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  • Breathwork: Pulmonary Hypertension with Professor Sean Gaine (Part 2)
    2025/07/07
    This week, we’re joined by Professor Seán Gaine, Ireland’s foremost expert in pulmonary hypertension. In this insightful episode, he shares his expert perspective on the diagnosis, classification, and clinical presentation of the condition, as well as the latest advances in treatment. A must-listen for all healthcare professionals, Professor Gaine also discusses when to suspect pulmonary hypertension and highlights the nuances in the management of patients with pulmonary hypertension. Don’t miss this opportunity to learn from a global leader in the field. Chapters 0:52 Rapid fire round on pulmonary hypertension 01:42 Definition of pulmonary hypertension 02:08 Signs and symptoms of pulmonary hypertension 02:56 Five groups of pulmonary hypertension 03:33 Group 1 pulmonary hypertension: Pulmonary arterial hypertension 04:34 Group 2 pulmonary hypertension: Left heart disease 05:23 Group 3 pulmonary hypertension: Chronic lung disease/hypoxia 05:58 Group 4 pulmonary hypertension: Pulmonary vascular obstruction 06:30 Group 5 pulmonary hypertension: Miscellaneous 07:25 Referral to the national pulmonary hypertension centre: right heart catheterisation 09:37 Work up in the pulmonary hypertension clinic 11:06 Risk stratification in pulmonary hypertension 12:06 Diagnostic criteria pulmonary hypertension Dynamic testing right heart catheterisation: Cardiopulmonary exercise testing Reliability of right heart catheterisation Treatment algorithm in pulmonary arterial hypertension Tripple therapy for high risk patients Double combination therapy for non-high risk patients Fourth treatment pathway, Quadruple therapy?: Sotatercept - an activin scavenger Treatment options for groups 4 pulmonary hypertension: Balloon pulmonary angioplasty Treatment options for groups 2, 3 and 5 Side effects of triple therapy Lung transplant in pulmonary hypertension: Double or single lung transplant Pitfalls in the acute management of patients with pulmonary hypertension Interpretation of the B Natriuretic Peptide level Medications contraindicated pulmonary hypertensions Outcomes in pulmonary hypertension Take home message on pulmonary hypertension Show Notes - https://lumen5.com/user/edofficer/sotatercept-emergin-d5jg6/ - Irish Thoracic Society Flashcard Pulmonary Hypertension https://irishthoracicsociety.com/wp-content/uploads/2021/06/5.-Pulmonary-Hypertension.pdf - Benza RL, Kanwar MK, Raina A, et al. Development and validation of an abridged version of the REVEAL 2.0 risk score calculator, REVEAL Lite 2, for use in patients with pulmonary arterial hypertension. Chest 2021; 159: 337–346. - Humbert M, Kovacs G, Hoeper MM, Badagliacca R, Berger RMF, Brida M, et al. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. European Respiratory Journal. 2022:2200879. DOI: https://doi.org/10.1183/13993003.00879-2022 - Chin KM, Gaine SP, Gerges C, Jing Z-C, Mathai SC, Tamura Y, et al. Treatment algorithm for pulmonary arterial hypertension. European Respiratory Journal. 2024;64(4):2401325. DOI: https://doi.org/10.1183/13993003.01325-2024 - Hoeper, M.M., Badesch, D.B., Ghofrani, H.A., Gibbs, J.S.R., GombergMaitland, M., McLaughlin, V.V. et al. (2023) ‘Phase 3 trial of sotatercept for treatment of pulmonary arterial hypertension’, New England Journal of Medicine, 388(17), pp. 1478–1490. Available at: https://doi.org/10.1056/NEJMoa2213558 - Humbert M, McLaughlin VV, Badesch DB, Ghofrani HA, Gibbs JSR, Gomberg-Maitland M, et al. Sotatercept in Patients with Pulmonary Arterial Hypertension at High Risk for Death. N Engl J Med. 2025;392(20):1987-2000. DOI: 10.1056/NEJMoa2415160
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    40 分
  • Inspire: Professor Sean Gaine on setting up pulmonary hypertension centres and his role as chief medical officer for the Irish Olympic Teams (Part 1)
    2025/06/23
    This week, we speak with Professor Sean Gaine about his distinguished career—from his work establishing the Pulmonary Hypertension Program at Johns Hopkins Hospital and later founding Ireland’s National Pulmonary Hypertension Centre as well as serving as Chief Medical Officer for the Irish Olympic Teams. He shares thoughtful insights and experiences from a remarkable career with more stories than could ever be squeezed into one episode. Chapters 01:56 Residency in the Johns Hopkins Hospital 03:37 Introduction to Pulmonary Hypertension 05:56 Establishing the Pulmonary Hypertension Unit in the Johns Hopkins Hospital 14:01 Establishing the National Pulmonary Hypertension Programme in Ireland 15:51 Essential role of clinical nurse specialists 18:01 Chief Medical Officer Irish Olympic Teams 25:46 Sustaining enthusiasm in a career in medicine Show Notes 1. Rubin, Lewis J., and Stuart Rich, editors. Primary Pulmonary Hypertension. Marcel Dekker, 1996. Lung Biology in Health and Disease. 2. https://www.irishtimes.com/sport/athletics/2024/05/18/jamie-costin-was-27-in-the-shape-of-his-life-ready-for-the-olympics-then-he-got-hit-by-a-truck/ 3. https://lumen5.com/user/edofficer/sean-gaine-olympic-cq0g0/
