An informative intragenic microsatellite marker suggests the IL-1 receptor as a genetic modifier in cystic fibrosis
Recent studies in mice with cystic fibrosis (CF)-like lung disease identified interleukin (IL)-1 receptor (IL-1R) signalling as an important pathway triggering neutrophilic airway inflammation that constitutes a key risk factor in the onset and progression of lung disease in patients with CF [1–4]. These studies demonstrated that CF-like airway mucus obstruction causes epithelial hypoxia and necrosis, which in turn leads to the release of IL-1α from dying cells and activation of IL-1R signalling triggering neutrophilic inflammation and structural lung damage in vivo [1, 5]. Further, necrotic epithelial cells we...
Source: European Respiratory Journal - December 28, 2017 Category: Respiratory Medicine Authors: Stanke, F., Hector, A., Hedtfeld, S., Hartl, D., Griese, M., Tümmler, B., Mall, M. A. Tags: Original Articles: Research letters Source Type: research

Correspondence regarding the article "The asbestos fibre burden in human lungs: new insights into the chrysotile debate"
We appreciate the opportunity to respond to the correspondence from X. Baur and colleagues regarding our article recently published in the European Respiratory Journal [1]. (Source: European Respiratory Journal)
Source: European Respiratory Journal - December 21, 2017 Category: Respiratory Medicine Authors: Feder, I. S., Tischoff, I., Theile, A., Schmitz, I., Merget, R., Tannapfel, A. Tags: Original Articles: Correspondence Source Type: research

Adherence in severe asthma: time to get it right
How many times have you sat in an asthma consultation and asked a patient "how many doses of your inhaler have you forgotten to take in that last week?" There are times when you may understandably question the person's response, and other times when you will be convinced that they "take their puffers without fail" only to subsequently discover that you have been mistaken. Whilst clinicians want to understand the individual's level of treatment adherence, this approach is clearly flawed and we need to do better. (Source: European Respiratory Journal)
Source: European Respiratory Journal - December 21, 2017 Category: Respiratory Medicine Authors: McDonald, V. M., Yorke, J. Tags: Asthma and allergy, Paediatric pulmonology Editorials Source Type: research

Correspondence regarding the article "The asbestos fibre burden in human lungs: new insights into the chrysotile debate"
We read with interest the generally excellent article by Feder et al. [1] published in the European Respiratory Journal and we would like to add just a comment. Authors screened the German Mesothelioma Register for patients with asbestos body (AB) counts ≥500 per gramme of wet lung (corresponding to approximately ≥5000 AB per gramme of dry lung tissue) which had been analysed twice from different tissue excisions at minimum interval of 4 years. In the 12 patients with longitudinal data the asbestos fibre burden in the lung tissue was stable in particular for chrysotile. Authors stated that the study was the...
Source: European Respiratory Journal - December 21, 2017 Category: Respiratory Medicine Authors: Sartorelli, P. Tags: Original Articles: Correspondence Source Type: research

The effect of smoking on exacerbation risk in eosinophilic patients with COPD
We thank C.R. Osadnik and co-workers for raising these comments and would like to explain the rationale behind our chosen strategy of analyses. (Source: European Respiratory Journal)
Source: European Respiratory Journal - December 21, 2017 Category: Respiratory Medicine Authors: Kerkhof, M., Hillyer, E. V., Price, D. B., on behalf of all authors Tags: COPD and smoking Original Articles: Correspondence Source Type: research

The effect of smoking on exacerbation risk in eosinophilic patients with COPD
We read with interest the findings of Kerkhof et al. [1], demonstrating an increased exacerbation risk in eosinophilic patients (eosinophil counts ≥0.45x109·L–1) with chronic obstructive pulmonary disease (COPD). When compared to a normal reference group (eosinophil counts of between 0.05 and 0.45x109·L–1), the rate ratios (RR) for exacerbations in the following year were lower in current smokers (RR=0.86) than in ex-smokers (RR=1.32). This finding is counter-intuitive and contrasts with data from large studies that demonstrate exacerbation reductions in COPD patients who cease smoking [2,...
Source: European Respiratory Journal - December 21, 2017 Category: Respiratory Medicine Authors: Osadnik, C. R., MacDonald, M. I., Bardin, P. G. Tags: COPD and smoking Original Articles: Correspondence Source Type: research

Two-year follow-up after endobronchial coil treatment in emphysema: results from the REVOLENS study
Severe emphysema is a difficult to treat condition with limited efficacy of currently available treatments. Endobronchial coil treatment (ECT) is a minimally invasive endobronchial treatment which consists of placing shape-memory nitinol coils in emphysematous lobes to enhance lung recoil and reduce lung hyperinflation at rest and during exercise [1, 2]. Randomised studies demonstrated an improvement in exercise capacity, lung function and quality of life, and showed an acceptable safety profile at 1 year [3–6]. However, to our best knowledge, longer term safety and effectiveness results beyond 1 year have ...
Source: European Respiratory Journal - December 21, 2017 Category: Respiratory Medicine Authors: Deslee, G., Leroy, S., Perotin, J. M., Mal, H., Dutau, H., Bourdin, A., Vergnon, J. M., Pison, C., Kessler, R., Jounieaux, V., Salaün, M., Marceau, A., Dury, S., Benzaquen, J., Bonnaire, M., Dukic, S., Barbe, C., Marquette, C. H., , on behalf of t Tags: COPD and smoking Original Articles: Research letters Source Type: research

