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Correspondence to Dr Robina Kate Coker, Respiratory Medicine, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, London, UK; robina.coker@imperial.ac.uk Introduction BTS recommendations for managing passengers with stable respiratory disease planning air travel were published in Thorax in 2011.1 This followed original guidance published in 20022 and an online update in 2004.3 The 2011 recommendations provided an expert consensus view based on literature reviews, aimed at providing practical advice for lung specialists in secondary care. [...]passengers booking such flights should note that airlines may, for operational reasons, switch at short notice to an aircraft with a higher normal cabin altitude. Besides the passenger’s respiratory condition and significant comorbidities, a decision regarding suitability for air travel should consider flight duration and timings, destination (especially if at altitude or subject to extreme weather conditions), equipment and medications, and whether equipment will operate effectively and safely at altitude. [...]the equipment used to deliver oxygen has changed significantly over the last decade, with much greater availability of portable oxygen concentrators (POCs). Attention has, therefore, been drawn in this Statement to newer data, especially those published since the 2011 BTS recommendations.1 Readers wanting more detailed background information on physiology and the flight environment should consult the 2002 and 2011 BTS documents.1 2 Scope The clinical statement provides practical advice for healthcare professionals in primary and secondary care managing passengers with pre-existing respiratory conditions planning commercial air travel, including those recovering from an acute event/exacerbation.

Correspondence to Dr James H Hull, Respiratory Medicine, Royal Brompton Hospital, London, UK; j.hull@rbht.nhs.uk Introduction This British Thoracic Society (BTS) Clinical Statement addresses the diagnosis, evaluation and management of respiratory problems in athletic individuals. [...]it is estimated that at least one in four individuals report troublesome exercise-related respiratory issues, such as breathlessness, cough and/or wheeze.1 Moreover, in competitive athletes, asthma is the most prevalent medical condition and encountered in approximately a quarter of those partaking in endurance sport.2 3 Although athletic individuals can develop any cardiorespiratory illness and thus general clinical guideline documents are broadly applicable, studies over the past three decades have highlighted issues that are particularly relevant when assessing respiratory problems in athletic individuals or in certain sporting scenarios. Scope The purpose of this document was to provide concise and pragmatic guidance to help clinicians from all aspects of the multidisciplinary team (ie, including doctors, physiotherapists, speech and language therapists, pharmacists, physiologists, psychologists and specialist nurses), in both primary and secondary care settings, in assessing and managing respiratory problems in athletic individuals. A thorough history should characterise the precise nature of exercise-related clinical features (eg, breathlessness and wheeze) and their relationship with exercise intensity and recovery.

Correspondence to Dr Christopher Michael Barber, Centre for Workplace Health, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, Sheffield, UK; chris.barber4@nhs.net This British Thoracic Society (BTS) Clinical Statement addresses occupational asthma and includes key clinical practice points. Summary of clinical practice points Section 1—introduction Healthcare professionals should be aware that occupational exposures account for around one in six cases of asthma in adults of working age. Objective tests commonly used in the UK include skin prick tests (SPTs), specific IgE antibody levels and serial measures of peak expiratory flow (PEF) or airway responsiveness; workplace and specific inhalation challenges (SIC) are less commonly required for OA diagnosis. For those in employment, asthma control may be adversely affected by factors in the workplace, and the term ‘work-related asthma’ (WRA) is used.1 3 Although the true frequency of this condition is unknown, it is relatively common, affecting around 20%–25% of working individuals with asthma.4–6 WRA is subdivided into three main phenotypes—work-aggravated asthma (WAA), allergic occupational asthma due to sensitisation and irritant-induced asthma (IIA)3 (figure 1).