Call for Repiratory patient organisation representatives to join the European Medicines Agency's management board

Dear Respiratory friends, this is speacial call for Respiratory Patient Organisations!
The Health and Food Safety Directorate-General of the European Commission has launched a call for expressions of interest to represent civil society in the Management Board of the European Medicines Agency (EMA).

http://ec.europa.eu/health/documents/public_call/call_index_en.htm

Two members representing patients’ organisations, one member representing healthcare professionals’ organisations and one member representing veterinarians’ organisations will be appointed for a renewable three-year period. The term of office of the current members expires on 20 March 2016.
Further details, including information on the assessment criteria and the application procedure, can be found on the Commission’s website.

2015 Guidelines for the diagnosis and treatment of pulmonary hypertension

2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension was presented by the the Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS), endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT).

Guidelines summarize and evaluate all available evidence on a particular issue at the time of the writing process, with the aim of assisting health professionals in selecting the best management strategies for an individual patient with a given condition, taking into account the impact on outcome, as well as the risk–benefit ratio of particular diagnostic or therapeutic means. Guidelines and recommendations should help health professionals to make decisions in their daily practice. However, the final decisions concerning an individual patient must be made by the responsible health professional(s) in consultation with the patient and caregiver as appropriate. 

Free full text:

http://erj.ersjournals.com/content/early/2015/08/28/13993003.01032-2015.extract?papetoc

Chest 2015: The Evolution of Cystic Fibrosis Care

Today in Chest was published Comprehensive review: The Evolution of Cystic Fibrosis Care.

Cystic fibrosis (CF) is the most common life-limiting inherited illness of whites. Most of the morbidity and mortality in CF stems from impaired mucociliary clearance leading to chronic, progressive airways obstruction and damage. Significant progress has been made in the care of patients with CF, with advances focused on improving mucociliary clearance, minimizing inflammatory damage, and managing infections; these advances include new antimicrobial therapies, mucolytic and osmotic agents, and antiinflammatory treatments.

http://journal.publications.chestnet.org/article.aspx?articleid=2203766&resultClick=3

More recently, researchers have targeted disease-causing mutations using therapies to promote gene transcription and improve channel function, which has led to impressive physiologic changes in some patients. As we develop more advanced, allele-directed therapies for the management of CF, it will become increasingly important to understand the specific genetic and environmental interactions that cause the significant heterogeneity of lung disease seen in the CF population. This understanding of CF endotypes will allow for more targeted, personalized therapies for future patients. This article reviews the genetic and molecular basis of CF lung disease, the treatments currently available, and novel therapies that are in development.

Full text:

http://journal.publications.chestnet.org/article.aspx?articleid=2203766&resultClick=3

Do you agree that E-cigarettes are 95% less harmful to health than normal cigarettes???

Last week, Public Health England (PHE) published landmark review of evidence about e-cigarettes. The headline in their press release quoted their top-line finding—“E-cigarettes around 95% less harmful than tobacco”. Kevin Fenton, Director of Health and Wellbeing at PHE, commented that, “E-cigarettes are not completely risk free but when compared to smoking, evidence shows they carry just a fraction of the harm”. Indeed, the 95% figure was widely picked up in news media.

There are more questions than answers after reading of this review!  In Lancet editorial this work  was  declared methodologically weak and controversial caused by the declared conflicts of interest surrounding its funding, raising serious questions not only about the conclusions of the this report, but also about the quality of the agency's peer review process.

2015 American Thoracic Society Research Statement: A Research Framework for Pulmonary Nodule Evaluation and Management

Just published An Official American Thoracic Society Research Statement: A Research Framework for Pulmonary Nodule Evaluation and Management

Background: Pulmonary nodules are frequently detected during diagnostic chest imaging and as a result of lung cancer screening. Current guidelines for their evaluation are largely based on low-quality evidence, and patients and clinicians could benefit from more research in this area.

Methods: In this research statement from the American Thoracic Society, a multidisciplinary group of clinicians, researchers, and patient advocates reviewed available evidence for pulmonary nodule evaluation, characterized six focus areas to direct future research efforts, and identified fundamental gaps in knowledge and strategies to address them. We did not use formal mechanisms to prioritize one research area over another or to achieve consensus.

