Irish Thoracic Society Podcast Productions

In this episode, we explore the complex and often overlooked world of refractory chronic cough—a condition that can significantly impact patients’ quality of life, yet is frequently misunderstood or underdiagnosed. Featuring insights from leading respiratory specialists in Ireland and the United States, we examine the latest approaches to diagnosis, management, and emerging treatments aimed at improving patient outcomes and supporting clinicians in navigating this challenging area of respiratory medicine. Our guests, Professor Lorcan McGarvey and Professor Brendan Canning—both internationally recognised leaders in respiratory medicine and cough research—share their expertise on the neurobiology of chronic cough, the substantial morbidity experienced by patients, and strategies for more effective diagnostic investigation. We also discuss current treatment options and promising therapies on the horizon, as chronic cough increasingly gains recognition as a disease in its own right rather than merely a symptom. Whether you are a clinician, researcher, or simply interested in advances in respiratory medicine, this episode offers valuable insights into a condition that is finally receiving the attention it deserves. -- Guests Professor Lorcan McGarvey Professor of Respiratory Medicine at the University of Belfast, with a focus on the neurobiology of cough. His research has significantly advanced understanding of cough hypersensitivity syndrome and contributed to the development of new therapeutic strategies. He is widely respected for his collaborative work and dedication to improving respiratory health. Professor Brendan Canning Distinguished researcher at Johns Hopkins University, specialising in the mechanisms of cough and airway diseases. His pioneering studies on neural pathways and receptor targets have helped pave the way for novel treatments in refractory chronic cough. He is recognised as a key figure in efforts to redefine chronic cough management. Hosts Dr Marissa O’Callaghan Irish-trained respiratory fellow currently undertaking a postdoctoral fellowship at Erasmus MC Rotterdam in the Netherlands. She completed her training in Respiratory and Internal Medicine, along with her PhD, in 2025. Her interests include interstitial and rare lung diseases, as well as clinical research, medical education, and innovation. She co-founded the ITS Podcast Series in June 2024 alongside Sandra Green. Dr Sandra Green Irish-trained respiratory fellow with a strong background in climate advocacy and multidisciplinary sustainability initiatives. She is co-founder of Irish Doctors for the Environment and completed an MSc in Leadership and Innovation in Healthcare at the Royal College of Surgeons in Ireland (2023–2025). Alongside Marissa O’Callaghan, she co-founded Irish Thoracic Society Podcast Productions in 2024 to share knowledge and innovation in respiratory care.

In this episode, we explore the remarkable career of Professor Gerry McElvaney, a world-leading figure in Alpha-1 antitrypsin deficiency research and translational medicine. Gerry shares his journey from clinical medicine to pioneering discovery science, revealing how curiosity, perseverance, and strategic thinking can drive real-world clinical breakthroughs. From building a research laboratory from scratch to establishing Ireland’s first national targeted detection programmes, Gerry reflects on the challenges of advocacy, diagnostics, and innovation. He discusses pioneering therapeutic development, lessons from high-profile research failures, and how unexpected influences—such as Dolly the sheep—shaped scientific understanding of protein therapies and treatment design. The conversation spans early detection, personalised medicine, gene editing, and the future of genetic lung disease, while also highlighting the human side of science: mentorship, multidisciplinary teamwork, patient-centred foundations, and the power of listening to clinical questions as the spark for transformative research. This episode is a masterclass in translational medicine—connecting bedside observations to laboratory discovery and back again—offering invaluable insight for clinicians, researchers, and early-career innovators. • Transition from clinical medicine to translational research • Establishing Ireland’s first Alpha-1 diagnostic and detection programmes • Advocacy with hospitals and government agencies • Lessons from gene therapy and research setbacks • Dolly the sheep and protein half-life discoveries • Funding strategies and research sustainability • Multidisciplinary team building • Patient foundations and community engagement • Future visions: early detection, AI, and gene editing • Translating ward-round questions into research breakthroughs Professor Gerry McElvaney is a world-renowned expert in Alpha-1 antitrypsin deficiency. He founded the Alpha-1 Foundation of Ireland and established Europe’s first national targeted detection programme. He is Director of the Cystic Fibrosis Unit at Beaumont Hospital, where his work spans cystic fibrosis, Alpha-1 antitrypsin deficiency, infection, and immunity. His leadership has transformed Ireland into a global hub for Alpha-1 research and patient care. Dr Barry Harnedy – Respiratory specialist trainee, digital innovation advocate, and current co-Educational Officer of the Irish Thoracic Society. Sandra Green – Irish-trained respiratory fellow, climate advocate, co-founder of Irish Doctors for the Environment, MSc in Leadership & Innovation in Healthcare at Royal College of Surgeons Ireland, and co-founder of Irish Thoracic Society Podcast Productions. 00:00 Welcome & introduction 05:46 National detection & screening journey 09:34 Dolly the sheep & protein research 12:30 Translational research in action 17:21 Gender differences in CF outcomes 27:05 Alpha-1 Foundation & community impact 30:30 Future visions: AI & gene editing 33:23 Advice for early-career clinicians

