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Stoptober takes place every October in the UK. Launched in 2012, the campaign encourages smokers to quit for 28 days. The theme for 2024 is ‘When you stop smoking, good things start to happen’. Bedfont® Scientific Ltd., world leaders in breath analysis, hosted a discussion with Smokerlyzer® Medical Advisory Board Members Dr Amer Siddiq Amer Nordin and Dr Anne Yee. The panel explored the impact Stoptober has on people’s quit smoking attempts as well as, the efforts made in their native Malaysia in regards to smoking cessation.

The discussion covered some interesting subjects around smoking cessation, including Stoptober, smoking cessation efforts in Malaysia, the increasing prevalence of vaping and the role carbon monoxide (CO) devices play in helping individuals quit smoking.

What is Stoptober?

Stoptober is now in its 14^th year; this month-long UK public health campaign encourages smokers to quit for 28 days. Research has shown that if you stop smoking for 28 days, you are 5 times more likely to quit for good¹. This campaign is designed to make quitting smoking more achievable by providing structured support during October, with the ultimate goal of improving public health.

How have marketing regulations around smoking-related products influenced smoking habits and cessation efforts?

Ultimately, we want people to attempt to quit smoking and the environment around those people to support that attempt. This can be done by:

• Giving people the opportunity to quit,
• Advertise and encourage people to quit,
• Provide people with stop smoking aids

The impetus of Stoptober has helped assist people to stop smoking and there are a variety of initiatives within the campaign that are quite useful. Quit smoking aids have been made highly accessible and it has driven healthcare providers to have the materials available to assist people’s quit attempts.

It is estimated that every Stoptober, around 300 – 400 thousand people in the UK attempt to quit smoking². The campaign creates a sense of community, promoting quitting together with a clear structure of 28 days. These points are what make Stoptober so successful.

Are there any behavioural or psychological mechanisms during Stoptober that increase the chance of stopping smoking for good?

During October, as individuals are driven to quit, they are provided with every opportunity to quit. The digital health programme by the University College London (UCL) empowers those who want to quit on their own to do so, but providing a digital app, means those people are not actually on their own. Those who prefer face-to-face interaction have access to stop-smoking clinics across the country.

Stoptober is supported by the government, which drives an actionable campaign for those who want to quit and quit together in masses. This is where the communal effort is helpful, support from others going through the same experience can help.

A good example of communal effort is Ramadan, Ramadan is an Islamic holy month where Muslims fast from dawn to sunset. As Muslims are required to abstain from smoking during fasting hours, this provides the perfect opportunity for Muslims to quit smoking indefinitely and can act as a natural starting point to quit smoking.

Government-led initiatives should not just be one-offs, there should be regular or continuous efforts. People’s motivation to quit smoking should not just be 1 month of the year, in May we have World No Tobacco Day, which then leads to Stoptober and then leads to the New Year when smokers are inspired to make a change and attempt to quit again if they previously were unsuccessful. Eventually, if the cycle continues, people will be more likely to quit for good.

What is happening in Malaysia concerning smoking cessation efforts?

The UK has a goal to be smoke-free by 2030, are there any similar targets in Malaysia?

Malaysia’s goal is to be smoke-free by 2040, reduced from the 2045 date originally set. This allows Malaysia 15 years to plan and strategize how they aim to meet this goal.

Does Malaysia face any unique challenges in comparison to other countries, about reducing smoking rates?

If this question had been asked this time last year, the biggest challenge would have been that Malaysia did not have a Tobacco Control Act, but thankfully this was enforced in October 2024.

Whilst there are some unique challenges, Malaysia faces the same barriers as many other countries in reducing smoking prevalence. Smoking rates are higher among individuals from lower socioeconomic backgrounds compared to those from wealthy backgrounds³. There is a link between poverty stress and smoking, making it more difficult for this group to quit, especially as they lack access to smoking cessation clinics, support and resources.

Higher rates of smoking are found among certain populations in Malaysia such as:

• People with mental health conditions,
• The homeless,
• People in prison,
• People who use illicit drugs.

Higher rates of smoking are also found across different regions in Malaysia and this is likely to be down to the difference in funding and resources available in those locations. In rural areas, even if someone wanted to give up smoking, they would find it hard, due to the lack of help in those areas.

The biggest concern currently in Malaysia is the rise of vaping among young people. In 2011, the prevalence of vaping in young people was around 0.8%, rising to 5.8% in 2023⁴. Resources are now being used to encourage this group of people to quit smoking and vaping.

What role do CO monitoring devices play in helping individuals quit smoking and how effective are they as a motivational tool?

CO devices play an important role in smoking cessation programmes as they offer immediate and tangible feedback to smokers on their CO levels. It is also a key indicator of how smoking impacts the body, providing real-time feedback on the immediate effects of their smoking behaviour. It also shows the results of their daily, weekly and monthly efforts to give up smoking by showing the reduction in CO levels.

Research has shown that those who used a CO device during their quit attempt have higher success rates than those who did not⁵.

We live in a digital world and these devices have the opportunity to integrate with digital health forms, allowing smokers to monitor their progress over time. The Bedfont® iCOquit® Smokerlyzer® does just that.

Malaysia has developed a digital health tool ‘GEMPAQ’ (Getting Every Smoker to Participate and Quit). The app offers smokers a convenient and accessible platform to receive tailored support to help them quit smoking. If this app could be integrated with the Smokerlyzer® devices, it would be a big help to those who want to quit smoking.

In summary, CO devices like the Smokerlyzer® range help to maintain that motivation to keep up with a person’s quit attempt and help them to maintain a no-smoking status. Immediate biofeedback is particularly helpful for some smokers, allowing them to see their quit attempt manifesting positively through the reduction of CO in their respiratory system, which correlates with the improvement of their overall health.

What advice can be given to someone who relapses after Stoptober?

Evidence suggests that the more times you attempt to quit, the more likely it is you will succeed. Stoptober is a great opportunity to re-attempt to quit if a previous attempt has failed earlier in the year.

