Managing Breathlessness in Pulmonary Fibrosis

Exceptional healthcare, personally delivered

The Bristol Interstitial Lung Disease Service at North Bristol NHS Trust cares for a catchment area of around 550,000 people (plus additional referrals from other centres), with a variety of interstitial lung diseases including Idiopathic Pulmonary Fibrosis (IPF), Hypersensitivity Pneumonitis (HP), Sarcoidosis, and pulmonary fibrosis related to auto-immune conditions such as Rheumatoid arthritis, SLE, systemic sclerosis, Sjogren’s syndrome, and also pulmonary fibrosis due to other causes. Our team includes of 2 consultant respiratory physicians with a specialist interest in interstitial lung disease, a specialist nurse and pharmacist, a clinical trials nurse and lung function technicians. Our specialist clinics are held twice weekly in G ward out-patient department. You may have been given an appointment time for your lung function and walk tests prior to seeing the doctor. These results help with monitoring your condition. You may also require some blood tests, or to see the nurse or pharmacist, so please allow additional time should this be needed. If for any reason you need to change your appointment, please contact the relevant secretary below, thank you.

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The team: Professor Ann Millar: Consultant in Respiratory Medicine Secretary: Elaine Musgrove Tel: 0117 323 5348

Fax: 0117 323 5018

Dr Huzaifa Adamali: Consultant in Respiratory Medicine Secretary: Rachel Cook Tel: 0117 323 6242

Fax: 0117 323 2947

Heather Lamb: Pulmonary Fibrosis (ILD) Nurse Specialist Tel: 0117 323 2514 / 0117 323 2508

Pager 07659 160531

Lloyd Mayers: ILD / Respiratory Pharmacist Tel: 0117 323 2514 / 0117 323 2508

Bleep 1549

Deborah Warbrick: Senior Clinical Trials Research Nurse Tel: 0117 323 5838 Lung Function Department (breathing and walk testing) Appointments: 0117 3235373

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Day to day living Waking up This can be a difficult time for people who experience breathing difficulties. Here are some handy hints: nn A radio alarm tuned to your favourite station is a far more pleasant way to start the day than a shrill alarm. Better still, if you do not have to be up at a certain time, wake up naturally. nn Try having a good stretch while lying down. This is something that many people with chronic breathlessness feel unable (or forget) to do because of the effort involved when you are upright. However, stretching helps to expand and loosen up your rib cage, shoulders and neck that become stiff overnight just like any other joints and limbs. Giving them a chance to loosen up before getting out of bed may just help you get up a bit more easily and with less breathlessness. nn Making a bed is a physically demanding household job. A lightweight duvet rather than sheets and blankets may be much easier altogether and the modern hollow fibre ones are easy to just pull straight or flick back over the end of the bed for the day. nn Fitted bottom sheets are a good idea as they are easier to put on and require little ironing as the creases are pulled out when the sheet is stretched onto the bed. nn Before getting up it is a good idea to do some of your dressing sitting on the edge of the bed. At night, leave your dressing gown and slippers or shoes, socks and underwear within reach of the bed; this allows you to start off slowly and build up.

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The start of the day will probably influence how you feel for the rest of it. Go slowly and take it in easy stages. Washing and bathing/showering This is another daily chore which many people find exhausts them before their day has really started. Here are some handy hints to prevent you being washed out: nn If you find a bath or shower too tiring use a bath seat (contact your local Red Cross or community occupational therapy department who may be able to supply one). If you don’t have a shower but a bath is too much, you may find that a rubber, hand-held shower attachment that fits onto the taps helpful. nn A long terry-towelling robe will eliminate the need for exhausting and breath-taking drying. Simply blot dry as necessary or do something else while you are drying. nn If excess humidity makes you breathless leave the bathroom door open or invest in a small extractor fan. Try not to bath or shower alone if you are feeling weak or unwell. nn It is not necessary to get wet all over, all at once to get clean. Washing at a sink at your own pace is just as good and can be a lot less tiring. A stool can be very helpful to sit on while you are washing this way. nn For people using oxygen it may be easier to pass the tubing up over the shower door/rail to keep it out of the way whilst in the bath or shower. It is okay to take your oxygen off for short periods whilst shaving, washing your face or applying make-up. nn Shaving or applying make-up is much easier if you have a low or portable mirror. This will allow you to sit down while doing this. nn Many people find strong scents irritate their chest and make them cough. Avoid toiletries that are heavily perfumed or you may find yourself or fellow sufferers gasping. Along Managing Breathlessness in Pulmonary Fibrosis

