Bulletin
No. 116 (March 2019)
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APSR News

Congress news

Vietnam 2019

2019 Congress banner

Preparations are picking up speed for the 2019 Congress to be held in Hanoi, Vietnam, 14-17 November 2019.

Immerse yourself in some of the fascinating Vietnamese culture, whilst broadening your expertise, sharing research with your peers, and finding valuable new contacts from the thousands of other delegates.

The congress website is now online:

apsr2019.com

Keep checking regularly for updates, and we'll also post updates on the APSR website as soon as we get them.

Congress committee leadership


Dr Chau

The Local Congress Committee in Vietnam is led by Dr Ngo Quy Chau, Deputy Director of Bach Mai Hospital, Hanoi; President of the Viet Nam Respiratory Society, and President of the 24th Congress of the APSR.

The Local Congress Committee is supported by the APSR's Central Congress Committee, led by Dr Kazuto Matsunaga of Yamaguchi University, Japan; and Central Congress Committee Chair.


Dr Matsunaga

We are delighted to announce that Dr Matsunaga has been re-elected to continue as chair of the Committee and will oversee the 2020 Congress in Kyoto and also the 2021 Congress in Seoul.

Under the guidance and leadership of such people, we are assured of great congresses.

Our Members, Our Future

Continuing this series we are delighted to share a tribute to Prof. Wah-Kit Lam, prepared by Prof. Mary Ip.

This series complements our APSR Members' Honour Roll, on which as a member, you are welcome to add your appreciation of your mentor(s) at any time.


Prof. Lam

Tribute to Professor Wah-Kit Lam

Prof Lam Wah-kit is held in high esteem in the medical community in Hong Kong for his immense contributions in laying solid foundations for postgraduate subspecialty training in internal medicine, not least in respiratory medicine. Prof Lam graduated from medical school at The University of Hong Kong in 1972, and soon joined his alma mater as a young Lecturer. Since the early 1980s, after receiving training in respiratory medicine locally and in London, England and in Denver, USA, he engaged in research in lung cancer, and published widely on its epidemiology, genetics and chemotherapy – the latter at a time when a relatively passive view of lung cancer treatment prevailed. He became Chief of Respiratory & Critical Care Medicine at the University Department of Medicine, Queen Mary Hospital, between 1989-2007; and also served as the Head of Medicine in 2001–2004.

Prof Lam was a key member of the core group of pulmonologists which led the establishment of local respiratory societies in the 1980s – these professional societies became the nidus of continuing professional development for future generations of respiratory specialists. He served as the Founding Honourary Secretary of the Hong Kong Thoracic Society in 1987 and was its President in 1989–1991. He then became the Founding Chairman of the Hong Kong Lung Foundation in 1996. Beyond the scope of the respiratory discipline, he contributed substantially to the development of structured higher subspecialty postgraduate training in the Hong Kong College of Physicians in the early days of its establishment in the late 1980s, and was the Founding Chairman of the Specialty Board in Respiratory Medicine for ten years from 1993. He designed and developed the format for training programmes and assessments, which constitute the backbone of structured post graduate training. He was Vice President in External Affairs of the College in 2004–2010, and has been the international advisor for Hong Kong in the Royal Colleges of Physicians in UK up till the present.

Prof Lam was also a core member of the APSR Executive Committee since the inception of the Society in 1988, and served as its President in 2002–2004. In acknowledgement of his numerous contributions to APSR and to the development of respiratory medicine in the Asia-Pacific region, he was awarded the APSR Medal in 2018.

Despite his official retirement at the University in 2008, he has remained an enthusiastic teacher of medical students as Emeritus Professor in Medicine. He still maintains an avid interest in the activities of the respiratory community.

Prof Lam is well known among colleagues for his stoic perseverance and wise counsel through troubled waters. It is indeed timely to pay tribute to him for his dedication and contributions which have far reaching impact upon medical professional training, and hence the community we serve, in Hong Kong and beyond.


Prof. Ip
Prepared by Mary Ip, MD, FRCP (London, Edinburgh and Glasgow), FHKAM, FHKCP
Mok Hing Yiu Endowed Chair Professor of Respiratory Medicine
Head of Medicine and Chief of Division of Respiratory and Critical Care Medicine
The University of Hong Kong

Prof. Ip has been a student, a mentee and then a colleague of Prof Lam at The University of Hong Kong for the past 40 years.

February 2019

Support our junior colleagues

On behalf of the Society, we would like to express our gratitude from the bottom of our hearts to you for your contribution to improving respiratory health in our region.

The work continues, of course, and we would like to ask you to kindly donate to support research, scholarship and advanced practice for young doctors in the region. (Please see apsresp.org/awards/yi.php for some of the previous recipients of APSR support.)

Your contributions also help our Assembly activities, such as the Assembly Fund Award for young doctors.

Any amount is welcome, particularly donations of USD40 (JPY3,000) or more.

