rachytherapy was administered to 34 (23.3%) patients. Brachytherapy seemed to be appropriate for 133 (91.1%) patients and inappropriate for 13 (8.9%) patients. The 3-year rates were 84.2% for overall survival and 90.1% for local control. Grade 3 late rectal complications occurred in two (1%) patients. Multivariate analysis showed that tumor characteristics (size, shape, and extent of invasion) were not risk factors, although inappropriate brachytherapy was significantly related to poor local control (p less then 0.001). CONCLUSION Pre-brachytherapy MRI may help to select appropriate brachytherapy for cervical cancer and reduce the likelihood of inappropriate brachytherapy leading to poor local control. © IGCS and ESGO 2020. No commercial re-use. See rights and permissions. Published by BMJ.INTRODUCTION Fractional exhaled nitric oxide (FENO), a biomarker of eosinophilic airway inflammation, may be useful to guide asthma treatment. FENO guided treatment may be more effective in certain subgroups for improving asthma outcomes compared to standard treatment. METHODS An individual patient data analysis was performed using data from seven randomised clinical trials (RCT) which used FENO to guide asthma treatment. The incidence of an asthma exacerbation and loss of control, and the time to first exacerbation and loss of control were described between five subgroups of RCT participants. RESULTS Data were available in 1112 RCT participants. Among those not treated with Leukotriene Receptor Antagonist (LTRA), but not among those who were treated with LTRA, FENO guided treatment was associated with reduced exacerbation risk (odds ratio (OR) 0.68 [95% CI 0.49, 0.94]), longer time to first exacerbation (hazard ratio (HR) 0.76 [0.57, 0.99]) and borderline reduced risk for loss of control (OR 0.70 [0.49, 1.00]). Non-obese children, compared to obese children, were less likely to lose asthma control when treatment was guided by FENO (OR 0.69 [0.48, 0.99]) and time to loss of control was longer (HR 0.77 [0.61, 0.99]). CONCLUSIONS Asthma treatment guided by FENO may be more effective in achieving better asthma outcomes for patients who are not treated with LTRA and who are not obese compared to standard practice. Copyright ©ERS 2020.Oral corticosteroids (OCS) are used to manage asthma exacerbations and severe, uncontrolled asthma, but OCS use is associated with adverse effects. We aimed to describe the patterns of OCS use in the real-world management of patients with asthma in western Europe.We used electronic medical records from databases in France, Germany, Italy, and the United Kingdom from July 2011 through February 2018. Patients aged ≥12 years with an asthma diagnosis, ≥1 non-OCS asthma medication within ±6 months of diagnosis, and available data ≥6 months prior to and ≥90 days after cohort entry were included. High OCS use was defined as OCS ≥450 mg prescribed in a 90-day window during follow-up. Baseline characteristics and OCS use during follow-up were described overall and by OCS use status.Of 702 685 patients with asthma, 14-44% were OCS users and 6-9% were high OCS users at some point during follow-up. Annual prevalence of high OCS use across all countries was approximately 3%. High OCS users had a mean 1-3 annual OCS prescriptions, with an average daily OCS dosage of 1.3-2.2 mg. For patients who continued to meet the high use definition, daily OCS exposure was generally stable at 5.5-7.5 mg for at least 2 years, increasing the risk of adverse effects.Our study demonstrates that OCS use is relatively common across the four studied European countries. Data from this study may provide decisive clinical insights to inform primary care physicians and specialists involved in the management of severe, uncontrolled asthma. Copyright ©ERS 2020.Idiopathic Pulmonary Fibrosis (IPF) is a complex disease of unknown etiology which makes drug development challenging. Single administration of bleomycin directly to the lungs of mice is a widely used experimental model for studying pulmonary fibrogenesis and to evaluate the effect of therapeutic anti-fibrotic strategies. Leupeptin concentration The model works by inducing an early inflammatory phase which transitions into fibrosis after 5-7 days. This initial inflammation makes therapeutic timing crucial. To accurately assess anti-fibrotic efficacy, the intervention should inhibit fibrosis without impacting early inflammation.Studies published between 2008 and 2019 using the bleomycin model to investigate pulmonary fibrosis were retrieved from PubMed, and study characteristics were analysed. Intervention based studies were classified as either preventative (starting 7 days). Studies were also cross-referenced with current major clinical trials to assess the availability of preclinical rational.A total of 976 publications were evaluated. 726 investigated potential therapies, of which 443 (61.0%) were preventative alone, 166 (22.9%) therapeutic alone, and 105 (14.5%) were both. Of the 443 preventative studies, only 70 (15.8%) characterised inflammation during the model's early inflammatory phase. Of the reported 145 IPF clinical trials investigating 93 compounds/combinations, only 25 (26.9.0%) had any PubMed-available preclinical data in bleomycin.Since 2008, we observed a shift (from less then 5% to 37.4%) in the number of studies evaluating drugs in the therapeutic setting in the bleomycin model. While this shift is encouraging, more characterisation of early inflammation and appropriate preclinical therapeutic testing are still needed. This will facilitate fruitful drug development in IPF, and more therapeutic strategies for patient with this devastating disease. Copyright ©ERS 2020.Alpha-1 Antitrypsin Deficiency (AATD), characterised by reduced levels or functionality of Alpha-1 Antitrypsin (AAT), is a significantly under-diagnosed genetic condition that predisposes individuals to lung and liver disease. Most of the available data on AATD is based on the most common, severe deficiency genotype (PI*ZZ); therefore, treatment and monitoring requirements for individuals with the PI*SZ genotype, which is associated with a less severe AAT deficiency, are not as clear. Recent genetic data suggest the PI*SZ genotype may be significantly more prevalent than currently thought, due in part to less frequent identification in the clinic and less frequent reporting in registries. Intravenous AAT therapy, the only specific treatment for patients with AATD, has been shown to slow disease progression in PI*ZZ individuals; however, there is no specific evidence for AAT therapy in PI*SZ individuals, and it remains unclear whether AAT therapy should be considered in these patients. The present narrative review evaluates the available data on the PI*SZ genotype, including genetic prevalence, the age of diagnosis and development of respiratory symptoms compared with PI*ZZ individuals, and the impact of factors such as index versus non-index identification and smoking history.