Preview of the ERS Lung Science Conference 2023 and Sleep and Breathing Conference 2023

Support statement: J. Cruz acknowledges the support of the Center for Innovative Care and Health Technology (ciTechCare) of the Polytechnic of Leiria, which is funded by Portuguese national funds provided by Fundação para a Ciência e Tecnologia (FCT) (UIDB/05704/2020).In this article, we provide a brief description of the @EuroRespSoc 2023 Lung Science Conference and the Sleep and Breathing Conference https://bit.ly/3WsCzj6 Here we provide a preview of the main topics to be addressed in the 2023 Lung Science Conference (LSC) and the Sleep and Breathing Conference, which this year will both have a hybrid format. The LSC is organised by the European Respiratory Society (ERS), while the Sleep and Breathing Conference is organised by ERS and the European Sleep Research Society (ESRS). Both conferences offer early career members (ECMs) the opportunity to network with peers from across the globe, present their work and participate in many activities that will contribute to boost their career in the respiratory field.info:eu-repo/semantics/publishedVersio

Being (past and present) President of the ERS: interview about the role, perspectives on career development, and vision for the Society

This article presents the views of the past and current Presidents of the ERS regarding their role, perspectives on career development and vision for the Society, along with important messages to inspire ECMs to build their own successful career. https://bit.ly/3kAvxIM

ERS International Congress, Madrid, 2019: highlights from the Sleep and Clinical Physiology Assembly

The 2019 European Respiratory Society (ERS) International Congress took place in Madrid, Spain, and served as a platform to find out the latest advances in respiratory diseases research. The research aims are to understand the physiology and consequences of those diseases, as well as the improvement in their diagnoses, treatments and patient care. In particular, the scientific sessions arranged by ERS Assembly 4 provided novel insights into sleep-disordered breathing and new knowledge in respiratory physiology. This article, divided by session, will summarise the most relevant studies presented at the ERS International Congress. Each section has been written by Early Career Members specialising in the different fields of this interdisciplinary assembly

Highlights of the ERS Lung Science Conference and Sleep and Breathing Conference 2021 and the new ECMC members

The Lung Science Conference (LSC) and the Sleep and Breathing Conference (SBC) are two conferences organised by the European Respiratory Society (ERS), the latter held in association with the European Sleep Research Society. This year, the LSC and SBC were both held in a virtual format with the participation of researchers and clinicians from around the world. The participation of Early Career Members (ECMs) was notable in both events: 216 of 363 (60%) delegates attending the LSC were under 40?years old, and 315 of 920 (34%) delegates were ?40?years of age at the SBC. Both conferences included outstanding talks on the most recent advances in respiratory medicine and science, oral/poster communication sessions on novel research, exciting opportunities to network with peers, and much more!This paper provides a brief overview of some of the most remarkable sessions of the LSC and SBC, written by ECMs attending the sessions.We also present the new members of the Early Career Member Committee (ECMC) of the ERS from Assemblies 1, 4, 10, 12 and 13, who were elected in the latest round of ERS elections. Welcome aboard

Assessing inflammatory patterns in asthma endotypes: new diagnostic and therapeutic perspectives