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with this should come the warning to avoid aerosols wherever possible; CFC free or not they are notorious for irritating people with breathing problems. Most toiletries are available in other forms, e.g. hair gel, roll-on deodorants, etc. Getting dressed Many people feel that they should finish getting dressed before breakfast. However, there are no hard and fast rules on this and you should do what you feel best for you on that day. Everybody has their own personal taste in clothing but here are a few ideas that may be worth considering: nn Tight or restrictive clothing can inhibit abdominal or chest expansion. Bras, belts and girdles are often uncomfortable for people with breathing difficulties. nn Men find braces are more comfortable than a belt and for ladies camisole tops are a pretty and comfortable alternative to a bra. nn Many women find trousers and socks are easier than struggling to put on tights or stockings. Avoid socks with tight tops as these may restrict blood flow in the legs. nn Bending over tying shoelaces can leave you gasping, so if possible opt for slip-on shoes. However, elastic laces can convert lace ups into slip-on shoes. Using a long handled shoehorn will make putting on any shoes a lot easier. Ready – steady – cook A healthy diet is vital for people suffering with chest problems. Breathing uses up a lot of calories but breathlessness makes it difficult not only to eat but also to prepare a meal in the first place. Here are some tips to help you get a meal on the table without being too exhausted to eat it. nn Plan your meals when you are neither tired nor hungry. This may sound ridiculous but light, well-balanced meals are vital 6

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and should not be left to last minute impulse cooking. It is very important to eat as nourishing a diet as possible. nn If you have been prescribed home oxygen you may find it beneficial to use during mealtimes to help with breathlessness. nn You may find you are less breathless eating a number of small meals throughout the day rather than “3 square meals a day”. This means your stomach does not become too full as this can make breathing more difficult for some people. nn Use convenience foods when you are feeling tired or unwell. Don’t forget options such as ‘meals-on-wheels’ or frozen ‘ready made’ meals from companies such as ‘Wiltshire Farm Foods’. nn Drink plenty of water and fruit juice, this will not only help to keep phlegm thinner and easier to cough up, but will also help to prevent constipation that may occur in people who are not very mobile. Constipation may also be a sideeffect of some of the medication that people with chest problems may be prescribed. nn When you are cooking your own meals try to make twice or three times the amount and freeze the meals that are extra to your needs that day. nn A microwave oven can reduce the time spent preparing meals and allows quick and easy defrosting and reheating of pre-prepared foods. It also reduces the kitchen temperature. Slow cookers are useful as they can cook your meal while you are doing other things. They are also good for cooking large amounts to freeze. nn When cooking, use an extractor fan or open a window or door. A portable fan is useful for keeping you cool, avoiding strong cooking odours and reducing the sensation of breathlessness.

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Cleaning Keeping your house clean and tidy can seem an impossibility when you are short of breath. Here are some hints that may help you: nn Long handled pick up tongs can be very useful. These are available through the Red Cross or occupational therapy department. Try putting an elastic band or piece of rubber tubing over the ends of the tongs. This makes it easier to grasp things, particularly small objects. nn Sweeping and feather dusting may cause the dust to be swept into the air, whereas a damp cloth may prevent this. nn Avoid using any cleaning products that may irritate your chest. nn Always have good ventilation when cleaning; open your windows and let in the fresh air. Gardening nn A small, light, long-handled hoe may allow you to remove weeds while they are still small. nn Another lightweight, easy to use tool is a long handled three-pronged cultivator. nn A stool of some sort is essential for taking a breather. Folding ones are very useful and there are also some that you can turn over to use either as a kneeler or as a seat. Do not forget that your long-handled tongs are just as useful in the garden. nn Plants grow well amongst gravel or bark, which helps keep weeds down. nn Raised garden beds or pots reduce bending time.

