Omalizumab, a humanised monoclonal anti-immunoglobulin E (IgE) antibody, is indicated as adjuvant treatment in refractory allergic severe asthma.1 In both chronic rhinosinusitis (CRS) with nasal polyps (NP) and allergic rhinitis, IgE is increased in mucosal tissue and frequently in serum. The role of omalizumab has been clearly established in allergic asthma and rhinitis, but remains to be elucidated in NP.2 The only evidence for the potential efficacy of omalizumab in NP relies on case reports and small series of patients which suggest that, when NP and asthma coexist, the anti-IgE may have therapeutic value on NP.3 4

We describe the evolution of NP in 19 patients who were treated with omalizumab for severe asthma and who also had CRS with NP (age 49±9.5 years, 58% women). The baseline serum IgE level was 257 KU/l (range 115–328). The subcutaneous dosage of omalizumab was based...

Although guidelines recommend targeted oxygen therapy for patients with hypoxia and exacerbations of chronic obstructive pulmonary disease (COPD), there is no strong evidence that this strategy is effective. In this study, Austin and colleagues perform the first randomised controlled trial, in the prehospital setting, of oxygen therapy titrated to target saturations in patients at risk of COPD.

Four hundred and five patients were recruited if upon paramedic assessment they fulfilled criteria for a presumptive diagnosis of COPD. The study suffered from a high level of deviation from the protocol, predominantly administration of high flow oxygen to patients in the titrated oxygen arm. Despite this limitation, intention to treat analysis demonstrated significantly reduced mortality (RR 0.42, 95% CI 0.2 to 0.89) in all patients in the titrated oxygen arm, including those later found to have no spirometric evidence of COPD and also in those with confirmed COPD (n=214) (RR 0.22,...

We applaud the British Thoracic Society (BTS) for its efforts to improve patient care through scientific evidence. We thus recognise the recent guidelines on pleural procedures and thoracic ultrasound (TUS) as an important attempt to develop a rational approach to chest sonography.1 However, we are concerned that the BTS has reached conclusions based on a less complete review of TUS.

The guidelines state that ‘the utility of thoracic ultrasound for diagnosing a pneumothorax is limited in hospital practice due to the ready availability of chest x-rays (CXR) and conflicting data from published reports’.1 This conclusion appears to be based on a small (but landmark) study of 11 patients from 1986 to 1989, two small studies with only four pneumothoraces in one and another small series whose ultrasounds were retrospectively reviewed. Against these small and somewhat dated studies, a large number of recent investigations support a...

This article summarises the key points from the 2011 British Thoracic Society (BTS) recommendations on managing passengers with respiratory disease planning air travel. The guidance aims to provide practical advice for respiratory specialists in secondary care and serves as a valuable reference for other healthcare professionals managing these patients. A greater awareness of the challenges posed by air travel will allow improved clinical assessment and practical advice to encourage patients to fly safely wherever possible.