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Toby GD Capstick,1 Nicholas S Hopkinson2 1Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK; 2National Heart and Lung Institute, Imperial College, London, UKCorrespondence: Nicholas S HopkinsonNational Heart and Lung Institute, Imperial College, London, Royal Brompton Hospital Campus, Fulham Road, London, SW3 6NP, UKEmail n.hopkinson@ic.ac.UkAbstract: The takeover of Vectura, a healthcare company specialising in inhaled medication, by Philip Morris International raises serious ethical concerns. The European Respiratory Society notes that “health professionals will avoid prescribing drugs from any company that enriches the tobacco industry due to the ethical implications”. People with chronic obstructive pulmonary disease (COPD) and asthma will also be reluctant to use medications which profit a company that is estimated to kill at least one million people every year. We discuss the practicalities involved in switching people with lung disease to inhaled medications that are not tobacco industry linked. Potential alternative inhaled medications are set out, which are likely to be equally effective for most patients. A consideration of beneficence, non-maleficence, autonomy, and distributive justice demonstrates strong ethical reasons to support switching away from the prescription of tobacco industry linked products.Keywords: ethics, corporate social responsibility, public health

Non-tuberculous mycobacteria (NTM) are ubiquitous environmental organisms that can cause significant disease in both immunocompromised and immunocompetent individuals. The incidence of NTM pulmonary disease (NTM-PD) is rising globally. Diagnostic challenges persist and treatment efficacy is variable. This article provides an overview of NTM-PD for clinicians. We discuss how common it is, who is at risk, how it is diagnosed and the multidisciplinary approach to its clinical management., Competing Interests: Declaration of competing interest All authors are members of NTM Network UK, which is a network of healthcare professionals, researchers and patients from across the UK who have an interest in infections caused by non-tuberculous mycobacteria. TGDC has received non-financial support from Napp and GSK for attendance at ERS conference; TGDC's employer has received payment for his participation in advisory boards or for providing teaching sessions from AstraZeneca, Chiesi, GSK, Novartis, Boehringer Ingelheim, and Insmed, outside the submitted work. CC received non-financial support from GSK for attendance at ERS; CC's employer has received financial support from AstraZeneca through her grant application; CC received payment for her participation in advisory boards or providing teaching from AstraZeneca, Chiesi, GSK and Insmed, outside the submitted work. RH has received consultancy fees from Insmed, outside the submitted work., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: The management of asthma and COPD is largely dependent on patients being able to use their inhaled medication correctly, but poor inhaler technique continues to be a recurring theme in studies and clinical practice. This is associated with poor disease control, increased risk of exacerbations and hospital admissions, and so there is a need to redesign services for patients to optimise their medicines use., Methods: A novel ward-based dedicated inhaler technique service was developed, and pharmacy support workers trained to provide this, focusing on optimising inhaler technique using a checklist and recommending protocol-guided inhaler device switches. Inpatients on adult respiratory wards with a diagnosis of exacerbation of asthma or COPD consented to receive this service, and the impact on exacerbations and hospital admissions were compared in the 6-months before and after the intervention., Results: 266 adults (74 asthma, 188 COPD, and four asthma-COPD overlap) received the inhaler technique service. Six-month exacerbation and hospital admission data were available for 184 subjects. Optimising inhaler technique achieved a significant reduction in the combined asthma and COPD annualised rate of moderate-to-severe exacerbations (Rate Ratio [RR] 0.75, p < 0.05) and annualised rate of hospital admissions (RR 0.57, p < 0.0005). Improvements were also observed in future length of stay (- 1.6 days) and the average cost of admission (-£748)., Conclusions: This novel inhaler technique service produced a significant reduction in the rate of moderate-to-severe exacerbations of asthma and COPD, and a reduction in the rate hospital admissions, length of stay and average cost of admission., (Crown Copyright © 2021. Published by Elsevier Ltd. All rights reserved.)