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At the end of June, the Triumvirate comes to the end of a 7 year stint as editors in chief of Thorax. We will hand over to a new Triumvirate of Cecilia O’Kane, Mark Griffiths and Jenni Quint. As we say farewell, we would like to thank everyone who made our time at Thorax so rich and rewarding: the editors (deputy, associate and statistical); the reviewers (for providing careful critiques in their non-existent free-time); the authors (for sending us their rigorously conducted research and often surprising findings); and to all the team at the BMJ group. Thank you! So as we finish our 7 year stretch, this month’s Airwaves takes its theme from popular culture and from characters who have served a long sentence…
‘Doing porridge’ is a British slang word for serving a period in prison and the name of a classic British sitcom charting the prison adventures on the old lag Fletcher and the inexperienced Godber, in Her Majesty’s Prison Slade. ‘Snout’ (tobacco) is a currency used frequently by Fletcher, undoubtedly leading to secondhand smoke exposure for Godber. But what would Fletcher make of e-cigarettes and should he care about Godber’s secondhand exposure to vaping? In this month’s journal (see page 663), Islam and colleagues present data from young adults in the Southern California Children’s Health Study cohort. Secondhand nicotine vape exposure increased from around 12% to 16% over 5 years and was associated with an increased risk of bronchitic symptoms and shortness of breath. An accompanying editorial (see page 638) cautions against replacing passive smoking with passive vaping. Incarceration in a prison cell could lead to prolonged exposure. Fletcher says to Godber in ‘Porridge’: ‘…you've got to tell yourself, you're just having a quiet night in.’ To which he replies: ‘Trouble is, I've got six hundred and ninety-eight quiet nights in to go…’ Good luck to the new editors!
Papillion – carried to freedom by the TIDe?
In the film Papillon, the eponymous anti-hero (Steve McQueen – convicted of murder) and Dustin Hoffman (forgery) do a long stretch in a prison in French Guiana. Papillon makes numerous imaginative escape attempts – ultimately leaping from a cliff on Devil’s Island to be carried out to sea and freedom, by the tide. In this issue of Thorax (see page 690), Daynes and colleagues evaluate one potential escape route for individuals imprisoned by dyspnoea. In the TIDe study (a randomised controlled trial of just over 100 participants with COPD) they test a high-frequency airway oscillating device vs a sham device. The trial shows no difference in a questionnaire measure of dyspnoea (CRQ-D) between the two arms. Papillon made it to freedom, and lived the rest of his life a free man, in contrast to the prison itself which did not survive. In a linked editorial (see page 636), Linda Nici applauds the efforts of the trialists and calls for innovative studies to help people with chronic respiratory disease. Let’s hope that trialists show all the inventiveness of Papillon in devising new strategies to help those imprisoned by chronic respiratory disease.
It’s a Wonderful Life
There is little doubt that those of us lucky enough to edit Thorax have had a wonderful life, although there have been moments of hardship. It’s a Wonderful Life is widely regarded as one of the greatest movies of all time and the actor who played the protagonist of this Christmas Classic, James Stewart, lived to a ripe old age before dying of a sudden cardiac death (SCD). His demise was brought on by complications of his decision not to replace the battery in his pacemaker. This may be an obvious risk factor for sudden cardiac death, but there are others. In this issue of Thorax (see page 652) Cheng et al use Lung Function data obtained from the Atherosclerosis Risk in Communities (ARIC) study to determine whether this is a risk factor for SCD. They found that regardless of smoking history lower FEV1 was associated with an increased risk of SCD even when adjusted for age, sex, and physical characteristics, and did not seem to be affected by bronchodilator use. The reason for this association, unlike switching your pacemaker off, is not known. However, as we relinquish the reigns of Airwaves we hope our contributions have brightened up your days, to misquote Clarence from a Wonderful life ‘Strange, isn't it? Each issue of Airwaves touches so many other lives. When it isn't around it leaves an awful hole, doesn't it?’ Well, we have no idea but there is no doubt that change in editorial team is a major risk factor for the sudden death of Airwaves. I feel a prospective analysis coming on.
The Breakfast Club
This Brat Pack film describes a day long period of mandatory reflection for five of high school students. Life is full of assumptions and stereotypes which can often lead people down the wrong path, lead to poor decisions and delay progress. The purpose of science and medicine is to put these assumptions to the test and usually the results surprise us. The common assumption, in idiopathic pulmonary fibrosis, is that alveolar cells are the source of all the problems and should be placed into detention to figure out who they are! However, in this issue of Thorax (see page 669) Kumar and colleagues challenge this assumption using publicly available data to demonstrate that airway Club Cells gene signatures are upregulated in IPF and correlate with poor lung function. Using a murine model of pulmonary fibrosis, they showed that inhibiting club cell derived molecular pathways can inhibit the development of pulmonary fibrosis challenging many assumptions relating to IPF. Time for us all to have a stretch of enforced reflection? Sincerely yours, the Breakfast Club.
Escape from a 5 month stretch of dyspnoea?
Test your diagnostic skills as a case of an elderly woman with dyspnoea gradually unfolds. Put figure 2 from page 736 here.