The current donation campaign runs until 30 June 2019 and you can use your credit card (until the end of April) via apsresp.org/members/donation/donation-input.php or by cash at the APSR booth at:

If you would like to personalise your donation by publicly acknowledging one of your Teachers or Mentors who have made a significant impact on your professional life, there is an APSR Members' Honour Roll. Details and current honourees can be seen at apsresp.org/members/honour-roll.php

Again, thank you very much for your great cooperation, and in particular for donations received since 1 July 2018 from:

  • Dr Norbert Berend (Australia)
  • Dr Andrew Bush (United Kingdom)
  • Dr John Noel Chan (Philippines)
  • Dr Philip Eng (Singapore)
  • Dr Yoshinosuke Fukuchi (Japan)
  • Dr Lai Ngoh Hooi (Malaysia)
  • Dr Muhammad Irfan Ilmi (Indonesia)
  • Dr Mary Sau-Man Ip (Hong Kong)
  • Dr Mitsuko Kondo (Japan)
  • Dr Ichiro Kuwahira (Japan)
  • Dr Hans Hamilton Liu (USA)
  • Dr Yoichi Nakanishi (Japan)
  • Dr Narendra Kumar Narahari (India)
  • Dr Prashanth Kumar Narukulla (India)
  • Dr Tsuyoshi Oguma (Japan)
  • Dr Vijayaravindh Ramachandra (India)
  • Dr Paul Reynolds (Australia)
  • Dr YoungSoo Shim (Republic of Korea)
  • Dr Wan Cheng Tan (Canada))
  • Dr Jennifer Ann Wi (Philippines)
  • Dr Tri Agus Yuarsa (Indonesia)
  • Dr Rex Chin-Wei Yung (USA)

* and all the other donors who have contributed anonymously.

Kwun Fong
President, APSR

Yasutomi Yamanaka
Executive Manager

Travel Award opportunities

The January 2019 issue of the APSR Newsletter includes glowing reports from last year's award winners.

Enjoy similar rewards yourself by taking advantage of the following opportunities:

APSR Travel Award to the ATS International Conference

ATS International Conference in Dallas, TX, USA, 17–22 May 2019

Application deadline: 1 March 2019

APSR Travel Award to the CHEST Annual Meeting

CHEST Annual Meeting 2019 in New Orleans, LA, USA, 19–23 October 2019

Abstract submission deadline: 15 March 2019

APSR Short-Term Research/Training Scholarship

The scholarship is to enable young respirologists to develop, acquire, and apply advanced research procedures and techniques in the area of respiratory medicine for up to six months in a foreign country/region within the Asia-Pacific region.

Application closing dates: 31 March, 31 July and 30 November

If you need a visa for the US, please note that processing can take a long time, depending on nationality and location. Contact your nearest US Embassy for details.

Details of several other 2019 awards can be seen at apsresp.org/awards/index.html

Respiratory Updates

The February issue (Vol 11.2) features Updates on Diagnosis and Treatment in ILD:

  • Diagnosis of Idiopathic Pulmonary Fibrosis; An Official ATS/ERS/JRS/ALAT Clinical Practice Guideline
  • Nintedanib plus Sildenafil in Patients with Idiopathic Pulmonary Fibrosis
  • Nintedanib with Add-on Pirfenidone in Idiopathic Pulmonary Fibrosis: Results of the INJOURNEY Trial
  • Safety of nintedanib added to pirfenidone treatment for idiopathic pulmonary fibrosis
  • Long-term safety and tolerability of nintedanib in patients with idiopathic pulmonary fibrosis: results from the open-label extension study, INPULSIS-ON
  • Long-term safety of pirfenidone: results of the prospective, observational PASSPORT study
  • Effect of Recombinant Human Pentraxin 2 vs Placebo on Change in Forced Vital Capacity in Patients With Idiopathic Pulmonary Fibrosis; A Randomized Clinical Trial
  • Diagnosis of Chronic Identification of Diagnostic Criteria for Chronic Hypersensitivity Pneumonitis:
  • Deep learning for classifying fibrotic lung disease on high-resolution computed tomography: a casecohort study
  • Diagnosis and management of pulmonary toxicity associated with cancer immunotherapy

Inside Respirology

Respirology Vol. 24 Issue 3

EDITORIALS
193TRPA1: A potential target for cold-induced airway disease?
Chantal Donovan B.Sc.(Hons), PhD, Philip M Hansbro B.App.Sc.(Hons), PhD
10.1111/resp.13453
195Pressuring stable patients with hypercapnic COPD to exercise
Collette Menadue BAppSc, PhD, Amanda J Piper BAppSc, MEd, PhD
10.1111/resp.13454
197The patients have spoken; now it is time for us to listen and move the needle forward
Kathleen O Lindell PhD, RN, ATSF, FAAN
10.1111/resp.13476
199In search of a good fit: CPAP therapy mask selection for obstructive sleep apnoea
Peter A Cistulli MBBS, PhD, MBA, FRACP, Colin E Sullivan MBBS, PhD, FRACP
10.1111/resp.13434
COMMENTARY
201Management of adverse reactions to high-dose moxifloxacin used in multidrug-resistant tuberculosis treatment programmes
Wing Wai Yew MBBS, Kwok Chiu Chang MSc, MBBS
10.1111/resp.13452
INVITED REVIEW SERIES
Molecular Techniques for Respiratory Diseases
204Genetic risk factors for the development of pulmonary disease identified by genome-wide association
Robert Hall, Ian P Hall, Ian Sayers
10.1111/resp.13436
215Somatic mutations and immune checkpoint biomarkers
Brielle A Parris, Eloise Shaw, Brendan Pang, Richie Soong, Kwun Fong, Ross A Soo
10.1111/resp.13463
Paediatric and Adult Bronchiectasis
227Airway clearance, mucoactive therapies and pulmonary rehabilitation in bronchiectasis
Katherine O'Neill, Anne E O'Donnell, Judy M Bradley
10.1111/resp.13459
ORIGINAL ARTICLES
Asthma and Allergy
238Repeated exposure to temperature variation exacerbates airway inflammation through TRPA1 in a mouse model of asthma
Chenqiu Du, Jun Kang, Wei Yu, Mingqing Chen, Baizhan Li, Hong Liu, Han Wang
10.1111/resp.13433

We evaluated the effect of temperature variation on an ovalbumin (OVA)-induced mouse model of asthma and investigated the role of transient receptor potential A1 (TRPA1). The results showed that repeated exposure to temperature variation impaired lung function. TRPA1 upregulation exacerbated inflammatory responses, while TRPA1 inhibition presented as a potential therapeutic target.

