Search

Globally, more than 1.2 billion inhalers are purchased for asthma and chronic obstructive pulmonary disease (COPD) annually. In Australia and New Zealand, pressurized metered dose inhalers (pMDIs) are the leading delivery device prescribed and pMDI salbutamol can be purchased over the counter in Australia. These inhalers are a major contributor to healthcare related greenhouse gases. This is due to the propellants that they currently contain which have extremely high global warming potential (GWP). In this position paper, we report the findings of a Thoracic Society of Australia and New Zealand (TSANZ) working group on the environmental impact of inhaled respiratory medicines. We reviewed the use of inhaled medicines in Australia and New Zealand and their contribution to climate change and other environmental degradation. We propose strategies for health professionals and consumers to reduce environmental impact in the management of airway diseases. These include accurate diagnosis to avoid unnecessary treatment, better disease control to minimize the need for reliever therapy and actively choosing inhaler devices with lower environmental impacts when clinically appropriate. Inhaler selection should be tailored to the individual, aiming to achieve the best possible clinical outcome. Choosing an appropriate inhaler for an individual involves consideration of factors such as dexterity, inspiratory capacity and cost. In our current climate emergency and with the availability of lower carbon alternatives, health professionals should also consider environmental impact. [ABSTRACT FROM AUTHOR]

Maternal urogenital human papillomavirus (HPV) infection may place neonates at risk of HPV acquisition and subsequently lower respiratory infections as HPV can influence development of immunity. The respiratory HPV prevalence is not known in remote‐dwelling Aboriginal infants, who are at high risk of respiratory infection and where the population prevalence of urogenital HPV in women is high. These data are necessary to inform HPV vaccination regimens. A retrospective analysis using PCR specific for HPV was performed on 64 stored nasopharyngeal swabs from remote‐dwelling Aboriginal infants < 6 months of age, with and without hospitalised pneumonia. HPV DNA was not detected in any specimen. Despite the negative result, we cannot exclude a role for HPV in respiratory infections affecting infants in this population; however, our data do not support HPV as an important contributor to acute respiratory infection in remote‐dwelling Aboriginal children. [ABSTRACT FROM AUTHOR]

Background and objective: Long‐term data on children with PBB has been identified as a research priority. We describe the 5‐year outcomes for children with PBB to ascertain the presence of chronic respiratory disease (bronchiectasis, recurrent PBB and asthma) and identify the risk factors for these. Methods: Prospective cohort study was undertaken at the Queensland Children's Hospital, Brisbane, Australia, of 166 children with PBB and 28 controls (undergoing bronchoscopy for symptoms other than chronic wet cough). Monitoring was by monthly contact via research staff. Clinical review, spirometry and CT chest were performed as clinically indicated. Results: A total of 194 children were included in the analysis. Median duration of follow‐up was 59 months (IQR: 50–71 months) post‐index PBB episode, 67.5% had ongoing symptoms and 9.6% had bronchiectasis. Significant predictors of bronchiectasis were recurrent PBB in year 1 of follow‐up (ORadj = 9.6, 95% CI: 1.8–50.1) and the presence of Haemophilus influenzae in the BAL (ORadj = 5.1, 95% CI: 1.4–19.1). Clinician‐diagnosed asthma at final follow‐up was present in 27.1% of children with PBB. A significant BDR (FEV1 improvement >12%) was obtained in 63.5% of the children who underwent reversibility testing. Positive allergen‐specific IgE (ORadj = 14.8, 95% CI: 2.2–100.8) at baseline and bronchomalacia (ORadj = 5.9, 95% CI: 1.2–29.7) were significant predictors of asthma diagnosis. Spirometry parameters were in the normal range. Conclusion: As a significant proportion of children with PBB have ongoing symptoms at 5 years, and outcomes include bronchiectasis and asthma, they should be carefully followed up clinically. Defining biomarkers, endotypes and mechanistic studies elucidating the different outcomes are now required. [ABSTRACT FROM AUTHOR]

The article discusses research which evaluated the effectiveness of heliox inhalation therapy versus air or oxygen alone, for the management of acute bronchiolitis in infants with respiratory distress. Topics covered include a comparison of heliox therapy to standard medical care alone, the seven different protocols for heliox inhalation used in the study, and the implications of the findings for the practice.