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Coarse and fine particles but not ultrafine particles in urban air trigger hospital admission for asthma in children

Conclusion Short-term exposure to air pollution can trigger hospital admission for asthma in children, with infants possibly being most susceptible. These effects seemed to be mediated by larger particles and traffic-related gases, whereas UFPs showed no effect. (Source: Thorax)

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GOLD COPD classification and prognostic pessimism regarding ICU admission

Incorporation of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification of severity of expiratory airflow limitation in chronic obstructive pulmonary disease (COPD) into the recent National Institute for Health and Clinical Excellence (NICE) guidelines is welcome and sensible.1 Describing a forced expiratory volume in one second (FEV1) of 51% predicted as ‘mild disease’ fails to capture the loss of lung function and irreversible damage done. Recognition and optimal early management of COPD cannot be overemphasised to limit its long-term health consequences. However, we have concerns that its adoption without adequate explanation in the UK could have unintended negative consequences in this patient group if presenting acutely unwell, when decisions rega...

Observational Study on the Impact of Initiating Tiotropium Alone Versus Tiotropium with Fluticasone Propionate/Salmeterol Combination Therapy on Outcomes and Costs in Chronic Obstructive Pulmonary Disease

Conclusions: Triple therapy with FSC added to TIO compared with TIO monotherapy was associated with significant reductions in the adjusted risks of moderate exacerbation and any exacerbation over a follow-up period of up to 1 year. These improvements were gained with triple therapy at roughly equal cost of that of TIO alone. (Source: Respiratory Research)

Impaired type I and III interferon response to rhinovirus infection during pregnancy and asthma

Background Acute respiratory tract infections are common ailments to all individuals and the human rhinoviruses (HRVs) cause most of these infections. Pregnant women have increased susceptibility and disease severity to viral infections like influenza and HRVs, as do asthmatics. Successful pregnancy requires immunological modulation to permit fetal tolerance.

Objectives To determine whether pregnant women have reduced innate antiviral interferon (IFN) responses to HRV infection compared with non-pregnant women.

Methods An in vitro culture system was used, where peripheral blood mononuclear cells (PBMCs) were isolated from whole blood of 54 women, including 10 stable asthmatics who were pregnant and 10 who were not pregnant, 10 non-asthmatic women who were pregnant, 10 who were ≥6 months post partum and 10 who were not pregnant. Samples were also collected from four exacerbating pregnant asthmatics. PBMCs were cultured with HRV43 and HRV1B. The antiviral proteins IFNα and IFNλ were measured from culture supernatants by ELISA.

Results Compared with healthy non-pregnant women, pregnant women had significantly reduced innate IFN responses to HRV infection (p<0.02), persisting ≥6 months post partum (p≤0.02). Pregnant asthmatics had significantly reduced IFNλ responses compared with healthy non-pregnant women (p≤0.034), while during current asthma exacerbations a decrease in IFNα (p≤0.023) and IFNλ (p=0.007) was observed. Induction by a TLR7 agonist induced a similar pattern of decreased innate IFNs during pregnancy as observed when HRV was the inducing agent.

Conclusions Reduced antiviral IFNs during pregnancy and asthma provide an important mechanism for increased susceptibility, morbidity and mortality in pregnant women with respiratory viral infection.

Impact of obesity on exercise performance and pulmonary rehabilitation

AbstractWhile the impact of obesity on respiratory function has been extensively studied and several definitive conclusions have emerged, its impact on exercise performance is complex, with the available data sometimes providing contradictory or inconclusive information.Based on the literature discussed, it appears that resting alterations in lung volumes and gas exchange become attenuated during exercise in the obese, while oxygen cost of breathing and dyspnea are increased. Respiratory muscle function also seems to be impaired, such that inspiratory muscle strength is reduced and respiratory drive is increased. Furthermore, while there is no reduction in the absolute values of maximal oxygen uptake compared to normal weight subjects, oxygen uptake at a given workload is increased and max...

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