Irish Thoracic Society Podcast Productions

In this episode, Dr Marissa O’Callaghan and Dr Sandra Green host Dr. Augusta Beach and Dr. Laura Fabbri, both Early Career Representatives of the European Respiratory Society. They discuss their journeys to becoming representatives, the responsibilities of their roles, and the importance of networking and engagement within the society. This conversation also focuses on the upcoming Congress, including key sessions, tips for poster presentations, and social events, emphasizing the value of participation and proactive involvement for early career members. Keywords European Respiratory Society, Early Career Representatives, Networking, Congress, ILD, COPD, Research, Eosinophils, Asthma, Clinical Trials

In this episode, Dr Marissa O'Callaghan and Dr Sandra Green host Dr. Margaret Higgins and Dr. Barry Harnedy, the new Educational Officers of the Irish Thoracic Society, to discuss the upcoming ERS Congress in Amsterdam. They share insights on how to strategies to get the most out of your conference attendance, the importance of networking, and opportunities for pursuing fellowships. The conversation also includes a fun quiz about the ERS Congress and practical tips for first-time attendees. Keyword / Tags ERS Congress, networking, fellowship, pulmonology, education, conference tips, respiratory health, international collaboration, poster sessions, early career

In this episode, Aisling McGowan takes us through the full journey of lung function testing — from referral to patient walkthrough — covering contraindications, the patient experience, and interpretation using the new GLI Guidelines.

Join us in this interview with Aisling McGowan, Chief 2 Physiologist at Connolly Hospital, Dublin, whose 34-year career in respiratory and sleep diagnostics has combined clinical expertise, education, and leadership. We explore the role of a respiratory physiologist, the varied training paths into the profession, career progression, opportunities in education and leadership, and the challenges and rewards of a career in respiratory physiology in Ireland. 01:10 Describing the role of the respiratory physiologist 03:13 The training pathway for respiratory physiology 06:32 Specialising in respiratory physiology 08:10 Postgraduate entry to respiratory physiology 08:50 Career progression; staff grade to senior to chief one and chief two 12:10 Advanced practice in respiratory physiology 13:53 Changes to the role if advanced practice came into effect 14:45 Opportunities abroad for Irish trainees 15:50 The pathway for internationally trained respiratory physiologists 16:20 Popularity of respiratory physiology degree courses 17:09 Challenges in recruitment and retention 17:50 Additional postgraduate training opportunities: Master of Science 20:10 Staff shortages and workloads 21:45 The impact of integrated community care hubs on tertiary care staffing 22:26 Vision for lung function diagnostics in the integrated care hub 27:18 What keeps you engaged?

This week, we speak to Dr. Laura Gleeson again—this time about pleural effusions. Our conversation covers all the pleural effusion basics, plus the nuances of radiology, when to insert a chest drain, and how to monitor it once it’s in place. Chapters: 01:05 – Rapid fire round 04:23 – Pleural effusion intro 05:30 – Symptoms at presentation with pleural effusion 06:40 – Interpreting a white-out on CXR 07:20 – When to do further radiology/imaging 08:35 – CT pre or post chest drain insertion? 10:25 – Light’s criteria – can it always be trusted? 12:00 – What tests to send on your pleural fluid sample 14:15 – Chest drain indications 16:35 – Monitoring your chest drain 21:00 – Flushing the chest drain 22:20 – How much fluid to drain 25:00 – Removing the chest drain 27:10 – Empyema management 30:10 – Fibrinolysis 31:55 – Following up your pleural patients 34:10 – Take-home points Show notes & resources: Light’s criteria – MDCalc calculator | CHEST Clinics article MIST trials – MIST2 – NEJM | MIST3 – ATS Journals

