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Pulmonary hypertension (PH) is defined by a mean pulmonary artery pressure greater than 20 mm Hg and classified into five different groups sharing similar pathophysiologic mechanisms, hemodynamic characteristics, and therapeutic management. Radiologists play a key role in the multidisciplinary assessment and management of PH. A working group was formed from within the Fleischner Society based on expertise in the imaging and/or management of patients with PH, as well as experience with methodologies of systematic reviews. The working group identified key questions focusing on the utility of CT, MRI, and nuclear medicine in the evaluation of PH: (a) Is noninvasive imaging capable of identifying PH? (b) What is the role of imaging in establishing the cause of PH? (c) How does imaging determine the severity and complications of PH? (d) How should imaging be used to assess chronic thromboembolic PH before treatment? (e) Should imaging be performed after treatment of PH? This systematic review and position paper highlights the key role of imaging in the recognition, work-up, treatment planning, and follow-up of PH. This article is a simultaneous joint publication in Radiology and European Respiratory Journal. The articles are identical except for stylistic changes in keeping with each journal's style. Either version may be used in citing this article. © 2021 RSNA and the European Respiratory Society. Online supplemental material is available for this article.

Interferon (IFN)-γ release assays (IGRAs) are probably the most accurate tests for the detection of latent Mycobacterium tuberculosis infection, but IGRAs are labour intensive and the transport of samples over longer distances is difficult. IFN-γ-induced protein (IP)-10 is expressed at 100-fold higher levels than IFN-γ, and IP-10 release assays have comparable performance to IGRAs. The aim of this study was to explore the diagnostic potential of a novel IP-10 release assay based on dried plasma spots (DPS). The presence of IP-10 and IFN-γ was determined in plasma and in DPS by ELISA. Diagnostic algorithms for plasma and DPS tests for IP-10 were developed on a training cohort comprising 60 tuberculosis (TB) patients and 59 healthy controls. Diagnostic accuracy was assessed in a validation cohort comprising 78 TB patients and 98 healthy controls. Plasma was measured in Spain and DPS samples were sent to Denmark using the conventional postal service for analysis. IP-10 was readily detectable in both plasma and DPS, and correlation was excellent (r2 = 0.95). QuantiFERON-TB Gold In-Tube (QFT-TB) and IP-10 in DPS and plasma rendered comparable sensitivity (78%, 82% and 84%, respectively), specificity (100%, 97% and 97%, respectively) and indeterminate rates (p>0.55). The DPS-based IP-10 test has comparable diagnostic accuracy to the QFT-TB and samples can be sent via conventional mail over long distances for analysis without affecting the results.

The Standards for the Diagnosis and Treatment of Patients with COPD document 2004 updates the position papers on chronic obstructive pulmonary disease (COPD) published by the American Thoracic Society (ATS) and the European Respiratory Society (ERS) in 1995 1, 2. Both societies felt the need to update the previous documents due to the following. 1) The prevalence and overall importance of COPD as a health problem is increasing. 2) There have been enough advances in the field to require an update, especially adapted to the particular needs of the ATS/ERS constituency. 3) It allows for the creation of a “live” modular document based on the web; it should provide healthcare professionals and patients with a user friendly and reliable authoritative source of information. 4) The care of COPD should be comprehensive, is often multidisciplinary and rapidly changing. 5) Both the ATS and the ERS acknowledge the recent dissemination of the Global Initiative of Obstructive Lung Disease (GOLD) 3 as a major worldwide contribution to the battle against COPD. However, some specific requirements of the members of both societies require adaptation of the broad GOLD initiative. Those requirements include specific recommendations on oxygen therapy, pulmonary rehabilitation, noninvasive ventilation, surgery in and for COPD, sleep, air travel, and end-of-life. In addition, special emphasis has been placed on issues related to the habit of smoking and its control. ### Goals and objectives The main goals of the updated document are to improve the quality of care provided to patients with COPD and to develop the project using a disease-oriented approach. To achieve these goals, both organisations have developed a modular electronic web-based document with two components. 1) A component for health professionals that intends to: raise awareness of COPD; inform on the latest advances in the overall pathogenesis, diagnosis, monitoring and management of COPD; and …

The recent white paper on lung cancer has some insights, but also some misconceptions http://ow.ly/RZLmM

This letter analyses paper acceptance time in respiratory journals and discusses novel ways to disseminate research http://ow.ly/b9uX306esnA

