Bulletin
No. 113 (December 2018)
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APSR News

23rd APSR Congress, Taipei
29 November – 2 December 2018

Countdown

This early edition of the Bulletin is being issued just a few days before the 23rd Congress of the APSR welcomes you in Taipei on 29 November.

Remember that as an APSR member, you get a special discount from your congress registration fee.

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Click here for an overview of the programme,

or here for a more detailed agenda,

See also apsr2018.com (or scan the QR code on the right) for the latest updates and additions.

Taipei correspondent


Dr Tan

To help you keep up to date with the latest news at the Congress, we are pleased to announce that Dr Irene Rosellen P Tan will live-tweet and upload to the APSR's social networking site accounts (such as Facebook, Twitter and Instagram) during the APSR congress 2018 in Taipei.

Please enjoy her messages and photos!

AGM

The APSR Annual General Meeting will be held during the 23rd Congress of the APSR in Taipei, Taiwan at 16:30–17:00 Thursday 29 November 2018 in the South Lounge, Taipei International Convention Center (TICC), Taipei, Taiwan.

We look forward to seeing you.

Kwun Fong
President, APSR

Warning: Phishing websites

The official website for the Congress in Taipei is www.apsr2018.com.

Other websites are displaying the APSR and Congress logos, and give the general appearance of being genuine.

There is only one official website for the APSR Congress: www.apsr2018.com. Take care not to give any personal information to any other website.

If you have any questions or concerns, please contact
the Congress Secretariat: info@apsr2018.com
or the APSR Secretariat: APSRinfo@theapsr.org
tel +81-3-5684-3370

Assembly leadership election results

With so many eminent candidates competing to join the assembly leadership, it was a very close election result for several of the assemblies. Whether elected or not, all those taking part in the election remain invaluable assets and resources. The APSR is undeniably very fortunate to benefit from their support and expertise.

The following nine members have been elected and will join the assembly leadership teams immediately after the 2019 Congress in Vietnam:

  • Clinical Respiratory Medicine Assembly Deputy Head: Dr Chao-Chi Ho
  • Environmental & Occupational Health and Epidemiology Assembly Head-Elect: Dr Kazuhiro Yatera
  • Environmental & Occupational Health and Epidemiology Assembly Deputy Head: Dr Jun-Pyo Myong
  • Respiratory Infections (non-tuberculosis) Assembly Head-Elect: Dr Chieh-Liang Wu
  • Respiratory Infections (non-tuberculosis) Assembly Deputy Head: Dr Masaki Fujita
  • Lung Cancer Assembly Deputy Head: Dr David Chi-Leung Lam
  • Asthma Assembly Deputy Head: Dr Shih-Lung Cheng
  • Critical Care Medicine Assembly Deputy Head: Dr Kuo-Chin Kao
  • Bronchoscopy and Interventional Techniques Assembly Deputy Head: Dr Chih-Yen Tu

The assembly leadership line-up is now as follows:

  • Clinical Respiratory Medicine Assembly

    Yun Wing Thomas Mok
    Assembly Head
    for the next 12 months
    Dushantha Madegedara
    Head-Elect
    for the next 12 months
    thereafter Assembly Head
    for the following two years
    Roland Leung
    Deputy Head
    for the next 12 months
    thereafter Head-Elect
    for the following two years
    Chao-Chi Ho
    (Taiwan)
    will become Deputy Head
    after the 2019
    Congress in Vietnam
  • Cell and Molecular Biology Assembly

    Takahide Nagase
    Assembly Head
    for the next 12 months
    Tomoaki Hoshino
    Head-Elect
    for the next 12 months
    Chul-Gyu Yoo
    Deputy Head
    for the next 12 months
  • Clinical Allergy and Immunology Assembly

    Yasuhiro Gon
    Assembly Head
    for the next 12 months
    Takashi Iwanaga
    Head-Elect
    for the next 12 months
    Janet Rimmer
    Deputy Head
    for the next 12 months
  • Environmental & Occupational Health and Epidemiology Assembly

    Yasuo Morimoto
    Assembly Head
    for the next 12 months
    Woo Jin Kim
    Head-Elect
    for the next 12 months
    thereafter Assembly Head
    for the following two years
    Kozo Kuribayashi
    Deputy Head
    for the next 12 months
    Kazuhiro Yatera
    (Japan)
    will become Head-Elect
    after the 2019
    Congress in Vietnam
    Jun-Pyo Myong
    (Republic of Korea)
    will become Deputy Head
    after the 2019
    Congress in Vietnam
  • Respiratory Infections (non-tuberculous) Assembly

    Ki-Suck Jung
    Assembly Head
    for the next 12 months
    Yuanlin Song
    Head-Elect
    for the next 12 months
    thereafter Assembly Head
    for the following two years
    Soon Hin How
    Deputy Head
    for the next 12 months
    Chieh-Liang Wu
    (Taiwan)
    will become Head-Elect
    after the 2019
    Congress in Vietnam
    Masaki Fujita
    (Japan)
    will become Deputy Head
    after the 2019
    Congress in Vietnam
  • Tuberculosis Assembly

    Erlina Burhan
    Assembly Head
    for the next 12 months
    Jennifer Ann Wi
    Head-Elect
    for the next 12 months
    Lalaine Mortera
    Deputy Head
    for the next 12 months
  • COPD Assembly

    Kazuto Matsunaga
    Assembly Head
    for the next 12 months
    Chin Kook Rhee
    Head-Elect
    for the next 12 months
    Hao-Chien Wang
    Deputy Head
    for the next 12 months
  • Lung Cancer Assembly

    Chong Kin Liam
    Assembly Head
    for the next 12 months
    Emily Stone
    Head-Elect
    for the next 12 months
    thereafter Assembly Head
    for the following two years
    Laksmi Sita Andarini
    Deputy Head
    for the next 12 months
    thereafter Head-Elect
    for the following two years
    David Chi-Leung Lam
    (Hong Kong)
    will become Deputy Head
    after the 2019
    Congress in Vietnam
  • Asthma Assembly

