ERJ Open Research最新文献

Background and objective: Paternal passive smoke exposure before 15 years of age was associated with offspring childhood asthma, but its association with asthma beyond childhood had not been investigated. We aimed to investigate such long-term association.

Methods: Data were from 1078 father-offspring and 1537 mother-offspring pairs from the Tasmanian Longitudinal Health Study. Offspring (probands of the original cohort) completed asthma surveys at age 7, 13, 18, 30, 43, 50 and 53 years. Life-course asthma trajectories were developed using group-based trajectory modelling. Parents self-reported their own passive smoke exposure before 15 years of age. Multinomial logistic regressions assessed associations between parental passive smoke exposure and offspring asthma trajectories. Active parental smoking, offspring sex, childhood respiratory illnesses and subsequent active smoking were evaluated for mediations and interactions.

Results: Paternal passive smoke exposure before 15 years of age was associated with an early-onset adult-remitting asthma trajectory (adjusted multinomial odds ratio (aMOR) 2.53, 95% CI 1.09-5.85) in offspring, but not persistent asthma trajectories. Maternal passive smoke exposure before 15 years of age was associated with an early-onset adult-remitting asthma trajectory in offspring who were also exposed to childhood passive smoke (aMOR 4.30, 95% CI 1.01-18.40; p-interaction=0.044). The observed associations were partly mediated through active parental smoking or offspring childhood respiratory illnesses (each <10%).

Conclusions: This study identified a novel association between parental passive smoke exposure before 15 years of age and an early-onset adult-remitting asthma trajectory in offspring, which is related to subsequent COPD. These findings suggest that in parents inevitably exposed to passive smoke during childhood/puberty, asthma risk in future generations associated with such exposure may be lower if parents avoid smoking around children.

Despite negative phase 2 trials including the FRONTIER-3 study in asthma, tozorakimab and other IL-33 targeting strategies have strong potential in asthma and beyond https://bit.ly/3JnWak2.

Objective: The aim of the study was to analyse the characteristics of rifampicin-resistant tuberculosis patients in Spain.

Methods: This was an ambispective observational study of a multicentre cohort of patients diagnosed between January 2019 and July 2023 in most Autonomous Communities (retrospective period 2019-2020, prospective 2021-2023).

Results: 94 patients were included; 83 (88.3%) had pulmonary tuberculosis. The mean age was 38.00±17.8 years; 67 (71.3%) were male, 62 (66.0%) were from countries other than Spain, six (6.4%) were HIV-infected and 24 (25.5%) had previously treated tuberculosis. Nine patients had rifampicin-resistant tuberculosis (RR-TB), 75 multidrug-resistant tuberculosis (MDR-TB), nine pre-extensively drug-resistant tuberculosis (pre-XDR-TB) and one XDR-TB. Treatment included bedaquiline in 39 (41.5%) patients, linezolid in 87 (92.6%), fluoroquinolones in 82 (87.2%), clofazimine in 64 (68.0%) and delamanid in 27 (28.7%). Treatment was supervised by experts in 63 cases (67.0%). In 43 patients (45.7%), there were difficulties obtaining authorisation for drug prescription (bedaquiline or delamanid). 21 patients (22.3%) had difficulties understanding the treatment. The final treatment outcomes were cured in 60 cases (63.8%), treatment completed in 23 (24.5%), deaths in 3 (3.2%), with 2 due to tuberculosis, loss to follow-up in five (5.3%) and not evaluated in three (3.2%). No treatment failures occurred. Successful outcomes were achieved in 83 patients (88.3%). MDR-TB compared with pre-XDR-TB (OR 8.77, 95% CI 1.42-45.55; p=0.01) and no treatment comprehension difficulties (OR 10.61, 95% CI 2.78-40.48; p=0.001) were both associated with successful outcomes.

Conclusions: Most patients achieved successful outcomes with individualised regimens guided predominantly by experts. Patients with pre-XDR-TB and those with comprehension difficulties had significantly reduced success rates.

In this editorial, Okereke and colleagues discuss the recent multinational registry work describing factors associated with hospitalisations in patients with IPF, which underscores the central role of registries in rare lung disease research https://bit.ly/4qz8eQm.

Introduction: Home monitoring of physical parameters, symptoms and quality of life in individuals with pulmonary fibrosis (PF) could overcome gaps in clinical care by enabling early detection of disease progression, guiding patient management and improving access to specialised care. However, its global adoption in clinical practice is lacking. The aim of this study is to gain a deeper understanding of healthcare professionals' (HCPs) perspectives on implementing home monitoring for individuals with PF.

Methods: Semi-structured interviews were conducted with HCPs. Transcripts were analysed through an inductive-deductive qualitative thematic analysis using the NASSS (nonadoption, abandonment, scale-up, spread and sustainability) framework, which provides a systematic method for examining barriers and facilitators that may hamper the implementation of technological innovations.

Results: 30 HCPs from 18 interstitial lung disease clinics in the Netherlands were interviewed, reflecting varying levels of experience with home monitoring. They were positive towards the implementation of home monitoring for individuals with PF, favouring a tailored hybrid care approach. HCPs preferred incorporating home spirometry and alerts for signs of deterioration. Different barriers were identified to implement home monitoring and hybrid care pathways, including technical challenges, such as reduced reliability of home spirometry in certain patients and concerns about replacing care for progressive or unstable patients. HCPs emphasised the need for a coordinated hybrid care pathway and they advocated for strong evidence on cost-effectiveness and quality of hybrid care models.