Bronchiectasis
246High-intensity inspiratory muscle training in bronchiectasis: A randomized controlled trial
Ozge Ozalp, Deniz Inal-Ince, Aslihan Cakmak, Ebru Calik-Kutukcu, Melda Saglam, Sema Savci, Naciye Vardar-Yagli, Hülya Arikan, Jale Karakaya, Lütfi Coplu
10.1111/resp.13397

The present randomized controlled study contributes to the literature about the impact of high-intensity inspiratory muscle training (H-IMT) in bronchiectasis. We showed that H-IMT increased respiratory muscle strength and endurance, exercise capacity and social aspects of quality of life in patients with non-cystic fibrosis bronchiectasis

COPD
254High-pressure non-invasive ventilation during exercise in COPD patients with chronic hypercapnic respiratory failure: A randomized, controlled, cross-over trial
Rainer Gloeckl, Vasileios Andrianopoulos, Antje Stegemann, Julian Oversohl, Tessa Schneeberger, Ursula Schoenheit-Kenn, Wolfgang Hitzl, Michael Dreher, A Rembert Koczulla, Klaus Kenn
10.1111/resp.13399

Non-invasive ventilation (NIV) with a high inspiratory pressure significantly improved cycle endurance time, reduced exercise-induced hypercapnia and relieved exertional dyspnoea in chronic obstructive pulmonary disease (COPD) patients with chronic hypercapnic respiratory failure. Complementary NIV with high inspiratory pressure support during cycling is feasible and a beneficial modality in the most severe COPD patients.

262Annual decline in arterial blood oxygen predicts development of chronic respiratory failure in COPD with mild hypoxaemia: A 6-year follow-up study
Kiyoshi Uemasu, Susumu Sato, Shigeo Muro, Atsuyasu Sato, Naoya Tanabe, Koichi Hasegawa, Yoko Hamakawa, Tatsushi Mizutani, Yoshinori Fuseya, Kazuya Tanimura, Tamaki Takahashi, Toyohiro Hirai
10.1111/resp.13402

We conducted serial arterial blood gas measurements in patients with COPD. Follow-up partial arterial pressure of oxygen (PaO2) at 1 year in patients with mild hypoxaemia is clinically helpful since change in PaO2 (ΔPaO2) of -3.05 Torr/year predicts patients at risk of developing chronic respiratory failure within 6 years.

Interstitial Lung Disease
270
Understanding the patient's experience of care in idiopathic pulmonary fibrosis
Kimberley Burnett, Ian Glaspole, Anne E Holland
10.1111/resp.13414

People with idiopathic pulmonary fibrosis (IPF) were dissatisfied with the information provided at diagnosis but valued specialist IPF care. Participants experienced a high burden of treatment side effects. Those with co-morbidities perceived that their care was not well coordinated. Participants felt that their active role in self-management of IPF was under-appreciated by health professionals. The Alfred Hospital in Melbourne, Australia (Source: Public Affairs, The Alfred).

Sleep and Ventilation
278
Choosing the right mask for your Asian patient with sleep apnoea: A randomized, crossover trial of CPAP interfaces
Ken Junyang Goh, Rui Ya Soh, Leong Chai Leow, Song Tar Toh, Pei Rong Song, Ying Hao, Ken Cheah Hooi Lee, Gan Liang Tan, Thun How Ong
10.1111/resp.13396

In this randomized crossover trial of mask interfaces in continuous positive airway pressure (CPAP) therapy for obstructive sleep apnoea (OSA), adherence was highest with nasal masks compared to oronasal masks and nasal pillows. Residual apnoea-hypopnoea index (AHI) was higher with an oronasal mask interface. Nasal masks should be the first-line interface during CPAP initiation. Example of a CPAP therapy mask for patients with OSA.

LETTER FROM ASIA-PACIFIC AND BEYOND
286Letter from the UK (if we still exist after recent events!): Air pollution: The public health challenge of our time
Stephen T Holgate FRCP, FMedSci
10.1111/resp.13475

Inside Respirology Case Reports

The following cases have been selected for inclusion in the new April 2019 Respirology Case Reports, Volume 07 Issue 3

Case Reports

Multiple huge "cluster" and "galaxy" signs on chest radiography in a patient with pulmonary tuberculosis
Miku Oda, Takeshi Saraya, Tatsuya Shirai, Narishige Ishikawa, Masachika Fujiwara, Hajime Takizawa
DOI: 10.1002/rcr2.398

In this article, we present a unique case of active pulmonary tuberculosis, with multiple huge "cluster" signs like fireworks, together with multiple "galaxy" signs. The repeated acid-fast sputum smears and both bronchial washings were all negative for Mycobacterium tuberculosis, but the acid-fast culture of sputum taken soon after the first bronchoscopy, and pleural fluid, turned out to be positive for M. tuberculosis at six weeks after admission. The present case clearly demonstrates that the "galaxy" and "cluster" signs are red herring signs of the low rates of isolating M. tuberculosis, which should be differentiated from pulmonary sarcoidosis.