    Peter Gibson
    Assembly Head
    for the next 12 months
    Kang-Yun Lee
    Head-Elect
    for the next 12 months
    thereafter Assembly Head
    for the following two years
    Phan Thu Phuong
    Deputy Head
    for the next 12 months
    thereafter Head-Elect
    for the following two years
    Shih-Lung Cheng
    (Taiwan)
    will become Deputy Head
    after the 2019
    Congress in Vietnam
  • Respiratory Neurobiology and Sleep Assembly

    Yoshitaka Oku
    Assembly Head
    for the next 12 months
    Christopher Kim-Ming Hui
    Head-Elect
    for the next 12 months
    Hiromasa Ogawa
    Deputy Head
    for the next 12 months
  • Critical Care Medicine Assembly

    Rodolfo Roman T Bigornia
    Assembly Head
    for the next 12 months
    Rex Chin-Wei Yung
    Head-Elect
    for the next 12 months
    thereafter Assembly Head
    for the following two years
    Phunsup Wongsurakiat
    Deputy Head
    for the next 12 months
    thereafter Head-Elect
    for the following two years
    Kuo-Chin Kao
    (Taiwan)
    will become Deputy Head
    after the 2019
    Congress in Vietnam
  • Bronchoscopy and Interventional Techniques Assembly

    Pyng Lee
    Assembly Head
    for the next 12 months
    Fumihiro Asano
    Head-Elect
    for the next 12 months
    thereafter Assembly Head
    for the following two years
    Phan Nguyen
    Deputy Head
    for the next 12 months
    thereafter Head-Elect
    for the following two years
    Chih-Yen Tu
    (Taiwan)
    will become Deputy Head
    after the 2019
    Congress in Vietnam
  • Paediatric Lung Disease Assembly

    Jessie Anne de Bruyne
    Assembly Head
    for the next 12 months
    Anna Marie Nathan
    Head-Elect
    for the next 12 months
    Anne Goh
    Deputy Head
    for the next 12 months
  • Respiratory Structure and Function Assembly

    Hajime Kurosawa
    Assembly Head
    for the next 12 months
    Greg King
    Head-Elect
    for the next 12 months
    Tsuyoshi Oguma
    Deputy Head
    for the next 12 months
  • Pulmonary Circulation Assembly

    Nobuhiro Tanabe
    Assembly Head
    for the next 12 months
    Masayuki Hanaoka
    Head-Elect
    for the next 12 months
    Talant Sooronbaev
    Deputy Head
    for the next 12 months
  • Interstitial Lung Disease Assembly

    Arata Azuma
    Assembly Head
    for the next 12 months
    Takafumi Suda
    Head-Elect
    for the next 12 months
    Moo Suk Park
    Deputy Head
    for the next 12 months

Respiratory Updates

The November issue (Vol 10.11) features Mesothelioma:

  • Tremelimumab as second-line or third-line treatment in relapsed malignant mesothelioma (DETERMINE): a multicentre, international, randomised, double-blind, placebo-controlled phase 2b trial.
  • Clinical safety and activity of pembrolizumab in patients with malignant pleural mesothelioma (KEYNOTE-028): preliminary results from a non-randomized, open-label, phase 1b trial
  • Assessment of potential predictors of calretinin and mesothelin to improve the diagnostic performance to detect malignant mesothelioma: results from a population-based cohort study.
  • National Cancer Database Report on Pneumonectomy Versus Lung-Sparing Surgery for Malignant Pleural Mesothelioma.
  • External validation of prognostic indices for overall survival of malignant pleural mesothelioma
  • Tremelimumab combined with durvalumab in patients with mesothelioma (NIBIT-MESO-1): an open-label, non-randomised, phase 2 study.
  • Nintedanib Plus Pemetrexed/Cisplatin in Patients With Malignant Pleural Mesothelioma: Phase II Results From the Randomized, Placebo-Controlled LUME-Meso Trial.
  • NGR-hTNF in combination with best investigator choice in previously treated malignant pleural mesothelioma (NGR015): a randomised, double-blind, placebo-controlled phase 3 trial.
  • Radiotherapy for the treatment of malignant pleural mesothelioma.
  • Geographic and socioeconomic factors in patients with malignant pleural mesothelioma in New South Wales and their impact upon clinical outcomes.

Inside Respirology

Editor's choice

In Respirology Vol. 23 Issue 12, the Editors have especially chosen to feature the following two articles:

  • Inflammation-dependent and independent airway remodelling in asthma
    John G Elliot, Peter B Noble, Thais Mauad, Tony R Bai, Michael J Abramson, Karen O McKay, Francis H Y Green, Alan L James
    10.1111/resp.13360

    1000-fold magnification of the airway smooth muscle layer with a counting grid overlay for planimetry assessment of the airway smooth muscle area.
    (Click image to enlarge)

  • Obstructive sleep apnoea independently predicts lipid levels: Data from the European Sleep Apnea Database

    Canan Gündüz, Ozen K Basoglu, Jan Hedner, Ding Zou, Maria R Bonsignore, Holger Hein, Richard Staats, Athanasia Pataka, Ferran Barbe, Pavel Sliwinski, Brian D Kent, Jean Lois Pepin, Ludger Grote on behalf of the European Sleep Apnea Database Collaborators
    10.1111/resp.13372

    ESADA researchers and collaborators from left to right: Holger Hein, Sven Svedmyr, Ding Zou, Canan Gündüz, Ludger Grote.
    (Click image to enlarge)

New Topics In Focus

Tuberculosis Updates 2018
Edited by Chi Chiu Leung, Cynthia Chee and Ying Zhang

Enjoy reading these reviews by international experts on important innovations and developments in a global effort to end the tuberculosis epidemic.

Inside Respirology Case Reports

The following cases have been selected for inclusion in the December 2018 Respirology Case Reports, Volume 06 Issue 9

Case Series

Methicillin-resistant Staphylococcus aureus in health-care workers with cystic fibrosis in Sydney
Yang Song, Lucy Rebecca Keatley, Peter Gordon Middleton
DOI: 10.1002/rcr2.378

Colonization with MRSA has been noted in a previous study of adults with CF who work in healthcare. Given the increasing number of adults with CF interested in pursuing a health-care profession, we performed an audit which determined that there was no increased risk of colonization/infection with this organism in our clinic in Sydney.

