"Predictors of mortality for patients with COVID-19 pneumonia caused by SARS-CoV-2: a prospective cohort study." Rong-Hui Du, Li-Rong Liang, Cheng-Qing Yang, Wen Wang, Tan-Ze Cao, Ming Li, Guang-Yun Guo, Juan Du, Chun-Lan Zheng, Qi Zhu, Ming Hu, Xu-Yan Li, Peng Peng and Huan-Zhong Shi. Eur Respir J 2020; 55: 2000524.
(Source: European Respiratory Journal)
Source: European Respiratory Journal - September 24, 2020 Category: Respiratory Medicine Tags: Author correction Source Type: research

Predictors of mortality for patients with COVID-19 pneumonia caused by SARS-CoV-2
We appreciate the thoughtful comments of H-J. Yang and co-workers in their correspondence addressing the predictors of mortality for patients with coronavirus disease 2019 (COVID-19) pneumonia caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Their comments are very helpful to improve the expression and increase the quality of our paper [1]. (Source: European Respiratory Journal)
Source: European Respiratory Journal - September 24, 2020 Category: Respiratory Medicine Authors: Du, R.-H., Liang, L.-R., Yang, C.-Q., Wang, W., Cao, T.-Z., Li, M., Guo, G.-Y., Du, J., Zheng, C.-L., Zhu, Q., Hu, M., Li, X.-Y., Peng, P., Shi, H.-Z. Tags: Original Articles: Correspondence Source Type: research

Insight into the impact of the COVID-19 epidemic on tuberculosis burden in China
We are interested in an article published in the journal recently, entitled "The potential impact of COVID-19-related disruption on tuberculosis burden". The study used a mathematical model to estimate the relative impact of reductions in social contacts and health services on tuberculosis (TB) burden due to the coronavirus disease 2019 (COVID-19) epidemic. There included data and projections on China, being one of 22 high TB burden countries for both TB and multidrug-resistant TB cases. COVID-19, which has spread rapidly and enveloped most of the world, is a unique global public health crisis for the century. By...
Source: European Respiratory Journal - September 24, 2020 Category: Respiratory Medicine Authors: Chen, H., Zhang, K. Tags: Original Articles: Correspondence Source Type: research

Predictors of mortality for patients with COVID-19 pneumonia caused by SARS-CoV-2
As an emerging infectious disease, coronavirus disease 2019 (COVID-19) pneumonia, which is caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in a severe global public health emergency. According to the World Health Organization (WHO) COVID-19 epidemic interactive dashboard, as of 19 June 2020, there have been 8 385 440 confirmed cases all over the world, including 450 686 deaths. Under such urgent conditions, it is of great clinical significance to distinguish patients with poor clinical outcome (such as severe, critical or death) from within the large number of patients with COV...
Source: European Respiratory Journal - September 24, 2020 Category: Respiratory Medicine Authors: Yang, H.-J., Zhang, Y.-M., Yang, M., Huang, X. Tags: Original Articles: Correspondence Source Type: research

Imaging risk in pulmonary arterial hypertension
Pulmonary arterial hypertension (PAH) is a Janus-faced entity with, on one side, the pulmonary circulation and, on the other side, the right ventricle (RV) [1]. While the disease process is turned on at the site of the pulmonary resistive vessels, the patient symptomatology and prognosis are largely determined by RV structure and function adaptation to increased afterload [2, 3]. Yet, this important cardiac aspect of PAH pathophysiology remains insufficiently recognised. The study by Ghio et al. [4], in the present issue of the European Respiratory Journal, is therefore a welcome step forward. (Source: European Respiratory Journal)
Source: European Respiratory Journal - September 24, 2020 Category: Respiratory Medicine Authors: Badagliacca, R., Vizza, C. D. Tags: Editorials Source Type: research

Pathogenesis of COVID-19-induced ARDS: implications for an ageing population
The coronavirus disease 2019 (COVID-19) pandemic has elicited a swift response by the scientific community to elucidate the pathogenesis of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2)-induced lung injury and develop effective therapeutics. Clinical data indicate that severe COVID-19 most commonly manifests as viral pneumonia-induced acute respiratory distress syndrome (ARDS), a clinical entity mechanistically understood best in the context of influenza A virus-induced pneumonia. Similar to influenza, advanced age has emerged as the leading host risk factor for developing severe COVID-19. In this review we ...
Source: European Respiratory Journal - September 24, 2020 Category: Respiratory Medicine Authors: Torres Acosta, M. A., Singer, B. D. Tags: Back to Basics Source Type: research

Elevated ACE-2 expression in the olfactory neuroepithelium: implications for anosmia and upper respiratory SARS-CoV-2 entry and replication
The ongoing outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a major threat to global health [1]. The mechanism of cellular entry by SARS-CoV-2 is through binding to angiotensin-converting enzyme 2 (ACE-2) [2, 3], a metalloproteinase ectoenzyme that primarily functions in the regulation of angiotensin II, but also has non-catalytic roles such as intestinal neutral amino acid transport. The level of ACE-2 protein and its subcellular localisation in the respiratory tract may be a key determinant of susceptibility to infection, symptoms and...
Source: European Respiratory Journal - September 24, 2020 Category: Respiratory Medicine Authors: Chen, M., Shen, W., Rowan, N. R., Kulaga, H., Hillel, A., Ramanathan, M., Lane, A. P. Tags: Original Articles: Research letters Source Type: research

