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The study of Hartley designed an easy-to-use score to predict mortality in noninvasively ventilated COPD patients. More information about NIV is gained, but the exact measures on how to improve NIV in clinical practice remains uncertain.https://bit.ly/3tFfg8F

Airway hyperresponsiveness (AHR) is associated with an increased mortality risk among men [1] and COPD patients [2]. However, this association is largely based on cross-sectional studies using a single measurement of AHR to predict mortality; inherently ignoring the longitudinal variability of AHR. AHR is variable regardless of disease or medication status, and is linked with changes in smoking habits, seasonal variations and exposure to pollutants [3–5]. Considering this, it remains unclear how changes in AHR affect mortality, specifically from causes such as COPD, cardiovascular disease (CVD) and cancer. Footnotes This manuscript has recently been accepted for publication in the European Respiratory Journal . It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article. Conflict of interest: Mr. Teferra has nothing to disclose. Conflict of interest: Dr. Vonk has nothing to disclose. Conflict of interest: Dr. Boezen has nothing to disclose.

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.

We have read with great interest the article by Walsh et al ., who investigated whether slower gait speed is an independent risk factor for readmission and mortality in patients hospitalised with chronic obstructive pulmonary disease (COPD) exacerbation [1]. This study included 213 patients hospitalised with COPD exacerbation. The Cox proportional hazards model and the Fine and Grey model revealed that four-meter gait speed (4MGS) within 24 h before hospital discharge was associated with both readmission and mortality within 12 months. Considering that 4MGS is a simple and potentially ameliorable measurement, 4MGS could be an important predictor; however, there are some concerns regarding the methodology of this study. Footnotes This manuscript has recently been accepted for publication in the European Respiratory Journal . It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.

PVR >5 WU proved to be the strongest independent haemodynamic predictor of mortality in COPD patients. This threshold may best identify COPD patients with severe pulmonary vascular disease.https://bit.ly/3v4QE96

Rationale There are no validated measures of disease activity in COPD. Since “active” disease is expected to have worse outcomes (e.g. mortality), we explored potential markers of disease activity in patients enrolled in the ECLIPSE cohort in relation to 8-year all-cause mortality. Methods We investigated 1) how changes in relevant clinical variables over time (1 or 3 years) relate to 8-year mortality; 2) whether these variables inter-relate; and 3) if any clinical, imaging and/or biological marker measured cross-sectionally at baseline relates to any activity component. Results Results showed that 1) after 1 year, hospitalisation for COPD, exacerbation frequency, worsening of body mass index, airflow obstruction, dyspnoea and exercise (BODE) index or health status (St George's Respiratory Questionnaire (SGRQ)) and persistence of systemic inflammation were significantly associated with 8-year mortality; 2) at 3 years, the same markers, plus forced expiratory volume in 1 s (FEV1) decline and to a lesser degree computed tomography (CT) emphysema, showed association, thus qualifying as markers of disease activity; 3) changes in FEV1, inflammatory cytokines and CT emphysema were not inter-related, while the multidimensional indices (BODE and SGRQ) showed modest correlations; and 4) changes in these markers could not be predicted by any baseline cross-sectional measure. Conclusions In COPD, 1- and 3-year changes in exacerbation frequency, systemic inflammation, BODE and SGRQ scores and FEV1 decline are independent markers of disease activity associated with 8-year all-cause mortality. These disease activity markers are generally independent and not predictable from baseline measurements., In patients with COPD, 1- and 3-year changes in exacerbation frequency, systemic inflammation, BODE and SGRQ scores, and FEV1 decline, are independent markers of disease activity associated with 8-year all-cause mortality https://bit.ly/2CyifcN

More research into coaching interventions for improving participation in physical activity in COPD patients is neededhttp://ow.ly/4neMkA

ECLIPSE offers an opportunity to examine ACOS in a large well-characterised COPD cohort followed over 3 years http://ow.ly/Zcycr

Commenting on the use of DNA sequencing in helping to reduce the reported under-diagnosing of alpha-1-antitrypsin deficiencyhttps://bit.ly/2ZPZbjx

Withdrawal of inhaled steroid treatment in COPD patients is challenging. The history of the patient needs to be carefully assessed to exclude that they are not being effective and/or safe; and a stepwise approach with careful monitoring seems advisable.https://bit.ly/2y3Tt2k

