JAMES G. FINGLETON, MD

Plain English
The Australia New Zealand Respiratory Audit Programme (ANZRAP) is a new initiative starting in 2025 that aims to improve the quality of care for people with chronic respiratory diseases like asthma and chronic obstructive pulmonary disease (COPD). The program plans to identify what works well and what doesn’t in the current healthcare system, with the goal of enhancing patient outcomes and making healthcare more efficient. This is important because it addresses the differences in care quality, ensuring that all patients receive better treatment regardless of where they live. Who this helps: Patients with chronic respiratory diseases.

Plain English
This study looked at the environmental effects of inhalers used for asthma and COPD, highlighting that over 1.2 billion inhalers are sold each year, with a significant portion contributing to greenhouse gas emissions because of their propellants. In Australia and New Zealand, a common type of inhaler can release gases with a very high potential to warm the planet. The researchers recommend selecting inhalers that are more environmentally friendly and ensuring patients are accurately diagnosed to avoid unnecessary use of these devices. Who this helps: Patients with asthma and COPD, as well as healthcare professionals.

Plain English
This study looked at a new way to manage asthma by focusing on specific traits that can be treated, even in patients not seen at specialized clinics. Researchers found that while 65% of participants still had poorly controlled asthma after 10 weeks, many liked the new approach and would be willing to join a larger study. Overall, participants had significant improvements in their asthma symptoms, but just targeting particular traits wasn't enough for most. Who this helps: This benefits asthma patients who struggle with control and may need personalized treatment options.

Plain English
This study looked at how severe asthma patients respond to new treatments called biologics, specifically focusing on those with different levels of a type of immune response known as T2 involvement. Researchers analyzed data from 3,675 patients and identified five groups based on their T2 levels. They found that all patient groups saw improvements after treatment, but those with higher T2 involvement experienced better results, such as a greater increase in lung function—specifically, a difference of 0.16 liters in how much air they could forcefully exhale in one second. Who this helps: This research benefits asthma patients and their doctors by providing insights into how to better tailor treatments based on individual T2 levels.

Plain English
This update provides new guidelines for managing Chronic Obstructive Pulmonary Disease (COPD) in New Zealand based on the latest research. It includes clear recommendations for diagnosing and treating COPD to help healthcare professionals give better care in hospitals and communities. These updated guidelines are important because they help ensure patients receive consistent and effective treatment based on the best available evidence. Who this helps: This helps patients with COPD and the healthcare professionals who care for them.

Plain English
This study looked at how general practitioners (GPs) in New Zealand feel about using a new test called liquid biopsy to diagnose advanced lung cancer. Researchers found that most GPs (91%) were unaware of liquid biopsy, and many (79%) felt uncomfortable with the necessary genetic counseling for it. However, after training and funding were discussed, 72% of GPs said they would be open to using liquid biopsies, which could lead to faster and fairer diagnoses for lung cancer patients, especially among Māori and other groups who face higher risks. Who this helps: Patients, especially those with lung cancer and marginalized communities.

Plain English
This study looked at the effectiveness of an intervention provided by community pharmacists to help asthma patients change their reliance on quick-relief inhalers, known as SABAs. They enrolled 44 patients, but only 15 completed the follow-up after 90 days. While the results didn't show a strong statistical significance, there were indications that the program reduced reliance on SABAs and encouraged better use of preventive inhalers. Who this helps: This helps asthma patients who struggle with using their inhalers correctly and want to improve their management of the condition.

Plain English
This study looked at how well biologic treatments work for adults with severe asthma in real-world settings, rather than controlled trials. Out of over 8,400 patients, 2,116 started biologic therapies, and while many experienced significant benefits—like a 59% reduction in asthma flare-ups and improved lung function—about 40-50% did not show the expected improvements. This research is important because it highlights that many severe asthma patients, who often do not qualify for clinical trials, can still benefit from biologics, but there remains a significant number who may need more tailored treatment options. Who this helps: This helps patients with severe asthma and their healthcare providers.

