Floating the invisible swan: noninvasive prediction of haemodynamics
Pulmonary hypertension (PH) describes a heterogeneous set of diseases associated with increased morbidity and mortality, regardless of the aetiology [1–4]. The gold standard for diagnosing and phenotyping PH remains invasive measurement via right heart catheterisation [5]. Noninvasive estimation of pulmonary haemodynamics is an attractive alternative to reduce procedural risk and to more broadly study patient subsets who do not uniformly undergo right heart catheterisation for evaluation of PH (e.g. most patients with PH due to left heart disease) [5–7]. However, imperfect correlations between invasive and noni...
Source: European Respiratory Journal - February 12, 2020 Category: Respiratory Medicine Authors: Agrawal, V., Brittain, E. L. Tags: Editorials Source Type: research

Defining "stable chronic hypercapnia" in patients with COPD: the physiological perspective
We would like to thank C. Hedsund and co-workers for their commentary on the "European Respiratory Society guidelines on long-term home non-invasive ventilation for management of COPD" [1]. We agree that the definition of "stable chronic hypercapnia" following exacerbation is challenging. (Source: European Respiratory Journal)
Source: European Respiratory Journal - February 12, 2020 Category: Respiratory Medicine Authors: Ergan, B., Scala, R., Windisch, W. Tags: Original Articles: Correspondence Source Type: research

Prevalence of sarcoidosis-associated pulmonary hypertension: cumulative analysis of two PULSAR studies
We have read with great interest the study by Huitema et al. [1] showing a pulmonary hypertension (PH) prevalence of around 3% in a large cohort of predominantly Caucasian sarcoidosis patients in a Dutch tertiary centre. According to the authors, a European Caucasian cohort has never been studied before this PULmonary hypertension in pulmonary SARcoidosis (PULSAR) study. In this context, in 2013 we reported another PULSAR study (PULmonary hypertension in SARcoidosis) in an albeit smaller cohort from a German tertiary centre [2]. Of interest, we showed very similar results, with a prevalence of precapillary PH of 3.6% with ...
Source: European Respiratory Journal - February 12, 2020 Category: Respiratory Medicine Authors: Pabst, S., Grohe, C., Skowasch, D. Tags: Original Articles: Correspondence Source Type: research

Defining "stable chronic hypercapnia" in patients with COPD: the physiological perspective
We read with interest the "European Respiratory Society guidelines on long-term home non-invasive ventilation for management of COPD" [1]. In recent years, several studies have attempted to improve outcomes by using home non-invasive ventilation in patients with end-stage COPD who suffer from chronic hypercapnic respiratory failure (CHRF). As noted in the guidelines, the definition of "stable chronic hypercapnia" following an acute exacerbation has historically been ambiguous, which has probably contributed to the inconsistent findings across clinical trials of home non-invasive ventilation [2]. (Source...
Source: European Respiratory Journal - February 12, 2020 Category: Respiratory Medicine Authors: Hedsund, C., Wilcke, T. R., Berg, R. M. G. Tags: Original Articles: Correspondence Source Type: research

Should we worry about bedaquiline exposure in the treatment of multidrug-resistant and extensively drug-resistant tuberculosis?
Recently, the World Health Organization (WHO) released the updated guideline on the treatment for multi-drug resistant tuberculosis (MDR-TB) treatment regimens based on new experimental and observational evidence [1]. In this new guidance the most important drugs are the late-generation fluoroquinolones (i.e. levofloxacin and moxifloxacin), linezolid and bedaquiline. Despite the new guidance, MDR- and extensively drug resistant (XDR) TB treatment is challenging due to the risk of drug-related adverse events (AE) and drug–drug interactions (DDI). Precision medicine-based approach to minimise the risk of resistance eme...
Source: European Respiratory Journal - February 12, 2020 Category: Respiratory Medicine Authors: Alffenaar, J.-W. C., Akkerman, O. W., Tiberi, S., Sotgiu, G., Migliori, G. B., on behalf of the Global Tuberculosis Network Bedaquiline study group Tags: Original Articles: Research letters Source Type: research

SABINA: global programme to evaluate prescriptions and clinical outcomes related to short-acting {beta}2-agonist use in asthma
(Source: European Respiratory Journal)
Source: European Respiratory Journal - February 12, 2020 Category: Respiratory Medicine Authors: Cabrera, C. S., Nan, C., Lindarck, N., Beekman, M. J. H. I., Arnetorp, S., van der Valk, R. J. P. Tags: Research Highlights Source Type: research

