Airwaves Thorax: first published as 10.1136/thoraxjnl-2019-214495 on 27 January 2020. Downloaded from Highlights from this issue

doi:10.1136/thoraxjnl-2019-214495 The Triumvirate

With the release of the twenty fifth James Quantum of Solace Bond movie early next month, “No time to In the 22nd Bond film James Bond goes after die,” this month’s Airwaves will whet your an errant environmentalist who works for the appetite with a Bond flavoured selection from secret organisation Quantum. The only solace Thorax. is that Bond gets his guy and saves the world. However, in patients with advanced progres- Altered relaxation time sive lung disease anything that might help At the beginning of “No time to die,” Bond relieve symptoms of breathlessness would has left the service and is enjoying some offer some quantum of solace. In this issue of relaxation time. Needless to say the relax- Thorax, Higginson et al (see page 176) under- ation time is brief and Bond is recruited on took a feasibility study using mirtazapine for data system used in Canada is more conducive a mission to find a missing scientist abducted severe breathlessness in advanced lung disease. to detection with Johnson and colleagues (see by the arch villain Safin. Altered relaxation Although they had to screen 409 patients to page 108) using this to improve early detec- times also feature in the paper by Kai Förster randomise 64 patients, 81% completed the tion of COPD. In their registry-based­ longi- and colleagues in this month’s Thorax (see 28 day trial without any differences in safety tudinal cohort study, 112 635 COPD and page 184). Their paper describes MRI relax- or tolerability compared with placebo. Much non-­COPD pairs were reviewed with COPD ation times in 61 spontaneously-breathing­ like the film this study is a multinational effort patients demonstrating higher rates of outpa- infants with bronchopulmonary dysplasia. that offers promise that a full clinical trial will tient services before diagnosis. Perhaps we Their study includes both exploration (n=40) demonstrate more than a single quantum need to incorporate some of the technology and validation cohorts (n=21). They found of solace for people with these devastating used by James Bond to develop a ‘Detector that increased T2 and decreased T1 relax- conditions. for Investigating COPD in Early’ disease ation time indicated BPD (area under the (DICE). However, until then, we will just curve=0.80). See teaser image (figure 1) A have to roll with it. linked editorial by Rosenow and Prayle (see From Russia with love Bond films are notable for their villains, in page 100) discusses how we can “look under Dr FeNo From Russia with Love featured the partic- the bonnet” of bronchopulmonary dysplasia, Dr. No, a Chinese-­German criminal scientist ularly compelling Rosa Klebb. Klebb was where MRI has the potential to define pheno- is one of the lead operatives for SPECTRE. the head of Operations and Executions and types and explore mechanisms. No one has After enrolling, but not completing medical would have found room for Krebs von den time to look under the bonnet of Bond’s Aston school, he adopted the title of doctor and Lungen-6 in her department, we could be Martin in the new Bond movie but the trailer subsequently changed his name to Dr Julius sure. Although KL-6, as it is more commonly promises machine guns behind the headlights! No. Dr Lo, and colleagues (see page 101), http://thorax.bmj.com/ known, sounds like the member of Spektor it follow the ‘Dr No’ theme in their study but is actually a biomarker associated with lung on this occasion Dr Lo used FeNO to study Morland of Grosvenor Street injury and fibrosis and identifies Mucin-1 the childhood asthma managed in primary In the original novels by Ian Fleming, Bond (MUC1). In this month’s Thorax Milara et care. In this prospective observational cohort smoked around 60 cigarettes per day and al (see page 132) describe the mechanism study, 612 children from 10 general practices had these specially made by Morland of by which high levels of phosphorylation of were included in which spirometry, FeNO, Grosvenor Street. They contained a mixture the cytoplasmic tail of MUC1 were associ- asthma control test scores and unplanned of Balkan and Turkish tobacco and had a ated with TGFβ activation and demonstrate higher nicotine content than normal. While healthcare attendances were measured. Dr Lo that the profibrotic mediator galectin-3 was on September 24, 2021 by guest. Protected copyright. found that abnormal lung function and FeNO there was nothing secondhand about Bond’s also able to activate MUC1 and served as a are common and relate poorly to symptom smokes, secondhand smoke does feature in link between TGF and MUC1. This paper β scores with a significant discrepancy between the paper by Milanzi et al (see page 153) in contains as many twists and turns as your symptom-­based assessment and objective the journal this month. The authors use data average Bond movie and leaves you just as testing such both are best combined to effec- from the Dutch Prevention and Incidence of satisfied at the end. Asthma and Mite Allergy (PIAMA) cohort. tively manage childhood asthma. Combining They find that secondhand smoke exposure Dr No and James Bond is unlikely to have the in childhood is associated with reduced lung Spectre same positive outcome. function growth and a lower lung function Members of the ‘Special Executive for achieved in in adolescence. In the upcoming Counterintelligence, Terrorism, Revenge Competing interests None declared. film, Bond shows no evidence of dyspnoea and Extortion’ (SPECTRE), an organisation Patient consent for publication Not required. during the action sequences which might be whose sole purpose is to instigate conflict attributed to reduced lung function. Indeed, between two superpowers, are referred to by Provenance and peer review Commissioned; in contrast to his first cinematic outings in number rather than by name. The numbers internally peer reviewed. the early 1960s, Bond is rarely if ever seen are initially assigned at random and then © Author(s) (or their employer(s)) 2020. No commercial to smoke in recent movies. It’s never too late rotated up by two digits on monthly basis to re-use­ . See rights and permissions. Published by BMJ. to quit! avoid detection. It is fortunate that the health

Thorax February 2020 Vol 75 No 2 97