Case Reports

Shisha smoking as a possible cause of bilateral granulomatous lung lesions
Eun Ho Choe, Luke Sutherland, Christopher Hills, Jai-deep Sood
DOI: 10.1002/rcr2.374

A 19 year old male who regularly smoked tobacco Shisha pipes presented with pleuritic chest pain, dyspnoea and cough. He was found to have multiple bilateral lung nodules on computed tomography. A biopsy of the lung revealed necrotizing granulomatous inflammation. There was spontaneous and complete clinical and radiographic resolution over the next 12 weeks.

Delayed breast cancer relapse with pleural metastasis and malignant pleural effusion after long periods of disease-free survival
Antony Divananth Rawindraraj, Christine Yang Zhou, Vikas Pathak
DOI: 10.1002/rcr2.375

Breast cancer relapse rates remain high within the first decade after initial treatment, after which the risk of relapse decreases. While common within the first year of breast cancer diagnosis, pleural metastasis with malignant pleural effusion (MPE) after 10-12 years of a disease-free period is rare. This case series presents two uncommon cases of delayed breast cancer relapses with pleural metastasis, which caused MPEs.

Bronchobiliary fistula after radiofrequency ablation for hepatocellular carcinoma successfully treated by double drainage
Yi Chen Chang, Yu Min Lin
DOI: 10.1002/rcr2.376

Chest computed tomography demonstrated right middle lobe consolidation with pleural effusion and right-side subphrenic fluid collection. Percutaneous transhepatic drainage of the subphrenic fluid and simultaneous cholangiography proved the bronchobiliary fistula. Percutaneous drainage combined with endoscopic retrograde biliary drainage successfully treated the patient.

Xanthogranulomatous pyelonephritis presenting as a left-sided pleural effusion
Maple Huang, Reuben Sum, Sheetal Deshpande, Simon A Joosten
DOI: 10.1002/rcr2.377

We present the case of a 42-year-old male who presented to the emergency department with a left-sided pleural effusion on plain radiograph and computed tomography. Further imaging of the abdomen indicated that this effusion was secondary to a splenic hilar abscess complicating a left-sided xanthogranulatous pyelonephritis.

Hydrocarbon pneumonitis caused by the inhalation of wood preservative
Munechika Hara, Shin-ichiro Iwakami, Issei Sumiyoshi, Takashi Yoshida, Shinichi Sasaki, Kazuhisa Takahashi
DOI: 10.1002/rcr2.379

This is a case of hydorocarbon pneumonitis due to inhaling a wood-preserving agent in an enclosed space. The diagnosis was established from the fluid resembling wood preservative collected using bronchoalveolar lavage. This case improved under intensive care, which included mechanical ventilation without administration of corticosteroids.

Regional society news

The spotlight this month is on

Republic of Korea

Each month we share details of activities of a particular country, region or society.

If you would like the spotlight to be on your country, region or society next month, contact the Bulletin Coordinator or APSR Secretariat.

Korean Academy of Tuberculosis & Respiratory Diseases (KATRD)

The 126th annual conference of the KATRD was held on 8–9 November in Seoul. The KATRD also held an English session during the conference. Many international experts participated the conference.

A COPD Day in Republic of Korea was held on 10 October. In the past, COPD days in Republic of Korea have been held only in Seoul, but this year, it was held in two cities: Seoul and Gwangju. The main purpose was to increase awareness about COPD to the general population. Free pulmonary function tests, consultations with COPD specialists, and education for smoking cessation were provided. During the day, many citizens participated and had a chance to improve awareness of COPD. The importance and burden of COPD were well educated.

Chin Kook Rhee, MD, PhD

Professor
Division of Pulmonary, Allergy and Critical Care Medicine
Department of Internal Medicine
Seoul St. Mary's Hospital
College of Medicine
The Catholic University of Korea

(Click any photo to enlarge)

(Click any photo to enlarge)

Other notable society events and news:

Australia

Asian Pacific Congress for Bronchology (APCB) 2019

Venue:Gold Coast, Australia
Dates:28–30 March 2019
Detailswww.apcb2019.com

The Asian Pacific Congress on Bronchology and Interventional Pulmonology (APCB 2019) will take place at the Gold Coast Exhibition and Convention Centre, Australia, 28–30 March 2019, preceding the TSANZSRS Annual Scientific Meeting (30 March – 2 April).

It will attract a distinguished audience comprised of researchers and clinicians in the field of bronchology and interventional pulmonology. The theme is "Case Based Training – Practice and Theory" and it will have a novel design with a hands-on focus; workshops will provide the core part of the Congress.

APCB 2019 promises to offer an exceptional learning opportunity. Case-based learning will take centre stage and local and international faculty have developed a range of interesting and informative cases across 9 key topics. As part of your registration package you will get to choose 4 half-day courses, which will include theory as well as plenty of time to gain hands-on practice in key procedural points relevant to the particular topic.

REGISTER NOW

For more information, or to sign up to receive updates, please go to www.apcb2019.com

We look forward to seeing you on the Gold Coast!

2019 Local Organising Committee
David Fielding
Congress President
Asia Pacific Congress of Bronchology 2019

Japan

Japanese Respiratory Society

The 59th Annual Meeting of the Japanese Respiratory Society will be held on 12-14 April 2019 at the Tokyo International Forum.

The Meeting's president will be Prof. Koichiro Tatsumi (Department of Respirology, Chiba University)

Details: www.jrs.or.jp/english/?content_id=27

Health news

Tuberculosis

The Global TB Consilium: a response to difficult-to-treat TB cases

The Global TB Consilium is a global initiative offered by the Global TB Network (GTN).

The newly established GTN, operating within WAidid (a recognized Infectious Diseases society offering free membership for GTN members), aims to foster and conduct research on key unmet therapeutic and diagnostic needs in the field of TB elimination leveraging on multi-disciplinary, multi-sectorial approaches and supportive interventions (i.e. training, and advocacy activities) within the framework of the WHO End TB Strategy without duplicating existing efforts.

The Global TB Consilium is a free cost e-clinical consultation initiative, which globally provides clinicians with detailed and coordinated expert opinion on challenging cases of MDR-TB, XDR-TB, performed by two qualified experts within a maximum of 48 hours of submitting the case.

The Global TB Consilium operates globally in English, Russian, Spanish and Portuguese. Other languages will be included based on needs.