Pulmonary artery enlargement and mortality risk in moderate to severe COPD: results from COPDGene
COPD is one of the leading causes of mortality worldwide [1]. Pulmonary hypertension has been associated with reduced survival among individuals with COPD [2] and is an independent risk factor for mortality following acute exacerbations of COPD (AECOPD) [3]. Measurement of the pulmonary artery to aorta (PA:A) ratio by computed tomography (CT) and assessment of pulmonary artery enlargement (PA:A>1) outperforms echocardiography in identifying pulmonary hypertension in severe COPD [4], and pulmonary artery enlargement has been independently associated with risk for total and severe AECOPD in two large prospective COPD coho...
Source: European Respiratory Journal - February 12, 2020 Category: Respiratory Medicine Authors: LaFon, D. C., Bhatt, S. P., Labaki, W. W., Rahaghi, F. N., Moll, M., Bowler, R. P., Regan, E. A., Make, B. J., Crapo, J. D., San Jose Estepar, R., Diaz, A. A., Silverman, E. K., Han, M. K., Hobbs, B., Cho, M. H., Washko, G. R., Dransfield, M. T., Wells, J Tags: Original Articles: Research letters Source Type: research

Noninvasive evaluation of pulmonary artery pressure during exercise: the importance of right atrial hypertension
This study examined the accuracy of Doppler echocardiography for the estimation of pulmonary artery pressures at rest and during exercise. Methods Simultaneous cardiac catheterisation-echocardiographic studies were performed at rest and during exercise in 97 subjects with dyspnoea. Echocardiography-estimated pulmonary artery systolic pressure (ePASP) was calculated from the right ventricular (RV) to right atrial (RA) pressure gradient and estimated RA pressure (eRAP), and then compared with directly measured PASP and RAP. Results Estimated PASP was obtainable in 57% of subjects at rest, but feasibility decreased to 15&nd...
Source: European Respiratory Journal - February 12, 2020 Category: Respiratory Medicine Authors: Obokata, M., Kane, G. C., Sorimachi, H., Reddy, Y. N. V., Olson, T. P., Egbe, A. C., Melenovsky, V., Borlaug, B. A. Tags: Original Articles: Pulmonary vascular disease Source Type: research

Mendelian randomisation analysis of red cell distribution width in pulmonary arterial hypertension
This study investigated whether elevated RDW is causally associated with PAH. A two-sample Mendelian randomisation (MR) approach was applied to investigate whether genetic predisposition to higher levels of RDW increases the odds of developing PAH. Primary and secondary MR analyses were performed using all available genome-wide significant RDW variants (n=179) and five genome-wide significant RDW variants that act via systemic iron status, respectively. We confirmed the observed association between RDW and PAH (OR 1.90, 95% CI 1.80–2.01) in a multicentre case–control study (cases n=642, disease controls n=15 88...
Source: European Respiratory Journal - February 12, 2020 Category: Respiratory Medicine Authors: Ulrich, A., Wharton, J., Thayer, T. E., Swietlik, E. M., Assad, T. R., Desai, A. A., Gräf, S., Harbaum, L., Humbert, M., Morrell, N. W., Nichols, W. C., Soubrier, F., Southgate, L., Tregouët, D.-A., Trembath, R. C., Brittain, E. L., Wilkin Tags: Genetics, Pulmonary vascular disease Original Articles: Pulmonary vascular disease Source Type: research

Effect of asthma exacerbation during pregnancy in women with asthma: a population-based cohort study
The association between asthma exacerbation during pregnancy and adverse maternal and child health outcomes have not been investigated appropriately. Our objective was to determine the short- and long-term intergenerational effect of asthma exacerbation in pregnant women with asthma. A population cohort study was conducted using data from the Ontario asthma surveillance system and population-level health administrative data. Asthma exacerbation in pregnant women with asthma was defined as at least one of the following criteria: at least five physician visits, or one emergency department visit or one hospital admission for ...
Source: European Respiratory Journal - February 12, 2020 Category: Respiratory Medicine Authors: Abdullah, K., Zhu, J., Gershon, A., Dell, S., To, T. Tags: Asthma and allergy Original Articles: Asthma Source Type: research

ESR/ERS statement paper on lung cancer screening
In Europe, lung cancer ranks third among the most common cancers, remaining the biggest killer. Since the publication of the first European Society of Radiology and European Respiratory Society joint white paper on lung cancer screening (LCS) in 2015, many new findings have been published and discussions have increased considerably. Thus, this updated expert opinion represents a narrative, non-systematic review of the evidence from LCS trials and description of the current practice of LCS as well as aspects that have not received adequate attention until now. Reaching out to the potential participants (persons at high risk...
Source: European Respiratory Journal - February 12, 2020 Category: Respiratory Medicine Authors: Kauczor, H.-U., Baird, A.-M., Blum, T. G., Bonomo, L., Bostantzoglou, C., Burghuber, O., Cepicka, B., Comanescu, A., Couraud, S., Devaraj, A., Jespersen, V., Morozov, S., Nardi Agmon, I., Peled, N., Powell, P., Prosch, H., Ravara, S., Rawlinson, J., Revel Tags: ERS Official Documents Source Type: research

