Breathing is life

Chronic obstructive pulmonary disease (COPD) is the name for a group of lung conditions that cause breathing difficulties. It includes: 

• emphysema – damage to the air sacs in the lungs; 
• chronic bronchitis – long-term inflammation of the airways. 

The main symptoms of COPD are: 

• shortness of breath, particularly when you're active; 
• a persistent chesty cough with phlegm – some people may dismiss this as just a "smoker's cough"; 
• frequent chest infections; 
• persistent wheezing. 

Without treatment, the symptoms usually get progressively worse. There may also be periods when they get suddenly worse, known as a flare-up or exacerbation. That’s why the 2023 theme for World COPD Day is “Breathing is Life - Act Earlier". This year's theme aims to highlight the importance of early lung health, early diagnosis, and early interventions. 

King’s Health Partners Cardiovascular and Respiratory Partnership’s  vision is to be a world-leading collaboration by building on the expertise of all our partners in heart, lung and critical care, to deliver the best outcomes for patients through pioneering care, research and education. 

We caught up with Laura Moth, Clinical Specialist Physiotherapist at Guy’s and St Thomas’ NHS Foundation Trust:  

How do you support new and existing COPD patients with pathways across the partnership?  

“My team works across Lambeth and Southwark to support accurate diagnostics in primary care, this includes the spirometry hubs which have been developed over the past few years. We are available to support GPs with prescribing advice for newly diagnosed and ongoing patients with a diagnosis of COPD.

“We are experts in supporting patients to manage their symptoms to help them to live the best quality of life. We hold a support line where patients can get direct access to a clinician 365 days a year. Sometimes patients with COPD require oxygen at home, we can assess for this and prescribe it where appropriate.

“We recommend that patients who are limited functionally by breathlessness as a result of COPD attend pulmonary rehabilitation. This is a course designed to help people breathe better, improving quality of life and reducing hospital admissions. We have five locations where patients can complete pulmonary rehabilitation across the Boroughs and soon to be a sixth.

“Sometimes patients with COPD become unwell and require a hospital admission, we will see them during their admission to ensure their care is optimised. This includes working across teams to ensure patients can have the best care to support them such as tobacco dependence teams, mental health services and dieticians.” 

How will you expand COPD services in the future to improve care for patients?  

“We hope to be able to provide more care closer to home. We have recently launched the virtual wards and are about to get an additional nurse and physio to be able to better support patients at home when they are unwell to avoid the need for a hospital admission or get them out of hospital earlier.

“We are expanding our pulmonary rehabilitation services so we can provide better access for more people in a more timely fashion and we are about to open an additional programme in Elephant and Castle.” 

We also spoke with Michelle Johnson, Clinical Nurse Lead of Integrated Respiratory Team (IRT) and Respiratory Nurse Specialist, part of a Multidisciplinary Team (MDT) at King’s College Hospital NHS Foundation Trust. 

How does being part of a partnership MDT help you to engage with patients, particularly those in underserved communities? 

“Early diagnosis of COPD is key, so we are always on hand for nurses and consultants to contact the team for advice if required.” 

“Some of our patients have complex needs. Our tobacco dependence team have good links with South London and Maudsley NHS Foundation Trust (NHS FT) to address different addictions and pathways jointly. The team are also currently working towards engaging those with addictions through partnership with Lorraine Hewitt House, the addiction rehabilitation centre in Lambeth.” 

“Patients with COPD are more likely to suffer with mental health problems as well as experiencing difficulties with finances, housing and work. The Integrated Psychosocial Team for Cardio-Respiratory (IPS-CR) consists of a psychologist, psychiatrist, and social worker and was recently recognised with an Outstanding Collaboration in Integrated Care award by King’s Health Partners. They support colleagues through advice and training on psychosocial issues as well as seeing patients directly for holistic assessment, treatment and advice. They attend the IRT MDT meetings weekly to discuss patients.” 

How does being part of the King's Health Partnership help your work? 

“What stands out as joint KHP working is the ability to cover complete support for patients. For example, if we have no weekend cover at King’s College Hospital NHS FT then a message is left to contact the helpline number at Guy’s and St Thomas NHS FT. This is just one way we are pooling our resources to ensure all patients receive the support they require. 

“Working in partnership also enables effective and meaningful peer support. Within the IRT service we have many sub-specialties - including Pulmonary rehab, Tobacco dependence, Oxygen services, plus those based in community and inpatient support and clinics.  The ability to share our expertise and learnings across Lambeth and Southwark – discussing pathways, changes, and challenges with each other in a safe and comfortable way - is wonderful.  It is extended team-working which we have done for many years and I love the way it works, and of course as a result improves patient care.”   

There is also a climate element to COPD care, as Michelle explains: 

“Patients with Respiratory conditions like COPD struggle in extremes of temperature and when air pollution is high. That’s why caring for patients with COPD also means caring for the planet. Inhalers which contain HFC propellants contribute to climate change as the gases are greenhouse gases.  

“At King’s Health Partners, we are committed to reducing the environmental impact of our treatment by supporting patients to transition to low carbon inhalers where possible and ensuring all inhalers are returned to hospital or local pharmacy for disposal. Excitingly we’re launching an inhaler recycling scheme very soon which means any remaining gas can be reclaimed and reused, and the plastic and metal can be recycled too."

Elsewhere in the partnership, Royal Brompton and Harefield Hospitals offers a world-class, multidisciplinary service to COPD patients in both the local community and across the country. For example, the severe COPD clinic at Harefield Hospital is a multidisciplinary consultant-led service that provides assessment and optimum clinical management for patients with COPD, who remain symptomatic despite maximum inhaler therapy. 

The Partnership has published a number of research studies focused on COPD, such as this study on the development and implementation of the lung volume reduction pulmonary rehabilitation tool to identify eligibility for lung volume reduction in people with COPD. 

We spoke also with Alexis M Perkins, a Clinical Research Physiologist at Royal Brompton Hospital, about their role as trial manager for the ON-PACE Trial – a major new COPD trial recruiting now. 

“The team is currently working on the NIHR funded project, The ON-PACE Trial, which is lead by the Royal Brompton Hospital in partnership with Imperial College London, and is open to patients across the Partnership.

The trial is investigating whether taking beetroot juice as a nutritional supplement is beneficial for people living with the most severe form of COPD. Beetroot juice is high in nitrate, and nitrate is needed in the body to absorb and break down nitric oxide. Nitric oxide is an important molecule in the body, as it influences how blood vessels work and how muscles use oxygen. The patient group included in the trial have low oxygen levels, and we want to know whether the supplement can improve the amount of daily physical activity they can do and how hard they find it. We have previously found that giving people with COPD who need to use oxygen a single dose of beetroot juice, produces a substantial increase in how far they could walk (EDEN-OX, 2021). We now want to see if this benefit is sustained over a longer period and if it is enough to make a difference to day-to-day activities.”  

For further information about the trial, please contact onpace@imperial.ac.uk. 

Find out more about King’s Health Partners Cardiovascular and Respiratory Partnership.