Plain English
This study focused on understanding how people with chronic obstructive pulmonary disease (COPD) feel about preventing hospital readmissions after severe breathing problems. Researchers interviewed 12 participants aged around 69 years and found that having a positive mindset, taking practical steps to manage their condition, and feeling in control of their health were crucial for staying out of the hospital. This is important because it highlights the need for programs that support patients' mental attitudes and involve their families in health plans, which can lead to better management of COPD. Who this helps: This helps patients with COPD and their families.

Plain English
This study looked at whether a special program called "Take Charge" could help people who recently left the hospital after a serious worsening of their Chronic Obstructive Pulmonary Disease (COPD). Researchers found that while the number of severe COPD episodes was similar for those in the "Take Charge" program (85 episodes) and the standard care group (84 episodes), the participants who took part in the program reported better quality of life, with lower health limitation scores. This is important because it shows that a supportive approach can improve well-being for these patients, even if it didn't significantly reduce hospital visits. Who this helps: Patients recovering from severe COPD episodes.

Plain English
This research paper studied how well epinephrine (adrenaline) works compared to a certain type of medication called selective beta-2-agonists for treating severe asthma attacks in children and adults. The findings showed that both treatments had similar effects on treatment failure rates, with epinephrine's odds of failure at 0.99, meaning it didn't significantly outperform beta-2-agonists. This matters because it challenges existing guidelines and could affect emergency asthma care practices. Who this helps: This helps patients experiencing acute asthma attacks and the doctors treating them.

Plain English
In this study, researchers looked at the effects of an inhaled asthma treatment called fluticasone furoate/vilanterol (FF/VI) on the body’s chemical make-up and airway inflammation in adults with asthma. They found that after 14 days of treatment, FF/VI reduced levels of exhaled nitric oxide (which indicates airway inflammation) by 60%, and there were some changes in the body's metabolites, though these changes were generally small. This matters because it helps us understand how FF/VI works to reduce inflammation in asthma patients while revealing limited effects on other body processes. Who this helps: This helps asthma patients and their doctors better understand the effectiveness and actions of this asthma treatment.

Plain English
This study looked at the availability and quality of respiratory and sleep services for adults in New Zealand by comparing a survey from 2019/20 to one from 2006. It found that there is a big difference in access to these services based on where people live; for instance, there are only 1.18 respiratory physicians for every 100,000 people, which is much lower than in Australia and the UK. Additionally, some regions had up to eight times more access to pulmonary rehabilitation than others, showing significant inequality in healthcare across the country. Who this helps: This research benefits patients who need respiratory care, especially those in underserved areas.

Plain English
This study focused on how to improve care for people with severe asthma in Australia and New Zealand. Experts gathered in forums to reach agreement on the best ways to manage severe asthma and found that better assessment, treatment options, and patient involvement are needed. They identified specific actions to enhance care, such as training for healthcare providers and new research on treatment strategies. Who this helps: This benefits patients with severe asthma and their healthcare providers.

Plain English
This study explored a new way to include Māori individuals in asthma research by using an animated comic shared on Facebook. The strategy brought in a high number of inquiries, with 101 people showing interest and 27 participating in discussions; notably, 16 of those participants were Māori, which is over five times their average representation in the local population. This is important because it helps ensure that the health needs of Māori people are better represented in research, particularly since they face more health challenges than non-Māori, especially with asthma. Who this helps: Patients, particularly those in Māori communities affected by asthma.

Plain English
This study looked at two different asthma treatments: using inhaled corticosteroid (ICS) with formoterol when needed versus a standard approach of daily ICS along with a short-acting reliever (SABA). The findings showed that using ICS-formoterol as needed can delay severe asthma attacks and reduce the daily steroid dose, but it also led to slightly worse control of asthma symptoms. Specifically, people using the as-needed treatment experienced their first severe attack 15% slower and took 177 micrograms less daily medication than those using the standard treatment. Who this helps: This research benefits asthma patients who may want a more flexible treatment option to prevent severe attacks.

