Journal club
Detection of bacterial pathogens in patients with COVID-19: role for rapid multiplex PCR Patients admitted to intensive care with COVID-19 have high rates of secondary bacterial infection, but few data exist on the usefulness of multiplex PCR in this population. Karolyi et al (Central Eur J Med conducted a single-centre retrospective observational study in Austria to analyse which pathogens were detected by a commercial PCR system (Pneumonia Panel (PP)), from tracheal aspirates and bronchoalveolar lavages of patients admitted to critical care with COVID-19 with suspected hospital-ac...
Source: Thorax - May 17, 2022 Category: Respiratory Medicine Authors: Hazenberg, P. Tags: Thorax Journal club Source Type: research

Transposition of the great indwelling pleural catheter
A 70-year-old male with sarcomatoid renal carcinoma presented to his general practitioner with worsening breathlessness. He was referred to the radiology department for a radiograph of the chest, which showed recurrence of a known right malignant pleural effusion (MPE) (figure 1A). After 4 days, he underwent an uncomplicated right indwelling pleural catheter (IPC) insertion and drainage. The postprocedure radiograph of the chest (figure 1B) showed improved appearances of the right MPE and a new small left pleural effusion that had been seen on the preprocedure ultrasound and likely progressed since his presenting radiograp...
Source: Thorax - May 17, 2022 Category: Respiratory Medicine Authors: Bedawi, E. O., Banka, R., Gleeson, F. V., Rahman, N. M., Wrightson, J. M. Tags: Images in Thorax, Thorax Source Type: research

Persistent hypoxaemia and a headache in a previously healthy 11-year-old girl
Introduction An 11-year-old girl presented with headache, fever and hypoxaemia. Two months earlier, she suffered a mild COVID-19 infection but was otherwise healthy and family history was unremarkable. At presentation, other than hypoxaemia with a room air oxygen saturation of 87%, her physical examination was normal. Blood test results showed a white cell count of 23x109/L and an elevated C reactive protein level of 3.5 mg/L. Chest X-ray (figure 1) demonstrated a retrocardiac opacity. The patient was admitted with a presumed diagnosis of pneumonia for intravenous cefuroxime and oral azithromycin treatment. During admissio...
Source: Thorax - May 17, 2022 Category: Respiratory Medicine Authors: Sadras, I., Mei-Zahav, M., Breuer, O. Tags: Thorax Pulmonary puzzle Source Type: research

Pulmonary arteriovenous malformations may be the only clinical criterion present in genetically confirmed hereditary haemorrhagic telangiectasia
Pulmonary arteriovenous malformations (PAVMs) result in preventable complications demanding specialty care. Underlying hereditary haemorrhagic telangiectasia (HHT) can be identified by genetic testing, if the diagnosis is considered. Retrospectively reviewing 152 unrelated adults with genetically confirmed HHT due to ACVRL1, ENG or SMAD4, we found that only 104/152 (68%) met a clinical diagnosis of HHT with three Curacao criteria. The genetic diagnostic rate was similar for patients with three (104/137, 76%) or one to two (48/71, 68%; p=0.25) criteria. Of 83 unrelated probands with PAVM(s) and genetically-confirmed HHT, 20...
Source: Thorax - May 17, 2022 Category: Respiratory Medicine Authors: Anderson, E., Sharma, L., Alsafi, A., Shovlin, C. L. Tags: Open access, Thorax Brief communication Source Type: research

Human papillomavirus (HPV) and cervical dysplasia in adult female cystic fibrosis (CF) lung transplant recipients
Human papillomavirus (HPV) is the principal risk factor for cervical cancer. Transplant recipients are at a disproportionate risk of HPV complications. We conducted a single-centre, retrospective study of adult female cystic fibrosis (CF) lung transplant recipients between 2008 and 2021. We observed 12 of 34 (35.3%) with ≥1 abnormal pap smear (median age: 26.7 years). Complications included refractory anogenital warts (n=3), vulvectomy (n=2) and cervical cancer (n=4), with two deaths from metastatic disease. None with HPV morbidity was vaccinated. Lung transplant recipients had greater odds of cervical dysplasia relativ...
Source: Thorax - May 17, 2022 Category: Respiratory Medicine Authors: Thornton, C., Somayaji, R., Chu, A., Parkins, M. D. Tags: Editor's choice, Thorax Brief communication Source Type: research