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    29 分
  • Breathwork: Asthma Biologic Therapies with Mr. Stephen Shelly (Part 2)
    2025/05/26
    Description This week we speak to Mr Stephen Shelly again about the exciting but sometimes mysterious world of asthma biologics. We speak about the different biologics, going about getting approval to start an asthma biologic, training, and treatment response. We speak about the potential impact that asthma biologics are going to have on the future of asthma (and hopefully COPD!), the cost benefit analysis and the limitations of these new wonder drugs. Chapters 0.42min Intro to Biologics 1.00min Rapid fire round 1.52min Severe asthma & biologic eligibility 3.50min Available biologics 6.50min Which biologic? 7.30min Journey to asthma biologic 13.55min Asthma biologic administration 15.30min Monitoring while on asthma biologic 16.40min Training for asthma biologic admin at home 18.50min Assessing treatment response 21:10min Patient expectations 24:50min Are inhalers still needed? 26:12min Pitfalls in treatment with asthma biologics 28:54min Cost-benefit analysis 31.30min Take-home points Show notes Dupilumab https://www.nejm.org/doi/10.1056/NEJMoa1804092 Mepolizumab https://www.nejm.org/doi/10.1056/NEJMoa1403290 Omalizumab https://www.jacionline.org/article/S0091-6749(01)65945-1/fulltext Benralizumab https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)31322-8/abstractTezepelumab https://doi.org/10.1164/rccm.202210-2005OC Difficult to treat asthma (GINA) https://ginasthma.org/wp-content/uploads/2024/11/GINA-Severe-Asthma-Guide-2024-WEB-WMS.pdf Asthma compliance programmes Ireland https://www.rcsi.com/dublin/research-and-innovation/innovation/investors-entrepreneurs-and-spin-outs/phyxiom
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    33 分
  • Inspire: Mr Stephen Shelly on pursuing a career as an advanced nurse practitioner (part 1)
    2025/05/13
    In this episode we speak to Mr Stephen Shelly, Advanced Nurse Practitioner in Respiratory Medicine in St James’ University hospital. Stephen completed his nursing, CNS and ANP training in SJH with a special interest in airways disease. In the ANP role he has introduced new pathways for direct GP referrals to his clinic and enhanced the early discharge programme for patients attending the emergency department with COPD. We discuss his career to date, the process for pursuing a career as an ANP, challenges along the way and tips for others with an interest in becoming an ANP. Chapters 00:45 Intro to Mr Stephen Shelly 02:05 Why he pursued a career in Respiratory medicine 04:30 Stephen’ early nursing career 05:40 Working as a clinical nurse specialist (CNS) 06:10 Overview of ANP training process 07:40 ANP Dragon’s Den 09:10 Different pathways to becoming an ANP 11:50 Future of ANPs in Ireland 14:00 Tips in advance of applying for an ANP role 19:30 Transition from CNS to ANP 22:10 Liaising with NCHDs/ junior doctors 24:30 Biggest challenges to date 28:30 Top tips for people starting out their nursing career 29:35 Wrap up Show notes ANP registration Ireland https://www.nmbi.ie/Registration/Add-New-Division/Advanced-Practitioners/Registering-as-ANP-AMP CNS training Ireland https://healthservice.hse.ie/about-us/onmsd/advanced-and-specialist-practice/specialist-practice.html Post graduate nursing courses Ireland https://www.nmbi.ie/Education/post-registration-courses
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    30 分
  • Breathwork: Sarcoidosis with Professor Anthony O'Regan (Part 2)
    2025/04/30
