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.
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.
The January issue (Vol 12.1) features Pulmonary Rehabilitation in COPD:
EDITORIALS | |
230 | COPD exacerbation phenotypes: The next frontier |
232 | Reducing the burden of respiratory symptoms and illness in the elderly and general population requires multi-pronged strategies |
234 | In search for a predictive marker of acute exacerbations of idiopathic pulmonary fibrosis |
236 | Further evidence of the generalizability of the Global Lung Function Initiative reference equations for spirometry |
238 | Expanding knowledge on non-expandable lungs |
240 | Periodic breathing: Fine tuning the phenotype |
242 | Obstructive sleep apnoea and susceptibility to cardiovascular disease: A blessing or curse of old age? |
COMMENTARIES | |
244 | Challenges in understanding lung microbiome: It is NOT like the gut microbiome |
246 | The history and future of short-acting beta2-agonist therapy in asthma |
INVITED REVIEW SERIES | |
New frontiers in sleep-disordered breathing | |
249 | The future of sleep-disordered breathing: Looking beyond the horizon |
251 | Advanced polysomnographic analysis for OSA: A pathway to personalized management? |
ORIGINAL ARTICLES | |
COPD | |
259 | Blood eosinophil count as a predictor of hospital length of stay in COPD exacerbations |
267 | Predicting life expectancy of older people using respiratory symptoms and smoking status: Data from the Australian Longitudinal Study of Ageing |
Interstitial Lung Disease | |
275 | Serum high-mobility group box 1 is associated with the onset and severity of acute exacerbation of idiopathic pulmonary fibrosis |
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 |
289 | Early menarche is associated with lower adult lung function: A longitudinal cohort study from the first to sixth decade of life |
Pleural Disease | |
298 | Inter-observer variation in image interpretation and the prognostic importance of non-expansile lung in malignant pleural effusion |
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 |
312 | Effect of age on the cardiovascular remodelling induced by chronic intermittent hypoxia as a murine model of sleep apnoea |
POSITION STATEMENT | |
321 | Diagnosis and treatment of lung disease associated with alpha one-antitrypsin deficiency: A position statement from the Thoracic Society of Australia and New Zealand* |
FORUM AND DEBATE | |
Scientific Letter | |
336 | Valproic acid and sleep apnoea: A disproportionality signal from the WHO pharmacovigilance database |
LETTER FROM ASIA-PACIFIC AND BEYOND | |
339 | Letter from Sri Lanka |
The following cases have been selected for inclusion in the March 2020 Respirology Case Reports, Volume 08 Issue 2
Three different CT and FDG PET/CT findings of pulmonary involvement in methotrexate-associated lymphoproliferative disease |
Isolated unilateral pulmonary artery agenesis presenting with massive hemoptysis |
Interstitial pneumonia with autoimmune features that met the proposed diagnostic criteria for IgG4-related respiratory disease |
The first case of micropapillary adenocarcinoma associated with cystic airspace in a non-smoking man |
Effectiveness of mepolizumab for eosinophilic pneumonia following bronchial thermoplasty |
Zosteriform cutaneous metastases: an unusual presentation of metastatic lung carcinoma |
Primary squamous cell carcinoma of the pleura treated with nivolumab |
Endoscopic ultrasound-guided pleural biopsy in the hands of the pulmonologist |
Omalizumab as add-on therapy in a patient with 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 |
Antibiotic-induced reduction of abnormal lung shadow in pulmonary nodular lymphoid hyperplasia |
Subacute invasive pulmonary aspergillosis after chemoradiotherapy for lung cancer |
Pembrolizumab-related pancreatitis with elevation of pancreatic tumour markers |
Difficult intubation in an asymptomatic patient with tracheobronchopathia osteochondroplastica |
Bronchial artery embolization for haemothorax and haemoptysis caused by primary lung cancer |
Pulmonary artery intimal sarcoma: a case report and literature review |
Left ventricular dysfunction in an idiopathic pulmonary fibrosis patient on nintedanib |
Primary resistance to osimertinib despite acquired T790M |
Restrictive ventilatory impairment and thrombosis due to a giant liver cyst |
Indwelling pleural catheter tract metastasis from renal cell carcinoma |
The following cases have been selected for inclusion in the April 2020 Respirology Case Reports, Volume 08 Issue 3
Unusual aetiology of lymphocyte-predominant exudative pleural effusion: primary mediastinal actinomycosis |
Remarkable response to nivolumab in sarcomatoid malignant pleural mesothelioma with high PD-L1 |
New perspectives for a huge traumatic pneumatocele treatment in a young adult |
Pulmonary lymphangitic carcinomatosis from gallbladder cancer mimicking diffuse alveolar haemorrhage |
The spotlight this month is on
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
World TB Day
World Asthma Day
World No Tobacco Day
Annual Academic Sessions
All Island National Schools Art Competition on Environmental Pollution and Lung Health
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The Thoracic Society of Australia and New Zealand ASM 2020 (www.tsanzsrs2020.com/program) to be held, also in Melbourne, 27-31 March. Abstract submissions have closed but the meeting programmes are available online, registration remains open and both meetings are potentially of interest for Lung Cancer Assembly members.
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.
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
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.
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
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.
The following members have kindly sent their donation towards the Society's goals, as outlined at apsresp.org/members/donors.php.
The APSR is profoundly grateful for their generosity.
Congratulations to the following members who have recently become Fellows of the APSR:
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.
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.
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.
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:
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.
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 |
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.
For more pulmonology events, see apsresp.org/calendar.html
(These events are for information only and APSR endorsement should not be assumed.)
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).