Podcasts about european respiratory society

This video presents a compelling case for the efficacy of hypertonic saline nasal drops in mitigating the symptoms and duration of the common cold in young children. A recent randomized controlled trial, presented at the European Respiratory Society Congress, demonstrated that the use of saline drops significantly reduced the overall duration of illness compared to conventional care. The underlying mechanism, involving the enhancement of cellular defense mechanisms, is explained in detail. Additionally, the potential for reducing the transmission of the cold virus to family members is highlighted. This video offers valuable insights for parents seeking safe and effective strategies to manage their children's respiratory health. #hypertonic_saline_nasal_drops #common_cold #salinesolution #saltwater #cold [1] Abstract no: OA1985 “A randomised controlled trial of hypertonic saline nose drops as a treatment in children with the common cold (ELVIS-Kids trial)”, by Dr Sandeep Ramalingam et al; Presented in session “Advancements in paediatric infectious respiratory health” at 15:45–17:00 CEST on Sunday 8 September 2024. hypertonic saline nasal drops, common cold, pediatric health, child health, natural remedies, randomized controlled trial, clinical research, public health, evidence-based medicine, pediatric respiratory health, ELVIS-Kids trial, European Respiratory Society, ERS Congress, saltwater nose drops, child health research, cold symptoms, viral replication, immune system, nasal congestion, sinusitis, upper respiratory infection, antiviral therapy, pediatrics, health care, medical research, health science --- Support this podcast: https://podcasters.spotify.com/pod/show/ralph-turchiano/support

This video presents a compelling case for the efficacy of hypertonic saline nasal drops in mitigating the symptoms and duration of the common cold in young children. A recent randomized controlled trial, presented at the European Respiratory Society Congress, demonstrated that the use of saline drops significantly reduced the overall duration of illness compared to conventional care. The underlying mechanism, involving the enhancement of cellular defense mechanisms, is explained in detail. Additionally, the potential for reducing the transmission of the cold virus to family members is highlighted. This video offers valuable insights for parents seeking safe and effective strategies to manage their children's respiratory health. #hypertonic_saline_nasal_drops #common_cold #salinesolution #saltwater #cold [1] Abstract no: OA1985 “A randomised controlled trial of hypertonic saline nose drops as a treatment in children with the common cold (ELVIS-Kids trial)”, by Dr Sandeep Ramalingam et al; Presented in session “Advancements in paediatric infectious respiratory health” at 15:45–17:00 CEST on Sunday 8 September 2024. hypertonic saline nasal drops, common cold, pediatric health, child health, natural remedies, randomized controlled trial, clinical research, public health, evidence-based medicine, pediatric respiratory health, ELVIS-Kids trial, European Respiratory Society, ERS Congress, saltwater nose drops, child health research, cold symptoms, viral replication, immune system, nasal congestion, sinusitis, upper respiratory infection, antiviral therapy, pediatrics, health care, medical research, health science --- Support this podcast: https://podcasters.spotify.com/pod/show/ralph-turchiano/support

This video presents a compelling case for the efficacy of hypertonic saline nasal drops in mitigating the symptoms and duration of the common cold in young children. A recent randomized controlled trial, presented at the European Respiratory Society Congress, demonstrated that the use of saline drops significantly reduced the overall duration of illness compared to conventional care. The underlying mechanism, involving the enhancement of cellular defense mechanisms, is explained in detail. Additionally, the potential for reducing the transmission of the cold virus to family members is highlighted. This video offers valuable insights for parents seeking safe and effective strategies to manage their children's respiratory health. #hypertonic_saline_nasal_drops #common_cold #salinesolution #saltwater #cold [1] Abstract no: OA1985 “A randomised controlled trial of hypertonic saline nose drops as a treatment in children with the common cold (ELVIS-Kids trial)”, by Dr Sandeep Ramalingam et al; Presented in session “Advancements in paediatric infectious respiratory health” at 15:45–17:00 CEST on Sunday 8 September 2024. hypertonic saline nasal drops, common cold, pediatric health, child health, natural remedies, randomized controlled trial, clinical research, public health, evidence-based medicine, pediatric respiratory health, ELVIS-Kids trial, European Respiratory Society, ERS Congress, saltwater nose drops, child health research, cold symptoms, viral replication, immune system, nasal congestion, sinusitis, upper respiratory infection, antiviral therapy, pediatrics, health care, medical research, health science --- Support this podcast: https://podcasters.spotify.com/pod/show/ralph-turchiano/support

Stefano Boeri ist der Creative Explorer der munich creative business week 2024. Er wird als Keynote Speaker beim mcbw design summit am Montag, den 13. Mai 2024 im Munich Urban Colab sprechen. Die munich creative business week findet vom 11. – 19. Mai 2024 unter dem Jahresmotto „How to co-create with nature“ statt. Stefano Boeri, Architekt und Stadtplaner, ist Professor für Stadtplanung am Politecnico di Milano und leitet das Future City Lab an der Tongji-Universität in Shanghai, ein Post-Doc-Forschungsprogramm, das die Mutation planetarischer Metropolen aus der Perspektive der Biodiversität und der städtischen Forstwirtschaft vorwegnimmt. Er war Gastprofessor an mehreren internationalen Universitäten wie der Harvard University Graduate School of Design, der École Polytechnique Fédérale de Lausanne, dem Berlage Institute in Rotterdam und der Akademie für Architektur in Mendrisio. Er ist Präsident des wissenschaftlichen Komitees von Forestami, dem städtischen Forstwirtschaftsprojekt im Großraum Mailand. Seit 2018 ist er Präsident der Triennale Milano. Als Architekt des 2014 in Mailand errichteten Bosco Verticale gehört Stefano Boeri zu den wichtigsten Protagonisten der Debatte über den Klimawandel im Bereich der internationalen Architektur. Im Jahr 2017 nimmt er am Programm Commonwealth Regenerative Development to Reverse Climate Change teil; er ist Ko-Vorsitzender des wissenschaftlichen Ausschusses des World Forum on Urban Forests (Mantua, 2018 - Washington, 2023) und stellt anlässlich des UN Climate Action Summit 2019 in New York das Projekt Great Green Wall of Cities /Green Urban Oases vor, das zusammen mit der FAO, C40 und anderen internationalen Forschungsinstituten realisiert wird. Im Jahr 2023 wird Stefano Boeri im Rahmen des internationalen Kongresses der European Respiratory Society mit dem ELF Award ausgezeichnet, eine Anerkennung der European Lung Foundation "für seine Arbeit zur Verbesserung der Luftqualität in städtischen Gebieten". Stefano Boeri ist bekannt für seine Forschungen und Visionen über die Zukunft der städtischen Verhältnisse in der Welt, was die Gestaltung von Regenerations- und Entwicklungsplänen für Metropolen und Großstädte betrifft, darunter São Paulo, Genf, Tirana, Cancun, Riad, Kairo und in Italien Mailand, Genua, Cagliari, Neapel, Padua, Taranto und viele andere. Seine Forschungsarbeiten wurden in internationalen Büchern und Zeitschriften veröffentlicht. Partner dieser Ausgabe ist die munich creative business week und deren Veranstalter bayern design. Website mcbw: https://www.mcbw.de Website bayern design GmbH: https://bayern-design.de

As part of the November issue, the European Respiratory Journal presents the latest in its series of podcasts. Chief Editor James Chalmers and ERS President Monika Gappa discuss awareness of child health and its importance for adult lung health.

