In this episode we speak to Mr Stephen Shelly, Advanced Nurse Practitioner in Respiratory Medicine in St James’ University hospital.

Stephen completed his nursing, CNS and ANP training in SJH with a special interest in airways disease. In the ANP role he has introduced new pathways for direct GP referrals to his clinic and enhanced the early discharge programme for patients attending the emergency department with COPD.

We discuss his career to date, the process for pursuing a career as an ANP, challenges along the way and tips for others with an interest in becoming an ANP.

Chapters

00:45 Intro to Mr Stephen Shelly

02:05 Why he pursued a career in Respiratory medicine

04:30 Stephen’ early nursing career

05:40 Working as a clinical nurse specialist (CNS)

06:10 Overview of ANP training process

07:40 ANP Dragon’s Den

09:10 Different pathways to becoming an ANP

11:50 Future of ANPs in Ireland

14:00 Tips in advance of applying for an ANP role

19:30 Transition from CNS to ANP

22:10 Liaising with NCHDs/ junior doctors

24:30 Biggest challenges to date

28:30 Top tips for people starting out their nursing career

29:35 Wrap up

Show notes

ANP registration Ireland https://www.nmbi.ie/Registration/Add-New-Division/Advanced-Practitioners/Registering-as-ANP-AMP

CNS training Ireland https://healthservice.hse.ie/about-us/onmsd/advanced-and-specialist-practice/specialist-practice.html

Post graduate nursing courses Ireland https://www.nmbi.ie/Education/post-registration-courses

In this episode, we delve into sarcoidosis with Professor Anthony O'Regan. We discuss the nuances of diagnosing sarcoidosis and revisit the pathophysiology of the condition. This episodes details the importance of follow up care and provides insights into how to tease out differentials. Furthermore, we address how to determine which patients should be treated, along with choice of treatments and duration.

00:15 Rapid fire round: sarcoidosis

00:45 Pathophysiology of sarcoidosis

05:30 Multisystem involvement in sarcoidosis

07:15 Granulomatous disease

09:00 Referral to respiratory clinic (Symptoms/Differentials/Family history/Travel)

10:30 Initial investigations

10:45 Coming to a diagnosis of sarcoidosis

14:05 The role of biopsy in diagnosis of sarcoidosis

15:50 Teasing out the differentials in follow up

17:35 When to treat in sarcoidosis

19:25 Duration of treatment

19:50 Relapse of disease

21:00 Starting dose of steroids

22:00 Disease modifying therapy

23:30 Antifibrotics

24:25 Follow up in sarcoidosis

25:01 The future of sarcoidosis

Show Notes:

- Judson MA, Baughman RP, Teirstein AS, Terrin ML, Yeager H Jr. Defining organ involvement in sarcoidosis: the ACCESS proposed instrument. ACCESS Research Group. A Case Control Etiologic Study of Sarcoidosis. Sarcoidosis, Vasculitis, and Diffuse Lung Diseases : Official Journal of WASOG. 1999 Mar;16(1):75-86. PMID: 10207945.

- 40 consecutive patients in Ireland

20% end up on steroids

- John Gibson study on steroids RCT

Gibson GJ, Prescott RJ, Muers MF, Middleton WG, Mitchell DN, Connolly CK. "British Thoracic Society Sarcoidosis study: effects of long-term corticosteroid treatment." Thorax. 1996;51(3):238-247. DOI: 10.1136/thx.51.3.238

- Nintedanib in patients with progressive fibrosing interstitial lung diseases—subgroup analyses by interstitial lung disease diagnosis in the INBUILD trial: a randomised, double-blind, placebo-controlled, parallel-group trial Wells, Athol UAbe, S. et al. The Lancet Respiratory Medicine, Volume 8, Issue 5, 453 – 460

- ITS Flashcard Sarcoidosis https://irishthoracicsociety.com/wp-content/uploads/2022/02/15.-Sarcoidosis-30.11.21.pdf

In this episode we speak to Dr Anthony O’Regan, Consultant Respiratory Physician working

in Galway University hospital. Anthony completed his early training in the US and since

coming back has worked with the Irish Thoracic Society, Royal College of Physicians Ireland

and National Doctors Training and Planning to try and improve working conditions and

training for junior doctors in Ireland. We discuss the progress made to date, ongoing projects

and healthcare planning for the future changes we will see in our population.

