ERJ Open Research最新文献

Background: The cardiac autonomic response to exercise and during recovery has been poorly explored in bronchiectasis.

Methods: A longitudinal study was conducted in adults with bronchiectasis. Sociodemographic and clinical data were collected at baseline and after 12 months of follow-up. The heart rate recovery after the first (HRR₁) and second minute (HRR₂) of recovery in the six-min walk test (6MWT) was estimated in both assessments. Adjusted regression models were used to identify predictors of a delayed HRR₁ (HRR₁≤14).

Results: 104 participants with a mean±sd age of 64±13 years and mostly women (67%) were included. A delayed HRR₁ after the baseline 6MWT was identified in 36% of participants. These participants presented a higher proportion of males, increased body mass index, higher disease severity, more likely to require hospitalisation, more impact on quality of life, lower exercise capacity, lower heart rate at the end of the 6MWT and lower HRR₂. Disease severity (β, 95% CI) (moderate and severe versus mild, -0.47 (-0.94 to -0.01)) and distance walked (0.34 (0.11 to 0.56)) were the independent variables associated with HRR₁. Of the 45 participants who completed the entire follow-up period, 24% exhibited delayed HRR₁. The presence of at least two exacerbations during the follow-up period (OR 16.89, 95% CI 1.44 to 197.48) was the only predictor of a delayed HRR₁ in the assessment completed at the end of the study.

Conclusion: HRR₁ is related to disease severity and is mainly affected by having severe exacerbations in people with bronchiectasis.

Background: With the introduction of the antifibrotic drugs targeting progressive pulmonary fibroses, it becomes imperative to provide reliable contemporary estimates of the most common interstitial lung diseases. We aimed to provide contemporary estimates of the incidence and survival of idiopathic pulmonary fibrosis (IPF), hypersensitivity pneumonitis (HP) and connective tissue disease-associated interstitial lung disease (CTD-ILDs), and to compare their survival to that of the general population. To do this we have used data extracted from the Optimum Patient Care Research Database (OPCRD).

Methods: In this matched cohort study, we extracted incident cases of HP, CTD-ILD and IPF, and age and sex matched controls for each case, for the years 2010-2019. We calculated annual incidence rates and analysed incidence trends over time using segmented regression modelling. We estimated survival for cases and controls using the Kaplan-Meier model.

Results: We extracted data for 18 914 incident cases of interstitial lung diseases between 2010 and 2019 from the OPRCD. Incidence rates varied across the different diseases, with rates of 18.12, 7.96 and 2.63 per 100 000 person-years for IPF, CTD-ILD and HP, respectively. 5-year survival for IPF, CTD-ILD and HP was 40%, 54% and 66%, respectively, and this was generally ∼50% lower than that of the general population.

Conclusion: Our population-based study emphasises the considerable burden of interstitial lung diseases, with >20 000 new cases diagnosed each year in the UK, many of whom will be eligible for antifibrotic drugs.

Aims: Parapneumonic pleural infections are frequently encountered, but the optimal treatment regimen remains controversial. The aim of this systematic review was to investigate whether immediate video-assisted thoracoscopic surgery (VATS) has advantages over intrapleural enzymatic therapy (IET).

Methods: We searched MEDLINE, Embase and Web of Science Core Collection till November 2023 and included studies comparing IET and VATS in adult patients with parapneumonic pleural infections. Primary outcome was length of hospital stay (LOS); secondary outcomes included mortality and morbidity. Study quality was assessed using ROBINS-I and RoB 2. Inverse variance random-effects meta-analysis was performed.

Results: We screened 2263 articles; eight were included in the final analysis, covering 1023 patients (n=465 IET (mostly single agent IET); n=558 VATS). Six were non-randomised studies (n=5 with serious risk of bias) comprising 964 patients, and two were small, randomised feasibility studies (n=1 with high risk of bias), comprising 59 patients. In the meta-analysis, LOS in non-randomised studies was shorter for patients treated by VATS (mean difference 4.2 days; 95% CI 1.5-7.0). However, no significant difference was reported in the randomised feasibility studies. Mortality and morbidity rates showed no significant difference.

Interpretation: In this meta-analysis of non-randomised studies with a high risk of selection bias, VATS appears superior to IET regarding LOS in the treatment of parapneumonic pleural infections, without increased mortality and morbidity rate. Two recently published randomised feasibility studies failed to confirm this finding, but were not designed to detect a difference in LOS. This meta-analysis highlights the need for high-quality studies.

Introduction: Chronic airflow obstruction is key for COPD diagnosis, but strategies for its early detection are limited. We aimed to define the optimal z-score thresholds for spirometry parameters to discriminate chronic airflow obstruction incidence.

Methods: The Burden of Obstructive Lung Disease study is a multinational cohort study. Information on respiratory symptoms was collected and pre- and post-bronchodilator spirometry was performed at baseline. 18 study sites were followed-up with repeat measurements after a median of 8.4 years. We converted lung function measurements into z-scores using the Third National Health and Nutrition Survey reference equations. We used the Youden index to calculate the optimal z-score thresholds for discriminating chronic airflow obstruction incidence. We further examined differences by smoking status.

Results: We analysed data from 3057 adults (57% female, mean age: 51 years at baseline). Spirometry parameters were good at discriminating chronic airflow obstruction incidence (area under the curve 0.80-0.84), while respiratory symptoms performed poorly. The optimal z-score threshold was identified for pre-bronchodilator forced expiratory volume in 1 s to forced vital capacity ratio (FEV₁/FVC) <-1.336, equivalent to the 9th percentile (sensitivity: 78%, specificity: 72%). All z-score thresholds associated with a lower post-bronchodilator FEV₁/FVC and greater odds of chronic airflow obstruction at follow-up. The risk of chronic airflow obstruction was slightly greater for current smokers and, to some extent, never-smokers with a pre-bronchodilator FEV₁/FVC <9th/10th percentiles at baseline, particularly among males.