Both Dr Amer Siddiq Amer Nordin and Dr Anne Yee say “You learn something from each quit attempt, making you stronger to face the next attempt. Each time you gain knowledge and can expand the support network, giving you a better chance of succeeding.”

The discussion covered some very important and interesting topics. To watch the full discussion, see below:

If you enjoyed our expert discussion on Stoptober, be sure to watch our previous discussion on World No Tobacco Day, featuring Dr Amer, Dr Anne and external guest speaker Professor Christopher Bullen.

References

1. Gov.uk. Department of Health and Social Care, NHS England and Neil O’Brien MP. [cited on 22/8/24] Available from https://www.gov.uk/government/news/95-of-ex-smokers-see-positive-changes-soon-after-quitting#:~:text=Stoptober%20is%20based%20on%20evidence,likely%20to%20quit%20for%20good.

2. ucl.ac.uk. UCL. [cited on 17/10/24] Available from https://www.ucl.ac.uk/impact/case-studies/2022/apr/ucl-research-informs-stoptober-helping-thousands-quit-smoking

3. BMC Public Health. Hock Kuang lim, Sumarni Mohd Ghazali, Cheong Chee Kee, Kuay Kuang Lim, Ying Ying Chan, Huey Chien The, Ahmad Faudzi Mohd Yusoff, Gurpreet Kaur, Zarinah Mohd Zain, Mohamad Haniki Niki Mohamad & Sallehuddin Salleh. [cited on 16/10/24] Available from https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-13-8

4. nst.com.my. Hana Naz Harun, Fuad Nizam. [cited on 16/10/24] Available from https://www.nst.com.my/news/nation/2024/05/1051419/600-pct-increase-e-cigarette-users-2023-2011-updated

5. pcrs-uk.org. Noel Baxter. [cited on 16/10/24] Available from https://www.pcrs-uk.org/sites/default/files/CarbonMonoxideTesting.pdf

Bedfont® Scientific Limited hosted an informative webinar Children with Asthma, with seasoned respiratory nurse Carol Stonham MBE leading the discussion along with Kirsty at Medway Asthma Self-Help (MASH). The webinar was a private screening for local Medway football coaches and gave valuable insights on managing, treating and recognising an asthma emergency.

Children spend a lot of time away from home, whether it is at school, nursery or clubs, therefore, it is important that when they are away from home, they are safe. If a child has asthma, the responsible adults around them need to know what to do in the case of an asthma emergency.

The webinar covers some important topics:

• What asthma is,
• When and how to use an inhaler,
• What to do in an asthma emergency.

How common is asthma?

Asthma is a common respiratory condition that affects around 5.4 million people in the UK¹, with 1.1 million of them being children². Asthma is the most common long-term condition among children and young people and the UK has among the highest mortality rates in Europe. It is thought that emergency admissions and deaths related to asthma are largely preventable, with these statistics being linked with deprivation².

It is encouraging to see a small reduction in deaths among children and young people as a result of asthma between 2008-2018³, however, even though the figures are low, they are still too elevated for a condition that should be manageable, making the deaths preventable.

Unfortunately, the trend seems to be rising among 15 – 24 year olds³. A report in 2019 found that out of 19 countries, young people are more likely to die from asthma in the UK, compared to those in other wealthy countries⁴. This is not good enough and we should be doing better than that.

What is asthma?

According to the British Thoracic Society (BTS) and Scottish Intercollegiate Guidelines Network (SIGN) guidelines, asthma is the presence of more than 1 of the following symptoms:

• Wheeze,
• Breathlessness,
• Chest tightness,
• Cough.

It is a combination of variable symptoms, and you may find that over weeks or months, you experience a difference in symptoms. The underlying problem is the airways, the airways can either have hyperresponsiveness, which is an increased sensitivity of the airways or inflammation.

What symptoms do asthma sufferers typically suffer from?

The most common symptoms of asthma are:

• Cough,
• Wheeze,
• Shortness of breath,
• Exercise limitation,
• Duration of symptoms,
• Triggers.

Hopefully, no one suffers from all of the above, but symptoms are variable and can come and go over a period of time. Quite often the person knows what sets their symptoms off.

How does asthma affect the lungs?

Asthma causes an inflammation of the mucous membrane, which can lead to swelling into the airspace, increase in mucous production, twitch airways and bronchospasms.

How do we measure asthma?

There are a few ways asthma can be measured/monitored. First would be a peak expiratory flow meter, this is a simple test where you have a device with a scale. First, you would make sure the slide on the scale is on 0, you would then take a deep breath in and provide a short, sharp blow into the meter.

Another way is spirometry, which is a more advanced look at how the air moves in and out of the chest. It measures how much air you can move out of your chest and how quickly you can do that, as well as the pattern the air follows as it leaves the chest. This test would be carried out in a clinic.

Finally, there is a Fractional exhaled Nitric Oxide (FeNO) test. As standard, we produce small amounts of Nitric Oxide in our breath, but when a patient has inflammation in the chest, the type typically seen in asthma, more Nitric Oxide is produced. A FeNO test, carried out by the NObreath® is suitable for both adults and children, it requires you to take a deep breath in and blow into the device at a steady pace.

Asthma is a serious, long-term condition, and poorly controlled asthma can present physical symptoms. Symptoms in children can include:

• Shortness of breath,
• Tight chest,
• Wheeze.

These symptoms can create further issues in children, as if they feel unwell, they are less likely to take part in physical activity, this then leads them to become deconditioned and at risk of obesity, which can make asthma worse. Poorly controlled asthma can also disturb sleep, which affects concentration, emotions and behaviour.

There are also psychological effects that poorly controlled asthma can have on children. Children, typically like to be like other children and having asthma can make them feel different. They might be embarrassed by their inhaler, meaning they may not use it when needed. They may have experienced an asthma attack in the past and it might make them frightened to do things that could trigger another attack, limiting them to what they can do.

