bluuebunny/crossref_metadata_2025_split huggingface dataset:
Paediatric interstitial lung disease
Authors: Bush A. 
Published: September 2016

Key pointsPresentation of ILD is very non-specific.Imaging, especially HRCT, confirms the presence of ILD, but is rarely diagnostic.Invasive diagnosis is almost always needed.Bronchoscopy rarely gives diagnostic information in paediatric ILD.For most paediatric ILD, transbronchial or percutaneous lung biopsy gives insufficient tissue for diagnosis and carries increased risk.Open lung biopsy or VATS is the diagnostic investigation of choice.Educational aimsTo allow the reader to correctly identify infants and children with interstitial lung disease (ILD).To help the reader to appreciate the wide differential diagnosis, including that of disorders specific to infancy, comprising the surfactant protein disorders.To explain the strengths and weaknesses of the different investigative modalities used in establishing a firm diagnosis.To discuss the limited evidence for the different treatment options currently in use.SummaryPaediatric interstitial disease is rare, and comprises many disparate diseases. This article aims to provide the reader with an update on how to recognise infants and children who should be considered as possibly having ILD. The diagnostic process, including the roles of HRCT and bronchoscopy, and the different methods of lung biopsy, will be set out. The newly recognised entities, such as neuroendocrine cell hyperplasia of infancy, pulmonary interstitial glycogenosis and the disorders of surfactant protein metabolism, are also described. Finally, the article reviews the evidence that exists to guide treatment of these conditions.
Vocal cord dysfunction
Authors: Stanton A.E. , Bucknall C.E. 
Published: September 2016

Key pointsVCD is an increasingly recognised co-existing feature in asthmatics.VCD may arise from an alteration in the autonomic balance between the glottis and central control areas, with potential aggravation from direct laryngeal insult, laryngeal hyperresponsiveness and psychological factors.There is significant psychiatric co-morbidity in VCD patients.The classical appearances at laryngoscopy are adduction of the anterior two thirds of the vocal cords with the creation of a posterior glottic chink during inspiration.The current gold standard for diagnosis rests with laryngoscopy at the time of an attack of symptoms, with the role of challenge testing as a diagnostic strategy not clear at present.Treatment involves directing attention away from the inspiratory phase of breathing and oropharyngeal muscle use towards active expiration using anterior abdominal muscles along with psychiatric input if necessary.Educational aimsTo be aware of the possible co-existence of VCD in patients with poorly controlled asthma.To recognise the various clinical presentations of VCD.To be aware of the unanswered questions regarding the pathophysiology of VCD.To be aware of treatment strategies for VCD.SummaryRecently, there has been increasing recognition and understanding of vocal cord dysfunction (VCD), a condition characterised by abnormal adduction of the vocal cords, most often during inspiration, leading to airway obstruction and associated symptoms. VCD is recognised as a co-existing factor or an alternative diagnosis in patients with asthma, but the true prevalence and incidence are not entirely clear. VCD may arise from interrelationships between laryngeal hyperresponsiveness and autonomic imbalance. Diagnosis can be difficult and, although challenge testing may be helpful, there is no non-invasive alternative to direct visualisation of the larynx during an attack as a current gold standard. This review aims to summarise current understanding of the epidemiology, proposed underlying pathophysiological mechanisms, diagnosis and treatment of this disorder.
Inspiratory muscle training in obstructive lung disease
Authors: McConnell A.K. , Romer L.M. , Weiner P. 
Published: September 2016

Key pointsDyspnoea is influenced by inspiratory muscle strength and the load placed upon the inspiratory muscles.Dynamic hyperinflation is a major cause of dyspnoea and exercise intolerance in patients with expiratory flow limitation due to its detrimental effect upon inspiratory muscle loading.Specific IMT improves inspiratory muscle strength, reduces dyspnoea and improves exercise tolerance, even in individuals without inspiratory muscle weakness or hyperinflation.Pressure threshold IMT is the most reliable, convenient and commonly used method of IMT, eliciting improvements in a wide range of muscle functional characteristics, including strength, shortening velocity, power and endurance.Inspiratory muscles adhere to the same training principles as other skeletal muscles, with respect to overload, specificity and reversibility.Training loads must exceed 30% of inspiratory muscle strength, with at least once daily training and weekly increases in training load. Programmes should be least 6 weeks in duration, after which frequency can be reduced to two sessions, three times per week.IMT can be implemented as a stand-alone intervention or as part of a comprehensive programme of rehabilitation.Monitored outcomes should include inspiratory muscle strength, an index of dyspnoea (e.g. BDI/TDI and/or Borg CR-10) and exercise tolerance (e.g. 6MWD).Educational aimsTo provide an overview of the role of respiratory muscle function in the genesis of dyspnoea.To describe the response of inspiratory muscles to different types of training stimuli.To offer guidance on the implementation and monitoring of IMT.SummaryDyspnoea is strongly influenced by respiratory muscle function. Patients with obstructive lung disease become hyperinflated and experience an associated functional deficit in inspiratory muscle function, as well as a concomitant increase in the work of breathing. These changes result in a heightened sense of respiratory effort and a propensity for inspiratory muscle fatigue. There is now convincing evidence that specific inspiratory muscle training (IMT) improves respiratory muscle function, reduces dyspnoea and improves exercise tolerance. This review will describe the two most commonly implemented methods of IMT, and the specific functional adaptations that are elicited by each. It will also describe successful, evidence-based implementation and monitoring of the most commonly used method of IMT.
Induced sputum in occupational lung diseases
Authors: Fireman E. , Lerman Y. 
Published: September 2016

