COPD in Never-Smokers: BOLD Australia Study.

Purpose: Tobacco smoking is the major risk factor for COPD, and it is common for other risk factors in never-smokers to be overlooked. We examined the prevalence of COPD among never-smokers in Australia and identified associated risk factors. Methods: We used data from the Australia Burden of Obstructive Lung Disease (BOLD) study, a cross-section of people aged ≥40 years from six sites. Participants completed interviews and post-bronchodilator spirometry. COPD was primarily defined as an FEV1/FVC ratio <0.70 and secondarily as the ratio less than the lower limit of normal (LLN). Results: The prevalence of COPD in the 1656 never-smokers who completed the study was 10.5% (95% CI: 9.1-12.1%) [ratio

Cough in Children and Adults: Diagnosis, Assessment and Management (CICADA). Summary of an updated position statement on chronic cough in Australia.

INTRODUCTION: Cough is the most common symptom leading to medical consultation. Chronic cough results in significant health care costs, impairs quality of life, and may indicate the presence of a serious underlying condition. Here, we present a summary of an updated position statement on cough management in the clinical consultation. MAIN RECOMMENDATIONS: Assessment of children and adults requires a focused history of chronic cough to identify any red flag cough pointers that may indicate an underlying disease. Further assessment with examination should include a chest x-ray and spirometry (when age > 6 years). Separate paediatric and adult diagnostic management algorithms should be followed. Management of the underlying condition(s) should follow specific disease guidelines, as well as address adverse environmental exposures and patient/carer concerns. First Nations adults and children should be considered a high risk group. The full statement from the Thoracic Society of Australia and New Zealand and Lung Foundation Australia for managing chronic cough is available at https://lungfoundation.com.au/resources/cicada-full-position-statement. CHANGES IN MANAGEMENT AS A RESULT OF THIS STATEMENT: Algorithms for assessment and diagnosis of adult and paediatric chronic cough are recommended. High quality evidence supports the use of child-specific chronic cough management algorithms to improve clinical outcomes, but none exist in adults. Red flags that indicate serious underlying conditions requiring investigation or referral should be identified. Early and effective treatment of chronic wet/productive cough in children is critical. Culturally specific strategies for facilitating the management of chronic cough in First Nations populations should be adopted. If the chronic cough does not resolve or is unexplained, the patient should be referred to a respiratory specialist or cough clinic.

Symptom Clusters in Adults with Post-COVID-19: A Cross-Sectional Survey.

More than 100 symptoms have been reported for post-coronavirus disease 2019 (COVID-19) and this study aimed to organize self-reported symptoms by identifying symptom clusters. We used a cross-sectional survey with a convenience sample of 491 adults who reported experiencing prolonged symptoms of COVID. A list of 25 symptoms of post-COVID-19 was used to measure the symptoms, and exploratory factor analysis was undertaken to identify symptom clusters for people with symptoms lasting 5 to 8 weeks and 9 weeks or longer. Six symptom clusters were identified for each of the two groups, and five clusters were similar across both groups: respiratory, general viral, smell/taste, cognitive cardiac, and mental health. The >9-week group reported symptoms primarily from two factors: respiratory-muscular and mental health. Post-COVID-19 symptom clusters differ across timeframes. Symptom clusters were useful in establishing coherent patterns of multiple complex symptoms.

Cancer-related Fatigue in Lung Cancer: A Research Agenda: An Official American Thoracic Society Research Statement.

Background: Fatigue is the most common symptom among cancer survivors. Cancer-related fatigue (CRF) may occur at any point in the cancer care continuum. Multiple factors contribute to CRF development and severity, including cancer type, treatments, presence of other symptoms, comorbidities, and medication side effects. Clinically, increasing physical activity, enhancing sleep quality, and recognizing sleep disorders are integral to managing CRF. Unfortunately, CRF is infrequently recognized, evaluated, or treated in lung cancer survivors despite more frequent and severe symptoms than in other cancers. Therefore, increased awareness and understanding of CRF are needed to improve health-related quality of life in lung cancer survivors. Objectives: 1) To identify and prioritize knowledge and research gaps and 2) to develop and prioritize research questions to evaluate mechanistic, diagnostic, and therapeutic approaches to CRF among lung cancer survivors. Methods: We convened a multidisciplinary panel to review the available literature on CRF, focusing on the impacts of physical activity, rehabilitation, and sleep disturbances in lung cancer. We used a three-round modified Delphi process to prioritize research questions. Results: This statement identifies knowledge gaps in the 1) detection and diagnostic evaluation of CRF in lung cancer survivors; 2) timing, goals, and implementation of physical activity and rehabilitation; and 3) evaluation and treatment of sleep disturbances and disorders to reduce CRF. Finally, we present the panel's initial 32 research questions and seven final prioritized questions. Conclusions: This statement offers a prioritized research agenda to 1) advance clinical and research efforts and 2) increase awareness of CRF in lung cancer survivors.

