1
|
Stirling R, Khung S, Hew M, Dabscheck E, Keating D, Williams T. EP1.05-07 Examining Endobronchial Ultrasound (EBUS) Utilisation in Lung Cancer Diagnosis and Treatment Delay. A Restrospective Observational Study. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.2170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
2
|
Abstract
The care of patients with difficult-to-control asthma ("difficult asthma") is challenging and costly. Despite high-intensity asthma treatment, these patients experience poor asthma control and face the greatest risk of asthma morbidity and mortality. Poor asthma control is often driven by severe asthma biology, which has appropriately been the focus of intense research and phenotype-driven therapies. However, it is increasingly apparent that extra-pulmonary comorbidities also contribute substantially to poor asthma control and a heightened disease burden. These comorbidities have been proposed as "treatable traits" in chronic airways disease, adding impetus to their evaluation and management in difficult asthma. In this review, eight major asthma-related comorbidities are discussed: rhinitis, chronic rhinosinusitis, gastroesophageal reflux, obstructive sleep apnoea, vocal cord dysfunction, obesity, dysfunctional breathing and anxiety/depression. We describe the prevalence, impact and treatment effects of these comorbidities in the difficult asthma population, emphasizing gaps in the current literature. We examine the associations between individual comorbidities and highlight the potential for comorbidity clusters to exert combined effects on asthma outcomes. We conclude by outlining a pragmatic clinical approach to assess comorbidities in difficult asthma.
Collapse
Affiliation(s)
- T. R. Tay
- Allergy, Asthma and Clinical Immunology; The Alfred Hospital; Melbourne Vic. Australia
- Department of Respiratory and Critical Care Medicine; Changi General Hospital; Singapore
| | - M. Hew
- Allergy, Asthma and Clinical Immunology; The Alfred Hospital; Melbourne Vic. Australia
- School of Public Health & Preventive Medicine; Monash University; Melbourne Vic. Australia
| |
Collapse
|
3
|
Hiles SA, Harvey ES, McDonald VM, Peters M, Bardin P, Reynolds PN, Upham JW, Baraket M, Bhikoo Z, Bowden J, Brockway B, Chung LP, Cochrane B, Foxley G, Garrett J, Hew M, Jayaram L, Jenkins C, Katelaris C, Katsoulotos G, Koh MS, Kritikos V, Lambert M, Langton D, Lara Rivero A, Marks GB, Middleton PG, Nanguzgambo A, Radhakrishna N, Reddel H, Rimmer J, Southcott AM, Sutherland M, Thien F, Wark PAB, Yang IA, Yap E, Gibson PG. Working while unwell: Workplace impairment in people with severe asthma. Clin Exp Allergy 2018; 48:650-662. [DOI: 10.1111/cea.13153] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 03/22/2018] [Accepted: 03/29/2018] [Indexed: 11/27/2022]
|
4
|
Tay TR, Bosco J, Aumann H, O'Hehir R, Hew M. Elevated total serum immunoglobulin E (>1000 IU/mL): implications? Intern Med J 2017; 46:846-9. [PMID: 27405892 DOI: 10.1111/imj.13073] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 03/03/2016] [Accepted: 03/04/2016] [Indexed: 12/13/2022]
Abstract
Atopic eczema, allergic broncho-pulmonary aspergillosis, helminthic infections and rare primary immunodeficiencies are known to elevate total serum immunoglobulin E (IgE) above 1000 IU/mL. However, of 352 patients with IgE >1000 IU/mL seen in our hospital over a 5-year period, less than 50% had these conditions. Markedly elevated IgE levels in the rest of the patients were associated with asthma, allergic rhinitis and food allergy, instances where the test is of limited diagnostic utility.
