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Pirfenidone should be prescribed for patients with idiopathic pulmonary fibrosis

Pirfenidone works. There have been four randomised placebo-control trials of pirfenidone for the treatment of idiopathic pulmonary fibrosis (IPF); a phase II and phase III study in Japan, and two international multicentre phase III studies.1–3 In all four studies, patients treated with pirfenidone had slower rates of decline in lung volume (vital capacity (VC) in the Japanese studies and forced vital capacity (FVC) in the international studies) than placebo, and in three studies, the results were statistically significant. National Institute of Clinical Excellence (NICE) agrees that pirfenidone has a ‘modest but measurable effect on slowing the decline in lung function’.4 Therefore, whether patients receive pirfenidone depends on whether pirfenidone works enough to justif...

Triple therapy for idiopathic pulmonary fibrosis

This multicentre, randomised, double-blind placebo-controlled trial was designed to address the effectiveness of the antioxidant, N-Acetylcysteine (NAC), alone and in ‘triple’ therapy (prednisolone, azathioprine and NAC) in idiopathic pulmonary fibrosis (IPF).

Patients with IPF and mild to moderate lung function impairment (FVC≥50% and TLCO≥30%) were assigned to receive triple therapy, NAC alone or matched placebo for 60 weeks. Target recruitment was 130 patients per group, however, following a planned interim analysis (mean follow-up 32 weeks) the triple therapy arm (n=77) was halted. Compared with placebo (n=78), increased risks of death (8 vs 1), hospitalisation (23 vs 7), and serious adverse events (24 vs 8) were seen. The placebo and triple therapy groups h...

The COPD control panel: towards personalised medicine in COPD

Conclusion We recognise that this preliminary proposal needs debate, validation and evolution (eg, including ‘omics’ and molecular imaging information in the future), but we hope that it may stimulate debate and research in the field.

Evolution in surgical approach and techniques for lung cancer

To improve is to change; to be perfect is to change often. Sir Winston Churchill (1874–1965) We thoroughly enjoyed reading the succinct review article by Vallieres et al1 on therapeutic advances in non-small cell lung cancer. The authors pointed out that improvements in chest imaging and use of CT for diagnostic workup and screening have led to many more small tumours, and suspicious nodules being identified. In our practice, this has increasingly changed our management and surgical approach. For example, there has been advances in and refinement of technology to identify subcentimeter nodules intraoperatively by using preoperative CT-guided hookwire localisation, fiducial, methylene blue or radionucleotide marking.2 Furthermore, the era of hybrid operating theatres will provide real...

Is hypovitaminosis D a consequence rather than cause of disease?

Chalmers and colleagues1 have shown that vitamin D deficiency is common in bronchiectasis and correlates with markers of disease severity. The authors comment that although the study has identified a strong association, this does not demonstrate causality, but the results justify a randomised controlled trial of vitamin D therapy to determine if supplementation can improve outcomes. They mention that reduced outdoor physical activity and reduced exposure to sunlight might contribute to vitamin D deficiency. One possibility that the authors have not considered is that hypovitaminosis D may be a consequence rather than cause of disease. Vitamin D deficiency has been associated with an ever-expanding list of diseases.2 These have largely been observational studies, and when the benefits of vi...

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