Christine F. Mcdonald

Description:Home antiviral treatment (HAVT: nirmatrelvir/ritonavir [Paxlovid] and molnupiravir [Lagevrio]) for COVID-19 was approved in December 2021 by the U.S. Food and Drug Administration, but ensuing utilization during the COVID-19 pandemic was low. Factors associated with seeking HAVT treatment have not been fully explored. Cross-sectional survey of 9,944 U.S. adults to identify factors associated with seeking and receiving HAVT in persons with confirmed or suspected COVID-19. COVID-19 infection was confirmed or suspected in 4,355 (43.8%) participants. HAVT was sought by 1,331 (26.3%) and medication was received by 928 (20.7%). In comparison to those who were COVID-19 test negative and had no loss of taste or smell (aOR: 1.856, 95% C.I.: 1.262-2.728), the factor most associated with seeking HAVT was a loss of taste or smell irrespective of a positive (aOR: 3.823, 95% C.I.: 2.626-5.567) or negative COVID-19 test (aOR: 3.306; 95% C.I.: 2.086-5.241). Loss of taste or smell was similarly associated with receiving HAVT. Male sex, younger age, Black race, Hispanic ethnicity, conservative or liberal political preference, and medical discrimination were some of the other factors associated with a greater likelihood of seeking HAVT. Barriers to obtaining treatment included feeling uncomfortable obtaining HAVT while sick and lack of transportation; 14.7% of those seeking treatment reported at least one barrier. In a general population, HAVT was an underutilized resource during the COVID-19 pandemic. Loss of taste or smell was the most important factor among several others associated with seeking HAVT irrespective of COVID-19 test status.

Description:Lately, as numerous world events with life-changing consequences across the globe unfold, we have been reflecting upon relationships and how they can guide, and enhance, but also destroy. Relationships can be tricky to navigate and should never be assumed to be immutable. This topic has been especially at the forefront as the tenure of the Co-editors in Chief of Respirology draws to a close and after the recent 2024 Asia-Pacific Society of Respirology (APSR) Congress in Hong Kong. Since 2023/2024, the Board of the Thoracic Society of Australia and New Zealand (TSANZ) decided to pause en bloc membership of APSR. We believe this to be a regrettable ‘own goal’ and a decision that is not supported by members of the society. If this decision is not reversed, the leadership role and hard-won influence of TSANZ in this key geographic area are likely to be permanently damaged and may ultimately be squandered. The history of APSR bears reviewing. It was started in the late 1980s by Professors Ann Woolcock, an icon of Australian Respiratory Medicine, and Yoshi Fukuchi from Japan. They anticipated the rise of the Asia-Pacific as a major geographical region able to compete with the Americas and Europe. That has indeed been the case and the Asia-Pacific is now an economic (and political) powerhouse that is predicted to account for > 50% of global economic output by 2050. Ann believed that Australia was geographically linked closely to Asia-Pacific and had a key educational, scientific and leadership role to play in the region. She also understood that Australia had to wean from our colonial origins in Europe to become active contributors in the Asia-Pacific. Since the APSR's inception, the members of TSANZ have made large contributions to the APSR including Norbert Berend, Phil Thompson, Jane Bourke, Kwun Fong, Cheryl Salome, Guy Marks along with numerous other members who were involved in APSR activities. Importantly, the APSR journal, Respirology, has played an important role to raise the level of scientific publishing in the region. Joining the editorial team at Respirology has provided opportunity for junior TSANZ members and faculty to get involved in the world of publishing and to upskill in this field. By not continuing with en bloc membership of the APSR, TSANZ members risk losing these and other benefits. TSANZ disengagement with APSR will likely have other unforeseen detrimental effects. TSANZ members will be unable to hold APSR executive positions or to lead APSR interest groups and will lose access to the expedited peer review process afforded to en-bloc society position papers. TSANZ will also be unable to host the APSR Annual Scientific Meeting. It is clearly incumbent on TSANZ to negotiate the best financial and membership arrangements with APSR for its members. However, change is more easily achieved from within, than from without. TSANZ has an opportunity to advance its aims (e.g., to facilitate diversity and inclusivity in the region) within APSR, but such influence and actions are more challenging when TSANZ members are no longer part of the APSR. Ultimately it is up to individual TSANZ members to take advantage of en bloc membership. Like joining a gym, members might not take advantage of all the gym has to offer, all the time, but it is there for members to utilize if they so choose. Importantly, the APSR is in a phase of modernization and advancement, and there is much goodwill towards Australia despite the recent decision to halt en bloc membership. When en bloc membership is again reviewed by the TSANZ Board, the wider TSANZ membership should be consulted if continued disengagement, a momentous step, is to be further contemplated. It is our view—and we believe likely shared by many TSANZ members—that en bloc membership should not have been cancelled without wider consultation. We urgently request that TSANZ reconsiders this decision at the earliest possible time. We believe TSANZ has an important leadership role to play in the Asia-Pacific via our membership of APSR. This is ‘our place’ and our involvement will have a large impact by way of educational, clinical and scientific contributions from TSANZ members. We urge TSANZ and the membership not to miss this opportunity to continue to facilitate the advancement of respiratory and sleep medicine in our region.

