Search

In early 2014, the Hazelwood coalmine fire covered the regional Australian town of Morwell in smoke and ash for 45 days. One of the fire’s by-products, PM2.5, has been linked higher rates of COVID-19 infection to increased expression of the ACE2 receptor, which the COVID-19 virus uses to infect cells throughout the body. However, it is unclear whether the effect persists for years after exposure. In this study, we surveyed a cohort established prior to the pandemic to determine whether PM2.5from the coalmine fire increased long-term vulnerability to COVID-19 infection and severe disease.In late 2022, 612 members of the Hazelwood Health Study’s adult cohort, established in 2016/17, participated in a follow-up survey including standardised items to capture COVID-19 infections, hospitalisations, and vaccinations. Associations were evaluated in crude and adjusted logistic regression models, applying statistical weighting for survey response and multiple imputation to account for missing data, with sensitivity analyses to test the robustness of results.A total of 271 (44%) participants self-reported or met symptom criteria for at least one COVID-19 infection. All models found a positive association, with odds of infection increasing by between 4-21% for every standard deviation (12.3µg/m3) increase in mine fire-related PM2.5exposure. However, this was not statistically significant in any model. There were insufficient hospitalisations to examine severity (n=7; 1%).The findings were inconclusive in ruling out an effect of PM2.5exposure from coalmine fire on long-term vulnerability to COVID-19 infection. Given the positive association that was robust to modelling variations as well as evidence for a causal mechanism, it would be prudent to treat PM2.5from fire events as a risk factor for long-term COVID-19 vulnerability until more evidence accumulates.

Background The prognostic value of evaluating spirometry at a fixed time point using standardized population reference has not previously been evaluated. Our aim was to assess the association between spirometric phenotype at 12 months (Spiro 12M ), survival and incidence of chronic lung allograft dysfunction (CLAD) in bilateral lung transplant recipients. Methods We conducted a retrospective cohort study of bilateral lung transplant recipients transplanted between January 2003 and September 2012. We defined Spiro 12M as the mean of the 2 prebronchodilator FEV1 measurements 12-month post-transplant. Normal spirometry was defined as FEV1/FVC ≥0.7 and FEV1≥80% and FVC≥80% predicted population-based values for that recipient. Abnormal spirometry was defined as failure to attain normal function by 12-months. We used a Cox regression model to assess the association between Spiro 12M , survival, and CLAD. We used logistic regression to assess potential pretransplant donor and recipient factors associated with abnormal Spiro 12M Results One hundred and eleven (51%) lung transplant recipients normalized their Spiro12M. Normal Spiro12M was associated improved survival (hazard ratio [HR] 0.60, 95% confidence interval [CI] 0.41-0.88], p = 0.009. Each 10% decrement in FEV1 increased the risk of death in a stepwise fashion. Additionally, CLAD was reduced in those with normal Spiro12M (HR:0.65, 95%CI:0.46-0.92, p = 0.016). Donor smoking history (OR:2.93, 95% CI:1.21-7.09; p = 0.018) and mechanical ventilation time in hours (OR:1.03, 95% CI:1.004-1.05; p = 0.02) were identified as independent predictors of abnormal Spiro12M. Conclusions Abnormal Spiro12M is associated with increased mortality and the development of CLAD. The effect is dose dependent with increased dysfunction corresponding to increased risk. This assessment of phenotype at 12-months can easily be incorporated into standard of care.

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.

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 e-cigarettes 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 ± SD 45.2 ± 14.5 vs. 55.3 ± 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 non-users). 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.

In 2014, a six-week long fire at the Hazelwood open cut coal mine exposed residents in the adjacent town of Morwell to high concentrations of fine particulate matter with an aerodynamic diameter

See related Editorial See cover image, 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.

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.

Rationale. In 2014 the Hazelwood open cut coal mine in south eastern Australia burned for six weeks, exposing nearby residents to high concentrations of fine particulate matter (PM2.5). The long-te...

