Asthma varies considerably across the life course. Childhood asthma is known for its overall high prevalence with a male predominance prior to puberty, common remission, and rare mortality. Adult ...asthma is known for its female predominance, uncommon remission, and unusual mortality. Both childhood and adult asthma have variable presentations, which are described herein. Childhood asthma severity is associated with duration of asthma symptoms, medication use, lung function, low socioeconomic status, racial/ethnic minorities, and a neutrophilic phenotype. Adult asthma severity is associated with increased IgE, elevated FeNO, eosinophilia, obesity, smoking, and low socioeconomic status. Adult onset disease is associated with more respiratory symptoms and asthma medication use despite higher prebronchodilator FEV1/FVC. There is less quiescent disease in adult onset asthma and it appears to be less stable than childhood-onset disease with more relapses and less remissions.
After lung transplantation, pulmonary vein thrombosis is a rare, potentially life-threatening adverse event arising at the pulmonary venous anastomosis that typically occurs early and presents as ...graft failure and hemodynamic compromise with an associated mortality of up to 40%. The incidence, presentation, outcomes, and treatment of late pulmonary vein thrombosis remain poorly defined. Management options include anticoagulant agents for asymptomatic clots, and thrombolytic agents or surgical thrombectomy for hemodynamically significant clots. We present a rare case highlighting a delayed presentation of pulmonary vein thrombosis occurring longer than 2 weeks after lung transplantation and manifesting clinically as graft failure secondary to refractory pulmonary edema. The patient was treated successfully with surgical thrombectomy and remains well. We recommend a high index of suspicion of pulmonary vein thrombosis when graft failure after lung transplantation occurs and is not responsive to conventional therapy, and consideration of investigation with transesophageal echocardiography or computed tomography with venous phase contrast in such patients even more than 2 weeks after lung transplantation.
There is no consensus on criteria to include in an asthma remission definition in real-life. Factors associated with achieving remission post-biologic-initiation remain poorly understood.
To quantify ...the proportion of adults with severe asthma achieving multi-domain-defined remission post-biologic-initiation and identify pre-biologic characteristics associated with achieving remission which may be used to predict it.
This was a longitudinal cohort study using data from 23 countries from the International Severe Asthma Registry. Four asthma outcome domains were assessed in the 1-year pre- and post-biologic-initiation.
-defined remission cut-offs were: 0 exacerbations/year, no long-term oral corticosteroid (LTOCS), partly/well-controlled asthma, and percent predicted forced expiratory volume in one second ≥80%. Remission was defined using 2 (exacerbations + LTOCS), 3 (+control or +lung function) and 4 of these domains. The association between pre-biologic characteristics and post-biologic remission was assessed by multivariable analysis.
50.2%, 33.5%, 25.8% and 20.3% of patients met criteria for 2, 3 (+control), 3 (+lung function) and 4-domain-remission, respectively. The odds of achieving 4-domain remission decreased by 15% for every additional 10-years asthma duration (odds ratio: 0.85; 95% CI: 0.73, 1.00). The odds of remission increased in those with fewer exacerbations/year, lower LTOCS daily dose, better control and better lung function pre-biologic-initiation.
One in 5 patients achieved 4-domain remission within 1-year of biologic-initiation. Patients with less severe impairment and shorter asthma duration at initiation had a greater chance of achieving remission post-biologic, indicating that biologic treatment should not be delayed if remission is the goal. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Background
Pleural ultrasound guidance reduces complications of pleural procedures, and lung ultrasound can diagnose the cause of acute respiratory failure. Yet as recently as 5 years ago, many ...respiratory physicians lacked sufficient access, training and expertise to perform a chest ultrasound.
Aims
This study examines whether progress has been achieved in chest ultrasound amongst respiratory physicians in Australia and New Zealand.
Methods
We conducted a web‐based chest ultrasound survey of adult respiratory physicians across Australia and New Zealand. We also surveyed advanced trainees.
Results
The response rate was 38% among respiratory physicians. Between 2011 and 2016, access to bedside ultrasound increased from 53 to 90%. The proportion arranging ultrasound guidance for pleural aspiration rose from 66 to 95%. The proportion demonstrably competent in pleural ultrasound increased from 4 to 21%. In 2016, 67% of physicians and 80% of advanced trainees reported available workplace supervision for ultrasound training. Use of lung ultrasound to diagnose acute pulmonary oedema and consolidation improved from 2011 but remained low at 25 and 20% respectively.
Conclusion
These results establish pleural ultrasound guidance for pleural procedures as the standard of care in our region. However, lung ultrasound remains underutilised. Ultrasound training can and should be incorporated into specialist respiratory training.
Background
The association between socio‐economic status (SES) and lung cancer is internationally established, but in Australia this relationship remains ill defined.
Aims
To examine the association ...between SES, place of residence and lung cancer outcomes in a large Australian cohort.
Methods
A total of 2369 consecutive lung cancer patients managed by St Vincent's Hospital lung multidisciplinary meeting between 2001 and 2014 were included. Postcode data stratified participants by Socio‐economic indexes for areas, a validated measure of SES, and by geographical location, an important socio‐economic factor in Australia.