EinBlick – nachgefragt Podcast mit Interviews und Diskussionsrunden mit Expert:innen des Gesundheitswesens COPD – Epidemiologie und Ansätze zur Prävention Fachjournalist und EinBlick-Redakteur Christoph Nitz sprach mit Frau Professor Dr. Daiana Stolz über die ›vergessene Krankheit COPD‹. Die chronisch obstruktiven Lungenerkrankung COPD ist häufiger als Asthma – nach Schätzungen haben zwischen fünf und zehn von einhundert Menschen über 40 Jahren eine COPD. Professor Dr. Daiana Stolz ist seit 2021 Professorin für Innere Medizin mit Schwerpunkt Pneumologie am Universitätsklinikum Freiburg. Davor war sie Inhaberin einer Professur für Lungenheilkunde und Innere Medizin an der Klinik für Lungenheilkunde und Atemwegszellforschung des Universitätsspital Basel. Dort leitete Frau Professor Stolz eine translationale Forschungsgruppe für entzündliche Atemwegserkrankungen. Sie ist Fellow der European Respiratory Society und des American College of Chest Physicians und Mitglied der Redaktionsausschüsse des European Respiratory Journal und der Zeitschrift Chest. Sie hat mehr als 250 Veröffentlichungen in Fachzeitschriften mit Peer-Review verfasst, darunter mehrere Studien über pulmonale und systemische Biomarker zur Charakterisierung von Patienten mit COPD.

Olá! Neste episódio, vamos retomar a conversa com a Dra. Susana Moreira, Pneumologista Coordenadora do Laboratório de Fisopatologia Respiratória do Hospital de Santa Maria e da Unidade de Pneumologia do Hospital dos Lusíadas Lisboa e o Prof. Doutor João Carlos Winck, Professor Afiliado da Faculdade de Medicina da U.P., Coordenador das Unidades de Pneumologia dos Hospitais Alfena-Valongo e Trofa Saúde/Braga Centro, Secretário da Assembleia “Respiratory Intensive Care” da European Respiratory Society,  que nos vão falar sobre o tratamento dirigido para a tosse crónica, como tratar a tosse refratária e ainda sobre alguns tratamentos não farmacológicos ou de venda livre mais utilizados.Dra. Susana MoreiraAssistente Graduada de Pneumologia;Competência em Medicina do Sono pela Ordem dos Médicos; European Somnologist;Coordenadora do Laboratório de Fisiopatologia Respiratória do Hospital de Santa Maria;Coordenadora da Unidade de Pneumologia do Hospital Lusíadas Lisboa. Prof. Doutor João Carlos Winck Professor Afiliado da Faculdade de Medicina da Universidade do Porto (FMUP);Assistente Graduado de Pneumologia; Coordenador das Unidades de Pneumologia do Hospital Privado de Alfena-Valongo e do Hospital Privado de Braga-Centro (Trofa Saúde);Consultor do Núcleo de Reabilitação Cardio-Respiratória do Centro de Reabilitação do Norte (CRN-Centro Hospitalar VNGaia-Espinho);Secretário da Assembleia 2 “Respiratory Intensive Care” na European Respiratory Society.Olho Clínico é um Podcast da MSD de atualização científica, direcionado exclusivamente a Profissionais de Saúde. O conteúdo do mesmo não tem por objetivo induzir qualquer alteração de comportamento na prescrição ou toma de medicamentos. PT-NON-02423 05/2023

Hi everyone, and welcome to the LungFIT podcast. I am going to be taking a much needed break for the next while, so I hope you enjoy this past episode on Shuttle Walk Tests. I'll be back soon with new content, but until then, thank you again for your support. In this episode, I continue the conversation about field walking tests, with an overview of the Incremental Shuttle Walk Test and the Endurance Shuttle Walk Test. You can listen to the first episode on field walking tests, where we talk about the six minute walk test, here (https://lungfit.med.ubc.ca/the-six-minute-walk-test/). I mention the technical standard for field tests in chronic lung disease, put out by the European Respiratory Society and the American Thoracic Society. A link to that paper is here: https://erj.ersjournals.com/content/44/6/1428 I refer to the Leicester Hospital, UK website, where you can order the walk test and access the links to some of the research papers on the test: https://www.leicestershospitals.nhs.uk/aboutus/departments-services/pulmonary-rehabilitation/for-health-professionals/incremental-shuttle-walk/ I mention the Australia Pulmonary Rehabilitation Toolkit, a link to the page where exercise prescription using the Incremental Walk Test is here:  https://pulmonaryrehab.com.au/importance-of-exercise/exercise-prescription-and-training/endurance-lower-limb/intensity/ I welcome your feedback about the show or ideas for future episodes. You can contact me via the comments section here on the LungFIT website. If you listen to the LungFIT podcast on iTunes, please take a moment to review the show. Click here to be directed.

This EMJ podcast explores key topics addressed at the European Respiratory Society (ERS) International Congress 2022, during a symposium entitled ‘Re-IMAGinING the pathway for clinical decision making in rare lung disease – moving towards a united vision'. Focusing on key questions, including the unmet needs in interstitial lung disease, the value of data repositories for enhancing patient care in rare lung diseases, and the impact of exacerbation physiology on imaging parameters   The podcast is co-chaired by Charlie Strange, Professor of Pulmonary and Critical Care Medicine, and Daiana Stolz, Medical Director of the Clinic for Pneumology and Professor of Medicine, who are joined by guest Elizabeth Estes, Executive Director of the Open Source Imaging Consortium (OSIC). This podcast has been sponsored by CSL Behring.

Hi everyone, and welcome to the LungFIT podcast. I am going to be taking a much needed break for the next while, so I hope you enjoy this past episode on the Six Minute Walk test. I'll be back soon with new content, but until then, thank you again for your support. In this episode, I discuss the six minute walk test as an assessment tool, and outcome measure, and a way to create an exercise prescription. I mention a study we did in Canada to characterize the pulmonary rehabilitation programs which were running in 2015, including the use of the 6 minute walk test. The link to that paper is here (https://cts-sct.ca/wp-content/uploads/2018/02/PR-in-Canada-Report_CRJ.pdf). I also talk about an international survey on pulmonary rehabilitation, that citation is here: https://erj.ersjournals.com/content/43/5/1326.short I mention the technical standard for field tests in chronic lung disease, put out by the European Respiratory Society and the American Thoracic Society. A link to that paper is here: https://erj.ersjournals.com/content/44/6/1428 I mention the Australia Pulmonary Rehabilitation Toolkit, a link to the page where exercise prescription using the six minute walk distance is here: https://pulmonaryrehab.com.au/importance-of-exercise/case-studies/case-study-one/ I welcome your feedback about the show or ideas for future episodes. You can contact me via the comments section on the LungFIT website. If you listen to the LungFIT podcast on iTunes, please take a moment to review the show. Click here to be directed.