Poorly controlled asthma can also affect education outcomes, as children with asthma may be absent from school for medical appointments or asthma attacks. They might also have reduced concentration due to disturbed sleep or feeling unwell.

How do we treat asthma?

There are around 119 different inhalers available, so there are lots of treatments and options. Our aim is for anyone with asthma to have:

• No daytime symptoms,
• No night symptoms,
• No activity limitations,
• No need for using a rescue inhaler,
• No side effects from treatment,
• Normal lung function.

The main part of treating asthma is treating the underlying inflammation, and if we get that treatment right, the swelling will settle down, the airways will open back up and the patient will find it easier to breathe. However, not all treatment is instant, if a brown-coloured preventer inhaler is used, it must be used for a few days. This allows the medication to settle down the inflammation slowly and once settled it is likely to be needed long-term.

Inhalers are broken down into 2 categories:

If anyone is using a blue rescue inhaler more than 3 times a week, their treatment is not quite right and this would need to be assessed. It is important to know the difference between the treatment inhaler, usually orange and brown in colour and the rescue inhaler which is always blue.

Maintenance and reliever therapy (MART) is also used, this is a combination inhaler. The inhaler contains treatment and rescue medication and is used regularly twice a day if there are symptoms. Extra doses of this inhaler should only be needed occasionally.

It is important to get the inhaler technique right, sadly, many people do not know how to use their inhaler properly and this is partly due to insufficient advice from their healthcare provider. This proves that education is key to enabling patients to take their medication correctly.

Types of inhalers:

• Pressurised metered dose inhaler,
• Spacer devices,
• Breath-actuated meter dose inhaler,
• Dry powder inhaler.

Knowing the different types and the correct way to use them is important. If you have a metered dose inhaler, the breathing technique should be slow and gentle, if you have a dry powder inhaler, you should breathe in fast and hard. If you use the fast and hard technique with a metered dose inhaler, the medication will hit your throat rather than go into your lungs, likewise with the dry powder inhalers, if you do not breathe in fast and hard, you will not move the powder into the lungs.

Spacers are available, usually for children. They are chambers for metered dose inhalers, to slow the speed of the medication and hold it for a few seconds, allowing more time for the user to breathe in. There are many different sizes of spacers available, depending on the age and capability of the users.

What if my asthma is not that good?

If you have all of the previous steps in place and your treatment is correct, asthma can still flair up. If this happens, there are steps you can take to tackle this.

• Use treatment inhalers regularly,
• Make sure you know how to best use your inhaler,
• Be aware of triggers,
• Book a review with the asthma nurse,
• If you need your blue rescue inhaler more than 3 times a week, book an appointment,
• If you are short of breath and your inhaler is not helping, make an urgent GP appointment for the same day.

What should you do in an asthma attack?

Knowing what to do during an asthma attack can be the difference between life and death, the below graphic from Asthma + Lung UK shows the steps you should take during an attack.

https://www.asthmaandlung.org.uk/conditions/asthma/asthma-attacks#:~:text=an%20AIR%20inhaler-,Sit%20up%20%2D%20try%20to%20keep%20calm.,not%20improving%2C%20repeat%20step%202

To ensure the care is right, everyone should have a personalised asthma action plan. Various formats are available, an example from Asthma + Lung UK below is:

Action plan available from https://www.asthmaandlung.org.uk/conditions/asthma/manage/your-asthma-action-plan

The green area represents when your asthma is good, this is how it feels when my asthma is good and this is the medication I take to maintain good asthma control.

Amber is when things are starting to get worse, how can I recognise when it is beginning to deteriorate? It gives you steps to follow to improve symptoms and move back into the green.

Red represents an asthma emergency and what to do in this situation.

It is important to recognise when you are in the red and what to do in case this happens, but it is also good to realise when you are in the amber so you can get yourself back on track to green.

How can we manage the effect of our triggers?

Sometimes, there is not much that can be done to avoid our triggers, but where possible, you can eliminate or avoid them. You can treat other conditions that trigger your asthma and make sure your asthma is well managed. You can predict the triggers. For example, if hay fever is a trigger, start treating your hay fever early. Lastly, always have your rescue medication to hand.

Parents and carers must understand asthma to understand how the medication works and why it is important. They need to have an asthma action plan, know how to maintain control and know what to do in an emergency. They also need to know what to do if an inhaler has been forgotten.

With asthma still an ongoing serious respiratory condition that kills children every year, this webinar has helped people understand the following:

• Asthma and the treatment,
• The goals of the treatment,
• How and when to use inhalers,
• Why asthma worsens,
• What to do in an emergency.

To watch the full webinar and gain in-depth insights, click here.

References

1. Asthma + Lung UK. [cited on 8/10/24] Available from https://www.asthmaandlung.org.uk/conditions/asthma/what-asthma
2. RCPCH State of Child Health. [cited on 8/10/24] Available from https://stateofchildhealth.rcpch.ac.uk/evidence/long-term-conditions/asthma/
3. PMC PubMed Central. Wei-Yu Chen, Ching-Wei Lin, Ju Lee, Po-Sung Chen, Hui-Ju Tsai and Jiu-Yao Wang. [cited on 8/10/24] Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8102795/
4. BBC News. [cited on 8/10/24] Available from https://www.bbc.co.uk/news/health-47292157#:~:text=Young%20people%20in%20the%20UK%20are%20more%20likely%20to%20die,of%2019%20high%2Dincome%20countries.

Bedfont® receives recognition for creating a supportive and inclusive workplace and commitment to mental wellbeing.

 The Kent Mental Wellbeing Awards, an event delivered by Mind in Bexley, are held annually to showcase the people, organisations and initiatives that help us cope with life. Bedfont® was nominated for one of these awards last Summer.

