ERJ Open Research最新文献

Background: Severe asthma (SA) imposes a significant burden on patients' health-related quality of life (HRQoL). This study aimed to quantify HRQoL burden and identify clinical determinants associated with HRQoL impairment in patients with SA.

Methods: Cross-sectional data were collected from 701 patients (592 with SA, 109 with non-severe asthma (NSA)) in the Korean Severe Asthma Registry (KoSAR). HRQoL was measured using the EuroQoL 5-dimension 5-level (EQ-5D-5L) and Severe Asthma Questionnaire (SAQ). Asthma control status was assessed with the Asthma Control Test (ACT) scores. Multivariable and ordinal logistic regression analyses were conducted to identify factors associated with HRQoL.

Results: Patients with SA had lower EQ-5D-5L scores than those with NSA (SA: 0.83 versus NSA: 0.87, p<0.001). Among patients with SA, recent rescue medication use, reduced lung function and uncontrolled symptoms were associated with impaired HRQoL. Uncontrolled SA was associated with greater impairments than controlled SA (uncontrolled: 0.75 versus controlled: 0.85, p<0.001). Uncontrolled SA was associated with higher odds of worse health states across all five domains, with greatest impairments in the usual activities domain. The EQ-5D-5L scores decreased in proportion to the level of asthma control. ACT scores strongly correlated with both EQ-5D-5L (r=0.608, p<0.001) and SAQ (r=0.680, p<0.001). Amongst ACT items, "daily functioning" was the strongest determinant of HRQoL.

Conclusion: Uncontrolled asthma, particularly its impact on daily functioning, was associated with HRQoL impairment in patients with SA. Enhancing asthma control may significantly reduce the disease burden and improve HRQoL in SA.

Insights from the Pulmonary Hypertension Global Patient Survey https://bit.ly/4m5MOaS.

Introduction: Treatment of non-tuberculous mycobacterial pulmonary disease (NTM-PD) is often complex, relying on long treatment courses with multiple antibiotics, which are associated with treatment intolerance and failure. Current guidelines provide limited insight into non-pharmacological treatment, which is believed to be an important component of symptom control and is related to treatment outcomes with an established evidence base in other chronic respiratory diseases.

Methods: The authors conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify studies on non-pharmacological interventions for NTM-PD, focusing on airway clearance techniques, pulmonary rehabilitation, nutritional support and psychological care.

Results: There was little evidence regarding the impact of non-pharmacological interventions in NTM-PD. We identified three studies that described a positive impact of airway clearance techniques, including oscillating positive expiratory pressure, chest physical therapy with devices such as Acapella and Flutter, as well as chest oscillatory techniques (e.g. Vest) and hypertonic saline nebulisation. We found no relevant studies in NTM-PD reporting the use of nutrition, pulmonary rehabilitation or psychological care as interventions in this group of patients.

Conclusions: Non-pharmacological interventions show potential in managing NTM-PD, although significant evidence gaps remain. This review highlights the importance of expanding high-quality studies on the use of these interventions to people with NTM-PD.

This is the first study to compare well-phenotyped patients with ILD-PH in a single centre. Unlike broader cohorts, once PH is severe enough to warrant RHC, survival appears independent of the underlying ILD subtype when comparing IPF-PH with non-IPF-PH. https://bit.ly/3IimPxW.

Cigarette smoking is related to increased small pulmonary vein and artery volumes. These findings highlight the potential of CT imaging to assess smoking-related vascular changes in diseases like COPD and pulmonary hypertension. https://bit.ly/4ljnU6q.

Background: Respiratory syncytial virus (RSV) is the primary cause of hospitalisation due to acute bronchiolitis and viral pneumonia in infants and young children. Recently, a maternal RSV vaccine (Pfizer's Abrysvo) has been approved to protect infants from birth up to 6 months of age. However, there is currently no vaccine or antiviral therapy against RSV for children aged >6 months. Therefore, there is an urgent need for novel antiviral therapies against RSV infection for young children.

Methods: We hypothesised that blocking a host protein called B-Raf kinase would inhibit RSV replication and protect airway epithelial cells against infection. We investigated the in vitro effects of dabrafenib, a US Food and Drug Administration-approved B-Raf kinase inhibitor, against RSV. Human airway epithelial cell lines and primary nasal epithelial cells were infected with RSV and treated with dabrafenib. Real-time PCR, plaque assay, quantitative mass spectrometry, ELISA and immunofluorescence were performed.

Results: Dabrafenib impaired RSV infection and replication (p=0.0003), while protecting cells against RSV-induced lytic cell death (p<0.0001). Proteomics and PCR analyses revealed that dabrafenib decreased the expression of the interferon-stimulated genes IFIT1 (p<0.0001) and ISG15 (p<0.0001) and corresponding proteins in airway epithelial cells. Therapeutic treatment with dabrafenib differentially modulated the release of type I and III interferons.