Presently working via email, it will soon operate on a secure ad hoc electronic platform website.

The aims of the Global TB Consilium are to:

  • Improve the clinical management of difficult-to-treat TB cases or micro-epidemics (including TB/HIV and paediatric cases)
  • Provide scientifically sound and evidence-based advice to support physicians in managing diagnosis and treatment of MDR/XDR-TB cases (due to lack of clinical experience, frequent occurrence of adverse events, problems in patients' adherence, and limited availability of adequate diagnostics and second-line anti-TB drugs in some countries) with special attention to the use of new drugs, new regimens and management of side effects
  • Prevent the emergence of MDR/XDR-TB
  • Support clinicians in handling micro-epidemics and management of latent TB infection
  • Assess to what extent WHO policies and guidelines are applied (or not!) through an ad hoc Monitoring & Evaluation (M&E) function

Three additional services are provided by the TB Consilium related to:

  1. Independent opinion on the inclusion of patients in compassionate use of new drugs: the use of potentially life-saving drugs that are experimental as they have not received regulatory approval. The Global TB Consilium experts are qualified to provide a technically independent opinion on the rationale use of these drugs.
  2. Guidance on management of latent tuberculosis infection and management of micro-epidemics.
  3. Connecting resources among countries for the management of trans-border migration cases.

To ask advice from the Global TB Consilium please email to: tbconsilium@gmail.com

How the Global TB Consilium works;

Any clinician who needs clinical support can:

  1. Send an email to tbconsilium@gmail.com explaining the reason to ask an advice for
  2. He/she will be asked to fill in the Patient Form with anonymised clinical information following GDPR rules
  3. He/she will receive a rapid clinical advice within 48 hours, independently provided by two selected global TB experts and consolidated by a Clinical Coordinator

Three gold points for you!

The GOLD Reports for 2019 are now available.

2019 Global strategy for prevention, diagnosis and management of COPD
An evidence-based strategy document for COPD diagnosis, management, and prevention, with citations from the scientific literature.

2019 GOLD Pocket Guide
A quick-reference guide for physicians and nurses, with key information about patient management and education.

GOLD Teaching Slide Set
PowerPoint slide set summarizing GOLD's objectives, documents, and management recommendations from the 2019 update of the GOLD Report, with background information about COPD and the burden of this disease.

World Days

Check the APSR website on 1 December for a press release in celebration of World AIDS day.

There were two "World Days" of special interest in November. The FIRS have produced the following press releases and facts sheets which you may find useful for your papers. The first was:

World Pneumonia Day

FIRS press release:
We must do more to prevent and treat pneumonia, says international respiratory group

In support of World Pneumonia Day, 12 November, the Forum of International Respiratory Societies (FIRS) calls for renewed efforts to prevent and treat pneumonia.

Pneumonia is one of the most preventable and treatable illnesses in global health and yet every minute, 2 children die from this illness. Most (99%) deaths occur in low or middle-income countries. Pneumonia in early childhood may also increase the likelihood of developing a chronic lung disease such as asthma or chronic obstructive respiratory disease (COPD) in adulthood.

Pneumonia is also a common cause of death or illness in the elderly, being the single most common cause of death from infectious disease in this group.

World Pneumonia Day brings people from all over the world together, to demand that efforts are strengthened to fight pneumonia, which is largely preventable and treatable.

Pneumonia is commonly caused by different germs that may be bacteria or viruses. Vaccines are available to protect children from some of the common germs and these can prevent pneumonia.

Exclusive breastfeeding for the first 4 to 6 months of life, adequate complementary feeding and good nutrition can also help to prevent pneumonia. Avoiding cigarette smoke exposure or indoor air pollution, especially during pregnancy and the early childhood years, is important to reduce the risk of pneumonia and severe illness. Reducing HIV infection and early use of antiretroviral therapy and antibiotics are effective to prevent pneumonia in HIV-infected children and adults.

To treat pneumonia, case management guidelines that include indications for hospital referral and the use of antibiotics are effective. Oxygen is life-saving for those with severe disease.

Unfortunately, children are still dying from pneumonia because they are denied the benefits of prevention, accurate diagnosis and treatment. 170 million children in low and middle-income countries are not vaccinated against pneumonia. Globally, only 35% of eligible children get the required three doses of pneumococcal vaccine. Around 40 million episodes of pneumonia go untreated each year. Almost 880,000 children under 5 years of age still die each year from pneumonia. In sub-Saharan Africa, less than half of children with symptoms are taken to a health care provider.

To reduce pneumonia cases and deaths we need to:

  • Raise awareness about pneumonia, the leading killer of young children.
  • Strengthen and sustain interventions to prevent and treat pneumonia.
  • Increase access to available, effective interventions.
  • Conduct research to develop innovative strategies to reduce the burden of pneumonia.

No child should die from pneumonia. No family should suffer the distress associated with a pneumonia death.

FIRS calls upon governments, health care providers, researchers, funders and families to ensure:

  1. Improved and sustained access to effective interventions that prevent and treat pneumonia.
  2. Strengthen health systems that promptly and effectively deliver strategies to reduce pneumonia deaths, including provision of effective antibiotics and oxygen delivery systems.
  3. Increase support for strategies to prevent pneumonia including prevention of mother-to-child HIV transmission, provision of anti-retroviral therapy for HIV-infected children, reduction of exposure to tobacco and air pollution, and increasing access to safe drinking water and sanitation.
  4. Support research towards innovative diagnostic, prevention and treatment strategies.

Fact Sheet
Pneumonia – the preventable killer

  • Every minute, 2 children die from pneumonia.
  • Every year, about 880,000 children under 5 years old die from pneumonia; 80 percent of deaths are in children under 2 years. Most (99 percent) deaths occur in low or middle-income countries.
  • 170 million children in low and middle-income countries are not vaccinated against pneumonia. Globally, only 35 percent of eligible children get the required three doses of pneumococcal vaccine.
  • Around 40 million episodes of pneumonia go untreated each year. In sub-Saharan Africa, less than half of children with symptoms are taken to a health care provider.
  • Pneumonia in early childhood may also increase the likelihood of developing a chronic lung disease such as asthma or chronic obstructive respiratory disease (COPD) in adulthood.
  • Pneumonia is also a common cause of death or illness in the elderly, being the single most common cause of death from infectious disease in this group.

