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European Respiratory Journal 04/07/2020 06:17
Idiopathic Pulmonary Fibrosis (IPF) is thought to result from aberrant tissue repair processes in response to chronic or repetitive lung injury. The origin and nature of the injury, as well as its cellular and molecular targets, are likely heterogeneous, which complicates accurate pre-clinical modeling of the disease and makes therapeutic targeting a challenge. Efforts are underway to identify central pathways in fibrogenesis which may allow targeting of aberrant repair processes regardless of the initial injury stimulus. Dysregulated endothelial permeability and vascular leak have long been studied for their role in acute lung injury and repair. Evidence that these processes are of importance to the pathogenesis of fibrotic lung disease is.
European Respiratory Journal 04/07/2020 06:17
The number of people infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is increasing dramatically throughout the world [1], and in Italy [2, 3], particularly in the northern region of Lombardy [4]. Regional Italian medical and political authorities have implemented extraordinary measures to contain the spread of the virus. This disease may cause massive diffuse alveolar damage resulting in acute respiratory failure (ARF) that requires, in a high percentage of cases, mechanical ventilation [5–8]. Based on our general experience so far in dealing with the disease and on the existing knowledge (albeit still limited and evolving) [5–8], Italian respiratory scientific societies proposes here an Early Consensus Statement
European Respiratory Journal 04/07/2020 06:17
We report the case of a 28-year-old woman admitted with acute respiratory failure. The patient had no personal or familial medical history involving respiratory disease as asthma, thrombotic events or bleeding. She was a heavy smoker (15 cigarettes per day for the past five years) and "vaped" electronic-cigarettes (e-cigarettes) one month prior to the incident. She consumed 10 mL of e-liquid bottle with nicotine salt (12 mg·mL –1 ) in two days. No cannabidiol (CBD) or tetrahydrocannabinol (THC) was detected. No other home-made components were added. The patient did not take any regular medicines or contraceptives. No consumption of cannabis, cocaine or any other drugs was reported (confirmed with negative urinary drug test).
European Respiratory Journal 04/07/2020 06:17
Background. The role of bronchoalveolar lavage fluid (BAL) lymphocyte% to diagnose chronic hypersensitivity pneumonitis (CHP) is unclear. We conducted a systematic review and meta-analysis of BAL lymphocyte% in the diagnosis of CHP. Methods. We searched Medline, Embase and Cochrane library from inception to August 2019. Individual patient data were obtained to test performance characteristics of BAL lymphocyte% at different thresholds. Random-effects models were used for pooled estimates, with comparisons made between CHP and non-CHP interstitial lung diseases (ILD). Results. Fifty-three studies were included in the systematic review and 42 in the meta-analysis. The pooled estimate for BAL lymphocyte% was 42.8% (95%CI 37.7–47.8, I 2 =95.3%) in.
European Respiratory Journal 04/07/2020 06:17
Severe respiratory consequences of the COVID-19 pandemic have prompted urgent need for novel therapies. Cell-based approaches, primarily using mesenchymal stem (stromal) cells (MSCs), have demonstrated safety and possible efficacy in patients with the acute respiratory distress syndrome (ARDS), although not as yet well studied in respiratory virus-induced ARDS. Limited pre-clinical data suggest that systemic MSC administration can significantly reduce respiratory virus (Influenza strains H5N1 and H9N2)-induced lung injury, however, there are no available data in models of coronavirus respiratory infection. There are a rapidly increasing number of clinical investigations of cell-based therapy approaches for COVID-19. These utilise a range of.
European Respiratory Journal 04/07/2020 06:17
Severe asthma is associated with a substantial burden of disease including premature death and reduced quality adjusted life years [1]. Care in specialist centres is associated with reduced exacerbation rates and healthcare utilisation, but at the cost of increased use of systemic steroids and increased body mass index (BMI) [2]. Common co-comorbidities such as metabolic syndrome and type 2 diabetes are associated with low levels of moderate-vigorous physical activity (MVPA) [3]. Guidelines recommend that adults accumulate either =150 minutes of moderate intensity activity or =75 minutes of vigorous intensity activity per week, accumulated in bouts of any length [4]. Adults with severe asthma may avoid MVPA due to negative expectations and
European Respiratory Journal 04/07/2020 06:17
In January 2019, a European Respiratory Society (ERS) Research Seminar entitled "Targeting the detrimental effects of sleep disturbances and disorders" was held in Dublin, Ireland. It provided the opportunity to critically review the current evidence of pathophysiological responses of sleep disturbances, such as sleep deprivation, sleep fragmentation or circadian misalignment and of abnormalities in physiological gases such as oxygen and carbon dioxide which are frequently occurring in respiratory conditions during sleep. A specific emphasis of the seminar was placed on the evaluation of the current state of knowledge of the pathophysiology of cardiovascular and metabolic diseases in obstructive sleep apnoea (OSA). Identification of the det.
European Respiratory Journal 04/03/2020 03:09
While immunoglobulin (Ig) E is a prominent biomarker for early-onset, its levels are often elevated in non-allergic late-onset asthma. However, the pattern of IgE expression in the latter is mostly polyclonal, with specific IgEs low or below detection level albeit with an increased total IgE. In late-onset severe asthma patients, specific IgE to Staphylococcal enterotoxins (se-IgE) can frequently be detected in serum, and has been associated with asthma, with severe asthma defined by hospitalisations, oral steroid use and decrease in lung function. Recently, se-IgE was demonstrated to even predict the development into severe asthma with exacerbations over the next decade. Staphylococcus aureus manipulates the airway mucosal immunology at va.