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Lifting and carrying Carrying things can put a lot of strain on people with breathlessness as it involves using upper body muscles. Here are a few tips on what to do and what to avoid. nn To ease the burden of actually carrying things around there are a number of aids on the market to help you with this. For example, a small shopping trolley will allow you to carry a number of items in one go with the minimum of effort. There are also special walkers that have a basket underneath and a top that, when flipped down, doubles as a handy seat on which to stop and have a breather. nn Carrying things downstairs is not usually a problem for most people but carrying things upstairs is a different matter. A good way to take the strain out of this is to adopt the following system: on an OUT breath lift your burden 2 or 3 steps and put it down. Rest and catch your breath. Climb another 2 or 3 steps, rest again. Repeat until you reach the top. This may be a bit slow but it will save you precious energy and breath. nn If you have to climb stairs it is a good idea to have a chair at the top of the stairs to rest if needed. Try to do it in slow easy stages. Shopping nn If you are going shopping with oxygen try to get a shopping trolley from one of the trolley parks in the car park. That way you can put your cylinder in it straight away and avoid carrying it all the way to the shop. nn Try to pick a quiet day and time to go shopping. This way you can shop at a leisurely pace without being jostled and having to queue to pay. nn Always make use of the shop’s services; you may find there are assistants available to take you round the shop by wheelchair, many stores will pack your shopping and take it Managing Breathlessness in Pulmonary Fibrosis

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to your car and load it in the boot for you, and some larger hypermarkets have electric wheelchairs or scooters so that you can be independent. Internet shopping and delivery may be an option for you. Travelling nn If you have trouble getting from A to B, it doesn’t matter whether the problem arises in your legs or your lungs, you are entitled to a disabled parking permit. Once you have a permit, always make sure it is displayed when you are parking. Some shopping centres and car parks will clamp cars which are parked in disabled spaces and do not display a licensed permit. nn It is a good idea for people with breathing problems who travel alone to invest in a mobile phone. Always check the phone is fully charged before leaving home. nn Wherever possible try to avoid travelling during the rush hour. nn For information on oxygen equipment for holidays or flying, contact your Respiratory Nurse/Physiotherapy Specialist. Pacing yourself Pacing yourself is one of the first lessons to learn and one of the hardest to put into practice. A prime consideration in regulating the tempo of daily life should be the awareness that your abilities will fluctuate from day to day, even from hour to hour. There will be times when you wake up and know that today is not such a good day. Other mornings you might get up feeling great. The important thing is to learn to trust your own feelings and go with them. Don’t take on more than you can handle and when you feel tired, stop. It is good to try and stay as active as possible. Here are a few suggestions that will help: 10

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nn Wait at least an hour after eating before starting something. Digestion draws blood (and the oxygen in it) away from the muscles leaving them less able to cope with extra demands put on them. Pace yourself and do not rush. nn If you feel breathless use breathing control. And so to bed… These are some hints to try and help you get to bed in the best possible way: nn Ensure you are well supported with pillows in bed. A backrest is available from the occupational therapy department if appropriate. nn Try doing some gentle breathing and relaxation exercises to help you get to sleep. Concentrate on relaxing all your muscles and listening to your breathing. It may help to try and imagine yourself in one of your favourite places, be it in your armchair or on the beach at St. Tropez! nn Go to bed in easy stages so that you arrive relaxed not worn out. Try putting on your nightclothes and dressing gown then read or watch TV for a while. nn Arrange the area near your bed so that everything you need is at hand. Two important things are a phone and a light. Many people wake up breathless at night and lying in the dark unable to reach a light will only add to your stress. Other things to have on your bedside table are a clock radio, any medication you might need overnight and a glass of water or fruit juice.