Hi everyone, and welcome to the LungFIT podcast. I am going to be taking a much needed break for the next while, so I hope you enjoy this past episode about some questions related to pulmonary rehabilitation and COVID-19. I'll be back soon with new content, but until then, thank you again for your support. On this episode, I talk about COVID-19 and pulmonary rehabilitation, including questions that health care professionals should ask themselves when they consider admitting patients who have had COVID-19 and ongoing symptoms. I mentioned some papers that I would recommend reading, that discuss some of these questions in more detail, as well as provide guidance to you as you consider caring for patients who have had COVID-19, in your pulmonary rehabilitation programs. Spruit MA, Holland AE, Singh SJ, Tonia T, Wilson KC, Troosters T. COVID-19: Interim guidance on rehabilitation in the hospital and post-hospital phase from a European Respiratory Society and American Thoracic Society-coordinated International Task Force. Eur Respir J 2020; in press (https://doi.org/10.1183/13993003.02197-2020). This paper can be found here.   American Thoracic Society Assembly on Pulmonary Rehabilitation. “Guidance for Re-opening Pulmonary Rehabilitation Programs.” This paper can be found here.   American Physical Therapy Association Webinars on “Physical Therapy Considerations of COVID-19 in the Post-Acute Setting” aired on April 18, 2020 and “COVID-19: Clinical Best Practices in Physical Therapy Management”, aired on March 28, 2020. 

No primeiro episódio da série de Olho Clínico dedicada à Tosse Crónica estaremos à conversa com os pneumologistas Professor Doutor João Carlos Winck e a Dra. Susana Moreira.  Quais as diferenças entre a Tosse Aguda, a Sub-aguda e a Crónica? O que é a tosse crónica refratária? Quais os fenótipos da tosse crónica?  Descubra a resposta a esta e outras questões e ainda os mitos associados à Tosse Crónica neste primeiro episódio da nova série!Prof. Doutor João Carlos Winck Professor Afiliado da Faculdade de Medicina da Universidade do Porto (FMUP); Assistente Graduado de Pneumologia; Coordenador das Unidades de Pneumologia do Hospital Privado de Alfena-Valongo e do Hospital Privado de Braga-Centro (Trofa Saúde); Consultor do Núcleo de Reabilitação Cardio-Respiratória do Centro de Reabilitação do Norte (CRN-Centro Hospitalar VNGaia-Espinho); Secretário da Assembleia 2 “Respiratory Intensive Care” na European Respiratory Society.  Dra. Susana Moreira Assistente Graduada de Pneumologia; Competência em Medicina do Sono pela Ordem dos Médicos; European Somnologist; Coordenadora do Laboratório de Fisiopatologia Respiratória do Hospital de Santa Maria; Coordenadora da Unidade de Pneumologia do Hospital Lusíadas Lisboa.Olho Clínico é um Podcast da MSD de atualização científica, direcionado exclusivamente a Profissionais de Saúde. O conteúdo do mesmo não tem por objetivo induzir qualquer alteração de comportamento na prescrição ou toma de medicamentos. PT-NON-01819. 06/2022 

In this episode, Professor Jan Beyer-Westendorf and Dr Cecilia Becattini discuss the treatment of vulnerable patients with venous thromboembolism. In particular, they focus on the treatment of patients who have received the devastating diagnosis of pulmonary embolism. Other specific patient groups are also discussed, including patients who are considered vulnerable and therefore carry a significant additional burden, even beyond the heavy load afforded by a VTE diagnosis. These include frail patients, children and those who are also navigating a cancer diagnosis and treatment. Practical guidance for the treatment of these patients is discussed, based upon a hierarchy of risk and the options available to physicians at each point along the spectrum, from intensive care admission to home treatment. The views and opinions expressed throughout this podcast are those of the speakers based on their expertise and do not necessarily reflect those of Bayer. Further details: • Further details on the HoT-PE study of rivaroxaban for the home treatment of PE can be found here: https://academic.oup.com/eurheartj/article/41/4/509/5497670 • Further details on the EINSTEIN-Junior phase III clinical trial of rivaroxaban for the treatment and prevention of VTE in paediatric patients can be found here: https://www.thelancet.com/journals/lanhae/article/PIIS2352-3026(19)30219-4/fulltext • An overview of the CALLISTO program of studies of rivaroxaban in patients with cancer-associated thrombosis can be found here: https://onlinelibrary.wiley.com/doi/10.1002/rth2.12327 • Further details on studies within the CALLISTO program can be found through the following links: – CASSINI: https://www.nejm.org/doi/full/10.1056/NEJMoa1814630 – CASTA-DIVA: https://journal.chestnet.org/article/S0012-3692(21)04079-4/fulltext – SELECT-D: https://ascopubs.org/doi/10.1200/JCO.2018.78.8034 – COSIMO: https://www.thrombosisresearch.com/article/S0049-3848(21)00381-9/fulltext • The 2019 European Society of Cardiology guidelines for the diagnosis and management of acute pulmonary embolism, developed in collaboration with the European Respiratory Society, can be found here: https://academic.oup.com/eurheartj/article-lookup/doi/10.1093/eurheartj/ehz405 • The American College of Chest Physicians guidelines for antithrombotic therapy for VTE disease can be found here: https://journal.chestnet.org/article/S0012-3692(15)00335-9/fulltext • The summary of product characteristics for rivaroxaban can be found here: https://www.medicines.org.uk/emc/product/2793/smpc#gref • The summary of product characteristics for apixaban can be found here: https://www.medicines.org.uk/emc/product/2878/smpc#gref • The summary of product characteristics for edoxaban can be found here: https://www.medicines.org.uk/emc/product/6905/smpc#gref • The summary of product characteristics for dabigatran can be found here: https://www.medicines.org.uk/emc/product/4703/smpc#gref Recording approval code: PP-XAR-ALL-2606 Shownotes approval code: PP-XAR-ALL-2607

The European Respiratory Society has provided 8 conditional recommendations for the use of nasal high flow/high flow nasal cannula/high flow oxygen/whatever you want to call it. Here, I review the 8 recommendations and add some commentary on them. Show Notes: https://eddyjoemd.com/high-flow/ Citation: Oczkowski S, Ergan B, Bos L, Chatwin M, Ferrer M, Gregoretti C, Heunks L, Frat JP, Longhini F, Nava S, Navalesi P, Ozsancak Uğurlu A, Pisani L, Renda T, Thille AW, Winck JC, Windisch W, Tonia T, Boyd J, Sotgiu G, Scala R. ERS clinical practice guidelines: high-flow nasal cannula in acute respiratory failure. Eur Respir J. 2022 Apr 14;59(4):2101574. doi: 10.1183/13993003.01574-2021. PMID: 34649974. --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app Support this podcast: https://anchor.fm/eddyjoemd/support

Dr. Emily Grieshaber (e-mail) of East Tennessee State University is interviewed by Stephen M. Shaffer regarding a presentation she gave at the 2021 AAOMPT Conference titled, “Providing Musculoskeletal Care to the Post-COVID Community.” This episode contains information that will be interesting for practitioners who want to begin to understand the complexities associated with both SARS-CoV-2 infections and COVID-19 as they relate to physical therapy practice. Additionally, to access the resources mentioned by Dr. Grieshaber during the interview use the following links: Stanford Hall consensus statement for post-COVID-19 rehabilitation, Interim Guidance on Rehabilitation in the Hospital and Post-Hospital Phase from a European Respiratory Society and American Thoracic Society-coordinated International Task Force, APTA COVID-19 Core Outcome Measures, and the Pacer Project. Find out more about the American Academy of Orthopaedic Manual Physical Therapists at the following links:Academy website: www.aaompt.orgTwitter: @AAOMPTFacebook: https://www.facebook.com/aaompt/Instagram: https://www.instagram.com/officialaaompt/?hl=enPodcast e-mail: aaomptpodcast@gmail.comPodcast website: https://aaomptpodcast.simplecast.fm

