Annual General Meeting of the Irish Thoracic Society - IJMS | Irish ...

VOLUME 174 NUMBER 4 OCTOBER, NOVEMBER, DECEMBER 2005 

SUPPLEMENT 3 

Annual General Meeting of 

the Irish Thoracic Society 

Westwood House Hotel, Galway 

11th and 12th November 2005

ANNUAL MEETING OF THE IRISH THORACIC SOCIETY • 11 - 12 November 2005 • WESTWOOD HOUSE HOTEL, GALWAY 

EDITORIAL BOARD 

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Editor 

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Members 

David Bouchier-Hayes 

Brian Sheppard 

Helen Moore 

John Daly 

Alan Kelly 

C Shields 

TN Walsh 

OS Breathnach 

CF Donegan 

J Fenton 

ADK Hill 

F Howell 

H O’Connor 

S Sreenan 

S Tierney 

FD O’Kelly 

J O’Connor 

D Bouchier-Hayes 

TN Walsh 

K O’Boyle 

E Kay 

D McCormack 

D Curtin 

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IRISH JOURNAL OF MEDICAL SCIENCE • VOLUME 174 • NUMBER 4 • SUPPLEMENT 3

1 

ANNUAL 

SPONSORS 

MEETING OF THE IRISH THORACIC SOCIETY • 11 - 12 November 2005 • WESTWOOD HOUSE HOTEL, GALWAY 


WELCOME 

The Irish Thoracic Society would like to thank the following companies for 

their generous support of the 2005 Annual Meeting: 

• Abbott Laboratories Ireland Ltd 

• Actelion Pharmaceutical 

• Air Products Medical 

• Allen & Handburys 

• Alpha One Foundation 

• Altana Pharma 

• AstraZeneca 

• BOC Vitalair 

• Boehringer Ingelheim – Pfizer 

• Cephalon UK Ltd 

• Cruinn Diagnostics Ltd 

• Direct Medical Ireland 

• Home Health Care Ltd 

• Medicare Rental & Sales Ltd 

• Merck Sharpe & Dohme Ireland 

(Human Health) Ltd 

• MicroMedical Ltd 

• Novartis Ireland Ltd 

• ResMed PEI 

• RespCare Ltd 

• Schering AG 

• Sword Medical Ltd 

• Wyeth Pharmaceuticals 

IRISH THORACIC SOCIETY ANNUAL MEETING 

Westwood House Hotel, Galway 

11th – 12th November 2005 

Welcome 

Welcome to the Westwood House Hotel, Galway for the Irish Thoracic Society 2005 Annual Meeting. 

We look forward to meeting you and hope that you have a stimulating, informative and sociable conference. 

Dr. JJ Gilmartin 

Consultant Respiratory Physician 

Conference programme sponsored by: 

Allen & Handburys and Merck Sharpe & Dohme Ireland (Human Health) Limited 

ii IRISH JOURNAL OF MEDICAL SCIENCE • VOLUME 174 • NUMBER 4 • SUPPLEMENT 3 

IRISH JOURNAL OF MEDICAL SCIENCE • VOLUME 174 • NUMBER 4 • SUPPLEMENT 3 

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1 

SESSION PROGRAMME ONE 

Thursday, 10th November 

14.00 – 17.00 SpR Training — Boardroom 

Friday, 11th November 

8.00 – 8.30 Registration / Tea & Coffee on Arrival — Lobby 

8.45 – 11.45 PHYSIOTHERAPY FORUM 

SPONSORED BY CRUINN DIAGNOSTICS LTD 

8.45 – 11.45 TECHNICIANS’ FORUM 


8.45 – 11.45 NURSES’ FORUM 


Session 1: COPD / Interstitial Disease / Cystic Fibrosis (8.30 – 10.45) 

— Robert Martin Suite 

Chairpersons 

Charlie Gallagher, St Vincents Hospital, Dublin 

Gerry Daly, Altnagelvin Area Hospital, Londonderry 

8.30 1.1 Twice versus once weekly supervision during pulmonary rehabilitation (PR) in 

COPD: 2- and 6-month follow-up 

B O’Neill 1 , JM Bradley, 2,3 I Bradbury, 4 J MacMahon 3 

1. School of Rehabilitation Sciences, University of Ulster, Belfast; 2. School of 

Health and Rehabilitation Sciences Research Institute, University of Ulster, 

Belfast; 3. Dept of Respiratory Medicine, Belfast City Hospital, Belfast; 4. School 

of Biomedical Sciences, University of Ulster, Belfast 

8.42 1.2 Analysis of FEV 1 

/FEV 6 

as an alternative to FEV 1 

/FVC in diagnosing airway 

obstruction using USA and European reference values in an Irish elderly 

population 

J Kelly, 1 PJ Manning, 1 P Goodman 2 

1. Bon Secours Hospital Glasnevin, Dublin 

2. School of Physics, DIT, Kevin Street, Dublin 

8.54 1.3 Inappropriate fractional inspired oxygen concentration (FiO 2 

) in pre-hospital 

and A&E management of acute exacerbations of COPD 

E Hayes, K Russell, U Quinn, G McElvaney and S O’Neill 

Beaumont Hospital, Dublin 


1 

PROGRAMME 

SESSION ONE 

1 

ANNUAL MEETING OF THE IRISH THORACIC SOCIETY • 11 - 12 November 2005 • WESTWOOD HOUSE HOTEL, GALWAY ANNUAL MEETING OF THE IRISH THORACIC SOCIETY • 11 - 12 November 2005 • WESTWOOD HOUSE HOTEL, GALWAY 


9.06 1.4 Influence of CFTR genotype on pulmonary disease in adult Cystic Fibrosis 

patients from Belfast and Dublin Referral Centres 

B Plant, 1, 2 J Courtney, S Elborn, 3 C Gallagher, 2 Clare O’Connor 1 

1. UCD School of Medicine and Medical Science, The Conway Institute 

2. St Vincent’s University Hospital, Dublin 

3. Respiratory Research Group, Depts of Medicine and Clinical Biochemistry and 

Metabolic Medicine, The Queen’s University of Belfast, Belfast 

*Presented by A M McLaughlin, St Vincents University Hospital, Dublin 

9.18 1.5 Outcomes following treatment with home intravenous therapy for acute 

exacerbations of Cystic Fibrosis lung disease 

S O’Beirne, P Barry, T McMahon, CG Gallagher 

Dept of Respiratory Medicine and the National Referral Centre for Adult Cystic 

Fibrosis, St Vincent’s University Hospital, Dublin 

9.30 1.6 Quality of life in Cystic Fibrosis patients at Cork University Hospital 

N Murphy, A Arya, C Sort and CP Bredin 

Dept of Respiratory Medicine, Cork University Hospital, Wilton, Cork 

9.42 1.7 Reversible hypercapnia during acute pulmonary exacerbations in adults with 

Cystic Fibrosis 

DF Waterhouse, CG Gallagher 

Dept of Respiratory Medicine and the National Referral centre for Adult Cystic 


9.54 1.8 Macrophage Migration Inhibitory Factor (MIF) enhances growth of 

P. aeruginosa in vitro: potential therapeutic strategy in Cystic Fibrosis 

AM McLaughlin, ME Armstrong, JA Baugh, SD Donnelly 

Dept of Medicine and Therapeutics, The Conway Institute of Biomolecular and 

Biomedical Research, UCD and St Vincent’s University Hospital, ElmPark, Dublin 

10.06 1.9 ADAM family of genes play a role in collagen deposition in an in vitro model of 

pulmonary fibrosis 

DT Keating, 1, 2 A Patricelli, 1 D Sadlier, 1 P Doran, 1 JJ Egan 2 

1. Genome Research Unit and 

2. Advanced Lung Disease Program, Mater Misericordiae Hospital, Dublin 

10.18 1.10 Safety and efficacy of prolonged treatment of fibrosing alveolitis in 

scleroderma with cyclophosphamide 

MT Henry, 2 S Dass, 1 C Fernandes, 1 B Griffiths, 1 P Emery, 1 

1. Dept of Rheumatology and 

2. Dept of Respiratory Medicine, Leeds General Infirmary, Leeds, UK 

Session 2: Asthma (11.15 – 12.30) — Robert Martin Suite 

Chairpersons 

Anthony O’Regan, University College Hospital, Galway 

Joe McMahon, Belfast City Hospital 

11.15 2.1 Non-adherence remains a problem in difficult asthma 

J Gamble, A Lazenbatt, LG Heaney 

Belfast City Hospital 

11.27 2.2 Osteoporosis in the difficult to treat asthma population 

B Korn, S Kealy, P Manning 

Dept of Respiratory Medicine, St James’ Hospital, Dublin 

11.39 2.3 Fluticasone propionate/salmeterol in combination improves health outcomes 

and quality of life in children with poorly controlled asthma in Ireland 

P Hill, 1 D Grant, 2 W Sawyer, 2 P Reeves, 2 J Hughes 3 

1. Blackpool Health Centre, Blackpool, Co Cork; 2. Fourth Hurdle Consulting, 

London UK; 3. Medical Dept, GlaxoSmithKline, Rathfarnham, Dublin 

11.51 2.4 A randomized, placebo-controlled study of the effects of budesonide and 

budesonide/formoterol during allergen challenge in atopic subjects with 

asthma 

TM O’Connor, MM Kelly, J Otis, GM Gauvreau, J Gauldie, PM O’Byrne 

Mercy University Hospital, Cork; McMaster University, Ontario, Canada 

12.03 2.5 The direct hospital based cost of an acute Asthma exacerbation in the Republic 

of Ireland: COAX study 

JM Hughes, 4 PJ Manning, 1 W McNigholas, 2 S Lane 3 

1. St James’ Hospital, Dublin; 2. St Vincent’s Hospital, Dublin; 3. Adelaide & Meath 

Hospital, Tallaght, Dublin; 4. Medical Dept GlaxoSmithKline, Dublin 

12.15 2.6 Childhood Asthma Admissions, 3 Twelve-Month Studies over 15 Years 

A Shabu, M Carr, BG Loftus 

Dept of Paediatrics, NUI, Galway 

12.30 – 13.00 LUNCH — Restaurant 

SPONSORED BY AIR PRODUCTS MEDICAL 

13.00 – 14.30 POSTER VIEWING — Robert Martin Suite 

10.30 1.11 Efficacy of pulmonary rehabilitation in interstitial lung disease 

DCP McSharry, 1 N Naji, 1 S Donnelly, 2 MC Connor, 1, 3 TJ McDonnell 1, 2 

1. Dept of Respiratory Medicine, St Michael’s Hospital; 2. St Vincent’s University 

Hospital, Dublin; 3. Dept of Physiotherapy, St Michael’s Hospital, Dun Laoghaire 

10.45 – 11.15 MORNING TEA & COFFEE — Exhibition Area 

SPONSORED BY ASTRAZENECA 



1 

PROGRAMME 

SESSION ONE 

1 



Session 3: Poster Discusssion (14.30 – 15.30) — Robert Martin Suite 

Convenors 

Cathal Bredin, Cork University Hospital 

James Hayes, Cavan General Hospital 

Eithne Mulloy, St John Hospital, Limerick 

COPD 

3.1 Long term oxygen therapy use in Ireland; audit of a regional hospital 

I Kamal, A O’Brien 

Midland Regional Hospital Mullingar, Co. Westmeath 

3.2 Unmet daily needs of COPD patients 

A Box, M Logue, A Kennedy, M McCloskey, M Kelly, JG Daly, RA Sharkey 

Foyle Trust, Abercorn Road, Derry, Dept of Respiratory Medicine, Altnagelvin 

Hospital, Derry 

3.3 Lung volume reduction surgery: an unmet need? 

BB Shu, M Connor, G Lawless, M Tolan, TJ McDonnell 

Depts of Respiratory Medicine and Thoracic Surgery St Michael’s and 

St Vincent’s University Hospital, Dublin 

3.4 The efficacy of an assisted discharge programme for patients with Chronic 

Obstructive Pulmonary Disease – a necessary expansion of COPD Outreach 

services at Beaumont Hospital 

JM Shortt, CC Byrne, BM Deering, SJ O’Neill, NJ McElvaney, RW Costello 

Dept of Respiratory Medicine, Beaumont Hospital Dublin 

3.5 Setting up a Pulmonary Rehabilitation Programme 

R O’Farrell, A O’Mahony, A Donnelly, N Brennan, TM O’Connor 

Mercy University Hospital, Cork 

3.6 Prolonged Pulonary Rehabilitation may lead to greater improvements in 

exercise capacity and health related quality of life in COPD 

CA Moore, L Emmett, A Jones, T Platten, PK Plant, MT Henry 

Dept of Respiratory Medicine, Leeds General Infirmary, UK 

3.7 The two year survival for patients with COPD who undergo non-invasive 

ventilation for hypercapnic respiratory failure 

M McCloskey, R Sharkey, S Gallagher, MG Kelly, JG Daly 

Respiratory Unit, Altnagelvin Area Hospital, Glenshane Road, Derry 

3.8 Effect of COPD early discharge programme on length of stay and cost 

S Kealy, M Lawlor, J Farran, L Clancy, J Keane, D O’Riordan, F O’Connell 

Respiratory Assessment Unit, St James’s Hospital, Dublin 

3.9 Alpha 1 Antitryspin Deficiency National Targeted Detection Programme 

T Carroll, C Taggart, C O’Connor, R Costello, SJ O’Neill and NG McElvaney 

Dept of Respiratory Research, RCSI Building, Beaumont Hospital, Dublin 

3.10 Registration to initiation of NPPV – analysis of the time factor in identifying 

suitable patients with COPD 

S Asgedom, L Clancy 

St. James’s Hospital, Dublin 

3.11 Audit on non-invasive ventilation (NIV) and its effectiveness in an exacerbation 

of Chronic Obstructive Pulmonary Disease (COPD) 

TA Howe, JR Williams, G Shivashanker, M Jadoon, F Hardoo 

Medical ward, Erne Hospital, Enniskillen, Co Fermanagh 

3.12 Results Post Initiation of an Out-Patient Pulmonary Rehabilitation Programme 

S Kealy, M Lawlor, J Farran, P Coss, F O’Connell, H Fisher 

Dept of Respiratory Medicine and Physiotherapy Dept, St James’s Hospital, Dublin 

PNEUMOTHORAX 

3.13 Acupuncture associated Pneumothorax 

J Gallagher, MS Murphy, J Carroll 

Dept of Medicine, St Luke’s Hospital, Kilkenny 

3.14 Chest drain management: identifying what nurses need to provide best care 

D Lehwaldt 

School of Nursing, Dublin City University, Glasnevin, Dublin 

3.15 Review of the role of VATS pleurectomy in patients presenting with acute 

pneumothorax with active air leak 

AM Elsiddig, K Doddakula, TB Wedde, A Musa, W Ahmad, CK Young 

Dept of cardiothoracic Surgery, St James Hospital, Dublin 

POPULATION STUDIES 

3.16 A study to estimate the prevalence of idiopathic pulmonary fibrosis in Ireland 

BN McCullagh, JM Coyle, DT Keating, MB Codd, JJ Egan 

Heart Lung Transplant Unit, Mater Misercordiae Hospital, Dublin 

3.17 Investigation of the prevalence of undiagnosed airflow obstruction in 

symptomatic subjects attending a large physiotherapy deptartment 

H Fisher, 1 N Murphy, 1 F O’Connell, 2 J Gormley 3 

1. Physiotherapy Dept and; 2. Dept of Respiratory Medicine, St James’s Hospital, 

Dublin; 3. School of Physiotherapy, Trinity College Dublin 

3.18 The effects of the workplace ban on smoking on the lung function of bar 

workers in Dublin 

M Agnew, P Goodman, L Clancy 

Dept of Respiratory Medicine, St James’s Hospital, Dublin; 

Physics DIT, Kevin Street, Dublin 



1 

PROGRAMME 

SESSION ONE 

1 



SLEEP 

3.19 Endothelial-1 (ET-1) levels in obstructive sleep apnoea (OSA) patients and effect 

of continuous positive airway pressure (CPAP) treatment 

A Arya, M Stack, K O’Sullivan, F Shanahan, CP Bredin 

Dept of Respiratory Medicine, Cork University Hospital, Wilton, Cork and Dept of 

Statistics, University College of Cork, Cork 

3.20 The role of angiogenesis in obstructive sleep apnoea (OSA) 




3.21 Effect of continuous positive pressure (CPAP) treatment on proangiogenic 

factors of angiogenesis in obstructive sleep apnoea (OSA) patients 




PHYSIOLOGY 

3.22 Correlation between spirometry and respiratory resistance measured by 

impulse oscillometry in patients with COPD 

S Morrin, O Corrigan, N Stephens, J Power 

Dept of respiratory Medicine, Naas General Hospital, Co Kildare 

CYSTIC FIBROSIS 

3.23 Distinguishable clinical clusters during acute pulmonary exacerbations of cystic 

fobrosis 

DF Waterhouse, R Barry, CG Gallagher 



3.24 Reproducibility of peripheral muscle strength testing in adult Cystic Fibrosis 

patients 

CM Reilly, 1 DF Waterhouse, 2 CG Gallagher 2 

1. Dept of Physiotherapy and; 2. Dept of Respiratory Medicine, National Referral 

Centre for Adult Cystic Fibrosis, St Vincent’s University Hospital, Dublin 

3.25 The introduction of once daily Tobramycin dosing at the national referral centre 

for adult Cystic Fibrosis in St Vincent’s University Hospital, Dublin 

C Muldowney, C Keane 

Pharmacy Dept, St Vincent’s University Hospital, Dublin 

3.26 Emergence of high grade Tobramycin resistance in P. aeruginosa isolates in the 

sputum of children on bedulised tobramycin solution for inhalation 

P McNally, G Leen, M Doyle, P Murphy, P Greally 

Dept of Cystic Fibrosis National Children’s Hospital, Talaght, Dublin 

3.27 Changes in the nature, severity and frequency of symptoms in patients with 

Cystic Fibrosis during periods of clinical stability 

SU McKenna, DF Waterhouse, CG Gallagher 



3.28 The administration of aminoglycosides to patients with Cystic Fibrosis: 

current practice 

BC Keane 


SARCOIDOSIS 

3.29 Update on familial sarcoidsis in Ireland 

P Govender, SC Donnelly 

Dept of Medicine & Therapeutics, St Vincent’s University Hospital, Dublin 

3.30 Best diagnostic bronchoscopic technique in sarcoidosis 

Y Vapra, A Shamboul, A O’Brien 

Midland Regional Hospital Mullingar, Co Westmeath 

3.31 Audit on the use of serum ACE in an Irish Regional Hospital 

C Murtagh, A Shamboul, Y Vapra, A Brennan, A O’Brien 

Midland Regional Hospital Mullingar, Co Westmeath 

ASTHMA 

3.32 Auditing paediatric asthma – doest it work? 

S Thavagnanam, M Smith 

Dept of Paediatrics and AIR Centre, Craigavon Area Hospital 

3.33 Asthma admissions in children in Galway, trends over 15 years 

A Shabu, E Crushell, BG Loftus 

Dept of Paediatrics, NUI, Galway 

3.34 An evaluation of nurse-led respiratory service in the 21 st century: Can clinical 

nurse specialists make a difference? 