In this episode, we speak with Dr. Laura Gleeson, Respiratory Consultant in St James Hospital, about her journey into respiratory medicine and her diverse specialist interests. She shares valuable insights on preparing for consultant interviews and highlights the importance of networking. We explore the realities of early career life and the transition into the first years as a consultant. Dr. Gleeson also reflects on the challenges of setting up a new clinical service and the key tools that can support success. (Recorded June 2024). Chapters 00:43 Introduction 01:24 Pathway to respiratory and special interest in immunology, TB, and pleural disease 07:00 Networking and preparation ahead of a consultant interview 10:23 The interview for a consultant post 11:00 Being on the consultant interview panel 12:35 The inspo for the ambulatory pleural service 14:00 Career focus and fellowship 16:45 Challenges when developing a new clinical service 18:59 Money talks and other methods of engaging management 22:14 Gaining momentum and the Spark Innovation Fund Show Notes 1. Developing an Ambulatory Pleural Effusion Service https://www.gov.ie/en/department-of-public-expenditure-infrastructure-public-service-reform-and-digitalisation/publications/developing-an-ambulatory-pleural-effusion-service/ 2. Healthcare team of the year award for the St Jame’s Hospital Ambulatory Pleural Effusion Sevice https://x.com/stjamesdublin/status/1926927226848633028

This week, we’re joined by Professor Seán Gaine, Ireland’s foremost expert in pulmonary hypertension. In this insightful episode, he shares his expert perspective on the diagnosis, classification, and clinical presentation of the condition, as well as the latest advances in treatment. A must-listen for all healthcare professionals, Professor Gaine also discusses when to suspect pulmonary hypertension and highlights the nuances in the management of patients with pulmonary hypertension. Don’t miss this opportunity to learn from a global leader in the field. Chapters 0:52 Rapid fire round on pulmonary hypertension 01:42 Definition of pulmonary hypertension 02:08 Signs and symptoms of pulmonary hypertension 02:56 Five groups of pulmonary hypertension 03:33 Group 1 pulmonary hypertension: Pulmonary arterial hypertension 04:34 Group 2 pulmonary hypertension: Left heart disease 05:23 Group 3 pulmonary hypertension: Chronic lung disease/hypoxia 05:58 Group 4 pulmonary hypertension: Pulmonary vascular obstruction 06:30 Group 5 pulmonary hypertension: Miscellaneous 07:25 Referral to the national pulmonary hypertension centre: right heart catheterisation 09:37 Work up in the pulmonary hypertension clinic 11:06 Risk stratification in pulmonary hypertension 12:06 Diagnostic criteria pulmonary hypertension Dynamic testing right heart catheterisation: Cardiopulmonary exercise testing Reliability of right heart catheterisation Treatment algorithm in pulmonary arterial hypertension Tripple therapy for high risk patients Double combination therapy for non-high risk patients Fourth treatment pathway, Quadruple therapy?: Sotatercept - an activin scavenger Treatment options for groups 4 pulmonary hypertension: Balloon pulmonary angioplasty Treatment options for groups 2, 3 and 5 Side effects of triple therapy Lung transplant in pulmonary hypertension: Double or single lung transplant Pitfalls in the acute management of patients with pulmonary hypertension Interpretation of the B Natriuretic Peptide level Medications contraindicated pulmonary hypertensions Outcomes in pulmonary hypertension Take home message on pulmonary hypertension Show Notes - https://lumen5.com/user/edofficer/sotatercept-emergin-d5jg6/ - Irish Thoracic Society Flashcard Pulmonary Hypertension https://irishthoracicsociety.com/wp-content/uploads/2021/06/5.-Pulmonary-Hypertension.pdf - Benza RL, Kanwar MK, Raina A, et al. Development and validation of an abridged version of the REVEAL 2.0 risk score calculator, REVEAL Lite 2, for use in patients with pulmonary arterial hypertension. Chest 2021; 159: 337–346. - Humbert M, Kovacs G, Hoeper MM, Badagliacca R, Berger RMF, Brida M, et al. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. European Respiratory Journal. 2022:2200879. DOI: https://doi.org/10.1183/13993003.00879-2022 - Chin KM, Gaine SP, Gerges C, Jing Z-C, Mathai SC, Tamura Y, et al. Treatment algorithm for pulmonary arterial hypertension. European Respiratory Journal. 2024;64(4):2401325. DOI: https://doi.org/10.1183/13993003.01325-2024 - Hoeper, M.M., Badesch, D.B., Ghofrani, H.A., Gibbs, J.S.R., GombergMaitland, M., McLaughlin, V.V. et al. (2023) ‘Phase 3 trial of sotatercept for treatment of pulmonary arterial hypertension’, New England Journal of Medicine, 388(17), pp. 1478–1490. Available at: https://doi.org/10.1056/NEJMoa2213558 - Humbert M, McLaughlin VV, Badesch DB, Ghofrani HA, Gibbs JSR, Gomberg-Maitland M, et al. Sotatercept in Patients with Pulmonary Arterial Hypertension at High Risk for Death. N Engl J Med. 2025;392(20):1987-2000. DOI: 10.1056/NEJMoa2415160

