Reply to: When adopting Global Lung Function Initiative reference values, can we also adapt them to a local context as needed?
We thank S. Verbanck and co-workers for their insightful response to the recent official European Respiratory Society technical standards for Global Lung Function Initiative (GLI) reference lung volumes [1]. The data presented highlight the real-world impact of using published equations and how equipment or protocol offsets can impact clinical interpretation. We generally agree with S. Verbanck and co-workers that more precise approaches are ideal, and that is the ultimate goal of the GLI Network. (Source: European Respiratory Journal)
Source: European Respiratory Journal - September 16, 2021 Category: Respiratory Medicine Authors: Stanojevic, S., Cooper, B., Filipow, N., Kirkby, J., Ruppel, G., Steenbruggen, I., Thompson, B., Hall, G. Tags: Original Articles: Correspondence Source Type: research

When adopting Global Lung Function Initiative reference values, can we also adapt them to a local context as needed?
We have read with interest the official European Respiratory Society technical standards for Global Lung Function Initiative (GLI) reference lung volumes [1], and we welcome the user-friendly online computation module that facilitates translation of spirometry, transfer factor and lung volume variables into % predicted and z-scores [2]. The latter allows lung function researchers to stay up-to-date with the latest normative values of variables that are being measured in the routine lung function lab, while awaiting upgrades of their laboratory equipment to the latest reference values for carbon monoxide transfer factor (25...
Source: European Respiratory Journal - September 16, 2021 Category: Respiratory Medicine Authors: Verbanck, S., Vanderhelst, E., Hanon, S. Tags: Original Articles: Correspondence Source Type: research

COVID-19 pneumothorax in the UK: a prospective observational study using the ISARIC WHO clinical characterisation protocol
Pneumothorax is an important complication of coronavirus disease 2019 (COVID-19) [1, 2]. Based on a series of 60 individuals, we previously estimated that 0.91% of people admitted to hospital with COVID-19 develop pneumothorax [1]. Males accounted for three quarters of those affected, and patients requiring noninvasive or invasive ventilatory support appeared at elevated risk. In a separate series of ventilated patients with COVID-19, barotrauma, defined as pneumothorax or pneumomediastinum, was found to be an independent risk for death [2]. During the pandemic, treatment strategies have evolved, influenced by large random...
Source: European Respiratory Journal - September 16, 2021 Category: Respiratory Medicine Authors: Marciniak, S. J., Farrell, J., Rostron, A., Smith, I., Openshaw, P. J. M., Baillie, J. K., Docherty, A., Semple, M. G. Tags: Original Articles: Research letters Source Type: research

Outbreak of pre- and extensively drug-resistant tuberculosis in northern Italy: urgency of cross-border, multidimensional, surveillance systems
Multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB) are a major public health threat because of reduced treatment options and poor patient outcomes. New antimicrobials and regimens have been developed in recent years, but their effectiveness has been hampered by the rise and spread of drug-resistant strains. Whole genome sequencing (WGS) has emerged as a tool able to revolutionise TB surveillance and the clinical management of TB. This approach is now widely used by public health agencies in detecting outbreaks and transmission chains, thus supporting the formulation of evidence-based health po...
Source: European Respiratory Journal - September 16, 2021 Category: Respiratory Medicine Authors: Villa, S., Tagliani, E., Borroni, E., Castellotti, P. F., Ferrarese, M., Ghodousi, A., Lamberti, A., Senatore, S., Faccini, M., Cirillo, D. M., Codecasa, L. R. Tags: Original Articles: Research letters Source Type: research

COVID-19 pneumonia and the pulmonary vasculature: a marriage made in hell
Automated analysis of medical images is not new [1–3]. Researchers in the respiratory sciences and, particularly, the field of interstitial lung diseases, have long enthused about the potential for computers to analyse medical images thereby revealing "signals" hitherto invisible to the human eye: an enthusiasm only enhanced by recent developments in machine learning and artificial intelligence [4–6]. By leveraging the central importance of computed tomography (CT) scanning for diagnosis, treatment decisions and prognostication, a key aim is to identify imaging biomarkers to more accurately phenotype ...
Source: European Respiratory Journal - September 16, 2021 Category: Respiratory Medicine Authors: George, P. M., Desai, S. R. Tags: Editorials Source Type: research

"You can leave your mask on": effects on cardiopulmonary parameters of different airway protective masks at rest and during maximal exercise
During the COVID-19 pandemic, the use of protective masks has been essential to reduce contagions. However, public opinion is that there is an associated subjective shortness of breath. We evaluated cardiorespiratory parameters at rest and during maximal exertion to highlight any differences with the use of protective masks. 12 healthy subjects performed three identical cardiopulmonary exercise tests, one without wearing a protective mask, one wearing a surgical mask and one with a filtering face piece particles class 2 (FFP2) mask. Dyspnoea was assessed using the Borg scale. Standard pulmonary function tests were also per...
Source: European Respiratory Journal - September 16, 2021 Category: Respiratory Medicine Authors: Mapelli, M., Salvioni, E., De Martino, F., Mattavelli, I., Gugliandolo, P., Vignati, C., Farina, S., Palermo, P., Campodonico, J., Maragna, R., Lo Russo, G., Bonomi, A., Sciomer, S., Agostoni, P. Tags: Respiratory clinical practice, Respiratory infections and tuberculosis Original Articles: Pulmonary infection Source Type: research

