No. 128 (March 2020)
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Latest news COVID-19

Take a break

Thousands of health workers have contracted the coronavirus, and some have died. News is coming in of APSR colleagues becoming infected from patients they are investigating and treating, and fortunately some have recovered sufficiently to return to work, demonstrating their amazing commitment to their patients' health.

As we all know, but often forget, the good health of medical staff must take priority in order to remain capable of treating patients. Sufficient rest not only avoids the burn out from hyperactivity, but also remains an important part of personal armoury against infection.

Schedule rest. Make it a priority.

If you have been treating COVID-19 patients and wish to share your experience with other members through this Bulletin, please contact us.

APSR News

APSR Congress news

2020 Congress in Kyoto

Call for Papers! Abstracts can now be submitted online. The Scientific Committee welcomes the submission of abstracts on wide variety topics in respiratory and related topics. Accepted abstracts will be published in a dedicated supplement issue of Respirology, the official journal of the APSR.

Online pre-registration will start on Monday 2 March 2020.

See the congress website www.apsr2021.jp for the latest details.

For your safety, please be aware of fraudulent websites linking to the APSR Congress to offer registrations, hotel bookings and other services. The APSR does not accept any responsibility for bookings made via unofficial websites/agencies or any money lost as a result.

apsr2021.jp is the official and only APSR Congress website.

Respiratory Updates

The January issue (Vol 12.1) features Pulmonary Rehabilitation in COPD:

  • Diaphragmatic motor cortex hyperexcitability in patients with chronic obstructive pulmonary disease.
  • Exercise ameliorates emphysema of cigarette smoke-induced COPD in mice through the exerciseirisin-Nrf2 axis.
  • IL13-driven pulmonary emphysema leads to skeletal muscle dysfunction attenuated by endurance exercise.
  • Telomere length in COPD: Relationships with physical activity, exercise capacity, and acute exacerbations.
  • Use of pedometers as a tool to promote daily physical activity levels in patients with COPD: a systematic review and meta-analysis.
  • Behavioural interventions targeting physical activity improve psychocognitive outcomes in COPD.
  • Determinants of the Diminished Exercise Capacity in Patients with Chronic Obstructive Pulmonary Disease: Looking Beyond the Lungs.
  • Effect of Virtual Reality-Based Rehabilitation on Physical Fitness in Patients with Chronic Obstructive Pulmonary Disease.
  • Physical Activity and Sedentary Behaviour Patterns in 326 Persons with COPD before Starting a Pulmonary Rehabilitation: A Cluster Analysis.
  • Home versus outpatient pulmonary rehabilitation in COPD: a propensity-matched cohort study.
  • Physical Activity and Sedentary Behaviour Patterns in 326 Persons with COPD before Starting a Pulmonary Rehabilitation: A Cluster Analysis.
  • Home versus outpatient pulmonary rehabilitation in COPD: a propensity-matched cohort study.

Inside Respirology

Respirology Vol. 25 Issue 3

EDITORIALS
230COPD exacerbation phenotypes: The next frontier
Angela Moran MBChB, FRACP; Ian D Pavord FMedSci
10.1111/resp.13693
232Reducing the burden of respiratory symptoms and illness in the elderly and general population requires multi-pronged strategies
Guy B Marks MBBS, PhD, FRACP, FAFPHM, GAICD
10.1111/resp.13654
234In search for a predictive marker of acute exacerbations of idiopathic pulmonary fibrosis
Yuben Moodley MBChB, FCP, FRACP, MD, PhD
10.1111/resp.13666
236Further evidence of the generalizability of the Global Lung Function Initiative reference equations for spirometry
Sanja Stanojevic PhD
10.1111/resp.13684
238Expanding knowledge on non-expandable lungs
Y C Gary Lee MBChB, PhD, FCCP, FRCP, FRACP
10.1111/resp.13718
240Periodic breathing: Fine tuning the phenotype
Matthew T Naughton MD, FRACP
10.1111/resp.13657
242Obstructive sleep apnoea and susceptibility to cardiovascular disease: A blessing or curse of old age?
Jonathan C Jun MD; Vsevolod Y Polotsky MD, PhD
10.1111/resp.13679
COMMENTARIES
244Challenges in understanding lung microbiome: It is NOT like the gut microbiome
De Chang MD, PhD; Charles S Dela Cruz MD, PhD; Lokesh Sharma PhD
10.1111/resp.13759
246The history and future of short-acting beta2-agonist therapy in asthma
Thomas Hills MBChB DPhil; Richard Beasley MBChB DSc
10.1111/resp.13727
INVITED REVIEW SERIES
New frontiers in sleep-disordered breathing
249The future of sleep-disordered breathing: Looking beyond the horizon
Matthew T Naughton MBBS, MD, FRACP; Peter A Cistulli MBBS, PhD, MBA; Philip de Chazal BE, MBiomedE, PhD
10.1111/resp.13715
251Advanced polysomnographic analysis for OSA: A pathway to personalized management?
Philip de Chazal, Kate Sutherland, Peter A Cistulli
10.1111/resp.13564
ORIGINAL ARTICLES
COPD
259Blood eosinophil count as a predictor of hospital length of stay in COPD exacerbations
Fanny W S Ko, Ka Pang Chan, Jenny Ngai, So-Shan Ng, Wing Ho Yip, April Ip, Tat-On Chan, David S C Hui
10.1111/resp.13660

For patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease (AECOPD), an eosinophil count at a cut-off value of <2% of the total leucocyte count or an absolute count of <0.144 × 109/L was associated with a longer length of stay (LOS) independent of other factors including age, gender, past history of exacerbations and lung function.

267Predicting life expectancy of older people using respiratory symptoms and smoking status: Data from the Australian Longitudinal Study of Ageing
Kate Petrie, Michael J Abramson, Amanda J Cross, Johnson George
10.1111/resp.13603

Respiratory symptoms (cough, shortness of breath and wheeze) predict mortality in older people and their effects are modified by smoking status. This study is the first to present mortality risk related to respiratory symptoms as an impact on life expectancy, an easier way to communicate mortality risk.

