Respiratory GURU: Genuinely Useful Respiratory Updates – Détails, épisodes et analyse

In this next episode, we return to talk to Chris about ABPA treatment, including recommendations for monitoring and treatment dependant patients. Hope this helpful, as we certainly learnt a lot!

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This podcast we discuss ABPA diagnosis including the investigations and their parameters which have recently changed. Listen when Mike and I discuss the guidelines with one of the paper's authors and get to grips with ABPA diagnosis even if those cases that are a little trickier. 

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This month's episode is all about COPD, and I am joined by the brilliantly intelligent Professor Alice Turner. Her knowledge of the research in this field is remarkably in-depth, yet she is generous with her experience and answers the questions you want to ask but may not feel comfortable exposing the chasms in your knowledge like I did! 40 minute podcast, strap in for a detailed, transformative and revelatory podcast with an international COPD leader.

Studies discussed include:

Prevalence and Impact of Pulmonary Bacterial Colonisation in Stable State Chronic Obstructive Pulmonary Disease (COPD). PMID: 35052762

Pye A, Hill SL, Bharadwa P, Stockley RA. Effect of storage and postage on recovery and quantitation of bacteria in sputum samples. PMID: 17893120

Prevalence, Pattern, Risks Factors and Consequences of Antibiotic Resistance in COPD:  PMID: 35016569.

https://www.nice.org.uk/guidance/ng115

Home Non-Invasive Ventilation in COPD: A Global Systematic Review. PMID: 35259290.

Effect of Home Noninvasive Ventilation With Oxygen Therapy vs Oxygen Therapy Alone on Hospital Readmission or Death After an Acute COPD Exacerbation: A Randomized Clinical Trial. PMID: 28528348

Long-Term Risk of Mortality Associated with Isolation of Pseudomonas aeruginosa in COPD: A Systematic Review and Meta-Analysis.  PMID: 35210766

Effect of Inhaled Corticosteroid Withdrawal on Chronic Obstructive Pulmonary Disease Exacerbations in Patients Taking Triple Therapy at Baseline. PMID: 33204084

Long-term cost and utility consequences of short-term clinically important deterioration in patients with chronic obstructive pulmonary disease: results from the TORCH study PMID: 31190781

Blood eosinophils to guide inhaled maintenance therapy in a primary care COPD population. PMID: 35141324

Effect of Theophylline as Adjunct to Inhaled Corticosteroids on Exacerbations in Patients With COPD: A Randomized Clinical Trial. PMID: 30326124

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A vibrant discussion with Dr Sarb Clare MBE and author of Ultrasound for the Generalist about point of care lung USS and how we can use lung USS to achieve rapid diagnoses, without needing to wheel down to imaging. No more distinctly average portable CXRs, USS offer us the ability to do bedside serial imaging on our unwell respiratory patients and to see with our own eyes what is going on inside when we don't quite believe the CXR or our vocal resonance examination.

Resources discussed include:

https://www.generalistultrasound.com/book/

https://www.generalistultrasound.com/

Díaz-Gómez JL, Mayo PH, Koenig SJ. Point-of-Care Ultrasonography. N Engl J Med. 2021 Oct 21;385(17):1593-1602. doi: 10.1056/NEJMra1916062. PMID: 34670045.

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A great discussion of the recent MDR TB Clinical Advice Service Annual Report, and a complex MDR TB case as a great demonstration of the intricacies of it's management. Dr Guy Hagan is our local TB lead and an encyclopaedia of TB treatments, and we talk about a tricky pericardial TB patient and his clinical journey. I learnt so much about the group A, B and C selection of medications for MDR TB, how to use the clinical advice service and look out for the rare side effects. 

Discussed link are below: 

https://www.brit-thoracic.org.uk/quality-improvement/lung-disease-registries/bts-mdr-tb-clinical-advice-service/

https://www.who.int/publications/i/item/9789240007048

https://clinicaltrials.gov/ct2/show/NCT03086486

Oelofse S, Esmail A, Diacon AH, Conradie F, Olayanju O, Ngubane N, Howell P, Everitt D, Crook AM, Mendel CM, Wills GH, Olugbosi M, Del Parigi A, Sun E, Calatroni A, Spigelman M, Dheda K. Pretomanid with bedaquiline and linezolid for drug-resistant TB: a comparison of prospective cohorts. Int J Tuberc Lung Dis. 2021 Jun 1;25(6):453-460. doi: 10.5588/ijtld.21.0035. PMID: 34049607; PMCID: PMC8171246.

