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Palliative care for people with COPD: effective but underused
Nearly 100 000 men and over 65 000 women die from chronic obstructive pulmonary disease (COPD) in Europe each year [1]; more die from one of its comorbidities but face the challenges of living and dying with severe COPD during their last years and months. Globally, COPD is the third most common cause of death worldwide and the Global Burden of Disease project estimated that, in 2015, COPD caused 3.2 million deaths, an increase of 11.6% compared with 1990 [2]. (Source: European Respiratory Journal)
Source: European Respiratory Journal - February 14, 2018 Category: Respiratory Medicine Authors: Halpin, D. M. G. Tags: COPD and smoking Editorials Source Type: research

Putting the brake on accelerated lung function decline in asthma
The focus of most asthma care is on symptom control and exacerbation (attack) prevention. This focus is needed; asthma is a very common disease, still leads to an unnecessarily high symptom burden and is a cause of preventable deaths [1, 2]. This negative impact occurs despite the recognition that asthma is a heterogeneous disease with various subtypes [3] requiring different treatment approaches [4], with the development of multiple new targeted therapies [5]. Although the identification of biomarkers to help predict exacerbations and understand the interactions between asthma, risk and comorbidities is a key research pri...
Source: European Respiratory Journal - February 14, 2018 Category: Respiratory Medicine Authors: Shaw, D. Tags: Asthma and allergy Editorials Source Type: research

Tuberculosis re-treatment after exclusion of rifampicin resistance
We agree with Falzon et al. [1] that treatment of isoniazid-resistant tuberculosis (TB) is an important issue. The first-line re-treatment regimen for previously treated TB patients, which was known as the category II regimen, comprised 8 months of isoniazid, rifampicin and ethambutol supplemented by streptomycin for the initial 2 months, and pyrazinamide for the initial 3 months (2SHRZE/HRZE/5HRE). It was introduced in the collaborative programme of the International Union Against Tuberculosis and Lung Disease in which the first-line initial regimen for new TB patients was an 8-month regimen comprising 2&nb...
Source: European Respiratory Journal - February 14, 2018 Category: Respiratory Medicine Authors: Chiang, C.-Y., Trebucq, A. Tags: Respiratory infections and tuberculosis Original Articles: Correspondence Source Type: research

Dyspnoea modifies the recognition of fearful expressions by healthy humans
Brainstem neural oscillators normally generate resting breathing. Yet cortical premotor and motor respiratory-related networks can operate voluntary breathing and compensate for defective automatic respiratory drive [1, 2]. These networks are engaged when the respiratory system load-capacity balance is compromised, typically during experimental inspiratory loading [3] that is associated with dyspnoea of the "excessive inspiratory effort" type. An emerging body of evidence suggests that respiratory-related cortical activation (and by extension the corresponding dyspnoea) can have a cognitive cost [4–6], thou...
Source: European Respiratory Journal - February 14, 2018 Category: Respiratory Medicine Authors: Vinckier, F., Morelot-Panzini, C., Similowski, T. Tags: Respiratory clinical practice Original Articles: Research letters Source Type: research

Tracheal replacement
This article reviews the advantages and limitations of each technique used over the past few decades in clinical practice. The main limitation seems to be the capacity for tracheal tissue regeneration. The physiopathology behind this has yet to be fully understood. Research on stem cells sparked much interest and was thought to be a revolutionary technique; however, the poor long-term results of this approach highlight that there is a long way to go in this research field. Currently, an autologous tissue composite, with or without a tracheal allograft, is the only long-term working solution for every aetiology, despite its...
Source: European Respiratory Journal - February 14, 2018 Category: Respiratory Medicine Authors: Etienne, H., Fabre, D., Gomez Caro, A., Kolb, F., Mussot, S., Mercier, O., Mitilian, D., Stephan, F., Fadel, E., Dartevelle, P. Tags: Lung cancer Reviews Source Type: research

Immunotherapy: a new standard of care in thoracic malignancies?: A summary of the European Respiratory Society research seminar of the Thoracic Oncology Assembly
In May 2017, the second European Respiratory Society research seminar of the Thoracic Oncology Assembly entitled "Immunotherapy, a new standard of care in thoracic malignancies?" was held in Paris, France. This seminar provided an opportunity to review the basis of antitumour immunity and to explain how immune checkpoint inhibitors (ICIs) work. The main therapeutic trials that have resulted in marketing authorisations for use of ICIs in lung cancer were reported. A particular focus was on the toxicity of these new molecules in relation to their immune-related adverse events. The need for biological selection, cur...
Source: European Respiratory Journal - February 14, 2018 Category: Respiratory Medicine Authors: Costantini, A., Grynovska, M., Lucibello, F., Moises, J., Pages, F., Tsao, M. S., Shepherd, F. A., Bouchaab, H., Garassino, M., Aerts, J. G. J. V., Mazieres, J., Mondini, M., Berghmans, T., Meert, A.-P., Cadranel, J. Tags: Lung cancer Perspective Source Type: research

Asthma treatment impacts time to pregnancy: evidence from the international SCOPE study
Asthma is a common chronic disease affecting the lives of reproductive age women and is associated with 8–13% of pregnancies [1]. While maternal asthma has been consistently associated with significant perinatal morbidities and mortality [2, 3], impacts on fertility are conflicting. In light of limited and conflicting evidence, the aim of this study was to examine the impact of asthma and asthma medication use on fecundability and time to pregnancy. (Source: European Respiratory Journal)
Source: European Respiratory Journal - February 14, 2018 Category: Respiratory Medicine Authors: Grzeskowiak, L. E., Smithers, L. G., Grieger, J. A., Bianco-Miotto, T., Leemaqz, S. Y., Clifton, V. L., Poston, L., McCowan, L. M., Kenny, L. C., Myers, J., Walker, J. J., Norman, R. J., Dekker, G. A., Roberts, C. T. Tags: Original Articles: Research letters Source Type: research