Interstitial Lung Disease
275Serum high-mobility group box 1 is associated with the onset and severity of acute exacerbation of idiopathic pulmonary fibrosis
Kakuhiro Yamaguchi, Hiroshi Iwamoto, Shinjiro Sakamoto, Yasushi Horimasu, Takeshi Masuda, Shintaro Miyamoto, Taku Nakashima, Shinichiro Ohshimo, Kazunori Fujitaka, Hironobu Hamada, Noboru Hattori
10.1111/resp.13634

This study showed that elevated levels of serum high-mobility group box 1, a mediator of acute lung injury through the acceleration of pro-inflammatory signalling, predicts earlier onset of acute exacerbation (AE) in patients with stable idiopathic pulmonary fibrosis and shorter survival in patients with AE.

Lung Function
281
Global Lung Function Initiative-2012 'other/mixed' spirometry reference equation provides the best overall fit for Australian Aboriginal and/or Torres Strait Islander children and young adults
Tamara L Blake, Anne B Chang, Mark D Chatfield, Julie M Marchant, Margaret S McElrea
10.1111/resp.13649

We examined the appropriateness of the Global Lung Function Initiative (GLI)-2012 spirometry reference equations for Indigenous Australian children and young adults (3–25 years). Of the available GLI-2012 reference equations, other/mixed provided the best fit for Indigenous Australians (3–25 years).

289Early menarche is associated with lower adult lung function: A longitudinal cohort study from the first to sixth decade of life
Brittany Campbell, Julie A Simpson, Dinh S Bui, Caroline J Lodge, Adrian J Lowe, Melanie C Matheson, Gayan Bowatte, John A Burgess, Garun S Hamilton, Benedicte Leynaert, Francisco Gómez Real, Paul S Thomas, Graham G Giles, Peter A Frith, David P Johns, Gita Mishra, Judith Garcia-Aymerich, Debbie Jarvis, Michael J Abramson, E Haydn Walters, Jennifer L Perret, Shyamali C Dharmage
10.1111/resp.13643

This is the first longitudinal study with data on key early life confounders to link early age at menarche to lung function deficits in middle age and provide novel evidence on potential biological pathways contributing to this link.

Pleural Disease
298Inter-observer variation in image interpretation and the prognostic importance of non-expansile lung in malignant pleural effusion
Geoffrey A Martin, Andrew C Kidd, Selina Tsim, Paul Halford, Anna Bibby, Nick A Maskell, Kevin G Blyth
10.1111/resp.13681

Non-expansile Lung (NEL) often complicates malignant pleural effusion management. This multicentre study identifies significant limitations in radiographic NEL detection and an association between NEL and adverse survival. These findings are relevant to clinical practice and should be considered in future trial design.

Sleep and Ventilation
305
Association of serious adverse events with Cheyne–Stokes respiration characteristics in patients with systolic heart failure and central sleep apnoea: A SERVE-Heart Failure substudy analysis
Faizan Javed, Renaud Tamisier, Jean-Louis Pepin, Martin R Cowie, Karl Wegscheider, Christiane Angermann, Marie-Pia d'Ortho, Erland Erdmann, Anita K Simonds, Virend K Somers, Helmut Teschler, Patrick Levy, Jeff Armitstead, Holger Woehrle
10.1111/resp.13613

Analysis of the Treatment of Sleep-Disordered Breathing with Predominant Central Sleep Apnea by Adaptive Servo Ventilation in Patients with Heart Failure (SERVE-HF) substudy found that patients with systolic heart failure who experienced serious adverse events during the trial had longer Cheyne–Stokes respiration (CSR)-related characteristics at baseline. These findings suggest that CSR-related events could be used to define central sleep apnoea phenotypes for future risk stratification.

312Effect of age on the cardiovascular remodelling induced by chronic intermittent hypoxia as a murine model of sleep apnoea
Anabel L Castro-Grattoni, Monique Suarez-Giron, Ivan Benitez, Marta Torres, Isaac Almendros, Ramon Farre, Josep M Montserrat, Mireia Dalmases, David Gozal, Manuel Sánchez-de-la-Torre, on behalf of the Spanish Sleep Network
10.1111/resp.13610

Chronic intermittent hypoxia (CIH) is a major determinant of cardiovascular morbidity associated with obstructive sleep apnoea (OSA), but its adverse impact may be influenced by ageing. We show that deleterious cardiovascular effects associated with CIH are not evident in aged mice, and early cardiovascular ageing may be potentiated by CIH in young mice.

POSITION STATEMENT
321Diagnosis and treatment of lung disease associated with alpha one-antitrypsin deficiency: A position statement from the Thoracic Society of Australia and New Zealand*
Jack Dummer, Claudia C Dobler, Mark Holmes, Daniel Chambers, Ian A Yang, Lianne Parkin, Sheree Smith, Peter Wark, Anouk Dev, Sandra Hodge, Eli Dabscheck, Julian Gooi, Sameh Samuel, Steven Knowles, Anne E Holland
10.1111/resp.13774
FORUM AND DEBATE
Scientific Letter
336Valproic acid and sleep apnoea: A disproportionality signal from the WHO pharmacovigilance database
Bruno Revol, Ingrid Jullian-Desayes, Kelly Guichard, Jean-Arthur Micoulaud-Franchi, Renaud Tamisier, Pierre Philip, Marie Joyeux-Faure, Jean-Louis Pépin
10.1111/resp.13771
LETTER FROM ASIA-PACIFIC AND BEYOND
339Letter from Sri Lanka
Duminda Yasaratne MBBS, MD, MRCP; Shyamali C Dharmage MBBS, MSc, MD, PhD
10.1111/resp.13758

Inside Respirology Case Reports

The following cases have been selected for inclusion in the March 2020 Respirology Case Reports, Volume 08 Issue 2