Substance Use and the Self-Management of Persistent Symptoms of COVID-19.

Background: Understanding the self-management practices of persistent symptoms of SARS-Cov-2 (COVID-19) is critical given the misinformation that has been presented about this disease in the U.S. The purpose of this descriptive study is to assess the self-management of persistent symptoms of COVID-19 with commonly used and misused substances (i.e., alcohol, marijuana and commonly prescribed medications) among adults in the U.S. Methods: The data for this study comes from a cross-sectional survey of U.S. adults that was designed to broadly assess symptom burden, persistent symptom patterns, self-efficacy for symptom management and self-management strategies among people who experienced persistent/Long COVID. Multiple logistic regression analyses were used to assess how symptom length of COVID-19 was associated with the use of several substances to manage these persistent symptoms. Results: The analysis found that adults who had COVID-19 symptoms that persisted for 13 weeks or longer had higher rates of using alcohol (27.3%), marijuana (30.9%) and prescription tranquilizers (21.4%) to manage these symptoms when compared to their adult peers who had COVID-19 symptoms persist for only 4 weeks or less. For instance, the odds of indicating the use of marijuana (AOR = 4.21 95% CI = 1.68,10.5) to manage COVID-19 related symptoms was roughly four times higher for respondents who had COVID-19 symptoms persist for 13 weeks or longer when compared to respondents whose COVID-19 symptoms persisted for only 4 weeks or less. Conclusion: The findings suggest that screening of substance use disorders should be considered among healthcare providers who are treating adults who have persistent symptoms of COVID-19.

Need and baseline for harmonising nursing education in respiratory care: preliminary results of a global survey.

Background: The COVID-19 pandemic confirmed that respiratory nurses are critical healthcare providers. Limited knowledge is available about appropriate education to prepare nurses to deliver high-quality respiratory care. A survey was developed by the International Coalition for Respiratory Nursing (ICRN) group to identify the need for a respiratory nursing core curriculum. Method: A 39-item survey was distributed to 33 respiratory nursing experts in 27 countries. Questions asked about current roles, perception of need, expectations for a core curriculum project and respiratory content in nursing education in their countries. Results: 30 responses from 25 countries were analysed; participants predominantly worked in academia (53.3%, 16/30) and clinical practice (40%, 12/30). In total, 97% (29/30) confirmed a need for a core respiratory nursing curriculum. Post-registration nursing programmes at bachelor (83.3%, 25/30) and masters (63.3%, 19/30) levels include internal/medical nursing care; less than half identified separate respiratory nursing content. The core educational programme developed should include knowledge (70%, 21/30), skills (60%, 18/30), and competencies (50%, 15/30), with separate paediatric and adult content. Conclusion: Survey results confirm a wide variation in nursing education and respiratory nursing education across the world, with many countries lacking any formal educational programmes to prepare nurses capable of providing enhanced quality respiratory care. These findings support the need for a core respiratory curriculum. To advance this significant work the ICRN group plans to conduct a Delphi study to identify core curriculum requirements for respiratory nursing education at pre-registration and advanced educational levels to flexibly meet each country's specific educational requirements for recognition of respiratory nursing speciality practice.

Thoracic Society of Australia and New Zealand Position Statement: Respiratory nursing.

The Thoracic Society of Australia and New Zealand's (TSANZ) Position Statement recognizes the pivotal role respiratory nurses play in the lung health of Australians and New Zealanders. The national and international lung health strategies are evidence based to ensure optimal professional clinical support for patients. Respiratory nurses are essential to the success of these strategies as a professional workforce, irrespective of healthcare setting, as they are at the forefront of the delivery of world-class evidence-based respiratory care. Respiratory nursing, as an entity, does not have the status as a nursing specialist area despite its range of professional practice across the life span and diverse settings, including disease prevention, public health, occupational health, symptom management, health education, surgery, rehabilitation, non-invasive ventilation, support for a life-limiting illness and adjustments to living with a chronic disease. Recognition of the specialized nature of work and specialist nursing practice status has been conferred by nurse registration boards upon cancer, emergency, cardiac, critical care, midwifery, mental health and palliative care nurses. It is time to confer this speciality practice recognition upon respiratory nurses of Australia and New Zealand. Through this position statement, the TSANZ advocates for respiratory nursing as a speciality area of professional nursing practice, thus supporting registered nurses in respiratory practice as well as the development of future generations of respiratory nurses. Furthermore, this statement validates the strong partnerships between all professions within the society for the advancement of lung health.

