralnik J, Brown JC, et al. Short physical performance battery and all-cause mortality: systematic review and meta-analysis. BMC Med. 2016;14(1):215. doi:10.1186/s12916-016-0763-7

25. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;1977:159–174. doi:10.2307/2529310

26. Chen SY, Feng Z, Yi X. A general introduction to adjustment for multiple comparisons. J Thorac Dis. 2017 ;9(6):1725–1729. doi: 10.21037/jtd.2017.05.34

27. Peduzzi P, Concato J, Feinstein AR, et al. Importance of events per independent variable in proportional hazards regression analysis. II. Accuracy and precision of regression estimates. J Clin Epidemiol. 1995;48(12):1503–1510. doi:10.1016/0895-4356(95)00048-8

28. de Torres JP, Cote CG, López MV, et al. Sex differences in mortality in patients with COPD. Eur Respir J. 2009;33(3):528. doi:10.1183/09031936.00096108

29. Puhan MA, Hansel NN, Sobradillo P, et al. Large-scale international validation of the ADO index in subjects with COPD: an individual subject data analysis of 10 cohorts. BMJ Open. 2012;2:6. doi:10.1136/bmjopen-2012-002152

30. IBM Corp. IBM SPSS Statistics for Windows, Version 27.0. Armonk, NY: IBM Corp; 2020.

31. Ter Beek L, van der Vaart H, Wempe JB, et al. Coexistence of malnutrition, frailty, physical frailty and disability in patients with COPD starting a pulmonary rehabilitation program. Clin Nutr. 2019;39:2557–2563. doi:10.1016/j.clnu.2019.11.016

32. Mittal N, Raj R, Islam E, et al. Pulmonary rehabilitation improves frailty and gait speed in some ambulatory patients with chronic lung diseases. Southwest Respir Crit Care Chron. 2015;3(12):2–10. doi:10.12746/swrccc2015.0312.151

33. Patel MS, Mohan D, Andersson YM, et al. Phenotypic Characteristics associated with reduced short physical performance battery score in COPD. Chest. 2014;145(5):1016–1024. doi:10.1378/chest.13-1398

34. Bernabeu-Mora R, Oliveira-Sousa SL, Sanchez-Martinez MP, et al. Frailty transitions and associated clinical outcomes in patients with stable COPD: a longitudinal study. PLoS One. 2020;15(4):e0230116. doi:10.1371/journal.pone.0230116

35. Puhan MA, Frey M, Buchi S, et al. The minimal important difference of the hospital anxiety and depression scale in patients with chronic obstructive pulmonary disease. Health Qual Life Outcomes. 2008;6(1):46. doi:10.1186/1477-7525-6-46

36. Singh SJ, Jones PW, Evans R, et al. Minimum clinically important improvement for the incremental shuttle walking test. Thorax. 2008;63(9):775–777. doi:10.1136/thx.2007.081208

37. Brighton LJ, Bristowe K, Bayly J, et al. Experiences of pulmonary rehabilitation in people living with chronic obstructive pulmonary disease and frailty. A qualitative interview study. Ann Am Thorac Soc. 2020;17(10):1213–1221. doi:10.1513/AnnalsATS.201910-800OC

38. Singer JP, Lederer DJ, Baldwin MR. Frailty in Pulmonary and critical care medicine. Ann Am Thorac Soc. 2016;13(8):1394–1404. doi:10.1513/AnnalsATS.201512-833FR

39. van Dam van Isselt EF, van Eijk M, van Geloven N, et al. A prospective cohort study on the effects of geriatric rehabilitation following acute exacerbations of COPD. J Am Med Dir Assoc. 2019;20(7):850–56.e2. doi:10.1016/j.jamda.2019.02.025

40. Brighton LJ, Evans CJ, Farquhar M, et al. Integrating comprehensive geriatric assessment for people with COPD and frailty starting pulmonary rehabilitation: the breathe plus feasibility trial protocol. ERJ Open Res. 2021;7(1):00717–2020. doi:10.1183/23120541.00717-2020

41. Brighton LJ, Miller S, Farquhar M, et al. Holistic services for people with advanced disease and chronic breathlessness: a systematic review and meta-analysis. Thorax. 2019;74(3):270–281. doi:10.1136/thoraxjnl-2018-211589

42. Morley JE, Malmstrom TK, Miller DK. A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans. J Nutr Health Aging. 2012;16(7):601–608. doi:10.1007/s12603-012-0084-2

43. Rockwood K, Song X, MacKnight C, et al. A global clinical measure of fitness and frailty in elderly people. Can Med Assoc J. 2005;173(5):489–495. doi:10.1503/cmaj.050051

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Unusual Sudden Cardiac Arrest Symptoms: 9 Signs You Are About To Have A Cardiac Arrest

What happens inside your body right before cardiac arrest? Dr Pravin K Goel, Director - Interventional Cardiology, Heart Institute Medanta shares some important symptoms that you may notice.

Sudden Cardiac Arrest (SCA) is a serious heart ailment that necessitates prompt medical attention and treatment. There is a sudden loss of heart function in cardiac arrest. The heart stops or beats too quickly, cutting off blood flow to the brain and the rest of the body. As a result, people experiencing cardiac arrest collapse and become unresponsive. To understand a sudden cardiac arrest, and the various symptoms that the body may show up right before it hits you, we spoke to Dr Pravin K Goel, Director - Interventional Cardiology, Heart Institute Medanta, here's what the doctor has to say.

Each heartbeat is triggered by an electrical impulse sent by the heart. When this electrical impulse pattern abruptly changes, the heartbeat becomes irregular, and the heart stops beating. The heart is unable to transmit oxygen-rich blood to the brain and the rest of the body as a result. If not treated immediately, cardiac arrest can be fatal.

