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Letters intended for publication should be clearly marked as being for the web-site. Names, but not addresses, will be published unless otherwise requested. Any topic can be addressed provided it does not reflect poorly on the Society or its members. Anything deemed unsuitable will be returned to the author.
K.G.

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Archive

RE: Robert Jenson Award for Excellence in Respiratory Measurement

I would like to thank Prof. Robert Jensen and the ANZSRS for their support of my work at the 2010 ASM in Brisbane. Because of their support through the 'Robert Jensen Award' I was able to present my research at the most recent European Respiratory Society ASM in Barcelona. The presentation went well and I had some useful questions and comments.

I would also like to thank my colleagues and fellow researchers who contributed to the work which I presented at the ERS.

Kind Regards,

Vanessa Kelly

Department of Pulmonary and Critical Care Medicine
Massachusetts General Hospital
Boston, MA, USA.
e-mail: vjkelly@partners.org.au
phone: +1 617 726 8769

11 November 2010

I'd like to thank Michael Panagopolous and the rest of the team from Asencia for sponsoring the 2010 AFL Tipping Competition. It was great fun and enjoyed by a large contingent of ANZSRS members. What started out as some light-hearted fun amongst co-workers all of a sudden became very serious when a series of speculative tips propelled me up the leader board. Of the leaders I was only assured that Brett would pick his beloved Carlton, thus fall by the wayside. Debbie & Leigh also would pick their Swannies through thick & thin. I was hoping Maureen rode the Dockers during their poor end of the season run.

Any, it was in spite of my strategy and not because of it that I somehow ended up at the top of the pile. I would like to take the opportunity to acknowledge the early leader and self proclaimed Football Expert - Jarrod Warner - who was a runaway leader midway through the season, but found the going a little tough when it mattered most. As a Demon supporter I believe he was expecting about 4 or 5 "priority points" as charity.

Once again - thankyou Mike & Ascencia. I look forward to defending the title next year.

Brenton Eckert

9-Oct-2010

Dear Ed

I would like to thank Simon Wilson and CARE Medical (www.caremed.co.nz) for their generous travel award which funded my participation in the ANZSRS regional meeting in Queenstown. I would also like to acknowledge Chris O'Dea and Dr Ben Brockway for putting together a wonderfully engaging programme. Well done!

Kinds regards,

Paul T Kelly, PhD
Team Leader
Sleep Unit
Christchurch Hospital
New Zealand

9-Oct-2010

Hi Mike and Kevin

Just thought a update from Christchurch was the best way to communicate to all who have been so kind with their calls, texts and e-mail,

Everybody in the laboratory is fine and no one has major housing damage.

The laboratory is up and running and we were testing people first thing this morning. A few gas tanks, computer screens and filing cabinets tipped. We have several ceiling tiles hanging and lots of plaster dust. All our equipment is operational.

We have been lucky. It was rather frightening particularly in the pitch black. Power and water were back on for most people during Saturday. It is going to take months for the city to recover.

Thank you everyone for your kindness and concern.

Kind regards
Maureen

Maureen P Swanney, CRFS, PhD
Scientific Director, Respiratory Physiology Laboratory
4th Floor, Riverside Building
Christchurch Hospital, Private Bag 4710
Christchurch 8140, New Zealand

9-Sep-2010

Dear Editor,

I would like to thank Craig Abud and Niche Medical for their generous sponsorship of the Best Oral Presentation. I was thrilled to win this award in Brisbane and this has given me the opportunity to travel to an international meeting.

Our study identified significant alterations in pulmonary blood perfusion during "lung packing", a technique used to enhance Freediving performance. These athletes continually surprise us with regards to what the healthy lung can tolerate.

I would like to acknowledge my new colleagues in Nuclear Medicine, who were extremely patient with my imaging naivety and of course the members of the "Sydney Freedivers" who are always happy and enthusiastic.

Kind regards

Leigh Seccombe
Senior Scientist
Department of Thoracic Medicine
Concord Repatriation General Hospital

12 June 2010

To my fellow ANZSRS members

I'd like to very sincerely express my appreciation to all in ANZSRS for the award of Life Membership bestowed on me at the ASM dinner in Brisbane. I feel incredibly honoured to have my contribution to the Society over the years recognised by my peers, but also quite humbled when I consider the contributions of those others who have received this award before me - I'm not convinced that I belong in that company, however I accept the award gratefully!

As I said on the night (I think!), I've gotten much more out of ANZSRS than I've put in, & I'd like to take this opportunity to urge our younger members particularly to not be backward when the opportunity arises to make your own contributions to our wonderful group - any efforts you make will ultimately be repaid to you many times over.

My thanks go to those who were instrumental in organising the award, and especially for enabling my family to share in the proceedings - it was a most memorable occasion for us all!

Thanks again

Mike Brown

2-June-2010

Dear Editor
Re: ANZSRS Best Poster Presentation

I would like to thank Compumedics for their sponsorship of the ANZSRS Best Poster Presentation. I am honoured to have received this award at the 2010 Brisbane Annual Scientific Meeting.

For those of you who were not at the meeting, here is my entire thank you speech: "Thank you Compumedics………….Yep!"

There was supposed to be more to it than that, including thanking my colleagues at Christchurch Hospital. I also promptly retrieved my poster from the rubbish bin outside the meeting room following the prize giving.

I had a great amount of discussion and feedback about my poster entitled "Supporting and Monitoring the Quality of Community Spirometry". The main point of the poster was that despite regular quality feedback to community spirometry testers, acceptability and repeatability of spirometry manoeuvres did not improve to the expected ATS/ERS standards.

Thanks again to Compumedics for your continuing support of this award. The prize money will help me get to the ERS meeting in Barcelona, September 2010.

Kind Regards
Josh Stanton
Respiratory Physiology Laboratory
Christchurch Hospital
Christchurch, New Zealand

16-May-2010

RE: 2010 ANZSRS Young Investigator Award

I would like to express my sincere appreciation to Bird Healthcare for their generosity in sponsoring the ANZSRS Young Investigator Award. I am deeply honoured to have received the award at the 2010 ANZSRS Annual Scientific Meeting in Brisbane.

The award provides the opportunity to advance my professional development in addition to acknowledging the thoughtful guidance and support from Bruce Thompson and Brigitte Borg and the team at the Alfred Hospital.

It is my intention to make use of the prize to attend the 2011 European Respiratory Society meeting. This will be my first conference overseas therefore the commendable assistance from Bob and the team at Bird Healthcare is one that certainly allows young investigators to launch into their career.

With great gratitude,
Mahesh Dharmakumara.
Lung Function Laboratory
The Alfred Hospital
Melbourne, Australia.

14-Apr-2010

Dear Editor

I was just thinking back over my 7-years as a member of the ANZSRS and re-reading many of the excellent letters and items on the ANZSRS web site. I was pleasently suprised by the range of questions and the depth of answers provided, and then I clicked on the letters archive and came across one I wrote in response to the August 2003 Train of Thought. My response was one of many all of which considered the question posed which related to Vision, and vision for the Society.

I reflect now sitting at my desk nearly 7 years later to see where the ensuing Board discussion around Vision has ended up. At the 2010 AGM the ANZSRS membership approved the adoption of a new Constitution and provided overwhelming support for the Board to implement the new Governance structure. Those of us who have put many years in to this project are both relieved and excited to see the culmination of work result in such a monumentous outcome, one that will, we believe, set the ANZSRS on a stong footing for the next 30-years.

It is worth taking time to remember the people who have dedicated a significant amount of time to this project. As if echoing David John's comments in his reply back in August 2003, we have seen a small number of dedicated people give a huge amount of both themselves and their time to ensure that all members of the society can continue to benifit from being a member of ANZSRS. This is just a small part of the story though. The Vision that the Board agreed to, Leading Respiratory Science in Australasia through the 21st Century, has with out a shadow of a doubt been lived up to as evidenced by the first Respiratory Physiology Roadshow in Hong Kong and the planned second Roadshow in Vietnam. The links that the ANZSRS has developed and strengthened through its members work with both American and European societies, and the on going discussions around worldwide collaboration in research, education and web based professional discussion sites reflect the drive of our membership to achieve our Vision.

It is a worry that as we look outwards more and more we might forget to support our members in Australia & NZ. I think the evidence speaks for itself, ANZSRS has more grants and awards than it had 7 years ago and actively supports each other more than it did.

The first 30-years of the ANZSRS has given the Society a solid footing on which to continue to grow; grow out beyond our traditional borders of Australia and NZ and in to the challenging Asia Pacific where our knowledge and expertise can benifit those who also aim to improve the respiratory health of their communities.

It is time to remember our roots and celebrate the successes of all over the 30-years, and turn our gaze to the future of the Society. The old guard, at least for a few more years, will still be there at the back of the ASM dinner drooling in to their beer and red wine and telling stories of events that have passed in to the history of ANZSRS - now is the time for the next generation of ANZSRS members to come to the fore and provide the leadership of ANZSRS for the next 30-years.

I raise a glass to all those people with whom I have sat around the table discussing governance, constitutions, legislation and legal points of order, and of course vision which is what got me in to this in the first place. And now that the next chapter begins I would like to take the time to thank the two people who I have spent many hours discussing these issues with; Brigitte Borg and Paul Guy. Brigitte because her attention to detail was unending and Brigitte was the person who first realised our Constitution was illegal, and Paul who was able to convert my unruley enthusiasm at Board meetings in to issues that could be voted on.

Here is to the next 30-years of ANZSRS.

David Robiony-Rogers

14-Apr-2010

Dear Editor

I would like to thank Pharmaxis for their travel grant which enabled me to attend the recent APSR meeting in Bangkok, Thailand.

I had two roles at this congress. One was presenting alongside other ANZSRS members in post graduate courses for "Setting up a pulmonary function laboratory" and "Exercise testing for assessing respiratory capacity and function". Both of these sessions generated a large attendance from APSR delegates.

I also had the opportunity to present some of our local research at the APSR meeting on the short term stability of biological control data on an ultrasonic and rolling seal spirometer. This study supported the previously reported stability of the EasyOne spirometer's calibration. The biological stability demonstrated in the study also suggested that biological quality control testing would contribute to the identification of instrument errors on spirometers using ultrasound based measurement.

Again, thank you to Pharmaxis for providing me the opportunity to travel to Bangkok.

Kind Regards

Josh Stanton
Respiratory Physiology Laboratory
Christchurch Hospital

31-Mar-2009

Hi Kevin,

I would like to recommend our colleagues two recent articles, and an abstract with slides (presented in the annual meeting in Darwin) regarding world's first detection of common respiratory viruses in human exhaled breath.