Treating and preventing pneumonia

  • Pneumonia is commonly caused by bacteria or viruses. Vaccines for children are available to prevent pneumonia from some of the common germs and can PREVENT pneumonia from these.
  • Vaccines are available against pneumococcal, measles, Haemophilus influenzae type b, pertussis (whooping cough), diphtheria and influenza germs.
  • Exclusive breastfeeding for the first 4 to 6 months of life, adequate complementary feeding and good nutrition can also help prevent pneumonia.
  • Avoiding cigarette smoke exposure or indoor air pollution, especially during pregnancy and early childhood years, is important to reduce the risk of pneumonia and severe illness.
  • Reducing childhood HIV infection through strengthened mother-to-child prevention programmes and early use of antiretroviral therapy, in children who are HIV-infected, is also key to reducing the burden of childhood pneumonia.
  • To treat pneumonia, case management guidelines that include indications for hospital referral and the use of antibiotics are effective. Oxygen is life-saving for those with severe disease.

The second World Day of interest in November was:

World COPD Day

FIRS press release:
It is never too early, never too late for COPD diagnosis and treatment: The Forum of International Respiratory Societies

Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease that causes breathlessness, chronic sputum production and cough, there are 251 million current cases of COPD in the world. COPD is currently the 3rd leading cause of death globally and is highly prevalent in low resource countries. Exposure to tobacco smoke and other inhaled toxic particles and gases are the main risk factors for COPD, although recent research has identified that suboptimal lung growth before and after birth can also increase the risk of COPD later in life.

World COPD Day is an annual global initiative run by the Global Initiative for Chronic Obstructive Lung Disease (GOLD), who are members of the Forum of International Respiratory Societies (FIRS).

This year, the 17th annual World COPD Day takes place on 21 November. The theme "never too early, never too late" emphasises that COPD can originate early in life (therefore, early diagnosis and intervention is key) as well as that it is never too late for diagnosis and treatment.

"The early stages of COPD are often unrecognised. This is partly because they are not considered in infancy and, partly because many older individuals discount their symptoms such as breathlessness, chronic cough, and bringing up phlegm as a normal part of getting older or an expected consequence of cigarette smoking.", states Prof. Alvar Agusti (Spain), Chair of the GOLD Board of Directors.

COPD is diagnosed with a breathing test called spirometry. This test is easy to perform, non-invasive and painless, it only takes a few minutes. Finding cases early on is very important to prevent disease progression, and this approach may reduce the burden of disease and mortality rates in future. Increasing public knowledge of COPD, specifically prevention strategies, is enormously important. People with chronic breathlessness of any type, or cough and sputum production should have a spirometry test.

Initiatives to reduce the burden of COPD are taking place worldwide, including smoking cessation programmes, fighting against both indoor and outdoor air pollution, as well as examining childhood disadvantage factors (such as parental smoking, lung infections and uncontrolled asthma).

Although there is no current cure for COPD, action can take place at every stage of the disease. It is never too early to diagnose lung dysfunction and intervene prophylactically and therapeutically; and it is never too late to stop smoking and start fighting the disease and its consequences. Currently available therapies can alleviate the symptoms of breathlessness, cough and sputum production, and disease flare-ups.

Improved COPD prevention, early diagnosis and appropriate interventions will contribute to "ensure healthy lives and promote well-being for all at all ages" which is one of the most important United Nations (UN) 2030 Sustainable Development Goals.

Fact Sheet

  • There are 251 million current cases of Chronic Obstructive Pulmonary Disease (COPD) in the world.
  • 3 million people die each year from COPD.
  • COPD is currently the 3rd leading cause of death globally.
  • COPD is highly prevalent in low resource countries.
  • Exposure to tobacco smoke and other inhaled toxic particles and gases are the main risk factors for COPD.
  • Recent research has identified that suboptimal lung growth before and after birth can also increase the risk of COPD later in life.

Preventing and treating COPD

  • Discouraging individuals from starting to smoke tobacco and encouraging smokers to reduce and quit smoking are the first and most important priorities in preventing COPD.
  • COPD is diagnosed with a breathing test called spirometry. This test is easy to perform, non-invasive and painless. It takes only few minutes.
  • Finding cases early on is very important to prevent disease progression, and this approach may reduce the burden of disease and mortality rates in future.
  • People with chronic breathlessness of any type, or cough and sputum production should have a spirometry test.
  • Initiatives to reduce the burden of COPD are taking place worldwide, including smoking cessation programmes, fighting against both indoor and outdoor air pollution, as well as examining childhood disadvantage factors (such as parental smoking, lung infections and uncontrolled asthma).
  • Although there is no current cure for COPD, action can take place at every stage of the disease.
  • Currently available therapies can alleviate the symptoms of breathlessness, cough and sputum production, and disease flare-ups.

Common symptoms of COPD

  • Shortness of breath.
  • A repetitive cough.
  • Increased phlegm or mucus production.
  • Feeling tired.
  • More frequent chest infections.
  • Taking longer to recover from a cold or chest infection.

FIRS calls for these essential actions to reduce the burden of respiratory disease and improve global health:

  1. Increase public and policy makers' awareness that respiratory health is essential to global health and that childhood respiratory disease may have long-term negative consequences on adult health by advocating at world health meetings and through publications and media postings.
  2. Reduce, and then eliminate, the use of all tobacco products through universal support of the Framework Convention on Tobacco Control.
  3. Adopt WHO standards, at a minimum, to reduce ambient, indoor, and occupational air pollution for all countries.
  4. Promote universal access to quality healthcare, including the availability of affordable, quality-assured, essential medicines and universal coverage for childhood and adult immunisations, including new conjugate vaccines by advocacy through WHO and government programmes.
  5. Improve early diagnosis of respiratory diseases through improving awareness and access to current procedures and the development of new tools through world health meetings and publications.
  6. Increase education and training of health professionals in respiratory disease worldwide though programmes of the FIRS societies, WHO and other governmental and non-governmental organisations.
  7. Standardise the monitoring of the prevalence, severity and management of respiratory diseases to enable development of well-informed national strategies though programmes of WHO and governmental and non-governmental organisations.
  8. Increase respiratory research to develop programmes, tools and strategies to better prevent and treat respiratory diseases though advocacy for governmental and nongovernmental research organisations.