Altered pulmonary blood volume distribution as a biomarker for predicting outcomes in COVID-19 disease
Conclusions The data suggest BV5% as a novel biomarker for predicting adverse outcomes in patients with COVID-19 seeking acute medical care. (Source: European Respiratory Journal)
Source: European Respiratory Journal - September 16, 2021 Category: Respiratory Medicine Authors: Morris, M. F., Pershad, Y., Kang, P., Ridenour, L., Lavon, B., Lanclus, M., Godon, R., De Backer, J., Glassberg, M. K. Tags: Lung imaging, Respiratory infections and tuberculosis Original Articles: Infection and imaging Source Type: research

Medium-term impact of COVID-19 on pulmonary function, functional capacity and quality of life
Background Coronavirus disease 2019 (COVID-19) has spread worldwide, having a dramatic impact on healthcare systems. The aim of this study is to evaluate mid-term clinical impact of COVID-19 on respiratory function. Methods 379 patients were evaluated 4 months after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diagnosis. Patients were divided in two groups based on the presence of pneumonia during COVID-19. Clinical conditions, quality of life, symptomatology, 6-min walk test, pulmonary function test with spirometry and diffusing capacity of the lung for carbon monoxide were analysed. Data were compar...
Source: European Respiratory Journal - September 16, 2021 Category: Respiratory Medicine Authors: Anastasio, F., Barbuto, S., Scarnecchia, E., Cosma, P., Fugagnoli, A., Rossi, G., Parravicini, M., Parravicini, P. Tags: Respiratory infections and tuberculosis Original Articles: Pulmonary infection Source Type: research

The role of cigarette smoking-derived pollutants in the risk of mortality in idiopathic pulmonary fibrosis
We thank T. Yasuma and co-workers for their valuable comments on our paper describing the association between individual-level long-term concentrations of air pollutants at the residential addresses of patients with idiopathic pulmonary fibrosis (IPF) and mortality among them [1]. We agree that the release of nitrogen dioxide (NO2) or particulate matter in cigarette smoke is one of the considerations in interpreting our results. Thus, we stratified all patients into ever- and non-smokers according to their smoking status and analysed the effect of air pollutants on mortality risk in these patients using our health analysis...
Source: European Respiratory Journal - September 9, 2021 Category: Respiratory Medicine Authors: Yoon, H.-Y., Kim, S.-Y., Kim, O.-J., Song, J. W. Tags: Original Articles: Correspondence Source Type: research

The role of cigarette smoking-derived pollutants in the risk of mortality in idiopathic pulmonary fibrosis
We read with great interest the work reported by Yoon et al. [1]. The authors found that a high concentration of nitrogen dioxide at an individual's residential address is significantly associated with increased mortality in idiopathic pulmonary fibrosis (IPF) patients when all confounders are included in the health analysis model. However, an important question that remains unclear in the study is whether active or passive cigarette smoking-associated release of nitrogen dioxide or particulate matter plays a role in the clinical outcome of IPF patients. (Source: European Respiratory Journal)
Source: European Respiratory Journal - September 9, 2021 Category: Respiratory Medicine Authors: Yasuma, T., D'Alessandro-Gabazza, C. N., Hataji, O., Kobayashi, T., Gabazza, E. C. Tags: Original Articles: Correspondence Source Type: research

Acute respiratory distress syndrome is associated with impaired alveolar macrophage efferocytosis
Acute respiratory distress syndrome (ARDS) is an inflammatory disorder of the lungs, with sepsis as the predominant aetiology. Despite advances in ventilation strategies, mortality for moderate to severe ARDS remains at 40–46% [1]. ARDS is associated with neutrophil influx into alveoli. Persistently high neutrophil and low alveolar macrophage (AM) numbers in bronchoalveolar lavage (BAL) fluid are associated with greater mortality [2]. While the inflammatory alveolar environment of early ARDS initially delays apoptosis, these neutrophils ultimately undergo apoptosis within alveoli [3]. Efficient efferocytosis of apopt...
Source: European Respiratory Journal - September 9, 2021 Category: Respiratory Medicine Authors: Mahida, R. Y., Scott, A., Parekh, D., Lugg, S. T., Hardy, R. S., Lavery, G. G., Matthay, M. A., Naidu, B., Perkins, G. D., Thickett, D. R. Tags: Original Articles: Research letters Source Type: research

Between inflammation and thrombosis: endothelial cells in COVID-19
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is causing the current coronavirus disease (COVID-19) pandemic [1]. Over recent months, a plethora of novel research articles has been published, dealing with multiple aspects and manifestations of the disease. Increasing evidence points to a central role of endothelial cells in SARS-CoV-2 infection [2–5]. Early studies have already indicated increased expression of vascular and inflammatory factors (such as vascular cell adhesion molecule (VCAM)-1, interleukin (IL)-8 or monocyte-chemoattractant protein (MCP)-1) in COVID-19 lung tissue [2]. Such markers of ...
Source: European Respiratory Journal - September 9, 2021 Category: Respiratory Medicine Authors: Birnhuber, A., Fliesser, E., Gorkiewicz, G., Zacharias, M., Seeliger, B., David, S., Welte, T., Schmidt, J., Olschewski, H., Wygrecka, M., Kwapiszewska, G. Tags: Original Articles: Research letters Source Type: research

