Loss of asthma control can be discriminated from clinically stable episodes by longitudinal monitoring of exhaled metabolites measured by GC/MS and particularly eNose. Part of the uncovered biomarkers was associated with sputum eosinophils. These findings provide proof of principle for monitoring and identification of loss of asthma control by breathomics.

Background: Evidence-based guidelines from the World Health Organization (WHO) have recommended a high (80%) fraction of inspired oxygen (FiO 2 ) to reduce surgical site infection in adult surgical patients undergoing general anaesthesia with tracheal intubation. However, there is ongoing debate over the safety of high FiO 2 . We performed a systematic review to define the relative risk of clinically relevant adverse events (AE) associated with high FiO 2 . Methods: We reviewed potentially relevant articles from the WHO review supporting the recommendation, including an updated (July 2018) search of EMBASE and PubMed for randomised and non-randomised controlled studies reporting AE in surgical patients receiving 80% FiO 2 compared with 30e35% FiO 2 . We assessed study quality and performed meta-analyses of risk ratios (RR) comparing 80% FiO 2 against 30e35% for major complications, mortality, and intensive care admission. Results: We included 17 moderateegood quality trials and two non-randomised studies with serious-critical risk of bias. No evidence of harm with high FiO 2 was found for major AE in the meta-analysis of randomised trials: atelectasis RR 0.91 [95% confidence interval (CI) 0.59e1.42); cardiovascular events RR 0.90 (95% CI 0.32e2.54); intensive care admission RR 0.93 (95% CI 0.7e1.12); and death during the trial RR 0.49 (95% CI 0.17e1.37). One non-randomised study reported that high FiO 2 was associated with major respiratory AE [RR 1.99 (95% CI 1.72e2.31)]. Conclusions: No definite signal of harm with 80% FiO 2 in adult surgical patients undergoing general anaesthesia was demonstrated and there is little evidence on safety-related issues to discourage its use in this population.

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Asthma is a dynamic disease, in which lung mechanical and inflammatory processes interact in a complex manner, often resulting in exaggerated physiological, in particular, inflammatory responses to exogenous triggers. We hypothesize that this may be explained by respiratory disease-related systems instability and loss of adaptability to changing environmental conditions, manifested in highly fluctuating biomarkers and symptoms. Using time series of inflammatory (eosinophils, neutrophils, FeNO), clinical and lung function biomarkers (PEF, FVC,FEV1), we estimated this loss of adaptive capacity (AC) during an experimental rhinovirus infection in 24 healthy and asthmatic human volunteers. Loss of AC was estimated by comparing similarities between pre- and post-challenge time series. Unlike healthy participants, the asthmatic’s post-viral-challenge state resembled more other rhinovirus-infected asthmatics than their own pre-viral-challenge state (hypergeometric-test: p=0.029). This reveals loss of AC and supports the concept that in asthma, biological processes underlying inflammatory and physiological responses are unstable, contributing to loss of control.

More than a decade has passed since the finalization of the Human Genome Project.Omics technologies made a huge leap from trendy and very expensive to routinely executed and relatively cheap assays. Simultaneously, we understood that omics is not a panacea for every problem in the area of human health and personalized medicine. Whilst in some areas of research omics showed immediate results, in other fields, including asthma, it only allowed us to identify the incredibly complicated molecular processes. Along with their possibilities, omics technologies also bring many issues connected to sample collection, analyses and interpretation. It is often impossible to separate the intrinsic imperfection of omics from asthma heterogeneity. Still, many insights and directions from applied omics were acquired-presumable phenotypic clusters of patients, plausible biomarkers and potential pathways involved.Omics technologies develop rapidly, bringing improvements also to asthma research. These improvements, together with our growing understanding of asthma subphenotypes and underlying cellular processes, will likely play a role in asthma management strategies.