Results: There was widespread agreement that novel tests (including novel imaging tests and biopsy techniques, biomarkers, and prognostic models) may improve diagnostic accuracy for identifying cancerous nodules. Before they are used in clinical practice, however, better evidence is needed to show that they improve more distal outcomes of importance to patients. In addition, the pace of research and the quality of clinical care would be improved by the development of registries that link demographic and nodule characteristics with patient-level outcomes. Methods to share data from registries are also necessary.

Conclusions: This statement may help researchers to develop impactful and innovative research projects and enable funders to better judge research proposals. We hope that it will accelerate the pace and increase the efficiency of discovery to improve the quality of care for patients with pulmonary nodules.

Full text:

http://www.atsjournals.org/doi/abs/10.1164/rccm.201506-1082ST#.VeDGuJcXyUk

New Journal: COPD Research and Practice

Dear friends we are happy to present you new Respiratory Journal: COPD Research and Practice.

COPD Research and Practice publishes basic and clinical research and cutting edge reviews related to chronic obstructive pulmonary disease (COPD). The journal aims to facilitate discussion and dissemination of knowledge to help translate new ideas from bench to bedside by encouraging international and interdisciplinary collaboration.

Editorial from Editor in Chief Professor Mario Cazzola from the University of Rome Tor Vergata, Rome, Italy:

Chronic obstructive pulmonary disease (COPD) is now the fourth leading cause of death globally, and the World Health Organization (WHO) has predicted that it will become the third most common cause of death in the world by 2030 [1]. In developed countries, current information estimates a prevalence of 8 % to 10 % among adults 40 years of age and older, whereas in developing countries, prevalence varies significantly among countries and is difficult to quote [2].

It is estimated that more than 210 million people have the disease worldwide [3]. Concerning a large number of subjects, COPD generates important health and social costs. However, although COPD is one of the most common chronic diseases and has a high health and social impact, it is still poorly recognized among the general public and also clinicians. Consequently, there is a major and urgent need to better understand this complex disease.

Free full text:

http://www.copdrp.com/content/1/1/6

Community-acquired pneumonia in 2015

Fresh article on CAP in todays Lancet!

Community-acquired pneumonia causes great mortality and morbidity and high costs worldwide. Empirical selection of antibiotic treatment is the cornerstone of management of patients with pneumonia. To reduce the misuse of antibiotics, antibiotic resistance, and side-effects, an empirical, effective, and individualised antibiotic treatment is needed. 

Follow-up after the start of antibiotic treatment is also important, and management should include early shifts to oral antibiotics, stewardship according to the microbiological results, and short-duration antibiotic treatment that accounts for the clinical stability criteria. New approaches for fast clinical (lung ultrasound) and microbiological (molecular biology) diagnoses are promising. Community-acquired pneumonia is associated with early and late mortality and increased rates of cardiovascular events. Studies are needed that focus on the long-term management of pneumonia.

Full text: 

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2815%2960733-4/abstract

Standards for Diagnosis and Management of Individuals with Alpha-1 Antitrypsin Deficiency

In 2003, the American Journal of Respiratory and Critical Care Medicine published the ATS/ERS: Standards for Diagnosis and Management of Individuals with Alpha-1. The Standards recommend testing for Alpha-1 in all of your adult patients suffering from COPD, emphysema, incompletely reversible asthma, unexplained liver disease, and siblings of an individual with Alpha-1. 

Full text:

http://www.atsjournals.org/doi/abs/10.1164/rccm.168.7.818#.VdCbNpcXyUk

2015 Current Understanding and Future Research Needs in Tobacco Control and Treatment by American Thoracic Society

Yesterday in Am J Respir Crit Care Med was published An Official American Thoracic Society Research Statement: Current Understanding and Future Research Needs in Tobacco Control and Treatment.

Introduction: Since the mid-20th century, the scientific community has substantially improved its understanding of the worldwide tobacco epidemic. Although significant progress has been made, the sheer enormity and scope of the global problem put it on track to take a billion lives this century. Curbing the epidemic will require maximizing the impact of proven tools as well as the development of new, breakthrough methods to help interrupt the spread of nicotine addiction and reduce the downstream morbidity.

Methods: Members of the Tobacco Action Committee of the American Thoracic Society queried bibliographic databases, including Medline, Embase, and the Cochrane Collaborative, to identify primary sources and reviews relevant to the epidemic. Exploded search terms were used to identify evidence, including tobacco, addiction, smoking, cigarettes, nicotine, and smoking cessation. Evidence was consolidated into three thematic areas: (1) determinants of risk, (2) maternal-fetal exposure, and (3) current tobacco users. Expert panel consensus regarding current gaps in understanding and recommendations for future research priorities was generated through iterative discussion.

