Pub Date : 2025-03-18DOI: 10.1136/thorax-2024-222391
Catherine Plum, Marie Stolbrink, Obianuju Ozoh, Shamanthi Jayasooriya, Rebecca Nightingale, Kevin Mortimer, David Halpin
Smoking cessation is more effective when supported by medicines. Data on the availability, cost and affordability of these treatments in low-income and middle-income countries (LMIC) are limited. Cross-sectional data for smoking cessation medications were collected from pharmacies, healthcare facilities and central medicine stores in 60 LMIC (2022-2023). Medications had varying availability, large price ranges and were essentially unaffordable. Enabling access to these medications is important in reducing tobacco consumption and associated disease. Strategies for integrating smoking cessation services into health systems are needed to reach Sustainable Development Goal targets.
{"title":"Availability, cost and affordability of essential medicines for smoking cessation in low-income and middle-income countries: a cross-sectional study.","authors":"Catherine Plum, Marie Stolbrink, Obianuju Ozoh, Shamanthi Jayasooriya, Rebecca Nightingale, Kevin Mortimer, David Halpin","doi":"10.1136/thorax-2024-222391","DOIUrl":"10.1136/thorax-2024-222391","url":null,"abstract":"<p><p>Smoking cessation is more effective when supported by medicines. Data on the availability, cost and affordability of these treatments in low-income and middle-income countries (LMIC) are limited. Cross-sectional data for smoking cessation medications were collected from pharmacies, healthcare facilities and central medicine stores in 60 LMIC (2022-2023). Medications had varying availability, large price ranges and were essentially unaffordable. Enabling access to these medications is important in reducing tobacco consumption and associated disease. Strategies for integrating smoking cessation services into health systems are needed to reach Sustainable Development Goal targets.</p>","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":"248-250"},"PeriodicalIF":9.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-18DOI: 10.1136/thorax-2024-222622
Róisín Mongey, Diana A van der Plaat, Seif O Shaheen, Laura Portas, James Potts, Matthew David Hind, Cosetta Minelli
Background: Vitamin A, an essential micronutrient obtained through the diet, plays a crucial role in lung development and contributes to lung regeneration. We aimed to investigate its effect on adult lung function using triangulation of evidence from both observational and genetic data.
Methods: Using data on 150 000 individuals from UK Biobank and correcting for measurement error (generalised structural equation modelling), we first investigated the association of dietary vitamin A intake (total vitamin A, carotene and retinol) with lung function (forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1)/FVC)). We then assessed the causality of these associations using Mendelian randomisation (MR), and we investigated the effects on adult lung function of 39 genes related to vitamin A, and their interaction with vitamin A intake.
Findings: Our observational analysis suggests a positive association between carotene intake and FVC only (13.3 mL per 100 µg/day; p=2.9×10-9), with stronger associations in smokers, but no association of retinol intake with FVC or FEV1/FVC. The MR similarly shows a beneficial effect of serum beta-carotene on FVC only, with no effect of serum retinol on FVC nor FEV1/FVC. Nine of the vitamin A-related genes were associated with adult lung function, six of which have not been previously identified in genome-wide studies and three (NCOA2, RDH10, RXRB) in any type of genetic study of lung function. Five genes showed possible gene-vitamin A intake interactions.
Interpretation: Our triangulation study provides convincing evidence for a causal effect of vitamin A, carotene in particular, on adult lung function, suggesting a beneficial effect of a carotene-rich diet on adult lung health.
