Respiratory care

Mucus plugging and mucolytics in patients admitted with acute exacerbation of chronic obstructive pulmonary disease (COPD); investigating impact on short term mortality (2024)

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Type of publication:

Conference abstract

Author(s):

*Abugassa E.; *Bosher O.; *Makan N.; *Crawford E.; *Saleem M.A.; *Srinivasan K.; *Moudgil H.

Citation:

European Respiratory Journal. Conference: European Respiratory Society International Congress, ERS 2024. Vienna Austria. 64(Supplement 68) (pp PA3010), 2024. Date of Publication: 01 Sep 2024.

Abstract:

Background: Although mucus plugging occluding medium to large sized airways in COPD is associated with increased long term all-cause mortality, acute exacerbations require further investigation, particularly where, despite reducing morbidity and improving quality of life, long-term use of mucolytics remains controversial. Objectives were (1) to quantify chest CT evidence of mucus plugging, (2) relate findings to mucolytics, and (3) investigate mucus plugging association with short term mortality.

Method(s): Retrospective review of 100 patients admitted with exacerbation of COPD (105 admissions).comparative analysis by chi square (x2) and logistic regression, significant p<.05.

Result(s): Mean (SD, range) age was 74.7 (10.5, 41-97) years with 54% male; mean FEV1/FVC 55% with FEV1 1.2(0.59, 0.4-3.6) litres at 49% predicted. 23 were on long term oxygen (LTOT). Mean stay was 6.3 (1-41) days. 24 died in the first 6 months. Where a historical or admission chest CT was available (n=82), 12 (15%) had mucus plugging with mucolytics prescribed to 6 (50%) compared to 32/70 (46%) without plugging (x2 0.057, NS). 9/56 (16%) with mucus plugging vs 3/26 (12%) without (x2 0.2921, NS) had emphysema and 3/13 (23%) vs 9/69 (13%) without (x2 1.016, NS) bronchiectasis. Regression investigating mortality at 6 months showed adverse outcomes for male sex, lower FEV1, and LTOT.

Conclusion(s): 15% with acute COPD admissions have current or historical evidence of mucus plugging. Mucolytics are prescribed for 45% irrespective of prior CT radiology. Mortality (24%) at 6 months is high but not shown related to mucus plugging or reduced by mucolytics.

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Pleural infection presentation and timeline of events: Real-world data from a tertiary hospital in the UK (2024)

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Type of publication:

Conference abstract

Author(s):

Mannan S.; Waseem T.; Safwan N.; Ganaie M.;

Citation:

Pleural infection presentation and timeline of events: Real-world data from a tertiary hospital in the UK.

Abstract:

Background: Pleural infection remains a significant burden on mortality and morbidity in the Western world even with the advancement of clinical management.

Objective(s): This paper aims to study the clinical course of empyema thoracic patients managed in a tertiary hospital in the UK.

Method(s): We did a retrospective observational study of the hospital's electronic records of patients who were diagnosed and managed for empyema thoracic from January 2021 to December 2022.

Result(s): The total cohort was 104 empyema thoracic patients. The mean age was 60. The affected males were almost double than females (68 vs 36). We did a retrospective RAPID score of our cohort. The RAPID score could not be calculated for 35 patients due to the unavailability of pleural fluid data. High inpatient mortality (23%) was observed in the medium- risk (RAPID score 3-4) group and high 3-month mortality (25%) was observed in the high-risk (RAPID score 5-7) group. The majority of the patients were managed conservatively. No difference was noticed in the median length of hospital stay (11d) in all the risk groups. A high rate of (37%) surgical management was observed in the low-risk (RAPID score 0-2) group.

Conclusion(s): Our cohort's data comply with the predicted mortality risk of the RAPID score. We emphasize that RAPID score calculation can be a significant tool in the management of empyema thoracic patients.

