Christine Faye McDonald

Objectives: Ambulatory oxygen therapy (AOT), defined as the use of oxygen during activities of daily living and exercise, may be prescribed to optimise quality of life and physical activity in people with fibrotic interstitial lung disease (fILD) with exertional hypoxaemia. The aim of this study was to compare patient experiences of ambulatory therapy with oxygen or air delivered via an identical portable oxygen concentrator (POC) in order to understand perceptions of therapy in both active and sham conditions. Design: A qualitative study using semistructured interviews with open-ended questions was conducted over the telephone. Setting: Participants data were used from a 6-month clinical trial of AOT ( NCT03737409 ) in three hospitals in Australia. Participants: Included participants were randomised 1:1 to receive AOT using a POC (oxygen group) or sham therapy using an identical POC delivering air (air group). Participants were instructed to use the POC whenever they were physically active over 6 months. Participants were blind to group allocation. Interviews were conducted after the intervention period and were recorded and transcribed verbatim, and thematic analysis was used to report on experiences. Results: 23 participants with fILD agreed to be interviewed (12 oxygen group, 11 air group). Participants presented with moderate to severe fILD. Four major themes with subthemes were identified in both groups: benefits of POC use, negative aspects of POC use, equipment features, personal decisions about POC use. Themes and experiences did not differ between oxygen and air groups. Conclusions: POC use provides benefits and challenges. Shared decision-making and consideration of the balance between perceived benefits and harms are required when prescribing this therapy. Trial registration number: NCT03737409 .

Purpose: To determine whether capillary blood gas carbon dioxide values can substitute for arterial sampling to calibrate transcutaneous carbon dioxide during polysomnography. Methods: Participants underwent capillary (arterialized earlobe) and blood gas (radial artery) sampling at polysomnography commencement (Evening) and end (Morning). Participant and scientist sample preference, and participant pain were recorded. The transcutaneous offset from the corresponding arterial/capillary sample, and the transcutaneous electrode drift over the night were determined. Results: Seventy-five people consented and 44 had complete paired timepoint data. Both the capillary and arterial carbon dioxide values were higher than the transcutaneous (capillary evening mean -0.9 ± standard deviation 2.8, capillary morning -2.5 ± 3.9, arterial evening -3.7 ± 2.7, arterial morning -5.6 ± 3.8 mmHg). Capillary and arterial measures were comparable for assessing transcutaneous carbon dioxide drift (mean difference -0.3 mmHg (95% confidence interval -1.3, 0.7). The failure rate for both techniques was equivalent. Patients and scientists both preferred the capillary method. Conclusion: Capillary blood gas sampling of carbon dioxide levels from the earlobe is feasible. Capillary sampling provides a comparable measure of transcutaneous carbon dioxide drift, but not absolute offset, during polysomnography to that observed with radial arterial sampling. Importantly, patients prefer the capillary technique as it is less painful.

Introduction: Although fewer than 1% of pulmonary nodules are malignant, appropriate evaluation is essential in optimising patient outcomes. The 2017 Fleischner Society Guidelines provide recommendations on management of incidentally detected nodules; however, studies to date have shown variable guideline adherence. Adherence to guidelines in Australian nodule clinics has not been reported. Methods: A retrospective analysis of medical records was conducted for new patients evaluated in a pulmonary nodule clinic between 1 July 2017 and 1 July 2020. Patient demographics, past medical history, family history of malignancy, smoking history, baseline lung function tests, reasons for referral and lung nodule characteristics were analysed. Follow‐up recommendations were evaluated to determine Guideline adherence. Final diagnoses, where available, were extracted from multidisciplinary meeting (MDM) data. Results: Three hundred sixty‐one patients were included (mean age 68.2 years, female 44.3%). One hundred ten patients (30.5%) were never smokers, 106 (29.3%) current smokers, and 140 (38.8%) former smokers. Most lung nodules were identified incidentally (77.0%) with mean diameter (±SD) 12.1 ± 6.4 mm averaged from the long and short axes. Adherence to guidelines was 97.2%. Ninety‐seven patients (26.9%) were diagnosed with malignancy. Among patients diagnosed with lung cancer, former smokers had a higher risk (48.1%, relative risk (RR) 1.8; 95% confidence interval (CI) 1.08–3.1; P = 0.02) of lung cancer than never smokers (20.3%), with current smokers being intermediate in risk (31.6%, RR 1.6; 95% CI 0.96–2.84; P = 0.07). Conclusion: Our findings from this first‐in‐Australia study demonstrate appropriate lung nodule follow‐up in accordance with Fleischner Society Guidelines in a dedicated respiratory physician‐led nodule clinic.

