World Aspergillosis Day 2020

World Aspergillosis Day 2020 is almost here! The big day is February 27th and here's a few ideas of ways that you can support the occasion and help to raise awareness of aspergillosis.

Submit your selfie!

The Aspergillosis Trust are asking people to show their support by downloading a selfie card, taking a selfie with it, and uploading it to their 'Selfie Hall of Fame'. Please get involved and show your support!

Add a WAD2020 graphic to your email signature.

We have produced a signature graphic for you to use on emails. Feel free to save your favourite colour version and share it far and wide!

Show your support for WAD2020 on your social media profile pictures.

You can support the campaign to raise awareness of aspergillosis by adding our twibbon to your profile picture. Twibbon will create a new profile picture for you containing the WAD2020 logo. Download this image and upload it to Twitter. Voila!

For Facebook it's much simpler! Just add our frame!

Show your support for WAD2020 on your social media profile pictures.

You can support the campaign to raise awareness of aspergillosis by adding our twibbon to your Twitter profile picture. Simply visit https://twibbon.com/support/world-aspergillosis-day-2020 and add the twibbon to your profile picture in. Twibbon will then create a new profile picture for you containing the WAD2020 logo. Download this image and upload it to Twitter. Voila!

For Facebook it's much simpler! Just add our frame!

Use our social media header images for LinkedIn, Twitter and Facebook.

Please take a look and download and choose your favourite colours.

Display our poster in your office or in a window at home

Print out and display our WAD2020 poster.

Host a coffee morning to raise awareness

On February 27th at 10am The National Aspergillosis Centre will be hosting a virtual coffee morning whilst at AAAM2020. We'll be talking online to patients, researchers and clinicians. We invite you to run your own events at home and at work. So why not gather your friends, family or colleagues, make a brew, enjoy a slice of cake and tweet about taking a moment out of your day to raise awareness using the hashtag #worldaspergillosisday2020

Here's a few assets to download to decorate your home or office. There's bunting, cake labels and invitations!

WAD2020 Coffee Morning Assets


Hope on the horizon: Novel antifungal treatments in development

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A review published recently describes the new antifungals that are in the pipeline that offer hope for the future.

The new drugs described in the review have novel mechanisms of action to overcome resistance, and some offer new formulations providing distinct advantages over current therapies to improve safety profiles and reduce interactions. For example, Rezafungin has shown activity against Aspergillus species and has reduced liver toxicity, better penetration and less risk of resistance.

It is very encouraging to see that several of the compounds have potent activity against Aspergillus species and that Ibrexafungerp, a compound affecting the fungal cell wall, has activity against several Aspergillus species and is in phase 3 clinical trials.

The potential benefits of this drug include:

  • Oral and IV formulation
  • Active against resistant strains
  • Better penetration (IAC)
  • Minimal drug-drug interactions

In addition, olorofim, VL2397 and ABA all have potent activity against Aspergillus species and are in various stages of clinical trial. All in all, there is real hope on the horizon


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How can I protect myself from air pollution?

Air pollution is increasingly reported as being something we need to improve if we are to prevent damaging the health of millions of people. Anyone who experienced the 'pea-souper' fogs of the 1960s and earlier needs little introduction to the subject, but the Clean Air Acts in the UK in 1956, 1963 and 1993 sorted that out didn't they? After all, we don't see those dreadful weather conditions any more do we and now that we no longer burn coal very much those chimneys belching black smoke are a thing of the past?

In truth, conditions are very much better now compared with the 50s but we are a long way from eliminating the air pollution problem, The rise of the motor car and diesel goods transport is a major factor and the harmful, irritant gasses released are much less obvious so tend to be hidden. In the UK these pollutants are now closely monitored by the Environmental Agency and include nitrogen dioxide, sulfur dioxide, carbon monoxide, pm2.5 particulates.

Exposure to airway irritants is still very common outside the home - the popularity of wood-burning stoves in urban and suburban areas is a good example of a new trend that can make matters worse. Bonfires and fireworks are a problem at some times of the year and Global Warming may also lead to increased risk of uncontrolled burning such as happened on the moors surrounding Manchester in 2018 and happens in the US and are currently ongoing in large parts of Australia. Burning causes vast quantities of very fine dust particles and gasses to be released that someone with asthma can find very disabling and after the ongoing bushfires National Asthma Council Australia have published useful help about how to cope with asthma if you find yourself in a smoky area.

