Respiratory GURU: Genuinely Useful Respiratory Updates

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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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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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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A vibrant discussion with our two regional leads for occupational lung disease and a specialised solicitor dealing with OLD claims into how to drill down into the details of an occupational lung disease, how to refer, how to write your clinical letters and how to direct patients towards compensation if it's right for them. 

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A perfect introduction to series 2, a COPD podcast with Professor Turner and Dr LJ Smith where we jump into MART for COPD,  the new P2X3 receptor agonist Filapixant, antihyperglycaemic drugs preventing COPD exacerbations and much more. Happy listening!

Studies discussed:


Association of the Use of Novel Antihyperglycemic Drugs With Prevention of COPD Exacerbations Among Patients With Type 2 Diabetes 
BMJ. 2022 Nov 1;379:e071380. doi: 10.1136/bmj-2022-071380. PMID: 36318979;

Budesonide/Formoterol Maintenance and Reliever Therapy vs Fluticasone/Salmeterol Fixed-Dose Treatment in Patients With COPD
Thorax. 2023 May;78(5):451-458. doi: 10.1136/thorax-2022-219620. Epub 2023 Feb 1. PMID: 36725331.


The P2X3 receptor antagonist filapixant in patients with refractory chronic cough: a randomized controlled trial
Respir Res. 2023 Apr 11;24(1):109. doi: 10.1186/s12931-023-02384-8. PMID: 37041539; 

Prospective Detection of Early Lung Cancer in Patients With COPD in Regular Care by Electronic Nose Analysis of Exhaled Breath
Chest. 2023 May 19:S0012-3692(23)00754-7. doi: 10.1016/j.chest.2023.04.050. Epub ahead of print. PMID: 37209772.

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This fascinating episode delivers pragmatic advice and recommendations for how to identify and manage patients with inducible laryngeal obstruction (ILO)-the new phrase for vocal cord dysfunction, GORD and breathing pattern disorders-the new phrase for dysfunctional breathing. This will make so much difference to how you do your consults with your breathless patients who have one of these disorders, how to reassure them, treat them and not feel a deep heart sink when you read your last letter about them before calling them into your consultation room. The quality of this podcast recording is not at the highest standard I strive to achieve, so bear with me, and turn up the volume a little when prof is speaking, you won't want to miss a word!

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Next instalment of the aspergillosis podcast, where we move on to talk about chronic pulmonary aspergillosis and invasive aspergillosis. Hope you've had time to digest part 1, part 2 is filled with useful content about diagnostics again, including the utility or lack of as it might be of galactomannans and Beta D Glucans in aspergillosis. Thank you again to Dr Chris Kosmidis. 

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An interview with Dr Chris Kosmidis, Clinical Senior Lecturer at Wythenshawe Hospital and Aspergillosis centre about aspergillosis. Divided into two parts, the first part of our discussion covers ABPA for the generalist, and is a goldmine of information for diagnosing, treating and monitoring response in these patients. I now feel comfortable interpreting the serology, prescribing antifungals where appropriate and how to look out for a relapse which is a long way from where I started!

References for this podcast include:

Kosmidis C, Denning DW. The clinical spectrum of pulmonary aspergillosis. Thorax. 2015 Mar;70(3):270-7. doi: 10.1136/thoraxjnl-2014-206291. Epub 2014 Oct 29. PMID: 25354514.

Godet et al. Nebulised liposomal amphotericin-B as maintenance therapy in allergic bronchopulmonary aspergillosis: a randomised, multicentre trial. Eur Respir J. 2022 Jun 16;59(6):2102218. doi: 10.1183/13993003.02218-2021. PMID: 34764182.

Agarwal R, Muthu V, Sehgal IS, Dhooria S, Prasad KT, Garg M, Aggarwal AN, Chakrabarti A. A randomised trial of prednisolone versus prednisolone and itraconazole in acute-stage allergic bronchopulmonary aspergillosis complicating asthma. Eur Respir J. 2021 Sep 9;59(4):2101787. doi: 10.1183/13993003.01787-2021. PMID: 34503983.