The frequent occurrence of comorbidities in patients with chronic obstructive pulmonary disease (COPD) suggests that they may share pathobiological processes and/or risk factors.To explore these possibilities we compared the clinical diseasome and the molecular diseasome of 5447 COPD patients hospitalised because of an exacerbation of the disease. The clinical diseasome is a network representation of the relationships between diseases, in which diseases are connected if they co-occur more than expected at random; in the molecular diseasome, diseases are linked if they share associated genes or interaction between proteins.The results showed that about half of the disease pairs identified in the clinical diseasome had a biological counterpart in the molecular diseasome, particularly those related to inflammation and vascular tone regulation. Interestingly, the clinical diseasome of these patients appears independent of age, cumulative smoking exposure or severity of airflow limitation.These results support the existence of shared molecular mechanisms among comorbidities in COPD.

Chronic obstructive pulmonary disease (COPD) patients have an increased prevalence of cardiovascular disease, cancer or psychiatric diseases, among many other comorbid conditions. This is explained in part by smoking history, along with genetic factors, ageing and the low grade inflammation characteristic of COPD [1, 2]. Although comorbidities may be present at the time of the initial diagnosis, their frequency increases with COPD progression, and are particularly common in patients with more advanced disease, especially in those hospitalised with acute exacerbations [3, 4]. These comorbidities complicate the management of COPD patients, lengthen hospital stay, cause physical functional dependency, increase number of readmissions, and are associated with decreased survival in the short, medium and long term [4–6]. A comorbidome is a useful representation of the prevalence and impact of comorbidities in hospitalised COPD patients

Comorbidities are important determinants of future risk in COPD patients and should be considered in the assessment of future risk http://ow.ly/L2qJp

Oxygen administration inhibits spontaneous and ANP-stimulated lipolysis in adipose tissue in severe COPD http://ow.ly/ZVg53022Yah

Improving end-of-life care for respiratory and COPD patients through better communication from secondary care http://ow.ly/U3ecw

Introduction/Aim: Results from the recent one-year FLAME study demonstrated superior efficacy of IND/GLY over SFC in reducing the annual rate of moderate and severe exacerbations in COPD patients with moderate to very severe airflow limitation and ≥1 exacerbation in the preceding year. This economic evaluation aims to determine whether this clinical effect translates into health economic benefits using a cost-effectiveness analysis from the Swedish payer’s perspective.Methods: A previously published and validated patient-level simulation model was updated with population and clinical data from the FLAME study and exacerbation and maintenance cost data from the real-world retrospective ARCTIC Swedish cohort study (n=18,586). Both direct costs and benefits were analyzed over various time horizons and were discounted at 3% per annum. Here, we present results for the time horizon of 3 years.Results: IND/GLY was associated with lower total direct costs and better outcomes compared with SFC over the time horizon of 3 years. Results showed that the use of IND/GLY over SFC resulted in an incremental gain in 0.008 quality-adjusted life-years and 0.005 life-years with cost savings of €732 per patient. The average number of moderate and severe exacerbations per patient was predicted lower with the use of IND/GLY compared with SFC at 3 years (1.98 vs. 2.39).Conclusion: This cost-effectiveness analysis showed that treatment with IND/GLY is more effective and less costly compared to treatment with SFC in Swedish COPD patients with moderate to very severe airflow limitation and ≥1 exacerbation in the preceding year.

The “paradoxical” effect of inhaled corticosteroids increasing pneumonia incidence in COPD but reducing post-pneumonia and all-cause mortality is no paradox but due to selection and immortal time biases in the observational studies of mortalityhttp://bit.ly/2Yd3hDh

Blood eosinophil counts are increased in COPD patients compared to healthy controlshttp://bit.ly/2ML6pzZ

It is of utmost importance to obtain smoking cessation in COPD patients exhibiting eosinophilic inflammationhttp://bit.ly/2VkkxQv

It is still necessary to explore the recording of α1-antitrypsin deficiency testing (and diagnosis) in other large primary care populations and datasetshttp://ow.ly/PANZ30mIvw7

Apparent increasing trends in blood test requesting observed using UK primary care electronic medical records (EMRs) may be confounded by adoption of electronic test requesting systems linked to EMRs rather than changes in clinical practicehttp://ow.ly/M3Er30mIsJq

