Ireland has the fourth highest prevalence of asthma globally, with over 470,000 people with an asthma diagnosis. 1 In general, asthma symptoms can be controlled with inhaled corticosteroids, with the addition of a long-acting β 2 -agonist as indicated, alongside other agents including long-acting anti-muscarinic agents and anti-leukotrienes. 2 The GINA 2021 Guidelines state that many cases of difficult-to-treat-asthma are partly secondary to modifiable factors such as incorrect inhaler technique. An important distinction is that in severe refractory asthma, a subset of difficult-to-treat-asthma, despite adherence to maximized optimal therapies and the treatment of contributory factors, asthma remains uncontrolled. 3 In this subset of patients, symptoms remain inadequately controlled despite maximum conventional therapy and adherence, with 3-10% considered to have severe refractory disease. 4 A number of biological agents targeting the components of type 2 inflammation have been transformative in the management of severe refractory asthma. 5 Omalizumab, the first such agent to be approved for use in severe allergic asthma, is a humanized anti-immunoglobulin E (IgE) antibody. 2 In Ireland, omalizumab is not reimbursed by national bodies but paid for directly by individual hospital budgets, potentially limiting access for patients.Anti-interleukin-5 (IL-5) therapies were first approved for use in Ireland in 2018 and there are currently three agents available for treating adults with severe eosinophilic asthma that is inadequately controlled despite maximum conventional therapy. Mepolizumab and reslizumab target IL-5, 4 whereas benralizumab is an anti-eosinophil monoclonal antibody that binds to the alpha subunit of the IL-5 receptor. 6 Irish guidelines state that patients may be eligible for anti-IL-5 therapy if they have a confirmed diagnosis of severe refractory eosinophilic asthma by a respiratory physician, they have been fully adherent to maintenance therapy, the blood eosinophil count is elevated, and they have had two or more exacerbations in the previous 12 months requiring systemic corticosteroids. 7,8 We performed a retrospective, observational, single-centre review of clinical outcomes in patients switched from omalizumab to an anti-IL-5 therapy in a regional specialist asthma centre in Cork University Hospital, Ireland. This study was approved by the Clinical Research Ethics Committee, University College Cork. Informed consent was obtained from each of the included patients. The study complied with the Declaration of Helsinki. Clinical outcomes in severe eosinophilic asthmatics who remained suboptimally controlled despite omalizumab and were therefore switched to an anti-IL-5 therapy were assessed. Suboptimal control was defined as inadequate control of a patient's asthma and/or multiple exacerbations despite omalizumab.All patients ≥18 years old who switched therapy in our centre from 2018 to 2020 were included. The parameters assessed included the Asthma Control Questionnaire (ACQ) score, annual commun...

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Background Data regarding the risk of infection related to reusable bronchoscopes, the global drive toward disposable technology and the COVID-19 pandemic have led to an increase in the use and production of single use or disposable bronchoscopes. An in-depth comparison of all available devices has not been published. Methods A benchtop comparison of the Ambu®aScopeTM, Boston Scientific® EXALTTM Model B, the Surgical Company Broncoflex© Vortex, Pentax® Medical ONE Pulmo™, and Vathin® H-SteriscopeTM (all 2.8 mm inner dimension other than the Pentax single-use flexible bronchoscope (3 mm)) was undertaken including measurement of maximal flexion and extension angles, thumb force required and suction with and without biopsy forceps. Thereafter, preclinical assessment was performed with data collected including experience, gender, hand size, and scope preference. Results The Vathin single-use flexible bronchoscope had the biggest range of tip movement from flexion to extension with and without forceps. The Boston single-use flexible bronchoscope required the maximal thumb force but had the least reduction of tip movement with forceps. The Boston single-use flexible bronchoscope significantly outperformed all other scopes including the standard Pentax scope and was the only scope capable of suctioning pseudo-mucus around the forceps. Although there was no significant difference in preference in the overall group, females and those with smaller hand size preferred the Pentax and males the Broncoflex single-use flexible bronchoscope. Conclusions Currently available single-use flexible bronchoscopes differ in several factors other than scope sizes and monitor including suction, turning envelope, and handle size. Performance in the clinical setting will be key to their success.