22-25 Aug 2024
UCT GSB Academic Conference Centre V&A Waterfront | Cape Town
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Our Guidelines & Recommendations are updated regularly.
Prof Richard van Zyl-Smith
Prof Michelle Wong
Prof Coenraad Koegelenberg
Prof Refiloe Masekela
Prof Greg Calligaro
SATS President’s In-coming Statement.
The world and particularly Pulmonology has been a very difficult place these past 2 years since the COVID-19 pandemic emerged. Pulmonology is so much more than just COVID, but for many of us we have been able to do little else other than care for those with severe COVID-19 ARDS. We have missed face to face contact, we have missed out on conferences and learning opportunities, and our patients have missed out on us being able to care for the ‘normal’ respiratory illness.
As we look forward to the “new normal”, we have opportunity to do things better, to be more involved in the basics of pulmonology that have been pushed aside by COVID. The huge burden of asthma and unacceptable mortality in South Africa, the inequality of access to care for COPD patients, the burden of severe ILD and lung cancer with limited access to timeous diagnosis and appropriate therapy, the ongoing burden of tuberculosis and drug resistance, the intersection of poverty and air pollution and tobacco smoking all demand our attention.
Ensuring that the people of South Africa get the respiratory care they need starts with basic education in respiratory medicine to all health professionals. We need to do better. Access to services and appropriate referral pathways, we need to do better. Access to simple diagnostics such as lung function to make a diagnosis of COPD, we need to do better. Universal access to basic medications such as inhaled steroids and long-acting bronchodilators for asthma and COPD, we need to do better. Appropriate access for those with rare and life threating diseases to effective and innovative medication, we need to better. Advocating for clean air and tobacco free environments, we need to do better. Advocating for respiratory health, we need to do better.
We have so much that we can do, we have so much that we should do, but there is only so much that we are able to. As a Society we have the ability to draw on a large group of individuals to collectively make an impact. It may be local, or it may be global – but we must make a difference in our world by caring for the patient in front of us – but also participating in the fight for respiratory health and access to appropriate and affordable care for all our fellow South Africans.
I look forward to leading the South African Thoracic Society, for the next 2 years as we face the realities of our new normal, ensuring that we promote excellence in respiratory care and advocate for all essentials needed for respiratory health in our Country.
Professor Richard van Zyl-Smith
President South African Thoracic Society
EducAir launches 30 November 2022!
The South African Thoracic Society in collaboration with GSK South Africa is proud to present the EducAir online educational series available on the SATS website: www.pulmonology.co.za. from 30 November 2022. This is part of SATS and GSK South Africa’s ongoing efforts to improve the management of patients living with obstructive airways disease in South Africa.
The first installment in the series consists of four modules focusing on clinical decision making with COPD patients and COPD pharmacological treatment options. This includes the latest recommendations from the Global Obstructive Lung Disease report (GOLD 2023).
Continuation of surveillance spirometry testing in South Africa
The COVID pandemic continues in the form of several ‘waves of infection’ occurring every couple of months and it is likely to continue in this manner for some time. The safety of lung function testing thus also varies with each wave and is to some degree dependent on the virulence and infectivity of each new variant.
Position statement on endoscopic lung volume reduction in South Africa: 2022 update
Chronic obstructive pulmonary disease (COPD) remains one of the most common causes of morbidity and mortality in South Africa. Endoscopic lung volume reduction (ELVR) was first proposed by the South African Thoracic Society (SATS) for the treatment of advanced emphysema in 2015. Since the original statement was published, there has been a growing body of evidence that a certain well-defined sub-group of patients with advanced emphysema may benefit from ELVR, to the point where the current Global Initiative for Chronic Obstructive Lung Disease (GOLD) Guidelines and the United Kingdom National Institute for Health and Care Excellence (NICE) advocate the use of endoscopic valves based on level A evidence.