Respiratory irritants in e-cigarette refill liquids across nine European countries: a threat to respiratory health?
The rapid expansion of the e-cigarette market across European countries has raised a number of concerns within the scientific community [1, 2]. The most recent data from across the European Union revealed a substantial increase in e-cigarette experimentation, with 15% of European citizens reporting having tried e-cigarettes in 2017, representing a 7.0% increase since 2012 [3]. Annual e-cigarette sales in Europe have reached EUR 1.33 billion, and are projected to reach over EUR 10 billion by 2020 [4]. (Source: European Respiratory Journal)
Source: European Respiratory Journal - December 21, 2017 Category: Respiratory Medicine Authors: Vardavas, C., Girvalaki, C., Vardavas, A., Papadakis, S., Tzatzarakis, M., Behrakis, P., Tsatsakis, A. Tags: COPD and smoking Original Articles: Research letters Source Type: research

Growth and nutritional status, and their association with lung function: a study from the international Primary Ciliary Dyskinesia Cohort
In this study, based on the international PCD (iPCD) Cohort, we calculated z-scores for height and BMI using World Health Organization (WHO) and national growth references, and assessed associations with age, sex, country, diagnostic certainty, age at diagnosis, organ laterality and lung function in multilevel regression models that accounted for repeated measurements. We analysed 6402 measurements from 1609 iPCD Cohort patients. Height was reduced compared to WHO (z-score –0.12, 95% CI –0.17 to –0.06) and national references (z-score –0.27, 95% CI –0.33 to –0.21) in male and female pati...
Source: European Respiratory Journal - December 21, 2017 Category: Respiratory Medicine Authors: Goutaki, M., Halbeisen, F. S., Spycher, B. D., Maurer, E., Belle, F., Amirav, I., on behalf of the PCD Israeli Consortium, Behan, L., Boon, M., Carr, S., Casaulta, C., on behalf of the Swiss PCD Group, Clement, A., on behalf of the French Reference Centre Tags: CF and non-CF bronchiectasis Original Articles: Primary ciliary dyskinesia Source Type: research

Correspondence regarding the article "The asbestos fibre burden in human lungs: new insights into the chrysotile debate"
The article by Feder et al. [1] states that the lung asbestos fibre burden in 23 955 patients was analysed to address fibre type and biopersistence; data from 12 patients undergoing two tissue excisions at intervals at least 4 years were considered. (Source: European Respiratory Journal)
Source: European Respiratory Journal - December 21, 2017 Category: Respiratory Medicine Authors: Oliver, L. C., Belpoggi, F., Budnik, L. T., Egilman, D., Frank, A. L., Mandrioli, D., Soskolne, C. L., Terracini, B., Welch, L., Baur, X. Tags: Original Articles: Correspondence Source Type: research

Mediastinal staging by videomediastinoscopy in clinical N1 non-small cell lung cancer: a prospective multicentre study
A quarter of patients with clinical N1 (cN1) non-small cell lung cancer (NSCLC) based on positron emission tomography–computed tomography (PET-CT) imaging have occult mediastinal nodal involvement (N2 disease). In a prospective study, endosonography alone had an unsatisfactory sensitivity (38%) in detecting N2 disease. The current prospective multicentre trial investigated the sensitivity of preoperative mediastinal staging by video-assisted mediastinoscopy (VAM) or VAM-lymphadenectomy (VAMLA). Consecutive patients with operable and resectable (suspected) NSCLC and cN1 after PET-CT imaging underwent VAM(LA). The prim...
Source: European Respiratory Journal - December 21, 2017 Category: Respiratory Medicine Authors: Decaluwe, H., Dooms, C., D'Journo, X. B., Call, S., Sanchez, D., Haager, B., Beelen, R., Kara, V., Klikovits, T., Aigner, C., Tournoy, K., Zahin, M., Moons, J., Brioude, G., Trujillo, J. C., Klepetko, W., Turna, A., Passlick, B., Molins, L., Rami-Porta, R Tags: Lung cancer Original Articles: Lung cancer Source Type: research

Exhaled breath to screen for malignant pleural mesothelioma: a validation study
Malignant pleural mesothelioma (MPM) is predominantly caused by asbestos exposure and has a poor prognosis. Breath contains volatile organic compounds (VOCs) and can be explored as an early detection tool. Previously, we used multicapillary column/ion mobility spectrometry (MCC/IMS) to discriminate between patients with MPM and asymptomatic high-risk persons with a high rate of accuracy. Here, we aim to validate these findings in different control groups. Breath and background samples were obtained from 52 patients with MPM, 52 healthy controls without asbestos exposure (HC), 59 asymptomatic former asbestos workers (AEx), ...
Source: European Respiratory Journal - December 21, 2017 Category: Respiratory Medicine Authors: Lamote, K., Vynck, M., Thas, O., Van Cleemput, J., Nackaerts, K., van Meerbeeck, J. P. Tags: Lung cancer Original Articles: Mesothelioma Source Type: research

Electronic monitoring of adherence to inhaled corticosteroids: an essential tool in identifying severe asthma in children
International guidelines recommend that severe asthma can only be diagnosed after contributory factors, including adherence, have been addressed. Accurate assessment of adherence is difficult in clinical practice. We hypothesised that electronic monitoring in children would identify nonadherence, thus delineating the small number with true severe asthma. Asthmatic children already prescribed inhaled corticosteroids were prospectively recruited and persistence of adherence assessed using electronic monitoring devices. Spirometry, airway inflammation and asthma control were measured at the start and end of the monitoring per...
Source: European Respiratory Journal - December 21, 2017 Category: Respiratory Medicine Authors: Jochmann, A., Artusio, L., Jamalzadeh, A., Nagakumar, P., Delgado-Eckert, E., Saglani, S., Bush, A., Frey, U., Fleming, L. J. Tags: Original Articles: Paediatric asthma Source Type: research