The Fleischner Society White Paper and the ATS/ERS/JRS/ALAT guidelines recently redefined the computed tomography (CT) scanning patterns of usual interstitial pneumonia (UIP) [1,2]. Both publications confirmed honeycombing as the cornerstone of UIP pattern diagnosis, and introduced peripheral traction bronchiolectasis (PTB) as a key feature of the new “probable UIP” category. Therefore, improving the distinction between these two features may be critical, especially when the clinical likelihood of IPF is uncertain: a lung biopsy should be discussed for patients with PTB without honeycombing, but is not recommended for patients presenting with clear honeycombing and typical UIP pattern [2]. 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: Dr. de Margerie-Mellon reports grants from Institut Servier, grants from Olea Medical, outside the submitted work. Conflict of interest: Dr. Belin has nothing to disclose. Conflict of interest: Dr. Boussouar has nothing to disclose. Conflict of interest: Dr. Khafagy has nothing to disclose. Conflict of interest: Dr. Debray reports personal fees and non-financial support from Boehringer-Ingelheim, personal fees and non-financial support from Roche, outside the submitted work. Conflict of interest: Dr. Levand has nothing to disclose. Conflict of interest: Dr. Chabi has nothing to disclose. Conflict of interest: Dr. KHALIL has nothing to disclose. Conflict of interest: Dr. Benattia has nothing to disclose. Conflict of interest: Dr. Israel-Biet has nothing to disclose. Conflict of interest: Dr. crestani reports personal fees and non-financial support from astra zeneca, grants, personal fees and non-financial support from boehringer ingelheim, grants from MedImmune, grants, personal fees and non-financial support from Roche, personal fees from Sanofi, outside the submitted work. Conflict of interest: Dr. Nunes reports grants and personal fees from Roche/Genentech, grants and personal fees from Boehringer Ingelheim, outside the submitted work. Conflict of interest: Dr. Cadranel has nothing to disclose. Conflict of interest: Dr. GRENIER has nothing to disclose. Conflict of interest: Dr. Valeyre reports personal fees from Boehringer ingelheim, personal fees from Roche, personal fees from Boehringer ingelheim Roche, outside the submitted work. Conflict of interest: Dr. Naccache has nothing to disclose. Conflict of interest: PYB has received personal fees for teaching actions from Boehringer Ingelheim and Roche.

“Asbestos” is a term used to characterise a number of natural mineral fibres of silica that can be categorised according to their structure in the serpentine-type fibres, mainly represented by chrysotile, and the amphibole-type fibres, which include crocidolite, amosite, anthophyllite, actinolite and tremolite [1]. Due to its remarkable durability and fire resistance, asbestos has been used in pottery and clothing since for at least 4500 years. However, modern commercial production of asbestos began during the second half of the 19th century when industry started to exploit its unique chemical characteristics for manufacturing various products, such as pipe insulation, brake linings, cement pipes, protective clothing, etc. With the increasing use of such materials, individuals working in the construction (e.g. builders, plumbers, etc.) and ship building (e.g. dockyard workers) industries began to be exposed to high concentrations of inhaled asbestos fibres. Approximately 50–70 years after the introduction of asbestos in commercial use, the first reports of asbestos-related diseases emerged [1]. Since then, multiple studies have connected asbestos exposure with a variety of malignant and non-malignant lung disorders., Novel aspects of the pathogenesis of asbestos-related diseases are still coming to light http://ow.ly/EPDa30e8JqK

Cystic fibrosis (CF) is an autosomal recessive disorder caused by mutations in the CF transmembrane conductance regulator (CFTR) gene [1]. The CFTR protein is an ion channel that mediates chloride and bicarbonate transport in epithelial cells of multiple organs including lungs, pancreas and intestine [2, 3]. A defective CFTR protein produces an impaired ion and fluid secretion in the epithelial cells affecting several organs and leading to severe lung disease. More than 2000 CF-causing mutations have been identified [4, 5]. The most common mutation, the deletion of phenylalanine at position 508 (F508del), induces misfolding of the protein that is retained in the endoplasmic reticulum and degraded by proteasomal pathways [6]., The entry into the clinic of CFTR modulators such as TRIKAFTA has significantly improved life for ∼90% CF patients carrying one or two F508del mutations but challenges remain for rare CFTR mutations and the management of lung infections @SaraOcana1 https://bit.ly/3aRafQF

Chronic obstructive pulmonary disease (COPD) is characterised by persistent respiratory symptoms and airflow limitation, which is caused by small airway disease (bronchiolitis) and alveolar destruction (emphysema) [1]. Patients primarily suffering from severe emphysema are often limited in exercise capacity due to the consequences of hyperinflation [2]., The STELVIO trial was crucial to ensure that bronchoscopic lung volume reduction using one-way valves has evolved from an experimental intervention into a state-of-the-art treatment option for specific patients with advanced emphysema http://bit.ly/2IgMrsp

The aim of this position paper is to define quality control and acceptance criteria for measuring passive respiratory mechanics in infants using the occlusion techniques to ensure that valid results are obtained. These guidelines cover numerous aspects including: 1) terminology and definitions; 2) equipment; 3) data acquisition; 4) data handling and analysis; 5) reporting of results. Adherence to these guidelines should ensure that measurement of passive respiratory mechanics in infants in different lung function laboratories could be performed with an acceptable degree of safety, precision, and reproducibility. This will facilitate multi-centre collection of data and performance of clinical investigations.