Whether you’re preparing for a specialty registrar or consultant post—or are part of the wider respiratory multidisciplinary team—excelling in healthcare interviews requires clarity, authenticity, and strategic storytelling. In this episode, career and communication expert Sarah Geraghty shares practical guidance on standout interview preparation, avoiding common pitfalls, and clearly demonstrating your value. Prioritise evidence-based answers over generic statements Use the STAR framework (Situation, Task, Action, Result) to structure responses Practice speaking answers out loud rather than memorising scripts Address gaps or perceived weaknesses honestly and positively Align your unique experiences with the specific needs of the role Stay composed when faced with unfamiliar or unexpected questions Understand interviewer priorities and tailor responses accordingly Deliver a strong closing statement to reinforce suitability Leverage informal meetings and networking strategically Build a consistent professional brand and story bank for long-term success Sarah Geraghty Head of Careers at The Communications Clinic, specialising in high-stakes interview preparation and career transitions. A communication trainer and coach with a background in journalism and editorial work (Irish Times, The Journal, Assistant Editor of Gloss Magazine), Sarah brings real-world insight into performing under pressure and articulating professional value. Marissa O’Callaghan Irish-trained respiratory fellow and postdoctoral researcher at Erasmus MC, Rotterdam. Completed Irish respiratory and internal medicine training and a PhD in 2025. Interests include interstitial and rare lung diseases, clinical research, medical education, and healthcare innovation. Co-founder of the ITS Podcast Series (2024). Sandra Green Irish-trained respiratory doctor and climate advocate; co-founder of Irish Doctors for the Environment. Holds an MSc in Leadership and Innovation in Healthcare (RCSI, 2023–2025). Co-founder of Irish Thoracic Society Podcast Productions (2024). 00:00 – Introduction and episode overview 02:25 – Why speaking answers out loud matters 04:20 – Evidence over experience: thinking like an interviewer 06:15 – Building a targeted story bank 08:35 – Avoiding scripts and improving fluency 10:22 – Answering “Tell me about yourself” 13:09 – Structuring competency and scenario responses 18:03 – Addressing gaps and unfamiliar topics 24:23 – What to do when you don’t know an answer 27:49 – Demonstrating leadership and management skills 32:45 – Closing with impact 36:14 – Interview prep realities in busy clinical roles 56:55 – Differences in prep for SpR vs consultant roles 61:08 – Networking and informal meetings 63:43 – Crafting your professional brand Sarah Geraghty (LinkedIn): https://ie.linkedin.com/in/sarah-geraghty-comms The Communications Clinic: https://www.communicationsclinic.ie/ STAR Method: https://nationalcareers.service.gov.uk/careers-advice/interview-advice/the-star-method

