scholarly journals Improving spirometry testing by understanding patient preferences

2020 ◽  
pp. 00712-2020
Author(s):  
Barbara Johnson ◽  
Irene Steenbruggen ◽  
Brian L. Graham ◽  
Courtney Coleman
Keyword(s):  
Coming Out ◽  
Online Survey ◽  
Task Force ◽  
Patient Comfort ◽  
European Respiratory Society ◽  
Technical Standards ◽  
Testing Environment ◽  
Individual Health ◽  
Clear Information

The American Thoracic Society and European Respiratory Society commissioned a task force to update the technical standards for spirometry testing with the aim of increasing the accuracy, precision, and quality of spirometry measurements and improving the patient experience.To inform the task force with patient experiences, European Lung Foundation, in collaboration with the task force, conducted an online survey in 10 languages between August and September 2018.There were 1760 respondents from 52 countries. The majority were adults (97.1%) and the most common reasons for spirometry referral were diagnosis (35.5%) and management of an ongoing condition (60.9%). 53.2% reported regularly using inhalers.Respondents were very experienced with spirometry: 89.9% completed more than one test; 48% completed 10 or more tests. However, most reported not knowing what FEV1 means (59.4%) and only 39.6% knew their most recent FEV1; the exception was respondents with cystic fibrosis (CF) who reported much greater knowledge.Respondents rated as moderately or seriously problematic: being told to keep blowing when they felt nothing is coming out (31.4%), coughing (30.4%), tiredness (26.3%) and concern about shortness of breath (20.1%).Overall, respondents found spirometry to be acceptable, however an important minority (17%) find it difficult. Patients want clear information before, during and after the test, including information on stopping medications. Operators have an important role in increasing the ease of patients, and changes to the testing environment can increase patient comfort. Patients want access to their results and want to understand how they relate to their individual health.

Standardization of spirometry: what’s new in 2019 update (Part 2)

2020 ◽  
Vol 1 (14) ◽  
pp. 10-18
Author(s):  
L. D. Kiryukhina ◽  
P. V. Struchkov
Keyword(s):  
Task Force ◽  
Test Session ◽  
American Thoracic Society ◽  
European Respiratory Society ◽  
Technical Standards ◽  
Joint Task ◽  
Joint Task Force ◽  
International Joint ◽  
New Research

Improvements in equipment, new research studies and enhanced quality assurance approaches have led to the need to update the 2005 technical standards for spirometry. The article presents the main updates, developed by an international joint task force by the American Thoracic Society and the European Respiratory Society in 2019. The characteristics of acceptability, usability, and repeatability, criteria grading the quality of the test session, the choice of main reported values are described.

scholarly journals Standardization of spirometry: what’s new in 2019 update. Part 1

2020 ◽  
pp. 9-14
Author(s):  
L. D. Kiryukhina ◽  
P. V. Struchkov
Keyword(s):  
Negative Impact ◽  
Task Force ◽  
International Standards ◽  
Functional Tests ◽  
Functional Diagnostics ◽  
European Respiratory Society ◽  
Technical Standards ◽  
Joint Task ◽  
Joint Task Force

Spirometry is the basic method for pulmonary function evaluating but it is very dependent on the quality of performance. Currently, specialists in lung function diagnostics rely on the 2005 technical standards of spirometry, jointly developed by the American thoracic Society (ATS) and the European Respiratory Society (ERS), adapted for our country by the Russian Respiratory Society in 2013. New technical capabilities and research studies have shown the need to improve approaches to ensuring the measurements quality. A joint task force with experience in conducting and analyzing pulmonary functional tests assigned by the ATS and ERS has significantly updated international standards to ensure quality laboratory practice. The article discusses the standards update by the 2019 consensus, as well as the new added factors that were not previously mentioned. New standards are needed for manufacturers, clinicians, functional diagnostics specialists and researchers in order to increase the accuracy of spirometric measurements and reduce the negative impact on the patient.

scholarly journals A European Respiratory Society technical standard: exhaled biomarkers in lung disease

