With such a high volume of academic papers being published daily and increasing open online access, it can be hard to know where to start your reading when you join the training programme, when you are revising for the SCE or when you are updating yourself about an unfamiliar area of practice. A good place to start is wikijournalclub which provides a shortcut into understanding some of the big/landmark trials such as SMART, UPLIFT, TORCH, and PIOPED II, and there’s also an app.

To further help direct your reading we asked some familiar names in Respiratory Medicine to recommend their favourite papers for Respiratory SpRs. If you can’t access one of the papers below through Athens, get in touch and we’ll try to help.

You should of course critically appraise any paper you read, to see if the conclusions are justified, and whether it should lead you to change your practice. Have a look at the Research page for links to helpful resources on improving your critical appraisal skills.

COPD

• Dr Anant Patel, The Royal Free Hospital, recommends:
  • Hogg, James C., et al. “The nature of small-airway obstruction in chronic obstructive pulmonary disease.” New England Journal of Medicine 350.26 (2004): 2645-2653.
• Dr Nick Hopkinson, Imperial, recommends:
  • Greening, Neil J., et al. “An early rehabilitation intervention to enhance recovery during hospital admission for an exacerbation of chronic respiratory disease: randomised controlled trial.” BMJ 349 (2014): g4315.
  • Clark, Samuel J., et al. “Surgical approaches for lung volume reduction in emphysema.” Clinical Medicine 14.2 (2014): 122-127.
  • Köhnlein, Thomas, et al. “Non-invasive positive pressure ventilation for the treatment of severe stable chronic obstructive pulmonary disease: a prospective, multicentre, randomised, controlled clinical trial.” The Lancet Respiratory Medicine 2.9 (2014): 698-705.
• Dr Will Ricketts, Barts Health, recommends:
  • Austin, Michael A., et al. “Effect of high flow oxygen on mortality in chronic obstructive pulmonary disease patients in prehospital setting: randomised controlled trial.” BMJ 341 (2010): c5462. A reminder that seemingly simple interventions (such as using titrated oxygen rather than high flow) can have a significant effect on hard outcomes. Oxygen is a drug…
• Dr Angshu Bhowmik, Homerton Hospital, recommends:
  • Celli, Bartolome R., et al. “An official American Thoracic Society/European Respiratory Society statement: research questions in COPD.” European Respiratory Journal 45.4 (2015): 879-905. Very useful reading for prospective researchers in COPD.
  • Brill SE, Wedzicha JA. “Oxygen therapy in acute exacerbations of chronic obstructive pulmonary disease.” International Journal of Chronic Obstructive Pulmonary Disease. 2014;9:1241-1252. doi:10.2147/COPD.S41476. A useful educational article about oxygen use. 

Smoking

• Dr Anant Patel, Royal Free Hospital, recommends:
  • Doll, Richard, and A. Bradford Hill. “Smoking and carcinoma of the lung.” BMJ 2.4682 (1950): 739-748. A classic! Some great lessons on epidemiology, causation and the political power of scientific knowledge.
• Dr LJ Smith, Kings College Hospital, recommends:
  • Hiding in Plain Sight: Treating Tobacco Dependancy in the NHS. This 2018 RCP report addresses the harms and costs arising from smoking in the patients we see every day, and argues for a new approach to treating their addiction, with a focus on the responsibility of secondary care. A great read, full of useful data! 

Asthma

• Dr Simon Quantrill, Whipps Cross Hospital, recommends:
  • França-Pinto, Andrezza, et al. “Aerobic training decreases bronchial hyperresponsiveness and systemic inflammation in patients with moderate or severe asthma: a randomised controlled trial.” Thorax (2015): thoraxjnl-2014. Consider how you might arrive at an “exercise prescription” for any given patient, and the value of pulmonary rehab in asthma.
  • Levy, Mark L., and Robert Winter. “Asthma deaths: what now?.” Thorax (2015): thoraxjnl-2015. Do you ask patients’ GPs for a record of their last 12 months respiratory prescriptions? You might get a shock if you do. Before addressing “patient compliance”, find out the quantity of inhalers your patient is being prescribed in the first place and consider electronic methods of tracking this in primary/secondary care.

Corticosteriods

• Prof Graham Bothamley, Homerton Hospital, recommends:
  • Maberly, D. J., G. J. Gibson, and A. G. Butler. “Recovery of adrenal function after substitution of beclomethasone dipropionate for oral corticosteroids.” BMJ1.5856 (1973): 778-782.
  • Webb, J. R., and T. J. Clark. “Recovery of plasma corticotrophin and cortisol levels after three-week course of prednisolone.” Thorax 36.1 (1981): 22-24. When prescribing steroids do you think about how long they can be given for without significant adrenal suppression? How quickly do patients recover?