{"title":"Effect of vitamin A on adult lung function: a triangulation of evidence approach.","authors":"Róisín Mongey, Diana A van der Plaat, Seif O Shaheen, Laura Portas, James Potts, Matthew David Hind, Cosetta Minelli","doi":"10.1136/thorax-2024-222622","DOIUrl":"10.1136/thorax-2024-222622","url":null,"abstract":"<p><strong>Background: </strong>Vitamin A, an essential micronutrient obtained through the diet, plays a crucial role in lung development and contributes to lung regeneration. We aimed to investigate its effect on adult lung function using triangulation of evidence from both observational and genetic data.</p><p><strong>Methods: </strong>Using data on 150 000 individuals from UK Biobank and correcting for measurement error (generalised structural equation modelling), we first investigated the association of dietary vitamin A intake (total vitamin A, carotene and retinol) with lung function (forced vital capacity (FVC), forced expiratory volume in 1 s (FEV<sub>1</sub>)/FVC)). We then assessed the causality of these associations using Mendelian randomisation (MR), and we investigated the effects on adult lung function of 39 genes related to vitamin A, and their interaction with vitamin A intake.</p><p><strong>Findings: </strong>Our observational analysis suggests a positive association between carotene intake and FVC only (13.3 mL per 100 µg/day; p=2.9×10<sup>-9</sup>), with stronger associations in smokers, but no association of retinol intake with FVC or FEV<sub>1</sub>/FVC. The MR similarly shows a beneficial effect of serum beta-carotene on FVC only, with no effect of serum retinol on FVC nor FEV<sub>1</sub>/FVC. Nine of the vitamin A-related genes were associated with adult lung function, six of which have not been previously identified in genome-wide studies and three (<i>NCOA2, RDH10, RXRB</i>) in any type of genetic study of lung function. Five genes showed possible gene-vitamin A intake interactions.</p><p><strong>Interpretation: </strong>Our triangulation study provides convincing evidence for a causal effect of vitamin A, carotene in particular, on adult lung function, suggesting a beneficial effect of a carotene-rich diet on adult lung health.</p>","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":"236-244"},"PeriodicalIF":9.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143410752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: High-level exposure to crystalline silica dust is the key factor in silicosis. Long-term exposure to low-level silica dust, for example, lower than that in occupational exposure limits, still needs to be studied for their risk of silicosis.
Methods: A total of 30 697 workers were included from a cohort in China. Low-level silica dust exposure was defined as those having a lifetime mean silica dust concentration equal to or under permissible exposure limits, including 0.05 mg/m3, 0.10 mg/m3 and 0.35 mg/m3. Cumulative respirable silica dust exposure (CDE) for individual workers was assessed by linking a job-exposure matrix to personal work history.
Results: Among those with average exposure level equal to or lower than 0.05 mg/m3, compared with the lowest quartile CDE (Q1), the HRs of silicosis were 1.32 (95% CI 0.82 to 2.10) for Q2, 1.87 (95% CI 1.22 to 2.88) for Q3 and 2.00 (95% CI 1.30 to 3.09) for Q4. Among those exposed to 0.10 mg/m3 or less exposure level, compared with Q1, the HRs were 2.52 (95% CI 1.88 to 3.38) for Q2, 4.08 (95% CI 3.09 to 5.39) for Q3 and 4.02 (95% CI 3.04 to 5.32) for Q4. Among those exposed to 0.35 mg/m3 or less exposure level, compared with Q1, the HRs were 2.80 (95% CI 2.38 to 3.28) for Q2, 5.76 (95% CI 4.93 to 6.73) for Q3 and 7.14 (95% CI 6.07 to 8.40) for Q4, respectively. Stratified analysis showed that the results and trends did not change with facilities and smoking status.
Conclusion: Long-term exposure to low-level silica dust is still associated with a higher risk of silicosis. Control measurements and personal protective equipment should be emphasised to protect the health of workers.