Notice to all pulmonologists and general physicians
The African Journal of Thoracic and Critical Care Medicine is now SA DoHET-accredited and indexed with NCBI databases including PubMed. AJTCCM will consider submissions on basic science, translational, and clinical work in the broad fields of respiratory and critical care medicine, and including tuberculosis and sleep medicine. There is a mechanism for appropriate articles, including those about COVID‑19, to undergo rapid publication and gain immediate visibility
Misinformation on vaccination
The South African Thoracic Society (SATS) hereby voice our collective disappointment with the views expressed by Dr Susan Vosloo, as well as the highly irresponsible sharing of her recording on social media. Although they enjoy the right to free speech, healthcare professionals should not utilise social or formal media to spread such blatant misinformation, particularly if it can lead to (preventable) suffering and death.
South African Thoracic Society position statement on post-acute sequelae of SARS-CoV-2 infection
The COVID-19 pandemic caused by the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) has caused significant mortality and morbidity in South Africa. The initial clinical focus was on the waves of acute disease and the focus has now shifted to those with post-COVID-19 symptoms and impairments. It is anticipated that COVID-19 will have a long-term impact on the physical, emotional, mental, cognitive, and social status of survivors.
GUIDANCE TO THE APPLICABILITY OF THE GLOBAL LUNG INITIATIVE SPIROMETRY REFERENCE EQUATIONS FOR SOUTH AFRICAN POPULATIONS
To the Editor: The lack of appropriate reference data for assessment of respiratory function in African populations and its implications for correct diagnosis and management of respiratory disease are longstanding concerns. The Global Lung Initiative 2012 (GLI2012) has the largest data set that provides guidance for spirometry reference equations across all ages for diverse populations across the world. Until recently, the major limitation to its use in Africa was the lack of data from black African populations. A similar limitation applies to other currently used equations, and it is the reason for current recommendations for ethnic corrections, although the latter are not broadly validated, particularly in paediatric and adolescent populations.
SOUTH AFRICAN THORACIC SOCIETY STATEMENT ON OBSTRUCTIVE AIRWAYS DISEASE AND COVID-19
Asthma and COPD occur commonly in South Africa. SARS-CoV-2 is a novel coronavirus, which can result in COVID-19-associated severe respiratory infection with respiratory failure and the need for mechanical ventilation. The South African Thoracic Society has prepared a guidance statement to assist clinicians and patients with asthma and COPD during the current epidemic.
PEOPLE LIVING WITH HIV AND COVID-19: A REPORT ON 2 CLINICAL CASES FROM SOUTH AFRICA
The impact of HIV in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has not been well established. It is uncertain if outcomes are better or worse in these patients compared with COVID-19 patients with diabetes mellitus, hypertension and other chronic diseases. The course and outcome is also unknown in HIV-positive patients who are virally suppressed on antiretroviral treatment (ART) compared with those who are treatment-naive. We present two HIV-positive cases with COVID-19 pneumonia – one virally suppressed and the other newly diagnosed. Both patients had favourable outcomes.
SOUTH AFRICAN CYSTIC FIBROSIS REGISTRY ANNUAL REPORT 2018
It is with great pleasure that we present this first annual cystic fibrosis (CF) registry report for South Africa (SA) which represents the combined efforts over many years of the CF community in SA. Cystic fibrosis care in SA has historically been organised around recognised CF clinics in our main government hospitals as well as private practice doctors with expertise in CF care. However, a clear understanding and knowledge of basic facts of CF in SA was lacking which represented a significant barrier to advancing care, conducting research and advocating for better treatment for CF patients in SA.
POSITION STATEMENT OF THE SOUTH AFRICAN THORACIC SOCIETY ON THERAPEUTIC BRONCHOSCOPY IN THE MANAGEMENT OF SEVERE COVID-19
The South African Thoracic Society (SATS) is concerned that a recently aired Carte Blanche interview with Dr E Taban may have sparked an inappropriate and potentially unsafe practice of “routine” therapeutic bronchoscopy for patients with severe COVID-19 pneumonia. The interview (https://youtu.be/3aYmoLjuf8Y) has been shared extensively on social media and has led to some conspiracy theories (“What the government is not telling you…”). Dr Taban also published his observations in our society’s journal [Afr J Thoracic Crit Care Med 2020;26(4)]. It is important to note that this was a small case series which did not show a mortality benefit.