MF O’Driscoll, 1 MM Nagle, 1 Dr TJ Mc Donnell 2 

1. Dept of Nursing and 

2. Respiratory Medicine, St Michaels Hospital, Dun Laoghaire, Co Dublin 

LUNG INFECTION / MECHANISMS 

3.35 Adrenal insufficiency in patients with community acquired pneumonia 

E Kelly, NG McElvaney, SJ O’Neill 

Dept of Respiratory research, Beaumont Hospital, Dublin 

3.36 Predicting bacteraemia in patients with community acquired pneumonia 

E Kelly, P Kane, C Canniffe, NG McElvaney 

Dept of Respiratory Medicine, Beaumont Hospital, Dublin 



1 

PROGRAMME 

SESSION ONE 

1 



3.37 Thalidomide treatment in chronic lung infection 

Y Gunning, N Hopkins, P McLoughlin 

UCD, School of Medicine & Medical Science, Conway Institute 

3.38 Elafin modulates lipopolysaccharide signalling in monocytes 

MW Butler, CC Taggart, I Robertson, CM Greene, SJ O’Neill, NG McElvaney 

Respiratory Research Division, Royal College of Surgeons in Ireland, Education 

and Research Centre, Beaumont Hospital, Dublin 

3.39 Hypoxic induction of proliferation in primary human lung fibroblasts: potential 

implications in pulmonary fibrosis 

AB Byrne, L Li, SC Donnelly, JA Baugh 

Dept of Medicine and Therapeutics, The Conway Institute for Biomolecular and 

Biomedical Research, University College Dublin 

3.40 Congenital Tracheo-Oesophageal Fistula: an unusual cause of recurrent RTIs in 

an adult 

B Kent, D O’Callaghan, D Breen, F O’Connell 

CResT Directorate, St James’s Hospital, Dublin 

MALIGNANCY / TECHNIQUES 

3.41 Angiosarcoma arising from the right atrium: an usual case of recurrent 

pulmonary embolism 

DS O’Callaghan, 1 DP Breen, 1 B Kent, 1 CJ D’Adhemar, 2 M Higgins, 3 F O’Connell, 1 

V Young 1 

1. CResT Directorate, LabMed Directorate; 2. HOPE Directorate; 

3. St James’s Hospital, Dublin 

3.42 St James’ Lung Cancer Audit 2004 

M Devlin, R Luddy, F O’Connell 

St James’s Multidisciplinary Thoracic Oncology Group 

3.43 Managing mesothelioma: a study of local experience 

N Chapman, MA McCann, J Frazer, RP Convery 

Air Lab, Craigavon Area Hospital 

3.44 Five year audit of Abrams Pleural Biopsy 

B Kent, D Breen, D O’Calaghan, F O’Connell 

CResT Directorate, St James’s Hospital, Dublin 

3.45 Single surgeons audit of carinal resections 

K Doddakula, T Akbar, M El Siddig, A Raza, V Young 

Dept of Cardiothoracic Surgery, St James’s Hospital, Dublin 

3.46 Malignant chest wall tumours and tumours invading the chest wall: Surgical 

techniques and results 

K Doddakula, W Ahmed, T Akbar, I Chong, V Young 


3.47 Role of Vascular reconstruction in the resection of thoracic malignancy 

K Doddakula, W Ahmed, T Akbar, I Chong, V Young 


15.30 – 16.00 AFTERNOON TEA/COFFEE — Exhibition Area 


Irish Thoracic Society Lecture (16.00 – 17.00) 

Guest Lecturer 

Professor Tim O’Brien, Professor of Medicine, Dept of Medicine NUIG and 

Director of the REMEDI Programme 

‘Prospects for gene therapy in lung disease’ 

Chairperson 

Professor Gerry McElvaney, Professor of Medicine RCSI 

Irish Thoracic Society AGM & Council Meeting (17.00 – 18.00) 

19.30 WINE RECEPTION 

SPONSORED BY BOC VITALAIR 

20.00 GALA DINNER 

SPONSORED BY ACTELION PHARMACEUTICALS 

Saturday, 12th November 2005 

Session 4: Lung Injury / Inflammation (9.00 – 10.30) 


Chairpersons 

Clare O’Connor,Conway Institute,UCD 

Prof Shane O’Neill, RCSI 

9.00 4.1 Hypercapnia does not attenuate oxidation in the endotoxin induced acute 

lung injury 

A Nichol, D O’Croinin, F Naughton, P McLoughlin 

University College Dublin, School of Medicine and Medical Sciences 

9.12 4.2 Up-regulation of matrix metalloproteases and cathepsins by neutrophile 

elastase: a novel hierarchy in protease regulation 

M Rogan, P Geraghty, C Greene, M Brantly, C Taggart, S O’Neill, NG McElvaney 

Pulmonary research Division, RCSI, Beaumont Hospital, Dublin and 

Dept of Medicine, University of Florida, USA 



1 

PROGRAMME 

SESSION ONE 

1 



9.24 4.3 Endoplasmic reticulum stress-induced apoptosis and its inhibition by 

Tauroursodeoxycholic acid in Alpha-1 antitryspsin deficiency 

S Miller, C Greene, C Taggart, C McElvaney, S O’Neill 

Dept of Medicine, Respiratory Research Division, RCSI Education and Research 

Centre, Beaumont Hospital, Dublin 

9.36 4.4 The role of IL-17 in inflammation and remodelling in the post-transplant airway 

DM Murphy, 1 IA Forrest, 1 C Ward, 1 PA Corris, 1 G Pritchard, 1 D Jones, 2 AJ Fisher, 1 

JJ Egan, 3 TE Cawston, 2 JL Lordan 1 

1. The Applied Immunobiology and Transplantation Research Group and 

2. The Faculty of Medical Sciences, The University of Newcastle-upon-Tyne 

3. The Musculoskeletal Research Group, The Faculty of Medical Sciences, 

The Irish Lung Transplant Programme, The Mater Hospital, Dublin 

9.48 4.5 Mast cells and obstructive airways disease 

M O’Mahony, A Mohd Thabit, H Misran, S O’Neill, N McElvaney 

Respiratory Research, RCSI, Dublin 

10.00 4.6 Viral infection and cytokine responses in exacerbations of COPD 

TE McManus, 1,2 AM Marley, 1 F De Courcey, 3 N Baxter, 1 SN Christie, 2 

HJ O’Neill, 2 JS Elborn, 3,4 PV Coyle, 2 JC Kidney 1 

1. Dept of Respiratory Medicine, Mater Hospital 

2. Regional Virus Laboratory, Royal Victoria Hospital 

3. Respiratory Research Group, Institute of Clinical Science 

4. Dept of Respiratory Medicine, Belfast City Hospital 

10.12 4.7 Increased levels of Cysteinyl and Metalloproteases mediated by a TH 1 response 

in COPD patients 

P Geraghty 

Royal College of Surgeons in Ireland 

10.30 – 11.00 MORNING TEA/COFFEE — Exhibition Area 


Session 5: Smoking / Lung Cancer (11.00 – 12.00) 


Chairpersons 

Luke Clancy, St James Hospital 

Richard Shepherd, Belfast City Hospital 

11.00 5.1 A study to compare the efficiency of sterile talc, tetracycline and bleomycin as 

sclerosing agents for medical pluerodesis in the treatment of malignant 

pleural effusions 

MT Henry, 1 B Ladd, 1 J Tuggey, 1 C Bowker, 1 AG Arnold 2 

1. Dept of Respiratory Medicine, Leeds General Infirmary, UK 

2. Castle Hill Hospital, East Yorkshire, UK 

11.12 5.2 Diagnostic usefulness of central transbronchial needle aspirate 

D O’Callaghan, D Breen, B Kent, S Nicholson, J Keane, F O’Connell 

Dept of Respiratory Medicine, CResT Directorate, St James’s Hospital, Dublin 

11.24 5.3 Diagnostic yield of fluoroscopic-guided transbronchial needle aspiration of 

peripheral pulmonary lesions 

D Breen, D O’Callaghan, B Kent, S Nicholson, J Keane, F O’Connell 

Dept of Respiratory Medicine and Histopathology, St James’s Hospital, Dublin 

11.36 5.4 The Irish workplace smoking ban: an analysis of the exposure levels in Dublin bars 

M McCaffrey, 1 PG Goodman, 2 L Clancy 3 

1. Dublin City Council; 2. Dublin Institute of Technology; 

3. Research Institute for a Tobacco Free Society 

11.48 5.5 Positron Emission Tomography (PET) Staging of nodal disease in patients with 

non-small cell lung cancer 

N Al-Sarraf, K Doddakula, R Aziz, E McGovern, V Young 


Irish Thoracic Society Lecture (12.00 – 13.00) 

SPONSORED BY BOEHRINGER INGELHEIM 

Guest Lecturer 

Dr Frank Sullivan, Consultant Radiation Oncologist, Galway Regional Hospitals 

‘From palliative to prospects of cure; early detection and new modalities in 

treating lung cancer’ 

Prize Presentations (13.00 – 13.15) 

Best Oral Presentation 

ALLEN & HANDBURYS 

Best Basic Poster 

presented by Dr Colin Edwards of 

BOEHRINGER INGELHEIM 

Best Clinical Poster 

presented by Dr Colin Edwards of 

BOEHRINGER INGELHEIM 

13.15 – 14.15 BUFFET LUNCH 

10 IRISH JOURNAL OF MEDICAL SCIENCE • VOLUME 174 • NUMBER 4 • SUPPLEMENT 3 

IRISH JOURNAL OF MEDICAL SCIENCE • VOLUME 174 • NUMBER 4 • SUPPLEMENT 3 11

1 

SESSION ONE 

1 


Session 1: COPD / Interstitial Disease / Cystic Fibrosis 

SESSION ONE 

1.1 

Twice versus once weekly supervision during pulmonary 

rehabilitation (PR) in COPD: 2- and 6-month follow up 

Introduction 

Although two supervised exercise sessions per week 

are recommended in pulmonary rehabilitation (PR), 

33% of UK programmes provide only one supervised 

session. We have previously presented the results 

of a 6 week programme which compared twice 

versus once weekly supervised PR. The aim of this 

study was to compare the long term outcome of this 

programme. 

Method 

91 patients with COPD were randomly assigned to 

Group 1 (n=46): one supervised exercise session per 

week and two unsupervised sessions, or Group 2 (n= 

45): two supervised exercise sessions per week and 

one unsupervised session for 6 weeks. Each group 

attended one standardised education session per 

week. Patients attended for follow up at two and six 

months after completion of the 6 week programme. 

Outcome measures included: Incremental Shuttle 

Walk Test (ISWT), Endurance Shuttle Walk Test 

(ESWT), Chronic Respiratory Disease Questionnaire 

(CRDQ), London Chest Activities of Daily Living 

(LCADL) Questionnaire, and Hospital Anxiety and 

Depression (HAD) scale. 

Statistic analysis 

Repeated measures analysis of variance. 

Results 

Long term data were available for 58 patients (G1 

n=29, G2 n=29). Irrespective of group allocation 

patients demonstrated a decline of the initial 

training effect in all the outcome measures. All of the 

outcome measures had returned to near baseline 

levels at 6 month follow up. Patients who did not 

attend for follow up at 6 months (G1 n=17, G2 n=16) 

demonstrated significantly poorer baseline outcome 

measures relating to disability and handicap than 

those who completed the follow up period. Reasons 

for non completion included illness n=17, unwilling 

to continue n=8, deceased n=5, chest pain n=2, 

transport issues n=1. 

Conclusions 

Irrespective of the frequency of supervision patients 

lost the benefit from the PR programme after 6 

months. This highlights the need to develop strategies 

which will maintain the improvement achieved by PR. 

A minimum standard for follow up and maintenance 

should be identified in future clinical guidelines for 

PR. More disabled patients may be less adherent with 

a hospital based out-patient based PR programme 

and future research needs to determine how best to 

deliver PR to this subgroup patients. 

Acknowledgements 

Multidisciplinary pulmonary rehabilitation team at 

Belfast City Hospital. 

1.2 Analysis of FEV /FEV as an alternative to FEV /FVC in 

1 6 1 

diagnosing airway obstruction using USA and European 

reference values in an Irish elderly population 

Introduction 

Studies from abroad using USA reference values 

have shown the FEV 1 

/FEV 6 

value to be an accurate, 

reproducible, and reliable alternative to the FEV 1 

/FVC 

ratio in the diagnosis of airway obstruction. This 

ratio is particularly useful for patients who cannot 

maintain expiration to provide a satisfactory FVC end 

point. 1 This study was undertaken to evaluate this 

ratio in an Irish population using the USA reference 

values for FEV 1 

/ FEV 6 

. We also evaluated the only 

European published reference values for this ratio, 

which relate to the older 65-85 Yrs population cohort, 

and compared the diagnosis of airways obstruction 

in an elderly Irish patient group (age 65-85yrs) using 

both the USA and European reference values. 

Method 

A retrospective analysis of spirometry data was 

conducted on 68 patients aged 65-85Yrs who 

could exhale for at least six seconds following an 

expiratory maneuver and who met the ATS criteria 

for this. The intra subject coefficient of variance for 

both sets of references was calculated for FEV 1 

/FEV 6 

and FEV 1 

/FVC. Using 2*2 tables the sensitivity and 

specificity of FEV 1 

/FEV 6 

values for diagnosing airways 

obstruction as defined by FEV 1 

/FVC was calculated. 

B O’Neill 1 , JM Bradley, 2,3 

I Bradbury, 4 

J MacMahon 3 

1. School of 

Rehabilitation 

Sciences, University 

of Ulster, Belfast 

2. School of Health 

and Rehabilitation 

Sciences Research 

Institute, University 


3. Dept of Respiratory 

Medicine, Belfast 

City Hospital, Belfast 

4. School of Biomedical 

Sciences, University 


J Kelly, 1 PJ Manning, 1 

P Goodman 2 

1. Bon Secours 

Hospital Glasnevin, 

Dublin 

2. School of Physics, 

DIT, Kevin St, Dublin 

Results 

1.3 

Conclusions 

This study has shown that the reduced intra subject 

variability in FEV 1 

/FEV 6 

compared to FEV 1 

/FVC in both 

reference sets suggests that FEV 6 

is a more explicitly 

defined variable for end of the spirometry test and a 

more accurate way of defining airways obstruction 

in an Irish population undergoing spirometry testing. 

We found significant agreement between FEV 1 

/FVC 

and FEV 1 

/FEV 6 

in both sets of references. Sensitivity 

and Specificity of FEV 1 

/FVC in this Irish cohort reflects 

Introduction 

High flow oxygen administered to patients with 

COPD can exacerbate respiratory acidosis. Current 

management guidelines recommend an FiO 2 

≤ 28% 

for COPD patients pending the result of an arterial 

blood gas (ABG) analysis. However, many COPD 

patients admitted acutely are initially treated with 

inappropriately high FiO 2 

en route to hospital and 

in A&E. 

Method 

We prospectively studied 100 patients presenting to 

A&E with a diagnosis of acute exacerbation of COPD. 

We collected data on FiO 2 

and pH at presentation; 

subsequent need for non-invasive ventilation (NIV) 

and/or intubation; and mortality. 

Results 

Respiratory acidosis was present in 25% of patients 

on initial ABG. Fifteen (60%) acidotic patients were 

USING USA REFERENCE VALUES 2 

USING EUROPEAN REFERENCE 

VALUES 3 

Sensitivity % 100 100 

Specificity % 90.2 93.4 

Intra subject coefficient of 

variation % 

FEV 1 

/FVC = 17.8% FEV 1 

/FVC = 18.3% 

FEV 1 

/FEV 6 

= 13.7% FEV 1 

/FEV 6 

= 14.3% 

the values obtained in previous studies in other 

countries. This work suggests there is a need for 

updated European reference values for FEV 6 

to be 

made available for other age groups. 

References 

1. Swanney,M.Am.J.Respir.Crit.Care Med. 162(3) 917 

2. Hankinson,J.L.Am.J.Respir.Crit.Care Med.159:179- 

187.,1999. 

3. Garcia-Rio et al Eur Respir J 2004;24:397-405 

Inappropriate fractional inspired oxygen concentration 

(FiO 2 

) in pre-hospital and A&E management of acute 

exacerbations of COPD 

treated with an FiO 2 

100% at presentation and the 

FiO 2 

was not documented in a further seven (28%) 

patients. Thirteen (52%) acidotic patients were 

commenced on NIV, one (4%) was intubated, and six 

(24%) died during their admission of which three 

(12%) had received FiO 2 

100% and two did not have 

their initial FiO 2 

documented. 

Conclusions 

Many COPD patients admitted acutely are treated 

with an inappropriately high FiO 2 

. Acidosis is an 

adverse prognostic sign with a 24% mortality 

rate among our acidotic patients, 50% of whom 

were initially treated with a high FiO 2 

. Guidelines 

on oxygen therapy in COPD patients should be 

implemented in the acute care setting to minimise 

acidosis related morbidity and mortality. 

E Hayes, K Russell, 

U Quinn, G McElvaney, 

S O’Neill 

Beaumont Hospital, 

Dublin 



1 

SESSION ONE 

1 


SESSION ONE 

1.4 

1.5 

Influence of CFTR genotype on pulmonary disease in adult 

Cystic Fibrosis patients from Belfast and Dublin referral centres 

Background 

In referring to differences in survival between Cystic 

Fibrosis (CF) patients in the Republic and Northern 

Ireland, the recent Pollock Report 1 also cautions 

on the interpretation of available data, citing 

variation in diagnosis and coding as factors that can 

complicate comparisons. Another factor that can 

greatly influence survival in CF is CFTR genotype. 