Low uptake of palliative care for COPD patients within primary care in the UK
Mortality and symptom burden from chronic obstructive pulmonary disease (COPD) and lung cancer are similar but there is thought to be an inequality in palliative care support (PCS) between diseases. This nationally representative study assessed PCS for COPD patients within primary care in the UK. This was a cohort study using electronic healthcare records (2004–2015). Factors associated with receiving PCS were assessed using logistic regression for the whole cohort and deceased patients. There were 92 365 eligible COPD patients, of which 26 135 died. Only 7.8% of the whole cohort and 21.4% of deceased patients receiv...
Source: European Respiratory Journal - February 14, 2018 Category: Respiratory Medicine Authors: Bloom, C. I., Slaich, B., Morales, D. R., Smeeth, L., Stone, P., Quint, J. K. Tags: COPD and smoking Original Articles: COPD Source Type: research

Predictors of accelerated decline in lung function in adult-onset asthma
Little is known about the prognosis of adults with new-onset asthma. Cross-sectional studies suggest that these patients may exhibit accelerated decline in forced expiratory volume in 1 s (FEV1). However, risk factors for accelerated decline in lung function have not yet been identified. We aimed to identify these risk factors in a prospective 5-year follow-up study in 200 adults with newly diagnosed asthma. In the current study, clinical, functional and inflammatory parameters were assessed annually for 5 years. Linear mixed-effects models were used to identify predictors. Evaluable lung function sets of 141 pat...
Source: European Respiratory Journal - February 14, 2018 Category: Respiratory Medicine Authors: Coumou, H., Westerhof, G. A., de Nijs, S. B., Zwinderman, A. H., Bel, E. H. Tags: Asthma and allergy Original Articles: Asthma Source Type: research

Palatal prolapse as a signature of expiratory flow limitation and inspiratory palatal collapse in patients with obstructive sleep apnoea
This study demonstrates that expiratory palatal prolapse can be quantified noninvasively, is associated with EFL and predicts the presence of inspiratory isolated palatal collapse. (Source: European Respiratory Journal)
Source: European Respiratory Journal - February 14, 2018 Category: Respiratory Medicine Authors: Azarbarzin, A., Sands, S. A., Marques, M., Genta, P. R., Taranto-Montemurro, L., Messineo, L., White, D. P., Wellman, A. Tags: Sleep medicine Original Articles: Sleep Source Type: research

Lung transplantation after allogeneic stem cell transplantation: a pan-European experience
This study assesses survival in highly selected patients undergoing lung transplantation for LONIPCs after SCT. SCT patients undergoing lung transplantation at 20 European centres between 1996 and 2014 were included. Clinical data pre- and post-lung transplantation were reviewed. Propensity score-matched controls were generated from the Eurotransplant and Scandiatransplant registries. Kaplan–Meier survival analysis and Cox proportional hazard regression models evaluating predictors of graft loss were performed. Graft survival at 1, 3 and 5 years of 84%, 72% and 67%, respectively, among the 105 SCT patients prove...
Source: European Respiratory Journal - February 14, 2018 Category: Respiratory Medicine Authors: Greer, M., Berastegui, C., Jaksch, P., Benden, C., Aubert, J., Roux, A., Lhuillier, E., Hirschi, S., Reynaud-Gaubert, M., Philit, F., Claustre, J., LePalud, P., Stern, M., Knoop, C., Vos, R., Verschuuren, E., Fisher, A., Riise, G., Hansson, L., Iversen, M Tags: Interstitial and orphan lung disease Original Articles: Rare lung disease Source Type: research

Analysis of airway pathology in COPD using a combination of computed tomography, micro-computed tomography and histology
This study examined small airway pathology using a novel combination of multidetector row computed tomography (MDCT), micro-computed tomography (microCT) and histology. Airway branches visible on specimen MDCT were counted and the dimensions of the third- to fifth-generation airways were computed, while the terminal bronchioles (designated TB), preterminal bronchioles (TB-1) and pre-preterminal bronchioles (TB-2) were examined with microCT and histology in eight explanted lungs with end-stage COPD and seven unused donor lungs that served as controls. On MDCT, COPD lungs showed a decrease in the number of 2–2.5 m...
Source: European Respiratory Journal - February 14, 2018 Category: Respiratory Medicine Authors: Tanabe, N., Vasilescu, D. M., Kirby, M., Coxson, H. O., Verleden, S. E., Vanaudenaerde, B. M., Kinose, D., Nakano, Y., Pare, P. D., Hogg, J. C. Tags: COPD and smoking Original Articles: COPD Source Type: research

Heat shock protein-90 toward theranostics: a breath of fresh air in idiopathic pulmonary fibrosis
Heat shock proteins (HSPs), also known as stress proteins, constitute a complex network of proteins highly conversed across species that have been classified into different families according to their molecular weight: HSP110, HSP90, HSP70, HSP60, HSP40 and the small HSPs [1]. Although they are mainly known for their chaperone and cytoprotective properties, HSPs also participate in the regulation of many cellular signalling processes [2]. These proteins have been involved in various physiological as well as pathological conditions, including respiratory diseases such as asthma, chronic obstructive pulmonary disease, sarcoi...
Source: European Respiratory Journal - February 7, 2018 Category: Respiratory Medicine Authors: Bonniaud, P., Burgy, O., Garrido, C. Tags: Lung biology and experimental studies, Interstitial and orphan lung disease Editorials Source Type: research

