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  • The unmet medical need of pulmonary hypertension in idiopathic pulmonary fibrosis
    Eur. Respir. J. (IF 10.569) Pub Date : 2018-01-01
    Vincent Cottin; Laura C. Price; Claudia Valenzuela

    Prospective studies are needed for noninvasive detection of pulmonary hypertension in patients with IPF http://ow.ly/Yydw30hoGqk

    更新日期:2018-01-18
  • The increasing mortality of idiopathic pulmonary fibrosis: fact or fallacy?
    Eur. Respir. J. (IF 10.569) Pub Date : 2018-01-01
    Christopher J. Ryerson; Martin Kolb

    There are likely multiple reasons that IPF-related mortality appears to be increasing in most European countries http://ow.ly/Maty30gRrDl

    更新日期:2018-01-18
  • Persistently elevated exhaled nitric oxide fraction is associated with increased risk of exacerbation in COPD
    Eur. Respir. J. (IF 10.569) Pub Date : 2018-01-01
    Bernardino Alcázar-Navarrete; Oliverio Ruiz Rodríguez; Pablo Conde Baena; Pedro José Romero Palacios; Alvar Agusti

    Preventing the occurrence of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is a major therapeutic goal. We hypothesise that persistently increased levels of exhaled nitric oxide (FeNO) during follow-up can identify a group of COPD patients at higher risk of AECOPD. To test this hypothesis, we measured FeNO levels (HypAir FeNO®, Medisoft; Sorinnes, Belgium) prospectively in 226 clinically stable COPD outpatients at recruitment and during follow-up (at 6 and 12 months). Patients were stratified according to the number of visits with FeNO ≥20 ppb. FeNO was <20 ppb in all three visits in 44.2% of patients, 29.6% in visit 1 and 26.1% in visit 2 or 3. These three groups suffered progressively higher AECOPD rates during follow-up (0.67, 0.91 and 1.42, respectively, p<0.001). After adjusting for potential confounding variables (log-rank test), the hazard ratio for AECOPD was higher in the latter group (1.579 (95% CI 1.049–2.378), p=0.029). Likewise, time to first moderate and severe AECOPD was shorter in these patients. Finally, there was no relationship between FeNO levels and circulating eosinophils. Persistent FeNO levels ≥20 ppb in clinically stable COPD outpatients are associated with a significantly higher risk of AECOPD.

    更新日期:2018-01-18
  • Intensity of exposure to pulmonary tuberculosis determines risk of tuberculosis infection and disease
    Eur. Respir. J. (IF 10.569) Pub Date : 2018-01-01
    Carlos Acuña-Villaorduña; Edward C. Jones-López; Geisa Fregona; Patricia Marques-Rodrigues; Mary Gaeddert; Carolina Geadas; David Jamil Hadad; Laura F. White; Lucilia Pereira Dutra Molina; Solange Vinhas; Rodrigo Ribeiro-Rodrigues; Padmini Salgame; Moises Palaci; David Alland; Jerrold J. Ellner; Reynaldo Dietze

    Household contacts of pulmonary tuberculosis (TB) patients are at increased risk of TB infection and disease. However, their risk in relation to the intensity of exposure remains unknown. We studied smear-positive TB cases and their household contacts in Vitória, Brazil. We collected clinical, demographic and radiographic information from TB cases, and obtained tuberculin skin test (TST) and QuantiFERON-TB Gold (QFT) results from household contacts. We measured intensity of exposure using a proximity score and sleep location in relation to the TB index case and defined infection by TST ≥10 mm or QFT ≥0.35 UI·mL−1. We ascertained secondary TB cases by reviewing local and nationwide case registries. We included 160 TB index cases and 894 household contacts. 464 (65%) had TB infection and 23 (2.6%) developed TB disease. Risk of TB infection and disease increased with more intense exposures. In an adjusted analysis, the proximity score was associated with TB disease (OR 1.61, 95% CI 1.25–2.08; p<0.000); however, its diagnostic performance was only moderate. Intensity of exposure increased risk of TB infection and disease among household contacts; however, its diagnostic performance was still suboptimal. A biomarker to target preventive therapy is urgently needed in this at-risk population.

    更新日期:2018-01-18
  • A scoring system to predict the elevation of mean pulmonary arterial pressure in idiopathic pulmonary fibrosis
    Eur. Respir. J. (IF 10.569) Pub Date : 2018-01-01
    Taiki Furukawa; Yasuhiro Kondoh; Hiroyuki Taniguchi; Mitsuaki Yagi; Toshiaki Matsuda; Tomoki Kimura; Kensuke Kataoka; Takeshi Johkoh; Masahiko Ando; Naozumi Hashimoto; Koji Sakamoto; Yoshinori Hasegawa

    Elevated mean pulmonary arterial pressure (MPAP; ≥21 mmHg) is sometimes seen in patients with idiopathic pulmonary fibrosis (IPF) and has an adverse impact upon survival. Although early diagnosis is crucial, there is no established screening tool that uses a combination of noninvasive examinations. We retrospectively analysed IPF patients at initial evaluation from April 2007 to July 2015 and, using logistic regression analysis, created a screening tool to identify elevated MPAP. Internal validation was also assessed for external validity using a bootstrap method. Using right-heart catheterisation (RHC), elevation of MPAP was determined to be present in 55 out of 273 patients. Multivariate models demonstrated that % predicted diffusing capacity of the lung for carbon monoxide (DLCO) <50%, ratio of pulmonary artery diameter to aorta diameter (PA/Ao) on computed tomography (CT) ≥0.9 and arterial oxygen tension (PaO2) <80 Torr were independent predictors. When we assigned a single point to each variable, the prevalence of elevation of MPAP with a score of zero, one, two or three points was 6.7%, 16.0%, 29.1% and 65.4%, respectively. The area under curve (AUC) for the receiver operating characteristic (ROC) curve was good at 0.757 (95% CI 0.682–0.833). A simple clinical scoring system consisting of % predicted DLCO, PA/Ao ratio on CT and PaO2 can easily predict elevation of MPAP in patients with IPF.

    更新日期:2018-01-18
  • Neurophysiological mechanisms of exertional dyspnoea in fibrotic interstitial lung disease
    Eur. Respir. J. (IF 10.569) Pub Date : 2018-01-01
    Michele R. Schaeffer; Christopher J. Ryerson; Andrew H. Ramsook; Yannick Molgat-Seon; Sabrina S. Wilkie; Satvir S. Dhillon; Reid A. Mitchell; A. William Sheel; Nasreen Khalil; Pat G. Camp; Jordan A. Guenette

    Our understanding of the mechanisms of dyspnoea in fibrotic interstitial lung disease (ILD) is incomplete. The aims of this study were two-fold: 1) to determine whether dyspnoea intensity is better predicted by neural respiratory drive (NRD) or neuromechanical uncoupling (NMU) of the respiratory system in fibrotic ILD, and 2) to examine the effect of breathing 60% oxygen on NRD, NMU and dyspnoea ratings. Fourteen patients with fibrotic ILD were included. Visit 1 comprised a familiarisation incremental cycle exercise test, Visit 2 comprised a normoxic incremental cycling test to address Aim 1, and Visits 3 and 4 consisted of constant-load cycling while breathing room air or 60% oxygen to address Aim 2. Diaphragmatic electromyography (EMGdi) was used as a surrogate of NRD. NMU was calculated as the ratio between EMGdi (%max) and tidal volume (%vital capacity). On adjusted analysis, NMU and its constituents were all significantly associated with dyspnoea ratings during incremental cycling, with EMGdi having the strongest correlation. The between-treatment change in dyspnoea ratings during constant load cycling was only correlated with change in exercise endurance time and NMU. Dyspnoea more strongly reflected the level of EMGdi than NMU in fibrotic ILD. However, the improvement in dyspnoea with 60% oxygen was better predicted by improvements in NMU.

    更新日期:2018-01-18
  • Trends in mortality from idiopathic pulmonary fibrosis in the European Union: an observational study of the WHO mortality database from 2001–2013
    Eur. Respir. J. (IF 10.569) Pub Date : 2018-01-01
    Dominic C. Marshall; Justin D. Salciccioli; Barry S. Shea; Praveen Akuthota

    Idiopathic pulmonary fibrosis (IPF) is the most common of the idiopathic interstitial pneumonias and is characterised by progressive accumulation of scar tissue in the lungs. The objective of this study was to describe the current mortality rates due to IPF in Europe, based on the World Health Organization (WHO) mortality database. We used country-level data for IPF mortality, identified in the WHO mortality database using International Classification of Diseases 10th Edition (ICD-10) codes, for the period 2001–2013. Joinpoint analysis was performed to describe trends throughout the observation period. The median mortality was 3.75 per 100 000 (interquartile range (IQR) 1.37–5.30) and 1.50 per 100 000 (IQR 0.65–2.02) for males and females, respectively. IPF mortality increased in the majority of the European Union (EU) countries with the exceptions of Denmark, Croatia, Austria and Romania. There was a significant disparity in rates across Europe, in the range 0.41–12.1 per 100 000 for men and 0.24–5.63 per 100 000 for women. The most notable increases were observed in the United Kingdom and Finland. Rates were also substantially higher in males, with sex disparity increasing across the period. The reported IPF mortality appears to be increasing across the EU; however, there is substantial variation in mortality trends and overall reported mortality rates between countries.