SCA can result in a person's sudden death if medical aid is not offered within the first few minutes. The heart beats at a pace of 60-100 beats per minute, and any fluctuation in this rate, whether too slow (Bradycardia) or too fast (Tachycardia), is referred to as cardiac arrhythmia. Arrhythmia can be fatal in people who have a sudden rise in heart rate or who are genetically susceptible to heart disease.

Warning Sudden Cardiac Arrest Signs

Occasionally up to 2 weeks before an SCA episode, few warning signs and symptoms may occur. The earliest and, in many cases, the sole indication of SCA is loss of consciousness (fainting) caused by a shortage of blood to the brain, which leads to a loss of heartbeat or pulse.

While in most of the cases (>50%) SCA occurs without any prior warning symptoms, some of the symptoms that could occur immediately before an attack are:

  1. Weakness or fatigue
  2. Fainting due to shortness of breath
  3. Feeling dizzy or lightheaded
  4. Palpitations in the heart
  5. Chest ache
  6. Nausea, Vomiting

SCA symptoms also vary slightly between men and women. Men are more likely than women to experience chest pain and have fewer other indicators of discomfort, whereas women are more likely to claim shortness of breath, chest pain, nausea/vomiting, and back or jaw pain.

Unusual Sudden Cardiac Arrest Signs

While chest discomfort is a prominent symptom of SCA, the pain can occur anywhere in the body. It can be in the front, left, or right shoulder, left or right hand, upper tummy, jaw, neck, back between the two shoulder blades, or anywhere between the chin and the umbilicus, front or back.

Recent research studies have shown that a specific type of back pain can also be an early indicator of SCA. This includes upper back discomfort, which may be accompanied by shoulder pain, or new-onset back pain. Furthermore, back pain along with sweating, exhaustion, and shortness of breath are uncommon symptoms of SCA. Having said that, it is also important to check if there is any unusual discomfort while exercising. Feeling dizzy, having unbearable chest pain, breathlessness, fainting, having an irregular heartbeat, and becoming excessively fatigued during or immediately after exercising could be early red flags for a potential episode of SCA.

Cardiac Arrest Response

If you detect signs of sudden cardiac arrest stated above and have experience with CPR, you should immediately call additional help and an ambulance. You can also ask for someone nearby to search for an AED (automated external defibrillator) in nearby buildings. Meanwhile, you can check for the patients breathing and start chest compressions if the individual is not breathing or is merely gasping for air. Mouth-to-mouth breathing is a possibility. At a pace of 100 to 120 reps per minute, press down at least two inches in the middle of the chest. After each rep, let the chest rise back to its starting position. If an AED is available, power up the device and follow the on-screen instructions. Keep doing CPR until the patient begins breathing or moving or until a medical professional with greater experience, arrives to take over.

Critical differences exist between a heart attack and cardiac arrest. When the heart abruptly stops beating, it is called cardiac arrest, which is frequently the result of heart illness. When a person loses consciousness, they stop breathing and show other signs of life. The first hour after this happens is the "Golden Hour" because it is crucial.

Managing the Heart

To maintain overall cardiovascular health, one must implement daily healthy lifestyle practices. A healthy lifestyle includes eating a nutritious balanced diet, exercising regularly, abstaining from, and overcoming bad habits including smoking and drug use, regulating, and restricting alcohol use, ensuring proper sleep cycles, and managing stress. Furthermore, one should be aware of any family history and take the necessary safeguards. Heart attack survivors also need to be more careful and take proper precautions to maintain good health. Regular check-ups are required to diagnose any problems and treat them with the medications and regimens prescribed by the doctor.

In patients who have survived SCA but are at risk of recurrence, an implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy (CRT) device may be used to monitor and improve the heartbeat as well as deliver electrical shocks during potentially fatal cardiac arrhythmias to restore the normal heart rate.

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Singing instructor with the Tune UP programme Namie Rasman said that during the sessions, which are held in three purpose-built spaces called “wellness kampungs” in Yishun, the group does body exercises and vocal warm ups before starting with the singing. 

“The aim is to allow these participants to be aware of their breath and their posture, and also for them to have fun,” she said. 

EFFECTS OF SINGING

Aside from having fun, the singing sessions have helped with the participants’ breathing, she noted.

"Their voices get louder and louder … and they sing longer phrases. So that means they have better control of their breath and are more aware (of their breathing techniques), and they are able to breathe out longer,” she said.

Ms Koh said that being able to better control their breathing can also help with anxiety, which tends to be a common feature in people with breathlessness.

“In a group setting surrounded by other friends who also have breathlessness, that can then also help to give them a sense of belonging, and hopefully also improve their social as well as their psychological well-being,” she said.

Tune UP was adapted from a programme in the United Kingdom by the British Lung Foundation. In that programme, research done on more than 100 participants showed that after 12 weeks of singing, there were significant improvements in how their conditions affected daily living. 

At least two in five reported fewer doctor visits and nearly 20 per cent had fewer hospital admissions.

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I am pregnant but I run out of breath even after walking a short distance.  This did not happen with my other two pregnancies. What could be the cause? Ikara J

Dear Ikara, a number of pregnant women may have the same symptoms associated with pregnancy but sometimes, a pregnancy may not come with the same associated symptoms in women or the same person.

Shortness of breath or mild exertion can happen early on in the pregnancy or in the later months. However, when this is not accompanied by symptoms, it is unlikely that the breathlessness is due to a worrying condition. It is still necessary for your doctor to investigate its cause so that further advice is given.

Breathlessness in pregnancy without symptoms may be due to low fitness levels, becoming overweight or after eating a large meal, among other causes. 

Most times, when it happens in early in pregnancy, increased levels of hormones, especially progesterone which increases the depth of breathing so that more oxygen is taken to the growing baby may be the cause.

