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A review of the British Thoracic Society scientific meeting 1-3 December 2010.

This review presents the inaugural report of the British Thoracic Society Winter Scientific Meeting held from 1(st)-3(rd) December 2010.

Although a wide spectrum of respiratory research was presented at the meeting the content of the review focuses specifically on three key themes of inflammation and lung injury, airways disease and respiratory infection. Advances in both clinical and translational respiratory research presented within the major symposia and spoken sessions related to these themes are summarised.

Clinical and laboratory features distinguishing pandemic H1N1 influenza-related pneumonia from interpandemic community-acquired pneumonia in adults.

Early identification of patients with H1N1 influenza-related pneumonia is desirable for the early instigation of antiviral agents.

A study was undertaken to investigate whether adults admitted to hospital with H1N1 influenza-related pneumonia could be distinguished clinically from patients with non-H1N1 community-acquired pneumonia (CAP).

Predicting the unpredictable: is it possible clinically to separate H1N1 from non-H1N1 community-acquired pneumonia?

In the spring of 2009 a novel influenza A virus (H1N1) of swine origin was identified in the USA and Mexico and rapid spread led to the declaration of a global influenza pandemic by the World Health Organization in June 2009. 

The virus, which derives six genes from triple-reassortant North American swine virus lineages and two genes from Eurasian swine virus lineages, predominantly affected children and young adults with a low incidence of acute illness in those over 60 years of age. By June 2010, cases had been identified in over 200 countries and territories worldwide and over 18 000 associated deaths were reported. ...

CT assessment of subtypes of pulmonary emphysema in females.

We performed a retrospective study examining the prevalence and subtypes of pulmonary emphysema (PE) identified by computed tomography (CT) in females.

We reviewed the records of 1,687 female subjects who had undergone CT. They were divided into the following 2 age groups:group A (＜50 years) and group B (≥50 years). PE was diagnosed by the presence of low-attenuation areas using visual assessment (grades 0-3) on CT images.

Two subtypes of PE were observed:centrilobular emphysema (CLE) and paraseptal emphysema (PSE). PE was divided into the following 3 categories:I (CLE or CLE-predominant);II (CLE and PSE of equal extent);and III (PSE or PSE-predominant). PE was found in 64 of 274 smokers (23.3%) and 54 of 1,413 non-smokers (3.8%). In smoking subjects, when grades 1 and 2 were grouped together as mild PE, the mean age for CT grade 3 (severe PE) was significantly higher than that for mild PE. In group A, category III predominated, whereas category I was more prevalent in group B, in both smoking and non-smoking subjects.

A high incidence of PE was found in smoking subjects as compared with non-smoking subjects. PSE predominated in younger subjects, whereas CLE predominated in older subjects.

Choice of bronchodilator therapy for patients with COPD.

Chronic obstructive pulmonary disease (COPD) is a progressive airway inflammatory condition that is associated with accelerated decline of lung function and is characterized by worsening dyspnea with episodes of increased number and severity of symptoms, termed exacerbations.

The main objectives of managing COPD are a reduction in the severity of symptoms and the prevention of exacerbations. Bronchodilator therapy is central to the management of COPD; this treatment produces modest increases in lung function as measured by spirometry and a reduction in the dynamic hyperinflation that leads to the dyspnea of COPD. Patients with COPD often present to their physician with dyspnea, and bronchodilators are often the first therapy prescribed. Initially, short-acting bronchodilators, such as albuterol, may be used, but in patients with persistent symptoms, long-acting bronchodilators provide more uniform relief.

Currently there are two classes of long-acting bronchodilators available — long-acting β2-agonists and long-acting anticholinergic agents, and both classes of agents, as compared with placebo, have been shown to provide relief from symptoms in patients with COPD...

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