Results: Although much has been accomplished, significant gaps in understanding remain. Implementation often lags well behind insight. This report identifies a number of investigative opportunities for significantly reducing the toll of tobacco use, including: (1) the need for novel, nonlinear models of population-based disease control; (2) refinement of “real-world” models of clinical intervention in trial design; and (3) understanding of mechanisms by which intrauterine smoke exposure may lead to persistent, tobacco-related chronic disease.

Discussion: In the coming era of tobacco research, pooled talent from multiple disciplines will be required to further illuminate the complex social, environmental and biological codeterminants of tobacco dependence.

Read More:  

http://www.atsjournals.org/doi/abs/10.1164/rccm.201506-1081ST#.Vc68j5cXyUk

Take A Nap (6 benefits of napping)

The stigma against napping is finally starting to wane - and for good reason. Taking a timeout to sleep during the day does much more than just give us a quick energy boost. It also confers some serious cognitive and health advantages as well.

Benefits of napping: 

• prevents heart attacks 
• Improved cognitive performance 
• Increased alertness 
• Improved memory 
• Improved relaxation 
• Stress reduction

Even a short 20 minute nap in the afternoon can provide all the benefits of napping. However, the length of your nap will determine what sort of benefits you’re likely to experience. According to the WebMD napping can be broken up into different categories:

20 Minute Nap – While a short 20 minute power nap does enhance memory, it has a more dramatic effect on mental alertness and motor learning skills.

20 To 30 Minute Nap – This length of nap will typically enhance creativity while at the same time also boosting memory.

30 To 60 Minute Nap – This type of nap has an incredibly beneficial impact one’s decision making skills. It also improves the part of your memory that’s responsible for memorizing things such as the alphabet; directions and etc.

60 To 90 Minute Nap – Taking this type of nap will ensure that you get REM (Rapid Eye Movement) sleep, and as such, this type of nap is the most beneficial of them all. Once you reach REM sleep, it’s almost as if the brain resets itself. One could say it’s like starting at the beginning again. Studies have shown that a 60 to 90 minute nap can have a dramatic effect on the brain in terms of problem solving. Here again, NASA has conducted their own studies, and they land up with the same result.

2015 guidelines for the investigation and management of pulmonary nodules

This guideline is based on a comprehensive review of the literature on pulmonary nodules and expert opinion. Although the management pathway for the majority of nodules detected is straightforward it is sometimes more complex and this is helped by the inclusion of detailed and specific recommendations and the 4 management algorithms below. The Guideline Development Group (GDG) wanted to highlight the new research evidence which has led to significant changes in management recommendations from previously published guidelines. These include the use of two malignancy prediction calculators (section ‘Initial assessment of the probability of malignancy in pulmonary nodules’, algorithm 1) to better characterise risk of malignancy. There are recommendations for a higher nodule size threshold for follow-up (≥5 mm or ≥80 mm³) and a reduction of the follow-up period to 1 year for solid pulmonary nodules; both of these will reduce the number of follow-up CT scans (sections ‘Initial assessment of the probability of malignancy in pulmonary nodules’ and ‘Imaging follow-up’, algorithms 1 and 2). Volumetry is recommended as the preferred measurement method and there are recommendations for the management of nodules with extended volume doubling times (section ‘Imaging follow-up’, algorithm 2). Acknowledging the good prognosis of sub-solid nodules (SSNs), there are recommendations for less aggressive options for their management (section ‘Management of SSNs’, algorithm 3). 

The guidelines provide more clarity in the use of further imaging, with ordinal scale reporting for PET-CT recommended to facilitate incorporation into risk models (section ‘Further imaging in management of pulmonary nodules’) and more clarity about the place of biopsy (section ‘Non-imaging tests and non-surgical biopsy’, algorithm 4). There are recommendations for the threshold for treatment without histological confirmation (sections ‘Surgical excision biopsy’ and ‘Non-surgical treatment without pathological confirmation of malignancy’, algorithm 4).

