Recommendations From the Medical Education Editor

Since the first reports of vocal cord dysfunction and subsequent classification as inducible laryngeal obstruction (ILO) [1, 2], excessive supraglottic or glottic laryngeal narrowing has been increasingly recognised as common and morbid [3, 4]. Additionally, patients with comorbid ILO and asthma present a real clinical challenge in the emergency room or outpatient setting, and growing concern over lifetime systemic corticosteroid exposure in asthma underscores the importance of improved recognition and specific treatment for ILO. To this end, Haines et al. [5] report their work on developing a standardised approach to non-pharmacologic therapy for ILO. They employed established strategies for designing complex interventions: the Medical Research Council framework, supported by the INDEX study principles. Their work incorporates analysis of the existing evidence base, healthcare practitioner and patient opinions and intervention design and evaluation, resulting in a framework that can now be explored in further research (Figure 1). Their Upper Airway Control Therapy (U-ACT) model is centred on two core components: education and empowerment, and reliever breath control. These elements are supported by biofeedback training, prevention strategies, managing others' reactions to their ILO and treating comorbid conditions. A home-based five-times-daily practice of at least 5 min reinforces the education and reliever breath control core components, in addition to the in-person and remote sessions with treating clinicians throughout the 4-month intervention cycle. The multidisciplinary and multi-modal nature of their intervention aligns with best practices. The robust approach to developing and conceptually validating the U-ACT model encourages optimism; however, it needs to be studied and assessed across various settings and patient groups. We look forward to reports of such research. Oral corticosteroid (OCS) stewardship in asthma is becoming an increasingly important topic, with international guidelines emphasising the need to minimise OCS exposure due to their long-term side effects [6, 7]. Professor McDonald highlights the importance of better understanding patients' views on both inhaled corticosteroid (ICS) and OCS use, along with their associated risks, in her November editorial accompanying the next educational selection [8]. She observes that while prescribing ICS according to guideline recommendations may reduce OCS exposure, this potential might be limited by poor adherence to ICS. Howell et al. [9] describe the results of their Discrete Choice Experiment study in their November paper, noting their enrolment of participants with a self-reported diagnosis of asthma and healthcare workers (HCW) with self-reported experience in asthma treatment. Participants were asked to choose between two hypothetical therapies with different treatment outcomes and side-effect rates in 12 questions. HCWs were asked questions with comparable wording focused on patient outcomes (see Figure 1 of Howell et al. for examples). Among participants recruited from the United Kingdom and New Zealand, 824 patients and 171 HCWs completed the survey. Results were analysed to assess the impact on treatment choices, and the risk of permanent side effects was found to have the greatest influence on both the patient and HCW groups. Symptom improvement at 7 days was also significant for both groups; however, HCWs' decisions were more likely to be affected by the risk of a subsequent GP visit or hospitalisation within 28 days. Patients with a history of poor asthma control and/or hospitalisation for asthma were more inclined to accept the risk of permanent side effects than others. This research emphasises the different views of patients and HCWs on treatment goals and the importance of avoiding adverse outcomes. Shared decision-making in healthcare requires that patients are well-informed and that management options are fully discussed. However, research into patients' perspectives and the safety and effectiveness of shared decision-making will be essential for developing a responsive, patient-centred approach. The final educational selection for 2025 involves a new approach for detecting microplastics in bronchoalveolar lavage (BAL) samples. Microplastics are defined as plastic particles ranging from 1 μm to 5 mm in size. The effect of microplastics on lung health is an active research area, with reviews highlighting oxidative stress, inflammation and cell death as possible disease mechanisms [9]. They may also adsorb other environmental pollutants and serve as carriers, resulting in ‘synergistic toxicity’ [10]. In their December article, Tokito et al. [11] describe their efforts to develop a new method for identifying microplastics in BAL samples. After highlighting the limitations of existing detection techniques, the authors suggest using Nile Red staining and fluorescence microscopy to identify and classify microplastics by size, shape, concentration and type. They collected five 10 mL saline samples injected via a bronchoscope as controls, along with BAL fluid specimens from 30 patients with diffuse lung disease. Histology specimens from three patients who underwent lobectomy for lung cancer were also examined, and air samples from the rooftop of their hospital were collected. Potential microplastic particles were found in BAL samples from all patients, with 80% being smaller than 10 μm. Raman spectroscopy of 14 samples confirmed that about 73% of the suspected particles were plastic. The most common microplastics identified were polyvinyl chloride, polystyrene and polyethylene terephthalate. Although the microplastic counts in BAL samples were higher than in the control specimens, contamination could not be entirely ruled out. The author has nothing to report. The author declares no conflicts of interest.