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The Active Cycle of Breathing Technique (ACBT) This guide is designed to teach you the ‘Active Cycle of Breathing Technique’ (ACBT). It is a set of breathing exercises designed to help you to loosen and clear phlegm from your lungs. Done regularly it can help to maintain your lungs in good condition and make it easier to breathe. Your physiotherapist or respiratory nurse specialist will be able to teach you the technique and give you specific instructions for your chest condition. The ACBT is made up of:

Breathing control This is normal relaxed breathing, with your upper chest and shoulders relaxed. This part of the cycle is very important to let you and your lungs rest between the deep breaths and huffing. Your physiotherapist or respiratory nurse specialist will teach you to judge how long to do this part of the cycle.

Deep breathing These are 3-4 long slow deep breaths in and relaxed breaths out. It is these deep breaths that help to loosen up the phlegm from deep in your lungs.

Huffing This is taking a medium size breath in and squeezing it out through an open mouth using your stomach and chest muscles, 12

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as if you were steaming up a mirror with you breath. This helps to move phlegm up and out of your lungs. You should do 1 or 2 huffs at a time, but always have a period of breathing control between huffs.

Coughing This should follow huffing. Cough only if you feel that phlegm is ready to come. The parts of the ACBT fit together like this: To perform the technique you go round and round the cycle to coax up the phlegm. Never force a cough, but you may feel the need to cough after huffing. If the phlegm will not clear easily, be patient, go back to the beginning of the cycle and start again.

How long for? You need to go around the cycle for at least 10 minutes each treatment or until your chest clears. Your physiotherapist or respiratory nurse specialist will give you guidelines.

How often? Usually 1-2 times a day, depending on the amount of phlegm on your chest. You may need to increase the amount and length of treatments if you have a chest infection.

When? Whenever you find it most convenient to fit into your day. Mornings are most common to clear the lungs for the day and bedtime to have a good night’s sleep. You may have a certain time of day that you start to cough. If you are taking inhaled or nebulised drugs, you need to time your physiotherapy with them, speak to your physiotherapist for advice.

In what position? The ACBT works in any position, but you should be comfortable and relaxed. Your physiotherapist may suggest a specific way to sit or lie when you do your treatment, depending on your chest condition. Managing Breathlessness in Pulmonary Fibrosis

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‘Breathing Control’ When you feel short of breath you may have found that you do one or a number of the following: nn Use your shoulders and upper chest to help you breathe nn Increase your rate of breathing nn Take smaller shallow breaths nn Have feelings of fear, anxiety, panic or general unrest Although these are natural responses they can make your breathlessness worse. The aim of breathing control is to help steady and pace your breathing rate and pattern during these times. Breathing control is designed to retrain you and your muscles to work more efficiently. The technique is described below: nn Make sure you are in a comfortable position nn Make sure your head, neck and shoulders are not tense, let your shoulders fall into their natural resting position. nn To recognise whether you are relaxed or tense, pull your shoulders up to your ears as far as you can and hold for a count of 5 seconds and then let them relax. You should feel the difference between a tense and relaxed state. nn By relaxing your upper chest, the effort of breathing is reduced and you use less oxygen. nn Place a hand on the upper part of your stomach nn As you breathe in your hand should rise a little, as you breathe out it should fall. nn Try to feel the expansion of the lower ribs and upper stomach as air comes in. nn This will give you a feeling of breathing around the waist. 14

