Improving respiratory care from a primary care perspective:  International Respiratory Coalition 

Last congress morning, a much-changed Milan and ERS appeared: the temperature had dropped, there was light rain, the city smelled of flowers and green grass, and a scarcity of people in the huge conference convention. All the voices, faces, queues and noise of the hard-working ventilation – soon just a memory.

COVID-19 – a fading memory?

The International Respiratory Coalition (IRC) presented its work, and we were reminded that the world suffered from the COVID-19 pandemic just two years ago, but even that memory seems to be fading. The political area lost the knowledge of the pandemia, says Tobias Welte, Hannover, Germany. The next pandemic will, no doubt, come at some point in time, and we must not miss the chance to be better prepared. The IRC was initiated to develop ways to tackle hazards for health care in the respiratory field.

While during the COVID-19 pandemic an increased life expectancy in people living with chronic respiratory conditions was observed¹, re-prioritisation of health care resources also reduced the chances of survival in case of hospital admissions². Hospital mortality of an acute COPD exacerbation, Welte reminds the audience, is 5%, while 30% of persons experiencing an acute exacerbation of their COPD will be re-admitted to hospital. This comprises huge consequences for people and healthcare. Moreover, during the pandemic, more people died due to de-prioritised or delayed care of conditions like lung cancer, cardiovascular diseases or other comorbidities³. Exacerbation rates in COPD became higher than before⁴.

COPD: cheaper to stick to guidelines

Marc Miravitlles, Spain, showed numbers on the financial impact of low adherence to treatment guidelines in COPD^5,6, underlining the societal costs related to exacerbations. One COPD exacerbation has been shown to be a prognosticator for the next exacerbation⁷. Susceptibility to exacerbations in defined groups of persons and prognostics risk factors are known, thus, Dr. Miravitlles concludes: “We know whom we shall concentrate our efforts on in the first place”.

Wildfires, a burning health topic

More threats to global lung health: Christine Jenkins, Sydney, Australia, shows scientific evidence of the devastating impacts of wildfires on health: wildfire smoke is recognised for its toxicity, partly caused by the immense amount of respirable particulate matter. The frequency of wildfires increases after periods of dryness, and as we remember from pictures in the newspapers during summer 2023, wildfires are not limited to Australia or America, but occur in Europe. This gives rise to short and long-term consequences for lung health⁸:
Again, persons living with respiratory conditions are extra vulnerable in such environments, as shown by the increased need for oral corticosteroids⁹. Wildfires release greenhouse gases also contributes to global warming.

So, what can be done NOW to be better prepared for the future?

HEPA filters: For the threats caused by wildfires, use of HEPA filters as well as recommendations for vulnerable groups (children, pregnant women, elderly, and persons living with asthma and/or COPD) to wear face masks and assure valid rescue medication at home were discussed during the presentation.

Vaccinate: The importance of preventive vaccinations cannot be overemphasised, as it has been shown to both reduce morbidity and mortality¹⁰. Furthermore, there is still a need to improve diagnosis of COPD, primarily using spirometry, and with this, to identify persons with increased health risks.

Communicate: In the capacity as representative of GAAPP, an international coalition of 108 patient advocacy groups, Tonya Winders, Hendersonville, USA, emphasised the patient ́s perspective:
we were presented with a clear communication on what matters for patients with respiratory conditions.

We need to look at the person, not just the patient or the diseased organ, says Winders.

Moreover, mortality, morbidity, knowledge of risk factors, and communication matters to patients. She expands the point of the importance of communication and demands information in native languages, taking cultural adaptations into account, and the use of lay language. “Talk as if you were addressing a ten-year old.” As parts of the world are challenged in literacy, reliable digital health information is important, eg. collaborations with YouTube Health or the use of chatbots to manage chronic disease.

What can YOU yourself do?

Educate yourself: More suggested actions can be found in the paper “Climate change and respiratory disease: clinical guidance for healthcare” (see recommended reading).

Organize. If existing channels/organizations can be used to create more impact, use your voice. The IRC is welcoming actions to prepare healthcare for future challenges, but the IRC does not (yet) have national committees in the Nordic region. However, the IRC offers help and support to form one. Go to https://international-respiratory-coalition.org and find the “Join us” form.

Recommended reading:

IRC manifesto:

https://international-respiratory-coalition.org/ wp-content/uploads/2023/06/IRC-Manifesto-Final.pdf

Andersen ZJ, Vicedo-Cabrera AM, Hoffmann B, Melén E. Climate change and respiratory disease: clinical guidance for healthcare professionals. Breathe (Sheff). 2023 Jun;19(2):220222. doi: 10.1183/20734735.0222-2022. Epub 2023 Jul 11. PMID: 37492343; PMCID: PMC10365076.