Bulletin
No. 121 (August 2019)
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Vietnam 2019

New travel award announced
but hurry!

APSR Travel Award to the 60th Annual Meeting of the Japanese Respiratory Society in Nagoya, Japan, 24–26 April 2020

Application deadline: 25 August 2019

The APSR is pleased to announce the availability of Awards for three members to attend and present at the 60th Annual Meeting of the Japanese Respiratory Society in Nagoya, Japan, 24–26 April 2020.

The awardees will be those judged by the APSR Research Committee to have submitted the best abstracts.

The Award includes:

  • Travel subsidy of $1,000 for each awardee normally resident in Northeast Asia, or $1,500 for those normally resident in Southeast Asia
  • Cost of accommodation at an JRS-designated hotel
  • Meeting registration

Eligibility:

You must be:

  • an APSR member (through en bloc membership or individual membership)
  • specialized field: ARDS, or Cell and Molecular Biology
  • normally resident in Northeast Asia or Southeast Asia. Note that this award is designed for Young Investigators from Asian countries/regions and who do not have the benefit of JRS membership.
  • aged ≤40
  • the First Author of the abstract for the Meeting and able to attend the Meeting in person.

Post-meeting requirements:

  • Awardees are required to send a report (circa 500 words) of their experience at the Meeting, together with their photo at the Meeting, to the APSR Secretariat within one month after the Meeting. The report may be published on the Young Investigators webpage, APSR Bulletin and/or Newsletter.

Application:

  • Abstract of up to 1,500 words with no more than 1 figure or table
  • One-page bio-sketch (NIH template)
  • Letter of support from your supervisor or head of department
  • To be received by the APSR Secretariat rina.kishigami@theapsr.org before 25 August 2019

12th Congress of ALAT

The 12th Congress of the Asociación Latinoamericana del Tórax (ALAT) took place at the ATLAPA Convention Center in Panama City.

Dr Kwun Fong (APSR President) and Dr David C L Lam (Immediate Past Chair of the APSR Education Committee) spoke at the meeting and here is their report:


ATLAPA Conference Centre



Gustavo Zabert, ALAT President, (centre)

The APSR is very grateful to the ALAT, as the regional peak Lung Association in Latin America for the first ever ALAT-APSR joint session at the 2019 ALAT Congress held in Panama City, 3~6 July 2019. It was an honour for both of us to represent our Society at the joint ALAT-APSR session on the 3–6 July 2019.

The Congress was very impressive and of the high set quality as demonstrated by the breadth and depth of the scientific topics and content.

Well over 1,500 participants attended ATLAPA, a superb Conference centre in the lovely and friendly Panama City, home to the legendary Panama Canal, a fine testament to the central contribution of this delightful city to global shipping and reducing the time to travel alternatively around South America. Surely this must help in limiting the use of carbon based fuels and help reduce air pollution, likely to be a key cause of lung disease in the future.

ALAT President Gustavo Zabert and team are to be congratulated for a superb Congress, held in Spanish and English and in many ways typify the challenges of a regional organisation with multiple countries, and several languages; a situation not too dissimilar to ours, so we learn how ALAT achieves a high quality meeting despite the challenge of language (Spanish, Portuguese, English and local dialects) in the ALAT region.

David C L Lam and Kwun M Fong were warmly received by the ALAT and partook in the first ever ALAT-APSR Session and spoke on Essentials Medicines for smoking cessation and also lung cancer. We also hear from Victoria Lopez-Varela on the FIRS application to list LAMAs on the WHO Essential Medicines List, as a result of FIRS GOLD, ALAT and APSR contributions. Although the audience was relatively modest on the last day of the conference, important discussions were held and both organisations agreed to continue building the bridge of collaboration and friendship as we share many of the same lung health issues.

The quality of the Congress was excellent and we were additionally invited to their smoking cessation and ENDS (electronic nicotine delivery systems) which was very interesting and a special focus of ALAT, who have led many initiatives in this area including the statement.

So in summary, it was privilege for us to represent the APSR at the ALAT Congress, gracias ALAT, and we look forward to future collaborations to build our relationship and most importantly, build bridges for younger investigators and healthcare professionals to network and work together to achieve better lung health for all.

David C L Lam
President, Hong Kong Thoracic Society
Kwun M Fong
President, APSR

Our Members, Our Future

Continuing this series we are delighted to share a tribute to Prof. Young-Soo Shim, prepared by Prof. Young Whan Kim.

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. Shim

Tribute to Professor Young-Soo Shim, MD, PhD

Professor Emeritus Seoul National University, Seoul, Republic of Korea

Professor Young-Soo Shim graduated from the College of Medicine, Seoul National University, Seoul, Republic of Korea in 1969. After three years of military service in the Republic of Korea Navy, he moved to the United States for medical training. After medical internship and residency, he finished a fellowship in pulmonary medicine in the Albert Einstein College of Medicine, New York in 1978. Then he worked as a director of the respiratory therapy department in Jersey City Medical Center until 1980.

In 1980, he returned to Republic of Korea, and worked as a professor in Seoul National University Hospital for 30 years until 2010 when he retired at the university. For more than 10 years, he chaired the university's Division of Pulmonary and Critical Care Medicine, enhancing basic science research using molecular research techniques and improving the care of critically ill patients. As the first U.S. board-certified pulmonary specialist in Korea, he introduced his colleagues to the American postgraduate training system.

During his career in Seoul National University Hospital, he introduced modern sleep medicine into Korea by establishing a sleep laboratory after a fellowship in Sleep Medicine in University of California at Irvine, USA in 1988. Because he was interested in education in pulmonary medicine, he organized the education programme in Seoul National University Hospital for young pulmonologists in Korea.