We investigated the short-term bronchodilator effects of RPL554 (an inhaled dual phosphodiesterase 3 and 4 inhibitor) combined with other bronchodilators in chronic obstructive pulmonary disease patients with reversibility (>150 mL to short-acting bronchodilators). Study 1 was a six-way, placebo-controlled crossover study (n=36) with single doses of RPL554 (6 mg), salbutamol (200 µg), ipratropium (40 µg), RPL554 (6 mg)+salbutamol (200 µg), RPL554 (6 mg)+ipratropium (40 µg) or placebo. Study 2 was a three-way crossover study (n=30) of tiotropium (18 µg) combined with RPL554 (1.5 or 6 mg) or placebo for 3 days. Forced expiratory volume in 1 s (FEV1), lung volumes and specific airway conductance (sGaw) were measured. In study 1, peak FEV1 change compared with placebo was similar with RPL554, ipratropium and salbutamol (mean 223, 199 and 187 mL, respectively). The peak FEV1 was higher for RPL554+ipratropium versus ipratropium (mean difference 94 mL; p, The dual PDE3 and PDE4 inhibitor RPL554 causes additional bronchodilation when combined with commonly used short- or long-acting bronchodilators http://ow.ly/CUYi30lDcYW

Studies have suggested that larger hospitals have better resources and provide better care than smaller ones. This study aimed to explore the relationship between hospital size, resources, organisation of care and adherence to guidelines. The European COPD Audit was designed as a pilot study of clinical care and a survey of resources and organisation of care. Data were entered by clinicians to a multilingual web tool and analysed centrally. Participating hospitals were divided into tertiles on the basis of bed numbers and comparisons made of the resources, organisation of care and adherence to guidelines across the three size groups. 13 national societies provided data on 425 hospitals. The mean number of beds per tertile was 220 (lower), 479 (middle), and 989 (upper). Large hospitals were more likely to have resources and increased numbers of staff; hospital performance measures were related in a minority of indicators only. Adherence to guidelines also varied with hospital size, but the differences were small and inconsistent. There is a wide variation in the size, resources and organisation of care across Europe for hospitals providing chronic obstructive pulmonary disease care. While larger hospitals have more resources, this does not always equate to better accessibility or quality of care for patients.

The role of ambient air pollution in the development of chronic obstructive pulmonary disease (COPD) is considered to be uncertain. We review the evidence in the light of recent studies. Eight morbidity and six mortality studies were identified. These were heterogeneous in design, characterisation of exposure to air pollution and methods of outcome definition. Six morbidity studies with objectively defined COPD (forced expiratory volume in 1 s/forced vital capacity ratio) were cross-sectional analyses. One longitudinal study defined incidence of COPD as the first hospitalisation due to COPD. However, neither mortality nor hospitalisation studies can unambiguously distinguish acute from long-term effects on the development of the underlying pathophysiological changes. Most studies were based on within-community exposure contrasts, which mainly assess traffic-related air pollution. Overall, evidence of chronic effects of air pollution on the prevalence and incidence of COPD among adults was suggestive but not conclusive, despite plausible biological mechanisms and good evidence that air pollution affects lung development in childhood and triggers exacerbations in COPD patients. To fully integrate this evidence in the assessment, the life-time course of COPD should be better defined. Larger studies with longer follow-up periods, specific definitions of COPD phenotypes, and more refined and source-specific exposure assessments are needed.

Short-term effects of air pollutants on respiratory mortality and morbidity have been consistently reported but usually studied separately. To more completely assess air pollution effects, we studied hospitalisations for respiratory diseases together with out-of-hospital respiratory deaths. A time-stratified case-crossover study was carried out in six Italian cities from 2001 to 2005. Daily particulate matter (particles with a 50% cut-off aerodynamic diameter of 10 μm (PM10)) and nitrogen dioxide (NO2) associations with hospitalisations for respiratory diseases (n = 100 690), chronic obstructive pulmonary disease (COPD) (n = 38 577), lower respiratory tract infections (LRTI) among COPD patients (n = 9886) and out-of-hospital respiratory deaths (n = 5490) were estimated for residents aged ≥35 years. For an increase of 10 μg·m(-3) in PM10, we found an immediate 0.59% (lag 0-1 days) increase in hospitalisations for respiratory diseases and a 0.67% increase for COPD; the 1.91% increase in LRTI hospitalisations lasted longer (lag 0-3 days) and the 3.95% increase in respiratory mortality lasted 6 days. Effects of NO2 were stronger and lasted longer (lag 0-5 days). Age, sex and previous ischaemic heart disease acted as effect modifiers for different outcomes. Analysing multiple rather than single respiratory events shows stronger air pollution effects. The temporal relationship between the pollutant increases and hospitalisations or mortality for respiratory diseases differs.

