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Livingstone Chishimba Q & A session with National Aspergillosis Centre patients support meeting - May 2012


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Dr Livingstone Chishimba is a specialist aspergillosis doctor working at the National Aspergillosis Centre, Manchester, UK.

This is the second session he has run discussing & answering questions from our patients and those who are members of our support groups online

Published in: Health & Medicine
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Livingstone Chishimba Q & A session with National Aspergillosis Centre patients support meeting - May 2012

  2. 2. Programme 1pm Introduction & future 1:30 Livingstone Chishimba 2:30 Tea & Coffee 3:00 Close
  3. 3. Quick Contact Last week showed the need for me to be able to contact people who hope to attend via a reliable direct method – newsletters and contact via online groups didn’t work Give me your mobile numbers and I can text everyone easily – instant and up to date
  4. 4. Local Patients Support Group London meeting was blighted by illness but have an interest group of 9 to support future efforts 1 patients attended Identified Brompton Hospital as a ‘target’ for support* Identified a specialist nurse to help out by attending*Brompton now agreed to display information about support group
  5. 5. AwarenessFacebook80 members so far (69 friends)Several ‘pages’ Aspergillosis Support: Local groups:  Liverpool:  West Midlands:  London:
  6. 6. Awareness Mouldy buildings  Writing guidelines  Facebook page (awareness)  Awareness campaigns   Revised patients notes
  7. 7. Student competitionsAim: Building awareness amongst younger people & parents Art & music Original compositions £1200 prize (school & individual share) Theme is ‘funky fungi’ UPDATE: 3-400 entries – will be judged over the summer  www.
  8. 8. eBooks written by Patients2 now available – both via download from Amazon ( The Lady with the Aspergillus (£1.94 all Proceeds to Fungal Research Trust) by Julie Michael A Fly on the Ward (£1.94) by Michael Chapman
  9. 9. Aspergillosis Study Day For all professions allied to medicine – nurses, physio’s to improve knowledge & awareness 70 people attended full day course organised by Goergina – seemed very successful Feedback analysed?? Georgina… Hope to repeat?...
  10. 10. Next Meeting (June) Centre Manager (Chris Harris) & Specialist Nurse (Deb Kennedy) will talk about the new home service available to some of our patients – who we can offer this to, how it will be delivered.
  11. 11. Thank You“The best chance we have of beating this illness is to work together” Living with it, Working with it, Treating it Fungal Research Trust
  12. 12. Patient meeting -Q &A Dr Livingstone ChishimbaUniversity Hospital of South Manchester
  13. 13. Patient doctor
  14. 14. Doctor Patient
  15. 15. Q4• Does climate make any difference?
  16. 16. Helpful fungi:• Most of us use fungi every day without knowing it.• We eat mushrooms and Quorn (a vegetarian fungal protein), but we also prepare many other foods using fungi.• The yeast Saccharomyces cerevisiae is used to ferment sugar to alcohol and carbon dioxide – the process used to make beer and wine and also to make bread rise.• The fungi Aspergillus oryzae and Aspergillus sojae are used in the production of the oriental foods soy sauce and miso.• We also use fungi to produce flavourings, vitamins and enzymes and to mature many cheeses.• Fungi play an essential role in both the Nitrogen and Carbon cycle by breaking down dead organic material.
  17. 17. Helpful fungi:• We get some important drugs from fungi such as the antibiotic penicillin and cyclosporin A - a drug that stops organ rejection after transplantation.• Research scientists use several fungi to investigate basic functions that occur in all cells because they are simple and easy to grow; some cancer research is done using fungi.• Fungi are responsible for breaking down dead organic matter which allows nutrients to be cycled through the ecosystem.
  18. 18. Importance of fungi:• Without fungi we would not have• bread, beer, wine or antibiotics, but more importantly without the nutrient recycling and plant nutrition provided by fungi - we probably could not survive at all.
  19. 19. The life cycle of AspergillusSpores inhaled GerminationMass of hyphae Hyphal elongation(plateau phase) and branching
  20. 20. Hospital demolitionHansen et al. JHI 2008; 70: 259-264.
  21. 21. Source of Aspergillus
  22. 22. Exposure in the garden
  23. 23. Heavy excavation! Nihtinen et al. 2007 BMT
  24. 24. Allergy Aspergillosis * acute allergic reaction (bronchospasm, …) * allergic sinusitis * allergic bronchopulmonary aspergillose (ABPA)•Asthmatic bronchitis
  25. 25. ABPA and severe asthma
  26. 26. Chronic Pulmonary Aspergillosis (CPA) Underlying diseases • Classical tuberculosis * ~20% • Atypical tuberculosis * • Allergic bronchopulmonary aspergillosis * • Lung cancer survivor * • Pneumothorax * • COPD/emphysema * • Sarcoidosis (stage II/III) * • Rheumatoid arthritis • Thoracic surgery • Asthma • Chest radiotherapy • None* Common Smith, ISHAM 2009
  27. 27. Chronic pulmonary aspergillosis
  28. 28. Chronic cavitary aspergillosis in a patient with old TBC
  29. 29. Aspergilloma
  30. 30. Aspergillosis3/ Invasive * invasive pulmonary aspergillosis * tracheobronchitis * sinusitis * cerebral aspergillosis * skin aspergillosis * osteomyelitis (bones)
