European Respiratory Review最新文献

The prevalence of allergic upper respiratory diseases is rising, and while air pollution may worsen them, study results vary, and comprehensive analyses are lacking. This study aimed to systematically evaluate the link between air pollution and these diseases (allergic rhinitis, asthma and chronic sinusitis (with/without nasal polyps)) to provide evidence for reducing their prevalence. A systematic search of PubMed, Embase, Web of Science and Scopus was conducted to find studies published up to 1 September 2024, regarding association between air pollution and allergic upper respiratory diseases. Meta-analyses calculated odds ratios and 95% confidence intervals for the outcomes. Sensitivity and subgroup analyses were performed to explore heterogeneity, and publication bias was assessed using Egger and Begg tests with funnel plots. We included 64 studies with 12 440 647 participants. The prevalence of allergic rhinitis, asthma and chronic sinusitis due to air pollution was 16%, 11% and 12%, respectively. Allergic rhinitis was linked to nitrogen dioxide (NO₂) (OR 1.083), particulate matter with aerodynamic diameter <10 µm (PM₁₀) (OR 1.026) and <2.5 µm (PM_2.5) (OR 1.104), sulfur dioxide (SO₂) (OR 1.116), ozone (OR 1.058) and carbon monoxide (CO) (OR 1.070). Asthma was associated with NO₂ (OR 1.146), PM_2.5 (OR 1.087), PM₁₀ (OR 1.037), polluted air (OR 1.038), ozone (OR 1.032), SO₂ (OR 1.090) and CO (OR 1.184). Chronic sinusitis was linked to PM_2.5 (OR 1.135), polluted air (OR 1.767), NO₂ (OR 1.091), SO₂ (OR 1.08), CO (OR 1.13), PM₁₀ (OR 1.22) and oxides of nitrogen (OR 1.18). Subgroup analyses showed that age (especially the young), region (especially in Europe), gender (especially men) and pollutant concentration (particularly high levels of pollution) affected these associations. Air pollution is positively correlated with prevalence of allergic rhinitis and asthma, increasing risk of allergic upper respiratory tract diseases.

The advent of positron emission tomography (PET) combined with computed tomography (CT) in the field of inflammatory/infectious diseases heralds an era of personalised disease management using these noninvasive technologies. This nuclear medicine technique can be a useful tool in tuberculosis (TB) for assessing the extent of extrapulmonary disease, evaluating treatment response and identifying patients at higher risk of disease relapse. The fusion of functional imaging provided by PET with the anatomical and morphological details captured by CT has enabled clinicians to better understand the dynamics of the pathophysiology and natural course of Mycobacterium tuberculosis infection. Using its whole-body field of view, host responses are most commonly visualised using ¹⁸F-fluorodeoxyglucose, which reflects the glycolytic activity of cells. The strict indications for PET/CT in TB are matched by the caution required in interpreting its qualitative, quantitative and volumetric imaging patterns. In this narrative review, we aim to summarise evidence supporting the use of this molecular imaging modality in thoracic presentations of TB, particularly pulmonary and lymph node involvement, together with concepts to aid in the reporting and interpretation of the tests. We will also explore future indications for PET/CT in TB and discuss challenges to its routine use.

Primary ciliary dyskinesia (PCD) is a heterogeneous multiorgan genetic disease characterised by motile cilia impairment that primarily affects the respiratory system. Multiple breath washout (MBW) is an emerging pulmonary function test. Its main outcome, the lung clearance index (LCI), is a valuable sensitive measure in obstructive lung disease, especially in cystic fibrosis. The potential value of MBW as a monitoring tool for patients with PCD is not well known. This systematic review summarises all articles published by the end of 2022 reporting MBW data in patients with PCD and compares MBW parameters to spirometry and chest imaging findings. We searched PubMed, Embase and Scopus for original studies with MBW measurements in patients with PCD. 14 studies were included in the analysis with a total number of 398 patients. The mean/median LCI ranged from 7.98 to 11.8, whereas mean/median forced expiratory volume in 1 s (FEV₁) z-score ranged from -1.98 to -0.5. The LCI was abnormally increased in all studies, whereas only two studies had abnormally decreased FEV₁ The LCI also had a stronger correlation with chest computed tomography and magnetic resonance imaging results, compared to FEV₁ In conclusion, this review shows that the LCI is abnormally high in PCD from the preschool age up to adulthood. MBW appears to be more sensitive than spirometry in identifying pulmonary function impairment at the early stages of disease. These findings support the use of the LCI in daily clinical practice and provide evidence of using it as an outcome measure in upcoming clinical trials for patients with PCD.

