Respiratory disease

Bronchiectasis is gaining recognition as an important chronic lung disease of increasing prevalence

Simone K Visser · Peter Bye · Lucy Morgan

New assessment and treatment opportunities for people with severe asthma promise better outcomes

Peter G Gibson

From its early infancy in 1986, it continues to evolve and is internationally recognised as demonstrating worldÕs best practices

Miranda A Paraskeva · Kovi C Levin · Glen P Westall · Gregory I Snell

Despite recent advances in our knowledge of sarcoidosis, it remains a diagnosis of exclusion

Hasib Ahmadzai · Shuying Huang · Chris Steinfort · James Markos · Roger KA Allen · Denis Wakefield · Margaret Wilsher · Paul S Thomas

Strategies for reducing exposure should be communicated to parents of children at risk of asthma

Luke D Knibbs · Solomon Woldeyohannes · Guy B Marks · Christine T Cowie

Smoking rates in the Busselton community have declined and lung function has improved over the past 50 years

Arthur (Bill) Musk · Michael Hunter · Jennie Hui · Matthew W Knuiman · Mark Divitini · John P Beilby · Alan James

A 37-year-old woman admitted for elective reduction mammoplasty developed stridor after extubation

Clarissa Susanto

Objectives: To review the accuracy of diagnoses of chronic obstructive pulmonary disease (COPD) in primary care in Australia, and to describe smokers’ experiences with and preferences for smoking cessation. Design, setting and participants: Patients were invited to participate if they were at least 40 years old and had visited participating general practice clinics in Melbourne at least twice during the previous 12 months, reported being current or ex-smokers with a smoking history of at least 10 pack-years, or were being managed for COPD. Interviews based on a structured questionnaire and case finding (FEV1/FEV6 measurement) were followed, when appropriate, by spirometry testing and assessment of health-related quality of life, dyspnoea and symptoms. Results: 1050 patients attended baseline interviews (February 2015 – April 2017) at 41 practices. Of 245 participants managed for COPD, 130 (53.1%) met the spirometry-based definition (post-bronchodilator FEV1/FVC < 0.7) or had a clinical correlation; in 37% of cases COPD was not confirmed, and no definitive result was obtained for 9.8% of patients. Case finding and subsequent spirometry testing identified 142 new COPD cases (17.6% of participants without prior diagnosis; 95% CI, 15.1–20.5%). 690 participants (65.7%) were current smokers, of whom 360 had attempted quitting during the previous 12 months; 286 (81.0% of those attempting to quit) reported difficulties during previous quit attempts. Nicotine replacement therapy (205, 57.4%) and varenicline (110, 30.8%) were the most frequently employed pharmacological treatments; side effects were common. Hypnotherapy was the most popular non-pharmacological option (62 smokers, 17%); e-cigarettes were tried by 38 (11%). 187 current smokers (27.6%) would consider using e-cigarettes in future attempts to quit. Conclusions: COPD was both misdiagnosed and missed. Case finding and effective use of spirometry testing could improve diagnosis. Side effects of smoking cessation medications and difficulties during attempts to quit smoking are common. Health professionals should emphasise evidence-based treatments, and closely monitor quitting difficulties and side effects of cessation aids. Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12614001155684.

Jenifer Liang · Michael J Abramson · Nicholas A Zwar · Grant M Russell · Anne E Holland · Billie Bonevski · Ajay Mahal · Kirsten Phillips · Paula Eustace · Eldho Paul · Sally Wilson · Johnson George

A 20-year-old man with asthma presented with a 5-day history of coughing bouts and pleuritic chest pain

Ching Soong Khoo · Siti Soraya Ab Rahman

Poor quality spirometry or incorrect interpretation compromises clinical diagnosis and management

John R Wheatley

Parkes’ occupational lung disorders, 4th edition

Arthur (Bill) W Musk

Challenging concepts in respiratory medicine: cases with expert commentary

David J Barnes

Respiratory health is threatened by changes to our climate and environment — but there is also good news

Matthew J Peters · Jane E Bourke

Current recommendations to titrate oxygen administration are confirmed

Janine Pilcher · Michael Richards · Leonie Eastlake · Steven J McKinstry · George Bardsley · Sarah Jefferies · Irene Braithwaite · Mark Weatherall · Richard Beasley

Idiopathic pulmonary fibrosis (IPF) is a fibrosing interstitial lung disease associated with debilitating symptoms of dyspnoea and cough

Helen E Jo* · Jyotika D Prasad* · Lauren K Troy · Annabelle Mahar · Jane Bleasel · Samantha J Ellis · Daniel C Chambers · Anne E Holland · Fiona R Lake · Gregory Keir · Nicole S Goh · Margaret Wilsher · Sally de Boer · Yuben Moodley · Christopher Grainge · Helen M Whitford · Sally A Chapman · Paul N Reynolds · David Beatson** · Leonie J Jones · Peter Hopkins · Heather M Allan · Ian Glaspole*** · Tamera J Corte***

Sensitivity to rye grass may predict susceptibility to thunderstorm-related asthma

Michael F Sutherland · Emma Le Portelli · Allison L Collins · Muhammad Aziz Rahman · Christine F McDonald

Chronic obstructive pulmonary disease (COPD) is characterised by persistent respiratory symptoms and chronic airflow limitation, and is associated with exacerbations and comorbidities

Ian A Yang · Juliet L Brown · Johnson George · Sue Jenkins · Christine F McDonald · Vanessa M McDonald · Kirsten Phillips · Brian J Smith · Nicholas A Zwar · Eli Dabscheck

Occupational exposures are an important determinant of respiratory health

Ryan F Hoy · Fraser Brims