Dietary antioxidants and 10-year lung function decline in adults from the ECRHS survey
The relationship between lung function decline and dietary antioxidants over 10 years in adults from three European countries was investigated. In 2002, adults from three participating countries of the European Community Respiratory Health Survey (ECRHS) answered a questionnaire and underwent spirometry (forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC)), which were repeated 10 years later. Dietary intake was estimated at baseline with food frequency questionnaires (FFQ). Associations between annual lung function decline (mL) and diet (tertiles) were examined with multivariable analyses....
Source: European Respiratory Journal - December 21, 2017 Category: Respiratory Medicine Authors: Garcia-Larsen, V., Potts, J. F., Omenaas, E., Heinrich, J., Svanes, C., Garcia-Aymerich, J., Burney, P. G., Jarvis, D. L. Tags: Lung structure and function Original Articles: Lung function Source Type: research

ERJ December Podcast: An interview with new editors
As part of the December issue, the European Respiratory Journal presents the latest in its series of podcasts. Chief editor Marc Humbert interviews the incoming Chief Editor Martin Kolb and Deputy Chief Editor James Chalmers about the future of the ERJ, and reflects on his own time as Chief Editor. (Source: European Respiratory Journal)
Source: European Respiratory Journal - December 21, 2017 Category: Respiratory Medicine Tags: Electronic Resources Source Type: research

"Infertility in an adult cohort with primary ciliary dyskinesia: phenotype-gene association." Gert Jan Vanaken, Laurence Bassinet, Mieke Boon, Rahma Mani, Isabelle Honore, Jean-Francois Papon, Harry Cuppens, Martine Jaspers, Natalie Lorent, Andre Coste, Estelle Escudier, Serge Amselem, Bernard Maitre, Marie Legendre and Sophie Christin-Maitre. Eur Respir J 2017; 50: 1700314.
(Source: European Respiratory Journal)
Source: European Respiratory Journal - December 14, 2017 Category: Respiratory Medicine Tags: Author Correction Source Type: research

Always think of the right ventricle, even in "low-risk" pulmonary embolism
Patients with pulmonary embolism (PE) represent a prognostically heterogeneous patient population. Therefore, the current European Society of Cardiology (ESC) guidelines recommend risk stratification to guide risk-adjusted management [1]. Since no individual clinical, imaging or laboratory finding has been shown to predict risk of an adverse in-hospital outcome with adequate sensitivity and specificity to justify treatment decisions numerous studies have investigated combination models for an optimised risk classification [2, 3]. Despite considerable progress made in the identification of intermediate-high-risk patients wh...
Source: European Respiratory Journal - December 14, 2017 Category: Respiratory Medicine Authors: Lankeit, M. Tags: Pulmonary vascular disease Editorials Source Type: research

To progress understanding of disease triggers and modifiers in sarcoidosis, stratification is the key
The vast majority of sarcoidosis literature starts with something similar to the following sentence "Sarcoidosis is a multi-system granulomatous disease of unknown aetiology predominantly affecting the lung". The unknown cause continues to inspire researchers to search for a possible trigger, especially if new and high-throughput methods are at their disposal. The histological hallmark of sarcoidosis is epithelioid cell granuloma. Formation of granuloma is a common reaction towards, for example, bacterial agents. Evidence for bacterial involvement in sarcoidosis consist of presence of bacterial peptides inside lu...
Source: European Respiratory Journal - December 14, 2017 Category: Respiratory Medicine Authors: van Moorsel, C. H. M. Tags: Interstitial and orphan lung disease Editorials Source Type: research

Prognostic value of right ventricular dilatation in patients with low-risk pulmonary embolism
The prognosis of multidetector computed tomography (MDCT) assessed right ventricular dilatation (RVD) is unclear in patients with pulmonary embolism (PE) and a simplified Pulmonary Embolism Severity Index (sPESI) of 0. We investigated in these patients whether MDCT-assessed RVD, defined by a right to left ventricular ratio (RV/LV) ≥0.9 or ≥1.0, is associated with worse outcomes. We combined data from three prospective cohorts of patients with PE. The main study outcome was the composite of 30-day all-cause mortality, haemodynamic collapse or recurrent PE in patients with sPESI of 0. Among 779 patients with a sPE...
Source: European Respiratory Journal - December 14, 2017 Category: Respiratory Medicine Authors: Cote, B., Jimenez, D., Planquette, B., Roche, A., Marey, J., Pastre, J., Meyer, G., Sanchez, O. Tags: Pulmonary vascular disease Original Articles: Pulmonary vascular diseases Source Type: research

Temporal trajectories of novel object recognition performance in mice exposed to intermittent hypoxia
Intermittent hypoxia is one of the major perturbations of sleep-disordered breathing and has been causally implicated in neurocognitive deficits. However, the reversibility of such deficits is unclear. Male C57BL/6J mice were exposed to either intermittent hypoxia or room air for 3–240 days, and then half were randomly selected and allowed to recover in normoxic conditions for the same duration of the previous exposure. A novel object recognition (NOR) test was performed. NOR performance was stable over time in room air. Intermittent hypoxia induced significant reductions in recognition index that progressed ove...
Source: European Respiratory Journal - December 14, 2017 Category: Respiratory Medicine Authors: Gozal, D., Khalyfa, A., Qiao, Z., Almendros, I., Farre, R. Tags: Original Articles: Sleep Source Type: research