JAK inhibitors in COVID-19: the need for vigilance regarding increased inherent thrombotic risk
There is accumulating evidence that coronavirus disease 2019 (COVID-19) is a hypercoagulable state. Reports of thrombotic events and autopsy findings of pulmonary thrombotic microangiopathy in patients with COVID-19 are rising [1]. Bompard et al. [2] recently reported a cohort study of 137 patients with COVID-19 pneumonia, in which retrospective review of computed tomography pulmonary angiography scans demonstrated a cumulative incidence of pulmonary emboli (PE) of 24% overall and 50% in intensive care. Although it was initially thought that insidious venous thromboembolic events (VTE) were mainly confined to ventilated pa...
Source: European Respiratory Journal - September 24, 2020 Category: Respiratory Medicine Authors: Mehta, P., Ciurtin, C., Scully, M., Levi, M., Chambers, R. C. Tags: Original Articles: Correspondence Source Type: research

Similarities between COVID-19 and anti-MDA5 syndrome: what can we learn for better care?
As yet, no direct-acting antiviral drugs have demonstrated efficacy in the disease. In contrast, increasing evidence indicates an immune-mediated pathophysiology that is paving the way for the evaluation of immunomodulation strategies [2]. In support of this view, we would like to highlight the striking similarities between COVID-19 and a rare autoimmune disease: the anti-MDA5-syndrome. (Source: European Respiratory Journal)
Source: European Respiratory Journal - September 24, 2020 Category: Respiratory Medicine Authors: Giannini, M., Ohana, M., Nespola, B., Zanframundo, G., Geny, B., Meyer, A. Tags: Original Articles: Correspondence Source Type: research

A comprehensive echocardiographic method for risk stratification in pulmonary arterial hypertension
Question addressed Echocardiography is not currently considered as providing sufficient prognostic information to serve as an integral part of treatment goals in pulmonary arterial hypertension (PAH). We tested the hypothesis that incorporation of multiple parameters reflecting right heart function would improve the prognostic value of this imaging modality. Methods and main results We pooled individual patient data from a total of 517 patients (mean age 52±15 years, 64.8% females) included in seven observational studies conducted at five European and United States academic centres. Patients were subdivided in...
Source: European Respiratory Journal - September 24, 2020 Category: Respiratory Medicine Authors: Ghio, S., Mercurio, V., Fortuni, F., Forfia, P. R., Gall, H., Ghofrani, A., Mathai, S. C., Mazurek, J. A., Mukherjee, M., Richter, M., Scelsi, L., Hassoun, P. M., Tello, K., TAPSE in PAH investigators Tags: Pulmonary vascular disease Original Articles: Pulmonary hypertension Source Type: research

Extrafine triple therapy in patients with asthma and persistent airflow limitation
The addition of a long-acting muscarinic antagonist (LAMA) is a recognised treatment option for patients whose asthma is uncontrolled with an inhaled corticosteroid (ICS) plus long-acting β2-agonist (LABA) combination [1]. The data supporting this recommendation were provided from studies in which the LAMA tiotropium was added to ICS/LABA combinations using separate inhalers [2, 3]. The use of separate inhalers, most often of different design, with contrasting instructions for use and dosing regimens is not only inconvenient for patients and healthcare providers who provide instruction on correct inhaler use but can a...
Source: European Respiratory Journal - September 24, 2020 Category: Respiratory Medicine Authors: Singh, D., Virchow, J. C., Canonica, G. W., Vele, A., Kots, M., Georges, G., Papi, A. Tags: Original Articles: Research letters Source Type: research

Effect of history of tuberculosis on specificity of Xpert MTB/RIF
Tuberculosis (TB) is the leading cause of mortality among infectious diseases. In 2018, 1.5 million people died due to TB [1]. Early diagnosis of TB is key in achieving WHO End TB targets, and molecular diagnostic tests have been developed. However, molecular tests cannot differentiate between viable and non-viable bacteria [2, 3], leading to challenges in the interpretation of positive test results in patients with recent TB. (Source: European Respiratory Journal)
Source: European Respiratory Journal - September 24, 2020 Category: Respiratory Medicine Authors: Haraka, F., Schumacher, S. G., Ross, A., Mantsoki, A., Gagneux, S., Reither, K., Denkinger, C. M. Tags: Original Articles: Research letters Source Type: research

Effect of long-acting {beta}-agonist on bronchodilator response in children with asthma
Spirometry is the most common pulmonary function test (PFT) used to follow asthma patients. It is recommended to withhold short-acting β2-agonists (SABA) a few hours before pulmonary function testing and to withhold long-acting β2-agonists (LABA) for diagnosis purpose but not for the assessment of response to a current treatment [1]. In children with asthma, the addition of LABA to inhaled corticosteroids (ICS) has no clear clinical benefit, but it has proved to improve baseline forced expiratory volume in 1 s (FEV1) [2]. The maximal increase in FEV1 after a single dose of formoterol was measured 3 h af...
Source: European Respiratory Journal - September 24, 2020 Category: Respiratory Medicine Authors: Taytard, J., Aupiais, C., Jovien, S., Assouline Kabla, J., Haziot, N., Fuger, M., Alberti, C., Beydon, N. Tags: Original Articles: Research letters Source Type: research