    更新日期:2018-01-18
  • Dasatinib increases endothelial permeability leading to pleural effusion
    Eur. Respir. J. (IF 10.569) Pub Date : 2018-01-01
    Carole Phan; Etienne-Marie Jutant; Ly Tu; Raphaël Thuillet; Andrei Seferian; David Montani; Alice Huertas; Jan van Bezu; Fabian Breijer; Anton Vonk Noordegraaf; Marc Humbert; Jurjan Aman; Christophe Guignabert

    Pleural effusion is a frequent side-effect of dasatinib, a second-generation tyrosine kinase inhibitor used in the treatment of chronic myelogenous leukaemia. However, the underlying mechanisms remain unknown. We hypothesised that dasatinib alters endothelial integrity, resulting in increased pulmonary vascular endothelial permeability and pleural effusion. To test this, we established the first animal model of dasatinib-related pleural effusion, by treating rats with a daily regimen of high doses of dasatinib (10 mg·kg−1·day−1 for 8 weeks). Pleural ultrasonography revealed that rats chronically treated with dasatinib developed pleural effusion after 5 weeks. Consistent with these in vivo observations, dasatinib led to a rapid and reversible increase in paracellular permeability of human pulmonary endothelial cell monolayers as reflected by increased macromolecule passage, loss of vascular endothelial cadherin and zonula occludens-1 from cell–cell junctions, and the development of actin stress fibres. These results were replicated using human umbilical vein endothelial cells and confirmed by decreased endothelial resistance. Interestingly, we demonstrated that this increased endothelial permeability is a reactive oxygen species (ROS)-dependent mechanism in vitro and in vivo using a cotreatment with an antioxidant agent, N-acetylcysteine. This study shows that dasatinib alters pulmonary endothelial permeability in a ROS-dependent manner in vitro and in vivo leading to pleural effusion.

    更新日期:2018-01-18
  • Cigarette smoking and response to inhaled corticosteroids in COPD
    Eur. Respir. J. (IF 10.569) Pub Date : 2018-01-01
    Surya P. Bhatt; Julie A. Anderson; Robert D. Brook; Peter M.A. Calverley; Bartolome R. Celli; Nicholas J. Cowans; Courtney Crim; Fernando J. Martinez; David E. Newby; Jørgen Vestbo; Julie C. Yates; Mark T. Dransfield

    Inhaled corticosteroids (ICS) and long-acting β-agonists (LABA) are frequently used in patients with chronic obstructive pulmonary disease (COPD). Combination treatment with ICS/LABA improves lung function and quality of life, and reduces exacerbation frequency compared to treatment with either ICS or LABA alone. Although it is presumed that continued cigarette smoking impairs acute responses to these medications in patients with COPD, there is little direct evidence to support this view. Studies of ICS use in asthma have shown less short-term improvement in lung function and reduced anti-inflammatory effects in active smokers compared to non-smokers [1, 2]. Although similar effects are plausible in COPD, they have not been definitively demonstrated. We hypothesised that former smokers with COPD would have greater short- and long-term changes in lung function, respiratory-related quality of life, and exacerbation risk, in response to ICS than continuing and intermittent smokers. Current smokers have a blunted FEV 1 response and exacerbation reduction with inhaled corticosteroids Author contributions were as follows. Study design: S.P. Bhatt and M.T. Dransfield. Statistical analyses: J.A. Anderson and N.J. Cowans. Data interpretation: S.P. Bhatt and M.T. Dransfield. Manuscript writing: S.P. Bhatt and M.T. Dransfield. Critical review of the manuscript for important content: all authors.

    更新日期:2018-01-18
  • Daily home spirometry to detect early steroid treatment effects in newly treated pulmonary sarcoidosis
    Eur. Respir. J. (IF 10.569) Pub Date : 2018-01-01
    Caroline E. Broos; Monique Wapenaar; Caspar W.N. Looman; Johannes C.C.M. in ’t Veen; Leon M. van den Toorn; Maria J. Overbeek; Marco J.J.H. Grootenboers; Roxane Heller; Rémy L. Mostard; Linda H.C. Poell; Henk C. Hoogsteden; Mirjam Kool; Marlies S. Wijsenbeek; Bernt van den Blink

    Prednisone is the mainstay of sarcoidosis treatment. However, prednisone treatment optimisation is warranted, since prolonged high-dose prednisone therapy is associated with burdensome and harmful side-effects [1, 2]. Early prednisone dose tapering has the potential to reduce side-effects. Gaining insight in the early treatment response can help to determine when tapering could be initiated. To date, there are no prospective studies that look at early treatment response to prednisone in sarcoidosis by monitoring clinical symptoms and daily patient-administered lung function. Therefore, we initiated a multicentre, prospective and observational study with daily home spirometry to detect early steroid treatment effects in newly treated pulmonary sarcoidosis (Dutch National Trial Register NTR4328; [www.trialregister.nl/trialreg][1]). The major treatment effect of prednisone on FVC is reached within 2 to 3 weeks in newly treated sarcoidosis patients The authors gratefully acknowledge patients, research nurses, respiratory function technologists and physicians participating in this study from Erasmus MC, Franciscus Gasthuis & Vlietland, Ikazia hospital, Amphia hospital, Haaglanden Medical Centre and Zuyderland Medical Center Heerlen (all the Netherlands). The authors thank Mirjam van Manen, Linda de Kleer, Frans Mertens and Hadassa de Raaf (Dept of Pulmonary Medicine, Erasmus MC, Rotterdam, the Netherlands) for technical assistance. The authors contributed as follows. C.E. Broos, M. Wapenaar, J.C.C.M. in 't Veen, L.M. van den Toorn, M.J.J.H. Grootenboers, R. Heller, L.H.C. Poell, H.C. Hoogsteden, M.S. Wijsenbeek and B. van den Blink contributed to the study concept and design. C.E. Broos, M. Wapenaar, J.C.C.M. in 't Veen, L.M. van den Toorn, M.J.J.H. Grootenboers, R. Heller M.J. Overbeek, R.L. Mostard, L.H.C. Poell, H.C. Hoogsteden, M. Kool, M.S. Wijsenbeek and B. van den Blink, patient recruitment and data collection. C.E. Broos, M. Wapenaar, C.W.N. Looman, M.S. Wijsenbeek and B. van den Blink, data analysis and interpretation. C.E. Broos, M. Wapenaar, C.W.N. Looman, M.S. Wijsenbeek and B. van den Blink, manuscript preparation and manuscript drafting. All authors gave final approval on the manuscript.. [1]: http://www.trialregister.nl/trialreg

    更新日期:2018-01-18
  • Improved identification of thrombolysis candidates amongst intermediate-risk pulmonary embolism patients: implications for future trials
    Eur. Respir. J. (IF 10.569) Pub Date : 2018-01-01
    Stefano Barco; Eric Vicaut; Frederikus A. Klok; Mareike Lankeit; Guy Meyer; Stavros V. Konstantinides

    Contemporary classification of acute pulmonary embolism (PE) severity is based on the risk of early death, which is influenced by demographic factors, comorbidity, and the functional status of the right ventricle (RV) under acute pressure overload [1]. Shock or persistent arterial hypotension, indicating overt RV failure at presentation, has long been identified as a key determinant of poor prognosis [2] and represents the only widely accepted indication for (systemic) thrombolytic therapy to date [3]. In contrast, for normotensive patients who present with imaging findings that indicate RV dysfunction and biochemical evidence of myocardial injury, anticoagulation remains the primary treatment option [3, 4]. This recommendation is supported by the Pulmonary Embolism Thrombolysis (PEITHO) trial, which showed that patients fulfilling these latter criteria were unlikely to derive a net clinical benefit from routine use of systemic thrombolysis in view of the high risk for major bleeding [5]. Defining a “higher-risk” population among intermediate-risk patients with pulmonary embolism included in PEITHO

    更新日期:2018-01-18
  • Can YKL-40 be used as a biomarker and therapeutic target for adult asthma?
    Eur. Respir. J. (IF 10.569) Pub Date : 2018-01-01
    Xiang Tong; Dongguang Wang; Sitong Liu; Yao Ma; Hong Fan

    The YKL-40 may be used as a potential biomarker and therapeutic target for adult asthma http://ow.ly/fgAw30h99Nt

    更新日期:2018-01-18
  • 更新日期:2018-01-18
  • Cross-infection risk in patients with bronchiectasis: a position statement from the European Bronchiectasis Network (EMBARC), EMBARC/ELF patient advisory group and European Reference Network (ERN-Lung) Bronchiectasis Network
    Eur. Respir. J. (IF 10.569) Pub Date : 2018-01-01
    James D. Chalmers; Felix C. Ringshausen; Bridget Harris; J. Stuart Elborn; Annette Posthumus; Charles S. Haworth; Nicola Pilkington; Eva Polverino; Thomas Ruddy; Stefano Aliberti; Pieter C. Goeminne; Craig Winstanley; Anthony De Soyza

    Risks of cross-infection in bronchiectasis are small, and should not currently restrict access to specialised care http://ow.ly/dkVl30hcu5p

    更新日期:2018-01-11
  • Time for a longer and better life for patients with COPD
    Eur. Respir. J. (IF 10.569) Pub Date : 2018-01-01
    Lowie E.G.W. Vanfleteren; Anders Ullman; Leonardo M. Fabbri