Key pointsBAL, an important tool in assessing occupational lung diseases, is an invasive technique and thus unsuitable for screening programmes, the evaluation of exposure and the monitoring of hazardous dust.Examination of induced sputum is a noninvasive method to directly study particulate burden and inflammatory processes in the lung.The correlation between cells retrieved by BAL and induced sputum shows different proportions of leukocytes, but similar eosinophil cell counts and qualitative/quantitative analyses of particles.Many accumulating lines of evidence have shown that the eosinophil count is a useful marker for monitoring OA.Educational aimsTo introduce induced sputum methodology in the field of occupational lung diseases.To describe the eosinophil count as a method of monitoring occupational asthma.To explain how to use quantitative and qualitative analysis of inhaled particles in hazardous dust exposure.SummaryInduced sputum is a particularly promising procedure, since it provides specific information on both the cellular and molecular constituents in inflammation. In the period 1950–1970, sputum cells were examined on stained smears in both research and clinical settings. After their recovery by spontaneous coughing, the cells were used to study lung cancer and respiratory infections, and, later on, to diagnosePneumocystis cariniipneumonia in patients infected with HIV. The method was widely improved upon by the induction of sputum with aerosol of hypertonic saline, and then extended to become part of the assessment of airway inflammation in bronchial asthma and COPD. However, less attention was given to the use of induced sputum in occupational exposures. This review analyses the value of induced sputum and presents its applications in pulmonary occupational and environmental medicine.
Postgraduate Course ERS Copenhagen 2005 - The side-effects of TB therapy
Authors: Zaleskis R. 
Published: September 2016

Educational aimsTo provide up-to-date insights on:the side-effects of anti-TB chemotherapythe symptom-based approach to the management of side-effectsthe influence of side-effects on the outcomes of anti-TB treatment.SummaryThere is still much debate concerning the frequency and severity of symptoms of TB when undergoing chemotherapy. In addition, the frequency of complications is hard to quantify as many patients are treated with a range of different drugs. However, this article aims to give a brief overview of the side-effects associated with anti-TB drugs and the most appropriate management approaches to take.
Pulmonary arterial hypertension
Authors: Humbert M. , Jaïs X. , Sitbon O. , Parent F. , Hervé P. , Simonneau G. 
Published: September 2016

Key pointsPAH is defined by RHC showing a pre-capillary PH.Clinical suspicion of PH should arise in the case of symptoms such as dyspnoea without overt signs of specific heart or lung disease.RHC is required to confirm the diagnosis of PAH, to assess the severity of the haemodynamic impairment and to test the vasoreactivity of the pulmonary circulation.Variables that have been shown to predict prognosis in IPAH include baseline NYHA functional classification, history of right heart failure, baseline 6-minute walk distance, and baseline haemodynamics.FPAH segregates as an autosomal dominant trait, but with markedly reduced penetrance. Germline BMPR2 mutations have been detected in at least 60% of the families studied to date, as well as in cases of so-called IPAH.Basic PAH therapy includes oxygen, diuretics and warfarin.Chronic treatment with oral CCBs should be considered for PAH patients who respond to acute vasodilator challenge.Cohort analysis of IPAH patients receiving continuous intravenous epoprostenol, as compared to historical control groups, clearly demonstrated clinical benefits in NYHA functional class III and IV patients.Two double-blind, randomised, placebocontrolled trials have supported the efficacy of oral bosentan in patients with PAH class III.One double-blind, randomised placebocontrolled trial has supported the efficacy of oral sildenafil in patients with symptomatic PAH.Lung transplantation is the ultimate alternative for severe PAH cases who cannot be managed medically.Educational aimsTo improve awareness of PAH.To describe the novel classification of PH.To provide information regarding the therapeutic approach of PAH.SummaryPulmonary arterial hypertension (PAH) is a rare condition characterised by elevated pulmonary arterial resistance, leading to right heart failure. PAH can be sporadic (idiopathic PAH), familial or related to other conditions. Echocardiography is the investigation of choice for non-invasive screening. Measurement of haemodynamic parameters during right heart catheterisation (RHC) is mandatory to establish the diagnosis. Recent advances in the management of PAH include prostaglandins, endothelin receptor antagonists and PDE5 inhibitors. Lung transplantation is the last option for patients who deteriorate despite medical treatment. This review aims to update the reader on all these aspects of PAH.
Postgraduate Course ERS Copenhagen 2005 - Diet in respiratory disease
Authors: Romieu I. , McKeever T. 
Published: September 2016

