NPJ Primary Care Respiratory Medicine最新文献

The relationship between systemic inflammation and centripedal obesity in predicting mortality risk among patients with Preserved Ratio Impaired Spirometry (PRISm) has garnered increasing interest. This study aims to elucidate the joint effects of these factors on mortality risk in this patient population. This study included data from the National Health and Nutrition Examination Survey (NHANES) of U.S. adults collected from 2007-2012, calculating both the systemic inflammation response index (SIRI) and the weight-adjusted waist index (WWI). Lung function parameters were used to define PRISm cases. Generalized linear models and logistic regression were used to assess the individual and combined effects of SIRI and WWI, and further explored the mediating role of the SIRI. A total of 1454 PRISm patients were included in this study, with a median follow-up period of 9.5 years, during which 10.9% died from all causes and 3.6% from cardiovascular diseases. The restricted cubic spline curves for SIRI and WWI showed J-shaped associations with mortality. Participants with both high WWI (≥11.18) and high Ln SIRI (≥0.13) had significantly higher all-cause and cardiovascular mortality compared with those with low WWI and low SIRI. In the discordant groups, high WWI with low SIRI was associated with increased all-cause mortality (HR = 1.795, 1.050-3.064), while low WWI with high SIRI was linked to higher cardiovascular mortality (HR = 4.844, 1.505-15.591). This effect was more pronounced in the smoking subgroup. Additionally, SIRI mediated 9% of the association between WWI and all-cause mortality, and 12.94% of the association with cardiovascular mortality. Our study provides evidence for the relationship between SIRI and WWI with mortality in PRISm patients. The joint association of these factors provide potential insights for additional information for prognostic prediction and may contribute to identifying risk stratification in PRISm.

Upper respiratory tract infections (URTIs) are among the most common diseases encountered in primary medical care. Recurrent URTIs (RURTIs) considerably affect patient health and quality of life. Recent evidence indicates that increased attention is being paid to symptom improvement in clinical practice. However, the therapeutic opportunities associated with using a vector for improving the immune status of patients remain underestimated. As the most common sources of URTI are viral infections, antiviral agents with the potential to enhance host immune responses can be considered auxiliary, effective, and safe for children and adults with URTIs and RURTIs. This review reports the current evidence and expert opinions on immunity-targeted approaches in the management of viral URTIs. Undelayed diagnosis and initiating treatment in the early stages of URTIs are crucial elements that can significantly improve disease evolution and the overall health of patients of any age group. An immunomodulatory remedy would be optimal for facilitating the healing of acute infections, reducing recurrence and complications, antibiotic consumption, and the consequences of antibiotic overuse. Maintaining and protecting the intestinal microbiota is also an important step toward effective URTI treatment. The findings of this review provide valuable insights into the effective management of URTIs and RURTIs based on the latest clinical evidence.

The utility of fractional exhaled nitric oxide (FeNO) was evaluated alongside blood eosinophils in phenotyping mild asthma. Inclusion of FeNO improved classification accuracy and calibration in an adapted ISAR-based model; however, its predictive improvement was modest and its susceptibility to transient elevations suggests limited added value for routine clinical classification. Simplified algorithms may offer more accurate phenotyping in population-based settings with real-world constraints.

To achieve progression criteria for a definitive phase three randomised controlled trial (RCT). Prospective phase two multicentre parallel-group RCT. Participants recruited from secondary care respiratory clinics in two health boards in Scotland, United Kingdom. 110 adults with moderate-severe COPD and co-morbidities. Tailored Intervention for COPD and Co-morbidities by Pharmacists and Consultant Physicians (TICC-PCP): home visits (for a year) by generalist prescribing pharmacists collaborating with consultant respiratory physicians. Pharmacists assessed, prescribed, de-prescribed, and referred participants to health and social care services as appropriate, in addition to Usual Care (UC). Recruit ≥100 participants; deliver TICC-PCP to ≥70% intervention-arm participants; collect ≥90% in-person data; retain ≥80% participants until 21-months. Secondary outcomes include clinical and health service utilisation. Recruitment, data collection, retention and participant retention targets were achieved over 21 months. TICC-PCP delivery: the median number of contacts, nine per participant in one year, matched the a-priori target although fewer than expected (13 (27%)) received the planned schedule of contacts (monthly for six months then every other month for six months). Secondary outcomes included increased prescribing of bone strengthening medicines, de-prescribing of medicines associated with increasing falls risk; delayed time to emergency health care contacts, fewer exacerbations; improved health related quality of life and longer duration of hospitalisation. A definitive phase three RCT of TICC-PCP may improve outcomes for people with moderate-severe COPD and co-morbidities. Trial registration: The trial is registered with the UK Clinical Trials Registry ( https://doi.org/10.1186/ISRCTN43508703 ). Registration date: 3/1/2020.