The aim of this study was to evaluate differences in 

CFTR genotype between CF patients attending adult 

referral centres in Dublin and Belfast and to assess 

the influence of these differences on pulmonary 

function, a major indicator of pulmonary prognosis 

and survival in CF. 

Methods 

CFTR genotypes on 205 patients attending the 

Dublin centre and 115 patients attending the Belfast 

centre were collected. Pulmonary function was 

assessed on all patients when clinically stable with 

no evidence of acute infection. 

Results 

Just over half (50.4%) of the Belfast group had CFTR 

Introduction 

The management of acute pulmonary exacerbations 

in Cystic Fibrosis has changed in recent years with 

the increasing usage of home intravenous therapy. 

Method 

A retrospective examination of hospital admission 

of patients with acute pulmonary exacerbations 

of Cystic Fibrosis in 2004 was carried out. Total 

admission figures were derived from the HIPE 

system. A review of all home IV prescriptions during 

this time was performed. This was accompanied 

by review of FEV1 values and sputum culture and 

sensitivity corresponding with time of exacerbation. 

Results 

In total there were over 300 episodes of acute 

exacerbations in 2004. There were 298 admissions 

to SVUH with exacerbations in 2004. In this year 

131 courses of home IV’s were prescribed to 77 

patients. Of these 104 were initiated and completed 

genotypes that are associated with mild disease 

compared only 25% of Dublin patients (p

1 

SESSION ONE 

1 


SESSION ONE 

1.8 

1.9 

Macrophage Migration Inhibitory Factor (MIF) enhances 

growth of P. aeruginosa in vitro: potential therapeutic strategy 

in Cystic Fibrosis 

Introduction 

MIF is a pro-inflammatory factor involved in the 

pathogenesis of inflammatory diseases. We have 

demonstrated increased levels of MIF in plasma from 

CF patients. MIF is a unique cytokine as a result of its 

enzymatic activity, the role of which is undetermined. 

Here, we examine the effect of MIF on P. aeruginosa 

growth in vitro and the role of its enzymatic activity 

on bacterial growth. 

Method 

P. aeruginosa (ATCC TM 27853) was cultured according 

to standard methods in DMEM (Gibco BRL) in the 

presence or absence of recombinant human MIF 

(rhMIF; 1-100 ng/ml). The number of bacteria (CFU/ 

ml) was confirmed by serial dilution followed by 

culture on LB plates. To investigate the role of the 

enzymatic activity of MIF, P. aeruginosa was cultured 

in conditioned media harvested from embryonic 

fibroblasts from either MIF + / + , MIF - / - mice or mice 

which were devoid of MIF enzymatic activity 

(P1G mice). 

Results 

An increase in P. aeruginosa growth (CFU/ml) was 

observed in the presence of rhMIF at (1ng/ml; 3.0x10 9 

± 9.5 x 10 8 ) compared with media alone (1.69 x 10 9 

± 2.59 x 10 8 ). Furthermore, a significant increase in P. 

aeruginosa growth was observed following culture in 

conditioned media from embryonic fibroblasts from 

MIF+/+ mice (2.4X10 9 ±1.1 9 CFU/ml) compared with 

mice that were devoid of MIF enzymatic activity (P1G 

mice) (7.7X10 8 ±2.6x10 8 CFU/ml). 

Conclusion 

P. aeruginosa growth is enhanced in the presence of 

rhMIF and this effect may be due to its enzymatic 

activity. This novel observation suggests a potential 

for anti-MIF strategies in the management of 

pseudomonas infection in CF. 

ADAM family of genes play a role in collagen deposition in 

an in vitro model of pulmonary fibrosis 

AM McLaughlin, 

ME Armstrong, 

JA Baugh, SD Donnelly 

Dept of Medicine and 

Therapeutics, The 

Conway Institute of 

Biomolecular and 

Biomedical Research, 

UCD and St Vincent’s 

University Hospital, 

ElmPark, Dublin 

1.10 

Safety and efficacy of prolonged treatment of fibrosing 

alveolitis in scleroderma with cyclophosphamide 

Background 

Although cyclophosphamide has been widely 

used for the treatment of fibrosing alveolitis in 

Scleroderma, there has been debate over the optimal 

treatment regime. 

Methods 

Two groups of patients were studied separately at 

our centre. The first group (Group A, 14 patients) 

were treated with 6 intravenous pulses of 

cyclophosphamide and methylprednisolone at 

monthly intervals for 6 months 1 . A second group of 

patients (Group B, 26 patients) were treated with 15 

pulses of cyclophosphamide and methylprednisolone 

at intervals increasing from 3 to 12 weeks. 

There was the option of increasing the dose of 

cyclophosphamide if patients deteriorated during 

treatment. Both groups were assessed with serial 

pulmonary function tests and HRCT thorax. 

Time 

(months) 

Results 

Both groups of patients had similar characteristics in 

terms of disease duration and initial lung function. 

The effects of treatment on pulmonary function 

tests are shown below. 

Conclusion 

Prolonged treatment with cyclophosphamide and 

methylprednisolone appears safe and may be more 

effective in reducing the progression of lung fibrosis 

in scleroderma. 

Reference 

1. Griffiths B et al. Systemic sclerosis and 

interstitial lung disease: a pilot study to assess 

pulse intravenous methylprednisolone and 

cyclophosphamide J Rhematol 2002; 29(11):2371. 

GROUP A GROUP B GROUP A GROUP B 

% Change 

in DLCO 

p-value 

% Change 

in DLCO 

p-value 

% Change 

in FVC 

p-value 

Change in 

FVC 

p-value 

6 -7.4 0.24 0.5 0.75 0 0.66 0 0.70 

12 -8.6 0.39 -4.3 0.06 3.3 0.34 0.25 0.20 

24 -10 0.04 -6.6 0.14 0.5 0.25 1.2 0.16 

*P-values have been calculated by the Wilcoxon rank test. 

*No patients withdrew from treatment because of toxicity from cyclophosphamide and no deaths were recorded. 

1.11 

MT Henry, 2 S Dass, 1 

C Fernandes, 1 

B Griffiths, 1 P Emery, 1 

1. Dept of 

Rheumatology, and 


Medicine, Leeds 

General Infirmary, 

Leeds, UK 

Introduction 

The molecular mechanisms of Idiopathic Pulmonary 

Fibrosis(IPF) remain elusive. Transforming Growth 

Factor beta 1(TGF-ß1) is a key effector cytokine in the 

development of lung fibrosis. We used microarray 

and computational biology strategies to identify 

gene clusters whose expression is significantly 

altered in alveolar epithelial cells. 

Method 

A549 cells were exposed to 10ng /ml TGFß1 for serial 

time points. Total RNA was used for hybridisation to 

Affymetrix Human Genome U133A microarrays. Each 

in vitro time-point was studied in triplicate and an 

average RMA value computed. Expression data for 

each time point was compared to control and a signal 

log ratio of 0.6 or greater taken to identify significant 

differential regulation. Using normalised RMA values 

and unsupervised Average Linkage Hierarchical Cluster 

Analysis, a list of 200 ECM proteins or modulators of 

matrix turnover was curated via Onto-Compare 

and Gene-Ontology(GO) databases for baited cluster 

analysis of ECM associated genes. 

Results 

Interrogation of the dataset using ontological 

classification focused cluster analysis revealed 

coordinate differential expression of a large cohort 

of extracellular matrix associated genes. Of this 

grouping members of the ADAM (A disintegrin and 

Metalloproteinase domain containing) family of 

genes were found to be differentially expressed. We 

probed pathologenomic activities (activation and 

functional activity) of ADAM19 and ADAMTS9 using 

siRNA and collagen assay. 

Conclusion 

Knockdown of ADAM genes resulted in diminished 

production of collagen in A549 cells exposed to 

TGFß1, suggesting a role for these molecules in ECM 

accumulation in IPF. 

DT Keating, 1, 2 

A Patricelli, 1 D Sadlier, 1 

P Doran, JJ Egan 2 

1. Genome Research 

Unit, and 

2. Advanced Lung 

Disease Programme, 

Mater Misericordiae 

Hospital, Dublin 

Efficacy of pulmonary rehabilitation in interstitial lung disease 

Background 

Pulmonary rehabilitation (PRP) is effective in 

improving exercise endurance and quality of life 

(QoL) in COPD. However, data on the efficacy of PRP in 

interstitial lung disease (ILD) is limited . 

Methods 

35 patients with ILD (mean DLCO 40.3±14.9%pred 

, mean age 67.7±10.7) were admitted to PRP; 19 

completed the 8 weeks programme and 10 were 

followed to 1 year. Pulmonary function tests, exercise 

endurance and QoL (Chronic Respiratory Disease 

- CRDQ, St.George’s Respiratory - SGRQ, Hospital 

Anxiety and Depression - HAD) and dyspnoea were 

measured at baseline, 8 weeks and 1 year. The sample 

studied was subgrouped - group 1 DLCO ≤35%pred. 

(n=14), group 2 DLCO >35% pred. (n=17). 4 patients 

were unable to perform the test. 

Results 

Overall exercise endurance (treadmill) improved 

at 8 weeks (p

21 

1 

SESSION TWO ONE 


Session 2: Asthma 


2 

SESSION 


2.1 

Introduction 

Non-adherence to medication is a probable 

cause of poor control in some difficult asthma 

cases. Management strategies which address this 

issue need to be studied; however we first need 

to understand the extent of the problem. We 

determined the number of patients attending our 

difficult asthma service, who were significantly nonadherent 

to inhaled corticosteroids, (prescription 

filling of ≤50% of prescribed). 

Non-adherence remains a problem in difficult asthma 

prescribed inhaled steroids, 10 (17%) were taking 10 - 

20%, 17 (30%) were taking 31-40% and 26 (46%) were 

taking 41-50%. Of those taking ≥ 50% medication [79 

(55%)], 24 (30%) were taking >100%, 36(46%) were 

taking 71-100% and 19(24%) were taking 51-70%. 

Many of those who were non-adherent requested 

multiple beta-agonist inhalers (6 month period, 

median 8, range 0 to 88), suggesting that symptoms 

remained prominent and retrieving prescriptions 

was not the primary problem. 

J Gamble, A Lazenbatt, 

LG Heaney 

Belfast City Hospital 

2.3 

osteoporosis or osteopenia. Patients with these 

conditions tended to be older. However, this is a 

younger group than expected for these conditions. 

Severity of asthma did not seem to affect level of 

osteoporosis in both genders. Overall t - scores were 

lower in the spine compared to the hip. 

Conclusions 

This audit showed high incidence of reduced 

BMD in this group of asthma patients. Patients 

with more difficult to treat asthma need bone 

health assessments. Further studies focussing on 

osteoporosis treatment, preventative strategies and 

evaluation of such measures are required. 

Fluticasone propionate/salmeterol in combination improves 

health outcomes and quality of life in children with poorly 

controlled asthma in Ireland 

Method 

Patient prescription refill data for inhaled 

corticosteroids for the preceding 6 months was 

obtained from GPs. Refill rates were compared 

to prescribed medication and expressed as a 

percentage. 

Results 

143 subjects were assessed, of those 57 (40%) were 

non-adherent [7 (5%) none available]. Of those who 

were non-adherent 4 (7%) were taking < 10% of 

2.2 

Introduction 

Assessment for the development of osteoporosis in 

the asthma population using Dexa scanning is now 

becoming more common. To evaluate bone health 

of asthma patients in SJH, a retrospective audit was 

performed. 

Method 

Data was analysed on 74 patients (58 F, 16M) mean 

age 55.27 +/- 12.23, attending a difficult to manage 

asthma clinic. FEV1 % predicted ranged between 38- 

Conclusion 

Despite severe symptoms and attendance at a 

difficult asthma service a significant proportion 

of patients remain non-adherent to inhaled 

corticosteroid therapy. These results support the 

need for the development of strategies to improve 

adherence in this population. It also suggests that 

objective review of computerised prescribing records 

should be a mandatory part of the assessment of 

difficult asthma. 

Osteoporosis in the difficult to treat asthma population 

N=74 

NORMAL BMD 

N = 31.1% 

OSTEOPENIA 

N = 41.9 % 

112%. Patients were randomly referred for Dexa scans 

between 1999-2005. Anova and Chi square analysis 

was used to examine relationship between bone 

mass density (BMD) and other variables. 

Results 

See table below. 

Discussion 

High rates of osteoporosis and osteopenia were 

found in this population. 2/3 of patients have either 

OSTEOPOROSIS 

N = 27% 

P VALUE 

Mean age (SD) 49.91 +/-12.87 56.61 +/- 10.37 60.6 +/- 10.6 P=2 points 

between w0 and w16*. Mean day and night time 

symptoms scores improved by 1.5 points* and 1.6* 

points respectively between w0 and w16. Patients 

reported a mean of 3.9 more days per week without 

asthma symptoms and 4.6 fewer days using short 

acting βtwo agonist medication per week between 

w0 and w16*. Children missed 1.6 fewer school days 

per month between w0 and w16*. Carers missed a 

mean of 1.2 fewer days per month from work*. No 

treatment related adverse events were reported. 

Conclusions 

SFC significantly improved asthma symptoms, 

quality of life and daily activities of uncontrolled 

paediatric asthma patients and their families. 

* P

21 

1 




2 

SESSION 


2.5 

Results 

Inhaled budesonide and budesonide / formoterol 

significantly increased methacholine PC 20 

from day 

1 to day 8, attenuated the late allergen response and 

prevented a significant fall in methacholine PC 20 

after 

allergen challenge. However, inhaled budesonide 

/ formoterol led to a greater increase in preallergen 

methacholine PC 20 

compared with inhaled 

budesonide alone, significantly attenuated the 

early allergen response and prevented a significant 

rise in sputum eosinophils after allergen challenge. 

The latter effects were not seen in subjects taking 

inhaled budesonide alone. 

Conclusions 

Formoterol has additional anti-inflammatory actions 

as well as expected bronchodilating properties during 

allergen challenge in atopic subjects with asthma. 

The direct hospital based cost of an acute asthma 

exacerbation in the Republic of Ireland: COAX study 

Introduction 

Despite the standards of asthma control 

recommended in national and international 

evidenced-based guidelines, patients continue to 

demonstrate sub-optimal control of symptoms 

and experience acute asthma exacerbations. 

Exacerbations are a key cost driver in asthma 

management. Given that routine clinical practise 

for the management of exacerbations varies across 

international healthcare systems, it is difficult 

to extrapolate Irish costs from any previously 

undertaken studies. Hence the purpose of this 

study was to estimate the direct cost of managing 

a hospital based acute asthma exacerbation in the 

Republic of Ireland (ROI). 

 

 

 

 

 

 

 

 

 

 

 

 

 

Methods 

Patients, ≥ 16 years of age, with asthma and who made 

an unscheduled visit to one of the three main teaching 

hospitals serving the south Dublin catchment 

area with an exacerbation asthma were recruited. 

Information on healthcare resource utilization and 

the outcome of the exacerbation were recorded. 

The economic analysis was conducted from the 

perspective of the Irish healthcare system. 

Results 

A total of 105 patients were recruited. The mean (SD) 

age was 37.3 years (15.6). Women accounted for 68% 

of the sample. The number of patients with mild/ 

moderate and moderate/severe asthma were similar. 

The mean (SD) direct costs of an asthma exacerbation, 

by severity of the exacerbation, are shown in table 1. 

PJ Manning, 1 

W McNigholas, 2 

S Lane, 3 JM Hughes 4 

1. St James’ Hospital, 

Dublin 

2. St Vincent’s 


3. Adelaide & Meath 

Hospital, Tallaght, 

Dublin 

4. Medical Dept 

GlaxoSmithKline 

Dublin 

2.6 

Childhood asthma admissions, three 12-month studies over 

15 years 

Background 

Admissions for childhood asthma have declined over 

the past 10 years. The reasons for this decline are not 

known. 

Setting 

Paediatric unit in a regional general hospital, with 

a stable urban/rural catchment population of 

approximately 45,000 children under 15 years. 

Design 

A prospective study of all acute asthma admissions 

of children aged 1-14 years over a 12 month period 

was undertaken. Data was compared to a similar 

study in 1990, and a retrospective study in 1997. 

Results 

There was a large decline in the number of 

admissions. The fall was most marked in school age 

children. The treatment of asthma in the community, 

and in hospital was more aggressive. There were 

more children diagnosed, and on prophylactic 

therapy prior to admission. There was greater use 

of oxygen and nebulised ipratropium in hospital, 

and milder cases were discharged more quickly. 

Subjective assessment of attacks indicated increased 

severity. 

Conclusions 

We have shown that the fall in asthma admissions 

was accompanied by more aggressive management 

in the community, with only minor changes in 

the severity of symptoms in those admitted. The 

reduction in admissions was most evident in school 

age children. These data are consistent with the 

hypothesis that better management of asthma in 

the community is responsible for the reduction in 

admissions. 

A Shabu, M Carr, 

BG Loftus 

Dept of Paediatrics, 

NUI, Galway 

Table 1 

MEAN (SD) DIRECT COST OF AN ACUTE ASTHMA EXACERBATION BY SEVERITY OF EXACERBATION, E 

SEVERITY OF PATIENT 

ASTHMA EXACERBATION 

MEDICATIONS & 

DEVICES 

HOSPITALISATION 

OTHER DIRECT 

COSTS 

TOTAL 

Mild (19%) 

Moderate (36%) 

Severe (45%) 

1754.3 (6990.5) 

718.9 (1218.5) 

867.8 (458.8) 

762.7 (1302.4) 

1882.8 (1646.8) 

2520.1 (1754.8) 

56.5 (93.1) 

120.3 (102.4) 

203.4 (177.3) 

2573.6 (7008.7) 

2722.0 (2394.0) 

3591.3 (2136.6) 

Total 982.8 (3113.6) 1954.7 (1748.2) 145.3 (149.9) 3082.8 (3639.6) 



31 

1 

SESSION THREE ONE 


Session 3: Poster Discusssion Session 


3 

SESSION 


COPD 

3.1 

Long term oxygen therapy use in Ireland; audit of a 

regional hospital 

Introduction 

An audit of the use of long-term oxygen therapy 

(LTOT) in an Irish Regional Hospital. 