In patients with more severe chronic obstructive pulmonary disease ( COPD), the benefits of rehabilitation might not be clear and, therefore, new treatment options have been developed to increase the benefits of rehabilitation. This review provides an overview of new approaches being developed as an addition to exercise training. In turn, the benefits of adding ventilatory support, oxygen, anabolics or neuromuscular stimulation to a rehabilitation programme will be discussed. While positive benefits for a number of these approaches have been found, many questions remain unsolved. Therefore, at present, we cannot recommend these new tools as part of the routine management of patients with COPD who start a rehabilitation programme.

Pulmonary rehabilitation is available to only a sliver of COPD patients. Studies have explored less resource intensive approaches. Unless they prove to be at least as effective, traditional pulmonary rehabilitation availability may be further reduced. http://ow.ly/fyh930lYFo2

There is an increase in pneumonia risk in COPD patients who have higher blood eosinophil counts at baselinehttp://ow.ly/XPVh30kvOpZ

Mindfulness-based cognitive therapy can improve well-being in COPD patients beyond usual therapeutic measures: this is additional evidence for a holistic approach to chronic breathlessnesshttp://ow.ly/Dz2630irqvR

Mesenchymal stromal cell infusion may provide an alternative immune-based therapeutic option for COPD patients http://ow.ly/5DpA30hQS6y

Discharge support for the most seriously ill chronic obstructive pulmonary disease (COPD) patients is a key issue in minimising the impact of the acute episode and preventing future relapses. Alternatives to hospitalisation are crucial in the cost minimisation of COPD care. However, besides efficiency, there are clinical reasons for promoting alternatives to conventional hospital admission. Hospital stay itself conveys a risk to patients. The discharge process is a key element in the healthcare continuum. Hospital at home is a safe alternative to hospital admission, but it is not the only means of supporting discharge. Some home care schedules, mainly supported by nurses, have been proven to be good alternatives. Home care is also useful in the prevention of hospital admission. Integrated care is a comprehensive response to the needs of severely affected COPD patients achieved through models of shared care utilising all relevant health providers and promoting self-management. The framework for integrated care is the so-called chronic care model, centred on the promotion of self-management, the holistic appraisal of the patient, the most appropriate design of healthcare delivery responding effectively to the needs of the patient and a good system of shared and accessible information.

The present study investigated how end-expiratory ribcage and abdominal volume regulation during exercise is related to the degree of dynamic chest wall hyperinflation in patients with different spirometric severity of chronic obstructive pulmonary disease (COPD) based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification. In total, 42 COPD patients and 11 age-matched healthy subjects were studied during a ramp-incremental cycling test to the limit of tolerance (W(peak)). Volume variations of the chest wall (at end expiration (EEV(cw)) and end inspiration) and its compartments (ribcage (V(rc)) and abdominal (V(ab))) were computed by optoelectronic plethysmography. At W(peak), only patients in GOLD stages III and IV exhibited a significant increase in EEV(cw) (increase of 454+/-509 and 562+/-363 mL, respectively). These patients did not significantly reduce end-expiratory V(ab), whereas patients in GOLD stage II resembled healthy subjects with significantly reduced end-expiratory V(ab) (decrease of 287+/-350 mL). In patients, the greater the increase in EEV(cw) at W(peak), the smaller the reductions in end-expiratory V(ab) and the greater the increase in end-expiratory V(rc). In chronic obstructive pulmonary disease patients with different spirometric disease severity, greater degrees of exercise-induced dynamic chest wall hyperinflation were accompanied by lower degrees of end-expiratory abdominal volume displacement and larger increases in end-expiratory ribcage volume.