India

Press release date: 22 November 2018.
FIRS warns of a link between ambient air pollution and the high incidence of hypersensitivity pneumonitis in urban cities

An article published in the European Respiratory Journal (doi.org/10.1183/13993003.01563-2018*) found that a higher proportion of patients diagnosed with hypersensitivity pneumonitis (HP) lived in cities with higher levels of air pollutants.1

"We discovered that the majority of patients with HP in India, were living in urban cities, prompting an investigation into the link between ambient air pollution in urban India and the high incidence of HP," said Ganesh Raghu, MD, senior research author and Professor of Medicine and Laboratory Medicine, University of Washington.2

HP, formerly called extrinsic allergic alveolitis, is inflammation of both lungs (pneumonitis) because of an immune response (hypersensitivity) to environmental factors inhaled by the person. Continued/recurrent exposures and untreated HP leads to progressive scarring in both lungs (pulmonary fibrosis) that is irreversible and deadly to those susceptible.

The clinical manifestation and the need to make an accurate and prompt diagnosis of HP, for appropriate management and awareness of the environmental factors associated with HP, have been recently discussed3. "This study provides more support for prior work that suggests a correlation between inhaled ambient pollution and development of hypersensitivity pneumonitis," said Clayton T. Cowl, MD, MS, Chair of the Division of Preventive, Occupational and Aerospace Medicine at Mayo Clinic in Rochester, Minnesota and member of FIRS Environmental Committee.4

"Not only is teasing out specific exposures such as inhalation of specific antigens from animal or vegetable sources critical, but medical history focusing on geography and urban versus rural environments is becoming more important in the diagnosis of this condition. Ambient air pollution is likely accountable for a variety of respiratory conditions besides asthma and diseases of the airways – conditions traditionally associated with poor air quality."

Barbara Hoffmann, Professor of Environmental Epidemiology and member of FIRS Environmental Committee said: "This study points to an area of research which has received comparatively little attention in air pollution epidemiology so far: That exposure to air pollution may not only influence the innate immune system and downstream disease, but also the adaptive immune system. While some mechanisms have been studied in animal experiments, there is still a lack of targeted studies in humans."5

This study raises concerns for people living in polluted urban areas, who are also exposed to other occult environmental factors such as birds, mould, unkept ventilation/heating/cooling systems and manifesting respiratory problems, progressing to incurable chronic HP, pulmonary fibrosis and death. Another area of concern is the link between air pollution and interstitial lung diseases, especially idiopathic pulmonary fibrosis, a fatal lung disease, and poor outcomes in lung transplant recipients.6–8.

Breathing clean air is essential to prevent deathly diseases. "The public and health care community need to be alerted to HP as a preventable disease, making the results of this study known to ensure they take preventive measures to minimize the risk of manifesting HP and/or perpetuating progression of pulmonary fibrosis associated with chronic HP" concludes Ganesh Raghu.

  1. Singh S, Collins BF, Bairwa M, et al. Hypersensitivity pneumonitis and its correlation with ambient air pollution in urban India. Eur Respir J 2018; in press. The paper can be viewed at: doi.org/10.1183/13993003.01563-2018*
  2. Dr Raghu is Professor of Medicine and Laboratory Medicine, University of Washington and Director of the Center for Interstitial Lung Diseases at University of Washington Medical Center. He is a leading expert and international authority on interstitial lung diseases (ILD), pulmonary fibrosis including hypersensitivity pneumonitis, sarcoidosis and has had a longstanding focused research and clinical interest in the field of ILD.
  3. Vasakova M, Morell F, Walsh S, Leslie K, Raghu G. Hypersensitivity Pneumonitis: Perspectives in Diagnosis and Management. AJRCCM 2017; 196: 680–899.
  4. Dr Cowl is board certified in Pulmonary, Critical Care, Occupational, and Internal Medicine and is the President of CHEST. He chairs the Division of Preventive, Occupational, and Aerospace Medicine at the Mayo Clinic. He is the Immediate Past-President of the Civil Aviation Medical Association. His research interests are in occupational asthma and toxic inhalations.
  5. Dr Barbara Hoffmann is Professor of Environmental Epidemiology at the University of Düsseldorf, Germany. She chairs the Environment and Health Committee or ERS. Her research focuses on the investigation of acute and chronic cardiopulmonary, metabolic and neurological health effects of air pollution and noise.
  6. Lucile Sesé, Hilario Nunes, Vincent Cottin et al Role of atmospheric pollution on the natural history of idiopathic pulmonary fibrosis http://dx.doi.org/10.1136/thoraxjnl-2017-209967
  7. Sack CS, Doney BC, Podolanczuk AJ, et al: The Multi-Ethnic Study of Atherosclerosis (MESA) Air-Lung Study. Am J Respir Crit Care Med. 2017. doi: 10.1164/rccm.201612-2431OC. PubMed PMID: 28753039.
  8. Kaufman JD, Raghu G. Should we be concerned about air quality as a contributor to poor outcomes in lung transplant recipients? Eur Respir J. 2017 Jan 18;49 (1). pii: 1602369. doi: 10.1183/13993003.02369-2016. PMID: 28100554.

* Note: ERJ login required to access full article

About the Forum of International Respiratory Societies

The Forum of International Respiratory Societies (FIRS) is an organization comprising the world's leading international respiratory societies working together to improve lung health globally: American College of Chest Physicians (CHEST), American Thoracic Society (ATS), Asian Pacific Society of Respirology (APSR), Association Latino Americana De Thorax (ALAT), European Respiratory Society (ERS), Global Initiative for Chronic Obstructive Lung Disease (GOLD), and the Global Initiative for Asthma (GINA), International Union Against Tuberculosis and Lung Diseases (The Union), and the Pan African Thoracic Society (PATS).

The goal of FIRS is to unify and enhance efforts to improve lung health through the combined work of its more than 70,000 members globally.

Contact: Lisa Roscoe, lisa.roscoe@firsnet.org

APSR Membership

Donations received

has kindly sent his donation towards the Society's goals, as outlined at apsresp.org/members/donors.php.

The APSR is profoundly grateful for his generosity.

