ERJ Open Research最新文献

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.

Rationale: COPD is a long-term condition with comorbidities such as anxiety and depression that are associated with poorer health outcomes. The TANDEM (Tailored intervention for Anxiety and Depression Management in COPD) trial investigated whether a psychological intervention, delivered by respiratory healthcare professionals ("facilitators") using a tailored cognitive behavioural approach, would reduce anxiety and/or depression and improve pulmonary rehabilitation attendance in patients with advanced COPD. The intervention did not reduce anxiety or depression or improve pulmonary rehabilitation attendance. As part of the trial process evaluation, we explored facilitators' communication with patients, professional role and identity, and perspectives on implementation.

Methods: Qualitative interviews with 14 facilitators (nurses, physiotherapists and occupational therapists) who were trained to deliver the cognitive behavioural approach sessions.

Results: Facilitators recognised the need for psychological care and were positive about the training, practice and clinical supervision. The intervention was viewed as helpful for some, but not all, patients. Comorbidities and social and personal challenges affected patient engagement in identifying and addressing COPD-related anxiety and depression. There was scepticism about incorporating a cognitive behavioural approach intervention such as TANDEM into routine healthcare due to resource constraints.

Conclusions: Respiratory healthcare professionals valued being trained and supported to deliver a tailored intervention using a cognitive behavioural approach to patients with COPD. The complexity of comorbidity and patients' social context presented barriers to engagement. The intervention was viewed as unlikely to be delivered as part of routine care. Greater focus on patient engagement in the context of multimorbidity and psychosocial complexity is recommended.

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.

Treatable traits in bronchiectasis are diverse and reflect patient heterogeneity. Identifying these traits can guide personalised care, improve outcomes and optimise resource allocation in real-world clinical practice. https://bit.ly/3TqDgun.

Background: Mycobacterium avium complex pulmonary disease (MAC-PD) is a chronic inflammatory disease with systemic manifestations affecting multiple aspects of patients' lives. Current microbiological outcome measures are often difficult to obtain and insufficient to reflect the impact of disease and treatment. We developed an international consensus-based set of core outcome domains (COD) for MAC-PD clinical trials using a modified Delphi consensus methodology.

Methods: We invited relevant stakeholders in MAC-PD including people living with MAC-PD, their family members and friends, clinicians, researchers and research funding organisations to participate in an electronically administered Delphi consensus process. Participants rated preliminary domain importance, without regard to availability, feasibility or validity of potential measurement instruments. We used descriptive analyses to evaluate participant demographics and domain ratings, with predetermined criteria for COD inclusion.

Results: A total of 306 participants representing 17 countries participated in round 1, 197 (64.4%) in round 2 and 173 (56.5%) in round 3. Over half of participants were people living with MAC-PD (57.2%), with 31.1% reporting their primary role as clinician, 9.2% as researcher. Symptoms, microbiology, treatment side-effects, chest imaging, physical function, treatment burden, and vitality/energy domains met criteria for COD inclusion in round 1. Disease recurrence and biomarkers met COD inclusion criteria in round 2 and round 3, respectively.

Conclusion: Participants evaluated 11 outcome domains and suggested two additional domains for consideration, reaching COD consensus inclusion criteria for nine domains. Identification and dissemination of these CODs will help guide research priorities for measurement instruments and facilitate composite measure of disease activity development for MAC-PD.