Today, the uncountable negative effects of cigarette smoking are widely accepted, and it might seem odd to think about the fact that they were largely unsuspected until the 1950s, when many researchers started to study them in different parts of the world., The British doctors study: the first strong statistical proof of association between smoking and many diseases http://ow.ly/N2Ii302hD4v

The aim of this position paper is to define minimal performance criteria for the separate items comprising equipment used to measure respiratory function in infants together with overall performance criteria for the assembled pieces of such equipment. These guidelines cover numerous aspects including: 1) safety, 2) documentation and maintenance of equipment, 3) physical characteristics of mechanical parts and signal transducers, and 4) data acquisition. Further, validation procedures for individual components as well as for the integrated equipment are recommended. Adherence to these guidelines should ensure that infant lung function measurements can be performed with an acceptable degree of safety, precision and reproducibility. They will also facilitate multicentre collection of data and performance of clinical investigations. Manufacturers of infant respiratory function equipment should make every effort to comply with these guidelines, which represent the current standards of paediatric health professionals in this field.

The aim of the study was to investigate whether measurement of nitric oxide in exhaled air could be used for assessing the effects of irritants on the respiratory system, in this case recurrent ozone gassing in an occupational setting. The study population comprised bleachery workers (n=56) from a Swedish pulpmill carrying out ozone-based pulp bleaching since 1992 and controls (n=39). Both groups were investigated by measuring NO in exhaled air, methacholine challenge test and answers to a questionnaire concerning history of respiratory symptoms and accidental exposure to ozone peaks. There was no significant difference in NO output between exposed subjects and controls (median 67.2 versus 55.0 nL x min(-1), p=0.64). However, among bleachery workers reporting ozone gassings, the median NO output was 90.0 nL x min(-1) compared to 58.8 nL x min(-1) among those not reporting such incidents (p=0.019). There was no relation between exhaled NO and the prevalence of respiratory symptoms or bronchial hyperresponsiveness. In a multiple regression model, only reported ozone gassings were associated (p=0.016) with NO output. The results indicate an association between previous response to ozone gassing and nitric oxide output. The increased nitric oxide output among the bleachery workers reporting peak ozone exposure may indicate that chronic airway inflammation is present. Further studies are needed to evaluate the extent to which nitric oxide can be used for biological monitoring of respiratory health effects, and to relate it to other markers of airway inflammation.

Lower respiratory infections include acute bronchitis, influenza, community-acquired pneumonia, acute exacerbation of COPD and acute exacerbation of bronchiectasis. They are a major cause of death worldwide and often affect the most vulnerable: children, elderly and the impoverished. In this paper, we review the clinical presentation, diagnosis, severity assessment and treatment of adult outpatients with lower respiratory infections. The paper is divided into sections on specific lower respiratory infections, but we also dedicate a section to COVID-19 given the importance of the ongoing pandemic. Lower respiratory infections are heterogeneous entities, carry different risks for adverse events, and require different management strategies. For instance, while patients with acute bronchitis are rarely admitted to hospital and generally do not require antimicrobials, approximately 40% of patients seen for community-acquired pneumonia require admission. Clinicians caring for patients with lower respiratory infections face several challenges, including an increasing population of patients with immunosuppression, potential need for diagnostic tests that may not be readily available, antibiotic resistance and social aspects that place these patients at higher risk. Management principles for patients with lower respiratory infections include knowledge of local surveillance data, strategic use of diagnostic tests according to surveillance data, and judicious use of antimicrobials.

Data analysis methods play an important role in respiratory research. We evaluated the application and complexity of data analytical methods in high-impact respiratory journals and compared the statistical reporting in these respiratory articles with reports published in other eminent medical journals. This study involved a total of 160 papers published in 2015 in the European Respiratory Journal, American Journal of Respiratory and Critical Care Medicine, Chest and Thorax, and 680 papers published between 2007–2015 in other medical journals including the Lancet and New England Journal of Medicine. We manually reviewed the articles to determine the way in which they reported the methods applied in data analysis. The statistical intensity in the respiratory journals was equal to that in eminent medical journals. Traditional ways of testing statistical significance were widely used in respiratory articles. Statistical procedures were not always described in sufficient detail, and the prominent respiratory journals did not display different profiles with respect to their statistical content. Readers of the prominent respiratory journals need to possess a substantial level of statistical expertise if they wish to critically evaluate the design, methodology, data analysis and interpretation of the findings published in these journals., Statistical data analysis methods play an important role in prominent respiratory journals http://ow.ly/DMQz30k7PPS