6 pags.-1 fig., The aim of this study was to determine the relationship between C-reactive protein (CRP) levels and factors known to predict outcome in stable chronic obstructive pulmonary disease (COPD) patients. The following were studied in 130 stable COPD patients: spirometry, lung volume, arterial oxygen tension (Pa,O2,), dyspnoea, 6-min walk distance (6MWD), body mass index, fat-free mass index, BODE (body mass index, obstruction, dyspnoea and exercise capacity), health-related quality of life, smoking status, the presence of cardiovascular risk factors or disease, corticosteroid use and number of exacerbations in the previous year. CRP levels were measured in these patients and in 65 controls. Using univariate and multivariate analyses, any possible association with the predictors of outcomes was evaluated. CRP levels were higher in COPD patients than in controls (4.1 versus 1.8 mg-L-1, respectively). Correlation was found with the following variables: forced expiratory volume in one second (FEV1; -0.23), FEV1% (-0.20), forced vital capacity (FVC; -0.24), FVC% (-0.24), Global Initiative for Chronic Obstructive Lung Disease stage (0.17), BODE (0.17), inspiratory capacity/total lung capacity (-0.20), Pa,O2 (-0.40) and 6MWD (-0.30). Using multivariate analysis, Pa,O2 and 6MWD manifested the strongest negative association with CRP levels. C-reactive protein levels in stable chronic obstructive pulmonary disease patients are best correlated with arterial oxygen tension and 6-min walk distance. This should be considered when C-reactive protein levels are measured in stable chronic obstructive pulmonary disease patients. Copyright © ERS Journals Ltd 2006.

Alpha1-antitrypsin (alpha1-AT) deficiency is an underdiagnosed condition in patients with chronic obstructive pulmonary disease (COPD). The present authors have conducted a nationwide case detection programme of alpha1-AT deficiency in unselected patients with COPD using dried blood spots. The first phase analysed samples from 971 patients by determining alpha1-AT concentrations and identifying the deficient Z allele by genotyping using rapid real-time PCR. The second phase analysed 1,166 samples with alpha1-AT concentrations and identified both the S and the Z allele, but only in samples with low alpha1-AT concentrations. A total of eight (0.37%) individuals with the severe deficiency PiZZ were detected. In addition, three patients were identified with the PiSZ genotype in the second phase (0.3%). The global cost of the programme was 41,512, which represents 19.42 per sample and 5,189 per PiZZ detected. A sensitivity analysis demonstrated that performing Z genotype to all samples would have resulted in increased costs of 28 per sample and 7,479.5 per PiZZ case identified. In conclusion, a case detection programme of alpha1-antitrypsin deficiency in patients with chronic obstructive pulmonary disease using dried blood spots is feasible and at a reasonable cost per case detected. Diagnostic yield and costs depend largely on inclusion criteria and the protocol for processing of samples.

To the Editor: Clinical trials in chronic obstructive pulmonary disease (COPD) patients have shown that the long-term use of inhaled corticosteroids (ICS) in COPD patients reduced the number of exacerbations per patient per year and improved health status [1]. Early studies have suggested increased ICS efficacy in patients with low lung function and frequent exacerbations [2]. The efficacy was reinforced when ICS was used in conjunction with long-acting β2-agonists (LABA) [3]. In most countries, health authorities approved ICS/LABA combinations in COPD patients with severe airflow impairment and frequent exacerbations, as also recommended in the Global Initiative for Obstructive Lung Disease (GOLD) 2007 document [4]. However, several surveys found poor adherence to this proposal among primary care physicians and pulmonologists in “real life”, ICS being often prescribed at a milder stage of the disease. The GOLD 2011 document proposed a new multidimensional system for the assessment and management of patients with COPD [5]. This system classifies COPD patients into four categories (A, B, C and D) based on the level of symptoms (dyspnoea or global clinical impact) and the risk of future exacerbations, as assessed using the severity of airflow limitation and the past history …