Intensity and quality of exertional dyspnoea in patients with stable pulmonary hypertension
Dynamic hyperinflation is observed during exercise in 60% of patients with clinically stable pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH), intensifying exertional dyspnoea. The impact of dynamic changes in respiratory mechanics during exercise on qualitative dimensions of dyspnoea in these patients has not been evaluated. 26 patients (PAH n=17; CTEPH n=9) performed an incremental symptom-limited cycle exercise test. Minute ventilation (V'E), breathing pattern, operating lung volumes and dyspnoea intensity were assessed throughout exercise. Dyspnoea quality was serially ass...
Source: European Respiratory Journal - February 12, 2020 Category: Respiratory Medicine Authors: Boucly, A., Morelot-Panzini, C., Garcia, G., Weatherald, J., Jaïs, X., Savale, L., Montani, D., Humbert, M., Similowski, T., Sitbon, O., Laveneziana, P. Tags: Pulmonary vascular disease Original Articles: Pulmonary vascular disease Source Type: research

GINA recommendations in adults with symptomatic mild asthma and a smoking history
N.C. Thomson and R. Chaudhuri raise an important issue about treatment recommendations for patients with asthma who have a significant smoking history. The exclusion of such patients from most asthma studies appears to have largely been driven by the requirement by regulators for pure "asthma" and "COPD" populations in pharmacotherapy studies that are designed for obtaining regulatory approval. However, once that is obtained, there is an important need for additional clinical trials to be performed in broader populations, and with more pragmatic designs, to increase the generalisability of evidence to c...
Source: European Respiratory Journal - February 6, 2020 Category: Respiratory Medicine Authors: Reddel, H. K. Tags: Original Articles: Correspondence Source Type: research

Incidental venous thromboembolism, detected by chance, but still venous thromboembolism
Incidental venous thromboembolism (VTE) refers to deep venous thrombosis or pulmonary embolism (PE) diagnosed on an imaging test, usually computed tomography, performed for another reason than the clinical suspicion of VTE. Incidental VTE is particularly frequent in patients with cancer who have an increased risk of VTE and who underwent frequent imaging tests for staging purposes and assessment of anticancer treatment. (Source: European Respiratory Journal)
Source: European Respiratory Journal - February 6, 2020 Category: Respiratory Medicine Authors: Meyer, G., Planquette, B. Tags: Pulmonary vascular disease Editorials Source Type: research

No man is an island: e-cigarette, or vaping, associated lung injury in Europe
An outbreak of e-cigarette, or vaping, associated lung injury (EVALI) was noted in the USA starting in March of 2019 [1]. Although there have been prior reports of various lung diseases associated with e-cigarette use since they first came on the market in 2011 [2], the outbreak this summer was remarkable in the large number of patients affected (2409 reported hospitalised with 52 deaths as of 13 December, 2019 in the USA alone [1]) and the severity of lung injury. Although e-cigarette use is quite common in Europe [3], to date no cases of EVALI that developed in Europe have been reported. Questions regarding the geographi...
Source: European Respiratory Journal - February 6, 2020 Category: Respiratory Medicine Authors: Blagev, D. P. Tags: Editorials Source Type: research

Author response: The human cough reflex has separate, distinct pathways
We thank J.A. Smith and co-workers for their interest in our paper [1]. Perhaps an even more ancient truth, that of William of Occam [2], should be applied to this discussion. (Source: European Respiratory Journal)
Source: European Respiratory Journal - February 6, 2020 Category: Respiratory Medicine Authors: Morice, A. H., Kitt, M. M., Ford, A. P., Tershakovec, A. M., Wu, W.-C., Brindle, K., Thompson, R., Thackray-Nocera, S., Wright, C. Tags: Original Articles: Correspondence Source Type: research

An imported case of e-cigarette or vaping associated lung injury in Barcelona
Very recently, Layden et al. [1] published the first series of 53 patients with acute lung injury associated with the use of e-cigarettes (also known as vaping) in Wisconsin and Illinois, USA. To our knowledge, only a few cases of e-cigarette, or vaping, associated lung injury (EVALI) have been reported outside the USA (in Canada and Japan) and, so far, none in Europe [2]. Here we present the case of a 31-year-old woman who lived in Chicago (Illinois, USA) and arrived in Barcelona (Spain) on vacation on September 17, 2019 and, as detailed below, suffered EVALI. (Source: European Respiratory Journal)
Source: European Respiratory Journal - February 6, 2020 Category: Respiratory Medicine Authors: Casanova, G. S., Amaro, R., Soler, N., Sanchez, M., Badia, J. R., Barbera, J. A., Agusti, A. Tags: Original Articles: Research letters Source Type: research

The role of gene-environment interactions in lung disease: the urgent need for the exposome
Since the human genome was sequenced, extensive effort has been placed into mapping the role of genes in the onset of disease. It was expected that we would be able to explain the cause of disease and understand the genetic basis of health. However, we have found that while the genetic contribution to individual diseases varies, non-genetic factors have far greater attributable risks, often in the range of 80–90%. The dominance of non-genetic components highlights the importance of the environment to chronic disease risks and has led to the advent of the nascent field of exposome science. (Source: European Respiratory Journal)
Source: European Respiratory Journal - February 6, 2020 Category: Respiratory Medicine Authors: Wheelock, C. E., Rappaport, S. M. Tags: Editorials Source Type: research