Physical exercises such as brisk walking or swimming (not soon after a big meal) and not eating lots of food, especially sweet or fatty foods as advised by the antenatal clinic can help. 

The hormonal issue, though uncomfortable, is harmless and symptoms usually improve as the body gets used to the hormones' bid to expand the lungs to offer more oxygen required by both the mother and growing baby.

With time, the uterus will gradually expand and move upwards, hence reducing the capacity of the lungs which leads to mild exertion. After delivery, this will most likely improve unless there is another cause which may require proper investigation and treatment.

Should any pregnant woman suddenly suffer from shortness of breath, especially after not experiencing the same with her previous pregnancies, or in addition to symptoms such as fatigue, chest pain, cough and difficulty breathing, then she should visit the antenatal clinic immediately. 

The doctors will be able to rule out and manage dangerous conditions including pneumonia, blood clots in the lungs, anaemia, preeclampsia, pre-existing asthma, or a heart condition among others.

Meanwhile, sleeping propped up, avoiding smoking, managing weight through a diet and physical exercise may all help manage your problem.

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by Dr Touseef Khalil Kamal

Herbs also help increase the production of interferons (proteins) and antibodies to generate an immune response against viruses and increase the rate of phagocytosis to destroy microorganisms, thus, increasing immunity from containing viral infections.

At the entrance of the Shalimar Garden in Srinagar outskirts, the health staff on August 26, 2021, is testing a visitor for Covid19. Visitors planning entry into the Mughal garden is subjected to proof that the person is inoculated against the Covid19 or has to undergo a Covid19 test. This is aimed at preventing mass morbidity in anticipation of the third-wave fears. KL Image: Bilal Bahadur

Since December 2019, the world faces the respiratory pandemic, Covid19, an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The term epidemic was coined by Hippocrates who is considered the father of Unani medicine which is based on four humours.

In the Unani System of Medicine (USM) equivalent term for the epidemic is Wabā.  In classical Unani literature symptoms of Nazla-i-Wabā’iyya and Humma-i-Wabā’iyya closely resemble with the symptoms of Covid19. Major manifestations of this outbreak are cough, fever, headache, nausea, and breathlessness. This pandemic takes place due to a change in the quality of the surrounding air.

To date, there is no defined protocol for the management of Covid -19. In these times of crisis. The present control strategies of the disease include interrupting the mode of transmission, reduction of secondary infections by early diagnosis and isolation of cases, providing optimal care to infected patients, and developing effective diagnostic, preventive and therapeutic strategies, including vaccines.

The holistic approach of AYUSH systems of medicine focuses on prevention through lifestyle modification, dietary management, prophylactic interventions for improving immunity and simple remedies based on the presentation of the symptoms.

We reviewed the concept of Wabā, its prevention, and the management strategies available in USM. There is a detailed description of wabah (epidemic), Alahidagee (isolation) and quarantine. It was Hippocrates who coined the term quarantine and advised restriction of movement for forty days to the suspects. Asbab-e-Sittah Zarooriyah (six essentials of life) one of the basic principles of Unani can play an important in the overall development of immunity of a person and the prevention of disease which will be discussed in a full-length paper. Fumigation of surroundings with herbs, use of modified and specific diets and Unani drugs to enhance quwat-e-mudabar-e-badan (innate immunity) can play an important role to fight this covid19 pandemic.

Health experts are time and again insisting on boosting our immunity. Although it has not been proven whether strong immunity helps in treating the novel Coronavirus or not, it may help you to have overall better health. While some people are blessed with good immunity, others are resorting to various natural ways to strengthen their stamina, immune system and overall health. Many of us are practising regular yoga, breathing exercises and more and even trying natural concoctions like herbal teas, drinks and kadhas.

Speaking about kadha, it will not be an exaggeration if we term it to be one of the oldest and most treasured medicinal secrets of India. It is basically a mix of various traditional herbs and spices that help us to keep strong from within.

These herbs also help increase the production of interferons (proteins) and antibodies to generate an immune response against viruses and increase the rate of phagocytosis to destroy microorganisms, thus, increasing immunity from containing viral infections.

Dr Shahid Badar, BUMS from Aligarh is an Internal Medicine Specialist and has over 15 years of experience in the medical field. One of the best Unani physicians, he advised me to prescribe the Unani kadha (Joshanda-e-Badar) to the patients for immune boosting.

It can be prepared with some herbs like 6 gm-Afsanteen, 6 gm-Giloy and 6 gm-Chiraita.

When I contracted Covid19, I started Consuming Unani Kadha twice a day and took proper rest. It helped me survive and within 15 days, I was Covid19 negative. I did not take any anti-biotic.

Outbreaks of respiratory viral infections like severe acute respiratory syndrome (SARS), Middle-East Respiratory Syndrome (MERS), and Covid19 have been a regular occurrence in the past many years. A significant proportion of the morbidity and mortality in influenza is attributed to the co-morbidities and complications induced by the disease, involving vital organs and physiological functions.

Dr Touseef Khalil Kamal

In this context, traditional medicines offer effective protective, palliative, and therapeutic benefits, as observed in several studies on various types of influenza, including Covid19. The Unani herbal decoction comprising Unnāb (Ziziphus jujuba Mill fruit), Sapistān (Cordia dichotoma G. Forst fruit), and Behīdāna (Cydonia oblonga Mill seed) was originally prescribed by Hakim Ajmal Khan (1868-1927 AD) for various respiratory ailments as a bronchodilator, anti-inflammatory, and for clearing the respiratory tract.

During Covid19, the decoction was prescribed by the Ministry of Ayurveda, Yoga, Unani, Siddha, and Homeopathy (AYUSH), Government of India, for mild patients in home isolation, and also as a self-care drink for healthy people. Preliminary studies are of the view that the decoction could reduce Covid19 incidence and prevent severe disease in the population where it was administered.

