Alternative outcomes for the multiple breath washout in children with CF

BACKGROUND The lung clearance index (LCI) measured by multiple-breath washout (MBW) has been proposed as an outcome for clinical trials; however, MBW is time consuming and LCI can be affected by breathing pattern. We aimed to evaluate moment ratios and abbreviated LCI in school-aged children with mild-to-moderate CF lung disease. METHODS Using existing data from three studies we assessed the sensitivity of moment ratios and abbreviated LCIs to (i) detect mild-to-moderate CF lung disease and (ii) detect treatment effects after 4weeks of hypertonic saline or dornase alfa inhalation. MBW was measured by respiratory mass spectrometry using 4% "sulphur hexafluoride as a tracer gas. RESULTS Compared to the traditional LCI, moment ratios and abbreviated LCIs were similarly sensitive to detect CF lung disease. Moment ratios consistently demonstrated treatment effects, whereas abbreviated LCIs were less sensitive. CONCLUSIONS Both moment ratios and abbreviated LCI are suitable to differentiate health from disease. Sensitivity is decreased for abbreviated LCIs in interventional studies in mild CF lung disease.

Betula pendula, Betula pubescens and other birches in Europe: distribution, habitat, usage and threats

Silver birch (Betula pendula Roth) and downy birch (Betula pubescens Ehrh.) are short-lived, relatively small broadleaved trees that occur throughout most of Europe, particularly in northern regions. In southern Europe, birch trees are confined to mountainous areas, as they do not tolerate prolonged summer drought. Birch has a light canopy of small serrated leaves, and characteristic smooth, white to grey bark. In northern regions, birch trees can dominate the landscape up to the tree-line, whereas in the centre of their range they often occur early in secondary succession because of their abundant seed production, low demands on soil quality, and intolerance of shade. Birch trees provide the predominant hard wood source in northern Europe, and some varieties of Betula pendula produce highly priced veneers, while Betula pubescens is mostly used for pulp and fire wood. Other rarer species of birch are endemic to Europe contributing to the continental biodiversity even at high elevations and latitudes.