Bronchodilator response in FOT parameters in middle-aged adults from SCAPIS: normal values and relationship to asthma and wheezing
Forced oscillation technique (FOT) is a measure of respiratory impedance first described by DuBois more than 60 years ago [1]. Respiratory impedance (Zrs) can be calculated by superimposing sound waves on normal tidal breathing without special breathing manoeuvres. (Source: European Respiratory Journal)
Source: European Respiratory Journal - September 9, 2021 Category: Respiratory Medicine Authors: Johansson, H., Wollmer, P., Sundström, J., Janson, C., Malinovschi, A. Tags: Original Articles: Research letters Source Type: research

When things go wrong: exploring possible mechanisms driving the progressive fibrosis phenotype in interstitial lung diseases
Interstitial lung diseases (ILDs) comprise a large and heterogeneous group of disorders of known and unknown aetiology characterised by diffuse damage of the lung parenchyma. In recent years it has become evident that patients with different types of ILD are at risk of developing progressive pulmonary fibrosis, known as progressive fibrosing ILD (PF-ILD). This is a phenotype that behaves similar to idiopathic pulmonary fibrosis, the archetypical example of progressive fibrosis. PF-ILD is not a distinct clinical entity but describes a group of ILDs with similar clinical behaviour. This phenotype may occur in diseases displa...
Source: European Respiratory Journal - September 9, 2021 Category: Respiratory Medicine Authors: Selman, M., Pardo, A. Tags: Reviews Source Type: research

Point-of-care lung ultrasound assessment for risk stratification and therapy guiding in COVID-19 patients: a prospective noninterventional study
Conclusions LUZ-score is an easy, simple and fast point-of-care ultrasound tool to identify patients with severe lung injury due to COVID-19, upon admission. Baseline score is predictive of severity along the whole period of hospitalisation. The score facilitates early implementation or intensification of treatment for COVID-19 infection. LUZ-score may be combined with clinical variables (as estimated by PAFI) to further refine risk stratification. (Source: European Respiratory Journal)
Source: European Respiratory Journal - September 9, 2021 Category: Respiratory Medicine Authors: Rubio-Gracia, J., Gimenez-Lopez, I., Garces-Horna, V., Lopez-Delgado, D., Sierra-Monzon, J. L., Martinez-Lostao, L., Josa-Laorden, C., Ruiz-Laiglesia, F., Perez-Calvo, J. I., Crespo-Aznarez, S., Garcia-Lafuente, J., Pena Fresneda, N., Amores Arriaga, B., Tags: Lung imaging, Respiratory infections and tuberculosis Original Articles: Infection and imaging Source Type: research

Chest radiography or computed tomography for COVID-19 pneumonia? Comparative study in a simulated triage setting
Introduction For the management of patients referred to respiratory triage during the early stages of the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) pandemic, either chest radiography or computed tomography (CT) were used as first-line diagnostic tools. The aim of this study was to compare the impact on the triage, diagnosis and prognosis of patients with suspected COVID-19 when clinical decisions are derived from reconstructed chest radiography or from CT. Methods We reconstructed chest radiographs from high-resolution CT (HRCT) scans. Five clinical observers independently reviewed clinical charts ...
Source: European Respiratory Journal - September 9, 2021 Category: Respiratory Medicine Authors: Sverzellati, N., Ryerson, C. J., Milanese, G., Renzoni, E. A., Volpi, A., Spagnolo, P., Bonella, F., Comelli, I., Affanni, P., Veronesi, L., Manna, C., Ciuni, A., Sartorio, C., Tringali, G., Silva, M., Michieletti, E., Colombi, D., Wells, A. U. Tags: Lung imaging, Respiratory infections and tuberculosis Original Articles: Infection and imaging Source Type: research

Lung function and cardiovascular disease: a two-sample Mendelian randomisation study
Conclusion There is strong evidence that reduced FVC is independently and causally associated with coronary artery disease. Although the mechanism remains unclear, FVC could be taken into consideration when assessing cardiovascular risk and considered a potential target for reducing cardiovascular events. FEV1 and airflow obstruction do not appear to cause increased cardiovascular events; confounding and collider bias may explain previous findings of a causal association. (Source: European Respiratory Journal)
Source: European Respiratory Journal - September 9, 2021 Category: Respiratory Medicine Authors: Higbee, D. H., Granell, R., Sanderson, E., Davey Smith, G., Dodd, J. W. Tags: Genetics Original Articles: Genetics Source Type: research

Omega-3 polyunsaturated fatty acids and FADS genotype: is personalised prevention of asthma on the horizon?
Asthma is the most common chronic illness diagnosed in children. Despite the relatively steady trends in incidence observed in developed countries over the past 10 years [1], asthma remains one of the most frequent causes of hospital admissions in children, representing a major societal and public health concern [2]. The extensive body of epidemiological evidence examining the causes of asthma shows that this is a complex multifactorial disorder, with a combination of genetic, environmental and lifestyle-related factors involved in its causal pathway. (Source: European Respiratory Journal)
Source: European Respiratory Journal - September 2, 2021 Category: Respiratory Medicine Authors: Garcia-Larsen, V. Tags: Editorials Source Type: research