In this episode we chat with Claire Slinger Consultant Speech & Language Therapist (Lancashire & South Cumbria Severe Asthma & Airways service ) and one of her patients, Iain, about the speech and language therapy role in assessment, diagnosis and treatment of upper airways disorders. We look at the the impact that upper airways disorders have on patients and how speech and language therapy can make  a positive difference.References:Newman KB, Mason 3rd UG, Schmaling KB. Clinical features of vocal cord dysfunction. American journal of respiratory and critical care medicine. 1995 Oct;152(4):1382-6 Murphy JM, Stephen S, Pearson F, DeSoyza A. P108 A systematic review to explore the relationship between inducible laryngeal obstruction and healthcare utilisation in adults with Asthma.Useful links:RCSLT updated position paper on upper airways disorders: https://www.rcslt.org/wp-content/uploads/2020/03/RCSLT-upper-airways-position-paper-October-2021.pdfNHS England Specialised Respiratory Services (adult) - Severe Asthma https://www.england.nhs.uk/publication/specialised-respiratory-services-adult-severe-asthma/European Respiratory Society Cough guidelines on the diagnosis and treatment of chronic cough in adults and children | European Respiratory Society (ersjournals.com) https://erj.ersjournals.com/content/55/1/1901136The interview is conducted by Jacques Strauss, freelance digital producer.

In this episode, Dr Mari Thomas and Professor Jan Beyer-Westendorf discuss practical considerations for how physicians should take patient preference into account when deciding on an anticoagulant for the treatment of cancer-associated thrombosis. Further details: • Information on patient persistence with oral anticoagulant treatment compared with parenteral can be found here: https://onlinelibrary.wiley.com/doi/full/10.1002/rth2.12002 • Details on the COSIMO study can be found here: https://thrombosisjournal.biomedcentral.com/articles/10.1186/s12959-018-0176-2 and https://ashpublications.org/blood/article/134/Supplement_1/2161/427953/Baseline-Characteristics-and-Clinical-Outcomes • The American Society of Hematology 2021 guidelines for management of venous thromboembolism: prevention and treatment in patients with cancer guidelines can be found here: https://ashpublications.org/bloodadvances/article-lookup/doi/10.1182/bloodadvances.2020003442 • The American Society of Clinical Oncology venous thromboembolism prophylaxis and treatment in patients with cancer clinical practice guideline update can be found here: https://ascopubs.org/doi/10.1200/JCO.19.01461?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed • The 2019 International Initiative on Thrombosis and Cancer clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer can be found here: https://linkinghub.elsevier.com/retrieve/pii/S1470-2045(19)30336-5 • The International Society on Thrombosis and Haemostasis guidelines on the role of direct oral anticoagulants in the treatment of cancer-associated venous thromboembolism can be found here: https://doi.org/10.1111/jth.14219 • The 2019 European Society of Cardiology guidelines for the diagnosis and management of acute pulmonary embolism, developed in collaboration with the European Respiratory Society can be found here: https://academic.oup.com/eurheartj/article-lookup/doi/10.1093/eurheartj/ehz405 Recording approval code: PP-M_RIV-ALL-0195-1; Shownotes approval code: PP-M_RIV-ALL-0196-1

A Deep Dive Into Shuttle Walk Tests   In this episode, I continue the conversation about field walking tests, with an overview of the Incremental Shuttle Walk Test and the Endurance Shuttle Walk Test. You can listen to the first episode on field walking tests, where we talk about the six minute walk test, here (https://lungfit.med.ubc.ca/the-six-minute-walk-test/).   I mention the technical standard for field tests in chronic lung disease, put out by the European Respiratory Society and the American Thoracic Society. A link to that paper is here: https://erj.ersjournals.com/content/44/6/1428   I refer to the Leicester Hospital, UK website, where you can order the walk test and access the links to some of the research papers on the test: https://www.leicestershospitals.nhs.uk/aboutus/departments-services/pulmonary-rehabilitation/for-health-professionals/incremental-shuttle-walk/ I mention the Australia Pulmonary Rehabilitation Toolkit, a link to the page where exercise prescription using the Incremental Walk Test is here:  https://pulmonaryrehab.com.au/importance-of-exercise/exercise-prescription-and-training/endurance-lower-limb/intensity/    

In this episode, I discuss the six minute walk test as an assessment tool, and outcome measure, and a way to create an exercise prescription. I mention a study we did in Canada to characterize the pulmonary rehabilitation programs which were running in 2015, including the use of the 6 minute walk test. The link to that paper is here (https://cts-sct.ca/wp-content/uploads/2018/02/PR-in-Canada-Report_CRJ.pdf). I also talk about an international survey on pulmonary rehabilitation, that citation is here: https://erj.ersjournals.com/content/43/5/1326.short I mention the technical standard for field tests in chronic lung disease, put out by the European Respiratory Society and the American Thoracic Society. A link to that paper is here: https://erj.ersjournals.com/content/44/6/1428 I mention the Australia Pulmonary Rehabilitation Toolkit, a link to the page where exercise prescription using the six minute walk distance is here:  https://pulmonaryrehab.com.au/importance-of-exercise/case-studies/case-study-one/   I welcome your feedback about the show or ideas for future episodes. You can contact me via the comments section on the LungFIT website. If you listen to the LungFIT podcast on iTunes, please take a moment to review the show. Click here to be directed.  

This episode highlights key takeaways for the use of tocilizumab, remdesivir, monoclonal antibodies, and other therapeutics in patients with COVID-19 from the National Institutes of Health, European Respiratory Society, Infectious Diseases Society of America, and Surviving Sepsis Campaign COVID-19 guidelines. (Originally recorded March 11, 2021) Moderator: Casey Cable, MD, MSc. Panelists: Barbara Jones, MD, MSc, and Stefano Aliberti, MD. For more tools to help in the fight against COVID-19, visit CHEST's COVID-19 Resource Center at chestnet.org/COVID19.

