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Sarcoidosis is the most prevalent interstitial lung disease in the Western world, yet there is no single diagnostic test. Flexible bronchoscopy is usually used in the first instance, owing to its reasonable diagnostic yield and low cost; however, it is not uncommon for clinicians to be faced with a non-diagnosis following bronchoscopy. Belgian researchers studied 137 patients to determine whether endoscopic ultrasound improved the diagnostic yield of sarcoidosis. 
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Pulmonary rehabilitation: today and tomorrow
L. Nici, R. ZuWallack
 
Comprehensive and effective clinical management of chronic obstructive pulmonary disease (COPD) requires an interdisciplinary, integrated care approach that includes both pharmacological and nonpharmacological therapies. Pulmonary rehabilitation is a nonpharmacological, interdisciplinary, patient-centred intervention that is a crucial component of the optimal care for patients with COPD, and, as such, has a prominent place in all current guidelines for the treatment of this disease.
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Integrated care of the COPD patient: a pulmonary rehabilitation perspective
R. ZuWallack, L. Nici

The current acute care model for COPD is, in general, insufficient for optimal management of the disease. Single disease guidelines often fall short for diseases such as COPD that have prominent systemic manifestations and frequent comorbidities contributing to disease burden. Coordination of services is often inadequate, especially at the time of the COPD exacerbation, which is characterised by high morbidity, increased healthcare utilisation and increased mortality risk.
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Discharge planning and management for patients with chronic respiratory failure using home mechanical ventilation
A. Piper

The use of home mechanical ventilation (HMV) to manage chronic respiratory failure (CRF) is becoming increasingly prevalent, and is usually delivered by means of a mask interface and pressure preset device. Although the transition from initial acclimatisation and prescription of ventilation to long-term home use is fairly straightforward for many patients with respiratory failure, issues such as nutrition, progressive ventilatory dependence and psychosocial problems can arise.
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Outpatient pulmonary rehabilitation
S. Singh, K. Wagg

Pulmonary rehabilitation provides a package of education, nutritional support and physical training that promotes the skills required for patients to successfully self manage their respiratory condition. Improvements in quality of life, exercise tolerance, physical activity and function are key outcomes for the individual. There are many tools available which measure these changes and can be used to identify individual deficits and needs.
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What does the respiratory physician interested in sleep need to know about bariatric surgery?
H. Ramsey, D.J. Pournaras, A. Ahmed, C. le Roux, M.R. Partridge
 
Obstructive sleep apnoea/hypopnoea syndrome (OSAHS) is reported to affect 4% of middle-aged males and 2% of middle-aged females in the UK, with one of the most widely recognised major risk factors being obesity. The prevalence of obesity in many countries is rising – in England, 24% of males and females were classified as obese in 2007, compared with 13.2% of males and 16.4% of females in 1993.
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Continuous positive airway pressure and humidification
G. Nilius, K-H. Ruhle
 

Upper airway complications are very common during noninvasive positive-pressure ventilation, particularly continuous positive airway pressure (CPAP). Acceptance of CPAP is compromised if such complaints occur; thus proactive management is very important for the achievement of good compliance. The use of conventional heated humidifiers is standard therapy when complications with upper airways arise during CPAP therapy.
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Pathogenesis and diagnosis of bronchiectasis
P.T. King, E. Daviskas
 

Management of bronchiectasis
P.T. King, E. Daviskas Non-cystic fibrosis (non-CF) bronchiectasis remains a common and difficult respiratory condition to manage. Patients with bronchiectasis generally tend to have persistent symptoms and require long-term medical treatment. There are a large number of treatment options available for the management of bronchiectasis. However only a limited number of trials to assess efficacy of treatment have been conducted.
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Medical aerosols: ins and outs of inhalation therapy 
S. Radic, E. Salonini

Cough and dyspnoea is not always bronchial asthma
L. Junker, S. Lamm, M. Tamm, D. Lardinois

 

 A 39-yr-old female patient who never smoked suffered from chronic dry cough and progressive exercise-induced dyspnoea over a period of 18 months. In 2007, lung volumes were normal, but there was moderate bronchial hyperreactivity as assessed by bronchoprovocation with methacholine.
There was a drop in forced expiratory volume in 1 s (FEV1) of 22% predicted following administration of 0.2 mg methacholine.
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Step-up therapy for children with uncontrolled asthma receiving inhaled corticosteroids
M. Brouwer, P. Merkus 

Every clinician treating children with asthma knows the dilemma: which step-up treatment will be the right choice for a child with uncontrolled asthma receiving low-dose corticosteroids? There was a lack of evidence to guide practitioners.
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Role of pneumococcal vaccine on the incidence of childhood empyema 
F. Saretta, G. Marrone, M. Canciani

This is a retrospective cohort study of children <18 yrs, based on the Kids’ Inpatient Database in the US, which contains discharge, diagnostic and procedure codes of 80% of hospitalised children throughout the US.  
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An electronic diary recording of craving variations in real-world smokers 
J. Prignot

Craving is considered as one of the most difficult obstacles to successful quitting and conditions of craving are high-risk situations for relapse. This study aimed to demonstrate the variations in craving intensity in a real-world setting.
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Long-term follow-up after thymoma surgery

Thymomas are rare mediastinal neoplasms. Their staging and optimal therapy remain controversial. Long-term results in surgically resected thymomas associated with myasthenia gravis remain unclear. From 1972 to 2007, 317 patients underwent surgical
resection of a thymoma.  
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Insomnia in chemotherapy patients 
J. Verbraecken

General sleep disruption is common among patients receiving chemotherapy, but insomnia, a specific type of sleep disruption, has received little attention. The prevalence of insomnia in this population has yet to be determined in large-scale studies.
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One CME credit can be gained from this issue of Breathe. To receive the credit you need to read the CME article and complete a CME test by answering multiple choice and/or true-false questions.
CME credits will be awarded for successful completion of a test with a grade of 75% or higher. You can directly print your certificate!  
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Pulmonary arterial hypertension (PAH) is a rare condition affecting about 15 to 25 people out of every million. It is caused by very high blood pressure in the arteries that lead from the heart to the lungs, known as pulmonary arteries. This increase in blood pressure puts strain on the heart, and will eventually cause the right side to stop working. PAH is a very serious disease, for which there is unfortunately no cure.