Bronchoscopic observation with linked colour imaging
Shinichi Yamamoto, Tomoki Shibano, Masaya Sogabe, Hideki Negishi, Sayaka Mitsuda, Shunsuke Endo
DOI: 10.1002/rcr2.399

We report two cases of the comparison of diagnosis made with linked color imaging (LCI) and conventional white-light imaging (WLI) on the same patients. Both mucosal inflammatory and malignant lesions were better visible with LCI in comparison to WLI.

Pleural empyema in a patient with a perinephric abscess and diaphragmatic defect
Pei Sze Carmen Tan, Arash Badiei, Deirdre B Fitzgerald, Yi Jin Kuok, Y C Gary Lee
DOI: 10.1002/rcr2.400

Pleural infection as a complication of ascending urological infection is rare, and the mechanism often unclear. We report a complicated case of pleural infection and perinephric abscess in a patient who presented with a large right-sided pleural effusion.

Transformation of epidermal growth factor receptor T790M mutation-positive adenosquamous carcinoma of the lung to small cell carcinoma and large-cell neuroendocrine carcinoma following osimertinib therapy: an autopsy case report
Shuhei Moriguchi, Hironori Uruga, Takeshi Fujii, Yoichi Yasunaga, Yui Takahashi, Kazuma Kishi
DOI: 10.1002/rcr2.402

Resistance mechanisms to osimertinib are of two types: epidermal growth factor receptor (EGFR) dependent, such as point mutations containing C797S, and EGFR independent, such as bypass signal pathway or histological transformation to small cell lung carcinoma (SCLC) and large-cell neuroendocrine carcinoma (LCNEC). Here, we report an autopsy case with EGFR T790M-positive adenosquamous carcinoma that transformed to EGFR T790M-negative SCLC and LCNEC after osimertinib therapy.

Lung adenocarcinoma and anti-transcriptional intermediary factor 1-gamma positive dermatomyositis complicated with spontaneous oesophageal rupture
Takeshi Saraya, Masaki Tamura, Keisuke Kasuga, Masachika Fujiwara, Hajime Takizawa
DOI: 10.1002/rcr2.403

A 58-year-old man presented with a two-month history of facial erythema and dry cough. After testing he was diagnosed with co-occurring transcriptional intermediary factor 1-gamma (TIF1-γ) positive dermatomyositis (DM) and lung adenocarcinoma. He subsequently developed muscle weakness and was administered oral prednisolone but developed TIF1-γ positive DM-associated oropharyngeal dysphagia complicated by spontaneous oesophageal rupture. Despite treatment, he gradually deteriorated and died from progression of chemoresistant lung cancer six months later.

Non-parallel anti-tumour effects of pembrolizumab: a case of cardial tamponade
Motoko Tachihara, Masatsugu Yamamoto, Masako Yumura, Asuka Yoshizaki, Kazuyuki Kobayashi, Yoshihiro Nishimura
DOI: 10.1002/rcr2.404

We present the case of a 70-year-old man with stage IV lung adenocarcinoma. He was treated with pembrolizumab, a programmed cell death-1 inhibitor, as a first-line therapy. After six cycles of pembrolizumab, he suddenly developed cardiac tamponade. With the exception of newly massive malignant pericardial effusion, the other malignant lesions improved. Pembrolizumab was continued and the patient has shown a durable response for two years.

Management of recurrent haemoptysis in malignancy with combined TISSEEL and intrabronchial valves
James Di Michiel, Corinna Pan, Alvin Ing, Tajalli Saghaie
DOI: 10.1002/rcr2.406

It is hypothesized that intrabronchial valves would stabilize the fibrin sealant and prevent expectoration or migration. Here we describe the use of combination TISSEEL and intrabronchial valves for the management of recurrent haemoptysis secondary to malignancy. This combination therapy, to the best of our knowledge, represents a novel intervention for palliative management of this condition.

An atypical pneumonia
Benjamin Gerhardy
DOI: 10.1002/rcr2.407

We present the first documented case of small vessel vasculitis, manifesting with renal and pulmonary failure, in a patient with underlying HIV.

Successful management of pleural infection with very low dose intrapleural tissue plasminogen activator/deoxyribonuclease regime
Jodi Andrea Hart, Arash Badiei, Y C Gary Lee
DOI: 10.1002/rcr2.408

We report a case of a complex parapneumonic effusion in a patient with coagulopathy that was successfully treated with a very low dose tissue plasminogen activator (1 mg) and deoxyribonuclease (5 mg) regime.

Clinical Images

Spontaneous aspiration of a long tree twig as foreign body
Kosuke Hashimoto, Kyoichi Kaira, Kunihiko Kobayashi, Yoshitake Murayama, Hiroshi Kagamu
DOI: 10.1002/rcr2.401

Spontaneous aspiration of a long tree twig as foreign body is extremely a rare condition. The presence of a permanent tracheal stoma in a laryngectomized patient should be considered as a predisposing factor for foreign body aspiration.

Regional society news

The spotlight this month is on

CAMBODIA

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.