{"title":"Long-term exposure to low-level crystalline silica and risk assessment of silicosis: a cohort study.","authors":"Dongming Wang, Wenzhen Li, Min Zhou, Jixuan Ma, Yanjun Guo, Weihong Chen","doi":"10.1136/thorax-2024-222660","DOIUrl":"https://doi.org/10.1136/thorax-2024-222660","url":null,"abstract":"<p><strong>Background: </strong>High-level exposure to crystalline silica dust is the key factor in silicosis. Long-term exposure to low-level silica dust, for example, lower than that in occupational exposure limits, still needs to be studied for their risk of silicosis.</p><p><strong>Methods: </strong>A total of 30 697 workers were included from a cohort in China. Low-level silica dust exposure was defined as those having a lifetime mean silica dust concentration equal to or under permissible exposure limits, including 0.05 mg/m<sup>3</sup>, 0.10 mg/m<sup>3</sup> and 0.35 mg/m<sup>3</sup>. Cumulative respirable silica dust exposure (CDE) for individual workers was assessed by linking a job-exposure matrix to personal work history.</p><p><strong>Results: </strong>Among those with average exposure level equal to or lower than 0.05 mg/m<sup>3</sup>, compared with the lowest quartile CDE (Q1), the HRs of silicosis were 1.32 (95% CI 0.82 to 2.10) for Q2, 1.87 (95% CI 1.22 to 2.88) for Q3 and 2.00 (95% CI 1.30 to 3.09) for Q4. Among those exposed to 0.10 mg/m<sup>3</sup> or less exposure level, compared with Q1, the HRs were 2.52 (95% CI 1.88 to 3.38) for Q2, 4.08 (95% CI 3.09 to 5.39) for Q3 and 4.02 (95% CI 3.04 to 5.32) for Q4. Among those exposed to 0.35 mg/m<sup>3</sup> or less exposure level, compared with Q1, the HRs were 2.80 (95% CI 2.38 to 3.28) for Q2, 5.76 (95% CI 4.93 to 6.73) for Q3 and 7.14 (95% CI 6.07 to 8.40) for Q4, respectively. Stratified analysis showed that the results and trends did not change with facilities and smoking status.</p><p><strong>Conclusion: </strong>Long-term exposure to low-level silica dust is still associated with a higher risk of silicosis. Control measurements and personal protective equipment should be emphasised to protect the health of workers.</p>","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-13DOI: 10.1136/thorax-2025-223133
Georgina Bailey, Carole A Ridge
While the pulmonary microvasculature is thought to be one of the causative factors in emphysema pathogenesis, there is little in vivo evidence in the general population to confirm this. Hermann and colleagues have investigated this link by quantifying the microvascular blood volume using dual-energy computed tomography (DECT) in a diverse, community-based cohort of older adults with and without emphysema.1 Their findings reveal that lower pulmonary microvascular blood volume (PMBV) is linked to emphysema severity, specifically in those with the diffuse emphysema subtype. This association persisted even in participants without a history of smoking or evidence of airflow limitation on spirometry. DECT allows characterisation of materials by measuring attenuation values at two different X-ray energy levels.2 After the administration of iodinated intravenous contrast, DECT can be used to create iodine maps of the lungs at the voxel level, equivalent to pulmonary perfusion, and allows calculation of perfused PMBV.3 In the current study, PMBV is defined as the blood volume in the peripheral 2 cm of lung tissue excluding the area adjacent to the mediastinum, which was selected automatically in order to assess the regions of lung proven …
{"title":"Pulmonary microvascular blood volume and emphysema: in vivo link shown in the MESA cohort","authors":"Georgina Bailey, Carole A Ridge","doi":"10.1136/thorax-2025-223133","DOIUrl":"https://doi.org/10.1136/thorax-2025-223133","url":null,"abstract":"While the pulmonary microvasculature is thought to be one of the causative factors in emphysema pathogenesis, there is little in vivo evidence in the general population to confirm this. Hermann and colleagues have investigated this link by quantifying the microvascular blood volume using dual-energy computed tomography (DECT) in a diverse, community-based cohort of older adults with and without emphysema.1 Their findings reveal that lower pulmonary microvascular blood volume (PMBV) is linked to emphysema severity, specifically in those with the diffuse emphysema subtype. This association persisted even in participants without a history of smoking or evidence of airflow limitation on spirometry. DECT allows characterisation of materials by measuring attenuation values at two different X-ray energy levels.2 After the administration of iodinated intravenous contrast, DECT can be used to create iodine maps of the lungs at the voxel level, equivalent to pulmonary perfusion, and allows calculation of perfused PMBV.3 In the current study, PMBV is defined as the blood volume in the peripheral 2 cm of lung tissue excluding the area adjacent to the mediastinum, which was selected automatically in order to assess the regions of lung proven …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"26 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143618421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-13DOI: 10.1136/thorax-2024-221960
