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Background and aim: There are few long-term studies of respiratory health effects of landscape fires, despite increasing frequency and intensity due to climate change. We investigated the association between exposure to coal mine fire PM2.5 and fractional exhaled nitric oxide (FeNO) concentration 7.5 years later. Methods: Adult residents of Morwell, who were exposed to the 2014 Hazelwood mine fire over 6 weeks, and unexposed residents of Sale, participated in the Hazelwood Health Study Respiratory Stream in 2021, including measurements of FeNO concentration, a marker of eosinophilic airway inflammation. Individual exposure to coal mine fire PM2.5 was modelled and mapped to time-location diaries. The effect of exposure to PM2.5 on log-transformed FeNO in exhaled breath was investigated using multivariate linear regression models in the entire sample and stratified by potentially vulnerable subgroups. Results: A total of 326 adults (mean age: 57 years) had FeNO measured. The median FeNO level (interquartile range [IQR]) was 17.5 [15.0] ppb, and individual daily exposure to coal mine fire PM2.5 was 7.2 [13.8] µg/m3. We did not identify evidence of association between coal mine fire PM2.5 exposure and FeNO in the general adult sample, nor in various potentially vulnerable subgroups. The point estimates were consistently close to zero in the total sample and subgroups. Conclusion: Despite previous short-term impacts on FeNO and respiratory health outcomes in the medium term, we found no evidence that PM2.5 from the Hazelwood coal mine fire was associated with any long-term impact on eosinophilic airway inflammation measured by FeNO levels. [ABSTRACT FROM AUTHOR]

Background: In 2014, the Hazelwood coalmine fire shrouded the regional Australian town of Morwell in smoke and ash for 6 weeks. One of the fire's by‐products, PM2.5, is associated with an increased risk of COVID‐19 and severe disease. However, it is unclear whether the effect persisted for years after exposure. In this study, we surveyed a cohort established prior to the pandemic to determine whether PM2.5 from the coalmine fire increased long‐term vulnerability to COVID‐19 and severe disease. Methods: From August to December 2022, 612 members of the Hazelwood Health Study's adult cohort, established in 2016/17, participated in a follow‐up survey that included standardized items to capture COVID‐19 cases, as well as questions about hospitalization and vaccinations. Associations were evaluated in crude and adjusted logistic regression models. Results: A total of 268 (44%) participants self‐reported or met symptom criteria for having had COVID‐19 at least once. All models found a positive association, with odds of COVID‐19 increasing by between 4% and 30% for a 10 μg/m3 increase in coalmine fire‐related PM2.5 exposure. However, the association was significant in only 2 of the 18 models. There were insufficient hospitalizations to examine severity (n = 7; 1%). Conclusion: The findings are inconclusive on the effect of coalmine fire‐related PM2.5 exposure on long‐term vulnerability to COVID‐19. Given the positive association that was robust to modelling variations as well as evidence for a causal mechanism, it would be prudent to treat PM2.5 from fire events as a long‐term risk factor until more evidence accumulates. Surveying a cohort established before the pandemic, we investigated long‐term COVID‐19 vulnerability due to coalmine fire smoke exposure. There was a positive but generally non‐significant association between PM2.5 and COVID‐19. It would therefore be prudent to treat extreme but discrete coalmine fire smoke as a long‐term COVID‐19 risk factor. See relatededitorial [ABSTRACT FROM AUTHOR]

The Thoracic Society of Australia and New Zealand (TSANZ) and the Australian and New Zealand Society of Respiratory Science (ANZSRS) commissioned a joint position paper on pulmonary function testing during coronavirus disease 2019 (COVID‐19) in July 2021. A working group was formed via an expression of interest to members of both organizations and commenced work in September 2021. A rapid review of the literature was undertaken, with a 'best evidence synthesis' approach taken to answer the research questions formed. This allowed the working group to accept findings of prior relevant reviews or societal document where appropriate. The advice provided is for providers of pulmonary function tests across all settings. The advice is intended to supplement local infection prevention and state, territory or national directives. The working group's key messages reflect a precautionary approach to protect the safety of both healthcare workers (HCWs) and patients in a rapidly changing environment. The decision on strategies employed may vary depending on local transmission and practice environment. The advice is likely to require review as evidence grows and the COVID‐19 pandemic evolves. While this position statement was contextualized specifically to the COVID‐19 pandemic, the working group strongly advocates that any changes to clinical/laboratory practice, made in the interest of optimizing the safety and well‐being of HCWs and patients involved in pulmonary function testing, are carefully considered in light of their potential for ongoing use to reduce transmission of other droplet and/or aerosol borne diseases. [ABSTRACT FROM AUTHOR]