Expression of interferon-{gamma} and its effect on cough hypersensitivity in chronic refractory cough patients
Chronic refractory cough (CRC) is characterised by cough hypersensitivity. Interferon- (IFN-) has been reported to induce calcium influx, action potentials of vagal neurons in vitro and cough response in guinea pigs. While the effect of IFN- in CRC patients remains unknown. Here, via flow-cytometry and inhalation cough challenge, we found CRC patients had significantly increased levels of sputum IFN-+CD4+ T cells, IFN-+CD8+ T cells as well as supernatant of IFN-. The average number of coughs in CRC patients increased as the concentration of inhaled IFN- went up in IFN- cough challenge. Two or more coughs and five or more c...
Source: Thorax - May 17, 2022 Category: Respiratory Medicine Authors: Sun, J., Zhan, C., Deng, Z., Luo, W., Chen, Q., Jiang, M., Zhong, N., Lai, K. Tags: Thorax Brief communication Source Type: research

Inhaled corticosteroids reduce senescence in endothelial progenitor cells from patients with COPD
Cellular senescence contributes to the pathophysiology of chronic obstructive pulmonary disease (COPD) and cardiovascular disease. Using endothelial colony-forming-cells (ECFC), we have demonstrated accelerated senescence in smokers and patients with COPD compared with non-smokers. Subgroup analysis suggests that ECFC from patients with COPD on inhaled corticosteroids (ICS) (n=14; eight on ICS) exhibited significantly reduced senescence (Senescence-associated-beta galactosidase activity, p21CIP1), markers of DNA damage response (DDR) and IFN--inducible-protein-10 compared with patients with COPD not on ICS. In vitro studie...
Source: Thorax - May 17, 2022 Category: Respiratory Medicine Authors: Paschalaki, K., Rossios, C., Pericleous, C., MacLeod, M., Rothery, S., Donaldson, G. C., Wedzicha, J. A., Gorgoulis, V., Randi, A. M., Barnes, P. J. Tags: Open access, Thorax Brief communication Source Type: research

Prospective validation of the 4C prognostic models for adults hospitalised with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol
Conclusion Both 4C risk stratification models demonstrate consistent performance to predict clinical deterioration and mortality in a large prospective second wave validation cohort of UK patients. Despite recent advances in the treatment and management of adults hospitalised with COVID-19, both scores can continue to inform clinical decision making. Trial registration number ISRCTN66726260. (Source: Thorax)
Source: Thorax - May 17, 2022 Category: Respiratory Medicine Authors: Knight, S. R., Gupta, R. K., Ho, A., Pius, R., Buchan, I., Carson, G., Drake, T. M., Dunning, J., Fairfield, C. J., Gamble, C., Green, C. A., Halpin, S., Hardwick, H. E., Holden, K. A., Horby, P. W., Jackson, C., Mclean, K. A., Merson, L., Nguyen-Van-Tam, Tags: Open access, Thorax Respiratory research Source Type: research

Global and regional burden of interstitial lung disease and pulmonary sarcoidosis from 1990 to 2019: results from the Global Burden of Disease study 2019
Conclusions Our study suggests the incidence, mortality and DALYs from ILD and pulmonary sarcoidosis are increasing globally. To reduce the ongoing burden of this condition, early diagnosis and treatment are vital, and more targeted and specific strategies should be established in high-burden regions. Differences in incidence and mortality across regions may reflect the influence of genetic, environmental, diagnostic, pharmacotherapeutic, and health system factors. (Source: Thorax)
Source: Thorax - May 17, 2022 Category: Respiratory Medicine Authors: Ma, X., Zhu, L., Kurche, J. S., Xiao, H., Dai, H., Wang, C. Tags: Thorax Interstitial lung disease Source Type: research

Survival after inpatient or outpatient pulmonary rehabilitation in patients with fibrotic interstitial lung disease: a multicentre retrospective cohort study
Conclusions Patients with fibrotic ILD who improved physical performance during PR had better survival compared with those who did not improve performance. Confirmation of these hypothesis-generating findings in a randomised controlled trial would be required to definitely change clinical practice, and would further support efforts to improve availability of PR for patients with fibrotic ILD. (Source: Thorax)
Source: Thorax - May 17, 2022 Category: Respiratory Medicine Authors: Guler, S. A., Hur, S. A., Stickland, M. K., Brun, P., Bovet, L., Holland, A. E., Bondarenko, J., Hambly, N., Wald, J., Makhdami, N., Kreuter, M., Gloeckl, R., Jarosch, I., Tan, B., Johannson, K. A., McBride, S. A., De Boer, K., Sandoz, J. S., Sun, K., Ass Tags: Thorax Interstitial lung disease Source Type: research