GINA recommendations in adults with symptomatic mild asthma and a smoking history
The Global Initiative for Asthma (GINA) 2019 report makes a major change in asthma management by recommending that adults and adolescents with mild symptomatic asthma (Step 1) receive as-needed low-dose inhaled corticosteroid (ICS)–formoterol rather than a short-acting β2-agonist alone [1]. At step 2, daily low-dose ICS is recommended, and GINA 2019 considers low-dose ICS–formoterol reliever as an alternative "preferred controller". (Source: European Respiratory Journal)
Source: European Respiratory Journal - February 6, 2020 Category: Respiratory Medicine Authors: Thomson, N. C., Chaudhuri, R. Tags: Original Articles: Correspondence Source Type: research

Electrical stimulation in obstructive sleep apnoea: the less invasive the better?
We read with interest the article by Eastwood et al. [1] on bilateral hypoglossal nerve stimulation for treatment of adult obstructive sleep apnoea (OSA), the BLAST OSA trial. The authors present data on a novel approach, the Genio system, to stimulate the hypoglossal nerve and provide neuromuscular tone to the genioglossus, the main dilator muscle of the upper airway, to improve upper airway patency in OSA. The primary outcomes of the BLAST OSA trial focus on indices describing severity of OSA, the apnoea–hypopnoea index (AHI), and the safety of this approach. The AHI improved by 10.8 events per hour at 6 month...
Source: European Respiratory Journal - February 6, 2020 Category: Respiratory Medicine Authors: Pengo, M., Schwarz, E. I., Steier, J. Tags: Original Articles: Correspondence Source Type: research

Training curriculum for European thoracic surgeons: a joint initiative of the European Society of Thoracic Surgeons and the European Respiratory Society
In the most recent issue of the European Journal of Cardio-Thoracic Surgery, the joint task force group on training in thoracic surgery, set up by both the European Society of Thoracic Surgeons and the European Respiratory Society (ERS), has published the core document describing the recommended training curriculum [1]. This document takes its roots from the European syllabus published in 2018 [2, 3]. According to a methodology validated by education scientists, the working group has described, for each item, the expected level of competence in terms of knowledge, skills and attitudes, listed possible learning resources, a...
Source: European Respiratory Journal - February 6, 2020 Category: Respiratory Medicine Authors: Massard, G., Tabin, N., Konge, L., Frick, A. E., Batirel, H., Brunelli, A., Elia, S., Huertgen, M., Molins, L., Papagiannopoulos, K., Subotic, D., van Schil, P., Varela, G., van Raemdonck, D. Tags: Editorials Source Type: research

Pulmonary xenon-129 MRI: new opportunities to unravel enigmas in respiratory medicine
(Source: European Respiratory Journal)
Source: European Respiratory Journal - February 6, 2020 Category: Respiratory Medicine Authors: Eddy, R. L., Parraga, G. Tags: ERJ Methods Source Type: research

Immunotherapy for nonsmall cell lung cancer: a new therapeutic algorithm
After a nihilistic period lasting for decades, major progress in nonsmall cell lung cancer (NSCLC) therapy were linked to the introduction of platinum-based regimens, third generation chemotherapeutic drugs and, more recently, with the discovery of oncogenic driver mutations and the development of very effective targeted therapies [1]. However, for a long time, despite known significant immune dysregulations in the lung cancer environment, clinical trials with immune therapy failed to be superior to standard therapy. Adjuvant vaccination was one of the most recent prominent failures [2]. (Source: European Respiratory Journal)
Source: European Respiratory Journal - February 6, 2020 Category: Respiratory Medicine Authors: Berghmans, T., Dingemans, A.-M., Hendriks, L. E. L., Cadranel, J. Tags: Editorials Source Type: research

Clinical implications of incidental venous thromboembolism in cancer patients
Conclusion Clinical adverse outcomes are substantial in both cancer patients with incidental and symptomatic VTE, supporting current guideline recommendations that suggest treating incidental VTE in the same manner as symptomatic VTE. (Source: European Respiratory Journal)
Source: European Respiratory Journal - February 6, 2020 Category: Respiratory Medicine Authors: Mulder, F. I., Di Nisio, M., Ay, C., Carrier, M., Bosch, F. T. M., Segers, A., Kraaijpoel, N., Grosso, M. A., Zhang, G., Verhamme, P., Wang, T.-F., Weitz, J. I., Middeldorp, S., Raskob, G., Beenen, L. F. M., Büller, H. R., van Es, N. Tags: Pulmonary vascular disease Original Articles: Pulmonary vascular disease Source Type: research

"Truth is ever to be found in simplicity, and not in the multiplicity and confusion of things" -- Sir Isaac Newton
We read with interest the recent publication by Morice et al. [1] "The effect of gefapixant, a P2X3 antagonist, on cough reflex sensitivity: a randomised placebo-controlled study" and the accompanying editorial by Turner and Birring [2] "Chronic cough: ATP, afferent pathways and hypersensitivity". The authors of both publications conclude the results are suggestive of two separate neuronal pathways mediating the cough reflex; however, there are significant issues with this interpretation of the data. (Source: European Respiratory Journal)
Source: European Respiratory Journal - February 6, 2020 Category: Respiratory Medicine Authors: Smith, J. A., Wortley, M. A., Bonvini, S., Birrell, M., Belvisi, M. G. Tags: Original Articles: Correspondence Source Type: research

