European Clinical Respiratory Journal最新文献

Background: Severe asthma is frequently associated with psychological comorbidities that negatively affect disease control and quality of life. Despite clinical guideline recommendations, psychological care remains limited in multidisciplinary asthma units.

Objective: To evaluate the effectiveness of an online group psychological intervention in improving emotional well-being and disease control in patients with severe asthma.

Methods: A longitudinal study was conducted between 2021 and 2024 in a specialized severe asthma unit. The intervention consisted of eight weekly online sessions combining cognitive-behavioral techniques and emotional regulation strategies. Psychological and quality-of-life variables were assessed at baseline, post-intervention, and at 6 and 12 months of follow-up.

Results: A total of 41 patients completed the program. Significant and sustained improvements were observed in anxiety, depression, hyperventilation, and asthma-related quality of life up to 12 months after the intervention. No changes were found in alexithymia, perceived social support, or family functioning.

Conclusion: An online group psychological intervention is a feasible and effective approach to improving emotional health and quality of life in patients with severe asthma. Its integration into asthma care units may contribute to a more comprehensive and patient-centered management strategy.

Registry-based randomised controlled trials (R-RCTs) represent a paradigm shift in research, with the potential to accomplish pragmatic but large trials with high external validity. In this paper, we review our experiences from planning and performing the REgistry-based randomised controlled trial of treatment Duration and mortality in long-term OXygen therapy (REDOX) trial, the first R-RCT within respiratory medicine. The REDOX study compared the two established treatment options of home oxygen 15 and 24 h per day. Previous recommendations to use oxygen for at least 15 h but preferably 24 h per day were based on a non-randomised comparison of two different studies. We hypothesised that oxygen 24 h/day was non-superior to 15 h/day and used the Swedish National Registry for Respiratory Failure (Swedevox) to perform an R-RCT showing that home oxygen 24 h/day does not improve survival, hospitalisation or patient-reported outcomes within 1 year. We describe the entire procedure of REDOX from planning to publication and use it to discuss challenges and potential solutions for future R-RCTs. In summary, common features of R-RCTs are the use of a registry for identification and randomisation of participants and for reporting and collecting baseline and outcome data, and the design is typically used to compare two treatment options. Important strengths are high generalisability, low cost, feasibility for consecutive recruitment in clinical practice, and high completeness of follow-up. Limitations include that coverage, completeness and accuracy of baseline data may differ between registries. Specific challenges (and solutions) in REDOX were addressing an important question (pragmatic clinical trials), management (clinical research support teams), costs (using registry-based infrastructure), different electronic data capture systems (posttrial linkage), slow recruitment (amendment of protocol) and resistance to challenge treatment traditions.

Introduction: Non-invasive ventilation (NIV) treatment is effective and potentially lifesaving in patients with respiratory acidosis and acute exacerbation of chronic obstructive pulmonary disease (AECOPD). However, feelings of anxiety during NIV treatment are common, potentially leading to premature patient-initiated termination of treatment.The primary aim of this study is to examine whether psychiatric disorders are a risk factor of premature patient-initiated termination of NIV treatment. The secondary aim is to examine the patterns in use of sedative drugs during NIV treatment.

Methods: This retrospective cohort study includes 195 patients with AECOPD receiving NIV between 1 January and 31 December 2018, in hospitals in the Northern Region of Denmark. Information was obtained from medical records. Psychiatric disorders were defined by the use of psycholeptics at home, right before admission.Primary outcome was premature patient-initiated termination of NIV treatment. Secondary outcome was the use of any sedative drug during NIV treatment.

Results: Patient-initiated premature termination was seen in 41 (21%) of cases. This group had a significantly higher mortality (43.9% vs. 19.5% in the total population, p < 0.01). A higher risk of patient-initiated premature termination was seen in patients with psychiatric disorders (Odds ratio 2.18, p < 0.05) and older age (Odds ratio 1.06, p < 0.05). No significant difference in the use of sedative drugs was seen (34.1% vs. 38.1% in the total population, p 0.12).

Conclusion: A significantly higher risk of premature patient-initiated termination of NIV treatment was seen in patients with psychiatric disorders and older patients, but not in patients with active smoking or excessive use of alcohol. No significant difference in the pattern of sedative drug use during treatment was seen.

Background: Obstructive sleep apnea (OSA) is a common condition affecting around one billion people worldwide. Emerging evidence from recent studies suggests that Glucagon-like peptide 1 receptor (GLP-1) agonists may reduce OSA severity. Hence, this meta-analysis aims to evaluate the efficacy and safety of GLP-1 agonists in patients with OSA.

Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched four electronic databases (PubMed, EMBASE, Cochrane Library, Scopus, and Web of Science) to identify eligible studies reported up to 24 June 2024. Using Review Manager software, we reported outcomes as risk ratios (RRs) or mean difference (MD) and confidence intervals (CIs). The protocol for this review has been registered and published in PROSPERO with the ID (CRD42024562853).

