EMJ Respiratory最新文献

{"title":"Asthma in Children Under 5 Years in Rural Kyrgyzstan: A Diagnostic Vacuum? a Qualitative FRESH AIR Study","authors":"Marianne Stubbe Østergaard, J. Kjærgaard, M. Kristensen, S. Reventlow, A. Poulsen, E. Isaeva, A. Akylbekov, T. Sooronbaev","doi":"10.33590/emjrespir/10314133","DOIUrl":"https://doi.org/10.33590/emjrespir/10314133","url":null,"abstract":"Background: Worldwide, asthma is the most frequent non-communicable disease in childhood, often starting in infancy. However, asthma is underdiagnosed in children <5 years of age (Under-5s) in low and middle-income countries.\u0000\u0000Aims: This study explored perceptions of, and reasons for, underdiagnosis of asthma in Under-5s in rural Kyrgyzstan.\u0000\u0000Methods: Semi-structured qualitative interviews with 22 rural primary care health professionals and 13 caregivers to Under-5s with recurrent lower respiratory tract illnesses.\u0000\u0000Results: Most health professionals and caregivers perceived asthma as a severe, debilitating, and potentially fatal disease in young children. None of the health professionals had diagnosed any Under-5s with asthma. In the health professionals’ biomedical understanding, asthma occurs predominantly in adolescents and adults, and consists of attacks of respiratory distress, with mandatory heredity and allergy. The health professionals veered away from the asthma diagnosis to avoid scaring parents, and they replaced the diagnostic vacuum with infectious diagnoses. Surprisingly, stigma regarding the population with asthma appeared to be uncommon. Most caregivers were receptive to the idea of treatment with inhaled medication and to the statement that asthma could also be a mild disease.\u0000\u0000Conclusion: The apparent systemic underdiagnosis of asthma in rural Kyrgyzstan seemed self-perpetuating. The misconceptions and dated diagnostic criteria and tradition had no provision for asthma in Under-5s; therefore, few children were diagnosed with asthma. This reinforced the inappropriate fear and belief in society that asthma is a rare, severe, and debilitating disease. Training of health professionals and providing information to the public should address the current perception of asthma and raise awareness that asthma is often a mild and treatable disease.","PeriodicalId":300382,"journal":{"name":"EMJ Respiratory","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127939138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Living with Alpha-1 Antitrypsin Deficiency: Empowering Patients and Healthcare Professionals","authors":"H. Boreham","doi":"10.33590/emjrespir/10312283","DOIUrl":"https://doi.org/10.33590/emjrespir/10312283","url":null,"abstract":"Exacerbations in chronic obstructive pulmonary disease (COPD) impose a substantial healthcare burden and are key drivers of negative clinical outcomes and reduced patient quality of life. Prof Stockley highlighted the main differences in exacerbations between alpha-1 antitrypsin deficiency (AATD) and non-AATD-related COPD and considered potential implications for patient management. Early treatment of exacerbations with purulent sputum is known to be associated with improved patient outcomes. Emerging evidence from clinical studies also suggests that alpha-1 antitrypsin (AAT) therapy can have a positive impact on the nature and course of exacerbations in AATD.\u0000\u0000Dr Zanichelli outlined how self-administration of intravenous drugs, which is a routine procedure that patients safely implement in other indications, has the potential to be successfully used by carefully selected AATD patients. Reflecting the current trend towards a more personalised approach to AATD therapy, self-administration can empower patients to assume an increasingly active role in their own disease management, thereby bringing improvements in treatment satisfaction, disease control, clinical outcomes, and quality of life.\u0000\u0000A unique patient’s perspective on AAT self-administration was provided by Karen Skålvoll, who highlighted the key benefits offered by self-infusion, such as reduced localised trauma and increased freedom to travel and enjoy life. Photographs from Karen’s many global travels illustrate the unparalleled freedom that self-administration has afforded her as an AATD patient.\u0000\u0000From the physician’s standpoint, Prof Sandhaus summarised his experience of how patients can be empowered to self-administer AAT therapy independently with minimal training. Among motivated individuals, self-administration can provide a successful long-term treatment solution for their AATD. The drive towards self-treatment also delivers the dual benefits of reduced healthcare burden and enhanced convenience and flexibility for patients.