Bedfont® is a local MedTech company, based in Harrietsham, with over 47 years of expertise and knowledge in designing and manufacturing medical breath analysis devices. With mental wellbeing at the heart of Bedfont®, there is a dedicated team of Wellbeing Warriors in force, ensuring a healthy work/life balance for all staff members.

Jason Smith, CEO at Bedfont® comments “At Bedfont®, mental wellbeing is at the core of everything we do. We understand that when our employees feel supported and empowered, they thrive, not just professionally, but personally as well.”

The Bedfont® Wellbeing Warriors continue to bring employees together, encouraging them to take a break from their desks and join in activities designed to help them switch off from work temporarily, giving their minds a break.

To keep up to date with all the activities and news at Bedfont®, follow their social channels. @bedfontLtd

Bedfont® champions Heart of Kent Hospice auction by winning sponsored sculpture and contributing to the memorial garden.

Bedfont® Scientific Ltd. a local med-tech company with over 47 years of expertise in the design and manufacture of medical breath analysis devices, proudly sponsored a Shaun the Sheep sculpture in this year’s Shaun in the Heart of Kent Art Trail. Organised by Heart of Kent Hospice, the event took place in the summer and saw many Shaun the Sheep sculptures lovingly decorated by local artists and community initiatives. The sculptures were then placed in various locations in and around Maidstone, aiming to raise vital funds for the hospice. The Bedfont® sponsored sculpture ‘Shorn the Return’ was located by the Old Boat Café in Maidstone.

Over 250 people attended the auction event and every sculpture was sold, raising a staggering £267,250.00 on the night. The event proved to be a massive success and the vital funds raised will allow Heart of Kent Hospice to continue the much-needed care and support to those at the end of their lives, along with their families and friends.

To find out more about the Bedfont® efforts in supporting Heart of Kent Hospice, follow the social channels @bedfontltd.

Bedfont® Scientific Limited hosted an insightful webinar Mastering Gut Health: Understanding SIBO, Carbohydrate Malabsorption, and Accurate Gastrointestinal Investigation. Gastrointestinal Physiologist and Bedfont® Medical Advisory Board member Melissa Dooley, led the discussion and shared valuable information on various gastrointestinal disorders and the importance of not self-diagnosing.

The webinar covers some important topics:

• SIBO & dietary malabsorption
• Finger-prick food intolerance testing. Does it play a supporting role in clinical testing, or is it a costly test without scientific evidence?
• Food allergies vs food intolerances
• Home breath testing devices & regulations

Small Intestinal Bacterial Overgrowth (SIBO) What is it?

SIBO occurs when there are higher numbers of bacteria in the small intestine. Too much bacteria here can interfere with the digestion and the absorption process. Bacteria, however, can also provide some benefits, such as:

What causes SIBO?

One of the most common causes is a dysfunction of the normal intestinal motility. Slow movement through the intestines allows bacteria to grow, causes of this can be:

• History of food poisoning
• Diabetes
• Certain medications
• Nerve damage

However, in some cases, the cause can be unknown. Melissa continues to discuss the consequences of SIBO, which include the dampening of villi, protein and carbohydrate malabsorption and B12 deficiency to name a few.

How can we test for SIBO?

The ‘Gold standard’ of SIBO diagnosis, culturing jejunal aspirate, is limited because many bacteria species do not grow in routine culture media, not to mention how invasive and costly this procedure is. The hydrogen breath test was developed due to difficulty accessing the small intestine and is used to detect SIBO and dietary malabsorption.

How can breath samples tell me what is happening in my intestines?

During metabolism, all cells produce carbon dioxide, however, only bacteria produce hydrogen and methane as metabolic by-products. These gases pass through the walls of the intestine into the blood. Once the blood reaches the lungs, a gas exchange occurs, allowing these gases to be detected in exhaled breath.

How to take a SIBO or malabsorption test

Before drinking the relevant substrate, a baseline breath sample is taken. The substrate ingested is mixed with 250ml of water and the type of substrate depends on the test being taken. The substrates can be either:

• Glucose
• Lactulose
• Sucrose
• Sorbitol

Breath samples are then taken at 15-30-minute intervals, depending on the test and can take up to 4 hours depending on the type of test. Treatment can involve antibiotics or dietary changes, depending on the test type and results.

Fructose malabsorption

• Inherited or acquired abnormality of the fructose-transporting protein
• Overuse of high fructose corn syrup or fruit juices in children
• SIBO
• Celiac disease
• Chemotherapy or radiation
• Dumping syndrome

Symptoms of fructose intolerance can include:

• Bloating
• Diarrhoea
• Constipation
• Flatulence

Unfortunately, there is no known cure, but an appropriate diet would help. Foods that have a high content of glucose will help absorb fructose.

To test for fructose intolerance, the patient would need to ingest 25g of fructose in 250ml of water. Breath samples would then be taken at 30-minute intervals over 3 hours.

Lactose malabsorption

Lactose is normally hydrolysed into glucose and galactose, which is readily absorbed in the jejunum. Lactose needs to be hydrolysed in the small intestine by lactase. If the lactase enzyme is lacking, the lactose will not be completely hydrolysed and result in lactose malabsorption. Symptoms of lactose malabsorption can include:

• Distension
• Cramps
• Flatulence

Lactose malabsorption is the most common intolerance, affecting almost half the world’s population.

Food allergies vs food intolerances

Often people confuse a food intolerance and a food allergy. A food intolerance can be caused by a change of routine, hormones, and eating out. Symptoms can be quite disruptive to someone’s life and lead them to avoid social activities due to the unpredictability of the symptoms. Because of this, many sufferers will turn to the internet for a quick and easy solution.

An intolerance is where the enzymes in the gut responsible for breaking foods down are deficient, defective, or there is an issue with the mechanism that transports the molecules through the small intestine. Symptoms are:

• Abdominal pain
• Discomfort
• Diarrhoea

Common food intolerances are:

• Lactose
• Fructose
• Sucrose
• Sorbitol

It’s important not to self-diagnose as many conditions can cause similar symptoms to irritable bowel syndrome (IBS) & SIBO, but they will have different treatments and management. It’s always important to visit your GP or healthcare professional. A food intolerance can be diagnosed by an elimination diet or a breath test.