Collapse
Affiliation(s)
- T R Tay
- Allergy, Immunology and Respiratory Medicine, Alfred Hospital, Melbourne, Victoria, Australia
| | - J Bosco
- Allergy, Immunology and Respiratory Medicine, Alfred Hospital, Melbourne, Victoria, Australia
| | - H Aumann
- Department of Haematology, Alfred Hospital, Melbourne, Victoria, Australia
| | - R O'Hehir
- Allergy, Immunology and Respiratory Medicine, Alfred Hospital, Melbourne, Victoria, Australia
| | - M Hew
- Allergy, Immunology and Respiratory Medicine, Alfred Hospital, Melbourne, Victoria, Australia.,Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
5
|
Gibson PG, Reddel H, McDonald VM, Marks G, Jenkins C, Gillman A, Upham J, Sutherland M, Rimmer J, Thien F, Katsoulotos GP, Cook M, Yang I, Katelaris C, Bowler S, Langton D, Robinson P, Wright C, Yozghatlian V, Burgess S, Sivakumaran P, Jaffe A, Bowden J, Wark PAB, Yan KY, Kritikos V, Peters M, Hew M, Aminazad A, Bint M, Guo M. Effectiveness and response predictors of omalizumab in a severe allergic asthma population with a high prevalence of comorbidities: the Australian Xolair Registry. Intern Med J 2017; 46:1054-62. [PMID: 27350385 DOI: 10.1111/imj.13166] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 06/02/2016] [Accepted: 06/21/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Severe asthma is a high impact disease. Omalizumab targets the allergic inflammatory pathway; however, effectiveness data in a population with significant comorbidities are limited. AIMS To describe severe allergic asthma, omalizumab treatment outcomes and predictors of response among the Australian Xolair Registry participants. METHODS A web-based post-marketing surveillance registry was established to characterise the use, effectiveness and adverse effects of omalizumab (Xolair) for severe allergic asthma. RESULTS Participants (n = 192) (mean age 51 years, 118 female) with severe allergic asthma from 21 clinics in Australia were assessed, and 180 received omalizumab therapy. They had poor asthma control (Asthma Control Questionnaire, ACQ-5, mean score 3.56) and significant quality of life impairment (Asthma-related Quality of Life Questionnaire score 3.57), and 52% were using daily oral corticosteroid (OCS). Overall, 95% had one or more comorbidities (rhinitis 48%, obesity 45%, cardiovascular disease 23%). The omalizumab responder rate, assessed by an improvement of at least 0.5 in ACQ-5, was high at 83%. OCS use was significantly reduced. The response in participants with comorbid obesity and cardiovascular disease was similar to those without these conditions. Baseline ACQ-5 ≥ 2.0 (P = 0.002) and older age (P = 0.05) predicted the magnitude of change in ACQ-5 in response to omalizumab. Drug-related adverse events included anaphylactoid reactions (n = 4), headache (n = 2) and chest pains (n = 1). CONCLUSION Australian patients with severe allergic asthma report a high disease burden and have extensive comorbidity. Symptomatic response to omalizumab was high despite significant comorbid disease. Omalizumab is an effective targeted therapy for severe allergic asthma with comorbidity in a real-life setting.
Collapse
Affiliation(s)
- P G Gibson
- Centre for Healthy Lungs, Department of Respiratory and Sleep Medicine, John Hunter Hospital, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia.
| | - H Reddel
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,University of Sydney, Liverpool Hospital, Sydney, New South Wales, Australia
| | - V M McDonald
- Centre for Healthy Lungs, Department of Respiratory and Sleep Medicine, John Hunter Hospital, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia.,School of Nursing and Midwifery, University of Newcastle, Newcastle, New South Wales, Australia
| | - G Marks
- Department of Respiratory Medicine, Liverpool Hospital, Sydney, New South Wales, Australia
| | - C Jenkins
- Department of Thoracic Medicine, Concord Hospital, Sydney, New South Wales, Australia
| | - A Gillman
- Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital, Melbourne, Victoria, Australia
| | - J Upham
- Department of Respiratory Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - M Sutherland
- Department of Respiratory and Sleep Medicine, Austin Hospital, Melbourne, Victoria, Australia
| | - J Rimmer
- St Vincent's Clinic, Campbelltown Hospital, Sydney, New South Wales, Australia
| | - F Thien
- Department of Respiratory Medicine, Box Hill Hospital, Melbourne, Victoria, Australia
| | - G P Katsoulotos
- St George Specialist Centre, Campbelltown Hospital, Sydney, New South Wales, Australia
| | - M Cook
- Department of Immunology, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - I Yang
- Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - C Katelaris
- Department of Respiratory and Sleep Medicine, Campbelltown Hospital, Sydney, New South Wales, Australia
| | - S Bowler
- Department of Respiratory and Sleep Medicine, Mater Adult Hospital, Brisbane, Queensland, Australia
| | - D Langton
- Department of Thoracic Medicine, Frankston Hospital, Melbourne, Victoria, Australia
| | - P Robinson
- Department of Respiratory Medicine, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - C Wright
- Department of Respiratory Medicine, Nambour Hospital, Nambour, Queensland, Australia
| | - V Yozghatlian
- Department of Respiratory and Sleep Medicine, St George Hospital, Sydney, New South Wales, Australia
| | - S Burgess
- QLD Children's Lung and Sleep Specialists, Brisbane, Queensland, Australia
| | - P Sivakumaran
- Department of Respiratory Medicine, Gold Coast District Hospital, Gold Coast, Queensland, Australia
| | - A Jaffe
- Department of Respiratory Medicine, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - J Bowden
