European Clinical Respiratory Journal最新文献

The first formal meeting of Nordic professors in pulmonary medicine took place in Gothenburg in December 1995. In Reykjavik in June 2003, the laws and statutes of the Nordic Respiratory Academy (NORA) were approved, and the first board was elected. NORA aimed to improve education, research, and clinical practice and became a meeting place for building friendships and exchange of ideas among academic teachers in pulmonary medicine in the Nordic region. The meetings initiated cooperative research among the university departments of respiratory medicine, and NORA reestablished the Nordic chest physicians' own pulmonary medical journal with roots in the Nordic region. Until 2025, 20 NORA meetings have been held. Its future depends on the perceived need for such a meeting place and academics that are willing to continue organizing and using this institution as a think tank.

Introduction: The financial burden of asthma in young adults remains sparsely investigated. Our study aims to estimate the Swedish national financial burden of asthma in adults aged 18-45 using nationwide databases.

Methods: The financial burden of asthma in Sweden was estimated using the Swedish burden of disease, cost of medical care, and sick leave utilization data from 2022, together with healthcare consumption estimates from a nationwide burden of asthma study (data from 2014 to 2018). Costs were calculated as total costs and excess costs compared to matched controls.

Results: The total annual financial burden for individuals with asthma was €3,572 per patient, divided into primary care (€929), secondary care (€1,137), medicine (€605), and sick leave transfers (€902). When compared to an age-, sex-, cohabitation-status-, and residence-matched control group, an annual excess cost of €2,299 (2,288-2,310) per patient with asthma was found. When stratified according to disease severity, patients at GINA 2020 Step 2 incurred the lowest annual cost at €2,916 (2,960-3,092), whereas GINA 2020 Step 5 represented the highest annual cost at €6,697 (6,559-6,793). Pooling the total mean costs for all young Swedish adults with ICS-treated asthma (n = 88,898) revealed an excess annual financial burden of €204,375,739, of which 39% (€ 80,150,137) were sick leave transfers.

Conclusion: Asthma in Sweden is associated with a substantial financial burden from both direct costs and asthma-related sick leave compared to matched controls, and the pooled excess burden of ICS-treated asthma in young adults exceeded €200,000,000 annually.

Background: Patients with incurable lung disease may have high symptom burden, which can be difficult to alleviate. We wanted to examine patients' experiences of music therapy regarding disease management, symptom relief and quality of life, and how the service could be integrated in their care during a hospital stay.

Method: We conducted a pilot study in adult patients admitted with incurable lung disease during the spring 2021 at a university hospital in Norway, using an exploratory mixed methods implementation design. Qualitative interviews were analysed using systematic text condensation. Quantitative data, comprising symptom burden, functional status and quality of life, were analysed with descriptive statistics.

Results: Eighteen participants (7 men, 11 women, age 57-90 years) were included in the period April 6th to 15 June 2021 out of a total of 93 screened patients. 1-4 music therapy sessions were conducted per participant, resulting in a total of 24 sessions, with conversation and listening to music that had personal significance for a patient as the main activities. The symptom burden was lowest immediately after the session with music therapy compared to measurements before and after the end of the project period, but without statistical significance due to the small number of participants. Participants reported how music therapy supported them in three domains: 1) Through the emphasis on their life-course narrative and situatedness. 2) Through the therapeutic relationship and importance of collaboration. 3) Through the experience of coping and getting a break from illness.

Conclusion: Our findings suggest that music therapy, individually tailored to each patient, may enhance coping and well-being, and is feasible on a busy pulmonary ward. Music therapy should be considered as part of the comprehensive treatment of patients with incurable lung disease, supplementing existing care.

Introduction: Interpretation of spirometry data depends on the availability of reference equations that reflect the physiological norms of the assessed population. Although GAMLSS models provide clinically acceptable models, they may lack simplicity and ease of application. This study evaluated the efficiency of machine learning (ML)-based spirometry reference equations as an alternative for Jordanian adults.

Method: In this cross-sectional study, ML models were trained using age and height to predict FEV₁, FVC and FEV₁/FVC. Model development was based on the same datasets previously used to construct GAMLSS-based Jordanian equations, which included 1,948 participants (54.2% females). External validation was performed on a newly recruited sample of healthy, non-smoking adults (n = 487, 46.6% females).

Results: ML predicted and lower limits of normal (LLNs) values were compared with those from the Jordanian GAMLSS, GLI equations, using z-score distributions, residual plots, and clinical diagnostic agreement. For both sexes, ML models consistently produced comparable mean squared errors (MSE) to the Jordanian GAMLSS equations and lower MSE values and z-scores closer to zero when compared with global reference equations. Agreement analyses revealed that the ML and Jordanian models more reliably classified individuals within ± 0.5 and ± 1.0 z-score thresholds, emphasizing their superior calibration. ML and Jordanian models were the only ones to classify all the healthy study sample as normal spirometry.