Standardised classification of the aetiology of bronchiectasis using an objective algorithm
Bronchiectasis (BE) is a chronic and progressive respiratory disease with multiple possible causes [1, 2]. Many require a specific therapy and thus, a systematic aetiologic evaluation is recommended by guidelines [3]. Studies have shown wide heterogeneity in the proportion of different aetiologies identified among centres [4–8], which can be partially justified because of geographical risks factors, but may also reflect variations in testing practice or in the definitions of aetiology used [9]. The proportion of patients classified as idiopathic varies (26–74%) across the literature, and this variability is lik...
Source: European Respiratory Journal - December 14, 2017 Category: Respiratory Medicine Authors: Araujo, D., Shteinberg, M., Aliberti, S., Goeminne, P. C., Hill, A. T., Fardon, T., Obradovic, D., Dimakou, K., Polverino, E., De Soyza, A., McDonnell, M. J., Chalmers, J. D. Tags: CF and non-CF bronchiectasis Original Articles: Research letters Source Type: research

Dual responses of CD14 methylation to distinct environments: a role in asthma and allergy
Gene–environment interactions are believed to cause an increased prevalence of asthma and allergic diseases in Western Countries, in comparison to Eastern Countries. To date, research has been inconclusive about which specific genetic and environmental risk factors are important, how the epigenetics/genetics interact with the environment, and which pathogenic mechanisms underlie the development of asthma and allergy. Inconsistencies in research outcomes are mainly attributed to substantial variations in genetic backgrounds and environmental conditions between different populations. Furthermore, a poor understanding o...
Source: European Respiratory Journal - December 14, 2017 Category: Respiratory Medicine Authors: Song, Y., Khoo, S.-K., Lee, K. H., Mäkelä, M., Haahtela, T., LeSouëf, P., Zhang, G. Tags: Asthma and allergy Original Articles: Research letters Source Type: research

The potential effects of pregnancy in a patient with idiopathic pulmonary arterial hypertension responding to calcium channel blockade
Pulmonary arterial hypertension (PAH) results in increased pulmonary vascular resistance, right ventricular failure and premature death. Around half of patients with PAH are diagnosed with idiopathic pulmonary arterial hypertension (IPAH), where no distinct cause is identified [1, 2]. Patients with IPAH in World Health Organization (WHO) functional classes I–III can be challenged with a vasodilator, such as inhaled nitric oxide, during a right heart catheterisation (RHC) study [3]. "Vasoresponsive" IPAH is universally held to be an excellent prognostic indicator with an entirely different disease course fro...
Source: European Respiratory Journal - December 14, 2017 Category: Respiratory Medicine Authors: Bostock, S., Sheares, K., Cannon, J., Taboada, D., Pepke-Zaba, J., Toshner, M. Tags: Pulmonary vascular disease Original Articles: Correspondence Source Type: research

Chest computed tomography-derived low fat-free mass index and mortality in COPD
Low fat-free mass index (FFMI) is an independent risk factor for mortality in chronic obstructive pulmonary disease (COPD) not typically measured during routine care. In the present study, we aimed to derive fat-free mass from the pectoralis muscle area (FFMPMA) and assess whether low FFMIPMA is associated with all-cause mortality in COPD cases. We used data from two independent COPD cohorts, ECLIPSE and COPDGene. Two equal sized groups of COPD cases (n=759) from the ECLIPSE study were used to derive and validate an equation to calculate the FFMPMA measured using bioelectrical impedance from PMA. We then applied the equati...
Source: European Respiratory Journal - December 14, 2017 Category: Respiratory Medicine Authors: McDonald, M.-L. N., Diaz, A. A., Rutten, E., Lutz, S. M., Harmouche, R., San Jose Estepar, R., Kinney, G., Hokanson, J. E., Gower, B. A., Wouters, E. F. M., Rennard, S. I., Hersh, C. P., Casaburi, R., Dransfield, M. T., Silverman, E. K., Washko, G. R. Tags: COPD and smoking Original Articles: COPD Source Type: research

ERS statement: interventional bronchoscopy in children
Paediatric airway endoscopy is accepted as a diagnostic and therapeutic procedure, with an expanding number of indications and applications in children. The aim of this European Respiratory Society task force was to produce a statement on interventional bronchoscopy in children, describing the evidence available at present and current clinical practice, and identifying areas deserving further investigation. The multidisciplinary task force panel performed a systematic review of the literature, focusing on whole lung lavage, transbronchial and endobronchial biopsy, transbronchial needle aspiration with endobronchial ultraso...
Source: European Respiratory Journal - December 14, 2017 Category: Respiratory Medicine Authors: Eber, E., Anton-Pacheco, J. L., de Blic, J., Doull, I., Faro, A., Nenna, R., Nicolai, T., Pohunek, P., Priftis, K. N., Serio, P., Coleman, C., Masefield, S., Tonia, T., Midulla, F. Tags: Paediatric pulmonology Original Articles: ERS statements Source Type: research