Innate lymphoid cells in isocyanate-induced asthma: role of microRNA-155
Conclusion TDI exposure is associated with increased numbers of ILCs. The proinflammatory microRNA-155 is crucial in a murine model of TDI asthma, suggesting its involvement in the pathogenesis of occupational asthma due to low molecular weight agents. (Source: European Respiratory Journal)
Source: European Respiratory Journal - September 24, 2020 Category: Respiratory Medicine Authors: Blomme, E. E., Provoost, S., Bazzan, E., Van Eeckhoutte, H. P., Roffel, M. P., Pollaris, L., Bontinck, A., Bonato, M., Vandenbroucke, L., Verhamme, F., Joos, G. F., Cosio, M. G., Vanoirbeek, J. A. J., Brusselle, G. G., Saetta, M., Maes, T. Tags: Lung biology and experimental studies, Asthma and allergy Original Articles: Asthma and basic science Source Type: research

Antibiotics for paediatric community-acquired pneumonia in resource-constrained settings
Despite Streptococcus pneumoniae and Haemophilus influenzae type b vaccination strategies, pneumonia remains the leading infectious cause of child mortality. Greater access to appropriate treatment is critical; however, defining "appropriate" is problematic. World Health Organization (WHO) guidelines recommend diagnosing pneumonia using clinical signs and a non-specific, pragmatic case definition: fast breathing or chest indrawing (pneumonia) and presence of WHO danger signs (severe pneumonia) in children with cough or difficulty breathing [1]. It is unclear whether all "pneumonia" using these definitio...
Source: European Respiratory Journal - September 17, 2020 Category: Respiratory Medicine Authors: Ginsburg, A. S., Klugman, K. P. Tags: Original Articles: Correspondence Source Type: research

Characteristics and outcomes of health and social care workers testing positive for SARS-CoV-2 in the Tayside region of Scotland
The spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and reported outcomes among health and social care workers (HSCWs) is concerning [1–3]. Early in the outbreak it was recommended in the UK that HSCWs experiencing symptoms of a cough or fever remain absent from work for 7 days. In order to address this problem, National Health Service (NHS) Tayside, a health board in Scotland covering a population of 400,000, was the first in Scotland to set up a drive-through testing programme for HSCWs, other key workers and their symptomatic household contacts (including children), with results availab...
Source: European Respiratory Journal - September 17, 2020 Category: Respiratory Medicine Authors: Siddiqui, M. K., Parcell, B., Allstaff, S., Palmer, C., Chalmers, J. D., Bell, S. Tags: Original Articles: Correspondence Source Type: research

Pandemic treatments on trial: the bigger picture. N of many thinking in an N of one scenario
That the above two quotes are arguably truer now than at the time they were written is perhaps surprising. That this truth resonates equally for the authors who have experienced the two most recent respiratory infection pandemics (H1N1/09 influenza and coronavirus disease 2019 (COVID-19)) and the ongoing bias towards relatively small, uncontrolled treatment trials from very different perspectives, across, between and within hemispheres, countries, healthcare systems, socio-economic-political cultures, populations and individuals [1–6], is even more so. (Source: European Respiratory Journal)
Source: European Respiratory Journal - September 17, 2020 Category: Respiratory Medicine Authors: Kotsimbos, T., Humbert, M. Tags: Editorials Source Type: research

SARS-CoV-2 disrupts clinical research: the role of a rare disease-specific trial network
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has disrupted clinical trials worldwide [1]. This could delay the approval of new medicines and reduce access to investigational treatments via clinical trials. This particularly impacts patients with rare diseases such as cystic fibrosis (CF). (Source: European Respiratory Journal)
Source: European Respiratory Journal - September 17, 2020 Category: Respiratory Medicine Authors: van Koningsbruggen-Rietschel, S., Dunlevy, F., Bulteel, V., Downey, D. G., Dupont, L. Tags: Original Articles: Correspondence Source Type: research

ERS Scientific Working Group 09.04, "Psychologists and behavioural scientists": the next step towards multidisciplinary respiratory care
Impaired lung function is a cardinal feature in people with various chronic respiratory diseases, which is predominantly treated pharmacologically with additional smoking cessation if appropriate. Despite optimal medical treatment, many people with respiratory disease still experience daily physical, psychological and social limitations [1, 2]. As the degree of lung function impairment only partially explains these daily limitations, diagnostics and management must focus beyond biomedical and pharmacological approaches. Therefore, the role of allied respiratory professionals is essential within comprehensive disease manage...
Source: European Respiratory Journal - September 17, 2020 Category: Respiratory Medicine Authors: von Leupoldt, A., Brighton, L. J., Peters, J., Volpato, E., Verkleij, M., Hutchinson, A., Heijmans, M., Farver-Vestergaard, I., Langer, D., Spruit, M. A., on behalf of the ERS Scientific Working Group 09.04 Tags: Editorials Source Type: research