(The author is an Unani Physician and a Medical Officer (AYUSH) working under National Health Mission at PHC Suid in Block Dachhan District Kishtwar. The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of Kashmir Life.)


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Chronic obstructive pulmonary disease, or COPD, refers to a group of disease that cause airflow obstruction and breathing-related problems. It includes emphysema and chronic bronchitis and has become a major burden to people’s health and economy. COPD is a silent killer in low- and middle-income countries (LMICs): an estimated 328 million people have COPD worldwide , and in 15 years, COPD is expected to become the leading cause of death and the economic impact of COPD among LMICs is expected to increase to £1.7 trillion by 2030

The Month of November Is COPD Awareness Month and 16th November is World COPD Day. The 2022 theme for World COPD Day is “Your Lungs for Life” . This year’s theme aims to highlight the importance of lifelong lung health. Everyone is born with a healthy lung (except congenital cases)but in due course of time smoking, air pollution takes a toll in our lungs and leads to various respiratory disease. In This article we are discussing the preventions and things we should follow to prevent and control COPD other than the medicine part.

Smoking is the leading cause of COPD. Smoking and secondhand smoke exposure during childhood and teenage years can slow lung growth and development and can increase the risk of developing COPD later in life. Secondhand smoke is smoke from burning tobacco products, such as cigarettes,hookah or smoke that has been exhaled, or breathed out, by a person .Quitting to smoke is the easiest way to prevent COPD and those already suffering from COPD ,quitting cigarette smoking helps to prevent Disease Progression.

Air pollution is a known factor which contributes in both causing and exacerbating the symptoms of COPD. Outdoor air pollution from industrial production, garbage burning, secondhand smoke, cigarette smoking and indoor air pollution from biomass fuel are some of the potential sources of air pollution. Common adverse health effects of air pollution are increased irritation of the respiratory tract, chronic cough, chest tightness, decreased pulmonary function and increased vulnerability to allergens and other immune system challenges. Many cities and regions in the developed nations keep a check on their air pollution levels so that people who are suffering from COPD avoid the outdoors when pollution levels are high. In developing nations and underdeveloped regions, there should be implementation of COPD awareness programmes for understanding the disease and being conscious of it. Biomass Fuel exposure is a leading cause of COPD in women hence women should avoid biomass fuel exposure to cook food.

Changes in lifestyle are possible and may be beneficial in preventing COPD. Chest Physiotherapy like Deep Diaphragmatic exercise and purse lip Breathing, Nutritional counselling, education on lung disease help us succeed to curb progression of the disease. The progressive course of COPD is connected with the development of extra pulmonary complications such as cardiovascular diseases, skeletal muscle dysfunction, osteoporosis, cachexia, anxiety and depression. Respiratory rehabilitation is a multidisciplinary program for treating patients with chronic pulmonary diseases and its principal goal is to improve both a person’s quality of life and also how well they function during daily activities.. Physiotherapy is the cornerstone in the structure of respiratory rehabilitation. Physiotherapy includes strength and endurance exercises and breathing exercises to optimize exercise tolerance ,add vigour in daily activities, reduces breathlessness, improves quality of life by applying various therapeutic exercises and breathing techniques.

Next comes the role of Vaccine in Controlling COPD. Patient Suffering From COPD should take their Influenza Vaccine and Pneumococcal Vaccines timely as they help in reducing COPD exacerbation

Lastly before concluding I would emphasize that in COPD ,inhalers are the mainstay of treatment and right inhalers with proper inhalation technique should be taught to COPD patients and COPD patients should never stop their medicine themselves without consulting their doctor. If we follow these simple things, not only COPD can be controlled to a great extent but can also reduce the economic burden which is having a great toll in the developing countries.

Disclaimer: This article is a paid publication and does not have journalistic/editorial involvement of Hindustan Times. Hindustan Times does not endorse/subscribe to the content(s) of the article/advertisement and/or view(s) expressed herein. Hindustan Times shall not in any manner, be responsible and/or liable in any manner whatsoever for all that is stated in the article and/or also with regard to the view(s), opinion(s), announcement(s), declaration(s), affirmation(s) etc., stated/featured in the same.

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The winter season can affect the respiratory system and aggravate respiratory diseases like asthma and chronic obstructive pulmonary disease (COPD). Breathing in cold air can irritate the airway and trigger symptoms like breathlessness, coughing, and mucus production. There are many reasons why asthma symptoms may get worse in the winter.

One is that we spend more time inside and may breathe in air containing triggers such as mold, pet dander, dust mites, and even fires in the fireplace. If we venture out, there is a chance to get exposed to cold air, which may exacerbate asthma symptoms. To make the situation worse, there is an increase in respiratory infections like colds and flu, which may further lead to asthma attacks.

Tips for asthma patients to stay safe in winter

asthma in winter
How to protect yourself against asthma attacks in winter. Image courtesy: Shutterstock

Prevention is the best strategy to tackle asthma. Here are a few tips to keep complications at bay this winter:

1. Hydration is key

Drink a lot of fluids to keep yourself hydrated. In winter, people tend to restrict fluid intake, which may harm their lungs. Also, eat nutritious food to keep yourself healthy and protects yourself against respiratory infections.

Also Read: Eating more omega-3-rich foods can reduce risk of asthma in kids: Study

2. Keep your hands clean

Hand hygiene is one of the best ways to protect yourself. Wash hands with soap and water to prevent respiratory illnesses, such as colds and flu.