Results: The meta-analysis included three randomized controlled trials with 828 patients. Pooled analysis of patients administered GLP-1 agonists or tirzepatide showed improvement in Apnea/Hypopnea Index (MD -16.57 events per hour, 95% CI [-27.41, -5.73], p = 0.003), weight reduction (MD -12.71%, 95% CI [-21.38, -4.03], p = 0.004), and systolic blood pressure (MD -4.93 mmHg,95% CI [-7.67, -2.19], p = 0.0004). Tirzepatide showed a reduction in high-sensitivity C-reactive protein (MD -0.89 mg/dl, 95% CI [-1.25, -0.54], p < 0.0001) and sleep apnea-specific hypoxic burden (MD -66.21%/min, 95% CI [-81.75, -50.67], p < 0.0001). Despite the heterogeneity observed in the AHI and weight, it was resolved, and the results were consistent. GLP-1 agonists/tirzepatide showed comparable outcomes concerning diastolic blood pressure (MD -1.34 mmHg, 95% CI [-2.80, 0.12], p = 0.07). No significant serious adverse events were observed for GLP-1 agonists/tirzepatide, but it was associated with a higher incidence of gastrointestinal adverse events.

Conclusion: GLP-1 agonists, including tirzepatide, improved Apnea/Hypopnea Index, weight, and systolic blood pressure in adults with moderate-to-severe OSA. However, the evidence remains limited to two published studies comprising three randomized controlled trials using different pharmacological agents. Consequently, further research is needed before firm conclusions can be drawn.

Background: Studies indicate a U-shaped relationship between alcohol consumption (AC) and chronic obstructive pulmonary disease (COPD) with low-moderate AC being protective. We investigated the influence of AC debut (ACD) at different ages on forced expiratory volume in the first second (FEV1), forced vital capacity (FVC) and COPD development.

Methods: In a multi-center cohort study, data on AC were collected through a questionnaire and spirometry performed at baseline and follow-up. COPD was defined as FEV1/FVC-ratio <0.7 on post-bronchodilator spirometry. Modelling determined odds ratio (OR) of COPD and mean differences in FEV1 and FVC in stratified age groups of ACD. Never drinkers were used as reference. Adjustments were made for age, sex, smoking parameters, asthma, and education.

Results: In total, 4,717 participated in the initial work-up and 2,751 completed follow-up. A higher FEV1 and FVC was found in all groups compared to never drinkers. Highest statistically significant difference in FEV1 and FVC was found in age group 14-16 (0.17 and 0,23 L, respectively). With rising age of ACD a smaller difference in FEV1 and FVC was observed with the smallest difference in age group >25 (0.11 L) and age group 17-18 (0.13 L), respectively. A lower, but not statistically significant OR for COPD in ACD age 14-16 (OR = 0.83) and higher OR in the remaining groups with 21-25 being highest (OR = 1.36) was indicated.

Conclusion: This study found higher FEV1 and FVC in all groups drinking alcohol compared to never drinkers with the highest among participants with ACD at age 14-16. The findings on risk of COPD development were not statistically significant.

Background: Urban-rural differences in treatment within chronic obstructive pulmonary disease (COPD) have been documented in Denmark, and we aim to investigate such differences in the risk of pneumonia.

Methods: A Danish register-based cross-sectional study including patients with an International Classification of Diseases 10^th revision (ICD-10) diagnosis code of COPD (J.44) alive on the 31st of December 2018 (99,057 patients). Patients were grouped by municipality type on an urban-rural gradient (capital, metropolitan, provincial, commuter, rural). We identified outpatient pneumonias (redeemed prescriptions of antibiotics typically used for pneumonia) and pneumonia hospitalizations (ICD-10 codes) during 2018. Three groups were defined: 1) No pneumonia, 2) at least one outpatient pneumonia (but no pneumonia hospitalization), and 3) at least one pneumonia hospitalization. A multivariable multinomial logistic regression model was performed with municipality type as main explanatory variable. The 'No pneumonia' group was used as reference outcome group.

Results: Patients outside capital municipalities had significantly increased risk of experiencing outpatient pneumonia (Metropolitan: Odds ratio (OR) = 1.32, 95% confidence interval (CI): 1.25-1.39. Provincial: OR = 1.26, 95% CI: 1.21-1.31. Commuter: OR = 1.25, 95% CI: 1.20-1.31. Rural: OR = 1.28, 95% CI: 1.23-1.33). No significant differences were found for pneumonia hospitalization.