As a researcher, Professor Shim published more than 300 original and review articles. As a distinguished clinician scientist, he wrote review articles on paragonimiasis (Semin Resp Med 1991;12:35-45), endobronchial tuberculosis (Respirology 1996;1:95-106), and COPD and alpha1 antitrypsin deficiency (Respirology 2001;6:S9-S11). His main research area was COPD (J Korean Med Sci 2007;22:839-845, Respirology 2009;14:90-97) and genetics of pulmonary diseases. He published several articles on the genetics of COPD (Lung 2002;180:119-125, Respirology 2005;10:223-228)), tuberculosis (Human Immunology 2005;66:1074-1081), bronchiectasis (J Korean Med Sci 2007;22:667-671, Respirology 2007;12:49-53) and diffuse panbronchiolitis (Am J Respir Crit Care Med 1999;159:526-529).

Professor Shim has contributed substantially to the medical societies in Korea and the Asia-Pacific region. He served as Secretary General and President of the KATRD (The Korea Academy of Tuberculosis and Respiratory Disease). When he was the President of KATRD, he revolutionized the structure and function of the society to its present shape. In 1992, he held the 12th APCDC (Asia-Pacific Congress on Diseases of the Chest) in Seoul, Republic of Korea, successfully as the Secretary General. Professor Shim was also a core member of the APSR Executive Committee for several decades and served as its president in 2008-2010. Mr Yasutomi Yamanaka, APSR Executive Manager, remembers that Professor Shim's management skill was very sophisticated and impressive to him. In 2009, as the President of APSR, he held the 14th Congress of the APSR successfully in Seoul, Republic of Korea.

Professor Shim's colleagues remember him as the smart and enthusiastic clinician scientist, and a very kind and warm-hearted doctor to his patients.


Prof. Kim

Prepared by
Young Whan Kim, MD, PhD
Professor
Division of Pulmonary and Critical Care Medicine
Department of Internal Medicine
Seoul National University Hospital
Seoul, Republic of Korea

Prof. Kim was a mentee and then a colleague of Prof. Shim at Seoul National University Hospital for 30 years. Prof. Kim is currently a member of APSR Strategic Planning Committee and chair of APSR Research Committee.

July 2019

Respiratory Updates

The July issue (Vol 11.7) features Asthma-COPD Overlap:

  • Asthma is a risk factor for respiratory exacerbations without increased rate of lung function decline. Five-year follow-up in adult smokers from the COPDGene study.
  • Omalizumab treatment response in a population with severe allergic asthma and overlapping COPD
  • Asthma and COPD overlap (ACO) is related to a high burden of sleep disturbance and respiratory symptoms: Results from the RHINE and Swedish GA2 LEN surveys
  • Biological exacerbation clusters demonstrate asthma and chronic obstructive pulmonary disease overlap with distinct mediator and microbiome profiles
  • Childhood predictors of lung function trajectories and future COPD risks: a prospective cohort study from the first to the sixth decade of life
  • Physiological and morphological differences of airways between COPD and asthma-COPD overlap
  • Nitrosative stress in patients with asthma-chronic obstructive pulmonary disease overlap
  • ACO: time to move from the description of different phenotypes to the treatable traits
  • Comparative effectiveness of LABA-ICS versus LAMA as initial treatment in COPD targeted by blood eosinophils: a population-based cohort study
  • Asthma-COPD overlap: identification and optimal treatment

Inside Respirology

Respirology Vol. 24 Issue 8

EDITORIALS
710Importance of lifestyle change for patients with sleep apnoea
R Doug McEvoy MBBS, MD, FRACP
10.1111/resp.13627
712Does ISWT evaluate maximal exercise capacity in subjects with severe asthma?
Celso R F Carvalho PT, PhD
10.1111/resp.13563
714Multidisciplinary team working for vocal cord dysfunction: Now it's GO time
James H Hull FRCP, PhD
10.1111/resp.13560
716What's in the CART? A decision rule to predict short-term mortality during COPD exacerbations
Don D Sin MD, MPH
10.1111/resp.13561
718Novel exploratory data in interstitial lung disease
Athol U Wells MD
10.1111/resp.13621
COMMENTARIES
720Smokeless tobacco: Why does it need special attention?
Kamran Siddiqi PhD, Masuma P Mishu PhD
10.1111/resp.13612
722E-cigarettes for smoking cessation: Current state of play
Christine F McDonald AM, MBBS (Hons), FRACP, PhD, FCCP, FThorSoc
10.1111/resp.13630
INVITED REVIEW SERIES
Non-invasive ventilation
724Non-invasive ventilation or high-flow oxygen therapy: When to choose one over the other?
Jean-Pierre Frat, Rémi Coudroy, Arnaud W Thille
10.1111/resp.13435
732Home mechanical ventilation for chronic obstructive pulmonary disease: What next after the HOT-HMV trial?
Eui-Sik Suh, Patrick B Murphy, Nicholas Hart
10.1111/resp.13484
SYSTEMATIC REVIEW
740Assessing the impact of diet, exercise and the combination of the two as a treatment for OSA: A systematic review and meta-analysis
Bradley A Edwards, Claire Bristow, Denise M O'Driscoll, Ai-Ming Wong, Ladan Ghazi, Zoe E Davidson, Alan Young, Helen Truby, Terry P Haines, Garun S Hamilton
10.1111/resp.13580
ORIGINAL ARTICLES
Asthma and Allergy
752Understanding the measurement properties of the incremental shuttle walk test in patients with severe asthma
Sally Majd, Stacey M Hewitt, Lindsay D Apps, Anna C Murphy, Peter Bradding, Sally J Singh, Ruth H Green, Rachael A Evans
10.1111/resp.13519

The measurement properties of the incremental shuttle walk test (ISWT) are unknown in patients with severe asthma. The study results show ISWT can be used to assess exercise capacity in patients with severe asthma. However, the small increase in distance on repeated testing would need to be considered in non-randomized trials.