Analytic summary Starting with a description of the state of the art in the management of bronchial asthma, this dissertation aims to pinpoint how and in which parts the current diagnostic and therapeutic algorithm might be improved in order to achieve a tailored clinical management and deeper understanding of the multiple pathophysiological pathways underlying common asthmatic symptoms and signs. Bronchial asthma is a chronic airway disease affecting more than three hundred million patients worldwide. Given the high prevalence of this disease and the social and economic burden resulting from under- or mistreatment, the optimal management of this condition represents therefore a key goal. During the last decades, it came to light that asthma represents an umbrella term encompassing different disease subtypes. In the last years, the scientific Literature tried to define a more precise classification, based on clinical and instrumental features, that categorises different asthmatic patient subpopulations as different phenotypes. Although some progress has been made in terms of tailored therapy, such classification contributes only partially to the full and deep understanding of the multiple inflammatory pathways underlying this remarkable heterogeneity. Therefore, in order to investigate the pathophysiological roots of the disease, a rather new trend in the Literature suggests categorising different asthmatic patient subpopulations on the basis of their specific molecular patterns, which are supposed to represent the key pathological determinant leading to one particular group of symptoms and signs – i.e. a phenotype – rather than another one. Therefore, asthma endotypes are the key for understanding such heterogeneity and treating asthmatic patients with a precision medicine approach. Different diagnostic methods enabling such personalised patient assessment are described in this dissertation. Firstly, a clinical study led by Pisa and Oxford Universities investigates the differences in the expression levels of multiple inflammatory molecules between different subpopulations of asthmatic patients, previously labelled on the basis of their sputum differential cell count as affected by eosinophilic, neutrophilic, mixed, or paucigranulocytic asthma. The results of the study show that sputum IL-8, IL-17 and TNF-α are leading molecules in the neutrophilic asthma endotype, while sputum IL-5 and IL-33 underlie eosinophilic asthma. The mixed endotype is defined by high levels of sputum IL-5, IL-8 and IL-33. There are no significant results regarding paucigranulocytic asthma. The serum levels of these inflammatory molecules provide no useful information for defining and differentiating the aforementioned asthma endotypes. These pathophysiologic differences might be used in a compact, multi-cytokine assessment test that defines univocally the specific patient’s inflammatory pattern. Such results, which would benefit from higher numbers of patients for attaining higher levels of evidence, shed light on the multifaceted inflammatory environment in bronchial asthma and might promote further research in order to define new targeted-therapy strategies for those patients with difficult-to-treat asthma. The prognostic and therapeutic potential of other diagnostic tools, which are already in use or might be adopted in a clinical environment, is subsequently examined. The techniques taken into consideration are sputum-guided therapy, quantitative measurement of bronchial wall remodelling markers, fractional exhaled nitric oxide (FeNO) measurement, and chest high-resolution computed tomography (HRCT). For each one of these, the state of the art and current use of the diagnostic tool is described. Each technique has its own distinctive features and is (or might be) used in different ways and for various purposes. More specifically, sputum-guided therapy represents a precision medicine approach to different asthma endotypes whereby treatment is tailored to the characteristics of induced sputum in the individual patient. The definition of specific sputum bronchial wall remodelling biomarkers might allow to understand which mediators lead to fixed airway obstruction, a condition that worsens the prognosis of asthmatic patients. Fractional exhaled nitric oxide provides useful information during the diagnostic assessment and follow-up of eosinophilic asthma patients. A new chest HRCT scoring system uses key imaging features to differentiate eosinophilic from non-eosinophilic asthmatic patients. In conclusion, patient endotyping is a modern concept of precision medicine that will enable in the near future personalised treatment in the individual patient. Although the heterogeneity of asthma is far from being understood in its entirety, every single diagnostic tool takes us a step closer to understanding the multiple and often intertwined pathways underlying the condition in the individual patient. Riassunto analitico Prendendo le mosse dalla descrizione dello stato dell’arte nella gestione del paziente affetto da asma bronchiale, la tesi di Laurea si prefigge di analizzare come ed in quali sue parti l’attuale protocollo diagnostico e terapeutico possa