Interstitial lung disease (ILD) is a major area of respiratory medicine It is important that trainees gain competence and confidence in this area. Methods A survey of BTS trainee members was conducted in November 2013 to examine training provision in ILD, including trainee’s opportunities, experience and confidence in aspects of ILD. Results There were 104 respondents out of a possible 574. 33% of respondents were not expecting any subspecialty clinics in ILD in the course of their training. 42% of trainees expect to spend 3 months or less attending specialist clinics. Trainee attendance at MDTs is far from guaranteed, with 45% expecting to attend less than half during their period in these hospitals. The majority of trainees are trained in performing BAL for cell differential analysis (73%) and transbronchial biopsies (84%), however only 48% are confident performing transbronchial biopsies. Confidence interpreting investigation results increases with the frequency these are performed. The self rated knowledge in a range of subject areas was also assessed and demonstrated that most areas were moderately well understood, however knowledge of the less frequently encountered IIPs was rated lower. 54% of trainees felt their ILD training was inadequate for SCE preparation. 94% would value a BTS Short Course on ILD to improve their knowledge and confidence. Discussion This survey highlights areas where there are clear opportunities to enhance the training of registrars in ILDs. It is worth noting that some of the data is in conflict with previous BTS surveys in this area and there is the possibility of self-selection bias in the response population. Whilst most trainees are trained in performing relevant procedures, their confidence interpreting the results of common investigations in ILD is low. To give evidence of training and competence in this area, deaneries may wish to consider requesting logbook evidence of procedures related to ILD, in addition to evidence of ILD MDT attendance. There is undoubtedly a need for a BTS short course on ILD for trainees.

Introduction and Objectives Non-Tuberculous Mycobacteria (NTM) are ubiquitous species typically residing in soil and water. Their presentation as pathogens in disease is believed to be rising with the most common site of isolation being pulmonary. We have examined the epidemiology and characteristics of NTM presenting to our clinic over the period 2005–2012. Method Our database, including all patients with at least one identification of an NTM during the period of 2005–2012, was reviewed. Data presented includes all incidences documented from 2009 onwards, with additional data from before 2009 used to gain further demographic information about the population. Those who were non-resident in the area were excluded. The data was collected from Clinical Letters, Radiology and Pathology records, with data being reviewed by the lead investigator and one other in cases where information was uncertain. Results Data was obtained from 74 new isolations, with a total of 11 different species of NTM identified. Patients presenting had a median age of 68 and a range of 8–88 years. 39(53%) were female and 46 (62%) were “one-off” isolates. M. Avium-intracellulare (MAI) was the most frequently reported isolate (42 cases, 57%) followed by M. Chelonae (8, 11%) and M. Xenopi (6, 8%). The majority (68, 92%) of isolates were pulmonary with 45(66%) of these found in standard sputum culture. Most frequently recorded co-morbidities were bronchiectasis (35 cases, 47%) and COPD (20, 27%). Of the total of 74 cases only 24 (32%) had received treatment by the time of our survey. The overall rates for eradication and subsequent relapse in those treated patients were 50% and 25% respectively for the total population and 57% and 38% for those with MAI. At completion of the study the mortality rate within 2 years of the first positive sample was 18%. Conclusion In keeping with previous UK surveys, the majority of isolates in our population were pulmonary with MAI being the most frequently seen species of NTM. In those in whom treatment was indicated low eradication rates and significant relapse rates confirm complexity of managing this population of patients.

Introduction and Objectives There are limited data on the healthcare resource use that arises as a consequence of idiopathic pulmonary fibrosis (IPF). Navaratnam et al1 have recently reported rising hospital admissions due to IPF but utilisation of other health related services by individuals with IPF is unknown. As part of a real world assessment of the clinical experience of pirfenidone via the UK Named Patient Program data were collected to determine the burden placed on healthcare resources as a consequence of IPF. Methods A multi-centre, retrospective, cohort review was undertaken across 4 NHS Trusts. Hospital resource use data were collected from the clinical records of individuals starting pirfenidone for IPF through the NPP before June 2012. Results Data were available from 100 patients (76% male) at baseline and 67 through to nine months from baseline. At baseline, the mean ± S.D. age was 69.3 ± 7.5 years, mean ± S.D. FVC% predicted was 70% ± 19% and 62 patients were on oxygen therapy. In the first 6 months from baseline, 11 patients had 15 IPF-related hospitalisations of which 6 were for an acute exacerbation. One patient was hospitalised in the 6–9 months period. The mean ± S.D. and median (IQR) hospital bed days in the first 6 months were 11.0 ± 7.5 and 11.0 (6.0–13.5) days respectively for hospitalised patients and mean ± S.D. 1.2 ± 4.2 days for all patients. One patient was admitted to the Intensive Care Unit, for 5 days. Eighteen patients had IPF-related Accident and Emergency department visits, 3 had an IPF-related day-case and 67 outpatient clinic visits, with a mean of 2.1 ± 2.0 outpatient clinic visits per patient in the first 6 months of the observation period. Conclusion IPF is a terminal disease associated with significant morbidity and mortality. This is reflected in the high level of resource use and frequent accessing of health care services by this severely ill cohort of patients. Whether resource use has been positively impacted by the introduction of pirfenidone is unknown but merits prospective assessment. Reference Navaratnam V, Fogarty AW, McKeever T, Hubbard RB. The Increasing Secondary Care Burden of Idiopathic Pulmonary Fibrosis Hospital Admission Trends in England >From 1998 to 2010. CHEST 2013; 143(4):1078–1084