Álvaro Dubois-Silva, Behnood Bikdeli, David Jiménez, Cristina Barbagelata-López, Carmen Fernández-Capitán, Andris Skride, Khanh Quoc Pham, José Antonio Porras, Nazaret Pacheco-Gómez, Manuel Monreal
Background The impact of deep vein thrombosis (DVT) location on acute pulmonary embolism (PE) prognosis remains uncertain. Methods Using the Registro Informatizado de Enfermedad TromboEmbólica registry, we assessed 30-day and 90-day outcomes in patients with acute symptomatic PE and concomitant upper-extremity (UEDVT) versus lower-extremity DVT (LEDVT). Cox regression was employed for analysis, and standardised differences (SRD) were used for reporting clinical characteristics to minimise type I error overinflation. The primary outcome was 30-day all-cause mortality, with secondary outcomes including 90-day mortality, fatal PE, venous thromboembolism (VTE) recurrences, and major bleeding. Results Among 21 617 patients with PE (March 2001–April 2023), 508 had UEDVT, and 21 109 had LEDVT. Patients with UEDVT were younger (SRD: 0.231), more often had cancer (SRD: 0.395) or non-central PEs (SRD: 0.445), but less frequently had raised troponin levels (SRD: 0.376) or right ventricle dysfunction (SRD: 0.249). Thirty-day mortality was higher in UEDVT compared with LEDVT (7.3% vs 3.5%; p<0.001), with similar trends at 90 days (14% vs 6.0%) and in subgroup analysis in patients without cancer. Increased rates of PE-related mortality, VTE recurrences and major bleeding were noted in patients with UEDVT at both 30 and 90 days. UEDVT was associated with a higher risk for 30-day (adjusted HR (aHR): 1.49; 95% CI 1.04 to 2.13) and 90-day (aHR: 1.52; 95% CI 1.15 to 2.00) all-cause mortality on multilevel multivariable analysis. Conclusions Patients with concomitant UEDVT experienced worse short-term outcomes, including higher mortality, despite fewer clinical signs of PE severity compared with LEDVT. These findings suggest that unrecognised patient characteristics might influence prognosis, warranting further research. Data are available upon reasonable request.
{"title":"Clinical presentation and prognosis of acute symptomatic pulmonary embolism in patients with concomitant upper-extremity versus lower-extremity deep vein thrombosis","authors":"Álvaro Dubois-Silva, Behnood Bikdeli, David Jiménez, Cristina Barbagelata-López, Carmen Fernández-Capitán, Andris Skride, Khanh Quoc Pham, José Antonio Porras, Nazaret Pacheco-Gómez, Manuel Monreal","doi":"10.1136/thorax-2024-221960","DOIUrl":"https://doi.org/10.1136/thorax-2024-221960","url":null,"abstract":"Background The impact of deep vein thrombosis (DVT) location on acute pulmonary embolism (PE) prognosis remains uncertain. Methods Using the Registro Informatizado de Enfermedad TromboEmbólica registry, we assessed 30-day and 90-day outcomes in patients with acute symptomatic PE and concomitant upper-extremity (UEDVT) versus lower-extremity DVT (LEDVT). Cox regression was employed for analysis, and standardised differences (SRD) were used for reporting clinical characteristics to minimise type I error overinflation. The primary outcome was 30-day all-cause mortality, with secondary outcomes including 90-day mortality, fatal PE, venous thromboembolism (VTE) recurrences, and major bleeding. Results Among 21 617 patients with PE (March 2001–April 2023), 508 had UEDVT, and 21 109 had LEDVT. Patients with UEDVT were younger (SRD: 0.231), more often had cancer (SRD: 0.395) or non-central PEs (SRD: 0.445), but less frequently had raised troponin levels (SRD: 0.376) or right ventricle dysfunction (SRD: 0.249). Thirty-day mortality was higher in UEDVT compared with LEDVT (7.3% vs 3.5%; p<0.001), with similar trends at 90 days (14% vs 6.0%) and in subgroup analysis in patients without cancer. Increased rates of PE-related mortality, VTE recurrences and major bleeding were noted in patients with UEDVT at both 30 and 90 days. UEDVT was associated with a higher risk for 30-day (adjusted HR (aHR): 1.49; 95% CI 1.04 to 2.13) and 90-day (aHR: 1.52; 95% CI 1.15 to 2.00) all-cause mortality on multilevel multivariable analysis. Conclusions Patients with concomitant UEDVT experienced worse short-term outcomes, including higher mortality, despite fewer clinical signs of PE severity compared with LEDVT. These findings suggest that unrecognised patient characteristics might influence prognosis, warranting further research. Data are available upon reasonable request.