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Title: Is smoking associated with higher cardiovascular risk and increased unplanned acute medical attendance? A retrospective analysis from the Lung Cancer screening cohort (2023)

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Type of publication:

Conference abstract

Author(s):

Haider R.; Finn E.; *Zeb S.; *Bharwana F.; Fitzgerald A.; Iftikhar S.; Hussain I.;

Citation:

European Respiratory Journal. Conference: European Respiratory Society International Congress, ERS 2023. Milan Italy. 62(Supplement 67) (pp PA1345), 2023. Date of Publication: 01 Sep 2023.

Abstract:

Intro: Active smoking plays a crucial role in cardiovascular disease. We looked at the rate of attendance to primary and secondary care amongst current smokers with increased QRISK and CAT scores.

Methodology: Data were drawn retrospectively from electronic medical records from a large tertiary care hospital covering Staffordshire region over a one year period 2019-2020. Data was extracted from lung cancer screening cohort.

Result(s): The data comprised of 1232 patients (516 female, 716 male). Of these, 566 were exsmokers and 666 current smokers. Average age was 62 years. Analysis was done using ANOVA. This confirms that current heavy smokers, had an increased QRISK score >10 (p value <0.05, 95% CI 0.00 to 0.02). 1 year mortality in this group was 2.8%. Heavy smokers were not at an increased risk of attending primary care (p value 0.862) or at increased risk of unplanned secondary care admissions (p value 0.09) as compared to light smokers. Median length of hospital stay was 8 (0 – 16) bed days in heavy smokers as compared to 4 bed days (0 – 8) in ex smokers. Female ex smokers had fewer hospital attendances as compared to female current smokers, male current and ex smokers (p value <0.05, tests statistic 4.207). A high CAT score was documented as >20 denoting impact of COPD on patient's life. It was not identified as a predictor of increased attendance to primary or secondary care.

Conclusion(s): Heavy smokers have a higher economic burden on acute secondary care on account of higher number of bed days. Early smoking cessation intervention may help reduce attendance into secondary care.

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The continued burden of pleural mesothelioma; a review of 10 years experience at this hospital Trust (2023)

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Type of publication:

Conference abstract

Author(s):

*Gohir Q.; *Mcadam J.; *Crawford E.; *Bosher O.; *Saleem M.; *Srinivasan K.; *Moudgil H.;

Citation:

European Respiratory Journal. Conference: European Respiratory Society International Congress, ERS 2023. Milan Italy. 62(Supplement 67) (pp PA3444), 2023. Date of Publication: 01 Sep 2023.

Abstract:

Background: Prognosis with pleural mesothelioma depends not only on histological typing but also distribution of metastatic disease (including stage 4 with distant spread) and performance status. Analysing all patients presenting at his hospital Trust over 10 years, this work (1) reports the pattern of metastatic disease and, accepting the complex multi-modality approach to treatment, (2) relates findings to survival.

Method(s): Retrospective computer based analysis conferring with oncology and radiology records. 169 patients (84% male) with mean (range) age 74.4 (44 to 93) years.

Result(s): Respectively, performance status was 0 (16%), 1 (34%), 2 (26%), 3 (18%) and 4 (1%). 70% only had thoracic disease (pleural, pericardial, mediastinal, pulmonary) and 30% extrathoracic extension (chest wall/extrapleural, diaphragmatic, peritoneal/omental/ascites), liver/spleen/adrenal, spine and bone, and other (including brain and brachial plexus). Overall, 94% were diagnosed on tissue samples; where histology was clarified, 63% with epithelioid survived longer at (mean) 15 months compared to the 37% with 12.6 months for sarcomatoid or biphasic typing. Although active treatments often involved the complexity of multimodality, 34% had best supported care (usually worse performance status).

Conclusion(s): Findings highlight the aggressive nature of pleural mesothelioma confirming at least 30% had extrathoracic metastases and marginally improved outcomes with epithelioid histology.

