Pub Date : 2024-10-07DOI: 10.1136/thorax-2024-222034
Camille Miard, Vincent Thomas de Montpreville, Jean-François Bernaudin, Julien Adam, Chakib Djediat, Francois Stephan
The mechanism of thrombocytopenia during acute pulmonary hypertension (PH) decompensation may be partly due to platelet aggregation in the lung. Platelet aggregates in explanted lung from 16 lung transplant patients during acute PH decompensation with and without thrombocytopenia were identified by immunohistochemistry. Scanning electron microscopy (SEM) was performed. 7 explant lung controls without PH and thrombocytopenia were also examined. Compared with controls, the median number of platelet aggregates was higher in patients with acute PH decompensation with thrombocytopenia (19.4 [IQR 3.4–38.3] vs 147.5 [IQR 26.5–203.2]). SEM showed capillaries filled with platelet aggregates. Our study suggests that platelets may aggregate in the lungs during acute PH decompensation.
{"title":"Platelet aggregates in lung capillaries in severely decompensated pulmonary hypertension","authors":"Camille Miard, Vincent Thomas de Montpreville, Jean-François Bernaudin, Julien Adam, Chakib Djediat, Francois Stephan","doi":"10.1136/thorax-2024-222034","DOIUrl":"https://doi.org/10.1136/thorax-2024-222034","url":null,"abstract":"The mechanism of thrombocytopenia during acute pulmonary hypertension (PH) decompensation may be partly due to platelet aggregation in the lung. Platelet aggregates in explanted lung from 16 lung transplant patients during acute PH decompensation with and without thrombocytopenia were identified by immunohistochemistry. Scanning electron microscopy (SEM) was performed. 7 explant lung controls without PH and thrombocytopenia were also examined. Compared with controls, the median number of platelet aggregates was higher in patients with acute PH decompensation with thrombocytopenia (19.4 [IQR 3.4–38.3] vs 147.5 [IQR 26.5–203.2]). SEM showed capillaries filled with platelet aggregates. Our study suggests that platelets may aggregate in the lungs during acute PH decompensation.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"14 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142384155","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 : 2024-10-07DOI: 10.1136/thorax-2024-221910
Neeraj M Shah, Anne Rossel, Bawan Abdulaziz, Shauna Sheridan, Sophie Madden-Scott, Gillian Radcliffe, Rebecca D’Cruz, Eui-Sik Suh, Joerg Steier, Nicholas Hart, Patrick Brian Murphy, Michelle Ramsay, Georgios Kaltsakas
Sniff nasal inspiratory pressure (SNIP) is used to assess respiratory muscle strength in neuromuscular diseases like amyotrophic lateral sclerosis (ALS). The effect of contralateral nostril occlusion and mouth sealing on SNIP measurement are unclear. 81 participants were included (16 healthy, 39 patients with limb-onset ALS and 26 patients with bulbar-onset ALS). SNIP was obtained with combinations of mouth open/sealed and contralateral nostril open/occluded. Occluding the contralateral nostril (with mouth closed) increased SNIP by 12 cmH2O (95% CI 4, 20; p=0.003) in the healthy participants, by 9 cmH2O (95% CI 5, 12; p<0.001) in the limb-onset cohort and by 10 cmH2O (95% CI 5, 14; p<0.001) in the bulbar-onset cohort. Opening the mouth decreased SNIP by 19 cmH2O (95% CI 5, 34; p<0.009) in healthy participants, by 8 cmH2O (95% CI 4, 13; p<0.001) in the limb-onset cohort and by 13 cmH2O (95% CI 7, 19; p<0.001) in the bulbar-onset cohort. With contralateral nostril occlusion, 11% fewer individuals would have qualified for non-invasive ventilation. In conclusion, contralateral nostril occlusion increased SNIP compared with standard technique, likely reflecting true strength. Opening the mouth reduced SNIP, emphasising the need for good mouth sealing. Documenting SNIP technique is important for longitudinal assessments and clinical decision-making.
