News in brief: Biologics guidance for chronic rhinosinusitis with nasal polyps; Unsupervised home spirometry effective in adults with CF; ILST lung screening already saving Australian lives

2 Dec 2021

Biologics guidance for chronic rhinosinusitis with nasal polyps

A new position paper could clear up treatment pathways for chronic rhinosinusitis with nasal polyps (CRSwNP), the Australasian Society of Clinical Immunology and Allergy (ASCIA) hopes.

The paper, released by ASCIA and the Australian Society of Otolaryngology Head and Neck Surgery, features recommendations on CRSwNP diagnosis and management, with a spotlight on first-line therapies and biologics.

“Despite CRS’s significant incidence and quality of life implications, there are relatively few large and well-conducted studies of current first-line therapies,” the overview read.

While intranasal corticosteroids and saline are “safe and effective” long-term, “many patients remain suboptimally controlled and require surgical management” and/or biologics.

The paper aims to provide a modern framework for treating patients appropriately, equitably and cost-effectively, it said.


Unsupervised home spirometry effective in adults with cystic fibrosis

Many adults with cystic fibrosis have nailed at-home spirometry during COVID-19, giving clinicians confidence in the usefulness of unsupervised testing, but some patients may still need coaching on acceptable technique and adherence, Australian respiratory scientists say.

A study of 74 patients accessing remote appointments at Royal Prince Alfred Hospital’s (RPAH) Cystic Fibrosis Clinic between February and December 2020 found 95% and 93% of patients achieved grade A (excellent) or B (very good) spirometry quality with and without online supervision, respectively, independent of lung function severity.

It also saw “no significant differences” in forced expiratory volume in 1 second with paired spirometry performed within a 24 hour period.

While spirometry is usually performed in pulmonary function laboratories with respiratory scientist-supervision, COVID-19 meant increased telehealth sessions and patients were encouraged to monitor lung function at home, without supervision, RPAH respiratory specialist Jody Bell and her team wrote in the Journal of Cystic Fibrosis.

Despite concerns about its usefulness with reduced training and quality assurance, this study showed most adults CF patients could perform the test with acceptable and repeatable results.

“Regular quality control measures by respiratory scientists and opportunities for additional coaching for patients who experience difficulty performing acceptable spirometric manoeuvres will likely still be necessary until longer multisite studies evaluating patient adherence and quality of remote spirometry are available” they concluded.


ILST lung screening already saving Australian lives

Lung cancer screening is already providing early detection and curative treatment for Australians, according to WA clinicians involved in the International LungScreen Trial (ILST) evaluation program.

Australia is one of five countries that embarked on the ILST study in 2017, in which high risk individuals are being invited to Fiona Stanley Hospital to have lung screening with low dose CT.

The study led by FSH Respiratory Physician Dr Annette McWilliams and Project Manager Jacqueline Logan has already led to detection of cancers in 21 people that would otherwise have been missed, the investigators say.

Dr McWilliams said 86% of participants found to have lung cancer as part of the study have been able to undergo curative surgery.

“It is an excellent result for the participants, the study and the Western Australian community who through this trial, are able to access a greater level of potentially life-saving screening,” she says.

“As a clinician researcher, this type of support for translational work is crucial.”

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