3. Cover yourself properly

Always keep yourself covered, especially while going out. Keep a scarf, gloves, and an extra jacket with you, just in case there is a sudden dip in temperature. This would make sure that you are not left gasping for air when it’s too cold.

asthma in winter
Wear clothes properly to avoid asthma attacks in winter. Image courtesy: Shutterstock

4. Try to breathe through your nose

Winter is the flu season that can trigger and even exacerbate asthma symptoms. It is better to breathe through your nose when you’re outside as nasal passages moisten the air before it moves into your lungs.

5. Get vaccinated and take medicines

Be ready for the season by getting your recommended vaccination against influenza,  pneumonia, and COVID-19.

Continue taking your asthma medication as prescribed by your doctor. Don’t miss them or stop them on your own even if you are not having symptoms as these medicines will protect you from getting flare-ups. It’s important to carry your medication with you at all times.

6. Avoid scented products

Avoid using scented products like candles, cleaning supplies, or laundry products, as asthma attacks can be triggered, if you are exposed to the smell. Also, take precautions while you are in the kitchen, as sudden fume, smoke, or strong smell may also trigger asthma. You should also avoid open fires, and wood-burning stoves as smoke can cause much harm.

asthma in winter
Scented products can trigger asthma attacks in winter. Image courtesy: Shutterstock

7. Don’t spend too much time with your pets

Limit time around pets as having a dog or cat in your home may trigger your asthma. Try to keep it out of the bedroom as far as possible.

8. Look out for dust mites

Dust mites present on carpets and mattresses may trigger asthma. Use mite-proof covers on the mattress, box springs, and pillows if possible. Keep the house cool and dry as dust mites and mould don’t grow very well when it’s cool and dry. Other tips to keep your home safe are

  • Running the fan in the bathroom to dry the walls and floor
  • Use the exhaust fan in the kitchen
  • Fix leaky pipes and windows to avoid dampness

Infections like the common cold, cough, and flu are more common during the winter months. It also makes those around you more susceptible to cold and cough due to the aerosol that is released when you cough. Stay away from people who are coughing or suffering from respiratory infections. Also, take appropriate measures

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Fish oil, often referred to as omega 3, has been used for a long time and is well known for its health benefits. Fish like trout, mackerel, tuna, herring, sardines, and salmon that are oily or good for you are used to make fish oils.

They are rich in omega-3 fatty acids and vitamins A and D. It is frequently made from oily fish including tuna, mackerel, anchovies, and herring.

However, it is only seldom manufactured from the livers of other animals, like cod liver oil. According to the  World Health Organization (WHO), 1-2 servings of fish should be consumed weekly. This is due to the fact that fish, which contains omega-3 fatty acids, has a number of health benefits and the ability to prevent a number of diseases.

A separate FDA study recommends daily fish oil consumption. It significantly reduces cholesterol levels in the body and enhances heart health. Additionally, it encourages normal blood circulation. Additionally, it guards against heart disease and stroke. Additionally helpful for a number of kidney-related illnesses is fish oil.

Let us know Omega 3 Fish Oil holds for us - i.e what are it’s actual benefits

1) Helps improving brain function

All other systems in an organism are controlled by the brain. According to study, lower blood levels of omega-3 fatty acids are associated with less melancholy and anxiety. Fish oil supplements have been demonstrated to be superior to a placebo in the treatment of depression when taken in conjunction with recognised therapy.

A proper intake of omega-3 also encourages appropriate cerebral blood flow. Increased blood flow to particular brain regions has been linked to greater performance on particular cognitive activities, according to research on brain imaging.

Additionally, healthy blood flow enhances cognition and lowers the risk of dementia.

2) Helps improve bone density

Taking DHA and EPA omega-3 supplements, according to research, helped elderly people’s spines have higher bone mineral density. A separate research found that taking fish oil supplements was associated with a decreased occurrence of bone fractures, particularly in persons having a greater hereditary risk for this type of damage.

Extensive research has shown that omega-3 fatty acids can inhibit vascular calcification and microcalcification in cancer tissues. These fatty acids improve bone quality by reducing bone degradation and boosting mineralization.

3) Facilitates strong, long and lustrous hair growth

Omega-3 fatty acids have been demonstrated in several studies to nourish hair, encourage its development, and also reduce inflammation, which is occasionally linked to hair loss.

Your skin may appear more young and moisturised after consuming omega-3 fatty acids, and your hair may appear more lustrous and healthy. The hormone that causes hair loss is produced by the enzyme 5-alpha reductase, which is inhibited by omega-3 fatty acids.

4) Boosts skin growth

Omega-3 fatty acids can help control the amount of oil produced by the skin, enhance balanced hydration, lessen breakouts, and delay ageing.

Omega-3 fatty acids also soothe rough, dry skin and aid in the reduction of inflammation and dermatitis. Additionally, they help to create the skin barrier, stop acne, and leave your skin looking radiant and healthy.

5) Treatment for Asthma

A lung condition called asthma leads to breathlessness. Pulmonary edoema is the main factor. 90% of asthma patients have exercise-induced hypersensitivity.

According to one study, supplementing with omega-3 PUFAs may be a successful adjuvant therapy for treating airway hyperresponsiveness. Consequently, it could aid in reducing asthmatic symptoms.

6) Protects against sun damages

Although using sunscreen won’t totally shield you from the sun, being outside is unavoidable. However, fish oil can aid in defending you against the negative effects of UV rays. It can be used to lessen the negative effects of prolonged sun exposure, such tanning and sunburn.

7) Benefits pregnant women

Fish oil supplements may aid in foetal development. It also promotes the development of their brain and eyes. As a result, pregnant women are advised to take fish oil supplements.

Pregnant women, on the other hand, should avoid high-mercury seafood at this time. As a result, pregnant women now require additional fish oil supplements. According to one study, pregnant mothers who took omega-3 or fish oil supplements had children who performed better intellectually.

As a result, prenatal supplements include EPA and DHA. They are required for the early embryogenesis.