嗅鼻吸气压力（SNIP）用于评估肌萎缩性脊髓侧索硬化症（ALS）等神经肌肉疾病的呼吸肌强度。目前还不清楚对侧鼻孔闭塞和口腔密封对 SNIP 测量的影响。该研究共纳入了 81 名参与者（16 名健康人、39 名肢端型 ALS 患者和 26 名球部型 ALS 患者）。SNIP测量采用张口/封口和对侧鼻孔张开/闭合的组合方式。闭合对侧鼻孔（嘴闭合）可使健康参与者的SNIP增加12 cmH2O（95% CI 4, 20; p=0.003），使肢体发病组群的SNIP增加9 cmH2O（95% CI 5, 12; p<0.001），使躯干发病组群的SNIP增加10 cmH2O（95% CI 5, 14; p<0.001）。健康参与者张开嘴后，SNIP 下降了 19 cmH2O (95% CI 5, 34; p<0.009)，肢端发病者下降了 8 cmH2O (95% CI 4, 13; p<0.001)，球部发病者下降了 13 cmH2O (95% CI 7, 19; p<0.001)。如果对侧鼻孔闭塞，符合无创通气条件的患者将减少 11%。总之，与标准技术相比，对侧鼻孔闭塞会增加 SNIP，这可能反映了真正的强度。张开嘴巴会降低 SNIP，这强调了良好的口腔密封的必要性。记录 SNIP 技术对于纵向评估和临床决策非常重要。
{"title":"Effect of nostril occlusion and mouth sealing in the measurement of sniff nasal inspiratory pressure","authors":"Neeraj M Shah, Anne Rossel, Bawan Abdulaziz, Shauna Sheridan, Sophie Madden-Scott, Gillian Radcliffe, Rebecca D’Cruz, Eui-Sik Suh, Joerg Steier, Nicholas Hart, Patrick Brian Murphy, Michelle Ramsay, Georgios Kaltsakas","doi":"10.1136/thorax-2024-221910","DOIUrl":"https://doi.org/10.1136/thorax-2024-221910","url":null,"abstract":"Sniff nasal inspiratory pressure (SNIP) is used to assess respiratory muscle strength in neuromuscular diseases like amyotrophic lateral sclerosis (ALS). The effect of contralateral nostril occlusion and mouth sealing on SNIP measurement are unclear. 81 participants were included (16 healthy, 39 patients with limb-onset ALS and 26 patients with bulbar-onset ALS). SNIP was obtained with combinations of mouth open/sealed and contralateral nostril open/occluded. Occluding the contralateral nostril (with mouth closed) increased SNIP by 12 cmH2O (95% CI 4, 20; p=0.003) in the healthy participants, by 9 cmH2O (95% CI 5, 12; p<0.001) in the limb-onset cohort and by 10 cmH2O (95% CI 5, 14; p<0.001) in the bulbar-onset cohort. Opening the mouth decreased SNIP by 19 cmH2O (95% CI 5, 34; p<0.009) in healthy participants, by 8 cmH2O (95% CI 4, 13; p<0.001) in the limb-onset cohort and by 13 cmH2O (95% CI 7, 19; p<0.001) in the bulbar-onset cohort. With contralateral nostril occlusion, 11% fewer individuals would have qualified for non-invasive ventilation. In conclusion, contralateral nostril occlusion increased SNIP compared with standard technique, likely reflecting true strength. Opening the mouth reduced SNIP, emphasising the need for good mouth sealing. Documenting SNIP technique is important for longitudinal assessments and clinical decision-making.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"41 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142384153","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 : 2024-10-07DOI: 10.1136/thorax-2024-221874
Dimitris Evangelopoulos, Hanbin Zhang, Lia Chatzidiakou, Heather Walton, Klea Katsouyanni, Roderic L Jones, Jennifer K Quint, Benjamin Barratt
Introduction While associations between ambient air pollution and respiratory health in chronic obstructive pulmonary disease (COPD) patients are well studied, little is known about individuals’ personal exposure to pollution and associated health effects by source. Aim To separate measured total personal exposure into indoor-generated and outdoor-generated pollution and use these improved metrics in health models for establishing more reliable associations with exacerbations and respiratory symptoms. Methods We enrolled a panel of 76 patients with COPD and continuously measured their personal exposure to particles and gaseous pollutants and location with portable monitors for 134 days on average. We collected daily health information related to respiratory symptoms through diary cards and peak expiratory flow (PEF). Mixed-effects models were applied to quantify the relationship between total, indoor-generated and