In most chronic obstructive pulmonary disease (COPD) patients, dyspnoea and functional exercise capacity may improve as a result of inspiratory muscle training (IMT). However, the long-term benefits of IMT have been investigated to a much lesser extent. The present study investigated the short-term and long-term benefits of IMT on inspiratory muscle performance (strength and endurance), exercise capacity and the perception of dyspnoea. Thirty-eight patients with significant COPD had 3 months of basic IMT and were then randomised into a group that received maintenance IMT for the next year, and a group that got training with very low load. Following the basic training there was a statistically significant increase in inspiratory muscle performance, 6-min walk test (6MWT), and a decrease in the dyspnoea. During the second stage of the study, the training group continued to maintain the improvement in all parameters, while there was already deterioration in the inspiratory muscle performance, exercise capacity and dyspnoea in the low intensity group during the 6-12 month period. The present study concludes that, in patients with significant chronic obstructive pulmonary disease, inspiratory muscle training results in improvement in performance, exercise capacity and in the sensation of dyspnoea. The benefits of 12-weeks of inspiratory muscle training decline gradually over 1 yr of follow-up if maintenance training is not performed.

Short­burst oxygen therapy (SBOT) remains an unproven treatment for reduction of exertional dyspnoea in chronic obstructive pulmonary disease (COPD). This study aimed to assess whether SBOT before exercise reduces dyspnoea or improves performance, and whether SBOT after exercise reduces dyspnoea during recovery. Twenty­two clinically stable COPD patients (mean forced expiratory volume in one second 34% predicted, mean resting saturation 94%) attended a respiratory gymnasium and undertook four 6‐min walk (6MW) tests at each of two sessions, 1 week apart. Cylinder air or oxygen was administered single­blind in random order for 5 min prior to the first two 6MW and during recovery following the final two 6MW. Dyspnoea was self­rated by subjects using the modified Borg scale. There was no significant difference in mean 6MW distance or final Borg score for air and oxygen given before exercise. There was also no significant difference in mean time­to­resting Borg score for air and oxygen given after exercise. Only two subjects demonstrated a clinically significant and consistent reduction in dyspnoea for oxygen compared with air either before or after exercise. Overall, short­burst oxygen therapy neither reduced dyspnoea nor improved performance. This study does not support the use of short­burst oxygen therapy either immediately before or after exercise.

To the Editors: Due to the lack of standardised procedures for exhaled breath condensate (EBC), a noninvasive technique for investigating lung inflammatory mediators [1], the between-laboratory comparison of results is difficult. Moreover, different collecting devices have been reported to influence the EBC content [2, 3]. The analysis of metabolic profiles (“metabolomics”) of EBC using nuclear magnetic resonance (NMR) spectroscopy discriminates between chronic obstructive pulmonary disease (COPD) patients and healthy subjects (HS) [4]; asthmatic children and HS [5]; and patients with stable cystic fibrosis and unstable cystic fibrosis and HS [6]. This approach has recently been questioned as NMR-based metabolomics of EBC collected using a condenser with reusable parts was reported to be affected by cleaning procedures, generating artificial signals that were not related to the endogenous metabolites of the lungs [7]. In this study we assessed the effects of a different cleaning procedure of a reusable-part condenser on EBC metabolomics; the possible time and carry-over effects when the same device is repeatedly used; technique sensitivity; the ability of NMR spectroscopy of EBC to discriminate between COPD patients and HS; and the potential of NMR spectroscopy in identifying selective EBC metabolites. If the cleaning procedure produces artificial signals in the NMR spectra of EBC, the separation between COPD patients and HS reported previously [4] is certainly surprising, as the residual signals derived from the disinfectant Descogen (Antiseptica chem.-pharm. Produkte GmbH, Pulheim/Brauweiler, Germnay) should have randomly affected both groups. Moreover, using a different reusable-part condenser, Carraro et al . [5] reported that NMR-based metabolomics of EBC differentiates asthmatic children from HS with a success rate of 86% [5]. To verify the influence of the disinfectant on EBC metabolomics, we modified the …

Inhaled corticosteroids cause increases in sputum bacterial load in COPD patients with lower eosinophil levels http://ow.ly/kCcS30feTru

COPD patients with high symptom burden or CAT ≥10 have an increased likelihood of experiencing work productivity losshttp://ow.ly/FnG030e6uaY

Although evaluated in 3 different PR settings, the 1-min STS test shows consistent cross-sectional validity and MID http://ow.ly/kJ0v30equOI

Respiratory depression secondary to morphine use in COPD patients with refractory breathlessnesshttp://ow.ly/8NVw30aLZXv

Respiratory system reactance changed over 5 years and the initial level predicted the rate of change in COPD patients http://ow.ly/ONzz308E3aD

