Chronic respiratory diseases (CRDs) are diseases of the respiratory tract and are among the most prominent causes of disability and mortality globally(1). Chronic obstructive pulmonary disease (COPD) and lung cancer are among the leading cause of death among all CRDs(2). Evidence showed that diet, particularly ultra-processed foods (UPFs) are strongly associated with cardiovascular disease, diabetes, cancer, and depression(3). However, the link between UPFs intake and CRDs has rarely been investigated. we aimed to examine the association between UPF consumption and risk of mortality due to CRDs overall, COPD and lung cancer among adults in the USA. A total of 96,607 participants aged 55 years and over were obtained from Prostate, Lung, Colorectal and Ovarian (PLCO) cancer study, a randomised trial designed to investigate the effects of screening on cancer-related mortality. However, data collected also afforded the opportunity to examine the relationships between UPF intake and mortality caused by respiratory diseases. Dietary history of participants was collected at baseline using a validated food frequency questionnaire as was the presence of respiratory diseases. Food items were grouped into one of the four NOVA food classification system(4). Cox regression was fitted to estimate the risk of all-cause mortality and cause-specific mortality due to increased consumption of UPFs over time. Competing risk regression was used to account for the competing risks events and effect of participant loss. During the follow-up period of 1,379,655.5 person-years (median 16.8 years), 28700 all-cause, 4,901 all respiratory, 2,015 lung cancer and 1,536 COPD mortalities occurred. A dose-response association was found between higher UPF intake and mortality from all respiratory diseases and COPD, but not lung cancer. After considering competing events, higher intake of UPF increased the risk of mortality from all respiratory diseases by 10% (HR: 1.10; 95% CI: 1.01, 1.21) and COPD by 20% (HR: 1.20; 95% CI: 1.02, 1.42). After imputation for missing data, the risk of lung cancer increased by 25% among participants in the highest quintile of UPF intake. The PLCO trial data highlighted that consumption of UPF increased respiratory mortality, among those with COPD, however further mechanistic studies are recommended to further clarify the link between UPF and lung cancer. This study also indicated that a high intake of UPF generally increases the risk of mortality of those with respiratory diseases and contributes to a large body of evidence indicating that higher UPF consumption increases the overall risk of mortality.

The aim of this research was to develop a pamphlet that would enable patients with diabetes, rheumatic diseases, chronic respiratory disease, and dialysis treatment to be aware of changes in their physical conditions at an early stage of a disaster, cope with these changes, maintain self-care measures, and recover their health.

Illness-specific pamphlets were produced based on disaster-related literature, news articles, surveys of victims of the Great Hanshin-Awaji Earthquake Disaster and Typhoon Tokage, and other sources.

Each pamphlet consisted of seven sections—each section includes items common to all illnesses as well as items specific to each illness. The first section, “Physical Self-Care”, contains a checklist of 18 common physical symptoms as well as symptoms specific to each illness, and goes on to explain what the symptoms may indicate and what should be done about them. The main aim of the “Changes in Mental Health Conditions” section is to detect post-traumatic stress disorder (PTSD) at an early stage. The section “Preventing the Deterioration of Chronic Illnesses” is designed to prevent the worsening of each illness through the provision of information on cold prevention, adjustment to the living environment, and ways of coping with stress. In the sections, “Medication Control” and “Importance of Having Medical Examinations”, spaces are provided to list medications currently being used and details of the hospital address, in order to ensure the continued use of medications. The section, “Preparing for Evacuations” gives a list of everyday items and medical items needed to be prepared for a disaster. Finally, the “Methods of Contact in an Emergency” section provides details of how to use the voicemail service. The following content-specific to each illness also was explained in detail: (1) for diabetes, complications arising from the deterioration of the illness, attention to nutrition, and insulin management; (2) for rheumatic diseases, a checklist of factors indicating the worsening of the illness and methods of coping with stress; (3) for chronic respiratory disease, prevention of respiratory infections and management of supplemental oxygen; and (4) for patients requiring dialysis, conditions of dialysis (such as dry weight, dialyzer, number of dialysis treatments, and dialysis hours) and what to do if a disaster occurs during dialysis.

It is expected that these pamphlets will be useful to patients with chronic illnesses, and will be used to prepare for disasters, thereby helping the patients cope with the unusual situation that during a disaster and recover as soon as possible.