Join hosts Dr Margaret Higgins and Dr Marissa O’Callaghan as they sit down with respiratory physiology expert Ciarán Heatley to explore the science and clinical value of Cardiopulmonary Exercise Testing (CPET). Moving beyond static resting tests, this episode highlights how CPET provides dynamic, real-time insight into integrated cardiopulmonary, metabolic, and muscular responses to exercise. Ciarán, who leads the Respiratory Physiology Laboratory at Mater University Hospital Dublin, draws on over a decade of experience to explain what CPET truly measures and how it is applied in modern respiratory and cardiovascular care. The discussion covers CPET’s role in diagnosing unexplained dyspnoea, preoperative risk stratification, transplant assessment, pulmonary hypertension management, and personalised rehabilitation planning. Key Topics Covered 1. What CPET Really Measures CPET is more than a stress test—it evaluates ventilatory, cardiovascular, metabolic, and muscular responses during exercise. Core parameters discussed include VO₂ max, metabolic threshold (VT1), and respiratory compensation point (VT2), with emphasis on the distinction between aerobic capacity and functional capacity. 2. Clinical Applications CPET is valuable for: Investigating unexplained breathlessness Preoperative risk assessment for major surgery Heart and lung transplant evaluation Monitoring treatment response in pulmonary arterial hypertension Assessing pregnancy risk in congenital disease Individualised pulmonary rehabilitation planning 3. What the Test Involves A full CPET takes approximately 90 minutes, including setup, an 8–12 minute exercise phase, and interpretation. Bike ergometry is preferred clinically. Equipment includes ECG, spirometry, a metabolic mask, and continuous blood pressure monitoring. Safety protocols require two physiologists and one doctor present. 4. Interpreting CPET Data The episode breaks down: VT1 and VT2 identification Ventilatory efficiency (V̇E/V̇CO₂) Detection of V/Q mismatch and pulmonary hypertensionChronotropic incompetence and heart rate reserveVentilatory limitation vs maximum voluntary ventilationThe impact of obesity on interpretation 5. Referral Considerations Good referrals clearly state the clinical question, relevant comorbidities, and medications (especially beta-blockers). Contraindications include acute illness, recent MI, severe cognitive or mobility impairment, and significant claustrophobia. 6. CPET in Ireland CPET remains underutilised compared to the NHS, largely due to resource, training, and education gaps. However, there is growing recognition of respiratory physiology’s role within Irish healthcare. Educational Chapters 00:00 Introduction & disclaimer 03:28 What is CPET? 05:54 CPET procedure 09:32 Data interpretation 18:14 Clinical indications 22:51 Practical referrals 25:20 CPET in Ireland 29:32 Closing thoughts Further Learning ARTP CPET Course ERS Clinical Exercise Testing Course Cambridge CPET Course ATS/ACCP CPET Guidelines Wasserman’s Principles of Exercise Testing and Interpretation Guest: Ciarán Heatley, Chief II Respiratory Physiologist, Mater University Hospital Dublin Hosts: Dr Margaret Higgins & Dr Marissa O’Callaghan Disclaimer: Sponsored by AstraZeneca. Sponsor had no input into content. Always follow local clinical guidance.