Genomic characterisation of pulmonary subsolid nodules: mutational landscape and radiological features
Conclusions Our study provides the first comprehensive description of the mutational landscape and radiogenomic mapping of SSNs. (Source: European Respiratory Journal)
Source: European Respiratory Journal - February 6, 2020 Category: Respiratory Medicine Authors: Li, Y., Li, X., Li, H., Zhao, Y., Liu, Z., Sun, K., Zhu, X., Qi, Q., An, B., Shen, D., Li, R., Liu, T., Mi, J., Wang, L., Yang, F., Bai, F., Wang, J. Tags: Lung cancer Original Articles: Lung cancer Source Type: research

Longitudinal changes in airway hyperresponsiveness and COPD mortality
Airway hyperresponsiveness (AHR) is associated with an increased mortality risk among males [1] and chronic obstructive pulmonary disease (COPD) patients [2]. However, this association is largely based on cross-sectional studies using a single measurement of AHR to predict mortality; inherently ignoring the longitudinal variability of AHR. AHR is variable regardless of disease or medication status, and is linked with changes in smoking habits, seasonal variations and exposure to pollutants [3–5]. Considering this, it remains unclear how changes in AHR affect mortality, specifically from causes such as COPD, cardiovas...
Source: European Respiratory Journal - February 6, 2020 Category: Respiratory Medicine Authors: Teferra, A. A., Vonk, J. M., Boezen, H. M. Tags: Asthma and allergy Original Articles: Research letters Source Type: research

Differential DNA methylation in bronchial biopsies between persistent asthma and asthma in remission
Approximately 40% of asthmatics experience remission of asthma symptoms. A better understanding of biological pathways leading to asthma remission may provide insight into new therapeutic targets for asthma. As an important mechanism of gene regulation, investigation of DNA methylation provides a promising approach. Our objective was to identify differences in epigenome wide DNA methylation levels in bronchial biopsies between subjects with asthma remission and subjects with persistent asthma or healthy controls. We analysed differential DNA methylation in bronchial biopsies from 26 subjects with persistent asthma, 39 remi...
Source: European Respiratory Journal - February 6, 2020 Category: Respiratory Medicine Authors: Vermeulen, C. J., Xu, C.-J., Vonk, J. M., ten Hacken, N. H. T., Timens, W., Heijink, I. H., Nawijn, M. C., Boekhoudt, J., van Oosterhout, A. J., Affleck, K., Weckmann, M., Koppelman, G. H., van den Berge, M. Tags: Asthma and allergy Original Articles: Asthma Source Type: research

Diagnostic sensitivity of SILVAMP TB-LAM (FujiLAM) point-of-care urine assay for extra-pulmonary tuberculosis in people living with HIV
Diagnosing tuberculosis (TB) in people living with HIV (PLHIV) remains challenging in part, because of its diversity of clinical manifestations, including high rates of extra-pulmonary and disseminated disease [1]. In particular, disseminated TB, involving multiple organ systems, is associated with high mortality but often presents non-specifically, which may hinder prompt diagnosis [2, 3]. Xpert MTB/RIF (Xpert; Cepheid, Sunnyvale, CA, USA), is currently recommended by the World Health Organization (WHO) as the first line assay for evaluating a subset of extra-pulmonary TB disease (EPTB) manifestations [4]. (Source: Europe...
Source: European Respiratory Journal - February 6, 2020 Category: Respiratory Medicine Authors: Kerkhoff, A. D., Sossen, B., Schutz, C., Reipold, E. I., Trollip, A., Moreau, E., Schumacher, S. G., Burton, R., Ward, A., Nicol, M. P., Meintjes, G., Denkinger, C. M., Broger, T. Tags: Original Articles: Research letters Source Type: research

ERS/TSANZ Task Force Statement on the management of reproduction and pregnancy in women with airways diseases
This European Respiratory Society/Thoracic Society of Australia and New Zealand statement outlines a review of the literature and expert opinion concerning the management of reproduction and pregnancy in women with airways diseases: asthma, cystic fibrosis (CF) and non-CF bronchiectasis. Many women with these diseases are now living into reproductive age, with some developing moderate-to-severe impairment of lung function in early adulthood. The statement covers aspects of fertility, management during pregnancy, effects of drugs, issues during delivery and the post-partum period, and patients’ views about family plan...
Source: European Respiratory Journal - February 6, 2020 Category: Respiratory Medicine Authors: Middleton, P. G., Gade, E. J., Aguilera, C., MacKillop, L., Button, B. M., Coleman, C., Johnson, B., Albrechtsen, C., Edenborough, F., Rigau, D., Gibson, P. G., Backer, V. Tags: Original Articles: ERS/TSANZ statement Source Type: research