Educational aimsTo introduce dietary factors and nutrients linked to lung function and diseases.To describe host and environmental factors affecting pulmonary and systemic nutritional status.To present epidemiological evidence of the association between nutrition and respiratory health.To discuss nutritional counselling and vitamin supplementation.SummarySeveral lung diseases have been associated with oxidative stress. Consequently, dietary factors and nutrients with a potentially protective role in the oxidative process and inflammatory response have been implicated in the genesis or evolution of these diseases. Antioxidant vitamins and other nutrients have also been related to several components of the immune response. This paper briefly reviews the epidemiological evidence of an association between diet and lung health, focusing on the nutrients most frequently studied.
ERS School Course Basics in Asthma - Exercise testing, exercise induced asthma and sports
Authors: Carlsen K-H. 
Published: September 2016

Educational aimsTo inform about the occurrence of EIA, particularly in top athletes.To describe how EIA can be diagnosed.To describe the pathogenesis of the condition.To familiarise the reader with treatment modalities available to athletes.To make the reader aware of doping regulations in relation to EIA.SummaryExercise-induced asthma (EIA) is a general concern for growing children and adolescents, although it now occurs more commonly in top athletes. It specifically affects athletes competing in endurance sports in cold climates. EIA can be diagnosedviaexercise testing and can be easily treated both prophylactically and before exercise. However, with tight regulations now in force in the sporting world, athletes with EIA have to be sure that they adhere to doping rules. This review aims to briefly review these issues.
Lung transplantation: who, when?
Authors: Irani S. , Boehler A. 
Published: September 2016

Key pointsLung transplantation is an established therapeutic option for selected patients suffering from end-stage lung diseases, providing survival and quality of life benefits.Shortage of donor organs and chronic graft rejection in the form of bronchiolitis obliterans are the two major drawbacks in lung transplantation.When to refer to the lung transplant centre is at least as crucial as whom to refer,e.g. patients with idiopathic pulmonary fibrosis have a high mortality on the waiting list and, therefore, this group of patients should be referred early.The period of time on the waiting list should be used for active risk management: continuous optimisation of nutrition, comorbidities (e.g. osteoporosis), psychosocial issues and general health behaviour is important, and can be achieved through close collaboration with the lung transplant programme.Educational aimsTo provide information about the selection of appropriate patients for lung transplantation.To outline recommendations for chest physicians concerning who to refer and when.To better understand short- and long-term results after the procedure, considering underlying disease, quality of life and survival.To present future trends in lung transplant medicine.SummarySince the first successful lung transplantation was performed in the early 1980s, this procedure has emerged as a mainstay of therapy for patients suffering from end-stage lung diseases. Due to a shortage of donor organs, time on the waiting list is increasing in most transplant programmes and, hence, the timing of referral and listing is crucial. This review discusses the different aspects that should be considered when advising potential lung transplant recipients. Particular focus is given to the appropriate time of referral, matters of medical care whilst on the waiting list, post-transplant prognosis and quality of life issues.
ERS School Course Sleep Medicine: Non-respiratory causes of excessive daytime sleepiness
Authors: Viot-Blanc V. 
Published: September 2016

Educational aimsTo present the symptoms, methods of assessment and the different causes of excessive daytime sleepiness when nocturnal respiratory disturbances have been excluded.To enable physicians to confirm a diagnosis of sleepiness and recognise the pathology.SummaryExcessive daytime sleepiness (EDS) is defined as an inability to stay awake and alert during the major waking episodes of the day, resulting in unintended drowsiness or sleep episodes almost daily for at least 3 months. This review will examine the assessment of sleepiness and different causes of EDS.
Croup: diagnosis and treatment
Authors: Canciani M. , Morittu A. , Del Pin B. 
Published: September 2016

