Dr Libby Radcliffe talks about the aches & pains suffered by aspergillosis patients, the different causes and what can be done to reduce them. Professor Malcolm Richardson talks about the types of moulds we all come across every day and the damage they can cause in the wrong places. Dr Graham Atherton talks about the correct specification for facemasks used to reduce the inhalation of mould spores when carrying out routine daily tasks & hobbies.
1. Support Meeting for
Aspergillosis Patients
LED BY GRAHAM ATHERTON
SUPPORTED BY
GEORGINA POWELL, DEBBIE KENNEDY & DEBORAH HAWKER
NAC CENTRE MANAGER CHRIS HARRIS
ACHES & PAINS: LIBBY RATCLIFFE
NATIONAL ASPERGILLOSIS CENTRE
UHSM
MANCHESTER
Fungal Research Trust
2. Programme
1pm Light lunch, Tea Coffee
1.30pm Dr Libby Ratcliffe ‘Aches & Pains’
2pm Graham Atherton ‘Submitting your side effects’
2.20pm Break: Social time, chat to staff
2.40pm Malcolm Richardson ‘Everyday Moulds’
3pm Debbie Kennedy ‘Why we do drug levels’
3.15pm Meet the Team: Questions & Answers
3.30pm Close
7. Muscle aches
Injury or trauma including strains and sprains
Overuse- using muscles too much, too often,
too soon
Tension or stress
Drugs
Diseases
Electrolyte imbalance
16. Side Effects
What are they?
Why do they happen?
Why is this subject important for antifungal drugs in
particular?
17. What are side effects?
In medicine, a side effect is an effect, whether
therapeutic or adverse, that is secondary to the one
intended; although the term is predominantly
employed to describe adverse effects, it can also apply
to beneficial, but unintended, consequences of the use
of a drug.
18. When do they happen?
Some are predictable – we know if we suppress our
immune system to enable an organ transplant we
are also making ourselves more vulnerable to
infection
Some less predictable – who could have predicted
voriconazole would make many people sensitive to
light?
19. Are side effect always bad?
Occasionally, drugs are prescribed or procedures
performed specifically for their side effects; in that
case, said side effect ceases to be a side effect, and is
now an intended effect.
For instance, X-rays were historically (and are
currently) used as an imaging technique; the discovery
of their oncolytic capability led to their employ in
radiotherapy (ablation of malignant tumours).
20. Examples of therapeutic side-effects
Bevacizumab (Avastin) has been used against wet age-related macular degeneration, as well as
macular edema from diseases such as diabetic retinopathy and central retinal vein occlusion.[1]
Bupropion, an anti-depressant sold as Wellbutrin, is also used as a smoking cessation aid; this
indication was later approved, and the name of the smoking cessation product is Zyban. In Ontario,
Canada, smoking cessation drugs are not covered by provincial drug plans; elsewhere, Zyban is priced
higher than Wellbutrin, despite being the same drug. Therefore, some physicians prescribe Wellbutrin
for both indications.
Carbamazepine is an approved treatment for manic depression and convulsions, but has side effects
useful in treating attention-deficit hyperactivity disorder (ADHD), schizophrenia, phantom limb
syndrome, paroxysmal extreme pain disorder, neuromyotonia, and post-traumatic stress disorder.[4]
Dexamethasone and Betamethasone in premature labor, to enhance pulmonary maturation of the
fetus.[5]
Doxepin has been used to treat Angiodema and severe allergic reactions due to its strong
antihistamine properties.[6]
Gabapentin, approved for treatment of seizures and postherpetic neuralgia in adults, has side-effects
which are useful in treating bipolar disorder, essential tremor, hot flashes, migraine prophylaxis,
neuropathic pain syndromes, phantom limb syndrome, and restless leg syndrome.[7]
Magnesium sulfate in obstetrics for premature labor and preeclampsia.[5]
The SSRI medication sertraline is approved as an anti-depressant, but delays conjugal climax in men,
and thus may be supplied to those in which climax is premature.[9]
21. Why do they happen?
Developing drugs is difficult and complicated. Drugs are designed to
work against a specific illness. In doing this they often interfere with
other body systems.
It is difficult to make a drug that targets one part of the body without
affecting others.
Every new drug is developed to hopefully be better than existing drugs.
The current drugs may not be perfect, but they are better than they
have ever been. And drugs in development now will hopefully be better
still
Genetic variability, Age
22. Why aren’t side effects prevented?
A lot of attention is given to minimising side effects in a new
drug – testing is extensive
BUT tests are generally carried out by giving human
volunteers ONLY the drug being tested. These test results are
used to provide the guidance to doctors and patients
contained in the pack leaflets
In the real world patients often do not take only one drug.
Medicines often interact with each other. Result = side effects
that were not predicted
23. How can we all help?
We can report all of our side effects to those whose job
it is to monitor them. This is especially important for
new drugs and for side effects NOT already listed in
pack leaflets.
Your doctor/nurse are the main reporters – and still
are as they have a good idea of what are unusual side
effects
So tell them!
25. Yellow Card Scheme
MRHA are encouraging everyone to enter side
effects using their new website
http://yellowcard.mrha.gov.uk
Their software will highlight new side effects and
interacting relationships with other drugs
You will be directly helping with Research !!
26. Yellow Card - offline
There will still be a way for people who cannot access
the internet to report side effects – forms available at
pharmacists and are downloadable to print out too
from MHRA website.
This is a UK scheme. US patients have their own
authority
FDA Adverse Event Reporting System (FAERS)
(formerly AERS) www.fda.gov
27. Facemasks
HEPA filter. There are three grades of HEPA filters namely N95, N99
and N100 and the numbers refer to the percent of particles 0.3micron
in size that filter is capable of removing from air that passes through it.
An N95 filter will therefore remove 95% of all particles 0.3 micron in
size from air that passes through it. Fungal spores are 2-3 microns in
size so an N95 filter will remove far more than 95% of fungal spores
from the air, though some will still get through. This standard is
generally thought to be the best combination of efficiency and cost for
the average home user - such as a gardener. Industrial users (e.g.
workers remediating mouldy homes or other premises) may be exposed
to far more spores and may opt for the more efficient N99 or N100
filters at higher cost.
28. Facemasks
UK - In the UK and Europe the standards referred to
are FFP1 (not appropriate for this purpose), FFP2
and FFP3. FFP2 is equivalent to N95 and FFP3 offers
higher protection. Masks generally cost £2-3 each
and are intended for single use.
More expensive masks are available which can be
used more than once - see 3M for one possible
supplier.
29. What else?
Is there anything you would like to suggest as a
subject? – remember it can be any part of the service
and only has to be enough to fill 10-15min
Leave suggestions (& criticisms) using forms provided
– anonymously if you prefer.
or
Email to admin@aspergillus.org.uk
or
Phone 0161 291 5866 – leave message if no answer
34. Public concern!
”Exorcising a mold monster”
”Attack on the killer mold”
”It’s everywhere. Tales about rampant toxic
mold get plenty of attention, but science tells
a less dramatic story”
”The mold rush”
48. Joplin
13 identified case-patients
Median age: 48 years (13-76)
2 diabetics (15%)
10 admittted to ICU (77%)
Case-patients: mean of 4 wounds: foreign material
recovered from wounds in 6 patients (46%)
Systemic antifungals; all case-patients:
amphotericin B
5 deaths (38%)
Casepatients: all located in zone that sustained
most severe damage
51st ICAAC Chicago (2011)
66. Thank You
“The best chance we have of beating this illness is to
work together”
Living with it, Working with it, Treating it
Fungal Infection Trust