Long-term evolution of Mycoplasma pneumoniae pneumonia revealed ad integrum recovery of pulmonary lesions and normalisation of pulmonary function in all patients. Peripheral deconditioning was frequent and should be systematically evaluated and addressed. https://bit.ly/4lA2DWA.
Background: There is interest in digital technology-enabled models of pulmonary rehabilitation (Digital-PR) as a means of increasing capacity, uptake and accessibility. However, there are little data on real-world implementation or how Digital-PR could support other models of pulmonary rehabilitation delivery.
Methods: We conducted a mixed-methods, feasibility study to evaluate the acceptability of a hybrid model of pulmonary rehabilitation (Hybrid-PR) blending Digital-PR with traditional, supervised pulmonary rehabilitation (PR). To determine acceptability, we measured engagement and use of the app and conducted patient interviews. We assessed differences in PR completion, number of scheduled sessions and staff time between Hybrid-PR and a propensity-matched control group attending PR without Digital-PR (Control-PR).
Results: Of 69 people undergoing Hybrid-PR, 87% opted for in-person, centre-based care and 13% for home-based care (10% supported by video-teleconferencing, 3% supported by telephone). 86% activated Digital-PR at least once, but only 35% activated regularly (at least weekly for 8 weeks). 88% never accessed the exercise components of Digital-PR. There were no significant differences in PR completion rates, number of supervised PR sessions, nor staff time in Hybrid-PR when compared to Control-PR. Both patients and staff identified digital literacy, limited flexibility to adapt/tailor Digital-PR and increased time-commitment as potential barriers.
Conclusion: Hybrid-PR was not considered acceptable due to intervention fidelity and limited patient engagement with Digital-PR. Hybrid-PR was not associated with reduction in scheduled supervised sessions. Poor digital literacy is an important barrier to implementation of Digital-PR in the real-world setting.
Background: Neuroendocrine hyperplasia of infancy (NEHI), also called persistent tachypnoea of infancy (PTI), is one of the most prevalent forms of childhood interstitial lung disease (chILD) and one of the few with an overall favourable prognosis. Nevertheless, there is still much to be understood about the pathophysiology of NEHI and much to be done to harmonise diagnostic work-up and management.
Methods: A systematic search was conducted in PubMed, Embase, Cochrane Library, Scopus and Web of Science to identify eligible studies.
Results: The results are presented in a narrative format, providing an overview of the current understanding of NEHI epidemiology, clinical presentation, investigations and outcomes. In-depth discussions include the roles of clinical assessment, chest computed tomography scan and lung biopsy, along with prospects for new diagnostic tools. Additionally, the discussion covers the pathophysiology of NEHI, focusing on the possible roles of genetic predisposition and infectious triggers.
Conclusions: The morbidity of NEHI is particularly significant in the first months of life, underscoring the need for clinical and basic research to develop new targeted treatments. Some of these are discussed in this review. Finally, the improved diagnosis of this rare lung disease is facilitating the formation of new parent groups, which are becoming a crucial asset for progress.
The question addressed by the study: The optimal treatment for pleural infection is yet to be determined and recruitment to trials can be challenging. Research into patient priorities in pleural infection is lacking. This qualitative study aimed to help us understand the patient perspective regarding priorities of care, to identify patient-centred study outcomes, and to explore the understanding of the risks and benefits of randomisation to different pleural interventions.
Methods: A prospective, multicentre, qualitative study using a semi-structured interview methodology explored key themes addressing the experiences of participation in a pleural infection randomised controlled trial (RCT) of combination intrapleural enzyme therapy versus surgery as well as priorities of care. Thematic analysis was conducted using the Framework method.
Results: Thematic analysis identified five main themes: emotions, level of explanation and understanding, reaction to randomisation, influences on physical wellbeing, and overall experience. Pain was a significant feature due to both the infection and interventions. The overriding emotions described by patients were fear and anxiety. Participants demonstrated high levels of support for randomised allocation to intervention.
The answer to the question: A pleural infection patient-reported outcome measure should be developed to assess pain, fatigue, anxiety and breathlessness, so that valid health-related quality of life data can be captured. Pain is an undertreated symptom of pleural infection and should be incorporated into treatment protocols. There was no clear patient preference between the interventions, and a surgical versus nonsurgical pleural infection RCT is acceptable to participants.