Starting with the pioneering paper published in 1990 by D.J.P. Barker, “The fetal and infant origins of adult disease: the womb may be more important than the home” [1], and continuing with more recent papers on epigenetics and transgenerational developmental programming [2], the concept that in utero environment might play an important role on future health has reached the general public [3]. As far as respiratory health is concerned, we are all aware that asthma and allergic diseases often manifest themselves in early life, and that congenital factors play an important role in these [4]. Not only have prospective birth cohort studies been instrumental to investigate in utero determinants of chronic conditions such as asthma and IgE-associated diseases [5], but also studies based on several large population registries continue to contribute to better knowledge on this field [6]. Pre-eclampsia is detrimental to respiratory health in offspring and its effect is partly mediated by prematurity

Background The World Health Organization (WHO) recommends following up passengers following possible exposure to a case of infectious tuberculosis (TB) during air travel. This is known to be time consuming and difficult, and increasingly so with higher numbers of flights and passengers to and from countries with high TB endemicity each year. Objectives This paper systematically reviews the literature on contact tracing investigations following a plane exposure to active pulmonary TB. Evidence for in-flight transmission was assessed by reviewing the positive results of contacts without prior risk factors for latent TB. Data sources & Eligibility A search of Medline, EMBASE, BIOSIS, Cochrane Library and Database of Systematic Reviews was carried out, with no restrictions on study design, index case characteristics, duration of flight or publication date. Results Twenty-two papers were included, with a total of 469 index cases and 15 889 contacts. Only 26.4% of all contacts identified completed screening following exposure. The yield of either a single positive tuberculin skin test (TST) or a TST conversion attributable to in-flight transmission is between 0.19% (95%CI 0.13–0.27) and 0.74% (95%CI 0.61–0.88) of all contacts identified (0.00%, 95%CI 0.00–0.00 and 0.13%, 95%CI 0.00–0.61 in random effects meta-analysis). Limitations The main limitation is heterogeneity of reporting. Conclusions and implications of key findings The evidence behind the criteria for initiating investigations is weak and it has been widely demonstrated that active screening of contacts is labour intensive and unlikely to be effective. Based on our findings, formal comprehensive contact tracing may be of limited utility following a plane exposure.

The paediatric respiratory research community uses cohort studies extensively. However, the landscape of these studies and their quality of reporting has not been assessed.We performed a systematic review of publications on cohort studies reporting on paediatric lower respiratory problems published in 2018. We searched MEDLINE and Embase and extracted data on study and journal characteristics. We assessed the number of items of the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) checklist that a random sample (100 papers) reported. We analysed factors associated with the STROBE score and with the most poorly reported items, using Poisson and logistic regression.Of the 21 319 records identified, 369 full-text articles met our inclusion criteria. Most papers studied asthma aetiology through birth cohorts and were based in Europe or North America. The reporting quality was insufficient: 15% reported the 22 STROBE items; median (interquartile range) score 18 (16–21). The most poorly reported items were sources of bias, sample size, statistical methods, descriptive results and generalisability. None of the study or journal factors were associated with the STROBE score.We need a joint effort of editors, reviewers and authors to improve the reporting quality of paediatric cohort studies on respiratory problems.

BackgroundPersonalised airway clearance techniques are commonly recommended to augment mucus clearance in chronic suppurative lung diseases. It is unclear what current literature tells us about how airway clearance regimens should be personalised. This scoping review explores current research on airway clearance technique in chronic suppurative lung diseases, to establish the extent and type of guidance in this area, identify knowledge gaps and determine the factors which physiotherapists should consider when personalising airway clearance regimens.MethodsSystematic searching of online databases (MEDLINE, EMBASE, CINAHL, PEDro, Cochrane, Web of Science) was used to identify full-text publications in the last 25 years that described methods of personalising airway clearance techniques in chronic suppurative lung diseases. Items from the TIDieR framework provideda prioricategories which were modified based on the initial data to develop a “Best-fit” framework for data charting. The findings were subsequently transformed into a personalisation model.ResultsA broad range of publications were identified, most commonly general review papers (44%). The items identified were grouped into seven personalisation factors: physical, psychosocial, ACT type, procedures, dosage, response, and provider. As only two divergent models of airway clearance technique personalisation were found, the personalisation factors identified were then used to develop a model for physiotherapists.ConclusionsThe personalisation of airway clearance regimens is widely discussed amongst current literature which provides a range of factors that should be considered. This review summarises the current literature, organising findings into a proposed airway clearance personalisation model, to provide clarity in this field.

