A wake-up call on children’s well-being: do more, do it now

It’s official – the Chief Medical Officer is ‘profoundly ashamed’. In her report on child health, Professor Dame Sally Davies highlights appalling inequalities in the UK, with three times as many child deaths in the poorest areas compared with wealthier regions, and shows us to be a nation lagging behind our European neighbours too. Much more needs to be done to improve the health of Britain’s children and it needs to be done sooner, she says. Early, preventive action rather than reaction will benefit both the health and the wealth of the nation. I thought I’d take a look at where Cochrane evidence might fit into her vision of what needs to be done.

3 things to help people with COPD keep well and keep out of hospital

Today I have some good news about chronic obstructive pulmonary disease or COPD. This is an umbrella term covering a number of conditions, including chronic bronchitis and emphysema, where people have difficulty breathing because of lung damage. Smoking is by far the biggest cause of COPD, but environmental factors and genetics can also play a part. It’s a common, debilitating and life-threatening condition. It’s a global problem and in the UK it’s the second highest cause of hospital admission. COPD places a huge burden on the patient and on healthcare budgets, with much of the costs due to treatment in hospital. We need some good news on this and some good evidence to guide decisions about managing COPD.

So, what is the good news? We have a bunch of new and updated reviews from the Cochrane Airways Group which have some decent evidence to guide us on some things that work with respect to managing COPD. 

A mystery, missing evidence and some answers!

Contrary to what you might expect, you’ll have to wait until the end for the mystery, though in truth missing data and important questions that remain unanswered could also be labelled as that, and this is where I start.

My last blog was a round-up of new and updated reviews on asthma and I begin this one with another offering from the Cochrane Airways Group (do these people never take a day off?). It’s another tale of what we still don’t know, this time about a class of anti-inflammatory drugs called anti-leukotrines. For managing mild persistent asthma in children, low-dose inhaled corticosteroids (ICS) are recommended, but if symptoms aren’t well controlled with ICS then anti-leukotrines may be added. Almost ten years ago, a Cochrane review was published which pulled together the available evidence on the safety and effectiveness of this treatment for adults and children and found very little to go on, with just two small trials with children. Now a review has been published which looked for trials involving children (any age below 18) and finds we’re not much further on.

Exercise and asthma: what does the evidence say?

Some people with asthma find their symptoms are worse when they exercise, or restrict their physical activity for fear that this will be so. Others report that their asthma symptoms are better when they are fit. Several reviews from the Cochrane Airways Group have recently been published on aspects of exercise for people with asthma.

Getting people to exercise: what do we know about what works?

It’s not news that exercise is good for us, but exercise and health have grabbed the headlines again this week with the publication of new research in the BMJ which, according to the BBC, finds ‘exercise can be as good as pills’. For a nice summary of this research and a reminder that actually the data was patchy and the researchers warn that the findings should be interpreted with caution, read this blog by the Lifestyle Elf. Patchy data notwithstanding, we can agree that exercise is a Good Thing, but how can we get people to do it? Most adults are not active at the recommended level. A team at the Cochrane Heart Group has been busy pulling together the research on whether face-to-face interventions and remote and web 2.0 interventions can help promote physical activity (PA) and how they compare with each other and the results have just been published in three new reviews.

Alive, able and at home: stroke unit care offers better outcomes than alternatives

Key message: people who have a stroke are more likely to be alive, be at home and be independent after a year if they are cared for in a stroke unit

We probably all know someone who’s had a stroke, which is now the second leading cause of death and the third most common cause of disability worldwide. Many of us have followed broadcaster Andrew Marr’s progress in the wake of the stroke he had, aged 53, earlier this year and his wife, Jackie Ashley, caught the attention of many with her recent Guardian blog on their experience of this devastating event. She deemed the NHS to be “wonderful, wonderful, wonderful” and paid tribute to the health professionals who helped get her husband back on his feet, but pointed to the void in support offered by community services after intensive and generally excellent care in hospital. Not all hospital care is equal either, of course, and the type of care offered in hospital after acute stroke can make all the difference to whether, and how well, the person recovers.