Conclusion: ML-derived spirometry equations demonstrated strong alignment with the observed data and outperformed global standards in representing Jordanian adults. These findings support the use of reference equations customized for specific regions in respiratory diagnostics.

Background: Knowledge about the local prevalence and risk factors of respiratory symptoms helps to address healthcare resources. Furthermore, no studies have compared the prevalence and risk factors of several respiratory symptoms within the same population.

Objective: We conducted two cross-sectional email surveys in 2017 and 2021 for public service employees in two Finnish towns and Finnish Pensioners' Federation members. The questionnaires were sent to 40,185 subjects; 9,865 (24.6%) responded, 72.5% were female, and the mean age was 63 (range 18-94 years). Validated symptom questionnaires were included for each respiratory symptom. The questionnaire on sleep apnea symptoms was only included in the survey of retirees.

Results: Prevalence of current asthma was 8.9%, wheezing with dyspnea 12.5%, chronic rhinosinusitis 11.9%, chronic cough 12.8%, TBQ phenotype cough 9.6%, chronic bronchitis 17.6% and gastroesophageal reflux symptoms 15.6%. In the retired group, the prevalence of sleep apnea symptoms was 32,8%. More than one respiratory symptom was present in 27.1% of subjects. A higher body mass index (BMI), smoking, and allergy increased the risk of most symptoms, while high household income protected against some symptoms. Increased age was associated with an increased risk of chronic cough, chronic bronchitis, and gastroesophageal reflux symptoms. In contrast, decreased age was associated with an increased risk of wheezing with dyspnea and chronic rhinosinusitis. The male gender increased the risk of chronic bronchitis and sleep apnea symptoms. All respiratory symptoms were associated with multiple non-respiratory symptoms.

Conclusions: We gathered updated information on the prevalence of respiratory symptoms in Finland. Age, higher BMI, smoking, low household income, and allergy were significant risk factors for most respiratory symptoms.ClinicalTrials.Gov identifier: NCT03639727.

Introduction: Non-small lung cancer (NSCLC) carries a substantial risk for recurrence even after complete resection. Evidence regarding the survival impact of post-resection surveillance strategies remains limited. Danish guidelines for lung cancer recommend contrast-enhanced computed tomography (CE-CT) every 3 months for the first 2 years and every 6 months for the subsequent 3 years, a frequency twice that of major international guidelines. This study retrospectively assessed the outcomes of this high-frequency CT surveillance in Denmark, specifically focusing on recurrence detection within two years post-surgery, the potential for renewed curative-intent treatment, and post-recurrence prognosis during this initial period.

Method: A cohort of 1079 patients who underwent resection for NSCLC in the period 2019-2020 was identified from the Danish Lung Cancer Registry (DLCR). Detailed information regarding new diagnoses of lung cancer, offered treatments, and mortality was extracted from patients' medical records.

Results: Within two years following resection, 20% of patients developed a new diagnosis of lung cancer. Of these, 28.5% presented with localized disease (stage I-II), 26% with locally advanced disease (stage III), and 45% with metastatic disease. Recurrence frequencies ranged from 13% for pathological stage I (pStage I) to 44.5% for pStage III. Forty-eight percent of patients were offered renewed curative-intent treatment, demonstrating a 2-year post-recurrence survival of 78%. In contrast, patients offered palliative care or no treatment had a 2-year post-recurrence survival of 40%.

Conclusion: The proportion of recurrences presenting with metastatic disease was lower than reported in cohort studies with less frequent surveillance. A further notable finding was the high proportion of patients offered curative-intent treatment for recurrent disease, exceeding previously reported rates. These patients demonstrated a 2 year post-recurrence survival comparable to that observed following a primary NSCLC diagnosis. The presence of symptoms at the time of recurrence was a negative prognostic indicator, even among patients receiving palliative treatment.

Serotype 3 pneumococcal infection can cause severe invasive disease, even in immunocompetent adults, and is potentially preventable by vaccination. Invasive pneumococcal disease caused by serotype 3 is currently the most frequent serotype found in adults in Denmark. In this report, we present a 62-year-old immunocompetent man diagnosed with a severe pleural empyema caused by serotype 3, requiring a long course of antibiotics. The patient experienced clinical improvement, and follow-up imaging showed near-complete resolution of lung infiltrates. We also review the epidemiology of serotype 3 invasive pneumococcal disease in adults in Denmark and discuss the challenges related to serotype 3 and effective vaccines.