Naftali Kaminski MD is the Boehringer-Ingelheim Endowed Professor of Internal Medicine and Chief of the Pulmonary, Critical Care and Sleep Medicine, at Yale School of Medicine. After completing his medical school residency and fellowship in pulmonary medicine in Israel, Dr. Kaminski was appointed head of functional genomics at Sheba Medical Center. In 2002, he was recruited to head the Simmons Center for Interstitial Lung Diseases at University of Pittsburgh, where he stayed for over a decade before joining the faculty at Yale. Dr. Kaminski and his team are responsible for many breakthroughs in the diagnosis and treatment of interstitial lung diseases. And he has authored over 275 research papers. He was an associate editor of the American Journal of Respiratory and Critical Care Medicine and deputy editor of Thorax BMJ. He's an elected member of the Association of American Physicians, a fellow of the European Respiratory Society, and a fellow of the American Thoracic Society. In 2018, Dr. Kaminski received the Andy Tager Excellence and Mentorship Award by the American Thoracic Society for his contributions in training the next generation of physician scientists. Dr. Naftali Kaminski came to the United States from Israel for a research fellowship. He immediately went from being a confident and successful pulmonologist to feeling like the “dumbest person in the lab (and that too with an accent)”. With integrity, persistence, and some knowledge of baseball, Dr. Kaminski shares an incredible journey from shaping his career as a physician scientist to leading the Division of Pulmonary & Critical Care at Yale. He leaves us with some sage advice to overcome challenges: 1) leave your comfort zone and 2) advocate for yourself. Pearls of Wisdom: 1. Advice Dr. Kaminski's mother (who made him feel as the best person in the world) gave him: Don't think you're better than anyone else because of achievements, privilege, or financial status. 2. Two tips for overcoming challenges: First, don't withdraw into your comfort zone. Second, Don't be afraid to advocate for yourself. 3. A great formula for moving from the good to the great is full integrity plus persistence. 4. Being a physician, although a challenging profession, is a privilege. Appreciate the beauty in small, everyday successes so you don't live a one-dimensional life.