THE USE OF CORTICOSTEROIDS FOR COVID-19 INFECTION
The SARS-CoV-2 pandemic is continuing relentlessly in many parts of the world and has resulted in the outpouring of literature on various aspects of the infection, including studies and recommendations regarding the optimal treatment of infected patients. Not surprisingly, the use of corticosteroids in the management of such patients has featured prominently in many of these publications. There is considerable debate in the literature as to the likely benefits, as well as the potential detrimental effects of corticosteroid therapy in general viral respiratory infections and, in particular, COVID-19 infections.
POSITION STATEMENT OF THE SOUTH AFRICAN THORACIC SOCIETY ON PULMONARY FUNCTION TESTING
The South African Thoracic Society (SATS), in line with other international respiratory societies, recommends that pulmonary function testing (PFT) can be reintroduced where there is a clinical or other substantial indication for testing, provided personnel and subjects are adequately protected from contracting SARS‐CoV‐2.
SATS STATEMENT IN SUPPORT OF THE SMOKING BAN
The Executive Committee of the South African Thoracic Society expresses its support to the South African Government in its efforts to mitigate the potentially devastating impact of the COVID-19 pandemic. The SA Thoracic Society has championed the campaign to stop cigarette smoking because of its negative impact on health. There is no evidence of any potential benefit of cigarette smoking. We are proud to note that South Africa was among the first countries in the world to ban cigarette smoking in public places.
THE SOUTH AFRICAN THORACIC SOCIETY’S CONCERNED ABOUT THE SUSPENSION OF PROFESSOR EBRAHIM VARIAVA
The South African Thoracic Society is concerned and troubled about the suspension of Professor Ebrahim Variava, Head of Internal Medicine at Tshepong Hospital. Professor Variava is an internationally recognised researcher who has substantially contributed to our knowledge about the diagnosis and management of tuberculosis including drug-resistant TB. TB is the commonest cause of death in South Africa and has a substantial negative impact on our economy. His absence at the hospital will compromise patient care at a facility that is already short in personnel. The timing could not have been worse given the national crisis we are in. Thus, his suspension will compromise our fight against TB, optimal clinical care, and COVID 19.
CURRENT EVIDENCE FOR DIRECTED AND SUPPORTIVE INVESTIGATIONAL THERAPIES AGAINST COVID-19
Coronavirus disease 2019 (COVID-19) is a global health crisis. There is currently a great need for effective and safe therapies directed at the disease, but no drugs are presently registered for use in COVID-19. Several directed therapies have been proposed, and most are still in clinical trials. Currently available published, peer-reviewed results mostly involve small sample sizes with study limitations restricting the interpretation of the findings. Many trials currently published also do not have a control group, limiting the interpretation of the effect of the intervention. Investigational directed therapies as well as investigational supportive therapies against COVID-19 are reviewed here.
CORONAVIRUS DISEASE 2019: LESSONS, RISKS AND CHALLENGES
There have been several viral pandemics that have swept the globe over the past century. The latest one is the COVID-19 pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In this mini review, we outline the epidemiology, clinical presentation, management and prognosis of COVID-19. The pandemic is part of a rapidly changing landscape and it remains to be seen how events will unfold in South Africa, where there is a large reservoir of young people with sub-optimal lung immunity due to several causes, including HIV, post-tuberculous lung disease, smoking, biomass fuel exposure and poor socioeconomic circumstances.
DIAGNOSIS OF COVID-19: CONSIDERATIONS, CONTROVERSIES AND CHALLENGES
Coronavirus disease 2019 (COVID-19) due to a novel virus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a global pandemic that has resulted in over 1.5 million confirmed cases and close to 100 000 deaths. In the majority of symptomatic cases, COVID-19 results in a mild disease predominantly characterised by upper respiratory tract symptoms. Reverse transcription polymerase chain reaction (RT-PCR) using a nasopharyngeal sample is the mainstay of diagnosis, but there is an ~30% false negative rate early in the disease and in patients with mild disease, and therefore repeat testing may be required. RT-PCR positivity can persist for several days after resolution of symptoms.
