British Thoracic Society Winter Meeting 2001.

T he 2001 Winter Meeting of the British Thoracic Society covered a wide range of respiratory topics. Over 300 papers were presented and a number of lively symposia were delivered by internationally renowned speakers. ASTHMA During 2001 there has been much interest in the progress of new treatments in asthma as clinical trials of several agents targeting the Th1/Th2 imbalance have been published. 1–3 In a comprehensive review of these studies, Leckie et al suggested that the apparently disappointing results reflect the heterogeneous nature of the disease and the fact that individual agents are active against only tiny proportions of a complex inflammatory cascade. 1 A comparative immuno-histochemical study of asthma and eosinophilic bronchitis by Brightling et al reported a novel and exciting observation which may provide a future therapeutic target in asthma. 4 Their work, short listed for the BTS/BLF Young Investigator prize (see below), showed that, while there were no differences in eosinophilic inflammation between groups, mast cells were seen within the airway smooth muscle of patients with asthma but not those with eosinophilic bronchitis, and in numbers which negatively correlated with the degree of airway hyperresponsiveness. This suggests that the infiltration of airway smooth muscle by mast cells may be important in the pathogenesis of asthma. Since airway hyperresponsiveness is such a key feature of asthma, it was disappointing to hear that this is an area which remains under-used in the UK. Of 139 laboratories responding to Butterfield and Cushley's survey, 5 only 58 ever measure hyperresponsiveness, most measure it only rarely, and few adhere to published guidelines—suggesting significant room for improvement. Another often underexplored area in asthma is dysfunctional breathing. In a randomised controlled trial Thomas et al showed that the use of a physiotherapy based breathing retraining programme for patients treated for asthma in primary care resulted in significant improvements in health status at 1 and, to some extent, at 6 months. 6 Perhaps a useful future approach to the management of asthma would see such physical treatments used alongside the new pharmacological advances. It will be many years before we see whether novel approaches to asthma treatment reap benefits in terms of the prevention of decline in lung function. Prospective longitudinal studies provide important information about the long term outlook in asthma but are difficult to perform. It was therefore good to see two such studies presented at the meeting demonstrating the accelerated decline …