Most recently added articles listed first
Comment by Dr Mark Lavercombe:
In this retrospective cohort study, physicians at the Royal Brompton Hospital National Pulmonary Hypertension Service report on data collected over 21 years including 128 patients with interstitial lung disease with pulmonary hypertension. Included patients were required to have had right heart catheter study, pulmonary function testing and transthoracic echocardiogram. Patients with connective tissue diseases and other causes of pulmonary hypertension were excluded. In patients treated with PDE5 inhibitors, there was a significant improvement in overall survival independent of other prognostic markers, and this was most striking in those with normal right ventricular function at baseline.
Comment by Dr Mark Lavercombe:
The association between obstructive sleep apnoea and cardiovascular disease is well recognised. In this paper, the authors explore the role of comorbid elevation of the periodic limb movements in sleep index in a cohort of of patients with obstructive sleep apnoea, and demonstrate a significant elevation in systolic blood pressure, even after accounting for the degree of OSA with multivariate analysis. Further studies - including those utilising 24h BP monitoring - are recommended.
Comment by Dr Mark Lavercombe:
Differentiation of the causes of pulmonary hypertension has become more important with targeted treatments available that can change prognosis. This study demonstrates the potential utility of a simple non-invasive test to differentiate between PH and non-PH, and CTEPH and PAH. Further studies will be required to clarify test performance in other patient groups and to exclude confounders.
Comment by Dr Mark Lavercombe:
In this nationwide study of 83425 patients with COPD, of whom 2637 had one or more acute coronary syndrome events during follow-up, low rates of beta-blocker prescription is found. This finding is especially pronounced in those with very severe COPD despite international guidelines recommending the use of beta-blockers in patients with coronary ischaemia and COPD.
Comment by Dr Mark Lavercombe:
The authors of this paper publish the first data for a multi-ethnic Asian cohort of patients with pulmonary arterial hypertension and have follow-up to 14 years. The REVEAL risk score for prediction of one-year mortality is evaluated with a cut off of >6 found to have a hazard ratio for earlier death of 4.4.
Comment by Dr Mark Lavercombe:
This paper describes the findings of a retrospective review of 367 patients from a single centre who presented with pulmonary embolism. Pulmonary infarction was associated with younger age, absence of cardiopulmonary disease, presence of pleuritic chest pain and presence of an ipsilateral pleural effusion. Explanations based on pulmonary blood flow physiology and the development of collateral supply are proposed.
Comment by Dr Mark Lavercombe:
This intriguing study suggests the use of serum SA100A12 concentration as a prognostic marker in pulmonary hypertension. Despite relatively small sample sizes, elevated S100A12 levels were significantly associated with a diagnosis of PH, and negatively correlated to cardiac output. Increased overall mortality was associated with S100A12 levels in both discovery and validation cohorts.
Comment by Dr Mark Lavercombe:
The use of transthoracic echocardiography as a screening tool for pulmonary hypertension in patients with interstitial lung disease is explored in this study, which finds significant numbers of patients are misclassified based on TTE parameters. The possibility of a combined risk assessment using other clinical factors is suggested.
Comment by Dr Mark Lavercombe:
In this study, the authors seek to define the risks of pulmonary hypertension in patients with combined pulmonary fibrosis and emphysema compared with those with IPF alone. Their conclusion that CPFE is "not greater than the sum of its parts" helps guide prognostication in this patient cohort.
Comment by Dr Mark Lavercombe:
The PA:A ratio as measured on chest CT scan has been demonstrated to predict pulmonary hypertension in some studies. In this cohort PA:A > 0.9 is found to predict both elevated mPAP and survival in patients with idiopathic pulmonary fibrosis.
Pulmonary Rehabilitation Guidelines for Australia and New Zealand Jennifer A Alison, Zoe J McKeough, Kylie Johnston, Renae J McNamara, Lissa M Spencer, Sue C Jenkins, Catherine J Hill, Vanessa M McDonald, Peter Frith, Paul Cafarella, Michelle Brooke, Helen L Cameron-Tucker, Sarah Candy, Nola Cecins, Andrew S L Chan, Marita T Dale, Leona M Dowman, Catherine Granger, Simon Halloran, Peter Jung, Annemarie L Lee, Regina Leung, Tamara Matulick, Christian Osadnik, Mary Roberts, James Walsh, Sally Wootton, Anne E Holland, on behalf of the Lung Foundation Australia and the Thoracic Society of Australia and New Zealand 10.1111/resp.13025 (Apr 2017)
The aim of these Guidelines is to provide evidence-based recommendations for the practice of pulmonary rehabilitation (PR) specific to Australian and New Zealand healthcare contexts.
These first-ever pulmonary rehabilitation Guidelines for Australia and New Zealand were launched (24-28 March 2017) at the TSANZSRS Annual Scientific Meeting in Canberra, Australia (24-28 March 2017), and were drawn up following a systematic review of over 275 clinical trials.
The Guidelines recommend that all COPD patients should be offered pulmonary rehabilitation regardless of their disease severity.
See the full Editorial for these important Guidelines at onlinelibrary.wiley.com/doi/10.1111/resp.13039/full
Comment by Dr Mark Lavercombe:
This important study describes a large cohort of patients admitted with acute pulmonary embolism to Intensive Care Units across Australia and New Zealand. A subpopulation at very high risk of death is identified (those requiring mechanical ventilation). No improvement in mortality rate over time is seen.
Usefulness of transcutaneous PCO2 to assess nocturnal hypoventilation in restrictive lung disorders. Georges et al.
onlinelibrary.wiley.com/doi/10.1111/resp.12812/full (May 2016)
(Editorial: onlinelibrary.wiley.com/doi/10.1111/resp.12871/abstract)