bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dyspnoea and its measurement
Authors: Ambrosino N. , Scano G. 
Published: September 2016

Key pointsDyspnoea is the sensation of breathing discomfort that can be described with different terms according to different pathophysiological mechanisms that vary in intensity.The mechanisms of dyspnoea are complex.In COPD, whilst the intensity and quality of dyspnoea during activity correlates with the magnitude of lung hyperinflation and inspiratory events, it correlates poorly with FEV1.Valid, reliable and responsive instruments are available to measure the severity of dyspnoea in patients with respiratory disease.CME article: educational aimsTo introduce dyspnoea and explain its mechanisms.To present dyspnoea descriptors, which may help in the understanding of the language of dyspnoea, and to relate these to specific diseases.To describe some of the methods available for the measurement of dyspnoea.SummaryDyspnoea, a term used to characterise a subjective experience of breathing discomfort, is perhaps the most important symptom in cardiorespiratory disease. Receptors in the airways, lung parenchyma, respiratory muscles and chemoreceptors provide sensory feedbackviavagal, phrenic and intercostal nerves to the spinal cord, medulla and higher centres. Knowledge of dyspnoea descriptors can help in understanding the language of dyspnoea and these are presented here. It is important to appreciate that differences in language, race, culture, sex and previous experience can all change the perception of and the manner in which the feeling of being dyspnoeic is expressed to others. Therefore, standard tools to measure dyspnoea are available. In addition, there are tools that can help to relate the severity of symptoms with observed levels of cardiac and pulmonary responses while performing supervised tasks. A range of methods are described here. Inventories that involve aspects of dyspnoea related to quality of life are not yet a routine part of the history and physical examination, although they have proved useful in the clinic. Measurement instruments may involve a cost for use, may be self-administered or require an interviewer, and can vary in the time required for completion and scoring.
Air pollution: from sources of emissions to health effects
Authors: Pénard-Morand C. , Annesi-Maesano I. 
Published: September 2016

Key pointsImmissions (=concentration of air pollutants in the ambient atmosphere) result from the intensity and the type of emissions of air pollutants, the dispersion of air pollutants and their transportation.The main air pollution indicators are SO2, NOx, PM, CO, VOC and O3.Road traffic has become the first source of air pollution in urban areas.Health effects caused by air pollutants depend on the absorbed dose, the type of pollutants and the individual susceptibility.Educational aimsTo provide a thorough presentation of sources, dispersion and transformation of major air pollutants.To describe the health effects of these air pollutants.To explain the differences between emissions, immissions, exposure and absorbed dose.To help readers to understand what is at stake in the topical scientific and political debate on air pollution.SummaryAir pollution, particularly in urban areas, constitutes a public health concern, as it has a harmful effect on the health, survival and activities of humans and other living organisms.Here, the main types of air pollution commonly found in urban environments are presented, along with their sources, levels of emissions, mechanisms of dispersion, transformation, concentrations in ambient air (=immissions), and effects on the environment and health. In particular, the concepts of exposure, absorbed dose and individual susceptibility are explained. The recent evolution in air pollutant emissions and immissions due to the growing weight of road traffic is also described. Finally, European air quality criteria are highlighted.
Exercise testing: why, which and how to interpret
Authors: Gosselink R. , Troosters T. , Decramer M. 
Published: September 2016