Finally, and possibly most importantly, there are evidence-based recommendations about the information that people need and which should be provided. This document is intended to be used both as a summary in the day to day management of a person with a pulmonary nodule and a comprehensive reference text. 

link to free full text:

http://thorax.bmj.com/content/70/Suppl_2/ii1.full

2015-2016 Influenza Vaccination Guidelines

Updated recommendations on influenza vaccination for the 2015-16 season have been issued by the CDC's Advisory Committee on Immunization Practices. As reported in MMWR, changes from the 2014-2015 season include the following:

• Trivalent vaccines will include A/California/7/2009 (H1N1)-like virus, an A/Switzerland/9715293/2013 (H3N2)-like virus, and a B/Phuket/3073/2013-like (Yamagata lineage) virus. These A (H3N2) and B viruses are different from the previous season.
• The Fluzone Intradermal Quadrivalent vaccine is expected to replace the trivalent Fluzone Intradermal vaccine for adults aged 18 to 64.
• Children aged 6 months to 8 years who are receiving their first influenza vaccine still need two doses at least 4 weeks apart, but special consideration of influenza A(H1N1)pdm09 vaccination is no longer needed, since current vaccines incorporate that viral antigen.
• Live-attenuated vaccine (previously preferred for children aged 2–8 years) is no longer recommended over inactivated vaccine, because observational studies failed to support the superiority of live-attenuated vaccine seen in randomized trials.

Free links:

1. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6430a3.htm 
2. http://www.jwatch.org/na38646/2015/07/29/high-dose-influenza-vaccine-no-more-effective-standard
   

CHEST 2015 Annual Meeting in Montreal Canada

We are happy to invite you to Chest 2015 meeting!

Join CHEST 2015 Annual Meeting in Montreal Canada, your connection to learning opportunities that will help optimize the clinical decisions you make. We’ve packed as many education deliverables as we can into 4 days to make the BIGGEST impact on your professional development and patient care. We’ll offer a full schedule of sessions that address topics from an interdisciplinary and interprofessional perspective to ensure a comprehensive (and BIG) understanding of chest medicine. And, our international faculty and attendees will give you a worldwide viewpoint on clinical issues. It doesn’t get much BIGGER than that!

Don’t miss:

• Interdisciplinary programs
• Simulation programs
• Postgraduate courses
• More than 300 general sessions
• Expanded MOC opportunities
• Original investigation presentations
• New diagnostic and treatment solutions in the exhibit hall

more info:
http://chestmeeting.chestnet.org/

Interpretation of Arterial Blood Gases by American Thoracic Society

Interpreting an arterial blood gas (ABG) is a crucial skill for physicians, nurses, respiratory therapists, and other health care personnel. ABG interpretation is especially important in critically ill patients.

The following six-step process helps ensure a complete interpretation of every ABG. In addition, you will find tables that list commonly encountered acid-base disorders.

Many methods exist to guide the interpretation of the ABG. This discussion does not include some methods, such as analysis of base excess or Stewart’s strong ion difference. A summary of these techniques can be found in some of the suggested articles. It is unclear whether these alternate methods offer clinically important advantages over the presented approach, which is based on the “anion gap.”

6-step approach:
Step 1:  Assess the internal consistency of the values using the Henderseon-Hasselbach equation
Step 2:  Is there alkalemia or acidemia present?

pH < 7.35  acidemia 

pH > 7.45  alkalemia

Step 3:  Is the disturbance respiratory or metabolic?  What is the relationship between the direction of change in the pH and the direction of change in the PaCO₂? In primary respiratory disorders, the pH and PaCO2 change in opposite directions; in metabolic disorders the pH and PaCO₂ change in the same direction.
Step 4:  Is there appropriate compensation for the primary disturbance?  Usually, compensation does not return the pH to normal (7.35 – 7.45).
Step 5:  Calculate the anion gap (if a metabolic acidosis exists)
Step 6:  If an increased anion gap is present, assess the relationship between the increase in the anion gap and the decrease in [HCO₃-].
Link to Interpretation of Arterial Blood Gases (ABGs) by David A. Kaufman, MD:
http://www.thoracic.org/professionals/clinical-resources/critical-care/clinical-education/abgs.php

2015 World Allergy Organization Statement: Meteorological conditions, climate change, new emerging factors, and asthma and related allergic disorders

We are happy to present you interesting 2015 World Allergy Organization Statement on Meteorological conditions, climate change, new emerging factors, and asthma and related allergic disorders!

