ERJ Open Research最新文献

Introduction: In mild to moderate obstructive sleep apnoea (OSA), positive airway pressure (PAP) and mandibular advancement devices (MADs) are recommended treatments according to guidelines. This cross-sectional study aimed to determine the clinical and organisational predictors for treatment recommendations in mild to moderate OSA.

Methods: In the European Sleep Apnea Database, factors predicting the choice of MAD or PAP treatment were determined in patients with newly diagnosed mild to moderate OSA. Accessibility and reimbursement of MADs study sites was obtained via questionnaire. The regression model included anthropometrics, Epworth Sleepiness Scale score, OSA severity, MAD accessibility and reimbursement, and a comorbidity index variable.

Results: 6618 (65.5%) patients received PAP and 3491 (34.5%) were recommended MADs. MAD recommendations varied between centres (0% to 76%). Significant factors favouring MADs include mild versus moderate OSA (odds ratio 6.0, 95% CI 5.3-6.8), negligible versus moderate intermittent hypoxia (OR 2.0, 95% CI 1.7-2.4), no versus excess daytime sleepiness (OR 2.6, 95% CI 2.1-3.1), a comorbidity index score of 0 compared to 3 or more (OR 3.8, 95% CI 3.1-4.6) and no insomnia diagnosis versus diagnosed insomnia (OR 2.0, 95% CI 1.7-2.4). MAD accessibility and reimbursement predicted MAD treatment recommendations (OR 2.3, 95% CI 1.8-2.9 and OR 1.5, 95% CI 1.4-1.7, respectively).

Conclusion: In mild to moderate OSA, MADs are less frequently recommended than PAP, particularly amongst patients with a higher disease burden. MADs were more frequently used when they were more accessible and reimbursed. Thus, MADs are likely an underused treatment in mild to moderate OSA.

Toxic oil syndrome-associated PAH can develop decades after exposure, highlighting the need for lifelong monitoring of exposed individuals, better understanding of delayed pathophysiological mechanisms and vigilance for future large-scale toxic exposures https://bit.ly/423Gbhh.

Aims: Toxic oil syndrome (TOS) was one of the first described forms of drug-induced pulmonary arterial hypertension (PAH). Its long-term clinical evolution remains poorly understood. The objectives of the present study were to provide new clinical, pathological and genetic insights into TOS-associated PAH (TOS-PAH), and to evaluate its long-term outcomes.

Methods: Patients diagnosed with TOS-PAH and included in the Spanish Registry of PAH (REHAP) were prospectively analysed.

Results: 59 new cases were diagnosed between 1997 and 2025 (63% female; median age 47 years), including several in the past two decades. The median interval between TOS exposure and PAH diagnosis was 270.8 months (interquartile range (IQR) 204.9-398.0). Patients diagnosed in earlier periods were younger, with more advanced functional impairment and more severe haemodynamics. In contrast, recent cohorts showed a higher prevalence of cardiovascular and respiratory comorbidities. No significant differences were observed in overall or transplant-free survival across decades (p=0.677). Median transplantation-free survival was 97.2 months (IQR 64.2-199.4). Three patients achieved complete haemodynamic resolution. Genetic testing was negative in all evaluated patients. Pathological findings were comparable with those observed in other PAH forms, with some cases with significant venous remodelling.

Conclusions: TOS-PAH remains a distinct clinical entity, with new cases diagnosed decades after toxic exposure. Despite differences in presentation over time, its long-term clinical course appears similar to that of other PAH types.

Background: Plethysmographic airway resistance (R _aw) and specific airway resistance (sR _aw) are widely used to assess baseline lung function and bronchodilator reversibility in children unable to perform spirometry. However, no consensus exists on cut-offs for significant reversibility.

Methods: We conducted a retrospective study on a large cohort of asthmatic children tested during panting without electronic thermal compensation, to determine optimal R _aw and sR _aw cut-offs for detecting significant forced expiratory volume in 1 s (FEV₁) reversibility. A smaller cohort undergoing tidal breathing plethysmography with electronic thermal compensation was also analysed.

Results: From 2436 tests without thermal compensation, receiver operating characteristic curve analysis identified cut-offs of -34.4% (R _awtot) and -36.0% (sR _awtot) from baseline to detect significant FEV₁ reversibility, with sensitivities of 70% (95% CI 65-74%) and 72% (95% CI 67-76%) and specificities of 70% (95% CI 68-72%) and 73% (95% CI 71-75%), respectively. Expressing reversibility as a percentage of predicted did not improve accuracy, but required larger cut-offs (-42.6% for R _awtot, -56.1% for sR _awtot) and increased the influence of baseline value. In the 106 tests performed using electronic thermal compensation, R _awtot/eff and sR _awtot/eff cut-offs were lower than that without electronic thermal compensation (-25% of baseline) with sensitivities and specificities ranging from 63% to 70%.

Conclusion: R _awtot and sR _awtot reversibility effectively identify FEV₁ reversibility with cut-offs around -35% of the baseline value, showing no added benefit when using larger cut-offs expressed as a percentage of the predicted value. When electronic thermal compensation is applied, it may necessitate lower cut-offs of -25% of the baseline, compared to those determined without it.

Background: Refractory chronic cough (RCC) is a burdensome condition with few effective treatments. While behavioural cough-suppression therapy (BCST) has demonstrated high efficacy, access is limited by geographical and provider constraints. This pilot study evaluated the efficacy of BCST delivered in a group telehealth format.