Review of Fever Management Advice on Government and Hospital Websites in Australia.

BACKGROUND: The public often searches the Internet for information about managing symptoms of various diseases, with government and major hospital websites often providing valid and freely available information. OBJECTIVES: Fever is a common symptom of viral illness, and this review sought to identify information related to fever self-management on government and major hospital websites. METHODS: Two distinct search strategies were used. The first was an Internet-based search reviewing fever management advice published on Australian government websites (state, territory, and federal). The second search strategy pertained to fever management advice posted by major Australian tertiary adult and children's hospitals. RESULTS: A total of 4,797 results were identified during the two searches, with a total of 12 websites on fever self-management identified for inclusion; four were from either federal or state government, with the remaining eight from tertiary hospital websites. The information identified showed a discordant definition of fever and lack of consistency in self-management advice. DISCUSSION: This review identified a lack of consistent online government and hospital information. The information discrepancy across multiple websites was not underpinned by clinical evidence to support the self-management of fever.

Thoracic Society of Australia and New Zealand Position Statement on Acute Oxygen Use in Adults: 'Swimming between the flags'.

Oxygen is a life-saving therapy but, when given inappropriately, may also be hazardous. Therefore, in the acute medical setting, oxygen should only be given as treatment for hypoxaemia and requires appropriate prescription, monitoring and review. This update to the Thoracic Society of Australia and New Zealand (TSANZ) guidance on acute oxygen therapy is a brief and practical resource for all healthcare workers involved with administering oxygen therapy to adults in the acute medical setting. It does not apply to intubated or paediatric patients. Recommendations are made in the following six clinical areas: assessment of hypoxaemia (including use of arterial blood gases); prescription of oxygen; peripheral oxygen saturation targets; delivery, including non-invasive ventilation and humidified high-flow nasal cannulae; the significance of high oxygen requirements; and acute hypercapnic respiratory failure. There are three sections which provide (1) a brief summary, (2) recommendations in detail with practice points and (3) a detailed explanation of the reasoning and evidence behind the recommendations. It is anticipated that these recommendations will be disseminated widely in structured programmes across Australia and New Zealand.

Towards More Predictive, Physiological and Animal-free In Vitro Models: Advances in Cell and Tissue Culture 2020 Conference Proceedings.

Experimental systems that faithfully replicate human physiology at cellular, tissue and organ level are crucial to the development of efficacious and safe therapies with high success rates and low cost. The development of such systems is challenging and requires skills, expertise and inputs from a diverse range of experts, such as biologists, physicists, engineers, clinicians and regulatory bodies. Kirkstall Limited, a biotechnology company based in York, UK, organised the annual conference, Advances in Cell and Tissue Culture (ACTC), which brought together people having a variety of expertise and interests, to present and discuss the latest developments in the field of cell and tissue culture and in vitro modelling. The conference has also been influential in engaging animal welfare organisations in the promotion of research, collaborative projects and funding opportunities. This report describes the proceedings of the latest ACTC conference, which was held virtually on 30th September and 1st October 2020, and included sessions on in vitro models in the following areas: advanced skin and respiratory models, neurological disease, cancer research, advanced models including 3-D, fluid flow and co-cultures, diabetes and other age-related disorders, and animal-free research. The roundtable session on the second day was very interactive and drew huge interest, with intriguing discussion taking place among all participants on the theme of replacement of animal models of disease.

Have we got the right focus in asthma care in general practice? A qualitative study.

BACKGROUND AND OBJECTIVES: Asthma presentations are common in general practice, but opportunities to control asthma are often missed. The aim of this study was to explore how general practitioners (GPs) and practice nurses (PNs) deliver asthma care, with particular attention to perceived roles and challenges, and ways to improve management. METHOD: Using a qualitative approach, semi-structured interviews were conducted with GPs and PNs working in an area of cultural diversity and socioeconomic disadvantage in western Sydney. Inductive thematic analysis was undertaken. RESULTS: Nineteen interviews were conducted, with nine GPs and 10 PNs. The main focus of asthma care was on acute presentations, with less emphasis on follow-up and preventive care and underuse of general practice chronic disease models of care. PN roles were generally limited to acute asthma assessment and triage. GPs did not commonly use spirometry or access non-GP specialist input. DISCUSSION: Asthma care in general practice may be improved by a greater focus on prevention and control, including through follow-up after acute presentations, enhanced collaboration between GPs and PNs, and supportive practice models.