GIM/FP/GP: [Formula: see text] Allerg & Immunol: [Formula: see text] Pulmonology: [Formula: see text].

Puhrpose: To evaluate the short- and long-term cross-sectional associations between COVID-19 infection and multidimensional sleep health. Methods: Data from the COVID-19 Outbreak Public Evaluation (COPE) initiative were used to examine the association between a novel multidimensional sleep health measure (COPE Multidimensional Sleep Health Scale, CMSHS) modeled from the RuSATED instrument and (1) COVID-19 infection and (2) post-acute sequelae of SARS-CoV-2 infection (PASC). Results: Data from 11,326 respondents were used for this study. The cohort was comprised of 51% women, 61% non-Hispanic White, and 17% Hispanic adults. COVID-19 infection was more prevalent among participants who had not received a booster vaccination (55.4% vs. 30.2%, p<0.001); the number of comorbid conditions was higher among those who had been infected (2.2% vs. 1.7%, p<0.001). Participants with COVID-19 infection had significantly lower CMSHS scores indicative of worse sleep health compared with uninfected participants (3.52 ± 1.37 vs. 3.78 ± 1.30; p < 0.001). Participants with PASC had lower CMSHS scores in comparison to those without PASC (2.72 ± 1.30 vs. 3.82 ± 1.28, p<0.001). In adjusted models, a progressive decline in CMSHS scores was observed over 12 months following infection (3.52 ± 0.05 vs. 2.98 ± 0.04; p < 0.001 for <1 month vs. 6–12 months). Conclusion: Compared with uninfected individuals, multidimensional sleep health was worse among persons who had a COVID-19 infection. Individuals with PASC had greater and persistent reductions in sleep health for up to 12 months post-infection. Brief summary: Several studies have examined the negative effects of COVID-19 on sleep, however the effects of COVID-19 infection on multidimensional sleep health remain poorly understood as do these associations over time. Using a large, population-based cohort, this study evaluates short- and long-term effects of Covid-19 infection on overall sleep health. The study provides evidence that COVID-19 infection is associated with impairments in overall sleep health, with effects persisting up to 12 months post-infection. The findings in this study demonstrate that poor sleep health is an important long-term consequence of COVID-19 infection and emphasizes the need for sleep assessment among patients affected by COVID-19.

Home antiviral treatment (HAVT: nirmatrelvir/ritonavir [Paxlovid] and molnupiravir [Lagevrio]) for COVID-19 was approved in December 2021 by the U.S. Food

Background: The COVID‐19 pandemic caused disruption of respiratory laboratory services worldwide, with international respiratory societies recommending testing limitations. Aims: Our study aimed to quantify the impact of COVID‐19 on laboratory‐based respiratory function tests (RFTs) in Australia using data from Australia's publicly funded universal healthcare system, Medicare. Methods: We examined the online Medicare database for repeated cross‐sectional data to understand pre‐pandemic data trends, from July 1994 (earliest data) to September 2023. All laboratory‐based Medicare items related to RFTs were included, encompassing those before and after related changes in the Medicare Benefits Schedule implemented in 2018. Results: Following the COVID‐19 pandemic declaration in March 2020, there was a 45% fall (100 924 to 55 896) in laboratory‐based RFTs in Australia in the second quarter of 2020, compared with the same quarter the previous year. The yearly fall was 19% in 2020 (326 685) compared with 2019 (404 593). This was against the background of a yearly average±standard deviation increase in testing numbers of 7±3% from 1995 to 2018, followed by a 7% reduction in 2019 after Medicare changes. Fluctuations in testing were noted throughout 2020, 2021 and 2022, which state‐based data suggested were related to local lockdown conditions and COVID‐19 case numbers. Conclusions: Our analysis highlights the substantial impact that the COVID‐19 pandemic had on laboratory‐based Medicare‐funded respiratory function testing in Australia. State‐based fluctuations in testing numbers suggest the need for similar analysis elsewhere to fully understand the impact that COVID‐19 had on respiratory laboratories worldwide.