Will we be singing a different tune on combined post- and pre-capillary pulmonary hypertension?
There have been many well-intended pursuits in medicine that should have panned out, but did not. Case in point: premature ventricular complexes (PVC) post-myocardial infarction were noted to be associated with increased risk of death, and thus the Cardiac Arrhythmia Suppression Trial (CAST) Study investigated if pharmacological PVC suppression with class I anti-arrhythmics would reduce the rate of arrhythmic death [1]. Surprisingly, the study showed that although PVCs were successfully suppressed, there were excess deaths due to arrhythmia and shock in such patients treated with encainide or flecainide [1]. (Source: ...
Source: European Respiratory Journal - February 7, 2018 Category: Respiratory Medicine Authors: Hsu, S., Tedford, R. J. Tags: Pulmonary vascular disease Editorials Source Type: research

On Don Quixote and pink puffers: multi-organ loss of tissue COPD
"Del poco dormir y del mucho leer, se le secó el cerebro, de manera que vino a perder el juicio" [1]; that is, "From little sleep and much reading, his brain dried up, so he came to lose his mind". It is unknown whether Don Miguel de Cervantes, or his most famous character, Don Quixote, ever tried tobacco, at that time newly traded from the New World. However, we invite you to revisit Frank Netter's wonderful "pink puffer" and "blue bloater" illustrations [2], iconic images of the classical chronic obstructive pulmonary disease (COPD) phenotypes of emphysema and chronic bronch...
Source: European Respiratory Journal - February 7, 2018 Category: Respiratory Medicine Authors: Soriano, J. B., Burgel, P.-R. Tags: COPD and smoking Editorials Source Type: research

The great breathlessness of cardiopulmonary diseases
Shortness of breath is related to a loss of ventilatory efficiency [1, 2]. Wasted ventilation is proportional to the ratio of ventilation (V'E) to carbon dioxide output (V'CO2) taken as a measure of metabolic rate. Excessive V'E/V'CO2 measured during an exercise stress test is uniformly associated with a decreased life expectancy in cardiorespiratory diseases. Therefore, as argued by Weatherald et al. [3] in a scholarly fashion in the present issue of the European Respiratory Journal, cardiopulmonary exercise testing with measurements of ventilation and gas exchange have to be part of the initial evaluation and follow...
Source: European Respiratory Journal - February 7, 2018 Category: Respiratory Medicine Authors: Naeije, R., Faoro, V. Tags: Lung structure and function Editorials Source Type: research

Variation in incidence trends of malignant pleural mesothelioma in Europe
We read with interest the article by Ji et al. [1] regarding the epidemiology of malignant pleural mesothelioma (MPM) in Sweden and familial clustering. The data in the study show the incidence of MPM in Sweden peaked in 2000 and has sharply declined since 2005. Data from other countries suggest a more delayed peak [2–4]. The highest annual incidence of MPM in the world has been reported to occur in the UK and Australia [5]. The incidence of MPM was predicted to peak in UK between 2011 and 2015; this was based on the known associated high latency period and the ban in using asbestos-containing products [6]. This...
Source: European Respiratory Journal - February 7, 2018 Category: Respiratory Medicine Authors: Ahmed, M., Flannery, A., Mujammil, I., Breen, D. Tags: Lung cancer Original Articles: Correspondence Source Type: research

Should gatifloxacin be included in the model list of essential medicines?
We read with great interest the paper by Falzon et al. [1], which reported that gatifloxacin and moxifloxacin have been recommended by the World Health Organization (WHO) for both longer and shortened regimens in the treatment of rifampicin-resistant (RR) and multidrug-resistant (MDR) tuberculosis (TB). Gatifloxacin and moxifloxacin belong to the latest generation of fluoroquinolones that have comparable early bactericidal and sterilising activity in the treatment of TB. Gatifloxacin has been used in the treatment of bacterial infections and MDR-TB [2]. Gatifloxacin was also used in a clinical trial (OFLOTUB) comparin...
Source: European Respiratory Journal - February 7, 2018 Category: Respiratory Medicine Authors: Chiang, C.-Y., Trebucq, A., Piubello, A., Rieder, H. L., Van Deun, A. Tags: Respiratory infections and tuberculosis Original Articles: Correspondence Source Type: research

A comparison of linezolid lung tissue concentrations among patients with drug-resistant tuberculosis
Linezolid has become a frequent component of treatment regimens for drug-resistant tuberculosis and is a group C drug in the latest World Health Organization treatment guidelines [1]. However, linezolid has a narrow therapeutic index and there is no consensus on the optimal dose for patients with tuberculosis [2, 3]. A better understanding of lung tissue penetration could provide insight into ideal dosing and the utility of linezolid in patients with severe lung lesions. To evaluate target site lung concentrations of linezolid, we utilised the technique of microdialysis, which facilitates the measurement of unbound (p...
Source: European Respiratory Journal - February 7, 2018 Category: Respiratory Medicine Authors: Kempker, R. R., Heinrichs, M. T., Nikolaishvili, K., Sabulua, I., Bablishvili, N., Gogishvili, S., Avaliani, Z., Little, B. P., Bernheim, A., Derendorf, H., Blumberg, H. M., Vashakidze, S., Peloquin, C. A. Tags: Respiratory infections and tuberculosis Original Articles: Research letters Source Type: research