A New Method for Sample and Detection of Exhaled Respiratory Virus Aerosols KN Huynh, BG Oliver, S Stelzer, WD Rawlinson and ER Tovey Clin Infect Dis 2008; 46: 93

Influenza Virus in Human Exhaled Breath: A Observational Study P Fabian, JJ McDevitt, WH DeHaan, ROP Fung, BJ Cowling, KH Chan, GM Leung and DK Milton PLos ONE 3(7): e2691

Respiratory Viruses Are Aerosolised by Breathing ER Tovey, DSY NG, S Stelzer-Braid and WD Rawlinson Respirology 2009;14 (Suppl 1): A20. (attaching the slides with Dr Tovey's permission)

I hope they can be posted in Library Corner.

I think we should consider upgrading the infection control measures in clinical respiratory labs to prevent viral cross-infection of airborne transmission.

Kind regards,

Guang Zhang
Respiratory Investigation Unit
Gosford and Wyong Hospitals

9-May-2009

Dear Editor,

I would like to thank Ascencia for their generous sponsorship that permitted me to attend the Asia Pacific Society of Respirology Congress in Bangkok, Thailand.

They say "timing is everything", so it turned out with this meeting. My scheduled departure was delayed 24 hours due to the horrific storm damage inflicted upon north-western Brisbane (I couldn't even get to my house for 12 hours!). Even then I did the \"responsible\" thing by departing for Bangkok and leaving my family huddled around a candle awaiting the return of electricity! Much better timing on my return trip - escaping the turmoil that enveloped the Bangkok airport by a mere 48 hours!

The APSR meeting (and Bangkok) was fantastic. The ANZSRS sessions were well organised and allowed networking with like-minded health professionals from numerous countries within the Asia-Pacific region. This makes one reflect on how fortunate we are to live here in Australia, and our access to current health-care technology.

With the support of the Ascencia grant I was able to present departmental research which investigated the use of different criteria for determining improvement in patients undergoing assessment for ambulatory oxygen. Current available guidelines are either vague (ie. a "rapid improvement when breathing oxygen", or if prescriptive, look for varying improvements in oxygen saturation, breathlessness (BORG scale)or walking distance.

We found the number of subjects achieving the different improvement criteria varied enormously. 91% of subjects recorded an improvement in end exercise SpO2 of >3% when breathing supplemental oxygen. 50% of subjects improved their walking distance by 20%, but only 24% achieved an absolute improvement of > 50 metres. Only 11% of subjects recorded an improvement in sensation of breathlessness when breathing supplemental oxygen. We concluded that evidence based guidelines are required for the assessment of ambulatory oxygen therapy, including a standardised assessment procedure and definition of significant improvement.

A trip to Bangkok is not complete without a tuk-tuk ride, a journey on the very polluted waterways, wandering along Pat Pong Rd, visiting the numerous temples and palaces, and of course - immersing oneself in the local cuisine. All eye-opening, and extremely enjoyable experiences.

Thanks once again for this fabulous opportunity.

Kind regards

Brenton Eckert

Senior Respiratory Scientist
Princess Alexandra Hospital
Brisbane. Queensland.

12 March 2009

Hi Derek,

Now we have finished and are manufacturing and supplying the industry E-Chambers @ $3.95 each, it is obvious we have produced a solution for hospitals in regards to the new TGA regulations at a very cost-effective price.

The next project we have just started is addressing the issue of nose-clips as these also come under the same TGA regulation. Many labs are re-using single use items and we welcome any feed back or recommendations regarding what respiratory labs require for nose-clips. Currently the cost of a nose-clip is about $1.50 AUD and we believe we can deliver for approx 50 cents or less. The design is important and feed back in regards to the preference of foam pads or non-slip plastic webbing would be appreciated.

We also seek advice regarding the price range at which labs would consider purchasing the nose clips as an inclusion with a barrier filter, both being disposed off after single use.

Any one who is operating a private lab it is recommended that these cost be passed on to the patient at time of billing as an infection control consumable line item. Some labs are charging for such a pack, comprising filter - nose clip - e-chamber, for $9.95.

Regards,
Nick Bird

7-Jun-2006

I would like to thank Bird Healthcare for their generous prize of the Penfolds 1996 Grange Hermitage.

The winning of this wine has been an ordeal from the moment I received the letter from New Zealand Post stating that they had received a parcel for me from Australia and that I needed to contact NZ customs to pay the import duty on said item. Having paid NZ customs the monies they required, I then spent a day, a weekend and another day in conversation with New Zealand Post trying to track down the box and have its delivery diverted from Wellington Hospital either to my home address or to the Courier Post office where I could claim it in person. This was like reliving weeks 39 and 40 of pregnancy as a father to be knowing that birth is fairly imminent but never knowing when it will happen.

Thankfully a telephone call from Courier Post to inform me my parcel was sitting safe in the Wellington office for me to collect. Just like any expectant father I made the mad dash to the courier office to collect my new bundle of joy - delivered into my proud hands at around 12.45 on Tue 15 April.

The wine is now safely at home, where, like a new child I will look after it and tend to its every needs for at least the next 10-years before opening it and sampling what is reputedly Australia's finest example of old vine shiraz.

Once again - many thanks to Bird Healthcare for their generosity and their continuing support of the conferences and our profession.

David Robiony-Rogers
Wellington, NZ

10-May-2006

I would like to thank Bird Healthcare for their generous support of my attendance at the APSR congress on the Gold Coast.

I had the opportunity to present recently published data on air travel hypoxemia in passengers with COPD. The aim of the study was to assess the predictive capability of the hypoxia inhalation test (HIT) to in-flight hypoxemia in passengers with COPD. We found that air travel causes significant and in some cases severe desaturation in passengers with COPD. The HIT compared favourably with air travel, with differences explainable by PIO2 and physical activity. We concluded that the HIT is the best widely available laboratory test to predict in-flight hypoxemia.

Kind Regards

Paul Kelly
Respiratory Physiology Laboratory
Christchurch Hospital

12-Feb-2008

Dear Editor,

I would like to thank Pharmaxis and the ANZSRS for so generously sponsoring the Pharmaxis-APSR travel grant that allowed me to attend the Asia Pacific Society of Respirology Congress. This very interesting and diverse meeting was held on the Gold Coast in early December 2007. With the support of this grant I was able to present some work investigating the accuracy of pulse oximeters and the influence of sensor type in induced hypoxia. We investigated the accuracy of various oximeters and sensors by comparing pulse oximetry with arterial co-oximetry measurements. We found that all of the oximeter and sensor combinations tested met the criteria specified be US FDA (RMS error of less than 3%) over a range of oxygen saturations from 70 to 100%. Two of the oximeter/sensor combinations could improve their accuracy by altering the look-up table they utilise to calculate SpO2. The sensor with the least error was the forehead reflectance sensor. We also found that there is a significant delay of about 30 seconds from central (ear and forehead) to peripheral (finger) sensors.

Thanks once again for this fabulous opportunity.

Kind regards

Danny Brazzale
Respiratory Scientist
Austin Hospital
Melbourne, Victoria.

6-Feb-2008

I would like to thank Bob and everyone at Bird Healthcare for sponsoring a travel grant so that I could attend this years Asian Pacific Society of Respirology Congress. This generous grant enabled me to present some recent work that we have conducted on patients with OSA and their unexpected response to a flight simulation. We found that although these patients do not have lung disease and have normal gas exchange at sea level, more than half of them desaturated to unacceptable levels at simulated 8000ft. They also experienced increasing heart rate and oxygen uptake during the simulation, however their ventilatory response was not different to the normal group. Traditionally, hypoxaemia has been the sole end-point to whether a patient is fit or unfit to fly. This data suggests that other cardiovascular markers, such as VO2, may assist in determining which patients have the potential for an adverse event in-flight.

Kind regards

Leigh Seccombe
Senior Scientist
Concord Repatriation General Hospital

11-Dec-2007

Dear Editor,

I wish to express my sincere thanks to the society and to Mayo Healthcare for awarding me the WA Respiratory Scientist Travel Award for 2007.
I intend to use this award to attend the ANZSRS ASM in Melbourne in 2008. I will be presenting data investigating the effect of wait time on FRC during repeat Nitrogen washout testing in children. This study is being conducted at Princess Margaret Hospital.
In addition, I look forward to presenting the data we found at Royal Perth Hospital while investigating the effect of wait time on FRC, during subsequent Helium dilution measurements in adults.
These two studies have been undertaken to identify an appropriate waiting period between subsequent measurements of Lung volumes, as current guidelines are ambiguous in their recommendations and appear to lack evidence to support their suggestions.
I look forward to presenting our findings with the opportunity to discuss our research with fellow scientists, and the ASM is a fantasic medium for doing so.

Thank you once again to the Judging panel, ANZSRS and to Mayo healthcare for providing me with this opportunity.

Kind Regards,

Elizabeth Salamon

12-Nov-2007

Dear Kevin,

I wish to sincerely thank Compumedics for their generous sponsorship of the Best Poster Presentation Award which I received at the ANZSRS 2007 ASM in Auckland. I also wish to acknowledge my co-author, Maureen Swanney, and thank the ANZSRS for the travel grant to help me attend this meeting.

Our study looked at the difference between total lung capacity (TLC) determined by plethysmography and single-breath determined alveolar volume (VA). This work stemmed from the 2005 ATS/ERS Taskforce guidelines which suggest that VA, plus estimated dead space volume, is an acceptable surrogate for TLC in patients with normal lung function. Our study has shown that VA, determined with a single-breath washout method, is a poor estimate of TLC, even in non-obstructed patients. The difference between VA and TLC is greater in patients with airway obstruction. The single-breath method represents the regions of the lung into which the test gas is distributed. Poor gas mixing, particularly in patients with obstructive airways disease, reduces gas dilution and significantly underestimates VA. Reducing the time between single-breath DLCO measurements from > 4 minutes to < 2 minutes caused a statistically significant reduction in VA in 3 of the 5 patient groups (p < 0.05), however the differences were small and were within the limits of test repeatability.

Kind regards,

Lauren Wallace
Respiratory Scientist
Respiratory Physiology Laboratory
Christchurch Hospital
Christchurch
New Zealand

17-May-2007

Dear Editor,

I wish to sincerely thank the ANZSRS and Mayo Healthcare for providing me with the opportunity to attend the 2007Annual Scientific meeting in Auckland, New Zealand. I presented a poster entitled "Maximal Respiratory Pressures in Healthy Children". This abstract reflects preliminary data obtained from a large ongoing validation study of all lung function tests performed in our laboratory at Princess Margaret Hospital in Perth. We are hoping to validate our reference ranges over the ages of 5 to 18 years and are recruiting healthy children, both male and female (in each age group.)
I found the scientific meeting to be very challenging, educational and thoroughly enjoyable. I recommend other members apply for sponsorship towards the next annual meeting!
Many Thanks

Ms Jan Oostryck
Respiratory Scientist
Respiratory Medicine Department
Princess Margaret Hospital
Perth. WA.

