News in brief: LTOT patients miss out on palliative care; Pirfenidone backed for PPF but evidence limited; Rethink diagnostic imaging to cut carbon footprint

11 May 2022

LTOT patients miss out on palliative care

Respiratory patients prescribed long-term oxygen therapy (LTOT) have survival rates worse than many cancers, but only a few are referred for palliative care management, a Melbourne study has found.

A retrospective cohort study of 384 patients with a diagnosis of COPD (60%) or ILD treated at Austin Health found that home oxygen therapy was prescribed for almost half (49%) and ambulatory oxygen prescribed initially for many (55) who transitioned to LTOT over time.

Survival after commencement of LTOT was poor, with 38% of subjects overall surviving at five years, with survival worse for people with ILD (10% at five years) compared to those with COPD (52%). Two thirds of patients (65%) were referred for pulmonary rehabilitation but only 23% had palliative care referrals.

“Appropriate and early referrals to palliative care and improved care coordination for this complex group of patients are key areas for improvement in clinical practice,” said the authors led by Dr Amelia Harrison of the Department of Respiratory and Sleep Medicine, Austin Health.

The findings are published in Respiratory Care.

Pirfenidone backed for PPF, but evidence limited

Research findings have backed use of pirfenidone for progressive pulmonary fibrosis (PPF), albeit with low certainty because of limited evidence.

Researchers from Australia and the US undertook a systematic review of relevant literature via the MEDLINE, EMBASE and Cochrane databases, to assess whether patients with PPF should be treated with the antifibrotic.

Just two studies met the inclusion criteria, but these showed pirfenidone to be linked with a significant decrease in disease progression and significant protection in lung function.

According to the data, published in the Annals of the American Thoracic Society, pirfenidone showed significant changes versus placebo in FVC % predicted (mean difference [MD]: 2.3%), FVC in mL (MD: 100.0 mL), and 6MWD in meters (MD: 25.2).

In addition, the drug also fared better than control groups on change in DLCO (MD 0.40 mmol/kPa/min) and risk of DLCO falling more than 15% (relative risk [RR]: 0.27).

However, the authors from Melbourne University and NYU Langone Hospital also noted that the pirfenidone raised the risk of gastrointestinal discomfort (RR: 1.83) and photosensitivity (RR: 4.88).

Rethink diagnostic imaging to cut carbon footprint

Clinicians can help reduce the healthcare carbon footprint by adopting a three-pronged strategy to make more efficient use of diagnostic imaging, according to Australian researchers.

Diagnostic imaging and pathology testing account for almost 10% of the hospital carbon footprint, with MRI and CT scans accounting for a high proportion of it, a Melbourne University study found.

The carbon emissions from an MRI are equivalent to driving a car for 145 km, while a CT scan carbon emission is equal to driving 76 km, the findings in Lancet Regional Health showed.

Much of the large carbon footprint was due to electricity use by scanners, and in particular, their standby power use, said the researchers, who recommended that clinicians and administrators make efforts to reduce unnecessary imaging and/or switch imaging to a lower carbon modality such as X-rays.

Other carbon footprint reduction tips include turning scanners off when they are not required rather than leaving them on standby and ensuring existing scanners have high utilisation rates, they suggested.

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