- Department of Respiratory, Allergy and Sleep Medicine, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - P A B Wark
- Centre for Healthy Lungs, Department of Respiratory and Sleep Medicine, John Hunter Hospital, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
| | - K Y Yan
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - V Kritikos
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - M Peters
- Department of Thoracic Medicine, Concord Hospital, Sydney, New South Wales, Australia
| | - M Hew
- Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital, Melbourne, Victoria, Australia
| | - A Aminazad
- Department of Respiratory Medicine, Box Hill Hospital, Melbourne, Victoria, Australia
| | - M Bint
- Department of Respiratory Medicine, Nambour Hospital, Nambour, Queensland, Australia
| | - M Guo
- Clinical Management, Woolcock Institute of Medical Research, Sydney, New South Wales, Australia
| |
Collapse
|
6
|
Hew M, Gillman A, Sutherland M, Wark P, Bowden J, Guo M, Reddel HK, Jenkins C, Marks GB, Thien F, Rimmer J, Katsoulotos GP, Cook M, Yang I, Katelaris C, Bowler S, Langton D, Wright C, Bint M, Yozghatlian V, Burgess S, Sivakumaran P, Yan KY, Kritikos V, Peters M, Baraket M, Aminazad A, Robinson P, Jaffe A, Powell H, Upham JW, McDonald VM, Gibson PG. Real-life effectiveness of omalizumab in severe allergic asthma above the recommended dosing range criteria. Clin Exp Allergy 2016; 46:1407-1415. [PMID: 27377155 DOI: 10.1111/cea.12774] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 05/26/2016] [Accepted: 06/01/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND Omalizumab (Xolair) dosing in severe allergic asthma is based on serum IgE and bodyweight. In Australia, patients eligible for omalizumab but exceeding recommended ranges for IgE (30-1500 IU/mL) and bodyweight (30-150 kg) may still receive a ceiling dose of 750 mg/4 weeks. About 62% of patients receiving government-subsidized omalizumab are enrolled in the Australian Xolair Registry (AXR). OBJECTIVES To determine whether AXR participants above the recommended dosing ranges benefit from omalizumab and to compare their response to within-range participants. METHODS Data were stratified according to dose range status (above-range or within-range). Further sub-analyses were conducted according to the reason for being above the dosing range (IgE only vs. IgE and weight). RESULTS Data for 179 participants were analysed. About 55 (31%) were above recommended dosing criteria; other characteristics were similar to within-range participants. Above-range participants had higher baseline IgE [812 (IQR 632, 1747) IU/mL vs. 209 (IQR 134, 306) IU/mL] and received higher doses of omalizumab [750 (IQR 650, 750) mg] compared to within-range participants [450 (IQR, 300, 600) mg]. At 6 months, improvements in Juniper 5-item Asthma Control Questionnaire (ACQ-5, 3.61 down to 2.01 for above-range, 3.47 down to 1.93 for within-range, P < 0.0001 for both) and Asthma Quality of Life Questionnaire (AQLQ mean score (3.22 up to 4.41 for above-range, 3.71 up to 4.88 for within-range, P < 0.0001) were observed in both groups. Forced expiratory volume in one second (FEV1 ) improved among above-range participants. There was no difference in response between above-range and within-range participants. Above-range participants due to either IgE alone or IgE and weight had similar improvements in ACQ-5, AQLQ and FEV1 . CONCLUSIONS AND CLINICAL RELEVANCE Patients with severe allergic asthma above recommended dosing criteria for omalizumab have significantly improved symptom control, quality of life and lung function to a similar degree to within-range participants, achieved without dose escalation above 750 mg.
Collapse
Affiliation(s)
- M Hew
- The Alfred Hospital & Monash University, Melbourne, Vic., Australia.
| | - A Gillman
- The Alfred Hospital & Monash University, Melbourne, Vic., Australia
| | | | - P Wark
- Hunter Medical Research Institute, John Hunter Hospital, University of Newcastle, New Lambton Heights, NSW, Australia
| | - J Bowden
- Flinders Medical Centre, Bedford Park, SA, Australia
| | - M Guo
- Woolcock Institute of Medical Research, Glebe, University of Sydney NSW, Australia
| | - H K Reddel
- Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - C Jenkins
- Concord Hospital, Concord, NSW, Australia
| | - G B Marks
- Liverpool Hospital, Liverpool, NSW, Australia
| | - F Thien
- Box Hill Hospital, Box Hill, Vic., Australia
| | - J Rimmer
- St Vincent's Clinic, Darlinghurst, NSW, Australia
| | | | - M Cook
- Canberra Hospital, Woden, ACT, Australia
| | - I Yang
- The Prince Charles Hospital, Chermside, Qld, Australia
| | - C Katelaris
- Campbelltown Hospital, Campbelltown, NSW, Australia
| | - S Bowler
- Mater Adult Hospital, South Brisbane, Qld, Australia
| | - D Langton
- Frankston Hospital, Frankston, Vic., Australia
| | - C Wright
- Nambour Hospital, Nambour, Qld, Australia
| | - M Bint
- Nambour Hospital, Nambour, Qld, Australia
| | | | - S Burgess
- QLD Children's Lung and Sleep Specialists, Woolloongabba, Qld, Australia
| | - P Sivakumaran
- Gold Coast District Hospital, Southport, Qld, Australia
| | - K Y Yan
- Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - V Kritikos
- Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - M Peters
- Concord Hospital, Concord, NSW, Australia
| | - M Baraket
- Liverpool Hospital, Liverpool, NSW, Australia
| | - A Aminazad
- St Vincent's Clinic, Darlinghurst, NSW, Australia
| | - P Robinson
- Children's Hospital at Westmead, Westmead, NSW, Australia
| | - A Jaffe
- School of Women's & Children's Health, UNSW Medicine, Randwick, NSW, Australia
| | - H Powell
- Hunter Medical Research Institute, John Hunter Hospital, University of Newcastle, New Lambton Heights, NSW, Australia
