Being (past and present) President of the ERS: interview about the role, perspectives on career development, and vision for the Society

This article presents the views of the past and current Presidents of the ERS regarding their role, perspectives on career development and vision for the Society, along with important messages to inspire ECMs to build their own successful career. https://bit.ly/3kAvxIM

Exploration of physical activity knowledge, preferences and support needs among pulmonary hypertension patients

Objective: Physical activity (PA) is an established adjunct therapy for pulmonary hypertension (PH) patients to mitigate PH symptoms and improve quality of life. However, PA engagement within this population remains low. This study investigated PH patients’ knowledge of PA, recalled advice, exercise preferences and PA support needs. Methods: Semi-structured interviews were conducted with 19 adults (mean age 50 years; SD ±12 years) diagnosed with PH, living in Ireland. Interview scripts were digitally recorded and transcribed verbatim. Thematic analysis was used to analyse the data. Results: Four key themes were identified: Lack of PA knowledge; exercise setting preference; accountability and monitoring; and clinician delivered PA information and guidance. Conclusion: This study found that PH clinicians provide suboptimal PA advice, yet patients desired clinician-delivered PA guidance. Home-based exercise was preferred with monitoring and external accountability deemed as important to facilitate sustained engagement. Practice implications: PH clinicians are well positioned to play a critical role in assisting and empowering PH patients to engage in PA. Providing training and education to PH clinicians regarding exercise prescription may be beneficial. Further research is needed to evaluate the feasibility and efficacy of home-based exercise interventions to improve quality of life and physical activity in PH

Safety, Feasibility and Effectiveness of the remotely delivered Pulmonary Hypertension And Home-Based (PHAHB) Physical Activity intervention

Background Pulmonary hypertension (PH) is a heterogeneous condition, associated with a high symptom burden and a substantial loss of exercise capacity. Despite prior safety concerns regarding physical exertion, exercise training as a supportive therapy is now recommended for PH patients. Currently, most programs are hospital-based, which limits accessibility. There is a need to provide alternative approaches for physical activity engagement for PH patients. The aim of this research was to develop, implement and evaluate the safety, feasibility, and effectiveness of home-based physical activity intervention for PH. Methods An entirely remotely delivered home-based exercise intervention underpinned by behaviour change theory and informed by end-users, was assessed using a single-arm feasibility study design. Participants (n=19; 80% female) with a mean (±sd) age of 49.9±15.9 y with a diagnosis of PH undertook a 10-week, home-based exercise intervention with induction training, support materials, telecommunication support, health coaching, exercise training, and assessments, all remotely delivered. Training involved respiratory training along with a combination of aerobic and resistance exercises. Results The intervention was deemed safe as no adverse events were reported. A high level of feasibility was demonstrated as the protocol was implemented as intended, sustained a high level of engagement and adherence and was well accepted by participants in terms of enjoyment and utility. There was a significant improvement in functional capacity, physical activity, exercise self-efficacy and quality of life (QoL), between baseline and post-training. Conclusion The study demonstrates that an entirely remotely delivered home-based exercise program is safe, feasible and effective in improving functional capacity, physical activity, and QoL in PH patients

Lung cancer in young patients: tumour characteristics and treatment in an Irish population

Background: Lung cancer is the leading cause of cancer death in both sexes in Ireland. Studies suggest that lung cancer in younger patients has distinct characteristics. The aim of this study is to define the characteristics of lung cancer in patients 55-year-old or younger in an Irish population. Methods: Data was collected retrospectively from local medical records and the hospital electronic database regarding all patients diagnosed with lung cancer aged 55-year-old and younger, from 2010–2016. Information regarding patient demographics, smoking status, tumour histology, molecular analysis, stage and location, diagnostic modality and initial treatment choice was collected. In all cases the diagnosis of lung cancer was confirmed at the regional lung cancer multidisciplinary team (MDT) meeting. Results: In total, 8% (n=130) of all cases of lung cancer diagnosed from 2010 to 2016 in our center occurred in patients aged 55 years old or younger; 83% (n=108) were 45 to 55-year-old, 15% (n=19) were 35 to 44-year-old and 2% (n=3) were younger than 35-year-old; 88% (n=115) of patients reported a smoking history. There was a female preponderance (58%, n=76), higher rates of NSCLC non-squamous subtype (53%, n=69) and an upper lobe predominance (42%, n=54); 53% (n=68) of patients had IV or extensive disease at presentation. Epidermal growth factor receptor (EGFR), anaplastic lymphoma kinase (ALK) and Kirsten rat sarcoma oncogene (KRAS) mutation rates were 9% (n=4) and 3% (n=1) and 80% (n=4) respectively. Conclusions: Lung cancer in younger patients has distinct characteristics. This study suggests a female preponderance, high smoking rates and a predilection for the upper lobes. Further large-scale multicenter studies are required to verify these results and to clarify the responsible mechanisms

Coexistent sarcoidosis and lymphangioleiomyomatosis in a patient with cystic lung disease

A 45-year-old lady presented acutely with pleuritic chest pain, haemoptysis, and dyspnoea. Her background was significant for a 1.4 cm renal angiomyolipoma, and she was an ex-smoker without any relevant family history. A computed tomography (CT) pulmonary angiogram was negative for a pulmonary embolism but demonstrated diffuse cystic change throughout both lungs. A bronchoscopy confirmed a normal endobronchial tree, and pulmonary function tests demonstrated moderate airways obstruction, with reversibility and a normal diffusion capacity for carbon monoxide (DLCO). A video-assisted thoracoscopic surgery (VATS) lung biopsy showed non-caseating granulomas, and serum angiotensin converting enzyme (ACE) was elevated consistent with a diagnosis of pulmonary sarcoidosis. Further sectioning indicated focal areas that stained positive for Human Melanoma Black 45 (HMB-45), confirming lymphangioleiomyomatosis (LAM). A diagnosis of cystic lung disease secondary to coexistent sarcoidosis and LAM was made