Effectiveness of strategies to increase uptake of pertussis vaccination by new parents and family caregivers: A systematic review.

OBJECTIVES: Cocoon immunisation strategies involve administration of Bordetella pertussis containing vaccines to parents and family members who are in close contact with newborns. The objective of this systematic review was to evaluate the effectiveness of strategies to increase uptake of vaccination against Bordetella pertussis infection by parents and family caregivers of newborn children (< 3 months of age). DESIGN: A protocol driven systematic review was conducted between 2005 and February 2020. CINAHL, Medline, and Google Scholar databases were searched. SETTING: Inpatient maternity care units, ante-natal and post-natal clinics based in acute care or primary/community care contexts. PARTICIPANTS: (i) mothers, (ii) fathers and (iii) family caregivers or other regular household contacts of infants < 3 months of age. INTERVENTIONS: Health promotion interventions and immunisation clinics designed to promote "cocoon immunisation" against Bordetella pertussis infections of the newborn. MEASUREMENTS: Change in uptake of adult vaccination with a pertussis containing vaccine (dTpa or Tdap) by new parents and family caregivers. FINDINGS: Eight studies were included in this review. Strategies used to promote vaccination included: written and verbal education, promotional videos, provision of vaccine prescriptions and financial incentives, opportunistic vaccination of family members and population-based health promotional messaging. Six of the eight studies reported positive impacts on vaccination uptake. Four studies evaluating providing opportunistic immunisation during the obstetric admission reported statistically significant increases in maternal (+39% to +57%), paternal (+21% to +52%) and household members (+32%) vaccination rates. Targeted public health campaigns were also found to increase vaccination uptake but in isolation were insufficient to achieve vaccination of all household contacts. CONCLUSION: Promotion of pertussis vaccination to new parents and the provision of opportunistic vaccination during the obstetric admission or post-natal visit, was the most successful strategy to increase uptake of pertussis vaccination by family caregivers.

Diagnosis and treatment of lung disease associated with alpha one-antitrypsin deficiency: A position statement from the Thoracic Society of Australia and New Zealand.

AATD is a common inherited disorder associated with an increased risk of developing pulmonary emphysema and liver disease. Many people with AATD-associated pulmonary emphysema remain undiagnosed and therefore without access to care and counselling specific to the disease. AAT augmentation therapy is available and consists of i.v. infusions of exogenous AAT protein harvested from pooled blood products. Its clinical efficacy has been the subject of some debate and the use of AAT augmentation therapy was recently permitted by regulators in Australia and New Zealand, although treatment is not presently subsidized by the government in either country. The purpose of this position statement is to review the evidence for diagnosis and treatment of AATD-related lung disease with reference to the Australian and New Zealand population. The clinical efficacy and adverse events of AAT augmentation therapy were evaluated by a systematic review, and the GRADE process was employed to move from evidence to recommendation. Other sections address the wide range of issues to be considered in the care of the individual with AATD-related lung disease: when and how to test for AATD, changing diagnostic techniques, monitoring of progression, disease in heterozygous AATD and pharmacological and non-pharmacological therapy including surgical options for severe disease. Consideration is also given to broader issues in AATD that respiratory healthcare staff may encounter: genetic counselling, patient support groups, monitoring for liver disease and the need to establish national registries for people with AATD in Australia and New Zealand.

Nursing Research Priorities in Critical Care, Pulmonary, and Sleep: International Delphi Survey of Nurses, Patients, and Caregivers.

The objective of this workshop was to determine current nursing research priorities in critical care, adult pulmonary, and sleep conditions through input from consumer (patient, family, and formal and informal caregivers) and nursing experts around the world. Working groups composed of nurses and patients selected potential research priorities based on patient insight and a literature review of patient-reported outcomes, patient-reported experiences, and processes and clinical outcomes in the focal areas. A Delphi consensus approach, using a qualitative survey method to elicit expert opinion from nurses and consumers was conducted. Two rounds of online surveys available in English, Spanish, and Chinese were completed. A 75% or greater threshold for endorsement (combined responses from nursing and consumer participants) was determined a priori to retain survey items. A total of 837 participants (649 nurses and 188 patients, family, and/or caregivers) from 45 countries responded. Survey data were analyzed and nursing research priorities that comprise 23 critical care, 45 adult pulmonary, and 16 sleep items were identified. This project was successful in engaging a wide variety of nursing and consumer experts, applying a patient-reported outcome/patient-reported experience framework for organizing and understanding research priorities. The project outcome was a research agenda to inform, guide, and aid nurse scientists, educators, and providers, and to advise agencies that provide research and program funding in these fields.

