CRD Editor’s corner archive: October-December

Ventilator dependence in neuromuscular disease – managing life’s basics ... December 21st, 2021 When people with neuromuscular disease become more dependent on round the clock noninvasive ventilation (NIV), the simple basics of life such as eating, drinking and talking become a significant challenge. In the journal this month, Kinnear and colleagues, observe how people manage these functions whilst using NIV. Importantly, they manage to do this safely for example by timing swallowing between ventilator breaths. Providing the right support in this situation may allow tube feeding to be avoided an important consideration for many. -Mick Steiner, Editor-in-Chief, Chronic Respiratory Disease. Management of pleural disease during the COVID-19 pandemic. Keeping the show on the road. December 16th, 2021 A positive consequence of the pandemic has been the pace of innovation in the delivery of clinical services previously highly reliant on face to face patient contact. Ajmal and colleagues demonstrate nicely how this was achieved for the delivery of pleural services in a tertiary hospital by incorporating a triage process to direct cases to the most appropriate form of clinical-patient contact. It seems likely such innovations are here to stay – we look forward to seeing more data on impacts on clinical outcomes and the patient’s experience of their care. -Mick Steiner, Editor-in-Chief, Chronic Respiratory Disease. Ventilatory support in Motor Neurone Disease. Evidence beyond RCTs. December 2nd, 2021 The provision of ventilatory support in people with motor neurone disease is an intervention that therapists know can be effective but is supported by only limited clinical trial evidence. It would be difficult to undertake more trials now because withholding a standard care in a control group would be unethical. Judging effectiveness therefore requires different sources of evidence and in the journal this monthWalsh et al. provide insightful data from a clinical cohort of patients treated in their centre. They demonstrate that successful initiation and adherence to NIV is associated with longer survival in patients with bulbar predominant disease. Of course there may be a variety of confounding factors affecting the causal link between the intervention and the outcome. However, from the clinical perspective, these data should drive the offer of treatment to those who might need it and in particular underpin the support of the wider multi-professional team in helping patients use the equipment consistently. -Mick Steiner, Editor-in-Chief, Chronic Respiratory Disease. Achromobacter species in primary ciliary dyskinesia. How much should we worry? December 2nd, 2021 The clinical importance of persistent bacterial colonisation of the lung in bronchiectasis and cystic fibrosis is increasingly recognised but there are fewer data in rare conditions such as PCD and the role of less common organisms also uncertain. In the journal this month, Holgerson et al. present data from a PCD registry documenting the longitudinal prevalence of Achromobacter species in sputum cultures and the associations with disease severity. Only around 5% of patients demonstrated positive cultures each year but the finding was associated with poorer lung function. The causality of this association cannot easily be ascertained and it remains difficult to be sure whether intensive antibiotic therapy in response to a positive culture is warranted. Prospective intervention studies would of course be desirable but we understand how difficult this would be for an uncommon microbiological event in a rare disease! Cohort studies such as the study of Holgerson and colleagues offer significant insight but we will continue to have to rely on clinical judgement and experience when advising patients. -Mick Steiner, Editorin-Chief, Chronic Respiratory Disease. Modified exercise training techniques – getting the patient’s view