European Respiratory Journal最新文献

Background: Nontuberculous mycobacteria (NTM) are associated with chronic and challenging infections, particularly pulmonary disease (NTM-PD). While clinical guidelines provide treatment recommendations for the most common disease-causing species, they offer limited guidance on managing treatment failures. This study aims to develop a consensus-based decision-making framework for addressing treatment failure in NTM-PD.

Methods: A panel of 16 international experts used the e-Delphi method to address gaps in NTM-PD management. Initial statements were derived from an open-ended questionnaire, supported by a prior systematic review. Iterative rounds of expert evaluation were conducted until a consensus was reached on treatment failure definitions, decision-making criteria, therapeutic strategies and supportive care measures.

Results: Consensus defined treatment failure as the absence of culture conversion after 6 months of appropriate antimycobacterial therapy, while clinical and radiological deterioration were considered additional but non-mandatory criteria. Treatment intensification or de-escalation decisions were based on patient preferences, clinical status, comorbidities, disease severity, antibiotic tolerance, resistance patterns and previous treatment history. Treatment intensification highlighted the necessity for personalised multidrug antibiotic regimens. De-escalation strategies focus on delivering optimal, patient-centred supportive care while minimising pharmacological adverse effects, by opting for simplified antibiotic regimens, intermittent antibiotic courses for symptomatic control or the cessation of antimicrobial therapy.

Conclusion: This study offers a structured approach to managing treatment failure in NTM-PD, addressing patient selection, treatment intensification, de-escalation and supportive care, while championing individualised strategies. Future research should concentrate on validating predictive factors for treatment response, refining therapeutic regimens and investigating host-directed therapies to enhance patient outcomes.

Background: Sex is an important part of life for many adults, yet sexual function may be impacted by chronic respiratory diseases such as pulmonary fibrosis (PF). This multinational study sought to characterise the impact of PF on sex and sexual function, using mixed quantitative and qualitative methodology.

Methods: We analysed data from a patient registry, a clinical study, an online survey and patient interviews to accomplish our objective and develop a conceptual framework for describing the effects of PF on sex-related quality of life. These cohorts used three distinct questionnaires, University of California, San Diego Shortness of Breath Questionnaire (UCSD-SOBQ), Sheffield Profile for Assessment and Referral to Care (SPARC) questionnaire, and Changes in Sexual Function Questionnaire (CSFQ), to assess sexual dysfunction, respectively. Individual patient interviews were conducted and qualitatively evaluated using thematic analysis.

Results: Dyspnoea with sexual activity affected 2054/2759 (74%) of registry patients, associated with male sex, lower forced vital capacity (FVC) % predicted, lower diffusing capacity of the lung for carbon monoxide (D _LCO) % predicted and worse cough. Distress due to the effect of PF on their sex life was reported in 52/225 (23%) of the clinical cohort, associated with younger age, male sex, lower D _LCO % predicted and worse cough. Sexual dysfunction was common, affecting 56/67 (83%) female and 63/73 (86%) male survey respondents. Qualitative analysis of patient interviews identified several themes, including sex life limitations, changes in interpersonal relationships and quality of life. All patients wanted to discuss sex with trusted healthcare providers.

Conclusions: In this multinational study, patients with PF reported engaging in sex and sexual activities but were adversely impacted by the effect of PF on their sex life, with both physical and psychological limitations. Sexual dysfunction was common, driven by multiple disease domains. Sexual health appears to be an important component of comprehensive patient care.