a clinic visit by debbie kennedy to patient support group 5th novemebr 2010a

DEBBIE KENNEDY, SPECIALIST ASPERGILLOSIS NURSENATIONAL ASPERGILLOSIS CENTRE

UHSMMANCHESTER

Support Meeting for Aspergillosis Patients

Fungal Research Trust

A Clinic Visit

4th November 2010

Patient Support Meeting ERC

by Debbie Kennedy

Aspergillosis Specialist Nurse

Your Clinic Visit

Where National Aspergillosis Centre based in the North West Lung Centre at

University Hospital Manchester

WhenMonday am Wednesday pm Friday am

WhoForeground - Doctors, Specialist Nurses, Administration Manager,

Physiotherapists, Background - Specialist Laboratory staff, Researchers, Website

Information Architect

WhyNationally Commissioned Specialist Service to deliver all aspects of

Aspergillosis Care

HowFace to face Multidisciplinary Team approachNurse driven telephone support service

Your Clinic Visit

What Happens?

Welcomed Weight MRC Dyspnoea (breathlessness) score Quality of Life Questionnaire History Chest Examination Chest X-ray CT Scan Lung Function Studies Bronchoscopy Specialist Aspergillus Tests Information Giving Avoidance

Vignettewith

Georgina and Marie Aspergillosis Specialist Nurses

MRC Breathlessness Scale

History – Past & Recent

Who gets Aspergillosis

Inhalation of aspergillus spores is a common daily occurrence.

A healthy immune system would normally remove the spores and no symptoms or infection would occur.

In individuals whose immune system may be suppressed either because of illness e.g. AIDS, cancer patients or drugs, spores may germinate and resulting tissue or systemic aspergillus invasion can result.

Individuals with allergies such as asthma, can also be vulnerable to aspergillus disease.

History

Signs and SymptomsWeight loss 16 / 18 (89%)Cough 15 / 18 (83%)Shortness of breath 9 / 18 (50%)Haemoptysis 9 / 18 (50%)Fatigue / malaise 5 / 18 (28%)Chest pain 3 / 18 (17%)Sputum production ++ 3 / 18 (17%)Fever 2 / 18 (11%)

Denning DW et al, Clin Infect Dis 2003; 37:S265

Chest Examination

Vignettewith

Georgina and Marie Aspergillosis Specialist Nurses

Chest X-ray

Chest Xray Aspergilloma

Fungal Ball

Chest CT scan

Fungal Ball

Lung Function Studies

Lung Function Studies

Bronchoscopy

Vignettewith

Georgina and Marie Aspergillosis Specialist Nurses

Specialist Aspergillus Tests

Sputum test

Fungal Culture and Sensitivity

Sputum PCR

Sputum Fungal Culture

Your Clinic Visit

What Happens?

Blood tests Liver Function test Kidney function test Glucose Full Blood Count – anaemia, infection Immune system Inflammatory markers Allergy Levels Drug Monitoring Levels Vitamin D Levels Research Bloods

Vignettewith

Georgina and Marie Aspergillosis Specialist Nurses

Specialist Aspergillus Tests

Blood test

Aspergillus precipitins (IgG) and titre

Total Immunoglobulin E (IgE)

Aspergillus specific IgE (RAST)

Drug Monitoring Levels

Information

Contact Information Information Leaflets Website Information Smoking Cessation Physiotherapist Advice Aspergillus Avoidance

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Georgina and Marie Aspergillosis Specialist Nurses

How to avoid Aspergillus

Pulmonary infections can be prevented by Avoid smoking Do not use bedside humidifiers

Sources of Aspergillus spores animal stables Hay Mulch rotten plants, compost piles, wood chips construction sites

Where is Aspergillosis

Sources of Infection?

Aspergillus species are found in:

Soil Air; spores may be inhaled Water / storage tanks in hospitals etc Food Compost and decaying vegetation Fire proofing materials Bedding, pillows Ventilation and air conditioning systems Computer fans

www.aspergillus.org.uk

Thank you