\u0000\u0000Prof Koczulla reported that, overall, the available evidence indicates pulmonary rehabilitation as a successful strategy in AATD, which can significantly enhance a patients’ physical performance. Although the most effective training algorithm still needs to be prospectively validated, this approach may prove particularly advantageous in patients with anxiety, dyspnoea, and fear of physical activity. In order to achieve maximum benefit, therapy and goals of pulmonary rehabilitation must always be tailored to the individual patient in a personalised approach to care.\u0000\u0000The meeting concluded with the compelling ‘AATD Strongman Contest,’ which pitted Prof Koczulla against AATD patient Karen Skålvoll in a physical test of endurance (the so called ‘farmer’s walk’ involving carrying a heavy obstacle) and strength (dumbbell raises). Notwithstanding the expected impairment in aerobic ability, the domination of Karen in the strength test clearly demonstrates the physica","PeriodicalId":300382,"journal":{"name":"EMJ Respiratory","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133290760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Building Hope by Restoring Breathing in Airways Diseases","authors":"Bronwyn Boyes","doi":"10.33590/emjrespir/10311461","DOIUrl":"https://doi.org/10.33590/emjrespir/10311461","url":null,"abstract":"Prof Agustí opened the session by explaining the new challenges in airway diseases including the changing paradigm of our understanding of chronic obstructive pulmonary disease (COPD) that considers the entire lung function trajectory from birth to death, the complexity and heterogeneity of the disease, and the need to diagnose and treat COPD earlier in life. Prof Siddiqui then explained that all of the airways, including small airways, are critically important in the pathophysiology of asthma and COPD. The world’s largest multi-centre ATLANTIS study focussed on small airways dysfunction (SAD) confirmed that a simple combination of different assessments like oscillometry and spirometry could identify patients with the SAD phenotype. The prevalence of airway dysfunction in the full asthma cohort was 91%. Prof Papi discussed that exacerbations are a crucial event in the natural history of COPD and that they drive several health-related outcomes. He reviewed the clinical evidence to demonstrate the benefits of triple therapy in general and specifically of the extrafine fixed triple combination (beclometasone dipropionate, formoterol fumarate, glycopyrronium bromide) to consistently reduce the risk of exacerbations, and improve lung function and quality of life (QoL) with a favourable benefit-to-harm ratio. Furthermore, triple therapy showed promising signals in terms of improved survival. Prof Celli debated that inhaled corticosteroid (ICS) should be given to many patients because scientific trials have shown that: 1) ICS combined with bronchodilator (BD) are effective in improving health status and reducing exacerbations; 2) they also impact lung function decline and mortality; 3) ICS increase pneumonia risk (depending on type, dose, airflow limitation, BMI, and age) but have no untoward effect on mortality or hospitalisations for pneumonia; 4) blood eosinophil count (BEC) (<100 cell/µL) helps select patients unlikely to respond to ICS; and 5) ‘many’ COPD patients benefit from ICS combined with BD. Prof Singh focused on the fact that the magnitude of clinical benefit in preventing COPD exacerbations varies between individual patients, underlining the importance for clinicians of making the right decision for each patient when prescribing ICS, by balancing the potential risk/benefit. He concluded the debate by outlining that ICS have benefits in patients at increased exacerbation risk, and that the size of the benefits varies with BEC and the number/type of exacerbation.","PeriodicalId":300382,"journal":{"name":"EMJ Respiratory","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130487124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unilateral Right Exophthalmia Revealing Systemic Sarcoidosis: A Case Report and a Review of the Literature","authors":"Sofia Baina, L. Achachi, Mariam El Yahiyaoui, M. el Ftouh, L. Herrak","doi":"10.33590/emjrespir/10310020","DOIUrl":"https://doi.org/10.33590/emjrespir/10310020","url":null,"abstract":"Background: Sarcoidosis is only revealed in 3% of the cases among Caucasians by ophthalmic damage and, when it does, it presupposes that the visceral impairment has remained silent so far. In this article, the exceptional case of a patient with systemic sarcoidosis revealed by unilateral exophthalmia is reported.