Protective face masks add significant dead space
Lately, protective face masks have become part of everyday life and many patients and healthcare workers complain of reduced well-being and performance due to the permanent wearing of such masks. Reportedly, the main symptoms are headaches and difficult breathing, especially in combination with stress and physical exertion [1–3]. It is suspected that protective masks impede oxygen supply to the lungs and increase carbon dioxide rebreathing [4]. Theoretical estimations suggest that indeed the dead space increases for mask wearers [5] and this would translate into increased arterial CO2 levels with concomitant increase...
Source: European Respiratory Journal - September 2, 2021 Category: Respiratory Medicine Authors: Elbl, C., Brunner, J. X., Schier, D., Junge, A., Junge, H. Tags: Original Articles: Research letters Source Type: research

Dyspnoea upon hospital admission: listen to the bird of ill omen!
Dyspnoea, namely a patient's complaint of difficult, disturbing or distressing breathing, is a symptom that prompts physicians to undertake diagnostic and therapeutic procedures in order to identify and correct causative pathophysiological abnormalities. Dyspnoea can become self-perpetuating (a syndrome) when it persists despite mechanistic treatments. It then justifies symptomatic management to alleviate suffering [1, 2]. Above all, dyspnoea is an experience that changes patients’ lives and requires holistic approaches [3]. In this issue of the European Respiratory Journal, Stevens et al. [4], from a group that has ...
Source: European Respiratory Journal - September 2, 2021 Category: Respiratory Medicine Authors: Decavele, M., Similowski, T. Tags: Editorials Source Type: research

Mycobacterium tuberculosis borderline rpoB mutations: emerging from the unknown
Rifampicin drives the efficacy of the current first-line treatment regimen for tuberculosis (TB) [1]. Mutations in the rpoB gene cause rifampicin resistance (RR) of varying levels. Common mutations typically confer high-level, "high-confidence" resistance, providing a selective advantage to Mycobacterium tuberculosis during treatment at low fitness cost [2]. Growth-based phenotypic drug-susceptibility testing (pDST) is very reliable for high-confidence mutations. Mutations conferring low-level resistance at high fitness cost are easily lost during primary culture or will cause phenotypically false-susceptible res...
Source: European Respiratory Journal - September 2, 2021 Category: Respiratory Medicine Authors: Van Deun, A., Decroo, T., Aung, K. J. M., Hossain, M. A., Gumusboga, M., De Rijk, W. B., Tahseen, S., de Jong, B. C., Rigouts, L. Tags: Original Articles: Research letters Source Type: research

Considerations of a real life pragmatic clinical trial in adolescent asthma
We appreciate the interest shown by J.F.M. van Boven and co-workers in our study. PACT [1] was first and foremost designed as a pragmatic randomised controlled trial (RCT) reflecting current UK primary care practice. While addition of controller treatment for those in the personalised care group with poor control was guided by the study algorithm, the decisions with respect to monotherapy versus combination therapy, inhaler type and use of a spacer was down to the discretion of the participant's primary care team. (Source: European Respiratory Journal)
Source: European Respiratory Journal - September 2, 2021 Category: Respiratory Medicine Authors: Ruffles, T., Lipworth, B., Mukhopadhyay, S., on behalf of the PACT study group Tags: Correspondence Source Type: research

When biology meets behaviour: can medication adherence mask the contribution of pharmacogenetic effects in asthma?
We read the study of Ruffles et al. [1] with great interest. The authors undertook one of the first randomised controlled trials (RCTs) assessing the potential benefit of personalised prescription of bronchodilators according to Arg16Gly beta-2 genotype in adolescent patients with asthma. Following a 1-month run-in with inhaled corticosteroid (ICS) monotherapy, the intervention group received a bronchodilator according to their genotype, where AA and AG genotypes received an oral leukotriene antagonist (LTRA), montelukast, and GG genotype received an inhaled long-acting β2-agonist (LABA), salmeterol. The control group...
Source: European Respiratory Journal - September 2, 2021 Category: Respiratory Medicine Authors: van Boven, J. F. M., Dierick, B. J. H., Usmani, O. S. Tags: Correspondence Source Type: research

Triple therapy in uncontrolled asthma: a network meta-analysis of phase III studies
Conflicting evidence is currently available concerning the impact on asthma exacerbation of triple inhaled corticosteroid (ICS)/long-acting β2-adrenoceptor agonist (LABA)/long-acting muscarinic receptor antagonist (LAMA) fixed-dose combination (FDC). Since meta-analyses allow settling controversies of apparently inconsistent results, we performed a network meta-analysis of phase III randomised controlled trials including 9535 patients to assess the effect of ICS/LABA/LAMA combinations in uncontrolled asthma. Triple combination therapies with an ICS administered at high dose (HD) were more effective (p
Source: European Respiratory Journal - September 2, 2021 Category: Respiratory Medicine Authors: Rogliani, P., Ritondo, B. L., Calzetta, L. Tags: Asthma and allergy Original Articles: Asthma Source Type: research

Endothelial cells in the pathogenesis of pulmonary arterial hypertension
Pulmonary arterial hypertension (PAH) is a devastating disease that involves pulmonary vasoconstriction, small vessel obliteration, large vessel thickening and obstruction, and development of plexiform lesions. PAH vasculopathy leads to progressive increases in pulmonary vascular resistance, right heart failure and, ultimately, premature death. Besides other cell types that are known to be involved in PAH pathogenesis (e.g. smooth muscle cells, fibroblasts and leukocytes), recent studies have demonstrated that endothelial cells (ECs) have a crucial role in the initiation and progression of PAH. The EC-specific role in PAH ...
Source: European Respiratory Journal - September 2, 2021 Category: Respiratory Medicine Authors: Evans, C. E., Cober, N. D., Dai, Z., Stewart, D. J., Zhao, Y.-Y. Tags: Reviews Source Type: research