Conclusions: Collectively, our data indicate that B-Raf kinase is involved in RSV replication, interferon-stimulated gene induction, and type I and III interferon release in airway epithelial cells following infection. We propose that repurposing dabrafenib as a host-directed antiviral against RSV may be valuable in reducing disease pathogenesis associated with RSV infection.

TDM use in NTM management varies globally, with over half using it despite significant barriers. Safety seemed the main reason. Standardised protocols and clear guidelines are needed for effective and consistent TDM implementation. https://bit.ly/3TFYN2j.

Introduction: Learning-centred education is a paramount component of pulmonary rehabilitation. A variability in educational needs exists among patients with a chronic respiratory disease referred for pulmonary rehabilitation and their significant others. Healthcare professionals play a crucial role in meeting these needs by facilitating opportunities for learner-centred education. This study aimed to explore the perceptions of healthcare professionals involved in pulmonary rehabilitation regarding optimisation of patient education for people with a chronic respiratory disease referred for pulmonary rehabilitation and their significant others.

Methods: Focus groups were conducted, which took place on-site at Ciro, a centre of expertise for patients with chronic organ failure, and online. Focus groups consisted of 1) an interprofessional team of healthcare professionals affiliated with Ciro; and 2) hospital-based healthcare professionals who refer patients to Ciro for pulmonary rehabilitation. Focus groups were audiotaped, transcribed verbatim and analysed thematically by two independent researchers.

Results: Three focus groups were held, involving 17 healthcare professionals representing various disciplines. Four main themes were identified: facilitators for optimal patient education, barriers for optimal patient education, involving significant others in patient education and healthcare professionals' preferences for education.

Discussion: To enhance patient education in pulmonary rehabilitation, key recommendations include adopting personalised education, integrating e-health applications to complement face-to-face education and strengthening interprofessional collaboration for continuous and accessible education for both patients and their significant others.

The disproportionate burden of tuberculosis among migrants in the World Health Organization (WHO) European Region underscores the urgent need to address the public health challenges associated with global migration. Recommendations for screening of pulmonary tuberculosis (TB) and TB infection (TBI) are highly variable across European countries, highlighting the need for standardised practices and coordinated efforts to reduce TB risk more effectively. This study aims to produce a harmonised set of recommendations to contribute to elaboration for policy action using the Delphi method. It brings together a multidisciplinary panel of 33 TB experts from academia, healthcare, non-governmental organisations and government agencies across 22 countries to formulate consensus-based recommendations. The panel created 19 consensus statements and 36 recommendations for governments, health systems and other stakeholders. The recommendations span four key domains: 1) policy, 2) health systems and health professionals, 3) screening procedures and priority populations and 4) continued treatment and care. This study recommends a unified, evidence-based approach to TB screening in migrants, with free access to diagnosis and treatment, culturally sensitive care, use of digital tools and coordinated efforts across health systems to ensure effective and equitable TB control in Europe. Thus, the experts emphasised key recommendations that strike a balance between immediate health system interventions, screening procedures and cultural inclusivity to more effectively address TB among migrants. The findings of this study offer actionable policies to address gaps and weaknesses in Europe's response to tuberculosis among migrants, advancing efforts to eliminate TB as a public health threat.

Background: Amniotic epithelial cells are fetal-derived stem cells, capable of differentiating into all three germ layers, including mature epithelial cell populations. Here, we hypothesised that the amniotic epithelium might serve as a surrogate tissue source for investigating transcriptional profiles in the respiratory epithelium of newborns.

Methods: In this study, we compared gene expression profiles and weighted gene coexpression network structure in paired amniotic and newborn nasal epithelial samples from 85 participants in the Airway Epithelium Respiratory Illnesses and Allergy (AERIAL) cohort.

Results: In total, 11 867 genes (79.7%) were commonly expressed in both amniotic and nasal epithelium, with uniquely expressed genes (2563 and 458, respectively) enriched for biological functions related to the specialist function of each tissue (e.g. developmental programs and ciliation, respectively). We observed a strong overlap in weighted gene coexpression network structure between both tissues, with 10 coexpression modules identified by consensus network analysis. Genes commonly expressed in both tissues and/or found in the consensus network modules were enriched for biologically relevant gene signatures and pathways related to airway function. We observed significant overlap in gene expression and network structure between the amniotic epithelium and published datasets of epithelial samples from lower airways and other epithelial tissues, including skin and oesophagus, suggesting a global epithelial signature.

Conclusion: We observed significant overlap in gene expression and network structure between paired amniotic and nasal epithelial samples, supporting the potential of amnion as a noninvasive and abundant tissue surrogate. Future studies investigating amnion-based biomarkers for respiratory exposures in utero and childhood disease outcomes are needed to extend these results towards clinical translation.