Cost-effectiveness of ambulatory oxygen in improving quality of life in fibrotic lung disease: preliminary evidence from the AmbOx Trial
Fibrotic interstitial lung diseases (ILDs) are chronic and often progressive conditions resulting in substantial impact on morbidity, health-related quality of life (HRQoL), and health system costs. Ambulatory oxygen (AO) used during routine daily activities could lead to improved exercise performance, reduced symptoms and improved mobility in daily life. A UK prospective, multicentre, mixed method, randomised controlled crossover trial in patients with fibrotic ILD (AmbOx trial: NCT02286063), the first study on AO effects in daily life, reported improved HRQoL after 2 weeks of AO compared to no intervention, when mea...
Source: European Respiratory Journal - February 6, 2020 Category: Respiratory Medicine Authors: Whitty, J. A., Rankin, J., Visca, D., Tsipouri, V., Mori, L., Spencer, L., Adamali, H., Maher, T. M., Hopkinson, N. S., Birring, S. S., Farquhar, M., Wells, A. U., Sestini, P., Renzoni, E. A. Tags: Original Articles: Research letters Source Type: research

Relationship of obstructive sleep apnoea severity and subclinical systemic atherosclerosis
Obstructive sleep apnoea (OSA) is a common form of sleep disordered breathing. Untreated OSA might accelerate atherosclerosis, potentially increasing the cardiovascular disease burden in patients. The present study aimed to evaluate the association between objectively measured OSA severity and the presence of subclinical systemic atherosclerosis using noninvasive measurements, including tomographic quantification of the calcium burden. A total of 2157 participants of the Korean Genome and Epidemiology Study, who were free of structural heart disease and underwent both in-home polysomnography and chest computed tomography, ...
Source: European Respiratory Journal - February 6, 2020 Category: Respiratory Medicine Authors: Kim, S., Lee, K. Y., Kim, N. H., Abbott, R. D., Kim, C., Lee, S. K., Kim, S. H., Shin, C. Tags: Sleep medicine Original Articles: Sleep medicine Source Type: research

European Respiratory Journal, list of peer reviewers 2019
The European Respiratory Journal is voluntarily reviewed. We are most grateful for the hard work and dedication of those listed below, who reviewed articles for the ERJ in 2019. (Source: European Respiratory Journal)
Source: European Respiratory Journal - January 30, 2020 Category: Respiratory Medicine Tags: Acknowledgement Source Type: research

"ERS and tobacco harm reduction." Charlotta Pisinger, Elif Dagli, Filippos T. Filippidis, Linnea Hedman, Christer Janson, Stelios Loukides, Sofia Ravara, Isabel Saraiva and Jorgen Vestbo, the ERS Tobacco Control Committee, on behalf of the ERS. Eur Respir J 2019; 54: 1902009.
(Source: European Respiratory Journal)
Source: European Respiratory Journal - January 30, 2020 Category: Respiratory Medicine Tags: Author Correction Source Type: research

"Clinical phenotypes and outcomes of precapillary pulmonary hypertension of sickle cell disease." Laurent Savale, Anoosha Habibi, Francois Lionnet, Bernard Maitre, Vincent Cottin, Xavier Jais, Ari Chaouat, Elise Artaud-Macari, Matthieu Canuet, Gregoire Prevot, Christelle Chantalat-Auger, David Montani, Olivier Sitbon, Frederic Galacteros, Gerald Simonneau, Florence Parent, Pablo Bartolucci and Marc Humbert. Eur Respir J 2019; 54: 1900585.
(Source: European Respiratory Journal)
Source: European Respiratory Journal - January 30, 2020 Category: Respiratory Medicine Tags: Erratum Source Type: research

Airway mucus accumulation in COPD: the cholinergic paradox!
Mucus accumulation, related to excess mucus production and secretion in proximal and distal airways, is an established characteristic in the airways of patients with COPD. Chronic bronchitis, a consequence of cigarette smoking that can be found in smokers with or without COPD, is a disabling symptom and has been associated with increased rates of exacerbations and hospitalisations in patients with COPD [1] and in subjects with normal spirometry [2]. Chronic bronchitis is usually ascribed to inflammation and airway mucus hypersecretion by airway epithelium and submucosal glands in proximal airways [3]. (Source: European Respiratory Journal)
Source: European Respiratory Journal - January 30, 2020 Category: Respiratory Medicine Authors: Burgel, P.-R. Tags: Editorials Source Type: research

Should oral anticoagulation be discontinued after 3 months in the setting of a first high-risk pulmonary embolism secondary to a major transient/reversible risk factor?
We would like to thank H. Slabbynck and co-workers for their interest in the 2019 European Society of Cardiology/European Respiratory Society guidelines on the diagnosis and management of acute pulmonary embolism (PE), and for their interesting comment on the treatment duration of patients with a high-risk PE secondary to a major transient/reversible risk factor. (Source: European Respiratory Journal)
Source: European Respiratory Journal - January 30, 2020 Category: Respiratory Medicine Authors: Meyer, G., Konstantinides, S. Tags: Original Articles: Correspondence Source Type: research