    Managed care may reduce mortality in severe COPD patients with previous hospitalisation http://ow.ly/THpI30hiaYJ

    更新日期:2018-01-11
  • Breath analysis for label-free characterisation of airways disease
    Eur. Respir. J. (IF 10.569) Pub Date : 2018-01-01
    Stephen J. Fowler

    Potential breath volatile signatures emerge for key clinical characteristics and phenotypes in airways disease http://ow.ly/7HzJ30hoCIJ

    更新日期:2018-01-11
  • ELTGOL airway clearance in bronchiectasis: laying the bricks of evidence
    Eur. Respir. J. (IF 10.569) Pub Date : 2018-01-01
    Conroy Wong; Cameron Sullivan; Lata Jayaram

    ELTGOL therapy is one of the best evidence-based airway clearance techniques for bronchiectasis http://ow.ly/vXmU30gZUSR

    更新日期:2018-01-11
  • Program of Integrated Care for Patients with Chronic Obstructive Pulmonary Disease and Multiple Comorbidities (PIC COPD+): a randomised controlled trial
    Eur. Respir. J. (IF 10.569) Pub Date : 2018-01-01
    Louise Rose; Laura Istanboulian; Lise Carriere; Anna Thomas; Han-Byul Lee; Shaghayegh Rezaie; Roshan Shafai; Ian Fraser

    We sought to evaluate the effectiveness of a multi-component, case manager-led exacerbation prevention/management model for reducing emergency department visits. Secondary outcomes included hospitalisation, mortality, health-related quality of life, chronic obstructive pulmonary disease (COPD) severity, COPD self-efficacy, anxiety and depression. Two-centre randomised controlled trial recruiting patients with ≥2 prognostically important COPD-associated comorbidities. We compared our multi-component intervention including individualised care/action plans and telephone consults (12-weekly then 9-monthly) with usual care (both groups). We used zero-inflated Poisson models to examine emergency department visits and hospitalisation; Cox proportional hazard model for mortality. We randomised 470 participants (236 intervention, 234 control). There were no differences in number of emergency department visits or hospital admissions between groups. We detected difference in emergency department visit risk, for those that visited the emergency department, favouring the intervention (RR 0.74, 95% CI 0.63–0.86). Similarly, risk of hospital admission was lower in the intervention group for those requiring hospital admission (RR 0.69, 95% CI 0.54–0.88). Fewer intervention patients died (21 versus 36) (HR 0.56, 95% CI 0.32–0.95). No differences were detected in other secondary outcomes. Our multi-component, case manager-led exacerbation prevention/management model resulted in no difference in emergency department visits, hospital admissions and other secondary outcomes. Estimated risk of death (intervention) was nearly half that of the control.

    更新日期:2018-01-11
  • COMET: a multicomponent home-based disease-management programme versus routine care in severe COPD
    Eur. Respir. J. (IF 10.569) Pub Date : 2018-01-01
    Romain Kessler; Pere Casan-Clara; Dieter Koehler; Silvia Tognella; Jose Luis Viejo; Roberto W. Dal Negro; Salvador Díaz-Lobato; Karina Reissig; José Miguel Rodríguez González-Moro; Gilles Devouassoux; Jean-Michel Chavaillon; Pierre Botrus; Jean-Michel Arnal; Julio Ancochea; Anne Bergeron-Lafaurie; Carlos De Abajo; Winfried J. Randerath; Andreas Bastian; Christian G. Cornelissen; Georg Nilius; Joëlle B. Texereau; Jean Bourbeau

    The COPD Patient Management European Trial (COMET) investigated the efficacy and safety of a home-based COPD disease management intervention for severe COPD patients. The study was an international open-design clinical trial in COPD patients (forced expiratory volume in 1 s <50% of predicted value) randomised 1:1 to the disease management intervention or to the usual management practices at the study centre. The disease management intervention included a self-management programme, home telemonitoring, care coordination and medical management. The primary end-point was the number of unplanned all-cause hospitalisation days in the intention-to-treat (ITT) population. Secondary end-points included acute care hospitalisation days, BODE (body mass index, airflow obstruction, dyspnoea and exercise) index and exacerbations. Safety end-points included adverse events and deaths. For the 157 (disease management) and 162 (usual management) patients eligible for ITT analyses, all-cause hospitalisation days per year (mean±sd) were 17.4±35.4 and 22.6±41.8, respectively (mean difference −5.3, 95% CI −13.7 to −3.1; p=0.16). The disease management group had fewer per-protocol acute care hospitalisation days per year (p=0.047), a lower BODE index (p=0.01) and a lower mortality rate (1.9% versus 14.2%; p<0.001), with no difference in exacerbation frequency. Patient profiles and hospitalisation practices varied substantially across countries. The COMET disease management intervention did not significantly reduce unplanned all-cause hospitalisation days, but reduced acute care hospitalisation days and mortality in severe COPD patients.

    更新日期:2018-01-11
  • Clinical and inflammatory phenotyping by breathomics in chronic airway diseases irrespective of the diagnostic label
    Eur. Respir. J. (IF 10.569) Pub Date : 2018-01-01
    Rianne de Vries; Yennece W.F. Dagelet; Pien Spoor; Erik Snoey; Patrick M.C. Jak; Paul Brinkman; Erica Dijkers; Simon K. Bootsma; Fred Elskamp; Frans H.C. de Jongh; Eric G. Haarman; Johannes C.C.M in ‘t Veen; Anke-Hilse Maitland-van der Zee; Peter J. Sterk

    Asthma and chronic obstructive pulmonary disease (COPD) are complex and overlapping diseases that include inflammatory phenotypes. Novel anti-eosinophilic/anti-neutrophilic strategies demand rapid inflammatory phenotyping, which might be accessible from exhaled breath. Our objective was to capture clinical/inflammatory phenotypes in patients with chronic airway disease using an electronic nose (eNose) in a training and validation set. This was a multicentre cross-sectional study in which exhaled breath from asthma and COPD patients (n=435; training n=321 and validation n=114) was analysed using eNose technology. Data analysis involved signal processing and statistics based on principal component analysis followed by unsupervised cluster analysis and supervised linear regression. Clustering based on eNose resulted in five significant combined asthma and COPD clusters that differed regarding ethnicity (p=0.01), systemic eosinophilia (p=0.02) and neutrophilia (p=0.03), body mass index (p=0.04), exhaled nitric oxide fraction (p<0.01), atopy (p<0.01) and exacerbation rate (p<0.01). Significant regression models were found for the prediction of eosinophilic (R2=0.581) and neutrophilic (R2=0.409) blood counts based on eNose. Similar clusters and regression results were obtained in the validation set. Phenotyping a combined sample of asthma and COPD patients using eNose provides validated clusters that are not determined by diagnosis, but rather by clinical/inflammatory characteristics. eNose identified systemic neutrophilia and/or eosinophilia in a dose-dependent manner.

    更新日期:2018-01-11
  • Long-term benefits of airway clearance in bronchiectasis: a randomised placebo-controlled trial
    Eur. Respir. J. (IF 10.569) Pub Date : 2018-01-01
    Gerard Muñoz; Javier de Gracia; Maria Buxó; Antonio Alvarez; Montserrat Vendrell

    Keeping airways clear of mucus by airway clearance techniques seems essential in bronchiectasis treatment, although no placebo-controlled trials or any studies lasting longer than 3 months have been conducted. We evaluate the efficacy of the ELTGOL (slow expiration with the glottis opened in the lateral posture) technique over a 1-year period in bronchiectasis patients with chronic expectoration in a randomised placebo-controlled trial. Patients were randomised to perform the ELTGOL technique (n=22) or placebo exercises (n=22) twice-daily (ClinicalTrials.gov, NCT01578681). The primary outcome was sputum volume during the first intervention and 24 h later. Secondary outcomes included sputum volume during the intervention and 24 h later at month 12, exacerbations, quality of life, sputum analyses, pulmonary function, exercise capacity, systemic inflammation, treatment adherence, and side effects. Sputum volume during intervention and 24 h later was higher in the ELTGOL group than in the placebo group both at the beginning and end of the study. Patients in the ELTGOL group had fewer exacerbations (p=0.042) and a clinically significant improvement in the St George's Respiratory Questionnaire score (p<0.001) and the Leicester Cough Questionnaire score compared with the placebo group (p<0.001). Twice-daily ELTGOL technique over 1 year in bronchiectasis patients facilitated secretion removal and was associated with fewer exacerbations, improved quality of life, and reduced cough impact.

    更新日期:2018-01-11
  • Predicting response to oxygen therapy in obstructive sleep apnoea patients using a 10-minute daytime test
    Eur. Respir. J. (IF 10.569) Pub Date : 2018-01-01
    David Wang; Keith K. Wong; Luke Rowsell; Garrick W. Don; Brendon J. Yee; Ronald R. Grunstein

    There is no satisfactory treatment for obstructive sleep apnoea (OSA). Supplemental low-flow oxygen therapy (LFO2) has been shown to reduce hypoxaemia and is well tolerated by patients with OSA. However, oxygen therapy may be beneficial only to certain subsets of patients with OSA. In this study, we evaluated a 10-min awake ventilatory chemoreflex test in predicting individual OSA response to 2 months of LFO2 therapy. At baseline, patients with OSA underwent ventilatory chemoreflex testing in the afternoon, prior to the overnight polysomnography. Subjects were reassessed with polysomnography after 2 months of nocturnal oxygen treatment. 20 patients with OSA completed the study. After 2 months of O2 treatment, changes in the apnoea–hypopnoea index (AHI) were significantly correlated with baseline CO2 ventilatory response threshold (VRT) and chemosensitivity (p<0.05). In predicting a fall in AHI, the area under the receiver operating characteristic curve (AUC) was 0.79 for VRT and 0.89 for chemosensitivity. When these two variables were combined in a logistic regression model, the prediction effect became stronger with an AUC of 0.97, sensitivity of 0.92 and specificity of 0.83. Our awake ventilatory chemoreflex test could be considered a simple potential clinical tool to predict individual OSA response to oxygen therapy. It could provide a novel personalised medicine approach to OSA treatment.

