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  1. The Triumvirate

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The murine nose is not an object of intense interest for chest doctors but perhaps it should be. Recent advances in CFTR modulator therapy in cystic fibrosis (CF) have been genotype specific and have therefore excluded many patients from new therapies. Gene therapy offers the prospect of helping people with CF, independent of genotype. On page 137, Alton and colleagues present an elegant picture of the potency of gene transfer using lentivirus. Go and take a look! Pre-clinical models include the murine nose and human air-liquid interface cultures. These studies pave the way for a F/HN-pseudotyped lentiviral vector first-in-man CF trial in 2017. Thorax wishes a smooth passage to these “…best-laid schemes…” and hopes they won't “Gang aft agley

PSALTI therapy

If you thought PSALTI therapy meant a few weeks of convalescence in a seaside boarding house, to help get rid of your chronic cough, then you are about a century out of date! Nowadays, PSALTI stands for physiotherapy, and speech and language therapy intervention. This includes breathing exercise, cough suppression techniques and the mysteries of “laryngeal hygiene”. Chamberlain Mitchell and colleagues describe a randomised controlled trial in 75 participants with chronic refractory cough (see page 129). They have shown that PSALTI reduces cough frequency by 41%. It is likely to be better for your cough than two weeks in Skegness…


…or twice in the case of guidelines for screening for latent TB in people with HIV. Individuals with HIV infection are at risk of reactivation of latent TB. There are two sets of UK guidelines - one from the National Institute for Health and Care Excellence (NICE) and another from the British HIV Association and they give differing advice. A research letter in this month's journal describes the implementation of these guidelines in 162 of the 188 areas of the UK who responded to their survey (see page 180). Just over half of these areas reported any screening for latent TB in this population and there was no relationship between screening and HIV burden. The authors call for a uniform national guideline.

Yogic not Yogi

If yogic breathing puts you in mind of a certain cartoon bear, then you spent too much of your youth watching TV. Low and middle income countries are a big market for big tobacco. In this month's Editors' choice on page 167, Sarkar and colleagues describe a large cluster randomised trial that evaluated a brief community based intervention for smoking cessation (15 minutes of advice on quitting plus training in yogic breathing). They enrolled 1213 smokers and found significantly better quit rates in the intervention group (2.6%) than in controls (0.5%). “Smarter than the average bear…”

Red sap of the elephant tree

Legend has it that the Cahuilla people from the Colorado Desert in California used the sap of Bursera microphylla as a panacea. More recently statins have become a modern day panacea with well-recognized benefits in the treatment and prevention of heart disease and stroke. However, their role in IPF has been controversial with some people believing them harmful. In this issue, Kreuter and colleagues analyse pooled data from the CAPACITY and ASCEND studies that suggest that patients taking statins had significantly reduced risk if death and 6 minute walk decline, hospitalization and respiratory mortality (see page 148). These studies should reassure patients about taking statins if they have IPF, but a prospective trial is needed before we could recommend ‘putting them in the water’.

Asthmatics make hay when the sun shines

Patients with allergic disease often experience symptoms when exposed to aeroallergens such as cut grasses, hence the name hayfever, which when combined with wheeze and bronchial hyper-reactivity support a diagnosis of asthma. However, in some cases diagnosing asthma is difficult and measuring Nitric Oxide in exhaled breath (FENO) may aid diagnosis. Karrasch and colleagues report that FENO measurements have high specificity (82%) and fair accuracy for asthma diagnosis with a diagnostic odds ratio of 9.23 and an AUC of 0.80 (see page 109). It is, therefore, interesting to learn that ‘feno’ means hay in Portugese. So, somewhat ironically, asthmatics can literally make hay during fenofever season.

Neighbours from Hell,

Television studios have made numerous series about disputes between neighbours, and G.K Chesterton said that ‘The Bible tells us to love our neighbours, and also to love our enemies, probably because generally they are the same people.’ Two very well acquainted neighbours in the thorax are the heart and the lungs. Whilst the heart is an infrequent visitor to Thorax, it has made a comeback in this issue (see page 161). Navaratnam et al describes how bronchiectasis increases the risk of coronary heart disease and stroke. Whilst it might be a stretch to describe the lungs and heart as nightmare neighbours, we are sure this audience would love to see a television show describing how inflammation in the lung promotes cardiovascular disease.

Don't try this at home…

On page 196 is a cautionary tail of “do it yourself” traditional medicine.

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