\u0000\u0000Case presentation: The patient is a female with no history of substantial pathology. She had a unilateral right exophthalmia and ptosis evolving over 3 years. A dyspnea and dry cough were also reported with a duration of 1 year. The chest X-ray and CT scan revealed bilateral hilar opacities and mediastinal lymphadenopathy that lead to the suspicion of sarcoidosis. The cerebro-orbital CT scan led to the classification of the patient’s exophthalmia as Grade I and eliminated the possibility of other aetiologies. The mediastinoscopy indicated a granulomatous adenitis with no caseous necrosis, which allowed the diagnosis of a mediastinopulmonary sarcoidosis.\u0000\u0000Discussion and conclusion: The diagnostic approach to exophthalmia should involve a systematic search for sarcoidosis, although this aetiology remains exceptional.","PeriodicalId":300382,"journal":{"name":"EMJ Respiratory","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133724848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unilateral Right Exophthalmia Revealing Systemic Sarcoidosis: A Case Report and a Review of the Literature","authors":"S. Bania","doi":"10.33590/emjresp/19-00088","DOIUrl":"https://doi.org/10.33590/emjresp/19-00088","url":null,"abstract":"Background: Sarcoidosis is only revealed in 3% of the cases among Caucasians by ophthalmic damage and, when it does, it presupposes that the visceral impairment has remained silent so far. In this article, the exceptional case of a patient with systemic sarcoidosis revealed by unilateral exophthalmia is reported. Case presentation: The patient is a female with no history of substantial pathology. She had a unilateral right exophthalmia and ptosis evolving over 3 years. A dyspnea and dry cough were also reported with a duration of 1 year. The chest X-ray and CT scan revealed bilateral hilar opacities and mediastinal lymphadenopathy that lead to the suspicion of sarcoidosis. The cerebro-orbital CT scan led to the classification of the patient’s exophthalmia as Grade I and eliminated the possibility of other aetiologies. The mediastinoscopy indicated a granulomatous adenitis with no caseous necrosis, which allowed the diagnosis of a mediastinopulmonary sarcoidosis. Discussion and conclusion: The diagnostic approach to exophthalmia should involve a systematic search for sarcoidosis, although this aetiology remains exceptional.","PeriodicalId":300382,"journal":{"name":"EMJ Respiratory","volume":"48 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115849357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Persistent Cough: Changes in Prevalence, Impact, and Beliefs From 2006–2015 in Italy","authors":"R. D. Dal Negro, M. Povero, A. Zanasi, P. Turco","doi":"10.33590/emj/10313090","DOIUrl":"https://doi.org/10.33590/emj/10313090","url":null,"abstract":"Background: Persistent cough is one of the most common conditions affecting quality of life. The aim of this study was to assess people’s beliefs regarding the impact of, and changes in the prevalence of, persistent cough in the Italian general population over a 10-year time period.\u0000\u0000Methods: Two telephone surveys were conducted in 2006 and 2015, and the answers were compared. In 2015, the same questionnaire was also randomly distributed in paper form to another cohort. Sample sizes were precalculated for their representativeness and comparability (Chi-square test).\u0000\u0000Results: In total, 1,251 subjects in 2015 and 1,334 in 2006 completed the interviews. The corresponding completion rate for the interviews was 23.0% and 21.8%, respectively; 5,056 individuals completed the paper-form questionnaire. A substantial proportion of respondents stated that persistent cough should be regarded as a disease and not merely as a symptom. This belief increased from 38.8% to 46.4% (p<0.03) over the study decade. The prevalence of persistent cough recorded through computer-assisted telephone interview was 14.2% and 18.4% in the 2006 and 2015 surveys, respectively (p<0.02), and 35.5% in individuals answering the paper-form questionnaire (p<0.01). General practitioners (69.6%) and lung physicians (16.2%) were among the most frequently consulted medical professionals for cough. The majority of respondents disagreed with first-line antibiotic and/or systemic steroid use, while antitussive drugs and mucolytics were highly valued. The willingness of the patient to pay for their own treatment increased, with >40% of responders willing to pay >€10 at the pharmacy in 2015.