Cambodian Pulmonology Association (CPA)

Summary of activities in 2018 (to 31 October 2018); a report by Prof. Mich Vann and Prof. Saly Saint

The Cambodian Pulmonology Association undertook many activities in 2018, of which the important ones are:

Click any photo to enlarge



  • International Congress of Pulmonology 30 November 2018 in Phnom Penh cooperated with three other societies, the Medical Council of Cambodia (MCC), Aide Insuffisance Respiratoire Khmer (A.I.R Khmer) and Espace Francophone Pneumologie (EFP). The last two societies are French.
  • The meeting attracted approximately 530 attendees, society leaders and exposition of 11 booths and a premium sponsor.
  • Opening remark by Secretary State, Ministry of Health, H E Prof. Their Kruy.
  • Two candidates for APSR Councillors, Prof. Mich Vann and As. Prof. Saly Saint.
  • Two candidates for International Scientific Council Biennal EFP 2019, Prof. Mich Vann and As. Prof. Chanty Ny
  • En bloc member of EFP
  • Support World Lung Day, 2017, 2018...
  • Active formation and training associated with Medical Council of Cambodia for CME in all provinces of Cambodia since 2016.

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 APCB Congress Organising Committee looks forward to seeing you on the Gold Coast for the most engaging interventional programme on offer at APCB 2019!

They are thrilled to announce a Saturday morning session by Dr Noriaki Kurimoto Reading CT Scans to Make Virtual Pathways. This session is not to be missed with many finding the "Kurimoto method" indispensable in their practice sampling peripheral nodules.

When you register, consider the Introduction to Bronchoscopy Training session. Every trainee from novice to experienced bronchoscopists will learn an enormous amount from these sessions which will be staffed by the best trainers in the world; international faculty as well as local staff. Even consultants have learnt a great deal when they have done this course. Every attendee at these sessions will have a tick-box evaluation and personal feedback on technical tips.

REGISTER NOW for the congress which runs from 28–30 March 2019 at the Gold Coast Convention and Exhibition Centre for one of the most significant scientific events for the Bronchoscopy and Interventional Pulmonology Field. You can choose to stay on and attend the TSANZSRS Annual Scientific Meeting directly after APCB.

For more information visit our website. Please feel free to share this message with interested colleagues.

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

Extra-regional societies

Panama

The 12th Congress of the Asociación Latinoamericana del Tórax (ALAT) will take place at the ATLAPA Convention Center in Panama City 3–6 July 2019.

By the kind invitation of Congress Scientific Committee, Dr Kwun Fong (APSR President) and Dr David C L Lam (Immediate Past Chair of the APSR Education Committee) will be the APSR's representative speakers at the Congress.

The symposium APSR–ALAT–WHO essential medicine for respiratory illnesses: unique window of opportunity to address global equity, will be held on 08:00 – 10:00 on 6 July in La Huaca Room of the conference centre:

  • "Access of essential medicines in smoking cessation"
    Dr David C L Lam
  • "Access of essential drugs in COPD: LAMA"
    Dr Rogelio Perez Padilla
  • "Access of essential medicines in lung cancer"
    Dr Kwun Fong
  • "Access of essential medicines in Asthma: LABA / ICS"
    Dr Federico Daniel Colodenco
  • Q&A

The APSR is looking forward to collaborating further with the ALAT in the future.

Health news

World TB Day

In celebration of World TB Day, we are delighted to introduce the following special Topics In Focus Tuberculosis Updates, selected from articles recently published in Respirology. The editors of this Topics In Focus are Dr Chi Chiu Leung, Dr Cynthia Chee and Dr Ying Zhang.

The 2013 tuberculosis (TB) review series 'Tuberculosis: Current state of knowledge' highlighted important gaps in our existing knowledge on the complex interactions between the pathogen and the host. It also detailed major limitations in current control strategies. Since then, there have been major developments in new diagnostic tools and drugs/regimens for TB and latent TB infection (LTBI), some of which have modified clinical practice in both high- and low-burden countries. In 2014 the World Health Assembly approved the 'End TB Strategy' which set ambitious targets to achieve a 95% reduction in TB death and 90% reduction in TB incidence rate by 2035. To consolidate developments and to meet the upcoming challenges, we have invited a panel of international experts to critically re-examine the relevant issues in a new series of themed reviews focused on TB. Read more...

Tuberculosis updates 2018: Innovations and developments to end TB
Leung C C, Chee C and Zhang Y
Respirology 2017; 23: 356–358, doi: 10.1111/resp.13244
Tuberculosis vaccines: Opportunities and challenges
Zhu B, Dockrell H M, Ottenhoff T H M, Evans T G and Zhang Y
Respirology 2018; 23: 359–368, doi: 10.1111/resp.13245
Update on tuberculosis biomarkers: From correlates of risk, to correlates of active disease and of cure from disease
Goletti D, Lee M-R, Wang J-Y, Walter N and Ottenhoff T H M
Respirology 2018; 23: 455–466, doi: 10.1111/resp.13272
Epidemiological, clinical and mechanistic perspectives of tuberculosis in older people
Yew W W, Yoshiyama T, Leung C C and Chan D P
Respirology 2018; 23: 567–575, doi: 10.1111/resp.13303
Drug-resistant tuberculosis: An update on disease burden, diagnosis and treatment
Lange C, Chesov D, Heyckendorf J, Leung CC, Udwadia Z, Dheda K
Respirology 2018; 23: 656–673, doi: 10.1111/resp.13304
Where is tuberculosis transmission happening? Insights from the literature, new tools to study transmission and implications for the elimination of tuberculosis
Auld S C, Shah N S, Cohen T, Martinson N A, Gandhi N R
Respirology 2018; doi: 10.1111/resp.13333
Implementing the End TB Strategy in the Western Pacific Region: Translating vision into reality
Rahevar K, Fujiwara P I, Ahmadova S, Morishita F, Reichman L B
Respirology 2018; doi: 10.1111/resp.13308
Latent tuberculosis infection: Opportunities and challenges
Chee C B E, Reves R, Zhang Y, Belknap R
Respirology 2018; doi: 10.1111/resp.13346
New drugs and regimens for tuberculosis
Chang K-C, Nuermberger E, Sotgiu G, Leung C-C
Respirology 2018; doi: 10.1111/resp.13345
Drug resistance mechanisms and drug susceptibility testing for tuberculosis
Miotto P, Zhang Y, Cirillo D M, Yam W C
Respirology 2018; doi: 10.1111/resp.13393
Applying new tools to control tuberculosis
Leung C C, Chee C B E, Zhang Y
Respirology. 2018; doi: 10.1111/resp.13429