8) Improves overall performance

Omega 3 fatty acids elevate our mood and reduce anxiety, tension, and sadness, naturally. Fish oil supplements can encourage a mellower and more composed mood by assisting with mood regulation and ultimately improving total health.

9) Reduce the severity of COVID-19

Regardless of other factors, a reduced chance of developing severe COVID-19 has been linked to low blood levels of omega-3 fatty acids. This study suggests that consuming fish or taking fish oil supplements may reduce the risk of developing severe COVID-19 infections.

10) Helps improving breathing and combating asthma

Asthma is a lung disease that causes shortness of breath. The most common cause is pulmonary edoema. Exercise produces hypersensitivity in around 90% of persons with asthma, the most prevalent cause of the disease.

One study found that dietary omega-3 PUFA supplementation might be a useful treatment method and adjuvant therapy for airway hyperresponsiveness. As a result, it may help to reduce asthma symptoms.

The omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). 

Prorganiq Omega-3 Fish Oil 1000mg Capsules - which is formulated with the proper ratio of ingredients, it is a must to satisfy your daily requirements for Omega-3 fatty acids. This powerful Omega-3 Fish Oil has no odour and is free of heavy metals like lead and mercury.

One of the finest aspects of the product is the enteric coating on the  Prorganiq Omega-3 Fish Oil, which is swiftly and easily digested and absorbed by the body. This enables you to physically feel the consequences and is loved and acknowledged by people of all age and group.

Order Now: prorganiq.com/products/omega-3-fish-oil

“This article is part of sponsored content programme.”

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KIRSTY Brydges would always take deep breaths from her reliever inhaler, hoping it might ease her breathlessness.

"I was constantly wheezing and coughing," says Kirsty. "I had to sleep propped up on pillows and felt dreadful.

"I also developed a hoarse voice. I was terrified there was something seriously wrong with me, not just asthma."

Diagnosed at the age of 38 with the condition, Kirsty had been given an inhaler containing the drug salbutamol, which improves breathing by relaxing muscles in the airways.

But no matter how many puffs Kirsty took, nothing worked. That's because, six years after her asthma diagnosis, the true cause was identified.

In fact, she had acid reflux - or gastro-oesophageal reflux disease (GERD), where stomach acid repeatedly flows into the oesophagus, the tube connecting your mouth and stomach - usually because of pressure or problems with the valve that connects them.

But for some, the symptoms can be confused with asthma as if stomach acid rises up too far, it can fall into the airways, irritating the lungs and causing breathing difficulties.

For some with GERD, this breathlessness may be their only symptom - hence the scope for confusion.

Exactly how many are misdiagnosed is unclear, but a 2017 study in the Journal of the American Medical Association suggested it is relatively common.

When 613 people diagnosed with asthma were given formal tests (such as peak flow, which measures the ability to push air out in one breath), a third were found not to have the condition, but rather others, including GERD.

"GERD is incredibly common," says Jonathan Hoare, a consultant gastroenterologist at Imperial College Healthcare NHS Trust in London, who adds: "No-one has the perfect valve at the bottom of their oesophagus.

"Ten per cent of the population report a bit of reflux in a month - asthma affects 5.4 million people in the UK - and GERD will commonly co-exist. If someone is asthmatic, it may be that reflux is triggering and exacerbating the asthma."

When it comes to why reflux exacerbates asthma, one theory is that acid coming up the oesophagus stimulates the vagus nerve, which can narrow and constrict the airways.

The vagus nerve, connecting the brain and gut, oversees many vital body functions, including digestion and breathing.

"The other theory is that perhaps small amounts of acid come all the way up and go down to the lungs, causing irritation to the airways and narrowing, the same symptoms as in asthma," says Dr Hoare.

But while some research suggests that surgery for acid reflux can improve asthma for some, there is no good evidence that antacids can effectively treat asthma, adds Dr Hoare.

Occasional heartburn, which usually involves a burning pain for a few minutes when food regurgitates, is quite normal and something many people experience at some point.

But it is defined as GERD if the symptoms become more persistent, bothersome and include severe reflux - which is problematic because it can lead to long-term complications.

Risk factors for GERD include obesity, pregnancy and hiatus hernia, where part of the stomach bulges above the diaphragm. But Kirsty never experienced any reflux symptoms, so assumed her doctor's diagnosis of asthma was correct.

Her problems began in 2008 with what seemed to be a cold.

But after Kirsty, a property manager from Nottingham, had shaken off her "snuffles", a persistent cough remained.

"I couldn't get rid of it and was breathless all the time," she says. Her GP prescribed antibiotics for a chest infection but her symptoms were so bad she was constantly wheezing and could only breathe when propped up.

Further tests followed as her GP suspected pleurisy (where tissue between the lining of the lungs and the ribcage becomes inflamed). An X-ray was clear, but revealed a fractured rib.

"It turned out I'd fractured it? through extreme coughing," she says.

Finally after weeks of coughing and struggling for breath, her doctor diagnosed her with?asthma. "He gave me the blue reliever inhaler and told me to puff on it whenever needed," says Kirsty.

She duly went home and used it as instructed for several months, without any changes.

But at a check-up with a nurse a year later, she was given a peak-flow test which cast doubt on that diagnosis.

She recalls: "The nurse took one look at my results and said: 'You're not asthmatic. Your peak flow is too good.' I felt concerned." Still suffering, she returned to her GP in 2010, this time seeing a different doctor.

"I explained I was still breathless and the diagnosis of asthma must have been wrong because the inhaler did nothing to ease the symptoms," she says.

"This new GP listened to my symptoms and simply said: 'You've got GERD.' I had no idea what that even was."

Kirsty was referred to a gastroenterologist, who performed an endoscopy, where a tube with a camera was inserted down her oesophagus - and she was formally diagnosed with GERD. But she wasn't offered any treatment after diagnosis, and for six years Kirsty kept coughing constantly.