| | - J W Upham
- Princess Alexandra Hospital, Woolloongabba, Qld, Australia
| | - V M McDonald
- Hunter Medical Research Institute, John Hunter Hospital, University of Newcastle, New Lambton Heights, NSW, Australia
| | - P G Gibson
- Hunter Medical Research Institute, John Hunter Hospital, University of Newcastle, New Lambton Heights, NSW, Australia
| |
Collapse
|
7
|
Ingels A, Hew M, Algaba F, de Boer OJ, van Moorselaar RJA, Horenblas S, Zondervan P, de la Rosette JJMCH, Pilar Laguna Pes M. Vimentin over-expression and carbonic anhydrase IX under-expression are independent predictors of recurrence, specific and overall survival in non-metastatic clear-cell renal carcinoma: a validation study. World J Urol 2016; 35:81-87. [PMID: 27207480 DOI: 10.1007/s00345-016-1854-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 05/11/2016] [Indexed: 01/06/2023] Open
Abstract
PURPOSE Clinical outcomes prognostic markers are awaited in clear-cell renal carcinoma (ccRCC) to improve patient-tailored management and to assess six different markers' influence on clinical outcomes from ccRCC specimen and their incremental value combined with TNM staging. MATERIALS AND METHODS This is a retrospective, multicenter study. One hundred and forty-three patients with pT1b-pT3N0M0 ccRCC were included. Pathology specimens from surgeries were centrally reviewed, mounted on a tissue micro-array and stained with six markers: CAIX, c-MYC, Ki67, p53, vimentin and PTEN. Images were captured through an Ultra Fast Scanner. Tumor expression was measured with Image Pro Plus. Cytoplasmic markers (PTEN, CAIX, vimentin, c-MYC) were expressed as surface percentage of expression. Nuclear markers (Ki67, p53) were expressed as number of cells/mm2. Clinical data and markers expression were compared with clinical outcomes. Each variable was included in the Cox proportional multivariate analyses if p < 0.10 on univariate analyses. Discrimination of the new marker was calculated with Harrell's concordance index. RESULTS At median follow-up of 63 months (IQR 35.0-91.8), on multivariate analysis, CAIX under-expression and vimentin over-expression were associated with worse survival (recurrence, specific and overall survival). A categorical marker CAIX-/Vimentin+ with cutoff points for CAIX and vimentin of 30 and 50 %, respectively, was designed. The new CAIX-/Vimentin+ marker presented a good concordance and comparable calibration to the reference model. Limitations are the retrospective design, the need for external validation and the large study period. CONCLUSION Using an automated technique of measurement, CAIX and vimentin are independent predictors of clinical outcomes in ccRCC.
Collapse
Affiliation(s)
- A Ingels
- Department of Urology, Academisch Medisch Centrum, Postbus 22660, 1100DD, Amsterdam, Netherlands. .,IR4M, CNRS, Univ. Paris Sud, Université Paris-Saclay, 94805, Villejuif, France. .,Service d'urologie Hôpital Bicêtre, 78, rue du Général Leclerc, 94271, Le Kremlin-Bicêtre, France.
| | - M Hew
- Department of Urology, Academisch Medisch Centrum, Postbus 22660, 1100DD, Amsterdam, Netherlands
| | - F Algaba
- Department of Pathology, Fundació Puigvert, Universitat Autonoma de Barcelona, c/Cartagena 340-350, 08025, Barcelona, Spain
| | - O J de Boer
- Department of Pathology, AMC University of Amsterdam, Postbus 22660, 1100DD, Amsterdam, Netherlands
| | - R J A van Moorselaar
- Department of Urology, VU University Medical Center, de Boelelaan 1117, 1081 HV, Amsterdam, Netherlands
| | - S Horenblas
- Department of Urology, Antoni Van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, Netherlands
| | - P Zondervan
- Department of Urology, Academisch Medisch Centrum, Postbus 22660, 1100DD, Amsterdam, Netherlands
| | - J J M C H de la Rosette
- Department of Urology, Academisch Medisch Centrum, Postbus 22660, 1100DD, Amsterdam, Netherlands
| | - M Pilar Laguna Pes
- Department of Urology, Academisch Medisch Centrum, Postbus 22660, 1100DD, Amsterdam, Netherlands
| |
Collapse
|
8
|
Duan M, Steinfort DP, Smallwood D, Hew M, Chen W, Ernst M, Irving LB, Anderson GP, Hibbs ML. CD11b immunophenotyping identifies inflammatory profiles in the mouse and human lungs. Mucosal Immunol 2016; 9:550-63. [PMID: 26422753 PMCID: PMC7101582 DOI: 10.1038/mi.2015.84] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 07/12/2015] [Indexed: 02/04/2023]
Abstract
The development of easily accessible tools for human immunophenotyping to classify patients into discrete disease endotypes is advancing personalized therapy. However, no systematic approach has been developed for the study of inflammatory lung diseases with often complex and highly heterogeneous disease etiologies. We have devised an internally standardized flow cytometry approach that can identify parallel inflammatory alveolar macrophage phenotypes in both the mouse and human lungs. In mice, lung innate immune cell alterations during endotoxin challenge, influenza virus infection, and in two genetic models of chronic obstructive lung disease could be segregated based on the presence or absence of CD11b alveolar macrophage upregulation and lung eosinophilia. Additionally, heightened alveolar macrophage CD11b expression was a novel feature of acute lung exacerbations in the SHIP-1(-/-) model of chronic obstructive lung disease, and anti-CD11b antibody administration selectively blocked inflammatory CD11b(pos) but not homeostatic CD11b(neg) alveolar macrophages in vivo. The identification of analogous profiles in respiratory disease patients highlights this approach as a translational avenue for lung disease endotyping and suggests that heterogeneous innate immune cell phenotypes are an underappreciated component of the human lung disease microenvironment.
