European Respiratory Review最新文献

Objective: The aim of this study was to describe the characteristics of exercise therapies in randomised controlled trials (RCTs) targeted at improving cognitive function and to assess their efficacy in COPD.

Methods: We conducted a comprehensive search of eight databases, namely PubMed, Web of Science, Embase, Cochrane Library, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Wanfang and Weipu, covering the period from database construction to 23 April 2024. Our search specifically targeted RCTs studying the effects of exercise on cognitive functioning in COPD patients. Trials consisted of one or more exercise training interventions along with at least one cognitive outcome study. Two reviewers independently reviewed papers, extracted data and evaluated the research literature's quality using the Cochrane risk-of-bias assessment tool RoB 2.0 and the modified Jadad scale. Meta-analysis of Montreal Cognitive Assessment (MoCA) scores in the groups with and without exercise intervention was performed and subgroup analyses were undertaken to identify potential causes of heterogeneity.

Results: We included a total of nine studies that included 578 COPD patients (69% male). Each study demonstrated that patients improved significantly in at least one cognitive component following training. All current research focuses on attention, executive function, motor ability, mental capacity, verbal fluency, visuoconstructive abilities and memory. The results revealed that exercise significantly improved MoCA scores in COPD patients (standardised mean difference (SMD) 0.576 (95% CI 0.054-1.097); p=0.029). A subgroup analysis of the duration of each intervention revealed that exercise training with an intervention duration of >30 min significantly improved overall cognitive performance in COPD patients (SMD 0.499 (95% CI -0.165-1.163); p=0.000, I²=0.0%). A subgroup analysis of varied intervention durations revealed that 4 weeks of exercise training significantly improved overall cognitive performance in COPD patients (SMD 0.202 (95% CI -0.238-0.641); p=0.000, I²=0.0%). In addition, just one study had a year-long follow-up period.

Conclusion: Participation in exercise training, whether aerobic exercise alone or in combination with resistance or muscular strength, healthy qigong, dance or breathing exercises, can improve cognitive performance to varying degrees in people with COPD. Nonetheless, the findings should be regarded with caution due to the limitations of the included studies.

Introduction: Pulmonary rehabilitation is underutilised in patients after an acute exacerbation of COPD (AECOPD). Retrieving information regarding the setting, training modalities and the uptake and adherence to exercise interventions for these individuals in a vulnerable state could potentially guide future research.

Aim: To provide a comprehensive review of the existing literature on the content, uptake and adherence of different exercise interventions for patients after an AECOPD.

Methods: Eight different databases were searched for 1) patients experiencing an AECOPD and 2) performing any form of exercise intervention. Information on content, uptake and adherence was collected and the Consensus on Exercise Reporting Template (CERT) checklist was performed for each included record.

Results: 59 distinct interventions were identified between 1998 and 2023 including a total of 9238 patients. All studies included patients requiring hospitalisation for the AECOPD, four studies additionally included patients not requiring hospitalisation for the AECOPD. Nine different settings were identified, with the majority of studies conducted in an inpatient setting (n=26) and including whole-body and strength exercises. The overall uptake was mentioned in 38 (62%) studies and was 70% with a 13% dropout rate. No paper reported the full CERT checklist. Adherence was defined a priori in 16 (27%) studies, with the most common definition being attendance of >80% of sessions.

Conclusion: Studies properly reporting on the uptake and adherence of well-described interventions, including information regarding fidelity, are needed to further investigate suitable programmes for patients experiencing an AECOPD.

Introduction: People with idiopathic pulmonary fibrosis (IPF) and other forms of progressive pulmonary fibrosis (PPF) have a high symptom burden and a poor health-related quality of life (HRQoL). Despite efforts to offer specialised treatment, clinical care for these patients remains suboptimal and several nonmedical needs remain unaddressed. Developing a core outcome set (COS) can help to identify a minimum set of agreed-upon outcomes that should be measured and acted-upon in clinical care.

Aim: As a first step towards developing a COS for IPF/PPF, we aimed to identify outcome domains investigated in IPF/PPF research.

Methods: Conducted within the COCOS-IPF (Co-designing a Core Outcome Set for and with patients with IPF) project, this scoping review follows Joanna Briggs Institute methodology and PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines to search PubMed, Embase and Web of Science for quantitative, qualitative and mixed-methods papers. We extracted each paper's outcomes verbatim and classified them using the COMET (Core Outcome Measures in Effectiveness Trials) taxonomy. Then, the research team structured outcomes or concepts with similar meanings inductively into outcome domains.

Results: We included 428 papers, extracting 1685 outcomes. Most outcomes (n=1340) were identified in quantitative sources, which we could classify in 64 outcome domains, with the main domains being "all-cause survival" (n=237), "lung function" (n=164) and "exercise capacity" (n=99). Qualitative sources identified 51 outcome domains, with the most frequent being "capability to do activities you enjoy" (n=31), "anxiety, worry and fear" (n=26) and "dealing with disease progression" (n=25).

