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Flexible bronchoscopy is an essential, established and expanding tool in respiratory medicine. Its practice, however, needs to be safe, effective and for the right indications to maximise clinical utility. This guideline is based on the best available evidence and is a revised update of the British Thoracic Society guideline on diagnostic flexible bronchoscopy.Flexible bronchoscopy in adults is an essential, established and expanding tool in respiratory medicine. This new guideline aims to ensure that bronchoscopy remains a safe and effective procedure. Since the publication of the previous British Thoracic Society guideline on diagnostic flexible bronchoscopy in 2001 1 there has been a large amount of new evidence which has been incorporated into this guideline.

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Rationale: Most airway diseases, including chronic obstructive pulmonary disease (COPD), are associated with excessive coughing. The extent to which this may be a consequence of increased activation of vagal afferents by pathology in the airways (e.g., inflammatory mediators, excessive mucus) or an altered neuronal phenotype is unknown. Understanding whether respiratory diseases are associated with dysfunction of airway sensory nerves has the potential to identify novel therapeutic targets.Objectives: To assess the changes in cough responses to a range of inhaled irritants in COPD and model these in animals to investigate the underlying mechanisms.Methods: Cough responses to inhaled stimuli in patients with COPD, healthy smokers, refractory chronic cough, asthma, and healthy volunteers were assessed and compared with vagus/airway nerve and cough responses in a cigarette smoke (CS) exposure guinea pig model. Measurements and Main Results:Patients with COPD had heightened cough responses to capsaicin but reduced responses to prostaglandin E 2 compared with healthy volunteers. Furthermore, the different patient groups all exhibited different patterns of modulation of cough responses. Consistent with these findings, capsaicin caused a greater number of coughs in CS-exposed guinea pigs than in control animals; similar increased responses were observed in ex vivo vagus nerve and neuron cell bodies in the vagal ganglia. However, responses to prostaglandin E 2 were decreased by CS exposure.Conclusions: CS exposure is capable of inducing responses consistent with phenotypic switching in airway sensory nerves comparable with the cough responses observed in patients with COPD. Moreover, the differing profiles of cough responses support the concept of disease-specific neurophenotypes in airway disease.Clinical trial registered with www.clinicaltrials.gov (NCT 01297790).

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Quality of retinal image is vital for screening of ailments pertaining to eye such as glaucoma, diabetic retinopathy (DR) and age related macular degeneration. Therefore, assessing quality of retinal image prior to any kind of diagnosis has assumed significance in Computer Aided Desgin (CAD) applications. The rationale behind this is that reliability of retinal image is to be guaranteed to have dependable diagnosis. In this paper, we propose a novel retinal fundus image quality assessment (RIQA) method based on autoencoder network to assess retinal images if the image is acceptable for screening or not. The autoencoder network architecture is well suited to precisely to properly represent the key features of the image quality, especially when the network can correctly reconstruct the input image. The proposed model consists of encoder and decoder successive networks. The encoder will be used for representing the features of the input image. In turn , the decoder will be used for reconstruct the input image. The features get from encoder network will then be fed to a classifier in order to classify the quality of retinal image to two classes: gradable or ungradable. The experimental results revealed more useful assessment and the proposed deep model provides a superior performance for RIQA. Thus, our model can serve real-world Clinical Decision Support Systems in the healthcare domain.

Self-medication with antibiotics is a most rapidly emerging problem especially in developing countries like Pakistan. Antibiotics are easily accessible to the general public without consulting any practitioner even without prescriptions. So there are many risks linked to the inappropriate use of antibiotics. The main aim of this study was to assess the wrong practice of self-medication in public sector universities of southern Punjab. The current study also compares the self-medication practices in various departments of universities. A validated questionnaire was used to collect data. Descriptive statistics were used to analyze the data and inferential statistics (chi-square test). The study was included data from 900 students including both males and females from various departments. Among 900 students, 450 students of medical while 450 were non-medical students. Frequency of self-medication was found to 57 %. The antibiotics more frequently use for self-medication were Augmentin (37 %), Amoxicillin (23 %). Fever and cough were the most frequent indication for the use of self-medicated antibiotics. Because of their sufficient knowledge of pharmacology, most students were self-medicated (40%). Academic knowledge is the principal source of antibiotic information (60%). Just (39%) of the students thought that self-medication is part of the self-core, 31% of the students perceived that the availability of non-prescription drugs could prevent the growing trend of self-medication with antibiotics. 30% of students perceived that antibiotics were aware of the harms of self-medication or informed about them. Based on this study, it can be concluded that a high proportion of medical students and non-medical students use antibiotics without medical prescription and such practices are more common in the general public sector.

Poster sessions A128Thorax 2012;67(Suppl 2):A1-A204 Background Topical intranasal steroids are widely considered to be the most efficacious pharmacotherapy for the treatment of allergic rhinitis, and yet, for many, symptoms still remain troublesome. We hypothesise that the residual symptoms are a result of nasal neuronal hyperresponsiveness during the pollen season and should be ameliorated by a topical intranasal TRPV1 antagonist. SB705498 is a selective TRPV1 antagonist shown to produce significant inhibition in animal and human models involving nasal sensory nerves. Methods The study involved 70, male and female, subjects with proven rhinitis in a randomised, double-blind, placebo-controlled, 3-way incomplete block crossover design in a well validated Allergen Challenge Chamber paradigm in Vienna. Subjects received Placebo, FP (200ug), SB705498 (12mg), or FP+498. Subjects were dosed for 8 days, within the pollen season, before being exposed to a chamber challenge on the 8 th day. TNSS was the primary endpoint recorded for the 4 hours in the chamber. The comparisons of interest were FP+498 vs. FP, and 498 vs. Placebo. Additional endpoints consisted of symptoms over the 8 days of dosing, Active Anterior Rhinomanometry, Rhinoconjunctivitis QLQ, PK and tolerability. Each period was separated by 14-20 days. Results There was no evidence of a decrease in symptoms with FP+498 compared to FP alone, or for 498 compared to placebo. Statistically significant and clinically relevant reductions in TNSS compared with Placebo were observed at all time points during the challenge for FP and FP+498. The mean (95% CI) reduction in weighted mean TNSS was -2.94 (-3.38, -2.50) for FP alone and-2.28 (-2.79, -1.78) for the combination.