An excellent review of the harm air pollution can do to our health and a call to government to take action was released in 2018 by the Royal College of Physicians (Every breath we take: the lifelong impact of air pollution ) and it has been followed up two years later in 2020 when, rather discouragingly they note that some chances to change things have already been missed and progress has been minimal: https://www.rcplondon.ac.uk/news/reducing-air-pollution-uk-progress-report-2018

Is there anything we can do to reduce prevent us from inhaling these irritants?

The British Lung Foundation has an extensive article on this subject for outdoor air. They aren't particularly supportive about the use of facemasks but some aspergillosis patients report that there is some benefit, especially when travelling or gardening.

Indoors as long as we keep doors and windows closed we can keep out a lot of the pollution in the outside air, but of course, it is not always possible to do so as we also need to vent out excess moisture from our homes at regular intervals eg when we shower, bathe, cook or do the laundry. Air filters for use in the home have long been available varying from the token small device to large floor standing devices but are they any good? The answer is that they can reliably clean some things out of the air provided that they are big enough to suit your room size. Good Housekeeping has written a useful guide.

There is a freely available world map of air pollution at https://waqi.info/

map of air pollution

 


'Smart shirt' used to monitor lung function

Hexoskin smart shirt
Hexoskin - the technology used to monitor breathing in this study

'Smart shirts', which are already used to measure lung and heart function in athletes, have recently been tested to determine their reliability in monitoring the lung function of healthy people performing everyday activities. The shirts were found to be reliable, giving researchers hope that they may be used in the future to remotely monitor the lung function of people with lung disease.

Smart shirts, called Hexoskin, use the stretching and contraction of the fabric to sense the volume of air inhaled or exhaled with each breath. They then send this data to an app, where it can be reviewed. The Hexoskin is comfortable and could be worn under clothing, providing an alternative to the bulky equipment traditionally used to measure breathing.

Though the technology is expensive and more work is needed, this study provides hope that the lung function of lung disease sufferers could be monitored remotely and simply by doctors. This would have the advantage that any deterioration of the condition could be recognised at an earlier stage and appropriate medical interventions could be initiated more rapidly. According to one researcher, " Ultimately, we want to improve patients' quality of life. If we can accurately monitor patients' symptoms while they go about their normal activities, we might be able to spot problems and treat them sooner, and this in turn could mean less time in hospital."

Source: 'Smart shirt' can accurately measure breathing and could be used to monitor lung disease


Bedding, allergies and lung health

Image showing crumpled bedding

A recent case report in the British Medical Journal finds that a man has been treated for severe lung inflammation and breathlessness as a result of an allergy to his feather bedding. The source was found after potential triggers - such as his pets and a small amount of mould in his home - had been ruled unlikely, and it was discovered that his symptoms had begun soon after the purchase of new feather bedding. Blood tests revealed antibodies to bird feather dust and he was diagnosed with 'feather duvet lung', a severe immune response to the organic dust from the goose or duck down found within duvets and pillows. Left untreated the condition can cause irreversible scarring to the lungs.

Exposure to allergens can worsen the symptoms of people who suffer from allergies. In many cases, the more allergens there are in an environment, the worse it gets for the sufferer; for some people reducing the amount of allergen can help. The success of this approach depends on which allergen a person is allergic to (you can get tested by your doctor to check this), but if you find that your allergy is to indoor allergens such as dust mites or pet dander it can be worth trying to reduce your exposure to those allergens in your home. Likewise, if your allergy is to pollen or other allergens usually found outside the home, then you can attempt to filter incoming air. This may not work for you – take medical advice first before spending lots of money on ‘anti-allergy’ devices. However, if you find that there may be some point in trying to reduce your exposure to allergens in the home you will find a variety of products designed to do this on the Allergy UK website.

The Asthma charity Allergy UK provides a wide range of services to people suffering from allergies, including supervising a range of retail products that have been properly tested and assessed for efficiency at reducing our exposure to a range of allergens. For those sensitive to fungi we would point out in particular the pillow & mattress covers and HEPA filtered vacuum cleaners, but there are many more. For some homes (or places of work) there are underlying problems of damp - removing the sources of damp will also reduce the amount of fungi in your home and should improve your allergies.

The Allergy UK Seal of Approval

Our main endorsement is the ‘Seal of Approval’. When you see a product with this logo on it, you have the reassurance that the product has been scientifically tested to prove it is efficient at reducing/removing allergens from the environment, or that the product has significantly reduced allergen/chemical content.

The testing is carried out by an independent laboratory to protocols which have been created for the Seal of Approval by leading allergy specialists, specifically to benefit the sufferers of allergy, asthma, sensitivity and intolerance.