Intake of n-3 polyunsaturated fatty acids in childhood, FADS genotype and incident asthma
Longitudinal evidence on the relation between dietary intake of n-3 (-3) very-long-chain polyunsaturated fatty acids, i.e. eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), in mid-childhood and asthma risk is scarce. We aimed to investigate whether a higher intake of EPA and DHA from fish in childhood is associated with a lower risk of incident asthma. In the Avon Longitudinal Study of Parents and Children, dietary intakes of EPA and DHA from fish were estimated by food frequency questionnaire at 7 years of age. We used logistic regression, controlling for confounders, to analyse associations between intake ...
Source: European Respiratory Journal - September 2, 2021 Category: Respiratory Medicine Authors: Talaei, M., Sdona, E., Calder, P. C., Jones, L. R., Emmett, P. M., Granell, R., Bergström, A., Melen, E., Shaheen, S. O. Tags: Asthma and allergy, Paediatric pulmonology Original Articles: Paediatrics and asthma Source Type: research

Prediction of anti-tuberculosis treatment duration based on a 22-gene transcriptomic model
Background The World Health Organization recommends standardised treatment durations for patients with tuberculosis (TB). We identified and validated a host-RNA signature as a biomarker for individualised therapy durations for patients with drug-susceptible (DS)- and multidrug-resistant (MDR)-TB. Methods Adult patients with pulmonary TB were prospectively enrolled into five independent cohorts in Germany and Romania. Clinical and microbiological data and whole blood for RNA transcriptomic analysis were collected at pre-defined time points throughout therapy. Treatment outcomes were ascertained by TBnet criteria (6-month c...
Source: European Respiratory Journal - September 2, 2021 Category: Respiratory Medicine Authors: Heyckendorf, J., Marwitz, S., Reimann, M., Avsar, K., DiNardo, A. R., Günther, G., Hoelscher, M., Ibraim, E., Kalsdorf, B., Kaufmann, S. H. E., Kontsevaya, I., van Leth, F., Mandalakas, A. M., Maurer, F. P., Müller, M., Nitschkowski, D., O Tags: Respiratory infections and tuberculosis Original Articles: Tuberculosis Source Type: research

Combining pulmonary and cardiac computed tomography biomarkers for disease-specific risk modelling in lung cancer screening
Conclusions CT measures of CVD and COPD provides small but reproducible improvements to nodule-based lung cancer risk prediction accuracy from 3 years onwards. Self-reported patient characteristics may not be of added predictive value when CT information is available. (Source: European Respiratory Journal)
Source: European Respiratory Journal - September 2, 2021 Category: Respiratory Medicine Authors: Schreuder, A., Jacobs, C., Lessmann, N., Broeders, M. J. M., Silva, M., Isgum, I., de Jong, P. A., Sverzellati, N., Prokop, M., Pastorino, U., Schaefer-Prokop, C. M., van Ginneken, B. Tags: Lung imaging, Lung cancer Original Articles: Cancer and imaging Source Type: research

Association of dyspnoea, mortality and resource use in hospitalised patients
As many as one in 10 patients experience dyspnoea at hospital admission but the relationship between dyspnoea and patient outcomes is unknown. We sought to determine whether dyspnoea on admission predicts outcomes. We conducted a retrospective cohort study in a single, academic medical centre. We analysed 67 362 consecutive hospital admissions with available data on dyspnoea, pain and outcomes. As part of the Initial Patient Assessment by nurses, patients rated "breathing discomfort" using a 0 to 10 scale (10="unbearable"). Patients reported dyspnoea at the time of admission and recalled dyspnoea experi...
Source: European Respiratory Journal - September 2, 2021 Category: Respiratory Medicine Authors: Stevens, J. P., Dechen, T., Schwartzstein, R. M., O'Donnell, C. R., Baker, K., Banzett, R. B. Tags: Respiratory clinical practice Original Articles: Breathlessness Source Type: research

Assessing pulmonary hypertension severity in lung disease is a key step to improving outcomes: embrace resistance and don't be pressurised to go with the flow
Managing patients with pulmonary hypertension (PH) in association with chronic lung disease and/or hypoxia (PH-CLD) remains one of the most challenging areas in pulmonary vascular medicine. Its presence in COPD and interstitial lung disease (ILD) impacts negatively on symptoms and survival [1, 2], predicts more frequent exacerbations [3] and has the worst prognosis of all forms of PH [4]. In contrast to treatment advances seen in other forms of PH, for the majority of patients with PH-CLD, treatment remains aimed at the underlying lung disease, including lung transplantation in suitable patients. One of the major challenge...
Source: European Respiratory Journal - August 26, 2021 Category: Respiratory Medicine Authors: Kiely, D. G., Condliffe, R. Tags: Editorials Source Type: research