Discussion: Home monitoring is considered valuable in the management of PF. Identified preferences, barriers and facilitators can be used to inform strategies for sustainable implementation of home monitoring in clinical practice.

Standard models of bronchoscopy training are not suitable for low-income countries; a novel training programme comprising short intensive skills training and ongoing remote mentorship established bronchoscopy for management of airway emergencies https://bit.ly/46xDC8n.

Sleep medicine is shifting towards precision care, using pathophysiology, continuous data and personalised biomarkers to address disease heterogeneity. Future practice will be data-driven, gender-aware, environment-informed and patient-centred. https://bit.ly/44W914E.

Background: Pulmonary emphysema on computed tomography (CT) is a risk factor for all-cause mortality in individuals with and without airflow limitation. The aim of this study was to assess whether ¹⁸F-fluorodeoxyglucose (FDG) lung uptake on positron emission tomography (PET)/CT is associated with emphysema progression in participants who currently smoke and previously smoked.

Methods: This single-centre retrospective observational study included participants who repeatedly underwent intensive cancer screening with unenhanced chest CT and semiquantitative ¹⁸F-FDG PET/CT between January 2015 and July 2020. The 15th percentile point (Perc15) and volume-adjusted (VA)-Perc15 on CT were used to assess the degree of emphysema in the participants with at least 2 years of follow-up data. Multiple regression analysis was performed with changes in Perc15 and VA-Perc15 as dependent variables, including the median of the standardised uptake value (SUV) corrected for lean body mass and tissue fraction effects (cSUV_TF-median) as explanatory variables.

Results: We evaluated 2112 participants (1502 male; mean±sd age 59±10 years; 395 currently smoking, 820 previously smoked; 1958 no emphysema, 152 mild emphysema, two moderate emphysema on visual CT inspection). The median follow-up duration was 1470 (interquartile range 1330-1705) days. Higher cSUV_TF-median, higher Perc15 or VA-Perc15 at baseline and older age were associated with annual decreases in Perc15 or VA-Perc15 among the participants who currently or previously smoked.

Conclusion: Semiquantitative FDG uptake was independently associated with longitudinal emphysema progression in both of the participants who currently and previously smoked. Semiquantitative PET/CT may provide useful information for early intervention in participants at high risk for emphysema progression.

Background: Studies examining dendritic cell (DC) immunobiology in tuberculosis (TB) patients have been conflicting, and no studies have examined DCs in the peripheral blood or lungs of patients with pre- or extensively drug-resistant TB (XDR-TB).

Methods: To provide insight into DC immunobiology, we first compared the DC subsets in the peripheral blood of XDR-TB patients with that from participants with latent TB infection (LTBI). Second, we compared DC subsets from cavity biopsies from explanted lung sections with normal-appearing lung tissue from pre-XDR/XDR-TB patients undergoing resection surgery. DCs were assessed for phenotypic and functional markers using flow cytometry.

Results: In the peripheral blood of XDR-TB patients, plasmacytoid DCs (pDCs) expressed lower levels of cluster of differentiation 83 (CD83; p=0.01), toll-like receptor 2 (TLR-2; p<0.0001) and macrophage mannose receptor (MMR; p<0.0001), with higher levels of programmed cell death protein 1 (PD-L1; p=0.007) than pDCs from LTBI participants (p=0.01). MMR expression from the conventional DC1 (cDC1) subset in XDR-TB patients was found to be higher (p=0.02) than that from the cDC1 subset in LTBI participants. In the lung compartment (cavity and normal-appearing lung), the dominant DC subset was the pDCs (p=0.02), despite the conventional DC subsets (cDCs) expressing higher levels of C-C chemokine receptor 7 (CCR7) (p=0.02 for both comparisons), CD83 (p≤0.03 for both comparisons), TLR-2 (p=0.02 for both comparison), MMR (p=0.02 for both comparisons) and DC-SIGN (p≤0.05 for both comparisons).

Conclusions: The low frequency of cDCs in the lung cavity of XDR-TB patients in conjunction with the limited migratory and co-stimulatory expression of pDCs suggests that there is DC dysregulation in the lung mucosal milieu, possibly due to persistent disease.

Background and objective: Asthma remains a significant burden on health systems and individuals, with many hospitalisations in Australia considered preventable through improved management and community care. This study aimed to explore end-user perspectives on preventing potentially avoidable asthma hospitalisations and identify key themes, research questions and priorities.

Methods: This cross-sectional study involved administering an anonymous online survey as part of a national asthma research priority-setting initiative. The participants included people living with asthma, their carers, healthcare professionals, and policymakers in Australia, all of whom were asked to provide free-text responses regarding the research questions they considered important for preventing asthma hospitalisations. Responses underwent thematic and content analysis to identify themes.

Results: Of the 554 respondents, 461 (83%) were individuals living with asthma, primarily females aged 45-64 years. The analysis identified nine key themes; however, subgroup analysis revealed four dominant themes: 1) self-management support, focusing on increasing knowledge and confidence, awareness of when to seek help, and the use of digital health tools; 2) pharmacological approaches, seeking better medication options with minimal side-effects; 3) strategies for avoiding major asthma events, emphasising improved proactive measures to reduce asthma attacks; 4) asthma care, highlighting the need to make medications more affordable, and enhanced access to care.

Conclusions: This study highlights key research priorities from the collective voice of end-users on preventing potentially avoidable asthma-related hospitalisations. These novel data provide a foundation for future research aimed at supporting Asthma Australia's vision to reduce asthma-related hospitalisations by 50% by 2030.