Assembly news

APSR Assembly Meetings, 2018

The following meetings will be held during the 23rd APSR Congress at the Taipei International Convention Center (TICC) in Taipei

AssemblyDate/TimeRoom2018 Theme
Clinical Respiratory MedicineSaturday
1 December
07:15–08:00
201ELearning through dialogue
Cell and Molecular BiologySaturday
1 December
07:15–08:00
201FFuture perspectives of CMB Assembly
Clinical Allergy & ImmunologySaturday
1 December
07:15–08:00
201AOur mission in APSR
Environmental & Occupational Health and EpidemiologyFriday
30 November
07:15–08:00
201APopulation health burden from air pollution, by country in the Asia-Pacific Region
Respiratory Infections (non-tuberculosis)Friday
30 November 
07:15–08:00
201DTravel-associated infection control and prevention
TuberculosisSaturday
1 December
07:15–08:00
102APSR for TB elimination
COPDFriday
30 November
07:15–08:00
201BPersonalized management
Lung CancerSaturday
1 December
07:15–08:00
102Advancing precision medicine in lung cancer
AsthmaSaturday
1 December
07:15–08:00
201BWhat is the prevalence of eosinophilic airway inflammation in Asian patients with asthma
Respiratory Neurobiology and SleepFriday
30 November
07:15–08:00
201CSymposium proposal for APSR2019
Critical Care MedicineSaturday
1 December
07:15–08:00
201DVibrant & active online
Bronchoscopy and Interventional TechniquesFriday
30 November
07:15–08:00
201EBronchoscopy education for Asia-Pacific region
Respiratory Structure and FunctionSaturday
1 December
07:15–08:00
201CFuture plans for the Assembly
Pulmonary CirculationSaturday
1 December
07:15–08:00
103How to activate pulmonary circulation assembly of APSR
Interstitial Lung DiseaseSaturday
1 December
07:15–08:00
105Discovery of Interstitial Lung Disease

Any updates to this list will be shown at apsresp.org/archive/2018-assembly-meetings.html

New assembly leadership

We're delighted to announce and welcome the following assembly members who will join their assembly leadership team after the 24th APSR Congress in Vietnam, November 2019.

You can contact them through the Messages section of your assembly's webpage, shown below. They will welcome your ideas and greatly value your continued support.

A hearty congratulations to them all!

New assembly members

A warm welcome to the following members who have recently joined APSR assemblies. They will undoubtedly enjoy working with and networking with their assembly colleagues.

Assemblies
Mohamed Ismail
Maldives)
Clinical Respiratory Medicine
Tuberculosis
Bronchoscopy and Interventional Techniques
Irene Rosellen Tan
Philippines)
Critical Care Medicine
Bronchoscopy and Interventional Techniques
Clinical Respiratory Medicine
Kyi Kyi Zaw
(Australia)
Lung Cancer
Asthma
COPD
Jianmeng Zhou
(China)
Asthma
Clinical Allergy & Immunology
Clinical Respiratory Medicine

APSR Short-Term Research/Training Scholarship
- a post-training report from Dr Ralph Villalobos

Research/training:International pulmonology and chest ultrasound fellowship
2 July 2018 – 31 October 2018
Host institute:China Medical University Hospital, Taiwan
Host supervisor:Dr Chih Yen Tu

It is with little doubt that both the popularity and our scientific knowledge of the field of Interventional Pulmonology (IP) has risen dramatically in recent years. We have seen the rise of the Endobronchial Ultrasound (EBUS) as the primary tool in diagnosing lung tumors, largely replacing the conventional fluoroscopy-guided bronchoscopy. EBUS with transbronchial needle aspiration biopsy (EBUS-TBNA) has also unseated traditional mediastinoscopy in the diagnosis of mediastinal lymphadenopathies, and boasts superior yield and better safety profile. The recent years has also ushered new techniques in IP, such as medical pleuroscopy (which can even diagnose pleural effusions with a minimally invasive strategy and no need for general anesthesia), stent insertions (to rescue critical airway obstructions), and even transesophageal biopsies.


The timeline of IP development in CMUH
(Click any image to enlarge


CMUH boasts of a large number of IP procedures performed every year

However, we recognize that there is a great gap of knowledge in this very novel and important field in pulmonology worldwide. More developed countries enjoy the convenience of the availability of machines capable of these new technologies, while some countries still struggle. Taiwan is recognized as a developed country in Asia, with a comprehensive health insurance system and good quality healthcare. The Philippines is Taiwan's very close neighbor, and enjoy great political and economic ties. Despite the proximity in location however, Taiwan and the Philippine's IP fields are very much dissimilar, with the latter lagging behind.

I came to China Medical University Hospital (CMUH), under the mentorship of the Chief of the Pulmonary Medicine Division, Dr Chih Yen Tu. CMUH is located in Taichung City, the nation's economic center in Central Taiwan. It is a big academic medical center, with a 2,500 bed capacity and hundreds of patients seek care in this hospital on a daily basis. Undoubtedly, CMUH is the leading IP Center in Taiwan which started development in 2007, and continues to grow until now. The number of procedures in this center is much at par with the rest of the world, with more than 8,000 bronchoscopies, 4,000 EBUS, and hundreds of TBNA, stent insertions and pleuroscopies performed since the center started.


With the faculty and staff of the Division of Pulmonary Medicine in CMUH (to my left is Dr Chich Yeh Tu, and to my left are Dr Wei Chih Liao and Dr Chen Chia Hung)
(Click any image to enlarge


With Taiwan's renowned expert in Chest Ultrasound, Dr Hsu Wu Hei

The faculty of the Division of Pulmonary Medicine of CMUH is also very well-trained in IP cases. Dr Tu and his assistant Chief, Dr Chen Chia Hung, are trained extensively in IP and got their training from the National Cancer Center in Japan, and in the MD Anderson Center and Johns Hopkins University Hospital in the US. They have been practicing IP for more than 10 years. They have also authored a large number of internationally peer-reviewed articles, both in IP and other fields of Pulmonary Medicine. The Associate Dean of the University, Dr Hsu Wu Hei, is also a leading figure in the field of Chest Ultrasound in Taiwan.

