Volume 19 Issue 2 June 2010

• In their paper on pg 163 Miedinger et al. report the prevalence and predictors of airflow obstruction among Swiss smokers aged 40 and over, and the correlation between FEV1 and patient-reported symptoms in the 8,031 patients who had acceptable quality spirometry and symptom data. 29% of the patients had pre-bronchodilator airflow limitation, 58% had at least one current symptom, but there was no correlation between lung function and reported symptoms. In his accompanying editorial on pg 91 Enright puts this paper into context, emphasising the importance of performing simple pre-bronchodilator case-finding spirometry in all smokers irrespective of whether or not they have symptoms.
  
  
• Mapel and colleagues publish two papers in this issue. The first (on pg 93) is a review on the role of combination ICS/LABA treatment for COPD, including the indication for treatment, effects on lung function, exacerbation rates and survival, safety considerations, and cost issues. The discussion section is important, and puts the paper into context given the previously published meta-analyses and reviews on this subject. The second paper on pg 109 is a population-based historical cohort study using longitudinally-collected administrative data on 5,245 COPD patients and their risk of developing pneumonia while on inhaled treatment. In the context of previously-reported findings from the TORCH and UPLIFT studies, in this study COPD patients using ICS alone had a slightly increased but not significant risk of developing pneumonia, and patients on ICS/LABA combinations had no increased risk. The limitations of using historical cohorts to examine disease/treatment associations are discussed.
  
  
• The aim of the MAMBO study was to understand current approaches to acute asthma management in emergency departments around the world, and in their paper on pg 155 Fitzgerald et al. describe the frequency with which lung function testing was performed, as well as the asthma treatment prescribed for patients at discharge.
  
  
• Elsewhere in this issue, Soriano et al. present the results from a pilot population cohort to study the natural history of COPD and obstructive sleep apnoea in the Balearic islands (pg 140), Doyle et al. present a qualitative study on patients who had their inhaler device switched without their consent (pg 131), and the commissioned paper by Halpin on pg 170 is a superb ‘must-read’ for any clinician or researcher wanting to analyse the results of COPD treatment studies.