outdoor-generated personal exposures to pollutants with exacerbation and symptoms occurrence and PEF. Results Exposure to nitrogen dioxide from both indoor and outdoor sources was associated with exacerbations and respiratory symptoms. We observed an increase of 33% (22%–45%), 19% (12%–18%) and 12% (5%–20%) in the odds of exacerbation for an IQR increase in total, indoor-generated and outdoor-generated exposures. For carbon monoxide, health effects were mainly attributed to indoor-generated pollution. While no associations were observed for particulate matter2.5 with COPD exacerbations, indoor-generated particles were associated with a significant decrease in PEF. Conclusions Indoor-generated and outdoor-generated pollution can deteriorate COPD patients’ health. Policy-makers, physicians and patients with COPD should note the importance of decreasing exposure equally to both source types to decrease risk of exacerbation. No data are available. The datasets used for this manuscript contain personal data and cannot be shared.
{"title":"Air pollution and respiratory health in patients with COPD: should we focus on indoor or outdoor sources?","authors":"Dimitris Evangelopoulos, Hanbin Zhang, Lia Chatzidiakou, Heather Walton, Klea Katsouyanni, Roderic L Jones, Jennifer K Quint, Benjamin Barratt","doi":"10.1136/thorax-2024-221874","DOIUrl":"https://doi.org/10.1136/thorax-2024-221874","url":null,"abstract":"Introduction While associations between ambient air pollution and respiratory health in chronic obstructive pulmonary disease (COPD) patients are well studied, little is known about individuals’ personal exposure to pollution and associated health effects by source. Aim To separate measured total personal exposure into indoor-generated and outdoor-generated pollution and use these improved metrics in health models for establishing more reliable associations with exacerbations and respiratory symptoms. Methods We enrolled a panel of 76 patients with COPD and continuously measured their personal exposure to particles and gaseous pollutants and location with portable monitors for 134 days on average. We collected daily health information related to respiratory symptoms through diary cards and peak expiratory flow (PEF). Mixed-effects models were applied to quantify the relationship between total, indoor-generated and outdoor-generated personal exposures to pollutants with exacerbation and symptoms occurrence and PEF. Results Exposure to nitrogen dioxide from both indoor and outdoor sources was associated with exacerbations and respiratory symptoms. We observed an increase of 33% (22%–45%), 19% (12%–18%) and 12% (5%–20%) in the odds of exacerbation for an IQR increase in total, indoor-generated and outdoor-generated exposures. For carbon monoxide, health effects were mainly attributed to indoor-generated pollution. While no associations were observed for particulate matter2.5 with COPD exacerbations, indoor-generated particles were associated with a significant decrease in PEF. Conclusions Indoor-generated and outdoor-generated pollution can deteriorate COPD patients’ health. Policy-makers, physicians and patients with COPD should note the importance of decreasing exposure equally to both source types to decrease risk of exacerbation. No data are available. The datasets used for this manuscript contain personal data and cannot be shared.