Phenotyping long COVID
The public health consequences of the epidemic of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infections may well go beyond the current burden on hospital services and the indirect effects of social distancing and lockdowns. Patients, particularly older ones with comorbidities, experience persistent dyspnoea, fatigue, body aches and brain fog for months after the acute phase of coronavirus disease 2019 (COVID-19) [1]. Post-acute sequelae of SARS-CoV-2 infection, more commonly called "long COVID", attract considerable media attention, patient advocacy group-initiated research and, recently, USD 1....
Source: European Respiratory Journal - August 26, 2021 Category: Respiratory Medicine Authors: Naeije, R., Caravita, S. Tags: Editorials Source Type: research

Hyperventilation as one of the mechanisms of persistent dyspnoea in SARS-CoV-2 survivors
There are increasing reports of persistent dyspnoea several months after the onset of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection [1]. In most cases, functional disability seems out of proportion compared to residual pulmonary function impairment [2]. To date, knowledge about the functional limitations following a SARS-CoV-2 infection remains limited. (Source: European Respiratory Journal)
Source: European Respiratory Journal - August 26, 2021 Category: Respiratory Medicine Authors: Motiejunaite, J., Balagny, P., Arnoult, F., Mangin, L., Bancal, C., Vidal-Petiot, E., Flamant, M., Jondeau, G., Cohen-Solal, A., d'Ortho, M.-P., Frija-Masson, J. Tags: Original Articles: Research letters Source Type: research

Pulmonary vascular resistance predicts mortality in patients with pulmonary hypertension associated with interstitial lung disease: results from the COMPERA registry
Pulmonary hypertension (PH) is a common complication of many chronic lung diseases, especially COPD and interstitial lung disease (ILD) [1]. In these conditions, the development of PH is associated with an aggravation of symptoms and an increase in mortality risk. In most patients with chronic lung disease, the haemodynamic severity of PH is mild to moderate, while some patients develop severe PH, which is presently defined by a mean pulmonary arterial pressure (mPAP) ≥35 mmHg or mPAP ≥25 mmHg in the presence of a cardiac index
Source: European Respiratory Journal - August 26, 2021 Category: Respiratory Medicine Authors: Olsson, K. M., Hoeper, M. M., Pausch, C., Grünig, E., Huscher, D., Pittrow, D., Rosenkranz, S., Gall, H. Tags: Original Articles: Research letters Source Type: research

Biologics may have a beneficial effect in asthma patients with COVID-19
We take the opportunity to respond to P.A.B. Wark and co-workers, and their correspondence on the subject of our recent publication [1]. It is indeed worth exploring the relationships of respiratory disease and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, and the potential mechanisms involved to understand better the pathophysiology of coronavirus disease 2019 (COVID-19), and eventually consider new treatments. However, based on others and our own observations, we disagree with the statement that use of Th2 targeting biologics in patients with asthma may increase susceptibility to SARS-CoV-2 infe...
Source: European Respiratory Journal - August 26, 2021 Category: Respiratory Medicine Authors: Izquierdo, J. L., Soriano, J. B. Tags: Original Articles: Correspondence Source Type: research

Similarity network fusion for the integration of multi-omics and microbiomes in respiratory disease
(Source: European Respiratory Journal)
Source: European Respiratory Journal - August 26, 2021 Category: Respiratory Medicine Authors: Narayana, J. K., Mac Aogain, M., Ali, N. A. B. M., Tsaneva-Atanasova, K., Chotirmall, S. H. Tags: ERJ Methods Source Type: research

Cardiopulmonary exercise capacity and limitations 3 months after COVID-19 hospitalisation
This study aimed to describe cardiopulmonary function during exercise 3 months after hospital discharge for COVID-19 and compare groups according to dyspnoea and intensive care unit (ICU) stay. Methods Participants with COVID-19 discharged from five large Norwegian hospitals were consecutively invited to a multicentre, prospective cohort study. In total, 156 participants (mean age 56.2 years, 60 females) were examined with a cardiopulmonary exercise test (CPET) 3 months after discharge and compared with a reference population. Dyspnoea was assessed using the modified Medical Research Council (mMRC) dyspnoea...
Source: European Respiratory Journal - August 26, 2021 Category: Respiratory Medicine Authors: Skjorten, I., Ankerstjerne, O. A. W., Trebinjac, D., Bronstad, E., Rasch-Halvorsen, O., Einvik, G., Lerum, T. V., Stavem, K., Edvardsen, A., Ingul, C. B. Tags: Lung structure and function, Respiratory infections and tuberculosis Original Articles: Pulmonary function and infection Source Type: research

Elevated pulmonary vascular resistance predicts mortality in COPD patients
COPD is frequently associated with mild to moderate pulmonary hypertension (PH). However, a small subset of patients develops severe PH, which is currently haemodynamically defined as mean pulmonary arterial pressure (mPAP) ≥35 mmHg, or mPAP ≥25 mmHg in combination with cardiac index
Source: European Respiratory Journal - August 26, 2021 Category: Respiratory Medicine Authors: Zeder, K., Avian, A., Bachmaier, G., Douschan, P., Foris, V., Sassmann, T., Troester, N., Brcic, L., Fuchsjaeger, M., Marsh, L. M., Maron, B. A., Olschewski, H., Kovacs, G. Tags: Original Articles: Research letters Source Type: research