If you have a food intolerance you may be able to consume a small amount of the food, however, with an allergy you must avoid these foods as food allergies can be fatal. Food allergies can be tested through skin prick allergy testing or an elimination diet.

Tests currently not recommended by healthcare professionals for food intolerances are finger prick tests and hair analysis tests, as these do not have any supportive scientific evidence.

Breath testing is the recommended method for detecting lactose malabsorption for several reasons. If you proceed with an elimination diet and remove milk, you may still ingest lactose which can be found in many unsuspecting foods such as:

• Hot dogs
• Breaded chicken
• Sweets

So even if the patient attempts to remove lactose from their diet, they can un-intentionally ingest lactose.

Other test methods can include:

• Endoscopic biopsies (invasive & costly)
• Blood test (repeated every 30 minutes)
• Stool acidity test (infants, young children)

Home breath testing devices

Home breath testing devices were more widely optimised due to the COVID-19 pandemic, to prevent waiting list delays and people felt safer taking the tests at home. There are several benefits of home testing kits, such as:

• Living far from the clinic and difficulty getting there
• Difficulty getting time off work
• Childcare issues
• Difficulties leaving the house with symptoms

However, the limitation of a home test could be that the patient doesn’t collect their samples correctly, resulting in the test having to be retaken. Therefore, patients must be provided with very clear and precise instructions to follow.

There are many home testing devices available now, but using one of these devices without the advice or guidance of a healthcare professional could result in self-interpretation, misdiagnosis, and incorrect preparation, leading to unnecessary avoidance of important food groups.

Home testing devices must be sourced from a reputable healthcare professional, who can discuss the results or provide a report for the treating medical professional. This will ensure an appropriate follow-up is conducted to make sure the patient doesn’t end up with a nutritional deficiency due to self-diagnosis.

There are many factors involved in diagnosing and treating gastrointestinal conditions. Melissa has highlighted these conditions and discussed the importance of not self-diagnosing, watch the full webinar now:

Bedfont® named regional winner of the prestigious British Chamber of Commerce Digital Revolution Award.

The British Chamber of Commerce is a network of accredited Chambers of Commerce across the UK and overseas. Representing businesses of all sizes and sectors, the Chamber Business Awards is an annual event that celebrates and recognises the success and contributions of businesses throughout the UK. Bedfont® was nominated for the 2024 Chamber Business Awards by the Kent Invicta Chamber of Commerce.

Jason Smith, CEO of Bedfont® said “We are truly honoured to be recognised as Business of the Year by the British Chambers of Commerce. This achievement is a testament to the hard work, dedication, and passion of our entire team. It reflects our commitment to innovation, excellence, and customer service. I am incredibly proud of what we have achieved together, and this award motivates us to continue pushing boundaries, growing, and contributing positively to our industry. Thank you to the Chamber and everyone who has supported us on our journey.”

Winning Business of the Year is a significant milestone for Bedfont®. This award not only highlights the commitment to excellence and innovation but also fuels our drive to continue delivering outstanding service to our customers and providing cutting-edge technology to the breath analysis market.

To find out more about Bedfont® and how their breath analysis devices are improving patient care, click here.

World Lung Day was created in 2017 by the Forum of International Respiratory Societies (FIRS), the day was established to raise awareness about lung health and advocate for better lung health globally. Celebrated annually on the 25th of September, FIRS brings together several major respiratory organisations, including the American Thoracic Society (ATS) and the European Respiratory Society (ERS), to promote education and action on respiratory health issues worldwide.

This World Lung Day we are particularly focusing on asthma, a chronic respiratory condition affecting millions worldwide. In England alone, hospital admissions for asthma paint a concerning picture: 15,5328 children under the age of 19 and 34,824 adults were admitted for asthma emergencies during 2022/2023¹.

September can be a particularly challenging month for children, as the demand for GP visits and hospitals spike after the summer holidays². Figures show a 348% rise in the number of 5-14-year-olds admitted to hospital with an asthma attack in September³. This can be due to stress, coughs, colds, cold air and a lapse in asthma management routines over the summer². Another factor is air pollution, which further complicates asthma management. Between 2017 to 2019 in London alone, air pollution contributed to 7% of all paediatric asthma admissions⁴.

When asthma remains undiagnosed or receives inadequate treatment, it can lead to stress, anxiety, or depression, as well as lung infections, hindered growth and delayed puberty in children. Additionally, it can escalate to critical asthma attacks that can be life-threatening⁵.

So, what can we do to better manage asthma and reduce the need for emergency care? Establishing an early diagnosis and ensuring consistent monitoring is crucial. A key part of this is Fractional exhaled Nitric Oxide (FeNO) testing. A FeNO test measures airway inflammation, typically found in patients with asthma. The use of FeNO testing, in conjunction with a comprehensive clinical history and additional examinations, contributes to more efficient asthma diagnosis and enhances patient care. Furthermore, it enables the monitoring of patients’ responses to asthma interventions.

Carol Stonham MBE, a seasoned registered nurse who serves at Gloucestershire ICB, leading the Respiratory Clinical Programme Group, co-leads the NHSE South West Respiratory Network, and is also a member of Bedfont’s Medical Advisory Board says “The diagnosis of asthma isn’t always easy and sometimes evolves over time. We know the basis of asthma is inflamed airways, so to be able to measure that to help confirm the diagnosis as a part of the diagnostic puzzle is vital. It also demonstrates the inflammation to the patient helping them to understand the inflammatory process, and the effects of any inhaled medication they might be prescribed. It is also key at other asthma consultations to reiterate the vital aspect of patient education and to help guide follow up care and patient understanding.”.