This week, we speak with Professor Sean Gaine about his distinguished career—from his work establishing the Pulmonary Hypertension Program at Johns Hopkins Hospital and later founding Ireland’s National Pulmonary Hypertension Centre as well as serving as Chief Medical Officer for the Irish Olympic Teams. He shares thoughtful insights and experiences from a remarkable career with more stories than could ever be squeezed into one episode. Chapters 01:56 Residency in the Johns Hopkins Hospital 03:37 Introduction to Pulmonary Hypertension 05:56 Establishing the Pulmonary Hypertension Unit in the Johns Hopkins Hospital 14:01 Establishing the National Pulmonary Hypertension Programme in Ireland 15:51 Essential role of clinical nurse specialists 18:01 Chief Medical Officer Irish Olympic Teams 25:46 Sustaining enthusiasm in a career in medicine Show Notes 1. Rubin, Lewis J., and Stuart Rich, editors. Primary Pulmonary Hypertension. Marcel Dekker, 1996. Lung Biology in Health and Disease. 2. https://www.irishtimes.com/sport/athletics/2024/05/18/jamie-costin-was-27-in-the-shape-of-his-life-ready-for-the-olympics-then-he-got-hit-by-a-truck/ 3. https://lumen5.com/user/edofficer/sean-gaine-olympic-cq0g0/

Description This week we speak to Mr Stephen Shelly again about the exciting but sometimes mysterious world of asthma biologics. We speak about the different biologics, going about getting approval to start an asthma biologic, training, and treatment response. We speak about the potential impact that asthma biologics are going to have on the future of asthma (and hopefully COPD!), the cost benefit analysis and the limitations of these new wonder drugs. Chapters 0.42min Intro to Biologics 1.00min Rapid fire round 1.52min Severe asthma & biologic eligibility 3.50min Available biologics 6.50min Which biologic? 7.30min Journey to asthma biologic 13.55min Asthma biologic administration 15.30min Monitoring while on asthma biologic 16.40min Training for asthma biologic admin at home 18.50min Assessing treatment response 21:10min Patient expectations 24:50min Are inhalers still needed? 26:12min Pitfalls in treatment with asthma biologics 28:54min Cost-benefit analysis 31.30min Take-home points Show notes Dupilumab https://www.nejm.org/doi/10.1056/NEJMoa1804092 Mepolizumab https://www.nejm.org/doi/10.1056/NEJMoa1403290 Omalizumab https://www.jacionline.org/article/S0091-6749(01)65945-1/fulltext Benralizumab https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)31322-8/abstractTezepelumab https://doi.org/10.1164/rccm.202210-2005OC Difficult to treat asthma (GINA) https://ginasthma.org/wp-content/uploads/2024/11/GINA-Severe-Asthma-Guide-2024-WEB-WMS.pdf Asthma compliance programmes Ireland https://www.rcsi.com/dublin/research-and-innovation/innovation/investors-entrepreneurs-and-spin-outs/phyxiom