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"30 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143618438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-13DOI: 10.1136/thorax-2024-221537
Daniela Gompelmann, Maximilian Robert Gysan, Paul Desbordes, Julie Maes, Karolien Van Orshoven, Maarten De Vos, Markus Steinwender, Erich Helfenstein, Corina Marginean, Nicolas Henzi, Peter Cerkl, Patrick Heeb, Stephan Keusch, Gianluca Calderari, Paul von Boetticher, Bernhard Baumgartner, Daiana Stolz, Marioara Simon, Helmut Prosch, Wim Janssens, Marko Topalovic
Background The diagnosis of interstitial lung disease (ILD) can pose a challenge as the pulmonary function test (PFT) is only minimally affected at the onset. To improve early diagnosis, this study aims to explore the potential of artificial intelligence (AI) software in assisting pulmonologists with PFT interpretation for ILD diagnosis. The software provides an automated description of PFT and disease probabilities computed from an AI model. Study methods In study phase 1, a cohort of 60 patients, 30 of whom had ILD, were retrospectively diagnosed by 25 pulmonologists (8 junior physicians and 17 experienced pneumologists) by evaluating a PFT (body plethysmography and diffusion capacity) and a short medical history. The experts screened the cohort twice, without and with the aid of AI (ArtiQ.PFT, V.1.4.0, ArtiQ, BE) software and provided a primary diagnosis and up to three differential diagnoses for each case. In study phase 2, 19 pulmonologists repeated the protocol after using ArtiQ.PFT for 4–6 months. Results Overall, AI increased the diagnostic accuracy for various lung diseases from 41.8% to 62.3% in study phase 1. Focusing on ILD, AI improved the detection of lung fibrosis as the primary diagnosis from 42.8% without AI to 72.1% with AI (p<0.0001). Phase 2 yielded a similar outcome: using AI increased ILD diagnosis based on primary diagnosis (53.2% to 75.1%; p<0.0001). ILD detections without AI support significantly increased between phase 1 and phase 2 (p=0.028) but not with AI (p=0.24). Interpretation This study shows that AI-based decision support on PFT interpretation improves accurate and early ILD diagnosis. All data relevant to the study are included in the article or uploaded as supplementary information.
{"title":"AI-powered evaluation of lung function for diagnosis of interstitial lung disease","authors":"Daniela Gompelmann, Maximilian Robert Gysan, Paul Desbordes, Julie Maes, Karolien Van Orshoven, Maarten De Vos, Markus Steinwender, Erich Helfenstein, Corina Marginean, Nicolas Henzi, Peter Cerkl, Patrick Heeb, Stephan Keusch, Gianluca Calderari, Paul von Boetticher, Bernhard Baumgartner, Daiana Stolz, Marioara Simon, Helmut Prosch, Wim Janssens, Marko Topalovic","doi":"10.1136/thorax-2024-221537","DOIUrl":"https://doi.org/10.1136/thorax-2024-221537","url":null,"abstract":"Background The diagnosis of interstitial lung disease (ILD) can pose a challenge as the pulmonary function test (PFT) is only minimally affected at the onset. To improve early diagnosis, this study aims to explore the potential of artificial intelligence (AI) software in assisting pulmonologists with PFT interpretation for ILD diagnosis. The software provides an automated description of PFT and disease probabilities computed from an AI model. Study methods In study phase 1, a cohort of 60 patients, 30 of whom had ILD, were retrospectively diagnosed by 25 pulmonologists (8 junior physicians and 17 experienced pneumologists) by evaluating a PFT (body plethysmography and diffusion capacity) and a short medical history. The experts screened the cohort twice, without and with the aid of AI (ArtiQ.PFT, V.1.4.0, ArtiQ, BE) software and provided a primary diagnosis and up to three differential diagnoses for each case. In study phase 2, 19 pulmonologists repeated the protocol after using ArtiQ.PFT for 4–6 months. Results Overall, AI increased the diagnostic accuracy for various lung diseases from 41.8% to 62.3% in study phase 1. Focusing on ILD, AI improved the detection of lung fibrosis as the primary diagnosis from 42.8% without AI to 72.1% with AI (p<0.0001). Phase 2 yielded a similar outcome: using AI increased ILD diagnosis based on primary diagnosis (53.2% to 75.1%; p<0.0001). ILD detections without AI support significantly increased between phase 1 and phase 2 (p=0.028) but not with AI (p=0.24). Interpretation This study shows that AI-based decision support on PFT interpretation improves accurate and early ILD diagnosis. All data relevant to the study are included in the article or uploaded as supplementary information.