Atopobium and Fusobacterium as novel candidates for sarcoidosis-associated microbiota
Sarcoidosis is a granulomatous disease that mainly affects the lung. A role of microbial factors in disease pathogenesis is assumed, but has not been investigated systematically in a large cohort. This cross-sectional study compared the lung microbiota of 71 patients with sarcoidosis, 15 patients with idiopathic pulmonary fibrosis (non-infectious controls) and 10 healthy controls (HCs). Next-generation sequencing of 16S DNA was used on bronchoalveolar lavage samples to characterise the microbial composition, which was analysed for diversity and indicator species. Host genotypes for 13 known sarcoidosis risk variants were d...
Source: European Respiratory Journal - December 14, 2017 Category: Respiratory Medicine Authors: Zimmermann, A., Knecht, H., Häsler, R., Zissel, G., Gaede, K. I., Hofmann, S., Nebel, A., Müller-Quernheim, J., Schreiber, S., Fischer, A. Tags: Interstitial and orphan lung disease Original Articles: Sarcoidosis Source Type: research

Radiological abnormalities following bronchial thermoplasty: is the pathophysiology understood?
We read with great interest the correspondence by J.N.S. d'Hooghe and colleagues focusing on the pathophysiology of early transient radiological abnormalities following bronchial thermoplasty (BT). In line with our previous report [1], they have reported transient radiological opacities in all treated lobes of 12 BT-treated patients and in an adjacent untreated lobe in 31% of cases [2]. (Source: European Respiratory Journal)
Source: European Respiratory Journal - December 7, 2017 Category: Respiratory Medicine Authors: Debray, M.-P., Dombret, M.-C., Pretolani, M., Thabut, G., Alavoine, L., Brillet, P.-Y., Taille, C., Khalil, A., Chanez, P., Aubier, M. Tags: Original Articles: Correspondence Source Type: research

Malaria and the development of pulmonary fibrosis
Sorry for the bait-and-switch. This is not a review about the role of parasitic infections and lung scarring. Instead, the manuscript by Sack et al. [1] in this issue of the European Respiratory Journal gives us the opportunity to consider the relationship between air pollution, or "bad air" (the literal translation of the contracted Italian words mala aria), and the development of, and progression from, early stages of pulmonary fibrosis. (Source: European Respiratory Journal)
Source: European Respiratory Journal - December 7, 2017 Category: Respiratory Medicine Authors: Miller, E. R., Hunninghake, G. M. Tags: Interstitial and orphan lung disease Editorials Source Type: research

Ten principles for climate, environment and respiratory health
While not a meteorological fact, it is nonetheless commonly believed that every cloud has a silver lining. It seems they may also have a developed sense of irony as within days of announcing plans to pull the United States out of the United Nations Framework Convention on Climate Change (UNFCCC) Paris Agreement, President Trump moved to show his climate credentials by proposing to cover his Mexican border wall with solar panels. Despite such changes, The Lancet has noted that the response to the cloud of climate change could offer "...the greatest global health opportunity of the 21st century..." [1]. After all, ...
Source: European Respiratory Journal - December 7, 2017 Category: Respiratory Medicine Authors: Barry, M., Annesi-Maesano, I. Tags: Epidemiology, occupational and environmental lung disease Editorials Source Type: research

Asthma control and action plans
We would like to thank I. Amirav and M.T. Newhouse for their correspondence in response to our recent paper, "An evidence-based, point-of-care tool to guide completion of asthma action plans in practice" [1]. They raise an important issue surrounding confusion between the concepts of poor baseline asthma control and acute changes in symptoms that merit activation of the "yellow zone" of the asthma action plan (AAP). Although, contrary to their contention, this discussion does not affect the objective or outcome of our analysis, which was to provide a practical, evidence-based guide to populating th...
Source: European Respiratory Journal - December 7, 2017 Category: Respiratory Medicine Authors: Kouri, A., Boulet, L.-P., Kaplan, A., Gupta, S. Tags: Asthma and allergy Original Articles: Correspondence Source Type: research

Age should not be a barrier for pulmonary endarterectomy in carefully selected patients
Pulmonary endarterectomy (PEA) is the treatment of choice in operable chronic thromboembolic pulmonary hypertension (CTEPH) with excellent long-term outcomes [1]. It is a complex surgical procedure requiring cardiopulmonary bypass and removal of obstructive thromboembolic material during periods of deep hypothermic circulatory arrest [1]. We have observed an increase in the number of older CTEPH patients referred for consideration of PEA, which is consistent with other cardiothoracic surgeries. The UK population is ageing with a projected 3% increase in subjects aged>85 years in the next 20 years [2]. This may...
Source: European Respiratory Journal - December 7, 2017 Category: Respiratory Medicine Authors: Newnham, M., Hernandez-Sanchez, J., Dunning, J., Ng, C., Tsui, S., Bunclark, K., Sheares, K., Taboada, D., Toshner, M., Pepke-Zaba, J., Jenkins, D., Cannon, J. Tags: Pulmonary vascular disease Original Articles: Research letters Source Type: research

Care pathways for the selection of a biologic in severe asthma
Patients with severe asthma generally benefit from consultations with an asthma specialist to optimise their management, which may include the potential initiation of biologic agents that have made a breakthrough in the treatment of severe disease. (Source: European Respiratory Journal)
Source: European Respiratory Journal - December 7, 2017 Category: Respiratory Medicine Authors: Bousquet, J., Brusselle, G., Buhl, R., Busse, W. W., Cruz, A. A., Djukanovic, R., Domingo, C., Hanania, N. A., Humbert, M., Menzies Gow, A., Phipatanakul, W., Wahn, U., Wechsler, M. E. Tags: Asthma and allergy Editorials Source Type: research