Beyond forest plots: clinical gestalt and its influence on COPD telemonitoring studies and outcomes review.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a progressive chronic condition. Improvements in therapies have resulted in better patient outcomes. The use of technology such as telemonitoring as an additional intervention is aimed at enhancing care and reducing unnecessary acute hospital service use. The influence of verbal communication between health staff and patients to inform decision making regarding use of acute hospital services within telemonitoring studies has not been assessed. METHOD: A systematic overview of published systematic reviews of COPD and telemonitoring was conducted using an a priori protocol to ascertain the impact of verbal communication in telemonitoring studies on health service outcomes such as emergency department attendances, hospitalisation and hospital length of stay. The search of the following electronic databases: Cochrane Library, Medline, Pubmed, CINAHL, Embase, TROVE, Australian Digital Thesis and Proquest International Dissertations and Theses was conducted in 2017 and updated in September 2019. RESULTS: Six systematic reviews were identified. All reviews involved home monitoring of COPD symptoms and biometric data. Included reviews reported 5-28 studies with sample sizes ranging from 310 to 2891 participants. Many studies reported in the systematic reviews were excluded as they were telephone support, cost effectiveness studies, and/or did not report the outcomes of interest for this overview. Irrespective of group assignment, verbal communication with the health or research team did not alter the emergency attendance or hospitalisation outcome. The length of stay was longer for those who were assigned home telemonitoring in the majority of studies. CONCLUSION: This overview of telemonitoring for COPD had small sample sizes and a wide variety of included studies. Communication was not consistent in all included studies. Understanding the context of communication with study participants and the decision-making process for referring patients to various health services needs to be reported in future studies of telemonitoring and COPD.

An investigation of methods to improve recall for the patient-reported outcome measurement in COPD patients: a pilot randomised control trial and feasibility study protocol.

BACKGROUND: Patient-reported outcomes (PRO) are used to measure the effectiveness of interventions for management of chronic conditions such as chronic obstructive pulmonary disease. Many of these instruments require respondents to describe the change in their health status from baseline to a follow-up assessment and poor recall of previous health status often limits the usefulness and validity of these PRO measures. The use of technology has recently increased in PRO measurement. This study aims to mitigate the problems of poor recall by evaluating different strategies as a way to improve the validity of recall of health status among adults with COPD. METHODS: A pilot randomised controlled trial of three strategies to improve patient recall will be tested in an acute care clinical environment. The first strategy is the use of tablet computer technology's audio-visual facility, the second strategy is the provision of base line PRO responses prior to patients completing their follow-up questionnaires and third is standard practice of completing a questionnaire independently of previous responses. The feasibility of conducting this study in a busy clinical environment will be ascertained using the NIHR criteria for assessing feasibility. DISCUSSION: There is variability in a person's ability to recall past events. With studies utilising patient-reported outcome measurement, it has become critically important to develop strategies and ways of supporting the patient to be more accurate recalling their health status. The adaptation of various technological features within mobile devices may provide an opportunity in clinical research studies to improve patient recall of their health status. TRIAL REGISTRATION: ANZCTR12618001605280.

Concordant Evidence-Based Interventions in Cardiac and Pulmonary Rehabilitation Guidelines.

Chronic conditions such as chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD) contribute to a significant burden to patients and many experience a reduction in physical functioning, psychological health, and quality of life. The sentinel symptom for COPD and CVD is breathlessness. Rehabilitation programs have been proven to reduce disease symptoms and increase levels of physical and psychological wellness. Pulmonary and cardiac rehabilitation programs have been recommended in international and national guidelines for managing COPD and CVD. Given that these programs seek to reduce breathlessness and improve the physical and psychological functioning of people with COPD and CVD, this review examines the concordant evidence-based interventions in rehabilitation guidelines. The findings of this review indicate that there was concordance in the program design, location of programs, types of health professionals involved in program delivery, assessments of patient at commencement and completion of program, and the delivery of educational topics with minor deviations that were related to disease-specific topics. Apart from disease-specific recommendations, the main divergence from rehabilitation guidelines was found to be dietary screening, inspiratory muscle training, and psychological assessments in evidence-based recommendations for cardiac and pulmonary programs.