In this episode we speak to Mr Stephen Shelly, Advanced Nurse Practitioner in Respiratory Medicine in St James’ University hospital. Stephen completed his nursing, CNS and ANP training in SJH with a special interest in airways disease. In the ANP role he has introduced new pathways for direct GP referrals to his clinic and enhanced the early discharge programme for patients attending the emergency department with COPD. We discuss his career to date, the process for pursuing a career as an ANP, challenges along the way and tips for others with an interest in becoming an ANP. Chapters 00:45 Intro to Mr Stephen Shelly 02:05 Why he pursued a career in Respiratory medicine 04:30 Stephen’ early nursing career 05:40 Working as a clinical nurse specialist (CNS) 06:10 Overview of ANP training process 07:40 ANP Dragon’s Den 09:10 Different pathways to becoming an ANP 11:50 Future of ANPs in Ireland 14:00 Tips in advance of applying for an ANP role 19:30 Transition from CNS to ANP 22:10 Liaising with NCHDs/ junior doctors 24:30 Biggest challenges to date 28:30 Top tips for people starting out their nursing career 29:35 Wrap up Show notes ANP registration Ireland https://www.nmbi.ie/Registration/Add-New-Division/Advanced-Practitioners/Registering-as-ANP-AMP CNS training Ireland https://healthservice.hse.ie/about-us/onmsd/advanced-and-specialist-practice/specialist-practice.html Post graduate nursing courses Ireland https://www.nmbi.ie/Education/post-registration-courses

In this episode, we delve into sarcoidosis with Professor Anthony O'Regan. We discuss the nuances of diagnosing sarcoidosis and revisit the pathophysiology of the condition. This episodes details the importance of follow up care and provides insights into how to tease out differentials. Furthermore, we address how to determine which patients should be treated, along with choice of treatments and duration. 00:15 Rapid fire round: sarcoidosis 00:45 Pathophysiology of sarcoidosis 05:30 Multisystem involvement in sarcoidosis 07:15 Granulomatous disease 09:00 Referral to respiratory clinic (Symptoms/Differentials/Family history/Travel) 10:30 Initial investigations 10:45 Coming to a diagnosis of sarcoidosis 14:05 The role of biopsy in diagnosis of sarcoidosis 15:50 Teasing out the differentials in follow up 17:35 When to treat in sarcoidosis 19:25 Duration of treatment 19:50 Relapse of disease 21:00 Starting dose of steroids 22:00 Disease modifying therapy 23:30 Antifibrotics 24:25 Follow up in sarcoidosis 25:01 The future of sarcoidosis Show Notes: - Judson MA, Baughman RP, Teirstein AS, Terrin ML, Yeager H Jr. Defining organ involvement in sarcoidosis: the ACCESS proposed instrument. ACCESS Research Group. A Case Control Etiologic Study of Sarcoidosis. Sarcoidosis, Vasculitis, and Diffuse Lung Diseases : Official Journal of WASOG. 1999 Mar;16(1):75-86. PMID: 10207945. - 40 consecutive patients in Ireland 20% end up on steroids - John Gibson study on steroids RCT Gibson GJ, Prescott RJ, Muers MF, Middleton WG, Mitchell DN, Connolly CK. "British Thoracic Society Sarcoidosis study: effects of long-term corticosteroid treatment." Thorax. 1996;51(3):238-247. DOI: 10.1136/thx.51.3.238 - Nintedanib in patients with progressive fibrosing interstitial lung diseases—subgroup analyses by interstitial lung disease diagnosis in the INBUILD trial: a randomised, double-blind, placebo-controlled, parallel-group trial Wells, Athol UAbe, S. et al. The Lancet Respiratory Medicine, Volume 8, Issue 5, 453 – 460 - ITS Flashcard Sarcoidosis https://irishthoracicsociety.com/wp-content/uploads/2022/02/15.-Sarcoidosis-30.11.21.pdf

In this episode we speak to Dr Anthony O’Regan, Consultant Respiratory Physician working in Galway University hospital. Anthony completed his early training in the US and since coming back has worked with the Irish Thoracic Society, Royal College of Physicians Ireland and National Doctors Training and Planning to try and improve working conditions and training for junior doctors in Ireland. We discuss the progress made to date, ongoing projects and healthcare planning for the future changes we will see in our population. Chapters 0.45 Intro to Dr Anthony O’Regan 1.50 Why he pursued Respiratory mediicne 3.20 ITS presidency 7.25 ILD registries 8.50 RCPI and working conditions 14.00 Medical training in Ireland 18.45 Exit exams 20.50 Upcoming changes being introduced by NDTP 26.50 Projections for future workforce 31.20 Advice for upcoming trainees Show notes NDTP website (HSE) https://www.hse.ie/eng/staff/leadership-education-development/met/ All information on becoming a member, upcoming events and how to get involved in the RCPI https://www.rcpi.ie/ ITS website https://irishthoracicsociety.com/ Population changes and impacts on healthcare https://doi.org/10.1038/s41514-024-00148-2

