A breath of fresh air for the respiratory medicine community

The Medical Independent speaks to Dr Ruairi Fahy about the Irish Thoracic Society’s upcoming Annual Scientific Meeting.

The Irish Thoracic Society (ITS) will soon host its first in-person Annual Scientific Meeting since 2019. The meeting will take place in Killashee Hotel, Naas, Co Kildare, between 1-3 December. 

For Dr Ruairi Fahy, a member of the meeting’s organising committee, the face-to-face nature of the event is significant. 

“Interpersonal relationships are so important,” Dr Fahy, who is Consultant Respiratory Physician in St James’s Hospital, Dublin, told the Medical Independent (MI). 

“You can do a lot of things by Zoom… It is easy to disperse general knowledge through the Internet, through computers, but it is not the same as attending in person because you fail to make the individual connections that I think are important.” 

The first session of the meeting on Thursday, 1 December, will focus on specialist registrar training. This will be followed by two parallel sessions – a case study forum and a case study poster review. Case study oral presentations will round-off the evening, before the prize-giving ceremony and dinner. 

On Friday, 2 December, a poster review session will commence proceedings. Parallel discussions on specific diseases will follow. These will focus on: Asthma; interstitial lung disease; lung cancer; patient care; tuberculosis; and pleural and sleep disorders. After a short break, a second poster review session will take place, and additional parallel discussions. These will be on: Cystic fibrosis; chronic pulmonary obstructive disease (COPD); Covid-19; general respiratory; and telehealth. 

Lunch and the ITS AGM will take place from 1.00 to 2.30, followed by oral presentations and affiliate meetings, which will be held concurrently for the majority of the afternoon. These include the ITS paediatric forum and the ANÁIL forum. ANÁIL is a body that seeks to support specialist respiratory nurses and promote respiratory care in the wider nursing community nationally and internationally through creating opportunities for networking, education, and representation on regional and national fora. The forum of the Chartered Physiotherapists in Respiratory Care will also be held, as well as that of the Irish Institute of Clinical Measurement Physiology, Respiratory Faculty. 

Dr Fahy stressed the importance of the affiliate meetings, stating the members of these groups “are an integral part of the services we offer and we really can’t work effectively without them”. 

Sarcoidosis 

Following the affiliate meetings, the first guest lecture of the Annual Scientific Meeting will be heard. It will be delivered by Dr Elliott Crouser, Associate Professor, Internal Medicine, Ohio State University, US. Dr Crouser will speak about developments in sarcoidosis pathogenesis and treatment. 

Sarcoidosis is one of Dr Fahy’s areas of special interest and he is very much looking forward to the talk. 

“He’s going to talk about developments in sarcoidosis pathogenesis and treatment,” according to Dr Fahy. 

“So, he will be looking at new pathways of pathogenesis or disease progression that have been identified in the last five years and then new novel treatments that we have started to use over this period.” 

After the lecture, there will another prize-giving ceremony and drinks reception, followed by the gala dinner. 

E-cigarettes 

The final day of the meeting, Saturday, 3 December, will commence with a debate entitled ‘E-cigarettes are more harm than good.’ 

Dr Fahy said the debate will be interesting as “there are strong opinions” both for and against e-cigarettes. Some see the benefit of using e-cigarettes to help ‘wean’ patients, with COPD for example, off cigarettes. However, others believe they lead to the normalisation of smoking and can act as a gateway for young people. Also, the long-term health impact of inhaling e-cigarettes is not yet known and will take years to be understood. 

“I can see both sides of the argument,” Dr Fahy told MI. 

“I probably think that, if you want to use inhaled nicotine, it shouldn’t be available over the counter. It should on prescription for those patients, through their GP, or through their specialist, who want to quit but find it very difficult.” 

Interstitial lung disease and physiology lectures 

The debate will be followed by the second guest lecture. It will be delivered by Prof Aurelie Fabre, St Vincent’s University Hospital, Dublin (SVUH). The title of Prof Fabre’s talk is ‘The role of the pathologist in the diagnosis of interstitial lung disease’. 