Aim: Single (SLTx) and double lung transplantation (DLTx) are therapeutic options for end-stage interstitial lung disease (ILD). The aim of this study is to describe oscillometry indices in stable SLTx compared to DLTx recipients. Methods: Oscillometry & spirometry were performed on all stable LTx recipients at 2 Australian centres from 2020-2021 using TremoFlo C-100 to obtain resistance (R5, R5-19), reactance (X5) and reactance area (Ax). Subjects with baseline, acute or chronic lung allograft dysfunction were excluded. SLTx for ILD (SLTx-ILD) recipients were compared with DLTx for ILD (DLTx-ILD) and were matched by age and gender. Results: 17 SLTx-ILD were included and compared with 10 matched stable DLTx-ILD. Baseline demographics of SLTx-ILD [88% males; mean age 64 (SD 5)] and DLTx-ILD [90% males; mean age 63 (SD 6)] were similar. Median X5 (-1.86 vs -1.14, p=0.02) and Ax (12.60 vs 5.57, p=0.04) differed significantly between SLTx-ILD and DLTx-ILD recipients, but resistance (R5, R5-19) measurements did not. Conclusion: SLTx for ILD is characterised by significantly worse X5 and Ax (increased elastance) as compared to DLTx for ILD. The abnormal reactance, in addition to insignificant differences in resistance measurements between SLTx and DLTx, may be due to the fibrotic contralateral native lung. However, contribution from other factors such as differences in lung size matching needs to be assessed. Longitudinal oscillometry studies are required to ascertain whether abnormal reactance – when assessed against patients9 baseline measurements – can be indicative of earlier progressive lung graft dysfunction and a worse prognosis in SLTx, as compared to using traditional methods.

Knowing the limitations of reference equations is essential to minimising errors in diagnosis and clinical management. Choice of reference sets may impact access to treatment options where lung function based eligibility criteria exist. https://bit.ly/2WdOFDj

In 2014, a fire at an open cut coal mine in South-eastern Australia burned for about 6 weeks. Residents of the adjacent town were exposed to high levels of fine particulate matter (PMA cross-sectional analysis was undertaken in a group of exposed participants with asthma from Morwell (There was no evidence that exposed participants had more severe asthma symptoms, worse lung function, or more eosinophilic airway inflammation than unexposed participants. However, there was some evidence that Morwell participants had more uncontrolled than well-controlled asthma, compared to the participants from Sale (adjusted relative risk ratio 2.71 95% CI: 1.02, 7.21,Three and a half years after exposure, coal mine fire smoke did not appear to be associated with more severe asthma symptoms or worse lung function but might be associated with poorer asthma control.

BACKGROUND Spirometry forms the foundation investigation for the diagnosis and monitoring of common pulmonary conditions. However, potential variation in spirometry interpretation for airflow obstruction may impact subsequent clinical management. AIM To audit spirometry interpretation practices for airflow obstruction in Thoracic Society of Australia and New Zealand accredited laboratories. METHODS Thirty-nine accredited complex lung function laboratories were invited to participate in an online survey. The survey enquired about demographics, definition of lower limit of normal range for spirometry parameters, spirometric parameters used for identifying airflow obstruction, spirometric definition of airflow obstruction, definition of significant bronchodilator response and chosen spirometry reference equations. RESULTS Thirty-six laboratories provided complete responses (response rate, 92%). To define the lower limit of normal, 26 of 36 used the 5th percentile, 7 of 36 used a fixed cut-off and 3 used other. Twenty-nine laboratories utilised forced expiratory volume in 1 s/forced vital capacity (FEV1 /FVC) as the sole parameter to identify airflow obstruction, 3 of 36 used FEV1 /FVC and FEF25-75% , and 4 used other. To define airflow obstruction, 25 of 36 laboratories used FEV1 /FVC < 5th percentile, 9 of 36 used a fixed cut-off (FEV1 /FVC < 0.7, 6/36; FEV1 /FVC < 0.8, 2/36; FEV1 /FVC < 0.75, 1/36) and 2 of 36 used other. Twenty-six laboratories defined a significant bronchodilator response as an increase of at least 200 mL and 12% in FEV1 and/or FVC, 9 of 36 used ≥200 mL and ≥ 12% increase in FEV1 only, and 1 used other criteria. Reference equations utilised for interpretation of spirometry data included: Quanjer 2012 Global Lung Initiative (16/36), the third National Health and Nutritional Examination Survey (8/36), European Community of Coal and Steel (8/36) and other (4/36). CONCLUSIONS Significant heterogeneity in spirometry interpretation for airflow obstruction exists across Australian and New Zealand accredited lung function laboratories. Lack of standardisation may translate into clinically appreciable differences for the diagnosis and management of common respiratory conditions. Ongoing discussion regarding formal standardisation is required.