Asthma control and action plans
Kouri et al. [1] in Canada have developed a tool to guide completion of asthma action plans (AAPs). In their rationale, they suggest that "fewer than 25% of patients receive an AAP, partly due to prescribers' inability to complete ‘yellow zone’ instructions (how to intensify therapy for acute loss of control)". The authors "reviewed recent asthma guidelines and adult studies addressing acute loss of asthma control" and "developed evidence-based rules for yellow zone therapy and operational guidelines to maximise adherence and minimise errors". (Source: European Respiratory Journal)
Source: European Respiratory Journal - December 7, 2017 Category: Respiratory Medicine Authors: Amirav, I., Newhouse, M. T. Tags: Asthma and allergy Original Articles: Correspondence Source Type: research

Fluoroquinolone resistance in multidrug-resistant Mycobacterium tuberculosis independent of fluoroquinolone use
During the 1990s, multidrug-resistant tuberculosis (MDR-TB), resistant to at least isoniazid and rifampin, emerged as a great threat to global tuberculosis (TB) control [1]. For most MDR-TB patients, the World Health Organization (WHO) recommends a treatment regimen including second-line anti-TB drugs [2]. One of the most effective second-line drugs is fluoroquinolone [3]. During the treatment, MDR-TB may develop resistance to fluoroquinolone, or even become extensively drug-resistant (XDR-TB), which is resistant to both fluoroquinolone and at least one of three injectable second-line drugs [4]. The main genetic mechanism ...
Source: European Respiratory Journal - December 7, 2017 Category: Respiratory Medicine Authors: Che, Y., Song, Q., Yang, T., Ping, G., Yu, M. Tags: Respiratory infections and tuberculosis Original Articles: Research letters Source Type: research

Radiological abnormalities following bronchial thermoplasty: is the pathophysiology understood?
We read with great interest the paper by Debray et al. [1] reporting on early radiological lung abnormalities on computed tomography (CT) of the chest after bronchial thermoplasty (BT). The described findings in 13 patients are in line with our observations in 12 patients with severe asthma treated with BT in the TASMA trial (www.clinicaltrials.gov identifier number NCT02225392). Transient radiological abnormalities were seen after all 36 BT procedures, predominantly consisting of peribronchial consolidations with ground-glass opacities (figure 1a and c), partial occlusions/filling of bronchial lumen and atelectasis. Furth...
Source: European Respiratory Journal - December 7, 2017 Category: Respiratory Medicine Authors: d'Hooghe, J. N. S., Bonta, P. I., van den Berk, I. A. H., Annema, J. T. Tags: Original Articles: Correspondence Source Type: research

Novel magnetic resonance technique for functional imaging of cystic fibrosis lung disease
We examined the correlation between functional MRI, performed without administration of contrast agent, and lung clearance index (LCI) from nitrogen multiple-breath washout (N2-MBW). 40 children with CF (median (range) age 12.0 (6–18) years) and 12 healthy age-matched controls underwent functional and structural MRI and lung function tests on the same day. Functional MRI provided semiquantitative measures of perfusion (RQ) and ventilation (RFV) impairment as percentages of affected lung volume. Morphological MRI was evaluated using CF-specific scores. LCI measured global ventilation inhomogeneity. MRI detected f...
Source: European Respiratory Journal - December 7, 2017 Category: Respiratory Medicine Authors: Nyilas, S., Bauman, G., Sommer, G., Stranzinger, E., Pusterla, O., Frey, U., Korten, I., Singer, F., Casaulta, C., Bieri, O., Latzin, P. Tags: CF and non-CF bronchiectasis Original Articles: Cystic fibrosis Source Type: research

Asthma phenotypes: do cough and wheeze predict exacerbations in persistent asthma?
Little is known of the long-term symptom profile in uncontrolled asthma and whether symptoms can predict distinct phenotypes. The primary objective of these analyses was to assess diurnal profile of cough and wheeze in an uncontrolled asthma population. Secondary outcomes were to examine how these symptom profiles influence response to treatment. Twice-daily electronically recorded data from 1701 patients were examined in relation to the population demographics. Reliever treatment with salbutamol was then compared with extra-fine beclometasone/formoterol maintenance and reliever therapy (MART). Exacerbation frequency was t...
Source: European Respiratory Journal - December 7, 2017 Category: Respiratory Medicine Authors: Morjaria, J. B., Rigby, A. S., Morice, A. H. Tags: Asthma and allergy Original Articles: Asthma Source Type: research

ERS statement on obstructive sleep disordered breathing in 1- to 23-month-old children
The present statement was produced by a European Respiratory Society Task Force to summarise the evidence and current practice on the diagnosis and management of obstructive sleep disordered breathing (SDB) in children aged 1–23 months. A systematic literature search was completed and 159 articles were summarised to answer clinically relevant questions. SDB is suspected when symptoms or abnormalities related to upper airway obstruction are identified. Morbidity (pulmonary hypertension, growth delay, behavioural problems) and coexisting conditions (feeding difficulties, recurrent otitis media) may be present. SDB...
Source: European Respiratory Journal - December 7, 2017 Category: Respiratory Medicine Authors: Kaditis, A. G., Alonso Alvarez, M. L., Boudewyns, A., Abel, F., Alexopoulos, E. I., Ersu, R., Joosten, K., Larramona, H., Miano, S., Narang, I., Tan, H.-L., Trang, H., Tsaoussoglou, M., Vandenbussche, N., Villa, M. P., Van Waardenburg, D., Weber, S., Verh Tags: Sleep medicine, Paediatric pulmonology Original Articles: ERS statement Source Type: research

