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Journal: Respiratory medicine


An ongoing outbreak of coronavirus disease 2019 (COVID-19) has spread around the world. It is debatable whether asymptomatic COVID-19 virus carriers are contagious. We report here a case of the asymptomatic patient and present clinical characteristics of 455 contacts, which aims to study the infectivity of asymptomatic carriers.


Many patients with asthma remain symptomatic despite treatment with inhaled corticosteroids (ICS) with or without long-acting β2-agonists (LABAs). Tiotropium add-on to ICS plus a LABA has been shown to improve lung function and reduce exacerbation risk in patients with symptomatic asthma.

Concepts: Improve, Mucus, Pulmonology, Obstructive lung disease, Lung, Chronic obstructive pulmonary disease, Immune system, Asthma


The Phase II TOMORROW trial and two Phase III INPULSIS(®) trials investigated the efficacy and safety of nintedanib versus placebo in patients with idiopathic pulmonary fibrosis (IPF). To obtain an overall estimate of the treatment effect of nintedanib 150 mg twice daily (bid), pooled and meta-analyses of data from these three trials were conducted.

Concepts: Clinical trial, Idiopathic pulmonary fibrosis


Respiratory disease is a common co-morbidity with rheumatoid arthritis (RA). RA commonly affects the hands, but there is little research investigating whether these patients are physically able to operate inhalers.

Concepts: Arthritis, Respiratory disease, Rheumatology, Inhaler, Rheumatoid arthritis


Although physiotherapy is an integral part of the multiprofessional team in most ICUs there is only limited evidence concerning the effectiveness of its procedures. The objectives of this study were to verify if physiotherapy care provided within 24 h/day for hospitalized patients in the ICU reduce the length of stay, mechanical ventilation support, pulmonary infection and mortality compared to a physiotherapy care provided within 6 h/day.

Concepts: Volume, Heart, Lung, Pulmonology, Hospital


Single BCG vaccination has been considered as a protective factor against asthma. However the effect of a second dose of BCG on the prevalence rate of asthma and asthma-allergic rhinitis-eczema comorbidity has not been studied exclusively among adolescents. In this ISAAC protocol-based cross sectional study we assessed the association between one single versus two doses of BCG among 2213 individuals aged 13-14 years old. We found no association between BCG revaccination and asthma, associated (OR = 0.68, 95% CI, 0.37-1.25) or not to allergic rhinitis and/or atopic eczema (OR = 1.07, 95% CI, 0.84-1.36).

Concepts: Rhinitis, Medical statistics, Allergen, Immune system, Eczema, Atopy, Asthma, Allergy


Cells lining the respiratory tract are equipped with mechanisms that dampen the effects of oxidative stress. Nuclear factor (erythroid-derived 2)-like 2 (Nrf2) is a mediator involved in regulating oxidative stress. Recent data indicate Nrf2 also controls expression of secretory leukocyte protease inhibitor (SLPI). Sulforaphane (SFN), an isothiocyanate found in cruciferous vegetables, enhances Nrf2 activity. Therefore, we hypothesized that SFN supplementation induces SLPI secretion in the nasal mucosa in an Nrf2 dependent manner. Healthy nonsmoking adults ingested SFN-containing broccoli shake homogenate (BSH) for 3 consecutive days. Nasal lavage fluid (NLF) was collected before and after BSH ingestion and analyzed for SLPI protein levels. In follow up in vitro experiments, differentiated primary nasal epithelial cells were used to evaluate the relationship between SFN, Nrf2, and SLPI. Epithelial cells were transduced with Nrf2-specific shRNA to examine the regulatory role of Nrf2 on SLPI expression. Supplementation with BSH significantly increased SLPI levels in NLF. SFN supplementation in vitro significantly enhanced SLPI secretion and these effects were significantly decreased in cells transduced with Nrf2-specific shRNA. Our data support a relationship between nutritional supplementation, Nrf2 activation, and SLPI secretion. Therefore, ingestion of SFN-containing foods has therapeutic potential to augment SLPI expression in the nasal mucosa.