Collapse
Affiliation(s)
- M Duan
- grid.1002.30000 0004 1936 7857Department of Immunology, Monash University, Alfred Medical Research and Education Precinct, Melbourne, Australia ,grid.1008.90000 0001 2179 088XDepartment of Surgery, University of Melbourne, Melbourne, Australia ,grid.482095.2Ludwig Institute for Cancer Research, Melbourne, Australia ,grid.1018.80000 0001 2342 0938Department of Biochemistry and Genetics, La Trobe Institute for Molecular Science, La Trobe University, Bundoora, Australia
| | - D P Steinfort
- grid.416153.40000 0004 0624 1200Department of Respiratory Medicine, Royal Melbourne Hospital, Parkville, Australia
| | - D Smallwood
- grid.416153.40000 0004 0624 1200Department of Respiratory Medicine, Royal Melbourne Hospital, Parkville, Australia
| | - M Hew
- grid.1623.60000 0004 0432 511XDepartment of Allergy, Immunology and Respiratory Medicine, Alfred Hospital, Parkville, Australia
| | - W Chen
- grid.1018.80000 0001 2342 0938Department of Biochemistry and Genetics, La Trobe Institute for Molecular Science, La Trobe University, Bundoora, Australia
| | - M Ernst
- grid.1042.7The Walter and Eliza Hall Institute for Medical Research, Parkville, Australia ,grid.1008.90000 0001 2179 088XDepartment of Medical Biology, University of Melbourne, Melbourne, Australia ,grid.410678.cPresent Address: 10Present address: Olivia Newton-John Cancer Research Institute, Austin Health, Heidelberg, Victoria 3084, Australia., ,
| | - L B Irving
- grid.416153.40000 0004 0624 1200Department of Respiratory Medicine, Royal Melbourne Hospital, Parkville, Australia
| | - G P Anderson
- grid.1008.90000 0001 2179 088XDepartment of Pharmacology, University of Melbourne, Melbourne, Australia
| | - M L Hibbs
- grid.1002.30000 0004 1936 7857Department of Immunology, Monash University, Alfred Medical Research and Education Precinct, Melbourne, Australia
| |
Collapse
|
9
|
Hew M, McKinnon EJ, Kirwin B, Martinez OP, Lucas M. Systemic lupus erythematosus patients and tertiary specialist care--simple considerations dropping through the cracks: osteoporosis monitoring as an example. Intern Med J 2015; 45:596. [PMID: 25955477 DOI: 10.1111/imj.12748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 01/31/2015] [Indexed: 11/27/2022]
Affiliation(s)
- M Hew
- Department of Clinical Immunology, PathWest Laboratory Medicine WA, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia
| | - E J McKinnon
- Institute for Immunology and Infectious Diseases, Murdoch University, Perth, Western Australia, Australia
| | - B Kirwin
- School of Pathology and Laboratory Medicine, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - O P Martinez
- School of Pathology and Laboratory Medicine, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Perth, Western Australia, Australia.,Department of Clinical Immunology, Royal Perth Hospital, Perth, Western Australia, Australia.,Department of Clinical Immunology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - M Lucas
- Department of Clinical Immunology, PathWest Laboratory Medicine WA, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia.,Institute for Immunology and Infectious Diseases, Murdoch University, Perth, Western Australia, Australia.,School of Pathology and Laboratory Medicine, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Perth, Western Australia, Australia
| |
Collapse
|
10
|
Corcoran J, Wallbridge P, Rahman N, Mallett S, Hew M. S41 Looking Beyond The Pleura - A Systematic Review Of Thoracic Ultrasonography To Diagnose Lung Consolidation In Respiratory Failure. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
11
|
Hannan LM, Steinfort DP, Irving LB, Hew M. Direct ultrasound localisation for pleural aspiration: translating evidence into action. Intern Med J 2014; 44:50-6. [PMID: 24112296 DOI: 10.1111/imj.12290] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 09/17/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is strong evidence that direct ultrasound localisation for pleural aspiration reduces complications, but this practice is not universal in Australia and New Zealand. AIMS To describe the current utilisation and logistical barriers to the use of direct ultrasound localisation for pleural aspiration by respiratory physicians from Australia and New Zealand, and to determine the cost benefits of procuring equipment and training resources in chest ultrasound. METHODS We surveyed all adult respiratory physician members of the Thoracic Society of Australia and New Zealand regarding their use of direct ultrasound localisation for pleural aspiration. We performed a cost-benefit analysis for acquiring bedside ultrasound equipment and estimated the capacity of available ultrasound training. RESULTS One hundred and forty-six of 275 respiratory physicians responded (53% response). One-third (33.6%) of respondents do not undertake direct ultrasound localisation. Lack of training/expertise (44.6%) and lack of access to ultrasound equipment (41%) were the most frequently reported barriers to performing direct ultrasound localisation. An average delay of 2 or more days to obtain an ultrasound performed in radiology was reported in 42.7% of respondents. Decision-tree analysis demonstrated that clinician-performed direct ultrasound localisation for pleural aspiration is cost-beneficial, with recovery of initial capital expenditure within 6 months. Ultrasound training infrastructure is already available to up-skill all respiratory physicians within 2 years and is cost-neutral. CONCLUSION Many respiratory physicians have not adopted direct ultrasound localisation for pleural aspiration because they lack equipment and expertise. However, purchase of ultrasound equipment is cost-beneficial, and there is already sufficient capacity to deliver accredited ultrasound training through existing services.