Key pointsAn exercise test should be performed: if there is impaired exercise tolerance; to find out which system is limiting exercise; to establish which organ systems have an abnormal response during or after exercise; to investigate how much exercise is appropriate/safe in a patient; and to determine the response to treatment.Prediction of exercise performance based solely on resting pulmonary function tests is inaccurate.The gold standard in exercise testing is the incremental exercise test.Two types of ergometers can be selected for incremental exercise testing: a treadmill or a cycle ergometer. More muscle mass is put to work using a treadmill when compared with cycling.Incremental exercise testing and field testing have complementary value in, for example, pulmonary rehabilitation.Exercise laboratories should be encouraged to test some healthy control subjects in the age span of interest to evaluate which normal values best suit their laboratory setting.Educational aimsTo address some questions that often arise when exercise testing is performed in the clinical routine:What are the indications to perform an exercise test?Which test should be used for which situation?How should the test be carried out in practice?How should the results of the test be interpreted?SummaryExercise testing is widely applied in clinical practice. The aim of this article is to address some questions that often arise when exercise testing is performed in clinical routine. Two complementary tests will be discussed in more detail: the maximal incremental ergometer test and the timed walk test.First, the indication to perform exercise testing is discussed. The second question is which test to apply and how to carry out the test in practice. Finally, the interpretation of the results of the tests are discussed.
Assessing asthma quality of life: its role in clinical practice
Authors: Juniper E.F. 
Published: September 2016

Key pointsAsthma patients want help to improve their ability to function in their daily lives (physical, social, occupational and emotional).Awareness of patients’ problems and a willingness to treat them may improve both asthma control and quality of life.The clinician and the patient should negotiate a treatment plan that addresses both asthma control and the patient's needs, and that the patient is willing to follow.Valid, easy-to-use, self-administered asthma quality-of-life questionnaires can be used in the clinic to identify quickly the patient's specific problems and treatment goals.Educational aimsTo define HRQL and emphasise its importance in patients with asthma.To describe the HRQL impairments experienced by adults and children with asthma.To discuss the role of HRQL in clinical practice and the concept of shared decision making.To provide information on the selection, methods of administration, analysis, interpretation and cultural adaptation of HRQL questionnairesSummaryAn important contributor to poor patient compliance with treatment instructions may be a discrepancy between the goals of the clinician and those of the patient. Improved clinician awareness of patients’ asthma-related quality-of-life goals and a readiness to address them may enhance patients’ willingness to take medications and, thus, improve both their asthma control and their quality of life. The aim of this article is to explain how quick, valid, easy-to-use, self-administered and clinic-friendly HRQL can be used to identify patients’ greatest needs, ascertain how troublesome they are and ensure that they are included in the treatment plan. HRQL questionnaires can also be used to monitor patient progress over time.
ERS School Course - Smoking Cessation
Authors: Gratziou C. , Fagerstrüm K. 
Published: September 2016

Educational aimsTo provide healthcare professionals and respiratory physicians with a practical set of information based on the recommendations made by recent relevant guidelines to facilitate the treatment of tobacco dependence.SummaryThe potential health benefits of smoking cessation are substantial; however, many people find it very difficult to quit. The main physiological obstacle is addiction to nicotine. This article aims to describe the “5 As” for effective intervention for smoking cessation that should be followed in current smokers. In addition, some baseline and follow-up assessments to be performed during a smoking cessation programme are proposed.
Imaging: ultrasound in lung disease
Authors: Herth F.J.F. , Eberhardt R. 
Published: September 2016

Key pointsTransthoracic US is an inexpensive, lightweight and portable technique to evaluate the lungs and the pleural space.US-guided punctures are safe procedures in the case of pathological findings in the pleural space.With the help of EBUS, the diagnosis and staging of lung cancer can be improved.US will become a practical and essential tool for the pulmonologist in the near future.Educational aimsTo outline the situations where US is indicated.To discuss the importance of EBUS in the diagnosis and staging of lung cancer.To encourage the pulmonologist to learn ultrasonic techniques, particularly transthoracic US, and emphasise the importance of formal training programmes.SummaryUltrasound (US) has received increased interest from chest physicians in recent years. Modern US devices are user friendly, inexpensive, lightweight and portable, which makes them suitable for outpatient settings, as well as for bedside investigations of the severely ill.However, the view during bronchoscopy is limited to the inner surface in the case of parabronchial lesions. Therefore, endobronchial ultrasound (EBUS) systems were developed. In trials, it has been shown that, with the help of EBUS, the diagnosis and staging of lung cancer and other pathologies can be improved. EBUS is a safe technique and, so far, has proved extremely useful during diagnostic and interventional procedures. US is set to become a practical and essential tool for the pulmonologist in the near future. This review aims to assess the most important and interesting articles in the field and to encourage the pulmonologist to learn ultrasonic techniques, particularly with regard to transthoracic US.
Rare and orphan lung diseases
Authors: Cordier J-F. 
Published: September 2016