Context: Despite the clinical benefits, the administration of biologics in asthma is not without adverse effects. However, there is a lack of information on the safety profile, particularly in children.

Objective: To provide a systematic review of the range of reported adverse events (AEs) of biologic treatments approved for paediatric asthma (Xolair, Nucala, Dupixent, Fasenra and Tezspire).

Data sources: Databases (MEDLINE, CENTRAL, Scopus and Web of Science) and one registry (ClinicalTrials.gov).

Study selection: This review included randomised clinical trials, prospective clinical studies, real-world studies, exploratory studies, registry analyses, case series and case reports, which met predefined inclusion criteria.

Data extraction: Study characteristics and AEs were extracted into predefined forms and then summarised in terms of their frequency and study duration.

Results: Overall, 45 reports and 13 clinical trials met the inclusion criteria for data evaluation, of which eight studies were placebo-controlled. Overall, paediatric asthma patients' most frequently reported AEs were headache, injection site reactions, upper respiratory tract infections, pyrexia and urticaria. The systematic analysis revealed a similar safety profile of the biologics to that reported on the product labels.

Limitations: The small number of paediatric patients, missing placebo control groups, variant definitions of AEs and a lack of statistical evaluation limited the validation of specific AEs to individual biologics.

Conclusions: In this systematic review, no new safety concerns regarding the use of biologics in paediatric asthma were identified, even after an observation period of up to 7 years. In order to record rare side-effects and possible long-term consequences, further data from paediatric study cohorts are needed.

Dipeptidyl peptidase (DPP)-1 (also known as cathepsin C) inhibitors are the first disease-specific therapy shown to be effective in bronchiectasis. The mechanism of action of DPP-1 inhibitors is suppression of activity of neutrophil serine proteases (NSPs) by preventing them from being activated during neutrophil maturation in the bone marrow. NSPs exert multiple directly damaging effects and contribute to ongoing dysregulated airway inflammation. High airway levels of NSPs are linked to bronchiectasis disease severity. Several phase 2 and one phase 3 trial have now confirmed that DPP-1 inhibitors reduce activity of the NSPs in the airways and have clinical benefits in bronchiectasis including reducing exacerbations and improving other clinical end-points such as quality of life and slowing lung function decline. DPP-1 inhibition may also be a promising treatment avenue in other diseases where neutrophilic inflammation is implicated. Future directions include establishing direct and downstream effects of DPP-1 inhibitors in humans and seeking biomarkers to guide clinical application.

Rationale: Survivors of preterm birth (<37 weeks' gestation) have low peak oxygen uptake, a global measure of aerobic fitness and an established predictor of increased morbidity and mortality. However, little is known about other cardiopulmonary outcome measures in this population. We addressed the hypothesis that preterm birth is associated with abnormal respiratory, cardiovascular and metabolic responses to exercise, as assessed by cardiopulmonary exercise testing, via a systematic review and meta-analysis.

Methods: Six databases were systematically searched up to 29 November 2024 (PROSPERO: CRD42022320775). Studies reporting cardiopulmonary outcome measures obtained during a standardised exercise test were included if they had preterm-born participants and matched term-born controls. The standardised mean difference (SMD) between pooled preterm-born and term-born cohorts was calculated using random-effects models for the meta-analysis.

Results: Of the 12 143 records identified, 47 cohorts were included in the final meta-analysis. At peak exercise, the preterm-born cohort (n=2149) demonstrated lower oxygen uptake (SMD -0.39, 95% CI -0.52 to -0.26), work rate (SMD -0.53, 95% CI -0.70 to -0.35), minute ventilation (SMD -0.43, 95% CI -0.60 to -0.26), tidal volume (SMD -0.38, 95% CI -0.62 to -0.15), oxygen pulse (SMD -0.47, 95% CI -0.75 to -0.19), heart rate (SMD -0.18, 95% CI -0.28 to -0.07), anaerobic threshold (SMD -0.29, 95% CI -0.49 to -0.08) and gas exchange efficiency (SMD 0.22, 95% CI 0.04 to 0.41), compared to the term-born cohort (n=1650).