Inhaled therapies

• Dr James Goldring, Royal Free Hospital, recommends:
  • “How long should my regular inhaler last?” Not a paper, but a useful guide written by the Islington Responsible Respiratory Prescribing group. For those  inhalers without a dose counter it tells patients when to replace their inhalers as you can’t rely on just shaking the inhaler to tell.

Lung cancer

• Dr Neal Navani, UCLH, recommends:
  • Aberle, Denise R., et al. “Reduced lung-cancer mortality with low-dose computed tomographic screening.” The New England journal of medicine 365.5 (2011): 395-409. Will we see CT screening in the UK in our lifetimes? It seems more likely than ever now! 
• Prof Jerry Brown, UCLH, recommends:
  • Geddes, D. M. “The natural history of lung cancer: a review based on rates of tumour growth.” British journal of diseases of the chest. 73 (1979): 1-17.

Pleural disease

• Dr James Goldring, Royal Free Hospital, recommends:
  • Davies, Helen E., et al. “Effect of an indwelling pleural catheter vs chest tube and talc pleurodesis for relieving dyspnea in patients with malignant pleural effusion: the TIME2 randomized controlled trial.” JAMA 307.22 (2012): 2383-2389. Establishes that IPC is as effective at relieving dyspnoea (and probably more so at 6 months) but without needing to stay in hospital for 4 days and 51% of patients in the IPC arm were able to have their IPCs removed as the IPC itself had resulted in definitive pleurodesis.

Palliative care

• Dr Elin Lowri, Royal Shrewsbury Hospital,  recommends:
  • Pinnock, Hilary, et al. “Living and dying with severe chronic obstructive pulmonary disease: multi-perspective longitudinal qualitative study.” BMJ 342 (2011): d142. A reminder that we should not impose our own narrative on patients’ experiences, and encourages us to accept uncertainty.

Pulmonary infection

• Prof Jerry Brown, UCLH, recommends:
  • Lim, W. S., et al. “Study of community acquired pneumonia aetiology (SCAPA) in adults admitted to hospital: implications for management guidelines.” Thorax 56.4 (2001): 296-301.
  • Kosmidis, Chris, and David W. Denning. “Republished: The clinical spectrum of pulmonary aspergillosis.” Postgraduate medical journal 91.1077 (2015): 403-410.

TB (pulmonary)

• Prof Graham Bothamley, Homerton Hospital, recommends:
  • Comstock, George W., and Phyllis Q. Edwards. “The competing risks of tuberculosis and hepatitis for adult tuberculin reactors.” American Review of Respiratory Disease 111.5 (1975): 573-577. An editorial exploring age and risks of hepatitis on TB treatment. 
  • Citron, K. M., and G. O. Thomas. “Ocular toxicity from ethambutol.” Thorax 41.10 (1986): 737-739. Editorial providing reassurance that the incidence of ocular toxicity is low. 
  • Thiam, Sylla, et al. “Effectiveness of a strategy to improve adherence to tuberculosis treatment in a resource-poor setting: a cluster randomized controlled trial.” JAMA 297.4 (2007): 380-386. Evidence for DOT and factors that make it effective. 
  • Sharma, Surendra K., et al. “Safety of 3 different reintroduction regimens of antituberculosis drugs after development of antituberculosis treatment–induced hepatotoxicity.” Clinical Infectious Diseases 50.6 (2010): 833-839. How to reintroduce TB treatment after liver injury.
  • Van der Watt, J. J., et al. “Polyneuropathy, anti-tuberculosis treatment and the role of pyridoxine in the HIV/AIDS era: a systematic review .”The International Journal of Tuberculosis and Lung Disease 15.6 (2011): 722-728.
  • Lange, Christoph, et al. “Management of patients with multidrug-resistant/extensively drug-resistant tuberculosis in Europe: a TBNET consensus statement.” European Respiratory Journal 44.1 (2014): 23-63.
  • Jindani, Amina, et al. “High-dose rifapentine with moxifloxacin for pulmonary tuberculosis.” New England Journal of Medicine 371.17 (2014): 1599-1608. Evidence for an alternative continuation phase treatment regime. 

TB (latent)

• Prof Graham Bothamley, Homerton Hospital, recommends:
  • Mack, U., et al. “LTBI: latent tuberculosis infection or lasting immune responses to M. tuberculosis? A TBNET consensus statement.” European Respiratory Journal 33.5 (2009): 956-973. Understanding what a positive IGRA means.
  • Sterling, Timothy R., et al. “Three months of rifapentine and isoniazid for latent tuberculosis infection.” New England Journal of Medicine 365.23 (2011): 2155-2166. On treatment of LTBI.