Plain English
This study created a straightforward guide for doctors on how to diagnose and manage chronic obstructive pulmonary disease (COPD) in New Zealand. It includes practical recommendations based on the latest evidence to improve patient care. This is important because clear guidelines can help ensure that COPD patients receive consistent and effective treatment. Who this helps: This helps patients with COPD and the doctors who care for them.

Plain English
This study looked at a rare heart condition called an intracardiac blood cyst, which is often found on the mitral valve in adults. The researchers found that echocardiography, or ultrasound of the heart, is the best way to diagnose these cysts, and cardiac MRI can also help by showing that the cyst does not light up in images. Most importantly, if the cyst isn’t affecting heart function, doctors can take a wait-and-see approach rather than jumping into surgery. Who this helps: This helps patients with heart issues and their doctors in diagnosing and managing blood cysts.

Plain English
This study looked at whether a special type of therapy called nasal high flow rhinothermy (rNHF) could help reduce the severity and duration of common cold symptoms. Researchers tested 170 adults with cold symptoms and found no significant difference in symptom severity after 4 days between those who received rNHF and those who received a placebo treatment. Overall, both groups had similar outcomes, with rNHF showing no advantage in speeding up recovery time. Who this helps: This research is useful for patients suffering from the common cold, as it clarifies that rNHF is not an effective treatment.

Plain English
This study examined how tiny blood vessels in skeletal muscles respond to a substance that usually helps relax them, particularly before and after heart surgery. The researchers found that these vessels were less responsive to the relaxing effects of a chemical called isoproterenol after surgery, with a significant decrease in reaction observed (results showed a diminished response with a P-value of 0.01). This matters because if these microvessels do not function properly, it can lead to issues with blood pressure and overall organ health after heart surgery. Who this helps: This benefits patients undergoing cardiac surgery.

Plain English
This study looked at how certain changes in capnography waveforms can predict when patients stop breathing during sedation procedures. Researchers found that patients showing abnormal waveforms called hypopnea had more than double the risk of apneic episodes, with a hazard ratio of 2.14, while those with another abnormality called bradypnea did not have an increased risk. Understanding which waveform changes signal a need for immediate action is crucial for improving patient safety during sedation. Who this helps: This helps patients undergoing sedation and the doctors monitoring their safety.

Plain English
The study looked at how patients with mild to moderate asthma feel about two different treatment options: a medication taken only when symptoms arise vs. a regular daily medication. Most of the 306 patients who responded preferred the as-needed medication, with 90% of those who used it choosing it as their favorite compared to just 40% of those on the daily treatment. This matters because understanding patient preferences can help doctors provide treatments that patients are more comfortable with and willing to use, potentially improving their asthma management. Who this helps: This helps asthma patients and their doctors make better choices about treatment plans.

Plain English
This study looked at how people with mild asthma use their inhalers, comparing those who took as-needed medication (budesonide-formoterol) versus those who took a daily maintenance medication (budesonide) plus a rescue inhaler (terbutaline). The findings showed that those on the as-needed inhaler had significantly more days without using their corticosteroids (156 days compared to just 22 days for the maintenance group) and took lower daily doses of budesonide. This matters because the timing of using the inhaled corticosteroids in relation to needing the bronchodilator helps prevent severe asthma flare-ups, making it a more effective treatment strategy for many patients. Who this helps: This research benefits asthma patients who may find more flexible inhaler use less complicated and more effective.

Plain English
The 2020 asthma guidelines from the Asthma and Respiratory Foundation in New Zealand provide clear and practical advice for diagnosing and managing asthma in teenagers and adults. Key updates include combining guidelines for both groups into one document, emphasizing that long-term asthma treatment shouldn’t rely solely on short-acting relievers (SABAs), and promoting the use of a new type of reliever called 'anti-inflammatory reliever therapy' (AIR), specifically budesonide/formoterol. These guidelines aim to improve asthma care, leading to better health outcomes for patients. Who this helps: This helps patients with asthma and the healthcare professionals treating them.