Conclusions: In addition to a reduced peak oxygen uptake, survivors of preterm birth have impairments in the respiratory, cardiovascular and metabolic domains during cardiopulmonary exercise testing. Given that reduced aerobic capacity is associated with increased morbidity and mortality, exercise interventions that target cardiorespiratory fitness should be prioritised across the lifespan in those born preterm.

Background: The association between long-term ambient air pollution and adult lung function has been inconsistently reported. This systematic review and meta-analysis aimed to quantify the impact of long-term (≥1 year) ambient air pollution on adult lung function.

Methods: Original articles published between 1 January 2006 and 26 July 2024 were searched in PubMed, Embase and Web of Science. Random-effects models were used to assess the strength of associations of gaseous (nitrogen dioxide and ozone) and particulate matter (PM) pollutants with diameters ≤2.5 and 10 µg, with lung function (forced expiratory volume in 1 s (FEV₁), forced vital capacity (FVC) and FEV₁/FVC ratio). Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation system (GRADE) approach.

Results: Of 25 064 potential papers, 27 were included, of which 12 were meta-analysed. There was low-certainty evidence that a 10 µg·m^-3 increase in long-term NO₂ exposure was associated with lower FEV₁ (-15.6 mL, 95% CI -25.0- -6.2; I ²=86%; p<0.01) and high-certainty evidence for FVC (-25.3 mL, 95% CI -36.7- -14.0; I ²=70%, p<0.01). Similar associations were observed for PM_2.5, while long-term exposure to O₃ and PM₁₀ were associated with lower FEV₁ with high- and moderate-certainty evidence, respectively. Exposure to O₃ was associated with lower FEV₁/FVC (high-certainty evidence).

Interpretation: Long-term exposure to ambient air pollution adversely impacts adult lung function. This emphasises the importance of ongoing commitments to mitigating air pollution levels to preserve optimum lung health and prevent premature lung function decline that can lead to earlier and avoidable respiratory diseases.

Objective: To assess the effect of obesity on the prevalence of asthma, obstetric outcomes and delivery outcomes in pregnant women with asthma.

Methods: A comprehensive systematic review and meta-analysis were conducted up to 31 March 2024, using four public search engines. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, both quantitative and qualitative data were collected and analysed.

Results: We included 11 studies from 2006 to 2022 involving 77 611 386 pregnant patients (3.1% had asthma). Obesity increased the odds of asthma (n=2; OR 2.42, 95% CI 1.14-5.15) and increased that of uncontrolled asthma (n=6; OR 1.29, 95% CI 1.11-1.50) in pregnant women. In an adjusted pooled analysis, pregnant women with asthma were more likely to develop hypertensive disorders of pregnancy (HDP) (n=3; adjusted OR (aOR) 1.21, 95% CI 1.10-1.34), gestational diabetes mellitus (GDM) (n=3; aOR 1.14, 95% CI 1.04-1.26), fetal growth restriction (FGR) (n=2; aOR 1.18, 95% CI 1.15-1.21), preterm birth (PTB) (n=2; aOR 1.26, 95% CI 1.25-1.27), caesarean delivery (CD) (n=3; aOR 1.22, 95% CI 1.11-1.33) and severe maternal morbidity (n=1; aOR 1.50, 95% CI 1.45-1.55). Three comparator studies that examined the effect of obesity on obstetric outcomes cited obesity as a risk factor for HDP (n=1; aOR 1.7, 95% CI 1.3-2.3), GDM (n=1; aOR 4.2, 95% CI 2.8-6.3) and CD (n=1; aOR 1.6, 95% CI 1.3-2.0) in pregnant women with asthma.

Conclusions: Pregnancy with asthma may increase the risk of HDP, GDM, FGR, PTB and CD, and obesity has the potential to further increase the risk of HDP, GDM and CD in pregnant women with asthma.