11-May-2007

11-May-2007

11-May-2007

Dear Mr Tagliaferri,

My hospital is organizing the 2nd Asia Pacific congress of bronchology which will be held in Singapore from 12-16th July 2007. I would be most grateful if would allow us to put this congress under your calender of events. Please contact me if you have any queries.

The website is www.apcb2007.com

Thank you.

Dr Steve Yang
Singapore General Hospital

11-May-2007

I write in response to Kevin's most recent "Train of Thought" (March 2007 - Surviving the ASM). It brings to the fore much of the Society's "raison d'être". The camaraderie, networking, mentoring and even difference of opinion are all good for our professions.

Kevin's description of the ASM as a scary place is very different from how I see it but we all experience things differently. When I attended my first meeting, shortly after the battle of Hastings, I was wide eyed and exhilarated to see what other people were doing. Some of it went way over my head but eventually some of it sank in. Over the ensuing years I have looked forward to seeing my colleagues and friends (of decades) and have had the privilege to sit on Boards and Executives that directly and indirectly changed the standing of our various professions. I have been regularly humbled by the intellect of others and occasionally frustrated by the ideas, debates and decisions made.

Kevin is absolutely right to suggest that we all need to be informed about things which govern our collective and only make informed decisions. This should be a member's and any scientist's approach to all things. Kevin's massive contribution to the society website has, no doubt, been a source of frustration as the membership can sometimes seem disengaged as they deal with their day to day concerns.

The idea that there are numerous "threats" to be dealt with suggests a siege that the ASM attendee needs to repel. If this is how some newer members feel, it is incumbent on the more experienced (nee older) members to engage with this group. The Society is a co-operative beast that strives to provide support, encouragement and education for all members, as stipulated in our constitution and recognises that as members meet professional challenges, the Society, through its membership, is there in one form or another to provide support.

Our society faces great change over the next few years in terms of size and changing membership profile, particularly as we embrace the wider regions of the Asia Pacific. Registration also looms large as a significant change to our profession. Some may see this as a 'threat' but I see it, like I saw my first (ASRT/ANZSRS) meeting, as a great opportunity……not to be missed……and certainly something to contribute to.

I hope that all of our members do inform themselves about their work, their networks and their society and engage at this year's ASM with excitement rather than fear. If you feel intimidated or frustrated I challenge you to give Kevin, me and the Board a hard time.

Paul Guy
Chair
ANZSRS
Governance Sub Committee

14-March-2006

ANZSRS - the Society in 2007

The New Year is often a time when people evaluate what is important to them and what is important for the year ahead. This type of reflection is in most cases helpful for it gives time to reflect on what has gone before and what future is desired.

This is the same for ANZSRS. 2007 sees the Society moving in a direction that is both exciting and a little bit scary in that we are looking to step beyond Australia and New Zealand and open our doors to the wider world. As a Society we have reached the age of exploration outside our comfort zone. For some this is exciting whilst for others it may be threatening, but for all it should be about possibilities to develop and grow as a Society and as individuals.

Part of this growth as individuals is about putting in time to the Society either through active participation as state representatives, board or executive members, committee members or through shared ideas, visions and goals.

The Society is maturing and with this comes change and development. For ANZSRS to develop in a way that represents and supports all of the membership each member, either as an idividual or as a group, needs to speak out and be part of the development process.

I would like to see 2007 be the year that the whole of the ANZSRS membership informs the Executive of where we as a Society should be going, what is important to everyone and how will the Society best serve and support its membership.

I challenge every member to think about this and provide feedback that will provide direction for the Society to grow in 2007.

David Robiony-Rogers
Wellington New Zealand

15-Jan-2007

ANZSRS-WA Education Support Grant

It is with great pleasure I accept the inaugural ANZSRS-WA Education Support Grant, kindly sponsored by Mayo Healthcare (Australia Pty Ltd).

The abstract submitted to the WA branch of ANZSRS examined the normal ranges for MIPs and MEPs obtained from healthy WA children and compared our results with those from a similar study conducted by Tomalak, et al - reported in Paediatric Pulmonology, Vol 34, 2002. These results form part of an ongoing validation study involving a comprehensive range of lung function tests routinely performed in our laboratory.

My thanks are also extended to the following people who are assisting with this rather large study - Graham Hall, Maureen Verheggen, Vaska Stavreska and Karla Logie.

I intend to use the funds provided to cover registration (and possibly some accommodation) fees for attendance at the combined ANZSRS-TSANZ meeting in Auckland, March 2007. I am looking forward to an interesting and stimulating conference.

Ms Jan Oostryck
Respiratory Medicine Dept
Princess Margaret Hospital
Perth, WA

15-November-2006

Letter to Editor
Media Spokesperson for ANZSRS

Over the past year I have been writing reviews and commentary on research papers and historical material published in the Society's journal, VOLUME. This has provided the opportunity for me to reflect more broadly on the outputs of the Society, where it has been and where it is heading. I am struck by a number of things including a growing engagement with other professional groups in a mutually respectful environment, and increasing consultation by outside agencies seeking expert advice. These changes are built on the recognition of the ANZSRS as the peer professional body representing respiratory scientists.

It is clear to me that the ANZSRS has had a very positive impact not only in terms of the range, quality and impact of the clinical and scientific work performed by its members, but also in successfully encouraging the move towards providing a pro-active and research oriented clinical physiological service. Over the life of the Society, our members have earned 'ownership' of our profession and are now respected as independent and knowledgeable professionals who conduct research to inform and improve their clinical service. This is a paradigm shift, and is reflected as Respiratory Technicians have become Respiratory Scientists.

The work of the Society and its members has broad relevance beyond its membership. One of the responsibilities of a professional organisation is to promote quality and excellence not only to its members, but also to the wider community. I believe the Society needs to appoint a media/publicity spokesperson whose role would be to actively promote direct dialogue with other organisations and the media. Establishing a media spokesperson would provide a known contact for the media (etc) and would ensure a prompt response consistent with the Society Vision and policies, and also ensure that 'opportunities' for engagement are not missed. This could be a newly created position within the Society or an extension of an existing one. The important thing is to have a clearly identified spokesperson who has the time and communication skills to pro-actively develop and lead this role. Establishing a line of communication with the media and community would also provide feedback that we can use to further improve our service. This could lead to development of new areas on the ANZSRS website such as 'media releases' and also 'educational material' directed to the general public and our patients (e.g. how the lung works, what are lung function tests? how are they performed? how are the results used by your doctor? etc).

This suggestion introduces a new role in the Society but I think the Society is now well positioned to formally promote itself as a repository of expert opinion.

What do others think?

David P. Johns
School of Medicine
University of Tasmania

13-October-2006

Aloha!

My name is Dr. Joseph Pina and I am the co-director of the Hawaii Thoracic Society's 7th annual Current Concepts in Pulmonary and Critical Care conference, to be held at the Maui Prince Hotel on 21-24 January 2007. Dr. Peter Wagner, ex-president of the American Thoracic Society, is also a co-director. This clinical conference covers a variety of pulmonary and critical care topics including asthma, sleep medicine, mycobacterial infections, bronchiectasis, high altitude and diving illnesses, sarcoidosis, and pulmonary fibrosis. We will feature a Meet-the-Professor session (with actual case discussions), a pro-con debate and an expert panel discussion. In addition to Dr. Wagner, our speaker roster includes Dr. Barbara Philips, Dr. Jeffrey Myers, Dr. Sally Wenzel, Dr. Christian Sandrock, Dr. Dean Straufnagel and Dr. Ganesh Raghu. What a wonderful way to spend time after the holidays - a great CME conference in beautiful Maui.

Please refer to http://ala-hawaii.org/2007-symposium.asp for details on the conference and access to our early registration form. You can also see the agendas and speaker list of some of our past conferences.

Annually we get about 50-90 physicians, therapists and scientists from the mainland USA and several from Canada and Australia. We are very interested in seeing what interest there is from the Asia Pacific area. I was wondering if you might be interested in posting our seminar announcement in an appropriate spot on your website and newsletter. Please let me know if this is possible and, if so, what is the process and what the fee, if any, would be. Thanks for your time. jsp

Joseph S. Pina, MD, FACP, FCCP
President, Hawaii Thoracic Society;
Associate Clinical Professor of Medicine,
John A. Burns School of Medicine,
University of Hawaii
Honolulu, Hawaii

31-August-2006

Dear Kevin,

It has been suggested that spirometry (the most important aspect being FVC test) should be as readily available and routinely used as blood pressure measurement in the general practitioner's surgery. However, spirometry requires both the operator's appropriate skills and the patient's good cooperation, and therefore is more difficult and complicated to be performed than the measurement of blood pressure. If the operator of spirometry fails to master all of the key coaching and measuring points, and the accurate procedures, it may lead to poor quality spirometry, which is "worse than no spirometry at all".

In a recent practical assessment of FVC test for medical students who completed a spirometry training program with a two-hour lecture and a one-hour practice session, most of them missed out one or more of the key points. They either failed to ask the subject for full inspiration or maximal force on expiration, or did not remember how many acceptable trials were needed. This seems quite understandable, because they have lots other things to study and practice. And this is consistent with the results of a previous study by Dr Eaton et al that, despite their significant training effort, the quality of spirometry performed in primary care practice did not generally satisfy full ATS criteria for acceptability and reproducibility. (Chest 1999; 116:416)

As we know, in some training courses, simple acronyms have been developed as mnemonics to help trainees remember the key action points and the correct procedures more easily. For example, "DRABC" (Danger, Response, Airway, Breathing and Circulation) is used in cardiopulmonary resuscitation training; "RACE" (Raise alarm, Assist, Confine and Extinguish) is used in fire safety training.

I think it might be similarly helpful that, in the summary of a spirometry course for the people who work in primary care practices, we use a simple acronym or a series of simple numbers (if possible) to signify and emphasize the principles and characteristics of FVC test.

Based on ATS/ERS recommendations, I am using "3-3-2-1" with brief explanations to indicate the key points and the procedures of FVC test for the trainees:

  • 3 - THREE maximal manoeuvres on each trial. (maximal inhalation, maximal force right from the start of expiration and maximal exhalation with correct posture and good mouth seal by the subject; with active coaching by the operator.)

