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  1. Wisia Wedzicha Editor-in-Chief

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    STANDARDS OF CARE FOR OCCUPATIONAL ASTHMA

    In this month’s Thorax, we publish the standards of care document for occupational asthma that has been developed by the British Thoracic Society Standards of Care Subcommittee responsible for developing guidelines on occupational asthma. As pointed out in the introduction to this document, occupational asthma remains a common disease in the UK, with up to 3000 new cases diagnosed each year. It is also estimated that one in 10 cases of adult onset asthma relate to sensitisation in the workplace. This is an important document for all respiratory clinicians. I also recommend the editorial by Tarlo in which she discusses the significance of occupational asthma and also “work-related asthma” when asthma worsens at work but is not in fact occupational asthma caused by workplace sensitisers.

    See pages 190 and 240

    SALBUTAMOL AND ACUTE LUNG INJURY

    Acute lung injury (ALI) is an important cause of mortality in critically ill patients and is associated with alveolar oedema. Novel interventions are necessary. In this issue of Thorax we publish a very interesting paper on the effect on salbutamol in ALI by Perkins and colleagues with an editorial by Matthay and Lee discussing these results. Interest in salbutamol therapy in ALI came after a ranodmised controlled trial showed that 7 days’ treatment with intravenous salbutamol reduced extravascular lung water in ALI. Perkins et al show with both in vivo and in vitro work that salbutamol may stimulate epithelial repair. This original observation has important therapeutic implications and further trials in critically ill patients will now be required.

    See pages 189 and 215

    Figure 1
    Figure 1 Effect of intravenous infusion of salbutamol on PiCCO permeability index in patients with acute respiratory distress syndrome. The permeability index was derived from the ratio of extravascular lung water divided by pulmonary blood volume, as measured by the PiCCO system.
    Figure 2
    Figure 2 (A) Chest radiograph showing a pleurally-based opacity occupying the majority of the right hemithorax. (B) Contrast-enhanced CT image at the level of the aortic arch showing a heterogeneous pheurally-based mass with a medial rim of fat. (C) Selective digital subtraction angiogram of the right fifth intercostals artery confirming an intercostals artery aneurysm that was subsequently embolised (see page 294).
    Figure 3
    Figure 3 Immunohistochemical detection of somatostatin (sst) receptor sst2A in naïve mouse lung and after bleomycin instillation. In normal lung, sst2A was expressed by alveolar macrophages, epithelial bronchial cells, arterial and bronchial smooth muscle cells, some endothelial cells and some type 2 pneumocytes (inset).

    SOMATOSTATIN ATTENUATES PULMONARY FIBROSIS

    Idiopathic pulmonary fibrosis (IPF) is another condition with a poor prognosis and for which we desperately need novel interventions. Somatostatin is best known as a regulator of growth hormone secretion, though somatostatin receptors are found in the lung and expression of these receptors is increased in IPF. Borie and colleagues describe an animal experiment using the bleomycin model with a new somatostatin analogue (SOM230). The authors show that the somatostatin analogue has antifibrotic effects, perhaps mediated through TGF-β. This is thus another promising compound where clinical trials need to be developed in patients with IPF.

    See pages 251

    COMPLICATIONS ON PAVMS

    Although pulmonary arteriovenous malformations (PAVMs) are relatively rare, the consequences if PAVMs can be serious, sometimes resulting in development of ischaemic stroke or brain abscesses. Predicting which patients are likely to develop these complications is important. In this month’s Thorax, Shovlin and colleagues describe a cohort study of patients with PAVMs and many associated with hereditary haemorrhagic telangiectasia (HHT). They show that the size, severity and symptoms did not predict risk of complications. PAVM embolisation reduced ischaemic stroke. The authors conclude that greater emphasis is required on HHT diagnosis and PAVM screening as many PAVMs are asymptomatic.

    See pages 259

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