Methods: BCST was delivered to small groups (2-5 participants) via telehealth using a rolling enrolment model. Participants attended 4-6 sessions (60-90 min each), led by a trained speech-language pathologist and a graduate student. Each session followed a structured format with emphasis on understanding cough hypersensitivity, training in cough-suppression techniques, adherence monitoring and discussion of participant challenges related to cough suppression. Outcome measures included the Leicester Cough Questionnaire (LCQ) and Patient Global Impression of Severity (PGI-S), with optional cough frequency monitoring using the CoughPro smartphone app.

Results: 47 participants (mean age 56.8 years; 42 women) from four countries completed the study. Six participants provided sufficient cough monitoring data. After treatment, 98% (46 of 47) exceeded the LCQ's minimal clinically important difference of 1.3 points. Mean LCQ improvement was 7.04 at both 1 week and 1 month after treatment assessments (both p<0.001; d=2.54 and 2.35, respectively). PGI-S scores showed a median reduction of 2 points. Among those with cough monitoring, the mean hourly cough rate dropped by 68% and cough bouts decreased by 78%.

Discussion: Group telehealth BCST focused primarily on consistent cough suppression is an extremely efficacious intervention and can increase availability and access to treatment for patients with RCC.

Rationale: Higher peripheral blood monocyte count has been associated with disease progression and mortality in patients with fibrotic interstitial lung disease (fILD), but with uncertainty regarding the strength of this association and the potential impact of confounding. This study aimed to characterise the associations of clinically ascertained peripheral blood monocyte count with survival and lung function decline in patients with fILD.

Methods: Patients with fILD enrolled in the prospective Canadian Registry for Pulmonary Fibrosis (CARE-PF) with baseline complete blood count were included. Monocyte counts were analysed continuously and dichotomised ≥0.6 versus <0.6×10⁹ cells·L^-1 and ≥0.95 versus <0.95×10⁹ cells·L^-1. Cox proportional hazards models, unadjusted and adjusted for age, sex, lung function, smoking and treatment, evaluated associations of monocytes with transplant-free survival. Survival analysis was repeated using the prospective PROFILE cohort. Unadjusted and adjusted linear mixed models evaluated association of monocyte count with annual decline in forced vital capacity (FVC) % predicted.

Results: In 1489 patients with fILD, higher monocyte count was associated with reduced transplant-free survival in unadjusted models, but not after adjustment for relevant confounders (continuous model, HR 0.79, 95% CI 0.54-1.17; p=0.24; dichotomised at 0.6 cells·L^-1, HR 0.89, 95% CI 0.72-1.10; p=0.29; and dichotomised at 0.95 cells·L^-1, HR 0.93, 95% CI 0.68-1.26; p=0.62). Findings were consistent in the PROFILE external replication cohort. Monocyte count was not associated with FVC % decline in the full cohort or within fILD subtypes.

Conclusions: Peripheral blood monocyte count was not associated with transplant-free survival or lung function decline in this multicentre cohort study, indicating that it is not a reliable biomarker in fILD.

Introduction: Functional aspects of pulmonary immunity to SARS-CoV-2 infection and BNT162b2 mRNA vaccination in humans and their correlation with upper airway and systemic immunity remain largely unexplored. The aim of the present study was to explore anti-SARS-CoV-2 immunoglobulin levels and neutralisation in the lower airway mucosa and correlate them with salivary and systemic responses among BNT162b2 recipients.

Methods: Serum, saliva and bronchoalveolar lavage fluids (BALF) were collected from 100 individuals undergoing clinically indicated bronchoscopy. Anti-receptor binding domain (RBD) antibody levels and functional neutralisation were assessed.

Results: Anti-RBD antibodies were present in BALF of vaccinees and recovered individuals. IgGs and IgAs were highest among four-dose vaccinees (median 0.59 nM (IgG), 0.06 nM (IgA)). Neutralisation demonstrated augmented lower-airway mucosa protection against wild-type and Delta variant, while BALF neutralisation towards Omicron was substantially lower. While IgG levels among vaccinees correlated between BALF and serum (r=0.51, p=0.001), and between saliva and serum (r=0.58, p=0.001), the IgA levels between fluids did not correlate significantly. The correlation between BALF and serum antibodies was stronger in individuals who experienced previous SARS-CoV-2 infection. Comparison of specific neutralising activity of BALF and serum anti-SARS-CoV-2 IgGs suggested a 5.5-fold increased potency of the former.

Conclusion: The BNT162b2 vaccine elicits neutralising antibodies against the ancestral variants in the lower respiratory tract. The anti-RBD IgG response correlates overall between systemic and local mucosal sites, while the IgA distributions between BALF, saliva and serum seen specifically following natural exposure suggest locally specialised mucosal immunity. The higher neutralising potency of mucosal IgGs compared to circulatory IgGs highlights the protective importance of mucosal-specific IgGs in the alveolar space.

Comorbid obstructive sleep apnoea, together with impaired cardiac function, is prevalent in patients with COPD. Disease burden is elevated in this "triple trouble" phenotype, emphasising the need for its identification. https://bit.ly/40YK46z.

BMPR2 A-isoform expression is involved in PH with left heart disease and has potential as a novel prognosis biomarker, supporting the development of new therapeutic approaches targeting the BMPR2-activin type IIA receptor pathway https://bit.ly/45tywJI.

Findings based on asbestosis patients treated between 2004 and 2024 reveal a modest reduction in the rate of FVC decline (mean (95% CI) difference 7.0 (-5.8-19.7) mL·month^-1, p=0.22) and D _LCO decline (0.11% (-0.19-0.41%), p=0.30) after starting pirfenidone https://bit.ly/45fZ5TR.