Asthma, COPD and SARS-CoV-2 infection (COVID-19): potential mechanistic insights
We read with interest the manuscripts [1, 2] and the accompanying editorial [3] describing the risk of severe disease and infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and asthma, but are struck by the difference seen with risk of complications from asthma and coronavirus disease 2019 (COVID-19) compared to the experience during the 2009 influenza pandemic, where people with asthma were clearly at heightened risk, at least of hospitalisation [4]. In contrast, those who smoke or have COPD, appear at greater risk. Observational studies will never be able to provide evidence of cause and effect a...
Source: European Respiratory Journal - August 26, 2021 Category: Respiratory Medicine Authors: Wark, P. A. B., Pathinayake, P. S., Eapen, M. S., Sohal, S. S. Tags: Original Articles: Correspondence Source Type: research

Deconditioning as main mechanism of impaired exercise response in COVID-19 survivors
The objective of this observational, prospective study was to evaluate the sequelae of COVID-19 by assessing exercise performance during incremental CPET. (Source: European Respiratory Journal)
Source: European Respiratory Journal - August 26, 2021 Category: Respiratory Medicine Authors: Rinaldo, R. F., Mondoni, M., Parazzini, E. M., Pitari, F., Brambilla, E., Luraschi, S., Balbi, M., Sferrazza Papa, G. F., Sotgiu, G., Guazzi, M., Di Marco, F., Centanni, S. Tags: Original Articles: Research letters Source Type: research

Exercise-induced bronchoconstriction and bronchodilation: investigating the effects of age, sex, airflow limitation and FEV1
The objective of this study was to investigate the effects of age, sex, forced expiratory volume in 1 s (FEV1) and airflow limitation (FEV1/forced vital capacity (FVC)
Source: European Respiratory Journal - August 26, 2021 Category: Respiratory Medicine Authors: Satia, I., Priel, E., Al-Khazraji, B. K., Jones, G., Freitag, A., O'Byrne, P. M., Killian, K. J. Tags: Asthma and allergy Original Articles: Asthma Source Type: research

Neutrophil dysfunction in bronchiectasis: an emerging role for immunometabolism
Bronchiectasis is a heterogenous disease with multiple underlying causes. The pathophysiology is poorly understood but neutrophilic inflammation and dysfunctional killing of pathogens is believed to be key. There are, however, no licensed therapies for bronchiectasis that directly target neutrophilic inflammation. In this review, we discuss our current understanding of neutrophil dysfunction and therapeutic targeting in bronchiectasis. Immunometabolic reprogramming, a process through which inflammation changes inflammatory cell behaviour by altering intracellular metabolic pathways, is increasingly recognised across multip...
Source: European Respiratory Journal - August 26, 2021 Category: Respiratory Medicine Authors: Giam, Y. H., Shoemark, A., Chalmers, J. D. Tags: Reviews Source Type: research

European Respiratory Society guidelines for the management of children and adolescents with bronchiectasis
There is increasing awareness of bronchiectasis in children and adolescents, a chronic pulmonary disorder associated with poor quality of life for the child/adolescent and their parents, recurrent exacerbations, and costs to the family and health systems. Optimal treatment improves clinical outcomes. Several national guidelines exist, but there are no international guidelines. The European Respiratory Society (ERS) Task Force for the management of paediatric bronchiectasis sought to identify evidence-based management (investigation and treatment) strategies. It used the ERS standardised methodology that included a systemat...
Source: European Respiratory Journal - August 26, 2021 Category: Respiratory Medicine Authors: Chang, A. B., Fortescue, R., Grimwood, K., Alexopoulou, E., Bell, L., Boyd, J., Bush, A., Chalmers, J. D., Hill, A. T., Karadag, B., Midulla, F., McCallum, G. B., Powell, Z., Snijders, D., Song, W.-J., Tonia, T., Wilson, C., Zacharasiewicz, A., Kantar, A. Tags: Original Articles: ERS guidelines Source Type: research

Effectiveness of a specialised breathlessness service for patients with advanced disease in Germany: a pragmatic fast-track randomised controlled trial (BreathEase)
Conclusions These findings demonstrate positive effects of the MBS in reducing burden caused by chronic breathlessness in advanced illness across a wide range of patients. Further evaluation in subgroups of patients and with a longitudinal perspective is needed. (Source: European Respiratory Journal)
Source: European Respiratory Journal - August 26, 2021 Category: Respiratory Medicine Authors: Schunk, M., Le, L., Syunyaeva, Z., Haberland, B., Tänzler, S., Mansmann, U., Schwarzkopf, L., Seidl, H., Streitwieser, S., Hofmann, M., Müller, T., Weiss, T., Morawietz, P., Rehfuess, E. A., Huber, R. M., Berger, U., Bausewein, C. Tags: Respiratory clinical practice Original Articles: Breathlessness Source Type: research

Endothelial CFTR dysfunction and its involvement in the pathogenesis of pulmonary arterial hypertension
F. Antigny and co-workers raise interesting points in their comment on the transcriptomic analysis of cystic fibrosis transmembrane conductance regulator (CFTR)-impaired endothelial cells (ECs) revealing a pro-inflammatory phenotype [1]. Indeed, CFTR impairment in different endothelial models and organisms, and in the absence of concomitant infection, suggests that ECs are an overlooked mediator in the exaggerated pro-inflammatory phenotype observed in cystic fibrosis (CF). Whether endothelial CFTR is involved in other vascular diseases is an intriguing question. Indeed, a recent report indicates a pivotal role of CFTR in ...
Source: European Respiratory Journal - August 19, 2021 Category: Respiratory Medicine Authors: Declercq, M., Treps, L., Bousfia, S., Carmeliet, P., Witters, P. Tags: Original Articles: Correspondence Source Type: research