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BTS Position Statement on Sustainability and the Environment: Climate Change and Lung Health (2024)

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Type of publication:

National guidance

Author(s):

Laura-Jane Smith, Henry Marshall, Thomas Medveczky, *Jennifer Nixon, Gerrard Phillips, Ravijyot Saggu, Lewis Standing, Ruth Wiggans, Alexander Wilkinson

Citation:

British Thoracic Society 2024

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The diagnosis and management of systemic autoimmune rheumatic disease-related interstitial lung disease: British Society for Rheumatology guideline scope (2024)

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Type of publication:
Journal article

Author(s):
Hannah, Jennifer; Rodziewicz, Mia; Mehta, Puja; Heenan, Kerri-Marie; Ball, Elizabeth; Barratt, Shaney; Carty, Sara; Conway, Richard; Cotton, Caroline V; Cox, Sarah; Crawshaw, Anjali; Dawson, Julie; Desai, Sujal; Fahim, Ahmed; Fielding, Carol; *Garton, Mark; George, Peter; Gunawardena, Harsha; Kelly, Clive; Khan, Fasihul; Koduri, Gouri; Morris, Helen; Naqvi, Marium; Perry, Elizabeth; Riddell, Claire; Sieiro Santos, Cristiana; Spencer, Lisa G; Chaudhuri, Nazia; Nisar, Muhammad K.

Citation:
Rheumatology Advances in Practice. 8(2):rkae056, 2024.

Abstract:
Interstitial lung disease (ILD) is a significant complication of many systemic autoimmune rheumatic diseases (SARDs), although the clinical presentation, severity and outlook may vary widely between individuals. Despite the prevalence, there are no specific guidelines addressing the issue of screening, diagnosis and management of ILD across this diverse group. Guidelines from the ACR and EULAR are expected, but there is a need for UK-specific guidelines that consider the framework of the UK National Health Service, local licensing and funding strategies. This article outlines the intended scope for the British Society for Rheumatology guideline on the diagnosis and management of SARD-ILD developed by the guideline working group. It specifically identifies the SARDs for consideration, alongside the overarching principles for which systematic review will be conducted. Expert consensus will be produced based on the most up-to-date available evidence for inclusion within the final guideline. Key issues to be addressed include recommendations for screening of ILD, identifying the methodology and frequency of monitoring and pharmacological and non-pharmacological management. The guideline will be developed according to methods and processes outlined in Creating Clinical Guidelines: British Society for Rheumatology Protocol version 5.1.

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Lung Ultrasound for Diagnosis of Primary Graft Dysfunction in Lung Transplantation Recipients (2024)

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Type of publication:
Conference abstract

Author(s):
O'Brien E.; Curry S.; Rubino A.; Barker A.; *Miller A.; Parmar J.

Citation:
Journal of Heart and Lung Transplantation. Conference: ISHLT 44th Annual Meeting and Scientific Sessions Prague Congress Centre. Prague Czechia. 43(4 Supplement) (pp S345), 2024. Date of Publication: April 2024.

Abstract:
Purpose: To determine if lung aeration scores calculated using LUS correlate with the identification and grading of PGD in lung transplantation recipients identified on bedside chest radiography (CXR) and PaO2/FiO2 as the reference standard. Method(s): This is a two-year, single-centre, prospective observational study investigating lung transplantation patients admitted post-operatively to Critical Care at Royal Papworth Hospital (RPH). LUS assessments to examine 12-lung regions were conducted at specified timepoints and scored retrospectively. Differences between LUS aeration scores for PGD and non-PGD were tested for and correlation of LUS score and PGD grading was assessed. Result(s): To date, data has been collected from 29 consecutive adult patients in 12 months. A total of 816 lung ultrasound clips have been collected for analysis. The mean aeration scores in PGD patients was higher than non-PGD (t(42) = 4.58, p < 0.001). PGD severity grading and LUS score shows a moderate positive linear association r(42) =.67, p < 0.01. Conclusion(s): This interim data analysis demonstrates exciting potential of LUS as an imaging modality in this cohort for PGD. This study is set to continue for a further 12 months, to allow for a larger sample size and further analysis of the utilisation of LUS in this cohort.

Psychological distress in lung cancer: patient selfassessment versus lung cancer nurse specialist (LCNS) judgement (2023)

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Type of publication:
Conference abstract

Author(s):
Walker S.; Lamonby V.; Orwin R.; *McAdam J.; Bate G.; Vick J.; Elrick N.; Shepherd P.; Flint A.; Dalrymple P.