Socioeconomic correlates of SARS-CoV-2 and influenza H1N1 outbreaks
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak has disrupted social and economic life over large parts of the world [1]. The countermeasures designed and enforced by organisations and governments in order to contain the pandemic have had debated impact on its spread, but especially on societal structure and economic output [2]. In a fashion only precedented by war, an infectious pandemic challenges vulnerabilities of our societal structure, economic activity and healthcare [3]. While the battle for the discovery of the disease's origins, pathogenesis and cure is ongoing, a deeper understanding of...
Source: European Respiratory Journal - September 17, 2020 Category: Respiratory Medicine Authors: Kaiser, J. C., Stathopoulos, G. T. Tags: Original Articles: Research letters Source Type: research

Effects of downhill walking in pulmonary rehabilitation for patients with COPD: a randomised controlled trial
This study compared the effect of pulmonary rehabilitation (PR) comprising downhill walking training (DT) to PR comprising level walking (conventional training (CT)) in patients with COPD. In this randomised controlled trial, 35 patients (62±8 years; forced expiratory volume in 1 s (FEV1) 50±17% predicted) were randomised to DT or CT. Exercise tolerance (6-minute walk test distance (6MWD); primary outcome), muscle function, symptoms, quality-of-life and physical activity levels were assessed before and after PR. Absolute training changes and the proportion of patients exceeding the 30 m 6MWD minimal...
Source: European Respiratory Journal - September 17, 2020 Category: Respiratory Medicine Authors: Camillo, C. A., Osadnik, C. R., Burtin, C., Everaerts, S., Hornikx, M., Demeyer, H., Loeckx, M., Rodrigues, F. M., Maes, K., Gayan-Ramirez, G., Janssens, W., Troosters, T. Tags: COPD and smoking Original Articles: COPD and rehabilitation Source Type: research

The risk of multidrug- or rifampicin-resistance in males versus females with tuberculosis
Males are at an increased risk of tuberculosis (TB) disease compared to females. Additionally, several risk factors for multidrug-resistant (MDR) or rifampicin-resistant (RR) TB disease are more common in males, hence male TB patients may have a higher relative risk of MDR/RR-TB than female TB patients. We used sex-disaggregated data of TB patients reported to the World Health Organization for 106 countries to calculate male-to-female (M:F) risk ratios of having MDR/RR-TB. There was no evidence of either sex being more at risk of MDR/RR-TB in 81% (86 out of 106) of countries, with an overall random-effects weighted M:F ris...
Source: European Respiratory Journal - September 17, 2020 Category: Respiratory Medicine Authors: McQuaid, C. F., Horton, K. C., Dean, A. S., Knight, G. M., White, R. G. Tags: Respiratory infections and tuberculosis Original Articles: Tuberculosis Source Type: research

Ventilatory demand-capacity imbalance during incremental exercise in COPD: an in silico perspective
Exercise intolerance constitutes a key patient-oriented outcome in COPD [1]. There is mounting evidence that the so-called "ventilatory inefficiency" (as established by the linear minute ventilation (V'E) to carbon dioxide output (V'CO2) relationship during incremental cardiopulmonary exercise testing (CPET)) [2] has an important role in setting the limits of exercise tolerance in this disease [3]. The rationale is straightforward: the faster V'E increases (i.e. the steeper the V'E–V'CO2 slope), and the higher its resting value (~y-intercept) [2], the sooner V'E is expected to reach a lower compared to a hi...
Source: European Respiratory Journal - September 17, 2020 Category: Respiratory Medicine Authors: Neder, J. A. Tags: Original Articles: Research letters Source Type: research

Iron bioavailability and cardiopulmonary function during ascent to very high altitude
More than one hundred million people reside worldwide at altitudes in excess of 2500 m above sea level. In the millions more who sojourn at high altitude for recreational, occupational or military pursuits, hypobaric hypoxia drives physiological changes affecting the pulmonary circulation, haematocrit and right ventricle (RV) [1]. Coincident with these, maximal left ventricular (LV) stroke volume (SV) falls [2], with a reduction of 20% reported after a 2-week stay at 4300 m [3]. A rise in heart rate (HR) compensates at rest and during submaximal exercise but is insufficient during maximal intensity exercise, cons...
Source: European Respiratory Journal - September 17, 2020 Category: Respiratory Medicine Authors: Holdsworth, D. A., Frise, M. C., Bakker-Dyos, J., Boos, C., Dorrington, K. L., Woods, D., Mellor, A., Robbins, P. A. Tags: Original Articles: Research letters Source Type: research

Normal spirometry predictive values for the Western Indian adult population
Interpretation of spirometry involves comparing lung function parameters with predicted values to determine the presence/severity of the disease. The Global Lung Function Initiative (GLI) derived reference equations for healthy individuals aged 3–95 years from multiple populations but highlighted India as a "particular group" for whom further data are needed. We aimed to derive predictive equations for spirometry in a rural Western Indian adult population. We used spirometry data previously collected (2008–2012) from 1258 healthy adults (aged 18 years and over) by the Vadu Health and Demogra...
Source: European Respiratory Journal - September 17, 2020 Category: Respiratory Medicine Authors: Agarwal, D., Parker, R. A., Pinnock, H., Roy, S., Ghorpade, D., Salvi, S., Khatavkar, P., Juvekar, S., for the RESPIRE collaboration Tags: Lung structure and function Original Articles: Lung structure and function Source Type: research