Bedfont® Scientific Limited are world leaders in breath analysis, with over 47 years of knowledge and expertise in the design and manufacture of medical breath analysis devices; including the NObreath® FeNO device. The NObreath® plays a pivotal role in improving asthma diagnosis and management by measuring FeNO levels on a patient’s breath. This non-invasive test provides instant results, helping healthcare professionals make more informed decisions about a patient’s asthma status. The NObreath® helps ensure patients receive the right interventions at the right time, ultimately reducing the frequency of asthma attacks and hospital admissions.

As we observe World Lung Day 2024, it is clear that tackling asthma requires a multifaceted approach, by improving awareness, reducing environmental triggers like air pollution, and advancing diagnostic methods. By continuing to advocate for better respiratory care and investing in tools like FeNO testing, we can make a significant impact in reducing the burden of asthma worldwide. For more information on the NObreath® and how FeNO testing can aid in the diagnosis and management of asthma, please visit www.nobreathfeno.com.

References

1. Fingertips Public Health Profiles [Internet]. Department of Health and Social Care. 2024. [Cited
Thursday 5th September 2024]. Available from: https://fingertips.phe.org.uk/search/asthma
2. NHS warning to parents ‘asthma season’ hits [Internet]. NHS. 2019. [Cited Thursday 5th September
2024]. Available from: https://www.england.nhs.uk/2019/09/nhs-warning-to-parents-as-asthma-
season-hits/
3. Buelo A, McLean S, Julious S, Flores-Kim J, Bush A, Henderson J, Paton JY, Sheikh A, Shields M, Pinnock H. At-risk children with asthma (ARC): a systematic review. Thorax. 2018 Sep 1;73(9):813-24.
4. Health impact assessment of current and past air pollution on asthma in London [Internet]. Imperial College London. 2022. [Cited Thursday 5th September 2024]. Available from: https://www.london.gov.uk/sites/default/files/hia_asthma_air_pollution_in_london.pdf
5. Improving access to FeNO testing in primary care [Internet]. Health Innovation Network. 2023. [Cited Thursday 5th September 2024]. Available from: https://www.ahsnnetwork.com/programmes/respiratory-disease/bettering-access-to-feno-testing-in-primary-care/

Methods of measuring FeNO

Fractional exhaled nitric oxide (FeNO) measurement plays a crucial role in the diagnosis and management of airway inflammation. FeNO testing is recommended by the National Institute for Health and Care Excellence (NICE) to help diagnose asthma¹, with the NObreath® device one of three devices recommended by NICE¹.

In 2005 the American Thoracic Society (ATS) and the European Respiratory Society (ERS) published recommendations for standardised procedures of FeNO testing highlighting that whilst evidence shows ambient levels of nitric oxide (NO) do not affect the result; it is preferable to avoid doubt by removing it from the breath sample². This can be done by either ‘partitioning’ the sample; effectively ignoring the potential initial spike caused by ambient NO, or another method is inhaling through an NO scrubber before exhalation.

The NObreath® utilises the partition method. This article explores the partitioning method, how it works, and why Bedfont® Scientific Limited selected this method for the NObreath® device.

What is the partition method?

The partition method essentially ‘parts’ the breath sample, and omits the first few seconds to ensure any potential high ambient levels of NO present in the breath are not measured during sampling.

When performing a breath test with the NObreath®, the user will be prompted to take a deep breath and then instructed to blow gently into the mouthpiece with an onscreen flow meter to guide the patient on their exhalation rate. The NObreath® offers two test modes: A 12-second test mode and a 10-second test mode for those up to 10 years old who cannot complete the 12-second test mode.

As the breath sample enters the NObreath® device, the first few seconds are partitioned and vented through the device bypassing the sensor chamber. After the partition period has elapsed, the pump will draw the remaining viable sample into the sensor chamber, where the breath sample will be analysed. When the patient completes a breath test using the NObreath® a green tick will appear on the screen to indicate a successful test, and the patient’s results will be shown onscreen in parts per billion (ppb) instantly.

The NObreath® applying the partitioning method

The partition method is a user-friendly method designed to measure airway inflammation, providing instant results, and eliminating wait times for both patients and healthcare professionals. The patient does not have to inhale through a device that has been used on multiple prior patients, as even highly effective bacterial viral filters may not be 100% effective and the patient does not have to inhale through an NO scrubber*. Avoiding inhalation means these risks do not arise and this is another reason why Bedfont® chose this technique for NObreath®. The NObreath® also utilises an NO scrubber for accuracy but this does not form any part of the breath pathway.

To learn more about the NObreath® utilising partitioning method, please visit https://www.nobreathfeno.com/measuring-feno-with-the-nobreath/

FeNO testing

The use of FeNO testing, combined with a comprehensive clinical history and additional examinations, enhances the efficiency of asthma diagnosis and improves patient care. This allows for effective monitoring of patients’ responses to asthma interventions. Bedfont® are world leaders in breath analysis, with over 47 years of experience. Bedfont® has been manufacturing the NObreath® portable FeNO device for over 15 years. Used by healthcare professionals to measure airway inflammation to aid in the diagnosis and management of asthma, taking a minimal amount of valuable consultation time with the ability to monitor airway inflammation in both adult and child patients. With annual servicing and minimal consumables, the NObreath® can be used as a functional device for years**.

Visit https://www.nobreathfeno.com to learn how to support your patients with FeNO monitoring using the NObreath® from Bedfont® Scientific Limited.

*NO scrubbing filters typically utilise potassium permanganate (a potentially hazardous substance) which has been referenced in certain conditions, if inhaled, to cause irritation to the nose, throat and lungs causing coughing and/or shortness of breath^3,4,5,6.

**The NObreath® has been validated for up to 29,000 tests when used as instructed and properly maintained and serviced. The number of tests can be periodically checked within the settings of the device; when 29,000 tests are reached a service is recommended. Contact your local service centre.

