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Eosinophils best marker of steroid response

There are important aspects of the study design that cast doubt on the claim of Cowan et al that ‘modified responses’ to corticosteroids occur in patients with non-eosinophilic asthma.1

First, the population recruited was more likely to include patients who experienced loss of control of their asthma after steroid withdrawal than those who remained stable or improved. This increases the potential for regression to the mean as well as identifying a particularly steroid-responsive population. Secondly, it is not possible to make any firm claims about the efficacy of inhaled corticosteroids in either population as the intervention was not placebo controlled. In the only placebo-controlled trial, Berry et al2 showed no evidence of a response to inhaled corticosteroids in patients with non-eosinophilic asthma.

A more reasonable interpretation of the authors' findings is that there is a much greater response to re-introduction of inhaled corticosteroids in patients...

Acute exposure to biomass smoke causes oxygen desaturation in adult women

Long-term exposure to biomass fuel smoke indoors is causally associated with chronic obstructive pulmonary disease (COPD)1 but the effect of acute exposures has not been studied. Should acute effects occur, this might increase the risk of an exacerbation of pre-existing lung disease. We studied acute changes in lung function and oxygen saturation in individuals exposed regularly to biomass smoke in Nepal.

Spirometry (EasyOne spirometer using American Thoracic Society (ATS) criteria) and oxygen saturation data were collected from 26, randomly selected, life-long non-smoking women (mean±SD age 38.0±11.7 years) before and after cooking (morning or evening). Smoke concentrations were measured using a DustTrak (TSI, Shoreview, Minnesota, USA) during cooking events and expressed as PM2.5 (particulate matter of <2.5 µm in diameter).2

Geometric mean (range) PM2.5 exposures were 2742 (1951–3853) µg/m3 for a mean±SD period of 164±34 min.

Spirometry results are presented in table 1. Taking the best values, group...

CT screening for lung cancer in the UK: position statement by UKLS investigators following the NLST report

Background

The imminent publication of a randomised controlled trial from the USA that suggests CT screening reduces mortality from lung cancer by more than 20%, may potentially lead to one of the most important developments in lung cancer care. However, there remain important questions about the applicability of the results to the UK and the clinical effectiveness of this intervention, including its feasibility and cost-effectiveness.

 Objective

To describe the remaining questions that need to be answered by further research and to comment on the use of CT screening in the UK outside a clinical trial.

 Methods

The detailed design process of the UKLS protocol and international discussions were used to identify the research questions that remain to be answered and to inform those who may choose to consider offering CT screening, before these questions are answered.

 Results

A series of research imperatives have been identified and we advise that CT screening should be part of the ongoing clinical trial in the UK, currently in the pilot phase (UKLS). UKLS is randomising 4,000 individuals for the pilot and a total of 32,000 for the main study.

 Conclusion

There remain unresolved issues with respect to CT screening for lung cancer. These include its feasibility, psychosocial and cost-effectiveness in the UK, harmonisation of CT acquisition techniques, management of suspicious screening findings, the choice of screening frequency and the selection of an appropriate risk group for the intervention. UKLS is aimed at resolving these issues.

British Thoracic Society emergency oxygen audits

The British Thoracic Society (BTS) guideline for emergency oxygen use in adult patients was commissioned by the BTS and developed in conjunction with 21 other colleges and societies prior to publication in 2008. One of the specific aims of the Guideline Development Group was to audit the use of oxygen in UK hospitals before the guideline was published and at intervals afterwards.

Radiofrequency Ablation of Medically Inoperable Stage IA Non-Small Cell Lung Cancer: Are Early Posttreatment PET Findings Predictive of Treatment Outcome?

OBJECTIVE. The purpose of this study was to evaluate initial experience with 18F-FDG PET/CT after pulmonary radiofrequency ablation of stage IA non–small cell lung cancer to determine whether treatment success or residual disease can be predicted with early postablation PET.

SUBJECTS AND METHODS. Thirty patients with medically inoperable stage IA non–small cell lung cancer (12 men, 18 women; median age, 76 years; range, 60–87 years) underwent outpatient CT-guided radiofrequency ablation over a 33-month period. Mean tumor size was 2.0 cm (range, 1.3–2.9 cm). PET/CT was performed within 60 days before radiofrequency ablation (RFA), within 4 days after RFA, and 6 months after RFA. Metabolic response was categorized as complete response or partial or no response at early post-RFA PET/CT and complete response, partial response, or progressive metabolic disease at 6-month post-RFA PET/CT and was compared with the 1-year clinical event rate (death, disease progression at contrast-enhanced CT, or repeat ablation).

RESULTS. Early PET/CT images, obtained within 4 days of RFA, were evaluable for 26 patients (23 at 6 months). Patients with a complete metabolic response at early PET/CT had a 1-year event rate of 43%, whereas those with partial or no response or disease progression had a 1-year event rate of 67% (p = 0.27). Patients with a complete metabolic response at 6-month PET/CT had a 1-year event rate of 0%. Those with a partial response and those with disease progression had an overall event rate of 75% (p = 0.001).

CONCLUSION. Early post-RFA PET/CT is not necessary and 6-month post-RFA PET/CT findings correlate better with clinical outcome at 1 year.

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