News in brief: Aussie sleep apnoea leader recognised with ATS award; Steroid-sparing benefit from biologic in allergic bronchopulmonary aspergillosis; Take care with switching inhalers 

19 May 2022

Aussie sleep apnoea leader recognised with ATS award

Professor Colin Sullivan, widely recognised for developing nasal continuous positive airway pressure technology to treat obstructive sleep apnea, has been honoured with the ATS Research Innovation and Translation Achievement Award

The Award recognises outstanding contributions to the advancement of respiratory research focused on specific innovations to improve health by advancing practice, policy and health care delivery.

Professor Sullivan’s achievements include characterising the basic physiology of breathing during sleep and the recognition that arousal responses from sleep are crucial to survival in respiratory failure.

He has been the key person in Australia promoting the investigation of sleep disorders medicine and he established the first diagnostic sleep laboratories for adults and children.

Professor Sullivan has long standing associations with the University of Sydney and the Royal Prince Alfred Hospital and is an honorary consultant at the Sydney Children’s Hospitals Network.

Steroid-sparing benefit from biologic in allergic bronchopulmonary aspergillosis 

The anti-IgE biologic omalizumab significantly reduces exacerbations and OCS use in patients with allergic bronchopulmonary aspergillosis (ABPA), according to a systematic review and meta-analysis of the evidence presented at ATS 2022.

The meta-analysis, coauthored by the Royal Melbourne Hospital’s director of research Professor Jo Douglass, found omalizumab treatment for 8.3 to 12 months significantly reduced the annualised exacerbation rate compared with historical reports (mean difference (P<0.01).

Omalizumab treatment significantly reduced the number of patients on maintenance OCS (risk ratio: 0.35 [0.19 to 0.66], P<0.01), significantly reduced OCS use (risk difference [RD]: 0.77 [0.43 to 1.11], P<0.01), and significantly increased the termination of OCS use (RD: 0.53 [0.24 to 0.82], P<0.01).

OCS dose (mg/day) was also significantly reduced in ABPA patients receiving omalizumab (MD: −14.62 [−19.86 to −9.39]; P<0.01).

The study said that since most patients with ABPA – often those with underlying asthma or CF – receive long term OCS treatment, the findings were clinically meaningful and support an important role for the biologic in patient management.

Take care with switching inhalers 

Switching inhalers for non-clinical reasons such as cost can have highly variable clinical consequences in patients with asthma or COPD, according to data presented at ATS 2022.

A systematic review of the evidence on switching inhalers for any reason other than clinical need identified 21 studies with symptom control, use of reliever medications and exacerbations the most commonly reported outcomes.

It found five datasets, comprising 7,530 participants where an inhaler switch led to improved disease control. Consent in the process was unclear. Yet in another dataset of 1,648 patients, who did not consent to the switch, significantly worsened disease control was reported after the switch.

Similarly, a significant decrease in average daily SABA usage was reported following switching in the majority of participants (n=7,050) while others (n=2,574) reported a significant or numerical increase in SABA use.

Most participants (n=11,374) had fewer exacerbations after switching inhalers, but many (n=6,534) showed no difference and a minority had more exacerbations (n=2,884).

The researchers, including Professor Sinthia Bosnic-Anticevich from the Woolcock Institute of Medical Research, concluded that inhaler switching without engaging the patient in the process should be avoided.

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