    更新日期:2018-01-11
  • The impact of digital health technologies on tuberculosis treatment: a systematic review
    Eur. Respir. J. (IF 10.569) Pub Date : 2018-01-01
    Brian Kermu Ngwatu; Ntwali Placide Nsengiyumva; Olivia Oxlade; Benjamin Mappin-Kasirer; Nhat Linh Nguyen; Ernesto Jaramillo; Dennis Falzon; Kevin Schwartzman

    Digital technologies are increasingly harnessed to support treatment of persons with tuberculosis (TB). Since in-person directly observed treatment (DOT) can be resource intensive and challenging to implement, these technologies may have the potential to improve adherence and clinical outcomes. We reviewed the effect of these technologies on TB treatment adherence and patient outcomes. We searched several bibliographical databases for studies reporting the effect of digital interventions, including short message service (SMS), video-observed therapy (VOT) and medication monitors (MMs), to support treatment for active TB. Only studies with a control group and which reported effect estimates were included. Four trials showed no statistically significant effect on treatment completion when SMS was added to standard care. Two observational studies of VOT reported comparable treatment completion rates when compared with in-person DOT. MMs increased the probability of cure (RR 2.3, 95% CI 1.6–3.4) in one observational study, and one trial reported a statistically significant reduction in missed treatment doses relative to standard care (adjusted means ratio 0.58, 95% CI 0.42–0.79). Evidence of the effect of digital technologies to improve TB care remains limited. More studies of better quality are needed to determine how such technologies can enhance programme performance.

    更新日期:2018-01-11
  • National roll-out of latent tuberculosis testing and treatment for new migrants in England: a retrospective evaluation in a high-incidence area
    Eur. Respir. J. (IF 10.569) Pub Date : 2018-01-01
    Miranda G. Loutet; Matthew Burman; Nivenka Jayasekera; Duncan Trathen; Susan Dart; Heinke Kunst; Dominik Zenner

    Latent tuberculosis infection (LTBI) screening is an important intervention for tuberculosis (TB) elimination in low-incidence countries and is, therefore, a key component of England's TB control strategy. This study describes outcomes from a LTBI screening programme in a high-incidence area to inform national LTBI screening in England and other low-incidence countries. We conducted a retrospective cohort study of LTBI screening among eligible migrants (from high-incidence countries and entered the UK within the last 5 years), who were identified at primary-care clinics in Newham, London between August 2014 and August 2015. Multivariable logistic regression was used to identify factors associated with LTBI testing uptake, interferon-γ release assay (IGRA) positivity and treatment uptake. 40% of individuals offered LTBI screening received an IGRA test. The majority of individuals tested were 16–35 years old, male and born in India, Bangladesh or Pakistan. Country of birth, smoking status and co-morbidities were associated with LTBI testing uptake. IGRA positivity was 32% among those tested and was significantly associated with country of birth, age, sex and co-morbidities. This study identifies factors associated with screening uptake, IGRA positivity and treatment uptake, and improves understanding of groups that should be supported to increase acceptability of LTBI testing and treatment in the community.

    更新日期:2018-01-11
  • Baclofen and sleep apnoea syndrome: analysis of VigiBase, the WHO pharmacovigilance database
    Eur. Respir. J. (IF 10.569) Pub Date : 2018-01-01
    Bruno Revol; Ingrid Jullian-Desayes; Sébastien Bailly; Michel Mallaret; Renaud Tamisier; Marie-Sara Agier; Frédéric Lador; Marie Joyeux-Faure; Jean-Louis Pépin

    Baclofen is a centrally acting gamma aminobutyric acid (GABA)-B agonist, widely used for chronic spasticity in neurological disorders, available in oral and intrathecal formulations. Depending on the severity of spasticity and tolerance, standard treatment includes daily oral administration of 40–80 mg [1]. The main adverse effects reported with baclofen are sedation, sleepiness, weakness, dizziness and psychological disturbances [2]. According to the depressant effects of GABA on the central nervous system, baclofen might also induce or aggravate sleep-disordered breathing by depressing central ventilatory drive and/or increasing upper airway obstruction. A single oral low dose of baclofen did not significantly impair the apnoea–hypopnoea index (AHI) in a population with moderate obstructive sleep apnoea [3], but bolus intrathecal administration of the drug increased central sleep apnoea (CSA) in patients with severe spasticity [4].Baclofen is associated with sleep apnoea syndrome especially the high oral doses prescribed for alcohol addiction The authors would like to thank the UMC that provided and gave permission to use the data analysed in the present study. Results and conclusions are those of the authors and not necessarily those of the National Centers, UMC or WHO. We thank Alison Foote (Grenoble Alps University Hospital, France) for critically editing the manuscript.

    更新日期:2018-01-11
  • Tuberculosis elimination: a dream or a reality? The case of Oman
    Eur. Respir. J. (IF 10.569) Pub Date : 2018-01-01
    Fatma Al Yaquobi; Seif Al-Abri; Bader Al-Abri; Idris Al-Abaidani; Amina Al-Jardani; Lia D'Ambrosio; Rosella Centis; Alberto Matteelli; Davide Manissero; Giovanni Battista Migliori

    Until recently, the fight against tuberculosis (TB) was designed to pursue control of the disease, e.g. ensuring that infectious cases are rapidly diagnosed and effectively treated, thus breaking the chain of transmission [1–5].Tuberculosis pre-elimination approached in native population in Oman

    更新日期:2018-01-11
  • Pulmonary rehabilitation for patients with COPD during and after an exacerbation-related hospitalisation: back to the future?
    Eur. Respir. J. (IF 10.569) Pub Date : 2018-01-01
    Martijn A. Spruit; Sally J. Singh; Carolyn L. Rochester; Neil J. Greening; Frits M.E. Franssen; Fabio Pitta; Thierry Troosters; Claire Nolan; Ioannis Vogiatzis; Enrico M. Clini; William D-C. Man; Chris Burtin; Roger S. Goldstein; Lowie E.G.W. Vanfleteren; Klaus Kenn; Linda Nici; Daisy J.A. Janssen; Richard Casaburi; Takanobu Shioya; Chris Garvey; Brian W. Carlin; Richard L. ZuWallack; Michael Steiner; Emiel F.M. Wouters; Milo A. Puhan

    The European Respiratory Society (ERS) and American Thoracic Society (ATS) guideline on management of chronic obstructive pulmonary disease (COPD) exacerbations was published in the March 2017 issue of the European Respiratory Journal [1]. Based on evidence syntheses, including meta-analyses, relevant evidence up to September 2015 was summarised and clinical recommendations for treatment of COPD exacerbations were formulated. These guidelines were endorsed by the ERS Executive Committee and approved by the ATS Board of Directors in December 2016.Healthcare professionals should educate COPD patients and recommend rehabilitation in the peri-exacerbation period

    更新日期:2018-01-11
  • Pulmonary rehabilitation for patients with COPD during and after an exacerbation-related hospitalisation: back to the future?
    Eur. Respir. J. (IF 10.569) Pub Date : 2018-01-01
    Kevin C. Wilson; Jerry A. Krishnan; Pawel Sliwinski; Gerard J. Criner; Marc Miravitlles; John R. Hurst; Peter M.A. Calverley; Richard K. Albert; David Rigau; Thomy Tonia; Jørgen Vestbo; Alberto Papi; Klaus F. Rabe; Antonio Anzueto; Jadwiga A. Wedzicha

    We thank M.A. Spruit and colleagues for their questions about our decisions regarding initiating pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD) exacerbations. Their main objection is the recommendation against initiating pulmonary rehabilitation during the patient's hospitalisation. We agree that the recommendation was based primarily on the finding of increased mortality (6-min walking test had statistically significant improvement and hospital readmission had non-statistically significant improvement) and that the trial led by Greening et al . [1] contributed 389 out of 415 patients. We further agree that there is uncertainty about whether or not inpatient-initiated pulmonary rehabilitation is associated with increased mortality, particularly since the mortality difference emerged more than 5 months after hospital discharge in the study by Greening et al . [1] and that the per protocol analysis in this study found no difference in mortality among those who actually received pulmonary rehabilitation versus the control group.Guideline recommendation against the initiation of pulmonary rehabilitation during hospitalisation was justified

    更新日期:2018-01-11
  • Lack of penetration of amikacin into saliva of tuberculosis patients
    Eur. Respir. J. (IF 10.569) Pub Date : 2018-01-01
    Simone H.J. van den Elsen; Onno W. Akkerman; Justine R. Huisman; Daan J. Touw; Tjip S. van der Werf; Mathieu S. Bolhuis; Jan-Willem C. Alffenaar

