Current developments and future directions in COPD

The European Respiratory Society journals publish respiratory research and policy documents of the highest quality, offering a platform for the exchange and promotion of scientific knowledge. In this article, focusing on COPD, the third leading cause of death globally, we summarise novel research highlights focusing on the disease's underlying mechanisms, epidemiology and management, with the aim to inform and inspire respiratory clinicians and researchers

Deep learning-based lesion subtyping and prediction of clinical outcomes in COVID-19 pneumonia using chest CT

The main objective of this work is to develop and evaluate an artificial intelligence system based on deep learning capable of automatically identifying, quantifying, and characterizing COVID-19 pneumonia patterns in order to assess disease severity and predict clinical outcomes, and to compare the prediction performance with respect to human reader severity assessment and whole lung radiomics. We propose a deep learning based scheme to automatically segment the different lesion subtypes in nonenhanced CT scans. The automatic lesion quantification was used to predict clinical outcomes. The proposed technique has been independently tested in a multicentric cohort of 103 patients, retrospectively collected between March and July of 2020. Segmentation of lesion subtypes was evaluated using both overlapping (Dice) and distance-based (Hausdorff and average surface) metrics, while the proposed system to predict clinically relevant outcomes was assessed using the area under the curve (AUC). Additionally, other metrics including sensitivity, specificity, positive predictive value and negative predictive value were estimated. 95% confidence intervals were properly calculated. The agreement between the automatic estimate of parenchymal damage (%) and the radiologists' severity scoring was strong, with a Spearman correlation coefficient (R) of 0.83. The automatic quantification of lesion subtypes was able to predict patient mortality, admission to the Intensive Care Units (ICU) and need for mechanical ventilation with an AUC of 0.87, 0.73 and 0.68 respectively. The proposed artificial intelligence system enabled a better prediction of those clinically relevant outcomes when compared to the radiologists' interpretation and to whole lung radiomics. In conclusion, deep learning lesion subtyping in COVID-19 pneumonia from noncontrast chest CT enables quantitative assessment of disease severity and better prediction of clinical outcomes with respect to whole lung radiomics or radiologists' severity score

Fossil bee cells from the Canary Islands. Ichnotaxonomy, palaeobiology and palaeoenvironments of Palmiraichnus castellanosi

Fossil bee cells, attributable to the ichnospecies Palmiraichnus castellanosi, are recorded from the Pleistocene and Holocene of the easternmost Canary Islands. Cells bear a chamber with internal smooth lining, spiral closure, and an antechamber. They have a discrete wall that surrounds both the chamber and antechamber. The antechamber shows an internal smooth surface and a structureless filling of palaeosol material. These features enable this material to be assigned to the ichnospecies P. castellanosi, originally described from the Palaeogene of Uruguay. This record constitutes the first documented evidence for bees, and Hymenoptera, in the Quaternary of the Canaries and the first for this ichnospecies from Africa. By comparison with extant cells, the potential constructors are bees of the genus Andrena (Andrenidae). Palaeoecological and statistical data suggest that five species may have produced P. castellanosi in the Canary Islands. One on Lanzarote in the Holocene, another in south Fuerteventura in the Upper Pleistocene, two on Gran Canaria and another on Montan&tild;a Clara islet during the Middle Pleistocene. A high level of breeding success was probably favoured by the lack of predators or parasites and optimal environmental conditions, at least in the Pleistocene. During the Pleistocene, the abundance of P. castellanosi in the lowlands suggests a rich endemic shrubby flora and palaeoclimatic conditions similar to the present, but probably with a higher humidity. The land-snail assemblage associated with low densities of P. castellanosi in the Holocene mid-altitude belt suggests a cool moist palaeoenvironment, less favourable for P. castellanosi producers.Fil: La Roche, Francisco. Universidad de La Laguna; EspañaFil: Genise, Jorge Fernando. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Museo Argentino de Ciencias Naturales “Bernardino Rivadavia”; ArgentinaFil: Castillo, Carolina. Universidad de La Laguna; EspañaFil: Quesada, María Luisa. Universidad de La Laguna; EspañaFil: García Gotera, Cristo M.. Universidad de La Laguna; EspañaFil: De la Nuez, Julio. Universidad de La Laguna; Españ

