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Highlights from this issue
  1. The Triumvirate
  1. Lane Fox Respiratory Service, Guy’s and St Thomas' NHS Foundation Trust, London, UK

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The ‘Carry On’ films consisted of 31 British comedies that were produced between 1958 and 1992. In this edition of Airwaves, we consider if ‘Carry on Thorax’ would have made the Director’s cut…

Carry on Columbus

Although it has been over 500 years since Christopher Columbus discovered the Americas in 1492, it took Kamdar et al from the US 5 years to investigate the occupational outcome of patients after acute respiratory distress syndrome (ARDS) (see page 125). In a 5-year multisite prospective longitudinal cohort study, 138 ARDS survivors were followed up with 31% never returning to work over 5 years of follow-up. Predictors of delayed return to work included baseline comorbidity, mechanical ventilation duration and discharge location. The loss of earnings ranged from £28,662 to £32,515 per person per year.

Carry on Spying

A top-secret formula stolen by STENCH (the Society for the Total Extinction of Non-Conforming Humans) is the basis of this carry on farce. The algorithm for auto-adjusting continuous positive airway pressure devices is similarly surrounded by secrecy. Bloch et al investigated whether auto-CPAP is equivalent to fixed level CPAP in improving sleepiness in obstructive sleep apnoea syndrome (see page 174). In this multicentre equivalence trial, 208 somnolent severe OSA patients were randomised to auto-CPAP or fixed level CPAP. Co-primary outcomes were changes in subjective and objective sleepiness. At 2 years, auto-CPAP and fixed level CPAP were equivalent in patients with similar treatment costs. Better keep the secret formula under wraps….

Carry On Spying (the sequel)

The villain in Carry on Spying, an affectionate spoof of Graham Greene’s Third Man, is STENCH and indeed the stars of this film may well have been the acronyms. One could only wonder what they would have made of Neutrophil Extracellular Traps (NETs) but one suspects it would have involved a degree of innuendo not apparent in the manuscript by Gray et al (tempting but I wont do it) (see page 134). The authors found that neutrophils from patients with CF have reduced apoptosis and increased production of NETs, which in turn promotes inflammation. These defects were in part reversed through administration of Ivacaftor, which induced apoptosis in CF neutrophils. So whilst NETs would almost certainly have been approved of by the Society for the Neutralisation of Germs (SNOG) their pro-inflammatory effects would probably have not promoted their adoption by the Society for the Monopoly of Universal Technology (SMUT).

Carry on Screaming

Monsters Oddbod and Oddbod Junior were genetically identical but in the film there was marked phenotypical differences. Delgado-Eckert et al may have used this as inspiration when reporting the asthma exacerbation risk and response to long-acting β-agonists based on daily fluctuations of lung function in their study (see page 107). A cluster approach to phenotyping was used, incorporating twice-daily lung function measurements in 696 healthy and asthmatic school children (PASTURE/EFRAIM dataset) and 138 asthmatic adults (BIOAIR dataset) with mild-to-moderate or severe asthma. In the PASTURE/EFRAIM dataset, there were 4 clusters identified. Two clusters included children with clinical features of asthma but in cluster 3, children were from a farming environment with the majority carrying the asthma-risk allele rs7216389 of the 17q21 locus. In the BIOAIR dataset, 2 distinct clusters that discriminated mild-to-moderate and severe asthma were identified.

Carry on at your convenience

Bathroom ceramics factory W C Boggs & Son, with a major debt to the bank, would have been most appreciative of the financial advice that could have been provided from the next study. Indeed, Kerkhof et al report the prevalence of severe uncontrolled eosinophilic asthma (SUEA) and its cost using the UK Clinical Practice Research Datalink and the Optimum Patient Care Research Database (see page 116). SUEA was defined ≥ asthma attacks with a high blood eosinophil count. 363,558 active asthmatics with an elevated eosinophil count were identified with 2940 patients exhibiting severe uncontrolled eosinophilic asthma. Less than 1% of patients in a general asthma population have severe uncontrolled eosinophilic asthma, but these patients account for much greater asthma-related costs.

Carrying on Up the Khyber

When Sir Sidney Ruff-Diamond was asked what he intended to do in the face of impending doom he replied, “Do? Do? We’re British. We won’t do anything…” Major Shorthouse interjected “…until it’s too late.” “Exactly! That’s the first sensible thing you’ve said all day.” Sir Sidney Ruff-Diamond exclaimed. Let’s hope our partners around the world do not adopt this approach to air pollution as the consequences for patients with lung disease could be grave. This is exemplified by the manuscript by Dr Sese et al, which highlights the consequence of pollution in a cohort of IPF patients (see page 145). They demonstrate that exacerbations of IPF were associated with increasing Ozone and the PM10 and PM2.5 levels were associated with increased mortality. Whilst some may prefer the approach taken by Sir Sidney Ruff-Diamond our suggestion would be to take serious steps to reduce air-pollution around the globe.

Carry On Cleo

Stars two British artisans Hengist Pod, who famously invented the square wheel, and Horsa, are taken from Britain to Rome in an age when many believed that the Romans brought mycobacteria to Britain (http://www.sciencemag.org/news/2003/01/tuberculosis-uk-not-romans-fault). Dr James et al use Custom-quantitative PCR assays, microscopy and phylogenetic analyses to determine that the origin of an outbreak of metal workers hypersensitivity pneumonitis in the UK was due to a mycobacterium species closely related to MAI (see page 151). Understanding the aetiology of MWHP may now help develop preventative strategies for this occupational lung disease.

No laughing matter…

Can you identify this month’s mystery object? See page 195 for details.


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