Dr Fahy pointed out that Prof Fabre is an international expert in the area. She is Consultant Histopathologist at SVUH and Full Clinical Professor at University College Dublin (UCD), School of Medicine, with a special interest in thoracic pathology. She is also a member of the heart and lung transplant team of the national transplant unit at the Mater Misericordiae University Hospital, Dublin. Prof Fabre graduated from Trinity College Dublin in 1996, then received a Masters in medical sciences in pathology at UCD in 1998. She went on to train in histopathology in Paris and in London, where she received her MRCPath in 2002. Prof Fabre then completed a PhD thesis in lung fibrosis in parallel to a Fellowship in thoracic pathology at Bichat Claude-Bernard Hospital, Paris, in 2007. Her main interests include interstitial lung diseases, heart and lung transplant pathology, lung cancer, and cardiac/cardiovascular pathology. 

Interstitial lung disease is another of Dr Fahy’s special interests and he expects the lecture to be of great interest to attendees. 

“Pathology is one of the most important areas that we use to try and differentiate the different types of interstitial lung disease,” he said. 

“Some of it is relatively straightforward, but a huge amount of interstitial lung disease is idiopathic. As we develop genetic tests, and as we come up with new diagnostic parameters, we probably will chip away at that. That’s what happened in the last 20 years, by subcategorising these interstitial lung diseases more and more, which helps us treat them better.” 

Respiratory medicine, like a lot of other areas, has subspecialised to improve quality of care 

The third guest lecture asks, ‘What physiology is essential to the respirologist in 2022?’ It will be delivered by Prof Franco Laghi, Pulmonary and Critical Care Medicine, Loyola University Chicago, US. 

Prof Laghi has a particular interest in pulmonary function studies and cardiopulmonary exercise stress testing. Dr Fahy pointed out that these were standardised in the 1960s and 1970s, when “the basic physiology was the dominant part of respiratory medicine”. 

“The importance of this lecture will be getting an international expert to go over the pulmonary physiology in relation to cardiopulmonary stress testing, which we can make use of as respiratory physicians.” 

National programme 

Dr Fahy also highlighted the final guest lecture, which will provide an update on the HSE national clinical programme for respiratory health. The update will be provided by the Clinical Lead for the area, Dr Stanley Miller, who is also Consultant Respiratory Physician at the Mater Hospital. 

COPD is the most prevalent respiratory disease in Irish adults and is a major cause of morbidity and mortality. It is estimated that 380,000 people are living with COPD, yet only 110,000 are diagnosed. At least 1,500 patients die each year of this disease and over 15,000 patients are admitted to hospital in Ireland. The course of the disease involves ongoing medical care and in certain patients, results in frequent hospital admissions. 

A major initiative that the clinical programme has been involved with has been the roll-out of 34 community-based dedicated pulmonary rehabilitation teams around the country. These are intended to empower people living with COPD to improve their symptom management and decrease hospitalisations. 

The HSE and clinical programme continue to support people in community and hospital settings, with the establishment of specialist teams in the community, including respiratory integrated care teams. This will support the care of more patients in the community, and lessen the need for hospital-based care (hospital admissions for acute exacerbation of COPD can be significant events for patients). Some of the services that will be made available in the community include evidence-based interventions, such as pulmonary rehabilitation. 

Workforce 

Like many specialties in Ireland, respiratory medicine is under significant pressure due to insufficient consultant numbers. Dr Fahy said that even though respiratory medicine had a significant role to play in managing patients during the Covid-19 pandemic, the number of additional consultant appointments has been disappointing. 

“It is unfortunate that despite the Covid-19 pandemic and all the hard work that respiratory physicians and their ICU colleagues did in managing Covid-19 patients, it resulted in very little of an increase in respiratory physicians within Ireland,” he said. 

The Annual Scientific Meeting covers a vast range of topics, which Dr Fahy said is reflective of the subspecialisation that has taken place within the specialty over the last number of years. 

“Respiratory medicine, like a lot of other areas, has subspecialised to improve quality of care,” he explained. 

“That would be my take-home message in terms of the future of respiratory medicine. We are subspecialising, and because of subspecialising it is probably no longer tenable to have one or two respiratory physicians in any given centre. You really need about four or five to cover all the areas you need to be an expert in. That is where the future is.”