Asthma is a highly prevalent chronic condition worldwide, and is particularly common in younger people compared to other chronic conditions. Asthma can result in a number of symptoms that are detrimental to the quality of life of sufferers. The aim of the present systematic literature review was to analyse the existing literature on the relationship between asthma and fatal and nonfatal suicidal behaviours.Articles were retrieved from Scopus, PubMed, ProQuest and Web of Knowledge. We searched for the terms (suicid* OR self-harm) AND (asthma* OR “bronchial hyperreactivity”) published in English-language peer-reviewed journals between 1990 and December 2014. Original research papers providing empirical evidence about the potential link between asthma and suicidal behaviours were included.The initial search identified 746 articles. Specific limiting criteria reduced the number of articles to the 19 articles that were finally included in the systematic review.The review found a potential link between asthma and suicide mortality, ideation and attempts across the age groups. Limitations of the review include the restriction to English-language papers published within the chosen time period, the limited number of papers involving suicide mortality, and the fact that the majority of papers originated from the USA.

In this edition of Doing Science, we will address abstract writing, with a focus on conference abstracts. By providing an opportunity for discussing your work with your peers in specialised meetings, writing and submitting an abstract is often the very first step when you want to show the world the results of your work; be it your research, a clinical case or a review of the literature [1]. However, it can be be a daunting task to condense hours and hours of hard work into abstract format. But fear not! This edition of Doing Science will give you several approaches to writing abstracts, using your own data as well as that of others. Before we begin, a key message: always remember that writing an abstract follows typically the same path as writing a paper [2]. Begin by planning it, before actually writing it, proofreading it, sharing it with colleagues and finally doing the final revision and editing before you submit. In most cases, the keys to success are an important research question and interesting material to analyse in the hope of answering it. That being said, good abstract writing skills will increase your acceptance rate even for data of moderate importance, or seemingly complicated research ideas. So let’s begin... As every researcher knows, the function of a scientific abstract is to provide an overview of your work. But keep in mind that the abstract is what the referees will use to decide whether your work is accepted or rejected for presentation on the meeting. Also, have you remembered that the abstract is the only part of a paper that is published in conference proceedings [3]? Many researchers will even acknowledge that when they scroll through a conference programme, they look only at the titles …

More and more papers are published in medical journals every day, so how do you decide which ones to read and, having read a paper, how do you decide whether to change your practice as a result of what you have read? Perhaps the paper was atypical in some way. What does the other research on the topic say? The purpose of systematic reviews is to summarise all the available, high-quality evidence that can be found on a particular topic. A narrative review, in which an expert can cite a selection of papers that support a particular viewpoint, says very little about the papers that do not. In contrast, a systematic review involves a search for all available literature, whatever the findings may be. Systematic reviews start with a well-defined clinical question, and aim to identify, appraise, synthesise and then apply all the available good-quality evidence that can be found (published or unpublished) that is relevant to the question. In particular, Cochrane systematic reviews have to meet a defined set of quality standards and the authors and editors set out to make them the best around. They are the current gold standard in the systematic review field. The Cochrane Collaboration is an international group which is now 20 years old. The collaboration depends upon the voluntary contribution of thousands of authors and is supported by editorial bases and methodologists. In the UK, these bases are supported by funding from the National Institute of Health Research (NIHR), and any funding for editorial bases must be free from commercial interests. Review groups are divided up into areas of clinical interest and, within the respiratory field, there are groups for lung cancer (based in France), acute respiratory infections (based in Australia), cystic fibrosis (based in the UK) and airways (based in the UK …

The message presented by Tortoli and co-workers in their paper “Same meat, different gravy: ignore the new names of mycobacteria” is correct, but the paper contains many errors and misconceptions about the functioning of the Prokaryotic Code and the IJSEMhttp://bit.ly/2YD9u6s

It has been 2 years since the breakthrough publication of the National Lung Cancer Screening Trial (NLST) results, yet there are still unresolved questions about cancer screening. Despite the possibility of reducing lung cancer-related mortality, the risk of detecting indolent lesions that are not life threatening, especially in advanced-age patients, still exists. Another problem is the number of false-positive findings leading to unnecessary diagnostic work-ups. In the NSLT study, for example, 27.2% of computed tomography participants were false positives, leading to follow-up diagnostic procedures in 90% of cases and to surgery in 4.2% [1]. Of course, computed tomography protocols and criteria for screening positivity should ensure accurate detection of all potentially malignant lesions, but this goal alone is not sufficient. Ideally, screening protocols should allow us to detect only true lung cancers, leaving out benign lesions, and among the malignant lesions detected, we should only be identifying those that are sufficiently aggressive to be potentially life threatening. This issue of the European Respiratory Journal includes two articles addressing precisely these problems. The paper by Infante et al. [2] is a review article dedicated to the slow-growing lung cancer entity, whereas the paper from Horeweg et al. [3] gives an overview of the NELSON strategy’s performance, especially its rate of false positives. Infante et al . [2] provide evidence of slow-growing lung cancers by analysing tumour volume doubling times (VDTs) in different lung cancer series. Considering a VDT >400 days to define slow-growing lung cancers, they report a highly variable proportion, ranging from 3% in the International Early Lung Cancer Action Program (I-ELCAP) [4] to 45% in some Japanese series [5]. The authors emphasise that only a minority of baseline VDTs were assessed in I-ELCAP, but …