Background The BTS CAP audit is the largest national audit of adult CAP management. It relies on acute trusts entering data collected retrospectively from patients’ notes. Cases are selected for entry if they were admitted between 1st Dec 2012 and 31st Jan 2013 with a diagnosis of CAP confirmed by appropriate radiological changes. Participating institutions are required to submit a minimum of 20 cases. The audit also provides data on mortality. The national data shows a high mortality rate (18.2%) for CAP. However, the mortality data from our own institution was unexpectedly higher at 28.2%. Aim To determine if the high mortality rate from our institution is the result of selection bias. Methods We compared the outcomes of 39 audit cases entered from our institution, a large teaching hospital serving a semi-rural population, with all other cases of CAP admitted over the same period not entered into the audit. Proportions were compared using chi-square tests and continuous variables using Kruskal-Wallis test. Results During the two month audit period, 124 cases of CAP were identified of whom 39 (31.5%) were entered into the audit. There was no significant difference in age between those entered (77.1 yrs ± SD 11.0) and those not entered (70.1 yrs ± 18.5). However the inpatient mortality rate was significantly higher in those entered into the audit than those who were not (28.2% Vs 10.6%, p = 0.01). Conclusions These results show that selection bias accounts for the apparently high mortality rates. Although the notes of all patients admitted with CAP were requested for the audit, on reviewing the methods used by the audit department, it is apparent that patients whose notes are most readily available are collected first for audit. Deceased patients’ notes are more easily accessed by the audit team; since the national audit requires only a proportion of patients to be entered, this group are over-represented. If other institutions have similar practices, the national audit will over-estimate mortality from CAP. Case acquisition bias could be reduced by collecting cases prospectively, or by entering all cases of CAP over a shorter predefined time period.

Introduction and Objectives In March 2011, the novel anti-fibrotic, pirfenidone (Esbriet®), became the first drug to be licenced in Europe for the treatment of IPF. Since September 2011 pirfenidone has been available in the UK through a named patient programme (NPP). We present initial findings from a real-world study describing clinical experience with pirfenidone in routine UK clinical practise. Methods A multi-centre, retrospective, cohort review was undertaken across 4 NHS Trusts. Data (through to July 2012) were collected from the clinical records of individuals receiving pirfenidone for IPF through the NPP. Results Data was available from 68 patients (72% Male). Mean (±S.D.) age at diagnosis was 67.3±8.1 years. At initiation of pirfenidone FVC was 69.4±21.5% predicted and DLco 39.8±15.3% predicted. Domiciliary oxygen was being administered to 38.2% (26/68). At day 15, following a 14-day titration period, 92.3% (60/65) were receiving the recommended dose of 2403 mg/day pirfenidone. One patient had discontinued treatment. Data was available for 53 patients at 3 months; 42 (79.2%) continued to receive pirfenidone, whilst 11 (20.8%) had stopped therapy. Between 3 and 6 months, 93.1% (27/29) continued pirfenidone with only 2 further patients (6.9%) stopping treatment. Of the 68 patients, 30 (44.1%) experienced an adverse drug reaction (ADR) resulting in a change of dose or cessation of pirfenidone. The commonest ADRs were GI-upset and photosensitive rash. Of those experiencing ADRs, with data available, 12/22 (54.5%) continued pirfenidone after a dose-reduction. In 53 patients for whom pre-treatment liver function tests were available, only two showed a minor increase above the upper limit of normal. During the observation period 10.3% (7/68) of patients suffered an acute exacerbation. Collection of data to determine effect of pirfenidone on lung function at 6 months of treatment is on-going. Conclusions Patients enrolled in the NPP are demographically representative of the UK IPF population but have moderately severe disease that is on average more advanced than that seen in the CAPACITY study. Pirfenidone treatment is reasonably well tolerated. On-going observation of patients enrolled in the UK NPP should provide invaluable insights into the real-world benefits of pirfenidone in individuals with IPF.