No time to catch a breath for respiratory services

Irish Thoracic Society Annual Scientific Meeting, 3 – 4 December 2020

Paul Mulholland talks to President of the Irish Thoracic Society (ITS) Dr Aidan O’Brien about the Society’s upcoming annual meeting and the huge pressure Covid-19 is placing on the speciality

Even before the Covid-19 pandemic, respiratory services in Ireland were under pressure. According to the Irish Thoracic Society’s Respiratory Health of the Nation 2018 document, between 2008 and 2016 the number of deaths by respiratory disease increased by 14.6 per cent. This compared to a 7.5 per cent drop in cardiovascular deaths over the same time period. Ireland’s death rate from respiratory disease was the fourth highest in EU 28, and was 38 per cent higher than the EU average.

In terms of consultant numbers, Ireland only had one respiratory physician per 80,000, which is much fewer than recommended one per 35,000. According to ITS President and Consultant Respiratory Physician, University Hospital Limerick, Dr Aidan O’Brien, Covid-19 has made this concerning picture even worse. Speaking to the Medical Independent (MI), before the ITS’s Annual Scientific Meeting, which will take place virtually on 3-4 December, Dr O’Brien said respiratory services, not ICU services, are most affected by Covid-19. “Most Covid-19 admissions are for respiratory problems,” Dr O’Brien told MI. “Also, people with long-term symptoms as a result of Covid is quite a significant percentage. And a lot of those symptoms are respiratory. So a lot of the follow-up that is needed is going to be done by respiratory services.” This has had a resulting impact on non-Covid-19 services. “All the ongoing management of existing respiratory services have been affected. Patients also have avoided coming in for follow-up, which has led of the problems of prolonged waiting lists, delayed diagnosis, and more advanced stages of disease.”

It was a case of having to constantly move the goalposts according to the infection rate. It took a lot of work to coordinate, but it’s now coming together very, very nicely

Dr O’Brien said the ITS “very much welcomes” the additional investment in respiratory services outlined in the HSE’s recently published Winter Plan, but pointed out the funding was mainly in the community sector, and more support was still required for the acute sector. As a result of its significance, the first session of the ITS meeting will be on the subject of Covid-19. It will include a presentation on the ‘Respiratory management of Covid-19’ by Prof Stefano Nava, Professor of Respiratory Medicine, University of Bologna, Italy. As well as being a world expert in non-invasive ventilation for respiratory failure, Prof Nava also has first-hand experience of the pandemic in Italy, which was one of the most badly affected countries in the first wave of Covid-19. Dr O’Brien added that a “significant number” of research studies submitted to the Society for the meeting were on Covid-19.

Non-Covid respiratory disorders

Covid-19 will not dominate proceedings, and the meeting will feature talks and presentations on a wide range of respiratory and sleep disorders, from interstitial lung disease to COPD and asthma. “We cover all aspects of respiratory services,” Dr O’Brien said. “So we try to get our research and our speakers to try to address as many as those areas as possible. So this year we have broken the meeting up into themes, which we don’t normally do. We have put somewhat related entities together in each session to try and highlight the newest developments in those areas. Also, with local emphasis, to show what research is happening now in Ireland.”

The meeting features the usual wide range of high calibre international speakers. Prof Michael Polkey, Consultant Respiratory Physician, Royal Brompton Hospital Trust, UK, will deliver a talk on ‘Respiratory skeletal muscle weakness’; Prof Atul Malhotra, Research Chief of Pulmonary, Critical Care and Sleep Medicine at UC San Diego Health, US, will give a lecture on sleep medicine; and Prof Guy Brusselle, Associate Professor of Medicine, University Hospital Ghent, Belgium, will speak about ‘Immunology and management of severe asthma’. Like other medical and society meeting, this year’s meeting will be hosted on a virtual basis due to the Covid-19 physical distancing restrictions. When asked about the challenges in organising such a conference, Dr O’Brien said: “It was a case of having to constantly move the goalposts according to the infection rate. It took a lot of work to coordinate, but it’s now coming together very, very nicely. We were a little tentative about how people would take to this, but it has been of great interest. There has been great sign-up and registration for it, and great support from our usual sponsors.”