Case Series

Three different CT and FDG PET/CT findings of pulmonary involvement in methotrexate-associated lymphoproliferative disease
Sachi Matsubayashi, Manabu Suzuki, Keita Sakamoto, Shinyu Izumi, Masayuki Hojo, Haruhito Sugiyama
DOI: 10.1002/rcr2.520

Methotrexate (MTX) is one of the key drugs for treating rheumatoid arthritis (RA) and other autoimmune arthritis. Lymphoproliferative disease (LPD) is a complication of low-dose MTX therapy. We describe three cases of MTX-LPD where we conducted chest computed tomography (CT) and 18F-fluorodeoxyglucose (FDG)/positron emission tomography (PET)/CT. This report focuses on the radiological findings of MTX-LPD, including FDG PET/CT, based on these cases. FDG PET/CT might be a useful diagnostic tool as it may reflect disease progression and help identify separate lesions.

Case Reports

Isolated unilateral pulmonary artery agenesis presenting with massive hemoptysis
Min Kyun Kang, Do Kyun Kang, Youn-Ho Hwang
DOI: 10.1002/rcr2.511

A 21-year-old man presented with recurrent and persistent haemoptysis. Chest computed tomography showed a right-sided pulmonary artery agenesis and associated hypertrophic change of right-sided bronchial arteries. Thoracic aortogram revealed abnormal collateral arteries supplying the right lung. Minor haemoptysis continued despite endovascular embolization of collateral vessels. Thus, right pneumonectomy was performed and the patient was treated successfully. Physicians should be aware that unilateral pulmonary artery agenesis could be a source of haemoptysis and pneumonectomy may be the best treatment.

Interstitial pneumonia with autoimmune features that met the proposed diagnostic criteria for IgG4-related respiratory disease
Nobuhito Arakawa, Hideaki Yamasawa, Tamiko Takemura, Shinya Okada, Takafumi Taki, Shigemi Ishikawa
DOI: 10.1002/rcr2.512

We held a multidisciplinary discussion on a case of interstitial lung disease without extrathoracic lesions that met the classification criteria for interstitial pneumonia with autoimmune features (IPAF) and the proposed diagnostic criteria for immunoglobulin G4 (IgG4)-related respiratory disease (IgG4-RRD). We concluded that the present case was IPAF that met the proposed diagnostic criteria for IgG4-RRD.

The first case of micropapillary adenocarcinoma associated with cystic airspace in a non-smoking man
Saeko Takahashi, Saori Murata, Reishi Seki, Shoji Kuriyama, Masahiro Kaji, Morio Nakamura
DOI: 10.1002/rcr2.513

Lung cancers associated with cystic airspaces are typically adenocarcinoma with lepidic, papillary, and/or acinar patterns and are usually found in smokers. To date, there has been no report of those cancers revealing micropapillary patterns. Here, we describe the first case of pulmonary micropapillary adenocarcinoma associated with cystic airspaces in 79-year-old non-smoking man.

Effectiveness of mepolizumab for eosinophilic pneumonia following bronchial thermoplasty
Ryota Otoshi, Tomohisa Baba, Shigeru Komatsu, Masato Asaoka, Eri Hagiwara, Takashi Ogura
DOI: 10.1002/rcr2.514

Bronchial thermoplasty (BT) is a bronchoscopic procedure for treating severe asthma using thermal energy to reduce airway smooth muscle. There are some reports of complications such as bronchitis and atelectasis due to transient inflammation and oedema, but, to the best of our knowledge, no studies have reported eosinophilic pneumonia (EP) due to BT. Mepolizumab is an anti-interleukin-5 monoclonal antibody that is reportedly effective against eosinophilic inflammation such as bronchial asthma; however, only few studies have reported its use in treating EP. Here, we report the effectiveness of mepolizumab in treating EP following BT.

Zosteriform cutaneous metastases: an unusual presentation of metastatic lung carcinoma
Kirsty J L Wark, Melani Mahendran, Artiene Tatian, Amandeep Singh, Jane Woods, Ananthakrishnapuram Aravindan
DOI: 10.1002/rcr2.515

Zosteriform cutaneous metastases are a rare morphological variant. We present a case of metastatic adenocarcinoma of the lung in a 78-year-old presenting as zosteriform cutaneous metastases around a vascular catheter site.

Primary squamous cell carcinoma of the pleura treated with nivolumab
Ioanna Sigala, Nektarios Alevizopoulos, Konstantinos Elefteriou, Niki Gianniou, Ioannis Kalomenidis
DOI: 10.1002/rcr2.516

We report the case of a 48-year-old man who presented with persistent right-sided thoracic pain with chest computed tomography scan demonstrating a right-sided pleural effusion and pleural mass invading the ribs. Ultrasound-guided biopsy revealed a primary squamous cell carcinoma of the pleura. Positron emission tomography staging demonstrated metastatic lung and lymph node involvement precluding surgical therapy. Immunotherapy with nivolumab resulted in prolongation of survival with good quality of life.

Endoscopic ultrasound-guided pleural biopsy in the hands of the pulmonologist
Rana Bibi, Uffe Bodtger, Rafi Nessar, Henrik K Jensen, Ida Skovgaard Christiansen, Paul F Clementsen
DOI: 10.1002/rcr2.517

Endoscopic ultrasound (EUS) via the oesophagus can be performed either with the use of a conventional gastrointestinal endoscope (EUS-fine needle aspiration (FNA)) or by using the endobronchial ultrasound (EBUS) endoscope in the oesophagus (EUS-B-FNA). The use of EUS-B for the diagnosis and staging of thoracic malignancy is quickly gaining ground. We here present two cases demonstrating that EUS-B-guided FNA (EUS-B-FNA) of pleural lesions is possible.