CARDIAC COMPLICATIONS IN COMMUNITY-ACQUIRED PNEUMONIA AND COVID-19
Community-acquired pneumonia (CAP) remains a global health problem with significant morbidity and mortality. Much recent published literature about the infection has indicated that a substantial number of patients with CAP, particularly those ill enough to be admitted to hospital, will suffer a cardiovascular event. While these may include events such as deep venous thrombosis and stroke, most of the events involve the heart and include the occurrence of an arrhythmia (most commonly atrial fibrillation), new onset or worsening of heart failure and acute myocardial infarction.
GLOBAL TB NETWORK (GTN)
Although several Tuberculosis (TB) networks exist, we realize the need for a mechanism linking together clinicians, public health experts, patients, civil society, scientific societies, major organizations, WHO, UNION as well as donors and pharma.
To actively pursue TB Elimination with a global effort building on existing collaborations in the area of research, advocacy and training
THE GLOBAL TB CONSILIUM: A RESPONSE TO DIFFICULT-TO-TREAT TB CASES
The Global TB Consilium is a global initiative offered by the Global TB Network (GTN).
The newly established GTN, operating within WAidid (a recognized Infectious Diseases society offering free membership for GTN members), aims to foster and conduct research on key unmet therapeutic and diagnostic needs in the field of TB elimination leveraging on multi-disciplinary, multi-sectorial approaches and supportive interventions (i.e. training, and advocacy activities) within the framework of the WHO End TB Strategy without duplicating existing efforts.
POLICY STATEMENT ON CONFLICTS OF INTEREST
The South African Thoracic Society’s mandate is to promote lung health in South Africa, and Africa as a whole, through education, training, research and advocacy. The Society is formed by members from all spheres of pulmonology and thus competing and often conflicting interests may arise. To ensure that the Society maintains a transparent and accountable foundation, conflicts of interest (COI) need to be managed according to international best practice. This policy statement aligns with ATS and ERS policies on Conflicts of Interest.
The policy of COI applies directly to all elected officials, authors on guidelines, presenters at conferences, and those acting on behalf of the Society:
SOUTH AFRICAN THORACIC SOCIETY POLICY ON ACCREDITATION OF MEETINGS WITH ACADEMIC CONTENT
Prof K Dheda, Prof C Koegelenberg, Prof M Wong, Prof U Lalloo, Mr D Maree, Dr A Vanker, Dr C Smith, Dr I Schewitz, Prof R van Zyl-Smit, Dr MS Abdool-Gaffar, Dr O Kitchin, Dr A Peter, Prof E Irusen, Prof R Masekela, Dr Y Ramkillawan, Prof R Chauke, Dr G Tiva, Prof P Oluboyo, Dr G Calligaro, Dr C Verwey, Dr G Alexander, Dr P Goussard, Dr I Kalla, Dr A Ambaram, Prof A Goolam-Mahomed
Teaching and training is a critical part of pulmonology-related capacity development in order to train the next generation of pulmonologists in both the private and academic sectors. There are a number of stakeholders who contribute to such capacity development and the private sector, including pharmaceutical companies, play an important role in this regard. Thus, it is critical to maintain academic teaching and training standards.
SATS receives a number of requests for accreditation of meetings with academic content. These requests are processed through the relevant sub-committees in SATS and also through the SATS Council. Relevant due diligence and other background organisation needs to be performed. Where required, SATS also may contribute speaker representatives (subject to various terms and conditions) in order to provide academic content to the meeting.
In lieu of the due diligence, services rendered, and advice provided SATS will receive an unrestricted educational grant to be used by SATS as outlined in its constitution.
The financial value of the grant contribution will depend on several factors including the length of the meeting, the number of delegates invited to the meeting, and whether international speakers have been included in the meeting (this is not an exhaustive list).
Where appropriate, and at the discretion of the president and the SATS Council, the accreditation levy may be waived or reduced (for example for society or other related ac academic activity).
