analysis. K-ras mutations were found in 14 (25%) cases of adenocarcinoma; 13 were detected by direct sequencing and the remaining mutation was only detected by pyrosequencing analysis. Detected mutations were G12C (eight cases), G12V (four cases), G12D (one case) and G12A (the case identified by pyrosequencing). This group comprised eight females and six males, of whom 11 were current smokers, two were former smokers and one had never smoked. Two had stage II, seven had stage III and five had stage IV disease. None of the patients showed both EGFR and K-ras mutations.
Idiopathic pulmonary fibrosis (IPF) is a debilitating condition with life expectancy of two to five years from diagnosis. Treatment strategies for IPF are disappointingly limited and pirfenidone is currently the only licensed drug that has been shown to reduce the decline in forced vital capacity (FVC) at six months. We demonstrate our experience in prescribing pirfenidone in a single centre observational study of forty patients involved in a named patient programme (NPP) from September 2011 to January 2013. We demonstrate that improved adherence and compliance can be achieved by specialist nurse and clinician review, support and education of the patient. Twenty three of 40 (58%) patients experienced predominantly gastrointestinal adverse effects. Importantly we have enhanced patient adherence and compliance from an initial discontinuation rate of six patients (15%) at the beginning of the study to a zero discontinuation rate in the subsequent ten months. This study shows that in the real world pirfenidone is well tolerated and with expert regular specialist review adherence can be optimised and improved.
Background The aetiology of idiopathic pulmonary fibrosis (IPF) remains poorly understood. Recent animal studies and epidemiological data have suggested that activation of the coagulation cascade in the lung may have an important role in the pathogenesis of IPF. Methods We recruited incident cases of physician diagnosed IPF from five teaching hospitals and eight district general hospitals in England and Wales. Age and sex matched general population controls were recruited from the same region. Participants were asked for details of lifetime occupational history, current or previous illnesses, medication and smoking. Each case and control then had a venous blood sample taken for a thrombophilia screen, including inherited and acquired clotting defects. We also collected high resolution computed tomography (HRCT) scans for all cases, which were reviewed by two experienced thoracic radiologists to confirm
Background Methotrexate (MTX) immunosuppressive therapy is selectively used to assist with the reduction of the oral corticosteroid demand thereby decreasing the risk of potential side effects in individuals with steroid dependant asthma. Previous reported data has demonstrated similar significant reduction in corticosteroid load, asthma exacerbation and hospital admission rate. This study aims to compare similar variables collated from UK severe asthma specialist centres to further generate evidence for the continued use of MTX as an effective aid in the reduction of corticosteroid burden in a severe asthma cohort. Methods A retrospective data collection was performed across two UK severe asthma centres with data from a third pending. Patients included had a confirmed diagnosis of severe asthma and had been treated with MTX for at least 12 months to allow sufficient analysis. Variables assessed included mean average daily corticosteroid dose, overall percentage reduction of corticosteroid, exacerbation frequency and acute admission events both twelve months prior to and post commencement of MTX therapy. Data collection was examined for each individual centre then combined and examined for consistency of results. Background It has been suggested that aerosol inhaler characteristics such as fine particle size distribution, low plume velocity, and long duration of the aerosol cloud may assist coordination of inhalation with actuation, improve lung deposition, and reduce oropharyngeal deposition. This study compared 2 ICS/ LABA combination HFA pMDI inhalers: fluticasone propionate/ formoterol 125/5 µg (FP/FORM; flutiform ® ) and fluticasone propionate/salmeterol 125/50 µg (FP/SAL; Seretide ® Evohaler ® ). P195 PLUME CHARACTERISTICS OF FLUTICASONE PROPIONATE/FORMOTEROL PMDI COMPARED WITH FLUTICASONE PROPIONATE/SALMETEROL PMDIMethods Inhalers were operated according to their respective patient information leaflets, and were fired into still air. Plume data were recorded using an Oxford Lasers EnVision Pharma system with high speed CMOS camera and short-pulse laser light source. VidPIV 4.6 & EnVision 1.1.5 software was used to analyse the data and assess velocity and other characteristics of the plume at set intervals from the actuator (up to 9.5 cm which is representative of the distance from mouth to throat). Results FP/FORM pMDI had slower maximum velocity of plume than did FP/SAL at the distances measured (table)
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