Omalizumab as add-on therapy in a patient with severe asthma and OSA
Giulia Scioscia, Enrico Buonamico, Maria Pia Foschino Barbaro, Donato Lacedonia, Roberto Sabato, Giovanna Elisiana Carpagnano
DOI: 10.1002/rcr2.518

We report the case of a 61-year-old severe allergic asthmatic woman (body mass index (BMI): 38) who was followed up by our outpatient clinic for one year. She started treatment with omalizumab and underwent polysomnography showing a severe obstructive sleep apnoea (OSA) pattern (apnoea/hypopnoea index (AHI): 72.7). After six months, she showed functional improvement and good asthma symptoms control and underwent a new polygraphy for the persistence of the night symptoms which showed an ameliorated, despite still severe, OSA pattern (AHI: 31.9). The patient obtained complete polygraphic normalization after adequate positive airway pressure (PAP) titration. This is the first documented case report that demonstrates a possible role of omalizumab in improving the OSA pattern in a patient affected by severe asthma and OSA.

Squamous cell transformation as a mechanism of acquired resistance to tyrosine kinase inhibitor in EGFR-mutated lung adenocarcinoma: a report of two cases
Hironori Uruga, Takeshi Fujii, Nobuyuki Nakamura, Shuhei Moriguchi, Kazuma Kishi, Hisashi Takaya
DOI: 10.1002/rcr2.521

Pathological transformation to squamous cell carcinoma after epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI) treatment has been reported, but details of the transformation remain unclear. Here, we report two cases with transformation to squamous cell carcinoma after treatment with EGFR-TKIs. Both patients had PTEN genomic alterations and the PI3K/AKT/mTOR (mammalian target of rapamycin) pathway might play an important role in squamous cell transformation.

Antibiotic-induced reduction of abnormal lung shadow in pulmonary nodular lymphoid hyperplasia
Akari Tanino, Yukari Tsubata, Shunichi Hamaguchi, Akihisa Sutani, Mamiko Nagase, Takeshi Isobe
DOI: 10.1002/rcr2.522

A case of pulmonary nodular lymphoid hyperplasia (PNLH) that was difficult to diagnosis because of an abnormal shadow that was reduced due to antibiotics use was described. Histopathological examination indicated a diagnosis of PNLH and the pathological evidence of bacteria suggested an infective aetiology for PNLH.

Subacute invasive pulmonary aspergillosis after chemoradiotherapy for lung cancer
Hirofumi Watanabe, Toshihiro Shirai, Mika Saigusa, Kazuhiro Asada, Kazumori Arai
DOI: 10.1002/rcr2.523

Subacute invasive pulmonary aspergillosis (SIPA), a rapidly progressive fungal infection of less than three months arising from pre-existing lung lesions, generally afflicts moderately immunocompromised patients. We herein report the case of a 69-year-old man who developed SIPA following chemoradiotherapy for lung cancer and treated with multiple antifungal therapy.

Pembrolizumab-related pancreatitis with elevation of pancreatic tumour markers
Tamaki Kakuwa, Masao Hashimoto, Atsuko Izumi, Go Naka, Yuichiro Takeda, Haruhito Sugiyama
DOI: 10.1002/rcr2.525

We report a case of pembrolizumab-induced immune-related pancreatitis with the elevation of pancreatic tumour markers in a patient with squamous cell lung cancer.

Difficult intubation in an asymptomatic patient with tracheobronchopathia osteochondroplastica
Dona Kafili, Timothy Sampson, Sean Tolhurst
DOI: 10.1002/rcr2.526

Tracheobronchopathia osteochondroplastica (TO) is a rare, benign, slowly progressive disease of unknown aetiology. It is characterized by numerous sessile, cartilaginous, or osseous submucosal nodules distributed throughout the anterolateral walls of the trachea and projecting into the laryngotracheobronchial lumen. The diagnosis is usually incidental with distinct bronchoscopic or computed tomography (CT) scan findings. We present a case of asymptomatic TO identified through fibreoptic bronchoscopy and biopsy after having a difficult intubation for elective prostate surgery.

Bronchial artery embolization for haemothorax and haemoptysis caused by primary lung cancer
Shota Yamamoto, Shunsuke Kamei, Yusuke Kondo, Shinichiro Hiraiwa, Terumitsu Hasebe, Fumio Sakamaki
DOI: 10.1002/rcr2.529

This is the first report of primary lung cancer causing a massive haemothorax and haemoptysis simultaneously. We believe it is also the first such case in which haemostasis was secured using bronchial artery embolization.

Pulmonary artery intimal sarcoma: a case report and literature review
Ding-Yu Chang, Kun-Chang Lin, Jun-Yen Pan, Hung-Wei Liu, Shu-Hung Kuo, Lin Lee
DOI: 10.1002/rcr2.530

Pulmonary artery intimal sarcoma is a rare disorder arising from the intimal wall of the pulmonary artery. As the tumour decreases the lumen of the pulmonary artery, patients usually present with symptoms and signs of right ventricular failure, and it has often been misdiagnosed as pulmonary thromboembolism. In this report, we present the case of a patient in whom the diagnosis of pulmonary artery sarcoma was made promptly and surgery was performed soon after.

Left ventricular dysfunction in an idiopathic pulmonary fibrosis patient on nintedanib
Ryosuke Imai, Yutaka Tomishima
DOI: 10.1002/rcr2.533

We report a case of left ventricular dysfunction in a patient with idiopathic pulmonary fibrosis treated with nintedanib, which recovered after cessation of nintedanib. Nintedanib may induce left ventricular dysfunction, and early recognition is important since this condition is potentially reversible.

Primary resistance to osimertinib despite acquired T790M
Ling-Kai Chang, Yih-Leong Chang, Jin-Yuan Shih
DOI: 10.1002/rcr2.532

Liquid biopsy to diagnose T790M presence in non-small cell lung carcinoma (NSCLC) patients resistant to epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) might miss other possible resistance mechanisms. Tissue biopsy should be considered to exclude the presence of small cell lung carcinoma (SCLC) transformation.

