NPJ Primary Care Respiratory Medicine最新文献

A scoping review was conducted using the Arksey and O'Malley framework to develop a comprehensive overview of how the experience of breathing pattern disorder (BPD) has been conceptualized and reported in the literature. The Applied Social Sciences Index and Abstracts (ASSIA), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Medline and PsycINFO electronic databases were searched from the earliest available reports until 13^th May 2025. The reference lists of included reports were also screened for appropriate literature. Only reports relating to adults and published in English were included. Sixty-two reports were included in the final review. The following eight themes emerged; 1: Symptoms were diverse and frequently mimicked serious pathology. 2: Symptom triggers were often stress related. 3: Precipitating life experiences for BPD included physical or psychological trauma, chronic anxiety or stress. 4: The diagnostic pathway was often prolonged and complex. 5: Patient reaction to diagnosis varied from welcoming, sceptical or rejection. 6: Healthcare use was frequent due to symptoms mimicking serious pathology and a prolonged diagnostic pathway. 7: BPD was associated with panic, anxiety, fear, phobias and depression. 8: BPD was also associated with reduced quality of life and poorer asthma control. Evidence for the experience of BPD is poorly represented in the literature, mainly viewed from a Western perspective and found in simple case reports over 25 years old and snippets within empirical studies. Literature searching was confounded by the change in terminology over time, and the lack of agreed definition and diagnostic methods for BPD. Further research is required employing more diverse and rigorous study designs to clarify the definition and diagnostic methods for the condition, as well as explore experience of BPD, including experience from outside Europe and North America.

Background: China has the highest global disease burden for both lung cancer and tuberculosis (TB). Mobile low-dose computed tomography (LDCT) screening offers dual detection of early-stage lung malignancies and active TB radiographic manifestations. However, evidence regarding community-based post-screening compliance remains inadequate. This study aimed to evaluate hospital follow-up adherence and its associated factors among individuals who screened positive for lung cancer or TB in a community-based, non-risk-based LDCT screening program.

Methods: A prospective cohort study was conducted in Dongfang, Hainan Province, from June to September 2024. Permanent residents aged ≥40 years were enrolled in a community-based, non-risk-stratified mobile LDCT screening program. At the time of screening, participants completed a structured questionnaire to capture demographic characteristics, risk factors, and health status. Screening images were interpreted according to established guidelines; individuals with findings indicative of Lung-RADS category 4 (4 A, 4B, 4X) or suspected active pulmonary TB were considered screen-positive. The primary outcome, adherence to hospital-based diagnostic follow-up within six months, was objectively assessed by linking screening records to the provincial medical insurance claims database. Multivariable logistic regression was used to identify factors associated with adherence, stratified by screening finding.

Results: Among 22,933 participants (14,134 female and 8799 men), 547 (2.4%) had LDCT findings classified as Lung-RADS 4 and 653 (2.9%) displayed radiological features compatible with TB. Diagnostic follow-up within six months was completed by 303/547 lung-cancer suspects (55.4%) and 336/653 pulmonary TB suspects (51.5%). Among adherent individuals, 98 lung cancers (32.3%) and 95 active pulmonary TB cases (28.3%) were confirmed. In the lung-cancer cohort, respiratory symptoms increased the likelihood of follow-up (adjusted odds ratio [aOR] 2.47, 95% CI 1.13-5.41), whereas retired status decreased it (aOR 0.52, 0.32-0.85). In the pulmonary TB cohort, female sex was positively associated with adherence (aOR 1.39, 1.02-1.90), while formal employment was negatively associated (aOR 0.53, 0.31 - 0.90).

Conclusions: This study highlights the need for targeted interventions to optimize diagnostic follow-up and maximize the clinical and public health impact of integrated lung cancer-TB screening programs.

