News in brief: Switch inhalers to halve carbon footprint; Lung abnormalities seen in unhospitalised long COVID patients; Mepolizumab approved for adults with CRSwNP


Switch inhalers to halve carbon footprint

Asthma patients who switch from a pressurised metered dose inhaler to a dry powder inhaler based maintenance therapy more than halved their inhaler carbon footprint without loss of asthma control, a UK study has shown.

Post-hoc analysis of a subset of 2236 patients enrolled in the Salford Lung Study in Asthma showed that those who switched from a pMDI-based controller therapy to fluticasone furoate/vilanterol via a dry powder inhaler had a significantly lower annual CO2e kg per patient (108 kg vs 240 kg, p<0.001). Asthma control was consistently superior over the 12 months in the dry powder inhaler group, according to results published in Thorax.

The study authors said the hydrofluorocarbons in metered dose inhalers are potent greenhouse gases, with a single dose having an equivalent carbon footprint to driving one mile in a family car.


Study finds lung abnormalities in unhospitalised long COVID patients

Researchers funded by the National Institute for Health Research (NIHR) have identified abnormalities in the lungs of patients with Long COVID who experience breathlessness but whose other tests are normal.

Early results of the as yet unpublished EXPLAIN trial, which is using hyperpolarised xenon MRI scans to investigate possible lung damage in long COVID patients, suggest that COVID-19 may cause persistent impairment in gas transfer and underlying lung abnormalities. However, it is still unclear to what extent these abnormalities contribute to breathlessness, researchers noted.

While CT scans and X-rays showed normal results, the trial found that in 7 of 11 long COVID patients – who had never been in hospital, did not have acute severe illness from COVID, and had suffered breathlessness for more than 6 months post initial infection – had abnormal hyperpolarised xenon MRI scans, indicating ‘significantly impaired gas transfer’ from the lungs to the bloodstream.

“These are interesting results and may indicate that the changes observed within the lungs of some patients with long COVID contribute to breathlessness. However, these are early findings and further work to understand the clinical significance is key,” commented co-researcher Dr Emily Fraser, a Respiratory Consultant who leads the Oxford Post-COVID Assessment Clinic. “Extending this study to larger numbers of patients and looking at control groups who have recovered from COVID should help us to answer this question and further our understanding of the mechanisms that drive long COVID.”

However, the preliminary findings “further emphasise the need to ensure that adults and children who experience persistent symptoms following COVID-19 illness have access to comprehensive diagnostic assessments – informed by presenting symptoms, to inform care and support,” noted Dr Louise Sigfrid, Clinical Research Fellow and Public Health Specialist, Centre for Tropical Medicine and Global Health, University of Oxford.


Mepolizumab approved for adults with CRSwNP

The IL-5 inhibitor mepolizumab (Nucala) has received TGA approval as an add-on treatment in adult patients (18 years and above) with severe chronic rhinosinusitis with nasal polyps (CRSwNP) with an inadequate response to intranasal corticosteroids.

Biological treatments can play an important role in managing upper and lower airway diseases in patients with CRSwNP who often have coexisting severe asthma, said Dr Andrew Gillman, a Melbourne-based specialist respiratory physician, in a statement released by GSK.

“[Mepolizumab] … has demonstrated improvements in patient quality of life across nasal symptoms, ear/face symptoms, fatigue, impact on sleep and emotional impact. This means that in addition to targeting the underlying eosinophilic inflammation associated with recurrent nasal polyps, treatment is also helping improve quality of life for patients,” he said.


 

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