She eventually went back to her GP, who referred her for a barium swallow test (which examines the throat and food pipe while the patient swallows a liquid). This detected chronic inflammation and revealed Kirsty had severe GERD. The doctor said this may have caused her breathlessness.

Kirsty was prescribed lansoprazole, a drug that would stop her stomach making acid. Within days of taking the pills, she began to feel better.

"A tightness I'd always felt in my middle went away," she says. "My breathlessness improved. I still had a cough, but that sense of never getting a full breath went away."

Kirsty, now 50, no longer uses her inhaler. "I still take PPIs which have regulated my breathing but I am hoarse a lot of the time and cough a lot," she says.

Dr Hoare adds that while not all will have GERD, "if you're diagnosed with asthma and are getting heartburn, it's worth thinking: why don't I treat my heartburn for a while with a prescription antacid and see if my asthma gets better".

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Mumbai: Temperature fluctuations takes a toll on health, long cough rampant in city | Representational Image

Amid the fluctuating temperatures and high levels of humidity, the city has reported a rise in pneumonia and breathlessness cases among kids since the past few weeks. Health experts said children, the elderly, and those with underlying immunocompromised conditions such as diabetes and asthma are most susceptible to infection.

What are the common symptoms of such pneumonia?

They stressed that getting timely medical help is important to prevent further complications. Common symptoms of such illnesses include high grade fever with chills, breathing difficulty, phlegm, a constant and irritating dry cough, cold, fatigue, vomiting, irritability, etc.

What are doctor's saying?

A senior doctor from the civic-run hospital said there has been a sudden jump in cases since the last week of December, as children and the elderly are among the worst-affected; those with pre-existing lung problems are facing the brunt. “There is a definite rise in respiratory ailments, and it's sending even healthy kids to intensive care. Around 30% jump has been seen in such cases,” he said.

Dr Chetan Jain, a pulmonologist at the Zynova Shalby Hospital, said that winter is synonymous with respiratory issues due to constant weather changes. Children with weak immunity and chronic lung problems such as asthma, bronchitis, congenital heart disease, and kidney disease are prone to pneumonia.

It can cause severe lung damage and even result in death at times. Hence, timely treatment is necessary, he added. “Illnesses are more prevalent in the winter because contagious respiratory droplets spread more readily in dry air when a sick person coughs or sneezes. Patients are often most infectious 2–3 days after becoming ill. They can still spread the infection to others for up to two weeks while recuperating,” he said.

Dr Tanvi Bhatt, pulmonologist at the SRV Hospital, Chembur, said, “Children should especially avoid being in overcrowded areas, try to limit contact with sick people, cover their mouth and nose when coughing, wash their hands thoroughly, eat foods rich in all the essential nutrients, and perform breathing exercises as directed by the doctor in order to prevent pneumonia. During the winter, keep kids warm, offer them warm drinks, use a humidifier at home and avoid pollution.”


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The US Consumer Product Safety Commission backtracked on claims it was considering banning all gas stoves across the United States over health concerns.

Richard Trumka Jr., an agency commissioner, said that potential regulations would only 'apply to new products' in a tweet Monday. 'CPSC isn't coming for anyone's gas stoves. Regulations apply to new products,' he added.

The backtrack came in response to a tweet from Republican lawmaker Rep. Gary Palmer, who voiced outrage that unelected officials could ban an appliance used by tens of millions of Americans.

The idea of banning was first raised by Democrat lawmakers Sen. Cory Booker and Rep. Dan Beyer, who sent a letter to the the CPSC urging it to take action after a study found that gas stoves were linked to higher cases of asthma.

In his backtrack Monday, Trumka added that people who choose to switch to electric stoves would receive an $840 rebate due to President Biden's Inflation Reduction Act.

Richard Trumka Jr., an agency commissioner, said potential regulations would only 'apply to new products'

Richard Trumka Jr., an agency commissioner, said potential regulations would only 'apply to new products'

The CPSC had announced Monday that it plans to take action to address the pollution emitted by gas stoves, which in addition to asthma have been found to leak cancer-causing chemicals.

Trumpka told Bloomberg gas stoves were a 'hidden hazard,' and added that 'any option is on the table' and 'products that can't be made safe can be banned.' 

The agency could also elect to set standards on emissions for gas stoves. 

CPSC is now expected to open a public comment period about the harms of gas ranges later this winter.

It could then decide whether to ban them as soon as this year. 

Rep. Dan Beyer. of Virginia

Sen. Cory Booker, of New Jersey

Democrats Rep. Dan Beyer of Virginia and Sen. Cory Booker of New Jersey sent a letter to the commission last month saying gas stove emissions disproportionately affect black, Latino and low-income communities

The Consumer Product Safety Commission is now considering banning all gas stoves

The Consumer Product Safety Commission is now considering banning all gas stoves

The announcement comes on the heels of a new study that found roughly one in eight cases of childhood asthma in the US are the result of air pollution given off by gas stoves.

This puts emissions from gas cooking at the same asthma risk level as breathing in secondhand smoke.

Asthma affects roughly six million US children each year, and nearly 13 percent of them get it from breathing in the toxins that a gas stove gives off every day.

Findings from the team at the Rocky Mountain Institute in Colorado suggest that the roughly 35 percent of American homes that use gas stoves should mitigate the spread of toxins like nitrogen dioxide and benzene by switching to an electric induction stove.

Their research is the latest installment in a growing body that shows the danger of having a gas stove in the home, which can also emit carcinogenic toxins that put people at risk of severe health effects.