Key pointsThe term “croup” refers to a clinical syndrome characterised by barking cough, inspiratory stridor and hoarseness of voice.The standard work-up for clinical diagnosis includes the assessment of skin colour, hydration, breath sounds and air movement.The most important aspect in the treatment of patients with croup is airway maintenance.The standard management of croup includes corticosteroids andL-adrenalin.L-adrenalin is used because it is safe, cheap and available across the world.Educational aimsTo provide information on how to diagnose, treat and hospitalise patients with croup.To enable clinicians to determine the appropriate treatment for every situation, according to score.To explain the rationale of treatment.Summary“croup” (laryngotracheobronchitis) is a common illness during the first 6 years of childhood, which is characterised by barking cough, inspiratory stridor and hoarseness of voice. Patients with atypical features in whom the diagnosis is questionable or unclear should have a work-up to exclude other less common entities.The most important aspect of the treatment is airway maintenance, and standard management includes corticosteroids andL-adrenalin.Inhaled L-adrenalin has a transient beneficial effect on airway obstruction in children; even if it is not a definitive treatment, it may allow time for the basic pathology to resolve.
Postgraduate Course ERS Copenhagen 2005 - Therapeutic options for interstitial lung diseases in 2005
Authors: Baughman R.P. , du Bois R.M. 
Published: September 2016

Educational aimsTo discuss the role of corticosteroids in treating sarcoidosis.To provide information about when to consider cytotoxic drugs for chronic sarcoidosis.To outline how to monitor the use of cytotoxic drugs.To better understand the differences in response when using anti-tumour necrosis factor agents in treating sarcoidosisSummaryThe decision to treat a patient with sarcoidosis is dependent on many factors, the most important being whether the patient is symptomatic. Initial systemic therapy for symptomatic sarcoidosis usually includes corticosteroids. However, most symptomatic patients will require months to years of therapy. Therefore, alternatives to corticosteroids have been studied. This review will give a brief overview of the effect of corticosteroids and alternative treatments options available.
HERMES: a European Core Syllabus in Respiratory Medicine
Authors: Loddenkemper R. , Séverin T. , Eiselé J-L. , Chuchalin A. , Donner C.F. , Di Maria G. , Magyar P. , Muers M. , Muir J-F. , Nybo B. , Phillips G. , Riddell G. , Stevenson R. , Zach M. , Haslam P.L. 
Published: September 2016

SummaryHERMES is a project to promote better “Harmonised education and training in Respiratory Medicine for European Specialists”. The first aim of the project was to develop a European core syllabus listing core competencies that all respiratory specialists should possess. This report presents the resulting consensus-based document. A total of 50 experts in respiratory medicine from 29 countries took part in its development. Moreover, over 400 qualified respiratory physicians and over 100 trainees provided further feedback throughout the project.Competencies were identified and ranked through a three-round Delphi consensus process. Some 229 competencies were selected and split into nine sections and 51 modules. Of these, 14 were ranked as optional, 215 as mandatory. Items were further ranked into three different levels, according to the level of knowledge and competence expected. The Delphi process proved an effective tool for creating expert consensus and to enable “group” ownership of the project outcomes.
Severe asthma
Authors: Bel E.H. 
Published: September 2016

Key pointsNot all patients with “difficult-to-control” asthma have “severe asthma”. Many of them have either an incorrect diagnosis, or mild-moderate asthma with unrecognised aggravating factors, or are non-compliant with prescribed therapy.For a diagnosis of severe asthma, it is necessary to confirm the diagnosis of asthma, to evaluate and treat endogenous and exogenous aggravating factors, and to closely follow the patient for ≥6 months.Severe asthma is a heterogeneous condition with different phenotypes. Defining clinical phenotypes is necessary to improve understanding of underlying mechanisms, to help guide current treatment and to provide clues for novel therapeutic interventions.Despite intensive multi-drug treatment with high-dose inhaled and oral corticosteroids, many patients with severe asthma remain uncontrolled. There is an urgent need for new, more-effective treatments.Educational aimsTo help the reader distinguish between “difficult-to-control”, “refractory” and “severe” asthma.To discuss the initial approach to and assessment of a patient with difficult-to-control asthma.To inform the reader how to recognise different clinical phenotypes of severe asthma.To outline management strategies and discuss treatment modalities.Summary“Severe asthma” refers to asthma that remains difficult to control despite intensive multidrug therapy, extensive assessment and management of comorbidity, and long-term observation by an asthma specialist.The three main clinical phenotypes of severe asthma include asthma with frequent severe exacerbations, asthma with chronic airflow limitation, and steroid-resistant asthma.Many patients with severe asthma are oral-steroid dependent. Classical steroid-sparing drugs (gold, methotrexate, cyclosporin) are only weakly effective and have unacceptable side-effects. Monoclonal antibodies against immunoglobulin (Ig)E and tumour necrosis factor (TNF)-α have shown clinical benefit in subgroups of patients with severe asthma, and large studies are under way to confirm these promising findings.