Novel culture-independent techniques have recently demonstrated that the lower respiratory tract, historically considered sterile in health, contains diverse communities of microbes: the lung microbiome. Increasing evidence supports the concept that a distinct microbiota of the lower respiratory tract is present both in health and in various respiratory diseases, although the biological and clinical significance of these findings remains undetermined.

In this article, the authors review and synthesize published reports of the lung microbiota of healthy and diseased subjects, discuss trends of microbial diversity and constitution across disease states, and look to the extrapulmonary microbiome for hypotheses and future directions for study.

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Bronchial variability in COPD patients may be a phenotypic feature associated with clinical characteristics and differential treatment response.Objectives:We analysed whether symptoms, quality of life and exercise capacity varied in COPD patients as a function of bronchodilator test results. Further, we compared response to an exercise programme in the groups.

Methods:A positive bronchodilator test result was defined as FVC and/or FEV1>12% plus >200 ml improvement after 400 μg salbutamol. We studied 198 COPD patients, 94 with positive reversibility and 104 with negative reversibility. Training sessions were carried out on three non-consecutive days each week for 12 weeks, and consisted of a combination of resistance and strength training. Subjects were evaluated on two consecutive days at baseline, and at the end of the 12-week training programme.

Results:Those with positive reversibility had shorter time-to-exhaustion on the endurance test (19.1±12.6 min versus 24.5±14.5 min in negative reversibility patients; p<0.031), shorter distances in the shuttle walking test (380.6 ± 158.2 m versus 438.5±149.1 m in negative reversibility patients; p<0.029) and lower scores on the Chronic Respiratory Disease Questionnaire (18.7±4.6 versus 19.8±4.3 in negative reversibility patients; p<0.015), while we found no significant differences in peak exercise, peripheral muscle strength or dyspnoea. Further, differences between groups in improvements after exercise training were not significant.

Conclusions:Compared to COPD patients with negative reversibility, those with positive reversibility walk for shorter distances, and have shorter endurance times and a worse quality of life, but improvements after exercise training are similar.

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The economic and social costs of obesity are estimated to be considerable, particularly for inpatient care. The aim of this study was to compare the hospitalization rates of individuals with severe (body mass index [BMI] >=40 kg/m2) or complicated (BMI >=30 kg/m2) obesity with those of the general population in two regions of Northwest Italy, and to describe absolute costs of hospitalization and their determinants.

METHODS: Between 1996 and 2002, 6,516 patients who were admitted for the first time to a hospital offering a nutritional rehabilitation programme for obesity were enrolled and followed-up (mean follow-up time: 7.3 years). Standardized hospitalization rates (SHRs) were computed by sex for all-cause and cause-specific hospitalization. The general population of the two regions was used as the reference population. The annual cost of hospitalization was estimated for the study cohort only at the individual level, and its association with different determinants was assessed using a multivariable linear model for longitudinal data.

RESULTS: SHRs of the study cohort versus the general population increased for all-cause hospitalization (males: 3.53, 95% CI 3.45-3.61; females: 3.22, 95% CI 3.18-3.26) as well as for most obesity-related conditions. The absolute median annual cost of hospitalization was 2,436 euros for males and 2,293 euros for females. Older age at cohort enrolment, BMI >=40 kg/m2, waist circumference above the median (males: 1.26 metres; females: 1.13 metres), and the presence of co-morbidities, such as cardiovascular diseases, respiratory diseases, cancer, diseases of the musculoskeletal system and connective tissue, and mental disorders, significantly increased the absolute median annual costs of hospitalization.

CONCLUSIONS: The economic consequences of high hospitalization rates in obese individuals are relevant. Reducing the occurrence of co-morbidities among obese persons may be one important goal, not only for clinical reasons, but also from a public health point of view.

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