References:

1. Measuring fractional exhaled nitric oxide concentration in asthma: NIOX MINO, NIOX VERO and NObreath [Internet]. National Institute for Health and Care Excellence. 2014. [Cited Monday 12^th August 2024]. Available from: https://www.nice.org.uk/guidance/dg12/chapter/1-Recommendations
2. American Thoracic Society Documents. ATS/ERS recommendations for standardised procedures for the online and offline measurement of exhaled lower respiratory nitric oxide and nasal nitric oxide, 2005. Am J Respir Crit Care Med. 2005;171(8):912-30. DOI: 10.1164/rccm.200406-710ST.
3. Hazardous substance fact sheet [Internet]. New Jersey Department of Health and Senior Services. 2002. [Cited Monday 12^th August 2024]. Available from: https://nj.gov/health/eoh/rtkweb/documents/fs/1578.pdf
4. Safety data sheet potassium permanganate [Internet]. AquaPhoenix Scientific. 2015. [Cited Monday 12^th August 2024]. Available from: https://beta-static.fishersci.com/content/dam/fishersci/en_US/documents/programs/education/regulatory-documents/sds/chemicals/chemicals-p/S25497.pdf
5. . Potassium permanganate permanganic acid potassium salt [Internet]. Safety International Chemical Cards. 2016. [Cited Monday 12^th August 2024]. Available from: https://www.ilo.org/dyn/icsc/showcard.display?p_lang=en&p_card_id=0672&p_version=2
6. Potassium permanganate safety data sheet [Internet]. LabChem. 2014. [Cited Monday 12^th August 2024]. Available from: https://palsusa.com/wp-content/uploads/sites/6/2024/08/POTASSIUM-PERMANGANATE.pdf

A door opens to ensure the gold standard of FeNO testing is available in Latin America.

Bedfont® Scientific Limited, world leaders in breath analysis, with over 47 years of experience in the manufacturing and distribution of breath analysis devices have partnered with worldwide respected medical company Geratherm® Group, to enable them to manufacture a Fractional exhaled Nitric Oxide (FeNO) testing device.

Geratherm® Group predominantly known for their medical glass thermometers are an internationally aligned group that develop and produce medical solutions from respiratory therapy to women’s health at its five locations in Germany. They export 82% of their products to over 60 different countries every year, with many products in use in practices, clinics and rehabilitation facilities worldwide.

Their Latin America sales office, which was founded in May 2002 based in Brazil, is currently the focal point for sales, warehousing and customer service from Mexico to Chile for the entire group. This is where the partnership begins between Bedfont® and Geratherm®.

Marcio Souza, CEO of Geratherm® Medical Latin America visited the Bedfont® premises back in April, for a tour of the company, to oversee production. During the visit, final details were discussed and an agreement was reached.

Marcio Souza, CEO of Geratherm® says “We are excited to announce a new commercial partnership with Bedfont®, a recognised leader in the medical field, focused on respiratory analysis. This collaboration aims to bring the Brazilian market the best FeNO device available in the medical area, which will allow us to offer innovative and quality solutions to Latin American markets. Together, we are committed to delivering all benefits such as improving patient health, increasing efficiency, better costs and faster exam results. We believe that this union will be an important milestone in the advancement of medicine and the transformation of the healthcare experience.”

Adding to their already extensive well established product listing, Bedfont® are supplying the FeNObreath® kit which will allow Geratherm® to manufacture a FeNO testing device. Adding a FeNO device to their listing is a huge step forward in aiding the diagnosis and treatment of asthma in Latin America.

FeNO is a gas that is produced when airways are inflamed, a typical symptom of asthma. By measuring the FeNO on a person’s breath you can differentiate between allergic asthma and non-allergic asthma, as well as monitoring a person’s adherence to medication. A FeNO testing device is a great tool for asthma management and will certainly boost Geratherm’s already impressive catalogue of products.

Jason Smith, Managing Director of Bedfont® says “We are thrilled to announce our strategic partnership with Geratherm® for the manufacturing of our innovative FeNO device. This collaboration marks a significant milestone in our efforts to expand access to FeNO testing in Latin America. By leveraging Geratherm’s manufacturing expertise and our cutting-edge technology, we are poised to make a substantial impact on respiratory health management in the region. This partnership not only strengthens our global footprint but also reaffirms our commitment to improving patient care through advanced diagnostic solutions.”

For more information on how FeNO testing is revolutionising asthma care, visit nobreathfeno.com

FeNO Testing in Asthma Care

Although airway eosinophilic inflammation is a key characteristic of asthma, there are few methods available to measure it. This inflammation can be assessed by measuring eosinophils and eosinophilic cationic protein (ECP) in sputum or by measuring ECP in blood samples¹. However, these methods are considered time-consuming, expensive, and not readily available.

For most asthma patients, airway inflammation is driven by an allergen-induced Th2 response². Evidence from the literature suggests that fractional exhaled nitric oxide (FeNO) is a crucial biomarker for respiratory tract inflammation². Elevated FeNO levels in asthma are thought to result from inducible NOS2 expression in the inflamed airways². The NObreath® FeNO device provides a non-invasive and significantly more cost-effective alternative aid to diagnose asthma and assess airway eosinophilic inflammation.

This article delves into the challenges encountered within primary care and how the innovative technology of the NObreath® can assist. Additionally, the article discusses the transition of the use of the NObreath® from primary care environments to secondary care facilities.

Challenges in Primary Care

GPs often face restricted budgets due to resource allocation for population needs, and financial sustainability to stay within healthcare budgets and prevent overspending. Each patient appointment is typically limited to just 10 minutes.

Population needs

In the UK, approximately 5.4 million people, or about 8 in every 100 individuals, suffer from asthma³. The National Review of Asthma Deaths (NRAD) documented 195 asthma-related deaths among adults in 2013, highlighting preventable factors in 89 of the 195 deaths (46%), such as lack of specific asthma expertise (17%) and non-adherence to UK asthma guidelines (25%)⁴. FeNO testing is valuable in GP settings, as GPs often encounter a spectrum of asthma cases, from mild to severe. The NObreath® device facilitates rapid and reliable FeNO measurements, to allow GPs to make informed decisions and aid in identifying patients who do or do not require ongoing treatment⁵. This also reduces emergency visits and hospital admissions related to poorly controlled asthma.