Should oral anticoagulation be discontinued after 3 months in the setting of a first high-risk pulmonary embolism secondary to a major transient/reversible risk factor?
Important recommendations for the regimen and duration of anticoagulation after pulmonary embolism (PE) are proposed in the new/revised concepts in the 2019 European Society of Cardiology (ESC)/European Respiratory Society (ERS) guidelines for the diagnosis and management of acute pulmonary embolism. Potential indications for extended anticoagulation, after initial therapeutic anticoagulation for at least 3 months, depend on the presence of risk factors. (Source: European Respiratory Journal)
Source: European Respiratory Journal - January 30, 2020 Category: Respiratory Medicine Authors: Slabbynck, H., Clukers, J., Galdermans, D. Tags: Original Articles: Correspondence Source Type: research

Validation of short- and long-term demographic forecasts using the Canadian Cystic Fibrosis Registry
National cystic fibrosis (CF) data registries track patient characteristics over time and have provided insight into both emerging trends and current clinical needs. In a recent study, Burgel et al. [1] utilised the flow method, a demographic model that predicts future trends in populations, and forecasted a 50% increase in the Western European CF population by 2025, with the adult population experiencing the largest increase. Burgel et al. [2] subsequently used the French registry to validate short-term predictions; however, the accuracy of longer term projections has not been assessed. (Source: European Respiratory Journal)
Source: European Respiratory Journal - January 30, 2020 Category: Respiratory Medicine Authors: Martelli, V., Sykes, J., Burgel, P.-R., Bellis, G., Coriati, A., Stanojevic, S., Stephenson, A. L. Tags: Original Articles: Research letters Source Type: research

Subpopulations of cells from bronchoalveolar lavage can predict prognosis in sarcoidosis
Sarcoidosis is characterised by an accumulation of CD4+ T-cells in the lungs and an increased bronchoalveolar lavage fluid (BALF) CD4/CD8 ratio (>3.5) [1]. In sarcoidosis, an expansion of BALF CD4+ T-cells expressing the T-cell receptor Vα2.3 has been associated with good prognosis and with specific HLA-alleles, i.e. HLA-DRB1*0301 and HLA-DRB3*0101 (which is often carried together with HLA-DRB1*13). HLA-DRB1*03 and HLA-DRB3*0101 molecules show similarities in the region important for antigen presentation and both may therefore be capable of presenting identical antigens to the lung T-cells [2]. (Source: European Respiratory Journal)
Source: European Respiratory Journal - January 30, 2020 Category: Respiratory Medicine Authors: Darlington, P., Kullberg, S., Eklund, A., Grunewald, J. Tags: Original Articles: Research letters Source Type: research

Uncovering the mechanisms of exertional dyspnoea in combined pulmonary fibrosis and emphysema
The prevailing view is that exertional dyspnoea in patients with combined idiopathic pulmonary fibrosis (IPF) and emphysema (CPFE) can be largely explained by severe hypoxaemia. However, there is little evidence to support these assumptions. We prospectively contrasted the sensory and physiological responses to exercise in 42 CPFE and 16 IPF patients matched by the severity of exertional hypoxaemia. Emphysema and pulmonary fibrosis were quantified using computed tomography. Inspiratory constraints were assessed in a constant work rate test: capillary blood gases were obtained in a subset of patients. CPFE patients had lowe...
Source: European Respiratory Journal - January 30, 2020 Category: Respiratory Medicine Authors: Costa, C. M., Neder, J. A., Verrastro, C. G., Paula-Ribeiro, M., Ramos, R., Ferreira, E. M., Nery, L. E., O'Donnell, D. E., Pereira, C. A. C., Ota-Arakaki, J. Tags: Lung structure and function, Interstitial and orphan lung disease Original Articles: Interstitial lung disease Source Type: research

Circulating plasma exosomes in obstructive sleep apnoea and reverse dipping blood pressure
Conclusions Patients with RDBP have altered miRNA cargoes in circulating exosomes that invoke in vitro endothelial dysfunction. A selected number of circulating exosomal miRNAs play an important role in abnormal circadian regulation of blood pressure and may provide prognostic biomarkers of CVD risk in OSA. (Source: European Respiratory Journal)
Source: European Respiratory Journal - January 30, 2020 Category: Respiratory Medicine Authors: Khalyfa, A., Gozal, D., Chan, W.-C., Andrade, J., Prasad, B. Tags: Sleep medicine Original Articles: Sleep medicine Source Type: research

Excess mucus viscosity and airway dehydration impact COPD airway clearance
The mechanisms by which cigarette smoking impairs airway mucus clearance are not well understood. We recently established a ferret model of cigarette smoke-induced chronic obstructive pulmonary disease (COPD) exhibiting chronic bronchitis. We investigated the effects of cigarette smoke on mucociliary transport (MCT). Adult ferrets were exposed to cigarette smoke for 6 months, with in vivo mucociliary clearance measured by technetium-labelled DTPA retention. Excised tracheae were imaged with micro-optical coherence tomography. Mucus changes in primary human airway epithelial cells and ex vivo ferret airways were assess...
Source: European Respiratory Journal - January 30, 2020 Category: Respiratory Medicine Authors: Lin, V. Y., Kaza, N., Birket, S. E., Kim, H., Edwards, L. J., LaFontaine, J., Liu, L., Mazur, M., Byzek, S. A., Hanes, J., Tearney, G. J., Raju, S. V., Rowe, S. M. Tags: COPD and smoking, Lung biology and experimental studies Original Articles: COPD and basic science Source Type: research