This week we speak with Nazia again, this time about idiopathic pulmonary fibrosis or IPF for short. Nazia is a leading world expert in the diagnosis and management of IPF and in this episode she shares that expertise with us. Chapters 00:57 - Rapid fire round 01:35 - Introduction to ILD 03:20 - Definition of IPF 04:15 - What to include in your IPF referrals 06:40 - IPF workup 11:55 - Genetics in IPF 14:50 - Management of IPF 20:28 - Acute exacerbation of IPF (AE-IPF) 22:20 - Follow-up and surveillance of IPF patients 26:00 - Prognostication in IPF 27:40 - Encouraging clinical breakthroughs 29:05 - Key take home messages 31:00 - Wrap up Links IPF clinical practice update 2022 ATS/ERS/JRS/ALAT https://doi.org/10.1164/rccm.202202-0399ST Role of MDT in diagnosis of IPF https://doi.org/10.1513/AnnalsATS.202108-979ED Current and future treatments in IPF https://doi.org/10.1007/s40265-023-01950-0

This week we welcome Dr Nazia Chaudhuri to the podcast. In this Inspire episode, Dr Chaudhuri tells us how respiratory chose her and gives some insights into combining clinical and academic roles. We discuss emerging research opportunities in Northern Ireland in particular in interstitial lung disease. Show Notes https://medicine.yale.edu/profile/naftali-kaminski/

In this episode, we speak with Dr. Breda Cushen about Chronic Obstructive Pulmonary Disease (COPD). We discuss tertiary care referrals for severe COPD, managing comorbidities, initiating treatment, and ensuring adherence. Packed with practical insights, this episode offers valuable tips to enhance COPD care across the community, outpatient clinics, and hospital settings. Chapters 01.02 Rapid Fire Round 01.50 Definition of COPD 03.10 Tertiary care referrals for severe COPD 05.01 Information to include in the referral 06.40 Work up in severe COPD clinic 08.55 Comorbidities in COPD 10.18 Treatable Traits 14.16 Asthma & COPD 17.32 Initiating treatment in COPD 21.04 Treatment of emphysema with preserved lung function 23.21 Adherence and barriers to treatment 26.17 Identifying those at risk of exacerbation 27.34 Breakthrough in COPD 29.24 Take home message Show Notes 2025 Global Initiative for Chronic Obstructive Lung Disease (GOLD) Report https://goldcopd.org/2025-gold-report/ Westerik JA, Metting EI, van Boven JF, Tiersma W, Kocks JW, Schermer TR. Associations between chronic comorbidity and exacerbation risk in primary care patients with COPD. Respir Res. 2017 Feb 6;18(1):31. doi: 10.1186/s12931-017- 0512-2. PMID: 28166777; PMCID: PMC5294875. COPD/Integrated HST Respiratory Medicine Study Day 28 th February www.rcpi.ie

In this episode we speak to Dr Breda Cushen, Consultant Respiratory Physician in Beaumont hospital. Breda came back to Ireland less than 5 years ago after working as a consultant in the NHS. We discuss some of what Breda has achieved in these first few years, from virtual ward proof of concept projects to the minutiae of starting a severe COPD clinic. But also how she juggles it all and tips for others. Chapters 0.55min Intro to Dr Breda Cushen 1.40min ITS annual scientific meeting 2024 take-home messages 3.48min Career starting out 6.44min Developing a severe COPD clinic 12.05min Behind the scenes preparation 15.45min Other services built around the severe COPD clinic 17.59min Advice for others starting a service 19.55min Virtual wards proof of concept project 25.28min Juggling it all Show notes Virtual wards HSE https://www.hse.ie/eng/about/who/strategic-programmes-office- overview/national-virtual-ward-programme/ Access recordings and abstracts from previous ITS meetings https://irishthoracicsociety.com/about-us/its-scientific-meeting/ National Clinical Programme (NCP) Respiratory https://www.hse.ie/eng/about/who/cspd/ncps/ncpr/