2017 ◽  
Vol 49 (4) ◽  
pp. 1600965 ◽  
Author(s):  
Ildiko Horváth ◽  
Peter J. Barnes ◽  
Stelios Loukides ◽  
Peter J. Sterk ◽  
Marieann Högman ◽  
...  
Keyword(s):  
Task Force ◽  
Exhaled Breath Condensate ◽  
Research Priorities ◽  
Disease Diagnosis ◽  
Future Research ◽  
Exhaled Breath ◽  
Sample Collection ◽  
European Respiratory Society ◽  
Technical Standards ◽  
Breath Tests

Breath tests cover the fraction of nitric oxide in expired gas (FENO), volatile organic compounds (VOCs), variables in exhaled breath condensate (EBC) and other measurements. For EBC and for FENO, official recommendations for standardised procedures are more than 10 years old and there is none for exhaled VOCs and particles. The aim of this document is to provide technical standards and recommendations for sample collection and analytic approaches and to highlight future research priorities in the field. For EBC and FENO, new developments and advances in technology have been evaluated in the current document. This report is not intended to provide clinical guidance on disease diagnosis and management.Clinicians and researchers with expertise in exhaled biomarkers were invited to participate. Published studies regarding methodology of breath tests were selected, discussed and evaluated in a consensus-based manner by the Task Force members.Recommendations for standardisation of sampling, analysing and reporting of data and suggestions for research to cover gaps in the evidence have been created and summarised.Application of breath biomarker measurement in a standardised manner will provide comparable results, thereby facilitating the potential use of these biomarkers in clinical practice.

scholarly journals Technical standards for respiratory oscillometry

2019 ◽  
Vol 55 (2) ◽  
pp. 1900753 ◽  
Author(s):  
Gregory G. King ◽  
Jason Bates ◽  
Kenneth I. Berger ◽  
Peter Calverley ◽  
Pedro L. de Melo ◽  
...  
Keyword(s):  
Quality Control ◽  
Signal Processing ◽  
Task Force ◽  
Forced Oscillation Technique ◽  
European Respiratory Society ◽  
Technical Standards ◽  
Support Threshold ◽  
Adults And Children ◽  
Control Procedures ◽  
Testing Protocols

Oscillometry (also known as the forced oscillation technique) measures the mechanical properties of the respiratory system (upper and intrathoracic airways, lung tissue and chest wall) during quiet tidal breathing, by the application of an oscillating pressure signal (input or forcing signal), most commonly at the mouth. With increased clinical and research use, it is critical that all technical details of the hardware design, signal processing and analyses, and testing protocols are transparent and clearly reported to allow standardisation, comparison and replication of clinical and research studies. Because of this need, an update of the 2003 European Respiratory Society (ERS) technical standards document was produced by an ERS task force of experts who are active in clinical oscillometry research.The aim of the task force was to provide technical recommendations regarding oscillometry measurement including hardware, software, testing protocols and quality control.The main changes in this update, compared with the 2003 ERS task force document are 1) new quality control procedures which reflect use of “within-breath” analysis, and methods of handling artefacts; 2) recommendation to disclose signal processing, quality control, artefact handling and breathing protocols (e.g. number and duration of acquisitions) in reports and publications to allow comparability and replication between devices and laboratories; 3) a summary review of new data to support threshold values for bronchodilator and bronchial challenge tests; and 4) updated list of predicted impedance values in adults and children.

scholarly journals Why clinical training in China should improve: a cross-sectional study of MD graduates

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xiaoning Zhang ◽  
Chong Li ◽  
Cailing Yue ◽  
Xue Jiang ◽  
Junli Cao ◽  
...  
Keyword(s):  
Medical Education ◽  
Patient Safety ◽  
Clinical Supervision ◽  
Clinical Training ◽  
Online Survey ◽  
Task Force ◽  
Teaching Quality ◽  
Academic Degree ◽  
And Training