Conclusions: The identified outcomes, spanning diverse domains, highlight the complexity of patient experiences and can form the basis to develop a COS for IPF/PPF clinical care, as well as future research.

Background: Spirometry-based assessment of pulmonary function has limitations in detecting pulmonary toxicity following cancer treatment with chemotherapy, haematopoietic stem cell transplantation, radiotherapy or thoracic surgery. Nitrogen single and multiple breath washout tests are sensitive in assessing peripheral airway function, and lung imaging detects structural abnormalities, but little is known about their use in paediatric cancer patients and survivors. We aimed to 1) identify studies using nitrogen single or multiple breath washout tests and/or lung imaging to assess pulmonary toxicity in paediatric cancer patients and survivors, and 2) describe reported abnormalities.

Method: We systematically searched MEDLINE, Embase and the Cochrane Library for studies published in 1995‒2023. Eligible studies included paediatric cancer patients and survivors under 22 years of age receiving haematopoietic stem cell transplantation, chemotherapy, radiotherapy and/or thoracic surgery who underwent nitrogen single or multiple breath washout tests or lung imaging for detecting pulmonary toxicity. Two independent reviewers identified the studies, performed data extraction and assessed risk of bias.

Results: We included 12 of 6544 publications. Three studies used nitrogen single or multiple breath washout tests, seven conducted lung imaging using computed tomography and two used both nitrogen single or multiple breath washout tests and lung imaging. Abnormal test results for nitrogen single and multiple breath washout tests and lung imaging were mainly reported following haematopoietic stem cell transplantation (67%). All studies performing lung imaging reported structural abnormalities. Study results were heterogeneous due to varying patient and methodological characteristics.

Conclusion: We identified a limited number of studies, mainly after haematopoietic stem cell transplantation, reporting functional and structural lung abnormalities in paediatric cancer patients and survivors. Longitudinal studies with standardised assessments using nitrogen single or multiple breath washout tests and lung imaging are needed to improve our understanding of treatment-related pulmonary toxicity.

Introduction: Acute exacerbations of COPD (AECOPD) often involve mucus hypersecretion. Thus, management of sputum retention is critical. However, the use of airway clearance techniques (ACTs) in people with AECOPD across different healthcare settings and factors influencing their selection remain unclear.

Objective: To identify and map ACTs used for AECOPD in different healthcare settings and the factors influencing clinical decision-making worldwide.

Methods: Four electronic databases and grey literature were searched from 1995 to December 2023, with hand-searching of eligible records. The Joanna Briggs Institute methodology for scoping reviews was followed.

Results: 25 articles were included: 14 clinical studies, five guidelines/statements and six surveys/audits. Clinical studies reported the use of a wide range of single or combined ACTs, with no clear pattern in using particular ACTs in different parts of the world. Recent guidelines advise using ACTs for certain patients with AECOPD, particularly those with hypersecretion, with most guidelines recommending positive expiratory pressure (PEP) therapy. According to surveys, the most used ACTs in Australia and Europe are active cycle of breathing techniques, PEP or forced expiratory technique, while vibrations are most frequently used in Canada. Factors influencing the selection of specific ACTs include the presence of contraindications, level of dyspnoea, access to resources/equipment and ease of learning/performing the technique. All information was derived from hospital settings.

Conclusions: This scoping review identified and mapped ACTs used for people with AECOPD worldwide and their decision-making factors. Future work should focus on community settings.

Introduction: Numerous studies have characterised trajectories of asthma and allergy in children using machine learning, but with different techniques and mixed findings. The present work aimed to summarise the evidence and critically appraise the methodology.

Methods: 10 databases were searched. Screening, data extraction and quality assessment were performed in pairs. Trajectory characteristics were tabulated and visualised. Associated risk factor and outcome estimates were pooled using a random-effects meta-analysis.

Results: 89 studies were included. Early-onset (infancy) persistent, mid-onset (∼2-5 years) persistent, early-onset early-resolving (within ∼2 years) and early-onset mid-resolving (by ∼3-6 years) wheezing and eczema, respectively, were the most commonly identified disease trajectories. Intermediate/transient trajectories were rare. Male sex was associated with a higher risk of most wheezing trajectories and possibly with early-resolving eczema, while being slightly protective against mid-onset persistent eczema. Parental disease/genetic markers were associated with persistent trajectories of wheezing and eczema, respectively. Prenatal (and less so postnatal) tobacco smoke exposure was associated with most wheezing trajectories, as were lower respiratory tract infections in infancy (particularly with the early-onset resolving patterns). Most studies (69%) were of low methodological quality (particularly in modelling approaches and reporting). Few studies investigated allergic multimorbidity, allergic rhinitis and food allergy.

Conclusions: Childhood asthma/wheezing and eczema can be characterised by a few relatively consistent trajectories, with some actionable risk factors such as pre-/postnatal smoke exposure. Improved computational methodology is warranted to better assess generalisability and elucidate the validity of intermediate/transient trajectories. Likewise, allergic multimorbidity and trajectories of allergic rhinitis and food allergy need to be further elucidated.

