It is easy to take breathing for granted, that is, until it all goes wrong. For anyone who has seen a person with COPD struggling to catch their breath, or a person with heart failure drowning in their own lungs, the terror of not being able to breathe is difficult to witness.
In this issue of the BJGP, we focus on respiratory health. The COVID-19 pandemic has taken a particularly hard toll on primary care respiratory diagnostics, with huge disruptions in spirometry provision leading to a wave of undiagnosed COPD. Luke Daines’ Editorial describes the increasingly inequitable access to spirometry post- pandemic, which is a problem because if we can’t diagnose COPD, we can’t manage it effectively. The promise of artificial intelligence (AI) in health care seems always just beyond the horizon, but could AI play a role in increasing diagnostic capacity for spirometry? Gillian Doe et al take that blue sky thinking line and discuss the supportive roles AI could play in interpreting spirometry to increase capacity in primary care. And with smoking the biggest risk factor for COPD, it is good news that there is cross- party political support to increase the legal age for purchasing cigarettes by a year, every year, with a goal to create a smoke-free next generation in the UK.
As smoking bans have demonstrated, policy can make a difference in respiratory health. But what happens when the very air we breathe is poisoning us? Different pollutants and particulate matter in our air penetrate our lungs and damage lung tissue, with pro-inflammatory effects that cascade to other target organs and vasculature. Air pollution is linked to excessive deaths due to respiratory and cardiovascular disease, cancer, dementia, and increased stillbirth.1
The parents of Ella Kissi-Debrah, a 9-year- old girl who died from asthma exacerbated by air pollution near her home in Lewisham, know too well how the breath of the most vulnerable of our population can be stolen by a lack of clean air.2 As medical students we looked with horror at the lungs of Londoners preserved in the Gordon Museum of Pathology and in anatomy classes we were told that the blackened and scarred lungs from years of living in the city was the ‘London tattoo’, all the while wondering how our own lungs were being affected. Despite what we know about the importance of clean air, when the political will is there to reduce air pollution, it is weaponised by opponents. Sadiq Khan recently expanded the ultra-low emission zone in London, aiming to reduce air pollution and its associated health risks. But this policy is widely criticised as too expensive, despite evidence that clean air zones are good value for money through reduced hospital admissions and prescriptions for respiratory conditions.
We know the effects of breathing bad air. What we need in respiratory health is the equivalent of someone breaking the pump handle, because here’s where prevention and public health policy really count.
| Paul Little’s team continue their work on antibiotic stewardship with the external validation of a prognostic score to identify children at low risk of adverse outcomes, which could guide decisions to minimise antibiotics for lower respiratory tract infections. Many of us will have read Roger Neighbour’s The Inner Consultation – How to Develop an Effective and Intuitive Consulting Style, a medical classic and highly influential book that influenced how we perceive ourselves and our patients. He now asks us to extend our understanding of ‘housekeeping’ to a wider, system-level scope of practice in his powerful editorial, A duty to expose. In Life & Times, Euan Lawson discusses 10 clinically relevant BJGP articles recently presented at the Royal Society of Medicine’s primary care update; it’s a good reflection on how this research can directly feed into our day-to-day practice. |
- © British Journal of General Practice 2023