Methods 

Retrospective review of patients who were initiated 

on LTOT at the Midland Regional Hospital Mullingar 

between 2002 and 2004 

Research 

Data from 108 patients was reviewed. The mean age 

of the population was 68 years; 54% were male. 33% 

of the patients were actively smoking tobacco up until 

the time of initiating LTOT. Eighty five of the patients 

(79 %) had a diagnosis COPD as the reason for their 

hypoxaemia. Only 36% of the patients had pulmonary 

function tests performed, though the majority of 

patients (85%) had arterial blood gases taken. 

3.2 

Unmet daily needs of COPD patients 

Introduction 

The effects of exacerbation of COPD can remain 

long after the acute phase has passed. It impacts 

not only on lung function but also on Activities of 

Daily Living (ADLs) and emotional well-being. One 

month following discharge, 30% of elderly patients 

still have compromised mobility and 90% are unable 

to perform all household chores. Early Supported 

Discharge (ESD) schemes for COPD patients attempt 

to provide medical, nursing and social support 

in their own homes during the acute phase and 

many schemes report short term outcomes such as 

reduced length of hospital stay. However, it is not 

always clear if the longer-term needs of patients 

have been addressed. 

Method 

Review of documentation used by Foyle & 

Altnagelvin ESD scheme to assess the effectiveness 

of nursing interventions in relation patients longterm 

needs. 

Results 

89 patients’ (46F/43M) records between Nov. 2004 

- July 2005 were analysed. Mean age was 68yrs (51- 

Very few patients had their LTOT prescribed by GP’s 

(3%), the remainder having their oxygen prescribed 

by general and chest physicians. All patients had a 

back-up cylinder of oxygen provided, and 84% had 

concentrators; only a third (36%) had been provided 

portable oxygen. Though the concentration of oxygen 

had been prescribed in the majority (91%), only 79% 

had the duration of therapy specified. 86% of the 

patients were followed up in clinic; however, only 42% 

of them were re-evaluated for continued need for 

LTOT. None of the patients had their LTOT withdrawn. 

Conclusion 

LTOT is presently not being properly prescribed. 

Appropriate follow-up is also inadequate. 

85 years), 24% lived alone, 34% never left their home, 

36% were on LTOT and 48% had long term assistance 

with personal care. 

Nurse referrals for Long-term Personal Care = 9%, 

for ADL equipment = 60%, for Occupational Therapy 

assessment for adaptations =19%, for Specialist 

Nursing & PAMs input =15%, for pulmonary 

rehabilitation = 27% and miscellaneous referrals =10%. 

Conclusions 

This review highlighted that nursing follow-up of 

patients in their home can identify and address 

deficiencies in care and social support for COPD 

patients. Therefore, we would recommend that a 

home assessment of post exacerbation patients, who 

feel disabled, is an essential component of holistic 

COPD management. 

I Kamal, A O’Brien 

Midland Regional 

Hospital Mullingar, 

Co. Westmeath 

A Box, M Logue, 

A Kennedy, 

M McCloskey, M Kelly, 

JG Daly, RA Sharkey 

Foyle Trust, Abercorn 

Road, Derry, Dept of 

Respiratory Medicine, 

Altnagelvin Hospital, 

Derry 

3.3 

Lung volume reduction surgery: an unmet need? 

Therapeutic options for patients with severe COPD 

are limited but lung volume reduction surgery 

(LVRS) has been proposed for selected patients with 

severe emphysema. The procedure involves the 

bilateral resection of diseased lung through a median 

sternotomy. There is no established LVRS programme 

in Ireland. We report two patients with heterogeneous 

emphysema who underwent LVRS urgently following 

development of acute respiratory failure. 

Case 1 

A 48-year-old ex-smoking male was admitted with an 

exacerbation of COPD. He had received conventional 

treatment including pulmonary rehabilitation. Despite 

intensive treatment he failed to improve and proceeded 

to bilateral LVRS. He made a successful recovery. 

Preoperative and postoperative PFTs are shown. 

3.4 

Introduction 

In Beaumont Hospital, exacerbations of COPD 

account of 10% of total medical admissions. These 

patients are often ill-prepared for their transition 

from hospital to home. Our aim is to identify the 

benefits of an assisted discharge programme for 

this patient group who were ineligible for our COPD 

Outreach Programme. 

Method 

An initial inpatient assessment was completed 

by the Outreach team. An average of two home 

visits with follow-up phone calls over a two week 

period was carried out. Outcome measures included 

spirometry and Borg breathlessness scale. 

Emphasis was on medication compliance, education 

Case 2 

A 53-year-old ex-smoking male was admitted with an 

exacerbation of COPD in March 2005. Similarly he had 

received conventional treatment including pulmonary 

rehabilitation. He had known ischaemic heart 

disease. Despite intensive treatment he remained in 

respiratory failure dependent on NIV. He proceeded 

to LVRS. This was complicated by a post-operative 

cardiac arrest. The patient was slowly mobilized but 

deteriorated and died 111 days postoperatively. 

Both patients had been considered for LVRS electively 

but in the absence of an established programme 

they only proceeded to surgery when they acutely 

deteriorated. We conclude that an elective LVRS 

programme is needed in Ireland. 

PREOPERATIVE 

POSTOPERATIVE 

FVC 3.88 (72%) 4.25 (92%) 

FEV1 1.57 (42%) 2.87 (76%) 

TLCO 13.88 (43.86%) 18.36 (58.38%) 

TLC He. Dilution 6.71 (95.05%) 6.39 (90.48%) 

FRC 3.59 (103.7%) 3.12 (89.71%) 

TLC Body Plethysmography 9.25 (130.9%) 7.06 (99.9%) 

ITGV 6.36 (183.6%) 3.65 (104.8%) 

The efficacy of an assisted discharge programme for 

patients with chronic obstructive pulmonary disease 

– a necessary expansion of COPD outreach services at 

Beaumont Hospital 

and life-style changes including smoking cessation, 

coping mechanisms and self management plans. 

Results 

Over six months (January to July 2005), a total of 

24 patients were recruited. 12 Males and 12 Females 

with a mean age of 78 (± 8.6). Mean FEV 1 

% predicted 

- 35% (± 14.2). Median Borg score 0.5 (±1.1). Median 

MRC 2. Average length of stay 7.3 days (± 6.1). 80% of 

patients, post discharge, required further community 

referrals by the team for example: provision of home 

oxygen and social services. 

Conclusion 

An assisted discharge service bridges the gap 

between hospital and community by providing a 

safe, seamless transition home for COPD patients. 

BB Shu, M Connor, 

G Lawless, M Tolan, 

TJ McDonnell 

Depts of Respiratory 

Medicine and Thoracic 

Surgery St Michael’s 

and St Vincent’s 


Dublin 

JM Shortt, CC Byrne, 

BM Deering, SJ O’Neill, 

NJ McElvaney, 

RW Costello 

Dept of Respiratory 

Medicine, Beaumont 

Hospital Dublin 



31 

1 




3 

SESSION 


3.5 

Setting up a pulmonary rehabilitation programme 

Background 

Pulmonary rehabilitation for patients with chronic 

pulmonary disease is cost-effective, improves 

quality of life, increases exercise capacity and 

reduces exacerbations and inpatient admissions. We 

sought to establish a pilot pulmonary rehabilitation 

programme in our institution. 

Methods 

We researched the literature on the methods used in 

other centres, and visited an established program in 

another Irish hospital. Six patients were enrolled to 

the pilot group: 5 had COPD; 1 had asthma. Baseline 

demographic and anthropometric data were gathered. 

Pulmonary function, respiratory muscle strength and 

exercise capacity were assessed. Symptoms were 

evaluated using published respiratory questionnaires. 

Participants attended 16 sessions over 8 weeks, 

comprising biweekly exercise sessions, supervised by 

the physiotherapist, and weekly lectures from medical, 

paramedical and nursing staff. 

Results 

Attendance was 100% with 98% completion of 

sessions. Patients had improvements in respiratory 

symptoms and symptoms of anxiety and depression, 

3.6 

Prolonged pulonary rehabilitation may lead to greater 

improvements in exercise capacity and health related 

quality of life in COPD 

Background 

BTS guidelines recommend pulmonary rehabilitation 

(PR) for patients with COPD. The optimum number of 

training sessions has not been established. 

Methods 

Three outpatient PR programmes of 8, 12 or 16 

sessions, over 6 to 8 weeks, were conducted using 

standardized local guidelines. Patients with stable 

chronic respiratory disease were prospectively 

as measured by the St. Georges Respiratory, Chronic 

Respiratory Disease and Hospital Anxiety and 

Depression Questionnaires. Most strikingly, exercise 

capacity increased dramatically after completion of 

the programme (40% increase in Shuttle Walking 

Test and 68.6% increase in Treadmill distances). 

 

 

 

 

 

 

 

 

 

 

 

Conclusions 

The pilot study showed that results reported in 

international studies of pulmonary rehabilitation 

can be reproduced in an Irish hospital setting. 

Extrapolating our results into the future, we can 

expect significant, cost-effective improvements in 

morbidity, mortality and acute hospital admissions. 

recruited. The ISWT (incremental shuttle walk test) 

and SR-CRQ (self-reporting chronic respiratory 

questionnaire) were used to assess exercise capacity 

and quality of life pre and post programme. 

Results 

126 patients were included, matched between 

programmes for age, sex, lung function and baseline 

ISWT distance. Outcome results are expressed as a 

median. 

PROGRAMME NUMBER 

INCREASE 

CHANGE IN SR-CRQ 

IN ISWT DYSPNOEA FATIQUE EMOTION MASTERY 

A: 8 sessions 40 5 metres 0.60 0.75 0.40* 0.00* 

B: 12 sessions 42 55 metres† 0.70 1.25 0.80 1.00 

C: 16 sessions 44 90 metres† 0.60 0.65 0.86 0.75 

R O’Farrell, 

A O’Mahony, 

A Donnelly, N Brennan, 

TM O’Connor 

Mercy University 

Hospital, Cork 

CA Moore, L Emmett, 

A Jones, T Platten, 

PK Plant, MT Henry 



General Infirmary, UK 

3.7 

Increase in ISWT distance was highly significant in 

programmes B and C (p

31 

1 




3 

SESSION 


3.9 

Alpha 1 Antitryspin Deficiency National Targeted Detection 

Programme 

Introduction 

Alpha 1 antitrypsin (AAT), a serine protease inhibitor, 

is a glycoprotein synthesised chiefly in the liver and 

is the most important antiprotease in the lung. AAT 

deficiency is a hereditary autosomal codominant 

disorder, resulting from mutations in the AAT gene, 

and classically presents with emphysema in youngto 

middle-aged adults and liver disease in childhood 

and occasionally in adulthood. The most common 

phenotype presenting with clinical evidence of AAT 

deficiency is the Z phenotype, resulting in decreased 

levels of circulating AAT due to retention of the 

aberrantly folded protein in the liver. It is unclear 

whether the MZ phenotype confers increased risk 

for disease. Demographic studies indicate that AAT 

deficiency is under-diagnosed and prolonged delays 

in diagnosis are common. World Health Organisation 

guidelines advocate targeted detection programmes 

of patients with COPD and asthma. 

Results 

500 individuals with COPD or asthma attending 

3.10 

the respiratory outpatients clinic in Beaumont 

Hospital were screened. A combination of serum 

AAT measurement by radial immuno-diffusion (RID), 

AAT phenotyping by isoelectric focussing, and AAT 

genotyping by PCR identified 15 ZZ, 53 MZ, 39 MS, 

7 SZ, and 1 SS patient. 

Conclusions 

The percentage of deficiency alleles was higher than 

anticipated from studies in other populations. The 

S variant, common to the Iberian Peninsula, was 

detected with unusually high frequency. Several other 

rarer phenotypes were also identified. Further analysis 

will reveal whether these phenotypes predispose 

individuals to lung disease. Increased awareness and 

understanding of AAT deficiency will prevent the 

continuing under-diagnosis of this condition. 

Acknowledgements 

Alpha 1 Foundation Ireland and Department of 

Health and Children AAT Targeted Detection 

Programme. 

Registration to initiation of NPPV – analysis of the time 

factor in identifying suitable patients with COPD 

T Carroll, C Taggart, 

C O’Connor, 

R Costello, SJ O’Neill, 

NG McElvaney 


Research, RCSI Building, 


Dublin 

3.11 

Audit on non-invasive ventilation (NIV) and its 

effectiveness in an exacerbation of chronic obstructive 

pulmonary disease (COPD) 

Introduction 

The British Thoracic Society (BTS) published guidelines 

on the use of (NIV) in 2002 (Thorax 2002: 57: 192-211). 

On introducing this service in June 2004, we wished 

to determine its effectiveness of the Harmony Bipap 

machine (Respironics Inc), and the compatibility of our 

service with the BTS guidelines. 

Method 

We preformed an audit on all patients that received 

NIV from June 04 to May 05, using the NIV audit sheet 

from the BTS guidelines. 

Results 

Number of patients treated were fifteen, with two 

requiring a second application of NIV, (F=4,M=11). 

Diagnosis; 80% had COPD, 6% had COPD and asthma 

and 6% had COPD and obesity. Number of chest 

x-rays preformed prior to initiation = (Yes-16 + No- 

1).Arterial blood gases (ABG) prior to initiation = (Y-17 

+ N-0).ABG’s preformed pre-discharge = (Y-12 + N-5). 

Spirometery preformed pre-discharge = (Y-6 + No-11). 

Documentation of informed consent and action to 

taken if NIV fails = (Y-6 + No-11). Average length of 

stay of those treated with NIV = 12.5 days, and those 

receiving conservative treatment prior to the NIV 

service = 18.3 days. Benefits of NIV = (Y-13 + No-4). 

Final outcome was fourteen were discharged home, 

one was a bridge to mechanical ventilation and two 

died a few days later. Follow up as an outpatient = (Y-6 

+ No-9). 

Conclusions 

Marked improvements for patients treated with 

NIV. Reduced hospital stay and morbidity. Less need 

for intubations and it proved cost effective. Some 

of the recommendations made are; Proper written 

documentation regarding consent, prognosis 

and options if NIV fails. Early initiation of NIV. All 

patients followed up at outpatients. A new proforma 

based on the BTS guidelines. Induction for all new 

Junior Doctors on NIV and the use of the Harmony 

machine.12 monthly updates on NIV for all nurses and 

physio’s on medical ward. Changes to be considered; 

Dedicated respiratory beds with specialised nursing 

staff. An ABG analyser for medical ward. Domiciliary 

NIV service to be considered for the future 

TA Howe, JR Williams, 

G Shivashanker, 

M Jadoon, F Hardoo 

Medical ward, Erne 

Hospital, Enniskillen, 

Co Fermanagh 

Introduction 

For successful outcome NPPV has to be considered 

early in the course of respiratory failure before severe 

acidosis develops and early identification of suitable 

candidates for NPPV is essential. The purpose of 

this audit is therefore, to determine the time factor 

on the appropriate and effective use of the service. 

Furthermore the study examined the usefulness 

of the Manchester Triage System (MTS) to identify 

patients with acute exacerbation of COPD who need 

non-invasive ventilation. 

Methods 

All COPD patients who were treated with NPPV 

between Jan. 2000 and Dec. 2003 were included. 

Time intervals from registration to ventilation, triage 

category and index ABG were analyzed. Non-COPD 

patients, those who need immediate intubation and 

adjuvant to weaning and those on home NPPV 

were excluded. 

Results 

A total of 107 patients (with COPD as their primary 

diagnosis) out of 147 episodes of acute respiratory 

failure in 131 patients treated with NPPV were 

analyzed. 47 (44%) were males and 60 (56%) females 

with mean age of 66 years. 

The average time interval between registration and 

triage was 12minutes. According to MTS only 39% 

were in category 2 and 59% were given low priority 

(category 3 or above). 

The mean time interval to see a doctor and for 

respiratory consult (ventilation) were 82 minutes 

and 26 hours respectively. From the time of index 

ABG 28.5% of cases were ventilated after 29 hours. 

Average length of hospital stay and duration of 

ventilation were 22 days and 7.45 days respectively. 

13 patients admitted through out-patients stayed 

in hospital for an average of 17 days and needed 

ventilation for an average of 3.6 days. 

Conclusion 

There is significant delay on initiation of NPPV. This 

might be the reason for the prolonged hospital 

stay and duration of ventilation. Patients admitted 

through out-patients had a shorter on ventilation 

and shorter hospital stay. The MTS, which is proved 

to be sensitive, has failed to identify COPD patients 

who needs non-invasive ventilation and needs to be 

reviewed. Including ABG as part of the triage system 

should improve the sensitivity to identify this group 

of patients early. 

S Asgedom, L Clancy 

St. James’s Hospital, 

Dublin 

3.12 

Results post initiation of an out-patient pulmonary 

rehabilitation programme 

Introduction 

Despite being proven worldwide, pulmonary 

rehabilitation programmes are still not widely 

available to COPD patients in Ireland. In 2004, the 

Respiratory Assessment Unit launched a pulmonary 

rehabilitation programme. 

Method 

Patients attended twice weekly for eight weeks, 

for one hour of exercise, and an education talk. Pre 

and post programme individual out-patient assessments 

consisted of medical history, resting values 

of heart rate, respiratory rate, oxygen saturation, 

BORG breathlessness scale, medical research council 

dyspnoea scale (MRCD), and inhaler technique assessment. 

Patients performed a six-minute walk 

test, three-minute step test, and pulmonary function 

tests including inspiratory muscle strength testing. 

Patients completed a hospital anxiety and depression 

scale (HADS), and a St. Georges Respiratory Diseases 

Questionnaire (SGRQ). An anonymous patient satisfaction 

survey was returned at the end of the programme. 

Results 

Three classes enrolled to date (39 patients in total), 

with 32 patients (82.1%) completing the eight weeks. 

Analysis of results showed significant increases in 

6-minute walk test (p

31 

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3 

SESSION 


Pneumothorax 

3.13 

Acupuncture associated pneumothorax 

3.15 

Review of the role of VATS pleurectomy in patients 

presenting with acute pneumothorax with active air leak 

Introduction 

A 60 year old lady presented to the Emergency 

Department with a 10 hour history of left sided, 

non-pleuritic chest pain following an acupuncture 

session. She did not complain of dyspnoea. The 

treatment had involved the insertion of paravertebral 

needles and was performed by a medically qualified 

general practitioner. Chest radiograph showed a 

large left sided pneumothorax with no significant 

mediastinal shift. A 20Fr chest drain was and this 

was removed 24 hours later without complication. 

Discussion 

Acupuncture is a branch of ancient Chinese 

medicine that is increasingly being used in Ireland. 