essere migliorato affinché si possano raggiungere un management personalizzato del paziente ed una più completa comprensione delle molteplici vie fisiopatologiche sottendenti la sintomatologia asmatica. L’asma bronchiale è una patologia cronica delle vie aeree che interessa più di trecento milioni di pazienti in tutto il mondo. Considerate tale elevata prevalenza e le implicazioni socio-economiche derivanti da un trattamento non appropriato, un approccio di medicina di precisione risulta pertanto di fondamentale interesse ed attualità. Durante le ultime decadi, è diventato evidente come il concetto di “asma” rappresenti in effetti un termine ombrello sotto cui si raggruppano distinti sottotipi di patologia. Negli ultimi anni la Letteratura scientifica ha infatti tentato di definire in maniera più precisa tali sottotipi basandosi su caratteristiche cliniche e strumentali, classificando le diverse sottopopolazioni di pazienti come fenotipi distinti. Nonostante il fatto che tale suddivisione abbia permesso di compiere dei progressi nell’ambito della tailored therapy, i meccanismi sottostanti a tale eterogeneità sono rimasti ancora un ambito da esplorare. Per questo motivo una nuova scuola di pensiero suggerisce in Letteratura di categorizzare le differenti sottopopolazioni asmatiche sulla base dei loro specifici pattern molecolari, ritenuti i determinanti di patologia chiave per un particolare insieme di caratteristiche cliniche – cioè un fenotipo – piuttosto che un altro. Appare quindi evidente come tali endotipi asmatici rappresentino la chiave per comprendere l’eterogeneità della patologia asmatica e trattare i singoli pazienti con un approccio di medicina di precisione. Vari metodi di inquadramento diagnostico personalizzato sono descritti nella tesi. In primo luogo, uno studio clinico condotto congiuntamente dalle Università di Pisa ed Oxford esplora le differenze tra diverse sottopopolazioni asmatiche, suddivise a priori sulla base della cellularità dell’espettorato come affette da asma eosinofilico, neutrofilico, misto o paucigranulocitico, nei livelli di espressione di numerose molecole infiammatorie. I risultati mostrano che le molecole IL-8, IL-17 e TNF- α, rilevate nell’espettorato, determinano un asma neutrofilico, mentre le molecole IL-5 e IL-33, anch’esse quantificate su campioni di espettorato, sottendono un asma di tipo eosinofilico. L’endotipo misto è definito da una combinazione di IL-5, IL-8 e IL-33. Non ci sono risultati statisticamente significativi inerenti l’asma paucigranulocitico. I livelli plasmatici di queste molecole infiammatorie non forniscono informazioni utili nella definizione e differenziazione dei suddetti endotipi asmatici. Queste differenze fisiopatologiche offrono la possibilità di essere sfruttate in un test di inquadramento multi-citochina compatto che definisca in modo univoco il pattern infiammatorio dello specifico paziente. Tali risultati, che beneficerebbero di essere corroborati da una maggiore evidenza ottenuta da studi con campioni più ampi, fanno luce sullo sfaccettato panorama infiammatorio dell’asma bronchiale e promuovono future ricerche in questo ambito, in modo da definire con maggior chiarezza nuove strategie terapeutiche a bersaglio molecolare per i pazienti affetti da asma di difficile trattamento. Successivamente viene analizzato il potenziale diagnostico e terapeutico di altri strumenti diagnostici, già in uso o di cui è prevedibile l’uso nell’ambito clinico. Le tecniche prese in considerazione sono la sputum-guided therapy, la misurazione quantitativa del rimodellamento bronchiale, l’ossido nitrico esalato (FeNO) e la tomografia computerizzata ad alta risoluzione (HRCT) del torace. Per ciascuna di esse vengono descritti lo stato dell’arte e le applicazioni diagnostiche. Ogni tecnica possiede le proprie caratteristiche distintive ed è o potrebbe essere sfruttata in modi e per scopi diversi. Più precisamente, la sputum-guided therapy rappresenta un approccio di medicina di precisione secondo il quale la terapia dello specifico paziente viene modificata sulla base delle caratteristiche del proprio espettorato indotto. La definizione di specifici biomarcatori di rimodellamento bronchiale permette di comprendere quali mediatori conducono ad una condizione di non completa reversibilità dell’ostruzione delle vie aeree, evenienza che aggrava la prognosi dei pazienti asmatici. L’ossido nitrico esalato permette di ricavare informazioni utili durante l’inquadramento diagnostico ed il follow-up di pazienti affetti da asma eosinofilico. Un nuovo score radiologico basato sui risultati della tomografia computerizzata ad alta risoluzione del torace permette di differenziare pazienti con asma eosinofilico da quelli con asma non eosinofilico. Concludendo, l’endotyping rappresenta un moderno concetto di medicina di precisione che permetterà nel prossimo futuro il trattamento personalizzato dello specifico paziente. Sebbene la completa comprensione dell’eterogeneità dell’asma bronchiale è un obiettivo ancora lontano, ogni strumento diagnostico avvicina progressivamente alla definizione delle molteplici e spesso interconnesse vie patogenetiche determinanti la patologia del singolo paziente

