News in brief: lung transplant in bronchiectasis; improving CPAP adherence;

Wednesday, 17 Mar 2021

Bronchiectasis outcomes distinctly different from other post-transplant patients

Non-CF bronchiectasis patients have poorer outcomes after lung transplantation, including a lower 5-yr survival, than patients with other indications.

A retrospective study of consecutive lung transplant patients at Melbourne’s Alfred Hospital found mortality was 2.24 times higher in the bronchiectasis group than obstructive lung disease (OLD) patients (p=0.010), 2.22 times higher than for ILD patients (p=0.009), and 1.5 times higher than CF patients (p=0.19).

Similarly graft survival was significantly lower in bronchiectasis patients (32%) than patients with OLD (64%), CF (79%), ILD (55%) and pulmonary hypertension (62%).

The cause of lung allograft loss in bronchiectasis patients was driven by infective features.

Bronchiectasis patients also spent more time in hospital than other patients – 45.81 days versus 18.21 in CF, 12.46 in OLD and 12.45 in ILD patients.

“Lung transplantation remains an option for end stage bronchiectasis, however this study supports the hypothesis that bronchiectasis patients have a reduced survival and increased complications due to respiratory sepsis compared to patients undergoing lung transplantation for other chronic lung diseases,” the study said.

Internal Medicine Journal

The psychology of CPAP

With a drop out rate from CPAP therapy as high as 50% in the first year, clinicians need to work hard to engage OSA patients and improve their compliance with treatment.

A summary of effective behavioural interventions from the Sleep and Circadian Research Group at the University of Sydney includes:

  • Continued support through phone calls and ‘booster’ sessions
  • Positive messages around PAP are repeated frequently
  • Easy access for patients to health professionals
  • Treatments that are individualised and tailored to the patient
  • The patient’s perspective and feelings must be heard, their concerns properly taken into consideration and met.

Sleep Medicine Clinics

Asthma death due to substandard care in prison: coroner

An Indigenous man who died of asthma while in a NSW prison lacked access to basic care such as preventer inhalers despite having a history of very severe asthma, an inquest has heard.

Nathan Reynolds, 36, died after having an asthma attack at John Moroney prison, Sydney, in September 2018. Dr Greg King, Medical Director at the Royal North Shore Hospital’s Respiratory Investigation Unit, told an inquest that Mr Reynolds frequent hospitalisations and high usage of Ventolin inhalers were red flags for uncontrolled asthma that should have triggered a review of his condition.

However Mr Reynold did not receive any asthma assessment, monitoring, management plan or preventer medication after being jailed, despite his records showing a history of severe asthma.

The coroner concluded that the care and treatment provided by Corrective Services NSW fell well short of what would be considered adequate for a person suffering severe asthma. The inquest did not attribute blame, but recommended that prison health staff undergoing training in how to recognise and manage asthma.

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