    In the 2016 update of the World Health Organization treatment guideline for drug-resistant tuberculosis (TB), a shorter multidrug-resistant TB regimen was proposed because of its higher treatment outcomes [1]. However, therapeutic drug monitoring (TDM) is an excellent method to improve clinical outcomes as well and its practice is on the rise [2]. A well-known side-effect of group B injectable anti-TB drugs ( e.g . amikacin) is ototoxicity [3]. TDM could also be a solution to minimise side-effects by lowering the drug exposure [4]. In the study by van Altena et al. [5] , TDM was practised using the ratio of peak concentration ( C max) to minimal inhibitory concentration (MIC) and this resulted in a reduction in patients with hearing loss. Saliva is considered as an alternative matrix for TDM because it is easy, noninvasive and more patient friendly to sample [6]. Studies found a limited penetration of gentamycin and tobramycin into saliva [7], while detectable levels of amikacin in saliva of neonates were reported [8]. Given the low penetration of aminoglycosides into saliva and interest in C max for TDM of amikacin, our objective was to study whether the salivary C max of amikacin is measurable and useful in salivary TDM.Salivary C max TDM of amikacin was not feasible in TB treatment due to the very low penetration into saliva

    更新日期:2018-01-11
  • Balloon pulmonary angioplasty in sarcoid-related pulmonary hypertension
    Eur. Respir. J. (IF 10.569) Pub Date : 2018-01-01
    Jelco Tramper; Esther J. Nossent; Rutger J. Lely; Frans H. Krouwels; Lilian J. Meijboom; Anton Vonk Noordegraaf

    A 43-year-old, never-smoking, African-American female was referred to our outpatient clinic for progressive dyspnoea. She had a medical history of sarcoidosis with lymph-node, pulmonary, skin and ocular involvement. Diagnosis was based on a previously conducted chest high-resolution computed tomography (CT) that showed bilateral hilar and mediastinal lymphadenopathy containing calcifications and multiple small lung nodules with peri-lymphatic distribution along the pleura and fissures A histological analysis of biopsy specimens from a lymph node located in the left side of the neck revealed large granulomas with multinucleated foreign body giant cells without necrosis. Microbiological cultures were negative. Extrapulmonary manifestations consisted of anterior uveitis and several cutaneous lesions and the reason for initiating corticosteroid therapy, which ameliorated the sarcoidosis . After discontinuation of corticosteroid therapy, the patient's condition deteriorated and she developed progressive dyspnoea (New York Heart Association (NYHA) functional class 3). Thoracic CT showed bilateral pleural and pericardial effusion. There were no signs of pulmonary fibrosis or cardial signs of pulmonary hypertension (PH). Analysis of the pleural fluid showed exudation with lymphocytosis. An infectious cause was excluded.Balloon pulmonary angioplasty can be a successful treatment option in pulmonary hypertension due to sarcoidosis

    更新日期:2018-01-11
  • European Respiratory Journal, list of peer reviewers 2017
    Eur. Respir. J. (IF 10.569) Pub Date : 2018-01-01
    European Respiratory Society

    The European Respiratory Journal is voluntarily reviewed. We are most grateful to the hard work and dedication of those listed below, who reviewed articles for the ERJ in 2017

    更新日期:2018-01-11
  • Turning thirty: evolution but not revolution at the ERJ
    Eur. Respir. J. (IF 10.569) Pub Date : 2018-01-01
    Martin Kolb; James D. Chalmers

    The new chief editor team outlines how they’ll continue the journal’s great journey, started by the previous leaders http://ow.ly/1VRd30hi6F3

    更新日期:2018-01-04
  • Looking for a chronic care model in COPD patients
    Eur. Respir. J. (IF 10.569) Pub Date : 2018-01-01
    Enrico Clini; Ivana Castaniere; Roberto Tonelli

    A chronic care model in primary care is feasible and effective for the COPD population even at an early stage http://ow.ly/yZzR30gE26r

    更新日期:2018-01-04
  • Inhaler adherence in severe asthma: is there an electronic solution?
    Eur. Respir. J. (IF 10.569) Pub Date : 2018-01-01
    Mina Gaga; Konstantinos Samitas; Eleftherios Zervas

    Combining electronic devices with traditional methods, a good patient–doctor relationship, and mutual, informed decisions about treatment might provide the best inhaler adherence in severe asthma http://ow.ly/Ra8630gDQm3

    更新日期:2018-01-04
  • The inhaled corticosteroid/long-acting β-agonist maintenance and reliever therapy regimen: where to from here?
    Eur. Respir. J. (IF 10.569) Pub Date : 2018-01-01
    Richard Beasley; Irene Braithwaite; James Fingleton; Mark Weatherall

    ICS/LABA maintenance and reliever therapy is recommended for adolescents with asthma at risk of severe exacerbations http://ow.ly/xhhO30gKZ6W

    更新日期:2018-01-04
  • ERS/ATS workshop report on respiratory health effects of household air pollution
    Eur. Respir. J. (IF 10.569) Pub Date : 2018-01-01
    Akshay Sood; Nour A. Assad; Peter J. Barnes; Andrew Churg; Stephen B. Gordon; Kevin S. Harrod; Hammad Irshad; Om P. Kurmi; William J. Martin; Paula Meek; Kevin Mortimer; Curtis W. Noonan; Rogelio Perez-Padilla; Kirk R. Smith; Yohannes Tesfaigzi; Tony Ward; John Balmes

    Exposure to household air pollution (HAP) from solid fuel combustion affects almost half of the world population. Adverse respiratory outcomes such as respiratory infections, impaired lung growth and chronic obstructive pulmonary disease have been linked to HAP exposure. Solid fuel smoke is a heterogeneous mixture of various gases and particulates. Cell culture and animal studies with controlled exposure conditions and genetic homogeneity provide important insights into HAP mechanisms. Impaired bacterial phagocytosis in exposed human alveolar macrophages possibly mediates several HAP-related health effects. Lung pathological findings in HAP-exposed individuals demonstrate greater small airways fibrosis and less emphysema compared with cigarette smokers. Field studies using questionnaires, air pollution monitoring and/or biomarkers are needed to better establish human risks. Some, but not all, studies suggest that improving cookstove efficiency or venting emissions may be associated with reduced respiratory symptoms, lung function decline in women and severe pneumonia in children. Current studies focus on fuel switching, stove technology replacements or upgrades and air filter devices. Several governments have initiated major programmes to accelerate the upgrade from solid fuels to clean fuels, particularly liquid petroleum gas, which provides research opportunities for the respiratory health community.

    更新日期:2018-01-04
  • Effects of the “Living well with COPD” intervention in primary care: a comparative study
    Eur. Respir. J. (IF 10.569) Pub Date : 2018-01-01
    Claudia Steurer-Stey; Kaba Dalla Lana; Julia Braun; Gerben ter Riet; Milo A. Puhan

    The pivotal objective of chronic obstructive pulmonary disease (COPD) self-management programmes is behaviour change to avoid moderate and severe exacerbations and improve health related quality of life. In a prospectively planned, controlled study, COPD patients who participated in the “Living well with COPD” (LWWCOPD) self-management intervention were compared with usual care patients from the primary care COPD Cohort ICE COLD ERIC, who did not receive self-management intervention (NCT00706602) The primary outcome was behaviour change and disease-specific health related quality of life after 1 year. Secondary end-points included exacerbation rates. We calculated mixed linear, zero-inflated negative binomial and logistic regression models and used propensity scores to counteract confounding. 467 patients, 71 from the LWWCOPD and 396 from the usual care cohort, were included. The differences between intervention and control were 0.54 (95% CI 0.13−0.94) on the Chronic Respiratory Questionnaire domain “mastery”, 0.55 (95% CI 0.11−0.99) on “fatigue”, 0.54 (0.14−0.93) on “emotional function” and 0.64 (95% CI 0.14−1.14) on “dyspnoea”. The intervention considerably reduced the risk of moderate and severe exacerbations (incidence rate ratio 0.36, 95% CI 0.25−0.52). Self-management coaching in primary care improves health-related quality of life and lowers exacerbation rates and health care use.

    更新日期:2018-01-04
  • A randomised clinical trial of feedback on inhaler adherence and technique in patients with severe uncontrolled asthma
    Eur. Respir. J. (IF 10.569) Pub Date : 2018-01-01
    Imran Sulaiman; Garrett Greene; Elaine MacHale; Jansen Seheult; Matshediso Mokoka; Shona D'Arcy; Terence Taylor; Desmond M. Murphy; Eoin Hunt; Stephen J. Lane; Gregory B. Diette; J. Mark FitzGerald; Fiona Boland; Aoife Sartini Bhreathnach; Breda Cushen; Richard B. Reilly; Frank Doyle; Richard W. Costello

    In severe asthma, poor control could reflect issues of medication adherence or inhaler technique, or that the condition is refractory. This study aimed to determine if an intervention with (bio)feedback on the features of inhaler use would identify refractory asthma and enhance inhaler technique and adherence. Patients with severe uncontrolled asthma were subjected to a stratified-by-site random block design. The intensive education group received repeated training in inhaler use, adherence and disease management. The intervention group received the same intervention, enhanced by (bio)feedback-guided training. The primary outcome was rate of actual inhaler adherence. Secondary outcomes included a pre-defined assessment of clinical outcome. Outcome assessors were blinded to group allocation. Data were analysed on an intention-to-treat and per-protocol basis. The mean rate of adherence during the third month in the (bio)feedback group (n=111) was higher than that in the enhanced education group (intention-to-treat, n=107; 73% versus 63%; 95% CI 2.8%–17.6%; p=0.02). By the end of the study, asthma was either stable or improved in 54 patients (38%); uncontrolled, but poorly adherent in 52 (35%); and uncontrolled, but adherent in 40 (27%). Repeated feedback significantly improved inhaler adherence. After a programme of adherence and inhaler technique assessment, only 40 patients (27%) were refractory and adherent, and might therefore need add-on therapy.