758Multidisciplinary team clinic for vocal cord dysfunction directs therapy and significantly reduces healthcare utilization
Malcolm Baxter, Laurence Ruane, Debra Phyland, Elizabeth Leahy, Emily Heke, Kenneth K Lau, Kathy Low, Kais Hamza, Martin MacDonald, Philip G Bardin
10.1111/resp.13520

Multidisciplinary team (MDT) clinics use an integrated approach and individualized services that may benefit vocal cord dysfunction (VCD). We show that a VCD MDT clinic can be used to allocate appropriate management leading to a reduction in healthcare utilization.

COPD
765Risk stratification for short-term mortality at hospital admission for acute exacerbations of COPD
Roy T M Sprooten, Gernot G U Rohde, Glenn Lawyer, Wouter T Leijte, Emiel F M Wouters, Frits M E Franssen
10.1111/resp.13538

In the present study according Classification and Regression Tree analysis, high PaCO2 and age, low body mass index and previous (2 years) admission for exacerbations of chronic obstructive pulmonary disease (ECOPD) were the strongest predictors of 90-day mortality in patients with severe ECOPD. In absence of any of these factors, no patients died, suggesting that this model indeed enables risk stratification.

Interstitial Lung Disease
777Pulmonary artery enlargement predicts poor outcome during acute exacerbations of fibrotic interstitial lung disease
Mariko Kogo, Kojiro Otsuka, Takeshi Morimoto, Kazuma Nagata, Atsushi Nakagawa, Keisuke Tomii
10.1111/resp.13504

In patients with an acute exacerbation of interstitial lung disease and a pulmonary artery (PA) enlargement occurring during the exacerbation, a PA to aorta ratio ≥ 1 predicts poor survival at 90 days.

783In vivo probe-based confocal laser endomicroscopy in chronic interstitial lung diseases: Specific descriptors and correlation with chest CT
Mathieu Salaün, Florian Guisier, Stéphane Dominique, Anne Genevois, Vincent Jounieaux, Emmanuel Bergot, Caroline Thill, Nicolas Piton, Luc Thiberville
10.1111/resp.13507

Probe-based confocal laser endomicroscopy (pCLE) enables to image the acinar and alveolar areas at the microscopic level in vivo during flexible bronchoscopy. This study provides reproducible pCLE descriptors of idiopathic pulmonary fibrosis (IPF), asbestosis, connective-tissue disease-related interstitial lung diseases (ILD), sarcoidosis and hypersensitivity pneumonitis, which can be used to conduct prospective and follow-up studies.

792
Efficacy of corticosteroid and intravenous cyclophosphamide in acute exacerbation of idiopathic pulmonary fibrosis: A propensity score-matched analysis
Hironao Hozumi, Hirotsugu Hasegawa, Koichi Miyashita, Hideki Yasui, Yuzo Suzuki, Masato Kono, Masato Karayama, Kazuki Furuhashi, Dai Hashimoto, Noriyuki Enomoto, Tomoyuki Fujisawa, Naoki Inui, Yutaro Nakamura, Koshi Yokomura, Hidenori Nakamura, Takafumi Suda
10.1111/resp.13506

A propensity score-matched analysis demonstrated that in patients with idiopathic pulmonary fibrosis with a first episode of idiopathic acute exacerbation, compared with corticosteroids (CS) monotherapy, CS plus intravenous cyclophosphamide (IVCY) therapy did not significantly improve their survival. This suggests that routine use of IVCY with CS is not recommended.

Pleural Disease
799
Epithelial cell adhesion molecule (EpCAM) from pleural fluid cell lysates is a highly accurate diagnostic biomarker of adenocarcinomatous effusions
José M Porcel, Aureli Esquerda, Silvia Bielsa, Anna Novell, Maria Alba Sorolla, Sonia Gatius, Carlos Zamora, Silvia Vidal, Antonieta Salud
10.1111/resp.13539

The epithelial cell adhesion molecule (EpCAM) is routinely integrated into different immunocytochemical panels to detect adenocarcinoma cases in effusion samples. This study shows that its quantification in pleural fluid cell lysates by using immunoassays outperforms classical immunostainings on cell blocks for identifying adenocarcinomatous effusions (respective areas under the curve of 0.94 and 0.87).

SCIENTIFIC LETTER
805Loop gain in REM versus non-REM sleep using CPAP manipulation: A pilot study
Ludovico Messineo, Luigi Taranto-Montemurro, Ali Azarbarzin, Melania Marques, Nicole Calianese, David P White, Andrew Wellman, Scott A Sands
10.1111/resp.13608
CONTEMPORARY CONCISE REVIEW
809Contemporary Concise Review 2018: Interstitial lung disease
Pier-Valerio Mari, Mark G Jones, Luca Richeldi
10.1111/resp.13572
LETTER FROM ASIA-PACIFIC AND BEYOND
817Letter from Spain
Antoni Torres MD, PhD
10.1111/resp.13628
CORRESPONDENCE
819Can vitamin C help in managing tuberculosis associated with diabetes mellitus?
Wing-Wai Yew MB, BS, FRCP, Kwok-Chiu Chang MD, Denise P Chan PhD, Ying Zhang MD
10.1111/resp.13579
CORRIGENDUM
821CORRIGENDUM

Inside Respirology Case Reports

The following cases have been selected for inclusion in the October 2019 Respirology Case Reports, Volume 07 Issue 7

Case Series

Effect of bevacizumab on brain radiation necrosis in anaplastic lymphoma kinase-positive lung cancer
Kengo Tanigawa, Keiko Mizuno, Yusuke Kamenohara, Taiji Unoki, Shunsuke Misono, Hiromasa Inoue
DOI: 10.1002/rcr2.454

We assessed four anaplastic lymphoma kinase (ALK)-positive non-small cell lung cancer (NSCLC) patients who were treated with ALK-tyrosine kinase inhibitors (TKIs). They developed brain radiation necrosis and brain oedema after stereotactic irradiation. Here, we report the efficacy and safety of bevacizumab given in combination with ALK-TKIs for brain radiation necrosis in ALK-positive NSCLC.

