Ngaire A. Coombs

COPD patients have increased risk of developing pneumonia, which is associated with poor outcomes. It can be symptomatically indistinguishable from exacerbations, making diagnosis challenging. Studies of pneumonia in COPD have focused on hospitalised patients and are not representative of the ambulant COPD population. Therefore, we sought to determine the incidence and aetiology of acute exacerbation events with evidence of pneumonic radiographic infiltrates in an outpatient COPD cohort. One hundred twenty-seven patients with moderate to very severe COPD aged 42–85 years underwent blood and sputum sampling over one year, at monthly stable visits and within 72 h of exacerbation symptom onset. 343 exacerbations with chest radiographs were included. 20.1% of exacerbations had pneumonic infiltrates. Presence of infiltrate was highly seasonal (Winter vs summer OR 3.056, p = 0.027). In paired analyses these exacerbation events had greater increases in systemic inflammation. Bacterial detection rate was higher in the pneumonic group, with Haemophilus influenzae the most common bacteria in both radiological groups. Viral detection and sputum microbiota did not differ with chest radiograph appearance. In an outpatient COPD cohort, pneumonic infiltrates at exacerbation were common, and associated with more intense inflammation. Bacterial pathogen detection and lung microbiota were not distinct, suggesting that exacerbations and pneumonia in COPD share common infectious triggers and represent a continuum of severity rather than distinct aetiological events. Trial registration Number: NCT01360398 .

Objectives Sedentary behaviour (SB) is an emerging candidate risk factor for obesity in young people. Evidence to date is conflicting and it is unclear how different SB types are associated with obesity independently of physical activity. The objective of this study was to examine associations between a range of objectively measured and questionnaire-based SB indicators with obesity and body mass index (BMI) to assess whether these associations were independent of physical activity. Participants 4469 (705 with accelerometer data) children aged 5–15 years from the 2008 Health Survey for England. Outcomes The outcome was adiposity, classified using age-specific and sex-specific BMI SD scores (continuous) and obesity cut-offs (binary). Questionnaire-based measures comprised TV time, non-TV sitting time (such as homework, drawing, time at a computer or playing video games), total sitting time (TV time+non-TV sitting time) and average daily MVPA time. Objective SB and moderate to vigorous physical activity (MVPA) time were measured using an Actigraph GT1M accelerometer, with cut-offs of 100 and 200 counts per minute for SB, and 2802 counts per minute for MVPA. Multiple logistic and multiple linear regression models examined associations between each indicator of sedentary time with obesity and BMI SD scores. Results TV time (but not non-TV sitting or objectively-measured SB) was consistently associated with higher levels of obesity and BMI SD score, even after adjusting for MVPA and other potential confounders. Weaker associations were observed for total sitting time. Conclusions TV viewing (but not other forms of objectively-measured or questionnaire-based sedentary time) was associated with obesity in children and adolescents. Although a causal relationship cannot be established, TV time may be a reasonable target for obesity prevention in young populations.