Key pointsPatients suffering from rare and orphan lung diseases often feel frustrated and angry because of a delayed diagnosis and the insufficient experience of their nearest physician.As many diseases can be classed as rare or orphan, pulmonologists need to cooperate through networks and form connections with specialised reference centres to ensure optimal diagnosis and care.Participation in registries and clinical studies helps to increase the collective and individual knowledge of respiratory specialists.Providing information to patients both directly and through patients' associations is a necessity, as orphan diseases are not a regular subject covered in medical reports in the lay press.Action is being taken by the ERS to include rare and orphan lung diseases in scientific and educational programmes and to develop task forces for specific diseases.Educational aimsTo motivate the interest of chest physicians in rare orphan lung diseases.To define rare and/or orphan lung diseases.To provide information on orphan drugs.To give examples of orphan lung diseases.To provide details about patient associations, networks and reference centres.SummaryPatients with rare lung diseases often feel isolated, especially if their physician has limited experience and knowledge of their disease. They can feel like an “orphan” in the field of healthcare. A respiratory professional who does not work in a large hospital in a big town may not feel concerned by rare and so-called orphan lung diseases, since it is often supposed that these diseases are reserved for university specialists. However, this should not be the case, as patients live in different locations throughout every country and have proximity healthcare needs. Therefore, every respiratory professional should meet several patients with a rare disease in the course of their career. This review examines how to deal with such patients and where information can be obtained in order to offer the best current care.
Postgraduate Course ERS Copenhagen 2005: Biological and therapeutic implications of the united airways concept
Authors: Braunstahl G-J. 
Published: September 2016

Key pointsRhinitis is an important risk factor for the development of asthma.The nose interacts with the bronchi through the systemic circulation.Treatment of allergic rhinitis in patients with concomitant asthma provides better asthma control.Novel therapies are aimed at the systemic elements of allergic airway disease.Educational aimsTo introduce the factors involved in the expression of allergic phenotypes.To define the mechanisms that may play a role in nasobronchial cross-talk.To identify current and future therapies for combined asthma and rhinitis.SummaryThe condition of the nose affects the bronchi andvice versa. Local allergen exposure leads to a generalised airway response in atopic individuals, involving the systemic circulation. Therefore, upper and lower airways need to be regarded as one functional entity. This also has implications for rhinitis and asthma therapy, providing a rationale for combined treatment of both upper and lower airways. The systemic link between the upper and lower airways may provide new opportunities for systemic treatment.
Pulmonary rehabilitation: a year in review
Authors: Ambrosino N. , Serradori M. 
Published: September 2016

Educational aimsTo present innovative papers from the field of pulmonary rehabilitation published in 2005 and to discuss the important points and conclusions from each.SummaryThis paper summarises the findings of important papers that have been published over the last year.Two recently published studies have addressed the effects of different durations of pulmonary rehabilitation programme (PRP), indicating the greater benefits obtained by longer programmes.Three other papers have described the effects of pulmonary rehabilitation on pulmonary mechanics and oxidative stress, indicating that exercise is able to reduce the mechanical disadvantage of the respiratory system and some aspects of oxidative stress associated with chronic obstructive pulmonary disease (COPD).Other papers have discussed the effects of a number of breathing strategies, such as pursed-lip breathing (PLB), or training techniques, such as arm or inspiratory muscle training.Finally, the addition of drug therapy to pulmonary rehabilitation and the role of outcome measures in providing rehabilitation programmes were examined in two other studies.
The mesh nebuliser: a recent technical innovation for aerosol delivery
Authors: Vecellio L. 
Published: September 2016