Emphysema and extrapulmonary tissue loss in COPD: a multi-organ loss of tissue phenotype
We tested whether emphysema progression accompanies enhanced tissue loss in other body compartments in 1817 patients from the ECLIPSE chronic obstructive pulmonary disease (COPD) cohort. Clinical and selected systemic biomarker measurements were compared in subjects grouped by quantitative tomography scan emphysema quartiles using the percentage of low attenuation area (LAA%). Lowest and highest quartile patients had amino-acid metabolomic profiles. We related LAA% to 3 years decline in lung function (forced expiratory volume in 1 s (FEV1)), body mass index (BMI), fat-free mass index (FFMI) and exacerbations, hos...
Source: European Respiratory Journal - February 7, 2018 Category: Respiratory Medicine Authors: Celli, B. R., Locantore, N., Tal-Singer, R., Riley, J., Miller, B., Vestbo, J., Yates, J. C., Silverman, E. K., Owen, C. A., Divo, M., Pinto-Plata, V., Wouters, E. F. M., Faner, R., Agusti, A., on behalf of the ECLIPSE Study Investigators Tags: COPD and smoking Original Articles: COPD Source Type: research

Macitentan in pulmonary hypertension due to left ventricular dysfunction
The MELODY-1 study evaluated macitentan for pulmonary hypertension because of left heart disease (PH-LHD) in patients with combined post- and pre-capillary PH. 63 patients with PH-LHD and diastolic pressure gradient ≥7 mmHg and pulmonary vascular resistance (PVR)>3WU were randomised to macitentan 10 mg (n=31) or placebo (n=32) for 12 weeks. The main end-point assessed a composite of significant fluid retention (weight gain ≥5% or ≥5 kg because of fluid overload or parenteral diuretic administration) or worsening in New York Heart Association functional class from baseline to end of trea...
Source: European Respiratory Journal - February 7, 2018 Category: Respiratory Medicine Authors: Vachiery, J.-L., Delcroix, M., Al-Hiti, H., Efficace, M., Hutyra, M., Lack, G., Papadakis, K., Rubin, L. J. Tags: Pulmonary vascular disease Original Articles: Pulmonary hypertension Source Type: research

E-cigarette vapour enhances pneumococcal adherence to airway epithelial cells
This study suggests that E-cigarette vapour has the potential to increase susceptibility to pneumococcal infection. (Source: European Respiratory Journal)
Source: European Respiratory Journal - February 7, 2018 Category: Respiratory Medicine Authors: Miyashita, L., Suri, R., Dearing, E., Mudway, I., Dove, R. E., Neill, D. R., Van Zyl-Smit, R., Kadioglu, A., Grigg, J. Tags: Lung biology and experimental studies, Respiratory infections and tuberculosis Original Articles: Infection Source Type: research

Intravenous magnesium sulfate for acute wheezing in young children: a randomised double-blind trial
Magnesium sulfate has been shown to be an effective treatment in older children with asthma exacerbations, but it has not been investigated in acute severe virus-induced wheezing in young children. The study enrolled 61 children aged 6 months to 4 years. Inclusion criteria were severe wheezing, classified as a score of ≥6 points as assessed by the Respiratory Distress Assessment Instrument (RDAI) after initial treatment with salbutamol, and the symptoms of acute viral infection. The children were randomly allocated to receive either an infusion of magnesium sulfate (40 mg·kg–1) or 0.9% sodium...
Source: European Respiratory Journal - February 7, 2018 Category: Respiratory Medicine Authors: Pruikkonen, H., Tapiainen, T., Kallio, M., Dunder, T., Pokka, T., Uhari, M., Renko, M. Tags: Asthma and allergy, Paediatric pulmonology Original Articles: Asthma and paediatrics Source Type: research

The effect of text messaging on latent tuberculosis treatment adherence: a randomised controlled trial
There is limited high-quality evidence available to inform the use of text messaging to improve latent tuberculosis infection (LTBI) treatment adherence. We performed a parallel, randomised controlled trial at two sites to assess the effect of a two-way short message service on LTBI adherence. We enrolled adults initiating LTBI therapy from June 2012 to September 2015 in British Columbia, Canada. Participants were randomised in a 1:1 ratio to standard LTBI treatment (control) or standard LTBI treatment plus two-way weekly text messaging (intervention). The primary outcome was treatment completion, defined as taking ≥80%...
Source: European Respiratory Journal - February 7, 2018 Category: Respiratory Medicine Authors: Johnston, J. C., van der Kop, M. L., Smillie, K., Ogilvie, G., Marra, F., Sadatsafavi, M., Romanowski, K., Budd, M. A., Hajek, J., Cook, V., Lester, R. T. Tags: Respiratory infections and tuberculosis Original Articles: Tuberculosis Source Type: research