The absolute risk of pneumothorax in acupuncture 

has been found to be very low. However it is a 

significant cause of iatrogenic pneumothorax in 

countries where acupuncture is widely practised, as 

demonstrated by a study in Japan which showed 

that 9% of secondary pneumothoraces were due 

to acupuncture. In parasternal, midclavicular and 

supraclavicular regions it has been found that a 

puncture depth of 10-20mm can reach the lungs. 

Along the back, as in this case, the lungs lie 15-20mm 

below the skin. Depending on skin resistance and 

needle thickness a degree of soft tissue compression 

can occur which will shorten this distance to 

the lungs. 

Conclusion 

The safety of complementary therapies is what 

attracts many. It is important that healthcare 

workers are aware of the possible adverse effects and 

how they present given the rise in numbers seeking 

acupuncture and its increasing use by orthodox 

medical practitioners. The treatment of pain without 

proper diagnostic studies may lead to a delay in 

diagnosis of complications such as a pneumothorax 

and we would suggest that the use of chest 

radiography should be considered early if respiratory 

status changes following an acupuncture session. 

J Gallagher, 

MS Murphy, J Carroll 

Dept of Medicine, 

St Luke’s Hospital, 

Kilkenny 

Video assisted thoracic surgery (VATS) is now widely 

accepted to be superior to thoracotomy in elective 

treatment of primary spontaneous pneumothorax. 

It allows operations to be performed with a better 

cosmetic result, less pain and shorter recovery than 

conventional open thoracotomy. However the role 

of VATS in the management of patients with active 

air leak is less clear. The cardinal principles of open 

operation have been to identify and stop the leak as 

well as performing a surgical pleurodesis to prevent 

recurrence. It is difficult to reproducibly identify the 

air-leak in all patients videoscopically and some 

surgeons have avoided this technique in acute 

situations. 

We studied the role of videoscopic pleurectomy. All 

patients having surgery over a five year period by 

a single surgeon were included. One hundred and 

ninety-eight consecutive patients underwent VATS 

intervention for pneumothorax between January 

2000 and June 2005. Seventy-one of these had active 

air leak. The mean duration of pre-operative air leak 

was 12 days. There were 132 males and 66 females, 

with an age range from 16 to 48 years (mean 25 

years). There was one intra-operative and one postoperative 

(day 2) conversion to open thoracotomy. 

Both were for excessive bleeding. Two patients had 

prolonged air leak. One hundred and seventy-three 

of 198 patients were discharged within four days of 

surgery. 

This study demonstrates that VATS is suitable 

for both elective and urgent intervention for 

pneumothorax. This procedure has benefits of 

a shorter in-hospital stay, less pain and a better 

cosmetic result. 

AM Elsiddig, 

K Doddakula, 

TB Wedde, A Musa, 

W Ahmad, CK Young 

Dept of Cardiothoracic 

Surgery, St James’s 


3.14 

Chest drain management: identifying what nurses need 

to provide best care 

Chest drains are a common feature of patients 

admitted to acute respiratory or cardio-thoracic 

surgery care areas. However there appears to be 

a lack of consensus among doctors and nurses on 

the major principles of chest drain management 

(Parkin 2002). Many decisions tend to be based on 

personal factors rather than sound clinical evidence 

(Tang et al 1999). This study aimed to identify nurses’ 

needs in keeping up-to-date with chest drain care. A 

sample of 189 nurses from acute care units, cardiac 

and thoracic wards of two academic teaching 

hospitals in Dublin participated in the study. The 

results of the study revealed both consistencies 

and diversities in nurses’ knowledge on chest 

drain management. Good knowledge was reported 

on aspects of suction levels, bottle changes and 

clamping of chest drains. However, there seemed to 

be great uncertainty regarding the anatomical and 

underpinning principles of chest drain management, 

chest drain placement as well as in relation to the 

conditions requiring chest drain insertion. In addition 

nurses indicated poor knowledge on the frequency 

of dressing changes and the function of Heimlich 

Valves. It is argued that identification of educational 

needs of nursing care for chest drains is required 

on a local level, together with the development 

of responsive educational programmes. Several 

service led options exist with regard to improving 

knowledge in this area such as web-based learning, 

study-days and ward-based tutorials. These should 

include general and area specific aspects as well 

as they should develop nurses’ knowledge on the 

anatomical and underpinning principles of chest 

drain management. Nurses must be supported by 

local practice development and through personal 

portfolio use to identify gaps in knowledge and seek 

appropriate training and resources. 

References 

1. C Parkin. A retrospective audit of chest drain 

practice in a specialist cardiothoracic center and 

concurrent review of chest drain literature. Nursing 

in Critical Care, 2002; 7(1): 30-35. 

2. A Tang, T Hooper & R Hasan. Regional survey 

of chest drains: evidence-based practice? 

Postgraduate Medical Journal, 1999; 75: 471-474. 

D Lehwaldt 

School of Nursing, 

Dublin City University, 

Glasnevin, Dublin 



31 

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3 

SESSION 


Population Studies 

3.16 

A study to estimate the prevalence of idiopathic 

pulmonary fibrosis in Ireland 

3.18 

The effects of the workplace ban on smoking on the lung 

function of bar workers in Dublin 

Prevalence estimates for IPF vary from 3 to 20 cases 

per 100,000 in the general population. The aim of 

this study was to estimate the prevalence of IPF 

in Ireland. Information on patient admission and 

discharge was obtained from the hospital inpatient 

enquiry system (HIPE) and the private sector data 

sets. Sixty nine acute hospitals participate in HIPE. 

The period January 1999 to December 2003 was 

chosen. Age, sex and hospital admissions were 

estimated. 

YEAR 

3.17 

NO. PATIENTS WITH IPF 

(PUB SECTOR) 

Investigation of the prevalence of undiagnosed airflow 

obstruction in symptomatic subjects attending a large 

physiotherapy department 

Introduction 

Screening patients for COPD is well documented. 

However, there is little information regarding 

the prevalence of undiagnosed COPD in patients 

attending physiotherapy, and the benefits that 

screening may have. 

Method 

By providing information in the waiting area, patients 

(attending physiotherapy for other reasons) were 

encouraged to refer themselves to a clinic held once 

a week in the department.At the clinic, patients gave 

a brief medical background, had their height and 

body mass measured followed by spirometry using a 

Micro Medical Microlab. 

Results 

Sixteen patients presented themselves for 

spirometry at 15 clinics. – six male and 10 female, 

with a mean (SD) age of 59 (11.22), mean (SD) BMI 

Results 

Eight hundred and thirty eight IPF cases were 

identified.Seven hundred and thirty seven (62%) 

were male and 456 (38%) were female.The mean 

age was 67.5 years. The total number of hospital 

admissions between 1999 and 2003 n = 1193. 

The estimated mean prevalence per 100,000 of 

the general population over the 5 year period was 

calculated n = 4.2. Total deaths from IPF recorded 

over the 5 year period was n = 218. 

NO. PATIENTS WITH IPF 

(PRIVATE SECTOR) 

PREVALENCE IPF/100,000 

1999 124 74 5 

2000 130 64 4.9 

2001 118 64 4.6 

2002 86 35 3.1 

2003 107 36 3.6 

24.94 (5.85), and mean (SD) FEV 1 

/FVC 74.54 (11.66). Of 

these 16 patients, seven were diagnosed as having 

obstructive airways disease (44%) and were followed 

up at a COPD OPD clinic, as well as smoking cessation 

facilitation. One patient (6%) was diagnosed as 

having a high risk of developing COPD, and was 

followed up with smoking cessation facilitation. All 

seven of the patients who were smokers, were given 

details of how to contact the smoking cessation 

officer. Three of the smokers (43%) quit smoking as a 

result of the study. 

Conclusion 

Screening patients in a physiotherapy department 

is easily accomplished with the support of a 

Respiratory Consultant and a smoking cessation 

facilitator. The results suggest that screening is a 

beneficial service, and potentially may help to slow 

down the progression of the COPD through adequate 

medical management and smoking cessation. 

BN McCullagh, 

JM Coyle, DT Keating, 

MB Codd, JJ Egan 

Heart Lung Transplant 

Unit, Mater 

Misercordiae Hospital, 

Dublin 

H Fisher, 1 N Murphy, 1 

F O’Connell, 2 J Gormley 3 

1. Physiotherapy Dept 

and 


Medicine, St James’s 


3. School of 

Physiotherapy, 

Trinity College 

Dublin 

Background 

It has long been recognised that exposure to 

environmental tobacco smoke causes respiratory 

and cardio-vascular disease in those exposed to it. 

Bar staff are a group of workers with long hours of 

exposure at work, and as such, were an ideal group to 

study the effects of the government ban on smoking 

in the workplace. 

Methods 

Bar workers were recruited through their Trade 

Union, Mandate, and 81 participated in the first 

phase of testing between September 2003 and 

March 2004. They attended the Respiratory 

Laboratory in St. James Hospital for lung function 

tests and measurement of exhaled carbon monoxide. 

They also completed a questionnaire relating to their 

respiratory health, and smoking history. Seventy-five 

(93%) returned between September 2004 and March 

2005 for repeat testing and again completed the 

questionnaire. 

Results 

Subject demographics: 75 completed phase 1 and 

phase 2, all male. Nine (12%) of these had been 

diagnosed as asthmatic by a physician. For analysis 

two subjects were excluded due to change in 

smoking status on return. Thirty-four (47%) had never 

smoked. Thirt-one (42%) were ex-smokers. Eight (11%) 

were current smokers. 

Symptoms 

No. complaining 

of eye, nose and 

throat symptoms 

No. complaining 

of respiratory 

symptoms 

PHASE 1 PHASE 2 CHANGE 

65 (89%) 32 (44%) -51% 

65 (89%) 47 (64%) -28% 

Carbon Monoxide (CO) Measurement 

Mean CO levels 5.9ppm 4.2ppm -29% 

Lung Function Spirometry, lung volumes and 

gas transfer measurement were performed at 

both visits and showed changes as follows: 

Never 

smokers 

(34) 

Exsmokers 

(31) 

Smokers 

(8) 

FEV1 +2% -1% -5% 

FVC +5% +3% -3% 

PEF +12% +8% -2% 

TLC +3% +2% +2% 

DLCO +5% -1% -6% 

The figures in bold and italics are statistically significant (P

31 

1 




3 

SESSION 


Sleep 

Physiology 

3.19 

Endothelial-1 (ET-1) levels in obstructive sleep apnoea 

(OSA) patients and effect of continuous positive airway 

pressure (CPAP) treatment 

3.22 

Correlation between spirometry and respiratory 

resistance measured by impulse oscillometry in patients 

with COPD 

ET-1 Is a marker for endothelial dysfunction. 

There are contradictory reports about endothelial 

dysfunction in OSA patients as well as levels of ET-1. 

We undertook this prospective study to determine 

levels of ET-1 in OSA patients and the effect of 

CPAP treatment on these levels. Plasma ET-1 levels 

were measured in nonapnoeic snorer males with 

AHI 15 events 

/hour R (N=20). Groups were matched for age, 

Epworth sleepiness score, FEV1, FVC, lung volumes, 

haemoglobin, platelets and cholesterol levels. 

OSA patients were given treatment in the form of 

3.20 

CPAP for three months and plasma ET-1 levels were 

repeated. We found no significant difference in 

baseline plasma ET-1 levels between control and OSA 

patients (P>0.05). ET-1 levels did not correlate with 

AHI, minimum saturation of arterial oxygen (SAO2) 

or with mean SAO2 (P.0.05 for all parameters). There 

was no significant difference of baseline plasma 

levels among smokers and nonsmokers (P>0.05). 

In contrast, ET-1 levels decreased significantly from 

baseline after treatment with CPAP. In conclusion, no 

significant endothelial dysfunction in OSA patients 

was detected, CPAP treatment seems to have 

protective effect against Endothelial dysfunction. 

The role of angiogenesis in obstructive sleep apnoea 

(OSA) 

A Arya, M Stack, 

K O’Sullivan, 

F Shanahan, CP Bredin 


Medicine, Cork 


Wilton, Cork and Dept 

of Statistics, University 

College of Cork, Cork 

Introduction 

Impulse Oscillometry (IOS) is a technique that 

measures Respiratory Resistance (Rrs) at several 

frequencies through the interpretation of oscillatory 

impulses overlapping spontaneous breathing. It is 

a non-invasive, fast and easy to perform technique 

that requires minimal patient cooperation. 

The recorded parameters, which include Resistance 

at 5Hertz (R5) and Resistance at 20Hertz (R20), can 

provide valuable information for diagnosis of early 

lung disease. 

R5 is a measure of total respiratory resistance 

including extra thoracic, central and peripheral 

airways. R20 is a measure of proximal resistance 

including extra thoracic and central airways. 

COPD who presented for routine pulmonary function 

tests were assessed. Only tests that fulfilled European 

Respiratory Society criteria of acceptability and 

reproducibility were included. 

Results 

The 15 patients (eight female/seven male) had an age 

range 38 to 82 years (mean age 63 years). Traditional 

spirometry outcomes, FEV1, FEF25-75, FEF25, FEF50, 

and FEF75 were correlated with R5 and R20. We 

found an inverse correlation between FEV1 and R5 

(r=-0.867, p

31 

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3 

SESSION 



3.23 

Distinguishable clinical clusters during acute pulmonary 

exacerbations of Cystic Fibrosis 

Introduction 

Acute pulmonary exacerbations represent the most 

frequent complication in the evolution of Cystic 

Fibrosis (CF) pulmonary disease with at least 42% of 

CF patients experiencing one or more exacerbations 

during a six month period. Although concurrent 

symptoms are frequently reported in clinical practice, 

the presence of groupings of related symptoms during 

acute pulmonary exacerbations of CF has never 

previously been explored. This study investigated 

whether there exist subtypes of symptom patterns 

among adult CF patients presenting with acute 

pulmonary exacerbations of their disease. 

Methods 

Fifty-seven CF patients (23 male, 34 female) 

median age 24.9 years (range 18 to 46), admitted 

consecutively to hospital for management of an 

acute pulmonary exacerbation, were enrolled. Each 

patient was asked to complete a standardised 

questionnaire, consisted of twenty-one symptoms, 

to assess symptomatology at exacerbation 

presentation. Patients were asked to grade the 

intensity of each symptom as new in onset, 

increased from baseline, decreased from baseline, or 

not present. 

Results 

Using hierarchical cluster analysis, five clinically 

distinct symptom clusters were identified in the 

studied population, with the majority of patients 

presenting in the cough-predominant cluster. 

Conclusion 

These findings have important clinical implications 

on patient assessment and management. Clinical 

interventions tailored to the predominant cluster 

subtype may result in improved treatment outcome. 

Longitudinal studies are required to determine 

whether these proposed clusters remain stable and 

independent over time or merge into a single group 

over the course of illness. 

DF Waterhouse, 

R Barry, CG Gallagher 


Medicine and the 

National Referral 

centre for Adult Cystic 

Fibrosis, St Vincent’s 


Dublin 

Supported by the 


Association of Ireland 

and the Health 

Research Board 

3.25 

The introduction of once daily tobramycin dosing at the 

national referral centre for adult Cystic Fibrosis in 


Introduction 

Due to its good activity against Pseudomonas 

aeruginosa, tobramycin is one of the most 

commonly used drugs to treat an infective 

exacerbation of Cystic Fibrosis. Following the 

publication of the TOPIC study it was decided to 

introduce once daily dosing of tobramycin at the 

National Referral Centre for Adult Cystic Fibrosis 

(NRCACF) in St. Vincent’s University Hospital. 

Method 

The first 43 patients to receive tobramycin oncedaily 

were studied intensively. Among the most 

important parameters studied were pre- and postdoes 

tobramycin levels, serum creatinine levels and 

the single daily dose administered, expressed per 

kilogram bodyweight. 

Results 

The results of the study showed that 79.1% of 

patients received a tobramycin course in which the 

recorded levels were within the therapeutic range. 

This compares to just 50% of patients reaching 

therapeutic levels in a previous study carried 

out in St. Vincent’s University Hospital in 2002, 

which involved three-times daily administration 

of tobramycin. Two patients in the current study 

showed tobramycin levels in the toxic range, while 

a further four patients exhibited increases in serum 

creatinine suggestive of renal toxicity. There were no 

reports of ototoxicity during the study period. 

Conclusions 

The once-daily administration protocols compiled 

for the changeover from three-times daily to oncedaily 

tobramycin dosing ensured that the changeover 

occurred smoothly and with no disruption for 

patients. Switching to once daily tobramycin ensured 

that a higher proportion of patients achieved serum 

levels within the therapeutic range. 

C Muldowney, C Keane 

Pharmacy Dept, 

St Vincent’s University 


3.24 

Reproducibility of peripheral muscle strength testing 

in adult Cystic Fibrosis patient 

Introduction 

Accurate and quantitative muscle strength testing 

plays an important role in monitoring disease 

progression and assessing patient response to 

treatment intervention. The aim of this study was to 

investigate the test-retest repeatability of strength 

testing of the quadriceps muscle using a fixed 

hand held digital dynamometer (FHDD) versus one 

repetition maximum (1RM). The reproducibility of 

these indices has not previously been established 

Methods 

Twenty one CF patients (14 male, 7 female) median 

age 27 (range 17-53 years) with clinically stable 

disease were enrolled in the study. Quadriceps 

strength was measured in all participants, using 

both FHDD and 1RM, each week for a period of four 

consecutive weeks. Both patient and examiner were 

blinded to the previous week’s results at the time 

of strength testing. Furthermore, participants were 

clinically reviewed each week to ensure continued 

disease stability. 

Results 

Using the Bland and Altman method, results 

achieved on week one and week four display 

a learning curve and muscle fatigue, despite 

standardised rest period, when using 1RM. 

Additionally, using paired t-testing to compare 

results achieved, there was significant stability in 

results achieved with FHDD. 

Conclusion 

This research shows that the 1RM involves a skill 

factor and subsequent tests yield better results. 

Furthermore, no learning effect was observed with 

FHDD and this has been shown to be a highly 

reliable means of muscle strength assessment. 

Thus, in conclusion, FHDD is the most sensitive and 

least variable method of peripheral muscle strength 

assessment. 