How dirty air could be affecting our gut health

The following article was written by journalist Jessica Brown for the BBC (29 January 2019) about the effect of air pollution on the gut microbiome. It discusses how air pollution plays a part in triggering inflammatory bowel disease (IBD).

Such affliction might not be of primary interest to respiratory physicians and scientists, but the article may be of significant interest to anyone researching air pollution.

Jessica Brown writes:

"As countries industrialise, their air becomes dirtier – and this could have some far-reaching effects on the beneficial bacteria inside us.

In the series, we'll be looking at recent research into the microbiome of bacteria that lives in all of us.

We'll be exploring how it affects our health, what could be having detrimental effects on it, and recommending recipes that might help it thrive.

The gut microbiome is made up of billions of bacteria, and scientists have been trying to understand exactly how they affect our health, contribute to our risk of contacting [sic] diseases and how they interact with the vital organs and systems in the body, including the brain. It is quite a lot to unpick.

While there's no clear answer yet of what a healthy gut microbiome looks like, it's widely accepted that environmental factors, such as diet, can alter it. But one emerging theory is that air pollution is also one of these factors, and it can play a part in triggering debilitating diseases – bad news for our guts, since air quality has been deteriorating in cities around the world.

While much of our health is mapped out early in early life, our guts are different, says Marie Pedersen, an associate professor at the University of Copenhagen.

"The microbiome is dynamic and may change through life due to exposures. There is a lot of interplay between the gut and what we're exposed to," she says.

These exposures are known to play a part in triggering inflammatory bowel disease (IBD), which includes such conditions as Crohn's disease and ulcerative colitis, both of which are lifelong afflictions without any known cure. They occur when the immune system doesn't work properly and the body starts attacking itself, causing ulcers and inflammation in the gut.

"Imagine having a wound that never heals, only it's on the inside. Every time you eat or drink, it's like rubbing salt into that wound," says Jaina Shah, Chron's [sic] and Colitis UK publications and information manager.

Ulcerative colitis is localised and affects the large intestine, whereas Crohn's can affect anywhere in the gut. Both conditions can impact almost every part of the body, including hormones, digestion, energy levels and mental health. Shah says they require lifelong medication and, in many cases, major surgery.

"Crohn's and colitis are caused by the genes a person has inherited, plus an abnormal reaction of the immune system to certain bacteria in the intestines, probably triggered by something in the environment," says Shah.

According to research, these environmental triggers include diet, and stress. The hygiene hypothesis, meanwhile, argues that living in sanitary environments doesn't allow immune systems to properly develop.

Both genes and environmental factors can disrupt the gut in similar ways, according to Gilaad Kaplan, associate professor at the University of Calgary and author of several studies looking into the relationship between the gut and air pollution.

"More than 200 genes are currently known to make someone susceptible to IBD. These genes are related to the gut wall, and some are related to how the immune system, which sits on the gut wall, fights off bad bacteria," Kaplan says.

"Just as genetic mutations can interrupt with the gut barrier's protective abilities, environmental exposures can have the same impact by disrupting these barriers. If you carry a gene that makes the immune system or gut sluggish, this can trigger the disease."

Patterns in cases of IBD have led researchers to find out if air pollution is one of these environmental triggers, including data showing that they are more common in urban than rural areas, and that more developed nations have higher rates of IBD. One analysis found that the highest rates were in Europe and North America, while the number of cases in newly industrialised countries in Africa, Asia, and South America have been steadily rising.

It's thought that air pollution plays a part in the development of IBD by changing the gut microbiome, which causes an immune response and inflammation. In 2005, Kaplan attended a class on the mechanism of how air pollution impacts the heart, and realised that there were crossovers with IBD, his area of expertise.

"The first part of my research was looking at data to see if there were more cases of IBD in areas with more air pollution," he says.

Kaplan analysed data of over 900 cases of IBD in the UK, spanning three years. While he didn't find an association between newly diagnosed cases of IBD and levels of air pollution on the whole, he found that Crohn's disease was more commonly found in young people with higher exposures to nitrogen dioxide. Kaplan has also found similar links between air pollution and appendicitis and abdominal pain.

The complicating factor of these studies, however, is that people may not have lived for very long in areas of high pollution. Also, they don't prove that one data set causes the other, so it's important to explore mechanisms behind the data, says Kaplan.

Air pollution is made up of a number of substances, including carbon monoxide, nitrogen oxide (produced by diesel vehicles), ozone, sulphur dioxide and particulates (which consists of dust, pollen, soot and smoke). Such pollution is a leading cause of disease and death. It has been linked to many health conditions, including lung diseases, heart attacks, strokes, Alzheimer's, diabetes and asthma.

However, scientists also don't yet know which pollutants in particular are to blame.

"Most researchers use data from fixed monitoring sites, which are in almost every city, however it's limited to study those pollutants, which come to represent a proxy of different ones," says Kaplan.