A HERMES examination in adult respiratory medicine or in paediatric respiratory medicine is a knowledge-based examination with 90 multiple-choice questions (MCQ) in English. Condidates can sit a HERMES examination during the ERS Annual Congress or locally in the Netherlands or Russia in collaboration with those countries′ national societies. Each HERMES examination MCQ has a clinical focus reflecting real-life practice in adult or paediatric respiratory medicine. Taking a HERMES examination is a valuable benchmarking exercise for the participants. Each MCQ undergoes a rigorous process of formulation and validation by European representatives who ensure that state-of-the-art practices as well as authentic professional situations are illustrated. A participant is therefore given the opportunity to keep abreast of new developments in the field and verify and update their knowledge. If participating as a trainee, the examination can be used as a driver for learning. If sitting the examination for self-assessment, candidates can benchmark themselves against their peers and identify their potential educational needs. Participation in the examination in order to earn the European diploma demonstrates commitment to life-long learning and continuous professional development. Several positive actions follow the decision to take a HERMES examination: 1) getting ready by studying for the examination; 2) sitting the examination itself; 3) identifying potential educational needs based on the results; and 4) planning and attending educational activities to address these needs. These positive actions are geared towards ensuring the best possible care for patients, which is the ultimate goal of all HERMES programmes. Producing an actual HERMES examination paper follows a rigorous process with strict quality control in collaboration with the Institute of Medical Education at the University of Berne in Switzerland, the ERS examination committees and the MCQ authors. Everyone involved in the production of the HERMES examination paper is committed to ensuring the quality …

On December 13, 2016, the first Breathe journal club took place. During the annual ERS International Congress in London, UK, in September 2016, the Breathe editorial board agreed to set up this event. In the journal club, a recently published research article from another journal, in keeping with the thread of the current Breathe issue, is presented, supported by multimedia slides, in about 20 min by an expert in this field who is not an author of the paper. Afterwards, the paper is further discussed., A recap of the first Breathe online journal club by @fritsfranssen http://ow.ly/5uXX308xAG1

Professor Quanjer's editorial makes several errors in reporting our views on ethnicity and lung function [1], views that had been fairly summarised by Braun et al . [2] in the paper on which the editorial comments. Among his more unfortunate assertions is that our conclusions are reminiscent of the racist views of Hoffman. As the purpose of the paper to which the editorial refers was precisely to question the residual support that current assumptions provide for a racial explanation of ethnic differences [3], this seems particularly inappropriate. The observed differences in vital capacity between different ethnic groups raise two principal questions, “What accounts for these differences?” and “What implications do they have for health?” The first question is unanswerable on the current evidence but the prevalent view, and one that would seem to be encouraged by Prof. Quanjer's peroration on the development of genetic diversity, is that it is explained by genetics. As Prof. Quanjer himself points out, however, associations are not necessarily causal, and low ventilatory function is also strongly associated with poverty. Disentangling the contributions of genetics and poverty has not yet been possible. One technique used recently is liable to be over interpreted. Recognising that gene pools are increasingly mixed and that genetic structure may confound the interpretation of studies, geneticists have developed methods for quantifying genetic ancestry from the genome [4]. These methods are essential for adjusting for likely confounding in genetic studies, but they cannot be used to demonstrate a genetic origin for associated phenotypes. The greater the “African” component of the genome, the lower the lung function [5, 6], but this does not imply that the cause of …

What is the experience of people living with breathlessness due to medical conditions, those caring for them and those treating them, with regard to quality of life and the nature of clinical interactions?Electronic databases (Ovid MEDLINE, Embase, CINAHL Plus and PsycINFO) were searched (January 1987 to October 2017; English language), for qualitative studies exploring the experience of chronic breathlessness (patients, carers and clinicians). Two independent reviewers screened titles, abstracts and papers retrieved against inclusion criteria. Disagreements were resolved with a third reviewer. Primary qualitative data were extracted and synthesised using thematic synthesis.Inclusion and synthesis of 101 out of 2303 international papers produced four descriptive themes: 1) widespread effects of breathlessness; 2) coping; 3) help-seeking behaviour; and 4) clinicians’ responsiveness to the symptom of breathlessness. The themes were combined to form the concept of “breathing space”, to show how engaged coping and appropriate help-seeking (patient) and attention to symptom (clinician) helps maximise the patient's quality of living with breathlessness.Breathlessness has widespread impact on both patient and carer and affects breathing space. The degree of breathing space is influenced by interaction between the patient's coping style, their help-seeking behaviour and their clinician's responsiveness to breathlessness itself, in addition to managing the underlying disease.