COPD patients establish a flat shortening of QT interval during maximum exercise, irrespectively of medication taken http://ow.ly/XMrb308wUZt

The purpose of this study was to examine the accuracy of self-reports of symptom intensity in patients with chronic obstructive pulmonary disease (COPD) and factors that might influence recall of that intensity.Thirty COPD (forced expiratory volume in one second (FEV1) 36±17% predicted) subjects recorded their dyspnoea and fatigue intensity scores on a 0–10 scale for 14 consecutive days. On the fourteenth day, subjects recalled their average, greatest and least symptom intensity for the previous 14 days. General cognitive function, spirometry, and oxygenation were also measured.No significant differences were found between actual and recalled scores for dyspnoea or fatigue. General cognitive function, measured by the Mini Mental State Exam, correlated with the greatest and least dyspnoea and average fatigue difference scores (recall-actual) and contributed to the variance in the average and least dyspnoea recalled scores. The greatest contributor to the variance in the recall scores of both symptoms was the symptom intensity level on the day of recall.These results highlight the importance of current levels of symptom intensity and cognitive function when appraising symptoms in chronic obstructive pulmonary disease patients.

Lahousse et al. [1] have conducted an interesting study to investigate the association of chronic obstructive pulmonary disease (COPD) with various gait domains and explored a potential risk with falling. They have stressed the temporal gait parameter (rhythm) and have concluded that people who fall with COPD had worse rhythm. However, they have not tried to evaluate the other probable causes of disturbed rhythm in their subjects. The causes resulting in falls or disordered rhythm in COPD patients, could also be present primarily in the musculoskeletal and neurological systems because most of the subjects enrolled in the study were elderly, and problems related to musculoskeletal and neurological systems are more common in an elderly population [2]. The exclusion of such groups of people from the study has not been mentioned in the exclusion criteria. There were 152 participants with physical inability but the nature of physical inability is obscure. It would have been more rational or rather elucidative to assess other probable causes resulting in falls or decreased cadence in such elderly population with COPD. Association of poor gait and falling in Rotterdam study may be due to factors that were not considered

Lung function and relevance on choice of indacaterol or salmeterol/fluticasone combination in moderate COPD patients http://ow.ly/HGOCV

To the Editors: We read with great interest the article by Tashkin et al. 1 in a recent issue of the European Respiratory Journal evaluating effects of smoking status on long-term responses to maintenance bronchodilator therapy in the Understanding Potential Long-term Impacts on Function with Tiotropium (UPLIFT®) trial. The UPLIFT® trial 2 is a recent investigation in a long series of clinical trials assessing, among other things, the effects of different drugs on long-term forced expiratory volume in 1 s (FEV1) decline in patients with COPD, a “holy grail” of the pulmonological community. As tobacco smoking is the most frequent risk factor for COPD, researchers in the UPLIFT® trial paid the utmost attention to smoking status of the investigated cohort. They registered smoking status at inclusion, offered smoking cessation to every smoking patient before entry and checked smoking status at each follow-up visit during the 4 …

Ancient Chinese scholars believed there were two natural, complementary and contradictory forces in our universe: yin and yang (or in simplified Chinese ![Graphic][1] , in traditional Chinese ![Graphic][2] , and in pinyin (standard Mandarin romanisation) yīnyang). Yin represents the female, negative aspects, darkness, softness, moisture, night-time, even numbers, and docility. Yang represents the male, positive aspects, brightness, hardness, dryness, day-time, odd numbers, and dominance. Yin and yang are continually in a state of flux and always looking for a balance point. One moves, the other responds. Ancient scholars therefore treated this phenomenon as a natural universal law. In this issue of the European Respiratory Journal ( ERJ ), Man et al. 1 hypothesise that a ratio of fibronectin to C-reactive protein (CRP) is a more suitable tool than each separated biomarker to assess the prognosis of chronic obstructive pulmonary disease (COPD). Using the Lung Health Study III data 2, they updated (and improved on) their previous research on CRP only 3. It appears that in this well-described group of mild-to-moderate COPD patients, the relationship of the log transformed ratio of fibronectin to CRP (both in ug·mL−1) and mortality is L shaped, … [1]: /embed/inline-graphic-2.gif [2]: /embed/inline-graphic-3.gif