The importance of measles vaccination

A vaccination against the measles virus has been available since 1968 and is given to young children to protect them from this potentially deadly virus. This is a very good thing as measles can attack the central nervous system and cause severe damage - in unvaccinated countries it still accounts for hundreds of thousands of deaths and millions of infections.

The virus is highly infectious, spreading through the air and 9 out of 10 people who come into contact with the virus will get measles. It has been so effective that cases of measles in the UK, US and many other parts of the world are now rare. The graph below illustrates the startling effectiveness of the vaccine program in the US.

Measles cases in the US since 1954

Measles hasn't gone away

Despite this success, the measles virus has not been eliminated worldwide. To be fully effective at stopping new infections arriving from overseas (where vaccinations are not the norm) and triggering a spread of cases, it is important that the majority of the people in a country are still vaccinated (herd immunity). In most countries, vaccination is not compulsory, so future success depends on parents opting their children into the vaccination.

Vaccination rate is falling

Unfortunately, vaccination rates have fallen over the last 10 - 20 years, partly triggered by erroneous suspicion that the vaccine might cause autism or other health problems in young children. This means that the number of cases per year is now rising in countries that had all but eliminated measles which is bad for those who are now vulnerable to infection but a recent research report suggests that the problems run deeper and can directly affect aspergillosis patients amongst many others.

Top ten countries for measles cases 2019
Top ten countries for measles cases 2019

Measles virus destroys antibodies

Researchers have discovered that the measles vaccine works in two ways. Firstly it provides protection against the measles virus - but it also protects the immune system of the immunised person against severe attack. Someone who has had measles (child or adult) can have severely reduced protection from other infections for years as the viral infection also results in a huge loss of antibodies that have been built up over the patient's lifetime as a consequence of various infections. We need our antibodies so that our immune system can 'remember' earlier infections by bacteria, viruses and fungi - it enables us to respond quickly to a new infection. Failure to do so means that we have to experience the infection all over again, with all the risks to our health that that involves.

Aspergillosis patients

Aspergillosis patients, as well as people with other respiratory diseases, have a strong tendency to get more lung infections, These infections exacerbate their asthma symptoms and can make breathing so difficult a hospital admission is needed to provide oxygen and long courses of antibiotics are often important. The National Aspergillosis Centre in Manchester, UK has learned that vaccinating patients against these infections, where possible, is helpful as it controls exacerbations of the condition, reduced admissions and improves patients quality of life,

It may now be the case that aspergillosis patients will need to be checked to ensure that they are not at risk of getting measles, as succumbing to the virus could leave them even more vulnerable to secondary respiratory infections.


Fireworks, bonfires and aspergillosis

fireworks

From late October to new year it is common in the UK for fireworks to be lit. Traditional busy times of the year such as Bonfire Night are still the times of heaviest use but instead of all of the celebrations happening on one night, they can now spread over a week. New Year is also a time for fireworks in many parts of the world, though the actual day this is celebrated varies across the globe, with Chinese New Year celebrated at a completely different time of year compared with UK, US and much of the world outside of China.

Firework displays are enjoyed by many wherever and whenever they occur, but there is a downside for people with respiratory disease. Fireworks are made using lots of gunpowder and bonfires often contain lots of damp wood and other burnable materials. Asthma UK warns us that burning all that gunpowder and firewood causes the release of many irritants that we know can potentially cause asthmatic problems. The British Lung Foundation warns us that people with Chronic Obstructive Pulmonary Disease (COPD) are also at risk. Many people with aspergillosis also have asthma and COPD - aspergillosis often comes along with, sometimes as a consequence of other respiratory diseases.

Outside air pollution

If the outside air is very still the irritants can persist and build up in a wide area around large displays, and of course, there are often many smaller displays scattered throughout the neighbourhood. It is pretty common in urban areas for the smoke to build up into an obvious fog with a strong smell which acts as a clear warning that the air is unsafe to breathe for some. Sometimes that fog is still apparent the next morning! However irritant gasses like nitrogen dioxide gas (NO2) can build up and be completely invisible - the gas is colourless and odourless, so be aware and remain vigilant for telltale symptoms of worsening breathing (ie coughing, wheezing, tightness in the chest or shortness of breath).

Airway irritants

Irritants such as very fine particulates in the smoke and NO2 in the exhaust gasses are known to cause asthma attacks so Asthma UK advises avoiding the smoke if you can and to make sure that you have taken your preventer inhaler as prescribed, Bring your reliever inhaler with you if going out and ensure that people around you know what to do should your breathing be affected.