    In this episode, we delve into sarcoidosis with Professor Anthony O'Regan. We discuss the nuances of diagnosing sarcoidosis and revisit the pathophysiology of the condition. This episodes details the importance of follow up care and provides insights into how to tease out differentials. Furthermore, we address how to determine which patients should be treated, along with choice of treatments and duration. 00:15 Rapid fire round: sarcoidosis 00:45 Pathophysiology of sarcoidosis 05:30 Multisystem involvement in sarcoidosis 07:15 Granulomatous disease 09:00 Referral to respiratory clinic (Symptoms/Differentials/Family history/Travel) 10:30 Initial investigations 10:45 Coming to a diagnosis of sarcoidosis 14:05 The role of biopsy in diagnosis of sarcoidosis 15:50 Teasing out the differentials in follow up 17:35 When to treat in sarcoidosis 19:25 Duration of treatment 19:50 Relapse of disease 21:00 Starting dose of steroids 22:00 Disease modifying therapy 23:30 Antifibrotics 24:25 Follow up in sarcoidosis 25:01 The future of sarcoidosis Show Notes: - Judson MA, Baughman RP, Teirstein AS, Terrin ML, Yeager H Jr. Defining organ involvement in sarcoidosis: the ACCESS proposed instrument. ACCESS Research Group. A Case Control Etiologic Study of Sarcoidosis. Sarcoidosis, Vasculitis, and Diffuse Lung Diseases : Official Journal of WASOG. 1999 Mar;16(1):75-86. PMID: 10207945. - 40 consecutive patients in Ireland 20% end up on steroids - John Gibson study on steroids RCT Gibson GJ, Prescott RJ, Muers MF, Middleton WG, Mitchell DN, Connolly CK. "British Thoracic Society Sarcoidosis study: effects of long-term corticosteroid treatment." Thorax. 1996;51(3):238-247. DOI: 10.1136/thx.51.3.238 - Nintedanib in patients with progressive fibrosing interstitial lung diseases—subgroup analyses by interstitial lung disease diagnosis in the INBUILD trial: a randomised, double-blind, placebo-controlled, parallel-group trial Wells, Athol UAbe, S. et al. The Lancet Respiratory Medicine, Volume 8, Issue 5, 453 – 460 - ITS Flashcard Sarcoidosis https://irishthoracicsociety.com/wp-content/uploads/2022/02/15.-Sarcoidosis-30.11.21.pdf
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    27 分
  • Inspire: Dr Anthony O’Regan on improving junior doctor training and leadership roles in the HSE (Part 1)
    2025/04/14
    In this episode we speak to Dr Anthony O’Regan, Consultant Respiratory Physician working in Galway University hospital. Anthony completed his early training in the US and since coming back has worked with the Irish Thoracic Society, Royal College of Physicians Ireland and National Doctors Training and Planning to try and improve working conditions and training for junior doctors in Ireland. We discuss the progress made to date, ongoing projects and healthcare planning for the future changes we will see in our population. Chapters 0.45 Intro to Dr Anthony O’Regan 1.50 Why he pursued Respiratory mediicne 3.20 ITS presidency 7.25 ILD registries 8.50 RCPI and working conditions 14.00 Medical training in Ireland 18.45 Exit exams 20.50 Upcoming changes being introduced by NDTP 26.50 Projections for future workforce 31.20 Advice for upcoming trainees Show notes NDTP website (HSE) https://www.hse.ie/eng/staff/leadership-education-development/met/ All information on becoming a member, upcoming events and how to get involved in the RCPI https://www.rcpi.ie/ ITS website https://irishthoracicsociety.com/ Population changes and impacts on healthcare https://doi.org/10.1038/s41514-024-00148-2
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    34 分
  • Breathwork: All things IPF; Part 2 with Nazia Chaudhuri
    2025/03/31
    This week we speak with Nazia again, this time about idiopathic pulmonary fibrosis or IPF for short. Nazia is a leading world expert in the diagnosis and management of IPF and in this episode she shares that expertise with us. Chapters 00:57 - Rapid fire round 01:35 - Introduction to ILD 03:20 - Definition of IPF 04:15 - What to include in your IPF referrals 06:40 - IPF workup 11:55 - Genetics in IPF 14:50 - Management of IPF 20:28 - Acute exacerbation of IPF (AE-IPF) 22:20 - Follow-up and surveillance of IPF patients 26:00 - Prognostication in IPF 27:40 - Encouraging clinical breakthroughs 29:05 - Key take home messages 31:00 - Wrap up Links IPF clinical practice update 2022 ATS/ERS/JRS/ALAT https://doi.org/10.1164/rccm.202202-0399ST Role of MDT in diagnosis of IPF https://doi.org/10.1513/AnnalsATS.202108-979ED Current and future treatments in IPF https://doi.org/10.1007/s40265-023-01950-0
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    31 分
  • Inspire: Dr Nazia Chaudhuri Interview
    2025/03/18
    This week we welcome Dr Nazia Chaudhuri to the podcast. In this Inspire episode, Dr Chaudhuri tells us how respiratory chose her and gives some insights into combining clinical and academic roles. We discuss emerging research opportunities in Northern Ireland in particular in interstitial lung disease. Show Notes https://medicine.yale.edu/profile/naftali-kaminski/
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    29 分