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Introduction/Aim Acute exacerbations of chronic obstructive pulmonary disease can vary in severity and the degree of ventilatory support that is required, and there remain a significant cohort of patients that require admission to the intensive care unit for this indication. The aim of this study is to define the characteristics of patients admitted to the intensive care unit with exacerbations of COPD, with a focus on their comorbidities, and their mortality. Methods Retrospective review of patient admitted to the ICU at Logan Hospital with the primary diagnosis of an exacerbation of COPD, between 2014 and 2017. Results A total of 117 patients with an average age of 68 were admitted to the ICU for the management of an exacerbation COPD. The prevalence of comorbidities was high, including obesity (45%), hypertension (43%), and obstructive sleep apnoea (31%). The main reason for admission was hypercapneic respiratory failure, though this wasn't the exclusive cause, and 36% of patients were not acidaemic at the time of ICU admission. The predicted risk of death in hospital using APACHE2 ICU scoring system was 26.5% compared with the observed mortality of 22%. One year mortality was 47%. Only 45% of the admitted patients were known to the local respiratory team prior to admission to ICU. Conclusion Patients who required ICU admission due to an exacerbation of COPD were defined by multiple comorbidities and these admissions were associated with high mortality at 30 days and one year. Optimal monitoring and follow‐up can potentially be aided by acknowledging these findings.

In this work we study communication with a party whose secrets have already been compromised. At first sight, it may seem impossible to provide any type of security in this scenario. However, under some conditions, practically relevant guarantees can still be achieved. We call such guarantees “postcompromise security”. We provide the first informal and formal definitions for post-compromise security, and show that it can be achieved in several scenarios. At a technical level, we instantiate our informal definitions in the setting of authenticated key exchange (AKE) protocols, and develop two new strong security models for two different threat models. We show that both of these security models can be satisfied, by proposing two concrete protocol constructions and proving they are secure in the models. Our work leads to crucial insights on how postcompromise security can (and cannot) be achieved, paving the way for applications in other domains.

Many countries have introduced newborn screening for cystic fibrosis to facilitate diagnosis prior to the development of lung disease. Although most infants with cystic fibrosis are asymptomatic from a respiratory point of view at diagnosis, structural lung disease has been detected by computed tomography. We present a case of an asymptomatic infant with cystic fibrosis diagnosed following newborn screening who had endobronchial infection with Pseudomonas aeruginosa and radiological evidence of bronchiectasis at 3 months of age.

BackgroundRecently, an established “small macrophage” phenotype has been observed in the sputum of patients with CF and COPD. However, little is known about the prevalence of this phenotype in the airways of young children. Since respiratory inflammation begins early in CF, we hypothesised that these small macrophages would be increased in paediatric CF bronchoalveolar lavage (BAL).MethodsMacrophage populations in CF and disease control BAL were assessed by multicolour flow cytometry. BAL inflammatory indices were collected as part of the AREST-CF programme.ResultsSmall macrophages were present in CF (n=35, mean 36±12% of BAL macrophages) but not significantly different to the respiratory disease controls (n=7, mean 40±21%). Number of small macrophages correlated significantly with number of BAL neutrophils (r=0.44, p

Asthma is the commonest medical cause for hospital admission for children in Australia, affects more than 300 million people worldwide, and is incurable, severe in large number and refractory to treatment in many. However, there have been no new significant treatments despite intense research and billions of dollars. The advancement in our understanding in this disease has been limited due to its heterogeneity, genetic complexity and has severely been hampered particularly in children by the difficulty in obtaining relevant target organ tissue. This review attempts to provide an overview of the currently used and recently developed/adapted techniques used to obtain lung tissue with specific reference to the airway epithelium.

Background Interleukin-8 (IL-8) and neutrophil elastase (NE) are commonly measured markers of inflammation in bronchoalveolar lavage (BAL) fluid from patients with cystic fibrosis. Longitudinal analysis assumes uniform stability during storage, however the effect of extended low-temperature storage on these markers remains unclear. Methods BAL fluid from 104 children with cystic fibrosis was assayed for IL-8 and NE after storage at 4 °C for 7 days and − 80 °C for up to 6 years and compared with the initial assays performed soon after collection. Results IL-8 levels were stable after any measured length of time at − 80 °C or 4 °C. NE levels were stable for 6 months at − 80 °C but decreased beyond that or after 7 days at 4 °C. Conclusions Our data support the stability of IL-8 in BAL stored at − 80 °C for prolonged periods. NE in BAL decreases with storage and should be assayed as soon as practical after collection.