Evolution of respiratory function in Duchenne muscular dystrophy from childhood to adulthood
In Duchenne muscular dystrophy (DMD), it is still to be determined if specific timepoints can be identified during the natural evolution of respiratory dysfunction from childhood to adulthood and if scoliosis, steroid therapy and nocturnal noninvasive mechanical ventilation (NIMV) have any effect on it. In a 7-year retrospective study performed on 115 DMD patients (6–24 years), evaluated once or twice per year, with 574 visits in total, evolution mean curves of spirometry, lung volumes, spontaneous breathing and thoraco-abdominal pattern (measured by optoelectronic plethysmography) parameters were obtained by no...
Source: European Respiratory Journal - February 7, 2018 Category: Respiratory Medicine Authors: LoMauro, A., Romei, M., Gandossini, S., Pascuzzo, R., Vantini, S., D'Angelo, M. G., Aliverti, A. Tags: Lung structure and function Original Articles: Lung function Source Type: research

Detection of human cytomegalovirus in bronchoalveolar lavage of intensive care unit patients
In this study, we aimed to assess the incidence, clinical characteristics, risk factors and outcomes for intensive care unit (ICU) patients with CMV detection by bronchoalveolar lavage (BAL). (Source: European Respiratory Journal)
Source: European Respiratory Journal - February 7, 2018 Category: Respiratory Medicine Authors: Vergara, A., Cilloniz, C., Luque, N., Garcia-Vidal, C., Tejero, J., Perello, R., Lucena, C. M., Torres, A., Marcos, M. A. Tags: Respiratory infections and tuberculosis Original Articles: Research letters Source Type: research

Indoor bacteria and asthma in adults: a multicentre case-control study within ECRHS II
Both protective and adverse effects of indoor microbial exposure on asthma have been reported, but mostly in children. To date, no study in adults has used non-targeted methods for detection of indoor bacteria followed by quantitative confirmation. A cross-sectional study of 198 asthmatic and 199 controls was conducted within the European Community Respiratory Health Survey (ECRHS) II. DNA was extracted from mattress dust for bacterial analysis using denaturing gradient gel electrophoresis (DGGE). Selected bands were sequenced and associations with asthma confirmed with four quantitative PCR (qPCR) assays. 15 out of 37 ban...
Source: European Respiratory Journal - February 7, 2018 Category: Respiratory Medicine Authors: Pekkanen, J., Valkonen, M., Täubel, M., Tischer, C., Leppänen, H., Kärkkäinen, P. M., Rintala, H., Zock, J.-P., Casas, L., Probst-Hensch, N., Forsberg, B., Holm, M., Janson, C., Pin, I., Gislason, T., Jarvis, D., Heinrich, Tags: Asthma and allergy Original Articles: Asthma Source Type: research

Ventilatory response to exercise in cardiopulmonary disease: the role of chemosensitivity and dead space
The lungs and heart are irrevocably linked in their oxygen (O2) and carbon dioxide (CO2) transport functions. Functional impairment of the lungs often affects heart function and vice versa. The steepness with which ventilation (V'E) rises with respect to CO2 production (V'CO2) (i.e. the V'E/V'CO2 slope) is a measure of ventilatory efficiency and can be used to identify an abnormal ventilatory response to exercise. The V'E/V'CO2 slope is a prognostic marker in several chronic cardiopulmonary diseases independent of other exercise-related variables such as peak O2 uptake (V'O2). The V'E/V'CO2 slope is determined by two facto...
Source: European Respiratory Journal - February 7, 2018 Category: Respiratory Medicine Authors: Weatherald, J., Sattler, C., Garcia, G., Laveneziana, P. Tags: Lung structure and function Original Articles: Physiology in respiratory medicine Source Type: research

The scale of the problem of obstructive lung disease in Africa becomes clearer, but where are the solutions?
If you breathe in toxic air, lung damage will result. In much of sub-Saharan Africa as well as Asia, massive exposures to a range of toxic air from household air pollution, ambient air pollution and occupational exposures occur with consequent rising morbidity and mortality. The headline statistics are extraordinary: globally, in 2015, 2.8 people million died from household air pollution and 4.2 million people from ambient air pollution [1]. Chronic obstructive pulmonary disease (COPD) is now the third leading cause of death, with 3.2 million deaths worldwide and the same number dying from lower respiratory tract infection...
Source: European Respiratory Journal - January 31, 2018 Category: Respiratory Medicine Authors: Jones, R. Tags: COPD and smoking Editorials Source Type: research

Pseudomonas aeruginosa infection and exacerbations in bronchiectasis: more questions than answers
Apart from the presence of comorbidities [1], there are two other circumstances that have demonstrated a negative impact on the natural history of bronchiectasis: chronic bronchial infection (CBI) by Pseudomonas aeruginosa and exacerbations. Many studies have shown an association between CBI by P. aeruginosa and reduced quality of life [2], a steep decline in lung function [3], increased inflammation (both bronchial and systemic) [4], higher healthcare costs [5], and even a higher mortality rate [6]. One recent meta-analysis concluded that this association is more evident with CBI by P. aeruginosa rather than by other...
Source: European Respiratory Journal - January 31, 2018 Category: Respiratory Medicine Authors: Martinez-Garcia, M. A. Tags: CF and non-CF bronchiectasis Editorials Source Type: research

Physical activity to improve health: do not forget that the lungs benefit too
In this issue of the European Respiratory Journal, Hancox and Rasmussen [1], present an analysis of data from two cohorts, one from Denmark and the other from New Zealand, demonstrating that, in cross-sectional analyses at all ages in both cohorts, aerobic fitness during the childhood and adolescence period was positively associated with forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) (figures 1 and 2). This association persisted despite independently adjusting for height, weight, sex, current asthma and current smoking. Each standard deviation difference in fitness was associated with a modestl...
Source: European Respiratory Journal - January 31, 2018 Category: Respiratory Medicine Authors: Puente-Maestu, L., Stringer, W. W. Tags: Respiratory clinical practice Editorials Source Type: research