CM Reilly, 1 

DF Waterhouse, 2 

CG Gallagher 2 

1. Dept of 

Physiotherapy and 


Medicine, National 

Referral Centre 

for Adult Cystic 



Dublin 

Supported by the 


Association of Ireland 

and the Health 

Research Board 

3.26 

Emergence of high grade tobramycin resistance in 

P. aeruginosa isolates in the sputum of children on 

bedulised tobramycin solution for inhalation 

Background 

Chronic enbronchial infection with Pseudomonas 

aeruginosa (PA) is associated with a deterioration 

in lung function in patients with Cystic Fibrosis. 

Preservative-free tobramycin for inhalation (TOBI®) 

has been recently developed as maintenance 

anti-pseudomonal antibiotic. Randomised trials 

of alternate month use have shown beneficial 

effects on pulmonary function and weight gain, 

and reduction of bacterial load. Clinically significant 

high grade resistance has not been described. We 

previously reported the beneficial clinical effects 

of TOBI in our CF patient population. Like other 

investigators, we noted an increase in low grade 

(10mcg/ml) resistance to tobramycin. However 

high grade (200mcg/ml) resistance of P Aeruginosa 

isolates was not observed at that time. 

Aims 

The purpose of this study was to evaluate PA isolates 

for the presence of high grade TOBI resistance and 

if confirmed, to determine what, if any clinical 

parameters could be identified as risk factors for its 

development. 

Method 

A retrospective chart review was conducted on all 

children with a persistent growth of PA who were 

receiving TOBI. The following data was recorded 

subsequent to starting on treatment: Anthropometric 

indices, genotype, antibiotic resistance of PA 

strains, number of IV antibiotic courses, use of IV 

aminoglycosides and use of IV tobramycin. 

Results 

Twenty six patients with PA infection were being 

treated with TOBI. The mean duration of treatment 

at the time of study was 33 months. Low grade 

resistance developed in 16 patients, 8 of whom went 

on to develop high grade resistance. Mean duration 

to development of consistent low grade resistance 

was 15.6 months and to high grade resistance was 

P McNally, G Leen, 

M Doyle, P Murphy, 

P Greally 

Dept of Cystic Fibrosis 

National Children’s 

Hospital, Talaght, 

Dublin 



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38.5 months. Mean duration from first resistant 

strain to high grade resistance was 21.4 months. In 

those with high grade resistance, mean age was 7.05 

yrs, mean duration of TOBI was 39.9 months, mean 

courses of IV antibiotics was 4.87, (aminoglycosides 

4.0[53.2 days], tobramycin 3.25[44 days]). In those 

without high grade resistance, mean age was 11.82 

yrs, mean duration of TOBI was 29.9 months, mean 

courses of IV antibiotics was 3.0, (aminoglycosides 

2.3 [38.4 days], tobramycin 1.94 [32.3 days]). There 

was a trend towards a higher prevalence of ΔF508 

mutations in children with high grade resistance. 

3.27 

Changes in the nature, severity and frequency of 

symptoms in patients with Cystic Fibrosis during 

periods of clinical stability 

Introduction 

To date, there exists no cohesive definition for 

the accurate diagnosis of an acute pulmonary 

exacerbation in patients with Cystic Fibrosis (CF). 

Overall, it is the patients’ symptoms and subjective 

worsening of these symptoms which are used to 

make the diagnosis. However, no data currently 

exists to examine the daily change in symptom 

levels in the CF population. Thus, we examined the 

daily variability, severity and frequency of symptoms 

experienced by CF patients during periods of clinical 

stability of their disease 

Methods 

23 CF patients (13 males, 10 females, median age 25 

years) were enrolled in the study. Patients completed 

Daily Diary Cards (DDC) for a period of 4 weeks. These 

DDC’s applied a numerical value to the daily severity 

of each of eight symptoms. Additionally, participants 

attended a weekly review to ensure disease 

stability as well as to assess lung function (forced 

3.28 

Discussion 

Our data shows the development over time of high 

grade resistance to tobramycin in PA isolates in 

children on TOBI. Factors more commonly seen in 

children with high grade resistance include younger 

age, longer duration of TOBI, greater use of IV 

antibiotics and greater use of IV tobramycin. Further 

clinical follow-up is required to determine whether 

development of high grade resistance is associated 

with a reduction in clinical benefit from TOBI. 

expiratory volume in one second), body mass index 

(BMI) and measurement of biochemical markers of 

inflammation (WCC, ESR, CRP). 

Results 

Symptom variability was independent of sex and BMI 

throughout the studied population. Notably however, 

a high level of symptom variability and severity 

during disease stability correlates strongly with 

disease severity as measured by FEV1. Furthermore, 

this study demonstrates notable age-related 

variability in the symptom severity. 

Conclusion 

Assessment of significant change in symptom level 

may be more accurately by predetermining the 

variability of each individual, rather than applying 

group data. These findings have important clinical 

implications on patient assessment and subsequent 

management. 

The administration of aminoglycosides to patients with 

Cystic Fibrosis: current practice 

SU McKenna, 

DF Waterhouse, 

CG Gallagher 


Medicine and the 

National Referral 

centre for Adult Cystic 



Dublin 

to guide the changeover to OD dosing at the National 

Referral Centre for Adult Cystic Fibrosis, SVUH. 

Method 

A questionnaire was distributed via email to all 

members of the email group ‘cfpharmgroup@ 

yahoogroups.com’. This is the email group of the UK 

CF Pharmacists group, but has members from other 

countries. 

Results 

Eighteen replies were received, eight from adult 

centres and 11 from paediatric centres with one 

centre treating both. Tobramycin was the first line 

aminoglycoside in 78% of centres. Sixty-one per cent 

of centres use a dose of 10mg/kg daily, the range 

3.29 

Update on familial sarcoidsis in Ireland 

Introduction 

Ireland has the second highest prevalence of 

sarcoidosis in Europe with historical estimates at 

33/100,000. 1 Despite this high prevalence, current 

epidemiological data on sarcoidosis in Ireland is 

lacking. The last report on this topic in Ireland was 

done by our institution in 1984. It identified that the 

occurrence of sarcoidosis in more than one member 

of a family, i.e. familial sarcoidosis, is 9.6%. 2 This 

is the highest in Europe. Furthermore, it showed 

that a sibling of index cause has a 2.4% chance of 

developing the condition. The paper concluded that 

this high prevalence of familial cases is an argument 

for screening for sarcoidosis among affected families. 

Aim Perform a pilot study looking at prevalence of 

sarcoidosis within Irish families. 

Sarcoidosis 

was from 12 to 7mg/kg daily. Once daily dosing was 

practice in 66% of centres surveyed. The centres 

using OD dosing are administering tobramycin/ 

gentamicin as an IV infusion in 50 to 100mls sodium 

chloride over 30 to 60 minutes. Ninety-two per cent 

of centres are monitoring pre-dose levels with a 

target level of

31 

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sarcoidosis (non-caseating granulomata with 

negative stains and cultures for tuberculosis and 

fungi) underwent diagnostic fibreoptic brochoscopy. 

Six of the patients had Stage I sarcoidosis, 11 were 

Stage II, and the remaining five were Stage III. All 

patients had bronchoalvoelar lavage (BAL), 21 of 22 

had transbronchial lung biopsy (TBLB), 20 of 22 had 

transbrochial needle aspiration (TBNA) of subcarinal 

lymph nodes, and 20 of 22 had endobronchial 

biopsy (EBBB). Nineteen of the 21 patients had a 

positive TBLB (90.4%), four of 20 had positive EBBB 

(20%) of which only one had a negative TBLB, and 

two of 20 (10%) patients had positive histology 

on TBNA though both of whom also had positive 

3.31 

Audit on the use of serum ACE in an Irish regional 

hospital 

Introduction 

An audit on the clinical use of serum ACE levels 

(SACE) in an Irish Regional Hospital. 

Methods 

Retrospective chart review of patients who presented 

to the Midland Regional Hospital Mullingar between 

May 2003 and May 2004 and had a SACE level 

measured. 

Research 

283 patients had SACE levels measured. 100 of these 

patients were randomly selected for chart review. 80 

had levels measured as part of the diagnostic work-up 

for suspected sarcoidosis; the remaining 20 patients 

had levels drawn for assessment of disease activity in 

3.32 

Asthma 

TBLB. Six patients had significant lymphocytosis 

on BAL (27.2%); all had positive TBLB apart from 

one. The combined sensitivity of all four diagnostic 

procedures was 94.1%; the sensitivity of TBLB alone 

was 88.2%. Our data suggests that of the four 

bronchoscopic methods, TBLB had the maximum 

yield in the diagnosis of pulmonary sarcoidosis. There 

was no significant additional benefit from TBNA or 

BAL, and minimal additional benefit from EBB. 

Conclusion 

TBLB is the preferred diagnostic technique in 

sarcoidosis; BAL and TBNA are of no additive benefit. 

already diagnosed sarcoid patients. Of the 80 patients 

with SACE drawn for suspicion of sarcoidosis, only 13 

(16.3%) were finally diagnosed with sarcoidosis. Of 

these 13 patients, only 15.4% (2/13) had increased SACE. 

SACE levels were increased in 5 of the 80 diagnostic 

group (6.25%); only 2 (40%) of these patients were 

subsequently diagnosed with sarcoidosis. In patients 

with SACE levels measured as part of the diagnosis 

evaluation for sarcoidosis, the sensitivity, specificity, 

positive and negative predictive value of SACE was 

15.4%, 95.5%, 40.0% and 85.3% respectively. 

Conclusion 

SACE is not a sensitive test for the diagnosis of 

sarcoidosis and should not be included in the 

diagnostic work-up. 

Auditing paediatric asthma – does it work? 

Introduction 

Clinical audits are widely encouraged in the 

NHS although there is limited evidence of their 

effectiveness in improving key aspects of care. We 

wished to determine whether participation in a 

national audit programme for asthma resulted in 

defined improvements in patient care. 

Method 

Craigavon Area Hospital Paediatric department 

participated in the BPRS/ BTS Asthma audit in 

November 2002, 2003 and 2004. Changes were 

implemented after year 1. Results of this three-year 

audit were analysed and compared to that of the 

national standard (Natl). 

C Murtagh, 

A Shamboul. Y Vapra, 

A Brennan, A O’Brien 

Midland Regional 

Hospital Mullingar, 

Co Westmeath 

S Thavagnanam, 

M Smith 

Dept of Paediatrics and 

AIR Centre, Craigavon 

Area Hospital 

Results 

There were 11-16 patients with acute asthma admitted 

each November during the study periods (M: 74%, 

F: 26%). Ninety-seven per cent of patients received 

bronchodilators either via spacer /nebuliser as first 

line (Natl =98%). Oral/IV steroids were given on an 

average of 88% (Natl=88%). There was an increase 

in the use of aminophylline (19% vs 4% Natl), 

antibiotics (30% vs 20% Natl) and Chest X-rays (59% 

vs 34% Natl). An increasing proportion of patients 

were given management plans (32% to 64%) and had 

3.33 

3.34 

Asthma admissions in children in Galway, trends over 

15 years 

Objective 

To study trends in admissions with acute asthma in 

children aged one to 14 years over the past 15 years. 

Setting 

Paediatric department in Regional hospital serving a 

child population of c.45,000. 

Methods 

Analysis of hospital in-patient enquiry system for 

children with a diagnosis of acute asthma 1990 -2004. 

Results 

Admissions increased steadily from 1990 to 1995, and 

thereafter halved over the next 10 years. This decline 

was most evident in the school age population (5-14 

years). Age specific admission rates were higher in 

the pre-school group throughout, and the though 

all rates have declined, that in one- to four-year-olds 

is still five times greater than in 5-14 year olds. The 

increase, and subsequent decrease in admissions 

was more evident in males. 

Conclusions 

Admission of children to hospital with acute asthma 

has declined in this area. This decline is most evident 

in school age children. 

An evaluation of nurse-led respiratory service in the 21st 

century: can clinical nurse specialists make a difference? 

Introduction 

The work of a respiratory clinical nurse specialist 

(CNS) has a significant impact on changing outcomes 

and improving quality of patient care. Continuity 

of care has been a problem with COPD and asthma 

patients with care frequently delegated to junior non 

consultant hospital doctors (NCHD). In St Michael’s 

Hospital we have provided a respiratory nurse led 

service since October 2004. We assessed the patient’s 

perception of the benefits of this nurse led service. 

Methods 

The CNS has seen 60 patients since commencement of 

this service. Subjects (n= 25) were recruited to answer 

a postal questionnaire consisting of 12 questions. 

The questions were divided into five different areas: 

history, diagnosis, existing knowledge of condition, 

evaluation of service and additional comments. 

device technique assessed (50% to 64%). There was 

no change in frequency of information leaflets given 

(50% to 45%). 

Conclusions 

Participation and implementation of change based on 

the national asthma audit programme has resulted 

in an increase in evidence-based care however it has 

also highlighted deficiencies in certain areas. Effective 

implementation of change needs to involve all 

stakeholders and involve multi-layer interventions. 

Results 

The response rate to the questionnaire showed that 

94% were satisfied with the nurse led service however, 

6% expressed a concern there was inadequate 

explanation provided regarding their condition. 

Continuity of care is demonstrated by the fact that 

33% of the patients returned twice and 8% returned 

three times. 

Conclusion 

The results support the use of a respiratory nurse led 

service. This has demonstrated continuity of care and 

no patient has expressed a desire to relocate to the 

conventional doctor led clinic. This clinic is an example 

of how a nurse led respiratory service is progressing 

towards advanced nurse practitioner status. 

A Shabu, E Crushell, 

BG Loftus 

Dept of Paediatrics, 

NUI, Galway 

MF O’Driscoll, 1 

MM Nagle, 1 

TJ Mc Donnell 2 

1. Dept of Nursing, and 

2. Respiratory 

Medicine 

St Michael’s 

Hospital, 

Dun Laoghaire, 

Co. Dublin 



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Lung Infection / Mechanisms 

3.35 

Adrenal insufficiency in patients with community 

acquired pneumonia 

3.37 

Thalidomide treatment in chronic lung infection 

Introduction 

The role of adrenal insufficiency and physiological 

corticosteroid replacement has recently been 

reviewed in sepsis and in pneumonia in the intensive 

care (ICU) setting. We hypothesised that adrenal 

response would be affected in patients managed 

for community acquired pneumonia (CAP) outside 

the ICU and that this would correlate with severity 

of inflammatory response as measured by the proinflammatory 

cytokine IL-6. 

Method 

19 patients with CAP were assessed within 24 hours 

of admission. Severity of illness was assessed using 

the CURB-65 score and Pneumonia Severity Index. 

A short synacthen test was performed and a serum 

IL-6 was measured. 

Results 

One patient was excluded because of treatment with 

intravenous steroids. 50 % of the remaining patients 

had relative adrenal insufficiency (i.e. nonresponders) 

as defined by a cortisol response of 248nmol/L or 

less. Severity of pneumonia did not differ between 

the responders and the nonresponders. No deaths 

occurred in either group. The average hospital stay 

was 2 days longer in the nonresponder group. There 

was a recognised trend towards a higher IL-6 in the 

responders compared with the non-responder group. 

Conclusions 

There is a high incidence of relative adrenal 

insufficiency in patients admitted with community 

acquired pneumonia and managed outside the ICU. 

In this study we found adrenal insufficiency to be 

associated with a trend towards longer inpatient 

stay and higher IL-6 level. 

E Kelly, NG McElvaney, 

SJ O’Neill 


research, Beaumont 


Introduction 

We have previously reported that chronic airway 

infection causes angiogenesis in the pulmonary 

circulation. Inhibition of angiogenesis ameliorates 

chronic inflammatory diseases including rheumatoid 

arthritis and inflammatory bowel disease. We 

hypothesized that inhibition of angiogenesis with 

thalidomide would reduce inflammatory damage in 

chronic lung infection. 

Methods 

Adult male rats were anaesthetised and inoculated 

intratracheally with Pseudomonas aeruginosa 

incorporated into agar beads to induce chronic 

infection. Infected rats were treated with 

thalidomide, an angiogenesis inhibitor, or vehicle. A 

third group were inoculated with sterile agar beads. 

12 days post-inoculation, rats were anaesthetised and 

their lungs isolated and fixed at standard pressure. 

Results 

Both infected groups had increased BAL neutrophils. 

There was no significant difference in the tissue 

volume in the gas exchange region of the infected 

vehicle and infected thalidomide groups, although 

both were increased compared to the sterile group. 

In the infected thalidomide group, the volume of 

airspace in the gas exchange region was reduced 

compared to the infected vehicle group. 

Conclusions 

Thalidomide decreased compliance in the lungs 

suggesting that it augmented damage due to 

infection. 

STERILE (N=8) INFECTED VEHICLE (N=9) INFECTED THALIDOMIDE (N=9) 

BAL Neutrophils (x103/ml) 2.8 (1.4) 34.4 (12.5)* 35.6 (18.1)* 

Tissue volume (cm3) 1.86 (0.1) 2.33 (0.11)* 2.30 (0.13)* 

Airspace volume (cm3) 2.03 (0.12) 2.20 (0.15) 1.80 (0.09)† 

Y Gunning, N Hopkins, 

P McLoughlin 

UCD, School of 

Medicine & Medical 

Science, Conway 

Institute 

HRB Funded 

3.36 

Predicting bacteraemia in patients with community 

acquired pneumonia 

Values are means (SEM). * Significant difference from sterile group (P

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Malignancy / Techniques 

3.39 

Hypoxic induction of proliferation in primary human 

lung fibroblasts: potential implications in pulmonary 

fibrosis 

Introduction 

Idiopathic pulmonary fibrosis (IPF) is a disease 

of unknown aetiology that is associated with 

alveolar epithelial injury and the development of 

fibroblast proliferation and differentiation. This 

leads to increased matrix deposition and ultimately 

severe derangement of gas exchange units. Loss of 

alveolar function leads to impaired ventilation and 

potentially the development of local tissue hypoxia. 

Our hypothesis is that local tissue hypoxia in the 

lung contributes to aberrant remodelling. 

Results 

Control and patient-derived primary human lung 

fibroblasts and airway epithelial cells were used to 

study the effect of hypoxia on proliferation. Cells 

were cultured in controlled oxygen environments 

of 1%, 3%, 5%, and 21% for various times and 

proliferation was measured using tritiated thymidine 

incorporation. Significantly increased fibroblast 

proliferation was seen after culture in 3% and 5% 

oxygen. Conditioned media from hypoxic fibroblast 

cultures induced proliferation in naïve cells 

indicating that a soluble pro-proliferative mediator 

may be secreted into media by fibroblasts exposed 

to hypoxia. Furthermore, conditioned media from 

hypoxic epithelial cultures was also able to induce 

exaggerated proliferation in lung fibroblasts. 