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Discussion with Professor Adel Mansur who is the lead for the Birmingham Regional Asthma Service about the 4 main current biologics in the asthma NICE guidelines together with discussion of three more novel agents in development that have recently been published. A must listen for anyone reviewing asthma patients, Adel gives a great summary of the underlying mechanisms for these agents, their current use in clinical practice and importantly...how to pronounce them! Papers reviewed are as follows:

Dupilumab https://www.nice.org.uk/guidance/TA751
Mepolizumab https://www.nice.org.uk/guidance/TA671
Benralizumab https://www.nice.org.uk/guidance/TA565
Reslizumab https://www.nice.org.uk/guidance/TA479

Brightling CE, Nair P, Cousins DJ, Louis R, Singh D. Risankizumab in Severe Asthma - A Phase 2a, Placebo-Controlled Trial. N Engl J Med. 2021 Oct 28;385(18):1669-1679. doi: 10.1056/NEJMoa2030880. PMID: 34706172.

Wechsler ME, Ruddy MK, Pavord ID, Israel E, Rabe KF, Ford LB, Maspero JF, Abdulai RM, Hu CC, Martincova R, Jessel A, Nivens MC, Amin N, Weinreich DM, Yancopoulos GD, Goulaouic H. Efficacy and Safety of Itepekimab in Patients with Moderate-to-Severe Asthma. N Engl J Med. 2021 Oct 28;385(18):1656-1668. doi: 10.1056/NEJMoa2024257. PMID: 34706171.

Menzies-Gow A, Corren J, Bourdin A, Chupp G, Israel E, Wechsler ME, Brightling CE, Griffiths JM, Hellqvist Å, Bowen K, Kaur P, Almqvist G, Ponnarambil S, Colice G. Tezepelumab in Adults and Adolescents with Severe, Uncontrolled Asthma. N Engl J Med. 2021 May 13;384(19):1800-1809. doi: 10.1056/NEJMoa2034975. PMID: 33979488.

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This Christmas present is a summary of the recently updated guidelines for Sarcoidosis and asthma. 20 minute summary of the guidelines to listen to whilst munching on a mince pie and a glass of something festive. You're welcome.

Sarcoidosis guidelines

https://erj.ersjournals.com/content/58/6/2004079.long 

GINA asthma guidelines

https://ginasthma.org/gina-reports/

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November's summary of clinical respiratory updates; 30 min podcast to listen to on the way to work or any kind of multitasking so you can keep up to date without even trying. This month's papers and guidelines are:

Single-case metanalysis of fat embolism syndrome

https://pubmed.ncbi.nlm.nih.gov/34743891

Clinical and pathophysiological characteristics of valproate-induced pleural effusion

https://pubmed.ncbi.nlm.nih.gov/34259092

Randomised trial of the P2X 3 receptor antagonist sivopixant for refractory chronic cough

https://pubmed.ncbi.nlm.nih.gov/34649978

Eliapixant (BAY 1817080), a P2X3 receptor antagonist, in refractory chronic cough: a randomised, placebo-controlled, crossover phase 2a study

https://pubmed.ncbi.nlm.nih.gov/33986030/

Obstructive sleep apnoea/hypopnoea syndrome and obesity hypoventilation syndrome in over 16s

https://pubmed.ncbi.nlm.nih.gov/33740390

Effect of Continuous Positive Airway Pressure on Weight and Local Adiposity in Adults with Obstructive Sleep Apnea: A Meta Analysis

https://pubmed.ncbi.nlm.nih.gov/34495549

Integrated disease management interventions for patients with chronic obstructive pulmonary disease

https://www.nice.org.uk/guidance/ng202

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October's summary of clinically relevant respiratory publications released in the past month.
10 studies, and 2 interviews, your CPD for keeping up to date in just 52 minutes.