Abstract Background China is experiencing major medical education reforms that include establishing national training standards, standards for health professionals, and advanced health delivery system requirements. Graduate medical education (GME) is being piloted as a merger of Doctor of Medicine (MD) with PhD programs to improve academic research and clinical training. However, the academic degree-centred system has led to a preoccupation with research rather than clinical training. Unfortunately, there is a shortage of quality information regarding the clinical training of MD graduates from Chinese medical schools. To fill this gap, this general investigation aims to provide the perspective of recent MD graduates in China for the different subspecialties of clinical training as experienced in different contexts. Methods There were 432 MD graduates who participated in an online survey regarding their clinical training. Information collected included overall satisfaction, educational supervision, supervised learning events, curriculum coverage, local teaching, teamwork, educational governance, workload, supportiveness of the environment, feedback, clinical experience, patient safety, handovers, and reporting systems. Results Only 37.4% reported satisfaction with the overall clinical training quality; 54.6% rated the informal and bedside quality as “good”; 64.4% reported they knew who provided clinical supervision; but only 35.5% rated the quality of clinical supervision as high; 51.8% reported that they judged senior physicians as “not competent”; 41.9% agreed that the staff treated each other respectfully; 97.4% admitted that they worked beyond the mandatory hours and claimed they were regularly short of sleep; 84.2% raised concerns about patient safety; 45.3% reported that they received regular informal feedback; 48.1% believed that their concerns about education and training would be addressed. Conclusions This study suggests that the quality of clinical training for MD graduates should be improved. While the overall satisfaction with the teaching quality was acceptable, the quality of many clinical training aspects scored poorly. A major problem seems an undue focus on research in MD/PhD training at the cost of the quality of clinical training, due to career perspectives that undervalue clinical competence. The findings of this study should benefit from a deeper investigation to understand the causes and possible remediation. Suggestions include defining subspecialties and training lengths; monitoring, evaluation, and integration SST with MD degree; providing funds or rewards for academic and clinical training; establishing supervising teams to guide clinical training; and establishing physician scientist task force to help overcome challenges.

scholarly journals COVID-19: guidance on palliative care from a European Respiratory Society international task force

2020 ◽  
Vol 56 (3) ◽  
pp. 2002583 ◽  
Author(s):  
Daisy J.A. Janssen ◽  
Magnus Ekström ◽  
David C. Currow ◽  
Miriam J. Johnson ◽  
Matthew Maddocks ◽  
...  
Keyword(s):  
Palliative Care ◽  
Online Survey ◽  
Task Force ◽  
Psychosocial Care ◽  
Indirect Evidence ◽  
European Respiratory Society ◽  
Consensus Recommendations ◽  
Life Threatening ◽  
Advance Care ◽  
Consensus Guidance

BackgroundMany people are dying from coronavirus disease 2019 (COVID-19), but consensus guidance on palliative care in COVID-19 is lacking. This new life-threatening disease has put healthcare systems under pressure, with the increased need of palliative care provided to many patients by clinicians who have limited prior experience in this field. Therefore, we aimed to make consensus recommendations for palliative care for patients with COVID-19 using the Convergence of Opinion on Recommendations and Evidence (CORE) process.MethodsWe invited 90 international experts to complete an online survey including stating their agreement, or not, with 14 potential recommendations. At least 70% agreement on directionality was needed to provide consensus recommendations. If consensus was not achieved on the first round, a second round was conducted.Results68 (75.6%) experts responded in the first round. Most participants were experts in palliative care, respiratory medicine or critical care medicine. In the first round, consensus was achieved on 13 recommendations based upon indirect evidence and clinical experience. In the second round, 58 (85.3%) out of 68 of the first-round experts responded, resulting in consensus for the 14th recommendation.ConclusionThis multi-national task force provides consensus recommendations for palliative care for patients with COVID-19 concerning: advance care planning; (pharmacological) palliative treatment of breathlessness; clinician–patient communication; remote clinician–family communication; palliative care involvement in patients with serious COVID-19; spiritual care; psychosocial care; and bereavement care. Future studies are needed to generate empirical evidence for these recommendations.