Clinical Image

Restrictive ventilatory impairment and thrombosis due to a giant liver cyst
Keitaro Nakamoto, Chika Miyaoka, Aya Hirata, Yasuhiro Nakamura, Tetsuya Nakazato, Hajime Takizawa
DOI: 10.1002/rcr2.524

A small number of patients with liver cysts present with symptoms. Percutaneous needle aspiration with injection of a sclerosing agent can be an effective non-surgical treatment for patients with symptomatic cysts, and to our knowledge, this is the first case to show improvement of restrictive ventilatory impairment.

Indwelling pleural catheter tract metastasis from renal cell carcinoma
See-Wei Low, Kenneth K Sakata
DOI: 10.1002/rcr2.527

The importance of recognizing new nodules or subcutaneous mass in patients who has had indwelling pleural catheter (IPC) or overlying the IPC site is highlighted. This report describes the first case of catheter tract metastasis (CTM) due to renal cell carcinoma (RCC) and the second case of CTM post-IPC removal.

The following cases have been selected for inclusion in the April 2020 Respirology Case Reports, Volume 08 Issue 3

Case Reports

Unusual aetiology of lymphocyte-predominant exudative pleural effusion: primary mediastinal actinomycosis
Gil Myeong Seong, Chang Lim Hyun, Jee Won Chang, Changhwan Kim
DOI: 10.1002/rcr2.534

Mediastinal actinomycosis is a rare infectious condition and often mimics malignancy. A high level of clinical suspicion is needed to diagnose and cure actinomycosis in patients with indolent, unresolving, or relapsing chronic inflammatory disease.

Remarkable response to nivolumab in sarcomatoid malignant pleural mesothelioma with high PD-L1
Kazuya Tsubouchi, Shigesato Inoue, Ritsu Ibusuki, Takeshi Iwasaki, Taishi Harada
DOI: 10.1002/rcr2.536

We report herein a case of a 78-year-old male patient diagnosed with sarcomatoid malignant pleural mesothelioma (MPM) with high PD-L1 expression who was refractory to standard chemotherapy but had a remarkable and sustained response to nivolumab.

New perspectives for a huge traumatic pneumatocele treatment in a young adult
Sen-Ei Shai, Yi-Ling Lai, Hsiao-Wen Tang, Shih-Chieh Hung
DOI: 10.1002/rcr2.537

Traumatic pneumatocele (TP) is a very rare condition that occurs mostly in children and young adults. To the best of our knowledge, we present here a case of the largest TP without rib fracture. Under conservative treatment, the condition lasted for ~8 months before complete resolution. Detailed temporal changes in chest X-ray were recorded for the analysis of natural healing processes.

Pulmonary lymphangitic carcinomatosis from gallbladder cancer mimicking diffuse alveolar haemorrhage
Hisao Higo, Noriyuki Suzaki, Takuya Nagata, Taro Togami, Nobuya Ohara, Masaomi Marukawa
DOI: 10.1002/rcr2.540

An 81-year-old man was admitted due to dyspnoea and haemoptysis. We suspected diffuse alveolar haemorrhage based on computed tomography (CT) findings of diffuse bilateral ground-grass opacity and partial consolidation. Autopsy revealed pulmonary lymphangitic carcinomatosis of whole lungs and primary gallbladder cancer.

Regional society news

The spotlight this month is on

SRI LANKA

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.

The last decade witnessed a revolution in the practice of respiratory medicine in Sri Lanka. These include better diagnosis of lung diseases, advanced therapeutic modalities, wider use of technology and increased awareness on respiratory illnesses including diseases of airways, interstitium and pleura among medical fraternity and the public. These changes have occurred in parallel with the advancement of pulmonology as a medical specialty in the National Health System. While celebrating such achievements and advances in the developing Island Nation, this is a good juncture to look back over the path treaded, identify challenges waiting around the corner and propose the way forward for respiratory medicine in Sri Lanka beyond 2020.

Read the remainder of this Respirology article Letter from Sri Lanka by Duminda Yasaratne and Shyamali C Dharmage DOI: 10.1111/resp.13758

We are pleased also to share a report from the APSR Councillors from Sri Lanka of activities organized by the Sri Lanka College of Pulmonologists in 2019.

The Councillors are Dr Eshanth Perera (National Hospital for Respiratory Diseases, Welisara) and Dr Manil Peiris (General Hospital, Matale).

Click any photo to enlarge

Satellite Symposia

  • Teaching Hospital Batticaloa – 26 February 2019
  • Teaching Hospital Kurunegala – 11 March 2019
  • General Hospital Kalutara - 21 August 2019

World TB Day

  • Symposium on Tuberculosis at Teaching Hospital Karapitiya, Galle – 5 March 2019
  • Walk to commemorate World TB Day at Gampaha – 24 March 2019

World Asthma Day

  • Symposium on Asthma at National Hospital Colombo – 24 May 2019

World No Tobacco Day

  • Press conference and participation at National Programme - 17 June 2019

Annual Academic Sessions

  • Respire 11 Annual Academic Sessions 29-31 October 2019
    • Theme: Refining Respiratory Care Outcome
  • Pre-congress workshop on Pleural procedures – 28 October 2019 – NHRD Welisara



Click any photo to enlarge

All Island National Schools Art Competition on Environmental Pollution and Lung Health

  • D S Piumanthi Kumari Panditha
    St Joseph's B M V Kegalle
  • Shuhaila Shakir
    Girls' High School, Kandy

Other regional news:

Australia

China

The date has changed for the World Congress of Bronchology & Interventional Pulmonology (WCBIP), biennial flagship international congress of the WABIP (World Association of Bronchology & IP).

This had been scheduled to be held in Shanghai, China, on 16-19 April 2020, and for obvious reasons, the congress has had to be postponed. The tentative rescheduled date is 24-27 September 2020

Please check the WABIP webpage www.wabip.com/congress for the latest details.

Health

Tobacco; a growing concern

A common argument against tobacco control is the livelihood of impoverished farmers and factory workers whose jobs are at risk. Some 100 million people are employed worldwide in the tobacco sector, according to the International Labour Organisation.

