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

With no identified cause or cure, sarcoidosis is a challenging disease that has a heterogeneous presentation and an unpredictable clinical course. A recent paper in Thorax examined the outcomes for patients grouped by pulmonary function phenotypes, race and sex. First author for the study, Dr. Michelle Sharp¹, joins social media editor Dr. Kate Diomede to talk through the findings.

Read the paper: Pulmonary sarcoidosis: differences in lung function change over time

1. Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA 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.

The PulmPEEPs are back with another journal club episode. Dr. Kristina Montemayor and Dr. David Furfaro are joined by Thorax education editor Dr. Christopher Turnbull, and journal club author Dr. Ewan Mackay. They discuss a handful of selected papers focussing on COPD, covering the global impact of different household fuels on lung disease, early signs of CT changes in smokers before the detection of COPD, and a trial of treprostinil for the treatment of COPD related pulmonary hypertension.

Links:

• Journal club
• Estimated health effects from domestic use of gaseous fuels for cooking and heating in high-income, middle-income, and low-income countries: a systematic review and meta-analyses
• BEACON: A Missing Piece of the Puzzle for Chronic Obstructive Pulmonary Disease
• A New Global Definition of Acute Respiratory Distress Syndrome
• Inhaled treprostinil in pulmonary hypertension associated with COPD: PERFECT study results

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.

Lung conditions remain one of the biggest causes of death and cost the economy billions annually. Despite this they receive only 2.5% of total public research investment in the UK. The Asthma + Lung UK charity brought together a number of experts and stakeholders in an effort to improve the working approach to this problem. This group published a letter in Thorax recently with a number of recommendations. One of the authors, Dr. Samantha Walker¹, joins the podcast.

Links:

• Fixing lung health in the UK: accelerating respiratory research and innovation
• Asthma + Lung UK

1. Research and Innovation, Asthma + Lung UK, London, 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.

The growing use of artificial stone has seen the emergence of an aggressive, progressive respiratory disease, which is causing silicosis in young people. Dr. Johanna Feary¹ ² joins Thorax's Dr. Kate Diomede in the studio, to discuss. They talk through some the UK's earliest cases, the background to this phenomenon, international response, and the broader history of silicosis as a disease.

Links:

• Artificial stone silicosis: a UK case series
• Relationship between cumulative silica exposure and silicosis: a systematic review and dose-response meta-analysis

1. National Heart and Lung Institute, Imperial College, London, UK 2. Department of Occupational Lung Disease, Royal Brompton Hospital, London, 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.

A special journal club episode featuring guest-hosts Dr. Kristina Montemayor and Dr. David Furfaro of the PulmPEEPs. They're joined in conversation with Thorax education editor Dr. Christopher Turnbull, and Dr. Imran Howell, author of a recent journal club article in Thorax. Focussing on the theme of airway disease, they discuss the four papers in Imran's roundup, covering topics from nutritional impact on tuberculosis rates to infant vaccination against RSV.

Links:

• Journal club
• Blood eosinophil-guided oral prednisolone for COPD exacerbations in primary care in the UK (STARR2): a non-inferiority, multicentre, double-blind, placebo-controlled, randomised controlled trial
• Nutritional supplementation to prevent tuberculosis incidence in household contacts of patients with pulmonary tuberculosis in India (RATIONS): a field-based, open-label, cluster-randomised, controlled trial
• The airway microbiome mediates the interaction between environmental exposure and respiratory health in humans
• Respiratory syncytial virus infection during infancy and asthma during childhood in the USA (INSPIRE): a population-based, prospective birth cohort study

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.