scholarly journals Management of hospitalised adults with coronavirus disease-19 (COVID-19): A European Respiratory Society living guideline

2021 ◽  
pp. 2100048
Author(s):  
James D. Chalmers ◽  
Megan L. Crichton ◽  
Pieter C. Goeminne ◽  
Bin Cao ◽  
Marc Humbert ◽  
...  
Keyword(s):  
Task Force ◽  
Guideline Development ◽  
Meta Analysis ◽  
Invasive Mechanical Ventilation ◽  
Ventilatory Support ◽  
Supplemental Oxygen ◽  
European Respiratory Society ◽  
Antibody Treatment ◽  
Hospitalised Patients

IntroductionHospitalised patients with coronavirus disease 19 (COVID-19) as a result of SARS-CoV-2 infection have a high mortality rate and frequently require non-invasive respiratory support or invasive ventilation. Optimising and standardising management through evidence-based guidelines may improve quality of care and therefore patient outcomes.MethodsA task force from the European Respiratory Society and endorsed by the Chinese Thoracic Society identified priority interventions (pharmacological and non-pharmacological) for the initial version of this “living guideline” using the PICO (population, intervention, comparator, outcome) format. The GRADE approach was used for assessing the quality of evidence and strength of recommendations. Systematic literature reviews were performed, and data pooled by meta-analysis where possible. Evidence tables were presented and evidence to decision frameworks were used to formulate recommendations.ResultsBased on the available evidence at the time of guideline development (February 20th, 2021) the panel makes a strong recommendation in favour of the use of systemic corticosteroids in patients requiring supplementary oxygen or ventilatory support, and for the use of anticoagulation in hospitalised patients. The panel makes a conditional recommendation for IL-6 receptor antagonist monoclonal antibody treatment and high flow nasal oxygen or continuous positive airway pressure in patients with hypoxaemic respiratory failure. The panel make strong recommendations against the use of hydroxychloroquine and lopinavir-ritonavir. Conditional recommendations are made against the use of azithromycin, hydroxychloroquine and azithromycin, colchicine, and remdesivir, in the latter case specifically in patients requiring invasive mechanical ventilation. No recommendation was made for remdesivir in patients requiring supplemental oxygen. Further recommendations for research are made.ConclusionThe evidence base for management of COVID-19 now supports strong recommendations in favour and against specific interventions. These guidelines will be regularly updated as further evidence becomes available.

scholarly journals Task Force report: European Respiratory Society guidelines for the management of children and adolescents with bronchiectasis

2021 ◽  
pp. 2002990
Author(s):  
Anne B. Chang ◽  
Rebecca Fortescue ◽  
Keith Grimwood ◽  
Efthymia Alexopoulou ◽  
Leanne Bell ◽  
...  
Keyword(s):  
Children And Adolescents ◽  
Clinical Outcomes ◽  
Inhaled Corticosteroids ◽  
Task Force ◽  
Future Research ◽  
Advisory Group ◽  
European Respiratory Society ◽  
Task Force Report ◽  
Clinical Questions

There is increasing awareness of bronchiectasis in children and adolescents, a chronic pulmonary disorder associated with poor quality-of-life for the child/adolescent and their parents, recurrent exacerbations and costs to the family and health systems. Optimal treatment improves clinical outcomes. Several national guidelines exist, but there are no international guidelines.The European Respiratory Society (ERS) Task Force for the management of paediatric bronchiectasis sought to identify evidence-based management (investigation and treatment) strategies. It used the ERS standardised process that included a systematic review of the literature and application of the GRADE approach to define the quality of the evidence and level of recommendations.A multidisciplinary team of specialists in paediatric and adult respiratory medicine, infectious disease, physiotherapy, primary care, nursing, radiology, immunology, methodology, patient advocacy and parents of children/adolescents with bronchiectasis considered the most relevant clinical questions (for both clinicians and patients) related to managing paediatric bronchiectasis. Fourteen key clinical questions (7 “Patient, Intervention, Comparison, Outcome” [PICO] and 7 narrative) were generated. The outcomes for each PICO were decided by voting by the panel and parent advisory group.This guideline addresses the definition, diagnostic approach and antibiotic treatment of exacerbations, pathogen eradication, long-term antibiotic therapy, asthma-type therapies (inhaled corticosteroids, bronchodilators), mucoactive drugs, airway clearance, investigation of underlying causes of bronchiectasis, disease monitoring, factors to consider before surgical treatment and the reversibility and prevention of bronchiectasis in children/adolescents. Benchmarking quality of care for children/adolescents with bronchiectasis to improve clinical outcomes and evidence gaps for future research could be based on these recommendations.