"Nitrogen dioxide is a proxy for traffic pollutants, it's the one cities measure, so we study and attribute it to disease. This is similar to how we study the effects of nicotine in cigarettes, which contain many chemicals. It's challenging to narrow down the exact source."

It's well established that breathing in polluted air in the form of cigarette smoke is also a risk factor for the development of Crohn's, which has been the most studied environmental risk factor for IBD. There are, however, still unanswered questions in this field of research. One of the more surprising is why smoking itself is actually protective against ulcerative colitis.

As well as breathing airborne pollutants into our lungs, we can ingest them from food, which pollution can easily contaminate, through the body's mechanism of getting rid of toxins. This process, mucociliary clearance, filters the air we breathe and comes back out as oral secretion to the back of the throat as phlegm, which we then swallow and then enters the intestine.

Kaplan went on to study the effects of air pollution in lab settings. Alongside a group of researchers, he found that exposure to particulate matter (PM) can trigger the onset of gastrointestinal disease. Researchers gave mice a high oral dose of particulate matter for up to 14 days and fed another group for 35 days by putting it in their food.

The researchers aimed to mimic continued exposure to high levels of PM and contaminated food, using 18mcg m3 (micrograms per cubic metre of air) per day. Levels of PM in cities can range from 20 to 1,000 at peak concentrations, meaning a total inhaled dose of up to 20,000mcg over 24 hours.

They found that the mice fed particulate matter for a shorter amount of time had altered immune gene expression, evidence of inflammation and heightened innate immune response in the small intestine and increased gut permeability. Gut permeability impacts in the lining barrier of the gut wall are thought to be one of the causes of IBD.

"The lining of the gut designed to serve as a barrier to keep bad bacteria out of the body and allow good bacteria to do its thing," Kaplan says. "If something happens to impact the integrity of lining of wall, this can create little holes where pathogenic microbes to get it, which can trigger immune response."

The mice exposed for 35 days also showed signs of inflammation in the colon, and changes in their gut microbiome.

But pollution may not just play a part in triggering the onset of IBD, it could also alter the nature of the disease through the changes it makes to the gut microbiome. In another study, Kaplan compared cases of non-perforating and perforating appendicitis from 13 cities, and found that perforated appendicitis, which is the riskier of the two, was linked to higher exposure to air pollution. He concluded that pollution exposure might modify the type of gut disease.

"If you lived in an area with good air quality, you might have just had regular appendicitis, and air pollution may worsen the attack to perforated appendicitis," he says. But while Kaplan says this could also be the case for other gut-related disorders, research hasn't yet looked into it.

Research hasn't yet explained exactly why IBD is more common in urban areas, and while it is clear urbanisation plays a role, the underlying characteristics of urbanisation causing IBD remain unclear.

"These conditions were never seen a generation ago in these countries, but now I meet gastroenterologists who never saw IBD until very recently, and now see cases on a daily basis," says Simon Travis, a clinical professor and consultant gastroenterologist at the John Radcliffe Hospital in Oxford, whose work involves researching IBD in newly industrialised countries.

But this isn't the whole picture. Some research papers have associated increased IBD with the industrial revolution, since Crohn's first become recognisable in the 1930s during the advent of the automobile era. However, the first cases of ulcerative colitis emerged in the late 1800s.

"There is something about industrialisation in the current climate, but we also have to speculate why in some regions of the world that are most heavily polluted, in parts of urban China and Russia, for example, IBD has to date been uncommon," Travis says.

He has found that these diseases occur commonly in major cities in India, such as Delhi and Mumbai, but not at all in other cities. But he is adamant IBD is definitely a disease of urbanisation, one way or another.

As it stands, the consensus is that air pollution isn't a leading cause of gut disease, but could be one of a number of triggers.

"IBD are complex and multi-causal, and a number of environmental factors that can influence development, including exposure to antibiotics in infancy, breastfeeding, exposure to cigarette smoke." Each one, he says, could "chip away" at our health "until eventually something collapses".

"It's hard to say one gives the leading blow that led to an avalanche, but each contributes at a certain level," says Kaplan.

"Altering the gut microbiome is a leading cause of disease for Crohn's and ulcerative colitis, and lots of things cause that. Air pollution is one of those, without which we would still see cases from other causes."

"If we're going to find the causes of IBD, they're most likely going to be found in areas of the world where the conditions are evolving and occurring, because in the West and North America the conditions have almost completely evolved."

(Extracted from www.bbc.com/future/story/20190128-how-dirty-air-could-be-affecting-our-gut-health, 28 January 2019)

Following the article above, the Forum of International Respiratory Societies (FIRS) has also recently issued a press release on the wider reach of air pollution:

The lung is not the only organ affected by air pollution


Lahore, 5 Nov. 2016 CC by-sa 4.0

The Forum of International Respiratory Societies (FIRS) warns that air pollution exposure affects many organs beyond the lungs, posing a great risk to health. Outdoor fine particulate matter exposure is the fifth leading risk factor for death in the world, accounting for 4.2 million deaths and 103 million disability-adjusted life years lost according to the Global Burden of Disease Report.

FIRS' Environmental Committee published two articles in the journal CHEST on the effects of air pollution on health and evidence for its association with many diseases.

"It is well-known that air pollution is a major contributor to lung disease, but this review also shows how it can damage most other organ systems of the body. The hope is that people and organisations outside the respiratory realm will see just how air pollution affects other organs and join in the fight for clean air." Dean Schraufnagel, MD, review author and Executive Director of FIRS.