Case Reports

Exertion during a hypoxia altitude simulation test helps identify potential cardiac decompensation
Leigh Seccombe, Matthew Peters, Claude Farah
DOI: 10.1002/rcr2.450

We present the novel case of a 64-year-old female with a history of chronic thromboembolic pulmonary arterial hypertension and moderate bronchiectasis who experienced right ventricular failure during a clinically indicated flight simulation. While the subject recorded acceptable oxygenation during the simulation in resting conditions, echocardiography demonstrated underlying cardiopulmonary limitation that significantly worsened with mild exercise.

Successful salvage surgery following multimodal therapy in a patient who harboured ALK-rearranged advanced lung adenocarcinoma with multiple organ metastases
Yoshitsugu Horio, Tetsuya Mizuno, Yukinori Sakao, Yoshitaka Inaba, Yasushi Yatabe, Toyoaki Hida
DOI: 10.1002/rcr2.451

This case report highlights that multidisciplinary treatment planning is critical for stage IIIb-IV non-small cell lung cancer (NSCLC) patients in the era of highly effective treatments, including chemotherapy, molecular targeted therapy, and immunotherapy, which may demonstrate treatment-free remission (TFR) even in highly selected advanced lung cancer patients with poly-metastases, and we need more information about the association between each genetic alteration and the significance of salvage surgery.

Syncope due to tracheal adenoid cystic carcinoma
Eva Marianne Theresa Bots, Abraham Christoffel van Wyk, Jacques Teran Janson, Riegardt Wagenaar, Gerald Paris, Coenraad Frederik Nicolaas Koegelenberg
DOI: 10.1002/rcr2.452

We report the case of a 34-year-old male who presented with syncope secondary to a large adenoid cystic carcinoma (ACC) of the distal trachea. Tracheal tumours comprise a small proportion of respiratory tract neoplasm, accounting for only about 2% of airway malignancies. Syncope as a presenting symptom is exceedingly rare.

Non-small cell lung cancer with mesenchymal-epithelial transition gene exon 14 skipping mutation treated with crizotinib
Seigo Katakura, Nobuaki Kobayashi, Kohei Somekawa, Nami Masumoto, Makoto Kudo, Takeshi Kaneko
DOI: 10.1002/rcr2.453

Non-small cell lung cancer patients with mesenchymal-epithelial transition gene exon 14 skipping mutation were treated with crizotinib. The treatment was effective, and the patient had stable disease for 7 months.

Tracheobronchial calcification on bronchoscopy in a patient with end stage renal failure: an unusual cause of chronic cough
Alice Sawka, April Crawford, Chen Au Peh, Phan Nguyen
DOI: 10.1002/rcr2.456

In this report, we describe a 64-year-old female with a history of inadequate peritoneal dialysis who presented with severe and persistent chronic cough. Extensive white nodular tracheobronchial mucosal changes were identified on bronchoscopy despite the absence of corresponding abnormalities on CT imaging. We believe that the bronchoscopic findings represent a highly unusual presentation of metastatic pulmonary calcification and an unusual cause of chronic cough amongst patients with end-stage renal failure.

Very low-dose intrapleural tPA for indwelling pleural catheter-associated symptomatic fluid loculation
Norris Si Hao Lan, Sona Vekaria, Calvinjit Sidhu, Yun Chor Gary Lee
DOI: 10.1002/rcr2.457

This case report describes the successful use of 0.5 mg (the lowest reported dose) of tissue plasminogen activator in a patient with significant bleeding risks whose indwelling pleural catheter was complicated by symptomatic loculation.

Endobronchial one-way valve for persistent air leak and lung volume reduction
Wai Cho Yu, Hau Chung Kwok, Yu Hong Chan, Man Ying Ho, Ming Chiu Chan, Yiu Cheong Yeung
DOI: 10.1002/rcr2.461

Our patient with severe emphysema was denied bronchoscopic lung volume reduction by endobronchial valves because he failed the diffusion study. Later, he had endobronchial one-way valves (EBV) deployed for treatment of persistent air leak complicating a pneumothorax. His clinical status and lung function showed marked improvement afterwards.

Pulmonary nocardiosis caused by Nocardia exalbida mimicking lung cancer
Chika Miyaoka, Keitaro Nakamoto, Tatsuya Shirai, Maki Miyamoto, Yuka Sasaki, Ken Ohta
DOI: 10.1002/rcr2.458

Nocardiosis is an uncommon infection caused by Nocardia species that can often occur, mostly as pulmonary lesions, in immunocompromised patients with organ transplantation and cancer. Consolidation, masses, and nodules are frequent computed tomography (CT) findings, but lymph node enlargement is rare. We report a rare case of pulmonary nocardiosis caused by Nocardia exalbida with CT findings of a mass and lymph node enlargement, requiring differentiation from lung cancer and that was difficult to diagnose.

Pneumocystis jirovecii in a patient on dose-dense chemotherapy for early breast cancer
Chloe Khoo, Jenny Gilchrist, Jonathan Philip Williamson, Miriam Paul, Richard Kefford
DOI: 10.1002/rcr2.459

Adjuvant chemotherapy is associated with improved survival in early breast cancer (EBC) and is used as standard treatment for many patients following surgery. We present a fatal case of Pneumocystis jirovecii pneumonia – a rare and under-recognized complication – in an otherwise well patient undergoing a dose-dense adjuvant chemotherapy following surgery for EBC.

Respirology – Alternative Access to Articles

Exclusive feature for members

Now you can read full version of Respirology articles by either logging in using your APSR members-only user-id or your Respirology user-id.