Plain English
This study looked at what matters most to patients when choosing a treatment for mild to moderate asthma. Researchers found that 64% of the 288 participants preferred a new treatment that combines preventer and reliever medications as needed, rather than a daily treatment regimen. The most important factors for patients were having no shortness of breath and the lowest risk of asthma flare-ups, which helps ensure they can manage their condition effectively. Who this helps: This benefits patients with mild to moderate asthma by providing options aligned with their preferences.

Plain English
This study looked at what people with asthma prefer when it comes to managing their condition and using medication. Researchers found that 27 adults wanted to feel more in control of their asthma by developing personal strategies, using convenient medications, and having easy-to-use inhalers with dose counters. These preferences were shaped by how asthma affected their lives and their feelings about their treatment. Who this helps: This information helps asthma patients and their doctors make better decisions about asthma management together.

Plain English
This study looked at how well a combination inhaler of budesonide and formoterol worked as a rescue medication for Māori and Pacific people with mild to moderate asthma, compared to a regular inhaler of budesonide paired with another rescue inhaler. The researchers found that the inhaler with budesonide and formoterol significantly reduced severe asthma attacks, with 8% of participants identifying as Māori and 4% as Pacific. This means that the new inhaler works effectively across different ethnic groups, helping to ensure better asthma management for everyone involved. Who this helps: This helps patients with asthma, especially those in Māori and Pacific communities.

Plain English
This study looked at how certain markers of inflammation in the blood change after a severe asthma attack. It found that immediately after treatment, levels of eosinophils (a type of white blood cell) were very low at 0.07 compared to 0.33, while another marker, IgE, was high at 339 compared to 249. The findings suggest that doctors need to wait about 4-8 weeks to use these biomarkers for managing asthma after such an event, as levels fluctuate significantly during this time. Who this helps: This helps patients with asthma and their doctors in managing treatment after severe attacks.

Plain English
This paper studied the accuracy of a non-invasive way to monitor carbon dioxide levels in the blood using a device placed on the skin, known as transcutaneous carbon dioxide (TcCO) monitoring, compared to traditional blood tests. They found that on average, there was a slight difference of -0.1 mm Hg between TcCO and the blood tests, but this method showed a range of difference (from -15 to 15 mm Hg) that is not considered clinically acceptable—meaning it could lead to incorrect assessments. However, when the sensors were used on the earlobe with specific devices, the difference was much smaller (from -6 to 6 mm Hg), making it more reliable. Who this helps: This research benefits doctors and healthcare providers who use carbon dioxide monitoring to assess respiratory health in patients.

Plain English
This study focused on a new way to manage chronic airway diseases by identifying and treating specific problems, or "treatable traits," in patients. The workshop held in Australia highlighted the need to agree on which traits to target, how common they are, and their importance in treatment; it also addressed how to conduct effective research and develop care models that make this approach practical. This matters because a more personalized treatment could lead to better outcomes for patients. Who this helps: Patients with chronic airway diseases.

Plain English
The study focused on developing an electronic platform called SAGE to help doctors evaluate and manage patients with severe asthma more effectively. The platform includes tools for patients to complete questionnaires, track their symptoms, and accesses key asthma information, which led to better symptom control and fewer asthma attacks. This is important because it allows for a thorough and organized assessment, improving overall patient care. Who this helps: This helps patients with severe asthma and their doctors by providing a better way to manage their condition.

Plain English
This study compared two treatments for people with chronic obstructive pulmonary disease (COPD) who have trouble breathing due to high levels of carbon dioxide in their blood. Researchers found that non-invasive ventilation (NIV) lowered carbon dioxide levels more effectively than nasal high-flow therapy (NHF) by an average of about 2.8 mm Hg. However, patients preferred NHF because it was easier and more comfortable to use, suggesting it could be a better option for some individuals dealing with this condition. Who this helps: This benefits patients with COPD who struggle with chronic respiratory failure and their healthcare providers.

