Prophylactic use of azithromycin is common in the management of COPD patients with frequent acute exacerbations. But its application is conservative due to concerns around adverse events, interactions with other drugs, and bacterial resistance. Given these concerns, it is important to identify patients who are likely to be responders or non-responders.

According to the NICE guidance in the UK, you should consider azithromycin if the patient:

• Doesn't smoke.
• Has already accounted for non-drug treatments, inhaled therapies and vaccines.
• And has one or more of the following kinds of exacerbations:
  • Frequent exacerbations, more than four times a year, with high sputum production
  • Prolonged exacerbations with high sputum production.
  • Exacerbations causing hospitalisation.

In this episode, Thorax social media editor Dr. Kate Diomede speaks to Prof. Wim Janssens¹, author of a study proposing five parameters to predict the individual treatment effect of azithromycin. These parameters were developed using a machine learning model trained using the MACRO and COLUMBUS datasets. This led to the creation of an online calculator, serving as an aid in decision making.

Read the paper: Identifying azithromycin responders with an individual treatment effect model in COPD

1. Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium

Please engage in the conversation through the social media channels (Twitter - @ThoraxBMJ; Facebook - Thorax.BMJ) and subscribe on your preferred platform, to get the latest episodes directly on your device each month. We would love to hear your thoughts on the podcast, you can leave a review on Apple Podcasts or Spotify.

Another journal club episode featuring guest-host Dr. Kristina Montemayor of the PulmPEEPs, in conversation with Thorax education editor Dr. Christopher Turnbull, and Dr. Natalie McCleod, author of a recent journal club article focussing on the theme of ventilation and sleep. They discuss the four papers selected by Natalie, covering topics including CPAP therapy's benefit on blood pressure, and Hypoglossal nerve stimulation for obstructive sleep apnoea.

Links:

• Journal club
• Effect of CPAP therapy on blood pressure in patients with obstructive sleep apnoea: a worldwide individual patient data meta-analysis
• Hypoglossal nerve stimulation for obstructive sleep apnea in adults: An updated systematic review and meta-analysis
• Noninvasive Ventilation for Preoxygenation during Emergency Intubation
• Nasal high flow or noninvasive ventilation? navigating hypercapnic COPD exacerbation treatment: A randomized noninferiority clinical trial

For more from the PulmPEEPs, visit their podcast's website. You can find them Twitter (@PulmPEEPs) and Instagram (pulmpeeps), and hear past episodes on Apple Podcasts and Spotify.

To submit a journal club article of your own, you can contact Chris directly - christopher.turnbull@ouh.nhs.uk

Please engage in the conversation through the social media channels (Twitter - @ThoraxBMJ; Facebook - Thorax.BMJ) and subscribe on your preferred platform, to get the latest episodes directly on your device each month. We would love to hear your thoughts on the podcast, you can leave a review on Apple Podcasts or Spotify.

There are many factors which might contribute to asthma patients not adhering to their medication, such as access to services, or convenience of use. One well-known and important barrier in the United States is simply cost. Thorax social media editor Dr. Kate Diomede speaks to Dr. Chun-Tse Hung¹, Dr. Steven Erickson², and Prof. Chung-Hsuen Wu¹, the authors of a recent study on the subject.

Read the paper: Cost-related non-adherence to medications among adults with asthma in the USA, 2011–2022

1. School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan

2. Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, Michigan, USA