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  1. The Triumvirate

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“I do not like them Sam-I-am, I do not like green eggs and ham.”

It turns out that the green eggs are OK but you are best to avoid the ham—if you have asthma. On page 206 of this month's Thorax, Zhen and colleagues describe their findings from an analysis of the French EGEA study (Editors' choice). Participants who ate cured meat four times a week or more, were almost twice as likely to report a worsening in their asthma symptoms over the 7 year follow up period. They describe both a direct effect and one mediated by body mass index. Sadly the effect of green eggs is not documented.

“À bout de soufflé…”

…or in English translation Breathless burst onto cinema screens in 1960 and established Jean-Luc Godard as a leader of the French New Wave. However, it seems that if we relieve an individual's feeling of breathlessness they become more susceptible to pain. On page 230 of the journal, we bring you more French nouvelle vague—new wave physiology this time. Laurence Dangers and colleagues describe the analgesic effect of non invasive ventilation in volunteers. In patients with amyotrophic lateral sclerosis, the reverse effect is seen, as dyspnea is relieved pain threshold is also reduced.

“My family and other animals…”

“Cats, dogs, day care, bedroom sharing and older siblings” might sound like the plot of one of Gerald Durrell's autobiographical novels (well perhaps not daycare). However, in this case the list describes something very different—the biodiversity index. On page 236 Campbell and colleagues use European Community Respiratory Health Survey (II) data from over 10,000 people to investigate the risk of atopy for individuals brought up on a farm compared with those raised in an urban environment. They find significantly lower risks of atopic sensitisation, atopic bronchial hyper-responsiveness, atopic asthma and atopic rhinitis in the adults brought up on a farm. There was no effect on non-atopic outcomes. It bears out the old adage “…a dirty child is a happy child”.

“Complete control”

This 1977 single by The Clash was a tirade against record company executives but could easily be an objective of diabetes care—“complete control” of blood sugar. Yoon et al ask what effect diabetes and diabetes control might have on response to treatment for tuberculosis (see page 263). They describe the effects of diabetes on treatment response for a cohort of patients with TB. Patients with uncontrolled diabetes were significantly more likely to have a positive TB sputum culture after 2 months of treatment. Treatment failure and death were also more common in the group with diabetes, when compared with well-controlled diabetes or individuals without diabetes.

“Then I saw her face, now I'm a believer…”

If this is what you are playing on your HiFi then your musical tastes are many decades out of date. Or you might just be thinking of the BeLieVeR-HIFi study that showed the beneficial effect of, bronchoscopically placed, endobronchial valves in patients with advanced emphysema and interlobar collateral ventilation. On page 277 Zoumot and colleagues describe the outcome for control patients in the open label extension from the BeLieVeR-HIFi study, who had endobronchial valves placed combined with patients in the treatment arm without collateral ventilation. Three months after treatment, FEV1 increased by over a third and residual volume was reduced in twelve control patients who received valves. The 6 minute walk test and symptoms of dyspnea also improved. Will you be a believer?

If you know your ABC……

There's a pretty good chance you can become an ILD physician. It has long been a complaint that acronyms are far too prevalent in ILDs, what with your UIPs, NSIPs, CFPEs, RBILDs, DIPs etc. This is made worse as our understanding of the genetic risk of ILDs continues to increase. A particularly unpleasant genetic abnormality is homozygous deletion of the ABCA3 gene. As described by Kroner and colleagues on page 213 these patients usually do not survive beyond a few weeks and patients heterozygous for the null mutation do only marginally better. Although therapies have some effect the overall long-term survival for children with ABCA3 mutations is poor. It is clear that ILD physicians need to understand our ABC, rather than just knowing it.

An unusual cause of epigastric tenderness…

The importance following up on the results of TB screening tests (in the challenging environment of refugee health) is described on page 282 of this month's issue. This Case based discussion describes an unusual cause of epigastric tenderness.

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