Plain English
This study looked at whether a treatment called nasal high flow rhinothermy (rNHF), which delivers warm, humid air, can help reduce the severity and duration of common cold symptoms. Researchers recruited 170 participants who started showing cold symptoms within the last 48 hours and divided them into two groups: one received the rNHF treatment for five days while the other group received a fake treatment. They measured the effectiveness of the treatment using a symptom score after four days, which will show how well the rNHF worked compared to the fake treatment. Who this helps: This helps patients suffering from colds.

Plain English
This study examined how patients' breathing patterns changed during sedation for heart procedures. Researchers looked at 102 patients and identified four common breathing issues: normal breathing (41%), light breathing (38%), stopping breathing (15%), and slow breathing (7%). Understanding these patterns can help improve how medical teams respond to patients who have trouble breathing while sedated. Who this helps: This helps doctors and medical staff working with patients undergoing sedation.

Plain English
In this study, researchers compared two asthma treatment strategies in adults with mild to moderate asthma: using a combination inhaler of budesonide and formoterol as needed versus taking budesonide regularly along with terbutaline for quick relief. They found that those using the budesonide-formoterol inhaler had fewer severe asthma flare-ups, with an average of 0.119 severe episodes per patient per year, compared to 0.172 for the other method, which is a notable improvement. This is important because it could lead to a better way to manage asthma symptoms and reduce hospital visits for patients. Who this helps: This benefits patients with mild to moderate asthma.

Plain English
This study looked at how nasal high flow (NHF) therapy affects carbon dioxide levels in patients with stable chronic obstructive pulmonary disease (COPD). Researchers tested 48 participants by having them use NHF at different flow rates: 15, 30, and 45 liters per minute, and compared their results to breathing regular air. They found that at higher flow rates, carbon dioxide levels decreased significantly, with a drop of up to 2.4 mm Hg at the highest flow, and participants also had slower breathing rates. Who this helps: This benefits patients with stable COPD by providing a treatment option to manage carbon dioxide levels and breathing.

Plain English
This research paper looks at a new way to manage chronic airways diseases like asthma and COPD by focusing on specific traits of each patient rather than following a general treatment plan. The study finds that treating these specific traits can be more effective, but there is still uncertainty about how to implement these tailored treatments effectively in everyday medical practice. This matters because it could lead to better health outcomes for patients by providing individualized care rather than a standard treatment approach. Who this helps: This helps patients with chronic airways diseases by ensuring they receive more personalized treatment options.

Plain English
This study looked at whether a new treatment called rhinothermy, which uses humidified air to ease cold symptoms, is a viable option compared to taking vitamin C. Out of 79 potential participants, 30 were selected for the study, and all of them completed it. Those who received rhinothermy reported feeling better significantly faster, especially by day 4, with an average symptom score improvement of 6.4 points compared to the vitamin C group, surpassing the important threshold of 5 points that indicates a meaningful benefit. Who this helps: This benefits patients suffering from the common cold.

Plain English
This study looked at specific biological markers related to type 2 inflammation in asthma, such as blood eosinophils and certain proteins in the blood, to see how they relate to severe asthma attacks and lung function over time. The researchers followed 212 adults with asthma for about 3.8 years and found that 32% experienced at least one severe attack. Notably, higher levels of a marker called fractional exhaled nitric oxide (Feno) were linked to a lower risk of severe exacerbations, showing that monitoring these markers can help predict who might have more severe asthma issues. Who this helps: This benefits patients with asthma by identifying those at higher risk for severe attacks and guiding treatment decisions.

Plain English
This study examined how long the anti-inflammatory effects of the asthma medication fluticasone furoate/vilanterol (FF/VI) last compared to its ability to open airways (bronchodilation) in people with asthma. Researchers found that FF/VI reduced a marker of inflammation (measured by exhaled nitric oxide, or FeNO) significantly by day 3, with the greatest reduction occurring by day 14. After stopping the treatment, the anti-inflammatory effect lasted up to 18 days, which was longer than the bronchodilator effect that typically lasted only 3 to 4 days. Who this helps: This research benefits asthma patients, particularly those looking for long-lasting relief from airway inflammation.

