NAC Comms team becomes NAC CARES team

“So, what do you do?” What a difficult question! The communications team at the National Aspergillosis Centre have been mulling this one over a lot recently and have decided that they need to make things clearer.

They have been known as ‘the comms team’ for a long time. But what does that really mean? How can they explain what they really do? They have broken it down into five main areas and have become NAC CARES.

NAC CARES
NAC CARES: Community Awareness Research Education Support

This is what they want to communicate about the National Aspergillosis Centre.

Community

NAC is at the centre of a community. That community is made up of people with aspergillosis, their families and carers, clinicians, researchers, academics and allied health care professionals. We work with the Aspergillosis Trust, the Mycology Reference Centre Manchester and the Manchester Fungal Infection Group. We’re available to consult with staff from any other hospital if they need specialist advice about aspergillosis. Together we are fighting against aspergillosis.

Awareness

We strive to raise awareness of aspergillosis. We champion World Aspergillosis Day. We provide research and clinical resources for academics and health care professionals. We provide free information to patients.

Research

NAC has an extensive clinical research portfolio including azole resistance, optimising diagnostics, clinical outcomes and quality of life, genetic basis of disease and immunity.

Education

We provide information to patients about aspergillosis. We also provide diagnostic and clinical training to health care professionals and technical staff through a variety of online learning resources.

Support

NAC is a friendly place to visit both on and offline. Our staff are helpful and knowledgeable. As well as clinical care, we support people with aspergillosis and their families by hosting face to face and online support groups.

NAC CARES!

The first letter of each of these areas spells out the word ‘cares’. And that’s exactly what we do. So, your NAC comms team will now be known as your NAC CARES team.

Graham Atherton, NAC CARES team lead, said “This is a real step change for us in terms of communicating our function to the people who use our service.”

What are the risk factors for Chronic Pulmonary Aspergillosis returning once antifungal therapy has been stopped?

Chronic pulmonary aspergillosis (CPA) can be a scary disease. People can be on antifungal drugs for a very long time, sometimes indefinitely. This can be worrying. Is it ever possible to come off antifungal drugs? Will the fungus ever go away? If the drugs are stopped, might the fungus come back again?

A recent research paper from the National Aspergillosis Centre has attempted to find some answers.

The researchers wanted to know how many people with CPA relapsed once their antifungal treatment was stopped. They also wanted to know what the risk factors for relapse might be. Understanding these risk factors might help to manage the disease better and might tell us which patients are at a low risk of relapse. This means that for these patients, treatment could be stopped earlier and so antifungal resistance, toxicity and cost could be reduced.

The scientists looked at people with aspergillosis who were treated at the National Aspergillosis Centre between 2009 and 2017. They identified at 102 people whose antifungal treatment (mainly voriconazole) was stopped during this period.

In 21% of people, CPA came back (21 out of 102 people). The key risk factors for relapse were the involvement of both lungs and, to a lesser extent, the presence of an aspergilloma.

In a different study of patients with CPA who were mainly treated with itraconazole, presence of disease in more than one lobe on CT scan, younger age and longer duration of treatment to achieve remission were associated with a higher risk of relapse.

Even though the authors found that CPA came back for 21% of people in this study, the chance of relapse is a very difficult thing to predict. Many people with CPA have other conditions which affect their health such as bacterial infections, non-tuberculous mycobacterial infections or COPD. Doctors might look at information from scans, microbiology or blood test results to help inform them as to whether relapse is likely, or they might rely on whether a person seems to be ‘getting worse’ clinically.

That said, this study showed that where both lungs are affected and an aspergilloma is present, the likelihood of relapse is increased, although it should be noted that antifungals were stopped mainly because of side effects or resistance development, and not because of achieving remission of disease.

The full paper is available on the Aspergillus Website.

This is a figure from the research paper showing that people with bilateral aspergillosis (i.e. aspergillosis involving both lungs) are more likely to relapse that people with aspergillosis involving one lung (unilateral disease). The green line is for both lungs, the blue line is for one lung.
This is a figure from the research paper showing that people with bilateral aspergillosis (i.e. aspergillosis involving both lungs) are more likely to relapse that people with aspergillosis involving one lung (unilateral disease). The green line is for both lungs, the blue line is for one lung.

Hope on the horizon: Novel antifungal treatments in development

A review published recently describes the new antifungals that are in the pipeline that offer hope for the future.

The new drugs described in the review have novel mechanisms of action to overcome resistance, and some offer new formulations providing distinct advantages over current therapies to improve safety profiles and reduce interactions. For example, Rezafungin has shown activity against Aspergillus species and has reduced liver toxicity, better penetration and less risk of resistance.

A summary of the mechanism of action, spectrum of activity and expected benefits is provided in the paper which you can find on the Aspergillus Website. The authors have also produced a great illustration of the new antifungals and their activity so that the remaining gaps can easily be seen. Aspergillus species have been highlighted by the blue box.

It is very encouraging to see that several of the compounds have potent activity against Aspergillus species and that Ibrexafungerp, a compound affecting the fungal cell wall, has activity against several Aspergillus species and is in phase 3 clinical trials.

The potential benefits of this drug include:

  • Oral and IV formulation
  • Active against resistant strains
  • Better penetration (IAC)
  • Minimal drug-drug interactions

In addition, olorofim, VL2397 and ABA all have potent activity against Aspergillus species and are in various stages of clinical trial. All in all, there is real hope on the horizon

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Keep going! Keep going! Keep going!

At this month’s patient support meeting Phil Langridge, Specialist Physiotherapist at Manchester University NHS Foundation Trust, Wythenshawe Hospital, gave a fantastic talk all about spirometry and lung function tests.

He started the talk with a simple question “Do you look forward to lung function tests?” An audience member offered a simple reply “No, it’s purgatory”.

Lung function tests are hard. The thing is, they’re maximum function tests. The staff carrying out the tests sometimes sound a bit strict, firmly telling you to keep going and put more effort in. The tests are tough, and for some people they can take a while to recover from. That’s because they need maximum effort and it can take a lot out of some people.

Phil gave us an overview of most commonly used tests, starting with the spirometry test. Sometimes these tests can be done at your GP surgery with a practice nurse in a familiar setting. Sometimes they have to be done in hospital and this can lack privacy and be a bit intimidating. Try not to worry, staff understand this, just tell them you’re feeling nervous and they’ll do what they can to help so your test gives the best result possible.

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Yeast that live in the human gut can trigger the immune system to cause inflammation in the lung, especially in patients with ABPA.

The yeast Candida albicans lives in the gut as a commensal organism, usually without issue. C. albicans causes the body to produce a particular kind of immune cell, called Th17 sensitive cells, that stop the Candida from causing infections. A new research paper out this month shows that the Th17 cells that react to Candida in the gut also react to Aspergillus in the lung by a process called ‘cross reactivity’.

Cross reactivity was shown to increase the levels of Aspergillus reactive Th17 cells in the blood of patients with Cystic Fibrosis, COPD and asthma, especially during ABPA. This indicates that there is a direct link between the normal, protective Th17 responses against Candida in the gut, and harmful inflammation by Aspergillus in the lung.

In other words, problems in your lungs might be made worse by the normal immune response to Candida in your gut. This knowledge could affect the way we treat flare ups in future. For example, we already know that using antibiotics can increase the growth of Candida in the gut. This new information raises the possibility that increased Candida in the gut could cause increased lung inflammation or a ‘flare up’ of symptoms in patients with Aspergillosis, but further work would be needed to confirm this.

Read the paper here

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