Chronic respiratory diseases (CRDs), particularly asthma and chronic obstructive pulmonary disease (COPD), impose significant burdens on patients and their families in low- and middle-income countries (LMICs). Little is known about the experience of living with CRD in low- and middle-income countries (LMIC), and the impact of systemic inequities in primary care settings. To explore patient experiences of systemic inequities in CRD care in Klang District, Malaysia. We employed an adapted qualitative Photovoice study conducted between December 2023 and October 2024. The study involved adult patients with self-reported CRDs from five primary care clinics in Klang District, Malaysia. In-depth interviews were conducted at two time points using an interview guide and focused on the topics chosen by participants in their photographs. We transcribed audio-recordings verbatim, checked for accuracy and analysed them thematically. Patient and public involvement (PPI) was integral throughout the study, enhancing cultural relevance and ethical oversight. Fourteen participants (mean age 54 years; 57.1% men, 42.9% Malay, 50% diagnosed with asthma) completed the study. Four interconnected themes emerged: (1) indoor and outdoor air pollution (e.g. smoking and haze) worsened respiratory symptoms; (2) financial strain due to out-of-pocket expenses despite provision of universal healthcare; (3) occupational vulnerabilities, including transitions to precarious informal work due to health limitations; and (4) gendered caregiving burdens, including caring responsibilities while ill, pregnancy-related vulnerability, stigma, and household misunderstanding. Participants consistently showed resilience, proactively adopting coping strategies despite systemic barriers. This study highlights intersectional inequities faced by people with CRDs in Klang, Malaysia, emphasising environmental, financial, occupational, and gender-specific challenges. The use of participatory visual methodologies like Photovoice gives voice to people, allowing their narratives to advocate for culturally sensitive change to the lived environment supported by equitable provision of healthcare.

COPD remains a major health burden worldwide, with adherence to inhaled therapy being a key determinant of treatment success. The Test of Adherence to Inhalers (TAI) is a validated tool for assessing adherence, but does not provide tailored interventions. The TAI Toolkit was developed to address this gap by offering individualized adherence-enhancing strategies. We aimed to assess the usability of the TAI Toolkit among healthcare professionals in Kyrgyzstan. This observational study was conducted in primary and tertiary care settings at the National Centre of Cardiology and Internal Medicine in Bishkek, Kyrgyzstan. The TAI Toolkit was translated and adapted for the local context. Nine physicians and three residents applied the TAI Toolkit in routine practice with 100 COPD patients. Healthcare professionals received training and later assessed the TAI Toolkit's usability using the System Usability Scale (SUS). Primary outcomes included usability and feasibility, while secondary outcomes focused on adherence-enhancing interventions provided and patient and physician satisfaction. The mean SUS score was 74.6 (SD = 5.7), indicating good usability. Overall, 91.7% of physicians were satisfied with the Toolkit. The most frequently provided interventions were medication plans (91.7%), reminders and/or counseling (83.3%), and education and/or counseling (83.3%). Patients and physicians reported high satisfaction, with mean ratings of 8.8 (SD = 1.3) and 8.6 (SD = 1.9), respectively. The TAI Toolkit demonstrated good feasibility and usability among Kyrgyz healthcare professionals. Both patients and physicians found it beneficial for improving inhaler adherence management in COPD. Future research should explore its long-term clinical outcomes.