  • 3 - THREE acceptable spirograms. (each with good start and end; exhalation >6 seconds; no cough, pause and leak.)

  • 2 - TWO best FEV1's and FVC's being reproducible. (variation < 150 ml.)

  • 1 - ONE largest FEV1 and FVC being selected.

Alternatively, because FVC T(test) may also stand for Full efforts, Valid, Consistent and Top results, "3F-3V-2C-1T" from the combination of "3-3-2-1" and "F-V-C-T" could be used:

  • 3F - THREE Full effort manoeuvres on each trial.

  • 3V - THREE Valid spirograms.

  • 2C - TWO largest FEV1's and FVC's being Consistent.

  • 1T - ONE Top FEV1 and FVC being selected.

To serve as another reminder, a simple flowchart of FVC testing composed by the key points and the procedures with brief explanations could be placed around each of the spirometers used in primary care practices.

I hope our colleagues have more and better ideas.

Sincerely yours,

Yuguang Zhang
Respiratory Investigation Unit
Gosford Hospital and Wyong Hospital

10-June-2006

Dear ANZSRS members

Re: Depositing and drawing cheques from ANZSRS Accounts.

The Treasurer has not been able to deposit cheque's received from mid February til the present and this is the same for drawing cheques. The current undesirable situation is due to the auditor still having in his possession the ANZSRS financial folders, including cheque depositing books and cheque books. Unfortunately the auditor's report is still pending and there has been minimal communication regarding when this will be completed. Please note that I have received member's cheques and expense claim forms sent via mail.

The solution to depositing and drawing cheques will hopefully be rectified by receiving new cheque books sometime later this week. The Treasurer will be looking to deposit the outstanding cheques received (Mid February to the present) during the week commencing the 15th of May 2006. Please be advised that all members have sufficient funds available in their accounts to minimise potential dishonour fees.

The Treasurer will endeavour to distribute receipts quickly via e-mail once cheques have cleared.

Action has now been taken to minimise this situation from occurring again in the foreseeable future.

If you have any queries please contact the Treasurer.

Apologies for the inconvenience this may have caused.

Derek Figurski
Hon.Treasurer
ANZSRS

Department of Thoracic Medicine
The Canberra Hospital
PO Box 11 Woden ACT 2606
Phone: +61 2 6244 2806
Fax: (02) 6244 2604

11-May-2006

From Lauren Wallace, winner Bird Healthcare Young Investigator Prize.

Dear Kevin

I wish to sincerely thank Bird Healthcare for their generous sponsorship of the Young Investigator Award, which I received at the ANZSRS 2006 ASM in Canberra. I am looking forward to using this award to attend an international meeting this year. I also wish to thank the ANZSRS for the travel grant to help me attend this meeting and present my work on reducing the time interval between DL,CO tests.

THE EFFECT OF REDUCING THE TIME BETWEEN DL,CO TESTS
Wallace LA1, Graham B2 and Swanney MP1
1 Respiratory Physiology Laboratory, Christchurch Hospital, Christchurch, New Zealand.
2 Charles Sturt University, Wagga Wagga, NSW, Australia

Summary:
The ATS/ERS Taskforce recommend that the interval between Single-Breath Diffusing Capacity tests be no shorter than 4 minutes to allow sufficient washout time of test gas from the lungs. We compared DL,CO test data from 85 patients, using two sets of three repeat measurements, with intervals between measurements of > 4 minutes and < 2 minutes. We found that the recommended time may be excessive because no effect was observed on repeat measurements of DL,CO when the time between measurements was reduced to approximately 1.5 minutes. Results further suggest that there is no effect even in patients with severe airflow obstruction.

This study formed part of my Master of Science through Charles Sturt University. I would like to acknowledge and thank my Master's Supervisors and co-authors of this study, Maureen Swanney from Christchurch Hospital and Bruce Graham from Charles Sturt University.

Kind regards,

Lauren Wallace
Respiratory Scientist
Respiratory Physiology Laboratory
Christchurch Hospital
Christchurch
New Zealand

19-Apr-2006

From Elizabeth Salamon, Winner Compumedics Poster Prize.

Dear Kevin

First and foremost I would like to express my gratitude to Compumedics for sponsoring the best poster prize. I would like to acknowledge my co-authors, Kevin Gain, Paul Kelly and Nigel McArdle, as without their contributions in terms of time and professional knowledge and experience I would have been unable to complete this research. I would also like to thank my colleagues Chris Nathan and Elise McKeon for their support and input. I must also acknowledge the medical artists at RPH for their creativity. Thank you to the RPH Respiratory Medicine Department for the funding to attend the ANZSRS conference, and also to the ANZSRS for the travel grant for without these sources I would not have been able to present at all. To conclude, I just want to congratulate all of the members of the ANZSRS for making this conference so successful and informative.

Kind Regards,

Elizabeth Salamon
Royal Perth Hospital

19-Apr-2006

From Jeff Pretto, winner Technipro best Oral Presentation Prize

Dear Kevin

I would like to express my thanks to the Society for awarding me the Best Oral Presentation award at the 2006 Annual Scientific Meeting in Canberra for my presentation of our research investigating the effects of oxygen therapy on driving performance in hypoxaemic COPD. I would particularly like to extend my thanks to Ed Van Reit from Technipro for his most generous support of this award. The value of Technipro's support to the Society in supporting and encouraging research amongst ANZSRS members cannot be underestimated, and it certainly provides a wonderful opportunity for award recipients to present their work to the broader international scientific community. I plan to use this sponsorship to help present my research at the 2007 ERS conference in Stockholm. I would also like to acknowledge the financial support of the Victorian Tuberculosis and Lung Association in my project, and to thank my colleagues within the Department of Respiratory & Sleep Medicine at the Austin Hospital for their assistance and support.

Yours sincerely

Jeff Pretto
Senior Respiratory Scientist
Austin Health

19-Apr-2006

I recently attended the inaugural WA ANZSRS/TSANZ annual scientific meeting held in Mandurah. I was thrilled to receive the inaugural WA Respiratory Science Research Award for my poster .

Fitness to Fly in Healthy Infants and Young Children
Maureen Verheggen, Jan Oostryck, Vaska Murdzoska, Andrew Martin, Stephen M Stick and Graham L. Hall
Respiratory Medicine, Princess Margaret Hospital for Children, Perth, WA 6009.

The aim of this study was to document the response of healthy infants and children to a laboratory Flight test and to evaluate the results against the current British Thoracic Society guidelines. 27 children (age range 3 - 64 months) took part in the study. 22 children completed the study with 5 children not completing the study due to unwillingness to wear the facemask. The age range of this group was 9 - 36 months. The baseline oxygen saturation (SpO2) of those who completed the study was above 95%, and by the end of the test had fallen by a mean of 8.4% (range 2 - 26%). The magnitude of fall in saturation was significantly related to age, with younger children having greater falls than older children.

Children older than 6 months did not experience a fall in SpO2 below 90%, whereas half the children younger than 6 months fell below 90%. These children would have failed a clinical hypoxia test under the current guidelines (British Thoracic Society 2004) however none of these children who had previously flown had any symptoms reported by parents.

In conclusion, the results of the hypoxia test, using the Princess Margaret Hospital protocol, were related to age. As half of the children under 6 months of age would have failed a clinical hypoxia test, it is questionable whether current international guidelines are appropriate in very young infants.

I would like to thank Mayo Healthcare for their sponsorship of this award.

9-Feb-2006

Dear editor,

I would like to thank Ed van Reit and colleagues at Technipro for their generous sponsorship of the Best Presentation Award at this years ANZSRS ASM for our work on acute lung function changes in Freedivers. The $2500.00 prize gives me the opportunity to present this data at the ERS in Copenhagen, Denmark in September. Many thanks also to Peter Rogers and Christine Jenkins for their enthusiasm and support for this research.

Kind regards
Leigh
Leigh Seccombe
Respiratory Scientist
Concord Repatriation General Hospital

9-Jun-2005

Dear friends and colleagues,

I would like to thank the ANZSRS, for the opportunity of presenting my poster at our recent Perth ASM. And many thanks for granting me the Poster Presentation Award!

My poster was entitled "Evaluation of the EasyOne Spirometer for Paediatric Use: A Pilot Study." A small but significant bias in favour of the EasyOne over a SensorMedics Vmax 20C system was seen for FVC of 95ml. There were no statistically significant differences observed for FEV1, PEF, nor FEF25-75. The study showed that the EasyOne gives repeatable spirometry results in children, which are comparable with "a gold standard". A further study to fully validate its use in paediatrics is warranted.

The prize I received, a $200 book voucher from Ramsay Books in Adelaide, will help me to continue the evaluation of the EasyOne in paediatrics. The prize was kindly donated by Compumedics. I intend to purchase a couple of statistics texts with the voucher, in particular a book on SPSS (for Dummies) so that the next time I use SPSS it's hopefully easier.

Many thanks again to Craig Abud and Niche Medical for assisting me in attending the Perth ASM.

Also I need to give credit to others who presented, whose work was all of a high standard, and all deserving of awards. Keep it up everyone!

Andrew Coates, CRFS.
Department of Respiratory and Sleep Medicine,
Mater Children's Hospitals,
Queensland, 4101

9-Jun-2005

2005 Young Investigator Award - ANZSRS ASM

I would like to express my gratitude to Bob and the team at Bird Healthcare for their continued support of the ANZSRS and in particular their sponsorship of the Young Investigator Award at the 2005 ASM in Perth.

I am honoured to have received the Young Investigator Award, as I believe it not only acknowledges my own work, but the efforts of the entire team at the Alfred. A special thank you to my co-authors, Brigitte Borg and Bruce Thompson, who provided valuable support and assistance throughout the entire process.

The sponsorship provided by Bird Healthcare provides young or inexperienced scientists with the opportunity to accelerate their development by allowing them to further their research or to attend overseas meetings, which may not have previously been an option. It is my intention to utilize the award to attend the 2006 European Respiratory Society meeting in Munich, Germany.

Many thanks

Faizel Hartley
Respiratory Scientist
The Alfred
Melbourne

9-Jun-2005

Dear Kevin,

On the 9th March 2005 Brenton wrote about how we might be over-concerned about inter-laboratory variability, and possibly working ourselves into an early grave over it all. It is re-assuring to see that our COVs compared to other physical sciences compare favourably. Perhaps we are more cognisant of the need for quality assurance than these others, but shouldn't we always be striving and remain focused on quality, and on minimizing the variability inherent in our tests. I for one want to know what are the sources of variability, such as inaccurate / leaky syringes, so that we can know, understand and reduce them. I applaud the recent work of Jenny Savage, Linda Ruedinger and Andrew Southwell in Queensland, for finding such a low COV for Queensland Labs, probably through the attention to removing inter-operator variables such as the measure of height and weight, and how the tests are conducted. Sure it was the same operator / subject pair which is not the real world, but perhaps this demonstrates the gold standard for COVs. I'd like to see this repeated for more operator / subject pairs to be sure that this is what is the optimum. At the end of the day we will always have inherent variability, but I'd like to know that this variability is by chance and not due to preventable factors. Thanks for the letter Brenton, and perhaps others can contribute through the letters page just as constructively!