We all have trouble remembering so many different user-ids and passwords. From now, if you forget one, you can use the other.

How it works

When you click a link on the APSR website to a Respirology article, the system will automatically log you into the Wiley Online Library website and display the full version of that article.

The success of that redirection depends on you being registered for viewing APSR members-only webpages on the APSR website. If you are not registered, the system will prompt you to click the REGISTER button at the top of this Bulletin.

Successful redirection also depends on you logging in with a sufficiently strong password. (If you've forgotten your password, click here to reset it.) If your APSR password is not strong enough, you'll be prompted to strengthen it. (Access to the Wiley Online Library requires a password of at least ten mixed characters.)

In some cases, if you registered for APSR members-only access a long time ago, you may be asked to re-register. In this case, simply click the REGISTER button at the top of this Bulletin.

All the above points are to safeguard your privilege to see articles which cannot be seen by non-members

We hope you'll find this feature useful.

Try it now!

We've picked a recent article at random for you to try.

Click this link: 10.1111/resp.13462, then select the option to read the Full article

You'll be able to continue reading full articles for the rest of the time you remain logged in.

Viewing abstracts and Open Access articles will remain freely available to the public. Only you, as a member, have the privilege to get this direct access to the more significant articles.

If you have any questions about this procedure, please contact the APSR Secretariat.

Regional society news

The spotlight this month is on

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.

International Conference

of the KATRD

The Korean Academy of Tuberculosis & Respiratory Diseases (KATRD) will hold an International Conference 7-8 November 2019 at Lotte Hotel World, Seoul, Republic of Korea. Details at www,katrdic.org.

APSR President Dr Kwun M Fong and HKTS President Dr David C L Lam will attend as invited speakers together with following selected APSR members from the Asia-Pacific region as the KATRD Travel Awardees:

Dr Juliette DehovePostdoctoral Research Fellow: Cystic Fibrosis Airway Research Group, University of Adelaide
Respiratory & Sleep Medicine, Women's & Children's Hospital, Australia
Dr Chin-Chung ShuAttending physician, Division of Hospital Medicine, Department of Internal Medicine, National Taiwan University Hospital
Assistant Professor, National Taiwan University College of Medicine, Taiwan
Dr Jubert BenedictoUP-PGH; San Juan de Dios Hospital; Manila Medical Center;
Lung Center of the Philippines
Dr Giap Van VuGeneral Secretary of Vietnam Respiratory Society
Vice Director of Respiratory Center-Bach Mai Hospital, Hanoi, Vietnam
Senior Lecturer of Internal Medicine Department, Hanoi Medical University
Postdoctoral Research Fellow, The University of Sydney
Honorary Lecturer, The University of Sydney
Medical Advisor of Woolcock Institute of Medical Research, Vietnam

Other regional news:

Singapore

Standardised packaging & enlarged graphic health warnings for tobacco products from 1 July 2020

From 1 July 2020, all tobacco products sold in Singapore will be subject to standardised packaging and enlarged graphic health warnings (collectively, "the SP Measure"). The SP Measure will apply to all tobacco products, including cigarettes, cigarillos, cigars, beedies, ang hoon and other roll-your-own tobacco products.

The Ministry of Health (MOH) announced the decision to implement the SP Measure for all tobacco packaging on 31 October 2018, after an extensive process of reviewing and evaluating the available international and local studies, research and evidence on the SP Measure, as well as several rounds of public consultations.

Following the passage of amendments to the Tobacco (Control of Advertisements and Sale) Act in March 2019, MOH is introducing subsidiary legislation to implement the SP Measure for all tobacco products in Singapore and their packaging and labelling. The Tobacco (Control of Advertisements and Sale) (Appearance, Packaging and Labelling) Regulations 2019 (SP Regulations) were published on 1 July 2019 and will come into operation on 1 July 2020, i.e. 12 months after they are gazetted.

The requirements set out in the SP Regulations encompass the packaging, appearance and labelling on retail packaging of all tobacco products and include:

  1. The removal of all logos, colours, images and promotional information on the packaging of tobacco products (other than brand names and variant names displayed in a standard colour and font style); and
  2. An increase in the minimum size of the mandatory graphic health warnings from the existing 50% to 75% of all specified tobacco product packaging surfaces.

Implementation of the SP Measure

From 1 July 2020, all tobacco products imported into, or distributed, sold, offered for sale or possessed for sale in Singapore must comply with the SP Regulations. Non-compliance with the SP Regulations is an offence punishable with a fine not exceeding $10,000, imprisonment for a term of up to 6 months or both for first offenders. Those with a prior qualifying conviction will face heavier penalties.

A three-month transition period from 1 April 2020 to 30 June 2020 will be provided, via the Tobacco (Control of Advertisements and Sale) (Labelling) (Exemption) Order 2019, to allow tobacco products that comply with either the current Tobacco (Control of Advertisements and Sale) (Labelling) Regulations 2012 or the SP Regulations to be imported into, or distributed, sold, offered for sale or possessed for sale in Singapore. The transition period will help tobacco manufacturers, wholesalers and retailers to adjust and prepare for the full implementation of the SP Measure from 1 July 2020.

Singapore's multipronged approach on tobacco control

The SP Measure for tobacco products will, in conjunction with other tobacco control measures, contribute to achieving broader tobacco control aims such as discouraging non-smokers from picking up smoking, encouraging smokers to quit, and encouraging Singaporeans to adopt a tobacco-free lifestyle, which will ultimately lead to reduced smoking prevalence.

Other tobacco control measures include education, taxation, smoking cessation programmes, bans on tobacco advertising, the point-of-sale display ban and the institution of a minimum legal age for tobacco, so as to reduce the prevalence of smoking in Singapore, and meet the government's obligations under the World Health Organization Framework Convention on Tobacco Control.

