In an observational study including all patients undergoing lung surgery, we describe two clinical forms of acute lung injury (ALI): a delayed-onset form triggered by intercurrent complications and an early form associated with preoperative alcohol consumption, pneumonectomy, high intraoperative pressure index, and excessive fluid intake over the first 24 h.

Primary spontaneous pneumothorax (PSP) affects young healthy people with a significant recurrence rate. Recent advances in treatment have been variably implemented in clinical practice. This statement reviews the latest developments and concepts to improve clinical management and stimulate further research.The European Respiratory Society's Scientific Committee established a multidisciplinary team of pulmonologists and surgeons to produce a comprehensive review of available scientific evidence.Smoking remains the main risk factor of PSP. Routine smoking cessation is advised. More prospective data are required to better define the PSP population and incidence of recurrence. In first episodes of PSP, treatment approach is driven by symptoms rather than PSP size. The role of bullae rupture as the cause of air leakage remains unclear, implying that any treatment of PSP recurrence includes pleurodesis. Talc poudrage pleurodesis by thoracoscopy is safe, provided calibrated talc is available. Video-assisted thoracic surgery is preferred to thoracotomy as a surgical approach.In first episodes of PSP, aspiration is required only in symptomatic patients. After a persistent or recurrent PSP, definitive treatment including pleurodesis is undertaken. Future randomised controlled trials comparing different strategies are required. @ERSpublications A European Task Force reviews scientific evidence and suggests future research for primary spontaneous pneumothorax

Decreasing exposure to airborne particulates appears to attenuate the decline in lung function related to exposure to PM10. The effects are greater in tests reflecting small-airway function.

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OBJECTIVES: The Swiss Cohort Study on Air Pollution and Lung Diseases in Adults (SAPALDIA) was designed to investigate the health effects from long-term exposure to air pollution. METHODS: The health assessment at recruitment (1991) and at the first reassessment (2001-3) consisted of an interview about respiratory health, occupational and other exposures, spirometry, a methacholine bronchial challenge test, end-expiratory carbon monoxide (CO) measurement and measurement for atopy. A bio bank for DNA and blood markers was established. Heart rate variability was measured using a 24-hour ECG (Holter) in a random sample of participants aged 50 years and older. Concentrations of nitrogen dioxide (NO2), sulphur dioxide (SO2), ozone (O3) and particulates in ambient air have been monitored in all study areas since 1991. Residential histories collected over the 11 year follow-up period coupled with GIS modelling will provide individual long-term air pollutant exposure estimates. RESULTS: Of 9651 participants examined in 1991, 8715 could be traced for the cohort study and 283 died. Basic information about health status was obtained for 8047 individuals (86% of alive persons), 6 528 individuals (70%) agreed to the health examination and 5 973 subjects (62%) completed the entire protocol. Non-participants in the reassessment were on average younger than participants and more likely to have been smokers and to have reported respiratory symptoms in the first assessment. Average weight had increased by 5.5 kg in 11 years and 28% of smokers in 1991 had quit by the time of the reassessment. The most powerful approach for studying long-term effects from ambient air pollution on health is the long-term prospective follow-up of well-defined population-based cohorts with well-characterized air pollution exposure information (European Science Foundation 1998). There are currently only five cohort studies in adults, with published results, that address the long-term impact of air pollution (Abbey et al. 1999;Dockery et al. 1993;Finkelstein et al. 2004;Hoek et al. 2002; Pope et al. 2002;. All studies but one are based in the US and three of them (Dockery et al. 1993;Hoek et al. 2002; Pope et al. 2002), have only published findings related to mortality. The relation of longterm exposure to air pollution with respiratory and cardiovascular health and morbidity has yet to be measured in a large prospective cohort study in Europe. The large European Community Respiratory Health Survey (ECRHS) de- Probst-Hensch NM, et al. Follow-up of SAPALDIA 2, 1991-2003 signed to measure natural history and risk factors for respiratory diseases (particularly asthma and allergy) across Europe has recently included air pollution exposure assessment in its protocol (Burney et al. 1994;Hazenkamp-von Arx et al. 2004). However, the Swiss Cohort Study on Air Pollution and Lung Diseases in Adults (SAPALDIA) is the only prospective cohort study of respiratory and cardiovascular health in adults in Europe with detailed individual residential exposure hi...