Phenotypes of symptomatic airways disease in China and New Zealand
It is uncertain whether phenotypes of asthma and chronic obstructive pulmonary disease (COPD) vary between populations with different genetic and environmental characteristics. Here, our objective was to compare the phenotypes of airways disease in two separate populations. This was a cross-sectional observational study in adult populations from New Zealand and China. Participants aged 40–75 years who reported wheeze and breathlessness in the last 12 months were randomly selected from the general population and underwent detailed characterisation. Complete data for cluster analysis were available for 345 pa...
Source: European Respiratory Journal - December 7, 2017 Category: Respiratory Medicine Authors: Fingleton, J., Huang, K., Weatherall, M., Guo, Y., Ivanov, S., Bruijnzeel, P., Zhang, H., Wang, W., Beasley, R., Wang, C., for the NZ-China Study Group Tags: Original Articles: Airways disease Source Type: research

Outcomes in coronary artery disease patients with sleepy obstructive sleep apnoea on CPAP
This study was a parallel observational arm of the RICCADSA randomised controlled trial, conducted in Sweden between 2005 and 2013. Patients with revascularised CAD and OSA (apnoea–hypopnoea index (AHI) ≥15 events·h–1) with daytime sleepiness (Epworth Sleepiness Scale score ≥10) were offered continuous positive airway pressure (CPAP) (n=155); CAD patients with no OSA (AHI
Source: European Respiratory Journal - December 7, 2017 Category: Respiratory Medicine Authors: Peker, Y., Thunström, E., Glantz, H., Wegscheider, K., Eulenburg, C. Tags: Sleep medicine Original Articles: Sleep Source Type: research

Air pollution and subclinical interstitial lung disease: the Multi-Ethnic Study of Atherosclerosis (MESA) air-lung study
We studied whether ambient air pollution is associated with interstitial lung abnormalities (ILAs) and high attenuation areas (HAAs), which are qualitative and quantitative measurements of subclinical interstitial lung disease (ILD) on computed tomography (CT). We performed analyses of community-based dwellers enrolled in the Multi-Ethnic Study of Atherosclerosis (MESA) study. We used cohort-specific spatio-temporal models to estimate ambient pollution (fine particulate matter (PM2.5), nitrogen oxides (NOx), nitrogen dioxide (NO2) and ozone (O3)) at each home. A total of 5495 participants underwent serial assessment of HAA...
Source: European Respiratory Journal - December 7, 2017 Category: Respiratory Medicine Authors: Sack, C., Vedal, S., Sheppard, L., Raghu, G., Barr, R. G., Podolanczuk, A., Doney, B., Hoffman, E. A., Gassett, A., Hinckley-Stukovsky, K., Williams, K., Kawut, S., Lederer, D. J., Kaufman, J. D. Tags: Epidemiology, occupational and environmental lung disease, Interstitial and orphan lung disease Original Articles: Air pollution and interstitial lung diseases Source Type: research

Fluctuation Dynamics of Clinical Markers in Asthmatic and Healthy Subjects Challenged with Rhinovirus
Clinical biomarkers can improve asthma diagnosis and phenotyping, aiding disease monitoring and prediction of outcomes. Such biomarkers are dynamic, changing over time from clinically controlled states to loss of control (LOC)/exacerbations in asthma as opposed to static single time point cross sectional snapshots.Aims: To compare temporal fluctuations in lung function between asthmatic and healthy volunteers before and after destabilization by RhinoVirus (RV) challenge.Methods: It is a prospective observational follow up study for 3 months in 12 asthmatic and 12 healthy subjects. The first 2 months is the stable phase fol...
Source: European Respiratory Journal - December 6, 2017 Category: Respiratory Medicine Authors: Sinha, A., Binbin, X., Leoni, V., Delgado Eckert, E., Frey, U., Lutter, R., Sterk, P. J. Tags: Allergy and immunology Source Type: research

What predicts a deterioration of generic and disease-specific health-related quality of life in COPD? First longitudinal results of the COSYCONET cohort
Conclusion: Knowledge about factors predicting change in HRQL helps to identify subgroups of patients with special needs for care. (Source: European Respiratory Journal)
Source: European Respiratory Journal - December 6, 2017 Category: Respiratory Medicine Authors: Wacker, M. E., Jörres, R. A., Schulz, H., Karrasch, S., Koch, A., Leidl, R., Watz, H., Vogelmeier, C., Holle, R. Tags: Clinical Problems COPD Source Type: research

Mortality after an acute exacerbation of COPD (AECOPD): findings from the National COPD Audit Programme
The National COPD Audit Programme ran a secondary care audit between February and April 2014, aiming to capture all hospital admissions for AECOPD in this window.Aims: To investigate 30 and 90 day mortality rates following hospital admission for AECOPD.Methods: The audit obtained permission to collect patient identifiers. These were used to link the English audit cohort records to an externally available source of mortality data, held by the Office of National Statistics. Comparison was made against earlier audit data for 90-day mortality.Results: Data from 12594 English patients were analysed.Mortality within 90 days of a...
Source: European Respiratory Journal - December 6, 2017 Category: Respiratory Medicine Authors: Stone, R., Holzhauer-Barrie, J., Lowe, D., McMillan, V., Saleem Khan, M., Roberts, M. Tags: Clinical Problems COPD Source Type: research

