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2022 ◽  
pp. 00640-2021
Author(s):  
Sabina A. Guler ◽  
Sara Cuevas-Ocaña ◽  
Mouhamad Nasser ◽  
Wim A. Wuyts ◽  
Marlies S. Wijsenbeek ◽  
...  

This article provides an overview of scientific highlights in the field of interstitial lung disease (ILD), presented at the virtual European Respiratory Society Congress 2021. A broad range of topics was discussed this year, ranging from translational and genetic aspects to novel innovations with the potential to improve the patient pathway. Early Career Members summarize a selection of interesting findings from different congress sessions, together with the leadership of Assembly 12 – Interstitial Lung Disease.


Author(s):  
Mario Silva ◽  
Gianluca Milanese ◽  
Roberta E Ledda ◽  
Sundeep M Nayak ◽  
Ugo Pastorino ◽  
...  

Lung cancer screening (LCS) by low-dose computed tomography is a strategy for secondary prevention of lung cancer. In the last two decades, LCS trials showed several options to practice secondary prevention in association with primary prevention, however, the translation from trial to practice is everything but simple. In 2020, the European Society of Radiology and European Respiratory Society published their joint statement paper on LCS. This commentary aims to provide the readership with detailed description about hurdles and potential solutions that could be encountered in the practice of LCS.


2021 ◽  
pp. 2101499
Author(s):  
Sanja Stanojevic ◽  
David A. Kaminsky ◽  
Martin Miller ◽  
Bruce Thompson ◽  
Andrea Aliverti ◽  
...  

BackgroundAppropriate interpretation of pulmonary function tests (PFTs) involves the classification of observed values as within/outside the normal range based on a reference population of healthy individuals, integrating knowledge of physiologic determinants of test results into functional classifications, and integrating patterns with other clinical data to estimate prognosis. In 2005, the American Thoracic Society and the European Respiratory Society jointly adopted technical standards for the interpretation of PFTs. We aimed to update the 2005 recommendations and incorporate evidence from recent literature to establish new standard for PFT interpretation.MethodsThis technical standards document was developed by an international joint task force, appointed by the European Respiratory Society and the American Thoracic Society with multidisciplinary expertise in conducting and interpreting pulmonary function tests, and developing international standards. A comprehensive literature review was conducted, and published evidence was reviewed.ResultsRecommendations for the choice of reference equations and limits of normal of the healthy population to identify individuals with unusually low or high results, respectively are discussed. Interpretation strategies for bronchodilator responsiveness testing, limits of natural changes over time and severity are also updated. Interpretation of measurements made by spirometry, lung volumes and gas transfer are described as they relate to underlying pathophysiology with updated classification protocols of common impairments.ConclusionsPFTs interpretation must be complemented with clinical expertise and consider the inherent biological variability of the test and the uncertainty of the test result to ensure appropriate interpretation of an individual's lung function measurements.


2021 ◽  
Vol 30 (162) ◽  
pp. 210177
Author(s):  
John A. Mackintosh ◽  
Athol U. Wells ◽  
Vincent Cottin ◽  
Andrew G. Nicholson ◽  
Elisabetta A. Renzoni

The presence of clinical, serological and/or radiological features suggestive, but not confirmatory, of a defined connective tissue disease in patients with interstitial lung disease is a relatively frequent occurrence. In 2015, the European Respiratory Society and the American Thoracic Society proposed classification criteria for the interstitial pneumonia with autoimmune features (IPAF) research entity to capture such patients in a standardised manner, with the intention of nurturing clinical research. This initiative resulted in the publication of several series of IPAF patients, with significant variation between cohorts in clinical characteristics, outcome and the application of IPAF criteria in patient selection. From this increasing body of published work, it has become apparent that revision of IPAF criteria is now required in order to justify the eventual designation of IPAF as a standalone diagnostic term, as opposed to a provisional entity put forward as a basis for clinical research. This review covers the current state of IPAF, conclusions that can and cannot be drawn from the IPAF evidence base, and ongoing uncertainties that require further expert group consideration.


2021 ◽  
Vol 30 (162) ◽  
pp. 210171
Author(s):  
Megan L. Crichton ◽  
Pieter C. Goeminne ◽  
Krizia Tuand ◽  
Thomas Vandendriessche ◽  
Thomy Tonia ◽  
...  

Hospitalised patients with coronavirus disease 2019 (COVID-19) have a high mortality rate. There are an increasing number of published randomised controlled trials for anti-inflammatory, anti-viral and other treatments. The European Respiratory Society Living Guidelines for the Management of Hospitalised Adults with COVID-19 were published recently, providing recommendations on appropriate pharmacotherapy.Patient, Intervention, Comparator and Outcomes questions for key interventions were identified by an international panel and systematic reviews were conducted to identify randomised controlled trials meeting the inclusion criteria. The importance of end-points were rated, and mortality was identified as the key “critical” outcome for all interventions. Random-effects meta-analysis was used to pool studies and provide effect estimates for the impact of treatments on mortality.Corticosteroids, hydroxychloroquine, azithromycin, remdesivir, anti-interleukin (IL)-6 monoclonal antibodies, colchicine, lopinavir/ritonavir and interferon-β have been reviewed.Our results found further evidence in support of the use of corticosteroids, particularly dexamethasone, and anti-IL-6 receptor monoclonal antibody therapy. These data support the need to identify additional therapies with beneficial effects on mortality.


