Two years on: keeping lungs healthy

Our Taskforce Plan made recommendations about preventing lung disease. Here’s what’s happened in 2020.

Comment from the Taskforce’s Chair, Alison Cook

2020 has shown the importance of keeping our lungs healthy like never before; any of us can catch COVID-19, but the sad truth is that some people are at far greater risk of experiencing the most adverse effects from contracting the virus. Emerging evidence suggests that people who smoke who catch the virus can experience more severe symptoms, so it has never been more important to invest in smoking cessation services. There is also some evidence that exposure to poor air quality can worsen the effects of COVID-19. The government has delivered the biggest flu vaccination programme in history to contain the consequences of a simultaneous flu outbreak and additional waves of COVID-19. The health risks associated with people’s place of work have become much more apparent as we see those who work in public facing roles becoming ill with COVID-19 at the highest rates.

Against this backdrop, progress in preventing lung disease has been slow. The government committed to make England smokefree within a decade over a year ago, but still have not published any plans to make this a reality. The Environment Bill, which has the potential to set world-leading new air quality targets, has been delayed.

Together, Taskforce members have kept fighting for action to prevent lung disease, and we will move into 2021 with a stronger case than ever for investment to keep all our lungs healthy.

Recommendation 1a: Plan and fund effective, high-quality stop smoking services which are accessible to everyone who wants to quit

Recommendation 1b: All health care professionals to be trained in offering very brief advice on smoking cessation

Among people who smoke, there’s been increased motivation and quitting success this year, with an estimated one million people having stopped since the beginning of the COVID-19 pandemic.

Local stop smoking services have largely adapted to providing smokers with support from home. ASH reported that within a month of lockdown, most councils had remote provision in place. The British Thoracic Society’s latest smoking cessation audit also found almost twice the number of hospitals had an onsite stop smoking service as compared to 2016.

However, local services are still facing an uncertain future with no confirmed increase in public health funding for delivering tobacco control activity, and we’re still waiting for the government to publish their response to the prevention green paper.

This year research was commissioned by the Asthma + Lung UK to better understand VBA training needs in primary care clinicians. We intend to drive forward progress on this recommendation in year three.

Recommendation 1c: Introduce category D Clean Air Zones in the most polluted towns and cities across England

Recommendation 1d: Place new restrictions on particulate matter (PM) emissions from all sources

Recommendation 1e: Government to introduce a national system of air pollution alerts with health advice

During the first national lockdown levels of air pollution dropped dramatically in many towns and cities. One in six people living with a lung condition reported improvements to their conditions. We had a glimpse of what cleaner and traffic-free cities could look like, and surveys showed higher public support for clean air measures than ever before. In the autumn, before the second national lockdown, road traffic levels had returned to pre-pandemic levels, and it may take considerable time for the public’s use of public transport to return to early 2020 levels.

New research was published this year suggesting a link between COVID-19 and air pollution, but further investigation is needed. What is not in doubt is the contribution of air pollution to the development and exacerbation of long-term respiratory diseases, which can in turn increase the risk of more severe outcomes from COVID-19.

The development and adoption of clean air policies have been delayed nationally and locally. The Environment Bill’s journey through parliament was disrupted by the pandemic and it only returned in November 2020. Successful campaigning by Taskforce members sees air pollution as the only issue in the draft Bill that contains a commitment to establish specific targets on one pollutant (PM2.5). The Taskforce will continue to work with others to see these targets adopted in line with World Health Organisation (WHO) recommendations.

The Ultra-Low Emission Zone (ULEZ) in London has continued to deliver significant reductions in air pollution; since February 2017 there has been a 44% reduction in roadside nitrogen dioxide in the central London ULEZ, with 44,100 fewer polluting cars being driven in the zone daily. However, there have been delays in the introduction of similar zones in other cities including Birmingham, Manchester and Liverpool. This is extremely disappointing, and Taskforce members will continue to press for further and faster action across UK cities in 2021.

Recommendation 1h: Increase rate of flu vaccination among the clinical at-risk groups and front-line NHS and social care staff who have contact with patients

This year’s flu campaign has been bigger than ever before in response to concerns about the burden of the flu season coinciding with another COVID-19 wave. The government expanded the eligibility criteria for the free vaccine, and has set a target to vaccinate 30 million people during autumn/winter 2020.

There is a strong focus on vaccinating people with health conditions and an ambition has been set to vaccinate at least 75% of this group, in line with the Taskforce’s measure of success. It is too early to report on the 2020-2021 figures, but worryingly in 2019-20 uptake among people with chronic respiratory disease was just 48.8%, a fall from the previous year.

More positively, there has been a steady increase in frontline NHS workers receiving the vaccine, with 74.3% getting the jab in 2019-20, compared to 70.3% in 2018-19. However, there are considerable variations between the vaccination rates of different trusts and staff groups and the Taskforce wants to see consistently high levels.

In welcome news, the government has instructed social care providers to report their staff vaccination rate this year for the first time. Funding to support social care staff vaccination has again been provided by NHS England.