Keep going! Keep going! Keep going!

At this month’s patient support meeting Phil Langridge, Specialist Physiotherapist at Manchester University NHS Foundation Trust, Wythenshawe Hospital, gave a fantastic talk all about spirometry and lung function tests.

He started the talk with a simple question “Do you look forward to lung function tests?” An audience member offered a simple reply “No, it’s purgatory”.

Lung function tests are hard. The thing is, they’re maximum function tests. The staff carrying out the tests sometimes sound a bit strict, firmly telling you to keep going and put more effort in. The tests are tough, and for some people they can take a while to recover from. That’s because they need maximum effort and it can take a lot out of some people.

Phil gave us an overview of most commonly used tests, starting with the spirometry test. Sometimes these tests can be done at your GP surgery with a practice nurse in a familiar setting. Sometimes they have to be done in hospital and this can lack privacy and be a bit intimidating. Try not to worry, staff understand this, just tell them you’re feeling nervous and they’ll do what they can to help so your test gives the best result possible.

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Yeast that live in the human gut can trigger the immune system to cause inflammation in the lung, especially in patients with ABPA.

The yeast Candida albicans lives in the gut as a commensal organism, usually without issue. C. albicans causes the body to produce a particular kind of immune cell, called Th17 sensitive cells, that stop the Candida from causing infections. A new research paper out this month shows that the Th17 cells that react to Candida in the gut also react to Aspergillus in the lung by a process called ‘cross reactivity’.

Cross reactivity was shown to increase the levels of Aspergillus reactive Th17 cells in the blood of patients with Cystic Fibrosis, COPD and asthma, especially during ABPA. This indicates that there is a direct link between the normal, protective Th17 responses against Candida in the gut, and harmful inflammation by Aspergillus in the lung.

In other words, problems in your lungs might be made worse by the normal immune response to Candida in your gut. This knowledge could affect the way we treat flare ups in future. For example, we already know that using antibiotics can increase the growth of Candida in the gut. This new information raises the possibility that increased Candida in the gut could cause increased lung inflammation or a ‘flare up’ of symptoms in patients with Aspergillosis, but further work would be needed to confirm this.

Read the paper here

Pulmonary Rehabilitation – is it worth it?

In last month’s patient meetings here at Wythenshawe Hospital, the topic of pulmonary rehabilitation (PR) came up. Some people said it had been useful, some people felt pushed into it, some people felt it was too much and actually made them feel worse instead of better.

This gave us food for thought and we went away to look at the literature. Has anyone studied the outcomes of PR from the patients’ perspective?

The answer was yes! In October last year a paper was published on exactly that, a survey of 1685 people with self-reported chronic lung disease in 29 countries.

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Which foods can improve your gut bacteria?

In this series the team of BBC journalists and doctors investigate the truth behind a variety of different health topics that have recently been highlighted in the media. For example they regularly test which diets intended to lose weight actually work the best by carrying out simple experiments with volunteers. The experiments are generally well designed though often involve too few people to be ‘proper’ science – and the presenters point this out. Their aim is to inform us better on how we can improve our health without any commercial bias.

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