January Podcast: ERS guidelines on chronic cough
As part of the January issue, the European Respiratory Journal presents the latest in its series of podcasts. Deputy Chief Editor James Chalmers interviews Alyn Morice (University of Hull, Hull, UK) about the European Respiratory Society’s new guidelines on the diagnosis and treatment of chronic cough in adults and children published in this issue. (Source: European Respiratory Journal)
Source: European Respiratory Journal - January 30, 2020 Category: Respiratory Medicine Tags: ERJ Podcast Source Type: research

The evolution of the European Respiratory Journal: ready for the new decade!
It has already been 2 years since we took the privilege of leading the European Respiratory Journal and we want to wish all of our readers, authors, reviewers and editors a very happy and successful 2020. It has been another busy and successful year at the journal. (Source: European Respiratory Journal)
Source: European Respiratory Journal - January 23, 2020 Category: Respiratory Medicine Authors: Chalmers, J. D., Reeves, E. L., Bullen, N. J., Kolb, M. Tags: Editorials Source Type: research

Single cell analysis of human lung development: knowing what mesenchymal cells are and what they may be
Examination of the transcriptomic activity of an organ at single cell resolution is one of the major breakthroughs in modern biology. Single cell RNA sequencing (scRNA-seq) is built on the paradigm-shifting work of Brady and Iscove [1], who described a method for generating microgrammes of cDNA from samples as small as a single cell almost 30 years ago. This discovery was followed closely by single cell transcriptomic analysis in neurons, accomplished by microinjecting primer, nucleotides and reverse transcriptase enzyme into dissociated cells [2]. (Source: European Respiratory Journal)
Source: European Respiratory Journal - January 23, 2020 Category: Respiratory Medicine Authors: Sucre, J. M. S., Hagood, J. Tags: Editorials Source Type: research

Can a better understanding of frailty improve the quality of life of patients with fibrotic interstitial lung diseases?
Management of progressive fibrotic interstitial lung diseases (ILDs) has long been limited to compensatory oxygen therapy and/or corticosteroids, but work in recent years has established the efficacy of new antifibrotic treatments in slowing the decline of patients with idiopathic pulmonary fibrosis [1]. However, many factors contribute to the tolerance and efficacy of new drugs in patients with ILDs. (Source: European Respiratory Journal)
Source: European Respiratory Journal - January 23, 2020 Category: Respiratory Medicine Authors: Aguilaniu, B. Tags: Editorials Source Type: research

It is time to further expand research in tailoring self-management of COPD exacerbations!
We are grateful to the editors of the European Respiratory Journal for the opportunity to respond to the letter to the editor by S. Ramakrishnan and M. Bafadhel, whom we thank for their thoughtful remarks about our COPE-III self-management trial [1]. Whereas our study did not show a significant difference in the number of COPD exacerbation days per year, the results showed that exacerbation action plans for COPD patients with comorbidities, embedded in a patient-tailored self-management intervention, reduced the duration of COPD exacerbations and the risk of respiratory-related hospitalisation, without increasing all-cause...
Source: European Respiratory Journal - January 23, 2020 Category: Respiratory Medicine Authors: Lenferink, A., van der Palen, J., van der Valk, P. D. L. P. M., Burt, M. G., Frith, P. A., Brusse-Keizer, M. G. J., Effing, T. W. Tags: Original Articles: correspondence Source Type: research

Is it time to give up on "self-management" of COPD exacerbations?
We read with interest the report of the results of the COPE-III trial by Lenferink et al. [1]. This large randomised trial continues on from the authors’ earlier COPE-II study [1], with personalised exacerbation action plans based on associated comorbidities. The action plans were detailed, and designed to determine symptom changes and the signs of an ensuing exacerbation. The study was negative for its primary endpoint (COPD exacerbation days) and no improvement in quality of life was found using the self-management intervention. (Source: European Respiratory Journal)
Source: European Respiratory Journal - January 23, 2020 Category: Respiratory Medicine Authors: Ramakrishnan, S., Bafadhel, M. Tags: Original Articles: Correspondence Source Type: research

Respiratory medicine is not gender blind
Marie Curie is a legendary figure: her research had huge impact on medicine, and she was the first woman to receive a Nobel Prize. In fact, she received two, one in Physics in 1903, and one in Chemistry in 1911, and so early in the history of Nobel Prizes (they were first awarded in 1901) a woman was a laureate. This was before women's suffrage in most parts of the world, and before any notion of gender equality, when few women had a chance to follow a career in science or medicine or get any education, and Marie Curie showed that it was possible. She was admired, respected and a role model for women in science. But still,...
Source: European Respiratory Journal - January 23, 2020 Category: Respiratory Medicine Authors: Gaga, M., Stolz, D., Chorostowska-Wynimko, J., Welte, T., Simonds, A. Tags: Editorials Source Type: research