The prevalence of allergic airway diseases such as asthma and rhinitis has increased dramatically to epidemic proportions worldwide. Besides air pollution from industry derived emissions and motor vehicles, the rising trend can only be explained by gross changes in the environments where we live. The world economy has been transformed over the last 25 years with developing countries being at the core of these changes. Around the planet, in both developed and developing countries, environments are undergoing profound changes. Many of these changes are considered to have negative effects on respiratory health and to enhance the frequency and severity of respiratory diseases such as asthma in the general population. 

Increased concentrations of greenhouse gases, and especially carbon dioxide (CO ₂), in the atmosphere have already warmed the planet substantially, causing more severe and prolonged heat waves, variability in temperature, increased air pollution, forest fires, droughts, and floods – all of which can put the respiratory health of the public at risk. These changes in climate and air quality have a measurable impact not only on the morbidity but also the mortality of patients with asthma and other respiratory diseases. The massive increase in emissions of air pollutants due to economic and industrial growth in the last century has made air quality an environmental problem of the first order in a large number of regions of the world. A body of evidence suggests that major changes to our world are occurring and involve the atmosphere and its associated climate. These changes, including global warming induced by human activity, have an impact on the biosphere, biodiversity, and the human environment. Mitigating this huge health impact and reversing the effects of these changes are major challenges.

This statement of the World Allergy Organization (WAO) raises the importance of this health hazard and highlights the facts on climate-related health impacts, including: deaths and acute morbidity due to heat waves and extreme meteorological events; increased frequency of acute cardio-respiratory events due to higher concentrations of ground level ozone; changes in the frequency of respiratory diseases due to trans-boundary particle pollution; altered spatial and temporal distribution of allergens (pollens, molds, and mites); and some infectious disease vectors. According to this report, these impacts will not only affect those with current asthma but also increase the incidence and prevalence of allergic respiratory conditions and of asthma. The effects of climate change on respiratory allergy are still not well defined, and more studies addressing this topic are needed. Global warming is expected to affect the start, duration, and intensity of the pollen season on the one hand, and the rate of asthma exacerbations due to air pollution, respiratory infections, and/or cold air inhalation, and other conditions on the other hand. 

Free Full Text:

http://www.waojournal.org/content/8/1/25

World Lung Cancer Day 2015

World Lung Cancer Day is a grassroots effort, started by a lung cancer survivor and embraced by the lung cancer community. It is a day to celebrate survivors, remember those who have passed and spread awareness to the general public about lung cancer. It is a day created by, and for, people with lung cancer.

GOAL: The campaign aims to raise awareness about the global impact of lung cancer and encourages deeper understanding of lung cancer risk factors beyond smoking, as well as the importance of early treatment. Lung cancer is one of the deadliest cancers, and understanding this disease is key to preventing future deaths.
STATISTICS: The impact of lung cancer is widespread; global statistics include:
 Lung cancer is the most common cancer worldwide, accounting for 1.8 million new cases in 2012, and is responsible for nearly one in five cancer deaths.
 Lung cancer claims more lives yearly than breast, colon, and prostate cancers combined.
 Tobacco use is the most significant risk factor for cancer causing an estimated 70 percent of global lung cancer deaths.
 The risk of getting lung cancer increases with age and is greater in men than in women.
 The highest incidence of lung cancer is in North America and Europe; and the lowest incidence is in Africa, Latin America and the Caribbean.
RISK FACTORS: While smoking is widely recognized as a risk factor for lung cancer, other lessor known risks are also important:
 A history of cancer in another part of the body increases your risk.
 If one of your parents or siblings has had lung cancer, your risk of
developing lung cancer may be increased.
 Radiation increases the risk of developing lung cancer.
 Radon, asbestos, arsenic, beryllium and uranium have all been
linked to lung cancer.
 Diseases such as emphysema, chronic bronchitis, chronic obstructive pulmonary disease and TB may increase lung cancer risk by 50 percent to 100 percent.
PARTICIPANTS: More than 70,000 global FIRS members have united for World Lung Cancer Day, including: 

American College of Chest Physicians (CHEST) 

Asociación Latinoamericana del Thorax (ALAT)

American Thoracic Society (ATS)

Asian Pacific Society of Respirology (APSR)

European Respiratory Society (ERS)

International Union Against Tuberculosis and Lung Disease (The Union) 

Pan African Thoracic Society (PATS)