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nn Breathe in through your nose or mouth. The breath out should not require any effort. nn Some people find it easier to breathe out through pursedlips. Only do this if you find it comfortable. This is a technique that can be taught if felt it would be helpful to certain individuals. Your physiotherapist will be able to advise. If you are feeling especially breathless, try performing breathing control in a forward leaning position, sitting or standing to allow your stomach to drop forward away from your lungs. See photos. This technique might feel odd to begin with and takes lots of practice. To begin with you should practise it somewhere quiet when you are resting. Try to practise this regularly throughout the day. The aim is to get your body used to using this technique so it can be applied whenever you find it most useful. ‘Breathing is something we do 24 hours a day, every day – practising 10 minutes a day is not enough.’ You can then start to use this technique when you are feeling more breathless at rest or when you are exerting yourself, for example when walking, going up and down stairs or during other daily activities. nn Your rate of breathing increases when you are breathless. nn It is important not to panic. nn If necessary breathe in and out through your mouth, but This technique can be helpful for some individuals. However, if you feel this technique does not help your breathlessness and makes you feel worse, you should not continue with breathing control.

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Positions to use when breathless

Sitting leaning forward

Sit leaning forward with your arms resting on your thighs and with wrists relaxed.

Relaxed sitting

Make sure your back is well supported

Sitting at a table

Sit leaning forward from the hips with your upper chest and head supported on pillows or cushions.

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Standing leaning forward

Stand leaning forward from the hips, with your forearms resting on something the right height (e.g. window sills, kitchen work top, banister rails, back of arm chairs).

Standing leaning back

Stand leaning backwards against a wall, with your feet placed slightly apart, and about 12” out from the wall. Your shoulders should be relaxed with your arms hanging loosely by your sides.

High side lying

Lie on your side, rolled slightly forward with a slope of 4 or 5 pillows to raise the shoulders. Use an extra pillow to fill the gap between your waist and armpit to stop you sliding down the bed. The top pillow should be above the shoulder supporting the head and neck only. The underneath forearm can be placed either under the The knees should be slightly bent with the top Managing Breathlessness in Pulmonary Fibrosis

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Practical ideas to help those with lung conditions Pulmonary Rehabilitation Pulmonary rehab is a supervised, personalised exercise and education programme that can help you to learn to manage your breathlessness and remain active. The programmes are multi-disciplinary, meaning that the team includes Respiratory Physiotherapists, Nurses, Occupational Therapists, Dieticians, Doctors and others, and can help improve energy, strength and your quality of life. Your Specialist Nurse or Consultant will be able to refer you to a programme near you. Physiotherapy and Occupational Therapy Services Your physiotherapist can assess your ability to move and make recommendations to help you maintain and restore maximum movement and functional ability. They can offer advice regarding various aids such as a rollator (walking frame) or walking sticks that may be helpful for those who have difficulty walking. They will be able to give you specific exercises to help improve your physical fitness, and can advise regarding chest clearance and managing breathlessness. The occupational therapist’s focus is to enable a person to carry out their everyday routine. Breathlessness and fatigue are common symptoms of respiratory conditions which occupational therapy can help to address in practical ways. An occupational therapist’s role can include; assessment of activities of daily living such as personal care, equipment provision, home environment modification and advice regarding energy conservation techniques. Physiotherapy and occupational therapy services can be accessed through your local health centre via your GP.

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Care Direct provides information about care services, other types of support and welfare benefits such as: nn Help to look after yourself at home nn Advice, aids and adaptations to help people continue living at home nn Support for carers nn Help after leaving hospital nn Meals delivered to your home nn Advice on benefits nn Residential and nursing care, advice on very sheltered housing nn Piper lifeline Tel: 0117 9222700

www.bristol.gov.uk/adultcare

Care and Repair : a non-profit making organisation with charitable status. Services are available for homeowners in Bristol, South Gloucestershire and North Somerset who are over 60 or are disabled. They can advise regarding adaptations to your home, or general repairs and inform you of government grants and other organisations who may be able to help financially. Bristol & S Glouc Tel: 0117 9542222 Mon to Thurs 9.00 am 5.00 pm, Friday 9.00 am - 4.00 pm www.bristolcareandrepair.org.uk North Somerset Tel: 01275 858518 Mon to Thurs 9.00 am 5.00 pm, Friday 9.00 am - 4.00 pm