TB (extra-pulmonary)

• Prof Graham Bothamley, Homerton Hospital, recommends:
  • Torok, M. E., et al. “Dexamethasone and long-term outcome of tuberculous meningitis in Vietnamese adults and adolescents.” PLoS One 6.12 (2011): e27821.
  • Ruslami, Rovina, et al. “Intensified regimen containing rifampicin and moxifloxacin for tuberculous meningitis: an open-label, randomised controlled phase 2 trial.” The Lancet Infectious Diseases 13.1 (2013): 27-35.
  • Strang, J. I. G., et al. “Controlled clinical trial of complete open surgical drainage and of prednisolone in treatment of tuberculous pericardial effusion in Transkei.” The Lancet 332.8614 (1988): 759-764. Steroid use in pericardial effusions due to TB.

Sleep disordered breathing and Respiratory Failure

• Dr Will Ricketts, Barts Health, recommends:
  • Plant, P. K., J. L. Owen, and M. W. Elliott. “Early use of non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease on general respiratory wards: a multicentre randomised controlled trial.” The Lancet355.9219 (2000): 1931-1935. The classic NIV paper, on which many of your hospital guidelines on NIV outside ICU will be based.

Bronchiectasis and CF

• Prof Jerry Brown, ULCH, recommends:
  • Wong, Conroy, et al. “Azithromycin for prevention of exacerbations in non-cystic fibrosis bronchiectasis (EMBRACE): a randomised, double-blind, placebo-controlled trial.” The Lancet 380.9842 (2012): 660-667.
  • Chalmers, James D., et al. “Short-and long-term antibiotic treatment reduces airway and systemic inflammation in non–cystic fibrosis bronchiectasis.”American journal of respiratory and critical care medicine 186.7 (2012): 657-665.

Pulmonary vascular disease

• Dr Nick Murch, Royal Free Hospital, recommends:
  • Condliffe, R., Elliot, C. A., Hughes, R. J., Hurdman, J., Maclean, R. M., Sabroe, I., … & Kiely, D. G. (2013). Management dilemmas in acute pulmonary embolism. Thorax.  A practical and well-referenced article on dilemmas in all aspects of PE management including when to thrombolyse sub-massive PE, and whether to treat sub-segmental PEs. A godsend in this ‘evidence-light’ area.

Bronchoscopy

• José, Ricardo J., Shahzad Shaefi, and Neal Navani. “Sedation for flexible bronchoscopy: current and emerging evidence.” European Respiratory Review 22.128 (2013): 106-116.

Breathlessness

• Dr LJ Smith, Kings College Hospital, recommends:
  • Boulding R, Stacey R, Niven R, Fowler SJ. “Dysfunctional breathing: a review of the literature and proposal for classification. European Respiratory Review.” 2016 Sep;25(141):287–94.
  • Spathis, Anna, et al. “The Breathing, Thinking, Functioning clinical model: a proposal to facilitate evidence-based breathlessness management in chronic respiratory disease.” NPJ primary care respiratory medicine 27.1 (2017): 27.

Occupational lung disease

• Fishwick D, Barber CM, Bradshaw LM, et al. “Standards of care for occupational asthma: an update.” Thorax 2012; 67: 278-280.
• Nicholson PJ, Cullinan P, Burge PS, Boyle C. “Occupational asthma: Prevention, identification, and management: Systematic review and recommendations.” London: BOHRF 2010.

And now for something different

• Dr Anant Patel, Royal Free Hospital, recommends:
  • Butler, James P., et al. “Evidence for adult lung growth in humans.” New England Journal of Medicine 367.3 (2012): 244-247.  A pointer towards an ambitious future? A new meaning to the phrase “grow a pair”…?
• Dr Nick Hopkinson, Imperial, recommends:
  • Hopkinson, Joseph A., and Nicholas S. Hopkinson. “The hobbit—an unexpected deficiency.” The Medical Journal of Australia 199.11 (2013): 805-806.  Suggests that vitamin D deficiency in evil characters is a significant factor in the triumph of good over evil in Middle Earth. What more is there to say?
• Dr LJ Smith, Kings College Hospital, recommends:
  • West, John B. “Snorkel breathing in the elephant explains the unique anatomy of its pleura.” Respiration physiology 126.1 (2001): 1-8. If you’ve ever wondered why elephants don’t have a pleural space, then this paper is for you!