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"18 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143618422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-12DOI: 10.1136/thorax-2025-223052
Stephanie K Kim Mansell, Swapna Mandal
Obstructive sleep apnoea (OSA) is a highly prevalent condition affecting 2 billion adults globally.1 The economic burden of OSA has been reported to be in the billions.2 Continuous positive airway pressure (CPAP) remains the gold standard treatment for OSA.3 The clinical and cost-effectiveness of CPAP depend on patients’ adherence to treatment.4 As many clinicians will recognise, CPAP is often a difficult treatment for patients to tolerate, and published data demonstrate that more than one-third of patients are, in the long run, non-concordant with CPAP treatment.5 Many interventions to increase concordance with CPAP therapy have been investigated, including behaviour therapies such as motivational interviewing,6 management of side effects with interventions such as humidification or different interfaces7 and more recently telemedicine and mobile applications.8 While these interventions have been potentially beneficial in clinical trials, transferability to real-world clinical practice is variable. More recently, the timing of interventions to mitigate poor use has been considered with guidelines advocating follow-up after 1 week, 4–6 weeks and 12 weeks after treatment initiation.9 Dielesen et al 10 in their paper have conducted a study to investigate associations between early CPAP use behaviours …
{"title":"First impressions matter: early CPAP use predicts future success","authors":"Stephanie K Kim Mansell, Swapna Mandal","doi":"10.1136/thorax-2025-223052","DOIUrl":"https://doi.org/10.1136/thorax-2025-223052","url":null,"abstract":"Obstructive sleep apnoea (OSA) is a highly prevalent condition affecting 2 billion adults globally.1 The economic burden of OSA has been reported to be in the billions.2 Continuous positive airway pressure (CPAP) remains the gold standard treatment for OSA.3 The clinical and cost-effectiveness of CPAP depend on patients’ adherence to treatment.4 As many clinicians will recognise, CPAP is often a difficult treatment for patients to tolerate, and published data demonstrate that more than one-third of patients are, in the long run, non-concordant with CPAP treatment.5 Many interventions to increase concordance with CPAP therapy have been investigated, including behaviour therapies such as motivational interviewing,6 management of side effects with interventions such as humidification or different interfaces7 and more recently telemedicine and mobile applications.8 While these interventions have been potentially beneficial in clinical trials, transferability to real-world clinical practice is variable. More recently, the timing of interventions to mitigate poor use has been considered with guidelines advocating follow-up after 1 week, 4–6 weeks and 12 weeks after treatment initiation.9 Dielesen et al 10 in their paper have conducted a study to investigate associations between early CPAP use behaviours …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"99 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143608017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-11DOI: 10.1136/thorax-2024-222773
Ben Knox-Brown, Fu Chuen Kon, Karl Peter Sylvester, Akhilesh Jha
We investigated the association between time of day and season of testing on the level of bronchodilator responsiveness in a hospital-based population. We found that per 1-hour increment in the working day, the odds of a positive bronchodilator response decreased by 8%. A similar effect was seen when time of day was dichotomised into morning and afternoon time periods. When stratifying by referral reason, the impact of time of day was only seen in those referred for asthma/query asthma. We also found that bronchodilator responsiveness was more common in winter months compared with the rest of the year.