Inhaled corticosteroids and increased microbial load in COPD: potential role of epithelial adhesion molecules
We read with great interest the recent very elegant study by Contoli et al. [1] published in the European Respiratory Journal, and the accompanying editorial by Wilkinson [2], wherein authors investigated the long-term effects of inhaled corticosteroids (ICS) on microbial load in chronic obstructive pulmonary disease (COPD). It is an important area, and it is encouraging and reassuring that leading respiratory journals are recognising this. Understanding the mechanisms behind microbial infections is very important. In the discussion, the authors mentioned that the mechanisms by which these communities of different mic...
Source: European Respiratory Journal - January 31, 2018 Category: Respiratory Medicine Authors: Sohal, S. S. Tags: COPD and smoking Original Articles: Correspondence Source Type: research

Mindfulness-based cognitive therapy in COPD: a cluster randomised controlled trial
A considerable proportion of patients with chronic obstructive pulmonary disease (COPD) entering pulmonary rehabilitation (PR) report psychological distress, which is often accompanied by poor physical health status. Mindfulness-based cognitive therapy (MBCT) has been shown to improve psychological and physical outcomes in other chronic diseases. We therefore evaluated the efficacy of MBCT as an add-on to a standard PR programme in COPD. COPD patients eligible for PR were cluster randomised to receive either an 8-week, group-based MBCT programme as an add-on to an 8-week PR programme (n=39), or PR alone (n=45). The primary...
Source: European Respiratory Journal - January 31, 2018 Category: Respiratory Medicine Authors: Farver-Vestergaard, I., O'Toole, M. S., O'Connor, M., Lokke, A., Bendstrup, E., Basdeo, S. A., Cox, D. J., Dunne, P. J., Ruggeri, K., Early, F., Zachariae, R. Tags: COPD and smoking Original Articles: COPD Source Type: research

The independent contribution of Pseudomonas aeruginosa infection to long-term clinical outcomes in bronchiectasis
This study analysed data from 2596 bronchiectasis patients included from 10 different bronchiectasis clinical centres across Europe and Israel, with a 5-year follow-up period. Prevalence of P. aeruginosa chronic infection and its independent impact on exacerbations, hospitalisations, quality of life and mortality was assessed. The prevalence of P. aeruginosa chronic infection was 15.0% (n=389). P. aeruginosa was associated with a higher mortality in a univariate analysis (hazard ratio (HR) 2.02; 95% (confidence interval) CI 1.53–2.66; p
Source: European Respiratory Journal - January 31, 2018 Category: Respiratory Medicine Authors: Araujo, D., Shteinberg, M., Aliberti, S., Goeminne, P. C., Hill, A. T., Fardon, T. C., Obradovic, D., Stone, G., Trautmann, M., Davis, A., Dimakou, K., Polverino, E., De Soyza, A., McDonnell, M. J., Chalmers, J. D. Tags: Original Articles: Bronchiectasis Source Type: research

Effects of continuous positive airway pressure therapy on left ventricular diastolic function: a randomised, sham-controlled clinical trial
In this study, we investigated the effect of CPAP on LV diastolic function compared with sham treatment in patients with severe obstructive sleep apnoea (OSA). This 3-month prospective single-centre randomised sham-controlled trial analysed 52 patients with severe OSA. Patients were randomly assigned (1:1) to receive either CPAP or sham treatment for 3 months. The main investigator and patients were masked to the trial randomisation. The primary end-point was change of early diastolic mitral annular (e') velocity over the 3-month period. Secondary end-points were pulse wave velocity (PWV), 24-h ambulatory blood pressu...
Source: European Respiratory Journal - January 31, 2018 Category: Respiratory Medicine Authors: Shim, C. Y., Kim, D., Park, S., Lee, C. J., Cho, H.-J., Ha, J.-W., Cho, Y.-J., Hong, G.-R. Tags: Sleep medicine Original Articles: Sleep Source Type: research

Airway infection, systemic inflammation and lung clearance index in children and adults with cystic fibrosis
The lung clearance index (LCI) is a measure of ventilation distribution derived from multiple breath washout (MBW). It is a promising measure for monitoring early lung disease in cystic fibrosis (CF) [1–4] and is increasingly being used as a surrogate efficacy endpoint in CF clinical trials [5, 6]. LCI is reliable and more sensitive than forced expiratory volume in 1 s (FEV1) in detecting lung disease in infants, children and adults with CF [7–9], tracks early disease progression and symptoms [3], and predicts the onset of pulmonary exacerbations [10]. LCI has been shown to be elevated in infants and younger ch...
Source: European Respiratory Journal - January 31, 2018 Category: Respiratory Medicine Authors: O'Neill, K., Bradley, J. M., Reid, A., Downey, D. G., Rendall, J., McCaughan, J., Moore, J. E., Tunney, M. M., Elborn, J. S. Tags: CF and non-CF bronchiectasis Original Articles: Research letters Source Type: research

First trimester fetal size and prescribed asthma medication at 15 years of age
There is increasing evidence that antenatal factors predispose to childhood asthma. We tested the hypothesis that reduced first trimester fetal size is associated with increased risk for asthma at 15 years of age. Fetal size in the first and second trimester was ascertained by ultrasound scan. The primary outcome of being dispensed one or more asthma medications by the family doctor in the year before the 15th birthday was determined from routinely acquired dispensing data. Dispensing data were available for 1699 (88% of the original cohort) participants at 15 years of age and questionnaire data for 750 (39%). Ea...
Source: European Respiratory Journal - January 31, 2018 Category: Respiratory Medicine Authors: Turner, S., Fielding, S., Devereux, G. Tags: Asthma and allergy Original Articles: Asthma Source Type: research