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 (FEV1) % pred >40%. We assessed the clinical utility of LUM/IVA in all eligible adult CF patients with FEV1 % pred, In adults with severe cystic fibrosis lung disease, 1 year of treatment with lumacaftor/ivacaftor was associated with reduced infective exacerbations, days of intravenous antibiotics and rate of pulmonary function decline, and improved nutritional status https://bit.ly/2I07suR

In 2014, a six-week long fire at the Hazelwood open cut coal mine exposed residents in the adjacent town of Morwell to high concentrations of fine particulate matter with an aerodynamic diameter 2.5). The long-term health consequences are being evaluated as part of the Hazelwood Health Study (HHS).Approximately 3.5 to 4 years after the mine fire, adults from Morwell (n=346) and the comparison town Sale (n=173) participated in the longitudinal Respiratory Stream of the HHS. Individual fire-related PM2.5exposure was retrospectively modelled. Lung mechanics were assessed using the forced oscillation technique (FOT), which utilises pressure waves to measure respiratory system resistance (Rrs) and reactance (Xrs). Multivariate linear regression was used to evaluate associations between PM2.5and transformed Rrs5, area under the reactance curve (AX5) and Xrs5 controlling for key confounding factors.There were clear dose-response relationships between increasing mine fire PM2.5and worsening lung mechanics, including a reduction in post-bronchodilator Xrs5 and an increase in AX5. A 10 μg/m3increase in mine fire related PM2.5was associated with a 0.015 (95%CI: 0.004, 0.027) reduction in exponential(Xrs5) post bronchodilator, which was comparable to 4.7 years of aging. Similarly, the effect of exposure was associated with a 0.072 (0.005, 0.138) increase in natural log(AX5) post-bronchodilator, equivalent to 3.9 years of aging.This is the first study using FOT in adults evaluating long term respiratory outcomes after a medium-term ambient PM2.5exposure to coal mine fire smoke. These results should inform public health policies and planning for future events.

IntroductionIn 2014 the Hazelwood open cut coal mine burned for six weeks, exposing nearby residents to fine particulate matter (PM2.5). The long-term health consequences are being evaluated as part of the Hazelwood Health Study (HHS). These analyses explore the association between PM2.5 and chronic obstructive pulmonary disease (COPD).MethodsA sample of 346 exposed, and 173 unexposed, adults participated in the longitudinal Respiratory Stream of the HHS. Participants underwent spirometry and gas transfer measurements and answered validated respiratory questionnaires 3.5-4 years after the fire. Individual level mine fire-related PM2.5 exposure was modelled. Multivariate linear regression and logistic models were fitted to analyse associations between mean and peak PM2.5 exposure and clinical outcomes, stratified by smoking status.ResultsA 10 μg/m3 increase in mean PM2.5 exposure was associated with a 69% (95%CI: 11% to 158%) increase in odds of spirometry consistent with COPD amongst non-smokers and increased odds of chest tightness (odds ratio; OR 1.30, 95%CI 1.03 to 1.64) and chronic cough (OR 1.24, 95%CI 1.02 to 1.51) in the previous 12 months in all participants. For current smokers, increments in mean PM2.5 exposure were associated with higher odds of chronic cough in the preceding 12 months (OR 2.13, 95%CI 1.24 to 3.65).DiscussionAlmost four years after a six-week period of coal fire PM2.5 exposure, we identified a dose-response association between exposure and COPD in non-smokers. With climate change a likely contributor to increased risk of landscape fires, the findings will inform policy decisions during future sustained smoke events.KEY MESSAGESWhat is the key question?Are there long-term impacts of a six-week mine fire event generating PM2.5 on COPD and related respiratory symptoms in adults?What is the bottom line?Almost 4 years after the mine fire, each 10 µg/m3 increase in PM2.5 exposure was associated with a 69% increase in odds of spirometry consistent with COPD amongst non-smokers, and a 30% increase in odds of chest tightness and 24% increase in odds of chronic cough amongst all participants. Amongst smokers, each 10 µg/m3 increase in PM2.5 was associated with a 113% increase in odds of chronic cough.Why read on?With the recent megafires in Australia and the United States exposing communities to smoke for weeks to months, evidence of the long-term health impacts of similar duration PM2.5 generating pollution events are needed to inform the public health response.