Results
There was no difference between socio‐economic groups in age (68 years), sex (63% males) or presentation (75% symptomatic). Low socio‐economic patients had increased smoking rates and a trend towards less adenocarcinoma. More low SES patients were from rural locations, had a greater frequency of earlier stage disease and curative treatment with higher overall survival even after multivariate analysis. When stratified for SES, overall 5‐year survival was significantly better in the low SES group (33 vs 24%, n = 2275, P = 0.02), although stage‐stratified survival was similar in all socio‐economic groups.
Conclusions
Low SES patients were more frequently from rural locations and unexpectedly had earlier stage disease and higher overall survival. The excellent outcomes in rural and lower SES patients are reassuring, but suggest that there is a population of these patients with advanced lung cancer who are not referred for multidisciplinary care. Further studies are required to define this group better and determine the barriers to referral to improve overall lung cancer outcomes.
Purpose
Excessive daytime sleepiness (EDS) is a debilitating symptom which occurs commonly in both primary sleep and mood disorders. The prevalence of mood disorders in patients with EDS, evaluated ...objectively with a mean sleep latency test (MSLT), has not been reported. We hypothesize that mood disorders are highly prevalent in patients being investigated for EDS. This study aims to report the prevalence of mood disorder in the MSLT population and investigate the association between mood disorder and objective and subjective scores of sleepiness.
Methods
A retrospective multicenter study of adults with a MSLT and Hospital Anxiety and Depression Score (HADS) identified over a 3-year period. The HADS is a validated questionnaire in detecting depression (HADS-D ≥ 8) and anxiety (HADS-A ≥ 11) in the sleep clinic population. Data collected included demographics, medical, and sleep study information. Mood disorder prevalence was compared to the general sleep clinic population. Correlation between measures of sleepiness and mood was performed.
Results
Two hundred twenty patients were included with mean age 41.1 ± 15.7 years, mean body mass index 28.6 kg/m
2
of whom 30% had anxiety (HADS-A > 11) and 43% depression (HADS-D > 8). Mean results for the cohort are ESS 13.7, mean sleep latency 11.5 min, HADS-A 8.2, and HADS-D 7. There was no significant correlation between objective sleepiness, as measured by the mean sleep latency, and either HADS-A (−0.006,
p
= 0.93) or HADS-D score (0.002,
p
= 0.98). There was, however, a weak correlation between subjective sleepiness, as measured by the ESS, and the mean sleep latency (−0.25,
p
< 0.01), HADS-A (0.15,
p
= 0.03), and HADS-D (0.2,
p
= 0.004). There was no significant association between diagnosis of hypersomnia disorders and presence of anxiety (
p
= 0.71) or depression (
p
= 0.83).
Conclusions
Mood disorders are highly prevalent in the MSLT population. There was a weak correlation found between subjective measures of sleepiness and mood disorders, but not between objective measures of sleepiness and mood disorders. Routine screening for mood disorders in patients with hypersomnolence should be considered.
Severe asthma imposes a significant burden on individuals, families and the healthcare system. Treatment is complex, due to disease heterogeneity, comorbidities and complexity in care pathways. New ...approaches and treatments improve health outcomes for people with severe asthma. However, emerging multidimensional and targeted treatment strategies require a reorganisation of asthma care. Consensus is required on how reorganisation should occur and what areas require further research. The Centre of Excellence in Severe Asthma convened three forums between 2015 and 2018, hosting experts from Australia, New Zealand and the UK. The forums were complemented by a survey of clinicians involved in the management of people with severe asthma. We sought to: (i) identify areas of consensus among experts; (ii) define activities and resources required for the implementation of findings into practice; and (iii) identify specific priority areas for future research. Discussions identified areas of unmet need including assessment and diagnosis of severe asthma, models of care and treatment pathways, add‐on treatment approaches and patient perspectives. We recommend development of education and training activities, clinical resources and standards of care documents, increased stakeholder engagement and public awareness campaigns and improved access to infrastructure and funding. Further, we propose specific future research to inform clinical decision‐making and develop novel therapies. A concerted effort is required from all stakeholders (including patients, healthcare professionals and organisations and government) to integrate new evidence‐based practices into clinical care and to advance research to resolve questions relevant to improving outcomes for people with severe asthma.
Occupational aspects of irritable larynx syndrome Denton, Eve; Hoy, Ryan
Current opinion in allergy and clinical immunology,
2020-April, 2020-04-00, 20200401, Letnik:
20, Številka:
2
Journal Article
PURPOSE OF REVIEWThe aim of this article is to provide an update on occupational aspects of irritable larynx syndrome (ILS).
RECENT FINDINGSIt is being increasingly recognized that ILS is common ...amongst certain occupations. This is particularly true of occupations that require frequent voice use such as teachers; where there is exposure to workplace irritants such as World Trade Center responders; or mechanical factors that cause laryngeal dysfunction such as elite athletes. Work associated ILS impacts on quality of life but responds to speech and language therapy focusing on education, vocal hygiene, and laryngeal exercises that reduce cough and treat acute laryngeal obstruction episodes.
SUMMARYILS may be caused or exacerbated by many occupational exposures, causes significant symptoms, and impacts on quality of life. It is potentially treatable and may well be preventable. More research in this important area is required.
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