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Introduction Multiple Breath Washout (MBW) to measure Lung Clearance Index (LCI) is increasingly being used as a secondary endpoint in multicentre bronchiectasis studies. LCI data quality control or “over-reading” is resource intensive and the impact is unclear. Objectives To assess the proportion of MBW tests deemed unacceptable with over-reading, and to assess the change in LCI (number of turnovers), LCI coefficient of variation (CV%) and tidal volume (VT) CV% results after over-reading. Methods Data were analysed from 250 MBW tests (from 98 adult bronchiectasis patients) collected as part of the Bronch-UK Clinimetrics study in 5 UK centres. Each MBW test was over-read centrally using pre-defined criteria. MBW tests with

Summary Background Bronchiectasis is the outcome of a number of different airway insults. Very few studies have characterised the aetiology and utility of a dedicated screening proforma in adult patients attending a general bronchiectasis clinic. Methods A prospective observational study of 189 bronchiectasis patients attending two centres in the North East of England over a two-year period was performed. Results The aetiology of bronchiectasis was identified in 107/189(57%) patients. Idiopathic bronchiectasis (IB) represented the largest subgroup (43%). Post-infection bronchiectasis (PIB) constituted the largest proportion (24%) of known causes. Mean age (SD) at diagnosis was 54(20) years with a mean age at symptom onset of 37(24) years, accounting for a diagnostic delay of 17 years. Age of symptom onset was significantly younger in patients with PIB compared to IB ( p Pseudomonas sputum positive patients ( p = 0.007). Screening for APBA and total immunoglobulin deficiency identified 9 (5%) patients who then had tailored treatment. Routine screening for other aetiologies was deemed unnecessary. Conclusion IB and PIB accounted for two thirds of cases of bronchiectasis in a general population. We recommend routine screening for ABPA and total immunoglobulin deficiency but not for other rarer aetiologies.

Introduction Obliterative Bronchiolitis (OB) is characterised by fibrotic obliteration of small airways which adversely affecting graft function and survival after lung transplantation. It has been shown in vitro and in vivo that primary bronchial epithelial cells (PBEC) from the transplanted lung can undergo epithelial to mesenchymal transition (EMT) and this process may contribute to the development of OB. We have shown that activated macrophages can disrupt epithelial wound repair by accentuating TGF-β1-driven EMT. We hypothesised that this effect might be limited to macrophages with an M1 phenotype and that their secretory products might be a target for limiting the inflammatory accentuation of EMT. Methods and materials The THP-1 monocytic cell line was stimulated with clinical isolates of Pseudomonas aeruginosa (PA) and the effect of the activated cells or conditioned media on TGF-β1-driven EMT assessed in PBEC (Western blotting, confocal microscopy). In addition, THP-1 cells were differentiated to an M1 phenotype by treatment with IFNγ and an M2 phenotype with IL-4/IL-13 and cytokine release (ELISA) and their effect on TGF-β1 driven EMT assessed. The effect of blocking TNFα secreted from activated THP-1 cells on EMT was assessed using an anti-TNFα antibody. Results Treatment with TGF-β1+activated THP-1 cells had no effect on EMT marker expression (p>0.05 n=6). However, co-treatment with TGF-β1+conditioned media from activated THP-1 cells dramatically accentuated TGF-β1-driven EMT (p Conclusion The secretory products of M1, but not M2, macrophages significantly accentuate TGF-β1 driven EMT. TNFα appears to be a major constituent of this accentuating action. This raises the possibility that either TNFα targeted therapies or modulation of macrophage phenotype may inhibit the inflammatory accentuation of EMT in airway epithelium.