Apart from the actual experience of the procedure, they had prepared a series of lectures in EBUS, TBNA, pleuroscopy and central airway obstruction. I also participated in multidisciplinary case discussions with the IP team, chest surgeons and pathologists to tackle difficult cases involving IP. This was a very enriching academic experience for me, as well as the other trainees.

One particularly interesting case is a very interesting presentation of a primary pulmonary lymphoma. The patient's condition was only diagnosed with EBUS- cryobiopsy, after a series of non-diagnostic bronchoscopies and CT-guided biopsies. We have written a case report for this patient, since this is the first documented case of primary pulmonary lymphoma which was diagnosed via cryobiopsy, not requiring surgical intervention.


Dr Tu and I discussing a medical pleuroscopy procedure.
(Click any image to enlarge


One of the lectures delivered by the faculty.

During my four-month stay in CMUH, we have performed a total of 188 radial probe EBUS, 70 TBNA, fourteen stent insertions, fourteen pleuroscopies, eight balloon dilations, and a number of central airway tumor excisions, foreign body removals, and percutaneous tracheostomy. All these procedures were not associated with significant morbidity. Indeed, CMUH boasts not only of the volume of their procedures, but also of the quality of their procedures and cases. I am very much grateful for CMUH for letting me experience state-of-the-art facilities, and gain technical knowledge on planning, monitoring to the actual execution of the procedures.

As I return to the Philippines after a four-month training in IP, I plan to widen the knowledge base of both general physicians and chest specialists alike in this new and important subspecialty. IP is very underdeveloped in the Philippines, despite a huge number of patients needing interventions. The Philippine College of Chest Physicians (our local society of chest specialists) has already drafted to create a separate council dedicated towards the advancement of this field. It is indeed recognized that IP is continuing to grow, and that every nation should have the benefit of these technology and skills.

Lastly, I thank the APSR for being an instrument for my training, true to its commitment to enhance and improve lung care in the Asia-Pacific Region.

APSR Travel Award to the CHEST 2018 Annual Meeting
- a post-meeting report from Dr Galamay

I am very honoured to have been chosen to receive an APSR Travel Award to attend the CHEST 2018 Annual Meeting in San Antonio, Texas 5-10 October 2018. This was a very informative conference with a large range of medical and scientific sessions, with many novel and innovative information being presented. The meeting was by all accounts a world-class forum that comprised individuals at the forefront of respiratory research and I was fortunate enough to be exposed to great variety of quality clinical and medical researches. Furthermore, the CHEST Annual Meeting was a perfect opportunity to interact personally with respiratory researchers and discuss promising collaborative associations.

My role at this conference was to discuss and present my research paper in a thematic poster session under Critical Care Medicine entitled "Accuracy of Gas Exchange Measurements as Predictors of Early Successful Weaning among ICU Patients of Philippine Heart Center: a Prospective Cohort Study". Gas exchange measurements such as inspired-expired oxygen concentration difference (I–E)O2 and end-tidal carbon dioxide concentration (PETCO2) are useful in identifying patients who are likely to succeed in liberation from mechanical ventilation. By being able to determine the accuracy of gas exchange measurements, it will greatly aid the physicians in the ventilator management and weaning of the patients which would affect both morbidity and mortality.

The thematic poster session that I attended spanned a range of topics related to pulmonary and critical care with an emphasis on novel application to aid in the diagnosis and treatment of several pulmonary and respiratory pathologies to improve lung health. Learning from the constructive discussions I had at the session with the world-class and front-runner in pulmonary medicine and experienced researchers attending my poster presentation, has been one for the books and truly a memorable experience for me. The opportunity to network with the like-minded professionals in the field was invaluable and I feel very fortunate to be a part of such inspiring group of people.

I would like to thank my Institution, the Philippine Heart Center and the Division of Pulmonary and Critical Care Medicine, together with my research advisers Dr Maria Encarnita Blanco-Limpin, Dr Teresita S de Guia, Dr Aileen Guzman-Banzon, Dr Rommel Bayot and Dr Fernando Ayuyao, for being an inspiration as leading researchers in the field and for giving me the opportunity to carry this research work at the CHEST 2018 Annual Meeting; and to all my colleagues for their help and support.

Lastly, I would like to sincerely thank the APSR committee and staff for honouring me with the APSR Travel Award and for giving me the opportunity to attend the CHEST 2018 Annual Meeting. It was truly an excellent experience for me!

Dr J R Galamay

(Click any image to enlarge

Future Pulmonology Events

Here are the main respiratory events in Asia-Pacific region for the next few months. You can see our full listing on the APSR Calendar.

  • World AIDS Day
    1 December 2018, Worldwide (Details)
  • Cardiopulmonary diagnostics and pediatric pulmonary function testing
    11-12 January 2019, Ho Chi Minh City, Vietnam
    Details)
  • World TB Day
    24 March 2019, Worldwide
    Details)
  • Asian Pacific Congress for Bronchology (APCB) 2019
    28-30 March 2019, Gold Coast, Australia
    Details)
  • 59th Annual Meeting of the Japanese Respiratory Society
    12-14 April 2019, Tokyo, Japan
    Details)
  • 127th Conference of the Korean Academy of Tuberculosis and Respiratory Diseases (KATRD)
    13 April 2019, Gangwon-Do, Republic of Korea
    Details)
  • China-Japan-Korea Conference of Occupational Health
    22–24 April 2019, Nanjing, China
    Details)
  • 7th Conference of the International Union Against Tuberculosis and Lung Disease, Asia-Pacific Region 2019
    23-26 April 2019, Manila, Philippines
    Details)
  • World Asthma Day
    7 May 2019, Worldwide
    Details)
  • Asthma & COPD Outpatient Care Unit (ACOCU) Network Day
    12 May 2019, Ho Chi Minh City, Vietnam
    Details)
  • 92nd annual meeting of Japan Society for Occupational Health
    22–25 May 2019, Nagoya, Japan
    Details)
  • World No Tobacco Day
    31 May 2019, Worldwide
    Details)

For more pulmonology events, see apsresp.org/calendar.html
(These events are for information only and APSR endorsement should not be assumed.)

Contact

If you have news or announcements that may be of interest to other APSR members, please send details to Bulletin Coordinator Dr Arata Azuma (a-azuma@nms.ac.jp) or APSR Bulletin (bulletin@apsresp.org).


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