We assessed the prevalence of interstitial lung disease (ILD) in a cohort of smokers included in a lung cancer screening trial. Two observers independently reviewed for the presence of the CT findings consistent with ILD the CT examinations of 692 heavy smokers recruited by the Multicentric Italian Lung Detection (MILD) trial.

Four CT patterns were considered: usual interstitial pneumonia (UIP), other chronic interstitial pneumonia (OCIP), respiratory bronchiolitis (RB) and indeterminate. Subsequently, the evolution of ILD in those subjects undergone a repeat CT examination after three years was assessed. The UIP pattern and the OCIP pattern were identified in 2/692 (0.3%) and 26/692 (3.8%) patients, respectively; 109/692 (15.7%) patients showed CT abnormalities consistent with RB, while an indeterminate CT pattern was reported in 21/692 (3%) subjects Age, male sex and current smoking status were factors associated with the presence of OCIP and UIP (combined) pattern, although such relationship did not attain statistical significance. A progression of the disease was observed in 3/12 (25%) subjects with OCIP undergone repeat CT after three years.

Thin-section CT features of ILD, probably representing smoking-related ILD, are not uncommon in a lung cancer screening population and should not be overlooked.

European guidelines for treating acute cough/lower respiratory tract infection (LRTI) aim to reduce non-evidence based variation in prescribing, and better target and increase the use of first line antibiotics. However, application in primary care is unknown.

We explored congruence of both antibiotic prescribing and antibiotic choice with European Respiratory Society-European Society Clinical Microbiology and Infectious Diseases (ERS-ESCMID) guidelines for managing LRTI. Analysis of prospective observational data from patients presenting to primary care with acute cough/LRTI. Clinicians recorded symptoms on presentation, and their examination and management. Patients were followed up with self-complete diaries. 1776 (52.7%) patients were prescribed antibiotics. Given patients' clinical presentation, clinicians could have justified an antibiotic prescription for 1915 (71.2%) patients according to the ERS-ESCMID guideline. 761 (42.8%) of those who were prescribed antibiotics received a first choice antibiotic (i.e. tetracycline or amoxicillin). Ciprofloxacin was prescribed for 37 (2.1%) and cephalosporins for 117 (6.6%). A lack of specificity in definitions in the ERS-ESCMID guidelines could have enabled clinicians to justify a higher rate of antibiotic prescription.

More studies are needed to produce specific clinical definitions and indications for treatment. First choice antibiotics were prescribed to the minority of patients who received an antibiotic prescription.

It is known that autofluorescence bronchoscopy (AFB) has limited value in detection of lung cancer and preneoplastic lesions. Though a substantial number of studies have evaluated the diagnostic yield of AFB, the variable estimates limited the ability to accurately assess its test performance and future role in clinical practice. The clinical utility of AFB has never been supported by a meta-analysis due to the inconsistent characteristics in some of studies. A meta-analysis was performed to re-examine the diagnostic efficiency of AFB compared with white light bronchoscopy (WLB).

METHODS: Search of both MEDLINE and EMBASE database up to June 2009 was conducted and hand search was performed against the extracted reference list for relevancy. Included studies had to have a conclusive histology as diagnostic standard, and provided sufficient data to construct a 2X2 table for assessing the diagnostic yield of AFB for detection of lung cancer and preneoplastic lesions. After examining the source of variation, pooled sensitivity and specificity of AFB were estimated using a bivariate random-effects regressing model and compared with that of WLB.

RESULTS: Of 439 publications, 14 studies, providing 15 sets of data, were suitable for analysis. The pooled sensitivity and specificity of AFB and WLB were 0.90 (95% CI 0.84-0.93) and 0.56 (95% CI 0.45-0.66), 0.66 (95% CI 0.58-0.73) and 0.69 (95% CI 0.57-0.79). The contribution of differences in excitation light source, histological criteria and biopsy strategy was not counted as a covariate.

CONCLUSIONS: The result indicated that AFB was superior to conventional WLB in detecting lung cancer and preneoplastic lesions.

Airway diseases such as allergic asthma and rhinitis are characterized by a T-helper type 2 (Th2) response. Treatment of allergic airway diseases is currently limited to drugs that relieve disease symptoms and inflammation. In the search for new therapeutics, efforts have been made to treat allergic airway disease with gene therapy, and many preclinical studies have demonstrated its impressive potential. Most strategies focus on blocking the expression of proinflammatory proteins or transcription factors involved in the disease pathogenesis using antisense oligonucleotides, DNAzymes, small interfering RNA, or blocking of microRNAs using antagomirs. Changing the Th1/Th2 balance by overexpressing Th1-stimulating factors is another treatment option.

Although the proof of concept is convincing in animal models, progress in humans remains limited. In this review, we focus on preclinical models to describe the recent developments and major breakthroughs for treating allergic airway diseases with gene therapy.