Cheers
Andrew Coates
Senior Respiratory Scientist
Mater Health Services, Brisbane

28-Mar-2005

I write in response to the December "Train of thought" in which our editor bemoans the failing standards of the society.

First up I must declare my interest in this editorial. I am one of the "senior members" of the society who had to slightly rework an abstract for the meeting this year. I have no problems with this, it is the process of peer review and quality improvement that Kevin alludes to, that in fact maintains standards of scientific work. I would like to point out here that the same abstract was accepted by the TSANZ and the ERS as fit for publication.

This raises the issue of exactly who sets the standards for the quality of such work and how is it improved. Peer review is the ultimate test and the very reason we present our work in the first place. Peer review is not, as I understand it, an individual or an abstract review committee acting as judge, jury and executioner on the worth of one's endeavours. Against exactly whose standards does Kevin want to set the society and its members? An abstract review committee can reject an abstract that is not deemed acceptable or send it back for reworking as part of this process. My experience over twenty years in this field is that some abstracts and papers which I find not up to standard are in fact lauded by others as important work and papers submitted for publication invariably receive very different reports from different reviewers. This said, my major concerns with this particular "Train of thought" is that it implies a change in the rhetoric of the society from that of cooperating with and encouraging members, as mandated by our constitution, to a form of academic elitism which is less than encouraging of the membership.

The vast majority of members are not in fact employed to do research and generally perform clinical functions. These, however, still require scientific and not purely technical approaches. The suggestion that we rename the society must be offensive to these members. This is why we have worked so hard to have the society regarded a professional group that; represents the interests of both academic and clinical scientists, liaises with other peak bodies and interfaces with technical trade organisations.

This "Train of thought" lacked humility and had a sense of parochialism about it. It is my view that such a vitriolic outburst is disappointing and particularly unhelpful to the society's aims. Certainly my response can be interpreted as "sour grapes", this is a view I reject, as I hope it is evident from my history with the society that I have always put the needs of the society above my personal needs and prejudices. I have felt compelled to express my concerns about the use of the web site editorial in such a way. I would have been reluctant as president to have presumed so much authority.

Yours sincerely,

Paul Guy
Head Scientist
Monash Medical Centre
Melbourne.

9-Mar-2005

I have recently been reviewing past studies from Society members looking at inter-laboratory variability over the past 10 years. Most regions have been active in this area, and it remains a very important piece of a quality control program. Having identified inter-laboratory differences, some have gone on to identify potential sources of variability, including calibration (particularly standardisation of syringe), operator and methodology, in addition to instrumentation differences.

Despite these ongoing efforts, inter-laboratory differences remain, with coefficients of variation normally ranging from 2-6% for most indices, but around 10% for RV. What should we be aiming for? I sometimes get the feeling we "beat ourselves up" over this issue, and wonder whether our expectations are too high. I have often wondered what other investigational laboratories have found in terms of inter-laboratory (or inter-operator) variability in other measurements, and what are considered appropriate. A very brief search revealed:

Serum Lipids
A study of 10 different laboratories revealed coefficients of variation (CoV) of 9.5% for HDL cholesterol & 6% for LDL cholesterol.

INR (Warfarin)
A study of 3 identical analysers in the one laboratory using a control sample gave a CoV of 3.5%. Another inter-laboratory study with 92 participants revealed a CoV of approximately 10%.

Plasma Clozapine
The intra-individual variability of Clozapine levels was up to 20%

Biochemical Markers of Bone Turnover
The CoV of bone specific alkaline phosphatase was up to 48%. This paper commented "in identical samples, results by the same method differed up to 7-fold"

Blood Gases
One study of 32 different analysers using tonometered blood found CoV's of 5% for pO2 & 7% for pCO2. A second similar study revealed CoV's of approximately 7% for pO2 & 5% for pCO2, but only after outliers had been removed!

Cerebro Blood Volume
Ultrasound measurements of cerebro blood volume in neonates indicated inter-observer CoV of 6.3%. The 95% confidence limits of agreement between the 2 operators ranged from an under-estimation of 11% to an over-estimation by 13%.

Ultrasound Estimation of Central Venous Pressure
CoV of > 15% leading authors to say "absolute values may differ substantially between different investigators".

Trans-thoracic Pulmonary Venous Doppler Flow
The intra-observer CoV's for several indices ranged from 5-15%. Inter-observer differences ranged from 8 - 23%.

CT Assessment of Airway Wall Thickness
The mean intra-operator CoV was 7.8%

Cardiac Angiogram "Phantoms"
Using constructed images depicting various scenarios, there was up to 20% difference between operators in some reported indices.

Intra-vascular Ultrasound
This measurement of coronary atherosclerosis plaque volume demonstrated the CoV of baseline measures was approximately 1.5%, with CoV's of repeated measures over a 12 week period of between 3 % & 6%.

Whilst I don't profess to be an expert in most of these measures, I was taken aback with the magnitude of some of the inter-laboratory and inter-observer differences - even wondering about the usefulness of some of the tests! Clearly the lung function tests are no worse (and often better) than many other clinical chemistry or physiological measurements in terms of variability. I'll let you decide yourself if you find this re-assuring or terrifying!

So what is my "take" on all this? Yes, we as a profession should continue to pursue quality and accuracy in all measurements performed in our laboratories. This includes recognition of existing standards re testing procedures, understanding limitations of instrumentation and particular attention to quality control activities. External QC activities such as inter-laboratory testing should continue to assist with identification of easily rectified sources of variability. However I do believe we need keep in mind that we are measuring physiological signals with inherent variability. As such we need set ourselves realistic targets, and not collectively self-flagellate should our inter-laboratory studies reveal anything other than perfect agreement.

Brenton Eckert
Senior Respiratory Scientist
Princess Alexandra Hospital.

9-Mar-2005

Dear Kevin,

I have just read your Train of Thought for December 2004 and felt a strong need to respond.

I am saddened, but can appreciate where you are coming from, by the issues you raised in your article. In fact, it embarrassed me into getting my act together to try and finish a draft of the Society's review of Vision so I could get some feedback on it.

I too, have high expectations for what the Society as a professional body should be. As you and I both know however, there are many members unwilling to donate time and energy to a professional body that represents their potentially life long career! How we change this, I don't know. What I do know is that people have different motivations for undertaking employment - active interest in their chosen field and a desire to learn and grow, money, contribution to the community, time out from the kids - to name a few - so it is likely that there are different motivations for belonging to a professional body - pursuit of acknowledgement of profession from other parties, opportunities for active interaction with other professionals, access point for work related information. This is borne out at a local level, where you have members actively giving of their time and skill to present at regional meetings for the betterment of others, members attending regional meetings for professional development and an opportunity to network with peers and members who don't attend local meetings, but may look at the website for information every now and again.

Balance has to be another key contributor to this discussion. I have a young family to look after at home and also work full time. The Society, which I feel strongly about, frequently gets pushed to the end of the queue because it is not in my face all the time. I would suggest that this happens to others as well.

Ultimately, regardless of the numbers of non-contributors, if there are enough active members willing to contribute to an active professional body, there is still an opportunity to grow and succeed in achieving the Society objectives.

You spoke of vision. As I am currently tackling the increasingly complex issue of vision for the Society, I think our main downfall is that we do not appear to have clear direction nor do we have clearly identified core values on which we base our decisions. Having been a board representative for two years, I cannot remember being asked to make decisions based on the Society objectives, nor until I started researching for this document, did I know I should. Perhaps I'm naive to organisational decision making, but I'm quite sure there are others that have been or are on the board or the executive in the same boat as me. Hopefully the vision document will at least lead us in the right direction to getting on track even if it can't provide us with immediate solutions.

Finally, a suggestion to encourage contributions to Case of the Month. It may be better to roster laboratories, rather than individuals, each month so that a whole laboratory of staff put together a case. A laboratory would only need to contribute to case of the month once every two years or so. Where individuals lack confidence, this may help build them up. It will also encourage teamwork and present opportunities to learn. Ultimately, the Society grows and we meet four of the Society objectives:

  1. To provide a forum for scientific and technical communications between members.
  2. To advance the knowledge and practice of respiratory function measurement and respiratory physiology.
  3. To promote excellence in respiratory function measurement.
  4. To support and encourage training and education in respiratory function measurement.

Regards,

Brigitte

8-Feb-2005

After having a chat with Maureen Swanney in Glasgow ( Scotland) during the European Respiratory Society congress this September, about your (ANSRS) interest in our society, I am happy to be able to tell you that our new web-site will be "in the air" from 9 November on. Because it is still "under construction" not everything is in English, but almost every Dutch technologist writes and speaks English. So, if anyone wishes to communicate, the door will be open. It would be nice if you could link our site to yours, I have done the same over here. (The link has been added http://www.nvla.nl ,KG). I hope that there will be a good communication between our societies.

Greetings,

Han Beurskens
Dutch Society of Pulmonary Function Technologists.

22-Dec-2004

Dear Kevin

I would like to acknowledge Medipac Scientific for supporting the Best Poster Prize at the 2004 annual scientific meeting. Over the last two years the Respiratory Function Laboratory at Concord hospital I have been investigating the effects of simulated air travel in patients with COPD and ILD. This work has resulted in several publications including the poster presentation, 'The accuracy of pulse oximetry during acute hypoxia' presented in Sydney. I would like to extend a thankyou to Leigh Seccombe, Peter Rogers and Maureen Swanney for their support and advice with the pulse oximetry poster.

Kinds regards,

Paul Kelly

1-July-2004

Hello Ed,

I would like to thank you (Technipro) for sponsoring my award at this years ANZSRS meeting, & Technipro's cheque for $2,500; sorry for the late reply.....I have been run off my feet with this obesity study.

Your support will enable me to gain experience in European lung function laboratories, I hope to learn new techniques and skills in respiratory diagnostics whilst over there.

Once again my heart-felt thanks.

Cheers

Phillip

1-July-2004

Dear Kevin,

I would like to congratulate you and the other active web-site contributors (Derek, Brenton and Rob with their historical perspective, Christine with case of the month) on providing a high quality and vibrant web-site. It reflects well on all of us as respiratory scientists.