Collapse
Affiliation(s)
- L M Hannan
- Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Institute for Breathing and Sleep, Austin Health, Melbourne, Victoria, Australia
| | | | | | | |
Collapse
|
12
|
Börner EC, Thompson M, Bozinovski S, Bauer M, Hew M, Irving L. Assoziation zwischen dem Ausmaß einer chronisch obstruktiven Lungenerkrankung und Zeichen einer subklinischen Atherosklerose. Pneumologie 2013. [DOI: 10.1055/s-0033-1334665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
13
|
Affiliation(s)
- M. Hew
- University of Melbourne; Melbourne Victoria Australia
- Royal Melbourne Hospital; Melbourne Victoria Australia
| | - S. Heinze
- University of Melbourne; Melbourne Victoria Australia
- Royal Melbourne Hospital; Melbourne Victoria Australia
| |
Collapse
|
14
|
|
15
|
Dabscheck EJ, Steinfort DP, Irving LB, Hew M. Mediastinal staging of non-small-cell lung cancer among Australasian thoracic physicians: clinical practice and constraints on minimally invasive techniques. Intern Med J 2011; 42:627-33. [PMID: 22188414 DOI: 10.1111/j.1445-5994.2011.02683.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND/AIM We determined current practice among Australasian thoracic physicians in the mediastinal staging of non-small-cell lung cancer (NSCLC). We focused on the availability of endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA) and constraints to its use, as there has been no systematic analysis regarding the availability and uptake of this new technology among thoracic physicians. METHODS Physician members of the Thoracic Society of Australia and New Zealand were emailed a survey seeking their current approach to three scenarios requiring mediastinal staging of NSCLC. Respondents were also asked for their preferred investigation for each scenario if any current constraints were removed. Relevant demographic information was sought. RESULTS We received 164 responses from 512 Australasian physicians (34%). Without constraints, EBUS-TBNA was the preferred investigation for all three clinical scenarios, but only 33% of respondents had access to EBUS-TBNA. Constraints included lack of availability and lack of expertise. Reduced EBUS-TBNA access was associated with a number of clinician factors. CONCLUSIONS Australasian thoracic physicians prefer EBUS-TBNA for the mediastinal staging of NSCLC, but access to EBUS-TBNA services is limited. We recommend targeted measures to improve access to EBUS-TBNA use and optimise mediastinal staging of NSCLC.
Collapse
Affiliation(s)
- E J Dabscheck
- Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
| | | | | | | |
Collapse
|
16
|
Abstract
Chronic severe asthma remains a challenging clinical problem despite the availability of modern treatments. Relative corticosteroid insensitivity is present in severe asthma and may contribute to continuing disease severity. Advances in the understanding of molecular mechanisms underlying corticosteroid insensitivity may yield new therapeutic targets. Furthermore, aetiological factors for corticosteroid insensitivity have been identified and these may be amenable to modification.