\u0000\u0000Conclusion: These surveys showed the prevalence of persistent cough is increasing, together with the willingness of the patient to pay out of their own pocket for treatment. However, the methodology for data collection should be carefully considered before data are generalised.","PeriodicalId":300382,"journal":{"name":"EMJ Respiratory","volume":"48 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115818634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The National Institute for Health and Care Excellence (NICE) Updated Guidance on Endobronchial Valves: What Was Behind the Decision and What Does it Mean for Pulmonologists?","authors":"P. Shah","doi":"10.33590/emjrespir/10310006","DOIUrl":"https://doi.org/10.33590/emjrespir/10310006","url":null,"abstract":"In December 2017, the National Institute for Health and Care Excellence (NICE) updated its interventional procedures guidance, titled ‘Endobronchial valve insertion to reduce lung volume in emphysema’,1 to support the routine use of endobronchial valve therapy for emphysema. The NICE guidance states: 'Current evidence on the safety and efficacy of endobronchial valve insertion to reduce lung volume in emphysema is adequate in quantity and quality to support the use of this procedure provided that standard arrangements are in place for clinical governance, consent and audit.' NICE is the latest organisation to include endobronchial valves in its chronic obstructive pulmonary disease (COPD) treatment pathway, following the Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy report for the diagnosis, management, and prevention of COPD;2 the German Society for Pneumology and Respiratory Medicine (DGP) guidance;3 and the Australian and New Zealand guidelines for the management of COPD;4 however, what does this mean to us as respiratory physicians?","PeriodicalId":300382,"journal":{"name":"EMJ Respiratory","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122205257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Noninvasive Ventilation: Challenges and Pitfalls","authors":"Olcay Dilken, E. Erdoğan, Y. Dikmen","doi":"10.33590/emjrespir/10312141","DOIUrl":"https://doi.org/10.33590/emjrespir/10312141","url":null,"abstract":"Noninvasive ventilation (NIV) is frequently used in patients with acute respiratory failure and its success is dependent on the underlying cause of the condition. When used for cases with a more rapid, reversible nature, like cardiogenic pulmonary oedema or acute exacerbations of chronic obstructive pulmonary disease, early intervention before patient deterioration is a key factor in success. Gastric distention-associated anastomose leakage after bariatric surgery is overestimated and the success of NIV trials in patients with encephalopathy has a strong association with the triggering cause rather than the severity of a coma. Immunocompromised patients mostly benefit from a short period of ventilation and more invasive ventilation is associated with excessively high mortality independent of the cause. In other diseases with parenchyma inflammation or infection, little success with NIV has been shown. Limiting ventilator-induced lung injury in these patients is another issue and is mostly achieved with heavy sedation or paralysis. Since NIV failure increases the risk of mortality, determination of a failing patient is of paramount importance. Clinical and laboratory surrogates of muscle fatigue can also be assessed. Adequate pressure support and positive end-expiratory pressure levels vary and the haemodynamic status of the patients must be considered. Ventilator–patient asynchrony increases NIV failure. Unfit interfaces also result in asynchrony, which will inevitably lead to failure, and observing waveforms can address this issue. The aims of this review were to understand the mechanism of NIV that leads to its failure or success, to become aware that delaying the appropriate therapy increases mortality, and to elucidate that spontaneous breathing can be a double-edged sword in some circumstances.","PeriodicalId":300382,"journal":{"name":"EMJ Respiratory","volume":"103 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133912956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Focussing on The Patient: Future Prospects in Alpha 1 Management","authors":"J. Fricker","doi":"10.33590/emjrespir/10314829","DOIUrl":"https://doi.org/10.33590/emjrespir/10314829","url":null,"abstract":"With new patient-centric and scientific networks being created, Prof Chorostowska-Wynimko explored how these initiatives, such as the European Alpha-1 Research Collaboration (EARCO) and the European Reference Network-LUNG Alpha1 Antitrypsin Deficiency (ERN-LUNG AATD Core Network), will help to advance the management of alpha 1-antitrypsin deficiency (AATD) patients. EARCO plans to create a registry to gather information from centres across Europe and ERN-LUNG AATD plans to ensure highly specialised healthcare for AATD patients, including reliable AATD diagnostics across European laboratories.