    更新日期:2018-01-04
  • Budesonide/formoterol maintenance and reliever therapy in adolescent patients with asthma
    Eur. Respir. J. (IF 10.569) Pub Date : 2018-01-01
    Carin Jorup; Dan Lythgoe; Hans Bisgaard

    Asthma control is often suboptimal in adolescents, but few studies have evaluated asthma treatments in this population. This post hoc analysis assessed the efficacy and safety of budesonide/formoterol (BUD/FORM) maintenance and reliever therapy (MART) for treatment of persistent asthma in adolescent (age 12–17 years) subgroups within six randomised, double-blind trials. The primary end-point was time to first severe exacerbation. Secondary end-points included number of severe exacerbations, asthma-related symptoms, night-time awakenings, morning peak expiratory flow, forced expiratory volume in 1 s, as-needed medication use and five-item asthma control questionnaire scores. In adolescents (n=1847), BUD/FORM MART was similar to or more effective than comparators across each of the studies in reducing the risk of a first severe exacerbation (hazard ratios (HR) BUD/FORM MART versus comparators 0.15–1.01; pooled HR 0.49, 95% CI 0.34–0.70), with comparable outcomes to the adult subgroups (n=12 197). Similar treatment benefits for BUD/FORM MART were observed for secondary end-points. As-needed medication use was lower with BUD/FORM MART than comparators, and BUD/FORM as-needed use was lower in adolescents than adults. Treatment was well tolerated. This analysis supports the use of BUD/FORM MART in adolescents with persistent asthma, its efficacy and safety being consistent with that reported for adults.

    更新日期:2018-01-04
  • Risk factors for recurrent venous thromboembolism after unprovoked pulmonary embolism: the PADIS-PE randomised trial
    Eur. Respir. J. (IF 10.569) Pub Date : 2018-01-01
    Cécile Tromeur; Olivier Sanchez; Emilie Presles; Gilles Pernod; Laurent Bertoletti; Patrick Jego; Elisabeth Duhamel; Karine Provost; Florence Parent; Philippe Robin; Lucile Deloire; Florent Leven; Fanny Mingant; Luc Bressollette; Pierre-Yves Le Roux; Pierre-Yves Salaun; Michel Nonent; Brigitte Pan-Petesch; Benjamin Planquette; Philippe Girard; Karine Lacut; Solen Melac; Patrick Mismetti; Silvy Laporte; Guy Meyer; Dominique Mottier; Christophe Leroyer; Francis Couturaud

    We aimed to identify risk factors for recurrent venous thromboembolism (VTE) after unprovoked pulmonary embolism. Analyses were based on the double-blind randomised PADIS-PE trial, which included 371 patients with a first unprovoked pulmonary embolism initially treated during 6 months who were randomised to receive an additional 18 months of warfarin or placebo and followed up for 2 years after study treatment discontinuation. All patients had ventilation/perfusion lung scan at inclusion (i.e. at 6 months of anticoagulation). During a median follow-up of 41 months, recurrent VTE occurred in 67 out of 371 patients (6.8 events per 100 person-years). In main multivariate analysis, the hazard ratio for recurrence was 3.65 (95% CI 1.33–9.99) for age 50–65 years, 4.70 (95% CI 1.78–12.40) for age >65 years, 2.06 (95% CI 1.14–3.72) for patients with pulmonary vascular obstruction index (PVOI) ≥5% at 6 months and 2.38 (95% CI 1.15–4.89) for patients with antiphospholipid antibodies. When considering that PVOI at 6 months would not be available in practice, PVOI ≥40% at pulmonary embolism diagnosis (present in 40% of patients) was also associated with a 2-fold increased risk of recurrence. After a first unprovoked pulmonary embolism, age, PVOI at pulmonary embolism diagnosis or after 6 months of anticoagulation and antiphospholipid antibodies were found to be independent predictors for recurrence.

    更新日期:2018-01-04
  • Observational, multicentre study on the epidemiology of haemoptysis
    Eur. Respir. J. (IF 10.569) Pub Date : 2018-01-01
    Michele Mondoni; Paolo Carlucci; Sara Job; Elena Maria Parazzini; Giuseppe Cipolla; Matteo Pagani; Francesco Tursi; Luigi Negri; Alessandro Fois; Sara Canu; Antonella Arcadu; Pietro Pirina; Martina Bonifazi; Stefano Gasparini; Silvia Marani; Andrea Claudio Comel; Franco Ravenna; Simone Dore; Fausta Alfano; Giuseppe Francesco Sferrazza Papa; Fabiano Di Marco; Stefano Centanni; Giovanni Sotgiu

    Haemoptysis, which is a challenging symptom accounting for 10–15% of all pulmonology consultations, may be associated with life-threatening medical conditions such as lung cancer [1–7]. Malignancy is the main haemoptysis aetiology in our Italian cohort

    更新日期:2018-01-04
  • Immunotherapy and pulmonary toxicities: can concomitant immune-checkpoint inhibitors with radiotherapy increase the risk of radiation pneumonitis?
    Eur. Respir. J. (IF 10.569) Pub Date : 2018-01-01
    Guillaume Louvel; Rastislav Bahleda; Samy Ammari; Cécile Le Péchoux; Antonin Levy; Christophe Massard; Jérôme Le Pavec; Stéphane Champiat; Eric Deutsch

    Delaunay et al . [1] presented the results of a retrospective study of 1826 cancer patients treated with immune-checkpoint inhibitors (ICIs). 3.5% of the patients developed interstitial lung diseases (ILDs). The mechanisms of this toxicity remain largely unknown [2]. The cohort was mainly composed of lung cancer patients (75%). This explains why a significant proportion of the patients (40%) with ILD had received thoracic radiotherapy. However, patients with ILD features within the initial volumes of radiotherapy were excluded from the study to dissociate cases related to radiation pneumonitis. This study is important and brings to the light key data regarding the emerging field of clinical management of adverse ICI events. Cases of radiation pneumonitis developed after concomitant checkpoint inhibitors and lung SBRT: a matter of concern?

    更新日期:2018-01-04
  • The effects of 100% oxygen on breathing pattern are not limited to young children
    Eur. Respir. J. (IF 10.569) Pub Date : 2018-01-01
    Courtney Moore; Eric Horton; Nick Benseler; Renee Jensen; Felix Ratjen

    Breathing 100% oxygen has been reported to decrease tidal volume ( V T) in infants [1] and recent evidence published in the European Respiratory Journal suggest that transient less pronounced effects are also seen in preschool children [2]. It is unclear whether there is an age dependency beyond infancy in the response to 100% oxygen or whether it is limited to young children. Here we investigate the effects of 100% oxygen on breathing pattern across a spectrum of ages to identify the change in V T that occurs when subjects breathe 100% oxygen during a multiple breath nitrogen washout (MBNW) test. Changes in tidal breathing in response to 100% oxygen exposure are exhibited in subjects of all ages

    更新日期:2018-01-04
  • Macrolides, mucoactive drugs and adherence for the management of bronchiectasis
    Eur. Respir. J. (IF 10.569) Pub Date : 2018-01-01
    Wei-jie Guan; Yan Huang; Chun-lan Chen; Rong-chang Chen; Nan-shan Zhong

    The publication of the first European Respiratory Society guidelines for management of bronchiectasis [1] is a landmark of recent advancement in the field. Whilst the British Thoracic Society guidelines [2] delineated mechanisms of pathogenesis and offered recommendations for management of bronchiectasis, the latest document specifically addressed nine clinically important questions that may better inform clinical decisions. Although it is likely that these recommendations can be extrapolated to patients in Asian countries such as China, we have some further suggestions and/or recommendations for refinement. Macrolides, mucoactive drugs and adherence are crucial for the management of bronchiectasis W-J. Guan, Y. Huang and C-L. Chen drafted the manuscript; R-C. Chen and N-S. Zhang critically reviewed the manuscript and approved final submission.