Collapse
Affiliation(s)
- M Hew
- Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
| | | |
Collapse
|
17
|
Bhavsar P, Khorasani N, Hew M, Johnson M, Chung KF. Effect of p38 MAPK inhibition on corticosteroid suppression of cytokine release in severe asthma. Eur Respir J 2009; 35:750-6. [PMID: 19840967 DOI: 10.1183/09031936.00071309] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Patients with severe asthma respond less well to corticosteroids than those with non-severe asthma. Increased p38 mitogen-activated protein kinase (MAPK) activation in alveolar macrophages (AMs) from severe asthma patients has been associated with a reduced inhibition of cytokine release by dexamethasone. We determined whether p38 MAPK inhibitors would modulate corticosteroid suppression of cytokine release from AMs and peripheral blood mononuclear cells (PBMCs). PBMCs were isolated from venous blood and AMs by bronchoalveolar lavage in severe and non-severe asthma patients. PBMCs and AMs were exposed to lipopolysaccharide (LPS) with and without the p38 MAPK inhibitor, SD282, or dexamethasone. We determined the concentration-dependent effects of another p38 MAPK inhibitor, GW-A, on dexamethasone-induced inhibition of interleukin (IL)-8 release from PBMCs. Cytokines were assayed using an ELISA-based method. SD282 (10(-7) M), with dexamethasone (10( -6) M), caused a greater inhibition of release of IL-1beta, IL-6, macrophage inflammatory protein-1alpha and IL-10, than with dexamethasone alone in AMs from severe and non-severe asthma. At 10(-9) and 10(-10) M, GW-A, that had no direct effects, increased the inhibitory activity of dexamethasone (10(-8) and 10( -6) M) on LPS-induced IL-8 release in PBMCs from severe asthma. Corticosteroid insensitivity in severe asthma patients may be improved by inhibitors of p38 MAPK.
Collapse
Affiliation(s)
- P Bhavsar
- Section of Airways Disease, National Heart & Lung Institute, Imperial College & Royal Brompton and Harefield NHS Trust Hospital, London, UK
| | | | | | | | | |
Collapse
|
18
|
Macedo P, Hew M, Torrego A, Jouneau S, Oates T, Durham A, Chung KF. Inflammatory biomarkers in airways of patients with severe asthma compared with non-severe asthma. Clin Exp Allergy 2009; 39:1668-76. [PMID: 19622091 DOI: 10.1111/j.1365-2222.2009.03319.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND About 5-10% of patients with asthma suffer from poorly-controlled disease despite corticosteroid (CS) therapy. OBJECTIVE We determined whether there were any differences in inflammatory biomarkers between severe and non-severe asthma patients. METHODS Nineteen severe and 20 non-severe asthma patients were recruited and underwent collection of induced sputum, bronchoalveolar lavage (BAL) fluid and bronchial biopsies. RESULTS Biopsy results showed no differences in eosinophils (major basic protein positive), neutrophils, macrophages, T cells and mast cells in the bronchial submucosa. However, subbasement membrane (SBM) thickness and smooth muscle area were increased in the biopsies. No significant differences were observed in the induced sputum inflammatory cells. In BAL fluid, there was a significant increase in neutrophils but a significant decrease in macrophages. Eosinophil counts were non-significantly increased threefold in both sputum and BAL in severe asthma. Levels of IL-8 and IL-13 in sputum supernatants were similar in both groups of asthma patients. There was a significant inverse correlation between post-bronchodilator forced expiratory volume in 1 s and provocative concentration of methacholine causing a 20% fall in FEV(1) with SBM thickness. CONCLUSION Differences in inflammatory cells were observed mainly in terms of increased neutrophils and reduction in macrophage numbers in BAL fluid with a trend towards increased eosinophils in severe asthma compared with non-severe asthma. However, the most notable features are the increase in features of airway wall remodelling of SBM thickness and smooth muscle area.
Collapse
Affiliation(s)
- P Macedo
- Experimental Studies, Airway Disease Section, National Heart and Lung Institute, Imperial College, London, UK
| | | | | | | | | | | | | |
Collapse
|
19
|
|
20
|
Bhavsar P, Hew M, Khorasani N, Torrego A, Barnes PJ, Adcock I, Chung KF. Relative corticosteroid insensitivity of alveolar macrophages in severe asthma compared with non-severe asthma. Thorax 2008; 63:784-90. [PMID: 18492738 DOI: 10.1136/thx.2007.090027] [Citation(s) in RCA: 197] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND About 5-10% of patients with asthma suffer from poorly controlled disease despite corticosteroid (CS) treatment, which may indicate the presence of CS insensitivity. A study was undertaken to determine whether relative CS insensitivity is present in alveolar macrophages from patients with severe asthma and its association with p38 mitogen-activated protein kinase (MAPK) activation and MAPK phosphatase-1 (MKP-1). METHODS Fibreoptic bronchoscopy and bronchoalveolar lavage (BAL) were performed in 20 patients with severe asthma and 19 with non-severe asthma and, for comparison, in 14 normal volunteers. Alveolar macrophages were exposed to lipopolysaccharide (LPS, 10 mug/ml) and dexamethasone (10(-8) and 10(-6) M). Supernatants were assayed for cytokines using an ELISA-based method. p38 MAPK activity and MKP-1 messenger RNA expression were assayed in cell extracts. RESULTS The inhibition of LPS-induced interleukin (IL)1beta, IL6, IL8, monocyte chemotactic protein (MCP)-1 and macrophage inflammatory protein (MIP)-1alpha release by dexamethasone (10(-6) M) was significantly less in macrophages from patients with severe asthma than in macrophages from patients with non-severe asthma. There was increased p38 MAPK activation in macrophages from patients with severe asthma. MKP-1 expression induced by dexamethasone and LPS, expressed as a ratio of LPS-induced expression, was reduced in severe asthma. CONCLUSION Alveolar macrophages from patients with severe asthma demonstrate CS insensitivity associated with increased p38 MAPK activation that may result from impaired inducibility of MKP-1.