The FIRS' two-part review highlights the number and extent of diseases caused or made worse by air pollution. Stroke, dementia, many cancers, diabetes, obesity, metabolic syndrome, allergies, and osteoporosis are all associated with air pollution. Air pollution is controllable and, therefore, many of these adverse health effects can be prevented.

Dean Schraufnagel concludes: "The best way to reduce exposure to air pollution is to control it at its source, which is done by setting standards and regulatory processes. Individuals can reduce exposure by avoiding polluted areas, staying indoors in times of high outdoor pollution, and filtering air by wearing a personal respirator (face mask)."

The two-part articles, The Damaging Effects of Air Pollution and Air Pollution and Organ Systems, can be found on the journal CHEST website.

About FIRS

The Forum of International Respiratory Societies (FIRS) is an organisation comprised of 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), Asociación Latino Americana De Tórax (ALAT), European Respiratory Society (ERS), International Union Against Tuberculosis and Lung Diseases (The Union), Pan African Thoracic Society (PATS), Global Initiative for Asthma (GINA), and the Global Initiative for Chronic Obstructive Lung Disease (GOLD).

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.

For more information about FIRS please contact Lisa Roscoe lisa.roscoe@firsnet.org.

En bloc society reports on air pollution, presented at the ERS Congress in 2018

The theme was "Air pollution; we cannot survive under this. Let's regain the air of all creatures".

See also...

Air pollution statistics from the Asia-Pacific region

and

Air pollution: The public health challenge of our time, appearing in the March issue of Respirology, now available online.

Education

New educational articles

The following article has recently been selected from Respirology for its specific educational value. Previous articles on further topics can be seen at apsresp.org/education/articles/index.html


(Click image to enlarge)

Of special interest to those working in:
* Clinical Respiratory Medicine
* Respiratory Structure & Function

High-intensity inspiratory muscle training in bronchiectasis: A randomized controlled trial Ozge Ozalp, Deniz Inal-Ince, Aslihan Cakmak, Ebru Calik-Kutukcu, Melda Saglam, Sema Savci, Naciye Vardar-Yagli, Hülya Arikan, Jale Karakaya and Lütfi Coplu
onlinelibrary.wiley.com/doi/10.1111/resp.13397 (Mar 2019)

Comment by Dr Mark Lavercombe:
This study evaluates the effect of high-intensity inspiratory muscle training in patients with non-cystic fibrosis bronchiectasis. Two of the three weekly sessions were performed in the patients' homes using a threshold loading device. Improvements in shuttle walk distance and respiratory muscle strength and endurance are noted, along with the social dimension of quality of life. Treatment was well tolerated.

Author awareness of transparency for successful publishing:
Face the challenges and enjoy the benefits

Respirology is delighted to provide all APSR members access to the full content of the recent Respirology workshop "Author awareness of transparency for successful publishing: Face the challenges and enjoy the benefits". This event was organized as part of 23rd APSR Congress in Taipei, Taiwan, on 29 November 2018.

The event was sponsored by Respirology's publisher Wiley and featured invited presentations by the Chief Editor of the European Respiratory Journal, Prof. Martin Kolb, and the Editors in Chief of Respirology, Profs Philip Bardin and Paul Reynolds. Wiley Journal Publishing Manager Alison Bell, ORCID representative (Asia-Pacific) Chieh-Chih Estelle Cheng, and Respirology Managing Editors Lieve Bultynck and Anke van Eekelen also presented their insight knowledge on how to enhance your success in publishing clinically relevant research.

The presentations can be accessed at apsresp.org/education/how-to/transparency-for-successful-publishing.php

Respirology hopes that this training material, with a focus on the role of transparency in research publishing, will enhance awareness among APSR members of the latest developments in research publishing to improve research writing skills and publication success.

APSR Membership

TB Assembly news

At the Tuberculosis Assembly meeting during the 23rd Congress of the APSR in Taipei, Dr Burhan (TB Assembly Head) and Dr Mendoza (TB Assembly Head-Elect) provided an update of the global situation of tuberculosis.

On the local situations and efforts to combat tuberculosis, Dr Mortera (TB Assembly Deputy Head) provided an update from Philippines, and other members did likewise for Taiwan and Vietnam.

The scientific programme for tuberculosis sessions at the 24th Congress of the APSR in Hanoi was discussed, and the following draft proposals were made:

  • Update on new TB drugs, by Dr Charles Dahley
  • MDRTB, by Dr Erlina Burhan
  • Prevention of TB, by Dr Yi-Wen Huang


Dr Burhan addresses some of the assembly members

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
Koichi Nishi
(Japan)
Clinical Respiratory Medicine
COPD
Asthma
Yessy Susanty Sabri
(Indonesia)
Asthma
COPD
Tuberculosis
Yuko Tanaka
(Japan)
Respiratory Structure and Function
Interstitial Lung Disease
Asthma

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.

  • 38th Annual Chest Convention
    5-8 March 2019, Edsa Shangri-La, Mandaluyong City, Philippines
    (Details)
  • Advanced Course on Sleep & Breathing 2019 cum Annual Scientific Meeting 2019 of the Hong Kong Thoracic Society and CHEST Delegation Hong Kong and Macau Limited
    22-24 March, Hong Kong
    (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, 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)
  • MTS Annual Congress 2019
    18-21 July 2019, Kuala Lumpur, Malaysia
    (Details)
  • Annual Scientific Congress of Ho Chi Minh City Society of Asthma, Allergy & Clinical Immunology
    21 July 2019, Ho Chi Minh City, Vietnam
    (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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