FDA 批准RET选择性抑制剂治疗RET基因驱动的非小细胞肺癌JAMA 慢性阻塞性肺病患者出院后肺康复训练可以显著降低1年生存率Cell 超级抗生素的研制塞帕替尼（selpercatinib）RET基因融合是1%～2%非小细胞肺癌的致癌驱动基因，2020年5月，RET选择性抑制剂塞帕替尼（selpercatinib）同时被FDA批准用于治疗RET驱动的肺癌和甲状腺癌。本期节目首先介绍塞帕替尼在非小细胞肺癌中的临床研究，周五的内分泌科专题当中，会和大家讨论一下塞帕替尼在甲状腺癌中的应用。《LIBRETTO-001研究：塞帕替尼对RET融合阳性非小细胞肺癌的疗效的1/2临床研究》New England Journal of Medicine，2020年8月 (1)研究纳入接受过铂类化疗的和未接受过治疗的RET基因融合阳性的、晚期非小细胞肺癌患者共105例。中位随访12.1个月时，接受过铂类化疗的患者，客观缓解率64%；未接受过治疗的患者，客观缓解率85%；6个月时，90%的缓解仍持续。中枢神经系统转移的11例患者中，颅内缓解率91%。最常见严重不良事件包括高血压、谷丙转氨酶升高、谷草转氨酶升高、低钠血症和淋巴细胞减少，仅2%的患者因不良事件停药。结论：在RET融合阳性的、非小细胞肺癌患者中，塞帕替尼具有持久疗效。慢性阻塞性肺病 - 吸入剂治疗慢性阻塞性肺病（COPD）患者中使用吸入的支气管扩张剂，可以改善症状、运动能力。常用药物包括：快速起效的短效β受体激动剂吸入剂（SABA，如沙丁胺醇）；快速起效的长效β受体激动剂吸入剂（LABA，如沙美特罗、福莫特罗、阿福特罗、茚达特罗、维兰特罗、奥达特罗），长效抗毒蕈碱受体阻滞剂（LAMA，噻托嗅铵、阿地溴铵、芜地溴铵、格隆溴铵）；糖皮质激素吸入剂（ICS，布地奈德、倍氯米松、莫米松）。对于单用长效支气管扩张剂效果不好的患者，可以考虑联合方案，比如：LAMA联合LABA，LABA联合ICS。重症患者可以使用LAMA-LABA-ICS三联治疗。《IMPACT研究：使用氟替卡松/芜地溴铵/维兰特罗三联治疗方案降低COPD患者的全因死亡率》American Journal of Respiratory and Critical Medicine，2020年6月 (2)该研究纳入10355例、有未来恶化风险的COPD患者，随机给予ICS-LAMA-LABA三联吸入治疗方案（氟替卡松/芜地溴铵/维兰特罗），或者LAMA-LABA二联治疗方案（芜地溴铵/维兰特罗），或者ICS-LABA二联治疗方案（氟替卡松/维兰特罗）治疗。在三联治疗组和两个二联治疗组中，分别记录了2.36%、2.64%和3.19%的患者死亡。与二联治疗组相比，三联治疗组的患者死亡风险更低，风险比分别为0.72和0.89。结论：IMPACT研究证明，每日一次吸入氟替卡松/芜地溴铵/维兰特罗三联疗法，可以降低了有症状且有加重史的COPD患者的全因死亡率。《真实世界的队列研究：LAMA-LABA-ICS三联吸入方案和LAMA-LABA二联吸入方案对COPD的临床治疗比较效果》Chest，2020年4月 (3)研究者从英国临床实践研究数据链中确定了一组2002年至2015年间使用LAMA、LABA治疗方案或LAMA-LABA-ICS治疗方案的、≥55岁的、近2700例COPD患者，随访1年，观察中重度COPD加重和严重肺炎的发生情况。在COPD急性加重的发生率上来看，三联吸入疗法与LAMA-LABA二联疗法相比，风险比为0.97，没有统计学意义的降低。对于嗜酸性粒细胞计数>6%的患者，三联疗法可以显著降低COPD急性加重的风险，风险比0.66。对于反复因COPD急性加重住院的患者而言，三联疗法也可以显著降低COPD急性加重的风险，风险比0.83。但是在三联疗法组中，需要住院治疗的重症肺炎的发生率显著升高，风险比 1.46。结论：真实世界中，在预防COPD加重方面，LAMA-LABA-ICS三联吸入疗法与LAMA-LABA二联吸入疗法同样有效。但是在嗜酸性粒细胞增多、或频繁急性加重的患者中，三联治疗方案获益更多。除此之外，二联治疗方案可能更为可取，因为它与重症肺炎发生率较低相关。《系统综述和荟萃分析：布地奈德/格隆溴铵/福莫特罗三联吸入疗法和其他LAMA-LABA-ICS三联吸入疗法的疗效比较》Advances in Therapy，2020年6月 (4)这篇荟萃分析纳入了18项研究，29,232例患者的资料。在减轻中重度COPD患者病情加重、改善肺功能和症状方面，布地奈德/格隆溴铵/福莫特罗和其他三联吸入的固定剂量组合（氟替卡松/芜地溴铵/维兰特罗、倍氯米松/格隆溴铵/福莫特罗）没有统计学差异；和其他开放联合用药之间也没有统计学显著差异。敏感性分析和元回归分析的结果与基本情况一致。结论：在减轻中重度COPD患者病情加重、改善肺功能和症状方面，可布地奈德/格隆溴铵/福莫特罗与其他LAMA-LABA-ICS固定剂量三联疗法的疗效相似。小羽点评：从随机临床研究的角度看，固定剂量的三联吸入疗法在减少COPD患者病情加重方面的疗效是相似的，并且优于二联吸入疗法；然而，在真实世界中，三联吸入疗法的优势则不那么明显了，甚至还有可能增加重症肺炎的发生率。《IMPACT研究亚组分析：吸入糖皮质激素停用和基线吸入治疗对病情加重的影响》American Journal of Respiratory and Critical Care Medicine，2020年11月 (5)IMPACT研究证明，每日一次吸入氟替卡松/芜地溴铵/维兰特罗三联疗法，可以降低了有症状且有加重史的COPD患者的全因死亡率。这项亚组分析的目的是了解吸入糖皮质类固醇停药是否影响影响结果。与芜地溴铵/维兰特罗二联治疗方案相比，氟替卡松/芜地溴铵/维兰特罗三联治疗方案显著降低了以前使用糖皮质激素的患者中，COPD中重度急性的发生率显著降低29%（P < 0.001），但在先前不使用糖皮质激素的患者中这种获益并不显著（降低12%，P = 0.115）。无论先前是否使用过糖皮质激素，三联吸入治疗方案均可以降低重度急性发作达35%、持续改善第一秒用力呼气量谷值和圣乔治呼吸问卷评分（SGRQ）。结论：这些数据支持了三联治疗在减轻病情恶化、肺功能和生活质量方面的重要作用，而这些作用似乎与ICS的突然停用无关。《ISOLDE研究：吸入糖皮质激素治疗后血液嗜酸性粒细胞的变化可能预测慢性阻塞性肺病的长期临床反应》European Respiratory Journal，2020年5月 (6)此研究的目的是评价吸入糖皮质激素后，血液嗜酸性粒细胞的变化可以预测长期治疗结果。这项为期3年的双盲试验中，对751名中-重度COPD患者随机分入氟替卡松组和安慰剂组。研究发现，1年内的嗜酸性粒细胞的减少与治疗效果相关，而且是治疗反应的强预测因子。在嗜酸性粒细胞下降≥200/μL时，吸入糖皮质激素可降低第一秒用力呼气量（FEV1）下降率达32mL/年，恶化率降低30%。相反，在嗜酸性粒细胞升高≥200/μL时，吸入糖皮质激素可加速第一秒用力呼气量下降，下降速度为37mL/年，恶化率增加80% （P4年的患者患肺癌的风险比为0.92，无统计学意义。平均每日吸入糖皮质激素较高的患者肺癌的风险比为1.36（95% CI 1.03-1.81）。结论：在COPD患者中，吸入糖皮质激素与肺癌发病率的降低无关。《欧洲呼吸协会指南：慢性阻塞性肺病患者何时停用吸入糖皮质激素》European Respiratory Journal，2020年6月 (8)吸入糖皮质激素联合支气管扩张剂，可降低慢性阻塞性肺病患者病情加重的频率，但是糖皮质激素经常被用于疗效不确定的患者。因此文章建议对于下列情况停用吸入糖皮质激素：（1）若COPD患者没有频繁发作的病史，指南认为停用活继续糖皮质激素吸入治疗的获益风险比存在不确定性，需要充分告知和与患者讨论；（2）若血液嗜酸性粒细胞计数≥300/µl，指南强烈建议不要停用吸入糖皮质激素；（3）若准备停用吸入糖皮质激素，指南强烈建议使用一个或两个长效支气管扩张剂。COPD患者肺康复训练肺康复可以改善慢性呼吸系统疾病患者的症状、生存质量和肺功能。肺康复包括运动训练、促进将康的行为（比如戒烟、锻炼、营养支持、恰当用药和自我管理）和心理支持。运动训练可以采用下肢训练（如，固定式脚踏车、跑步机或自由行走）、上肢训练（如手臂训练）、间歇运动训练、抗阻力/力量训练和呼吸再训练。《回顾性队列研究：COPD出院后开始肺康复1年生存率的影响》JAMA，2020年5月 (9)肺康复训练与慢性阻塞性肺病患者生存率提高相关，但相关研究的患者数量少且异质性高。研究的目的时确定慢性阻塞性肺病患者出院后90天内开始肺部康复与1年生存率之间的关系。研究纳入197 376例患者、平均年龄76.9岁，1.5%的患者在出院后90天内开始肺康复。出院1年内死亡率19.4%，其中进行肺康复训练者死亡率7.3%，没有进行康复训练者死亡率19.6%。进行肺康复训练者绝对死亡风险下降6.7%，风险比 0.63。结论：慢性阻塞性肺病病人，出院后3个月内开始肺部康复1年死亡率显著降低。《随机对照研究：下坡行走对COPD患者肺部康复的影响》European Respiratory Journal，2020年5月 (10)收缩性肌肉疲劳影响COPD患者的训练反应。下坡步行诱发收缩肌疲劳、呼吸困难和疲劳程度较平地步行低。本研究比较了下坡步行训练和平地步行训练的方式进行肺康复对COPD患者的影响。在这项随机对照试验中，35例患者，平均年龄62岁，第一秒最大呼气量（FEV1）平均50%，随机分为下坡步行组或平地步行组。两组间，6分钟步行试验结果和肌肉活检没有差异（p=0.45）；但是94%的进行下坡行走锻炼的患者进步了，平地行走组仅为65%（p=0.03）。在其他方面，下坡行走组也有更大的改善。结论：在慢性阻塞性肺病患者中，结合下坡行走与常规步行在肺康复临床疗效上具有相似的效果；但是锻炼耐受性更好。《ON-EPIC研究：口服硝酸盐补充剂增强慢性阻塞性肺病肺部康复》Thorax 2020年7月 (11)研究的目的是评估口服硝酸盐是否能增强慢性阻塞性肺病患者的肺康复效果。这项双盲、安慰剂对照、平行组、随机对照研究在四个英国中心进行，登记了患有GOLD分级II-IV级的、医学研究委员会（Medical Research Council）呼吸困难评分3-5分或功能受限的COPD成年患者，进行每周两次、为期8周的肺康复训练计划。他们被随机分配到140ml富含硝酸盐的甜菜汁组（含12.9 mmol硝酸盐），或安慰剂组，服用前3小时进行肺康复训练治疗。积极治疗组(57例)的运动能力比安慰剂组(65例)提高更多;ISWT距离+60 m (10,85) vs +30 m(0,70)中值(IQR)变化，估计处理效果30 m (95% CI 10 ~ 40);p = 0.027。积极治疗对收缩压也有影响:治疗组-5.0 mm Hg (-5.0， -3.0) vs对照组+6.0 mm Hg(-1.0, 15.5)，估计治疗效果-7 mm Hg (95% CI 7 ~ -20) (p