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Travel Blue Badge The Blue Badge scheme allows drivers of passengers with severe mobility problems to park close to where they need to go. Depending upon your locality, application forms can be obtained as follows; South Gloucestershire: Forms can be collected and submitted at any of the one-stop shops in Kingswood, Patchway, Thornbury or Yate. You can also email: [email protected] Tel: 01454 868004 Bristol: Forms can be requested by calling 0117 922 2600, or emailing [email protected]. North Somerset: Download and complete the disabled parking permit application (pdf) and return to; Disabled Parking Permits, North Somerset Council, PO Box 53,Town Hall, Weston-super-Mare, BS23 1ZX Tel: 01275 888 801 Fax: 01275 884 258 https://www.n-somerset.gov.uk/Transport/Parking+and+access/ disabledparking-faq.htm#1 Community Transport and Dial a Ride Dial a ride provides door-to-door transport services to disabled and older people who are unable to use public transport because of mobility or communication impairments. Services vary so please contact your local office for further details; Bristol area Tel: 0845 130 1875

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www.bristoldialaride.org.uk

Managing Breathlessness in Pulmonary Fibrosis

Kingswood area Old School House, Kingswood Foundation, Britannia Road, Kingswood, S Gloucestershire BS15 8DB Tel: 0117 961 6016

www.kingswoodct.org.uk

Yate, Sodbury & District Community Transport (including Frampton Cotterell Enterprise Group) (group hire, Ring and Ride & voluntary car) The Yard, 390 North Road, Yate, South Gloucestershire, BS37 7LW Telephone: Ring & Ride 0845 241 0985 Office Tel: 01454 228706 www.accessible-transport.com Filton, Patchway, Stoke Gifford, Thornbury and Bradley Stoke. Four towns and Vale Link Community Transport Norman Scott Park, Coniston Road, Patchway, South Gloucestershire BS34 5JR Tel: 01454 868 529

www.accessible-transport.com

North Somerset

Tel: 01275 885176

Portishead Porters

Tel: 01275 855552

Nailsea & District Community Transport Tel: 01275 848190 www.accessible-transport.com

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Other Organisations British Lung Foundation (BLF) The BLF is a charity that promotes lung health and supports people affected by lung disease. It campaigns to raise public awareness of lung disease and the impact it has on peoples’ lives. Breathe Easy groups are run by members, with help and support from British Lung Foundation regional teams when it’s needed. There are more than 230 Breathe Easy groups across the length and breadth of Britain, so you should be able to find one near you wherever you live. Groups typically meet once a month and members arrange all kinds of things for their meetings, from talks on local patient services and advice from health care professionals, to arts and crafts and trips to the theatre or the seaside. There are currently 3 Bristol groups: New Brunswick Church, Wigton Crescent, Southmead Linda Tel: 07837 256708 2.00-4.00 pm 2nd Monday each month The Park, Daventry Road, Knowle Sandra Tel: 0117 9773902 2.00-4.00 pm 3rd Tuesday each month Withywood Community Centre, Queens Road, Withywood Florence: Tel 01275 834495 2.00-4.00 pm 1st Wednesday each month For confidential advice and support, and for answers to questions you might have about living with a lung condition, call the BLF Helpline on 03000 030 555 (Mon to Fri 10 am to 6 pm). 22

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They offer information and support on a number of subjects including Travel & Transport, Oxygen, Equipment, Welfare Benefits, as well as many issues relating to over 40 lung conditions. Alternatively, you can write to: British Lung Foundation 73-75 Goswell Road London EC1V 7ER Or call the BLF head office on Tel: 020 7688 5555.Website: www.lunguk.org Age UK is the new force combining Age concern and Help the aged Age UK publishes a large number of free Information Guides and Factsheets on a range of subjects including money and benefits, health, social care, end of life, legal, employment and equality issues. Age UK Advice Visit the Age UK website, www.ageuk.org.uk, or call Age UK Advice free on 0800 169 65 65 British Red Cross Provide short-term loans of medical equipment, such as wheelchairs, for people with a disability or illness. 83 Tower Road North, Bristol, Avon BS30 8XP Tel; 0117 301 2600 Monday to Friday 9.00 am-4.00 pm Carers UK National network of free and independent advice centres. Depending on available resources may offer benefits check and help with filling in forms. Tel: 020 7833 2181 (for local contact details only – not telephone advice) Website: www.adviceguide.org.uk Managing Breathlessness in Pulmonary Fibrosis