Financial sustainability

One of the ongoing challenges in primary care is maintaining financial sustainability. The NObreath® FeNO device is cost-effective, with minimal ongoing costs. The device requires only one consumable- the NObreath® mouthpiece which has a long shelf life and an integrated infection control filter, effectively removes airborne bacteria (>99%) and viruses (>98%)⁶. The device also incurs low annual servicing costs and imposes no test limits*.

Time with patient

When a GP determines the need for a FeNO test using the NObreath®, there’s no warm-up time, and the device operates through a simple exhale-only technique with on-screen visual guidance. Patients receive instant results, eliminating wait times. Intended for adult and paediatric patients**, the NObreath® offers two test modes: a 10-second test mode for those up to 10 years old who cannot complete the 12-second test mode.  GPs can store up to 25 results in up to 50 patient profiles and view a graph of results. If a GP office possesses only one NObreath®, they benefit from the device size and portability, ensuring that healthcare providers can efficiently utilise the device wherever patient care demands.

Carol Stonham, a member of Bedfont® Scientific Limited Medical Advisory Board and policy lead for Policy Care Respiratory Society (PCRS), comments “The NObreath® is my preferred choice for primary care in managing asthma for many reasons. Primarily it suits the unpredictability of the volume of testing in primary care – none of the consumables or device needs to be used or lost in a short time frame. It is an intuitive machine which is easy to use and teaches patients of all ages.”

Primary Care to Secondary Care

Using the NObreath® device in primary care can reduce the number of inappropriate referrals to secondary care clinics. However, if a patient is referred to an asthma specialist in secondary care, the NObreath® FeNO device can aid in the diagnosis and management of asthma. The NObreath® helps differentiate between allergic (eosinophilic) and non-allergic asthma⁷. FeNO measurements show the patient’s response to the treatment, enabling accurate prescription of medication and safer, monitored adjustments. This helps patients understand their condition better by demonstrating how their FeNO levels correlate with their symptoms and treatment adherence. Measuring airway inflammation with the NObreath® can help monitor the effectiveness of medication and predict the risk of asthma attacks⁸***

Gold Standard FeNO Testing

FeNO testing is increasingly recognised as a valuable tool in the management of asthma, but what makes the NObreath® stand out from other FeNO devices on the market? Developed by Bedfont® in 2008, the NObreath® has over 15 years of clinical use and has been featured in numerous studies worldwide, contributing to the advancement of FeNO testing. Conforming to both the American Thoracic Society (ATS) and European Respiratory Society (ERS) guidelines, the NObreath® is also one of three FeNO devices recommended by the National Institute for Health Care Excellence (NICE)⁹, an independent international organisation providing national guidance and advice to improve health and social care.

To find out how you can support your patients with FeNO testing in asthma care with the NObreath®, please visit: https://www.nobreathfeno.com/

*The NObreath® has been validated for up to 29,000 tests when used as instructed and properly maintained and serviced. The number of tests can be periodically checked within the settings of the device; when 29,000 tests are reached a service is recommended. Contact your local service centre.

**NObreath® can be used on paediatric and adult patients, provided they can follow test protocol. USA only: NObreath® can be used on patients 7+ years old.

***FeNO is not a definitive indication of asthma and should be used in conjunction with (but not limited to) spirometry, patient history, and symptoms.

References:

1. Pizzichini E, Pizzichini MM, Efthimiadis A, Dolovich J, Hargreave FE. Measuring airway inflammation in asthma: eosinophils and eosinophilic cationic protein in induced sputum compared with peripheral blood. Journal of allergy and clinical immunology. 1997 Apr 1;99(4):539-44. DOI: 10.1016/S0091-6749(97)70082-4.
2. Keller AC, Rodriguez D, Russo M. Nitric oxide paradox in asthma. Memórias do Instituto Oswaldo Cruz. 2005;100:19-23. PMID: 15962094 DOI: 10.1590/s0074-02762005000900005.
3. What is Asthma? [Internet]. Asthma+ Lung UK. 2024. [Cited Monday 8^th July 2024]. Available from: https://www.asthmaandlung.org.uk/conditions/asthma/what-asthma#:~:text=Asthma%20is%20a%20common%20condition,cough%20or%20a%20tight%20chest.
4. Royal College of Physicians. Why asthma still kills: the National Review of Asthma Deaths (NRAD) Confidential Report. London, RCP; 2014.
5. Taylor DR, Pijnenburg MW, Smith AD, Jongste J. Exhaled nitric oxide measurements: clinical application and interpretation. Thorax. 2006 Sep 1;61(9):817-27. PMID: 16936238 PMCID: PMC2117092 DOI: 10.1136/thx.2005.056093.
6. Public Health England. An Evaluation of Filtration Efficiencies Against Bacterial and Viral Aerosol Challenges. Salisbury: Public Health England; 2020.
7. Ref: Coumou H, Bel EH. Improving the diagnosis of eosinophilic asthma. Expert review of respiratory medicine. 2016 Oct 2;10(10):1093-103. DOI: 10.1080/17476348.2017.1236688.
8. Saito J, Gibeon D, Macedo P, Menzies-Gow A, Bhavsar PK, Chung KF. Domiciliary diurnal variation of exhaled nitric oxide fraction for asthma control. European Respiratory Journal. 2014 Feb 1;43(2):474-84. DOI: 10.1183/09031936.00048513.
9. Measuring fractional exhaled nitric oxide concentration in asthma: NIOX MINO, NIOX VERO and NObreath [Internet]. National Institute for Health and Care Excellence. 2014. [Cited Wednesday 10^th July 2024]. Available from: https://www.nice.org.uk/guidance/dg12/chapter/5-Outcomes