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Refresh and restart: what’s on the horizon for respiratory medicine in 2022?

By Selina Wellbelove

Recovery of respiratory clinicians and clinical services, dealing with persistent workforce challenges, and a continued focus on COVID are three key themes that will continue to shape respiratory medicine in 2022, according to respiratory consultants Dr Paul Walker and Professor James Chalmers.

As the Omicron wave begins to recede, a refresh and restart for respiratory physicians will be the first critical step on the way to recovery, essential to not only protect service provision but also ensuring continued progress in the field, noted Dr Walker, who is the Chair of the British Thoracic Society (BTS).

"There has clearly been an enormous impact on [respiratory healthcare professionals], and on some an impact that it is hard for us to understand entirely. People need time to recover and to reflect just to drive forward. This is vitally important, and if we don’t [allow] for that, I fear we’ll have more people leaving the specialty than is needed," he told the limbic.

The BTS has long voiced concern that the respiratory workforce is not sufficient to meet service demand, both now and in future; a situation that has been exacerbated by the pandemic. As such, workforce is an absolute priority for the foreseeable future, Dr Walker stressed. While some aspects will be easier to deal with, for example, within community diagnostic services FENO and spirometry don’t really need to be carried out by a fully trained respiratory physiologist, it will take years to have the workforce needed to fully deliver on the agenda, so the time to act is now.

"We have options to train people up, but we still need the people to train up, and we are so short of individuals in every different field and profession in respiratory medicine. We all have a passion to improve the outcomes for respiratory patients and their carers, families and friends, and to do that, we just need more people. My promise to the respiratory community is that we are doing everything within our power to push this as an agenda. We have to have a plan for workforce."

While recovery and workforce are absolutely front and centre of the respiratory agenda, other issues Dr Walker considers priority are the delivery of respiratory support units (RSU), ensuring greater access to a standard level of care for patients with pleural disease, expanding access to respiratory specialists for patients in hospital and improved community diagnostics.

"We've been talking about these things for years, now it’s time to deliver," he said. "We know how important NIV is, we know the difference that acute and chronic NIV services makes to people, but we’re still not adequately set up to provide that. If we're going to be serious about planning for the future then we have to have NIV services adequately set up so that we have the equipment, the staffing and the organisation to provide that next level of respiratory support."

Elsewhere, money invested in community diagnostic services will be really important for the respiratory community. "We can't have a situation where in 60% of people coming into hospital with COPD no-one has seen their spirometry results, and of those that have been seen one in eight don’t actually have COPD."

Effective community diagnostics coupled with better integration with primary care and communication could really help to reduce duplication within services and improve efficacy, he noted. "There's a huge amount of resource to be saved by reducing duplication and making IT and pathways more efficient, and we need to harness that."

Aside from tackling these issues, the BTS is planning to carry out a membership survey later this year to determine the key priorities within the respiratory community that will help shape the strategy of the organisation until 2025. "I hope our members are filled with a desire and a drive to look at their patch and their community and are empowered to make a difference by driving through some of their ideas," Dr Walker said. "I am confident that BTS members will come out of this with huge enthusiasm to drive change, but we need to help them with some sort of closure, recovery and then making sure we are planning for the future to deliver that agenda."

COVID-19 continues to dominate research agenda

Meanwhile, the research agenda for 2022 will continue to be heavily focused around COVID-19, though clinicians and scientists will also continue to work on combatting other major respiratory diseases, Professor James Chalmers, Chair of BTS' Science and Research Committee, told the limbic.

From a COVID perspective, Prof Chalmers sees a shift in research activity to the outpatients area. "Anitvirals and other preventative strategies are where a lot of clinical trial and development activity will be," he said. "Along the same lines, next generation vaccines are a really hot topic, [researchers are] trying to develop vaccines and strategies that are effective against all variants and future variants, so that we can avoid these intermittent waves that cause such disruption."

Another massive areas of focus in the COVID research sphere will be the longer term effects of the virus. "That’s already an important topic, but now that we’ve just had a huge wave of infection with Omicron and the anticipation that we’re going to see a lot more patients with Long COVID, developing a greater understanding of that condition and potential treatments are going to be incredibly important," Prof Chalmers noted.

However, he was also keen to emphasise that non-COVID research and care are not being neglected. "We’re seeing recent increases in mortality from cancer and other diseases, caused by the disruption to medical care that we’ve had during the pandemic. A major research focus will be on finding new effective ways of delivering respiratory care that are more efficient to help us cope with the backlog and address some of the excess mortality in a way that's sustainable."

Clinical research, he said, has been one of the beacons during the pandemic, and researchers are considering how some of the study designs and collaborative working can be applied to other respiratory problems. "The pandemic has shown us how quickly we can develop new treatments when we really have to, when there’s a co-ordinated research focus and everyone is pulling together in big research projects," he said.

"It would be great to see us leverage that learning, that understanding, that unprecedented collaboration in the respiratory field to develop new treatments for our core respiratory diseases like COPD, asthma, bronchiectasis, pulmonary fibrosis, lung cancer and many others."

One of the key lessons of the pandemic has been that some of the existing structures for retrieving information out of research were not fit for purpose. For example, pre-pandemic it could take 18 months for a study to be published, now following study completion the data can be published preprint and be in the public domain and changing practice within days.

"I don’t think people will want to go back, I think pre-print and rapid dissemination is here to stay,” Prof Chalmers said. “That’s not a bad thing but safeguards will be needed. Pre-prints are not peer reviewed, and so we do need to think about how we avoid non-peer reviewed data getting too quickly into the public domain, potentially being mistaken for peer reviewed data or having a negative impact on practice."

"Respiratory research is so exciting, because we have a really vibrant community of respiratory clinicians, researchers, and other professionals in the UK, who are all research literate and really keen to push forward better care. That’s why as soon as a new paper comes out, it's being discussed in the hospitals, it’s being discussed within research teams, it’s being discussed on twitter and practice is changing immediately, because we have such an interested and vibrant research community."

"The respiratory community has done an amazing job in delivery such a volume of research under the most immense pressure of caring for people on the front lines with COVID, and it should be proud of what it’s done in the last two years. And it will do even more in 2022."