Description:Importance: Patients with lung cancer have poor physical functioning and quality of life. Despite promising outcomes for those who undertake exercise programs, implementation into practice of previously tested hospital-based programs is rare. Objective: To evaluate a home-based exercise and self-management program for patients after lung resection. Design, setting, and participants: A randomized clinical trial with assessor blinding was conducted among 116 patients undergoing surgery for non-small cell lung cancer from November 23, 2017, to July 31, 2023, at tertiary hospitals in Australia. Patients were followed up for 12 months postoperatively. Intervention: Patients randomized to the intervention group received a postoperative 3-month home-based exercise and self-management program, supported by weekly physiotherapist-led telephone consultations. Patients randomized to the control group received usual care. Main outcomes and measures: The primary outcome was self-reported physical function (30-item European Organization for the Research and Treatment of Cancer Core Quality of Life Questionnaire [EORTC QLQ-C30] score) at 3 months. Secondary outcomes included objective measures of physical function and exercise capacity (at 3 and 6 months) and patient-reported outcomes including quality of life (at 3 and 6 months, with some questionnaires completed at 12 months). Analysis was performed on an intent-to-treat basis. Results: A total of 1370 patients were screened, with 177 eligible and 116 consented (mean [SD] age, 66.4 [9.6] years; 68 women [58.6%]). Of these 116 patients, 58 were randomized to the intervention and 58 to the control. A total of 103 patients (88.8%) completed assessments at 3 months, 95 (81.9%) at 6 months, and 95 (81.9%) at 12 months. There were no statistically significant differences between the intervention and control groups for self-reported physical function (EORTC QLQ-C30 physical functioning domain score) at the 3-month primary end point (mean [SD] score, 77.3 [20.9] vs 76.3 [18.8]; mean difference, 1.0 point [95% CI, -6.0 to 8.0 points]). Patients in the intervention group, compared with the control group, had significantly greater exercise capacity (6-minute walk distance: mean difference, 39.7 m [95% CI, 6.8-72.6 m]), global quality of life (mean difference, 7.1 points [95% CI, 0.4-13.8 points]), and exercise self-efficacy (mean difference, 16.0 points [95% CI, 7.0-24.9 points]) at 3 months as well as greater objectively measured physical function (Short Physical Performance Battery score: mean difference, 0.8 points [95% CI, 0.1-1.6 points]), exercise capacity (6-minute walk distance: mean difference, 50.9 m [95% CI, 6.7-95.1 m]), and exercise self-efficacy (mean difference, 10.1 points [95% CI, 1.9-18.2 points]) at 6 months. One minor adverse event and no serious adverse events occurred. Conclusions and relevance: In this randomized clinical trial, a postoperative home-based exercise and self-management program did not improve self-reported physical function in patients with lung cancer. However, it did improve other important clinical outcomes. Implementation of this program into lung cancer care should be considered. Trial registration: http://anzctr.org.au Identifier: ACTRN12617001283369.

Description:Electronic cigarette (EC) use, especially among younger members of society, has grown to concerning levels in many countries, including Australia and New Zealand. Uptake in the general population, driven by technological and pharmacological innovations, and accelerated by aggressive tobacco/vaping industry marketing, has outpaced medical research. As the harms of EC use become increasingly evident, the Australian Government has introduced policies to curb recreational EC use, whilst still allowing access for smoking cessation. This highly dynamic environment presents new challenges to clinicians as the evidence to support clinical practice with respect to vaping use and its cessation remains very limited. This guidance document from the Thoracic Society of Australia and New Zealand aims to address this unmet need by offering practical advice for clinicians to help protect their patients' lung and general health by: preventing EC uptake in children, adolescents, and young adults; providing guidance for ceasing EC use in adolescents and adults who have never smoked; and providing guidance for ceasing EC use in people who currently or formerly smoked who now use EC long-term. Underpinned by a systematic review, this multidisciplinary expert consensus document summarises the current landscape of EC use, nicotine addiction, behavioural and pharmacotherapy treatments. Illustrative case vignettes are provided. The advice, largely extrapolated from the smoking cessation literature, is based on the consensus of the authors in the absence of high-quality randomised trials for vaping cessation and is applicable to all age groups. We emphasise the urgent unmet need for vaping-specific cessation research to inform future practice.