ERS International Congress 2023: highlights from the Pulmonary Vascular Diseases Assembly.

peer reviewedPulmonary vascular diseases such as pulmonary embolism and pulmonary hypertension are important and frequently under-recognised conditions. This article provides an overview of key highlights in pulmonary vascular diseases from the European Respiratory Society International Congress 2023. This includes insights into disease modification in pulmonary arterial hypertension and novel therapies such as sotatercept and seralutinib. Exciting developments in our understanding of the mechanisms underpinning pulmonary hypertension associated with interstitial lung disease are also explored. A comprehensive overview of the complex relationship between acute pulmonary embolism and chronic thromboembolic pulmonary hypertension (CTEPH) is provided along with our current understanding of the molecular determinants of CTEPH. The importance of multidisciplinary and holistic care cannot be understated, and this article also addresses advances beyond medication, with a special focus on exercise training and rehabilitation

Being (past and present) President of the ERS: interview about the role, perspectives on career development, and vision for the Society

This article presents the views of the past and current Presidents of the ERS regarding their role, perspectives on career development and vision for the Society, along with important messages to inspire ECMs to build their own successful career. For this article, we invited early career members (ECMs) to interview the past and current Presidents of the European Respiratory Society (ERS), Professor Anita Simonds and Professor Marc Humbert, to share their motivations for becoming ERS President, experiences and goals during their presidency, perspectives on career development, visions for the society, and future challenges and opportunities in the respiratory field in the coming years. During the interviews, they provided important messages to help ECMs build their own successful career. We challenge ECMs to read the interviews and get inspired!info:eu-repo/semantics/publishedVersio

Aspiration and altered airway anatomy: a presentation with a twist

A 60-year-old woman presented to our hospital with severe hypercapnic respiratory failure in the absence of a prior smoking history. She reported a 1-day history of increased dyspnoea and a cough productive of green sputum. Her medical history was significant for severe idiopathic scoliosis, cleft palate repair, rheumatoid arthritis, hypothyroidism and recurrent lower respiratory tract infections. She was obtunded on presentation and required 24 hours of mechanical ventilation. A CT thorax was performed to further investigate her acute deterioration. Considerable distortion of thoracic anatomy secondary to kyphoscoliosis was noted. Right lower lobe atelectasis due to extrinsic compression of the bronchus intermedius by thoracic vertebrae and left lower lobe consolidation were reported (figures 1–3). Due to the vertical orientation of the left main bronchus (LMB), aspiration pneumonia was suspected (figure 2). Our patient initially improved with antimicrobial therapy, dietary modifications and proton pump inhibitors and was discharged home

Aspiration and altered airway anatomy: a presentation with a twist

A 60-year-old woman presented to our hospital with severe hypercapnic respiratory failure in the absence of a prior smoking history. She reported a 1-day history of increased dyspnoea and a cough productive of green sputum. Her medical history was significant for severe idiopathic scoliosis, cleft palate repair, rheumatoid arthritis, hypothyroidism and recurrent lower respiratory tract infections. She was obtunded on presentation and required 24 hours of mechanical ventilation. A CT thorax was performed to further investigate her acute deterioration. Considerable distortion of thoracic anatomy secondary to kyphoscoliosis was noted. Right lower lobe atelectasis due to extrinsic compression of the bronchus intermedius by thoracic vertebrae and left lower lobe consolidation were reported (figures 1–3). Due to the vertical orientation of the left main bronchus (LMB), aspiration pneumonia was suspected (figure 2). Our patient initially improved with antimicrobial therapy, dietary modifications and proton pump inhibitors and was discharged home.publishedVersio

Incidence and outcomes of pulmonary hypertension in the Ireland

Introduction Pulmonary hypertension (PH) is a progressive disease of the pulmonary vasculature, which is characterised by premature morbidity and mortality. The aim of this study is to define the characteristics of PH in the national PH unit (NPHU) in Ireland between 2010 and 2020.Methods Cases of PH which were referred to the NPHU between 2010 and 2020 were included. PH was defined as a mean pulmonary artery pressure ≥25 mm Hg at right heart catheterisation.Results Four hundred and fifteen cases of PH were identified during the study period. Group 1 pulmonary arterial hypertension (PAH) accounted for 39% (n=163) of cases, with a calculated annual incidence of 3.11 per million population (95% CI 1.53 to 4.70). The leading PAH subgroup was connective tissue disease-associated PAH (CTD-PAH), which was responsible for 49% of PAH referrals. This was followed by idiopathic PAH, with an estimated annual incidence of 0.63 cases per million population. The mean age at PAH diagnosis was 56±15 years and 86% (n=111) received double-combination or triple-combination therapy within the first 12 months of diagnosis. The 1-year, 3-year and 5-year transplant-free survival for PAH was 89%, 75% and 65%. This was significantly lower for individuals with CTD-PAH relative to other PAH subgroups (p<0.05).Discussion This study describes the incidence and outcomes of PH in Ireland. While the outcomes are comparable to other centres, the incidence of PAH and specific subgroups appears low, suggesting that improved disease awareness and case recognition are required. Furthermore, the survival of individuals with CTD-PAH is poor and requires additional exploration