In this episode, Irish respiratory fellows Barry and Sandra sit down with Professor Richard Costello to explore the rapidly evolving world of digital asthma care. From eosinophils and T2 inflammation to the future of smart inhalers and precision monitoring, this conversation dives deep into how technology is reshaping diagnosis, adherence, and long-term management. Professor Richard Costello discusses the challenges of diagnosing a highly variable disease, the limitations of symptom-based tools like the ACT, and why biomarkers and digital home spirometry are essential in modern asthma practice. They cover how digital devices can reveal patient behaviour, uncover hidden comorbidities, and distinguish difficult-to-treat asthma from true severe asthma. The episode also explores the emerging potential of closed-loop smart inhalers, real-time lung function monitoring, and how personalised dosing may soon become a reality. Along the way, the team unpacks overlooked side effects of chronic inhaled steroids, the importance of steroid stewardship, and how Ireland can move toward a more decentralised, digitally enabled model of asthma care. Chapters 00:00 – Introduction 00:31 – Episode Overview 01:15 – Rapid-Fire Round: True or False 03:45 – The Importance of Eosinophils & T2 InflammationDr. Costello explains why identifying T2 inflammation is central to diagnosing and managing asthma. 06:15 – Challenges in Diagnosing AsthmaVariability, biomarkers, bronchial responsiveness, and why asthma remains difficult to diagnose in 2025. 09:40 – The Role of Home SpirometryHow home monitoring helps differentiate asthma from mimics and guides treatment decisions. 12:10 – Differentiating Difficult-to-Treat vs Severe AsthmaUsing digital adherence data to distinguish true severity from difficult to treat asthma. 14:20 – The Future: Smart, Closed-Loop InhalersHow inhalers may soon auto-dose based on real-time airflow and physiology. 17:00 – Understanding the User, Not Just the DeviceDigital data reveals patient behaviour patterns and barriers to adherence. 20:10 – When Symptoms Aren’t AsthmaReflux, deconditioning, cardiac disease, and other asthma mimics uncovered through monitoring. 22:20 – Hidden Side Effects of High-Dose SteroidsAdrenal suppression, cataracts, diabetes, and why symptom-based escalation can lead to elevated steroid exposure. 25:00 – The Limitations of the ACT & Symptom ScoresWhy subjective questionnaires fall short in a multimorbid population. 27:10 – Ireland’s Future: Digital Home Monitoring & Decentralised CareHow integrated hubs and digital platforms could streamline diagnosis and management. 30:00 – Looking Ahead 31:29 – Closing Remarks Guest: Professor Richard Costello Professor Richard Costello is a professor of respiratory medicine at the Royal College of Surgeons in Ireland and a consultant at Beaumont Hospital, Dublin. He trained at RCSI, Beaumont, and Johns Hopkins University. A leading researcher in airways disease and digital respiratory health, he has published over 200 papers, holds several health innovation patents, and founded a company focused on inhaler adherence. He has served as Vice President of the Royal College of Physicians of Ireland and chaired the European Respiratory Society Educational Council, receiving the ERS Educational Award for his contributions to respiratory medicine. Hosts: Dr Barry Harnedy & Dr Sandra Green Dr Barry Harnedy is a respiratory specialist trainee in Ireland. He graduated from National University of Ireland Galway. He is the current Irish Thoracic Society co Educational Officer. He is passionate about digital innovation and airways assessment. Dr Sandra Green is a respiratory specialist trainee in Ireland. She is the current Irish Thoracic Society Sustainability Officer. As a founder of Irish Doctors for the Environment she is interested in healthcare sustainability and planetary health.

In this episode, Dr Marissa O’Callaghan and Dr Sandra Green host Dr. Augusta Beach and Dr. Laura Fabbri, both Early Career Representatives of the European Respiratory Society. They discuss their journeys to becoming representatives, the responsibilities of their roles, and the importance of networking and engagement within the society. This conversation also focuses on the upcoming Congress, including key sessions, tips for poster presentations, and social events, emphasizing the value of participation and proactive involvement for early career members. Keywords European Respiratory Society, Early Career Representatives, Networking, Congress, ILD, COPD, Research, Eosinophils, Asthma, Clinical Trials

In this episode, Aisling McGowan takes us through the full journey of lung function testing — from referral to patient walkthrough — covering contraindications, the patient experience, and interpretation using the new GLI Guidelines.

This week, we speak to Dr. Laura Gleeson again—this time about pleural effusions. Our conversation covers all the pleural effusion basics, plus the nuances of radiology, when to insert a chest drain, and how to monitor it once it’s in place. Chapters: 01:05 – Rapid fire round 04:23 – Pleural effusion intro 05:30 – Symptoms at presentation with pleural effusion 06:40 – Interpreting a white-out on CXR 07:20 – When to do further radiology/imaging 08:35 – CT pre or post chest drain insertion? 10:25 – Light’s criteria – can it always be trusted? 12:00 – What tests to send on your pleural fluid sample 14:15 – Chest drain indications 16:35 – Monitoring your chest drain 21:00 – Flushing the chest drain 22:20 – How much fluid to drain 25:00 – Removing the chest drain 27:10 – Empyema management 30:10 – Fibrinolysis 31:55 – Following up your pleural patients 34:10 – Take-home points Show notes & resources: Light’s criteria – MDCalc calculator | CHEST Clinics article MIST trials – MIST2 – NEJM | MIST3 – ATS Journals