Background and objective: Inhalational challenge with dry mannitol powder may potentially induce cough by two mechanisms: airway bronchoconstriction or laryngeal irritation. This prospective observational study investigated laryngeal and bronchial components of cough induced by mannitol challenge. Methods: We recruited consecutive patients referred for clinical mannitol challenge. The Newcastle Laryngeal Hypersensitivity Questionnaire (LHQ) was administered. Throughout testing, coughs were audio‐recorded to derive a cough frequency index per time and dose of mannitol. Relationships between cough indices, laryngeal hypersensitivity and bronchial hyperresponsiveness (BHR) were examined. Participants were classified by cough characteristics with k‐means cluster analysis. Results: Of 90 patients who underwent challenge, 83 completed both the questionnaire and challenge. Cough frequency was greater in patients with abnormal laryngeal hypersensitivity (p = 0.042), but not in those with BHR. There was a moderate negative correlation between coughs per minute and laryngeal hypersensitivity score (r = −0.315, p = 0.004), with lower LHQ scores being abnormal. Cluster analysis identified an older, female‐predominant cluster with higher cough frequency and laryngeal hypersensitivity, and a younger, gender‐balanced cluster with lower cough frequency and normal laryngeal sensitivity. Conclusion: Cough frequency during mannitol challenge in our cohort reflected laryngeal hypersensitivity rather than BHR. Laryngeal hypersensitivity was more often present among older female patients. With the incorporation of cough indices, mannitol challenge may be useful to test for laryngeal hypersensitivity as well as BHR. Cough commonly occurs during bronchoprovocation testing with mannitol. In this study, higher cough frequency in patients undergoing mannitol provocation was associated with laryngeal hypersensitivity, but not bronchial hyperresponsiveness. Greater cough frequency was found in older female patients. Mannitol provocation may be a useful test for laryngeal hypersensitivity. [ABSTRACT FROM AUTHOR]

Background and objective: E-cigarette use has become increasingly prevalent, but there is some evidence demonstrating potential harms with frequent use. We aimed to identify the profiles of e-cigarette users from a regional community in Australia and investigate the associations of e-cigarettes with respiratory symptoms and lung function. Methods: A total of 519 participants completed a cross-sectional study. Exposure to ecigarettes was collected via a validated questionnaire. Respiratory symptoms were evaluated via a self-reported questionnaire and lung function measured with spirometry and forced oscillation technique (FOT). Linear and logistic regression models were fitted to investigate the associations between e-cigarettes and outcomes, while controlling for confounders such as tobacco smoking. Results: Of the 519 participants, 46 (9%) reported e-cigarette use. Users tended to be younger (mean x SD 45.2 x 14.5 vs. 55.3 x 16.0 years in non-users), concurrently using tobacco products (63% vs. 12% in non-users), have a mental health diagnosis (67% vs. 37% in non-users) and have self-reported asthma (63% vs. 42% in nonusers). After controlling for known confounders, chest tightness (OR = 2.4, 95% CI 1.2-4.9, p = 0.02) was associated with e-cigarette use. Spirometry was not different after adjustment for confounding. However, FOT showed more negative reactance and a greater area under the reactance curve in e-cigarette users than non-users. Conclusion: E-cigarette use was associated with increased asthma symptoms and abnormal lung mechanics in our sample, supporting a potential health risk posed by these products. Vulnerable populations such as young adults and those with mental health conditions have higher usage, while there is high concurrent tobacco smoking. [ABSTRACT FROM AUTHOR]

Spirometry has been established as an essential test for diagnosing and monitoring respiratory disease, particularly asthma and COPD, as well as in occupational health surveillance. In Australia and New Zealand, there is currently no pathway for spirometry operators in community‐based healthcare settings to demonstrate spirometry competence. The Australia and New Zealand Society of Respiratory Science (ANZSRS) has identified a need for developing a pathway for operators working in community‐based practices in Australia and New Zealand to demonstrate spirometry competence and certification. Spirometry certification provides evidence to patients, clients, employers and organizations that an individual has participated in an assessment process that qualifies them to perform spirometry to current international spirometry standards set out by the American Thoracic Society and the European Respiratory Society (ATS/ERS). This document describes a competence assessment pathway that incorporates a portfolio and practical assessment. The completion of this pathway and the award of certification confer an individual is competent to perform spirometry for 3 years, after which re‐certification is required. The adoption of this competency assessment and certification process by specialist organizations, and the commitment of operators performing spirometry to undergo this process, will enhance spirometry quality and practice in community‐based healthcare settings. [ABSTRACT FROM AUTHOR]

