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As Māori and tāngata whaikaha (Māori with lived experience of disability) of the nation-state known as New Zealand, we are deeply concerned about the impacts of the COVID-19 pandemic. In this commentary, we invoke intersectionality as an analytical tool for understanding critical issues tāngata whaikaha face in the context of the universal approach encompassing New Zealand’s pandemic response. We propose a “call to action” framework comprising four elements: (1) guaranteeing self-determination for tāngata whaikaha; (2) addressing all forms of racism, ableism, and other structural forms of oppression; (3) rectifying historical injustices; and (4) allocating resources for the pandemic and beyond in alignment with need.

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Objectives: To explore the experiences of Australian and New Zealand clinicians with respect to care pathways, their awareness and use of non‐invasive ventilation guidelines, and their perspectives on delivering quality non‐invasive ventilation services to people with neuromuscular disorders. Design, setting, participants: Qualitative study; semi‐structured focus groups and individual interviews with Australian and New Zealand clinicians who provide non‐invasive ventilation services to people with neuromuscular disorders, recruited from participants at a 2017 sleep medicine conference. Interviews were conducted during 1 October 2017 – 31 May 2018. Main outcome measures: Major themes identified by an iterative, semantic, and inductive analysis. Results: A total of 28 participants attended the four focus group sessions and five individual interviews; fourteen each from New Zealand and Australia, seventeen women and eleven men, eighteen physicians and ten other clinicians. Two major themes were identified: decision making for current practice, and resource constraints. Participants noted variable use of clinical guidelines and limited training to meet the needs of people with neuromuscular disorders who require non‐invasive ventilation. They described a lack of dedicated funding, unstructured care pathways, equipment supply levels that do not meet need, low staff‐to‐patient ratios and staff shortages, and the inability to deliver quality multidisciplinary care. The need for clinical guidelines and service specifications was highlighted as requisite for reducing variation in clinical care. Conclusions: Systemic factors influence the needs‐based provision of non‐invasive ventilation for people with neuromuscular disorders. Development of clinical guidelines for Australia and New Zealand, dedicated funding for respiratory services for people with neuromuscular disorders, and specialist clinician training are important for equitable and high quality non‐invasive ventilation care. [ABSTRACT FROM AUTHOR]

Background: Home‐based noninvasive ventilation (NIV) is an effective treatment for a range of conditions that cause respiratory failure which reduces hospitalisation and mortality and improves quality of life. Aims: To collect NIV prevalence, disease burden and equity data needed for effective national NIV health service planning. Methods: The authors collected demographics and the primary diagnosis of patients receiving publicly funded NIV in New Zealand in 2018 by surveying all providers. National and regional prevalence rates were calculated using adult population data (aged ≥20 years) for each District Health Board region compared with a 2011 study. A subanalysis of individual‐level data was used to calculate age‐standardised rates by diagnostic category. Results: A total of 1197 adults were receiving NIV giving a national rate of 32.9 per 100 000; almost twice the 2011 rate (16.7 per 100 000). Significant regional variations in NIV provision (4.5–84.2 per 100 000) were observed. The most frequent indications were obesity hypoventilation syndrome (OHS) (562, 47%), obstructive pathologies (335, 28%) and neuromuscular disorders (175, 15%); all have significantly increased in prevalence since 2011. Māori and Pacific peoples were significantly overrepresented among NIV users (2.24 [95% confidence interval (CI), 1.72–2.93] and 7.03 [95% CI, 5.52–8.94], respectively). The prevalence of NIV‐dependent use (>15 h/day) was 4%. Conclusions: Home‐based NIV provision has doubled since the previous survey, reflecting increased burden from OHS and obstructive pathologies and a disproportionate disease burden among Māori and Pacific populations. The large regional variations are concerning and highlight the urgent requirement for national service specifications, education and equipment provision. Further research is needed to address access equity. [ABSTRACT FROM AUTHOR]

Neuromuscular disorders (NMD) encompasses a wide range of conditions, with respiratory weakness a common feature. Respiratory care can involve non-invasive ventilation (NIV) resulting in fewer hospital admissions, a lower mortality rate and improved quality of life. The aim of this study was to explore the 'lived experience' of NIV by people with NMD. Interpretive Phenomenological Analysis (IPA) with semi-structured, face to face interviews with 11 people with NMD, using bi-level positive airway pressure for NIV for more than 12 months. Three themes were interpreted: (i) Alive, with a life; (ii) Me and 'that' machine; and (iii) Precariousness of this life. NIV enabled hope, independence and the opportunity to explore previously perceived unattainable life experiences. Yet, participants felt dependent on the machine. Furthermore, practical considerations and fear of NIV failure created a sense of precariousness to life and a reframing of personal identity. The findings highlight the broad ranging positive and negative effects that may occur for people with NMD when using this important therapy. Ongoing non-judgemental support and empathy are required from health professionals as the use of NIV challenged concepts such as 'living life well' for people with NMD. Neuromuscular disorders may result in respiratory weakness requiring non-invasive ventilation (NIV). When prescribed early, NIV can results in fewer hospital admissions, a lower mortality rate and improved quality of life. The relationship of people with NMD with their NIV machine is complex and impacts on and requires adjustment to their identity. NIV users acknowledged that NIV provided hope but simultaneously recognised the precariousness of NIV on their life. In order to better support people with NMD healthcare professionals need to better understand how the physical, psychological and social implications of NIV affect an individual's life. [ABSTRACT FROM AUTHOR]

Rationale: Necroptosis, mediated by RIPK3 and MLKL, is a form of regulated necrosis that can drive tissue inflammation and destruction, however its contribution to COPD pathogenesis is poorly understood.Objectives: To determine the role of necroptosis in COPD.Methods: Levels of RIPK3, MLKL and activated phospho-MLKL were measured in lung tissues of COPD patients and non-COPD controls. Necroptosis-related mRNA and proteins and cell death were examined in the lungs and pulmonary macrophages of mice with cigarette smoke (CS)-induced experimental COPD. The responses of Ripk3- and Mlkl-deficient (-/-) mice to CS exposure were compared to wild-type mice. Combined inhibition of apoptosis (pan-caspase inhibitor qVD-OPh) and necroptosis (Mlkl-/- mice) was assessed.Measurements and Main Results: Protein levels of MLKL and pMLKL but not RIPK3 were increased in lung tissues of COPD patients compared to never smokers or smoker non-COPD controls. Necroptosis-related mRNA and protein levels were increased in lung tissue and macrophages in CS-exposed mice/experimental COPD. Ripk3 or Mlkl deletion prevented airway inflammation in response to acute CS-exposure. Ripk3 deficiency reduced airway inflammation and remodelling and development of emphysematous pathology following chronic CS-exposure. Mlkl deletion and qVD-OPh treatment reduced chronic CS-induced airway inflammation, but only Mlkl deletion prevented airway remodelling and emphysema. Ripk3 or Mlkl deletion and qVD-OPh treatment reduced CS-induced lung cell death.Conclusions: Necroptosis is induced by CS exposure and increased in COPD patient lungs and experimental COPD. Inhibiting necroptosis attenuates CS-induced airway inflammation, airway remodelling and emphysema. Targeted inhibition of necroptosis is a potential therapeutic strategy in COPD. [ABSTRACT FROM AUTHOR]