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No sense of self-preservation?
The editors were surprised to learn that over 40% of patients with COPD have positive anti-nuclear antibodies. This feature was not associated with smoking status, gender or severity of airflow limitation but did occur more commonly in patients with a low BMI. Whether the presence of positive anti-nuclear antibodies reflects a non-specific effect of tissue damage or an important and modifiable pathogenic pathway is not known. Self-perpetuating autoimmune inflammation could explain a number of features of established COPD including the continuation of airway inflammation and progressive airflow obstruction despite smoking cessation, and the presence of activated oligoclonal CD4+ lymphocytes within the airways. COPD and autoimmunity does seem to be an area which is gathering steam—or will it prove to be mere hot air? More work is needed. See page 101
Losing the lottery
Readers will be aware that occupational asthma can lead to long-term disability, unemployment and loss of income but will be surprised by the size of the financial costs. Ayres et …