Rationale: Targeted lung denervation (TLD) is a bronchoscopic radiofrequency ablation therapy for chronic obstructive pulmonary disease (COPD), which durably disrupts parasympathetic pulmonary nerves to decrease airway resistance and mucus hypersecretion.Objectives: To determine the safety and impact of TLD on respiratory adverse events.Methods: We conducted a multicenter, randomized, sham bronchoscopy–controlled, double-blind trial in patients with symptomatic (modified Medical Research Council dyspnea scale score, ≥2; or COPD Assessment Test score, ≥10) COPD (FEV1, 30–60% predicted). The primary endpoint was the rate of respiratory adverse events between 3 and 6.5 months after randomization (defined as COPD exacerbation, tachypnea, wheezing, worsening bronchitis, worsening dyspnea, influenza, pneumonia, other respiratory infections, respiratory failure, or airway effects requiring therapeutic intervention). Blinding was maintained through 12.5 months.Measurements and Main Results: Eighty-two patients (50% female; mean ± SD: age, 63.7 ± 6.8 yr; FEV1, 41.6 ± 7.3% predicted; modified Medical Research Council dyspnea scale score, 2.2 ± 0.7; COPD Assessment Test score, 18.4 ± 6.1) were randomized 1:1. During the predefined 3- to 6.5-month window, patients in the TLD group experienced significantly fewer respiratory adverse events than those in the sham group (32% vs. 71%, P = 0.008; odds ratio, 0.19; 95% confidence interval, 0.0750–0.4923, P = 0.0006). Between 0 and 12.5 months, these findings were not different (83% vs. 90%; P = 0.52). The risk of COPD exacerbation requiring hospitalization in the 0- to 12.5-month window was significantly lower in the TLD group than in the sham group (hazard ratio, 0.35; 95% confidence interval, 0.13–0.99; P = 0.039). There was no statistical difference in the time to first moderate or severe COPD exacerbation, patient-reported symptoms, or other physiologic measures over the 12.5 months of follow-up.Conclusions: Patients with symptomatic COPD treated with TLD combined with optimal pharmacotherapy had fewer study-defined respiratory adverse events, including hospitalizations for COPD exacerbation.Clinical trial registered with www.clinicaltrials.gov (NCT02058459).

The clinical effects of a bronchodilator, terbutaline sulphate, were compared after administration in the beginning of the inhalation by means of a standard inhaler and administration by actuating 2 seconds before starting the inhalation by means of an inhaler furnished with a 32 X 100 mm tube. No differences could be seen in the parameters measured-forced vital capacity (FVC), 1-second forced expiratory volume (FEV1), forced mid-expiratory flow (FMF), and oscillatory resistance (Ros). The results indicate that when attaching a tube to the standard inhaler co-ordination of inhalation and actuation of the aerosol is not of vital importance.

In late December 2019, a new virus from the coronavirus family (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) was identified as a worldwide epidemic (coronavirus disease 2019 [COVID-19]). Although the clinical impact of the disease on immunocompetent patients has been well described, its consequences on populations treated with immunosuppressive (IS) drugs remain poorly understood, especially concerning solid organ transplant (SOT) recipients. 1,2 To date, very few cases of lung transplant (LTx) patients affected by COVID-19 have been reported. 3-5 After lung transplantation, a long-term maintenance IS treatment is prescribed. This can lead to an increased risk of infections, especially viral infections, which are sometimes more severe than in the general

The clinical effect of 1.0 mg terbutaline given as a pressurized aerosol with a 750-ml spacer was compared with that of 4.0 mg terbutaline given as a nebulized solution (Pari Inhalier Boy). No differences were found in the parameters measured – forced vital capacity, 1 s forced expiratory volume, forced mid-expiratory flow, and oscillatory resistance. The results indicate that the same clinical response to a given dose of a pressurized aerosol supplied with a 750-ml spacer has the same effect as a fourfold dose via a nebulizer. It is concluded that the more practical 750-ml spacer should be tried when contemplating nebulization therapy.

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