Citation:
Lung Cancer. Conference: 21st Annual British Thoracic Oncology Group Conference 2023. Belfast United Kingdom. 178(Supplement 1) (pp S76), 2023. Date of Publication: April 2023.

Abstract:
Aims: Distress Thermometer (DT) tool compares LCNS' clinical judgment of patients' psychological distress to patients' self-reported assessment. Method(s): Few studies examine nurses' abilities assessing distress in patients, only one focusing lung cancer. They suggest Nurse Specialists within cancer settings struggle identifying distress using clinical judgement. The Distress Thermometer, a self-reported validated tool, can be used to screen for distress in cancer patients, but cannot replace comprehensive assessment. LCNUK members were surveyed May 2022. 44% used validated assessment tools and 75% confirmed these influenced management. LCNS each assessed 12 patients using The Distress Thermometer, face to face or telephone, occurring following first patient contact. The LCNS used DT tool assessing their perception of patient's distress level. Patients were asked to assess themselves using the same tool. Result(s): 45% assessments scored were identical 36.7% LCNS scored higher than patient 18.3% LCNS scored lower than patient 68.3% LCNS assessments within one DT point of patient Average difference of score between patient and LCNS was 0.4. 93.8% telephone assessments within 1 DT point 54.5% F2F assessments within 1 DT point Conclusion(s): LCNS's have excellent clinical judgement assessing patient distress, comparable to patient's self-assessment in most cases.

Improving Specialist Knowledge and Skills in Complex Airway Management In Critical Care (2023)

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Type of publication:
Service improvement case study

Author(s):
*Ashley Timms, with support from *Elaine France, *Matt Quarmby, and the *Critical Care Practice Education Facilitators.

Citation:
SaTH Improvement Hub, 2023

Abstract:
Following patient safety incidents it became clear that there was a need to focus on complex airway management and upskill the existing critical care teams across both sites.

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Crucial, complex, caring: a new professional development framework for Lung Cancer Nurse Specialists (2022)

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Type of publication:Conference abstract

Author(s):Roberts J.; Barton P.; Clayton K.; Fenemore J.; Ivey S.; *McAdam J.; Shepherd P.

Citation:Lung Cancer. Conference: 20th Annual British Thoracic Oncology Group Conference 2022. Virtual, Online. 165(Supplement 1) (pp S40), 2022. Date of Publication: March 2022.

Abstract:Introduction: Lung cancer specialist nursing is a varied, valuable and rewarding career, and the need for lung cancer nurse specialists (LCNS) is increasing. Lung Cancer Nursing UK (LCNUK) wants to encourage nurses to aspire to becoming an LCNS, and to support those already working in lung cancer teams to flourish professionally. We want employers to recognise LCNS' capabilities and to recruit and reward them accordingly. LCNUK therefore set out to draft the first professional development framework for LCNS. The Framework is intended to guide nurses, line managers and employers on the core skills, knowledge and expertise that LCNS will gain and demonstrate as they progress in role. Method(s): LCNUK convened a working group which reviewed exemplars and supporting literature. The team produced a draft framework setting out the qualifications, skills and capabilities needed by nurses operating at different levels, aligned with the (Figure Presented) four pillars of advanced practice. Feedback on the draft was sought from expert stakeholders before the final document was approved by the LCNUK Steering Committee. The Framework was developed in a collaboration between LCNUK and MSD, who funded a policy consultancy to provide secretariat support. LCNUK retained editorial independence of the framework content. Result(s): The Framework sets out the qualifications, clinical skills, knowledge, leadership and management and research capabilities that LCNUK expects aspiring and existing LCNS to demonstrate or be working towards. It includes case studies of nurses' career journeys and an example of a successful case for job matching and re-banding. The Framework is available on the LCNUK website at www.lcnuk.org. Conclusion(s): The Framework asserts the crucial role of LCNS in managing safety-critical and complex patient care and in leading service delivery and improvement. We hope it will prove a valuable tool to nurses, employers and policymakers in understanding the complexity and importance of this essential role.