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Bringing respiratory services together
The Irish Thoracic Society’s (ITS’s) Annual Scientific Meeting is a central event for anybody involved in respiratory medicine in Ireland. This year’s meeting will take place from 17-19 November in the Fitzpatrick Castle Hotel, Killiney, Co Dublin.
Highlights of this year’s meeting include a lecture on COPD by Prof Wisia Wedzicha, Imperial College London; a lecture on developments in inflammation research by Prof Luke O’Neill, Trinity College Dublin; a lecture on adherence to inhaled therapy by Prof Richard Costello, RCSI/Beaumont Hospital; and an update on pulmonary vasculitis by Prof Karina Keogh, Mayo Clinic, Rochester, US.
Original research is a key element of the meeting and will be presented in both oral and poster form. This year has seen a record number of abstracts and case study submissions, with well over 200 received in total. According to the Society, this reflects the high standard of innovative work taking place in clinical and research centres throughout the island.
In addition to the main programme, colleagues in the nursing, physiotherapy and respiratory physiology fields will hold meetings and forums on their work. The ITS Paediatric Forum will also meet on Friday, 18 November, while the ITS Case Study Forum will be held on the evening of Thursday, 17 November.
A noteworthy development this year is the presence for the first time of the Primary Care Respiratory Society Ireland (PCRSI) at the event. The PCRSI will hold its inaugural meeting on Saturday, 19 November.
ITS Vice-President Dr Ross Morgan, a Consultant Respiratory Physician in Beaumont Hospital, Dublin, said the invitation extended to the PCRSI to attend the meeting is intended to foster better communication and collaboration between primary and secondary care with regard to respiratory medicine.
“Asthma and COPD are very common conditions seen in the community,” Dr Morgan told the Medical Independent (MI).
“There is some of difficulty around the support of these patients in the community and the interaction between primary/community care with secondary care and tertiary care. There is a need to strengthen that bond because many of the problems that primary care is seeing are related to things that went wrong in secondary and tertiary care. These patients have a chronic disease that needs to be managed across the spectrum, not just at the hospital level. I think there is a big opportunity for more integration between primary and secondary care, which is reflected by the attendance of the PCRSI at the meeting. It reflects the mission of the current council of the ITS to try and get more engaged with the entire respiratory community and people who care for respiratory disease across the country. At our annual meeting, we will also have the patient representative groups, so it really is an opportunity for the whole community to get involved.”
Dr Morgan said the development of more respiratory-focused community interventions and community cases would help reduce the high number of hospital admissions in Ireland resulting from issues such as COPD exacerbations. A study published in the Irish Medical Journal in 2013, comparing Irish data with European data from a European Respiratory Society (ERS) COPD audit, found that although the mortality was lower during admission in Irish patients (3.3 vs 4.7 per cent), a higher proportion were re-admitted (41.3 vs 35.1 per cent) and died within 90 days (8.3 vs 6.1 per cent). According to the authors, it is possible that the Irish subset of patients represented a sicker cohort, reflected by the higher percentage of patients with consolidation on chest x-ray, treated with non-invasive ventilation and treated with antibiotics. It is also possible that higher mortality after hospital discharge and higher re-admission rates reflect earlier discharge and the lack of access to COPD outreach programmes at the time that the ERS COPD audit was conducted. The authors expressed the hope that improved home-based management of patients with COPD exacerbations through COPD outreach programmes would improve these mortality figures.
“I think there are a number of opportunities to support the community in managing these patients and in achieving admission avoidance,” according to Dr Morgan.
“That does require resources, such as the requirement for spirometry to be available in the community, and the ability for people who manage lung disease in the community to be able to rapidly interact with secondary care, which isn’t always possible because of waiting lists and appointments and so forth.
“So I think there is a need to improve ambulatory care management and the community outreach.”
Dr Morgan said the development of COPD services through the HSE’s National Clinical Programme for COPD, under the leadership of Prof Tim McDonnell, requires additional resources.
“It is not always [about] needing doctors. A lot of this work also involves respiratory physiotherapists who support patients in pulmonary rehabilitation, which we do fairly poorly in,” he commented.
“So there are a number of different aspects that need to be drawn together. It is slow work. It does require resources. I think at present in Ireland, when we look at international figures regarding outcomes for COPD, we don’t fare that well in European terms and in world terms in how patients who are exacerbating with COPD are managed and how they get on. There is a need for us to focus on that area.”
An interesting talk to be delivered during the meeting by Prof Richard Costello, Consultant Respiratory Physician, Beaumont Hospital, Dublin, will focus on the area of adherence to inhaled therapy. Adherence to asthma medication regimens tends to be very poor, with the reported rates of non-adherence ranging from 30-to-70 per cent. Non-adherence to asthma medications is considered a major problem and is a significant barrier to achieving good disease control in many patients. Poor asthma control is associated not only with an increased risk of life-threatening exacerbations, but also with decreased quality of life and increased use of healthcare services.
“We are looking forward to hearing his insight on this,” Dr Morgan said.
“It is a source of a lot of potential waste in terms of cost, where people are getting prescribed a lot of medications they are not using. And I think we need to understand a little bit more about why that might be.
“For instance, with the inhaled therapies, some of them might not be appropriate for the patient. Perhaps the patient is unable to use them. There are a number of different, and increasing numbers of, devices, which may be better for some patients than others and one inhaler is not suitable for everybody. I would say we need to have real-world evidence about how these are working because we prescribe them, and then the patient comes back and there may not be much of an improvement. It is sometimes difficult to know if they have been taking the medication or not, and if they have been taking it are they able to activate the device and use it appropriately.”
Speaking generally, Dr Morgan said the research environment for respiratory medicine is strong in Ireland and improving all the time.
“There has been an increasing development of good and internationally-recognised research coming from Ireland,” he stated.
“Many of the studies in cystic fibrosis are being led or are engaging Irish patients and research groups in Ireland. In lung cancer, similarly, patients in Ireland have access to clinical trials that have been changing the field and are associated with improvement in outcomes. In basic science of COPD and lung fibrosis, I think we also have a strong track record, which is also the case in tuberculosis and sleep apnoea. I think we have excellent and well-supported researchers in Ireland and the numbers thankfully are increasing. There are more clinician scientists and clinician researchers in Ireland in lung disease than I think there ever were before and they are competitive in terms of receiving grants and funding. The meeting is also an opportunity for our own trainees who present case studies and indeed their own research from Ireland and there will be a number of prizes given out on the basis of that research being done. An enormous amount of abstracts have been submitted to this meeting. It will be the largest meeting we have ever had; it has been growing year-on-year.”
In conclusion, Dr Morgan said that the meeting will showcase the latest developments and research in respiratory medicine, and will offer valuable information for clinicians and other medical professionals working in the area.
“I think it brings together the community of people who are interested and passionate about developing respiratory services and in advancing the care of people with respiratory disease in this country,” Dr Morgan explained.
“It is very important to have a meeting in which all of those people are represented. There is obviously a broad group of lung diseases, which is reflected in the programme of the meeting. Our Annual Scientific Meeting is an opportunity for everybody to get together and see how we are doing. As it is a scientific meeting, it allows us to hear about Irish research, in addition to hearing from international speakers, with the ultimate aim of helping us to provide better services to people with lung disease in Ireland.”
There will be full, exclusive coverage of the ITS Annual Scientific Meeting in MI.