Smoking status and second-hand smoke biomarkers in COPD, asthma and healthy controls

IntroductionTobacco smoke worsens COPD and asthma. For healthy individuals, quantifying active and second-hand smoke (SHS) exposure clarifies the epidemiology of tobacco consumption and the efficacy of nonsmoking measures. Identifying tobacco exposure biomarkers and cut-offs might allow the creation of sensitive and specific tests.AimWe describe the state-of-the-art serum, urinary cotinine and exhaled carbon monoxide (CO) cut-offs for assessing smoking status and SHS exposure in adult patients with COPD or asthma, and healthy controls.MethodologyAfter a keyword research in the PubMed database, we included papers reporting on the cut-offs of the investigated biomarkers in one of the populations of interest. Papers published before 2000, not in English, or reporting only data on nonadult subjects or on pregnant women were excluded from the analysis. 14 papers were included in the final analysis. We summarised diagnostic cut-offs for smoking status or SHS exposure in COPD, asthmatic and healthy control cohorts, reporting sensitivity and specificity when available.ConclusionSerum and urinary cotinine and exhaled CO are easy-to-standardise, affordable and objective tests for assessing smoking status and SHS exposure. Evidence on cut-offs with good sensitivity and specificity values is available mainly for healthy controls. For COPD and asthmatic patients, most of the currently available evidence focuses on exhaled CO, while studies on the use of cotinine with definite sensitivity and specificity values are still missing. Solid evidence on SHS exposure is available only for healthy controls. An integrated approach with a combination of these markers still needs evaluation.</jats:sec

Nocturnal heart rate variability in obstructive sleep apnoea: a cross-sectional analysis of the sleep heart health study

Background: Obstructive sleep apnoea (OSA) results in sympathetic overdrive. Increased nocturnal heart rate variability (HRV) is a surrogate marker of autonomic disturbance. The aim was to study the association of the apnoea-hypopnea index (AHI), nocturnal hypoxaemia, and sleep fragmentation with nocturnal HRV to address the pathophysiological mechanisms underlying autonomic disturbance in OSA. Methods: Participants of the Sleep Hearth Health Study with available data on nocturnal HRV and an AHI ≥10/h have been included in this cross-sectional analysis. The main outcome of interest was the association of sleep fragmentation, nocturnal hypoxaemia, and the AHI with nocturnal HRV. Multivariate regression modelling with the mean of the standard deviations of normal-sinus-to-normal-sinus-interbeat intervals in all 5-minute segments (SDNNIDX) and with low to high frequency power-ratio (LF/HF) as dependent variables controlling for prespecified confounders (age, sex, cups of coffee, beta blocker, nocturnal heart rate) was used to assess the contribution of the arousal index, total sleep time with an oxygen saturation <90% (TST90) and the AHI not due to arousals to HRV. The significance level was set at P<0.01. Results: In 258 patients with OSA (mean ± SD age 62±10 years, BMI 29±4 kg/m2, median (IQR) AHI 18.6/h (14.0-25.6), the arousal index (coef =0.42, P=0.002) was independently positively associated with SDNNIDX also after having controlled for potential confounders, whereas the AHI (coef =0.22, P=0.030) and TST90 (coef =0.36, P=0.054) were not. The arousal index-but not TST and AHI-was also independently associated with LF/HF. Conclusions: In OSA, pronounced sleep fragmentation is associated with higher nocturnal HRV and a sympatho-vagal imbalance with sympathetic dominance. OSA severity and nocturnal hypoxaemia did not independently predict nocturnal HRV. Keywords: Obstructive sleep apnoea (OSA); arousal index; heart rate variability (HRV); intermittent hypoxia; sleep fragmentation

Being (past and present) President of the ERS: interview about the role, perspectives on career development, and vision for the Society

This article presents the views of the past and current Presidents of the ERS regarding their role, perspectives on career development and vision for the Society, along with important messages to inspire ECMs to build their own successful career. For this article, we invited early career members (ECMs) to interview the past and current Presidents of the European Respiratory Society (ERS), Professor Anita Simonds and Professor Marc Humbert, to share their motivations for becoming ERS President, experiences and goals during their presidency, perspectives on career development, visions for the society, and future challenges and opportunities in the respiratory field in the coming years. During the interviews, they provided important messages to help ECMs build their own successful career. We challenge ECMs to read the interviews and get inspired!info:eu-repo/semantics/publishedVersio