Does physical fitness enhance lung function in children and young adults?
Although physical activity is important for lung health, it is unclear whether physical fitness influences lung function. We investigated associations between lung function and fitness in two population-based cohort studies of children and young adults. Aerobic fitness was measured using a maximal cycle ergometer test at ages 9, 15, 21 and 29 years in Odense, Denmark and using a submaximal cycle test at ages 15, 26, 32 and 38 years in Dunedin, New Zealand. Aerobic fitness was positively associated with forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) in cross-sectional analyses at ...
Source: European Respiratory Journal - January 31, 2018 Category: Respiratory Medicine Authors: Hancox, R. J., Rasmussen, F. Tags: Respiratory clinical practice Original Articles: Physiology Source Type: research

Role of a prolonged inpatient admission when evaluating children with problematic severe asthma
Severe asthma continues to be a significant cause of morbidity in children. Despite optimised standard therapy, many children remain symptomatic with subsequent impact on their quality of life and increased healthcare utilisation [1]. Children with ongoing poorly controlled asthma despite maximally prescribed treatment are identified as having problematic severe asthma [2]. Those whose poor control is due to modifiable factors including poor adherence to medications, continued exposure to allergens, social issues and psychological factors have difficult asthma. Severe therapy-resistant asthma is the term used for those wit...
Source: European Respiratory Journal - January 31, 2018 Category: Respiratory Medicine Authors: Nagakumar, P., Gambir, N., Sanghani, N., Hall, P., Jamalzadeh, A., Beresford, F., Saglani, S., Bush, A., Fleming, L. Tags: Asthma and allergy Original Articles: Research letters Source Type: research

Social deprivation and prognosis in Scottish patients with pulmonary arterial hypertension
Several demographic and clinical factors have prognostic significance in idiopathic pulmonary arterial hypertension (IPAH). Studies in China and the USA have suggested an association between low socioeconomic status and reduced survival. The impact of social deprivation on IPAH survival in the UK is not known. 280 patients with IPAH and hereditary PAH (HPAH) attending the Scottish Pulmonary Vascular Unit (Glasgow, UK) were assigned to social deprivation quintiles using the Scottish Index of Multiple Deprivation database. The association between survival and social deprivation quintile was assessed using Cox proportional ha...
Source: European Respiratory Journal - January 31, 2018 Category: Respiratory Medicine Authors: Pellino, K., Kerridge, S., Church, C., Peacock, A. J., Crowe, T., Jayasekera, G., Johnson, M. K., MacKenzie, A. M. Tags: Pulmonary vascular disease Original Articles: Pulmonary hypertension Source Type: research

Synergistic role of HSP90{alpha} and HSP90{beta} to promote myofibroblast persistence in lung fibrosis
Idiopathic pulmonary fibrosis (IPF) is a progressive disease of the lung parenchyma, causing significant morbidity through worsening dyspnoea and overall functional decline. IPF is characterised by apoptosis-resistant myofibroblasts, which are a major source for the excessive production of extracellular matrix (ECM) overtaking normal lung tissue. We sought to study the role of heat shock protein (HSP) isoforms HSP90α and HSP90β, whose distinct roles in lung fibrogenesis remain elusive. We determined the level of circulating HSP90α in IPF patients (n=31) and age-matched healthy controls (n=9) by ELISA. The ...
Source: European Respiratory Journal - January 31, 2018 Category: Respiratory Medicine Authors: Bellaye, P.-S., Shimbori, C., Yanagihara, T., Carlson, D. A., Hughes, P., Upagupta, C., Sato, S., Wheildon, N., Haystead, T., Ask, K., Kolb, M. Tags: Lung biology and experimental studies Original Articles: Basic science and interstitial lung disease Source Type: research

Prevalence, risk factors and clinical correlates of COPD in a rural setting in Tanzania
Chronic obstructive pulmonary disease (COPD) causes substantial burden of disease in developed countries, but there are limited data from Africa. We aimed to estimate the prevalence of COPD in Tanzania and identify the risk factors associated with it. This was a cross-sectional descriptive survey involving adults aged ≥35 years. We collected data on symptoms and risk factors using the Burden of Obstructive Lung Diseases questionnaire. Spirometry was performed and COPD diagnosed based on post-bronchodilator forced expiratory volume in 1 s/forced vital capacity
Source: European Respiratory Journal - January 31, 2018 Category: Respiratory Medicine Authors: Magitta, N. F., Walker, R. W., Apte, K. K., Shimwela, M. D., Mwaiselage, J. D., Sanga, A. A., Namdeo, A. K., Madas, S. J., Salvi, S. S. Tags: Original Articles: COPD Source Type: research

"Global strategy for asthma management and prevention: GINA executive summary." E.D. Bateman, S.S. Hurd, P.J. Barnes, J. Bousquet, J.M. Drazen, J.M. FitzGerald, P. Gibson, K. Ohta, P. O'Byrne, S.E. Pedersen, E. Pizzichini, S.D. Sullivan, S.E. Wenzel and H.J. Zar. Eur Respir J 2008; 31: 143-178.
(Source: European Respiratory Journal)
Source: European Respiratory Journal - January 31, 2018 Category: Respiratory Medicine Tags: Author Corrections Source Type: research