Plain English
Researchers studied how levels of a protein called periostin changed in people's blood after they experienced different types of bone injuries, including joint replacements, long bone fractures, and short bone fractures. They found that in joint replacement patients, periostin levels dropped initially and then peaked at eight weeks, while in long bone fracture patients, levels also dropped initially but increased gradually, reaching a high at eight weeks. For short bone fractures, levels dropped initially but returned to normal after a week, showing that bone injuries affect periostin levels differently over time. Who this helps: This research helps doctors understand how bone injuries can influence periostin levels, which is important for managing asthma in patients.

Plain English
This study looked at how nebulisers that use air compare to those that use oxygen in treating flare-ups of chronic obstructive pulmonary disease (COPD). Researchers found that using oxygen-driven nebulisers increased carbon dioxide levels in the blood by an average of 3.4 mmHg, while air-driven nebulisers did not cause significant changes. This matters because higher carbon dioxide levels can worsen symptoms and may be harmful for patients with COPD. Who this helps: This helps COPD patients experiencing acute exacerbations.

Plain English
This study looked at periostin levels in the blood of adults of Chinese descent, both with and without asthma, to see how these levels compare to individuals of other races. They found that women had higher periostin levels than men and that there was no significant difference in periostin levels between those with asthma and those without (57.0 ng/ml vs. 56.8 ng/ml). Importantly, Chinese adults had higher periostin levels than Caucasians, which indicates that race and sex should be considered when using periostin as a marker in asthma diagnosis and treatment. Who this helps: This information is useful for doctors treating asthma patients, particularly those of Chinese descent.

Plain English
This study looked at how the time of day affects levels of a protein called periostin in people with asthma who were receiving specific treatments, as well as in people without asthma. Researchers measured periostin levels every two hours from 8 AM to 6 PM and found that levels were higher in the morning (53.5 ng/mL) compared to the afternoon (50.9 ng/mL for asthmatics and 46.2 ng/mL for non-asthmatics). This finding is important because it shows that while there is a pattern in periostin levels based on time of day, it’s unlikely to impact treatment decisions for asthma. Who this helps: This helps doctors in managing asthma treatment effectively.

Plain English
This study looked at whether an extract from berry fruits could help reduce inflammation in the airways of adults with mild asthma who haven't used steroids. Researchers tested 28 participants, and after 4 weeks of taking the berry extract, their levels of a marker for airway inflammation (FeNO) were similar to those who took a placebo, showing no significant benefit from the berry extract. This matters because it suggests that despite promising results in animal studies, the berry extract did not help reduce inflammation in real patients with asthma. Who this helps: This helps patients with mild asthma seeking alternative treatments.

Plain English
This study looks at a new way to manage asthma in adults by comparing two treatment options: a combination inhaler that works quickly (budesonide/formoterol) used as needed, versus the standard treatment of daily inhaled corticosteroids (ICS) and a rescue inhaler (SABA) for emergencies. Researchers will track 890 adults over one year to see how often they experience severe asthma attacks. If successful, this approach could change how asthma is treated, making management more effective and easier for patients. Who this helps: This helps adult asthma patients who need ongoing treatment and quick relief from symptoms.

Plain English
This study looked at the types of breathing problems, like asthma and chronic obstructive pulmonary disease (COPD), in adults from China and New Zealand to see how they might differ. Researchers analyzed data from 345 participants and identified five main groups of these conditions, including one group with severe symptoms that started later in life and another with more moderate symptoms influenced by obesity. The findings show that even in different countries, many people experience similar breathing issues, but that obesity can complicate these conditions, especially in New Zealand. Who this helps: This helps patients with asthma and COPD, as well as doctors who treat them.