Conclusions: Compared to patients in capital municipalities, patients with a hospital-registered COPD diagnosis in non-capital municipalities had a higher risk of annually redeeming at least one prescription for antibiotics typically used for outpatient pneumonia. We were unable to detect differences in pneumonia hospitalization between municipality types. Our study was not designed to assess causality, and we stress the need for future research to provide actionable insights for health policy makers.

[This corrects the article DOI: 10.1080/20018525.2025.2470499.].

Background: Small lung lesions can represent early-stage lung cancer but are difficult to diagnose. The bronchoscopic approach has the lowest risk of complications; however, the diagnostic yield is generally lower compared to trans-thoracic biopsies. Cell-free tumor DNA (cftDNA) is fragmented DNA stemming from a tumor. CftDNA in the form of methylated HOXA9 has previously been detected in bronchial lavage (BL) and has been proposed as an adjunct to conventional biopsies to improve diagnostic yield. The aim of this study was to assess whether methylated HOXA in BL could be utilized as an add-on diagnostic modality for bronchoscopic tissue sampling.

Method: The study was conducted as a prospective diagnostic accuracy study in accordance with STARD guidelines. Patients undergoing bronchoscopy for diagnosing peripheral lung lesions were included. During bronchoscopy, BL samples were collected before and after biopsy. The samples were analyzed for methylated HOXA using a predefined cutoff and compared to histopathology or the result of CT surveillance.

Results: One hundred seventy-two patients were included, with samples collected from 155 patients. A definite diagnosis was obtained from bronchoscopic biopsies in 47.1%. The sensitivity and specificity of methylated HOXA9 in BL were 68.0 (58.0-76.8) and 76.3 (59.8-88.6), respectively. The positive likelihood ratio of methylated HOXA9 in patients with a non-diagnostic biopsy was 2.11.

Conclusion: The diagnostic accuracy of methylated HOXA9 in BL was too low to confirm or refute malignancy following an inconclusive biopsy; however, BL was superior to blood samples.

Background: Total lung capacity (TLC) measured with single-breath gas diffusion (TLCsb) is systematically lower than TLC measured with whole-body plethysmography (TLCwbp) especially in patients with obstructive defects. We aimed to develop and validate a regression correction equation to reduce the discrepancy between the two measurements of TLC. Second, we compared the ability to detect restriction (reduced TLC) from adjusted TLC measured by single-breath (TLCsb_adj) with gold standard TLCwbp.

Methods: Lung function data from 800 consecutive patients were analysed with multivariable linear regression. A group of 530 were included for model development, and 270 were used for model validation.

Results: TLCsb was found to be on average 1.1 L lower than TLCwbp (p < 0.001). This difference increased with degree of airway obstruction. After adjustment TLCsb_adj did not significantly differ from TLCwbp in obstructive and mixed obstructive-restrictive subjects. TLCsb_adj had a sensitivity of 70% and a specificity of 99% to predict restriction on an individual basis, with a 95% confidence interval (CI) of [-19.6%; 17.7%] percentage when comparing adjusted values of TLCsb with the true TLCwbp value.

Conclusions: After adjustment TLCsb was no longer significantly underestimated in obstructive and mixed restrictive-obstructive groups compared to TLCwbp. The adjustment can be used on individual subjects to estimate restriction via the TLCsb, thereby making the single-breath gas diffusion method a more valid alternative than without adjustment, when compared with the gold standard whole-body plethysmography to measure TLC.

Background and aim: The association of the gut microbiota to chronic obstructive pulmonary disease (COPD) phenotypes is underexplored. We aimed to compare stool samples from patients with COPD and subjects without COPD and relate findings to emphysema status, exacerbation rate, blood eosinophil levels, symptom score, and lung function.

Methods: We report findings from a single-centre case-control study with 62 current and former smoking patients with COPD and 49 subjects without COPD. DNA was extracted from stool samples, and the V3V4-region of the bacterial 16S-rRNA gene was sequenced. Emphysema was defined based on thoracic computed tomography (CT thorax) low attenuating areas ≥/<10% at threshold -950 and -910 hounsfield units, respectively. Differential abundance of taxa was evaluated using Analysis of Composition of Microbes with Bias Correction (ANCOM-BC). Beta diversity was compared using a distance-based permanova-test.

Results: The genus Veillonella was decreased and a genus belonging to class Clostridia was increased in COPD compared with controls without COPD. The composition of microbes (beta diversity) differed in emphysema compared to controls, and 27 genera were differentially abundant in emphysema vs. controls. Nine of these genera belonged to the family Lachnospiraceae. Lung function, blood counts and COPD assessment test score correlated with several genera's relative abundance. Of the genera showing significant correlation to lung function, nine belonged to the family Lachnospiraceae.

Conclusion: The gut microbiota in COPD differs from that in healthy individuals, even more so in emphysema. In particular, future studies should look into the mechanisms and therapeutic potential of dysbiosis affecting the family Lachnospiraceae.