Conclusions 

We believe that physiologically relevant hypoxic 

conditions induce significant increases in fibroblast 

proliferation and that this may have important 

implications in the pathogenesis of fibrotic lung 

disease. Ongoing studies are aimed at identifying the 

molecular mechanisms involved in hypoxia induced 

fibroproliferation. 

AB Byrne, L Li, 

SC Donnelly, JA Baugh 

Dept of Medicine and 

Therapeutics, The 

Conway Institute for 

Biomolecular and 

Biomedical Research, 

University College 

Dublin 

3.41 

Angiosarcoma arising from the right atrium: an usual 

case of recurrent pulmonary embolism 

Introduction 

Angiosarcoma is an uncommon primary cardiac 

malignancy that usually arises from the right atrium. 

Clinical features are non-specific, and the tumour is 

frequently undiagnosed until autopsy. 

Method 

We report the case of a 37-year-old male who 

presented with right-sided chest pain, haemoptysis 

and dyspnoea. 

Results 

Pulmonary embolism was diagnosed by spiral 

computed tomogram (CT) scanning, however 

the patient failed to improve with standard 

anticoagulant therapy. Repeat CT scan confirmed 

non-resolution of embolism and demonstrated a 

concomitant right atrial filling defect. Transthoracic 

3.42 

St James’ Lung Cancer Audit 2004 

echocardiography and magnetic resonance imaging 

were performed, and identified a mass lesion which 

extended from the free wall of the right atrium into 

the right main pulmonary artery. Surgical exploration 

confirmed extensive tumour, and radical resection 

was performed with right atrial reconstruction 

and evacuation of tumour from the pulmonary 

artery. Histological evaluation revealed a high-grade 

angiosarcoma, with positive immunohistochemial 

staining for CD31 and CD34. The patient was treated 

with adjuvant combination chemotherapy and 

remains in remission at 18 months follow up. 

Conclusions 

Although the diagnosis of angiosarcoma usually 

portends a poor prognosis, aggressive multimodality 

therapy can result in a favourable outcome. 

DS O’Callaghan, 1 

DP Breen, 1 , B Kent, 1 

CJ D’Adhemar, 2 

M Higgins, 3 

F O’Connell, 1 V Young 1 

1. CResT Directorate, 

2. LabMed Directorate, 

and 

3. HOPE Directorate, 

St James’s Hospital, 

Dublin 

3.40 

Congenital tracheo-oesophageal fistula: an unusual 

cause of recurrent RTIs in an adult 

Case Report 

A 56 year old woman presented with recurrent RTIs. 

She had had 5 episodes of cough with purulent 

sputum, fever and dull R pleuritic chest discomfort in 

the previous 18 months with less frequent episodes 

for many years prior to that. CXR showed dense R 

basal consolidation which was slow to improve with 

antibiotics. Bronchoscopy revealed a smooth, benignlooking 

tracheo-oesophageal fistula (TOF) posteriorly 

at the junction of the upper 2/3 and lower 1/3 of the 

trachea. Niopam contrast swallow demonstrated 

pooling of contrast in the lower oesophagus, which 

was dilated, and extensive spillover of contrast 

through the fistula leading to a bronchogram of the 

entire tracheo-bronchial tree. Bronchiectasis was 

noted in the R middle and lower lobes. PFTs showed 

mild combined restriction/airflow obstruction with 

mild impairment of gas transfer efficiency. After 

recovery from her current episode, the patient was 

advised to undergo surgical closure of the fistula, 

with consideration of R middle and lower lobectomy, 

but declined this advice. Three years later, she 

suffered a severe RTI with septicaemia, and after a 

prolonged ICU admission, passed away. 

Conclusion 

Congenital TOF is a rare, though easily diagnosed 

cause of recurrent RTIs and bronchiectasis in adults. 

B Kent, D O’Callaghan, 

D Breen, F O’Connell 

CResT Directorate, 


Dublin 

Introduction 

Lung cancer remains the foremost cancer killer in 

Ireland, responsible for 20% of all cancer deaths. 

Although prevalence has fallen in men, recent years 

have seen a dramatic increase in lung cancer in 

women. Patients tend to present with late stage 

disease and stage for stage, lung cancer survival is 

worse than for other common cancers. Overall 5 year 

survival is less than 10%. 

Aim 

To audit lung cancer at St James’s for 2004. 

Method 

Interrogation of the St James’s lung cancer database. 

Results 

297 patients attended St James’s with lung cancer 

in 2004, representing a 6% increase on the previous 

year and almost 20% of the national lung cancer 

population. Gender analysis showed 60.9% male, 39.1% 

female (male:female ratio 1.56:1) with women tending 

to present younger than men. Almost 50% were 

tertiary referrals from outside the HSE SW area. 6.7% 

were never-smokers while 36.4% reported a family 

history of cancer. Analysis of morphology showed 

NSCLC 75%, SCLC 17.3%, Carcinoid 2%, Mesothelioma 

5.1% and unknown 0.7%. Of note, females represented 

37.6% of NSCLC (male:female ratio 1.7:1) but 45.1% of 

SCLC (ratio 1.2:1). Stage analysis in NSCLC showed 30.4% 

had Stage I or II disease, 75% of whom had treatment 

with curative intent. 18.6% had stage III disease, 22% 

of whom had treatment with curative intent. 25% 

of those treated with curative intent for NSCLC had 

chemotherapy as part of their treatment. Almost 50% 

of patients with SCLC had limited stage disease. 

Conclusions 

Lung cancer attendances at St James’s continue to 

rise with increasing proportion of females, who tend 

to present younger and have a greater propensity to 

develop SCLC. Chemotherapy is playing an increasing 

role in treatment of NSCLC with curative intent. 

M Devlin, R Luddy, 

F O’Connell 

St James’s 

Multidisciplinary 

Thoracic Oncology 

Group 



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3.43 

Managing mesothelioma: a study of local experience 

3.45 

Single surgeons audit of carinal resections 

Introduction 

According to predictions the incidence of malignant 

mesothelioma cases is expected to peak by 2020 and 

to decline thereafter. As we approach this expected 

peak it is useful to consider the number of cases now 

being seen at District General Hospital level and the 

utilisation of healthcare services in the management 

of this condition. 

Method 

All cases of malignant mesothelioma made either 

by the pathology department, or from the clinical 

coding department at the hospital, from 2000 to 

2005, were included in the study. The notes were 

reviewed retrospectively in August 2005. The BTS 

statement on Malignant Mesothelioma 1 in the UK 

was used as a reference. 

Results 

A total of 14 cases diagnosed as malignant 

mesothlioma were included in this study. Of the 14 

cases a positive occupational link with asbestos was 

3.44 

identified in eight cases. One case was peritoneal 

mesothelioma, one case was female. The age range 

was 51-95, (mean 68.6). Half of the cases had a 

diagnosis confirming pleural biopsy. No patients 

were considered suitable for referral re radical meso 

surgery. Chemotherapy was used in two cases and 

Radiotherapy in five. 

Conclusions 

Malignant mesothelioma remains an uncommon 

malignancy but incidence is increasing as observed 

in one District General practice. It usually affects 

middle aged men. Ultrasound and CT guided biopsy 

are underutilised as an investigation tool. Palliative 

care involvement from the time of diagnosis is 

valuable given the limited treatment options and the 

very poor prognosis. 

Reference 

1. BTS Statement on Malignant Mesothlioma in the 

United Kingdom. Thorax 2001; 56:250-265 (April) 

Five-year audit of Abrams pleural biopsy 

Introduction 

Thoracentesis or pleural fluid aspiration is a common 

and relatively straightforward procedure in the 

investigation of unexplained pleural effusion. The role 

of Abrams pleural biopsy is less certain, particularly 

with increasing availability of thoracoscopy. 

Aim 

To assess the results and complications of Abrams 

pleural biopsy at St James’s from 2000-2004. 

Method 

Interrogation of the St James’s histopathology 

database and retrospective chart review. 

Results 

Seventy-five patients (mean age 63, 48 male, 27 

female) had Abrams biopsy as part of their work-up 

for unexplained pleural effusion. In 66 patients pleura 

was present in the biopsy material. Of these, 13 were 

reported malignant or suspicious for malignancy, all of 

whom had a final diagnosis of malignancy. Thirty-six 

showed inflammatory changes, nine of whom had a 

final diagnosis of malignancy and three of whom had 

lymphocytic inflammation and a final diagnosis of TB. 

Ten were reported normal, two of whom had a final 

diagnosis of malignancy. Therefore, of 24 patients with 

a final diagnosis of malignancy, 13 were confirmed or 

suspicious on Abrams Bx (including four of six with 

a final diagnosis of mesothelioma). Seven patients 

had granulomatous inflammation on Abrams Bx, all 

of whom had a final diagnosis of TB, but only two of 

whom were ZN positive on pleural fluid. One patient 

suffered a vasovagal episode and three suffered 

a small pneumothorax, none of whom required 

intercostal tube drainage. 

Conclusions 

Abrams pleural Bx has a high false negative rate in 

malignancy, but where positive may avoid the need 

for more invasive procedures such as thoracoscopy. 

The false negative rate for TB is low and the finding 

of granulomatous inflammation provides early 

confirmation of the diagnosis when the pleural 

fluid is ZN negative. The false positive rate for both 

malignancy and TB in this series was zero and the 

complication rate was low. 

N Chapman, 

MA McCann, J Frazer, 

RP Convery 

Air Lab, Craigavon Area 

Hospital 

B Kent, D Breen, 

D O’Calaghan, 

F O’Connell 

CResT Directorate, 


Dublin 

Carinal resection is one of the most complicated 

procedures in tracheo-bronchial surgeries. We 

present our experience of carinal resections 

with histological analysis, operative techniques, 

complications and long-term survival. 

Since 2001 we have performed six carinal resections 

in St. James’s Hospital. Indications for surgery 

included Non Small Cell Carcinoma (NSCCa). The 

length extended from one to five tracheal rings. 

The operative approach was right postero-lateral 

thoracotomy in all the cases. 

3.46 

One out of the six patients died post-operatively due 

to infection. As quoted in the literature mortality and 

the incidence of complications were significantly 

correlated to length of resection and preoperative 

patients functional status. 

The feasibility of carinal resection is limited by 

the patient’s pulmonary function status and the 

anatomical extension of the tumour growth. 

Thorough selection of patients may improve 

immediate and long-term results. 

Malignant chest wall tumours and tumours invading 

the chest wall: surgical techniques and results 

Primary chest wall tumours and lung cancer 

invading chest wall are the most common diseases 

indicating chest wall resection and reconstruction. 

We evaluated patients who underwent chest wall 

resection and reconstruction for primary chest wall 

tumours and lung cancer invading chest wall. 

Fourteen patients underwent chest wall resection 

and reconstruction for primary chest wall tumours 

and local invasion of lung cancer year between 

February 2001 to December 2004. Wide chest wall 

resection was performed and reconstruction was 

done by sandwich method with Composite Marlex 

mesh and Methyl-Metacryalate. In the majority of 

3.47 

cases it was possible to approximate the soft tissues 

over the reconstruction. However in a small number 

of cases Plastic surgical colleagues helped in closing 

the defect. 

There was no operative or postoperative mortality. 

We looked at the mean length of in-hospital stay, 

histological types, Morbidity and Long-term survival. 

Wide excision reduces the chances of local 

recurrence. Simultaneous skeletal reconstruction of 

the chest wall prevents postoperative complications 

and restores the respiratory dynamics by avoiding 

paradoxical or harmful movements. 

Role of vascular reconstruction in the resection of 

thoracic malignancy 

Since the revised staging of lung cancer in 1997 1 , local 

invasion of chest wall or vascular structures does not 

preclude curative lung resection. 

Vascular reconstruction is an important adjunct to 

resection of intra thoracic malignancy This includes 

primary lung tumours invading major vessels in 

the chest such as Superior Venacava and head and 

neck vessels as well as invasive thymomas which 

normally involves the superior venacava and the 

brachiocephalic vessels, in addition a small group of 

lung cancers are respectable with the exception of 

involvement of the left atrium and again a portion of 

left atrium may be excised to give a clear margin. 

We present a group of patients who had resection 

and reconstruction of a variety of vascular structures, 

including Superior Venacava, Brachiocephalic vein, 

Subclavian artery, Left Atrium and Pulmonary artery. 

Despite the technically complex nature of these 

operations we believe that they are justified if the 

thoracic malignancy is totally resectable otherwise. 

Reference 

1. Adapted from Mountain, CF, Chest 1997; 111:1710 

K Doddakula, T Akbar, 

M El Siddig, A Raza, 

V Young 




K Doddakula, 

W Ahmed, T Akbar, 

I Chong, V Young 




K Doddakula, 

W Ahmed, T Akbar, 

I Chong, V Young 






41 

1 

SESSION FOUR ONE 


Session 4: Lung Injury / Inflammation 


SESSION 

4SESSION FOUR ONE 

4.1 

Hypercapnia does not attenuate oxidation in the endotoxin 

induced acute lung injury 

Introduction 

Acute Lung Injury (ALI) is a major problem 

causing thousands of deaths annually worldwide. 

Hypercapnic acidosis (HCA) has protective effects in 

endotoxin-induced ALI and may have therapeutic 

potential. The mechanism of this protective action is 

unknown; it has been shown in vitro that high CO2 

can inhibit peroxynitrite-mediated oxidation, an 

important mechanism of damage in ALI. We tested 

the hypothesis that HCA attenuates ALI in vivo by 

inhibiting peroxynitrite-mediated oxidation. 

Methods 

Adult rats were anaesthetized, mechanically 

ventilated and ALI induced by intra-tracheal 

instillation of endotoxin. We measured the oxidative 

 

formation of rhodamine from dihydrorhodamine in 

bronchoalveolar fluid (BAL). NOS inhibition 

(L-NMMA) was used to prevent peroxynitrite 

formation. 

Results 

The formation of rhodamine was increased above 

controls following endotoxin injury, however there 

was no difference between the endotoxin groups 

(n=10 per group). 

Conclusions 

Oxidation was not inhibited by HCA in endotoxininduced 

ALI. The failure of NOS inhibition to reduce 

rhodamine formation, suggests that peroxynitrite 

was not an essential mediator of oxidation. 

 

 

A Nichol, D O’Croinin, 

F Naughton, 

P McLoughlin 

University College 

Dublin, School of 

Medicine and Medical 

Sciences 

Supported by 

ICSI, IRCSET 

4.2 

Up-regulation of matrix metalloproteases and cathepsins 

by neutrophile elastase: a novel hierarchy in protease 

regulation 

Introduction 

Matrix metalloprotease (MMP), cathepsin and 

neutrophil elastase (NE) activities were measured in 

bronchoalveolar lavage (BAL) from individuals with 

Alpha-1 Antitrypsin (AAT) deficiency, pneumonia 

and healthy controls. We observed correlation 

between NE activity and cathepsin and MMP activity 

postulating that NE might upregulate expression of 

these key proteases and that this upregulation could 

be inhibited by treatment with aerosolised plasma 

purified AAT (ppAAT). 

Methods 

Macrophage supernatants were assessed for 

cathepsin and MMP expression and activity 

following stimulation with NE. Cathepsin and MMP 

activities were assessed in pneumonia and control 

BAL and in BAL from AAT deficient patients pre- and 

post- aerosolisation of ppAAT. 

Results 

Cathepsin and MMP activity are significantly higher 

in BAL samples in AAT deficiency and pneumonia 

compared to controls and correlate significantly 

with NE activity. Treatment with ppAAT significantly 

decreases cathepsin and MMP activity and 

expression in BAL from AAT deficient patients in vivo 

and pneumonia patients in vitro. 

Conclusions 

We describe a novel protease cascade whereby 

NE upregulates cathepsin and MMP expression/ 

activation. Neutralization of NE by the antiprotease, 

AAT, inhibits this up-regulation. This 

new insight into protease function may facilitate 

targeted anti-protease therapy in diseases such as 

COPD, CF, pneumonia and A1AT deficiency where NEinduced 

cathepsin / MMP-mediated inflammation 

are a feature. 

M Rogan, P Geraghty, 

C Greene, M Brantly, 

C Taggart, S O’Neill, 

NG McElvaney 

Pulmonary research 

Division, RCSI, 


Dublin and Dept of 

Medicine, University of 

Florida, USA 

 

 

 

 

 

 

 

 

4.3 

Endoplasmic reticulum stress-induced apoptosis and 

its inhibition by Tauroursodeoxycholic acid in Alpha-1 

antitryspsin deficiency 

BAL NEUTROPHIL [*103/ML] PAO2[MMHG] RHODAMINE [PM] 

Control 9.1 (2.5) 136.4 (7.5) 23.3 (5.1) 

Normocapnia 5230* (991) 89.1* (6.0) 55.1* (4.8) 

Hypercapnia 5142* (1079) 105.4* (6.4) 48.7* (5.1) 

Normocapnia LNMMA 6065* (828) 103.3* (5.0) 46.4* (4.5) 

Hypercapnia LNMMA 5204* (1602) 92.4* (92.4) 52.9* (4.0) 

Values are mean (SEM). * significantly different from control [ANOVA].. 

 

Introduction 

Z alpha-1-antitrypsin (AAT) deficiency is a 

genetic disease associated with accumulation 

of misfolded AAT in the endoplasmic reticulum 

(ER). We investigated both the effect of ZAAT on 

apoptosis, using an in vitro model system of ZAAT ER 

accumulation, and the mechanism of inhibition of 

this apoptosis by tauroursodeoxycholic acid (TUDCA). 

Method 

Apoptosis was induced in HEK293 cells using 

thapsigargin, etoposide or by transfection with 

a ZAAT cDNA. Cleavage of caspases-3,-4 and -7, 

cytochrome c release and phosphorylation of the 

Bcl-2 family member Bad were assessed by western 

immunoblotting. Caspase activities were quantified 

by fluorimetry or luminometry, as appropriate. 

Apoptosis was demonstrated using TUNEL staining 

and cell viability assays were performed. The 

inhibitory effects of TUDCA were also assessed. 

Results 

ER accumulation of ZAAT, but not normal MAAT, 

leads to cleavage and activation of caspases -3,-4 

and -7. Similar effects were also induced using the 

ER agonist thapsigargin. TUNEL staining of ZAATexpressing 

cells confirmed the presence of apoptosis. 

