European Clinical Respiratory Journal最新文献

Introduction: Post-tuberculosis lung disease (PTLD) causes health problems among pulmonary TB (PTB) survivors. Post-TB patients may suffer from chronic respiratory symptoms, declining lung function, and persistent radiological abnormalities. However, studies regarding PTLD in children and adolescents are still scarce. Patterns of radiological abnormalities, including chest X-ray (CXR) imaging, high-resolution computed tomography (HRCT), and magnetic resonance imaging (MRI) in post-TB children, and adolescents are not fully understood.

Aim: In this study, we aim to review and analyse radiological features in children and adolescent TB survivors of the literature on the differences in imaging findings in drug-resistant (DR) and drug-sensitive tuberculosis (DS TB) children and adolescent TB survivors.

Method: We performed a systematic review to determine imaging patterns of DR and DS TB in children and adolescent survivors. Data collected include study design, number of subjects, age, TB category, treatment duration, time of evaluation, and imaging patterns. We searched MEDLINE/Pubmed, Google Scholar, Science Direct, Wiley Online Library, Cochrane Library, and Proquest and included four studies for data analysis. Study quality was assessed using a modified Newcastle-Ottawa score.

Result: Studies included 151 children and adolescents aged 0-17 years. Three out of four studies were conducted on DS-TB patients and one study compared DS- and DR-TB. Radiological abnormalities observed by CXR at TB treatment completion include calcification in the presence or absence of fibrosis, bronchiectasis, and destroyed lung, or lymphoid interstitial pneumonitis. Micronodules are most often seen in HRCT in the acute early stages of TB and were not seen in standard chest radiography. Cavities persisted in almost 50% of patients after TB treatment and fibrotic changes increased after treatment.

Conclusion: Imaging abnormalities after TB treatment are often seen in children and adolescents. Imaging evaluation should be performed in PTB survivors, especially in those with moderate or advanced lesions during active disease and those with severe clinical manifestations.

Background: Chronic respiratory diseases are on the rise globally, and growing evidence shows that lungs whether healthy or diseased harbor bacterial communities that primarily originate from the oral cavity. Despite this, longitudinal studies examining how oral bacteria influence respiratory health trajectories in the general population are lacking.

Aim: This study aimed to explore the influence of oral bacteria on lung function (LF) outcomes measured 6 years later in a community-based Norwegian population. Analyses included measurements of endotoxin load and lipid A profiling to assess the inflammatory potential of oral bacterial communities.

Methods: Saliva samples and spirometry data were collected from 75 participants in the RHINESSA study (Bergen, Norway) at baseline (2014-2015). Spirometry was repeated at follow-up (2020-2021). Bacterial community composition and endotoxin lipid A profiling were determined by targeted sequencing of the 16S rRNA gene (V3-V4 region). Associations between baseline salivary microbiota and lung function at follow-up were assessed using multivariate linear regression.

Results: The relative abundance of Selenomonas, Mogibacterium, Tannerella, and Prevotella was positively associated with both forced expiratory volume in 1 s (FEV₁) and forced vital capacity (FVC), while Kingella, and Anaerococcus showed negative associations. Endotoxin load was positively associated with FEV₁ and FVC. A negative association was observed between the proinflammatory hexa-acylated lipid A variant and LF outcomes, whereas a positive association was found for the penta-acylated lipid A variant.

Conclusions: Salivary bacterial community characteristics were associated with LF outcomes measured 6 years later. Our findings suggest that the oral microbiota may represent a potential target for disease prevention or intervention strategies, warranting further investigation.

[This corrects the article DOI: 10.1080/20018525.2023.2257993.].

Recurrent pleural effusions and ascites significantly impair quality of life, particularly in patients with advanced malignant and non-malignant disease. Traditional management often relies on repeated hospital-based procedures, which provide temporary symptom relief but place a considerable burden on patients and healthcare systems. This retrospective cohort study evaluates the safety, effectiveness, and clinical outcomes of indwelling pleural and peritoneal catheters (IPCs and IPeCs) in 63 patients treated at Lillebaelt Hospital Vejle between October 2019 and October 2024. A total of 30 patients received IPCs and 33 received IPeCs. Most had malignant effusions or ascites, but a notable proportion had non-malignant causes such as heart failure, liver cirrhosis, or renal disease. Following catheter placement, median survival was 45 days for IPC patients and 34 days for IPeC patients. Infection rates were low: 17% of IPC patients developed superficial skin infections, all treated successfully with oral antibiotics, and 6% of IPeC patients developed peritonitis, with one case potentially unrelated to the catheter. Importantly, 70% of IPC and 76% of IPeC patients had no hospital visits due to catheter-related complications, supporting the safety and outpatient feasibility of these devices. Additionally, a substantial proportion of patients-23% (IPC) and 30% (IPeC) - were able to remain in their own homes, potentially with support from home care services, rather than requiring institutionalization. These findings underline the benefit of early catheter placement in supporting patient autonomy and symptom control. Our results confirm that IPCs and IPeCs are safe and effective for managing both malignant and non-malignant effusions, with low complication rates and high patient benefit. Our findings support broader use of these catheters in palliative care. Earlier consideration of catheter placement may further improve outcomes and quality of life.