Background: The benefits of preoxygenation with noninvasive respiratory support (NRS), including high-flow oxygen therapy (HFOT) and noninvasive ventilation (NIV), compared to conventional oxygen therapy (COT) during emergency endotracheal intubation (ETI) remain unclear. This network meta-analysis aims to evaluate whether preoxygenation with NRS is more effective than COT in minimising the lowest recorded peripheral capillary oxygen saturation (S pO2 ) during emergency ETI.
Methods: A comprehensive literature search was conducted (PROSPERO-CRD42024606842) across Medline, Embase and Scopus. The PICOS criteria were: P: critically ill adult patients requiring emergency ETI; I: randomisation for receiving preoxygenation with NRS; C: randomisation for COT; O: the lowest recorded S pO2 during emergency intubation (and additional secondary outcomes); S: randomised clinical trials (RCTs).
Results: 15 RCTs (2939 patients) met the inclusion criteria. Compared to COT, all NRS methods improved the lowest S pO2 during emergency ETI (mean difference for HFOT was 1.50, 95% CI 0.43-2.58, p=0.006; for NIV was 3.30, 95% CI 1.81-4.79, p<0.001) (low evidence). Moreover, NIV reduced the occurrence of severe desaturations (S pO2 <80%) (OR 0.31, 95% CI 0.15-0.61, p<0.001) (very low evidence). Finally, preoxygenation with NRS did not increase the risk of complications (including aspiration, hypotension, barotrauma, arrhythmia or cardiac arrest), and no differences were found in postintubation gas exchange, mechanical ventilation or mortality compared to COT.
Interpretation: During emergency ETI in critical care areas, despite a low certainty of evidence, preoxygenation with NRS overperformed COT in maintaining S pO2 . Only NIV reduced the incidence of severe desaturation, while the risk of complications and adverse events was similar across different preoxygenation devices.
Background: Preserved ratio impaired spirometry (PRISm) is a prevalent lung function abnormality associated with an increased body mass index and an increased risk of cardiovascular disease and metabolic disorders. However, the strength and consistency of these associations across populations remain unclear. This systematic review and meta-analysis aimed to quantify the relationship between PRISm and key cardiometabolic comorbidities, including diabetes mellitus, hypertension, hypercholesterolaemia, ischaemic heart disease and heart failure.
Methods: A systematic search of PubMed, Embase and Web of Science was conducted to identify observational studies comparing the prevalence of cardiometabolic comorbidities in PRISm and normal spirometry populations. Meta-analyses were performed for conditions reported in three or more studies, and heterogeneity was assessed using the I2 statistic. Sensitivity and influence analyses were conducted to ensure the robustness of findings.
Results: A total of 18 studies were included, comprising over 500 000 participants. Meta-analysis showed significant associations between PRISm and diabetes (OR 2.08, 95% CI 1.78-2.42), hypertension (OR 1.78, 95% CI 1.55-2.03), ischaemic heart disease (OR 2.05, 95% CI 1.59-2.64), heart failure (OR 2.82, 95% CI 1.40-5.67) and hypercholesterolaemia (OR 1.46, 95% CI 1.16-1.85). PRISm populations also exhibited a higher body mass index (mean difference 1.49 kg·m-2, 95% CI 0.92-2.05 kg·m-2).
Conclusion: PRISm is strongly associated with cardiometabolic disease, reinforcing its role as a systemic condition rather than a purely pulmonary abnormality. These findings highlight the need for integrated screening and management strategies for PRISm patients to address their broader multimorbid risk profile.
Background: There is growing interest in identifying novel, non-invasive biomarkers reflecting endogenous inflammatory processes in asthma. This study aimed to evaluate the presence of volatile organic compounds (VOCs) in exhaled breath from patients with clinically controlled asthma and assess how tobacco exposure influences their expression.
Methods: Exhaled breath samples from 120 clinically controlled asthma patients and 89 healthy controls were collected using BioVOC breath samplers. Samples were analysed by gas chromatography-mass spectrometry, assessing five previously characterised VOCs: hexanal, heptanal, nonanal, propanoic acid and nonanoic acid.
Results: Compared to healthy controls, asthma patients exhibited a lower frequency of propanoic acid exhalation (25.0% versus 53.9%; p<0.001) and higher frequencies of nonanoic acid (30.8% versus 15.7%; p=0.019). These differences persisted after adjusting for smoking status. Stratified analysis revealed reduced propanoic acid exhalation in both smoking and non-smoking asthma subgroups compared to their respective controls (21.0% versus 55.6% and 29.3% versus 51.4%, respectively; p<0.001). Additionally, asthma current and former smokers had significantly increased detection of nonanoic acid compared to controls (33.9% versus 11.1%; p=0.0359). Multivariate analysis identified propanoic acid as a protective factor against asthma (OR 0.2 (95% CI 0.1-0.4); p<0.001), whereas nonanoic acid significantly increased asthma risk (OR 4.5 (95% CI 1.8-12.6); p=0.003).