scholarly journals ERS clinical practice guidelines on treatment of sarcoidosis

2021 ◽  
pp. 2004079
Author(s):  
Robert P. Baughman ◽  
Dominique Valeyre ◽  
Peter Korsten ◽  
Alexander G. Mathioudakis ◽  
Wim A. Wuyts ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Task Force ◽  
Treatment Guideline ◽  
Evidence Based ◽  
Insufficient Evidence ◽  
European Respiratory Society ◽  
Symptomatic Disease ◽  
First Choice ◽  
Treatment Of Sarcoidosis

BackgroundThe major reasons to treat sarcoidosis are to lower the morbidity and mortality risk or to improve quality of life (QoL). The indication for treatment varies depending on which manifestation is the cause of symptoms: lungs, heart, brain, skin, or other manifestations. While glucocorticoids (GC) remain the first choice for initial treatment of symptomatic disease, prolonged use is associated with significant toxicity. GC-sparing alternatives are available. The presented treatment guideline aims to provide guidance to physicians treating the very heterogenous sarcoidosis manifestations.Materials and MethodsA European Respiratory Society Task Force (TF) committee composed of clinicians, methodologists, and patients with experience in sarcoidosis developed recommendations based on the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) methodology. The committee developed eight PICO (Patients, Intervention, Comparison, Outcomes) questions and these were used to make specific evidence-based recommendations.ResultsThe TF committee delivered twelve recommendations for seven PICOs. These included treatment of pulmonary, cutaneous, cardiac, and neurologic disease as well as fatigue. One PICO question regarding small fiber neuropathy had insufficient evidence to support a recommendation. In addition to the recommendations, the committee provided information on how they use alternative treatments, when there was insufficient evidence to support a recommendation.ConclusionsThere are many treatments available to treat sarcoidosis. Given the diverse nature of the disease, treatment decisions require an assessment of organ involvement, risk for significant morbidity, and impact on QoL of the disease and treatment.MessageAn evidence based guideline for treatment of sarcoidosis is presented. The panel used the GRADE approach and specific recommendations are made. A major factor in treating patients is the risk of loss of organ function or impairment of quality of life.

Systemische Sklerose - eine systematische Übersicht

VASA ◽  
2011 ◽  
Vol 40 (1) ◽  
pp. 6-19 ◽  
Author(s):  
Klein-Weigel ◽  
Opitz ◽  
Riemekasten
Keyword(s):  
Pulmonary Hypertension ◽  
Systemic Sclerosis ◽  
Task Force ◽  
Systemische Sklerose ◽  
Systematische Übersicht ◽  
European Respiratory Society ◽  
High Association ◽  
Microscopic Features ◽  
European Society Of Cardiology ◽  
Genetic Burden

Due to its high association with Raynaud’s phenomenon systemic sclerosis (SSc) is probably the most common connective tissue disease seen by vascular specialists. In part 1 of our systematic overview we summarize classification concepts of scleroderma disorders, the epidemiologic and genetic burden, the complex pathophysiologic background, and the clinical features and the stage-dependent capillary microscopic features of SSc. Furthermore, we address the diagnostic recommendations propagated by the German Network for Systemic Sclerosis and the Task Force for Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology, the European Respiratory Society, and the International Society of Heart and Lung Transplantation.

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