European Respiratory Journal 04/03/2020 03:09
Background. The multiple breath nitrogen washout (N 2 MBW) technique is increasingly used to assess the degree of ventilation inhomogeneity in school-aged children with lung disease. However, reference values for healthy children are currently not available. The aim of this study was to generate reference values for N 2 MBW outcomes in a cohort of healthy Caucasian school-aged children. Methods. N 2 MBW data from healthy Caucasian school-age children between 6 and 18 years old were collected from four experienced centres. Measurements were performed using an ultrasonic flowmeter (Exhalyzer D, Eco Medics AG, Duernten, Switzerland) and were analysed with commercial software (Spiroware version 3.2.1, Eco Medics AG). Normative values and upper li.
European Respiratory Journal 04/03/2020 03:09
Over the past 12 years, many genome-wide association studies (GWAS) have been conducted to identify susceptibility variants for asthma [1–5]. The Trans-National Asthma Genetic Consortium (TAGC) recently conducted a large meta-analysis of GWAS [3], identifying 878 single nucleotide polymorphisms (SNPs) associated with asthma at 18 loci. The mechanisms underlying such associations are largely unknown but may include effects on gene expression that alter airway epithelial integrity and function.
European Respiratory Journal 04/03/2020 03:09
Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive, fibrosing lung disease that leads to unrelenting dyspnoea and chronic cough, and ultimately respiratory failure [1]. IPF is characterised by a variable disease course that remains difficult to predict for an individual at diagnosis [2]. In the current era, with the advent of anti-fibrotic therapy which can slow disease progression, it is increasingly important to identify patients with early disease and to target those patients who are at most risk of rapid decline [3]. However, despite multiple studies proposing novel potential prognostic biomarkers, the current American Thoracic Society/European Respiratory Society/Japanese Respiratory Society/Latin American Thoracic Society g.
European Respiratory Journal 04/03/2020 03:09
Often, the past can help us more than we realise. The European Respiratory Journal has, since its early childhood about 30 years ago, demonstrated that publication of reference values for various lung function tests is something that receives priority. Although one may argue that publication of reference values for lung function tests will not yield a Nobel Prize, everyone will agree that valid and reliable reference values are crucial for proper interpretation of test results of our patients and, therefore, indispensable for providing optimal care in respiratory medicine. In that sense, we owe the authors of such papers a lot.
European Respiratory Journal 04/03/2020 03:09
There is growing recognition for the involvement of blood vessels in pulmonary diseases beyond the classical scope of pulmonary vascular medicine. As an example, reports have described a vascular phenotype of COPD, or have proposed a vanishing pulmonary capillary syndrome to underly emphysema [1, 2]. Although the number of clinical and epidemiological studies supporting such a vascular hypothesis of pulmonary disease is steadily growing, biological underpinning in clinical studies remains to be provided.
European Respiratory Journal 04/03/2020 03:09
The comment by C. McCabe and colleagues provides thoughtful insights into the late sequalae of pulmonary embolism. The authors' views and suggestions, based on their clinical experience and expertise, may prove helpful in the ongoing process of reliably (and meaningfully) distinguishing chronic thromboembolic pulmonary hypertension (CTEPH) from chronic thromboembolic disease (CTED) without pulmonary hypertension at rest.
European Respiratory Journal 04/03/2020 03:09
Increasing bacterial burden in the lower airways of patients with idiopathic pulmonary fibrosis confers an increased risk of disease progression and mortality. However, it remains unclear whether this increased bacterial burden directly influences progression of fibrosis or simply reflects the magnitude of the underlying disease extent or severity. We prospectively recruited 193 patients who underwent bronchoscopy and received a multidisciplinary diagnosis of idiopathic pulmonary fibrosis. Quantification of the total bacterial burden in bronchoalveolar lavage fluid was performed by 16S rRNA gene qPCR. Imaging was independently evaluated by two readers assigning quantitative scores for extent, severity and topography of radiographic changes
European Respiratory Journal 04/03/2020 03:09
Acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) is an often deadly complication of IPF. No focussed international guidelines for the management of AE-IPF exist. The aim of this international survey was to assess the global variability in prevention, diagnostic and treatment strategies for AE-IPF. Pulmonologists with ILD expertise were invited to participate in a survey designed by an international expert panel. 509 pulmonologists from 66 countries responded. Significant geographical variability in approaches to manage AE-IPF was found. Common preventive measures included antifibrotic drugs and vaccination. Diagnostic differences were most pronounced regarding use of Krebs von den Lungen-6 and viral testing, while high-resolutio.
European Respiratory Journal 04/03/2020 03:09
Outdoor air pollution exposure increases chronic obstructive pulmonary disease (COPD) hospitalisations, and may contribute to COPD development. The mechanisms of harm, and the extent to which at-risk populations are more susceptible are not fully understood. Neutrophils are recruited to the lung following diesel exhaust exposure, a model of traffic-related air pollution (TRAP), but their functional role in this response is unknown. The purpose of this controlled human-exposure crossover study was to assess the effects of acute diesel exhaust exposure on neutrophil function in never-smokers and at-risk populations, with support from additional in vitro studies. 18 participants, including never-smokers (n=7), ex-smokers (n=4) and mild–moderat.
European Respiratory Journal 04/03/2020 03:09
Though the notion of a "lung microbiome", i.e . a complex community of microbes inhabiting and influencing the lower respiratory tract, is barely a decade old [1], there is nothing new about the idea that the lungs represent a crucial interface between us and the microbial universe we inhabit. Louis Pasteur demonstrated the presence of viable microbes in air [2], and one of his contemporaries calculated that healthy adults inhale between 1500 and 14 000 organisms each hour [3].

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