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Genome-wide association study identifies three new susceptibility loci for adult asthma in the Japanese population.

Bronchial asthma is a common inflammatory disease caused by the interaction of genetic and environmental factors.

Through a genome-wide association study and a replication study consisting of a total of 7,171 individuals with adult asthma (cases) and 27,912 controls in the Japanese population, we identified five loci associated with susceptibility to adult asthma.

In addition to the major histocompatibility complex and TSLP-WDR36 loci previously reported, we identified three additional loci: a USP38-GAB1 locus on chromosome 4q31 (combined P = 1.87 × 10(-12)), a locus on chromosome 10p14 (P = 1.79 × 10(-15)) and a gene-rich region on chromosome 12q13 (P = 2.33 × 10(-13)). We observed the most significant association with adult asthma at rs404860 in the major histocompatiblity complex region (P = 4.07 × 10(-23)), which is close to rs2070600, a SNP previously reported for association with FEV(1)/FVC in genome-wide association studies for lung function.

Our findings offer a better understanding of the genetic contribution to asthma susceptibility.

Explained variance for blood gases in a population with COPD.

Introduction:  Variation of blood gas levels in chronic obstructive pulmonary disease (COPD) patients has not been extensively reported and there is limited knowledge about predictors of chronic respiratory failure in COPD patients.

Objectives:  The aim of this study was to identify predictors of hypoxemia, hypercapnia and increased alveolar-arterial oxygen difference in COPD patients. We hypothesized that prediction of arterial blood gases will be improved in multivariate models including measurements of lung function, anthropometry and systemic inflammation.

Methods:  A cross-sectional sample of 382 Norwegian COPD patients, age 40-76, Global Initiative for Chronic Obstructive Lung Disease stage II-IV, with a smoking history of at least 10 pack-years, underwent extensive measurements, including medical examination, arterial blood gases, systemic inflammatory markers, spirometry, plethysmography, respiratory impedance and bioelectrical impedance. Possible predictors of arterial oxygen (PaO(2) ), arterial carbon dioxide (PaCO(2) ) and alveolar-arterial oxygen difference (AaO(2) ) were analyzed with both bivariate and multiple regression methods.

Results:  We found that various lung function measurements were significantly associated with PaO2, PaCO(2) and AaO(2) . In addition, heart rate and Fat Mass Index were predictors of PaO(2) and AaO(2) , while heart failure and current smoking status were associated with PaCO(2) . The explained variance (R(2) ) in the final multivariate regression models was 0.14-0.20.

Conclusions:  With a wide assortment of possible clinical predictors, we could explain 14-20% of the variation in blood gas measurements in COPD patients.

CTPA as the gold standard for the diagnosis of pulmonary embolism.

The estimated annual incidence of pulmonary embolism (PE) is between 69 to 205 cases per 100,000 persons-years. New imaging studies have been developed during the past decade. Chest CTPA, especially multidetector CT, has proven to be superior or equal to PA angiography, even detecting smaller filling defects.

We reviewed the differences in opinion to the diagnosis of PE between chest radiologists (CR) who interpret CTPA and interventional radiologists (IR) who perform PA angiography and what they consider the "gold standard" for the diagnosis of PE.

Unusual applications of noninvasive ventilation.

The use of noninvasive ventilation (NIV) in acute hypercapnic respiratory failure, cardiogenic pulmonary oedema, acute lung injury/acute respiratory distress syndrome (ARDS), community-acquired pneumonia and weaning/post-extubation failure is considered common in clinical practice.

Herein, we review the use of NIV in unusual conditions. Evidence supports the use of NIV during fibreoptic bronchoscopy, especially with high risks of endotracheal intubation (ETI), such as in immunocompromised patients. During transoesophageal echocardiography as well as in interventional cardiology and pulmonology, NIV can reduce the need for deep sedation or general anaesthesia and prevent respiratory depression induced by deep sedation. NIV may be useful after surgery, including cardiac surgery, and, with a lower level of evidence, in patients with pulmonary contusion. NIV should not be considered as an alternative to ETI in severe communicable airborne infections likely to progress to ARDS. NIV is being used increasingly as an alternative to ETI in end-stage symptomatic patients, especially to relieve dyspnoea.

The role of assisted ventilation during exercise training in chronic obstructive pulmonary disease patients is still controversial. NIV should be applied under close monitoring and ETI should be promptly available in the case of failure. A trained team, careful patient selection and optimal choice of devices, can optimise outcome of NIV.

Selected clinical highlights from the 2010 ERS Congress in Barcelona.

This article reviews a selection of presentations at the 2010 annual meeting of the European Respiratory Society held in Barcelona, Spain, which was the largest congress ever in the field of respiratory medicine.

The best abstracts from the groups of the Clinical Assembly (Clinical Problems, Rehabilitation and Chronic Care, Imaging, Interventional Pulmonology, Diffuse Parenchymal Lung Disease, and General Practice and Primary Care) are presented in the context of the current literature.

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