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"51 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142384154","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 Clinical studies have shown that glucagon-like peptide-1 receptor agonists (GLP-1 RA) can have beneficial effects on cardiopulmonary function. We conducted this longitudinal cohort study to compare the risk of cardiopulmonary outcomes and mortality between GLP-1 RA use and no use in patients with type 2 diabetes (T2D) and chronic obstructive pulmonary disease (COPD). Methods The study identified 8060 matched GLP-1 RA users and non-users from Taiwan’s National Health Insurance Research Database from 1 January 2008 to 31 December 2019. Cox proportional hazards models were used to determine the risk of cardiopulmonary outcomes between GLP-1 RA users and non-users. Results The mean follow-up time was 2.51 and 2.46 years for GLP-1 RA users and non-users, respectively. In the matched cohorts, GLP-1 RA users had a significantly lower risk of mortality (adjusted HR (aHR) 0.46, 95% CI 0.38 to 0.56), cardiovascular events (aHR 0.73, 95% CI 0.65 to 0.82), non-invasive positive pressure ventilation (aHR 0.66, 95% CI 0.47 to 0.93), invasive mechanical ventilation (aHR 0.64, 95% CI 0.51 to 0.8) and bacterial pneumonia (aHR 0.76, 95% CI 0.65 to 0.88) than GLP-1 RA non-users. The subsequent analyses for various subgroup and medication duration also showed that GLP-1 RA was associated with a significantly lower risk of mortality, cardiovascular events, ventilation support and bacterial pneumonia than non-GLP-1 RA. Conclusion This nationwide cohort study showed that GLP-1 RA had a lower risk of cardiopulmonary outcomes and all-cause mortality than non-GLP-1 RA in patients with T2D and COPD. GLP-1 RA may help manage diabetes in people with COPD. No data are available. Data of this study are available from the National Health Insurance Research Database (NHIRD) published by Taiwan National Health Insurance (NHI) Administration. The data used in this study cannot be made available in the paper, the supplemental files or in a public repository due to the ‘Personal Information Protection Act’ executed by Taiwan government starting from 2012. Requests for data can be sent as a formal proposal to the NHIRD office () or by email to stsung@mohw.gov.tw.
背景 临床研究表明，胰高血糖素样肽-1 受体激动剂（GLP-1 RA）可对心肺功能产生有益影响。我们进行了这项纵向队列研究，以比较 2 型糖尿病（T2D）和慢性阻塞性肺病（COPD）患者使用和不使用 GLP-1 RA 的心肺功能风险和死亡率。方法 该研究从2008年1月1日至2019年12月31日期间的台湾国民健康保险研究数据库中确定了8060名匹配的GLP-1 RA使用者和非使用者。采用Cox比例危害模型确定GLP-1 RA使用者和非使用者之间的心肺结局风险。结果 GLP-1 RA使用者和非使用者的平均随访时间分别为2.51年和2.46年。在匹配队列中，GLP-1 RA 使用者的死亡率（调整 HR (aHR) 0.46，95% CI 0.38 至 0.56）、心血管事件（aHR 0.73，95% CI 0.65 至 0.82）、无创正压通气（aHR 0.66，95% CI 0.47 至 0.93）、有创机械通气（aHR 0.64，95% CI 0.51 至 0.8）和细菌性肺炎（aHR 0.76，95% CI 0.65 至 0.88）。随后对不同亚组和用药时间的分析也显示，GLP-1 RA 与死亡率、心血管事件、通气支持和细菌性肺炎的相关风险显著低于非 GLP-1 RA。结论 这项全国性队列研究表明，与非 GLP-1 RA 相比，GLP-1 RA 可降低 T2D 和慢性阻塞性肺病患者的心肺预后风险和全因死亡率。GLP-1 RA 可帮助慢性阻塞性肺病患者控制糖尿病。暂无数据。本研究的数据来自台湾国民健康保险管理局（NHI）发布的国民健康保险研究数据库（NHIRD）。由于台湾政府自 2012 年起实施 "个人信息保护法"，本研究中使用的数据无法在论文、补充文件或公共资料库中提供。如需索取数据，可向国家健康保险研究所办公室（）提出正式申请，或发送电子邮件至 stsung@mohw.gov.tw。
{"title":"Glucagon-like peptide-1 receptor agonists may benefit cardiopulmonary outcomes in patients with COPD","authors":"Fu-Shun Yen, Chih-Cheng Hsu, James Cheng-Chung Wei, Fuu-Jen Tsai, Yuhan Huang, Teng-Shun Yu, Chii-Min Hwu","doi":"10.1136/thorax-2023-221040","DOIUrl":"https://doi.org/10.1136/thorax-2023-221040","url":null,"abstract":"Background Clinical studies have shown that glucagon-like peptide-1 receptor agonists (GLP-1 RA) can have beneficial effects on cardiopulmonary function. We conducted this longitudinal cohort study to compare the risk of cardiopulmonary outcomes and mortality between GLP-1 RA use and no use in patients with type 2 diabetes (T2D) and chronic obstructive pulmonary disease (COPD). Methods The study identified 8060 matched GLP-1 RA users and non-users from Taiwan’s National