A collaboration of multidisciplinary experts on the functional evaluation of lung cancer patients has been facilitated by the European Respiratory Society (ERS) and the European Society of Thoracic Surgery (ESTS), in order to draw up recommendations and provide clinicians with clear, up-to-date guidelines on fitness for surgery and chemo-radiotherapy.The subject was divided into different topics, which were then assigned to at least two experts. The authors searched the literature according to their own strategies, with no central literature review being performed. The draft reports written by the experts on each topic were reviewed, discussed and voted on by the entire expert panel. The evidence supporting each recommendation was summarised, and graded as described by the Scottish Intercollegiate Guidelines Network Grading Review Group. Clinical practice guidelines were generated and finalised in a functional algorithm for risk stratification of the lung resection candidates, emphasising cardiological evaluation, forced expiratory volume in 1 s, systematic carbon monoxide lung diffusion capacity and exercise testing.Contrary to lung resection, for which the scientific evidences are more robust, we were unable to recommend any specific test, cut-off value, or algorithm before chemo-radiotherapy due to the lack of data. We recommend that lung cancer patients should be managed in specialised settings by multidisciplinary teams.

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Theophylline and acetazolamide reduce sleep-disordered breathing at high altitude. R. Fischer, S.M. Lang, M. Leitl, M. Thiere, U. Steiner, R.M. Huber. #ERS Journals Ltd 2004. ABSTRACT: A randomised, double-blind, placebo-controlled study was conducted to evaluate the effects of theophylline and acetazolamide in the treatment of sleepdisordered breathing (SDB) after fast ascent to high altitude (3,454 m).The study was conducted at a high-altitude research laboratory and included 30 healthy male volunteers. Study medication was either oral slow release theophylline (26250 mg?day -1 ), oral acetazolamide (26250 mg?day -1 ) or a matched placebo tablet. Polysomnographic measurements were performed during two consecutive nights, and acute mountain sickness, pulse rate, oxyhaemoglobin saturation and arterial blood gases were assessed three times a day.Without active medication, the apnoea/hypopnoea index (AHI) was highly pathological ( Sleep-disordered breathing (SDB) of the Cheyne-Stokes type is commonly found during sleep at high altitude [1][2][3]. This typical breathing pattern with waxing and waning of the tidal volume is associated with profound desaturations and reduced overall oxygen saturation during sleep, but its association with an increased number of arousals is a matter of ongoing debate [4,5]. The use of acetazolamide at high altitude is known to reduce the time spent with periodic breathing, to improve overall oxygen saturation during sleep and to reduce the number of arousals [6].Acetazolamide inhibits the renal enzyme carbonic anhydrase, which leads to metabolic acidosis, and, as a result, increases ventilation and oxygenation. The beneficial effects of this drug at high altitude are thought to be due to this improved oxygenation. Although serious side-effects of acetazolamide are uncommon, an alternative treatment option would be desirable for patients with known sulphonamide intolerance. In a previous, prospective, randomised study, the authors were able to show that theophylline has a positive impact on symptoms of acute mountain sickness (AMS), compared with placebo [7]. As theophylline was shown to be effective in reducing periodic breathing in premature newborns and in patients with severe heart failure [8, 9], a similar effect in high-altitude periodic breathing could be assumed.Therefore, a randomised, double-blind, placebo-controlled study was conducted to evaluate the effect of theophylline and acetazolamide on periodic breathing and arterial oxyhaemoglobin desaturations during sleep at high altitude. The aims were to compare the efficacy of theophylline and acetazolamide in normalising high-altitude SDB and in decreasing nocturnal oxyhaemoglobin desaturation. Methods Study populationHealthy male volunteers (n=30) gave informed written consent to participate in the study. Of 30 subjects, 22 were engaged in regular mountaineering activities in their spare time, but none of them had experienced altitudes above 3,500 m. The study protocol was approved by the local ethics committee. Exclusion cr...

In a randomized, double-blind cross-over study 10 subjects were exposed to a simulated altitude of 4500 m for 10 h after administration of placebo, acetozolamide (250 mg bid) or theophylline (250 mg bid). T2-weighted magnetic resonances images (MRI) and diffusion weighted MRI were obtained directly after exposure to altitude under hypoxic conditions. Although eight of 10 subjects had moderate to severe acute mountain sickness (AMS), we found no evidence of cerebral oedema, irrespective of the medication taken. Almost all subjects showed a decrease in inner cerebrospinal fluid (iCSF) volumes (placebo - 10.3%, P= 0.02; acetazolamide - 13.2%, P= 0.008, theophylline -12.2%, n.s.). There was no correlation between AMS symptoms and fluid shift. However, we found a significantly positive correlation of large (>10 ml) iCSF volume and more severe AMS after administration of placebo (r = 0.76, P= 0.01). Moderate to severe AMS after high altitude exposure for 10 h is associated with a decreased iCSF-volume independent of AMS severity or medication without signs of cerebral oedema.