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Given commonly employed thresholds in the UK NHS, on balance co-trimoxazole may be a cost-effective treatment for IPF, although there is substantial decision uncertainty. However, recent guidance on the use of immunosuppressive therapy in IPF patients should be taken into account prior to any policy decision.

Background: Declining lung function signifies disease progression in idiopathic pulmonary fibrosis (IPF). Vascular endothelial growth factor (VEGF) concentration is associated with declining lung function in 6 and 12-month studies. Alveolar nitric oxide concentration (CANO) is increased in patients with IPF, however its significance is unclear. This study investigated whether baseline plasma VEGF concentration and CANO are associated with disease progression or mortality in IPF. Methods: 27 IPF patients were studied (maximum follow-up 65 months). Baseline plasma VEGF concentration, CANO and pulmonary function tests (PFTs) were measured. PFTs were performed the preceding year and subsequent PFTs and data regarding mortality were collected. Disease progression was defined as one of: death, relative decrease of ≥10% in baseline forced vital capacity (FVC) % predicted, or relative decrease of ≥15% in baseline single breath diffusion capacity of carbon monoxide (TLCO-SB) % predicted. Results: Plasma VEGF concentration was not associated with progression-free survival or mortality. There was a trend towards shorter time to disease progression and death with higher CANO. CANO was significantly higher in patients with previous declining versus stable lung function. Conclusion: The role of VEGF in IPF remains uncertain. It may be of value to further investigate CANO in IPF.

trained in pleural procedures (Group B) in 32 patients. Primary endpoints were success of the pleural procedure, procedural pain using visual analogue score (VAS), patient anxiety using short form State Trait Anxiety Index (STAI). Secondary outcome measures were complications. Non parametric statistical tests were used for analysis. Results There was no statistically significant (NS) difference between groups as assessed by primary endpoints (Table 1). There was one failure to undertake therapeutic pleural aspiration in Group B. Delayed complications were drain dislodgement in Group A and re-expansion pulmonary oedema in Group B. Conclusion We believe this is the first randomised control study to test if after appropriate training a Pleural Nurse Practitioner is able to safely and effectively undertake pleural procedures with equivalence in practice to trained doctors. Introduction and Objectives Attempts to develop standardised guidelines in the management of primary spontaneous pneumothorax (PSP) have been severely hampered by a lack of high quality clinical research. The American College of Chest Physicians (ACCP) and BTS guidelines are based on non-analytical studies and expert opinion. Remarkably, no consensus regarding the definition of PSP severity exists, with the ACCP and BTS each using different arbitrary measurements: hilar size > 2cm (BTS) versus apical size >3cm (ACCP). The objective of this study is to define the critical size of PSP.Methods A multi-centre prospective comparison of 168 consecutive patients presenting with PSP was performed in 13 NHS hospitals in the East of England over a period of 15 months. We compared the ability of the BTS and ACCP definitions to predict the eventual need for intercostal chest drain (ICD) insertion. Since current BTS guidelines state that pleural aspiration should be attempted prior to drainage in non-compromised PSP patients, we reasoned that ICD insertion was a valid endpoint. Using a logistic regression model that included hospital, age, hilar size, apical size and the hilar-apical interaction, we generated receiver operating characteristic (ROC) curves reflecting the probability of either measure correctly predicting the eventual need for ICD. Results One hundred and sixteen of 168 patients for whom data were collected had been treated according to BTS guidelines. Of these, 39 eventually required ICD insertion. The correlation between hilar and apical distances was high (0.7). The logistic regression showed that hilar distance was statistically significant (p < 0.001), but apical distance and the interaction were not. The sensitivity and specificity from using BTS guidelines were 0.667 (95% CI 0.510-0.794) and 0.805 (0.703-0.878) respectively, whereas the same values using the ACCP guidelines were 0. 948 (0.831-0.986) and 0.351 (0.253-0.462). Conclusion Guidelines based on hilar distance, such as the BTS's, are likely to be more informative in predicting the eventual need for ICD. However, the two distances are highly correlated. This study, for the first ...

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Fifty-two patients with chronic obstructive pulmonary disease (COPD) aged 44 to 71 yrs were examined. Of them, 26 ones suffered from type 2 diabetes mellitus (DM). We established that in patients with concomitant DM, COPD has more severe course with more advanced respiratory failure and chronic cor pulmonale and more frequent exacerbations. COPD patients with concomitant DM more often have co-morbidity, such as obesity, ischemic heart disease, chronic heart failure. Co-morbidity of COLD and DM requires more extensive pharmacotherapy.

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