Comment on: Transcriptomic analysis of CFTR-impaired endothelial cells reveals a pro-inflammatory phenotype
We read with interest the article "Transcriptomic analysis of CFTR-impaired endothelial cells reveals a pro-inflammatory phenotype" by Declercq et al. [1]. Cystic fibrosis transmembrane conductance regulator (CFTR) is a cyclic adenosine monophosphate (cAMP)-dependent and ATP-gated Cl– channel and mutations in the CFTR gene are responsible for cystic fibrosis (CF) [2]. Declercq et al. [1] report that CFTR impairment in endothelial cells (ECs) by CFTR silencing or inhibition (using CFTR inhibitor 172, CFTRinh-172) reduced EC proliferation, migration and autophagy. Moreover, the authors demonstrated that the l...
Source: European Respiratory Journal - August 19, 2021 Category: Respiratory Medicine Authors: Antigny, F., Le Ribeuz, H., Humbert, M., Montani, D. Tags: Original Articles: Correspondence Source Type: research

Air pollution and COVID-19: clearing the air and charting a post-pandemic course: a joint workshop report of ERS, ISEE, HEI and WHO
Air pollution is now recognised by governments, international institutions and civil society as a major global public health risk factor. The health burden of air pollution is large: 509 000 premature deaths every year in Europe [1] and serious aggravations of heart and lung diseases that affect millions of patients, both children and adults. The European Environmental Agency estimated that in 2018 there were 417 000 premature deaths attributable to particulate matter with diameter
Source: European Respiratory Journal - August 19, 2021 Category: Respiratory Medicine Authors: Andersen, Z. J., Hoffmann, B., Morawska, L., Adams, M., Furman, E., Yorgancioglu, A., Greenbaum, D., Neira, M., Brunekreef, B., Forastiere, F., Rice, M. B., Wakenhut, F., Coleen, E., Boogaard, H., Gehring, U., Melen, E., Ward, B., De Matteis, S. Tags: Editorials Source Type: research

World Health Organization treatment outcome definitions for tuberculosis: 2021 update
Tuberculosis (TB) remains an important global health concern, even though it is largely curable with treatment that is affordable and widely accessible for diagnosed and notified TB patients. If not administered correctly, TB treatment regimens may fail to deliver a relapse-free cure, favouring continued transmission and the emergence of drug resistance. Monitoring the effectiveness of TB treatment is thus critically important in both clinical practice and surveillance, to maximise the quality of individual patient care and the effectiveness of public health action. Standardised TB treatment outcome definitions have been a...
Source: European Respiratory Journal - August 19, 2021 Category: Respiratory Medicine Authors: Linh, N. N., Viney, K., Gegia, M., Falzon, D., Glaziou, P., Floyd, K., Timimi, H., Ismail, N., Zignol, M., Kasaeva, T., Mirzayev, F. Tags: Editorials Source Type: research

Impact of the revised definition of extensively drug-resistant tuberculosis
In this study, we aimed to measure retrospectively the impact of the revised definition on the epidemiology of XDR-TB in France. (Source: European Respiratory Journal)
Source: European Respiratory Journal - August 19, 2021 Category: Respiratory Medicine Authors: Veziris, N., Bonnet, I., Morel, F., Guglielmetti, L., Maitre, T., Fournier Le Ray, L., Sougakoff, W., Robert, J., Aubry, A., on behalf of the CNR MyRMA Tags: Original Articles: Research letters Source Type: research

Intrapulmonary bronchopulmonary anastomoses in COVID-19 respiratory failure
The spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to a devastating and worldwide pandemic disease known as coronavirus disease 2019 (COVID-19). COVID-19 causes acute hypoxic respiratory failure (COVID-ARF), a major cause of mortality and morbidity, with an incompletely understood pathophysiological mechanism. Gattinoni et al. [1] noted that COVID-19 patients with acute hypoxic respiratory failure have lung disease that is often characterised by a remarkable dissociation between relatively well-preserved lung mechanics, including lung compliance, and severe hypoxaemia. These findings are con...
Source: European Respiratory Journal - August 19, 2021 Category: Respiratory Medicine Authors: Galambos, C., Bush, D., Abman, S. H. Tags: Original Articles: Research letters Source Type: research

Exercise training in COPD: muscle O2 transport plasticity
Both convective oxygen (O2) transport to, and diffusive transport within, skeletal muscle are markedly diminished in patients with COPD. However, it is unknown how these determinants of peak muscle O2 uptake (V'mO2peak) respond to exercise training in patients with COPD. Therefore, the purpose of this study was to assess the plasticity of skeletal muscle O2 transport determinants of V'mO2peak in patients with COPD. Adaptations to 8 weeks of single-leg knee-extensor exercise training were measured in eight patients with severe COPD (mean±sem forced expiratory volume in 1 s (FEV1) 0.9±0.1 L) and eight...
Source: European Respiratory Journal - August 19, 2021 Category: Respiratory Medicine Authors: Broxterman, R. M., Wagner, P. D., Richardson, R. S. Tags: COPD and smoking Original Articles: COPD Source Type: research