FDA 批准RET选择性抑制剂治疗RET基因驱动的非小细胞肺癌JAMA 慢性阻塞性肺病患者出院后肺康复训练可以显著降低1年生存率Cell 超级抗生素的研制塞帕替尼（selpercatinib）RET基因融合是1%～2%非小细胞肺癌的致癌驱动基因，2020年5月，RET选择性抑制剂塞帕替尼（selpercatinib）同时被FDA批准用于治疗RET驱动的肺癌和甲状腺癌。本期节目首先介绍塞帕替尼在非小细胞肺癌中的临床研究，周五的内分泌科专题当中，会和大家讨论一下塞帕替尼在甲状腺癌中的应用。《LIBRETTO-001研究：塞帕替尼对RET融合阳性非小细胞肺癌的疗效的1/2临床研究》New England Journal of Medicine，2020年8月 (1)研究纳入接受过铂类化疗的和未接受过治疗的RET基因融合阳性的、晚期非小细胞肺癌患者共105例。中位随访12.1个月时，接受过铂类化疗的患者，客观缓解率64%；未接受过治疗的患者，客观缓解率85%；6个月时，90%的缓解仍持续。中枢神经系统转移的11例患者中，颅内缓解率91%。最常见严重不良事件包括高血压、谷丙转氨酶升高、谷草转氨酶升高、低钠血症和淋巴细胞减少，仅2%的患者因不良事件停药。结论：在RET融合阳性的、非小细胞肺癌患者中，塞帕替尼具有持久疗效。慢性阻塞性肺病 - 吸入剂治疗慢性阻塞性肺病（COPD）患者中使用吸入的支气管扩张剂，可以改善症状、运动能力。常用药物包括：快速起效的短效β受体激动剂吸入剂（SABA，如沙丁胺醇）；快速起效的长效β受体激动剂吸入剂（LABA，如沙美特罗、福莫特罗、阿福特罗、茚达特罗、维兰特罗、奥达特罗），长效抗毒蕈碱受体阻滞剂（LAMA，噻托嗅铵、阿地溴铵、芜地溴铵、格隆溴铵）；糖皮质激素吸入剂（ICS，布地奈德、倍氯米松、莫米松）。对于单用长效支气管扩张剂效果不好的患者，可以考虑联合方案，比如：LAMA联合LABA，LABA联合ICS。重症患者可以使用LAMA-LABA-ICS三联治疗。《IMPACT研究：使用氟替卡松/芜地溴铵/维兰特罗三联治疗方案降低COPD患者的全因死亡率》American Journal of Respiratory and Critical Medicine，2020年6月 (2)该研究纳入10355例、有未来恶化风险的COPD患者，随机给予ICS-LAMA-LABA三联吸入治疗方案（氟替卡松/芜地溴铵/维兰特罗），或者LAMA-LABA二联治疗方案（芜地溴铵/维兰特罗），或者ICS-LABA二联治疗方案（氟替卡松/维兰特罗）治疗。在三联治疗组和两个二联治疗组中，分别记录了2.36%、2.64%和3.19%的患者死亡。与二联治疗组相比，三联治疗组的患者死亡风险更低，风险比分别为0.72和0.89。结论：IMPACT研究证明，每日一次吸入氟替卡松/芜地溴铵/维兰特罗三联疗法，可以降低了有症状且有加重史的COPD患者的全因死亡率。《真实世界的队列研究：LAMA-LABA-ICS三联吸入方案和LAMA-LABA二联吸入方案对COPD的临床治疗比较效果》Chest，2020年4月 (3)研究者从英国临床实践研究数据链中确定了一组2002年至2015年间使用LAMA、LABA治疗方案或LAMA-LABA-ICS治疗方案的、≥55岁的、近2700例COPD患者，随访1年，观察中重度COPD加重和严重肺炎的发生情况。在COPD急性加重的发生率上来看，三联吸入疗法与LAMA-LABA二联疗法相比，风险比为0.97，没有统计学意义的降低。对于嗜酸性粒细胞计数>6%的患者，三联疗法可以显著降低COPD急性加重的风险，风险比0.66。对于反复因COPD急性加重住院的患者而言，三联疗法也可以显著降低COPD急性加重的风险，风险比0.83。但是在三联疗法组中，需要住院治疗的重症肺炎的发生率显著升高，风险比 1.46。结论：真实世界中，在预防COPD加重方面，LAMA-LABA-ICS三联吸入疗法与LAMA-LABA二联吸入疗法同样有效。但是在嗜酸性粒细胞增多、或频繁急性加重的患者中，三联治疗方案获益更多。除此之外，二联治疗方案可能更为可取，因为它与重症肺炎发生率较低相关。《系统综述和荟萃分析：布地奈德/格隆溴铵/福莫特罗三联吸入疗法和其他LAMA-LABA-ICS三联吸入疗法的疗效比较》Advances in Therapy，2020年6月 (4)这篇荟萃分析纳入了18项研究，29,232例患者的资料。在减轻中重度COPD患者病情加重、改善肺功能和症状方面，布地奈德/格隆溴铵/福莫特罗和其他三联吸入的固定剂量组合（氟替卡松/芜地溴铵/维兰特罗、倍氯米松/格隆溴铵/福莫特罗）没有统计学差异；和其他开放联合用药之间也没有统计学显著差异。敏感性分析和元回归分析的结果与基本情况一致。结论：在减轻中重度COPD患者病情加重、改善肺功能和症状方面，可布地奈德/格隆溴铵/福莫特罗与其他LAMA-LABA-ICS固定剂量三联疗法的疗效相似。小羽点评：从随机临床研究的角度看，固定剂量的三联吸入疗法在减少COPD患者病情加重方面的疗效是相似的，并且优于二联吸入疗法；然而，在真实世界中，三联吸入疗法的优势则不那么明显了，甚至还有可能增加重症肺炎的发生率。《IMPACT研究亚组分析：吸入糖皮质激素停用和基线吸入治疗对病情加重的影响》American Journal of Respiratory and Critical Care Medicine，2020年11月 (5)IMPACT研究证明，每日一次吸入氟替卡松/芜地溴铵/维兰特罗三联疗法，可以降低了有症状且有加重史的COPD患者的全因死亡率。这项亚组分析的目的是了解吸入糖皮质类固醇停药是否影响影响结果。与芜地溴铵/维兰特罗二联治疗方案相比，氟替卡松/芜地溴铵/维兰特罗三联治疗方案显著降低了以前使用糖皮质激素的患者中，COPD中重度急性的发生率显著降低29%（P < 0.001），但在先前不使用糖皮质激素的患者中这种获益并不显著（降低12%，P = 0.115）。无论先前是否使用过糖皮质激素，三联吸入治疗方案均可以降低重度急性发作达35%、持续改善第一秒用力呼气量谷值和圣乔治呼吸问卷评分（SGRQ）。结论：这些数据支持了三联治疗在减轻病情恶化、肺功能和生活质量方面的重要作用，而这些作用似乎与ICS的突然停用无关。《ISOLDE研究：吸入糖皮质激素治疗后血液嗜酸性粒细胞的变化可能预测慢性阻塞性肺病的长期临床反应》European Respiratory Journal，2020年5月 (6)此研究的目的是评价吸入糖皮质激素后，血液嗜酸性粒细胞的变化可以预测长期治疗结果。这项为期3年的双盲试验中，对751名中-重度COPD患者随机分入氟替卡松组和安慰剂组。研究发现，1年内的嗜酸性粒细胞的减少与治疗效果相关，而且是治疗反应的强预测因子。在嗜酸性粒细胞下降≥200/μL时，吸入糖皮质激素可降低第一秒用力呼气量（FEV1）下降率达32mL/年，恶化率降低30%。相反，在嗜酸性粒细胞升高≥200/μL时，吸入糖皮质激素可加速第一秒用力呼气量下降，下降速度为37mL/年，恶化率增加80% （P4年的患者患肺癌的风险比为0.92，无统计学意义。平均每日吸入糖皮质激素较高的患者肺癌的风险比为1.36（95% CI 1.03-1.81）。结论：在COPD患者中，吸入糖皮质激素与肺癌发病率的降低无关。《欧洲呼吸协会指南：慢性阻塞性肺病患者何时停用吸入糖皮质激素》European Respiratory Journal，2020年6月 (8)吸入糖皮质激素联合支气管扩张剂，可降低慢性阻塞性肺病患者病情加重的频率，但是糖皮质激素经常被用于疗效不确定的患者。因此文章建议对于下列情况停用吸入糖皮质激素：（1）若COPD患者没有频繁发作的病史，指南认为停用活继续糖皮质激素吸入治疗的获益风险比存在不确定性，需要充分告知和与患者讨论；（2）若血液嗜酸性粒细胞计数≥300/µl，指南强烈建议不要停用吸入糖皮质激素；（3）若准备停用吸入糖皮质激素，指南强烈建议使用一个或两个长效支气管扩张剂。COPD患者肺康复训练肺康复可以改善慢性呼吸系统疾病患者的症状、生存质量和肺功能。肺康复包括运动训练、促进将康的行为（比如戒烟、锻炼、营养支持、恰当用药和自我管理）和心理支持。运动训练可以采用下肢训练（如，固定式脚踏车、跑步机或自由行走）、上肢训练（如手臂训练）、间歇运动训练、抗阻力/力量训练和呼吸再训练。《回顾性队列研究：COPD出院后开始肺康复1年生存率的影响》JAMA，2020年5月 (9)肺康复训练与慢性阻塞性肺病患者生存率提高相关，但相关研究的患者数量少且异质性高。研究的目的时确定慢性阻塞性肺病患者出院后90天内开始肺部康复与1年生存率之间的关系。研究纳入197 376例患者、平均年龄76.9岁，1.5%的患者在出院后90天内开始肺康复。出院1年内死亡率19.4%，其中进行肺康复训练者死亡率7.3%，没有进行康复训练者死亡率19.6%。进行肺康复训练者绝对死亡风险下降6.7%，风险比 0.63。结论：慢性阻塞性肺病病人，出院后3个月内开始肺部康复1年死亡率显著降低。《随机对照研究：下坡行走对COPD患者肺部康复的影响》European Respiratory Journal，2020年5月 (10)收缩性肌肉疲劳影响COPD患者的训练反应。下坡步行诱发收缩肌疲劳、呼吸困难和疲劳程度较平地步行低。本研究比较了下坡步行训练和平地步行训练的方式进行肺康复对COPD患者的影响。在这项随机对照试验中，35例患者，平均年龄62岁，第一秒最大呼气量（FEV1）平均50%，随机分为下坡步行组或平地步行组。两组间，6分钟步行试验结果和肌肉活检没有差异（p=0.45）；但是94%的进行下坡行走锻炼的患者进步了，平地行走组仅为65%（p=0.03）。在其他方面，下坡行走组也有更大的改善。结论：在慢性阻塞性肺病患者中，结合下坡行走与常规步行在肺康复临床疗效上具有相似的效果；但是锻炼耐受性更好。《ON-EPIC研究：口服硝酸盐补充剂增强慢性阻塞性肺病肺部康复》Thorax 2020年7月 (11)研究的目的是评估口服硝酸盐是否能增强慢性阻塞性肺病患者的肺康复效果。这项双盲、安慰剂对照、平行组、随机对照研究在四个英国中心进行，登记了患有GOLD分级II-IV级的、医学研究委员会（Medical Research Council）呼吸困难评分3-5分或功能受限的COPD成年患者，进行每周两次、为期8周的肺康复训练计划。他们被随机分配到140ml富含硝酸盐的甜菜汁组（含12.9 mmol硝酸盐），或安慰剂组，服用前3小时进行肺康复训练治疗。积极治疗组(57例)的运动能力比安慰剂组(65例)提高更多;ISWT距离+60 m (10,85) vs +30 m(0,70)中值(IQR)变化，估计处理效果30 m (95% CI 10 ~ 40);p = 0.027。积极治疗对收缩压也有影响:治疗组-5.0 mm Hg (-5.0， -3.0) vs对照组+6.0 mm Hg(-1.0, 15.5)，估计治疗效果-7 mm Hg (95% CI 7 ~ -20) (p