Chronic obstructive pulmonary disease (COPD) and osteoporosis are significant public health concerns, often co-occurring due to shared risk factors such as ageing, smoking, and systemic inflammation, as well as treatment-related factors such as long-term glucocorticoid use. However, large-scale studies exploring these associations, their sex-specific effects, and mediating factors remain limited. A total of 8,274 participants aged ≥50 years from NHANES cycles 2005-2018 were included. COPD and osteoporosis were identified based on self-reported diagnoses, with Bone Mineral Density (BMD), measured by Dual-energy X-ray Absorptiometry (DXA), used as a sensitivity outcome. Weighted logistic regression analyzed the association between COPD and osteoporosis. Interaction and stratified analyses explored effect modification by sex, BMI, prednisone use, vitamin D, and race. Exploratory mediation analysis examined the indirect effects of prednisone, sleep problems, and vitamin D. COPD was significantly associated with osteoporosis risk (OR = 2.24, P < 0.001). A nominal sex interaction was observed (unadjusted P = 0.03), with a stronger association in males (adjusted OR = 4.85, 95% CI: 2.49-9.42, P < 0.001) than females (adjusted OR = 1.86, 95% CI: 1.30-2.65, P < 0.001). Exploratory mediation analyses suggested that prednisone use (mediated 5.1%) and sleep problems (mediated 9.3%) accounted for portions of the association, while vitamin D level did not show meaningful mediation. Sensitivity analyses confirmed an association between COPD and lower BMD (β = -0.032, P < 0.001), with significant mediation by prednisone (2.2%, P = 0.034). COPD is significantly associated with osteoporosis, with a stronger relative effect observed in males. Exploratory findings suggest potential mediation by prednisone use and sleep disorders. These results highlight the importance of integrated bone health management in COPD patients, with particular attention to sex-specific risks and modifiable factors such as glucocorticoid exposure and sleep quality.

In asthma, suboptimal disease control is common due to limited knowledge about self-management, undertreatment and infrequent follow-up visits. Most patients are treated in primary care where asthma/COPD clinics (ACC) are recommended in Sweden, but evidence of the effects is limited. The aim was to compare certified ACCs with clinics providing regular care in terms of adherence to asthma management guidelines, and the associations with asthma symptom control, healthcare consumption, and mortality in adults with asthma. In this cohort study, we extracted data from the Swedish National Airway Register, on 84230 adults with asthma, cared for at certified ACCs (n = 17 primary care centres) and regular care clinics (n = 650 primary care centres) in Sweden. Data were linked to other national registers in order to obtain data about pharmaceuticals, healthcare consumption, and mortality. The index date was the years 2015-2017, and the study ended in 2022. A binary logistic regression was used to assess morbidity and mortality associations at the study's end. A higher proportion of patients at certified ACCs received interventions such as patient education, written asthma action plan, smoking cessation, Asthma Control Test, spirometry, and inhaled corticosteroids than patients at regular care clinics. Certified ACCs were associated with a lower probability of uncontrolled asthma (OR 0.76, 95% CI 0.67-0.87), need of specialist/emergency care (OR 0.69, 95% CI 0.51-0.92) and death (OR 0.69, 95% CI 0.55-0.86). In conclusion, adherence to asthma management guidelines was higher in certified ACCs which were associated with a more well-controlled asthma, less secondary healthcare visits and lower all-cause mortality, but not with frequent exacerbations. Our findings highlight the importance of ACCs in providing evidence-based care in accordance with asthma management guidelines.

We aimed to assess an obstructive sleep apnoea (OSA) diagnostic approach performed solely in primary care centres (PCC) with the support of an autoscoring home sleep apnoea testing (aHSAT, ApneaLink^TM Air) device and compare the diagnoses with those undertaken by the manual analysis of home sleep apnoea testing (mHSAT), and polysomnography (PSG) if necessary, of a certified sleep specialist. This multicentre, cross-sectional study was undertaken between April 2016 and November 2020. We randomly selected patients aged 30-70 years with a high probability of OSA (≥ 3 points on the STOP-Bang questionnaire) who were visiting any of the four PCCs assigned for referral to the University Hospital Doctor Josep Trueta, Girona, Spain. 2599 patients were assessed for eligibility; 403 provided a high probability of OSA and 329 could be compared between PCC and hospital. 210 (63.8%) patients were male and the mean age was 56.5 (SD: 9.2) years. The global agreement between PCC and hospital diagnoses was 41.6% and severe OSA showed the highest level of agreement (96.2%). The Kappa index for severe OSA was 0.46 (95% CI: 0.37, 0.55) and the specificity was 0.99 (95% CI: 0.97, 1.00). The ApneaLink^TM Air device showed high specificity for severe OSA in a high-risk primary care population with a high pre-test probability of OSA. When aHSAT indicates severe OSA, hospital confirmation may be unnecessary, whereas negative or moderate findings may still require specialist assessment.