Nocturnal heart rate variability in obstructive sleep apnoea: a cross-sectional analysis of the Sleep Heart Health Study

Background: Obstructive sleep apnoea (OSA) results in sympathetic overdrive. Increased nocturnal heart rate variability (HRV) is a surrogate marker of autonomic disturbance. The aim was to study the association of the apnoea-hypopnea index (AHI), nocturnal hypoxaemia, and sleep fragmentation with nocturnal HRV to address the pathophysiological mechanisms underlying autonomic disturbance in OSA. Methods: Participants of the Sleep Hearth Health Study with available data on nocturnal HRV and an AHI ≥10/h have been included in this cross-sectional analysis. The main outcome of interest was the association of sleep fragmentation, nocturnal hypoxaemia, and the AHI with nocturnal HRV. Multivariate regression modelling with the mean of the standard deviations of normal-sinus-to-normal-sinus-interbeat intervals in all 5-minute segments (SDNNIDX) and with low to high frequency power-ratio (LF/HF) as dependent variables controlling for prespecified confounders (age, sex, cups of coffee, beta blocker, nocturnal heart rate) was used to assess the contribution of the arousal index, total sleep time with an oxygen saturation <90% (TST90) and the AHI not due to arousals to HRV. The significance level was set at P<0.01. Results: In 258 patients with OSA (mean ± SD age 62±10 years, BMI 29±4 kg/m2, median (IQR) AHI 18.6/h (14.0–25.6), the arousal index (coef =0.42, P=0.002) was independently positively associated with SDNNIDX also after having controlled for potential confounders, whereas the AHI (coef =0.22, P=0.030) and TST90 (coef =0.36, P=0.054) were not. The arousal index—but not TST and AHI—was also independently associated with LF/HF. Conclusions: In OSA, pronounced sleep fragmentation is associated with higher nocturnal HRV and a sympatho-vagal imbalance with sympathetic dominance. OSA severity and nocturnal hypoxaemia did not independently predict nocturnal HRV. Keywords: Obstructive sleep apnoea (OSA); heart rate variability (HRV); arousal index; intermittent hypoxia; sleep fragmentatio

Night-to-night variability of respiratory events in obstructive sleep apnoea: a systematic review and meta-analysis

Background: It is current practice to use a single diagnostic sleep study in the diagnostic workup of obstructive sleep apnoea (OSA). However, a relevant night-to-night variability (NtNV) of respiratory events has been reported. Methods: We evaluated the NtNV of respiratory events in adults with suspected or already diagnosed OSA who underwent more than one diagnostic sleep study. Data sources were PubMed, Cochrane and Embase up to 23 January 2019. Random-effects models were used for evidence synthesis. For moderator analysis, mixed-effects regression analysis was performed. The study was registered with PROSPERO (CRD42019135277). Results: Of 2143 identified papers, 24 studies, comprising 3250 participants, were included. The mean Apnoea-Hypopnoea Index (AHI) difference between the first and second night was -1.70/hour (95% CI -3.61 to 0.02). REM time differences (first to second night) were significantly positive associated with differences in mean AHI (β coefficient 0.262 (95% CI 0.096 to 0.428). On average, 41% (95% CI 27% to 57%) of all participants showed changes of respiratory events >10/hour from night to night. Furthermore, 49% (95% CI 32% to 65%) of participants changed OSA severity class (severity thresholds at 5/hour, 15/hour and 30/hour) at least once in sequential sleep studies. Depending on the diagnostic threshold (5/hour, 10/hour or 15/hour), on average 12% (95% CI 9% to 15%), 12% (95% CI 8% to 19%) and 10% (95% CI 8% to 13%) of patients would have been missed during the first night due to single night testing. Conclusion: While there was no significant difference between mean AHI in two sequential study nights on a group level, there was a remarkable intraindividual NtNV of respiratory events, leading to misdiagnosis and misclassification of patients with suspected OSA