In November 2006, the COST B26 action on cardiovascular disease in obstructive sleep apnoea/hypopnoea syndrome (OSAHS) convened a symposium in Copenhagen (Denmark). The symposium was an attempt to bring experts together to define the direction in which the fast pace of change in the fields of molecular biology and genetics was pushing frontiers, particularly in the context of cardiovascular diseases and OSAHS. An upcoming series that will be published over the next 6 months in the European Respiratory Journal ( ERJ ), presents some of the key papers from the symposium. The first paper in the series, by MacLeod et al. 1, introduces the importance of meticulous design, data collection and storage in studies of complex disease, using the example of Generation Scotland. The paper serves as the background for further contributions to the series, which continue with a discussion of the difficulties in phenotyping and, by inference, the difficulties inherent to genotyping such a complex disorder as OSAHS 2. The epidemiological aspects of OSAHS and sleep-disordered breathing (SDB) are discussed separately 3. The sequelae of OSAHS are considered in detail, particularly the molecular biology of oxidative stress mechanisms 4, as well as inflammatory pathways 5 which determine the comorbidities increasingly recognised in the context of SDB. Finally, the series concludes with evidence for and against the coexistence of and increased propensity of developing metabolic syndrome, hypertension and insulin resistance in SDB with and without hypoxaemia 6. In the first paper of the series, MacLeod et al. 1 demonstrate that when studying genetic aspects of complex diseases such as hypertension and OSAHS, good sample and data management is necessary to ensure that the data collected are stored accurately and efficiently, and passed through the process of analysis in an orderly manner. In order to be able to collect …

Educational aims To present innovative papers from the field of pulmonary rehabilitation published in 2005 and to discuss the important points and conclusions from each. Summary This paper summarises the findings of important papers that have been published over the last year. Two recently published studies have addressed the effects of different durations of pulmonary rehabilitation programme (PRP), indicating the greater benefits obtained by longer programmes. Three other papers have described the effects of pulmonary rehabilitation on pulmonary mechanics and oxidative stress, indicating that exercise is able to reduce the mechanical disadvantage of the respiratory system and some aspects of oxidative stress associated with chronic obstructive pulmonary disease (COPD). Other papers have discussed the effects of a number of breathing strategies, such as pursed-lip breathing (PLB), or training techniques, such as arm or inspiratory muscle training. Finally, the addition of drug therapy to pulmonary rehabilitation and the role of outcome measures in providing rehabilitation programmes were examined in two other studies.

Educational aims To present four innovative papers from the field on non-invasive ventilation published in 2004 and to discuss the important points and conclusions from each. Summary This paper summarises the findings of four important papers that have been published over the last year. The first paper reports data on the success rate of NIV in patients with early onset of ARF due to SARS. Furthermore, the paper discusses how NIV may be used in patients affected by highly contagious diseases in a way which is safe for healthcare workers. The second paper concentrates on dying at end-stage disease and the limits of medical care. It studies the use of NIV treatment in patients with CHF and COPD affected by ARF who have signed a DNI order. The next article investigates the use of both CPAP and NIV delivered by face mask in patients with CPE, when compared with the use of oxygen alone, and their effect on physiological parameters and avoiding intubation. Finally, the last paper reviewed reports on the use of NIV to treat an episode of post-extubation respiratory failure in “unselected” patients. This review article aims to keep the reader updated on the most recent and some of the important advancements in this field over the last year.

We are concerned that the paper by Harvey et al . [1] in a recent issue of the European Respiratory Journal and its accompanying editorial [2] are misleading the readership with regard to the possible association between gas transfer ( T LCO), referred to in the paper as diffusion capacity, and the subsequent risk of developing chronic obstructive pulmonary disease (COPD) in smokers. The authors selected two small groups of subjects (n=59 and 46) from within a larger dataset to compare what happened to their forced expiratory volume in 1 s (FEV1) to forced vital capacity (FVC) ratio over time. Both groups at baseline had FEV1 >80% of predicted and FEV1/FVC >0.7, but one group had T LCO >80% of predicted, and the other group had T LCO