Alternative work opportunities and alternative business opportunities for alternative products are constantly sought, and here's a sweet alternative gaining momentum:

The tobacco farmers chasing a sweeter crop
By Stav Dimitropoulos
BBC Business reporter, Athens, Greece

Seven years ago, a group of Greek farmers stopped growing tobacco and switched to a trendy alternative to sugar - stevia.

They made the change after being persuaded by a mechanical engineer called Christos Stamatis, who wanted to emulate the success of six California tobacco growers who had also started to cultivate the stevia plant.

An extract of the plant's leaves makes a natural, calorie-free sugar substitute. It has been around for centuries, but has only started to enter the mainstream in the past 10 years.

Mr Stamatis sought out farmers in his native region of Fthiotida - in their fields or during their breaks in the local cafés - to convince them to plant stevia instead of their less profitable tobacco crop.

His power of persuasion worked, as 150 farmers each contributed €500 ($557; £422) towards setting up the Stevia Hellas Co-operative. "We discovered crowdsourcing long before it became mainstream in my village," Mr Stamatis says. "People have power and we took advantage of it." It was the first business in Europe to produce stevia and it now employs around 300 people.

Created in 2012 and located a few hours' drive north of Athens, the co-operative broke even at the end of 2018 and is on track to make a profit this year. It sells liquid stevia extracts and stevia powders under its own brand name, La Mia Stevia, and also exports in bulk to western Europe, Canada, the US and the United Arab Emirates.

It is tapping into an industry that has enormous potential for growth. Global sales of stevia are forecast to almost double to $818m (£620m) by 2024, according to a study by the consultancy Research and Markets.

However, this still puts stevia's size well below that of artificial sweeteners such as aspartame or sucralose, which are expected to be worth $2.7bn per year by then. And for context, the global sugar market is predicted to reach annual sales of $89bn over the same period - albeit growing at a slower pace.

Andrew Ohmes, president of trade body International Stevia Council, admits that stevia is still the "new kid on the block" but that consumption will increase as consumers limit the amount of sugar in their diets. "Other sweeteners like aspartame or sucralose have been around far longer but stevia's consumption will be growing 19-21% over the next five to 10 years."

At first glance stevia looks expensive. Stevia powder on the supermarket shelves costs around €120 per kilo compared with a kilo of sugar for €0.83 euros. But Mr Stamatis says that stevia is actually more cost effective, because a little goes a long way - it is 200 times sweeter than sugar.

Stevia's proponents also say it is more ecologically friendly. It is said to have a water footprint that is 96% lower than cane sugar, and 92% lower than beet sugar. And it requires about 20% of the land to provide the same amount of sweetness.

Native to Paraguay and Brazil in South America, the full name of the stevia plant is stevia rebaudiana. Its properties have been known to indigenous groups for centuries. In the Guarani language it is known as "kaa he-he", which translates as "sweet herb".

It was the Japanese who first started producing stevia on a commercial scale, beginning in 1971. It was much slower to take off in the US and Europe, as regulators were unsure if it was safe. For example, in 1987 the US Food and Drug Administration (FDA) banned the marketing of stevia.

Things changed in 2008 when the FDA gave its approval to purified stevia extract. In 2011, the EU, Australia and New Zealand followed suit.

Even so, there is a still a debate about its use. "Stevia extract, unlike its chemical counterparts such as aspartame, does not form acid in the body," says certified nutritionist Kimberly Snyder. "Nor does it promote heart disease and tooth decay, and it has no impact on blood sugar levels."

"But the powder or liquid drops at grocery stores are processed with additives that may cause bloating, diarrhoea or headaches."

Because it is sweeter than sugar, she adds, it "might perpetuate your flavour preference toward sweet things, doing more harm than good if your sweet cravings are kicked into overdrive". Mr Ohmes says that using stevia instead of sugar "allows for significant calorie reduction".

However, registered dietician Rachel Fine encourages her clients to stick to simple cane sugar, and use less of it overall, with the exception of those struggling with diabetes, who may find stevia as a viable alternative without the impact on blood sugar.

Back in Greece, the Stevia Hellas Cooperative is now aiming for further growth. "Our next plan is to form a stevia supply chain with Mediterranean countries like Italy, Spain, France or Portugal," Mr Stamatis says.

The stevia plants the co-operative grows are currently sent to France for processing, and a second processing plant is to be opened in the Balkans in the next two years. "We have a unique climate for cultivating stevia," Mr Stamatis adds,

Other countries may also develop a suitable climate for growing stevia as they become more "tropical", says Michael Budziszek, an expert on global warming and associate professor at the Johnson and Wales University College of Arts and Sciences.

But securing the industry's growth will not be straightforward. Coca-Cola introduced a version of its signature drink to the UK market in 2014 that had been partially made with stevia. But after weak sales, the product - Coca-Cola Life - was discontinued three years later.

Extracted from www.bbc.com/news/business-50629107 2 January 2020

Education

Teaching Library

The Teaching Library is open for your self-study. Challenging yourself to choose the correct procedure for any of the 91 cases in the Library.

Click the link on any page on the website (Education → Teaching Library) or go to apsresp.org/education/teaching-library/index.php.

We are still collecting cases to add to the Library. Any member is welcome to submit a case through the same link as above.

New educational article

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


Figure 3 of 10.1111/resp. 13681
(Click image to enlarge)

Of special interest to those working in:
* Lung Cancer
* Clinical Respiratory Medicine
* Critical Care Medicine

Inter-observer variation in image interpretation and the prognostic importance of non-expansile lung in malignant pleural effusion Geoffrey A Martin, Andrew C Kidd, Selina Tsim, Paul Halford, Anna Bibby, Nick A Maskell and Kevin G Blyth (DOI: 10.1111/resp.13681)
onlinelibrary.wiley.com/doi/10.1111/resp.13681/full (Mar 2020)

Comment by Dr Mark Lavercombe:
Non-expansile lung is considered a contraindication to talc slurry pleurodesis in malignant pleural effusion, however inter-observer agreement for diagnosing non-expansile lung on chest radiography is unknown. This study demonstrates poor correlation between experienced observers. Implications for study design and clinical treatment choices are considered.