To develop international expert consensus statements on when and how to implement inhaler switches for patients with asthma or chronic obstructive pulmonary disease, informing clinicians and decision-makers on appropriate circumstances, stakeholder roles, and essential steps for safe and effective switching. An international panel of eight clinical, payer, and patient experts participated in a nominal group technique. Ideas were generated in response to four research questions and rated on a 7-point Likert scale (1 = not at all important; 7 = extremely important). The decision-making unit framework was applied for stakeholder mapping. Clinical and patient-focused drivers were identified as the most important drivers for inhaler switching (rated very or extremely important by >60% of experts), which included inadequate disease control, inhaler technique errors, switching to maintenance and reliever therapy, adding a spacer, and addressing poor satisfaction. Operational factors such as supply shortages were considered moderately important, while environmental and cost-related drivers were considered least important (rated not at all important to neutral by >60% of experts). Inappropriate circumstances for inhaler switching centred on patient safety (rated very or extremely important by >85% of experts), including lack of consultation, consent, education, or follow-up, switching clinically stable patients, and introducing complex regimens. Of essential activities required for a consultation, experts estimated a median time of 36 min would be required. Experts suggest inhaler switches should prioritise clinical need and patient involvement over cost or sustainability goals, and suggest policymakers consider the time and complexity required for implementation at scale.

Artificial intelligence (AI) is rapidly advancing respiratory disease management, from diagnosis to population lung health. This scoping review synthesizes the most promising uses of AI in respiratory medicine, with a particular focus on pulmonologists and family physicians interested in lung health. In diagnostics, deep-learning systems streamline chest-imaging workflows by triaging radiographs, detecting COVID-19 pneumonia, and classifying lung nodules on CT. In pulmonary function testing, algorithms detect technical errors and classify spirometric patterns, some claiming to outperforming pulmonologists. Acoustic analysis of cough, breathing, and speech captured on smartphones or wearables offers non-invasive decision support. For monitoring and prediction, AI helps shorten weaning from mechanical ventilation and guides closed-loop strategies for acute respiratory distress. In chronic care, connected devices integrated with environmental data help to forecast asthma and COPD exacerbations, while telehealth and predictive models enable earlier, more personalized interventions. Additional gains are emerging in paediatrics, sleep medicine, lung ultrasounds, and public health. Realizing these benefits will require rigorous multicentre validation and real-world evidence. It will also require proactive bias detection and mitigation with inclusive sampling and equity audits. High-quality, interoperable data and explainable models are needed to enable human oversight. Practical issues such as digital literacy, device access, and usability for children, older adults, and other vulnerable populations also matter for applications requiring patient interaction. With sustained collaboration among clinicians, engineers, AI experts, industry, regulators, and scientific societies, AI can increase the time invested in a satisfactory clinician-patient relationship. With all likelihood, AI can also measurably improve efficiency and accuracy across multiple domains of respiratory care.

Limited evidence exists on age-related differences in health-related quality of life (HRQoL) and patient-reported outcome and experience measures (PROMs/PREMs) among asthma patients. This study analysed data from 765 adults in the German PROMchronic trial, comparing generic HRQoL, asthma-control, and PREMs across age groups (18-44, 45-64, 65-74, ≥75 years), with analyses stratified by gender. Older adults, particularly women aged 65-74 years, reported slightly higher HRQoL (p = 0.004, η² = 0.017), and ≥75 aged reported better asthma control scores (p = 0.012, Cliffs Delta = 0.261). Categorical asthma control and most PREM domains did not differ significantly. Organisational aspects of care were rated more favourably by adults aged 65-74 years (p = 0.040, Cramér's V = 0.104), especially women. Age-related differences in PROMs and PREMs were small. These findings suggest subtle but relevant patterns in patient-reported quality of asthma care and support age-sensitive, patient-centred approaches in primary care.