This week we speak again to Dr Deirdre Fitzgerald on pneumothorax. We cover it all; the typical presentation, the diagnosis, categories of pneumothorax and management updates in the last 12 months. We discuss trends in the field of pleural disease and what to expect with respect to changes in guidelines in the coming years. Chapters 00.45 Introduction 01.00 Rapid fire round 01.50 Diagnosis of pneumothorax 02.30 Tests to do at presentation/ prior to referral 05.25 Initial management; does the size of the pneumothorax matter? 08.00 Conservative management of pneumothorax; the evidence 09.00 Medical management of pneumothorax 12.18 Chest drain specifics 15.28 Suction; the evidence 17.03 Removing the chest drain 17.38 Surgical management 19.08 Post pneumothorax guidance 21.23 Pitfalls in management of pneumothorax 22.28 Recent breakthroughs in pneumothorax management Show notes ERS 2024 guidelines on spontaneous pneumothorax https://publications.ersnet.org/content/erj/63/5/2300797 High flow oxygen papers https://www.bmj.com/content/4/5779/86, https://karger.com/res/article-abstract/44/2/147/286426/Noninvasive-Treatment-of Pneumothorax-with-Oxygen?redirectedFrom=fulltext BTS pleural guidelines 2023 https://thorax.bmj.com/content/78/11/1143

Description In our first episode of 2025 we speak to Dr Deirdre Fitzgerald, Consultant Respiratory Physician in Tallaght University Hospital. Deirdre splits her time between a tertiary hospital and community integrated care hub. In this episode she talks us through the integrated care model, setting up a pleural and new innovations she has brought into all aspects of her practice. Chapters 00.42 Introduction to Dr Deirdre Fitzgerald 01.33 Career path in Ireland 03.30 Fellowship in Perth, Australia 08.30 New consultant life 12.12 Management skills 15.20 Setting up a service 17.15 The community integrated care program 21.45 HSE Community hubs 22.10 Innovation in healthcare 24.48 Top tips for trainees Show notes Integrated care overview: https://www.hse.ie/eng/about/who/cspd/icp/ A guide for referral to Integrated care specialist services: https://www.hse.ie/eng/about/who/cspd/icp/chronic-disease/a-guide-for-referral-of-patients-to-the-chronic-disease-ambulatory-care-hub-services.pdf Innovations: https://www.hse.ie/eng/about/our-health-service/making-it- better/deirdre-seeks-to-improve-patient-care-through-innovation-at-tallaght-hospital.html Handheld ultrasound devices: https://www.butterflynetwork.com/?srsltid=AfmBOorQlIy9yP57vpTcQsFn7745-VmB6MwFdTvTd0WGSXMigfj32SvQ Lumen: https://lumen5.com/user/marissaocallaghan/untitled-video-qees0/

Dr Brian Kent covers the key information to be included in your sleep apnoea referrals and also key components of investigation and management of obstructive sleep apnoea. He also describes the advances in technology, wearables and medical treatment coming down the line. Tirzepatide in OSA NEJM paper: https://www.nejm.org/doi/10.1056/NEJMoa2404881 CPAP in OSA: https://www.nejm.org/doi/full/10.1056/NEJMoa1606599 https://thorax.bmj.com/content/61/5/430.long Con/pro debate for asymptomatic patients with OSA Pro: https://pmc.ncbi.nlm.nih.gov/articles/PMC6395978/ Con: https://publications.ersnet.org/content/breathe/15/1/11 Non-CPAP therapies in OSA: https://publications.ersnet.org/content/errev/30/162/210200 Lumen post: https://lumen5.com/user/marissaocallaghan/bk-breath-work-trail-fiig4/

This week, we speak with Dr Brian Kent, Consultant Respiratory physician in St James's Hospital, Dublin. Brian shares his experience as chief editor of Breathe, the clinical educational journal of the European Respiratory Society with insider tips and advice on how to successfully submit to a journal. ERS Breathe: https://publications.ersnet.org/content/breathe Breathe instructions for authors: https://publications.ersnet.org/authors/breathe/instructions A gin guide. Avoid a faux pas: https://www.theginguide.com/ Lumen post: https://lumen5.com/user/marissaocallaghan/bk-inspire-trailer-cxi4m/