I have, as part of my role as course advisor for our newly expanded Bachelor of Medical Science (Clinical Physiology) course, recently visited the web-sites for our counterparts in cardiovascular and neurophysiological clinical measurement. I also send our students to all three web-sites so they can get an idea of their potential profession and support offered by those already employed in the profession.

The Association of Neurophysiological Technicians of Australia (ANTA) has a good web-site that provides information about the clinical tests performed, membership etc. The Cardiac Society of Australia and New Zealand (CSANZ) has a link to an Affiliates page with only one message posted in 2002. My purpose is not to denegrate the web sites of these other professional groups but rather to applaud those within our Society who give of their time to provide all of us with a point of contact with the rest of the world that we can be very proud of.

Thanks for your efforts and those of the rest of the 'web-team'

Debbie Burton

9-May-2004

Hi Kevin

I fully support the establishment of a formal ANZSRS Mentorship Programme.

It has the potential to not only benefit individuals but through its' inclusive nature (rather than exclusivity) will ultimately help unite members and strengthen the Society. I don't have much formal experience here but am willing to help.

Regards

David Johns

4-Dec-2003

Hi Kevin

Much 'food for ..' within your 'train of thought', as usual.

I have no doubt that a mentoring scheme within ANZSRS is desirable, & should be pursued. I was fortunate in my early days in respiratory science (as a new graduate in a charge position in a lab with 2 technicians) to be on the receiving end of mentoring from a couple of sources. One was the then cardiac scientist at RBH, whose advice on management issues and coping with the bureaucracy within a large metropolitan hospital was invaluable, the other a respiratory scientist at another Brisbane Hospital (yep, there were some here before me) who was very generous in helping me gain expertise in aspects of respiratory function testing & lab operation in which I was deficient (ie just about everything!).

In the years since, as I've gained experience, I've endeavoured to 'pay it forward', by helping younger scientists entering the field, however I often wonder just how much benefit my help is - many I've given advice to are now working in completely different fields! Does that mean my help was really poor, really good, or totally irrelevant? I've no idea, really - I'm probably in need of a mentor mentor!

This does make me think that a formal, structured program with well defined goals would be best, though. It would give support to those taking on the mentor role, ensure the mentoring is appropriate, and also ensure that mentoring is available to all new scientists entering the field, not just those fortunate enough to have access to senior scientists willing to provide help.

So please count this as a 'for' vote!

cheers

Mike

4-Dec-2003

Letter to the Editor

Dear Kevin,

I started this letter as a reply to the Executives' request for feedback on the Review of the ANZSRS publications and the identification of the Societie's Vision statement. After writing it down, reviewing it and expanding it I realised it may be easier to put it as a letter to the Editor and get a the discussion stimulated further beyond the already very important contributions posted over the last 2-3 months.

Publication review.
A fantastic review. The authors should be very publicly congratulated. This is a major work and is an example of the type of document that should be preserved in both print and web format. After reading this with great interest I found I agreed with (nearly) all the recommendations.

I strongly believe we need to publish the abstracts accepted to the ASM (Recommendation 11). Published abstracts are recognised by most grant bodies as track record in research. Particularly in those individuals considered new investigators. I feel any short term "pain" associated with formatting and procedural changes would be far outweighed by the long-term benefits.

I feel that the expansion of the annual report to include the progress of the Society, the activities of the committees and other such activities would be sufficient. I don't think we would need two printed versions (Recommendation 12).

However, we could add a semi-annual report that could be added to the members' only section of the web site in PDF format. This could be viewed as an informal report not "passed" by the membership (as the report tabled at the AGM would be). This could be timed to be published approx 6 months after the ASM. This would allow the costs associated with printed publications to be kept within acceptable limits, yet still provide the membership with detailed, ongoing information about the progress of the Society. It would also dovetail with the suggested role of the Archivist (Recommendation 10).

I feel the addition of an official journal for the Society is important and provides a visible presence of the societies professional activities in the broader community. The costs and associated administration with establishing our own journal would be prohibitive for the Society as a whole and the involved individuals in general. Rather I feel the alignment of the Society with a suitable established Journal would be more appropriate. What would constitute an appropriate journal?

If the journal recognises (editorially) the importance of the field of respiratory physiology and PFT measurements, and has an associate editor to cover this area then that would benefit the Journal and Society. In reality this could be done without the society officially aligning itself with the journal.

Personally I feel Respirology would be a suitable choice. Respirology is the regional journal for respiratory science and is expanding. The journal has associate editors to represent certain areas. Stephen Stick is the associate editor for paediatrics and a new editor has been appointed to cover respiratory infections. Currently they do not have an editor appointed specifically to the field of respiratory physiology. Should the Society decide that aligning with an established Journal is the direction to take (rather than creating a new journal) then this would of course be an essential part of the discussions with any Journal.

I don't think we want to create the impression that we are aligning with a journal to make publishing easy. Publishing is not easy. We as the Society should however align ourselves with a journal that has an editorial policy compatible with the Society's research contributions.

ANZSRS Vision statement:
While I am a new member of the Society, I have been a member of TSANZ for many years and involved in respiratory research since 1995. As I see it my Vision of the Society is what I want to get from it and what I feel I should put back in to it. In 2003 I started a new job as the respiratory technologist within the Respiratory Function Laboratory at Princess Margaret Hospital and was instantly exposed to a wide range of activities I knew nothing about. Thus for me ANZSRS has given me the contact information of a wide range of very experienced individuals who can help me when I don't have the required information. So how does this fit with the Society's Vision statement? My impression is that the membership of the Society is predominated by staff of laboratories in tertiary hospitals. I would expect that relatively low numbers of members would come from smaller laboratories. So how can we change that? We have an obligation to provide help whenever possible. For example how can we improve the standards of GP spirometry (another well-debated topic in the ANZSRS web site). Should RFL within teaching hospitals provide quality control services to smaller hospitals as part of our own routine quality control?

My Vision would be to provide a way for smaller laboratories to easily participate in Society activities, to locally promote the Society and in particular to try to aid those areas without access to the types of information (such as journals, education material and local meetings).

Regards

Graham Hall PhD
Respiratory Technologist
Respiratory Medicine
Princess Margaret Hospital.

4-Dec-2003

A copy of a further letter regarding infection control sent to WHO by Yuguang Zhang.

Dr. Gueael Rodier
Director
Dept. of Communicable Disease Surveillance and Response
WHO

Dear Dr. Rodier,

On 21/08/2003, I sent a letter via email to Dr. David Heymann regarding infection control in pulmonary function testing. On 04/09/2003, he informed me that the letter had been referred to you to reply.

Now I am writing to you regarding another infection control issue: nebulization in health care facilities.

As we know, nebulization is one of the most common diagnostic and therapeutic methods in respiratory cares. On the one hand, it may deliver aerosols into patient's airways and lungs with bronchodilator, corticosteroid, antibiotic, topical anesthetic, hypo- or hyper- tonic saline, radioactive agent and so on. On the other hand, it may cause the surrounding air contamination with the aerosolized substances. Recent reports have shown nebulization may also cause air contamination with the patient's respiratory pathogens and spreading of highly contagious respiratory infectious diseases, although the exact mechanisms are not clear. Jones et al have detected epidemic P aeruginosa strains, by genomic typing, from room air when Cystic fibrosis patients performing nebulization.(1) A SARS outbreak in a respiratory ward in a Hong Kong hospital has been considered to be probably due to infected aerosols generated by a SARS patient during nebulizer therapy.(2) Therefore, nebulization in patient-sharing health care facilities may contribute to nosocomial respiratory infections, which are among the most common nosocomial infections and account for substantial morbidity and mortality world-wide. Until now, however, there are no universal infection control guidelines on nebulization in health care facilities, although expiratory filters are strongly recommended to be used in some antibiotics nebulizer therapies.(3)

Brown et al have demonstrated that airborne radioactive contamination is significantly reduced by using an air extractor in the nebulizer circuit during radioaerosol ventilation study.(4) Recently we have been installing a HEPA filter into the expired port of a ultrasonic nebulizer system for 4.5% saline bronchial challenge test with satisfactory outcome. During the test no visible aerosols can be seen escaping out to the atmosphere.

In a WHO document "Laboratory biosafety manual (third edition)", it points out: " As aerosols are important sources of infection, care should be taken to reduce the extent of their formation and dispersion." In my opinion, in order to prevent air contamination and cross-infection, expiratory HEPA filters should be install for all nebulizer therapies in patient-sharing health care facilities. As I mentioned in the letter to Dr. Heymann, high quality of HEPA filters are available and inexpensive. With the coordination of WHO, scientists can even develop better HEPA filters with less cost. The cost can be further cut by half if we can develop media-replaceable HEPA filters, with which patients can clean or disinfect the filter shells and replace the filter media regularly.

I would like to seek your opinions with this matter and would like to urge WHO to establish infection control guidelines on nebulization in health care facilities.

Thank you very much for your attention and Best Wishes.

Sincerely yours,

Mr Yuguang Zhang M.B. CRFS

Senior Scientist
Respiratory Investigation Unit,
Gosford Hospital, Gosford, NSW, 2250
Australia
E-mail address: zhangyg@tpg.com.au

References

  1. Jones AM, Govan JRW, Doherty CJ, et al. Identification of airborne dissemination of epidemic multiresistant strains of Pseudomonas aeruginosa at a CF centre during a cross infection outbreak. Thorax 2003; 58:525-7
  2. Wong GWK, Hui DSC. Severe acute respiratory syndrome (SARS): epidemiology, diagnosis and management. Thorax 2003; 58: 558-60
  3. Rau Jr JL. Aerosolized anti-infective agents. In: 4th ed. Respiratory care pharmacology. St Louis: Mosby, 1994: 285-310
  4. Brown A, Carter NJ, O'Doherty MJ. Microbiological and radioactive contamination from radioaerosol ventilation scanning: is there a problem? Nucl Med Commun 1999; 20: 755-60

4-Dec-2003

Kevin, your idea has great merit, and I fully support our Society operating a Mentoring scheme.

I have little formal experience at mentoring. From a middle management course that I once attended, I was grouped into a mentor program with two others. I guess a three-way mentor program has merit since it has a greater chance of success. However we found that there wasn\'t much call for it from my own group. It never really got off the ground. A lesson from this is that for such a thing to work, the initiative has to come from those in the group. Also important is how right the environment is, for it to run successfully. Each person must be available or have the time and meet regularly and often.

Aside from this if we have at least 20% of our members willing, I am sure successful mentorships will develop. This can only be positive. Anything negative should fade into insignificance.