Introduction Bronchiolitis obliterans syndrome (BOS) after allogeneic haemopoietic stem cell transplant (HSCT) is an under-recognised and difficult to treat disease. This occurs in the context of limited clinical research and inconsistent diagnostic criteria. Method Retrospective data was collected on 275 patients who underwent allogeneic HSCT at an Australian tertiary hospital between 2007 and 2017. The prevalence of BOS, defined by 2014 National Institute of Health criteria, as well as predictors for BOS and mortality were determined. Treatment outcomes, using serial spirometry, were compared between patients who received early versus late immunosuppression for BOS. Results The prevalence of BOS was 9.1%. Myeloablative conditioning (OR: 2.7, 95%CI: 1.13–6.50, p = 0.03) and extra-pulmonary chronic graft-versus-host disease (OR 2.62, 95% CI: 1.04–6.60, p = 0.04) were associated with BOS. There was reduced median survival in the BOS group compared with the non-BOS group, but this was not statistically significant (4.1years (IQR: 2.8, 6.8) versus 4.6years (IQR: 2.4, 7.8), respectively, p = 0.33). The vast majority (87.5%) of BOS patients failed to attain improvement in FEV1 at 12 months, regardless of treatment strategy. Patients who underwent a late immunosuppression strategy had worse mean FEV1 decline compared to those who received early immunosuppression (−36.3% versus −1.6%, respectively, p = 0.03). Conclusion BOS is a common and progressive disease following HSCT and is largely refractory to current treatment strategies. Compared to late immunosuppression, early augmentation of immunosuppression may slow lung function deterioration in the short term. However, further research is urgently needed to identify effective prevention and treatment strategies for BOS.

This study examined the relationship between diet quality scores and cardiometabolic risk factors in regionally-dwelling older Australian adults with increased cardiovascular risk. This study was a cross-sectional analysis of demographic, anthropometric, and cardiometabolic risk factor data from 458 participants of the Cardiovascular Stream of the Hazelwood Health Study. Participants completed a 120 item semi-quantitative food frequency questionnaire. Multivariable linear regression adjusting for age, sex, smoking, physical activity, education, diabetes, and body mass index was used to examine the relationship between diet and cardiometabolic risk factors. Mean (SD) age of participants was 71 (8) years, and 55% were male. More than half of men and women did not meet recommended intakes of fibre, while 60% of men and 42% of women exceeded recommended dietary sodium intakes. Higher diet quality in terms of intake of vegetables, grains, and non-processed meat, as well as intake of non-fried fish, was associated with more favourable cardiometabolic risk profiles, while sugar-sweetened soft drink intake was strongly associated with adverse cardiometabolic risk factor levels. In older, regionally-dwelling adults, dietary public health strategies that address whole grain products, vegetable and fish consumption, and sugar-sweetened soft-drink intake may be of benefit in reducing cardiometabolic risk.

BACKGROUND AND OBJECTIVE Non-invasive ventilation (NIV) improves clinical outcomes in hypercapnic acute exacerbations of COPD (AECOPD), but the optimal model of care remains unknown. METHODS We conducted a prospective observational non-inferiority study comparing three models of NIV care: general ward (Ward) (1:4 nurse to patient ratio, thrice weekly consultant ward round), a high dependency unit (HDU) (1:2 ratio, twice daily ward round) and an intensive care unit (ICU) (1:1 ratio, twice daily ward round) model in three similar teaching tertiary hospitals. Changes in arterial blood gases (ABG) and clinical outcomes were compared and corrected for differences in AECOPD severity (Blood urea > 9 mmol/L, Altered mental status (Glasgow coma scale (GCS) 109 bpm, age > 65 (BAP-65)) and co-morbidities. An economic analysis was also undertaken. RESULTS There was no significant difference in age (70 ± 10 years), forced expiratory volume in 1 s (FEV1 ) (0.84 ± 0.35 L), initial pH (7.29 ± 0.08), partial pressure of CO2 in arterial blood (PaCO2 ) (72 ± 22 mm Hg) or BAP-65 scores (2.9 ± 1.01) across the three models. The Ward achieved an increase in pH (0.12 ± 0.07) and a decrease in PaCO2 (12 ± 18 mm Hg) that was equivalent to HDU and ICU. However, the Ward treated more patients (38 vs 28 vs 15, P

