Time to re-set our thinking about airways disease: lessons from history, the resurgence of chronic bronchitis / PBB and modern concepts in microbiology.

In contrast to significant declines in deaths due to lung cancer and cardiac disease in Westernised countries, the mortality due to 'chronic obstructive pulmonary disease' (COPD) has minimally changed in recent decades while 'the incidence of bronchiectasis' is on the rise. The current focus on producing guidelines for these two airway 'diseases' has hindered progress in both treatment and prevention. The elephant in the room is that neither COPD nor bronchiectasis is a disease but rather a consequence of progressive untreated airway inflammation.

Evidence of Respiratory Syncytial Virus Persistence in a Subset of Pulmonary Dendritic Cells Following a Primary Infection.

Respiratory syncytial virus (RSV) causes annual epidemics of infections affecting the whole population. , it has been shown to infect and persist in human dendritic cells (DCs) for prolonged periods. Initially persistence is associated with low levels of replication before the virus becomes dormant.

The efficacy of biodiversity and ecosystem assessment approaches for informing a regenerative approach to built development.

The built environment, even at its "greenest," inevitably entails changing ecosystem structure and function. Multiple sustainable development tools and approaches are available to reduce environmental harm from built development. However, the reality that society exists within fully integrated socioecological systems, wholly interdependent on supporting ecosystems, is not yet adequately represented in regulation or supporting tools.

Methodological innovations within the RAWES framework for use in development scenarios.

Built development changes the nature of land and its ecosystems, with diverse ramifications for human well-being and the resilience of the socioecological system. Robust and replicable approaches are required to assess ecosystem services generated by sites both predevelopment and for evaluation of postdevelopment options, to assess change and to support a paradigm shift from a "do less harm" to a "regenerative" approach. The Rapid Assessment of Wetland Ecosystem Services (RAWES) approach provides an internationally recognized methodology for systemic assessment of the ecosystem services generated by a site, taking account of all ecosystem services and service categories across multiple spatial scales.

Assessment of the sustainable use of chemicals on a level playing field.

Misleading conclusions can result from applying tools beyond the purposes for which they were designed. A range of chemical assessment systems was compared against a set of principles germane to the sustainable use of chemicals relevant to the whole societal life cycles of finished products. These principles of sustainable use included: wider dimensions of sustainability, a foundation in science, consideration of life-cycle risk rather than simply intrinsic chemical properties, contributions to meeting human needs, open access, and peer review.

Challenging the paradigm.

https://bit.ly/30VkP8Q.

Controlled inhalation improves central and peripheral deposition in cystic fibrosis patients with moderate lung disease.

Aim: With progressive impairment of lung function, deposition of inhaled drug in the lungs becomes progressively more central, limiting its effectiveness. This pilot study explored the possibility that long slow inhalations might improve delivery of aerosol to the lung periphery in cystic fibrosis patients with moderate lung disease.

Methods: Five subjects aged 12-18 years (mean FEV 72%; range 63-80%) inhaled a radiolabelled aerosol from a jet nebuliser on two occasions.

Reassessing the multiple values of lowland British floodplains.

Ecosystem services provided by lowland British floodplains respectively under semi-natural conditions and converted for intensive maize production were assessed. Floodplains across lowland Britain have been extensively disconnected from river channels, depleting habitat for wildlife and other beneficial ecosystem services. Conservation measures are often regarded as costly constraints on economic and development freedoms whilst, conversely, conversion for intensive agricultural production is rewarded by markets despite many often-overlooked externalities.

Precision Medicine and Childhood Asthma: A Guide for the Unwary.

Many thousands of articles relating to asthma appear in medical and scientific journals each year, yet there is still no consensus as to how the condition should be defined. Some argue that the condition does not exist as an entity and that the term should be discarded. The key feature that distinguishes it from other respiratory diseases is that airway smooth muscles, which normally vary little in length, have lost their stable configuration and shorten excessively in response to a wide range of stimuli.

Bacterial Signatures of Paediatric Respiratory Disease: An Individual Participant Data Meta-Analysis.

The airway microbiota has been linked to specific paediatric respiratory diseases, but studies are often small. It remains unclear whether particular bacteria are associated with a given disease, or if a more general, non-specific microbiota association with disease exists, as suggested for the gut. We investigated overarching patterns of bacterial association with acute and chronic paediatric respiratory disease in an individual participant data (IPD) meta-analysis of 16S rRNA gene sequences from published respiratory microbiota studies.

High levels of inherent variability in microbiological assessment of bronchoalveolar lavage samples from children with persistent bacterial bronchitis and healthy controls.

Bronchoalveolar lavage (BAL) is widely regarded as providing "gold standard" samples for infective lower respiratory tract disease. Current approaches have been adopted empirically without robust assessment and hence carry many assumptions that have not been tested. Many of these uncertainties were highlighted in the ATS pediatric bronchoscopy guidelines.

The role of ecosystems in mitigation and management of Covid-19 and other zoonoses.

There is rising international concern about the zoonotic origins of many global pandemics. Increasing human-animal interactions are perceived as driving factors in pathogen transfer, emphasising the close relationships between human, animal and environmental health. Contemporary livelihood and market patterns tend to degrade ecosystems and their services, driving a cycle of degradation in increasingly tightly linked socio-ecological systems.