BackgroundOnline health discussion forums are used by different patient groups for sharing advice and information. Chronic cough is a common problem, and people with chronic cough use online health forums alongside formal medical therapies.ObjectiveThe objective of this study was to assess how chronic cough sufferers use online health forums, including the treatment advice they share with one another and the possible clinical uses of online forums in chronic cough.MethodsThree open-access health forums were searched for threads related to chronic cough. Identified threads were screened against inclusion and exclusion criteria adapted from the British Thoracic Society (BTS) Guidelines related to chronic cough diagnosis. Included data were subjected to qualitative thematic analysis. All study data were cross-validated by a second author and discrepancies were resolved.ResultsIn total, 96 threads were included in the analysis, consisting of posts by 223 forum users. Three main themes were identified: the effect of chronic cough on the lives of patients, the treatment advice shared between users, and the provision of support within forums.ConclusionsChronic cough symptoms had impacts on multiple aspects of patients’ health and well-being. To try and combat these issues, forum users suggested a variety of treatments to one another, ranging from mainstream traditional therapies to odd alternative remedies. The provision of support and empathy were also prominent themes in discussion threads. Online forums themselves may provide increasing benefit to users through the addition of a moderator.

BackgroundAsthma is a complex, heterogeneous disorder with similar presenting symptoms but with varying underlying pathologies. Exhaled breath condensate (EBC) is a relatively unexplored matrix which reflects the signatures of respiratory epithelium, but is difficult to normalize for dilution.MethodsHere we explored whether internally normalized global NMR spectrum patterns, combined with machine learning, could be useful for diagnostics or endotype discovery. Nuclear magnetic resonance (NMR) spectroscopy of EBC was performed in 89 asthmatic subjects from a prospective cohort and 20 healthy controls. A random forest classifier was built to differentiate between asthmatics and healthy controls. Clustering of the spectra was done using k-means to identify potential endotypes.ResultsNMR spectra of the EBC could differentiate between asthmatics and healthy controls with 80% sensitivity and 75% specificity. Unsupervised clustering within the asthma group resulted in three clusters (n = 41,11, and 9). Cluster 1 patients had lower long-term exacerbation scores, when compared with other two clusters. Cluster 3 patients had lower blood eosinophils and higher neutrophils, when compared with other two clusters with a strong family history of asthma.ConclusionAsthma clusters derived from NMR spectra of EBC show important clinical and chemical differences, suggesting this as a useful tool in asthma endotype-discovery.Electronic supplementary materialThe online version of this article (10.1186/s12967-017-1365-7) contains supplementary material, which is available to authorized users.

reusable-part condenser [4], and results obtained by others using a non-reusable-part condenser and mass spectrometry (MS) [7].The data mentioned previously demonstrate that the cleaning procedure with Milton does not alter the metabolic profiles of EBC, and that NMR spectroscopy is suitable for investigating EBC samples.By using an Anacon condenser (Biostec, Valencia, Spain), different results have been reported [7]. Collection devices are an important source of variability of EBC biomarkers [2, 3, 8]. The principal variability factors include cooling temperature [9] and condenser materials [2]. For example, a warm-up during condensation is observed when RTube or Anacon are used (condensers using a disposable collection kit), whereas EcoScreen cools down slightly during the procedure [8, 9]. Such differences affect biomarker concentrations [2, 9]. More importantly, there was no correlation between biomarkers measured in EBC collected with EcoScreen and Anacon condensers [9], and there was only an ,60% correlation between biomarkers measured in EBC collected with RTube and Anacon condensers; although both used a disposable collection kit [9]. However, as no NMR details were found (i.e. the operating magnetic field, the number of acquisitions, the possible use of a cryoprobe, and the detection limit), it is difficult to conclude that NMR spectroscopy cannot be used to analyse EBC samples because it does not have the sensitivity required to observe the endogenous metabolites in the EBC [7]. With our spectrometer set-up, we have estimated a detection limit that is notably low for NMR-based metabolomics [10].In conclusion, our cleaning procedure of EBC collection set-up does not generate artificial signals in the metabolic profile of EBC. Furthermore, NMR-based metabolomics are suitable for identifying specific EBC metabolites and are potentially useful for characterising the metabolic fingerprints of patients with respiratory diseases. Although a head-to-head comparison of different condensers is required, the combination of different reference analytical techniques, including NMR and MS, might consolidate ''breathomics'' as a new noninvasive approach to the assessment of patients with respiratory disease with important diagnostic and therapeutic implications.