Aspergillosis

People who have aspergillosis might also consider that autumn is a time for many trees to drop their leaves and other plant material to die back. The presence of so much food for moulds means that there can be lots of the Aspergillus fungus on the ground and in the air at these times of the year. Try to avoid places where there is lots of leaf mould being disturbed, for example by people walking to a display and it can be a good idea to wear a facemask to minimise the number of dust and spore particles you are inhaling. If wearing a facemask makes you feel uncomfortable there are now companies making attractive scarves that contain air filtration layer so when they are wrapped over your mouth & nose they provide reasonable protection.


How people with aspergillosis can help look after their liver

https://www.youtube.com/watch?v=GYFJ8oqNdCE

What does our liver do?

Our livers are really important for us to live a healthy life. Tucked right underneath our ribcage it is a large soft organ that has a rich blood supply. It can recognise and break down or filter any toxic substances that it may find - consequently our blood is quickly cleaned of anything that is not meant to be in our bloodstream.

Toxic substances can get into our body when we eat them, drink them, inhale then or when our doctors inject substances directly into our bloodstream. They can even be part of the daily process that continually renews the tissues that make up our bodies, breaking down proteins and ridding us of any toxic by-products of this process. This is a hugely complex process that we are as yet unable to reproduce artificially - the only way we can replace a badly damaged liver is to replace it with a transplanted donated liver.

What happens if our liver stops working?

Not surprisingly if our livers become dysfunctional our bodies soon start to suffer and there is a long list of illnesses caused by a sick liver. One of the most well-known ways we can damage our livers is to take alcoholic drinks to excess regularly, but we should also be aware that obesity is also a risk to our livers.

Why is this important to aspergillosis patients?

In addition aspergillosis patients should be aware that the medications that they have to take can risk damaging their livers. Doctors closely monitor their patients especially when they first prescribe a mediation that may cause toxicity. They need to watch closely for signs of the liver starting to be distressed by monitoring the signs using blood tests referred to as liver function tests. The purpose of these tests is to detect the very early signs of liver distress so that the doctor can take action to prevent any long term damage.
We know that antifungal medication can cause liver damage in some people, sometimes because the dose of an antifungal is too high and a quick adjustment can prevent further problems, or sometimes the patient is switched to a different drug if dose reduction doesn't have the desired impact on the liver.

What can I do?

What can you, the patient do to help yourselves when taking an antifungal medication? Firstly, of course, it is very important to have a good working relationship with your medication team and report any new symptoms quickly to your doctor can assess if any action is needed.

You can also help by keeping your liver in the best condition it can be so that it can detoxify your blood quickly and keep you in the best health possible. You may be surprised by some of the things you should and shouldn't do!

  • Smoking is bad. There are hundreds of toxins in cigarette smoke that your liver has to work on to keep you well while it should be working on other toxins
  • Coffee is good! Take a few cups a day but ensure you are still taking plenty of water as well
  • Alcoholic drinks - stick to medical advice. If you are taking antifungal drugs I am afraid the advice is no alcohol consumption (your liver will love you for it)
  • Eat the rainbow - select fruit and veg of every colour to be part of your diet.
  • Take care when using acetaminophen - often found in colds & flu remedies. No more than 4000 milligrams per day.
  • Weight - keep your Body Mass Index between 18 and 25
  • Infection control - wash your hands well after using the toilet and before preparing food
  • Exercise as much as you can - see your specialist physio for advice
  • Get vaccinated against hepatitis
  • Practice safe sex - diseases transmitted by sex can hurt your liver
  • Avoid 'liver detox' products eg milk thistle, turmeric. Tell your doctor what you are taking.

NOTE: Herbs and supplements cause 25% of the liver damage treated by doctors - especially borage, comfrey, groomwell, coltsfoot but also Atractylis gummifera, celandine, chaparral, germander and pennyroyal oil.

Good foods for your liver (all in moderation)

  • Coffee
  • Oatmeal
  • Green tea
  • Water
  • Almonds
  • Spinach
  • Blueberries
  • Herbs & spices

Foods you should limit

  • Sugar
  • Fatty foods
  • Salt
  • snack foods (usually rich in the above)
  • Alcohol

A step-change in computer power for aspergillosis genomics

Quantum supremacy

Future research in aspergillosis genetics will be (and is being) done with huge computers as they analyse entire genomes and generate huge amounts of data from the information gleaned when sequencing robots read entire genomes of complex living organisms - Aspergillus or human. The human genome contains about 3 billion base pair letters that together form a complex collection of 20-25,000 genes.