APSR Membership

Donations received

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

  • Dr Hans Hamilton Liu
  • Dr Amitabh Das Shukla FAPSR
  • Dr Prince George Varughese FAPSR

The APSR is profoundly grateful for their generosity.

New Fellows of the APSR

Congratulations to the following members who have recently become Fellows of the APSR:

  • Dharm Prakash Dwivedi FAPSR
  • Arnab Saha FAPSR
  • Amitabh Das Shukla FAPSR
  • Prince George Varughese FAPSR

Our Members, Our Future

Continuing this series, we are delighted to share a tribute to Prof. Chong-Kin Liam, prepared by Prof. Yong Kek Pang.

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. Liam

Tribute to Professor Chong-Kin Liam

I came to know Prof. Liam personally in 2002 when I joined the Respiratory Division of the Department of Medicine, University of Malaya Medical Centre as a trainee in respiratory medicine. I felt so privileged to be associated and mentored by an icon whose name is so well recognised in the respiratory circle of Malaysia.

Prof. Liam completed his undergraduate medical degree in 1980 at Malaysia's oldest university (the University of Malaya) and went on to obtain his postgraduate qualification of MRCP (UK) in 1984. After that, he took a special interest in respiratory medicine. Today, he is widely acknowledged as one of the pioneers who has helped to transform respiratory medicine into an important sub-specialised discipline in Malaysia.

During his earlier career, respiratory medicine was equated with tuberculosis medicine. While tuberculosis remains an important disease to reckon with for Malaysia, he has expanded the horizon of this sub-speciality to include other important respiratory disorders. He shall be credited for the efforts in turning the respiratory medicine discipline from one that was less popular to one that is well recognised, attractive and promising.

With the input of other experts in the field, he has also developed an examination format and a structured training programme for physicians who are interested to sub-specialise in this field. Apart from this, he also plays a key role in the setting up of the postgraduate training programme in internal medicine, the Master of Internal Medicine training programme in Malaysia.

Prof. Liam is a prolific writer and a keen researcher. This is testified by the numerous publications in various scientific journals/proceedings/books. His articles have been widely cited by many other authors and presenters. Besides, he is a much-sought-after speaker in the region for various respiratory disorders.

In the second half of his career, he has turned his focus on improving the standard of care for patients who suffer from a once deadly and devastating disease - lung cancer. Through his initiatives in disseminating the knowledge and skill to manage this disorder, the treatment landscape has improved remarkably throughout the years in this country. He has been regularly invited by many companies or organisations to advise them on matters related to lung cancer in the region.

Although he has often humbly claimed that administration is not his forte, he had still been elevated to the position of Deputy Dean in charge of postgraduate training in the Faculty of Medicine and was a member of the Senate in the University of Malaya. This is certainly a testimony of his capability and vast experience in training.

Despite his many commitments and responsibilities, he has never shirked his duty as a clinician. He is often seen in the ward and clinic attending to the needs and suffering of his patients, irrespective of their background and social class. This dedication has earned him many well-deserved accolades from his patients and multiple excellence service awards.

Prof. Liam is also very actively involved in professional societies and non-governmental organisations. He has established a well-connected network with many regional and international societies, such as the APSR, ERS, ATS and the International Association for the Study of Lung Cancer (IASLC). Of note, he was the congress president of the 8th Congress of the Asian Pacific Society of Respirology (APSR Congress 2003) held in Malaysia, chairman of the scientific committee for the International Union Against Tuberculosis and Lung Disease – Asia-Pacific Region Conference 2007 held in Kuala Lumpur, and co-chairman of the organising committee for the 2014 International Association for the Study of Lung Cancer (IASLC) Asia-Pacific Lung Cancer Conference. He was entrusted to lead the Lung Cancer Assembly of the Asian Pacific Society of Respirology from 2016 to 2019.

On the local front, he was the Council Member and then the President of the Malaysian Thoracic Society from 2001 to 2009. Besides, he is also one of the founders of the Lung Foundation of Malaysia in which he still serves as a Trustee.

It is time to pay tribute to Prof. Liam to exemplify his contributions and dedication to the field of respiratory medicine.


A Prof. Pang

Prepared by Associate Prof. Yong Kek Pang, MD (USM), MRCP (UK)
Senior Consultant Physician
Division of Respiratory Medicine
Department of Medicine,
University Malaya Medical Centre,
Malaysia

President
Malaysian Thoracic Society

In 2015, I was chair of Scientific Programme, the 20th Congress of the APSR in Kuala Lumpur closely working with him as congress advisor and Prof. Roslina Abdul Manap as the congress president, leading the success of the congress.

Awards available!

Left to right: Dr Chunxue Bai, Dr Norbert Berend, Dr Kwun Fong, Dr Yoshinosuke Fukuchi, Dr Guy Marks, Dr Peter Sly, Dr Malcolm Winterburn and Dr Paul Zimmerman; some of the benefactors of the 30+ awards available to members.

Many APSR awards are to support and encourage young investigators and early career doctors in particular fields. Others are more general, such as the Fukuchi (Respirology) Award for outstanding research papers published in Respirology.

This prestigious Award is named in honour of Professor Yoshinosuke Fukuchi who was Editor of Respirology 1996–1999 and President of the APSR 2004–2006.

The Awardees are selected by a panel of world-renowned international researchers, and the Award includes:

  • US$500 (jointly funded by Dr Fukuchi and the APSR)
  • Congress registration
  • Accommodation at the Congress
  • Invitation to social events at the Congress
  • Wiley voucher
  • Commemorative certificate

The accommodation will be for the length of the Congress (e.g. three nights for a four-day Congress) at a Congress-designated hotel.