Reply to "COVID-19 prediction models should adhere to methodological and reporting standards"
We would like to thank G.S. Collins, M. van Smeden, and R.D. Riley for their commentary on the design, analysis, and reporting of our article [1]. However, their comments seem to stem from a traditional biostatistics angle rather than from a translational research machine-learning approach and the overwhelming majority of criticisms arise from either misunderstandings or misreading. (Source: European Respiratory Journal)
Source: European Respiratory Journal - September 10, 2020 Category: Respiratory Medicine Authors: Wu, G., Woodruff, H. C., Chatterjee, A., Lambin, P. Tags: Original Articles: Correspondence Source Type: research

Carriers of a single CFTR mutation are asymptomatic: an evolving dogma?
Cystic fibrosis (CF) is a genetic autosomal recessive disease due to mutations in the gene encoding for the cystic fibrosis transmembrane conductance regulator (CFTR) protein [1, 2]. Mutations in the CFTR gene may cause a reduction of CFTR protein function, leading to abnormal chloride and bicarbonate transport in epithelia, resulting in abnormal mucus properties and a multiorgan disease dominated by respiratory and gastro-intestinal abnormalities [3]. The level of CFTR protein function is an important determinant of disease in humans and CF patients carrying two disease-causing CFTR mutations usually have very low levels ...
Source: European Respiratory Journal - September 10, 2020 Category: Respiratory Medicine Authors: Martin, C., Burgel, P.-R. Tags: Editorials Source Type: research

COVID-19 prediction models should adhere to methodological and reporting standards
The coronavirus disease 2019 (COVID-19) pandemic has led to a proliferation of clinical prediction models to aid diagnosis, disease severity assessment and prognosis. A systematic review has identified 66 COVID-19 prediction models: concluding that all, with no exception, are at high risk of bias due to concerns surrounding the data quality, statistical analysis and reporting, and none are recommended for use [1]. Therefore, we read with interest the recent paper by Wu et al. [2] describing the development of a model to identify COVID-19 patients with severe disease on admission to facilitate triage. However, our enthusias...
Source: European Respiratory Journal - September 10, 2020 Category: Respiratory Medicine Authors: Collins, G. S., van Smeden, M., Riley, R. D. Tags: Original Articles: Correspondence Source Type: research

Rationale and significance of patient selection in awake prone positioning for COVID-19 pneumonia
We thank C.F. Huang and co-workers for the points raised regarding our published paper entitled "Awake prone positioning for non-intubated oxygen dependent COVID-19 pneumonia patients" [1]. (Source: European Respiratory Journal)
Source: European Respiratory Journal - September 10, 2020 Category: Respiratory Medicine Authors: Ng, Z., Tay, W. C., Ho, C. H. B. Tags: Original Articles: Correspondence Source Type: research

Rationale and significance of patient selection in awake prone positioning for COVID-19 pneumonia
We read with interest the research letter by Ng et al. [1], which described their experience in prone positioning (PP) for awake patients with coronavirus disease 2019 (COVID-19) pneumonia, and concluded that this manoeuvre could delay or reduce the need for intensive care. We agree that the authors demonstrated safety and feasibility of PP in COVID-19 pneumonia patients. However, we humbly suggest a few crucial points be addressed before drawing conclusions on the efficacy of PP. (Source: European Respiratory Journal)
Source: European Respiratory Journal - September 10, 2020 Category: Respiratory Medicine Authors: Huang, C.-F., Tay, C. K., Zhuang, Y.-F., Liu, J., Sewa, D. W. Tags: Original Articles: Correspondence Source Type: research

Comparison of severity scores for COVID-19 patients with pneumonia: a retrospective study
Rapidly progressing hypoxemia and acute respiratory distress syndrome were commonly observed in patients with severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) viral pneumonia [1]. Although several severity scores including Pneumonia Severity Index (PSI) [2], CURB-65 and CRB-65 (confusion, (urea>7 mmol·L–1), respiratory rate ≥30 breaths·min–1, blood pressure
Source: European Respiratory Journal - September 10, 2020 Category: Respiratory Medicine Authors: Fan, G., Tu, C., Zhou, F., Liu, Z., Wang, Y., Song, B., Gu, X., Wang, Y., Wei, Y., Li, H., Wu, X., Xu, J., Tu, S., Zhang, Y., Wu, W., Cao, B. Tags: Original Articles: Research letters Source Type: research

Oscillometry: old physiology with a bright future
Taking an ancient notion from Roman and Medieval authors [1], Isaac Newton wrote to Robert Hooke: ‘if I have seen further, it is by standing on the shoulders of giants’ [2]. This reasoning feels particularly true in the field of respiratory physiology. In 1956, Arthur DuBois helped describe a new method of measuring the lung volume of a person in a sealed chamber by measuring the pressure changes at the mouth and within the container [3]. Body plethysmography was born and is now used across the world in the diagnosis and management of many respiratory conditions. In the same year, DuBois and colleagues analysed...
Source: European Respiratory Journal - September 10, 2020 Category: Respiratory Medicine Authors: Calverley, P. M. A., Farre, R. Tags: Editorials Source Type: research

