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  1. Wisia Wedzicha, Editor-in-Chief

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    Lower limb acivity in COPD

    As Morgan reminds us in his editorial in this month’s Thorax, maintaining physical activity plays an integral role in health and an increase in physical activity leads to a better prognosis in chronic obstructive pulmonary disease (COPD). In this issue, using activity monitoring, Walker and colleagues show that lower limb activity is reduced in COPD compared with normal patients and also lower limb activity is related to total daily activity. Lower limb activity improved after pulmonary rehabilitation and was predicted by forced expiratory volume in 1 s. However, as Morgan summarises at the end of his editorial, the results show that activity in COPD was not related to quality of life or functional exercise capacity and is thus a different domain of outcome measurement.See pages 663 and 683

    Expectorated bronchial cast. See Image page 754.

    Influenza-like illness in care homes

    In this issue, we publish a paper by Hui and colleagues that examines influenza-like illness in four residential care homes in Hong Kong over 12 months. These illnesses are important as they are a major cause of hospital admission and thus healthcare costs. An infectious cause was found in 61.4% of episodes (53.3% of these being bacterial infections and the remainder viral infections). Multiple infections were found in 16% of patients. Clinical features did not predict the underlying aetiology and there was no association between influenza vaccination status and aetiology, clinical presentation or outcome. The authors conclude that clinical presentation of these influenza-like illnesses is non-specific and is not usually due to influenza in this population.See page 690

    Varenicline for smoking cessation

    Varenicline is a recently introduced pharmacological treatment for smoking cessation that has been shown to be more effective than placebo and buproprion. In this month’s Thorax, Aubin and co-authors report on the first randomised trial that compares varenicline with transdermal nicotine as an open-label study. The results show that abstinence from smoking was greater and craving, withdrawal symptoms and smoking satisfaction were less with varenicline than with transdermal nicotine. In the accompanying editorial, Aveyard discusses the role of varenicline in smoking cessation and reminds us that stopping smoking involves more than just nicotine dependence and thus cognitive–behavioural therapies need to be developed with judicious use of medications.See pages 666 and 717

    Four-week end of treatment continuous abstinence rate (weeks 9–12 for varenicline and weeks 8–11 for nicotine replacement therapy (NRT) for the Primary Analysis Population (all randomised and treated participants who took at least one dose of study medication).

    Lung transplantation for CF

    In this issue, we publish two papers on outcomes of lung transplantation for cystic fibrosis (CF). Meachery and co-workers report the outcome in a UK cohort of patients with CF. Good functional outcomes were obtained, with 82% survival at 1 year and 51% at 20 years. As expected, those with Burkholderia cepacia (BCC) infections had poorer outcomes. The risk of bronchiolitis obliterans increased with time. In the second paper, Boussaud and colleagues report the outcome of lung transplantation in France, focusing on infection with BCC. The authors show that mortality was only increased in one type of BCC (Burkholderia cenocepacia). In the accompanying editorial, Noone discusses the two papers and concludes that patients with CF colonised with BCC should not be excluded from consideration for lung transplantation.See pages 668, 725 and 732

    CT scan of the chest showing bilateral nodular infiltrates. See Pulmonary puzzle page 746.
    Unusual finding in bronchoalveolar lavage. See Pulmonary puzzle page 746.
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