Health Insurance Research Database from 1 January 2008 to 31 December 2019. Cox proportional hazards models were used to determine the risk of cardiopulmonary outcomes between GLP-1 RA users and non-users. Results The mean follow-up time was 2.51 and 2.46 years for GLP-1 RA users and non-users, respectively. In the matched cohorts, GLP-1 RA users had a significantly lower risk of mortality (adjusted HR (aHR) 0.46, 95% CI 0.38 to 0.56), cardiovascular events (aHR 0.73, 95% CI 0.65 to 0.82), non-invasive positive pressure ventilation (aHR 0.66, 95% CI 0.47 to 0.93), invasive mechanical ventilation (aHR 0.64, 95% CI 0.51 to 0.8) and bacterial pneumonia (aHR 0.76, 95% CI 0.65 to 0.88) than GLP-1 RA non-users. The subsequent analyses for various subgroup and medication duration also showed that GLP-1 RA was associated with a significantly lower risk of mortality, cardiovascular events, ventilation support and bacterial pneumonia than non-GLP-1 RA. Conclusion This nationwide cohort study showed that GLP-1 RA had a lower risk of cardiopulmonary outcomes and all-cause mortality than non-GLP-1 RA in patients with T2D and COPD. GLP-1 RA may help manage diabetes in people with COPD. No data are available. Data of this study are available from the National Health Insurance Research Database (NHIRD) published by Taiwan National Health Insurance (NHI) Administration. The data used in this study cannot be made available in the paper, the supplemental files or in a public repository due to the ‘Personal Information Protection Act’ executed by Taiwan government starting from 2012. Requests for data can be sent as a formal proposal to the NHIRD office (<https://dep.mohw.gov.tw/DOS/cp-2516-3591-113.html>) or by email to stsung@mohw.gov.tw.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"23 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142363068","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 : 2024-10-01DOI: 10.1136/thorax-2024-222174
Ewan Christopher Mackay
Household air pollution has been estimated to be responsible for 3.2 million preventable deaths every year globally. With biomass exposure and environmental pollution linked to exacerbations of airways disease, this health impact disproportionately affects low and middle income countries. Puzzolo et al ( Lancet Resp Med 2024;12(4):281–293) undertook a systematic review and included 116 studies in the subsequent meta-analyses, to compare use of gaseous fuels in the domestic environment with more polluting fuels (wood/charcoal/kerosene) and cleaner fuels (electricity/solar) with no point of use pollution. Use of gas significantly decreased the risk of COPD (OR 0·37, 95%CI 0·23–0·60; p<0·0001), pneumonia (OR 0·54, 0·38–0·77; p=0·0008), deficits in lung function (OR 0·27, 0·17–0·44; p<0·0001), severe respiratory illness or death (OR 0·27, 0·11–0·63; p=0·0024) compared with more polluting fuels. Preterm births (OR 0·66, 0·45–0·97; p=0·033), and low birth weights were similarly reduced (OR 0·70, 0·53–0·93; p=0·015). Risk of asthma did not reach statistical significance. Gas compared with electricity did increase risk of COPD (OR 1·15, 1·06–1·25; p=0·0011) and pneumonia (OR 1·26, 1·03–1·53; p=0·025) but this was not significant in all studies. While having its own health and environmental impacts, switching to gas from more polluting fuels may reduce the burden of health risk in countries without …
