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Bodduluri and the COPDGene Investigators investigated the relationship between CT derived local lung expansion and contraction (Jacobian determinant) and functional outcome in COPD (see page 409). The deformation field between the two lung volumes, mapping local volume change with respiration, was associated with health related quality of life, exercise capacity and mortality. Will this be part of lung functioning testing going forward? Shiraz only knows.
The ‘Cristal’ Maze
John and colleagues are not using a crystal ball to try and see the future but genome-wide data (see page 400). They enrolled over 4000 adults to investigate if the genetic regions that impact on cross-sectional lung function were important in determining longitudinal lung function. In particular, they focussed on 26 known genetic regions and analysed the effect on longitudinal changes in FEV1 and FEV1/FVC. Although these regions had a strong relationship with baseline lung function, there was no effect on longitudinal lung function…predicting the future is more difficult than you think as the editorial highlights (see page 389).
Chateauneuf de PAP
Howard and colleagues report the next installation of PAP treatment for OHS – CPAP vs. NIV (see page 437). After 3 months, the investigators observed that the frequency of hospital admission, persistent chronic respiratory failure and non-adherence was similar in both the CPAP and NIV group. Indeed, there were similar improvements in both groups in terms of gas exchange, daytime somnolence and quality of life. As highlighted in the editorial (see page 398), it is always important to consider the enrolled patients who had clinically significant OSA and thus the findings may not be extrapolated to patients with OHS with mild or no OSA…roll on the outcome of the Pickwick Trial and we will open another bottle…
Demeyer and the PROactive consortium investigated the impact of semi-automated telecoaching, rather than the grapevine, on physical activity in COPD as part of a six centre European randomised controlled trial (see page 415). The 12-week programme included an exercise booklet with the exercise incentivisation provided by a step counter giving direct feedback as well as feedback via a smartphone application. The telecoaching group increased in step count, daily activity and exercise capacity…just remember you heard it here first, and not on the grapevine…
A Bottle of Bubbly
We should raise a glass of champagne to Gray and colleagues who have delivered an important study investigating lung function in African infants (see page 445). The Drakenstein Child Health Study enrolled 645 infants in a South African birth cohort and measured lung function at between 6–10 weeks of age. Infant size, sex, maternal smoking, maternal alcohol, maternal HIV and household benzene were associated with altered early lung function. Many of these would be treatable characteristics as part of a public health initiative…we will raise another glass when these measures are put in place…a Triumvirate Cheers
Wine Tasting in Napa Valley
When tasting a glass of red wine you and I may well be able to determine its origin, and the Masters of Wine will certainly be able to describe the grape and the year. However, an easier option is to look at the demographics on the label. In this issue Brownell and colleagues from Northern California, home of some fine wines, describe a score that takes into account the prevalence of Usual Interstitial Pneumonitia, age and gender that may reduce the requirement to ‘taste’ the lung with a biopsy (see page 424). We'll raise a glass to that.
Too much Blue Nun
A common cause of ARDS is aspiration pneumonia which may occur following a glass too many of Blue Nun. When pulmonary hypertension (PHT) occurs it is associated with poorer outcomes. Pandolfi and colleagues describe that ceramide and IL6 promote the development of PHT through direct effects on pulmonary artery smooth muscle cells and inhibiting acid sphingomyelinase in a rat model of ARDS limited PHT and ventilation-perfusion mismatch (see page 460). However, we do no recommend inhibiting acid sphingomyelinase prophylactically if you are taken to drinking Blue Nun, but would suggest quality rather than quantity.
Would you inhale your Chateau Margaux 1787?
Thomas Jefferson owned a bottle of Chateau Margaux 1787, which when famously dropped and broken at the Fours Season's restaurant in New York resulted in a $225,000 pay out. The wine was recovered in a plastic container and described as “a thick goo with an intense aroma'. It is well known that the skin of grapes contains resveratrol, and that is justification enough for many for a glass or two of red wine. However, with the exception of the most diligent of connoisseurs, people generally drink rather than inhale it. However, in this issue Navarro and colleagues describe the benefit of 1mg/kg (equivalent to about half a glass of 1992 Pinot/mouse/month1) of resveratrol instilled, intratracheally each month into the lungs of telomerase deficient mice (see page 451). Telomerase deficient mice show severe premature aging that was ameliorated by resveratrol, which slowed the loss of lung function, promoted alveolar epithelialcell survival and maintained lung structure. Now where did we put that bottle of Vosne Romanee.