Background: The morbidity and mortality associated with influenza viruses are a significant public health challenge. Annual vaccination against circulating influenza strains reduces hospitalisations and increases survival rates but requires a yearly redesign of vaccines against prevalent subtypes. The complex genetics of influenza viruses with high antigenic drift create an ongoing challenge in vaccine development to address dynamic influenza epidemiology. Understanding the evolution of influenza viruses and the vaccine's effectiveness against different types and subtypes is pivotal to designing public health measures against influenza.

Methods: We conducted a systematic review and meta-analysis of 192 705 patients, collecting information on the incidence and severity of the disease. The results of this meta-analysis were further validated using data from 6 594 765 patients from TriNetX. We analysed the prevalence of the most common influenza A virus (IAV) subtypes (H1N1 and H3N2) and influenza B virus (IBV), as well as vaccination effectiveness against them in three age groups, given that age is associated with influenza disease severity.

Results: Our analysis reflects that overall vaccination against H1N1 IAV and IBV is effective in reducing infection and influenza-related complications in children aged <5 years old, individuals between 5 and 65 years old and older adults aged >65 years old. By contrast, while vaccination against H3N2 IAV is effective in protecting against infection in infants <5 years old, it provides reduced protection against infection in older individuals.

Conclusions: Despite higher infection rates, vaccination against H3N2 remains as highly effective as vaccination against H1N1 and IBV in reducing influenza-related morbidity and mortality in all age groups. Detailing vaccine effectiveness in terms of infection protection and disease burden across different age groups is necessary for understanding vaccine impacts in terms of other outcomes, e.g. hospitalisations, mortality and disease severity; for improving vaccine formulations and public awareness; and for enhancing vaccination campaigns to improve coverage and public acceptance.

Asthma is considered severe if it remains uncontrolled despite optimal conventional therapy, characterised by poor symptom control, frequent exacerbations and increased exposure to systemic corticosteroids. This has a significant impact on morbidity, mortality and healthcare resource utilisation. Recent advances in the understanding of asthma heterogeneity and immunopathogenesis have helped delineate precise disease pathways. The discovery of these pivotal pathways has led to the development of highly effective biologic therapies. Currently available asthma biologics target immunoglobulin E, interleukin (IL)-5/IL-5Rα, IL-4Rα and thymic stromal lymphopoietin. Identification of specific asthma phenotypes, utilising easily measurable biomarkers, has paved the way towards personalised and precision asthma management. Biologic therapies play a significant role in reducing exacerbations, hospitalisations and the need for maintenance systemic steroids, while also improving the quality of life in patients with severe asthma. The evidence for their clinical efficacy comes from randomised controlled trials (RCTs), extension studies, metanalyses and real-world data. This review synthesises findings from early, pivotal RCTs and subsequent studies following the approval of biologics for severe asthma. The safety and efficacy data from these studies, completed in a variety of settings, provide practical perspectives on their application and enhance their generalisability.

The systemic use of corticosteroids for patients with severe community-acquired pneumonia (sCAP) remains controversial in clinical practice, particularly in terms of the safety profile of these drugs. This narrative review aims to analyse the available literature data concerning the safety of short-term steroid use in the treatment of sCAP, while also highlighting potential future research directions. Several trials and meta-analyses have evaluated corticosteroid therapy as an adjuvant treatment for sCAP, yielding heterogeneous results regarding its efficacy and safety. Despite the wide variability in results, it is generally accepted that steroids are not associated with a significant risk of healthcare-associated infections, gastrointestinal bleeding or acute kidney injury in patients with sCAP in the short term. Nevertheless, such drugs are linked to hyperglycaemia, necessitating regular monitoring and appropriate management. The influence of steroids on long-term outcomes and their potential risks in viral sCAP still needs to be investigated.

Silicotuberculosis, the combination of silicosis and pulmonary tuberculosis (TB), remains a substantial clinical and public health problem in high TB burden countries with silica-exposed workforces. The objectives of this narrative review are to propose a definition of silicotuberculosis which includes post-tuberculous lung disease, to emphasise the importance of understanding how the two diseases modify each other, and to identify as yet unanswered questions relevant to clinical practice and disease control and mitigation. The unique aetiological relationship between silica exposure and TB is now firmly established, as is the accelerated impairment and mortality imposed by TB on individuals with silicosis. However, the rich clinical, pathology and laboratory literature on combined disease from the pre-TB treatment era appears to have been largely forgotten. The close clinical and pathological appearance of the two diseases continues to pose a challenge to imaging, diagnosis and pathological description, while inconsistent evidence regarding TB treatment and TB preventive treatment prevails. Many other topics raise questions to be answered, inter alia: the range of phenotypes of combined disease; the rates and determinants of disease progression; the role of computed tomography in identifying and characterising combined disease; appropriate screening practice; acceptable policies of management of workers that combine risk reduction with social security; and the workplace respirable silica concentration that protects against the excess TB attributable to inhaled silica.