On this episode, I talk about COVID-19 and pulmonary rehabilitation, including questions that health care professionals should ask themselves when they consider admitting patients who have had COVID-19 and ongoing symptoms. I mentioned some papers that I would recommend reading, that discuss some of these questions in more detail, as well as provide guidance to you as you consider caring for patients who have had COVID-19, in your pulmonary rehabilitation programs. Spruit MA, Holland AE, Singh SJ, Tonia T, Wilson KC, Troosters T. COVID-19: Interim guidance on rehabilitation in the hospital and post-hospital phase from a European Respiratory Society and American Thoracic Society-coordinated International Task Force. Eur Respir J 2020; in press (https://doi.org/10.1183/13993003.02197-2020). This paper can be found here.   American Thoracic Society Assembly on Pulmonary Rehabilitation. “Guidance for Re-opening Pulmonary Rehabilitation Programs.” This paper can be found here.   American Physical Therapy Association Webinars on “Physical Therapy Considerations of COVID-19 in the Post-Acute Setting” aired on April 18, 2020 and “COVID-19: Clinical Best Practices in Physical Therapy Management”, aired on March 28, 2020. These webinars can be found here.

As part of the February issue, the European Respiratory Journal presents the latest in its series of podcasts. Deputy Chief Editor James Chalmers interviews Peter G. Middleton (University of Sydney, Sydney, Australia) about the European Respiratory Society and the Thoracic Society of Australia and New Zealand's new statment on the management of reproduction and pregnancy in women with airways diseases published in this issue.

As part of the January issue, the European Respiratory Journal presents the latest in its series of podcasts. Deputy Chief Editor James Chalmers interviews Alyn Morice (University of Hull, Hull, UK) about the European Respiratory Society's new guidelines on the diagnosis and treatment of chronic cough in adults and children published in this issue. Alyn Morice is Chief Editor of ERJ Open Research. Sign up for ERJ Open Research alerts at https://openres.ersjournals.com/alerts

As part of the December issue, the European Respiratory Journal presents the latest in its series of podcasts. Chief Editor Martin Kolb interviews Jørgen Vestbo (ERS Advocacy Council Chair) about the European Respiratory Society's position on tobacco harm reduction published in this issue.

Historically, people at high risk of getting HIV or hepatitis have been excluded from the organ donor registry in Australia.Researchers are now calling for a re-think on this long-standing policy as a review of the data shows that the actual risk of infection in people who test negative is very low.Meanwhile, the word on vaping from the European Respiratory Society is: don't. TMR reporter Penny Durham has the latest from the international experts.

This is a discussion I had with Cath and Rachael, both senior physios about the European Respiratory Society 2018. We also talk about how they finance some of the conferences they attend. Food for thought. Interview Questions for Advanced Critical Care Practitioners The Content on the website is provided for FREE as is the podcast. You could […]

As part of the September issue, the European Respiratory Journal presents the latest in its series of podcasts. Section Editor David Gozal interviews Walter McNicholas (St Vincent's University Hospital and University College Dublin, Ireland) about a report by an ad hoc working group of the Sleep Disordered Breathing Group of the European Respiratory Society and the European Sleep Research Society.