SMART and as-needed therapies in mild-to-severe asthma: a network meta-analysis
To date, there are no network meta-analyses comparing the impact of as-needed treatments in asthma, including the single maintenance and reliever therapy (known as "SMART" or "MART"; for simplicity, SMART will be used hereafter) and the use of inhaled corticosteroid (ICS)/long-acting β2-agonist (LABA) combination exclusively on an as-needed basis. Therefore, we performed a systematic review and network meta-analysis concerning the efficacy and safety of SMART and as-needed therapies in asthma. Data from 32 096 asthmatic patients were extracted from 21 studies, lasting from 6 to 12 months. In a...
Source: European Respiratory Journal - September 10, 2020 Category: Respiratory Medicine Authors: Rogliani, P., Ritondo, B. L., Ora, J., Cazzola, M., Calzetta, L. Tags: Asthma and allergy Original Articles: Asthma Source Type: research

Morbidity and mortality in carriers of the cystic fibrosis mutation CFTR Phe508del in the general population
Cystic fibrosis (CF) is caused by autosomal-recessive inheritance of a dysfunctional cystic fibrosis transmembrane conductance regulator (CFTR), up to 90% due to Phe508del mutation in the CFTR gene. We tested the hypothesis that CFTR Phe508del carriers have increased morbidity and mortality versus non-carriers in the general population. We genotyped 108 035 randomly selected white Danish individuals from the Copenhagen General Population Study (aged from 20–100 years) for CFTR Phe508del mutation (rs113993960). Risk of chronic bronchitis and airflow limitation was assessed cross-sectionally. Overall survival and ...
Source: European Respiratory Journal - September 10, 2020 Category: Respiratory Medicine Authors: Colak, Y., Nordestgaard, B. G., Afzal, S. Tags: CF and non-CF bronchiectasis Original Articles: Cystic fibrosis Source Type: research

Autotitrating external positive end-expiratory airway pressure to abolish expiratory flow limitation during tidal breathing in patients with severe COPD: a physiological study
Background The optimal noninvasive application of external positive end-expiratory pressure (EPAP) to abolish tidal-breathing expiratory flow limitation (EFLT) and minimise intrinsic positive end-expiratory pressure (PEEPi) is challenging in COPD patients. We investigated whether auto-titrating EPAP, using the forced oscillation technique (FOT) to detect and abolish EFLT, would minimise PEEPi, work of breathing and neural respiratory drive (NRD) in patients with severe COPD. Methods Patients with COPD with chronic respiratory failure underwent auto-titration of EPAP using a FOT-based algorithm that detected EFLT. Once opt...
Source: European Respiratory Journal - September 10, 2020 Category: Respiratory Medicine Authors: Suh, E.-S., Pompilio, P., Mandal, S., Hill, P., Kaltsakas, G., Murphy, P. B., Romano, R., Moxham, J., Dellaca, R., Hart, N. Tags: COPD and smoking Original Articles: COPD Source Type: research

Circulating RNA differences between patients with stable and progressive idiopathic pulmonary fibrosis
Idiopathic pulmonary fibrosis (IPF) is a chronic disease characterised by progressive decline in pulmonary function. The rate of decline can vary, with some patients remaining stable over longer periods of time and others rapidly progressing [1]. The variable progression of this disease makes it difficult to elucidate pathogenic pathways involved in the initiation and progression of IPF. Advances in high-throughput gene-expression analyses have led to improvements in our understanding of disease biology and prognostic gene signatures. We hypothesise that IPF has a unique circulatory transcriptional profile compared to heal...
Source: European Respiratory Journal - September 10, 2020 Category: Respiratory Medicine Authors: Clynick, B., Jo, H. E., Corte, T. J., Glaspole, I. N., Grainge, C., Hopkins, P. M. A., Reynolds, P. N., Chapman, S., Walters, E. H., Zappala, C., Keir, G. J., Cooper, W. A., Mahar, A. M., Ellis, S., Goh, N. S., Baltic, S., Ryan, M., Tan, D. B. A., Moodley Tags: Original Articles: Research letters Source Type: research

The impact of different antibiotic treatment regimens on mortality in Mycobacterium avium complex pulmonary disease: a population-based cohort study
Evidence-based guidelines recommend the combination of macrolide–ethambutol–rifamycin as first-line treatment for Mycobacterium avium complex pulmonary disease (MAC-PD) [1]. Whether this regimen results in improved survival is unknown. (Source: European Respiratory Journal)
Source: European Respiratory Journal - September 10, 2020 Category: Respiratory Medicine Authors: Brode, S. K., Chung, H., Campitelli, M. A., Kwong, J. C., Sutradhar, R., Marchand-Austin, A., Winthrop, K. L., Jamieson, F. B., Marras, T. K. Tags: Original Articles: Research letters Source Type: research

Day-to-day variability of forced oscillatory mechanics for early detection of acute exacerbations in COPD
Conclusions SDXinsp from FOT telemonitoring reflects COPD symptoms and may be a sensitive biomarker for early detection of AECOPD. (Source: European Respiratory Journal)
Source: European Respiratory Journal - September 10, 2020 Category: Respiratory Medicine Authors: Zimmermann, S. C., Huvanandana, J., Nguyen, C. D., Bertolin, A., Watts, J. C., Gobbi, A., Farah, C. S., Peters, M. J., Dellaca, R. L., King, G. G., Thamrin, C. Tags: COPD and smoking Original Articles: COPD Source Type: research