In this paper, the authors update the present knowledge about three risk factors for the prognosis of chronic obstructive pulmonary disease (COPD), which may be particularly relevant in elderly people: mucus hypersecretion, respiratory infections, and cardiovascular comorbidity. Chronic mucus hypersecretion (CMH) is a common respiratory symptom in old age, the relevance of which is analysed on the basis of data collected during the first three rounds of the Copenhagen City Heart Study. In subjects aged ≥65 yrs, CMH was a strong predictor of the incidence of respiratory infections in a 10-yr follow-up period and it was also a strong predictor of death from COPD (relative risk=2.5). However, CMH was associated with consistently lower forced expiratory volume in one second (FEV 1 ) values, but not with an accelerated decline of FEV 1 in this sample of an elderly population. Acute respiratory infections (ARI) are extremely common at all ages, mostly mild self-limiting illnesses at a young age, but severe often fatal illnesses in elderly people already affected by a chronic disease such as COPD. This paper summarises the present knowledge about aetiology, pathology, prognostic relevance, and prevention of ARI. Furthermore, the areas in which further research is needed are listed. Clinical cohort studies clearly support the relevance of cardiovascular comorbidity for the short- and long-term prognosis of elderly subjects affected by severe COPD. In this paper, the recently demonstrated association between particulate air pollution and cardiovascular events is reported to suggest the presence of an extremely susceptible cluster of elderly subjects in the population identified by the copresence of chronic obstructive pulmonary disease and cardiovascular comorbidity.

Background Nonsteroidal anti-inflammatory drugs (NSAIDs) may exacerbate respiratory symptoms. A recent European Academy of Allergy and Clinical Immunology position paper recommended the use of an acronym, N-ERD (NSAID-exacerbated respiratory disease), for this hypersensitivity associated with asthma or chronic rhinosinusitis with or without nasal polyposis. Our aim was to estimate the prevalence of N-ERD and identify factors associated with N-ERD. Methods In 2016, a cross-sectional questionnaire survey of a random adult population of 16 000 subjects aged 20–69 years was performed in Helsinki and Western Finland. The response rate was 51.5%. Results The prevalence was 1.4% for N-ERD, and 0.7% for aspirin-exacerbated respiratory disease (AERD). The prevalence of N-ERD was 6.9% among subjects with asthma and 2.7% among subjects with rhinitis. The risk factors for N-ERD were older age, family history of asthma or allergic rhinitis, long-term smoking and exposure to environmental pollutants. Asthmatic subjects with N-ERD had a higher risk of respiratory symptoms, severe hypersensitivity reactions and hospitalisations than asthmatic subjects without N-ERD. The subphenotype of N-ERD with asthma was most symptomatic. Subjects with rhinitis associated with N-ERD, which would not be included in AERD, had the fewest symptoms. Conclusion We conclude that the prevalence of N-ERD was 1.4% in a representative Finnish adult population sample. Older age, family history of asthma or allergic rhinitis, cumulative exposure to tobacco smoke, secondhand smoke, and occupational exposures increased odds of N-ERD. N-ERD was associated with significant morbidity., Population-based prevalence of N-ERD is 1.4%. N-ERD is symptomatic, with a rhinitis subgroup. The risk factors for N-ERD are older age, family history of asthma or allergic rhinitis, long-term smoking and exposure to environmental pollutants. https://bit.ly/3HxGftP

⇓The purpose of this European Respiratory Society/American Thoracic Society (ERS/ATS) Task Force position paper is to define the field of interventional pulmonology as well as to describe the minimal requirements in methodology and logistics, the indications, contraindications, outcome and training requirements for each interventional procedure. This position paper has been prepared by a group of European and North American experts. Fig. 1.— Schematic illustration of the three main types (a–c) of malignant central airway obstruction shown at the tracheal level, with identical degrees of narrowing of the lumen. a) intraluminal; b) extraluminal; c) mixed obstruction. Fig. 2.— Algorithm for the management of malignant central airway obstructions. Terms in hexagonal boxes are conditions; terms in rectangular boxes are procedures. Two-way arrows indicate the tendency of endobronchial tumours to recur and the repetitive need of multimodality treatment. Interrupted arrows: 1: rare cases of primarily inoperable lung cancers which become secondarily operable after initial therapeutic bronchoscopy usually followed by neo-adjuvant treatment; 2: rare cases of operated lung cancers initially presenting with central airway obstruction and still being operable after careful restaging of an endobronchial recurrence. TNM: tumour staging, including histology; CPR: cardiopulmonary reserves of the patient. Reproduced with permission from 81. Fig. 3.— Interventional pulmonology can be defined as “the art and science of medicine as related to the performance of diagnostic and invasive therapeutic procedures that require additional training and expertize beyond that required in a standard pulmonary medicine training programme”. Disease processes encompassed within this discipline include complex airway management problems, benign and malignant central airway obstruction, pleural diseases, and pulmonary vascular procedures. Diagnostic and therapeutic procedures pertaining to these areas include, but are not limited to, rigid bronchoscopy, transbronchial needle aspiration, autofluorescence bronchoscopy, endobronchial ultrasound, transthoracic needle aspiration and biopsy, laser bronchoscopy, endobronchial electrosurgery, argon-plasma coagulation, cryotherapy, airway stent insertion, balloon bronchoplasty and dilatation …