Each of these genes may be switched on or off in an infinite array of gene expression that not only makes an organism what it is but also regulates the response of a human body to external events such as infection. It is likely that mistakes in how some of these genes are expressed or how they function contribute to the reason why some of us are vulnerable to fungal infections such as aspergillosis while most of us aren't.

Working out which of this huge number of genes is responsible for allowing fungal infection is clearly a massive task, but it is more complicated than that. If we were to sequence the genome of one person we would only get very limited information about which of their genes are fungal infection susceptibility genes. Perhaps there is more than one gene involved? As a consequence, we need to sequence the genomes of many more people who have aspergillosis in order to get a more accurate impression of the number of genes involved, and which genes are involved in permitting a fungal infection.

We also have to sequence the genomes of people who haven't got aspergillosis so that we have something to compare the test subjects with. All in all, we will need to sequence dozens of individuals in order to arrive at reliable conclusions. This takes many months to achieve.

Computer power

Even with our most powerful computers at the University of Manchester this still takes a lot of time. Investment in Edinburgh genomic computing resources uses state of the art computer power that is 5 x faster than its predecessor, but this is just a linear progression rather than a dramatic step-change in performance likely to radically speed up the genomics work.

Additionally, however fast these computers already are, the rate of advance in computing speed will be forced to slow down as current technology will soon reach its fundamental limits - for example current computers work with 'bits' that represent two states - I and O so we have lots and lots of power but only the ability to work with 'yes' or 'no'. This isn't enough to process the forthcoming mass of incoming data - we need a complete step-change in how computers work to achieve fundamental accelerations in speed.

Google and quantum bits

Google, apart from being a huge company that provided services to you and I, is also a computer research company. It has been working on this fundamental limit to computer speed for some time and has just announced the successful construction of a computer that uses quantum particles rather than 'bits'. Quantum bits can work with many more states compared with 'bits' so you can imagine how that might speed things up a little. Instead of 'yes' or 'no', each particle can also store 'maybe', 'yes and no' and many more - each of these new states would have taken many current bits to achieve the same end.

We can only really appreciate the huge improvement in speed this offers by setting this new computer a really difficult problem to solve - one we know will take a computer using current technology a long time to finish. Google claims that when they set a current computer a particular test problem it would take 10,000 years for it to solve it - I presume that they haven't actually tested that using a realtime run!

Quantum supremacy

How long did the computer using quantum bits take to work out the same problem? It would be really amazing if it could do it in 100 years, incredible if it could do it in 10 years. In fact, Google claims it took just 200 seconds - truly a step-change in computer power for aspergillosis genomics.
If we are able to use that kind of computer power for genomics work in the future we would have results in fractions of a second, speeding up work on aspergillosis genomics 1000's of times, making it theoretically possible we could be doing complete genome checks in a single visit to the clinic in the future.

https://www.bbc.co.uk/news/science-environment-50154993


Advice for people with respiratory conditions in winter

https://www.youtube.com/watch?v=uvweHEQ6nYs

Many patients with respiratory conditions like aspergillosis report increased frequency of chest infections during the winter months, and this is mentioned repeatedly in our Facebook support groups (Public, Private). The cold weather brings problems of many kinds, but respiratory infection is one of the most serious. Infections by bacteria or virus have a major impact on their quality of life as their breathing becomes restricted and often they quickly become too exhausted to carry on with tasks of daily living.

Why does the winter cause increased vulnerability to respiratory infections? Is it because of the cold weather making us weaker and unable to fight off infection? In part - yes it is! Cold air cannot hold moisture as well as warmer air and thus cold air, is drier air. Inhaling dry air tends to dry out our airways and this can make us vulnerable to infection. This has two impacts - it irritates the lining of our airways and makes us cough, which itself increases our risk of infection, but it also dries out the mucous lining our airways and makes it more difficult to move - so we end up coughing much more than normal as we try to cough up this thickened substance.

People with chronic respiratory disease such as COPD, asthma, aspergillosis are particularly vulnerable to dry air as their airways are very sensitive to irritation.

Winter holds all kinds of pressures for the NHS and one of the biggest is a huge increase in people with respiratory conditions whose condition has become worse as a result of the cold weather. This video includes some advice on how to make sure the cold doesn't affect your condition to prevent you from needing hospital treatment.

Reproduced with thanks, produced by NHS Blackpool CCG 2019