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Highlights from this issue
  1. The Triumvirate

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This month’s “Airwaves” celebrates the musicals from the West End, Broadway and the Silver Screen…the Triumvirate’s guilty pleasure!

Grease: asthma self-management at Rydell high?

We don’t know if the effectiveness of school-based self-management interventions for asthma among children and adolescents was evaluated in Rydell High School. If it had been, it is likely that the “T birds” and the “Pink Ladies” would have been: “…wrapped up in trouble, laced with confusion…” No such confusion is evident in the systematic review reported by Dylan Kneale and colleagues ( page 432 ). They found 33 eligible randomised controlled trials and conclude that school-based interventions were effective in reducing emergency department visits and hospitalisations. It is not clear whether school absence is reduced or indeed whether such interventions might avoid “beauty school drop-outs.”

Mama Mia: how does cystic fibrosis affect birthweight?

The Nordic countries are famous for the quality of their patient registries and for Abba – winner of the 1974 Eurovision Song Contest and inspiration for many musicals and films, including “Mama Mia”. In this month’s Thorax, Daniela Schlüter and colleagues ( page 447 ) describe a national registry linkage study from Denmark and Wales which compares new-borns with cystic fibrosis (CF) to the general population. The CF babies were more likely to be born preterm and with low birth weight than the comparison group. The authors conclude that CF affects intrauterine growth, leading to reduced birth weight (partly through prematurity). CF clinicians have known for many years that improving nutrition from diagnosis is a priority in CF: “Mama Mia, here we go again…?”

The Pirates of Penzance

Gilbert and Sullivan’s opera about noble pirates has been an inspiration for many, including Tom Lehrer who famously wrote the Elements song that included a list of noble gases. Little did they know that on of these noble gases, Xenon would lead to a new imaging modality for the functional assessment of Idiopathic Pulmonary Fibrosis. In this issue of Thorax, Weatherley and colleagues ( page 500 ) describe a technique using Xenon to measures gas exchange in regions of fibrotic lung and how it changes over a year. It is able to detect changes in diffusion even when not possible through global assessments of gas transfer using the standard technic of DLco. Hopefully, we wont have to wait as long for Xenon to hit the mainstream as poor Mabel had to wait for the noble pirate Frederic.

Dracula the musical

Bram Stoker was famous for creating a monster that slept all day, would wake up at night stretch, and promote injury through extraction of blood. Not an obvious source of musical entertainment. IPF is a monstrous disease and stretching of the lung is a proposed mechanism of fibrosis, although how blood products contribute is less clear. In this issue of Thorax, Shimbori and colleagues ( page 455 ) describe how plasma tryptase derived from mast cells that have degranulated in response to mechanical stress may promote fibrosis through activation of TGFb. Maybe, the mast cell stabiliser cromoglycate would be a more be a better way to treat vampires as wooden stakes or silver bullets have as far as we are aware yet to be tested in a RCT.

‘Everything’s free in America’

Although the outcome of West Side Story, depicted from the 1961 film, is the tragic and untimely death of Tony, perhaps the current re-make being shot by Steven Spielberg will be more upbeat. Indeed, Jilles Fermont and colleagues may have got their direction for their systematic review and meta-analysis of biomarkers and clinical outcomes in COPD ( page 439 ) from the original film in order to find a way to avoid such tragic endings. The authors assessed the associations between physiological and performance measures, immune and inflammatory profiling and cardiovascular measures. Shorter 6MWD and elevated heart rate, fibrinogen, CRP and WCC were associated with higher risk of mortality. Shorter 6MWD and elevated fibrinogen and CRP were associated with exacerbation, and shorter 6MWD, higher heart rate, CRP and IL-6 were associated with hospitalisation. It is time to find re-write the script for both COPD and West Side Story to prevent such tragic endings.

Guys, Dolls

As morality battles with immorality at the Save-a-Soul Mission, the small-time gambler Nicely-Nicely Johnson rejoices in “Sit Down, You're Rockin' the Boat” and recalls a dream that encourages him and his fellow gamblers to repent. Although not necessarily “Rockin' the Boat”, Alicia Gayle and colleagues ( page 483 ) are definitely giving NHSE policy makers food for careful thought. The authors investigated causes of death for patients with chronic respiratory disease in England over a 10 year period. Using linked primary care and mortality data the authors found that chronic respiratory disease mortality was 54% higher than the general population with respiratory-related mortality constant over 10 years, while cardiovascular-related mortality decreased over the same time period. Not surprisingly, COPD accounted for the majority of respiratory-related deaths. Just as Nicely-Nicely Johnson modified his choices in life to improve his outcome, so must NHSE and NICE modify their choices to invest to improve the outcome of our patients with chronic respiratory disease.

Take my breath away…

“Top gun” has not yet been made into a musical. However, a future musical is bound to feature the song: “You take my breath away…” The same could be said for the lobulated mass in the left lower lobe shown here. See page 519 to test your diagnostic skills.

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