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Respiratory Health 2019

Why a cough and breathlessness can’t wait

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Dr Nicola Roberts

Research and Education Sub Committee, The Association of Respiratory Nurse Specialists (ARNS)

Beverley Bostock

Asthma Lead, The Association of Respiratory Nurse Specialists (ARNS)

Respiratory disease is the focus of 20% of all general practice consultations, the second most common reason for hospital admission, and the cause of one in five deaths in the UK, but it commands far less attention than heart disease or cancer.

Around 10,000 people in the UK are diagnosed with a lung disease every week (1). Cough and breathlessness are symptoms that should not be ignored. Five respiratory conditions – COPD, asthma, pneumonia, tuberculosis and lung cancer – are the most common causes of severe illness and mortality around the world and each can present with these symptoms (2). Symptoms lasting more than four weeks should be investigated through a combination of accurate history-taking, examinations, and the appropriate use of spirometry or other diagnostic tests (3,4,5).

What causes lung disease?

There are multiple causes of respiratory disease. Smoking, genetics and air pollution all play a part in different conditions. 

What does phlegm tell us?

Phlegm (sputum) can provide a lot of information. Coughing up blood can be a red flag – a sign of a significant underlying illness – and will normally trigger a fast-track referral to hospital. Green phlegm may be a sign of an infection, although this doesn’t always need antibiotics. Yellow phlegm may be seen in asthma.  

Is shortness of breath normal as we age?

In smokers, breathlessness can be another red flag, but any disproportionate breathlessness, even in non-smokers, will need to be investigated. 

What will a respiratory diagnosis mean?

It’s vital to get a confirmed diagnosis to ensure that appropriate, evidence-based treatment is provided. Post diagnosis, annual reviews and follow-ups are essential. All those with a long-term condition should be getting the flu vaccination, smoking cessation advice and, where appropriate, referral to pulmonary rehabilitation.

What can individuals do?

Lifestyle changes can have a big impact. Smoking cessation is crucial. Physical activity is important in respiratory conditions but too many people avoid this because of breathlessness so they get out of condition, which makes the breathlessness worse. Weight loss and a healthy diet can also help to reduce symptoms.  

What else is being done?

The good news is that research is ongoing into the causes and treatment of lung diseases.  The ultimate aim is to find cures, where possible.

1.  British Lung Foundation.  Lung disease in the UK – big picture | 2.  GBD 2015 Mortality and Causes of Death Collaborators. Global, regional, and national life expectancy, all cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016; 388: 1459–1544. | 3.  British Thoracic Society/Scottish Intercollegiate Guidelines Network (BTS/SIGN) SIGN 158. British guideline on the management of asthma. 2019. | 4.  National Institute for Health and Care Excellence. Chronic obstructive pulmonary disease in over 16s: diagnosis and management. 2019. | 5.  National Institute for Health and Care Excellence. Tuberculosis | Guidance and guidelines. | 6.  National Institute for Health and Care Excellence. Lung cancer: diagnosis and management (NICE guideline 122). Updated 2019. | 7.  Roberts NJ, Patel IS, Partridge MR. The diagnosis of COPD in primary care; gender differences and the role of spirometry.  Respir Med. 2016 Feb;111:60-3. doi: 10.1016/j.rmed.2015.12.008. 

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