Introduction: The volume of colistimethate sodium (CMS) that can be administered in a single application using a vibrating mesh nebulizer (VMN) is related to the capacity of the nebulization chamber. This study designed and tested a nebulization chamber and assessed the effects of the diluent volume on colistin nebulization.

Methods: A bench study was conducted to evaluate the performance of the nebulization chamber. A 7-day clinical scenario involving the nebulization of two diluent volumes of CMS (6 and 12 mL) was simulated. Each diluent volume was nebulized for seven consecutive days. Particle size and viscosity were analyzed for four diluent volumes of CMS (3 mL, 6 mL, 9 mL, and 12 mL).

Results: After 7 consecutive days of nebulization, residual colistin crystals were observed in both diluent volumes, with a higher incidence in the 6-mL than in the 12-mL diluent volume. The VMN malfunctioned once on day 5 when using the 6 mL diluent volume. Nebulized colistin output was inversely correlated with diluent viscosity.

Conclusion: The additional nebulization chamber facilitated the nebulization of a larger diluent volume of CMS in a single nebulization course. Larger diluent volumes resulted in fewer residual CMS crystals and lower diluent viscosity.

Background: Loss of appetite in patients with COPD can lead to malnutrition, which is associated with an increased risk of morbidity and mortality.

Aims: To identify factors associated with loss of appetite among COPD patients and explore their' experiences regarding appetite and eating.

Methods: A questionnaire on demographics, medical history and containing the Council on Nutrition Appetite Questionnaire (CNAQ) was posted in a COPD-specific online forum. CNAQ is validated to examine loss of appetite in older adults. The questionnaire contains 8 questions with five ordinal answer options. Ten patients who answered the questionnaire were randomly recruited for semi-structured phone interviews.

Results: Eighty-seven patients responded to the questionnaire. 61% had loss of appetite. Patients with loss of appetite had a lower FEV1% predicted (31% vs. 42%, p = 0.03), higher CAT-score, (23 vs. 18, p = 0.002), and a higher proportion lived alone, (68% vs. 32%, p = 0.02), and got all daily meals delivered (19% vs. 0%, p = 0.009). Among the interviewed patients, the following factors influenced their appetite: Lack of daily routine, insufficient knowledge on nutrition, lack of social contact, bodily limitations, inadequate help and support, limited physical activity and lack of acceptance of life situation.

Conclusion: Patients with loss of appetite are characterized by a low BMI, impaired lung function, more symptoms and live alone. Improvement in social contact and support, nutritional support, and acceptance of their current life situation will help address these challenges.

Traditionally, rehabilitation and palliative care are delivered as separate services, where rehabilitation focuses on regaining physical functions and palliative care on symptom relief and existential support. There is growing recognition of the potential benefit in integrating these approaches. This scoping review explores how integration or coordination of rehabilitation and palliative care is described in the literature, with a focus on heart failure, chronic obstructive pulmonary disease, and interstitial lung disease. A systematic search was conducted in MEDLINE, EMBASE, and CINAHL, identifying 20 relevant publications. Six overarching themes emerged: overlapping treatment goals; timing of services; inclusion of advance care planning (ACP); attention to existential and spiritual dimensions; barriers to integration; and the role of informal caregivers. The majority of the included studies were re-views or expert statements, with few interventional studies. Practical implementation remains limited and poorly defined. While guidelines increasingly support integrated care models, significant challenges persist, including lack of conceptual clarity, limited evidence of effect, and unclear roles for caregivers. There is broad consensus that integration could improve quality of life for both patients and caregivers by combining the functional focus of rehabilitation with palliative symptom management and its holistic approach. While publications support this integration, its implementation in clinical practice remains unclear. A key argument for integration is the overlap in treatment goals and the potential synergy between the two approaches. Several studies highlight the opportunity to incorporate end-of-life discussions, such as ACP, into traditional rehabilitation programs. Introducing palliative care principles earlier in rehabilitation may also increase the number of patients receiving appropriate end-of-life care.