Key pointsMesh nebulisers can be used to nebulise aqueous drugs and suspensions; however, with suspensions, there can be a reduction in performance in terms of aerosol output rate and inhaled mass.Based only onin vitrostudies, marketed mesh nebulisers for ambulatory patients might reduce the nebulisation time without reducing drug efficiency or overdose risk.The effect of disinfection and cleaning on marketed mesh nebulisers’ performances remains to be assessed.Educational aimsTo define the differences between the new mesh nebulisers and conventional jet and ultrasonic nebulisers.To give recommendations regarding the choice of a mesh nebuliser in order to administer a therapeutic aerosol.SummaryA nebuliser is a device that converts a liquid into aerosol droplets and must be loaded with the medication before each treatment. There are three types of nebulisers: jet nebulisers, which can nebulise all drugs and can be disposable; ultrasonic nebulisers, which are silent but can only nebulise aqueous solutions and may heat the drug; and mesh nebulisers, which can be used to nebulise aqueous solutions, but can be less efficient in nebulising suspensions. The latter are silent, portable and small. They can reduce the nebulisation time without reducing drug efficiency, but disinfecting and cleaning can be difficult.
Care of end-stage lung disease
Authors: Simonds A.K. 
Published: September 2016

Key pointsMost patients with COPD die during acute exacerbations; in those who have been treated with acute NIV, almost 80% will require admission in the following year.A comprehensive management plan for endstage lung disease patients needs to address symptom burden, provide information, support carers and assist with end-of-life planning.Management should include optimisation of treatment of airflow obstruction and pulmonary rehabilitation. In some patients, pharmacotherapy for dyspnoea, panic attacks, depression and insomnia have a key role, but the importance of practical measures, including stairlifts, bath aids and social support, should not be underestimated.Advance directives enable patients to give direction to the medical team about treatment preferences and should be part of routine care, especially in individuals who have already experienced an acute hypercapnic exacerbation.Educational aimsTo raise awareness of the symptom load of end-stage lung disease.To examine trajectories of end-stage disease.To discuss treatment strategies.SummaryIndividuals with end-stage lung disease have a substantial symptom burden, which is often poorly addressed compared to patients with malignant disease. Recognition of the disease trajectory in the last few years of life enables a symptom-based approach that combines palliative care with active treatment of exacerbations where appropriate. Discussion of advance directives is helpful for both the patient and the physician.
Pulmonary carcinoid tumours
Authors: André S. , Correia J.M. , Raposo M. , Matos C. , Nogueira F. , Abreu M.C. 
Published: September 2016