LUNG HEALTH IN AFRICA: AFRICAN SOLUTIONS FOR AFRICAN CHALLENGES – TO INFINITY AND BEYOND
Africa is a place of dichotomy. Our continent is crippled by the “colliding epidemics” of tuberculosis, HIV, and smoking-related diseases, but it is also a place of exceptional beauty, of great abundance, with a communal spirit, and considerable hope. The unique challenges of our resource-limited environment require unique and innovative solutions. Africa must, and can, provide solutions to our own health crises. Our health related research, whether it be basic science, epidemiological, or clinical must be relevant to Africa, and must be read, analysed, and implemented in Africa. It is only through this type of capacity development that we will create a multiplier effect. Thus, there is a niche and an unmet need to provide a high quality pulmonary and critical care forum on a continental level and that speaks to the needs and aspirations of the African continent (and that is not currently covered by other journals where intense competition for space has ‘crowded’ out Afrocentric views and perspectives). There are also business concerns and reviewer fatigue such that only few journals that are that are owned and run by an academic organisation, and well supported, are likely to thrive.
This year marks the 24th year of publication of the journal of the South African Thoracic Society (SATS), and the year that it transforms from the South African Respiratory Journal (SARJ) to the African Journal of Thoracic and Critical Care Medicine (AJTCCM). With the recent surge in submissions from authors based in other African countries, the journal has the potential to grow into the flagship thoracic journal of the African continent. Expansion is now assured as leading academics from African countries other than South Africa are now being incorporated into the journal’s editorial board. Furthermore, this year also marks the first combined SATS – Pan African Thoracic Society congress to be held in Durban, South Africa in April 2018.
The journal will take further leaps forward with its likely forthcoming accreditation with PubMed in early 2019. Additionally, we are accepting submissions internationally, which will greatly boost our circulation.
The AJTCCM aims to be the ideal platform for African basic scientists, epidemiologists and health care workers to disseminate their knowledge, research and experience. Is this a South African ‘big brother’ move to dominate and take charge? Absolutely not! By contrast we see the AJTCCM as a unifying initiative and we envision that it could serve as a platform of excellence for African pulmonary science, and a dissemination platform for many stakeholders including those from the academic, private and government sectors. Indeed, journals like Respirology serve as a proof of concept providing a publication platform for stakeholders from many different countries.
We call on the thoracic and critical care fraternities to support our new venture by submitting manuscripts to the AJTCCM for publication.
Let’s hold hands together and let the African excellence be made known to the world!
Coenie Koegelenberg (Deputy Editor) & Keertan Dheda (Editor-in-chief)
African Journal of Thoracic and Critical Care Medicine
POSITION STATEMENT OF THE SOUTH AFRICAN THORACIC SOCIETY: RESEARCH FUNDING FROM THE ‘FOUNDATION FOR A SMOKE FREE WORLD’
The South African Thoracic Society (SATS) is a professional society dedicated to the promotion of lung health in South Africa and Africa through education, training, research and advocacy.
Tobacco smoking results in over 7 million avoidable deaths annually and approximately 10% of all deaths in South Africa are attributed to tobacco smoking. The South African Thoracic Society along with the American Thoracic (ATS) and European Respiratory Societies (ERS) has previously established policies to not accept funding from tobacco companies. The Society views organisations/ institutions that are funded by tobacco industry money in the equivalent light. Thus, to accept funding, directly or indirectly, from a tobacco entity is counter to our mandate to promote lung health.
This position is aligned with that of the ATS and ERS and as such the “Foundation for a Smoke Free World”, established by Phillip Morris with expected tobacco industry funding of over $80 million, is considered to be tobacco company funded, even though it professes to be free of influence from the tobacco industry.
We as a Society will not accept research funding or other support, directly or indirectly, from any tobacco company source and strongly encourage our members and colleagues to follow suit. The South African Thoracic Society, like the American Thoracic and European Respiratory Society, will not allow publication or presentation of any research funded directly or indirectly by the tobacco industry at its meetings or in its journals.