    更新日期:2018-01-04
  • Macrolides, mucoactive drugs and adherence for the management of bronchiectasis
    Eur. Respir. J. (IF 10.569) Pub Date : 2018-01-01
    James D. Chalmers; Eva Polverino

    We thank W-J. Guan and colleagues for their comments on the European Respiratory Society (ERS) guidelines for bronchiectasis [1]. We agree these are an important landmark for the field, and hope that clinicians, health professionals, patients and researchers will use the guidelines to improve the quality of care for bronchiectasis patients and to use the gaps identified to stimulate further research [1, 2]. Only evidence-based recommendations were included in the @ERStalk bronchiectasis guidelines

    更新日期:2018-01-04
  • Genotypic and phenotypic M. tuberculosis resistance: guiding clinicians to prescribe the correct regimens
    Eur. Respir. J. (IF 10.569) Pub Date : 2017-12-01
    Andrea Maurizio Cabibbe; Giovanni Sotgiu; Santiago Izco; Giovanni Battista Migliori

    Interpreting genotypic tests can help clinicians to take right and timely therapeutic decisions http://ow.ly/jGHH30hcB6U

    更新日期:2017-12-31
  • Oxidative stress biomarkers and asthma characteristics in adults of the EGEA study
    Eur. Respir. J. (IF 10.569) Pub Date : 2017-12-01
    Miora Andrianjafimasy; Farid Zerimech; Zeina Akiki; Helene Huyvaert; Nicole Le Moual; Valérie Siroux; Régis Matran; Orianne Dumas; Rachel Nadif

    Asthma is an oxidative stress related disease, but associations with asthma outcomes are poorly studied in adults. We aimed to study the associations between several biomarkers related to oxidative stress and various asthma outcomes. Cross-sectional analyses were conducted in 1388 adults (mean age 43 years, 44% with asthma) from the Epidemiological Study of the Genetics and Environment of Asthma (EGEA2). Three blood antioxidant enzyme activities (biomarkers of response to oxidative stress) and exhaled breath condensate 8-isoprostanes and plasma fluorescent oxidation products (FlOPs) levels (two biomarkers of damage) were measured. Associations between biomarkers and 1) ever asthma and 2) asthma attacks, asthma control and lung function in participants with asthma were evaluated using regression models adjusted for age, sex and smoking. Biomarkers of response were unrelated to asthma outcomes. Higher 8-isoprostane levels were significantly associated with ever asthma (odds ratio for one interquartile range increase 1.28 (95% CI 1.06–1.67). Among participants with asthma, 8-isoprostane levels were negatively associated with adult-onset asthma (0.63, 0.41–0.97) and FlOPs levels were positively associated with asthma attacks (1.33, 1.07–1.65), poor asthma control (1.30, 1.02–1.66) and poor lung function (1.34, 1.04–1.74). Our results suggest that 8-isoprostanes are involved in childhood-onset asthma and FlOPs are linked to asthma expression.

    更新日期:2017-12-31
  • Role of common hypnotics on the phenotypic causes of obstructive sleep apnoea: paradoxical effects of zolpidem
    Eur. Respir. J. (IF 10.569) Pub Date : 2017-12-01
    Jayne C. Carberry; Lauren P. Fisher; Ronald R. Grunstein; Simon C. Gandevia; David K. McKenzie; Jane E. Butler; Danny J. Eckert

    Hypnotics are contraindicated in obstructive sleep apnoea (OSA) because of concerns of pharyngeal muscle relaxation and delayed arousal worsening hypoxaemia. However, human data are lacking. This study aimed to determine the effects of three common hypnotics on the respiratory arousal threshold, genioglossus muscle responsiveness and upper airway collapsibility during sleep. 21 individuals with and without OSA (18–65 years) completed 84 detailed sleep studies after receiving temazepam (10 mg), zolpidem (10 mg), zopiclone (7.5 mg) and placebo on four occasions in a randomised, double-blind, placebo-controlled, crossover trial (ACTRN12612001004853). The arousal threshold increased with zolpidem and zopiclone versus placebo (mean±sd −18.3±10 and −19.1±9 versus −14.6±7 cmH2O; p=0.02 and p<0.001) but not with temazepam (−16.8±9 cmH2O; p=0.17). Genioglossus muscle activity during stable non-REM sleep and responsiveness during airway narrowing was not different with temazepam and zopiclone versus placebo but, paradoxically, zolpidem increased median muscle responsiveness three-fold during airway narrowing (median −0.15 (interquartile range −1.01 to −0.04) versus −0.05 (−0.29 to −0.03)% maximum EMG per cmH2O epiglottic pressure; p=0.03). The upper airway critical closing pressure did not change with any of the hypnotics. These doses of common hypnotics have differential effects on the respiratory arousal threshold but do not reduce upper airway muscle activity or alter airway collapsibility during sleep. Rather, muscle activity increases during airway narrowing with zolpidem.

    更新日期:2017-12-31
  • Chest physician-reported, work-related, long-latency respiratory disease in Great Britain
    Eur. Respir. J. (IF 10.569) Pub Date : 2017-12-01
    Melanie Carder; Andrew Darnton; Matthew Gittins; S. Jill Stocks; David Ross; Chris M. Barber; Raymond M. Agius

    Much of the current burden of long-latency respiratory disease (LLRD) in Great Britain is attributed to historical asbestos exposure. However, continuing exposure to other agents, notably silica, also contributes to disease burden. The aim of this study was to investigate the incidence of work-related LLRD reported by chest physicians in Great Britain, including variations by age, gender, occupation and suspected agent. LLRD incidence and incidence rate ratios by occupation were estimated (1996–2014). Mesothelioma cases by occupation were compared with proportional mortality ratios. Cases were predominantly in men (95%) and 92% of all cases were attributed to asbestos. Annual average incidence rates (males) per 100 000 were: benign pleural disease, 7.1 (95% CI 6.0–8.2); mesothelioma, 5.4 (4.8–6.0); pneumoconiosis, 1.9 (1.7–2.2); lung cancer, 0.8 (0.6–1.0); chronic obstructive pulmonary disease (COPD), 0.3 (0.2–0.4). Occupations with a particularly high incidence of LLRD were miners and quarrymen (COPD), plumbers and gas fitters (asbestosis), and shipyard and dock workers (all other categories). There was a clear concordance between cases of SWORD mesothelioma and proportional mortality ratios by occupation. Occupationally caused LLRD continues to contribute to a significant disease burden. Many cases are attributable to past exposure to agents such as asbestos and silica, but the potential for occupational exposures persists.

    更新日期:2017-12-31
  • A standardised method for interpreting the association between mutations and phenotypic drug resistance in Mycobacterium tuberculosis
    Eur. Respir. J. (IF 10.569) Pub Date : 2017-12-01
    Paolo Miotto; Belay Tessema; Elisa Tagliani; Leonid Chindelevitch; Angela M. Starks; Claudia Emerson; Debra Hanna; Peter S. Kim; Richard Liwski; Matteo Zignol; Christopher Gilpin; Stefan Niemann; Claudia M. Denkinger; Joy Fleming; Robin M. Warren; Derrick Crook; James Posey; Sebastien Gagneux; Sven Hoffner; Camilla Rodrigues; Iñaki Comas; David M. Engelthaler; Megan Murray; David Alland; Leen Rigouts; Christoph Lange; Keertan Dheda; Rumina Hasan; Uma Devi K. Ranganathan; Ruth McNerney; Matthew Ezewudo; Daniela M. Cirillo; Marco Schito; Claudio U. Köser; Timothy C. Rodwell

    A clear understanding of the genetic basis of antibiotic resistance in Mycobacterium tuberculosis is required to accelerate the development of rapid drug susceptibility testing methods based on genetic sequence. Raw genotype–phenotype correlation data were extracted as part of a comprehensive systematic review to develop a standardised analytical approach for interpreting resistance associated mutations for rifampicin, isoniazid, ofloxacin/levofloxacin, moxifloxacin, amikacin, kanamycin, capreomycin, streptomycin, ethionamide/prothionamide and pyrazinamide. Mutation frequencies in resistant and susceptible isolates were calculated, together with novel statistical measures to classify mutations as high, moderate, minimal or indeterminate confidence for predicting resistance. We identified 286 confidence-graded mutations associated with resistance. Compared to phenotypic methods, sensitivity (95% CI) for rifampicin was 90.3% (89.6–90.9%), while for isoniazid it was 78.2% (77.4–79.0%) and their specificities were 96.3% (95.7–96.8%) and 94.4% (93.1–95.5%), respectively. For second-line drugs, sensitivity varied from 67.4% (64.1–70.6%) for capreomycin to 88.2% (85.1–90.9%) for moxifloxacin, with specificity ranging from 90.0% (87.1–92.5%) for moxifloxacin to 99.5% (99.0–99.8%) for amikacin. This study provides a standardised and comprehensive approach for the interpretation of mutations as predictors of M. tuberculosis drug-resistant phenotypes. These data have implications for the clinical interpretation of molecular diagnostics and next-generation sequencing as well as efficient individualised therapy for patients with drug-resistant tuberculosis.

    更新日期:2017-12-31
  • An informative intragenic microsatellite marker suggests the IL-1 receptor as a genetic modifier in cystic fibrosis
    Eur. Respir. J. (IF 10.569) Pub Date : 2017-12-01
    Frauke Stanke; Andreas Hector; Silke Hedtfeld; Dominik Hartl; Matthias Griese; Burkhard Tümmler; Marcus A. Mall

    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 were detected in mucus-obstructed airways in lung sections from patients with CF [1]. Hypoxic cell death is a well-established trigger of sterile neutrophilic inflammation in many other organs and previous studies have identified IL-1R signalling as a key pathway required for triggering this inflammatory response to dying cells [6]. In addition, the gene encoding the IL-1R ligand IL-1β that is induced by bacterial infection has been identified as a genetic modifier of CF by independent North American and European CF modifier studies [7, 8]. Collectively, these studies suggest that IL-1R signalling may play an important role in the pathogenesis of neutrophilic inflammation that is invariably detected in the airways of patients with CF, in the absence and presence of bacterial infection [2, 3]. However, the role of IL-1R and its association with disease severity in patients with CF remains unknown. IL1R modifies disease severity in CF patients, emphasizing the significance of IL-1 signalling for CF pathogenesis We thank the organisers of the PopGen Biobank () for providing DNA samples from a control population. Author contributions: conception and design of the study: F. Stanke, B. Tümmler, M.A. Mall; acquisition, analysis and interpretation of data: F. Stanke, A. Hector, S. Hedtfeld, D. Hartl, M. Griese, B. Tümmler, M.A. Mall; drafting the article or revising it critically for important intellectual content: F. Stanke, M.A. Mall.