Key pointsPulmonary carcinoid tumours account for 2% of all lung tumours, with an increase in incidence due to more accurate diagnostic techniques.Carcinoid tumours are relatively slow growing, although prognosis depends on histological subtype; atypical carcinoids have worse prognosisLocal pulmonary symptoms occur frequentlyParaneoplastic syndromes are dependent on the release of hormones or vasoactive peptides into the systemic circulation.Carcinoid syndrome manifests with diarrhoea and flushing, which can lead to dehydration, hypotension and arrhythmias.Carcinoid heart disease is a severe late complication of carcinoid syndrome, manifesting as valvular right-side heart disease, and is a frequent cause of death.Urinary 5-HIAA and CgA are good biochemical markers of carcinoid tumours.Nuclear scintigraphy techniques with111Indium-pentetreotide and131I-MIBG are very sensitive in the diagnosis of metastatic carcinoid tumour and are predictive of response to octreotide therapy.Somatostatin analogues are first-line treatment for carcinoid metastatic tumours.Systemic chemotherapy has limited success and is more effective in aggressive variants of carcinoid tumour; IFN-α therapy can also be used with good biochemical and symptomatic responses, but small effects on tumour reduction.Educational aimsTo describe the epidemiology and prognosis of pulmonary carcinoid tumours.To discuss the pathophysiology and clinical presentation of pulmonary carcinoid tumours.To outline the diagnostic procedures and treatment strategies in carcinoid metastatic disease.To highlight the importance of carcinoid-related heart disease and carcinoid syndrome in the prognosis of carcinoid tumours.SummaryCarcinoid tumours are neuroendocrine tumours derived from enterochromaffin cells, which are widely distributed in the body. Pulmonary carcinoids account for 25% of all carcinoid tumours and they comprise 1–2% of all lung tumours. The incidence of carcinoid tumours seems to be sharply increasing.Carcinoid tumours can be classified as typical or atypical, ranging from low-grade malignant to high-grade malignant, according to histological characteristics and differentiation level. Carcinoids can be placed in a spectrum of neuroendocrine tumours, ranging from low-grade malignant typical carcinoid to intermediate atypical carcinoid, to highgrade large cell neuroendocrine carcinoma and small cell lung carcinoma.Carcinoid pulmonary tumours can present with lymph node or distant metastases, most frequently at the liver. Carcinoid tumours have the ability to secrete many vasoactive peptides, most frequently serotonin. The hormonal secretion is related to systemic manifestations of carcinoid syndrome and carcinoid heart disease. Combining new diagnostic and treatment modalities in metastatic carcinoid patients may result in better prognosis.The review aims to elucidate the reader on the many aspects of carcinoid pulmonary tumours.
ERS School Course Early-stage lung cancer - What's new in the epidemiology of lung cancer: the female aspect
Authors: Quoix E. , Mennecier B. 
Published: September 2016

Key pointsLung cancer is more frequent in non-smoking females than in non-smoking males.Although the main reason for the tremendous increase in lung cancer incidence in females is tobacco, there are several other potential risk factors.There are genetic factors that could explain different susceptibility to lung cancer development in both sexes.Educational aimsTo describe the incidence of lung cancer in the USA and Europe.To identify the epidemiological specificities of lung cancer in females.To correlate some of these specificities with genetic and hormonal factors.SummaryThere has been a tremendous increase in lung cancer incidence in females, which is mainly due to the increase in tobacco consumption by females after the Second World War in the USA and from the end of the 1960s in Europe.However, there are more non-smoking females developing lung cancers than non-smoking males, and lung cancer can be attributed to active tobacco smoking only in ~70% of female lung cancer cases in Europe. Even if the female patients who develop lung cancer are smokers, the amount smoked is consistently less than that of males, thus suggesting an increased susceptibility to carcinogens of smoke. This increased susceptibility is still controversial, but there are several genetic differences that may account for such an increased susceptibility.
The global burden of chronic respiratory diseases
Authors: Maio S. , Baldacci S. , Carrozzi L. , Pistelli F. , Viegi G. 
Published: September 2016

Key pointsCurrently, the serious consequences of chronic diseases and their risk factors are not fully recognised by the international health community.In the period of 1990–2020, COPD deaths are expected to increase from 2.2 to 4.7 million worldwide.Reducing chronic disease death rates by an additional 2% annually would avert 36 million deaths by 2015.The abatement of the main risk factors for respiratory diseases, in particular tobacco smoking, environmental tobacco smoke, indoor biomass fuels, outdoor air pollution and unhealthy diet, can achieve huge health benefits.Educational aimsTo define the burden of chronic respiratory diseases all over the world.To underline the importance of chronic diseases recognition by the international health community.To provide details about the burden of chronic obstructive pulmonary disease (COPD): the predicted third cause of death by 2020.SummaryCurrently, the serious consequences of chronic diseases and their risk factors are not fully recognised by the international health community. Moreover, chronic diseases are not only a problem of the ageing population in developed countries. In fact, it has been estimated that 80% of mortality for chronic diseases occurred in low-income and middleincome countries in 2005. Thus, the World Health Organization (WHO) Dept of Chronic Diseases and Health Promotion has suggested a new Millennium Development Goal for the next few years: to reduce chronic disease death rates by an additional 2% annually, in order to avert 36 million deaths by 2015.