List of studies discussed below

1. Evaluation of multi-component interventions for prevention of nosocomial pneumonia in older adults: a randomized, controlled trial. Eur Geriatr Med. 2021 PMID34081314

2. Management and Treatment of Patients With Obstructive Sleep Apnea Using an Intelligent Monitoring System Based on Machine Learning Aiming to Improve Continuous Positive Airway Pressure Treatment Compliance: Randomized Controlled Trial. J Med Internet Res. 2021 Oct. PMID34661550

3. A weight-loss Mediterranean diet/lifestyle intervention ameliorates inflammation and oxidative stress in patients with obstructive sleep apnea: results of the "MIMOSA" randomized clinical trial. Eur J Nutr. 2021 Oct. PMID33839919

4.  Effectiveness of a motivational intervention based on spirometry results to achieve smoking cessation in primary healthcare patients: randomised, parallel, controlled multicentre study. J Epidemiol Community Health. 2021 Oct PMID33883199

5. Pragmatic Randomized Controlled Trial for Stepping Down Asthma Controller Treatment in Patients Controlled with Low-Dose Inhaled Corticosteroid and Long-Acting β2-Agonist: Step-Down of Intervention and Grade in Moderate Asthma Study. J Allergy Clin Immunol Pract. 2021 Oct PMID33940213

6. Efficacy of erlotinib and its effects on the quality of life of older patients with epidermal growth factor receptor-mutant non-small cell lung cancer: A prospective, multicenter, dose-modification study. Geriatr Gerontol Int. 2021 Oct PMID34378299

7.  Exploratory composite endpoint demonstrates benefit of trilaciclib across multiple clinically meaningful components of myeloprotection in patients with small cell lung cancer. Int J Cancer. 2021 Oct PMID34109630

8. Comparing the outcomes of intrapleural fibrinolytic and DNase therapy versus intrapleural fibrinolytic or DNase therapy: A systematic review and meta-analysis. Pulm Pharmacol Ther. 2021 Sep  PMID34571093

9.  Diagnostic accuracy of focused deep venous, lung, cardiac and multiorgan ultrasound in suspected pulmonary embolism: a systematic review and meta-analysis. Thorax. 2021 Sep PMID34497138

10.  Effect of Prophylactic Subcutaneous Scopolamine Butylbromide on Death Rattle in Patients at the End of Life: The SILENCE Randomized Clinical Trial. JAMA. 2021 Oct
PMID34609452

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Welcome back to the next instalment of respiratory GURU, this time we delve into two RCTs investigating rescue therapy for patients with CTD ILD. The EVER ILD study looks at MMF vs MMF plus rituximab, and the RECITAL study looks at rituximab vs cyclophosphamide. 2 very useful studies and I was thrilled to be joined by two national experts in the field, Dr Anjali Crawshaw and Dr Emma Derrett-Smith. Hopefully, this will make you feel more well-prepared for ILD MDTs, and give you a real insight into how these two experts view the recent literature in the context of their day-to-day practice. Here are the pubmed links for the two papers, the INBUILD study which we discuss briefly, and the American College of Rheumatology guidelines, which apparently is where most of the guidance we need regarding CTD ILD (for now) sits. Enjoy listening, thank you for being patient with the podcast releases whilst I birthed and raised my second child, and fingers crossed no more career interruptions!!

Mankikian J et al. Rituximab and mycophenolate mofetil combination in patients with interstitial lung disease (EVER-ILD): a double-blind, randomised, placebo-controlled trial. Eur Respir J. 2023 Jun 8;61(6):2202071. doi: 10.1183/13993003.02071-2022. PMID: 37230499.

Maher TM et al. Rituximab versus intravenous cyclophosphamide in patients with connective tissue disease-associated interstitial lung disease in the UK (RECITAL): a double-blind, double-dummy, randomised, controlled, phase 2b trial. Lancet Respir Med. 2023 Jan;11(1):45-54. doi: 10.1016/S2213-2600(22)00359-9. Epub 2022 Nov 11. PMID: 36375479.

interstitial-lung-disease-guideline-summary-treatment-2023.pdf (contentstack.io)

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