Using Gold Standard Framework Criteria in COPD: Empowering Patients to make Choices about End of Life Care
Conclusions: The majority of patients admitted with COPD to a respiratory ward meet GSF criteria and have a poor prognosis. We found that an MDT approach using GSF criteria to predict mortality at 12 months was accurate. Comparing deaths out of hospital (35%) to a pre project audit (18%) has demonstrated that by working in this way and initiating discussions about advanced care planning around the time of admission, resulted in a reduction in deaths in hospital. (Source: European Respiratory Journal)
Source: European Respiratory Journal - December 6, 2017 Category: Respiratory Medicine Authors: Gudur, S., O'Brien, F., Salem, A., Hasan, I., Hussain, N., Corcoran, C., Emery, S., Walker-Frost, Z., Fletcher, A., Marsden, P. Tags: Clinical Problems COPD Source Type: research

Elevated systemic biomarkers and persistent anxiety and depression in smokers with and without COPD: An analysis of the SPIROMICS cohort
We examined 1543 smokers with and without COPD and divided them into groups based on the Hospital Anxiety and Depression Scale (HADS), defining Persistent Anxiety (PA+) as HADS-A≥8 at baseline and year 1 (n=222), and Persistent Depression (PD+) as HADS-D≥8 at baseline and year 1 (n=137). We analyzed selected baseline biomarkers, divided them into quartiles and compared the percentages in the upper quartile (referred to as "high") between groups (PA+ vs. PA- and PD+ vs. PD-) with Chi squared tests.Preliminary Results: The PA+ group had greater percentages of high CBC (30.3 vs. 22.7%, p=0.014), CRP (30.6 vs. ...
Source: European Respiratory Journal - December 6, 2017 Category: Respiratory Medicine Authors: Kim, V., Zhao, H., Armstrong, H., O'Neal, W., Bailey, K., Rennard, S., Barr, R. G., Criner, G., Lovasi, G., Morrison, M. Tags: Clinical Problems COPD Source Type: research

A real world experience of COPD exacerbations and possible association with Bronchiectasis in a medium size teaching hospital in the northwest of England
Admissions due to COPD exacerbations is an issue. A distinct Chronic Obstructive Pulmonary Disease (COPD) phenotype associated with Bronchiectasis is important for therapeutic reasons (1). These patients have greater levels of bronchial inflammation, colonisation of the bronchial mucosa with potentially pathogenic microorganisms (PPM) and a longer duration of acute infectious exacerbations (2). They may possibly have a worse prognosis (2). However the prevalence in COPD varies from 4%-50% (2, 3).Our aim was to identify the recurrent exacerbations for possible interventions and also correlate with Bronchiectasis. We retrosp...
Source: European Respiratory Journal - December 6, 2017 Category: Respiratory Medicine Authors: Singh, H., Khan, S., Murrell, J. Tags: Clinical Problems COPD Source Type: research

High CAT score predicts lung parenchymal damage in COPD
COPD Assessment Test (CAT) is a measure of impact of COPD on a patient’s health status. We measured CAT score in 94 Chinese patients with a confirmed diagnosis of stable COPD (GOLD criteria). Age ranged 43-86 years, smoking pack years 0-104, and post-bronchodilatation FEV1/FVC under treatment 25-80%. CAT was compared to ventilation and perfusion tomography with Technegas™ (V/P SPECT*), diffusion capacity (DLCO) and FEV1, FVC and FEV1/FVC. Obstructive bronchitis was classified by penetration of Technegas™ to periphery and quantified to estimate % of missing lung function in relation to total lung volume. E...
Source: European Respiratory Journal - December 6, 2017 Category: Respiratory Medicine Authors: Bajc, M., Wang, J., Chen, Y., Lindqvist, A. E., He, X. Y. Tags: Clinical Problems COPD Source Type: research

Use of the Daily PROactive instrument to evaluate physical activity in patients with COPD: results from ACTIVATE
Conclusion: AB/FF 400/12 µg significantly improved D-PPAC scores vs PBO at Week 4. BI did not augment these improvements. (Source: European Respiratory Journal)
Source: European Respiratory Journal - December 6, 2017 Category: Respiratory Medicine Authors: Garcia Aymerich, J., Watz, H., Beeh, K. M., Paggiaro, P., Moya, M., Notari, M., Jarreta, D., Garcia Gil, E., Troosters, T. Tags: Clinical Problems COPD Source Type: research

Carbon monoxide transfer factor (DL,CO), age and gender add to the BODE index to predict survival in COPD patients
The BODE index is an important tool to predict survival in patients with COPD. Some data suggest that diffusion indices are related to survival, with COPD patients with a lower DL, CO having a worse survival. We are however unaware of any data examining the added value of DL, CO on top of the BODE index to predict survival in COPD.The BODE index was assessed as a routine in COPD patients followed in a tertiary care hospital with a lung transplantation (LTx) program. The files of 470 consecutive patients with a BODE index assessment in stable state were reviewed for DL, CO measurement (n = 436) at the time or within 3 month...
Source: European Respiratory Journal - December 6, 2017 Category: Respiratory Medicine Authors: Marchand, E., Pirard, L. Tags: Clinical Problems COPD Source Type: research