  32. 32. Treatment• Treat or not to treat?- – Various consideration – Risk benefit ratio• Antifungals• Surgical• Rx complications – keratitis• Symptomatic Rx – haemoptysis• Rx underlying disease• Environmental control
  33. 33. Patient doctor
  34. 34. Patient meeting -Q &A
  35. 35. Frequency, dose, duration of itraconazole• It seems that some people on the aspergillus site are using Sporanox every day/year as in order to prevent eruption of ABPA.• Some claims 200mg/day. Any experience with this situation?
  36. 36. Frequency, dose, duration of itraconazole• Indication in ABPA is treatment and not prevention• Not to be used for prevention if no disease even if – Family history or exposure to moulds• May be needed in those with relapses even without symptoms.
  37. 37. Some claim 200mg/day. Any experience with this situation?• BD, od• 100-200mg/day/BD depending on• Wt, tolerability & ability to metabolise meds
  38. 38. Q2a. Does the mould clear from my lungs in the summer months and grows again once the damp weather starts?• Not necessarily but increased exposure to mould may occur during damp weather.• Damp weather may also be associated with worsening of underlying/associated conditions – Asthma – COPD – bronchiectasis
  39. 39. Q2b• Why do I always have a croaky throat and feel like there is gunk sitting in my throat just stuck there?• Is that from medication or to do with the fungus?
  40. 40. Q2b: croaky throat & feeling of gunk sitting in my throat• Croaky throat may arise from various factors: fungal or non-fungal – Throat inflammation – Sputum – Secretions – Viral infections – Underlying/co-existing disease• Not necessary from medications.• If concerned speak to your GP
  41. 41. Should I be on anti-fungal medicine (the registrar said not) or is this only for severe cases?• Treat or not to treat? – Various consideration – Risk benefit ratio – Definitive diagnosis ( not doubt). – Previous experience with anti-fungals
  42. 42. Objective of treatment• Reduce symptoms• improve QOL,• improve lung faction,• prevent or reduce disease decline. – Stable or assymptomatic cases do not warrant treatment. – Anti-fungals like other drugs have side effects. – Benefit should outweigh risk• Definitive diagnosis ( not doubt).
  43. 43. Q2c• I have read a few things on forums where people feel they were misdiagnosed with pneumonia when it was actually the mould - wondering if this is the case with me?
  44. 44. Different diseases as pneumonia• Fungal disease• Cancer• Fluid• Lymphoma• Systemic dieases: WG, MPA etc• But – Pneumonia is the commonest and usually first thought – Doctors will always consider differential diagnosis – Other diagnosis may not be straight foward – Contact your doctor or alternative medical advice if concerned.
  45. 45. ABPA as non-resolving pneumonia Chishimba L , Journal of asthma, March 2002
  46. 46. Mould as cancerChishimba L , Journal of asthma, March 2002
  47. 47. Q2d. Do steroids/antibiotics cause mould to grow more?• Neither steroids nor antibiotics cause mould to grow but excessive steroids – Suppress body immunity and predispose to fungal colonisation, spread and complications • IA • ↑Frequency of infection • Candiasis: oral or genital etc • Aspergilloma in COPD patients (ICS)- Dr Wouter Meersseman, Belgium grp, ERS 2011, Amsterdam.
  48. 48. Are there things that I can eat/drink to help myself or anything that can make things worse?• Only balanced nutritious diet important for your body.• Avoid none nutritious food.• Always avoid alcohol.
  49. 49. Q3• What is the current thinking about people with ABPA taking some sort of anti-fungal (like itraconazole) for life versus taking an anti-fungal only for some period of time during flare ups?• Could one develop resistance to the anti-fungal over time?
  50. 50. Q3• anti-fungal (like itraconazole) for life in ABPA – Not always necessary – May be necessary in frequent relapses.• anti-fungal only for some period of time during flare ups? – Not advisable, – resistance, – infective and of no use
  51. 51. Q4• In addition to being allergic to aspergillus fumigatus, I am also allergic to other molds.• I began allergy shots in 2009 and my doctor did not include aspergillus fumigatus in my shots, but he did include the other molds.• Would it be better not to have any mold antigen in my shots?
  52. 52. Q6: ABPA and VitD• Is there any research showing a relationship between ABPA and vitamin D levels in the blood? In the past, each time I had an ABPA flare up, my blood test showed that I was deficient in vitamin D. I now take 5000 IU of vitamin D3 and am now in the normal range and have not had a flare up in almost two years.
  53. 53. Q6: ABPA and VitD• Strong link between Vit D deficiecy and lung disaese• Causal –effect relationship not well understood.• Studies underway at NAC.• Paper: Chishimba L, thorax 2010. Vitamin D and the lung.
  54. 54. Q7• It has always been rumored not to eat fungi related foods (i.e. mushrooms, soy sauce, yeast based products [breads, beer, etc.]). Is there any "science" behind this? What nutrition counseling does the patient receive when they receive the diagnosis of a fungal related disorder?• Do you recommend any vitamin and/or supplements and is there regular testing of levels of things like vitamin D, B-12, etc.
  55. 55. Sources of information• National Aspergillosis Centre ( Fungal Research Trust ( Aspergillus website ( Aspergillus Blog ( Aspergillus Trust ( Aspergillosis ( Aspergilloma ( SAFS (
  56. 56. Thanks for your attention• Any questions?