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The treatable traits approach is based on the recognition that the different clinical phenotypes of asthma and chronic obstructive airways disease (COPD) are a heterogeneous group of conditions with different underlying mechanisms and clinical manifestations, and that the identification and treatment of the specific clinical features or traits facilitates a personalised approach to management. Fundamentally, it recognises two important concepts. Firstly, that treatment for obstructive lung disease can achieve better outcomes if guided by specific clinical characteristics. Secondly, that in patients with a diagnosis of asthma, and/or COPD, poor respiratory health may also be due to numerous overlapping disorders that can present with symptoms that may be indistinguishable from asthma and/or COPD, comorbidities that might require treatment in their own right, and lifestyle or environmental factors that, if addressed, might lead to better control rather than simply increasing airways directed treatment. While these concepts are well accepted, how best to implement this personalised medicine approach in primary and secondary care within existing resource constraints remains uncertain. In this review, we consider the evidence base for this management approach and propose that the priority now is to assess different prototype templates for the identification and management of treatable traits in both asthma and COPD, in primary, secondary and tertiary care, to provide the evidence that will guide their use in clinical practice in different health care systems. [ABSTRACT FROM AUTHOR]

Point-of-care biomarkers in asthma management: Time to move forward In this capacity, they complement symptom scoring and lung function measurement in asthma management. The conclusions were to recommend FeNO measurement and spirometry to be used as initial assessments in all patients in whom asthma is suspected and propose FeNO measurement to be considered in the management of patients with asthma who remain symptomatic despite inhaled corticosteroid treatment. [Extracted from the article]

The paper presents new observations on the use and avoidance of different red scoria rocks on Easter Island ( Rapa Nui), made during fieldwork. It describes the different facies of the rock, their origins, their nature and their context of quarrying and use. From the latter, it is inferred that, for the prehistoric Rapanui, the meaning of red scoria transcended practical utility. A combination of stone context and ethnographic analogy suggests what this meaning or these meanings might be. Stone use on the Island is presented as a model against which the stone use of other prehistoric cultures might be measured. [ABSTRACT FROM AUTHOR]

The collapse of the global financial system following the events of September 2008 was unprecedented in its global reach and the response elicited from governments. The Global Financial Crisis has called into question the basic assumption of Efficient Markets Theory that traded financial instruments will always have a market price – indicating that capital markets as well as depository institutions can suffer liquidity crises or ‘runs’ due to asymmetric information. This paper traces the causes and implications of the GFC, focusing especially on the Australian financial system and its regulation. Attention is drawn to the need to review financial sector regulation in light of the GFC in order to rebalance the mix between competition and regulation in financial markets. But the paper also notes the danger of over-regulation with its potential to stifle innovation and constrain the risk-allocation function of financial markets. [ABSTRACT FROM AUTHOR]

Several factors including early-life antibiotic usage have been implicated in the rising prevalence of allergic sensitization and asthma. A nested case–control study comparing antibiotic exposure of 37 sensitized children with recurrent wheeze (age 3–5 yr) and 37 non-sensitized children who had never wheezed was carried out within a population-based birth cohort (matching for age, sex, parental atopy, allergen exposure, and pet ownership). We collected data on antibiotic prescriptions during first 3 yr of life (timing, type, indication) from the primary care medical records. Significantly, more cases than controls received one or more antibiotic courses during the first year of life (92% vs. 70%, p = 0.04). The median time to first antibiotic course was shorter for the cases than the controls (6 vs. 8 months, p = 0.03). The total number of antibiotic receipts was greater amongst cases in each of the first 3 yr of life, but this reached significance only when the whole three-year period was considered (249 vs. 182 courses, p = 0.05). The increased ratio of antibiotic receipt in cases over controls was highest in the first year of life (1.32, 95% CI 0.99–1.78). Significantly more cases than controls were prescribed antibiotics for lower respiratory tract infection during the first 3 yr (p = 0.007), but not during the first year of life (p = 0.52). Antibiotics use by class was similar in the two groups. Our data support the hypothesis that early life exposure to broad-spectrum antibiotics may have a causative role in sensitisation and the expression of wheeze. [ABSTRACT FROM AUTHOR]

The randomized controlled trial (RCT) is considered the gold standard methodology for determining the efficacy and tolerability of new treatments. However, RCTs cannot provide information on the effectiveness of interventions as they are used in real life. This study was conducted to investigate the effectiveness of montelukast, a leukotriene receptor antagonist, in the real-world management of asthma, through a large-scale, retrospective, observational study: the National Montelukast Survey. In order to ensure a robust methodology for the National Montelukast Survey we performed three pilot studies involving a total of almost 400 patients. During the pilots, the design of the study was extensively modified from a simple prescriber questionnaire used in the first pilot to the ‘triangulated’ methodology encompassing the perspectives of patient, prescriber and independent observer used in the National Montelukast Survey. Good levels of interobserver agreement confirmed the robustness of the final methodology. Achieving a robust methodology was dependent on the extensive piloting. It is possible to collect reliable observational data relating to treatment outcomes. We believe our methods are likely to have more widespread applicability and offer a potential improvement over postmarketing surveillance. [ABSTRACT FROM AUTHOR]

Introduction: A Task Force was commissioned jointly by the European Academy of Allergy and Clinical Immunology (EAACI) and the Respiratory Effectiveness Group (REG) to develop a quality assessment tool for real-life observational research to identify high-quality real-life asthma studies that could be considered within future guideline development. Methods: The resulting REal Life EVidence AssessmeNt Tool (RELEVANT) was achieved through an extensive analysis of existing initiatives in this area. The first version was piloted among 9 raters across 6 articles; the revised, interim, version underwent extensive testing by 22 reviewers from the EAACI membership and REG collaborator group, leading to further revisions and tool finalisation. RELEVANT was validated through an analysis of real-life effectiveness studies identified via systematic review of Medline and Embase databases and relating to topics for which real-life studies may offer valuable evidence complementary to that from randomised controlled trials. The topics were selected through a vote among Task Force members and related to the influence of adherence, smoking, inhaler device and particle size on asthma treatment effectiveness. Results: Although highlighting a general lack of high-quality real-life effectiveness observational research on these clinically important topics, the analysis provided insights into how identified observational studies might inform asthma guidelines developers and clinicians. Overall, RELEVANT appeared reliable and easy to use by expert reviewers. Conclusions: Using such quality appraisal tools is mandatory to assess whether specific observational real-life effectiveness studies can be used to inform guideline development and/or decision-making in clinical practice. [ABSTRACT FROM AUTHOR]

Presents a letter to the editor in response to an article about the use of quantitative structure activity relationship testing in place of animal studies to comply with the requirements under the proposed European Registration, Evaluation and Authorization of Chemicals legislation.