{"title":"Effect of time of day and seasonal variation on bronchodilator responsiveness: the SPIRO-TIMETRY study","authors":"Ben Knox-Brown, Fu Chuen Kon, Karl Peter Sylvester, Akhilesh Jha","doi":"10.1136/thorax-2024-222773","DOIUrl":"https://doi.org/10.1136/thorax-2024-222773","url":null,"abstract":"We investigated the association between time of day and season of testing on the level of bronchodilator responsiveness in a hospital-based population. We found that per 1-hour increment in the working day, the odds of a positive bronchodilator response decreased by 8%. A similar effect was seen when time of day was dichotomised into morning and afternoon time periods. When stratifying by referral reason, the impact of time of day was only seen in those referred for asthma/query asthma. We also found that bronchodilator responsiveness was more common in winter months compared with the rest of the year.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"54 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143599110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-06DOI: 10.1136/thorax-2024-222679
Eunhye Bae, Hyun-Jun Park, Heemoon Park, Jung-Kyu Lee, Eun Young Heo, Chang Hoon Lee, Deog Kyeom Kim, Hyun Woo Lee
Introduction Despite advancements in asthma management, many patients continue to experience poor disease control, lung function decline, and frequent exacerbations. Clinical remission (CR) has been proposed as a novel treatment target and surrogate marker for long-term outcomes. This study evaluates whether early CR at 1 year after inhaled corticosteroid (ICS) initiation influences lung function decline and exacerbation risk in asthma. Methods This retrospective cohort study evaluated 492 asthma patients treated with ICS at two teaching hospitals. Patients were classified into early CR and non-early CR groups. Early CR was defined based on a composite set of criteria, including sustained absence of exacerbations, no systemic corticosteroid use, symptom control and stable or improved lung function in the first year following ICS initiation. Study outcomes were the annual forced expiratory volume in one second (FEV1) decline and the moderate-to-severe exacerbations. Results Early CR was significantly associated with slower annual FEV1 decline (4-component CR, adjusted β=31.6 mL/year, p=0.001; 3-component CR, adjusted β=15.7 mL/year, p=0.043). The benefits of early 4-component CR on attenuating annual FEV1 decline were more pronounced in specific phenotypes, including type-2 high asthma, persistent airflow limitation, severe asthma and patients requiring add-on long-acting muscarinic antagonists. Early 4-component CR had a reduced risk of moderate-to-severe (adjusted HR (aHR)=0.591, p=0.011) and severe exacerbations (aHR=0.508, p=0.025). Conclusions Achieving CR within 1 year of ICS initiation was associated with improved lung function preservation and reduced exacerbation risk. These findings suggest the importance of achieving early CR as a clinical target in asthma management. Data are available on reasonable request. The data that support the findings of this study are not publicly available due to their containing information that could compromise the privacy of research participants but are available from IRB Committee of SNU-SMG Boramae Medical Center on reasonable request.
{"title":"Early clinical remission and its role in lung function decline and exacerbation in adult Korean patients with asthma","authors":"Eunhye Bae, Hyun-Jun Park, Heemoon Park, Jung-Kyu Lee, Eun Young Heo, Chang Hoon Lee, Deog Kyeom Kim, Hyun Woo Lee","doi":"10.1136/thorax-2024-222679","DOIUrl":"https://doi.org/10.1136/thorax-2024-222679","url":null,"abstract":"Introduction Despite advancements in asthma management, many patients continue to experience poor disease control, lung function decline, and frequent exacerbations. Clinical remission (CR) has been proposed as a novel treatment target and surrogate marker for long-term outcomes. This study evaluates whether early CR at 1 year after inhaled corticosteroid (ICS) initiation influences lung function decline and exacerbation risk in asthma. Methods This retrospective cohort study evaluated 492 asthma patients treated with ICS at two teaching hospitals. Patients were classified into early CR and non-early CR groups. Early CR was defined based on a composite set of criteria, including sustained absence of exacerbations, no systemic corticosteroid use, symptom control and stable or improved lung function in the first year following ICS initiation. Study outcomes were the annual forced expiratory volume in one second (FEV1) decline and the moderate-to-severe exacerbations. Results Early CR was significantly associated with slower annual FEV1 decline (4-component CR, adjusted β=31.6 mL/year, p=0.001; 3-component CR, adjusted β=15.7 mL/year, p=0.043). The benefits of early 4-component CR on attenuating annual FEV1 decline were more pronounced in specific phenotypes, including type-2 high asthma, persistent airflow limitation, severe asthma and patients requiring add-on long-acting muscarinic antagonists. Early 4-component CR had a reduced risk of moderate-to-severe (adjusted HR (aHR)=0.591, p=0.011) and severe exacerbations (aHR=0.508, p=0.025). Conclusions Achieving CR within 1 year of ICS initiation was associated with improved lung function preservation and reduced exacerbation risk. These findings suggest the importance of achieving early CR as a clinical target in asthma management. Data are available on reasonable request. The data that support the findings of this study are not publicly available due to their containing information that could compromise the privacy of research participants but are available from IRB Committee of SNU-SMG Boramae Medical Center on reasonable request.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"53 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143570444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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