Further details can be seen on Singapore's Ministry of Health webpage: moh.gov.sg/news-highlights/details/standardised-packaging-enlarged-graphic-health-warnings-for-tobacco-products-from-1-july-2020

UGLY

Singapore is filled with beauty, yet the abstract on the left explains how the country proudly uses something that is universally ugly.

The background colour of this border has the unenviable accolade of being called "The ugliest colour in the world".

After market researchers determined that it was the least attractive colour, it was selected in 2016 for plain tobacco and cigarette packaging in Australia.

The same colour has also been used for plain cigarette packaging in France, the United Kingdom, Israel, Norway and now Singapore.

(If you want to reproduce this colour for your education projects, its hex code is #4a412a)

Health news

Air pollution increases risk of death from cardiovascular disease, even at levels below the current US environmental standard

An article in the International Journal of Epidemiology reported that the fine particles in polluted air are linked to an increased risk of cardiovascular death, even at levels below current international standards.

"The remarkable thing about this work is that the authors analysed information from over 500,000 adults representing more than 7 million 'person-years' and found that the risk of death depended on the amount of fine particles inhaled," said Dean Schraufnagel, MD, executive director of the Forum of International Respiratory Societies (FIRS) and member of FIRS Environmental Committee.

The study evaluated data from the detailed health and diet survey conducted by the National Institutes of Health (NIH) and the American Association of Retired Persons (AARP). The study volunteers, aged between 50 and 71, were followed for 10 years.

The investigators cross-referenced information about the amount and type of particulate matter from the Environmental Protection Agency's Air Quality System and other databases and ruled out other causes associated with health and longevity. They found no significant difference in the effect of the fine particle exposure between the different genders, age groups, and socioeconomic levels.

"Our study is particularly notable because long-term exposure to fine particulate air pollution was associated with excess risks for cardiovascular disease mortality occurring in the range of, and even below, the present US long-term standard for ambient exposure to particulate matter (PM2.5)," says lead study investigator and health epidemiologist, Richard Hayes, DDS, PhD, a professor of population health and environmental medicine at NY University Langone campus.

According to senior study investigator, health epidemiologist George Thurston, ScD, fine particles can contribute to the development of potentially fatal heart disease and stroke because they slip past the body's defences and can be absorbed into the bloodstream. They are not sneezed or coughed out the way larger natural particles, such as dusts, are removed from the body's airways. Moreover, Dr. Thurston says, "the implications of this study to air quality regulations are that people may be dying from levels of air pollution below currently established US environmental guidelines. The US EPA needs to consider revision of the PM2.5 air quality limits down to lower levels than currently recommended, to properly protect public health".

The "dose-dependency" health risk that extends below current standards should warn policymakers that stricter standards are needed to protect lives.

Notes

The paper can be viewed by clicking here.

Dean Schraufnagel, Professor of Pulmonary, Critical Care, Sleep, and Allergy at University of Illinois at Chicago. Director of the Forum of International Respiratory Societies (FIRS) and member of FIRS Environmental Committee.

Richard Hayes, DDS, PhD, Professor of Population Health and Environmental Medicine at the NYU School of Medicine, Langone.

Dr George D Thurston, Professor of Environmental Medicine and Population Health, and Director of the Program in Human Exposures and Health Effects, at the NYU School of Medicine, NYU-Langone Medical Center.


Image © Environment Victoria and reproduced with their permission.

The Hazelwood coal mine fire was ignited by embers from wildfires in February 2014 in Victoria, Australia, and lasted for 45 days

Early life exposure to coal mine fire smoke emissions and altered lung function in young children

The following FIRS press release was issued just as the previous Bulletin was being distributed.

The Forum of International Respiratory Societies (FIRS) warns that short-term exposure to air pollution in early life may influence future lung growth and development

An article published in Respirology found a modest association between infant exposure to elevated particulate matter (PM2.5) during a six-week coal mine fire and reduced respiratory system reactance, measured three years after the fire. [1].

Short-term health impacts associated with exposure to fine PM have been well characterised. There is consistent evidence associating short-term smoke exposure with increased physician visits, emergency department presentations and hospitalisations for respiratory diseases. However, the long-term health risks from relatively short, that is days to weeks in duration, air pollution episodes have not been characterised, especially in children.

The authors studied children who were living near a coal mine in Victoria, Australia, during a mine fire episode lasting 45 days in Feb 2014.

"This research was driven by concern from members of the affected communities that the fire and severe smoke episodes could have increased the risk of health problems in the longer term. There is currently scant evidence about this, one way or the other – we wanted to address this gap," says article author Professor Fay Johnston, Head of Environmental Health Research Group, Menzies Institute for Medical Research, University of Tasmania. [2].

They selected 105 children under 2 years old, estimating their personal exposure to PM2.5 generated by the mine fire, and they measured their lung function 3 years after the fire to identify any long-term adverse effect on their lung development.

"This study is potentially important for public health because it aims to clarify if even short-term exposure to fine PM may cause any long-term impact on the lung growth of children, who might be more vulnerable because of their fast developing lungs," said Sara De Matteis, MD, MPH, PhD, Adjunct Professor at Humanitas University, Honorary Senior Lecturer at Imperial College London, and member of FIRS Environmental Committee. [3].

Infants and young children are more susceptible to the respiratory impacts of air pollution exposure due to their less developed airways and immune system, and faster breathing rates compared with adults. The first two years of life is a critical window for lung growth.

The study found that infant exposure to coal mine fire emissions could be associated with long-term impairment of lung reactance.

Dr De Matteis said "The findings of this study are of potential clinical importance in children most severely exposed to PM, or those with underlying lung conditions, such as asthma. We need further larger studies aimed to elucidate the long-term effects of air pollution on children's lung function to implement focused preventive strategies and so avoid the associated future public burden of respiratory diseases."