2021 ◽  
Author(s):  
Raquel Sebio-García ◽  
Fernando Dana ◽  
Elena Gimeno-Santos ◽  
Manuel López-Baamonde ◽  
Marta Ubré ◽  
...  

Abstract Objective the main objective was to assess repeatability and learning effect of the six-minute walk test (6MWT) in a cohort of preoperative cancer patients referred to a prehabilitation program. As a secondary objective we aimed to identify determinants of improvement in the second test. Materials and Methods secondary analysis from a large prospective study on the implementation of a multimodal prehabilitation program in a real-life scenario. Eligible patients were assessed at baseline before starting the prehabilitation program. The 6MWT was conducted according to the American Thoracic Society (ATS)/ European Respiratory Society (ERS) guidelines with two tests being performed under identical conditions separated by 30 minutes. The distance covered (in meters) and the physiological responses (heart rate, oxygen saturation, fatigue and dyspnea) to each test were recorded and compared. Results 170 patients (60.9%) were analyzed. Repeatability of the distance covered with the 6MWT was excellent (ICC = 0.98; 95% CI: 0.92 – 0.99), but a mean increase of +19.5 meters (95% CI: 15.6 - 23.5m; p=<.001) in the second test was found, showing a learning effect with limits of agreement between -31.3 and 70.4m. Coefficient of variation was 4%. No clinical factor was found to be associated with an improvement in the second test. Conclusions the 6MWT showed excellent repeatability in preoperative cancer patients, but a significant learning effect is present. No associated factors with a clinically meaningful improvement in the second test were identified. In light of these findings, two attempts of the 6MWT should be encouraged in this population.


2021 ◽  
Vol 30 (162) ◽  
pp. 210200
Author(s):  
Winfried Randerath ◽  
Johan Verbraecken ◽  
Christel A.L. de Raaff ◽  
Jan Hedner ◽  
Simon Herkenrath ◽  
...  

Treatment of obstructive sleep apnoea (OSA) in adults is evolving, as new therapies have been explored and introduced in clinical practice, while other approaches have been refined or reconsidered. In this European Respiratory Society (ERS) guideline on non-continuous positive airway pressure (CPAP) therapies for OSA, we present recommendations determined by a systematic review of the literature. It is an update of the 2011 ERS statement on non-CPAP therapies, advanced into a clinical guideline. A multidisciplinary group of experts, including pulmonary, surgical, dentistry and ear–nose–throat specialists, methodologists and patient representatives considered the most relevant clinical questions (for both clinicians and patients) relating to the management of OSA. Eight key clinical questions were generated and a systematic review was conducted to identify published randomised clinical trials that answered these questions. We used the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to assess the quality of the evidence and the strength of recommendations. The resulting guideline addresses gastric bypass surgery, custom-made dual-block mandibular advancement devices, hypoglossal nerve stimulation, myofunctional therapy, maxillo-mandibular osteotomy, carbonic anhydrase inhibitors and positional therapy. These recommendations can be used to benchmark quality of care for people with OSA across Europe and to improve outcomes.


2021 ◽  
pp. 115-128
Author(s):  
P. V. Gavrilov

Timely detection of bronchiectasis in children is of great prognostic value. The importance of modern bronchiectasis in children is due to their possible reversibility over time with effective treatment, as well as a number of significant differences between bronchiectasis in childhood and onset in children, which may reflect different phenotypes of bronchiectasis. In adult patients with bronchiectasis that began in childhood, the pathological process has a more severe and worse prognosis compared to bronchiectasis that began in adulthood. In 2020, the European Respiratory Society proposed a new formulation of the terminal «bronchiectasis» for children and adolescents, now this term refers to an abnormal expansion of the bronchi by computed tomography (CT) of the chest, which, if detected early, can be reversible. CT is the true «gold standard» for confirming bronchiectasis in children and adolescents. This method is included in the minimum set of tests for children and adolescents with suspected bronchiectasis according to the recommendations of the European Respiratory Society. When conducting CT, it is recommended to perform a continuous spiral scan with a collimation of 1 mm, the study is carried out without intravenous use using low-dose protocols. To assess the state of the bronchi in children and adolescents, it is necessary to use the pediatric norms of the broncho-arterial ratio (> 0.8). At the same time, radiation methods are not decisive in establishing the causes of bronchiectasis and only in rare cases can help in establishing bronchiectasis. Dynamic observation of bronchiectasis for children and adolescents is determined individually. Consideration should be given to repeat chest computed tomography scans to answer the question that will change treatment.


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