[⇓][1] 

SERIES “ATS/ERS TASK FORCE: STANDARDISATION OF LUNG FUNCTION TESTING” 

Edited by V. Brusasco, R. Crapo and G. Viegi 

Number 2 in this Series

 [1]: #F13

/pdf/standardisation-of-spirometry-1dkqxgifvl.pdf

Standardisation of spirometry

Global strategy for asthma management and prevention

https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(14)61632-3/pdf

Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance

admission. This proportion could already be greater in some parts of the country and may increase if referrals of cases of self-poisoning increase faster than the facilities for their assessment and management. The provision of social work and psychiatric expertise in casualty departments may be one means of preventing unnecessary medical admissions without risk to the patients. Dr Blake's and Dr Bramble's figures do not demonstrate, however, that any advantage would attach to medical teams taking over assessment from psychiatrists except that, by implication, assessments would be completed sooner by staff working on the ward full time. What the figures actually suggest is that if assessment of overdoses were left to house doctors there would be an increase in admissions to psychiatric units (by 19°U), outpatients (by 5O°'), and referrals to social services (by 140o). So for house doctors to assess overdoses would provide no economy for the psychiatric or social services. The study does not tell us what the consequences would have been for the six patients who the psychiatrists would have admitted but to whom the house doctors would have offered outpatient appointments. E J SALTER

Vitamin D deficiency.

Secret History: Return of the Black Death Channel 4, 7-8pm In 1348 the Black Death swept through London, killing people within days of the appearance of their first symptoms. Exactly how many died, and why, has long been a mystery. This Secret History documentary follows experts as they pick through the evidence and reveal why the plague killed on such a scale. And they ask, what might be coming next?

Medscape

Background Evolution of spirometry in primary ciliary dyskinesia (PCD) and its determinants are unclear. To assess morbidity and burden of this condition, we investigated the progression of spirometry in patients from two European centres. Methods Ninety-six patients with =1 spirometry (Naples, Italy, n=21; London, UK, n=75) were enrolled. Sixty-five (Naples, n=15; London, n=50) with 4 years spirometry were analysed longitudinally. Best annual FEV 1 , corresponding FVC, both expressed as z-scores, and sputum culture results were recorded. Results In Naples and London, age at referral to the centre was 9.8 (range, 0.1–20.2) and 6.1 years (range, 0.1–17.3), respectively (p=0.02), while age at first spirometry was 11.6 (range, 8.1–20.2) and 8.4 years (range, 4.2–17.3), respectively (p 1 and FVC z-scores (−0.53 (1.60) vs −1.66 (1.35), and 0.50 (1.55) vs −1.36 (1.32), p 1 z-scores over 4 years were −0.05 (95% CI −0.36 to 0.26) and 0.05 (95% CI −0.05 to 1.65) in Naples and London, respectively (p=0.38). No significant correlation was found between slopes of FEV 1 z-scores and age at referral or baseline FEV 1 z-score. Haemophilus influenzae was the most frequently isolated pathogen (95% and 79% of subjects in Naples and London, respectively, p=0.1). Naples subjects had higher prevalence of Pseudomonas aeruginosa (62% vs 36%, p=0.04). P aeruginosa isolation was not associated with worse baseline FEV 1 z-scores or slopes of FEV 1 z-scores. Conclusions The better lung function despite later diagnosis in Naples is apparently unexplained. However, as spirometry in PCD is stabilised during treatment, its short-term evolution is not related to age at referral or to baseline FEV 1 . Spirometry is thus not a useful end-point for randomised controlled trials of treatment. Late diagnosis is common for patients without situs anomalies. Although the potential impact of P aeruginosa infection on PCD lung function is unclear, its unexpectedly high prevalence merits further study to determine best prevention and management strategies.

https://thorax.bmj.com/content/thoraxjnl/66/Suppl_4/A139.2.full.pdf

P177 Evolution of lung function in primary ciliary dyskinesia: a two centre retrospective study

Both beta-2 agonists and anticholinergics are widely used even in young children. Response in the individual is difficult to predict, and a therapeutic trial of either or both is usually legitimate. Paradoxical broncho-constriction with nebulized ipratropium has been reported, probably related to the tonicity of the solution [1]. Bronchodilators can worsen symptoms due to tracheobronchomalacia due to reduction in smooth muscle tone [2]. There is little experience of long-acting beta-2 agonists in this age group.

Treatment options of asthma in infancy.

Early detection of lung disease in infants with cystic fibrosis diagnosed by newborn screening (nbs)

Background Associations have been reported between epithelial interleukin (IL)-33 expression and severe asthma in adults, but its role in the pathophysiology of paediatric severe therapy resistant asthma (STRA) remains unknown. Objectives We quantified IL-33 expression in endobronchial biopsies from children with STRA and explored its relationship with parameters of airway remodelling. Methods Children (n=45) (median age 11.3 [range 5.4-16.4] years) with STRA underwent detailed investigations including bronchoscopy and endobronchial biopsy. IL-33+ cells were quantified in the epithelium, smooth muscle and submucosa in biopsies from children with STRA and compared to that in age matched non-asthmatic controls. Reticular basement membrane (RBM) thickness was quantified as a marker of airway remodelling, and related to IL-33+ cells. Results Submucosal, but not epithelial or smooth muscle IL-33+ cells were significantly higher in children with STRA compared to controls (p=0.01, 0.21, 0.68 respectively). In addition, there was a positive correlation between IL-33+ cells and RBM thickness in children with STRA (Spearman r=0.35, p=0.018), but not in controls (p=0.33). Conclusions In contrast to adult studies, we have shown increased submucosal IL-33 expression in children with STRA, and for the first time have shown an association between this mediator and airway remodelling. These data suggest therapies that block IL-33 may be suitable for paediatric STRA, and specifically may impact on structural airway changes.

https://erj.ersjournals.com/content/erj/40/Suppl_56/4709.full.pdf

IL-33 and airway remodelling in paediatric severe therapy resistant asthma

The definition of asthma in young children is clinical, supplemented in older children by physiological measurements to define variable airflow obstruction. Understanding of the underlying processes, and hence best treatment, may be aided by defining different phenotypes on the basis of the components of inflammation, bronchial hyperreactivity and any persistent airflow limitation. In the preschool child, a noninflammatory phenotype, devoid of bronchial hyperreactivity, is characteristic of virus-associated wheeze and postbronchiolitic cough and wheeze. Chronic lung disease of prematurity is characterized by peak flow variability and persistent airflow limitation, whereas obliterative bronchiolitis is a pure form of fixed airflow obstruction. Atopic wheeze is likely a combination of inflammation and reactivity, as in the older child, although firm data are lacking. In the older child, a number of inflammatory and noninflammatory phenotypes are described, including (high dose) steroid sensitive asthma; persistent eosinophilic inflammation, with and without symptoms; neutrophilic inflammation; noninflammatory bronchial reactivity; obliterative bronchiolitis; overestimation of symptoms; and poor concordance with therapy. These concepts have been largely derived with invasive studies, which would be inappropriate to milder forms of asthma. Nonetheless, milder asthma can be assessed by the same protocols using noninvasive techniques. However, further multicenter, probably multinational, studies are needed to validate this approach.

Are There Different Phenotypes of Childhood Asthma

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