CRD editor's corner archive: July-September.

Impaired activities of daily living in pulmonary hypertension. But can it be modified?

September 30th, 2021

Like most chronic respiratory diseases, the burden of living with chronic pulmonary hypertension (PH) impacts of patients’ daily life. In the journal this month, Iwasawa and colleagues document the demographic and disease associations with impaired activities of daily living in a cohort of people with chronic thrombo-embolic PH. As expected the impact of the disease was significant – but the question remains whether these associations are modifiable. We look forward to seeing intervention studies.

Side effects are a bother….

September 26th, 2021

It’s always worth asking patients about the impact of treatments they receive. In a snapshot survey of patients with Sarcoidosis, Kahlmann and colleagues recorded self reported incidence and character of adverse effects of prednisolone and Methotrexate when used as disease modifying therapy. A likert scale of “bothersomeness” was also reported. It’s striking how frequent and burdensome such adverse effects were felt to be by patients. Of course, in making ongoing treatment decisions, these effects would need to be weighed against the benefits but we salute the authors for seeking patients’ views before embarking.

Asthma biologics and breathing

September 25th, 2021

As we repeatedly highlight in the pages of the journal, asking patients how they are feeling usually yields insight. In this vein, Hyland and colleagues provide data on the sensitivity of patient related outcome (PRO) measures in response to the initiation of biologic therapy in asthma. These drugs clearly impact the underlying inflammatory biology of the condition but it is comforting to see that patients also feel better and these data provide insightful data on how PRO instruments perform in this setting. Diving into breathing retraining in COPD

August 17th, 2021

Abnormal breathing pattern is under-recognised in COPD but might be modifiable with retraining interventions. In the journal this month, Borg et al. publish a pilot study of Free-Diving breathing techniques undertaken over a period of 6 weeks in a small group of women with COPD. The intervention was inspired by the Danish Free-Diving team and has the aim not only of modifying breathing pattern but inducing calmness in advance of a dive. The intervention appears feasible in this group of patients and the results promising. Small numbers however and before we consign our patients to Davy-Jones’ locker we’d better do some trials!

The downside of shielding during lockdown

August 12th, 2021

Evidence is accumulating that societal lockdown during the COVID-19 pandemic and additional rigorous shielding for patients at greater risk has reduced the frequency of exacerbation in people with respiratory disease. Many have been concerned however, about a potential adverse consequence on physical activity (PA) and conditioning and on and mental and physical well being. In the journal this month Fettes et al. highlight this by measuring PA, self-reported disability and limits to performance of activities of daily living in people with advanced lung disease. PA in many patients was lower and was associated with self reported disability with a knock on effect on independence. As society opens up, clinicians are going to have to deal with this legacy and weigh ongoing protection from the virus against the need for patients to restore previous activity and vigour.

Respiratory problems in hyper-mobility syndromes and Ehlers-Danlos syndrome

July 22nd, 2021

Helping people with rare diseases is always a challenge because individual physician experience of the syndrome in question will inevitably be limited and treatment strategies are often untested. In the journal this month Chohan and colleagues provide a comprehensive review of respiratory symptoms, organ pathology and management in Ehlers-Danlos syndrome and broader hyper-mobility syndromes. Although data is limited in many areas, it’s clear how burdensome respiratory symptoms are for many such patients. We think this article provides a valuable information resource for healthcare professionals supporting people with these conditions.

Lung disease in the Himalayas

July 6th, 2021

The damaging prevalence and morbidity of chronic lung conditions in low- and middle-income countries (LMICs) is highlighted again in the journal. Ekezie and colleagues systematically review papers reporting the prevalence and characteristics of lung disease in Nepal a country with a large rural population and vulnerable to the twin risks of tobacco consumption and indoor pollution. The authors found it difficult to draw clear conclusions on the prevalence of lung disease emphasizing the need for more robust studies in LMICs. The prevalence of comorbidities more associated with the developed world such as hypertension and diabetes suggests the health burden from lung disease will be substantial.

Functional assessment in ILD; Is all that Glittres gold?

July 5th, 2021

The range of tools available to measure the impact of respiratory disease on physical functioning is wide but most measure performance at a single task (for example walking, standing up from seated etc.). People’s day to day lives are of course much more complex requiring integration of multiple physical capabilities. In this issue of the journal, Alexandre and colleagues test the validity and reliability of a standardised circuit of real-life daily activities such as climbing steps and placing items on a shelf (the ADL-Glittre test) in people with interstitial lung disease. In contrast to the editor’s own housework abilities, participants improved their Glittre performance when it was repeated suggesting a small but significant learning effect. We leave it to readers to judge whether “unfamiliarised” performance offers more insight into the impact of the disease on daily activities.

Fear of COVID-19 in asthma: More than just numbers?

July 5th, 2021

The abrupt onset of the global COVID-19 pandemic in 2020 and the rigorous public health measures taken to counter transmission created a climate of health anxiety for asthma sufferers despite subsequent data suggesting overall risk was not especially high at least for those with mild to moderate disease. Has this had a measurable effect on the mental health of people with asthma? In the journal this month, De Boer et al. report anxiety and depression scores in people with asthma before and after the pandemic and also compare visual analogue scores representing fear of COVID-19 compared with non-asthmatic controls. A measurable impact of the pandemic on people with asthma was observed but overall, scores for anxiety and depression were notably low and did not point to a high prevalence of clinically significant psychological morbidity. We wonder whether the aggregated numbers conceal the impact of health anxieties combined with social lockdown for some individuals which will require a deeper narrative to uncover.