Chapters

0.45 Intro to Dr Anthony O’Regan

1.50 Why he pursued Respiratory mediicne

3.20 ITS presidency

7.25 ILD registries

8.50 RCPI and working conditions

14.00 Medical training in Ireland

18.45 Exit exams

20.50 Upcoming changes being introduced by NDTP

26.50 Projections for future workforce

31.20 Advice for upcoming trainees

Show notes

NDTP website (HSE) https://www.hse.ie/eng/staff/leadership-education-development/met/

All information on becoming a member, upcoming events and how to get involved in the

RCPI https://www.rcpi.ie/

ITS website https://irishthoracicsociety.com/

Population changes and impacts on healthcare https://doi.org/10.1038/s41514-024-00148-2

This week we speak with Nazia again, this time about idiopathic pulmonary fibrosis or IPF for short. Nazia is a leading world expert in the diagnosis and management of IPF and in this episode she shares that expertise with us.

Chapters

00:57 - Rapid fire round

01:35 - Introduction to ILD

03:20 - Definition of IPF

04:15 - What to include in your IPF referrals

06:40 - IPF workup

11:55 - Genetics in IPF

14:50 - Management of IPF

20:28 - Acute exacerbation of IPF (AE-IPF)

22:20 - Follow-up and surveillance of IPF patients

26:00 - Prognostication in IPF

27:40 - Encouraging clinical breakthroughs

29:05 - Key take home messages

31:00 - Wrap up

Links

IPF clinical practice update 2022 ATS/ERS/JRS/ALAT

https://doi.org/10.1164/rccm.202202-0399ST

Role of MDT in diagnosis of IPF

https://doi.org/10.1513/AnnalsATS.202108-979ED

Current and future treatments in IPF

https://doi.org/10.1007/s40265-023-01950-0

This week we welcome Dr Nazia Chaudhuri to the podcast. In this Inspire episode,

Dr Chaudhuri tells us how respiratory chose her and gives some insights into

combining clinical and academic roles. We discuss emerging research opportunities

in Northern Ireland in particular in interstitial lung disease.

Show Notes

https://medicine.yale.edu/profile/naftali-kaminski/

In this episode, we speak with Dr. Breda Cushen about Chronic Obstructive

Pulmonary Disease (COPD). We discuss tertiary care referrals for severe COPD,

managing comorbidities, initiating treatment, and ensuring adherence. Packed with

practical insights, this episode offers valuable tips to enhance COPD care across the

community, outpatient clinics, and hospital settings.

Chapters

01.02 Rapid Fire Round

01.50 Definition of COPD

03.10 Tertiary care referrals for severe COPD

05.01 Information to include in the referral

06.40 Work up in severe COPD clinic

08.55 Comorbidities in COPD

10.18 Treatable Traits

14.16 Asthma & COPD

17.32 Initiating treatment in COPD

21.04 Treatment of emphysema with preserved lung function

23.21 Adherence and barriers to treatment

26.17 Identifying those at risk of exacerbation

27.34 Breakthrough in COPD

29.24 Take home message

Show Notes

2025 Global Initiative for Chronic Obstructive Lung Disease (GOLD) Report

https://goldcopd.org/2025-gold-report/

Westerik JA, Metting EI, van Boven JF, Tiersma W, Kocks JW, Schermer TR.

Associations between chronic comorbidity and exacerbation risk in primary care

patients with COPD. Respir Res. 2017 Feb 6;18(1):31. doi: 10.1186/s12931-017-

0512-2. PMID: 28166777; PMCID: PMC5294875.

COPD/Integrated HST Respiratory Medicine Study Day 28 th February www.rcpi.ie

In this episode we speak to Dr Breda Cushen, Consultant Respiratory Physician in

Beaumont hospital. Breda came back to Ireland less than 5 years ago after working as a

consultant in the NHS. We discuss some of what Breda has achieved in these first few

years, from virtual ward proof of concept projects to the minutiae of starting a severe COPD

clinic. But also how she juggles it all and tips for others.