Conclusions: Exhaled propanoic and nonanoic acids may serve as complementary non-invasive biomarkers for monitoring controlled asthma, independently of tobacco exposure. VOC analysis has promising potential to improve asthma management, therapeutic monitoring and patient stratification.
Introduction: Comorbid cardiovascular disease has been reported extensively in community COPD populations, but to a lesser degree in acute hospital settings. Shared risk factors and acute infection both increase acute coronary syndrome (ACS) risk. Our objective is to assess a cohort of adults hospitalised for an acute lower respiratory tract infection (aLRTI) to determine whether COPD status is an independent risk factor for ACS.
Methods: A prospective observational cohort study of adults aged ≥40 years (n=8496) with community-acquired aLRTI (Bristol, UK) was conducted between 27 July 2020 and 28 November 2022. Cases included physician diagnosis of COPD; controls were aLRTI without COPD. Outcomes included physician-diagnosed ACS occurring within 30 days of admission. Logistic regression models were adjusted for shared cardiovascular risk factors and aLRTI severity.
Results: 30-day ACS events in patients hospitalised with aLRTI with COPD were 7.59% (190 out of 2502), versus without COPD 6.96% (417 out of 5994) (p=0.3094). Across both groups ACS incidence was 95.1 events per 100 inpatient years. There was no association between COPD and 30-day ACS risk, when adjusting for shared cardiovascular risk factors (OR 1.14, 95% CI 0.93-1.39). However, a diagnosis of COPD increased ACS risk in those without pneumonia versus controls (OR 1.38, 95% CI 1.02-1.87). Markers of infection were associated with increased risk of ACS in both groups (white cell count >10×109 cells·L-1 OR 1.31, 95% CI 1.10-1.56). Pneumonia was associated with the highest risk of ACS (OR 1.49, 95% CI 1.19-1.87 (no COPD); OR 1.46, 95% CI 1.11-1.92 (with COPD)).
Conclusions: In this large, real-world cohort of hospitalised adults with aLRTI, 30-day ACS event rates were high at ∼7-13%. A diagnosis of COPD even in the absence of pneumonia increases ACS risk versus our control group without COPD. Markers of infection severity appear to be key drivers of ACS in this population. This highlights the importance of both COPD and infection severity on risk of ACS following hospitalisation with aLRTI.
Background: COPD is often managed with triple therapy (long-acting β2-agonist, long-acting anticholinergic and inhaled corticosteroid). However, some patients experience COPD exacerbations and persistent symptoms, indicating poor disease control. This study aimed to describe the characteristics of uncontrolled COPD patients and assess clinical burden by comparing overall survival and exacerbation frequency between uncontrolled and controlled COPD patients, and between uncontrolled COPD patients and the general population.
Methods: This retrospective study included patients >40 years old, treated with triple therapy for ≥90 consecutive days in 2015, from the French National Health Data System. Patients were followed for up to 5 years. COPD patients were classified as uncontrolled (one or more severe, or two moderate exacerbations within 12 months before inclusion) or controlled. A random sample from the general population was included. Propensity score matching (1:2 for uncontrolled versus general population, 1:1 for uncontrolled versus controlled) was used. Overall survival was estimated using the Kaplan-Meier method; exacerbation risks were assessed using the Kalbfleisch and Prentice method.
Results: Of 186 963 COPD patients on triple therapy, 21.3% (n=39 847) had uncontrolled COPD. Uncontrolled patients had a shorter overall survival and higher mortality risk compared with controlled patients (hazard ratio (HR) 1.21, 95% CI 1.18-1.23) and the general population (HR 2.51, 95% CI 2.45-2.57). Median time to first exacerbation was 0.39 years for uncontrolled versus 1.80 years for controlled patients.
Discussion: This study demonstrates the high clinical burden of uncontrolled COPD, defined by persistent exacerbations and characterised by reduced survival and frequent exacerbations despite triple therapy.
Hybrid modalities of pulmonary rehabilitation (PR) have the potential to address some of the existing barriers associated with conventional centre-based PR. These models can be used to complement, and not only replace, centre-based PR. https://bit.ly/4nFtySE.
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