Background: Both anemia and polycythemia have previously been shown to influence outcomes in patients with COPD admitted to hospital with acute exacerbations (AECOPD). The aims of this study are to elucidate the prevalence of anemia and polycythemia and their prognostic value on readmission and mortality in patients admitted with AECOPD.

Methods: This retrospective cohort study included patients admitted with AECOPD to hospitals in the North Denmark Region in 2018. Age, gender, body mass index, lung function, smoking history, number of comorbidities, hemoglobin levels, information regarding readmission and mortality were included. Patients were stratified according to hemoglobin levels: Anemia (<12 g/dL in women, <13 g/dL in men), normal hemoglobin (12-15 g/dL in women, 13-17 g/dL in men), and polycythemia (>15 g/dL in women, >17 g/dL in men). Differences in group characteristics, one-year readmission, and mortality risk were investigated.

Results: In total 1525 subjects with COPD were included at first AECOPD admission in 2018, and divided in anemic, normemic, and polycythemia groups. Prevalence of polycythemia and anemia was 6.8% and 35.2%, respectively. One-year readmission and -mortality risk increased in anemic patients but did not increase in patients with polycythemia.

Conclusion: Anemia was predictive of increased risk of one-year readmission and -mortality on patients admitted with AECOPD.

Methacholine bronchial provocation (BMP) is a valuable tool in supporting the diagnosis of asthma, but the BMP must be validated regarding dosing, since the BMP basically is a dose response study. Historically, the dose delivered by a nebulizer has been calibrated gravimetrically, by weighing the nebulizer before and after dosing. However, this method is no longer recommended, since it has been recognized that a large fraction of the weight loss was due to evaporation. Unfortunately, practical alternatives are not available, forcing clinicians to rely on the manufacturer's specified dose output. We studied the validity of the dose claimed to be delivered by the Vyaire APS-Pro.

Methods: To determine the dose output, we applied a radioactive method, considered the gold standard, and we validated a commercially available chemical analysis of chloride.

Results: The output from the APS-Pro was found to be highly correlated (R² = 0.94) with the dose specified by the APS-Pro software but was consistently 1.8 times higher. The new chemical method demonstrated accuracy comparable to the radiometric approach. Notably, we observed significant variations in output across different nebulizers.

Discussion: The methacholine dose delivered to the mouth via the APS-Pro does not align with company specifications due to variability between nebulizers and a non-linear relationship between nebulization time and output, leading to higher output rates during shorter nebulization periods.

Conclusion: Individual output calibration of specific BMP systems remains necessary, as current systems still do not consistently meet manufacturer's specifications. Clinicians must therefore have access to practical calibration methods.

Background: Airway hyperresponsiveness (AHR), a key feature of asthma, leads to airway narrowing in response to bronchoconstrictor stimuli. Notably, AHR is also observed in individuals with chronic obstructive pulmonary disease (COPD). The Mannitol challenge test is an indirect method to assess airway hyperresponsiveness.

Objective: The primary aim of this study was to explore airway hyperresponsiveness to mannitol in subjects with asthma and COPD regarding inspiratory and expiratory resistance and reactance. A secondary aim was to investigate fractional exhaled nitric oxide (FeNO), blood eosinophils, allergen sensitization, and symptom scores concerning airway hyperresponsiveness to mannitol.

Methods: The Mannitol challenge test was conducted on 292 subjects: 238 with asthma, 25 with COPD, 14 healthy smokers, and 15 healthy never-smokers. The response was assessed using both spirometry and respiratory oscillometry, with inspiratory and expiratory resistance and reactance measured separately.

Results: A positive mannitol test was confirmed in 84 (35%) subjects with asthma, 13 (52%) with COPD, and 7 (50%) of healthy smokers. Subjects with asthma who had a positive mannitol test had a higher inspiratory R5 and R19 at baseline, and also greater change in both inspiratory and expiratory R5, R5-R19, and X5 (but not R19), compared to asthma subjects with a negative test. A similar tendency was seen among subjects with COPD and healthy smokers. Subjects with asthma with a positive mannitol test had more symptoms than subjects with a negative test (median 21 versus 22; p = 0.036).

Conclusion: Inspiratory resistance, as measured by respiratory oscillometry, was shown to predict hyperresponsiveness to mannitol in asthma patients. Furthermore, respiratory oscillometry revealed a significant increase in resistance, primarily in the peripheral airways, following a mannitol challenge in these subjects. Integrating resistance and reactance measurements, along with traditional spirometry may offer a more comprehensive understanding of the hyperreactive airway response.