Conclusions: Spirometry is better than respiratory symptoms at predicting chronic airflow obstruction incidence. A pre-bronchodilator FEV₁/FVC <9th/10th percentiles, particularly among current smokers, could suggest early airflow obstruction or pre-COPD.

There is no agreement or clear evidence on the usefulness of algorithms using ventilator data predicting deterioration. Future research is needed focusing on algorithms that predict outcomes relevant to patients and the healthcare system. https://bit.ly/4083nL2.

Background: Measurement of lung volumes forms an integral part of pulmonary function testing. Lung volumes determined by computed tomography (CT) scans are well established, but the comparability to other methods like plethysmography in large cohorts remains in question.

Methods: CanCOLD is a prospective longitudinal cohort study from Canada, including three matched groups of individuals with COPD I-II, smokers at risk and healthy controls. All participants underwent lung volume measurement by plethysmography and CT, using inspiratory and expiratory imaging. We compared total lung capacity (TLC) and residual volume (RV) in the different cohorts between plethysmography and CT.

Results: Data from 1235 (518 females) individuals were analysed. Baseline characteristics were comparable in all three groups. Significant differences between CT and plethysmography could be observed in all groups, with consistently higher TLC and lower RV by plethysmography, respectively. Correlation was strong for TLC between the methods of measurement with a very stable bias of about 1.68 L for all groups, but the correlation was only low/moderate for RV. Variability of differences seemed to be higher for RV. No correction for supine position or dead airspace was used for CT-based measurements.

Conclusion: Measurement of TLC and RV by plethysmography yields higher and lower values than by CT, respectively, so results of the different methods should not be used interchangeably.

There is an overlap between the respiratory, blood and gut microbiomes in patients with acute respiratory distress syndrome. Specific taxa in the lungs and blood are associated with an inflammatory response. https://bit.ly/3TdkHd7.

Having a family member with pulmonary fibrosis (PF) impacts the prognosis of sarcoidosis patients, as the majority of patients reporting at least one relative with PF present fibrotic characteristics and one-third develop a progressive phenotype https://bit.ly/40KC7Cr.

Study objectives: Studies on obstructive sleep apnoea (OSA) have identified clinically relevant symptom-based subtypes and novel OSA-specific nocturnal hypoxic measures. Both traits are individually associated with cardiovascular outcomes, but evidence about their independent or shared effects is unknown. This study investigated the simultaneous contributions of OSA symptom subtypes and hypoxic burden (HB) on incident cardiovascular outcomes.

Methods: Sleep Heart Health Study participants with high-quality oxygen saturation, apnoea-hypopnea index (AHI) and symptom data were included. Participants with OSA (AHI ≥5 events·h^-1) were grouped into symptom subtypes. HB was calculated from respiratory event-related hypoxia. Cox proportional hazards models assessed whether symptom subtypes and/or HB were independently associated with cardiovascular mortality and major adverse cardiovascular events (MACE).

Results: 4396 participants free of cardiovascular disease were analysed, with median follow-up >11 years. Higher HB was associated with worse cardiovascular mortality (HR (95% CI): 1.63 (1.13-2.35); p=0.009) independently of symptom subtypes. Compared to those without OSA, the excessively sleepy OSA subtype had higher risk of incident MACE (1.62 (1.23-2.15); p<0.001), independently of HB. Among participants with moderate-severe OSA (AHI ≥15 events·h^-1), excessively sleepy participants had higher risk of cardiovascular end-points compared to other subtypes, but HB was not associated with cardiovascular mortality or MACE risk.

Conclusion: OSA symptom subtypes and HB are independently associated with MACE and cardiovascular mortality, respectively. Thus, both are important for understanding OSA-related cardiovascular risk. Future studies using clinical samples including OSA therapy information that incorporate symptom subtypes and novel biomarkers, such as HB, could improve predictive models for cardiovascular disease risk.

Background: Cystic fibrosis transmembrane conductance regulator (CFTR) triple modulator therapy, elexacaftor-tezacaftor-ivacaftor (ETI) has transformed care for people with cystic fibrosis (CF) who have eligible mutations. It is, however, not curative. Response to treatment also varies and lung disease, although slowed, remains progressive. We have previously demonstrated inhibition of the epithelial sodium channel (ENaC) by selective furin inhibition to be an alternative, mutation-agnostic approach that can enhance airways hydration and restore mucociliary transport (MCT) in CF. Inhibition of furin therefore, offers a potential therapeutic strategy for those ineligible, intolerant or nonresponsive to ETI and may provide a further opportunity for clinical benefit for those currently treated with ETI. The aim of this study was to determine the impact of furin inhibition on ETI responses to assess its utility as an adjunct therapy.

Methods: Differentiated primary CF human bronchial epithelial cells (HBECs) were treated with the highly selective furin inhibitor BOS-318 and with ETI. Ion channel function was measured using a 24-channel Transepithelial Current Clamp (TECC-24) system and airways surface hydration was investigated by measuring airway surface liquid (ASL) height and MCT rate.

Results: The presence of BOS-318 had no effect on the ability of ETI to stimulate CFTR-mediated Cl^- secretion but contributed a reduced Na⁺ transport via robust inhibition of ENaC. This altered ion transport profile effected an improved ASL height and MCT rate, which were significantly greater than improvements observed with ETI alone, demonstrating the benefits of the dual approach.

Conclusions: Selective furin inhibition has the potential to further improve clinical outcomes for all people with CF and offers opportunity as an adjunct to improve responses to currently available CFTR modulator therapies.