This week, we’re joined by Professor Seán Gaine, Ireland’s foremost expert in pulmonary hypertension. In this insightful episode, he shares his expert perspective on the diagnosis, classification, and clinical presentation of the condition, as well as the latest advances in treatment. A must-listen for all healthcare professionals, Professor Gaine also discusses when to suspect pulmonary hypertension and highlights the nuances in the management of patients with pulmonary hypertension. Don’t miss this opportunity to learn from a global leader in the field. Chapters 0:52 Rapid fire round on pulmonary hypertension 01:42 Definition of pulmonary hypertension 02:08 Signs and symptoms of pulmonary hypertension 02:56 Five groups of pulmonary hypertension 03:33 Group 1 pulmonary hypertension: Pulmonary arterial hypertension 04:34 Group 2 pulmonary hypertension: Left heart disease 05:23 Group 3 pulmonary hypertension: Chronic lung disease/hypoxia 05:58 Group 4 pulmonary hypertension: Pulmonary vascular obstruction 06:30 Group 5 pulmonary hypertension: Miscellaneous 07:25 Referral to the national pulmonary hypertension centre: right heart catheterisation 09:37 Work up in the pulmonary hypertension clinic 11:06 Risk stratification in pulmonary hypertension 12:06 Diagnostic criteria pulmonary hypertension Dynamic testing right heart catheterisation: Cardiopulmonary exercise testing Reliability of right heart catheterisation Treatment algorithm in pulmonary arterial hypertension Tripple therapy for high risk patients Double combination therapy for non-high risk patients Fourth treatment pathway, Quadruple therapy?: Sotatercept - an activin scavenger Treatment options for groups 4 pulmonary hypertension: Balloon pulmonary angioplasty Treatment options for groups 2, 3 and 5 Side effects of triple therapy Lung transplant in pulmonary hypertension: Double or single lung transplant Pitfalls in the acute management of patients with pulmonary hypertension Interpretation of the B Natriuretic Peptide level Medications contraindicated pulmonary hypertensions Outcomes in pulmonary hypertension Take home message on pulmonary hypertension Show Notes - https://lumen5.com/user/edofficer/sotatercept-emergin-d5jg6/ - Irish Thoracic Society Flashcard Pulmonary Hypertension https://irishthoracicsociety.com/wp-content/uploads/2021/06/5.-Pulmonary-Hypertension.pdf - Benza RL, Kanwar MK, Raina A, et al. Development and validation of an abridged version of the REVEAL 2.0 risk score calculator, REVEAL Lite 2, for use in patients with pulmonary arterial hypertension. Chest 2021; 159: 337–346. - Humbert M, Kovacs G, Hoeper MM, Badagliacca R, Berger RMF, Brida M, et al. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. European Respiratory Journal. 2022:2200879. DOI: https://doi.org/10.1183/13993003.00879-2022 - Chin KM, Gaine SP, Gerges C, Jing Z-C, Mathai SC, Tamura Y, et al. Treatment algorithm for pulmonary arterial hypertension. European Respiratory Journal. 2024;64(4):2401325. DOI: https://doi.org/10.1183/13993003.01325-2024 - Hoeper, M.M., Badesch, D.B., Ghofrani, H.A., Gibbs, J.S.R., GombergMaitland, M., McLaughlin, V.V. et al. (2023) ‘Phase 3 trial of sotatercept for treatment of pulmonary arterial hypertension’, New England Journal of Medicine, 388(17), pp. 1478–1490. Available at: https://doi.org/10.1056/NEJMoa2213558 - Humbert M, McLaughlin VV, Badesch DB, Ghofrani HA, Gibbs JSR, Gomberg-Maitland M, et al. Sotatercept in Patients with Pulmonary Arterial Hypertension at High Risk for Death. N Engl J Med. 2025;392(20):1987-2000. DOI: 10.1056/NEJMoa2415160

Description This week we speak to Mr Stephen Shelly again about the exciting but sometimes mysterious world of asthma biologics. We speak about the different biologics, going about getting approval to start an asthma biologic, training, and treatment response. We speak about the potential impact that asthma biologics are going to have on the future of asthma (and hopefully COPD!), the cost benefit analysis and the limitations of these new wonder drugs. Chapters 0.42min Intro to Biologics 1.00min Rapid fire round 1.52min Severe asthma & biologic eligibility 3.50min Available biologics 6.50min Which biologic? 7.30min Journey to asthma biologic 13.55min Asthma biologic administration 15.30min Monitoring while on asthma biologic 16.40min Training for asthma biologic admin at home 18.50min Assessing treatment response 21:10min Patient expectations 24:50min Are inhalers still needed? 26:12min Pitfalls in treatment with asthma biologics 28:54min Cost-benefit analysis 31.30min Take-home points Show notes Dupilumab https://www.nejm.org/doi/10.1056/NEJMoa1804092 Mepolizumab https://www.nejm.org/doi/10.1056/NEJMoa1403290 Omalizumab https://www.jacionline.org/article/S0091-6749(01)65945-1/fulltext Benralizumab https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)31322-8/abstractTezepelumab https://doi.org/10.1164/rccm.202210-2005OC Difficult to treat asthma (GINA) https://ginasthma.org/wp-content/uploads/2024/11/GINA-Severe-Asthma-Guide-2024-WEB-WMS.pdf Asthma compliance programmes Ireland https://www.rcsi.com/dublin/research-and-innovation/innovation/investors-entrepreneurs-and-spin-outs/phyxiom