The Australian National Chronic Obstructive Pulmonary Disease (COPD) guidelines recommend that inhaled corticosteroids (ICS) be reserved for patients with a post-bronchodilator forced expiratory volume in 1 s (FEV1 ) less than 50% predicted and those who experience ≥2 exacerbations in 12 months. In total, 707 COPD patients were identified from the lung function test database at our tertiary hospital; 52.4% of patients with a post-bronchodilator FEV1 ≥50% were prescribed an ICS. Significant discordance exists between guideline recommendations and inhaler prescription.

Purpose Baseline and chronic lung allograft dysfunction (BLAD & CLAD) are leading causes of reduced patient survival. Airway oscillometry characterises the lung's mechanical properties with greater sensitivity than spirometry. This study aims to characterise BLAD and CLAD with airway oscillometry. Methods Oscillometry was performed on all bilateral lung transplant (LTx) recipients at 2 Australian centres between Jan-Oct 2020 with the TremoFlo C-100 device to obtain resistance (R5, R19-5), reactance (X5), and reactance area (Ax). Patients with acute lung allograft dysfunction were excluded. CLAD was diagnosed/staged using spirometry as per ISHLT 2019 Consensus Criteria. BLAD was defined as failure to ever achieve >80%-pred FEV1 and FVC. Multivariate logistic regression measured the association between oscillometry risk of CLAD. Results A total of 179 LTx recipients [47% males; median age 54 (IQR 25); duration post-LTx 5 years (IQR 7)] were recruited. 112/179 (63%) patients had no CLAD and of these 27 (24%) patients had BLAD. There was a significant difference in median X5 (-1.64 vs -1.20, p Conclusion BLAD is characterised by abnormal reactance (X5 & Ax), yet resistive airway properties (R5 & R5-19) are similar to patients without BLAD. The association between oscillometry parameters and CLAD demonstrates that oscillometry provides complimentary information about lung dysfunction after transplant. Longitudinal studies are required to determine whether oscillometry has a role in earlier detection of CLAD.

Spirometry training courses are provided by health services and training organizations to enable widespread use of spirometry testing for patient care or for monitoring health. The primary outcome of spirometry training courses should be to enable participants to perform spirometry to international best practice, including testing of subjects, quality assurance and interpretation of results. Where valid results are not achieved or quality assurance programmes identify errors in devices, participants need to be able to adequately manage these issues in accordance with best practice. It is important that potential participants are confident in the integrity of the course they attend and that the course meets their expectations in terms of training. This position statement lists the content that the Australian and New Zealand Society of Respiratory Science (ANZSRS) has identified as required in a spirometry training course to adequately meet the primary outcomes mentioned above. The content requirements outlined in this position statement are based on the current international spirometry standards set out by the American Thoracic Society and European Respiratory Society. Furthermore, recommendations around course delivery for theoretical and practical elements of spirometry testing and post-course assessment are outlined in this statement.