Nearly 13 per cent of asthma cases in children on average can be blamed on the toxins produced by gas ranges. That is considerably higher in several states for which data was available including California, Illinois, New York, Massachusetts, and Pennsylvania

Nearly 13 per cent of asthma cases in children on average can be blamed on the toxins produced by gas ranges. That is considerably higher in several states for which data was available including California, Illinois, New York, Massachusetts, and Pennsylvania

Brady Seals, manager of the carbon free buildings program at RMI, who led the research, said the study proved that by getting rid of gas stoves, the proportion of children being diagnosed with asthma could be reduced by 12.7 percent.

The researchers from Colorado as well as Australia and New York analyzed the risk posed to children from gas emissions and the proportion of American households that have gas stoves, concluding that using gas greatly increased the risk of asthma.

The authors relied on 2019 census data to determine what proportion of American children are exposed to asthma-causing toxins produced by gas stoves, borrowing methodology from a 2018 analysis that found 12.3 percent of pediatric asthma cases in Australia were attributable to cooking on gas ranges.

In some states, the proportion of childhood asthma cases linked to gas ranges is even higher than the nationwide average. Illinois had the highest PAF number at more than 21 percent, while New York’s came in at nearly 19 percent.

‘Said another way, if we theoretically got rid of all the gas stoves in NY, we could prevent an estimated 18.8% of childhood asthma,’ Ms Seals said.

Children living in homes with gas stoves are also 42 percent more likely to have asthma, according to a 2013 report.

Gas stoves introduce toxic pollutants into the air even when they are turned off. Cooking on a gas range creates nitrogen dioxide, a known precipitator of asthma. 

In fact, in 2019 alone, nearly two million cases of childhood asthma were estimated to be due to nitrogen dioxide poisoning.

That is the same pollutant associated with major highways. But because of the more enclosed nature of an indoor room when compared to outside, the pollution in a gas stove kitchen could be stronger than it is on a major freeway.

Gas stoves can also emit methane, which can cause a person to have trouble breathing and cause a rapid heartbeat.

Benzene may also leak from switched-off gas stoves. The chemical has been linked to the development of multiple cancers - though experts believe the amount leaked by stoves is not enough to pose serious danger.

Previous studies have found that gas stoves also give off hexane, which is known to cause permanent weakness and nerve damage in the feet, legs and hands of people who suffer long-term exposure.

Researchers have found the prevalence of about a dozen dangerous chemicals in gas stoves. One of them, hexane, has been linked to nerve damage. The cancer-causing benzene was detected in nearly every stove in a recent sample of gas ranges

Researchers have found the prevalence of about a dozen dangerous chemicals in gas stoves. One of them, hexane, has been linked to nerve damage. The cancer-causing benzene was detected in nearly every stove in a recent sample of gas ranges

Lawmakers have since asked the Consumer Product Safety Commission to consider requiring warning labels, range hoods and performance standards for gas ranges.

In a letter to the agency last month, Sen. Booker, of New Jersey, and Rep. Beyer, of Virginia, urged the commission to take action and called gas stove emissions a 'cumulative burden on black, Latino and low-income households that disproportionately experience air pollution.

The Commission is now planning to open a comment period on the hazards posed by gas ranges later this winter. 

Meanwhile, state and local policymakers are targeting the use of natural gas in buildings as they seek to reduce their carbon footprint.

Nearly 100 cities and counties have adopted policies that require or encourage a move away from fossil fuel-powered buildings, including in New York City where the city council voted to ban natural gas hookups in new buildings under seven stories by the end of the year.

The California Air Resources Board also voted unanimously in September to ban the sale of natural gas-fired furnaces and water heaters by 2030.

Gas stove manufacturers argue that they are just as harmful as other means of cooking

Gas stove manufacturers argue that they are just as harmful as other means of cooking 

But gas stove manufacturers say they are just as harmful as other means of cooking and should not be banned.

The Association of Home Appliance Manufacturers, which represents companies like Whirlpool Corp, said in a statement that cooking of any kind produces emissions and harmful byproducts.

'Ventilation is really where this discussion should be, rather than banning one particular type of technology,' Jill Notini, the group's vice president told Bloomberg. 

'Banning one type of a cooking appliance is not going to address the concerns about overall indoor air quality. We may need some behavior change, we may need [people] to turn on their hoods when cooking.'

Natural gas distributors also argue that a ban on natural gas stoves would drive up costs for homeowners and restaurants with little environmental gain.

The American Gas Association, for example, said that regulatory agencies have presented no documented evidence linking breathing problems to gas stoves.

'The US Consumer Product Safety Commission and EPA do not present gas ranges as a significant contributor to adverse air quality or hath hazard in their technical or public information literature, guidance or requirements,' said Karen Harbert, the president.

'The most practical, realistic way to achieve a sustainable future where energy is clean, as well as safe, reliable and affordable, is to ensure it includes natural gas and the infrastructure that transports it.'

Meanwhile, Republicans say a ban would be more government overreach, with Mike McKenna, a GOP energy lobbyist arguing: 'If the CPSC really wanted to do something about public health, it would ban cigarettes or automobiles long before it moved on to address stoves.

'It's transparently political,' he said. 

All about asthma 

Approximately 25 million Americans have it, including about six million children 

It's a common but incurable condition which affects the small tubes inside the lungs.

It can cause them to become inflamed, or swollen, which restricts the airways and makes it harder to breathe.

The condition affects people of all ages and often starts in childhood. Symptoms may improve or even go away as children grow older, but can return in adulthood.

Symptoms include wheezing, breathlessness, a tight chest and coughing, and these may get worse during an asthma attack.

Treatment usually involves medication, which is inhaled to calm down the lungs.

Triggers for the condition include allergies, dust, air pollution, exercise and infections such as cold or flu.

If you think you or your child has asthma you should visit a doctor, because it can develop into more serious complications like fatigue or lung infections.

 



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