Celebrating the ERS HERMES Self-Assessment Course
The European Respiratory Society (ERS) HERMES self-assessment course is celebrating its third year in 2020. Although it has a longer history, the course in its current format was launched in 2017 and has provided quality assessment to over 500 respiratory specialists around the world (table 1 shows a list of locations). Between 2018 and 2019, the number of courses delivered doubled and the first paediatric self-assessment course was offered in 2019. The ERS HERMES self-assessment course continues to grow in both its popularity and geographical reach. (Source: European Respiratory Journal)
Source: European Respiratory Journal - September 3, 2020 Category: Respiratory Medicine Authors: Primhak, R., Tumova, Z., Auer, A., Stolz, D. Tags: Editorials Source Type: research

COVID-19: guidance on palliative care from a European Respiratory Society international task force
Conclusion This multi-national task force provides consensus recommendations for palliative care for patients with COVID-19 concerning: advance care planning; (pharmacological) palliative treatment of breathlessness; clinician–patient communication; remote clinician–family communication; palliative care involvement in patients with serious COVID-19; spiritual care; psychosocial care; and bereavement care. Future studies are needed to generate empirical evidence for these recommendations. (Source: European Respiratory Journal)
Source: European Respiratory Journal - September 3, 2020 Category: Respiratory Medicine Authors: Janssen, D. J. A., Ekström, M., Currow, D. C., Johnson, M. J., Maddocks, M., Simonds, A. K., Tonia, T., Marsaa, K. Tags: Respiratory infections and tuberculosis Task Force Report Source Type: research

Intermittent regimens for tuberculosis treatment: Back to the Future?
Despite all efforts to accelerate the response against tuberculosis (TB), many countries are struggling to achieve the milestones of the End TB strategy [1]. The investment required in a strong healthcare system to combat TB is significant. Lack of a short and highly active sterilising TB treatment regimen is the main reason for treatment failure and emergence of drug resistance [2]. With increasing drug resistance, the treatment becomes longer and more difficult to manage due to use of more toxic and less active drugs. Although treatment management is focused on prevention of adverse drug reactions, most patients will exp...
Source: European Respiratory Journal - September 3, 2020 Category: Respiratory Medicine Authors: Alffenaar, J.-W. C., Tiberi, S., Cirillo, D. M., Migliori, G. B. Tags: Editorials Source Type: research

Sarcoidosis in a time of pandemic
We are living in a historic event: a novel virus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), emerged in Wuhan, China at the end of 2019 and began its global circulation. By January 24, 2020, at least 830 cases and 26 fatalities were reported across Asia and the USA [1]. 6 months later, there are more than 8 million confirmed cases of the disease associated with SARS-CoV-2, coronavirus disease 2019 (COVID-19), and over 430 000 reported deaths worldwide [2]. The pandemic has exposed cracks in healthcare systems throughout the world and identified populations vulnerable for severe disease and poorer outcome...
Source: European Respiratory Journal - September 3, 2020 Category: Respiratory Medicine Authors: Govender, P., Cozier, Y. C. Tags: Editorials Source Type: research

Blood eosinophils do not predict inhaled budesonide response in bronchiectasis
We would like to thank B. Lipworth and co-workers for their feedback on our study, which showed that 6-month treatment with inhaled fluticasone proprionate (FP) significantly improved quality of life in bronchiectasis patients with neither asthma nor COPD, and with blood eosinophil counts either ≥3% or≥150 cells·μL–1 [1, 2]. We agree with B. Lipworth and co-workers on the higher dose-dependent suppression of blood eosinophils due to the systemic absorption of FP. We re-analysed previously published data on bronchiectasis patients treated with budesonide, which has less systemic potency than FP [3...
Source: European Respiratory Journal - September 3, 2020 Category: Respiratory Medicine Authors: Aliberti, S., Sotgiu, G., Martinez Garcia, M.-A. Tags: Original Articles: Correspondence Source Type: research

Potential of regulatory T-cell-based therapies in the management of severe COVID-19
"Cytokine storm", inflammation-mediated severe lung damage and defective haemostasis are the main underlying reasons for morbidity and mortality in coronavirus disease 2019 (COVID-19) patients [1]. Several immunotherapies that target various inflammatory processes have been successfully used in COVID-19 patients and many other strategies are under evaluation [2, 3]. However, in view of dysregulated immune responses in severe COVID-19 patients, we suggest that CD4+CD25+FoxP3+ regulatory T-cell (Treg)-based strategies could be considered for patient management. (Source: European Respiratory Journal)
Source: European Respiratory Journal - September 3, 2020 Category: Respiratory Medicine Authors: Stephen-Victor, E., Das, M., Karnam, A., Pitard, B., Gautier, J.-F., Bayry, J. Tags: Original Articles: Correspondence Source Type: research