In this episode, we delve into sarcoidosis with Professor Anthony O'Regan. We discuss the nuances of diagnosing sarcoidosis and revisit the pathophysiology of the condition. This episodes details the importance of follow up care and provides insights into how to tease out differentials. Furthermore, we address how to determine which patients should be treated, along with choice of treatments and duration. 00:15 Rapid fire round: sarcoidosis 00:45 Pathophysiology of sarcoidosis 05:30 Multisystem involvement in sarcoidosis 07:15 Granulomatous disease 09:00 Referral to respiratory clinic (Symptoms/Differentials/Family history/Travel) 10:30 Initial investigations 10:45 Coming to a diagnosis of sarcoidosis 14:05 The role of biopsy in diagnosis of sarcoidosis 15:50 Teasing out the differentials in follow up 17:35 When to treat in sarcoidosis 19:25 Duration of treatment 19:50 Relapse of disease 21:00 Starting dose of steroids 22:00 Disease modifying therapy 23:30 Antifibrotics 24:25 Follow up in sarcoidosis 25:01 The future of sarcoidosis Show Notes: - Judson MA, Baughman RP, Teirstein AS, Terrin ML, Yeager H Jr. Defining organ involvement in sarcoidosis: the ACCESS proposed instrument. ACCESS Research Group. A Case Control Etiologic Study of Sarcoidosis. Sarcoidosis, Vasculitis, and Diffuse Lung Diseases : Official Journal of WASOG. 1999 Mar;16(1):75-86. PMID: 10207945. - 40 consecutive patients in Ireland 20% end up on steroids - John Gibson study on steroids RCT Gibson GJ, Prescott RJ, Muers MF, Middleton WG, Mitchell DN, Connolly CK. "British Thoracic Society Sarcoidosis study: effects of long-term corticosteroid treatment." Thorax. 1996;51(3):238-247. DOI: 10.1136/thx.51.3.238 - Nintedanib in patients with progressive fibrosing interstitial lung diseases—subgroup analyses by interstitial lung disease diagnosis in the INBUILD trial: a randomised, double-blind, placebo-controlled, parallel-group trial Wells, Athol UAbe, S. et al. The Lancet Respiratory Medicine, Volume 8, Issue 5, 453 – 460 - ITS Flashcard Sarcoidosis https://irishthoracicsociety.com/wp-content/uploads/2022/02/15.-Sarcoidosis-30.11.21.pdf

This week we speak with Nazia again, this time about idiopathic pulmonary fibrosis or IPF for short. Nazia is a leading world expert in the diagnosis and management of IPF and in this episode she shares that expertise with us. Chapters 00:57 - Rapid fire round 01:35 - Introduction to ILD 03:20 - Definition of IPF 04:15 - What to include in your IPF referrals 06:40 - IPF workup 11:55 - Genetics in IPF 14:50 - Management of IPF 20:28 - Acute exacerbation of IPF (AE-IPF) 22:20 - Follow-up and surveillance of IPF patients 26:00 - Prognostication in IPF 27:40 - Encouraging clinical breakthroughs 29:05 - Key take home messages 31:00 - Wrap up Links IPF clinical practice update 2022 ATS/ERS/JRS/ALAT https://doi.org/10.1164/rccm.202202-0399ST Role of MDT in diagnosis of IPF https://doi.org/10.1513/AnnalsATS.202108-979ED Current and future treatments in IPF https://doi.org/10.1007/s40265-023-01950-0