European Cystic Fibrosis Society Conference 2021

About Jonathan

I am a postgraduate research student currently undertaking my MD in Diagnostic Challenges of Fungal Disease in Wales. Some of the projects relate to examining the mould Exophiala dermatitidis and the impact this has on the lung function of cystic fibrosis patients. I am also a respiratory registrar and as part of my training have worked with cystic fibrosis patients in an inpatient and outpatient setting. I’m based simultaneously in the Clinical Research Facility in University Hospital of Wales (UHW) for my clinical work and based in Centre for Trials Research for my MD.

Background

In June this year I was able to attend the 44^th European Cystic Fibrosis Society conference. Nominally hosted in Milan, like a lot of conferences in 2021 it was entirely online. Perhaps unsurprisingly for cystic fibrosis, the ECFS conference is heavily scientific with complex new data and studies being delivered by world leaders. Beyond biomedical scientific research there was a heavy representation of allied healthcare professionals such as physiotherapists talking about exercise in the COVID-era and pharmacists who had a lot to talk about with the increasing use of CTFR modulators.

I was fortunate to present 2 posters at the conference. Exophiala dermatitidis is a black yeast which appears to be growing more frequently in the cystic fibrosis population. I presented a poster showing data that suggests that infection with this organism is associated with poorer lung function and accelerated lung function decline. A second poster also suggested a model of transmission as the majority of the tested cystic fibrosis group shared genetic typing.

The virtual conference

When training events, courses and conferences started up again after the COVID-related hiatus it was using platforms such as zoom and teams. The learning curve was steep and learning events in general were not very well suited or poorly adapted to this new style. A year later and the landscape is drastically different. Whilst there is still the occasional “sorry, you’re on mute”, the software and capability of these events is unrecognisable. The interactive programme builder allowed for picking and choosing talks, the poster uploading software was straightforward and the interface in general was far more user-friendly than turning up to a huge conference centre and immediately getting lost or not being able to attend a talk simply because you couldn’t find the room!

There are downsides to the overwhelming adoption of the virtual environment. Whilst the opportunity to speak online from distance and record seminars early has, I’m sure, secured for conferences big names in their respective worlds, the lack of physical presence in a conference limits the immersive experience of learning, depersonalises talks, reduces networking opportunities and eliminates the social interaction altogether. For research minnows like myself, submitting a poster to a conference feels significant and I have enjoyed previously walking along rows of peer’s research in poster form and taken the opportunity to informally discuss their work and my own over a coffee. However, whilst the posters are still visible and the abstracts available, they are hidden behind a webpage that requires deliberate access which I strongly suspect deters all but the most interested party. Sponsors and representatives from industry and academia have a role to play in large conferences and with flashy stalls and interesting pitches they can be difficult to ignore in a conference centre atrium. They can be easily swerved online as their “stalls” are separate on the website but wouldn’t recommend it as I learnt more about nebulised antibiotics during an online chat with a representative than in years of training.

Highlights

I attended a series of talks looking at clinical trials in cystic fibrosis. Traditionally a key outcome measure for CF trials has always been time until pulmonary exacerbation. In the new age of highly effective modulator therapy, the number needed to enrol in order to be powered for this outcome is likely to drastically increase which means that different outcome measures will need to be sought. Similarly, with modulators being introduced to national guidelines around the world in wake of their success in clinical trials, a new ethical dilemma presents itself; can a patient being given a trial modulator therapy or be safely taken off one for the purpose of clinical trial when the non-trial therapy is so effective? And what alternatives to “traditional” randomised controlled trials exist to improve this?

My favourite forum style was the “meet the experts” webinar where discussion and questions were encouraged on the named topic. This style was repeated on several occasions on multiple topics. Despite my reservations about the ability of the online style to capture the spirit of these conferences, these webinars were a fascinating fly on the wall look at the decision-making processes taking place to enable the formation of policy and guideline in the face of new technology. For example, one particular thread of conversation of interest was regarding mucolytics. Mucolytics are commonly used in CF to allow breakdown of thick sputum and easier cough and clearance. This is also helpful for CF physicians as this sputum is regularly collected for sampling to guide future antibiotics regimes and ensure no rare or destructive pathogens are present. However, again the new world of widespread modulator use, many patients no longer have a very productive chest and understandably are not keen to continue unnecessary therapy. Fascinating discussion about the other important roles mucolytics serve then continued and led to discussion about the possible need for more frequent bronchoscopy. If the patients are not producing sputum to monitor for infection and inflammation, do we need to do bronchoscopy to search for it more actively?

Conclusion

Whilst I am by no means a total convert to the online events style, this conference was by far the slickest iteration I have seen. The expertise available was world class and the topics relevant and interesting. The software and organisers kept a complicated event on track and organised with minimal fuss and technical difficulty. Overall, I thoroughly enjoyed the conference, even if the closest I’ll get to Milan this year is a rather sad looking pizza in my own living room.

The conference posters and recordings of the presentations remains open on the digital platform until 12^th September 2021 and can be accessed here: https://www.ecfs.eu/digital2021

– Jonathan Ayling-Smith

Ayling-SmithJ8@cardiff.ac.uk