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Showcasing the latest advances and research in respiratory medicine

The Irish Thoracic Society (ITS) Annual Scientific Meeting 2015 is taking place in the Radisson Blu Hotel, Cork, from 12 to 14 November. The meeting will cover a wide range of high quality, topical research related to respiratory medicine.

Dr David Curran, Consultant Respiratory Physician, Mercy University Hospital, Cork, told the Medical Independent (MI) that the meeting is one of the highlights in the calendar of the ITS.

“We have a very exciting programme,” Dr Curran commented.

“It is an opportunity for all our trainees to showcase the research that they are involved in. This is something that has gotten better and better as the years have rolled on. The calibre of the research that is being presented this year is the best I have seen in quite a long time. But in addition to that we have some internationally renowned guest speakers who are going to be giving various different lectures. We have a very exciting line up in that context as well.”

Dr Curran said the topics related to respiratory medicine that will be covered in the presentations over the two-day meeting will include bacterial infections in COPD, obstructive sleep apnoea and the management of severe asthma.

“We decided to cover a number of different areas so that there was something for everyone essentially, in terms of their own particular field of interest,” Dr Curran explained.

“The research papers that are being presented also cover a variety of different disciplines within respiratory medicine so there is quite a broad spectrum of topics covered.”

COPD

Due to his interest in COPD, Dr Curran is particularly interested in the presentation to be delivered by Prof Sanjay Sethi, Professor of Medicine and Assistant Vice President for Health Sciences at the University at Buffalo, State University of New York, US, entitled: ‘Bacterial Infection in COPD: Consequences and Mechanisms’, in one of the four key guest lectures at the meeting.

The main research interest of Prof Sethi, who is described by Dr Curran as being internationally renowned in his field, is uncovering why and how patients with COPD become more prone to lung infection. In addition to bench research in this field, Prof Sethi is also working to develop better ways to prevent and treat these infections by leading and participating in several clinical research studies in this field that are open to both veterans and the general public.

In the clinical scenario there has been a plethora of new medications coming on stream and we are just at a point now to see what particular role these new medications have with regard to the overall spectrum of medications that we have available to us

According to Dr Curran, bacterial infections are responsible for approximately 30 per cent of COPD exacerbations so Prof Sethi’s talk is important for clinicians dealing with the condition.

Regarding COPD in general, Dr Curran said there is ongoing research in terms of reducing exacerbation rates within the context of new medications that have recently become available.

“In the clinical scenario there has been a plethora of new medications coming on stream and we are just at a point now to see what particular role these new medications have with regard to the overall spectrum of medications that we have available to us,” according to Dr Curran.

The research centres on whether combinations of the long-acting muscarinic antagonist (LAMA) and long-acting β2-agonist (LABA)  bronchodilators (dual bronchodilation) can supplant LABA/inhaled corticosteroids (ICS) combinations in the treatment of COPD patients who have frequent exacerbations.

Sleep apnoea

The scheduled presentation on sleep apnoea by Prof Walter McNicholas, Newman Clinical Research Professor at UCD and Director of the Pulmonary and Sleep Disorders Unit, and Consultant Respiratory Physician, St Vincent’s University Hospital, Dublin, is also eagerly anticipated by Dr Curran. He described Prof McNicholas as an international authority on sleep-related breathing disorders, particularly sleep apnoea, who has mentored many of the leading researchers in the field in Ireland.

One of these researchers, Dr Silke Ryan of St Vincent’s University Hospital and UCD, Dublin, recently delivered the prestigious Cournand Lecture at the 2015 European Respiratory Society (ERS) International Congress in Amsterdam. The Cournand Lecture is awarded every three years to the most successful young investigator in any field of respiratory disease and was the flagship lecture of this year’s ERS Congress. 

Prof McNicholas’s own research interests include the pathophysiology, treatment and outcomes of sleep apnoea syndrome, the cardiovascular and metabolic consequences of the disorder, basic cell and molecular mechanisms and consequences of intermittent hypoxia, in addition to sleep disturbances in COPD and other chronic respiratory disorders. He is also closely involved in the evaluation of novel ambulatory monitoring devices for sleep disorders. He is a past Associate Editor of the European Respiratory Journal, and has published over 190 papers in Pub-Med listed journals, in addition to more than 30 book chapters, and has edited three textbooks on breathing disorders during sleep. The title of his talk at the ITS Scientific Meeting is ‘Sleep apnoea: A disorder calling for attention’.