Testing the effects of combining azithromycin with inhaled tobramycin for P. aeruginosa in cystic fibrosis: a randomised, controlled clinical trial
Conclusions Despite having greater reduction in P. aeruginosa density in participants able to provide sputum samples, participants randomised to placebo with inhaled tobramycin did not experience significantly greater improvements in lung function or other clinical outcomes compared with those randomised to azithromycin with tobramycin. (Source: Thorax)
Source: Thorax - May 17, 2022 Category: Respiratory Medicine Authors: Nichols, D. P., Singh, P. K., Baines, A., Caverly, L. J., Chmiel, J. F., GIbson, R. L., Lascano, J., Morgan, S. J., Retsch-Bogart, G., Saiman, L., Sadeghi, H., Billings, J. L., Heltshe, S. L., Kirby, S., Kong, A., Nick, J. A., Mayer-Hamblett, N., TEACH St Tags: Open access, Thorax Cystic fibrosis Source Type: research

Use of inhaled corticosteroids and risk of acquiring Pseudomonas aeruginosa in patients with chronic obstructive pulmonary disease
Conclusion Use of ICS in patients with COPD followed in Danish outpatient clinics was associated with a substantially increased and dose-dependent risk of acquiring P. aeruginosa. Caution should be taken when administering high doses of ICS in severely ill patients with COPD. These results should be confirmed in comparable cohorts and other settings. (Source: Thorax)
Source: Thorax - May 17, 2022 Category: Respiratory Medicine Authors: Eklöf, J., Ingebrigtsen, T. S., Sorensen, R., Saeed, M. I., Alispahic, I. A., Sivapalan, P., Boel, J. B., Bangsborg, J., Ostergaard, C., Dessau, R. B., Jensen, U. S., Hansen, E. F., Lapperre, T. S., Meteran, H., Wilcke, T., Seersholm, N., Jensen, Tags: Open access, Thorax Chronic obstructive pulmonary disease Source Type: research

Epinephrine (adrenaline) compared to selective beta-2-agonist in adults or children with acute asthma: a systematic review and meta-analysis
Conclusion The low-quality evidence available suggests that epinephrine and selective β2-agonists have similar efficacy in acute asthma. There is a need for high-quality double-blind RCTs to determine whether addition of intramuscular epinephrine to inhaled or nebulised selective β2-agonist improves outcome. PROSPERO registration number CRD42017079472. (Source: Thorax)
Source: Thorax - May 17, 2022 Category: Respiratory Medicine Authors: Baggott, C., Hardy, J. K., Sparks, J., Sabbagh, D., Beasley, R., Weatherall, M., Fingleton, J. Tags: Thorax Asthma Source Type: research

Blood eosinophil cationic protein and eosinophil-derived neurotoxin are associated with different asthma expression and evolution in adults
Conclusions EDN and ECP were associated with different asthma expression in adults. EDN could be a potential biomarker to monitor asthma evolution in adults. (Source: Thorax)
Source: Thorax - May 17, 2022 Category: Respiratory Medicine Authors: Granger, V., Zerimech, F., Arab, J., Siroux, V., de Nadai, P., Tsicopoulos, A., Matran, R., Akiki, Z., Nadif, R. Tags: Thorax Asthma Source Type: research

BTS clinical statement for the assessment and management of respiratory problems in athletic individuals
Introduction This British Thoracic Society (BTS) Clinical Statement addresses the diagnosis, evaluation and management of respiratory problems in athletic individuals. The overall recommendations issued in this document are built on a synthesis of the best available published evidence, where available and appropriate, but are largely based on expert opinion, with emphasis on providing readers with pragmatic clinical advice, when faced with respiratory problems in exercising individuals. Participation in vigorous exercise or sport plays an important role in many people’s lifestyle and is associated with a broad range ...
Source: Thorax - May 17, 2022 Category: Respiratory Medicine Authors: Hull, J. H., Burns, P., Carre, J., Haines, J., Hepworth, C., Holmes, S., Jones, N., MacKenzie, A., Paton, J. Y., Ricketts, W. M., Howard, L. S. Tags: Thorax BTS clinical statement Source Type: research