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Well Aware A guide to health, wellbeing and community services in Bristol, South Gloucestershire and Bath & North East Somerset. “Well aware” have an A-Z of all the services to find support for a friend, family member, client or patient, or for yourself. They can offer advice regarding personal health services, a lunch club or social group, help round the home or in the garden, dentistry, counselling or any other form of support for carers or particular disabilities. www.wellaware.org.uk Tel: 0808 808 5252 (freephone) SSAFA - Soldiers, Sailors, Airmen and Families Association As one of the UK’s leading Armed Forces charities, SSAFA support around 50,000 people each year. SSAFA Forces Help provides financial, practical and emotional assistance to anyone that is currently serving or has ever served in the Army, Navy or RAF, and their families. www.ssafa.org.uk or call the Central Office on Tel: 020 7403 8783 for your local office details

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Benefits: Attendance allowance is a tax free benefit. You may be entitled to Attendance allowance if you are over 65 and need help with personal care. The allowance is based on the help you need – not the help you actually get. Disability Living Allowance (DLA) is a tax free benefit for people under 65. You may be entitled to DLA if you have a disability severe enough for you to need help caring for yourself or you have walking difficulties. Disability Living Allowance has two parts called components: nn a care component - if you need help looking after yourself or supervision to keep safe nn a mobility component - if you can’t walk or need help getting around Some people will be entitled to get just one component; others may get both. The care component and mobility component are paid at different rates depending on how your disability affects you. (From 2013 a new Personal Independence Payment will replace Disability Living Allowance for disabled people aged 16 to 64) Industrial Injuries Benefit: Industrial Injuries Disablement Benefit (IIDB) is for people who are disabled because of an accident at work or who are ill or disabled as a result of a disease such as asbestosis or mesothelioma caused by work. Carers Benefit: you may be able to get carers allowance if you are aged 16 or over and are caring for someone for more than 35 hours a week who are receiving attendance allowance, or DLA at middle or higher rate for personal care.

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The Carers Allowance Unit can send you a claim form. Write to: The Carers Allowance Unit, Palatine House, Lancaster Road, Preston PR1 1HB Tel: 0845 608 4321 8.30 am -5.30 pm Monday - Thursday, 8.30 am - 4.30 pm Fridays Email: [email protected] The Benefit Enquiry Line is a telephone advice and information service, before you have made a claim. You can call if you are sick or disabled or if you are caring for someone and acting on their behalf. Telephone: 0800 88 22 00, 8.30 am to 6.30 pm Monday to Friday. www.direct.gov.uk http://www.direct.gov.uk/en/DisabledPeople/FinancialSupport/ Introductiontofinancialsupport/DG_065148 Pension credit is an income related benefit for pensioners living in Great Britain. It is made up of 2 parts, Guarantee Credit and Savings Credit. You can call The Pension Service on 0800 99 1234, 8.00 am to 8.00 pm Monday to Friday. http://www.direct.gov.uk/en/ Pensionsandretirementplanning/PensionCredit/DG_10018692

NHS Constitution. Information on your rights and responsibilities. Available at www.nhs.uk/aboutnhs/constitution [Last Accessed November 2012] 26

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How to contact us: ILD team C Ward office Southmead 0117 3232514 Mon-Fri 8-4.30

www.nbt.nhs.uk

If you or the individual you are caring for need support reading this leaflet please ask a member of staff for advice. © North Bristol NHS Trust. First Published November 2012. Review due November 2014. NBT002694