Asthma is a leading chronic illness in children worldwide, and school staff are often the first responders when asthma emergencies occur at school. Despite their crucial role, many school staff lack adequate training in asthma management. Online training has emerged as a standardised and scalable solution, but its broader effectiveness remains uncertain. This systematic review aimed to evaluate the effectiveness of online asthma training programmes for school staff. A comprehensive search was conducted across six databases (PubMed, CINAHL, Scopus, Web of Science, ProQuest, and Education Research Complete) in June 2024. Eligible studies included those that evaluated online asthma training programmes targeting school staff (teachers, classroom assistants, and school nurses). The effectiveness of interventions was assessed using the Kirkpatrick evaluation model, which categorises outcomes into four levels: reaction, learning, behaviour, and results. Methodological quality was appraised using the Mixed Methods Appraisal Tool (MMAT). Eight studies met the inclusion criteria with quality scores ranging from 40 to 80%. Interventions identified included web-based modules (n = 4), online classrooms (n = 2), an eBook (n = 1), and a PowerPoint presentation (n = 1). All reported participants' positive satisfaction with the training and improvements in asthma knowledge (levels 1 and 2). However, none of the studies evaluated behavioural change or organisational outcomes (levels 3 and 4). Most studies had small sample sizes and lacked long-term follow-up, limiting assessment of real-world impact. Online asthma training programmes improve school staff's knowledge and satisfaction, and appear to be as effective as face-to-face training. However, their impact on behavioural or organisational change remains lacking. Future research should explore long-term effects to support real-world implementation.

Many patients with COPD use inhaled corticosteroids (ICS) without proper indication. We developed a multifaceted tailor-made de-implementation strategy-including a toolbox, communication plan, and training-to reduce inappropriate ICS use in general practice. We evaluated its effectiveness (i.e. decline in percentage of patients with COPD that use ICS) and other outcomes during a 15-month study in Drenthe, the Netherlands. Less patients (-4.7%,95%CI: 2.6-6.7%) used ICS at the end of follow-up and the percentage of ICS-users declined by 8.2% (95%CI: 2.9-13.4%) across the 14 practices that fully participated in the project. ICS user percentages declined significantly moreover time in the fully participation group than in the control group (beta-regression, β = -0.041,SE = 0.011, p < 0.01). While these findings are promising, further research is needed to assess additional penetration and sustainability of the strategy in the region and to explore the applicability of comparable regional ICS de-implementation plans.

Chronic obstructive pulmonary disease (COPD) is a respiratory disease which may significantly impact health status. To reduce symptoms and improve quality of life, pharmacological treatment should be complemented by addressing extrapulmonary traits and lifestyle- and psychosocial factors, such as physical deconditioning, decrease in muscle mass, smoking or depression. Treatment of these non-pharmacological traits is commonly conducted in a primary care setting and often requires multiple healthcare providers (HCPs). To provide complementary care, high quality interprofessional collaboration (IPC) is required. Therefore, our aim was to develop an IPC model for COPD patients treated in primary care. To achieve our aims, we used co-creation sessions (CCS), a recognised method within the participatory action research (PAR) approach. Co-creation, characterised by collaboration and a bottom-up strategy, has repeatedly shown to be suitable for developing care improvements. We recruited two independent groups of stakeholders to participate in six CCS in parallel. They were purposefully sampled and included patients and HCPs from both primary and secondary/tertiary care. Given the considerable overlap in results between the two independent teams, we developed a joint model which is ready to be pilot tested. Our model is based on current and local work methods and can be implemented in existing local contexts and structures. We noted some differences between the teams: the choice of the routing and timing of IPC commencement, and the choice for the communication platform. Using the PAR approach and co-creation, we developed an actionable IPC model in primary care for COPD patients.

Despite its importance in global TB elimination, tuberculosis preventive treatment (TPT) remains underutilized. Psychosocial barriers significantly contribute to this issue. This systematic review aims primarily to synthesize psychosocial interventions to improve the initiation of TPT. We analyzed psychosocial outcomes as secondary objectives when relevant data were available. This review included studies indexed in PubMed, Scopus, and PsycInfo until August 25, 2025. Original studies addressing psychosocial interventions for people with latent tuberculosis infection (LTBI) indicated for TPT were included in this review. The risk of bias was assessed via the Crowe Critical Appraisal Tool (CCAT). A narrative synthesis summarized the characteristics of interventions, including the format of delivery, settings, intervention providers, psychosocial content, duration, and outcomes. Among the 1725 identified studies, nine (14,428 participants) met the inclusion criteria. The CCAT classification was moderate to high quality, with strengths in clearly articulated study rationales but weaknesses in study design. Most studies were from upper-middle-income countries with a high burden of TB; none were from Asia. Health education is a core component, often incorporating culturally adapted survivor testimonials to reduce stigma and increase motivation. Interventions were mostly community-based and led by multidisciplinary healthcare professionals and community workers. TPT initiation improved in all included studies, with risk differences ranging from 10-52%. This review emphasizes the potential of psychosocial interventions in supporting behavior change and increasing TPT initiation. Methodological limitations and a lack of research in high-burden Asian contexts restrict the current evidence. Future studies should focus on developing rigorous, contextually appropriate strategies for scalable psychosocial interventions that are effective and sustainable.

At-home spirometry could provide added value for the diagnosis and monitoring of obstructive pulmonary disease in primary care. However, it is unknown whether implementation in a real-world setting is practicable and produces good quality spirometry. We studied feasibility, quality and added value of at-home spirometry in primary care practices in the Netherlands and Sweden. Adults with an asthma- or COPD-related spirometry indication were provided with equipment to perform unsupervised spirometry at-home. Differences in FEV₁ and FVC-values from home and general practice were compared, and questionnaires on feasibility were completed by participants and healthcare professionals (HCPs). Of 140 participants, 89.3% completed a home spirometry session, of whom 59.2% produced acceptable spirometry. Overall, HCPs and participants rated home spirometry as feasible and of added value for asthma and COPD monitoring in primary care, though less helpful for diagnostic purposes. A small mean difference in spirometry results was observed, with FEV₁ and FVC at-home being 0.076 and 0.094 L higher than at the GP office, respectively.