Good work!

Cheers

Andrew

4-Dec-2003

2003 ANZSRS - Young Investigator Award

I am honoured to have received the Young Investigator's Award at the 2003 ANZSRS Annual Scientific meeting in Adelaide. This award acknowledges our work on bronchial provocation methodology and practice across New Zealand and Australia.

A great deal of gratitude goes to Bob and Vicki Bird of R.J. & V.K. Bird for their sponsorship of the award. Sponsorship of this nature assists recipients to further their research and/or education and stimulates them to further develop their skills. The ability to attend overseas meetings and to visit centres of excellence in Australia and overseas - is an important tool in continuous quality improvement. It is my intention to use the award to assist me to attend the 2004 ATS in Orlando.

PRESENTATION: BRONCHIAL CHALLENGE - DO WE MEET THE CHALLENGE?

Bronchial challenges are performed routinely by most pulmonary physiology laboratories and although the initial impetus for this study was a very simple question the information received from the on-line survey provided a comprehensive picture of practice in the wider respiratory community. Adherence to published protocols and correct interpretation of results are the cornerstone for the diagnosis of asthma. Failure to do this accurately has far-reaching implications in both the management of the disease and the life-style and employment choices open to some patients.

We surveyed all members of the society as to protocols used, nebuliser choices and quality control practices with the request of one response per laboratory. 37 laboratories (62%) returned surveys. There was a split across the Tasman with New Zealand laboratories offering Methacholine whereas both Methacholine and Histamine challenges are performed in Australia.

The survey also raised a perceived belief that histamine is an unauthorised substance whereas Provocholine (FDA approved form of Methacholine) is approved. This is not the case in Australia. Neither has been registered by the TGA for human consumption. Use is authorised on a single prescriber basis.

We found that performance of bronchial challenges is being done according to the original described protocols for Histamine and Methacholine. However, only 1 laboratory uses the current ATS recommendations for reporting thresholds. Saline challenges on the other hand were inconsistent in both performance and interpretation eg. time of inhalation, volume of saline inhaled or greatest change in FEV1 all variously used as the response index.

The survey showed there is a need for laboratories to be more diligent in keeping their protocols up to date.

Two recommendations have been submitted to ANZSRS for consideration:

  • Endorsement of a standard hypertonic saline protocol
  • Encouraging the replacement of Histamine with Methacholine for provocation testing.

Christine Nathan

6-Nov-2003

Dear Editor

Short Spirometry Lectures are Legitimate

Like many ANZSRS members we are regularly invited to speak to groups of General Practitioners and other healthcare professionals on spirometry. The time allocated is usually limited to 1 - 2 hours as they are often conducted in the evening. We are therefore often confronted with the same dilemma outlined by Kevin in his September, Train of Thought - should we decline an invitation to deliver a short spirometry 'course' when we know that at least a whole day is needed to effectively cover the core theory and provide adequate practical sessions.

Unfortunately, there still exist many who hold to the view that spirometry is a simple and easily learnt test that takes only a few minutes to perform. Of course this may be true if the operator is provided with a clean and accurate spirometer and a highly motivated patient who can easily follow instructions to produce reproducible and maximal manoeuvres. This view may also be reinforced if only one blow is done or the operator has little knowledge and experience and therefore does not recognise poor quality spirometry. Reality, of course is quite different as considerable skill and experience is required to efficiently and consistently obtain accurate spirometry.

To become competent in spirometry requires the integration of both theory and practical experience. Only then will the operator be able to confidently overcome the long list of potential technical and patient related problems. The theory can be taught during a spirometry course but this needs to be put into context and made sense of by including a practical session(s). However, practical experience can only be gained after testing many patients and, preferably, receiving regular feedback from an experienced person. It is unlikely, therefore, that a single spirometry course can turn a novice into an effective 'spirologist' able to work solo.

It is important to remember that the objective and content for such short sessions is the responsibility of the person giving the talk and in almost all cases this will be discussed before fliers are sent out. In our experience, one is seldom asked to deliver a comprehensive short course/lecture covering all aspects of spirometry, but if such a request were made it would be quite easy to point out the oxymoron in this. Typical requests are usually along the following lines:

  1. The participants would like a basic introduction to the measurement and interpretation of spirometry.
  2. The participants would like a practical session covering the measurement of spirometry.
  3. The participants want to know how to obtain quality spirometry.
  4. The participants have experience in the measurement of spirometry and would like you to focus on the pitfalls and QA aspects of spirometry.
  5. The participants wish to gain a better understanding of how to interpret spirometry in their practice.

Returning to Kevin's dilemma. We take the view that short lectures such as these can be a very valuable stepping stone in the educational process for the novice and for reinforcing the salient points to those with experience. They also provide the opportunity to point out that spirometry as currently performed by inexperienced and 'knowledge poor' people is inevitably of poor quality and, to quote Dr Hankinson, "poor quality spirometry is worse than no spirometry at all". However, we must realise that poor quality spirometry is being performed and without input from ANZSRS members who have the required knowledge and experience to act as 'mentors' the quality is unlikely to improve. We find it useful to make oneself freely available as a resource to the participants on an on-going basis. These sessions also provide the opportunity to stress the need to undertake a 'certified' spirometry course and to put into context that the information presented only represents a small fraction of the requirements of such a course.

Having said this, we do agree that a whole day course that focuses on all aspects of spirometry and includes a significant practical session(s) is important if the novice is to gain and retain sufficient knowledge and confidence to perform the test 'solo' to accepted standards. Perhaps the Society should consider attendance at one or more short courses as one way to maintain on-going 'certification' for those 'spirologists' who have already completed a "certified spirometry course".

David P Johns, University of Tasmania

Debbie Burton, Charles Sturt University

9-Oct-2003

Dear Kevin,

re: "While I was out" or the "2 Hour Spirometry Training Program".

Yet another thought-provoking Train of Thought. Perhaps you should not go "out" as much in the future!

I have a deep interest in Spirometry Training, and too have been asked to provide anything from a 30 minute "Readers Digest" version through to the full 10 hour program, so your article found a target. Indeed I apologise for not replying sooner, however my first task was to ammend Laboratory protocols on Spirometry to include the "Yell, clap your hands... etc" instructions suggested by the AARC!

Despite the request for what is considered by both the ANZSRS and TSANZ as inadequate training program, I was heartened to see that our Society members are being recognised as having the necessary skills and expertise to provide such a course. Indeed, every time I hear of an ANZSRS member being approached by a group to provide any element of spirometry training at all, I am particularly encouraged by the recognition it affords our Society and importantly the realisation of the group in question that they do actually need some level of spirometry training. It\'s been a long, hard road, but the "training" message has eventually filtered through.

Whilst many groups are now recognising this need for training, they, as you alluded in your column, have little knowledge of what constitutes an appropriate training course. Certainly those groups advocating or asking for the 30 minutes to 2 hours sessions should be educated to the pitfalls of persuing this pathway. Hopefully the ANZSRS/TSANZ Spirometry Training Guidelines will assist in this regard.

However, like you, many members are still being asked to provide short spirometry training courses/updates/education sessions. My personal view is that we should accept these invitations to participate. However we should make it perfectly clear that the ensuing presentation is not called a "Spirometry Training Program" or "All you need to know about Spirometry". The title should reflect the brevity of the program, and in my opinion not contain the "training" word. If asked to provide such a presentation, I have settled on (after much rumination)"Spirometry - a brief overview". Of course it should be stated throughout such a presentation that it is not a full training program and falls well short of the ANZSRS/TSANZ guidelines. Ideally information concerning access to an appropriate Spirometry Training Course should be provided.

In my experience many of the short program attendees will ignore this message, however many more will request information about full training. It is one of the more enjoyable aspects of such presentations when you see the conversion of health workers who believed spirometry was a simple matter of mouthpiece + patient = good spirometry to realising that specialist knowledge and expertise was in fact required to produce and interpret meaningful data. If we did not provide the initial short presentation then this message would not have got through. As important is the PR damage any refusal to do such presentations may cause the Society. We may be perceived as unhelpfull or un-willing to participate, thus forcing groups to look elsewhere for spirometry education.

So, like you, I think we take the training message one step at a time. The most important thing however is that you have them in your audience (and not the someone providing the 30 minute "training"). Only when in our audience can we poke/prod/cajole them in the right direction, hopefully towards an appropriate full sprirometry training course. Whilst we have the capacity to supply both short the "Overview of Spirometry" and longer "Spirometry Training Courses", I think we should do everything possible to direct demand for such sessions towards the appropriate longer training session. This requires a coordinated approach by the ANZSRS to ensure a consistency in the message delivered by this Society.

So Kevin, you are not deluded (at least in terms of spirometry training!). Raising the awareness for training is as important as the training that follows. I look forward to other members feedback on this very important topic.

Yours sincerely

Brenton Eckert

9-Oct-2003

Dear Jacqui,

Hi,

Recently I have sent the following email regarding infection control in PF lab to WHO.

Maybe some people are interested in it.

Best regards,

Guang


Dr David Heymann
Executive Director
Communicable Diseases
WHO

Dear Dr Heymann,

I am writing to you regarding infection control in pulmonary function (PF) laboratory, which is in need of review and improvement globally.

As you mentioned last year, the world faces the prospect of surprises arising from the volatile microbial world on a daily basis (1). The recent devastating outbreaks of SARS are such good examples. Although PF equipment has been widely considered to pose little risk of cross-infection for patients, it may, in my opinion, actually serve as an important transmitting source of infectious diseases such as SARS, if there are no adequate measures of infection control.

As you may know, forced spirometry test, the most common PF test, requires patients to exhale forcefully and fully into PF equipment and this quite often causes patients to cough during the test. Both forced exhalation and coughing can create a large amount of visible and invisible droplets from patients' airways. (Duguid demonstrated a cough expelled approximately 90,000 droplets with sizes between 0.1 to 22 um. (2)) Therefore the equipment is highly subject to the contamination of patients' droplets of saliva and mucus which may contain a wide variety of pathogens. Studies from USA, UK, Germany, India and Spain (3-7) showed that various bacteria or fungi were isolated from different types of PF equipment or testing media after patients' forced exhalations, or even normal exhalations, with contaminating rate up to 90% (7) and the most contaminated site being proximal tubing (5). (the contaminating rate could be even higher, if TB and virus isolate tests were done.) Because almost all detailed PF tests also require patients to inhale from PF equipment, if no infection control measures are taken between patient uses, contaminated equipment may become a reservoir of transmittable pathogens and pose substantial risk to subsequent patients. The main transmitting route of respiratory infectious diseases is through infected droplets within short distances of 1-2 meters. In PF tests, the shortest distance from patient's airway to the proximal tubing (mouthpiece adaptor) of PF equipment is only about 0.05 meters, therefore the chance of cross-infection is much higher.