ECMO support for viral induced cardiogenic shock: a bridge too far?
The global coronavirus disease 2019 (COVID-19) pandemic has captured the world's conscious thought in a way not experienced in most of our lifetimes. In a world where Presidents conduct foreign policy by Twitter, we are not lacking information volume. In medicine, our version of the gold standard for truth is two well-conducted randomised controlled trials with concordant results. With the pandemic impacting health services so rapidly, decisions about treatment options may be required well ahead of this level of certainty. (Source: European Respiratory Journal)
Source: European Respiratory Journal - September 3, 2020 Category: Respiratory Medicine Authors: Williams, T. J., Pellegrino, V. Tags: Editorials Source Type: research

Systemic effects of fluticasone on blood eosinophils in bronchiectasis
We read with interest the observations of Aliberti et al. [1] showing that blood eosinophilia predicts the quality of life response to inhaled fluticasone propionate (FP) in bronchiectasis, apparently independently of concomitant asthma or COPD. Pointedly they only appeared to have measured blood eosinophils at baseline and not during treatment with FP. This is pertinent as FP produces dose-dependent suppression of blood eosinophils due to systemic absorption from the lung. Hence, 1 mg of inhaled fluticasone in asthma patients is systemically equivalent to 5.3 mg of oral prednisolone for blood eosinophil suppress...
Source: European Respiratory Journal - September 3, 2020 Category: Respiratory Medicine Authors: Lipworth, B., Chan, R., Kuo, C. R. Tags: Original Articles: Correspondence Source Type: research

Gene expression and in situ protein profiling of candidate SARS-CoV-2 receptors in human airway epithelial cells and lung tissue
We present confirmatory evidence for the presence of TMPRSS2, CD147 and GRP78 protein in vitro in airway epithelial cells and confirm broad in situ protein expression of CD147 and GRP78 in the respiratory mucosa. Collectively, our data suggest the presence of a mechanism dynamically regulating ACE2 expression in human lung, perhaps in periods of SARS-CoV-2 infection, and also suggest that alternative receptors for SARS-CoV-2 exist to facilitate initial host cell infection. (Source: European Respiratory Journal)
Source: European Respiratory Journal - September 3, 2020 Category: Respiratory Medicine Authors: Aguiar, J. A., Tremblay, B. J.-M., Mansfield, M. J., Woody, O., Lobb, B., Banerjee, A., Chandiramohan, A., Tiessen, N., Cao, Q., Dvorkin-Gheva, A., Revill, S., Miller, M. S., Carlsten, C., Organ, L., Joseph, C., John, A., Hanson, P., Austin, R. C., McManu Tags: Respiratory infections and tuberculosis Original Articles: Infectious disease Source Type: research

Mechanical circulatory support in refractory cardiogenic shock due to influenza virus-related myocarditis
Conclusion Despite initial stabilisation with combined MCS in patients with rCS-complicated influenza-related myocarditis, the detrimental course of shock could not be stopped and all patients died. Influenza virus infection potentially critically affects other organs besides the heart, leading to irreversible end-organ damage that MCS cannot compensate for and, therefore, results in a devastating outcome. (Source: European Respiratory Journal)
Source: European Respiratory Journal - September 3, 2020 Category: Respiratory Medicine Authors: Sieweke, J.-T., Akin, M., Stetskamp, S., Riehle, C., Jonigk, D., Flierl, U., Pfeffer, T. J., Hirsch, V., Dutzmann, J., Hoeper, M. M., Kühn, C., Bauersachs, J., Schäfer, A. Tags: Lung cancer Original Articles: Critical care Source Type: research

Risk of first and recurrent serious infection in sarcoidosis: a Swedish register-based cohort study
Serious infections impair quality of life and increase costs. Our aim was to determine if sarcoidosis is associated with a higher rate of serious infection and whether this varies by age, sex, time since diagnosis or treatment status around diagnosis. We compared individuals with sarcoidosis (at least two International Classification of Diseases codes in the Swedish National Patient Register 2003–2013; n=8737) and general population comparators matched 10:1 on age, sex and residential location (n=86 376). Patients diagnosed in 2006–2013 who were dispensed at least one immunosuppressant ±3 months fro...
Source: European Respiratory Journal - September 3, 2020 Category: Respiratory Medicine Authors: Rossides, M., Kullberg, S., Eklund, A., Di Giuseppe, D., Grunewald, J., Askling, J., Arkema, E. V. Tags: Original Articles: Sarcoidosis Source Type: research

Initial combination therapy of macitentan and tadalafil in pulmonary arterial hypertension
Initial combination therapy plays a central role in managing pulmonary arterial hypertension (PAH) [1–4]. Patients with low- or intermediate-risk of 1-year mortality at diagnosis should be treated with initial combination therapy with an endothelin receptor antagonist (ERA) and phosphodiesterase type-5 inhibitor (PDE5i) [2–4]. Benefits of initial therapy with the ERA ambrisentan and PDE5i tadalafil were demonstrated in AMBITION [1]; prospective evidence for other treatment combinations within these drug classes is needed. (Source: European Respiratory Journal)
Source: European Respiratory Journal - September 3, 2020 Category: Respiratory Medicine Authors: Sitbon, O., Cottin, V., Canuet, M., Clerson, P., Gressin, V., Perchenet, L., Bertoletti, L., Bouvaist, H., Picard, F., Prevot, G., Bergot, E., Simonneau, G. Tags: Original Articles: Research letters Source Type: research