Professor Fay Johnston concludes "All efforts to improve air quality and protect sensitive groups, including the very young, from episodic air pollution will have important public health benefits. However, our results also demonstrated the larger and more serious adverse impacts from exposure to second-hand tobacco smoke and once again confirmed the importance of supporting parents, prospective parents, and other adults who have regular contact with children not to smoke."

Notes:

[1] The paper can be viewed at: apsresp.org/publications/respirology/https://onlinelibrary.wiley.com/doi/full/10.1111/resp.13617

[2] Associate Professor Fay Johnston heads the Environmental Health group, in the Public Health and Primary Care and Cardiorespiratory research themes of the Menzies Institute for Medical Research, University of Tasmania. She is a medical graduate with specialist qualifications in public health and general practice and a PhD in environmental epidemiology.

[3] Dr Sara De Matteis is Occupational and Environmental Health Physician and epidemiologist whose research centers on the effect of the environment and genetics on health, especially with regard to occupational lung diseases ranging from asthma to lung cancer.

About the Forum of International Respiratory Societies (FIRS)

The Forum of International Respiratory Societies (FIRS) is an organisation composed 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), Associatión Latino Americana De Thórax (ALAT), European Respiratory Society (ERS), International Union Against Tuberculosis and Lung Disease (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.

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

Respirology is a journal of international standing, publishing peer-reviewed articles of scientific excellence in clinical and clinically-relevant experimental respiratory biology and disease. Fields of research include immunology, intensive and critical care, epidemiology, cell and molecular biology, pathology, pharmacology, physiology, paediatric respiratory medicine, clinical trials, interventional pulmonology and thoracic surgery.

APSR Membership

Young Investigator Awardee alumni

We are honoured to introduce the following travel award winners who presented at the ISRD-APSR Joint Session in the American Thoracic Society International Conference 2019 (ATS 2019) 18 May 2019 in Dallas.

They join the growing list of APSR Awardee Alumni who will be making significant improvements to respiratory health in the Asia-Pacific region and beyond.

Hui Juan Dorothy Cheong

(National University of Singapore)

Presented: Anti-Remodelling and Anti-Airway Hyperresponsiveness Properties of Anti-Malarial Drug, Artesunate, in a House Dust Mites-Induced Chronic Mouse Model of Asthma (See post-session report)

Crestita Gorme

(Philippine Heart Center, Division of Pulmonary and Critical Care Medicine, Section of Pediatric Pulmonology)

Presented: "Utility of Fractional Exhaled Nitric Oxide (FeNO) Levels in DifferentiatingUpper Respiratory Tract Infection and Bronchial Asthma from Healthy Normal School Children" (See post-session report)

Edward Harris

(Sir Charles Gairdner Hospital, Perth, Western Australia)

Presented: "Malignant and non-malignant findings from 5 years of Low dose CT scans screening for lung cancer in the Western Australian Asbestos Review Programme" (See post-session report)

Yet-Khor Hong

(Austin Health / Alfred Health / University of Melbourne, Australia)

Presented: "A Pilot Randomised Controlled Trial of Ambulatory Oxygen versus Air via Portable Concentrator in Fibrotic Interstitial Lung Disease" (See post-session report)

Youlim Kim

(Hallym University Chuncheon Sacred Heart Hospital, Republic of Korea)

Presented: "Impact of bronchiectasis on clinical outcome and medical utilization in COPD patients" (See post-session report)

Yasushi Murakami

(Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan)

Presented: "The prognostic role of blood lymphocytopenia in patients with postoperative pneumonia" (See post-session report)

Sheng-Wei Pan

(Taipei Veterans General Hospital)

Presented: "The risk of tuberculosis and other infections in diabetic patients using statins versus nonstatin lipid-lowering agents" (See post-session report)

Clarice Tang

(Western Sydney University, Australia)

Presented: "Does an immediate commencement of pulmonary rehabilitation following hospitalisation for an exacerbation of COPD positively impact attendance and completion rates: A pilot randomised controlled trial" (See post-session report)

Hiroki Tashiro

(Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University)

Presented: "Sex differences in the effect of dietary fibre on ozone-induced airway hyperresponsiveness: role of the microbiome" (See post-session report)

Miranda Ween

(Royal Adelaide Hospital, Australia)

Presented: "What's Your Flavour? Effects of E-cigarette Coil Temperature on Flavour Dependent Reductions of Phagocytosis of Bacteria and Apoptotic Airway Cells" (See post-session report)

Jung-Ki Yoon

(Seoul National University Hospital, Republic of Korea)

Presented: "Whole genome sequencing (WGS) of nontuberculosis mycobacterium (NTM) from co-habiting patients with NTM pulmonary disease (NTM-PD) to track the source of infection (See post-session report)

Assembly News

Environmental & Occupational Health and Epidemiology Assembly, July 2019

Editor:Prof. Yasuo Morimoto
University of Occupational and Environmental Health, Japan

Activities

A training workshop on occupational lung disease, as an activity with WHO collaborating centres, was held in Vientiane, Lao PDR, on 27-28 June 2019.

Dr Jun-Pyo Myong (Catholic University of Korea) and Dr Yasuo Morimoto (University of Occupational and Environmental Health, Japan) provided practical training for reading ILO chest X-ray film of pneumoconiosis and asbestosis, a lecture on patho-physiological and diagnostic issues of occupational lung diseases, a lecture on treatment and measure of occupational health to prevent occupational lung disease in the dust workplace, and surveillance of occupational lung disease in Japan and Korea.

Approximately 20 pulmonologists in Vientiane took part in this workshop, which became successful through the exchange of information and opinions.


(Click image to enlarge)

(Click image to enlarge)

(Click image to enlarge)

Dr Yasuo Morimoto (University of Occupational and Environmental Health, Japan) gave an oral presentation entitled by "Activity of WHO Collaborating Centre for Occupational Health" at the 29th China-Korea-Japan Conference on Occupational Safety and Health, organized by Mr Wang Dexue, president of the China Occupational Safety and Health Association, on 22-23 April 2019 in Nanjing, China.

