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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.
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.
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