Collapse
Affiliation(s)
- P Bhavsar
- National Heart & Lung Institute, Imperial College, Dovehouse Street, London SW3 6LY, UK
| | | | | | | | | | | | | |
Collapse
|
21
|
Abstract
BACKGROUND Bronchiectasis is a suppurative airway disease characterised by persistent cough and sputum production associated with bronchial dilatation. A study was undertaken to determine whether cough sensitivity is increased in bronchiectatic patients. METHODS Twenty two patients with bronchiectasis and 20 healthy non-smoking controls matched for age and sex were recruited into the study. Quality of life (Leicester Cough Questionnaire score), total cough symptom score, and extent of bronchiectasis on HRCT scans were recorded. Cough sensitivity was assessed using incremental inhalation of capsaicin concentrations; the concentration at which 5 or more coughs occurred (C5) was recorded. RESULTS Patients with bronchiectasis had increased sensitivity to capsaicin compared with controls (mean (SE) log10 C5 1.22 (0.20) v 1.89 (0.21); p<0.03). Capsaicin sensitivity correlated positively with the Leicester Cough Questionnaire score (r = 0.64; p = 0.005) and inversely with the total cough symptom score (r = -0.58; p = 0.004), but not with the extent of the disease. It also correlated with forced expiratory volume in 1 second (FEV1) in litres (r = 0.58; p = 0.005) but not with FEV1 % predicted. Capsaicin sensitivity was not related to the presence of infected sputum or to corticosteroid or bronchodilator use. CONCLUSIONS : Patients with bronchiectasis have a sensitive cough reflex which reflects the severity of cough symptoms. A measure of cough severity could be part of health assessment for patients with bronchiectasis.
Collapse
Affiliation(s)
- A Torrego
- National Heart and Lung Institute, Imperial College, Dovehouse Street, London SW3 6LY, UK
| | | | | | | | | | | | | |
Collapse
|
22
|
Chung KF, Hew M, Score J, Jones AV, Reiter A, Cross NCP, Bain BJ. Cough and hypereosinophilia due to FIP1L1-PDGFRA fusion gene with tyrosine kinase activity. Eur Respir J 2006; 27:230-2. [PMID: 16387954 DOI: 10.1183/09031936.06.00089405] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Eosinophil-associated conditions, such as asthma and eosinophilic bronchitis, have been associated with chronic persistent cough, usually responding to corticosteroid therapy. This case study reports a case of persistent cough associated with gastro-oesophageal reflux (GOR) and hypereosinophilia. Treatment of GOR with proton pump inhibitors and fundoplication did not control the cough. However, high dose prednisolone, but not inhaled corticosteroids, did. The presence of the FIP1L1-PDGFRA fusion gene in myeloid cells was confirmed by fluorescence in situ hybridisation analysis using CHIC2 deletion as a surrogate marker. The cough and other disease features were subsequently suppressed by the tyrosine kinase inhibitor, imatinib. This is the first case of persistent cough caused by hypereosinophilic syndrome characterised by FIP1L1-PDGFRA fusion gene and aberrant tyrosine kinase activity.
Collapse
Affiliation(s)
- K F Chung
- National Heart and Lung Institute, Imperial College and Royal Brompton Hospital, London SW3 6LY, UK.
| | | | | | | | | | | | | |
Collapse
|
23
|
Bryson JM, Cooney GJ, Wensley VR, Phuyal JL, Hew M, Denyer GS, Caterson ID. High-fat feeding alters the response of rat PDH complex to acute changes in glucose and insulin. Am J Physiol 1995; 268:E752-7. [PMID: 7733276 DOI: 10.1152/ajpendo.1995.268.4.e752] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The activity of the pyruvate dehydrogenase complex (PDHC) was studied in tissues of controls and insulin-resistant fat-fed rats (FFR) both in the fed state and in overnight fasted animals after the induction of short-term changes in plasma insulin by an intravenous glucose load. Significant responses by the PDHC to the glucose challenge were seen in heart and white adipose tissue (WAT) in controls with smaller changes in brown adipose tissue (BAT) and quadriceps muscle (QM) and no change in liver. Reduced PDHC responses and lower fed values were seen in heart and BAT of FFR. The response in WAT of FFR was prolonged with no change in the PDHC response in QM. Plasma nonesterified fatty acids (NEFA) were decreased in response to the glucose load with no differences between controls and FFR. Tissue triglyceride levels were higher in liver and QM but not heart of FFR. These results show differential tissue PDHC responses to short-term changes in plasma insulin. The decreased PDHC activity in some tissues of the fat-fed animals despite the lack of change in plasma NEFA, together with the triglyceride accumulation seen in some tissues but not others, suggests that local intracellular fatty acid metabolism is important in the regulation of intracellular glucose oxidation.
Collapse
Affiliation(s)
- J M Bryson
- Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | | | | | | | | | | | | |
Collapse
|