Respiratory GURU: Genuinely Useful Respiratory Updates Diana Kavanagh

Welcome back to the next instalment of respiratory GURU, this time we delve into two RCTs investigating rescue therapy for patients with CTD ILD. The EVER ILD study looks at MMF vs MMF plus rituximab, and the RECITAL study looks at rituximab vs cyclophosphamide. 2 very useful studies and I was thrilled to be joined by two national experts in the field, Dr Anjali Crawshaw and Dr Emma Derrett-Smith. Hopefully, this will make you feel more well-prepared for ILD MDTs, and give you a real insight into how these two experts view the recent literature in the context of their day-to-day practice. Here are the pubmed links for the two papers, the INBUILD study which we discuss briefly, and the American College of Rheumatology guidelines, which apparently is where most of the guidance we need regarding CTD ILD (for now) sits. Enjoy listening, thank you for being patient with the podcast releases whilst I birthed and raised my second child, and fingers crossed no more career interruptions!!



Mankikian J et al. Rituximab and mycophenolate mofetil combination in patients with interstitial lung disease (EVER-ILD): a double-blind, randomised, placebo-controlled trial. Eur Respir J. 2023 Jun 8;61(6):2202071. doi: 10.1183/13993003.02071-2022. PMID: 37230499.

Maher TM et al. Rituximab versus intravenous cyclophosphamide in patients with connective tissue disease-associated interstitial lung disease in the UK (RECITAL): a double-blind, double-dummy, randomised, controlled, phase 2b trial. Lancet Respir Med. 2023 Jan;11(1):45-54. doi: 10.1016/S2213-2600(22)00359-9. Epub 2022 Nov 11. PMID: 36375479.

interstitial-lung-disease-guideline-summary-treatment-2023.pdf (contentstack.io)
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A vibrant discussion with our two regional leads for occupational lung disease and a specialised solicitor dealing with OLD claims into how to drill down into the details of an occupational lung disease, how to refer, how to write your clinical letters and how to direct patients towards compensation if it's right for them. 
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A perfect introduction to series 2, a COPD podcast with Professor Turner and Dr LJ Smith where we jump into MART for COPD,  the new P2X3 receptor agonist Filapixant, antihyperglycaemic drugs preventing COPD exacerbations and much more. Happy listening!

Studies discussed:


Association of the Use of Novel Antihyperglycemic Drugs With Prevention of COPD Exacerbations Among Patients With Type 2 Diabetes 
BMJ. 2022 Nov 1;379:e071380. doi: 10.1136/bmj-2022-071380. PMID: 36318979;

Budesonide/Formoterol Maintenance and Reliever Therapy vs Fluticasone/Salmeterol Fixed-Dose Treatment in Patients With COPD
Thorax. 2023 May;78(5):451-458. doi: 10.1136/thorax-2022-219620. Epub 2023 Feb 1. PMID: 36725331.


The P2X3 receptor antagonist filapixant in patients with refractory chronic cough: a randomized controlled trial
Respir Res. 2023 Apr 11;24(1):109. doi: 10.1186/s12931-023-02384-8. PMID: 37041539; 

Prospective Detection of Early Lung Cancer in Patients With COPD in Regular Care by Electronic Nose Analysis of Exhaled Breath
Chest. 2023 May 19:S0012-3692(23)00754-7. doi: 10.1016/j.chest.2023.04.050. Epub ahead of print. PMID: 37209772.
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This fascinating episode delivers pragmatic advice and recommendations for how to identify and manage patients with inducible laryngeal obstruction (ILO)-the new phrase for vocal cord dysfunction, GORD and breathing pattern disorders-the new phrase for dysfunctional breathing. This will make so much difference to how you do your consults with your breathless patients who have one of these disorders, how to reassure them, treat them and not feel a deep heart sink when you read your last letter about them before calling them into your consultation room. The quality of this podcast recording is not at the highest standard I strive to achieve, so bear with me, and turn up the volume a little when prof is speaking, you won't want to miss a word!
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Next instalment of the aspergillosis podcast, where we move on to talk about chronic pulmonary aspergillosis and invasive aspergillosis. Hope you've had time to digest part 1, part 2 is filled with useful content about diagnostics again, including the utility or lack of as it might be of galactomannans and Beta D Glucans in aspergillosis. Thank you again to Dr Chris Kosmidis. 
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An interview with Dr Chris Kosmidis, Clinical Senior Lecturer at Wythenshawe Hospital and Aspergillosis centre about aspergillosis. Divided into two parts, the first part of our discussion covers ABPA for the generalist, and is a goldmine of information for diagnosing, treating and monitoring response in these patients. I now feel comfortable interpreting the serology, prescribing antifungals where appropriate and how to look out for a relapse which is a long way from where I started!

References for this podcast include:

Kosmidis C, Denning DW. The clinical spectrum of pulmonary aspergillosis. Thorax. 2015 Mar;70(3):270-7. doi: 10.1136/thoraxjnl-2014-206291. Epub 2014 Oct 29. PMID: 25354514.

Godet et al. Nebulised liposomal amphotericin-B as maintenance therapy in allergic bronchopulmonary aspergillosis: a randomised, multicentre trial. Eur Respir J. 2022 Jun 16;59(6):2102218. doi: 10.1183/13993003.02218-2021. PMID: 34764182.

Agarwal R, Muthu V, Sehgal IS, Dhooria S, Prasad KT, Garg M, Aggarwal AN, Chakrabarti A. A randomised trial of prednisolone versus prednisolone and itraconazole in acute-stage allergic bronchopulmonary aspergillosis complicating asthma. Eur Respir J. 2021 Sep 9;59(4):2101787. doi: 10.1183/13993003.01787-2021. PMID: 34503983.

How do we treat aspergillosis? - Dr Chris Kosmidis - YouTube
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