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BACKGROUND: Many healthcare professionals performing spirometry in primary care have had less than half a day's training in spirometry practice, and the validity of the test results is questionable. Longer training periods, with or without follow-up training, may improve test validity. OBJECTIVE: To determine if a 14-hour spirometry training course provides sufficient skill to produce valid results, and if follow-up training improves test validity. METHODS: Nurses and physiotherapists from rural health facilities chosen by their local area health service undertook a 14-hour spirometry course facilitated by respiratory scientists with at least 5 years experience. Participants consented to on-site reviews at 5, 7, and 9 months after the course. Participants were assessed for adherence to American Thoracic Society (ATS) acceptability and repeatability criteria by undertaking an assessment of spirometry on a naïve subject and a retrospective review of a selection of spirometry results at each site at each visit. Further education was provided following the reviews at 5 and 7 months. RESULTS: Fifteen participants from 10 sites were available for all 3 visits. The prospective phase revealed poor adherence to ATS criteria at 5 months, though this improved over the study period with follow-up training (40% at 5 months, 67% at 7 months, 87% at 9 months). The retrospective review showed that 37%, 60%, and 58% of the tests at 5, 7, and 9 months, respectively, met the ATS criteria and had correctly selected the best test. CONCLUSION: A 14-hour spirometry training course alone does not provide sufficient skill to perform spirometry to ATS criteria, and short-term follow-up is an essential component for improving test validity. [ABSTRACT FROM AUTHOR]

Introduction: Lumacaftor/ivacaftor (LUM/IVA) has been shown to improve clinical outcomes in cystic fibrosis (CF) patients homozygous for Phe508del with forced expiratory volume in 1 s (FEV 1 ) % pred >40%. We assessed the clinical utility of LUM/IVA in all eligible adult CF patients with FEV 1 % pred <40% treated for at least 1 year under a single-centre managed access programme., Methods: Following clinical optimisation, eligible patients (n=40) with FEV 1 % pred <40% were commenced on LUM/IVA and monitored for tolerance and clinical outcomes, including health service utilisation, pulmonary function, weight and body composition. 24 patients reached 1 year of treatment by the time of evaluation. Six patients discontinued due to adverse events (five for increased airways reactivity) and three underwent lung transplantation., Results: In comparison with the year prior to LUM/IVA commencement, significant reductions (median per year) were observed in the treatment year in the number of pulmonary exacerbations requiring hospitalisation (from 3 to 1.5; p=0.0002), hospitalisation days (from 27 to 17; p=0.0002) and intravenous antibiotic (IVAB) usage days (from 45 to 27; p=0.0007). Mean±sd change in FEV 1 % pred was -2.10±1.18% per year in the year prior, with the decline reversed in the year following (+1.45±1.13% per year; p=0.035), although there was significant heterogeneity in individual responses. Mean±sd weight gain at 1 year was 2.5±4.1 kg (p=0.0007), comprising mainly fat mass (mean 2.2 kg). The proportion of patients severely underweight (body mass index <18.5 kg·m -2 ) decreased from 33% at baseline to 13% at 1 year (p=0.003)., Conclusion: This real-world evaluation study demonstrated benefits over several clinical domains (infective exacerbations requiring hospitalisation, IVABs, pulmonary function decline and nutritional parameters) in CF patients with severe lung disease., Competing Interests: Conflict of interest: S.J. King reports a lecture fee from Vertex Pharmaceuticals in November 2017, outside the submitted work. Conflict of interest: D. Keating reports consultation fees from Vertex Pharmaceuticals, outside the submitted work. Conflict of interest: E. Williams reports a consultancy fee from Vertex Pharmaceuticals for a paid, 1-day workshop, outside the submitted work. Conflict of interest: E. Paul has nothing to disclose. Conflict of interest: B.M. Borg has nothing to disclose. Conflict of interest: F. Finlayson has nothing to disclose. Conflict of interest: B.M. Button reports lecture and consultancy fees from Vertex Pharmaceuticals, outside the submitted work. Conflict of interest: J.W. Wilson reports consultancy and lecture fees from Vertex Pharmaceuticals, outside the submitted work. Conflict of interest: T. Kotsimbos reports lecture fees from Vertex Pharmaceuticals, outside the submitted work., (Copyright ©ERS 2021.)