Chapters

0.55min Intro to Dr Breda Cushen

1.40min ITS annual scientific meeting 2024 take-home messages

3.48min Career starting out

6.44min Developing a severe COPD clinic

12.05min Behind the scenes preparation

15.45min Other services built around the severe COPD clinic

17.59min Advice for others starting a service

19.55min Virtual wards proof of concept project

25.28min Juggling it all

Show notes

Virtual wards HSE https://www.hse.ie/eng/about/who/strategic-programmes-office-

overview/national-virtual-ward-programme/

Access recordings and abstracts from previous ITS meetings https://irishthoracicsociety.com/about-us/its-scientific-meeting/

National Clinical Programme (NCP) Respiratory https://www.hse.ie/eng/about/who/cspd/ncps/ncpr/

This week we speak again to Dr Deirdre Fitzgerald on pneumothorax. We cover it all; the typical presentation, the diagnosis, categories of pneumothorax and management updates in the last 12 months. We discuss trends in the field of pleural disease and what to expect with respect to

changes in guidelines in the coming years.

Chapters

00.45 Introduction

01.00 Rapid fire round

01.50 Diagnosis of pneumothorax

02.30 Tests to do at presentation/ prior to referral

05.25 Initial management; does the size of the pneumothorax matter?

08.00 Conservative management of pneumothorax; the evidence

09.00 Medical management of pneumothorax

12.18 Chest drain specifics

15.28 Suction; the evidence

17.03 Removing the chest drain

17.38 Surgical management

19.08 Post pneumothorax guidance

21.23 Pitfalls in management of pneumothorax

22.28 Recent breakthroughs in pneumothorax management

Show notes

ERS 2024 guidelines on spontaneous pneumothorax https://publications.ersnet.org/content/erj/63/5/2300797

High flow oxygen papers https://www.bmj.com/content/4/5779/86,

https://karger.com/res/article-abstract/44/2/147/286426/Noninvasive-Treatment-of Pneumothorax-with-Oxygen?redirectedFrom=fulltext

BTS pleural guidelines 2023 https://thorax.bmj.com/content/78/11/1143

Description

In our first episode of 2025 we speak to Dr Deirdre Fitzgerald, Consultant Respiratory Physician in Tallaght University Hospital. Deirdre splits her time between a tertiary hospital and community integrated care hub. In this episode she talks us through the integrated care model, setting up a pleural and new innovations she has brought into all aspects of her practice.

Chapters

00.42 Introduction to Dr Deirdre Fitzgerald

01.33 Career path in Ireland

03.30 Fellowship in Perth, Australia

08.30 New consultant life

12.12 Management skills

15.20 Setting up a service

17.15 The community integrated care program

21.45 HSE Community hubs

22.10 Innovation in healthcare

24.48 Top tips for trainees

Show notes

• Innovations: https://www.hse.ie/eng/about/our-health-service/making-it- better/deirdre-seeks-to-improve-patient-care-through-innovation-at-tallaght-hospital.html

Dr Brian Kent covers the key information to be included in your sleep apnoea referrals and also key components of investigation and management of obstructive sleep apnoea. He also describes the advances in technology, wearables and medical treatment coming down the line.

Tirzepatide in OSA NEJM paper: https://www.nejm.org/doi/10.1056/NEJMoa2404881

CPAP in OSA: https://www.nejm.org/doi/full/10.1056/NEJMoa1606599

https://thorax.bmj.com/content/61/5/430.long

Con/pro debate for asymptomatic patients with OSA

Pro: https://pmc.ncbi.nlm.nih.gov/articles/PMC6395978/

Con: https://publications.ersnet.org/content/breathe/15/1/11

Non-CPAP therapies in OSA: https://publications.ersnet.org/content/errev/30/162/210200

Lumen post: https://lumen5.com/user/marissaocallaghan/bk-breath-work-trail-fiig4/