Current developments and future directions in COPD

The European Respiratory Society journals publish respiratory research and policy documents of the highest quality, offering a platform for the exchange and promotion of scientific knowledge. In this article, focusing on COPD, the third leading cause of death globally, we summarise novel research highlights focusing on the disease\u2019s underlying mechanisms, epidemiology and management, with the aim to inform and inspire respiratory clinicians and researchers

ERS International Congress 2022: highlights from the Airway Diseases Assembly

The European Respiratory Society (ERS) celebrated the return of an in-person meeting in Barcelona, Spain, after 2 years of virtual congresses. The ERS Congress 2022 programme was replete with symposia, skills workshops and abstract presentations from all 14 assemblies, encompassing over 3000 abstracts presented in the form of thematic poster discussion and oral presentations. In this article, highlights from the ERS Congress 2022 (including from thematic poster sessions, oral presentations and symposia from keynote speakers), presented by Assembly 5 (Airway diseases, asthma, COPD and chronic cough), are reviewed by Early Career Members and experts in the field, with the aim of presenting key recent findings in the field

European Respiratory Society Short Guidelines for the use of as-needed ICS/formoterol in mild Asthma.

Recent clinical trials of as-needed fixed-dose combination of ICS/formoterol have provided new evidence that may warrant a reconsideration of current practice.A task force (TF) was set up by the European Respiratory Society to provide evidence-based recommendations on the use of as-needed ICS/formoterol as treatment for mild asthma. The TF defined two questions that were assessed using the Grading of Recommendations, Assessment, Development and Evaluation approach. The TF utilised the outcomes to develop recommendations for a pragmatic guideline for everyday clinical practice.The TF suggests that adults with mild asthma use as-needed ICS/formoterol instead of regular ICS maintenance treatment plus as-needed short-acting beta-2-antagonists (SABAs), and that adolescents with mild asthma use either as-needed ICS/formoterol or ICS maintenance treatment plus as-needed SABA (Conditional Recommendation; Low Certainty of Evidence). The recommendation for adults places a relatively higher value on the reduction of systemic corticosteroid use and the outcomes related to exacerbations and a relatively lower value on the small differences in asthma control. Either treatment options are suggested for adolescent patients as the balance is very close and data more limited.The TF recommends that adult and adolescent patients with mild asthma use as-needed ICS/formoterol instead of as-needed SABA (Strong Recommendation; Low Certainty of Evidence). This recommendation is based on the benefit of as-needed ICS/formoterol in mild asthma on several outcomes and the risks related to as-needed SABA in the absence of anti-inflammatory treatment.The implementation of this recommendation is hampered in countries (including European Union countries) where as-needed ICS/formoterol is not approved for mild asthma

Impact of Applying the Global Lung Initiative Criteria for Airway Obstruction in GOLD Defined COPD Cohorts: The BODE and CHAIN Experience

Introduction The Global Lung Function Initiative (GLI) has proposed new criteria for airflow limitation (AL) and recommends using these to interpret spirometry. The objective of this study was to explore the impact of the application of the AL GLI criteria in two well characterized GOLD-defined COPD cohorts. Methods COPD patients from the BODE (n = 360) and the COPD History Assessment In SpaiN (CHAIN) cohorts (n = 722) were enrolled and followed. Age, gender, pack-years history, BMI, dyspnea, lung function measurements, exercise capacity, BODE index, history of exacerbations and survival were recorded. CT-detected comorbidities were registered in the BODE cohort. The proportion of subjects without AL by GLI criteria was determined in each cohort. The clinical, CT-detected comorbidity, and overall survival of these patients were evaluated. Results In total, 18% of the BODE and 15% of the CHAIN cohort did not meet GLI AL criteria. In the BODE and CHAIN cohorts respectively, these patients had a high clinical burden (BODE ≥ 3: 9% and 20%; mMRC ≥ 2: 16% and 45%; exacerbations in the previous year: 31% and 9%; 6MWD < 350 m: 15% and 19%, respectively), and a similar prevalence of CT-diagnosed comorbidities compared with those with GLI AL. They also had a higher rate of long-term mortality – 33% and 22% respectively. Conclusions An important proportion of patients from 2 GOLD-defined COPD cohorts did not meet GLI AL criteria at enrolment, although they had a significant burden of disease. Caution must be taken when applying the GLI AL criteria in clinical practice