\u0000\u0000Explaining in more detail the plans for the new EARCO registry, Dr Barrecheguren argued the case for another AATD registry to gather large-scale data that clinical trials cannot provide. She provided an overview of the new EARCO prospective follow-up registry, to be launched next year, which will integrate existing national AATD registries, enhance long-term follow-up and quality of data, and facilitate research and quality improvements across healthcare systems.\u0000\u0000Discussing one of the first initiatives of the ERN-LUNG AATD Core Network, Dr Ferrarotti explored how to align AATD testing across Europe with the creation of European LAB-NET, an initiative first involving six European centres that will co-operate to collect, develop, verify, and make reference materials available for molecular and biochemical tests to correctly diagnose AATD and provide quality control in the laboratory diagnosis.\u0000\u0000Dr Greulich reported on a post-hoc pooled analysis from the RAPID-randomised controlled trial (RAPID-RCT) and the RAPID-open label extension (RAPID-OLE) study, which compared the safety and tolerability of adverse event (AE) rates for two different alpha-1 antitrypsin (AAT) dosing patterns, weekly infusions of 60 mg/kg AAT, and bi-weekly infusions of 120 mg/kg AAT. Results showed there were no significant differences for exposure-adjusted event rates (p=0.850), infusion-adjusted event rates (p=0.344), and serious treatment emergent AE (TEAE) (p=1.0); TEAE occurring in the first 24 and 48 hours were comparable for both groups.\u0000\u0000Prof Sandhaus presented the results of a telephone survey from the USA AlphaNet organisation of self-infusion practices in 555 patients with AATD. The survey found that 7.9% of respondents self-administered AAT and 92.1% who did not. Of the 44 patients who self-administered AAT, 95.4% reported being very satisfied and 4.6% were satisfied with their treatment.","PeriodicalId":300382,"journal":{"name":"EMJ Respiratory","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128396206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"State-of-the-Art Session: Respiratory Infections","authors":"Syneos Health","doi":"10.33590/emjrespir/10310867","DOIUrl":"https://doi.org/10.33590/emjrespir/10310867","url":null,"abstract":"In recent decades, there has been growing interest in the recognition and management of both bronchiectasis and nontuberculous mycobacteria (NTM) pulmonary disease. More specifically, interest in diagnosing NTM infection in patients with bronchiectasis has dramatically increased. Publication of the European Respiratory Society (ERS) guidelines and results from a number of large clinical trials have resulted in an exciting year for bronchiectasis research. Despite the increased knowledge and expanding options for disease management, a number of challenges persist. There remains a paucity of evidence to support management recommendations, which have not kept pace with the growing attention given to these diseases. To explore these limitations, Prof Chalmers summarised the reasoning behind the new guidelines.\u0000\u0000The main objectives of these two presentations were to provide an expert overview of the challenges and achievements in the management of bronchiectasis and NTM pulmonary diseases, as well as predicting future trends. Dr van Ingen called for caution when managing these diseases because neither bronchiectasis nor NTM pulmonary disease can be described as single disease entities and, therefore, cannot be treated as such. The presence of NTM pulmonary disease is often a sign of multiple underlying conditions that must be addressed in tandem with culture conversion. Likewise, bronchiectasis pathogenesis is complex and failure of antibiotic therapy to offer consistent clinical benefit suggests infection is not central to pathogenesis in all patients, and a holistic approach is required. Finally, these interactive sessions uncovered and discussed various aspects and attitudes associated with disease management and highlighted how quality of care may be closely linked to clinical outcomes.","PeriodicalId":300382,"journal":{"name":"EMJ Respiratory","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124388307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}