Concepts: Vegetables, Brassica oleracea, Cruciferous vegetables, Nutrition, Respiratory system, Respiratory epithelium, Sulforaphane, Mucus


BACKGROUND: To determine the safety and efficacy of BEA2180, an anticholinergic agent in patients with chronic obstructive pulmonary disease (COPD). METHODS: Smokers or ex-smokers ≥40 years with COPD and a postbronchodilator forced expiratory volume in 1 s (FEV1) <80% predicted and FEV1/forced vital capacity ≤70% participated in this multinational, randomised, double-blind, parallel study. Patients received BEA2180 (50, 100 or 200 μg), tiotropium (5 μg) or placebo once daily via Respimat(®) Soft Mist™. The primary endpoint was trough FEV1 after 24 weeks. Secondary endpoints included Transition Dyspnoea Index (TDI) focal score, St George's Respiratory Questionnaire (SGRQ) total score, exacerbations and adverse events. RESULTS: Patients (n = 2080, 64.5% male) had a mean age of 64.2 years and a baseline FEV1 of 1.2 L. Trough FEV1 at 24 weeks with all BEA2180 doses (0.044-0.087 L) and tiotropium 5 μg (0.092 L) was significantly higher (p < 0.0001) than placebo (-0.034 L) and BEA2180 (200 μg) was noninferior to tiotropium. Mean TDI focal scores were higher with BEA2180 (1.43-1.48) or tiotropium (1.46) versus placebo (0.94; p ≤ 0.01 for all). Mean SGRQ total scores also improved with BEA2180 (40.1-40.7) or tiotropium (39.5) compared with placebo (43.0, p < 0.01 for all). COPD exacerbation rates were reduced for all active treatments, reaching statistical significance for BEA2180 (50 and 200 μg) (p < 0.05, for both). CONCLUSION: All study doses of BEA2180 improved lung function, reduced symptoms and exacerbations, and improved health status in COPD; all treatments were well tolerated. Clinical trial identifier: NCT00528996.

Concepts: Clinical trial, Lung, Respiratory physiology, Pulmonology, Tiotropium, Spirometry, Asthma, Chronic obstructive pulmonary disease


Incorrect use of inhaler devices remains an obstacle for respiratory diseases management. We aimed to evaluate the frequency of inhaler technique errors; to determine the devices perceived as the easiest and favourite to use; to study the association of device type, demographics and patient preferences with inhaler technique (IT).

Concepts: Respiratory disease, The Association, Device, Diseases and disorders, Obstructive lung disease, Inhaler, Asthma


Patients with hyperventilation syndrome (HVS) report severe symptom-related suffering and often complain from insufficient medical attention. However, quality of life data in this context are scarce. We aimed at assessing the health-related quality of life (HRQoL) of HVS patients. Twenty-one HVS patients with extensive cardiorespiratory workup including cardiopulmonary exercise testing (CPET) filled in the generic SF-36 questionnaire and the results were compared to French normal values. Correlations between SF36 dimensions and clinical and functional data were established. All SF-36 scores were markedly decreased in HVS patients compared to healthy subjects: Physical Functioning: 44 ± 24, Social Functioning: 57 ± 27, Role Physical: 21 ± 32, Role Emotional: 48 ± 42, Mental Health: 51 ± 27, Vitality: 34 ± 20, Body Pain: 41 ± 21, General Health: 42 ± 21. These figures were all significantly lower in the HVS patients respective to the normal reference population. They were also lower than corresponding values published in patients with asthma or chronic obstructive pulmonary disease (COPD). “Vitality” and “Physical Functioning” scores were correlated with Nijmegen score (r = -0.594, p = 0.047) and peak respiratory frequency during CPET (r = -0.644, p = 0.019). The SF-36 Social Functioning score was correlated with the ventilatory threshold (r = 0.629, p = 0.034), peak V'E/V'CO2 (ventilation/CO2 production) (r = 0.650, p = 0.016) and peak PaCO2 (r = -0.664, p = 0.027). In conclusion, this study shows that HRQoL can be severely impaired in patients with HVS, which is one more reason to take this condition seriously.

Concepts: Medicine, Hyperventilation, Hyperventilation syndrome, Asthma, Chronic obstructive pulmonary disease