Announcements

A symposium by the Environmental & Occupational Health and Epidemiology Assembly at the 24th Congress of the Asian Pacific Society of Respirology will be held on 14-17 November in 2019 in Hanoi. The relationship between environmental factors including air pollution and respiratory diseases will be reported.

Cases of occupational lung disease for the APSR Teaching Library are being collected from our assembly members. If you have a suitable case, please let us know (yasuom@med.uoeh-u.ac.jp).

A workshop on occupational lung disease for sustainable training is being planned to take place in Hanoi, in Vietnam between 2019 and 2020, to perform early diagnosis of occupational lung disease.

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
Tara Ballav Adhikari
(Nepal)
COPD
Respiratory Structure and Function
Environmental & Occupational Health and Epidemiology
Woo Ho Ban
(Republic of Korea)
COPD
Bronchoscopy and Interventional Techniques
Asthma
Ying-Chun Chien
(Taiwan)
Critical Care Medicine
Lung Cancer
Respiratory Infections (non-tuberculous)
Dharm Prakash Dwivedi
(India)
Bronchoscopy and Interventional Techniques
Interstitial Lung Disease
Clinical Respiratory Medicine
Ester Jean Dy
(Philippines)
Bronchoscopy and Interventional Techniques
Critical Care Medicine
Respiratory Infections (non-tuberculous)
Vishnukanth Govindaraj
(India)
Clinical Respiratory Medicine
COPD
Respiratory Neurobiology and Sleep
Irfan U I Haq
(Pakistan)
Clinical Respiratory Medicine
Bronchoscopy and Interventional Techniques
Asthma
Sze Shyang Kho
(Malaysia)
Bronchoscopy and Interventional Techniques
Lung Cancer
Chuen Peng Lee
(Singapore)
Respiratory Neurobiology and Sleep
Bronchoscopy and Interventional Techniques
Critical Care Medicine
Di Lu
(China)
Lung Cancer
Critical Care Medicine
Cell and Molecular Biology
Gordon Malouf
(Singapore)
Respiratory Neurobiology and Sleep
Clinical Respiratory Medicine
COPD
Karn Mehra
(India)
Bronchoscopy and Interventional Techniques
Clinical Respiratory Medicine
Interstitial Lung Disease
Madhusmita Mohapatra
(India)
COPD
Clinical Allergy & Immunology
Bronchoscopy and Interventional Techniques
Tomas Realiza
(Philippines)
COPD
Interstitial Lung Disease
Critical Care Medicine
Mary Antonette Remonte
(Philippines)
Tuberculosis
Respiratory Infections (non-tuberculous)
COPD
Harikrishnan Selvaraj
(India)
Bronchoscopy and Interventional Techniques
Critical Care Medicine
Tuberculosis
Bobby Singh
(Indonesia)
Clinical Respiratory Medicine
Bronchoscopy and Interventional Techniques
Tuberculosis
Windfield Tan
(Philippines)
Lung Cancer
Bronchoscopy and Interventional Techniques
Critical Care Medicine
Deepak Thakur
(India)
Clinical Respiratory Medicine
Respiratory Infections (non-tuberculous)
COPD
Thanh-thu Tran-Thi
(Vietnam)
Paediatric Lung Disease
Critical Care Medicine
Respiratory Infections (non-tuberculous)
Pratap Upadhya
(India)
Tuberculosis
COPD
Lung Cancer
Wang Zhizhi
(China)
Lung Cancer
Cell and Molecular Biology
Critical Care Medicine

Donations received

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

  • Motoyasu Kato (Japan)
  • Hisako Matsumoto (Japan)
  • Keiji Oishi (Japan)

The APSR is profoundly grateful for their generosity.

New Fellows of the APSR

Congratulations to the following members who have recently become APSR Fellows.

  • Vishnukanth Govindaraj FAPSR (India)
  • Pratap Upadhya FAPSR (India)
  • Keshavan V FAPSR (India)

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 Lung Cancer Day
    1 August 2019, Worldwide
    (Details)
  • 16th Annual Meeting: Work Conference of the Indonesian Society of Respirology (ISR)
    11-14 September 2019, Surakarta, Indonesia
    (Details)
  • World Lung Day
    25 September 2019, Worldwide
    (Details)
  • WASOG/JSSOG 2019 (Joint Conference of International Conference on Sarcoidosis and Interstitial Lung Diseases 2019; and 39th Annual Meeting of Japan Society of Sarcoidosis and other Granulomatous Disorders)
    9–11 October 2019, Yokohama, Japan
    (Details)
  • Respire 11 annual academic sessions of the Sri Lanka College of Pulmonologists
    29–31 October 2019, Colombo, Sri Lanka
    (Details)
  • Autumn Respiratory Seminar 2019 of the Hong Kong Thoracic Society and CHEST Delegation Hong Kong and Macau Limited
    November (to be confirmed), Hong Kong
    (Details)
  • PULMOCON 2019 (6th International Conference on Lung Health)
    5–8 November, Dhaka, Bangladesh
    (Details)
  • 128th Conference of the Korean Academy of Tuberculosis and Respiratory Diseases (KATRD)
    7–8 November 2019, Seoul, Republic of Korea
    (Details)
  • 24th Congress of the APSR
    14–17 November 2019, Hanoi, Vietnam
    (Details)
  • Asthma & COPD Outpatient Care Unit (ACOCU) Network Day
    17 November 2019
    Ho Chi Minh City, Vietnam
    (Details)
  • World Pneumonia Day
    12 November 2019, Worldwide
    (Details)
  • World COPD Day
    20 November 2019, Worldwide
    (Details)
  • World AIDS Day
    1 December 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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