Latent Tuberculosis Infection

Tuberculosis (TB) is a major global public health problem and is the leading cause of death linked to a single pathogen, ranking above human immunodeficiency virus (HIV).1 Clinically, TB has been categorised as active disease (patients who are generally symptomatic and may be infectious if pulmonary involvement is present) and latent infection (asymptomatic and not infectious, but at variable risk for progression to active TB disease). It is increasingly being recognised that latent TB infection (LTBI) reflects diverse responses to infection with Mycobacterium tuberculosis and may lead to heterogeneous clinical outcomes. In an expert interview, Jean-Pierre Zellweger discusses the latest World Health Organisation (WHO) guidelines on the management of LTBI.

Inducible Laryngeal Obstruction in the Paediatric Population – Review of the Literature and Current Understanding

Inducible laryngeal obstruction (ILO) is a complex entity and its exact mechanisms are still unclear. It is characterised by transient and reversible narrowing of the larynx in response to external triggers, resulting in symptoms such as cough, dyspnoea and noisy breathing. The prevalence of this condition in adult or paediatric populations is uncertain. Management of ILO starts by establishing an accurate diagnosis, and treatment includes control of trigger factors, breathing and relaxation techniques, and speech and respiratory therapy. The aim of this article is to summarise current understanding and provide a review of the literature of ILO in the paediatric population.

Challenges in Diagnosing and Treating Obstructive Sleep Apnoea in Children

Prompt diagnosis and treatment of obstructive sleep apnoea in children is essential to prevent multiple health consequences, but distinctive symptoms are scarce. While overnight polysomnography is the standard diagnostic tool, it is not widely available. Nocturnal oximetry, respiratory polygraphy and standardised questionnaires are useful alternatives. Treatment options include positive airway pressure, weight loss interventions and anti-inflammatory treatment with nasal corticosteroids and/or oral montelukast. Combined treatment modalities may improve outcomes.

Epidemiology, Diagnosis and Available Treatment for Alpha 1 Antitrypsin Deficiency-related Emphysema in Europe

Alpha 1 antitrypsin (AAT) deficiency (AATD) is a rare genetic risk factor that predisposes an individual to develop early-onset emphysema. While accurate diagnosis of severe AATD is an important goal of clinical care, a minority of individuals with AATD are diagnosed and lack of awareness about the disease is the major suspected cause for this. Since the 1980s, therapy with human plasma-derived AAT has been the only specific treatment for AATD aiming to slow emphysema progression. The first randomised controlled trial to demonstrate this slowing of disease progression with AAT was the Randomized, placebo-controlled trial of augmentation therapy in Alpha1 Proteinase Inhibitor Deficiency (RAPID) study. The RAPID programme, consisting of the initial trial plus its open-label extension (OLE), is the largest completed clinical study of AAT therapy in AATD and the only trial designed specifically to explore the disease-modifying effect of AAT treatment. The RAPID-OLE data substantiate those of the RAPID trial, establishing the sustained efficacy and good tolerability for AAT treatment, providing evidence that AAT treatment modifies the disease course, and supporting the importance of early intervention.

The Use of Triple Therapy in Chronic Obstructive Pulmonary Disease and Outcomes of the IMPACT Trial

Triple inhaled therapy for chronic obstructive pulmonary disease (COPD) comprises the combination of an inhaled corticosteroid (ICS), a long-acting β2-agonist (LABA) and a long-acting muscarinic antagonist (LAMA). The use of triple therapy is recommended by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) for patients who experience recurrent exacerbations despite treatment with either a dual bronchodilator or LABA/ICS combination.1 Evidence exists for the superior efficacy of triple therapy compared with LABA/ICS and LAMA monotherapy with regards to improved lung function, health status, and exacerbation rate. However, the benefits of triple therapy compared with dual bronchodilation (LABA/LAMA) are uncertain.2 The IMPACT study compared triple therapy and dual inhaler therapy comprising LABA/LAMA in patients with COPD.3 In an expert interview, Dr Cazzola discusses this study and its implications for clinical practice.