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  1. The Triumvirate

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On 8 June, this year, voters in the United Kingdom will select their members of parliament (MPs) for 650 constituencies–lets hope they choose wisely. In this edition of Airwaves, we offer you an election special of politically themed recommendations from Thorax. We hope these are informative, challenging and a welcome antidote to pre election and post election punditry.

Agricultural Revolution

Farms in Ethiopia have experienced a dramatic increase in their use of pesticides in recent years. This has given rise to understandable concerns that agricultural workers may suffer ill effects from occupational exposure to these agents. Negatu and colleagues describe two cross sectional surveys of agricultural workers (see page 522). Workers exposed to pesticides were significantly more likely to experience breathlessness and chronic cough, compared to the unexposed. In the second survey there was also a significant negative effect on spirometry in exposed workers. Time for some robust occupational health measures!

Dangerous Coalition

Coalitions come in many forms and you may not wish to dwell on a coalition of urine and bleach. This month's journal we bring you occupational lung disease in cleaners (see page 579). It seems that an unsavoury mixture of urine and chlorine bleach produces chloramines–known sensitising agents for occupational asthma. The problem also afflicts swimming pool attendants and teachers. It remains to be seen whether 8 June will bring a coalition–unsavoury or otherwise.

Wealthier means healthier

In 1980 a conservative cabinet minister, Patrick Jenkin wrote, in the forward to the Black Report on social inequalities in health: “…there is generally little sign of health inequalities in Britain actually diminishing and, in some cases, they may be increasing…” Fast-forward to 2017 and Steiner et al describe–guess what–social inequalities in health (see page 530). Individuals with COPD, who live in the in the most deprived areas, are significantly less likely to complete pulmonary rehabilitation compared to their less deprived peers. However, in those that completed the course, deprivation did not diminish the benefit. The recommendations of the Black report were aimed at redressing these inequalities. The price tag was estimated to be an additional health expenditure of £2 billion per year. The Thatcher government said no. Will the new incumbent of number 10 be any more generous 35 years on?

Eat your greens!

There may or may not be an electoral breakthrough for the Greens in the June election. However, a breakthrough for greens in COPD is reported by Kaluza et al (see page 500). This Swedish cohort study found that eating lots of fruit and veg was related to a lower incidence of COPD in both current and ex-smokers. Greens had no effect on the virtuous never smokers. This finding should not minimise the far greater importance of quitting smoking!

Forty winks on the back benches

Not all politicians are ruthless careerists. Some are content to doze gently on the back benches whilst their honourable friends make their maiden speeches. If so, they may be at risk not only of obstructive sleep apnoea (OSA) but also secondary nocturnal hypertension. Serinel and colleagues describe a novel randomised double blind controlled trial where patients with OSA and hypertension were randomised to receive an anti-hypertensive in the morning or the evening (see page 550). All participants subsequently received CPAP. Sleep systolic blood pressure came down but there was no difference between the timings. Good news for MPs snoozing through late night sittings!

Rising levels of CO2 aren't all bad?!

The effect of rising levels of CO2 in the environment remains a surprisingly contentious issue, presumably because strategies to tackle it are likely to be more painful in the short term than ignoring or denying it. However, we wouldn't recommend climate change deniers get too excited by the concept of protective, or therapeutic hypercapnia, as described in this issue of Thorax (see page 538). Otulakowski and colleagues used Genome Wide gene expression analysis to understand the effects of hypercapnia associated with ventilator induced lung injury. They found the rising CO2 protects against VILI by inducing synthesis of α-tocopherol transfer protein (aTTP) and α-tocopherol (vitamin E). So at least if a party that denies the importance of climate change does get elected in to office, at least we might not have to worry about vitamin E deficiency?!

What to do in the event of a surprise election result

If the surprise of an election victory for the Liberal Democrats causes you to choke on your nutty granola breakfast cereal then you might need to know the quick fix, as beautifully demonstrated by Dr Hind (see page 576). This study demonstrates that an appropriately performed chair thrust maybe superior than the traditional Heimlich manoeuvre for removing foreign objects from the upper airway. However, be careful getting it wrong may leave you cursing more than a surprise election victory.

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