Purpose The effect of matching donor and lung transplant (LTx) recipient lung volumes on LTx outcomes is unknown. The Forced Oscillation Technique (FOT) is a simple measure of the mechanical properties of the respiratory system. We have recently developed novel measures of airway closure using FOT. This study aims to assess the effect of matching donor and recipient lung volumes on respiratory system mechanics using FOT. Methods A multi-centre (Alfred Hospital, Melbourne and St Vincent's Hospital, Sydney) prospective study of (n=19) subjects (63% male, age 56 ±13yrs) at one time point 3-6 months post bilateral LTx were divided into two groups: G1 - Recipient measured pre-LTx total lung capacity (rTLC) predicted dTLC, n=10. All subjects underwent pulmonary function testing including, spirometry, plethysmography and FOT (Tremoflo 2000, Thorasys, Canada). Results In G1, respiratory system elastance (stiffness=AX5) positively correlated with difference between dTLC and rTLC (p Conclusion Novel measurements of respiratory mechanics from FOT demonstrate both oversizing and under-sizing donor TLC can alter recipient respiratory mechanics post-LTx. Longitudinal studies are underway to correlate these effects with the incidence and extent of baseline or chronic lung allograft dysfunction (BLAD & CLAD).

Purpose A retrospective study of paediatric lung and heart-lung transplant (LTx) recipients to assess growth and its relationship with spirometric indices. Methods Analyses of relationships between serially assessed age, height, weight, forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) were undertaken. Serial spirometry at identical heights were analysed as means. Percentile height-for-age was calculated from the CDC 2000 dataset.1 95% confidence intervals are presented in parentheses after values. Results 42 LTx recipients ≤17 years (median at LTx = 13.6 years, 62% female) had spirometry and biometric data available. LTx indications included Cystic Fibrosis (n = 20) and Obliterative Bronchiolitis (n = 6). Median follow-up was 1.24 years (0.13-2.35). There was no significant difference between median biometric or spirometry value changes if recipients with 10cm. The median increase in FVC was 0.94L (0.15-1.72). Median predicted FVC and FEV1 were 67.8% (37.5-98.2) and 58.3% (27.8-88.8) of predicted respectively. Growth was not above expected for age with median change in height for age of -2.9 percentiles (-36.2-30.4). LTx recipients 1year follow-up) had a median height change of 7.5cm (-2.1-17.1 and median age-matched height percentile change of-4.55 percentiles (-22.6-13.47). Conclusion Most paediatric LTx recipients did not significantly change height after LTx. Unlike other solid organ Tx, where growth catch-up is expected, this does not occur.2 Additionally, graft function does not appear to impact growth trajectory. While significant steroid exposure contributes, further research will need to delineate the interplay of LTx on pubertal growth, immunosuppression and the effects of underlying conditions.

Spirometry forms the foundation investigation for the diagnosis and monitoring of common pulmonary conditions. However, potential variation in spirometry interpretation for airflow obstruction may impact subsequent clinical management.To audit spirometry interpretation practices for airflow obstruction in Thoracic Society of Australia and New Zealand accredited laboratories.Thirty-nine accredited complex lung function laboratories were invited to participate in an online survey. The survey enquired about demographics, definition of lower limit of normal range for spirometry parameters, spirometric parameters used for identifying airflow obstruction, spirometric definition of airflow obstruction, definition of significant bronchodilator response and chosen spirometry reference equations.Thirty-six laboratories provided complete responses (response rate, 92%). To define the lower limit of normal, 26 of 36 used the 5th percentile, 7 of 36 used a fixed cut-off and 3 used other. Twenty-nine laboratories utilised forced expiratory volume in 1 s/forced vital capacity (FEVSignificant heterogeneity in spirometry interpretation for airflow obstruction exists across Australian and New Zealand accredited lung function laboratories. Lack of standardisation may translate into clinically appreciable differences for the diagnosis and management of common respiratory conditions. Ongoing discussion regarding formal standardisation is required.

BACKGROUND Patients with persistent hypoxia following an acute hospital admission may be discharged with 'bridging' domiciliary oxygen as per criteria defined by the Thoracic Society of Australia and New Zealand. The need for continuous long-term oxygen therapy (LTOT) is then reassessed at a clinic review 1-2 months later. AIM To describe the characteristics of patients discharged from an acute hospital admission with continuous short-term oxygen therapy (STOT), and subsequently to investigate for differences between subjects who proceeded to qualify for continuous LTOT versus those who were able to cease STOT at review. METHODS This is a retrospective cohort study involving all subjects discharged from Alfred Health between 2011 and 2015 inclusive with bridging domiciliary oxygen. Multiple biochemical, physiological and demographic characteristics were collated and analysed. RESULTS Of all patients prescribed continuous STOT at time of discharge, 47.3% qualified for LTOT at outpatient review. This cohort had a significantly lower PaO2 measurement at time of discharge, compared with those who no longer qualified. CONCLUSION PaO2 at time of discharge provides a signal with the potential to identify who will require continuous LTOT following an acute hospital admission. Additionally, this study highlights the need to re-evaluate patients' oxygen requirements during a period of clinical stability.