It's time to evolve from Scadding: phenotyping sarcoidosis
Sarcoidosis is complex and highly variable, with protean clinical manifestations and a wide array of consequences for patients. The course is likewise unpredictable, leading to the moniker "sarcoidoses" to connote that sarcoidosis may be a syndrome rather than a single disease [1]. Delineating distinct subgroups, "phenotypes", has been an attempt to simplify prediction about individual patients and to homogenise groups for research purposes. Sarcoidosis phenotypes have been used most often to predict prognosis or to cluster patients with similar outcomes [2–5]. But phenotyping could also be used p...
Source: European Respiratory Journal - January 25, 2018 Category: Respiratory Medicine Authors: Culver, D. A., Baughman, R. P. Tags: Interstitial and orphan lung disease Editorials Source Type: research

Is chronic exposure to air pollutants a risk factor for the development of idiopathic pulmonary fibrosis?
The recent Lancet Commission on Pollution and Health emphasises the considerable health burden attributable to environmental pollution, including air, water, soil, heavy metal and chemical pollution, and occupational exposure [1]. All forms of pollution were responsible for an estimated 9 million deaths in 2015, and air pollution, including both household and ambient air pollution, was responsible for the largest part, with an estimate of 6.5 million deaths [1, 2]. In 2016, air pollution was among the first five risk factors in terms of attributable disability-adjusted life-years at the global level [3]. Notewort...
Source: European Respiratory Journal - January 25, 2018 Category: Respiratory Medicine Authors: Siroux, V., Crestani, B. Tags: Interstitial and orphan lung disease Editorials Source Type: research

RESPIRE: breathing new life into bronchiectasis
RESPIRE, definable as "the recovery of hope, courage and strength after a time of difficulty", is apt in the context of bronchiectasis therapy. Despite its recent renaissance, including the publication of the first international guidelines for the management of bronchiectasis, only a single treatment recommendation in the 2017 European Respiratory Society guidelines was supported by high-quality evidence [1]. This is a timely reminder of the real and challenging battle ahead, to deliver evidence-based appropriate and effective therapies to patients. In this issue of the European Respiratory Journal, a major "...
Source: European Respiratory Journal - January 25, 2018 Category: Respiratory Medicine Authors: Chotirmall, S. H., Chalmers, J. D. Tags: CF and non-CF bronchiectasis Editorials Source Type: research

How does inflammation contribute to pulmonary hypertension?
Pathogenic drivers of the pulmonary vascular disease that results in pulmonary arterial hypertension (PAH) are currently unclear, but there are many reasons to suspect that inflammation is a major contributor. Clinically, PAH is a complication of multiple autoimmune diseases including scleroderma and systemic lupus erythematosus, suggesting dysregulated immunity can trigger the vascular disease [1–3]. PAH can also complicate several infectious diseases, including HIV and schistosomiasis, suggesting there could be off-target effects of immune upregulation which inadvertently damage the pulmonary vasculature. Patients ...
Source: European Respiratory Journal - January 25, 2018 Category: Respiratory Medicine Authors: Kumar, R., Graham, B. Tags: Pulmonary vascular disease Editorials Source Type: research

Chronic breathlessness: re-thinking the symptom
We wholly applaud the move by Johnson et al. [1] to improve awareness of breathlessness and to raise its profile as a subject for focussed clinical research. We consider their research and the ensuing proposal to recognise breathlessness via a new medical term, "chronic breathlessness syndrome", as important and justified. We share their goal, which is to direct attention to this neglected, undertreated and under-researched symptom. (Source: European Respiratory Journal)
Source: European Respiratory Journal - January 25, 2018 Category: Respiratory Medicine Authors: Macnaughton, J., Oxley, R., Rose, A., Russell, A., Dodd, J. W., Carel, H. Tags: Respiratory clinical practice Original Articles: Correspondence Source Type: research

Chronic breathlessness: re-thinking the symptom
We agree with much presented in O.K. Faull and colleagues' response to our proposed chronic breathlessness syndrome and thank them for their views supporting chronic breathlessness as more than just a symptom [1]. In particular, we agree that naming and defining chronic breathlessness as a syndrome does not aim, or need, to constrain a recognition or understanding of quantitative and qualitative between-individual differences. We agree that our intention is to ensure patients and their families living with the daily disability affecting all domains of life, irrespective of cause, may legitimately bring this experience to t...
Source: European Respiratory Journal - January 25, 2018 Category: Respiratory Medicine Authors: Johnson, M. J., Yorke, J., Hansen-Flaschen, J., Lansing, R., Ekström, M., Currow, D. C. Tags: Respiratory clinical practice Original Articles: Correspondence Source Type: research

Inspiratory muscle training in stable COPD patients: enough is enough?
Inspiratory muscle dysfunction is a common finding in patients suffering from chronic obstructive pulmonary disease (COPD), contributing with other factors to dyspnoea and reduced exercise tolerance [1]. Pulmonary rehabilitation programmes (PRPs) including whole-body exercise training improve symptoms, exercise capacity and health-related quality of life (HRQL), and are recommended in all stages of COPD [2, 3]. In 1976, Leith and Bradley [4] were the first to show that the principles of training could be applied also to respiratory muscles: healthy strength trainers significantly increased their maximal static inspiratory ...
Source: European Respiratory Journal - January 25, 2018 Category: Respiratory Medicine Authors: Ambrosino, N. Tags: COPD and smoking Editorials Source Type: research