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‘Complete control’, the 1977 single from the Clash, was a violent response to attempts by record company executives to control the band’s output. Health professionals and patients, also aspire to complete control - of asthma. In a systematic review in this month’s Thorax Petsky and colleagues rigorously evaluate asthma control through eosinophilic markers (exhaled nitric oxide or sputum eosinophils) ( see page 1110 ). They include 16 studies based on the use of FeNO and six which used sputum eosinophils. Participants (who included both adults and children) randomised to the eosinophilic marker strategies were significantly less likely to have exacerbations. However, complete control was not achieved for inhaled corticosteroid dose, asthma control or lung function, with no significant difference between arms. So ‘complete control’ of the airways proves just as elusive as control of errant musicians…
The link between a 1980s new wave hit and alveolar macrophages may not be obvious but here it is. The band who gave us ‘Turning Japanese’ were the Vapours and those who vape (vapers?) may be putting their alveolar macrophages at risk. The paper by Scott et al has already the subject of media attention ( see page 1161 ).The authors describe the pro-inflammatory effects of e-cigarette vapour condensate on human alveolar macrophages. E cigarette liquid which has been through the vaping coil is significantly more toxic to alveolar macrophages than non-vaped liquid. The vaped liquid may induce an inflammatory state in macrophages and impair bacterial clearance. E cigarettes containing nicotine have been banned in Japan since 2010. Time to turn Japanese?
CRONICAS obstructive pulmonary disease
For many of us, Peru conjures condors, panpipes and Paddington’s Aunt Lucy. However, in this month’s journal, Catherine Miele describes the work of the CRONICAS cohort study group to determine the factors which lead to an accelerated decline in lung function in Peru ( see page 1120 ). The researchers studied a group of 3048 older adults from four poor areas of Peru who were followed up for an average of 2 and a half years. Data were stratified for age, sex and location. In a multivariable linear mixed-effects regression model the key factors in lung function decline were urbanisation, living at high altitude and hypertension. In a linked editorial, Andre Amaral and Jenni Quint conjecture that cigarette smoking and biomass fuel may not be the whole story in the evolution of COPD in resource-poor countries ( see page 1103 ).
Got a cough? get a check!
A Joe Jackson song cynically remarks: ‘Everything gives you cancer…’ However, areas of high deprivation and lung cancer incidence seem like a good place to start an awareness campaign. Early diagnosis of lung cancer offers the possibility of treatment with curative intent for some. In this month’s Thorax, Kennedy and colleagues describe the outcomes of an early diagnosis campaign for lung cancer in Leeds ( see page 1128 ). The authors observed a more than 80% increase in chest X-ray requests, following the campaign. There was a shift towards earlier stage lung cancer with an almost 9% increase in patients diagnosed with stage I/II lung cancer and a 9% reduction in the number of patients with stage III/IV disease. Joe Jackson also wrote the pro-smoking essay ‘Smoke, Lies and the Nanny State’. Sometimes Nanny knows best!
The epigram ‘the child is father of the man’ has been worn smooth with overuse. However, if can readily be applied to the work of Alice Hadchouel and her co-workers in this month’s issue ( see page 1174 ). In a cohort of individuals who had been born prematurely and were followed up to adolescence, they found that preschool wheeze is an independent risk factor for FEV1 impairment in adolescents. The authors suggest that this should encourage optimal management of early respiratory symptoms in preterm-born infants. Sadly there are no epigrams to summarise what this optimal management might look like…
Occam’s razor vs. Hickam’s Dictum
Do you know your Occam’s razor from your Hickam’s Dictum? Test your diagnostic abilities (and philosophical knowledge).
Competing interests None declared.
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