Spirometry training courses are provided by health services and training organizations to enable widespread use of spirometry testing for patient care or for monitoring health. The primary outcome of spirometry training courses should be to enable participants to perform spirometry to international best practice, including testing of subjects, quality assurance and interpretation of results. Where valid results are not achieved or quality assurance programmes identify errors in devices, participants need to be able to adequately manage these issues in accordance with best practice. It is important that potential participants are confident in the integrity of the course they attend and that the course meets their expectations in terms of training. This position statement lists the content that the Australian and New Zealand Society of Respiratory Science (ANZSRS) has identified as required in a spirometry training course to adequately meet the primary outcomes mentioned above. The content requirements outlined in this position statement are based on the current international spirometry standards set out by the American Thoracic Society and European Respiratory Society. Furthermore, recommendations around course delivery for theoretical and practical elements of spirometry testing and post-course assessment are outlined in this statement.

Introduction: The diagnosis of chronic respiratory diseases depends on lung function tests, but limited normative data exist for an older Australian population. Methods: Participants > 65 years were recruited randomly from the electoral roll. A validated postal questionnaire on respiratory symptoms and diagnoses was completed by 3,161 eligible participants. Spirometry, gas transfer and static lung volumes were measured (MGC diagnostics Elite DL system) in a small non-smoker subset of this cohort without respiratory disease or symptoms, major ECG abnormalities, major physical illness or kyphoscoliosis. %Predicted values were calculated using published equations of NHANES, Thompson et al (Thorax 2008;63:889-93) and ECCS (Stocks J, Quanjer PH. Eur Respir J. 1995;8:492-506). Results: Conclusions: These community dwelling healthy older subjects generally demonstrated better lung function than would have been expected from published reference values. These data will make a useful contribution to the Global Lung Initiative spirometry, T L co and static lung volumes reference sets. Supported by the Cooperative Research Centre for Asthma & Airways.

Michael J Abramson,1 Sonia Kaushik,1 Geza P Benke,1 Brigitte M Borg,2 Catherine L Smith,1 Shyamali C Dharmage,3 Bruce R Thompson21Department of Epidemiology & Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, 2Department of Allergy, Immunology & Respiratory Medicine, The Alfred Hospital, 3Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, AustraliaBackground: The European Community Respiratory Health Survey is a major international study designed to assess lung health in adults. This Australian follow-up investigated changes in symptoms between sexes and the roles of asthma, smoking, age, sex, height, and change in body mass index (ΔBMI) on lung function decline (LFD), which is a major risk factor for chronic obstructive pulmonary disease (COPD).Methods: LFD was measured as the rate of decline over time in FEV1 (mL/year) (ΔFEV1) and FVC (ΔFVC) between 1993 and 2013. Multiple linear regression was used to estimate associations between risk factors and LFD, separately for males and females. Multiple logistic regression was used to assess sex differences and changes in respiratory symptoms over time.Results: In Melbourne, 318 subjects (53.8% females) participated. The prevalence of most respiratory symptoms had either remained relatively stable over 20 years or decreased (significantly so for wheeze). The exception was shortness of breath after activity, which had increased. Among the 262 subjects who completed spirometry, current smoking declined from 20.2% to 7.3%. Overall mean (± standard deviation) FEV1 declined by 23.1 (±17.1) and FVC by 22.9 (±20.2) mL/year. Predictors of ΔFEV1 in males were age, maternal smoking, and baseline FEV1; and in females they were age, ΔBMI, baseline FEV1, and pack-years in current smokers. Decline in FVC was predicted by baseline FVC, age, and ΔBMI in both sexes; however, baseline FVC predicted steeper decline in females than males.Conclusion: Most respiratory symptoms remained stable or decreased over time in both sexes. Age, baseline lung function, and change in BMI were associated with the rate of decline in both sexes. However, obesity and personal smoking appear to put females at higher risk of LFD than males. Health promotion campaigns should particularly target females to prevent COPD.Keywords: cohort study, lung function, body mass index, tobacco smoking, COPD, respiratory symptoms