See apsresp.org/awards/2021/fukuchi-respirology.html for further details, and some of the previous Award winners.

Full details of other award opportunities are shown at apsresp.org/awards/index.html.

New and updated assembly memberships

A warm welcome to the following members who have recently joined or re-joined APSR assemblies.

Chaudhary Abhinav Bronchoscopy and Interventional Techniques
Respiratory Infections (non-tuberculous)
Tuberculosis
Joshi Ambarish Clinical Respiratory Medicine
Critical Care Medicine
Bronchoscopy and Interventional Techniques
Nadeem Arshad Interstitial Lung Disease
Clinical Allergy & Immunology
Asthma
Bansal Avya Clinical Respiratory Medicine
Asthma
COPD
Sourin Bhuniya Clinical Respiratory Medicine
Respiratory Neurobiology and Sleep
Interstitial Lung Disease
Nils Billo Tuberculosis
COPD
Asthma
Saadoun Bin-Hasan Respiratory Neurobiology and Sleep
Paediatric Lung Disease
Clinical Respiratory Medicine
Rhea Anne Celis COPD
Clinical Respiratory Medicine
Respiratory Structure and Function
Qingshi Chen Respiratory Neurobiology and Sleep
Lung Cancer
COPD
Bunpaul Chhar COPD
Tuberculosis
Interstitial Lung Disease
Sahajal Dhooria Interstitial Lung Disease
Bronchoscopy and Interventional Techniques
Respiratory Neurobiology and Sleep
Yoshinosuke Fukuchi COPD
Respiratory Structure and Function
Cell and Molecular Biology
Anne Goh Paediatric Lung Disease
Muhammad Irfan Ilmi Lung Cancer
Asthma
Tuberculosis
Aniket Vilasrao Inamdar Clinical Respiratory Medicine
Tuberculosis
Asthma
Kean Cheang Khoo Clinical Respiratory Medicine
Respiratory Infections (non-tuberculous)
Interstitial Lung Disease
Albert Martin Li Paediatric Lung Disease
Respiratory Neurobiology and Sleep
Asthma
Koh Mariko Asthma
COPD
Clinical Respiratory Medicine
Weravut Mingkuan Clinical Respiratory Medicine
COPD
Tuberculosis
Deebya Raj Mishra Tuberculosis
Lung Cancer
Bronchoscopy and Interventional Techniques
Teruaki Mizobuchi Lung Cancer
COPD
Bronchoscopy and Interventional Techniques
Prasanta Raghab Mohapatra Lung Cancer
Interstitial Lung Disease
Clinical Respiratory Medicine
Aldo Amador Navarro Rojas Asthma
COPD
Paediatric Lung Disease
José M. Porcel Clinical Respiratory Medicine
Bronchoscopy and Interventional Techniques
Respiratory Infections (non-tuberculous)
Alfian Nur Rosyid Asthma
COPD
Tuberculosis
Sarang Patil Sarang Clinical Respiratory Medicine
Respiratory Infections (non-tuberculous)
Critical Care Medicine
Bobby Singh Bronchoscopy and Interventional Techniques
Tuberculosis
Pulmonary Circulation
Retno Ariza Soeprihatini Soemarwoto COPD
Asthma
Tuberculosis
Bhattacharya Somnath Bronchoscopy and Interventional Techniques
Interstitial Lung Disease
Lung Cancer
Sivaraja Subramaniam Clinical Respiratory Medicine
Interstitial Lung Disease
Bronchoscopy and Interventional Techniques
Irmi Syafa'ah Bronchoscopy and Interventional Techniques
Critical Care Medicine
Lung Cancer
Pattraporn Tajarernmuang Bronchoscopy and Interventional Techniques
Critical Care Medicine
Lung Cancer
Wan-Cheng Tan Environmental & Occupational Health and Epidemiology
COPD
Asthma
Pawan Tiwari Clinical Respiratory Medicine
Tuberculosis
Interstitial Lung Disease
Nguyen Trang Asthma
Respiratory Infections (non-tuberculous)
Clinical Respiratory Medicine
Syed Umer Ahmed Tuberculosis
COPD
Lung Cancer
Wai Shiu Fred Wong COPD
Asthma
Cell and Molecular Biology

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.

  • 39th Annual Chest Convention of the Philippine College of Chest Physicians (PCCP)
    3-6 March 2020, Mandaluyong City, Philippines
    (Details)
  • The Thoracic Society of Australia and New Zealand ASM 2020
    27-31 March 2020, Melbourne, Australia
    (Details)
  • 129th Conference of the Korean Academy of Tuberculosis and Respiratory Diseases (KATRD)
    11 April 2020, Yeosu City, Republic of Korea
    (Details)
  • 60th Annual Meeting of the Japanese Respiratory Society
    24-26 April 2020, Nagoya, Japan Date and venue changed to: 20-22 September 2020. Kobe Convention Center, Japan
    (Details)
  • Asthma & COPD Outpatient Care Unit (ACOCU) Network Day
    17 May 2020, Ho Chi Minh City, Vietnam
    (Details)
  • Scientific conference with updates from The Congress of American Thoracic Society (ATS) 2020 (VNRS)
    29-30 May 2020, Hanoi, Vietnam
    (Details)
  • Malaysian Thoracic Society (MTS) 2020 Annual Congress
    16-19 Jul 2020, Nusajaya, Johor, Malaysia
    (Details)
  • Annual Scientific Congress of Ho Chi Minh City Society of Asthma, Allergy & Clinical Immunology
    26 July 2020, Ho Chi Minh City, Vietnam
    (Details)
  • Respire 12 Annual Academic Sessions of Sri Lanka College of Pulmonologists (SLCP)
    29-31 July 2020, Kandy, Sri Lanka
    (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 of interest to APSR members, please send details to one of the Bulletin Coordinators; Prof. A Azuma (a-azuma@nms.ac.jp) or Prof. C K Rhee (chinkook77@gmail.com).


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