    更新日期:2017-12-31
  • Renal Fanconi syndrome with meropenem/amoxicillin-clavulanate during treatment of extensively drug-resistant tuberculosis
    Eur. Respir. J. (IF 10.569) Pub Date : 2017-12-01
    Miriam E. Abadie; Jeffrey R. Strich; Tiffany Kim; Yingda L. Xie; Kevin P. Fennelly; Kenneth N. Olivier; Meryl Waldman; Kriti Arora; Steven M. Holland; Ray Y. Chen

    We read with interest the papers by Tiberi et al. [1, 2] describing the effectiveness of meropenem/clavulanate in treating multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB) patients. In these analyses, 96 patients were treated with meropenem/clavulanate for a median of 85 (interquartile range (IQR) 49–156) days with six adverse events, and 84 patients were treated with imipenem/clavulanate for a median (IQR) of 187 (60–428) days and three adverse events, none renally related. We report a patient with XDR-TB who developed renal Fanconi syndrome apparently due to meropenem/amoxicillin-clavulanate. Prolonged use of meropenem/amoxicillin-clavulate to treat XDR-TB may be associated with renal Fanconi syndrome

    更新日期:2017-12-31
  • ERJ December Podcast: An interview with new editors
    Eur. Respir. J. (IF 10.569) Pub Date : 2017-12-01
    European Respiratory Society

    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.

    更新日期:2017-12-21
  • Adherence in severe asthma: time to get it right
    Eur. Respir. J. (IF 10.569) Pub Date : 2017-12-01
    Vanessa M. McDonald; Janelle Yorke

    Adherence in severe asthma is suboptimal as are the clinic measures to assess adherence http://ow.ly/CSZH30gCsBQ

    更新日期:2017-12-21
  • Electronic monitoring of adherence to inhaled corticosteroids: an essential tool in identifying severe asthma in children
    Eur. Respir. J. (IF 10.569) Pub Date : 2017-12-01
    Anja Jochmann; Luca Artusio; Angela Jamalzadeh; Prasad Nagakumar; Edgar Delgado-Eckert; Sejal Saglani; Andrew Bush; Urs Frey; Louise J. Fleming

    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 period. 93 children (62 male; median age 12.4 years) were monitored for a median of 92 days. Median (range) monitored adherence was 74% (21–99%). We identified four groups: 1) good adherence during monitoring with improved control, 24% (likely previous poor adherence); 2) good adherence with poor control, 18% (severe therapy-resistant asthma); 3) poor adherence with good control, 26% (likely overtreated); and 4) poor adherence with poor control, 32%. No clinical parameter prior to monitoring distinguished these groups. Electronic monitoring is a useful tool for identifying children in whom a step up in treatment is indicated. Different approaches are needed in those who are controlled when adherent or who are nonadherent. Electronic monitoring is essential in a paediatric severe asthma clinic.

    更新日期:2017-12-21
  • Growth and nutritional status, and their association with lung function: a study from the international Primary Ciliary Dyskinesia Cohort
    Eur. Respir. J. (IF 10.569) Pub Date : 2017-12-01
    Myrofora Goutaki; Florian S. Halbeisen; Ben D. Spycher; Elisabeth Maurer; Fabiën Belle; Israel Amirav; Laura Behan; Mieke Boon; Siobhan Carr; Carmen Casaulta; Annick Clement; Suzanne Crowley; Sharon Dell; Thomas Ferkol; Eric G. Haarman; Bulent Karadag; Michael Knowles; Cordula Koerner-Rettberg; Margaret W. Leigh; Michael R. Loebinger; Henryk Mazurek; Lucy Morgan; Kim G. Nielsen; Maria Phillipsen; Scott D. Sagel; Francesca Santamaria; Nicolaus Schwerk; Panayiotis Yiallouros; Jane S. Lucas; Claudia E. Kuehni

    Chronic respiratory disease can affect growth and nutrition, which can influence lung function. We investigated height, body mass index (BMI), and lung function in patients with primary ciliary dyskinesia (PCD). 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 patients in all age groups, with variation between countries. Height and BMI were higher in patients diagnosed earlier in life (p=0.026 and p<0.001, respectively) and closely associated with forced expiratory volume in 1 s and forced vital capacity z-scores (p<0.001). Our study indicates that both growth and nutrition are affected adversely in PCD patients from early life and are both strongly associated with lung function. If supported by longitudinal studies, these findings suggest that early diagnosis with multidisciplinary management and nutritional advice could improve growth and delay disease progression and lung function impairment in PCD.

    更新日期:2017-12-21
  • Exhaled breath to screen for malignant pleural mesothelioma: a validation study
    Eur. Respir. J. (IF 10.569) Pub Date : 2017-12-01
    Kevin Lamote; Matthijs Vynck; Olivier Thas; Joris Van Cleemput; Kristiaan Nackaerts; Jan P. van Meerbeeck

    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), 41 patients with benign asbestos-related diseases (ARD), 70 patients with benign non-asbestos-related lung diseases (BLD) and 56 patients with lung cancer (LC). After background correction, logistic lasso regression and receiver operating characteristic (ROC) analysis, the MPM group was discriminated from the HC, AEx, ARD, BLD and LC groups with 65%, 88%, 82%, 80% and 72% accuracy, respectively. Combining AEx and ARD patients resulted in 94% sensitivity and 96% negative predictive value (NPV). The most important VOCs selected were P1, P3, P7, P9, P21 and P26. We discriminated MPM patients from at-risk subjects with great accuracy. The high sensitivity and NPV allow breath analysis to be used as a screening tool for ruling out MPM.

    更新日期:2017-12-21
  • Dietary antioxidants and 10-year lung function decline in adults from the ECRHS survey
    Eur. Respir. J. (IF 10.569) Pub Date : 2017-12-01
    Vanessa Garcia-Larsen; James F. Potts; Ernst Omenaas; Joachim Heinrich; Cecilie Svanes; Judith Garcia-Aymerich; Peter G. Burney; Deborah L. Jarvis

    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. Simes’ procedure was applied to control for multiple testing. A total of 680 individuals (baseline mean age 43.8±6.6 years) were included. A per-tertile increase in apple and banana intake was associated with a 3.59 mL·year−1 (95% CI 0.40, 7.68) and 3.69 mL·year−1 (95% CI 0.25, 7.14) slower decline in FEV1 and FVC, respectively. Tomato intake was also associated with a slower decline in FVC (4.5 mL·year−1; 95% CI 1.28, 8.02). Only the association with tomato intake remained statistically significant after the Simes’ procedure was performed. Subgroup analyses showed that apple, banana and tomato intake were all associated with a slower decline in FVC in ex-smokers. Intake of fruits and tomatoes might delay lung function decline in adults, particularly in ex-smokers.

    更新日期:2017-12-21
  • Mediastinal staging by videomediastinoscopy in clinical N1 non-small cell lung cancer: a prospective multicentre study
    Eur. Respir. J. (IF 10.569) Pub Date : 2017-12-01
    Herbert Decaluwé; Christophe Dooms; Xavier Benoit D'Journo; Sergi Call; David Sanchez; Benedikt Haager; Roel Beelen; Volkan Kara; Thomas Klikovits; Clemens Aigner; Kurt Tournoy; Mahmood Zahin; Johnny Moons; Geoffrey Brioude; Juan Carlos Trujillo; Walter Klepetko; Akif Turna; Bernward Passlick; Laureano Molins; Ramon Rami-Porta; Pascal Thomas; Paul De Leyn

    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 primary study outcome was sensitivity to detect N2 disease. Secondary endpoints were the prevalence of N2 disease, negative predictive value (NPV) and accuracy of VAM(LA). Out of 105 patients with cN1 on imaging, 26% eventually developed N2 disease. Invasive mediastinal staging with VAM(LA) had a sensitivity of 73% to detect N2 disease. The NPV was 92% and accuracy 93%. Median number of assessed lymph node stations during VAM(LA) was 4 (IQR 3–5), and in 96%, at least three stations were assessed. VAM(LA) has a satisfactory sensitivity of 73% to detect mediastinal nodal disease in cN1 lung cancer, and could be the technique of choice for pre-resection mediastinal lymph node assessment in this patient group with a one in four chance of occult-positive mediastinal nodes after negative PET-CT.

    更新日期:2017-12-21
  • Respiratory irritants in e-cigarette refill liquids across nine European countries: a threat to respiratory health?
    Eur. Respir. J. (IF 10.569) Pub Date : 2017-12-01
    Constantine Vardavas; Charis Girvalaki; Alexander Vardavas; Sophia Papadakis; Manolis Tzatzarakis; Panagiotis Behrakis; Aristidis Tsatsakis

    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]. Respiratory irritants within e-cigarette refill liquids are a cause for concern for respiratory health

    更新日期:2017-12-21
Some contents have been Reproduced with permission of the American Chemical Society.
Some contents have been Reproduced by permission of The Royal Society of Chemistry.
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