YEAR IN REVIEW Year in review 2011: Acute lung injury, interstitial lung diseases, physiology, sleep and lung cancer KAZUHISA TAKAHASHI, 1 NEIL D. EVES, 2 AMANDA PIPER, 3,4 YUANLIN SONG 5,6,7 AND TOBY M. MAHER 8,9,10 1 Department of Respiratory Medicine, Juntendo University School of Medicine, Bunkyo-ku, Tokyo, Japan, 2 School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada, 3 Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital and 4 Discipline of Sleep Medicine, University of Sydney, Sydney, New South Wales, Australia, 5 Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Respiratory Disease Institute, Fudan University and 6 Shanghai Public Health Clinical Centre, Jinshan, Shanghai, China, 7 Department of Anesthesia and Perioperative Care, University of California, San Francisco, California, USA, and 8 Interstitial Lung Disease Unit, Royal Brompton Hospital, 9 National Heart Lung Institute, Imperial College and 10 Centre for Respiratory Research, University College London, London, UK Key words: acute respiratory distress syndrome, idio- pathic pulmonary fibrosis, mesothelioma, obstructive sleep apnoea, sarcoidosis. ACUTE LUNG INJURY (ALI) Yuanlin Song ALI and acute respiratory distress syndrome remain severe respiratory diseases with a high morbidity and mortality. 1 For this reason ALI/acute respiratory dis- tress syndrome are an important topic of on-going research. During 2011 Respirology published a number of important papers focusing on risk factor identification, biomarker screening, imaging for lung injury assessment and potential novel treatments. Risk factors Robinson et al. comprehensively summarized the effects of natural disasters on human lung health. 2 It is not surprising that most natural disasters are associ- ated with respiratory disease due to inhalation of various particles and noxious gases. This is especially the case with ambient matter with a diameter less than 10 mm; a size of particle that can penetrate the distal airway and which can then injure airway and alveolar epithelial cells. These particles may well increase cell permeability partially through induction of occludin internalization. 3 Effective prevention, which relies on prompt and early intervention immediately after disasters, is very important to ensure safety and lung health. An alert system following disaster may mini- mize hazardous exposure and reduce subsequent morbidity and mortality in the general population. Lung injury assessment Quantification of lung injury enables optimization of treatment and provides an indication of prognosis. There are, however, currently very few practical tools that enable clinicians to make an accurate disease severity assessment in individuals with ALI. Lung infection is a major risk factor for ALI. Tagami et al. found plasma neutrophil elastase level correlates with pulmonary vascular permeability index. 4 This obser- vation could be useful for assessing endothelial per- meability changes in severe pneumonia patients. In another study, Bastin et al. found that a progressive drop in pH in exhaled breath condensation fluid during single lung ventilation is inversely correlated with increased lung injury. 5 The exact mechanism of exhaled breath condensation pH changes and associa- tion with ALI warrants further investigation. Imaging analysis demonstrates that CT can be used to measure tissue density and perfusion in normal and acute res- piratory distress syndrome lungs through intravenous injection of contrast fluid. 6 This imaging approach is thus useful for detecting heterogeneous blood perfu- sion in acute respiratory distress syndrome patients. Treatment There have been several studies in the last few years showing promising treatment strategies that are Correspondence: Toby M. Maher, Interstitial Lung Disease Unit, Royal Brompton Hospital, London SW3 6NP, UK. Email: t.maher@rbht.nhs.uk Received 31 December 2011; accepted 10 January 2012. © 2012 The Authors Respirology © 2012 Asian Pacific Society of Respirology Respirology (2012) 17, 554–562 doi: 10.1111/j.1440-1843.2012.02127.x