In 1981, Hazaleus et al (8) reported a cross-infection case where a patient was infected with TB following a spirometry test. In1984, Isles et al (9) raised concern with increased prevalence of Pseudomonas cepacia in a cystic fibrosis centre, which was attributed to a contaminated PF device. In 1990, Gough et al (10) revealed outbreaks of a specific strain of Haemophilus influenzae, which were strongly related to a spirometer. Until now, however, there are no universal and practical guidelines of infection control for PF laboratory. While many PF laboratories adopt high level of infection control measures with which either high-efficient particulate air (HEPA) filter, or disinfected, or disposable rebreathing parts (tubing, valve and flow meter) are used for each patient, many, perhaps the majority of PF laboratories, especially in developing countries, only replace mouthpiece between patients, and they may disinfect rebreathing parts daily, weekly or at longer intervals. It was quite disappointing to read that at a workshop of ATS and ERS in 1997, few participants endorsed the application of Universal Precaution in PF laboratory (11). Based on the above clinical and experimental evidence and the fact of world-wide increasing incidence of communicable infectious diseases, especially respiratory infectious diseases (TB, viral infections such as SARS), I fully support the view of Dr JL Clausen (one of the workshop participant, from San Diego, USA) that a particulate filter should be used for each patient unless the PF equipment is sterilized (disinfected) or replaced between patients, but I do not agree with some authors' view that PF equipment does not pose an appreciable threat to patients (12).

Recent reports (13) have showed that, despite adherence of all infection control guidelines for bronchoscopy, pathogen transmission still occurred. Culver et al presume that many similar cases have been unnoticed or unreported, and comment that true infections and pseudoinfections are notoriously difficult to detect and therefore likely under-recognized. In my opinion, much worse condition could happen in PF tests. Although very few cases of cross-infection related PF tests have been reported, the true cases could be grossly undetected, therefore underestimated because of ignorance, concealment, technical difficulty or the lack of infection control guidelines and surveillances. Recently, a registered nurse informed me that in 1996, her daughter who had immunosuppressed problems suffered from lung infection of Pseudomonas after performing some PF tests (without a single-use filter) on a device, which was shared by some cystic fibrosis patients, in a PF laboratory. While her respiratory specialist highly suspected the infection was due to the contaminated PF device, some people related it to "bad luck". This case has not been reported yet and I believe many cases like this have been dealt with the similar way and been missed out.

With first-hand experience in clinical PF tests, I have been very concerned about cross-infection. In 1993 the Thoracic Society of Australia and New Zealand published guidelines on infection control in PF laboratory (14) in which rebreathing parts were described as semi-critical items, but not required to be disinfected between patients; single-use filter was not recommended. I wrote a letter to one of the authors, questioning some of the guidelines. In 1994, following a report of 5 patients of hepatitis C infection caused by a contaminated anaesthetic circuit, I wrote a letter to the then president of Australian and New Zealand Respiratory Scientific Society, urged him to set up practical rules with single-use HEPA filter. In 2000, the Society changed the guidelines in which the use of HEPA filter is recommended for each patient. In 1999, when visiting a PF laboratory at a major hospital in south China, I noticed that only mouthpiece replaced between patients, and strongly recommended single-use HEPA filter be used for each patient. Later on I sent some filter samples to the PF laboratory, hoping they could purchase or develop HEPA filters for itself and the PF laboratories in China. Last December, I revisited the PF laboratory and found that they were still not using single-use filters. At the same period, I visited another PF laboratory at a different major hospital, in which filter was being used for each patient. But the staff there were reusing the filters after gas sterilization, which could change filtration efficiency and was not recommended by the manufacturer.

Many WHO documents emphasise the prevention of airborne contamination and transmission. In " Prevention of hospital-acquired infections: A practical guide", It states: "Infection may be transmitted over short distances by large droplets, and long distances by droplet nuclei generated by coughing and sneezing. Droplet nuclei remain airborne for long periods, may disseminate widely … and can be required by (and infect) patient directly and indirectly through contaminated medical devices." and " To minimize the transmission of microorganisms from equipment and the environment, adequate methods for cleaning, disinfecting and sterilizing must be in place. Written policies and procedures which are updated on a regular basis must be developed for each facility." In another WHO document " Laboratory biosafety manual (third edition)", it points out: "Note that no filter other than a HEPA filter will provide protection against microorganism." Although I can find many WHO documents regarding infection control guidelines for some hospital facilities and mandatory use of HEPA filters for microbiology laboratories, pharmacies, ICUs, operation rooms, respirators and airplanes, I am unable to locate any of the documents for PF laboratory on WHO website.

Some high quality HEPA filters, which contain much better quality of filtration media than other filters, have been developed for PF tests for some years. " AirSafety TEC200mg" the media of the filter that we are currently using, has been tested with the known smallest virus (Bacteriophage MS-2, size 0.02 um) at a high flow (750 L/Min) with filtration efficiency as high as 99.7%(15). Although some people are questioning the impact of filters on the accuracy of PF measurements, studies (5,16) have shown no clinically significant changes on PF results by using filters with low resistance and small dead space. For computerized PF equipment, calibrations with a filter installed could minimize the effect of the filter on flow and volume measurements. If still not satisfied, normal predicted values can be re-established with some certified HEPA filters. (most normal predicted values that are currently used were measured more than 20 years ago, updated data are needed anyway.) We have been using HEPA filters in our PF laboratory for 10 years with great satisfaction.

Comparing with other infection control measures, the cost of using a disposable HEPA filter for PF test is much lower, being only AU$ 2.0 - 2.5 each in Australia, 2 % of a total cost of a formal detailed PF test. I believe, with the coordination of WHO for verifying and unifying of HEPA filter and mass production, the cost even can be cut dramatically.

A recent study with genomic typing has showed that epidemic Pseudomonas aeruginosa strains were isolated from room air when patients with cystic fibrosis were performing spirometry tests, nebulization, and air clearance.(17) I think, air contamination can be significantly reduced by putting a HEPA filter into the tubing of spirometer, the outlet of nebulizer and patient's mouth when coughing.

By the way, the media of HEPA filter for PF can be used for the media of mask for prevention of virus (size down to 0.02 um). N95 mask is only good for preventing TB (0.3 um). On a TV report in China a few months ago, the medical staff there were wearing 3 cotton masks in SARS wards, feeling working at 5000 meters altitude, and developed some hypoxemia symptoms. If the HEPA filter media is used for mask, one mask is good enough to protect against SARS virus.

I have learnt a great deal in the aspects of respiratory communicable infectious diseases and prevention measures since the disastrous outbreak of SARS. The speed and extend of SARS virus spread through close contact indicate that the virus was mainly transmitted by aerosolized droplets and very small doses of it could cause lung infection, which highlights the importance of infection control in PF tests and strengthens my determination to advocate a single-use HEPA filter for each patient in PF tests.

I would like to have your opinions on infection control for PF testing and I would like to urge WHO to establish universal and practical infection control guidelines for PF laboratory, because " the threats posed by infectious diseases have global causes and effects that can only be managed with global partnerships".(1)

In summary, appropriate infection control on PF tests has been long neglected and the guidelines need to be established immediately. Until now, implementing in-line HEPA filter is the most efficient and practical way to prevent cross-infection.

Thank you very much for your attention and Best Wishes.

Sincerely yours,

Mr Yuguang Zhang M.B. CRFS
Senior Scientist
Respiratory Investigation Unit,
Gosford Hospital, Gosford, NSW, 2250
Australia
E-mail address: zhangyg@tpg.com.au

REFERENCE

  1. Heymann DL. The microbial threat in fragile times: balancing known and unknown risks. Bulletin of the WHO. 2002; 80(3):179.
  2. Duguid JP. The size and the duration of air-carriage of respiratory droplet- nuclei. J Hyg (Camb) 1946; 44:471.
  3. Rutala DR, Rutala WA, Weber DJ, et al. Infection risks associated with spirometry. Infection Control Hosp Epidemiol. 1991; 12(2):89-92.
  4. Kirk YL, Kendall K, Ashworth HA, et al. Laboratory evaluation of a filter for the control of cross-infection during pulmonary function testing. J Hosp Infect. 1992; 20(3):193-8.
  5. Strauss R, Wasser F, Mueller RL, et al. Effect of a filter system on measurement data and bacterial contamination in lung function studies. Pneumologie. 1993; 47(11):626-30.
  6. Singh V, Arya A, Mathur US. Bacteriology of spirometer tubing and evaluation of methodology to prevent transmission of infection. J Assoc Physicians India. 1993; 41(4):189.
  7. Burgos F, Torres A, Gonzalez J, et al. Bacterial colonization as a potential source of nosocomial respiratory infections in two types of spirometer. Eur Respir J 1996; 9(12):2612-7.
  8. Hazaleus RF, Cole J, Berdischewsky M. Tuberculin skin testing conversion from exposure to contaminated pulmonary function testing apparatus. Respir Care.1980; 26:53-5.
  9. Isles A, Maclusky I, Corey M, et al. Pseudomonas cepacia fibrosis: an emerging problem. J Pediatr 1984; 104:206-10.
  10. Gough j, Kraak WAG, Anderson EC, et al. Cross-infection by non-encapsulated Haemophilus influenzae. Lancet 1990; 336:159-60.
  11. Clausen JL. Lung Volume equipment and infection control. Eur Respir J 1997; 10:1928-32.
  12. American Thoracic Society. 1994 Update. Standardization of spirometry. Am J Respir Crit Care Med 1995; 152:1107-36
  13. Culver DA, Gordon SM, Mehta AC. Infection control in the bronchoscopy suite. Am J Respir Crit Care Med 2003; 167:1050-6.
  14. Crockett AJ, Grimmond T. Guidelines for infection control in respiratory function laboratory. Thoracic Society News. 1993; 4, 1:6-7.
  15. Kendrick AH, Milkins C, Smith EC, et al. Assessment of Spiroguard and Vitalograph bacterial filters for use with lung function equipment. Am J Respir Crit Care Med 1998; 157:A175
  16. Fuso L, Accardo D, Bevinani G, et al. Effects of a filter at the mouth on pulmonary function tests. Eur Respir J 1995; 8(2):314-7.
  17. Jones AM, Govan JRW, Doherty CJ, et al. Identification of airborne dissemination of epidemic multiresistant strains of Pseudomonas aeruginosa at a CF centre during a cross infection outbreak. Thorax 2003; 58:525-7.

9-Oct-2003

 

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