BACKGROUND: The statement of the American Thoracic Society and European Respiratory Society on the measurement of static lung volumes (SLV) suggests a preferred and alternate method for measuring and calculating SLV. OBJECTIVE: To determine if differences in functional residual capacity (FRC), vital capacity (VC), residual volume (RV), and total lung capacity (TLC), obtained using preferred and alternate measurement and calculation methodologies, exist in a clinical setting. METHODS: Patients attending for SLV at a hospital-based laboratory were recruited. Following spirometry, SLV was measured via body plethysmography, using the preferred and alternate methods in random order. Volumes were calculated using the preferred and alternate calculation methods. Subjects were classified according to standard ventilatory function interpretative strategies. Differences of the means between the measurement methods, and calculation methods were assessed. RESULTS: One hundred eight data sets were analyzed. Significant, but small differences ( CONCLUSIONS: Differences in FRC, VC, RV, and TLC obtained using the preferred and alternate measurement methodologies exist in the clinical setting in select classification groups and individuals. Differing calculation methods dependent on measurement method used may be unnecessary.

Summary Background and aims Inhalation of hypertonic saline (HTS) has short term positive effects on airways clearance in non-cystic fibrosis (CF) bronchiectasis, however its long term effects are unknown. The aim of this study was to determine the effect of HTS 6% on exacerbations, quality of life (QOL) and respiratory function over 12 months in non-CF bronchiectasis. Methods Forty patients were randomised to inhale isotonic saline (IS) 0.9% or HTS 6% daily for 12 months. Participants recorded their symptoms in a daily diary. Quality of life and respiratory function were measured after three, six and 12 months. Number of exacerbations and changes in sputum colonisation were recorded at 12 months. Participants, assessors and clinicians were blinded to group allocation. Results The exacerbation rate at 12 months was similar in the two groups and similar clinically significant improvements in QOL were seen in both groups. The FEV 1 increased in both groups after six months (mean 90 ml, 95% confidence interval 11–169 ml) with no difference between groups ( p = 0.394). The FEF 25–75% significantly improved at all time points (mean increase at 12 months 187 ml, 69–304 ml) with no difference between groups ( p = 0.705). There was a reduction in sputum colonisation in both groups ( p = 0.046). Conclusions Inhalation of HTS or IS has similar effects on exacerbations, QOL, sputum colonisation and respiratory function over 12 months in non-CF bronchiectasis. The trial was registered with both Clinical Trials.gov – NCT00484263 and Australian New Zealand Clinical Trials Registry – ACTRN12607000367448.

Airway distensibility appears to be unaffected by airway smooth muscle (ASM) tone, despite the influence of ASM tone on the airway diameter-pressure relationship. This discrepancy may be because the greatest effect of ASM tone on airway diameter-pressure behavior occurs at low transpulmonary pressures, i.e., low lung volumes, which has not been investigated. Our study aimed to determine the contribution of ASM tone to airway distensibility, as assessed via the forced oscillation technique (FOT), across all lung volumes with a specific focus on low lung volumes. We also investigated the accompanying influence of ASM tone on peripheral airway closure and heterogeneity inferred from the reactance versus lung volume relationship. Respiratory system conductance and reactance were measured using FOT across the entire lung volume range in 22 asthma subjects and 19 healthy controls before and after bronchodilator. Airway distensibility (slope of conductance vs. lung volume) was calculated at residual volume (RV), functional residual capacity (FRC), and total lung capacity. At baseline, airway distensibility was significantly lower in subjects with asthma at all lung volumes. After bronchodilator, distensibility significantly increased at RV (64.8%, P < 0.001) and at FRC (61.8%, P < 0.01) in subjects with asthma but not in control subjects. The increased distensibility at RV and FRC in asthma were not associated with the accompanying changes in the reactance versus lung volume relationship. Our findings demonstrate that, at low lung volumes, ASM tone reduces airway distensibility in adults with asthma, independent of changes in airway closure and heterogeneity.