Time to Say Goodbye to Bronchiolitis, Viral Wheeze, Reactive Airways Disease, Wheeze Bronchitis and All That.

The diagnosis and management of infants and children with a significant viral lower respiratory tract illness remains the subject of much debate and little progress. Over the decades various terms for such illnesses have been in and fallen out of fashion or have evolved to mean different things to different clinicians. Terms such as "bronchiolitis," "reactive airways disease," "viral wheeze," and many more are used to describe the same condition and the same term is frequently used to describe illnesses caused by completely different dominant pathologies.

Asthma: A Loss of Post-natal Homeostatic Control of Airways Smooth Muscle With Regression Toward a Pre-natal State.

The defining feature of asthma is loss of normal post-natal homeostatic control of airways smooth muscle (ASM). This is the key feature that distinguishes asthma from all other forms of respiratory disease. Failure to focus on impaired ASM homeostasis largely explains our failure to find a cure and contributes to the widespread excessive morbidity associated with the condition despite the presence of effective therapies.

Can nature-based solutions contribute to water security in Bhopal?

Bhojtal, a large man-made lake bordering the city of Bhopal (Madhya Pradesh state, central India), is important for the city's water supply, connoted the lifeline of the city. Despite the dry though not arid and markedly seasonal climate, soil impermeability hampers infiltration into the complex geology underlying the Bhojtal catchment. Rural communities in the catchment are nonetheless high dependent on underlying aquifers.

Can management of 'thirsty' alien trees improve water security in semi-arid India?

Arid and semi-arid regions of central India receive scarce and episodic precipitation during the short monsoon season, and also experience substantial evaporation. Traditional and innovative water harvesting and governance practices improve water stewardship, or abate some impacts of intensive mechanised water extraction. However, significant numbers of alien trees, in particular Eucalyptus species with high water demands, populate some regions practicing progressive water stewardship.

ERS statement on tracheomalacia and bronchomalacia in children.

Tracheomalacia and tracheobronchomalacia may be primary abnormalities of the large airways or associated with a wide variety of congenital and acquired conditions. The evidence on diagnosis, classification and management is scant. There is no universally accepted classification of severity.

'Dry' and 'wet' cough: how reliable is parental reporting?

Introduction: Chronic cough in childhood is common and causes much parental anxiety. Eliciting a diagnosis can be difficult as it is a non-specific symptom indicating airways inflammation and this may be due to a variety of aetiologies. A key part of assessment is obtaining an accurate cough history.

Mapping ammonia risk on sensitive habitats in Ireland.

The aim of this study was to provide a simple, cost-effective, risk-based map of terrestrial areas in Ireland where environmental quality may be at risk from atmospheric ammonia. This risk-based approach identifies Natura 2000 sites in Ireland at risk from agricultural atmospheric ammonia, collating best available data using Geographical Information Systems (GIS). In mapping ammonia risk on sensitive habitats (MARSH), the method identifies sources of ammonia, classifying them on a scale of risk from 0 to 5.

Key paediatric messages from the 2017 European Respiratory Society International Congress.

In this article, the group chairs of the Paediatric Assembly of the European Respiratory Society (ERS) highlight some of the most interesting findings presented at the 2017 ERS International Congress, which was held in Milan, Italy.

PGD2/DP2 receptor activation promotes severe viral bronchiolitis by suppressing IFN- production.

Prostaglandin D2 (PGD2) signals through PGD2 receptor 2 (DP2, also known as CRTH2) on type 2 effector cells to promote asthma pathogenesis; however, little is known about its role during respiratory syncytial virus (RSV) bronchiolitis, a major risk factor for asthma development. We show that RSV infection up-regulated hematopoietic prostaglandin D synthase expression and increased PGD2 release by cultured human primary airway epithelial cells (AECs). Moreover, PGD2 production was elevated in nasopharyngeal samples from young infants hospitalized with RSV bronchiolitis compared to healthy controls.

The impact of persistent bacterial bronchitis on the pulmonary microbiome of children.

Introduction: Persistent bacterial bronchitis (PBB) is a leading cause of chronic wet cough in young children. This study aimed to characterise the respiratory bacterial microbiota of healthy children and to assess the impact of the changes associated with the development of PBB. Blind, protected brushings were obtained from 20 healthy controls and 24 children with PBB, with an additional directed sample obtained from PBB patients.

Plasmacytoid dendritic cells protect from viral bronchiolitis and asthma through semaphorin 4a-mediated T reg expansion.

Respiratory syncytial virus-bronchiolitis is a major independent risk factor for subsequent asthma, but the causal mechanisms remain obscure. We identified that transient plasmacytoid dendritic cell (pDC) depletion during primary Pneumovirus infection alone predisposed to severe bronchiolitis in early life and subsequent asthma in later life after reinfection. pDC depletion ablated interferon production and increased viral load; however, the heightened immunopathology and susceptibility to subsequent asthma stemmed from a failure to expand functional neuropilin-1 regulatory T (T reg) cells in the absence of pDC-derived semaphorin 4a (Sema4a).