Aims: Obstructive sleep apnoea (OSA) is an increasing global public health problem. The primary treatment option is continuous positive airway pressure (CPAP). The cost-effectiveness of CPAP in patients with OSA is incompletely characterized.

Methods: For this scoping review, we conducted a PubMed search for cost-effectiveness analysis of CPAP treatment in European countries with tax-funded healthcare systems and for clinical practices to reduce costs of CPAP without reducing treatment quality. OSA severity was classified by the overnight apnoea-hypopnea index (AHI). The primary outcome was to define the cost-effectiveness of CPAP in high-income European countries with tax-funded healthcare systems. The second outcome was to describe possible clinical practices that may reduce costs of CPAP for patients with OSA without reducing CPAP treatment quality.

Results: CPAP is a cost-effective treatment for those with severe or moderate OSA with symptoms, especially for middle-aged and overweight males. However, the cost-effectiveness remains unclear in mild OSA or moderate OSA without disabling sleepiness. Although CPAP adherence affects cost-effectiveness, this was not considered in all cost-effectiveness studies. The cost of CPAP treatment can be reduced, for instance, by choosing overnight polygraphy at home for diagnostics, remote contacts, nurse- and primary care-led follow-up, and by evaluating the number of necessary healthcare contacts for CPAP.

Conclusion: CPAP seems to be cost-effective and should be initiated at least for those with severe OSA or moderate OSA with symptoms. CPAP adherence should be considered in cost-effectiveness studies. There are clinical practices that can reduce CPAP treatment costs without reducing treatment quality.

Background: Impaired lung function and fibrotic scarring of the lungs following severe COVID-19 infection are well-known manifestations. However, the risk factors and predisposing factors are still unknown. This study explored whether serological biomarkers for collagen synthesis associate with impaired lung function and fibrotic scarring after COVID-19 infection.

Methods: In a prospective, observational cohort study involving patients hospitalized with COVID-19 requiring intensive care from June 2020 to December 2021, patients were followed up at 1, 3, 6, and 12 months after discharge. Lung function, diffusion capacity, and a panel of serological biomarkers for collagen-based fibrogenesis (PRO-C3, PRO-C6, and PRO-FIB) were measured. Additionally, a high-resolution CT scan of the lungs was performed at 3 and 12 months.

Results: Thirty-four patients were included in the study. Twenty-seven (80%) were men (mean age 61 years). Most patients were former or active smokers (56%), while 44% were never smokers. Levels of both PRO-C3, PRO-C6, and PRO-FIB were higher 3 months after discharge compared to the normal range. The highest levels were measured 1 month after discharge, with PRO-C3 23.2 ng/ml, PRO-C6 15.9 ng/ml, and PRO-FIB 29.3 ng/ml. The levels of PRO-C3 declined up to 6 months after discharge and were hereafter stabilized, whereas the levels of PRO-C6 declined for the entire follow up period. Lung function improved during the first 6 months and then stabilized. Comparing lung function with PRO-C3 and PRO-C6 showed a positive correlation with lung function improving, while levels of the biomarkers declined. However, only PRO-C3 was found to be significantly associated with improvement in lung function 1 month after discharge.

Conclusions: This study found that PRO-C3 and PRO-C6 are associated with changes in lung function after severe COVID-19 infection. High levels of both PRO-C6 and PRO-C3 were found up to 6 months after discharge in patients with impaired lung function, however, the values declined towards reference levels after 12 months.

Objective: To study whether worsening asthma at school was related to generic health-related quality of life (HRQoL) and asthma-related impact and worry among 15-year-olds with current asthma in Sweden. In addition, we studied the association between worsening asthma at school at age 15 and the change in the degree to which asthma interfered with daily activities between ages 15 and 19 years.

Methods: Within the Obstructive Lung Disease in Northern Sweden (OLIN) studies, a cohort of schoolchildren has been followed from age 8 years until 19 years of age. In the current study, the sample included 266 adolescents with physician-diagnosed asthma, and either wheeze or use of asthma medication during the last 12 months at age 15 years.

Results: At age 15, HRQoL scores were lower among those who reported worsening asthma at school (standardised beta (β) =  -0.18, p = 0.003), they had more asthma-related worries (β =  -0.33, p < 0.001) and asthma impacted their life during activities more (β =  -0.46, p < 0.001) than those whose asthma did not worsen. Furthermore, the more adolescents reported that asthma worsened at school at age 15, the more it was associated with the increase in the degree to which asthma interfered with their activities between 15 and 19 years (β = 0.14, p = 0.038).

Conclusions: Worsening asthma at school was associated with lower generic health-related quality of life, higher asthma-related worry and impact on daily activities among teenagers with asthma.