“In the context of sleep apnoea there is a huge amount of interest globally in terms of the detrimental consequences of untreated sleep apnoea, particularly the cardiovascular consequences such as coronary artery disease, myocardial infarction, and stroke,” noted Dr Curran.

“That has been a focus of research over the last decade or so. It is all the more important that this condition is recognised and detected. There is an increasing focus among our colleagues in getting that message across to our colleagues in primary care.”

Asthma

One of the other key guest lectures at the meeting is on the subject of stratified medicine in severe asthma. It will be delivered by Prof Liam Heaney, Professor of Respiratory Medicine, Centre for Infection and Immunity, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast.

His major research area is the clinical assessment and mechanisms of ‘difficult’ asthma including identification and management of poor adherence to therapy. Difficult asthma represents between five and ten per cent of adult asthmatics but this group utilises approximately 60 per cent of the UK’s NHS asthma expenditure. Prof Heaney’s initial programme of research developed and validated a multidisciplinary systematic assessment and management model for difficult asthmatics.

Prof Heaney founded and now co-ordinates the BTS UK Severe Asthma Network and National Registry on Difficult Asthma. The registry, as well as standardising UK specialist clinical services, facilitates research into the assessment and clinical management of difficult asthma and holds the NICE (UK) Bronchial Thermoplasty Registry. The non-adherence research programme defined the significant scale of this problem in difficult asthma (30-50 per cent of subjects) and its current research is developing methods to better identify and manage this problem in the clinic using biomarker-based assessments of corticosteroid exposure and response.

A major evolving area is disease stratification to deliver personalised therapeutics in severe asthma. Dr Heaney leads the Medical Research Council UK Refractory Stratification Programme (RASP-UK), which will deliver early ‘proof of concept’ studies in stratified phenotypes in severe asthma.

Interstitial lung disease

The final guest lecture will be delivered by Prof Athol Wells, Consultant Physician, Royal Brompton Hospital and the National Heart and Lung Institute, Imperial College, London, UK, whose presentation is entitled: ‘Overall approach to ILD  [interstitial lung disease]: The critical importance of clinical  reasoning.’ The interstitial lung disease unit at Royal Brompton Hospital is the largest unit of its kind in Europe with more than 4,000 patients, and is the only unit in the UK dedicated to the management of patients with fibrosing lung disease. Prof Wells’s research interests include the prognostic evaluation in diffuse lung disease using high-resolution computed tomography (HRCT) and pulmonary function tests; the definition of relationships between structure and function in diffuse lung disease; the definition of disease type and severity in genetic and laboratory studies; and studies of new therapies in diffuse lung disease. He chairs the British Thoracic Society group revising guidelines in diffuse lung disease and also sits on the American Thoracic Society/European Respiratory Society group revising guidelines in idiopathic pulmonary fibrosis, as well as other joint groups involved in the definition of non-specific interstitial pneumonia, smoking-related diffuse lung disease, and acute exacerbations of idiopathic pulmonary fibrosis.

Dr Curran said that recently there have been a number of different research developments regarding idiopathic pulmonary fibrosis, as well as new medications that have become available.

Research

One of the newer highlights of the ITS Annual Scientific Meeting programme is the ITS Case Study Forum, which presents SpR trainees with an opportunity to present cases and there is an award for the best case presentation.

“That is something that is particularly useful for trainees,” explained Dr Curran.

“It is something that has evolved over the last number of years. It is a nice opportunity for specialist registrars who aren’t necessarily involved in research to hone their presentation skills and present to others.”

One of the many benefits of the ITS Annual Scientific Meeting is the opportunity it gives clinicians and researchers to meet and network, according to Dr Curran. He pointed out that the programme also includes forums for individual groups such as nurses, physiotherapists, respiratory physiologists and paediatricians.

“It provides an opportunity for researchers to network, to forge collaborations, and to further their research,” he said.

“The quality of the research has been improving year on year. You can see that from the programme that we have. This year at the meeting there are very exciting research papers that involve collaborators from several different institutions throughout the world. That is something we are seeing more and more with researchers in Ireland, forging important international collaborations and it is something we would like to build upon in the future.”

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