Inhibition studies using TUDCA demonstrated its 

ability to inhibit caspase-4 and caspase-3/7 activation, 

mitochondrial release of cytochrome c and apoptosis 

induced by ZAAT. TUDCA increased phosphorylation 

of Bad. Cell viability assays confirmed the beneficial 

effect of TUDCA on cell survival. 

Conclusions 

Our data shows a new mechanism of cell death 

in ZAAT deficiency: Activation of the caspase 

cascade and apoptosis via the ER-specific caspase- 

4. Inhibition studies using TUDCA demonstrate 

its ability to inhibit caspase activation via the 

phosphorylation of Bad and implicate it as a 

potential therapeutic agent in AAT deficiency. 

S Miller, C Greene, 

C Taggart, C McElvaney, 

S O’Neill 

Dept of Medicine, 

Respiratory Research 

Division, RCSI 

Education and 

Research Centre, 


Dublin 



41 

1 

SESSION FOUR ONE 



SESSION 

4SESSION FOUR ONE 

4.4 4.6 The role of IL-17 in inflammation and remodelling in the 

post-transplant airway 

4.5 Mast cells and obstructive airways disease 4.7 

Introduction 

Obliterative Bronchiolitis (OB) is the main cause 

of premature allograft failure following lung 

transplantation. It’s characterised by airway 

neutrophilia, epithelial injury and progressive 

fibroproliferative obliteration of small airways. 

Airway lymphocytosis is well described in the 

lung allograft, particularly during acute rejection 

episodes, but potential mechanisms linking this early 

inflammation to chronic neutrophilic inflammation 

and airway remodelling aren’t well understood. 

The lymphocyte-derived cytokine interleukin (IL)-17 

has been postulated to play a major role in airway 

neutrophilic inflammatory conditions. 

Aims 

To characterise airway expression of IL-17 in lung 

allografts and assess the effects of IL-17 on airway 

epithelium with specific reference to neutrophilic 

inflammation and remodelling. 

Methods 

Transbronchial biopsies from lung allografts with 

airway inflammation were stained for IL-17 and 

the degree of immunostaining in the epithelium 

and lamina propria quantified. Confluent primary 

bronchial epithelial cell cultures (PBECs) were 

established from bronchial brushings of stable 

lung allografts (n=10). PBECs were subsequently coincubated 

with IL-17 and the resulting levels of IL-8, 

IL-6, GCSF, GM-CSF, VEGF, MMP-2 and MMP-9 cell 

supernatant protein measured. 

Conclusions 

Our results suggest IL-17 as a potential mechanistic 

link between acute lung allograft rejection, 

neutrophil recruitment, airway remodelling and 

subsequent progression to OB. 

DM Murphy, 1 

IA Forrest, 1 C Ward, 1 

PA Corris, 1 G Pritchard, 1 

D Jones, 2 AJ Fisher, 1 

JJ Egan, 3 TE Cawston, 2 

JL Lordan 1 

1. The Applied 

Immunobiology 

and Transplantation 

Research Group and 

Results 

Our data demonstrate variable IL-17 immunostaining 

of the airway epithelium and mononuclear cell 

infiltrate of transbronchial biopsies obtained from 

lung transplant recipients. PBEC stimulation with 

IL-17 caused significantly raised levels of IL-8, IL- 

6, GCSF, GM-CSF and VEGF from baseline. Matrix 

metalloproteinase (MMP)-2 and -9 protein levels 

were not affected. 

2. The Faculty of 

Medical Sciences, 

The University of 

Newcastle-upon- 

Tyne 

3. The Musculoskeletal 

Research Group, The 

Faculty of Medical 

Sciences, The Irish 

Lung Transplant 

Programme, The 

Mater Hospital, 

Dublin 

This work was 

supported by ERS and 

MRC fellowships and 

Newcastle-upon-Tyne 

Special Trustees. 

Viral infection and cytokine responses in exacerbations 

of COPD 

Introduction 

In COPD exacerbations can be triggered by viral 

and bacterial infections. Real-time PCR allows 

faster and more accurate detection of respiratory 

viral infections and assessment of cytokine mRNA 

responses. We studied patients with COPD when 

stable and during exacerbations to determine the 

role of viral infection and airway inflammation. 

Method 

Patients were recruited with 24 hours of hospital 

admission for a COPD exacerbation (AECOPD). 

Patients with stable COPD who had no change in 

treatment or symptoms over the previous eight 

weeks were also recruited (SCOPD). Sputum, nasal 

and throat swab specimens were obtained and 

screened for respiratory viruses using nested PCR. 

Real-time PCR was used to measure mRNA cytokine 

responses. Ribosomal RNA (18s rRNA) was employed 

as a housekeeping gene. Supernatant from sputum 

specimens was analysed for corresponding protein 

concentrations of cytokines using the BioPlex system. 

All mRNA levels are adjusted for 18s rRNA and 

expressed as copies /ml of sputum (c/ml). 

Results 

One hundred and thirty six patients were recruited 

during an acute exacerbation and 68 when stable. 

Mean (±SD) age of each group was 70 yrs (± 9) and 

66 yrs (± 9) respectively. FEV 1 

(% predicted) was as 

follows; AECOPD 0.84 ± 0.5 (39%), SCOPD 1.00 ± 0.5 

(48%). Smoking history AECOPD 48 ± 39 and SCOPD 

42 ± 26 pack years. A respiratory virus was detected 

in 50 (37%) AECOPD and in 8 (12%) SCOPD patients (p 

< 0.001). TNF-α mRNA levels were higher in AECOPD 

(1392 c/ml) than SCOPD (139 c/ml) patients. IL-6 and 

IL-8 mRNA was also significantly increased during 

AECOPD (219c/ml, 38429 c/ml,) in comparison to 

stable patients (27 c/ml, 4071 c/ml p < 0.005). GRO-α 

and GM-CSF mRNA levels were increased during 

exacerbations (p < 0.005). Expression of growth 

factors TGF-β1 and TGF-β2 were also increased in 

AECOPD. Corresponding protein concentrations of 

IL-6, TNF-α, Interferon-γ and IL-4 were raised during 

exacerbations (p < 0.005). TGF-β1 and TNF-α mRNA 

levels were higher during those exacerbations in 

which a virus was not isolated. 

Conclusions 

Patients with AECOPD have an increased airway 

inflammatory response when compared to the stable 

patients. The expression of some cytokine targets are 

modulated by respiratory viral infection. 

Increased levels of cysteinyl and metalloproteases 

mediated by a TH 1 response in COPD patients 

TE McManus, 1,2 

AM Marley, 1 

F De Courcey, 3 

N Baxter, 1 SN Christie, 2 

HJ O’Neill, 2 JS Elborn, 3,4 

PV Coyle, 2 JC Kidney 1 


Medicine, Mater 

Hospital 

2. Regional Virus 

Laboratory, Royal 

Victoria Hospital 

3. Respiratory Research 

Group, Institute of 

Clinical Science 


Medicine, Belfast 

City Hospital 

Introduction 

A few studies have suggested that there are 

increased numbers of mast cells in the airways of 

patients with COPD. It is thought that they may play 

a role in mucous secretion and fibroblast activation. 

We looked for evidence of increased mast cell 

number in airway biopsies of patients with COPD 

and Alpha-1 Antitrypsin deficiency. 

Method 

Bronchoscopy was performed on six subjects 

with COPD, four subjects with Alpha-1 Antitrypsin 

deficiency and four normal non-smoking controls. Up 

to six biopsies were taken from the subcarinae of the 

second to the fourth divisions of the bronchial tree. 

Samples were embedded in a GMA resin and stained 

immunohistochimically using an antibody to mast 

cell tryptase. Positive cells in the submucosa 

were expressed per high powered (HP) field at 40x 

magnification. 

Results 

There were more mast cells in the samples from 

subjects with COPD compared to normal controls 

(1.2 cells / HP field versus 0.73) but this did not reach 

statistical significance, (p=0.16). Interestingly there 

was a significantly greater number of mast cells seen 

in the samples from the individuals with Alpha-1 

antitrypsin deficiency compared to controls (2.42 

versus 0.73, p

51 

1 

SESSION FIVE ONE 


Session 5: Smoking / Lung Cancer 


5 

SESSION 


5.1 

A study to compare the efficiency of sterile talc, tetracycline 

and bleomycin as sclerosing agents for medical pluerodesis 

in the treatment of malignant pleural effusions 

Background 

Malignant pleural effusion is a common 

complication of metastatic disease.Particularly 

lung cancer, that is often managed by drainage 

and medical pleurodesis. Sterile talc, tetracycline, 

and bleomycin have all been shown to be effective 

sclerosants. No randomized clinical trial has 

directly compared all three agents in the medical 

management of malignant pleural effusion. 

Methods 

A prospective, randomised trial was carried out across 

multiple sites between September 2001 and August 

2005. After complete drainage with symptom relief, 

patients with confirmed malignant pleural effusions, 

were allocated to receive intrapleural sterile talc (5g), 

tetracycline (1500mg) or bleomycin (60mg). Exclusion 

criteria included WHO performance status >2, small 

cell cancers and leukaemias. Primary outcome was 

response rate evaluated by radiographic improvement 

at one month after pleurodesis. 

Results 

Seventy patients were enrolled in the study; six 

patients were withdrawn before pleurodesis. 

Demographics and pleural fluid characteristics were 

comparable across all three groups. One patient 

randomised to talc experienced adult respiratory 

distress syndrome (ARDS). 

There was no significant difference in response rates 

between sclerosants. While there was a significantly 

higher CRP response to pleurodesis in the talc group, 

this was not associated with an improved response 

rate at one month. 

Conclusion 

There was no difference in the efficacy of sterile talc, 

tetracycline and bleomycin as sclerosant agents 

in the medical management of malignant pleural 

effusions. 

TALC TETRACYCLINE BLEOMYCIN P-VALUES 

N 23 19 22 

CXR response at one month 79% 77% 88% ns 

Mean ΔCRP mg/L 

(Pre to Day 3 post pleurodesis) 

+156 +63 +43 

Talc:Tet, 0.023, 

Talc:Bleo, 0.004 

Tet: Bleo, 0.455 

MT Henry, 1 B Ladd, 1 

J Tuggey, 1 C Bowker, 1 

AG Arnold, 2 



General Infirmary, 

Leeds, UK 

2. Castle Hill Hospital, 

East Yorkshire, UK 

5.3 

material in 58.1% of all patients (68.8% of Group 

A and 46.3% of Group B). It was the only positive 

procedure in 11.6% (11.1% of Group A and 12.2% 

of Group B). A cytopathologist attended 51.2% of 

procedures, resulting in a diagnostic TBNA in 63.6%. 

In comparison, TBNA was diagnostic in 42.8% when 

ROSE was not performed (p=0.053). 

Conclusions 

The results suggest that central TBNA compliments 

other diagnostic techniques in evaluation of the 

visualized portion of the endobronchial tree, and may 

improve diagnostic yield. This appears to be further 

enhanced by ROSE. 

Diagnostic yield of fluoroscopic-guided transbronchial 

needle aspiration of peripheral pulmonary lesions 

Introduction 

Peripheral pulmonary lesions which are not visible 

within the endobronchial tree usually require 

radiological or surgical techniques to provide tissue 

diagnosis. The role of transbronchial needle aspirate 

(TBNA) in central lesions is well documented. 

However it is not routinely utilized as part of the 

evaluation of peripheral lesions. 

Method 

We carried out a retrospective analysis of all 

patients over a two-year period in whom TBNA 

was performed as part of the diagnostic work-up 

of peripheral pulmonary lesions. We compared the 

overall yield of TBNA when rapid on-site cytologic 

evaluation (ROSE) was available with that when a 

cytopathologist was not available. We also compared 

the diagnostic yield of TBNA with that of BAL and 

transbronchial biopsy (TBBx) in those patients who 

had all 3 tests performed and had a final diagnosis of 

malignancy. 

Results 

Of 146 patients in whom TBNA was perfomed, 143 

were available for analysis. Mean age was 66 years. 

A cytopathologist attended for 60% of all procedures 

resulting in a diagnositic TBNA in 50.4%. In 

comparison, only 25.9% of TBNAs yielded a diagnosis 

when ROSE was not performed (p=0.003). 

Malignancy was confirmed in 56 patients by a 

combination of TBNA, TBBx and BAL. TBNA was 

positive for malignancy in 43 (76.8%) of cases, and 

was the only positive diagnostic procedure in 12 

(21.4%). TBBx was positive in 36 (64.3%) and was the 

only positive procedure in 10 (17.9%). BAL was positive 

in 19 (33.9%) but was the only positive procedure in 

only 2 cases (3.6%). 

Conclusions 

The addition of fluoroscopic-guided TBNA to BAL and 

TBBx enhances the diagnostic yield of bronchoscopy 

in peripheral lung cancer. This appears to be further 

enhanced by ROSE. 

D Breen, D O’Callaghan, 

B Kent, S Nicholson, 

J Keane, F O’Connell 


Medicine and 

Histopathology, 


Dublin 

5.2 

Med. Survival (days) 96 102 201 ns 

Diagnostic usefulness of central transbronchial needle 

aspirate 

Introduction 

Central transbronchial needle aspiration (TBNA) is an 

established tool for sampling the visualized portion 

of the endobronchial tree. This may compliment 

other conventional diagnostic techniques routinely 

used at bronchoscopy, including airway lavage, 

brushings and biopsy. 

Method 

We carried out a review of all patients over a twoyear 

period in whom central TBNA was performed as 

part of their diagnostic work-up. We also compared 

the overall yield of TBNA when rapid on-site cytologic 

evaluation (ROSE) was available with that when a 

cytopathologist was not available. 

Results 

Central TBNA was carried out in 86 patients. Average 

age was 64.1 years. An endobronchial abnormality 

[Group A] was noted in 45 (52.3%) and the airways 

were entirely normal [Group B] in 41 (47.7%). 

Specimens obtained by TBNA contained diagnostic 

D O’Callaghan, D Breen, 

B Kent, S Nicholson, 

J Keane, F O’Connell 


Medicine, CResT 

Directorate, St James’s 


5.4 

The Irish workplace smoking ban; an analysis of the 

exposure levels in Dublin bars 

Introduction 

On the 29 th March 2004, the Irish Government 

introduced legislation prohibiting the consumption 

of tobacco products in most workplaces. 

Controversially, the ban applied to the hospitality 

industry, including licensed premises. The time 

prior and subsequent to the introduction of the ban 

provided an opportunity to assess the exposure 

levels of particulates and benzene in Dublin pubs, 

and the effectiveness of the new legislation at 

protecting workers and patrons from unnecessary 

exposure to Environmental Tobacco Smoke 

Method 

Particulate levels (PM2.5 and PM10) were measured 

in 43 pubs, prior and subsequent to the introduction 

of the smoking ban, using a light scattering optical 

based instrument (Aerocet 531). For consistency 

purposes, repeat measurements were conducted 

on the same day of the week, and the same month, 

one year later from the original measurements. 

Simultaneously, benzene levels were monitored 

using passive benzene badges incorporating an 

activated carbon absorption element. In each public 

house, the benzene sampler was co-located with 

the AEROCET monitor, as near as possible to the 

breathing zone. 

M McCaffrey, 1 

PG Goodman, 2 

L Clancy 3 

1. Dublin City Council 

2. Dublin Institute of 

Technology, 

3. Research Institute 

for a Tobacco Free 

Society 



51 

SESSION 



RESULTS (µgm-3) PRE BAN POST BAN % CHANGE T VALUE 

Ave PM2.5 35.5 5.8 -83.6% -3.54 

Ave PM10 72.1 45.5 -36.9% -1.88 

(Ave) Max PM2.5 95.2 12.6 -86.8% -4.34 

(Ave) Max PM10 165.3 97.8 -40.9% -2.53 

Outdoor PM2.5 5.98 5.17 -13.55% NS 

Outdoor PM10 24.14 19.95 -17.36% NS 

Benzene (26 bars) 18.75 3.72 -80.20% -5.53 

Benzene (all bars) 17.91 4.10 -77.10% -6.42 

The study demonstrates a significant reduction in 

particulates (PM2.5 and PM10) and benzene levels 

in public houses following the introduction of the 

smoking ban. The only source of particles which 

changed over the monitoring period at all venues 

was the banning of smoking; all other sources of 

airborne particulates such as cooking remained 

unchanged. The study indicates that the smoking 

ban has lead to a significant reduction in indoor 

particulate and benzene levels in Dublin bars. 

Conclusions 

The smoking ban has successfully reduced the 

particulates (PM2.5 and PM10) and benzene exposure 

levels in Dublin pubs, thus indicating that ETS was 

the major contributor to these indoor exposure levels 

particularly the smaller particles. The continued high 

rate of compliance with the smoke-free legislation 

in public houses is conducive to better air quality for 

both staff and patrons. 

5.5 

Positron emission tomography (PET) staging of nodal 

disease in patients with non-small cell lung cancer 

Positron emission tomography (PET) has emerged 

as a valuable staging modality in Non-small cell 

lung cancer (NSCLC). It can help in identifying local 

regional spread as well as distant spread outside 

the thorax. We evaluated our experience of PET 

scanning as a staging tool in detecting lymph node 

involvement in potentially resectable NSCLC patients. 

Between February 2004 and August 2005, PET scan 

was performed on 62 patients with NSCLC who 

were candidates for surgical resection. Cervical 

mediastinoscopy was performed for patients with 

nodal-positive scan. The efficacy of PET scanning 

in detecting N1 and N2 disease were analysed by 

comparing prospective results of PET scanning with 

the histopathological results of mediastinoscopy 

and systemic lymph node dissection obtained during 

lung resection. 

In this study, all patients with nodal positive disease 

on PET scanning had mediastinoscopy. The sensitivity 

and specificity of PET scanning in detecting nodal 

involvement were 45% and 95% respectively. Positive 

predictive value in nodal disease was 82% and 

Negative predictive value was 78%. 

PET scanning plays a major role in staging NSCLC 

patients. Patients with nodal positive disease on PET 

scanning should have a cervical mediastinoscopy 

to define the exact nature of nodal involvement. 

Mediastinoscopy remains the gold standard for 

detecting mediastinal involvement. 

N Al-Sarraf, 

K Doddakula, R Aziz, 

E McGovern, V Young 




52 IRISH JOURNAL OF MEDICAL SCIENCE • VOLUME 174 • NUMBER 4 • SUPPLEMENT 3

Annual General Meeting of the Irish Thoracic Society - IJMS | Irish ...

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