How do we treat aspergillosis? - Dr Chris Kosmidis - YouTube

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This month's episode dives into progressive fibrosing ILD, previously a disadvantaged set of patients who have a progressive ILD but as they weren't specifically UIP they were not entitled to antifibrotic treatment. So thank goodness for the INBUILD trial back in 2020 and it's extension and NICE technological appraisal for injecting pragmastism not only in to the types of patients now referrable for antifibrotics, but also the referral criteria. This has moved away from FVC and towards radiological classification and gas transfer which we all know are useful parameters of parenchymal health. We also talk about post COVID fibrosis, anti-reflux medication and anti-cough medication. I am joined by two regional experts in the field, Dr Chris Huntley and Dr Gareth Walters.

References are below:

Pirfenidone in patients with idiopathic pulmonary fibrosis (CAPACITY): two randomised trials PMID: 21571362

A Phase 3 Trial of Pirfenidone in Patients with Idiopathic Pulmonary Fibrosis DOI: 10.1056/NEJMoa1402582

Efficacy and Safety of Nintedanib in Idiopathic Pulmonary Fibrosis DOI: 10.1056/NEJMoa1402584 

Efficacy of a Tyrosine Kinase Inhibitor in Idiopathic Pulmonary Fibrosis

DOI: 10.1056/NEJMoa1103690

Pirfenidone in patients with progressive fibrotic interstitial lung diseases other than idiopathic pulmonary fibrosis (RELIEF): a double-blind, randomised, placebo-controlled, phase 2b trial 

PMID: 33798455

Nintedanib in Progressive Fibrosing Interstitial Lung Diseases

DOI: 10.1056/NEJMoa1908681

Phase 2B Study of Inhaled RVT-1601 for Chronic Cough in Idiopathic Pulmonary Fibrosis: A Multicenter, Randomized, Placebo-controlled Study (SCENIC Trial)

PMID: 35050837

Effect of anti-reflux therapy on pulmonary function in idiopathic pulmonary fibrosis: a systematic review and meta-analysis. PMID: 34795926

Post COVID PFT and CT systematic review: PMID: 35642193

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Finally it's here, the pleural podcast! Ever wondered why you can't get a straight answer about suction, talc and fibrinolytics? That's because the evidence until recently has been poor and we're still using guidelines written 12 years ago. But with the assistance of two excellent pleural specialists we pull apart the latest studies to discuss all your usual pleural conundrums to help you manage 90% of pleural disease within your local hospital, minimise the time spent in a hospital bed and reduce the need for a surgeon getting involved.
 
 Studies discussed include:

 MARS 2: PMID: 32873681

Conservative versus Interventional Treatment for Spontaneous Pneumothorax: PMID: 31995686

Ambulant treatment with a digital chest tube for prolonged air leak is safe and effective: PMID: 35070365

The Impact of Gravity vs Suction-driven Therapeutic Thoracentesis on Pressure-related Complications: The GRAVITAS Multicenter Randomized Controlled Trial: PMID: 31711990

Steroid Therapy and Outcome of Parapneumonic Pleural Effusions (STOPPE): A Pilot Randomized Clinical Trial  PMID: 35081010

Efficacy of sonographic and biological pleurodesis indicators of malignant pleural effusion (SIMPLE): protocol of a randomised controlled trial PMID: 29225889

Effect of Thoracoscopic Talc Poudrage vs Talc Slurry via Chest Tube on Pleurodesis Failure Rate Among Patients With Malignant Pleural Effusions: A Randomized Clinical Trial  PMID: 31804680

The bacteriology of pleural infection (TORPIDS): an exploratory metagenomics analysis through next generation sequencing DOI:https://doi.org/10.1016/S2666-5247(21)00327-X

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