{"title":"Journal club","authors":"Ewan Christopher Mackay","doi":"10.1136/thorax-2024-222174","DOIUrl":"https://doi.org/10.1136/thorax-2024-222174","url":null,"abstract":"Household air pollution has been estimated to be responsible for 3.2 million preventable deaths every year globally. With biomass exposure and environmental pollution linked to exacerbations of airways disease, this health impact disproportionately affects low and middle income countries. Puzzolo et al ( Lancet Resp Med 2024;12(4):281–293) undertook a systematic review and included 116 studies in the subsequent meta-analyses, to compare use of gaseous fuels in the domestic environment with more polluting fuels (wood/charcoal/kerosene) and cleaner fuels (electricity/solar) with no point of use pollution. Use of gas significantly decreased the risk of COPD (OR 0·37, 95%CI 0·23–0·60; p<0·0001), pneumonia (OR 0·54, 0·38–0·77; p=0·0008), deficits in lung function (OR 0·27, 0·17–0·44; p<0·0001), severe respiratory illness or death (OR 0·27, 0·11–0·63; p=0·0024) compared with more polluting fuels. Preterm births (OR 0·66, 0·45–0·97; p=0·033), and low birth weights were similarly reduced (OR 0·70, 0·53–0·93; p=0·015). Risk of asthma did not reach statistical significance. Gas compared with electricity did increase risk of COPD (OR 1·15, 1·06–1·25; p=0·0011) and pneumonia (OR 1·26, 1·03–1·53; p=0·025) but this was not significant in all studies. While having its own health and environmental impacts, switching to gas from more polluting fuels may reduce the burden of health risk in countries without …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"20 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142236635","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 : 2024-09-27DOI: 10.1136/thorax-2024-221755
Nicole Filipow, Stephen Turner, Helen L Petsky, Anne B Chang, Thomas Frischer, Stanley Szefler, Francoise Vermeulen, Sanja Stanojevic
Aims Spirometry is used by many clinicians to monitor asthma in children but relatively little is understood about its variability over time. The aim of this study was to determine the variability of forced expiratory volume in 1 s (FEV1) in children with symptomatically well-controlled asthma by applying three different methods of expressing change in FEV1 over 3-month intervals. Methods Data from five longitudinal studies of children with asthma which measured FEV1 at 3-month intervals over 6 or 12 months were used. We analysed paired FEV1 measurements when asthma symptoms were controlled. The variability of FEV1% predicted (FEV1%), FEV1 z-score (FEV1z) and conditional z score for change (Zc) in FEV1 was expressed as limits of agreement. Results A total of 881 children had 3338 FEV1 measurements on occasions when asthma was controlled; 5184 pairs of FEV1 measurements made at 3-month intervals were available. Each unit change in FEV1 z score was equivalent to a Zc 1.45 and an absolute change in FEV1% of 11.6%. The limits of agreement for change in FEV1% were −20 and +21, absolute change in FEV1 z were −1.7 and +1.7 and Zc were −2.6 and +2.1. Regression to the mean and increased variability in younger children were present for change in FEV1% and FEV1z comparisons, but not Zc. Conclusion Given the wide limits of agreement of paired FEV1 measurements in symptomatically well-controlled children, asthma treatment should primarily be guided by symptoms and not by a change in spirometry. Data may be obtained from a third party and are not publicly available. Original data may be obtained by contacting the lead for each of the five study populations whose data contributed to the present analysis.
{"title":"Variability in forced expiratory volume in 1 s in children with symptomatically well-controlled asthma","authors":"Nicole Filipow, Stephen Turner, Helen L Petsky, Anne B Chang, Thomas Frischer, Stanley Szefler, Francoise Vermeulen, Sanja Stanojevic","doi":"10.1136/thorax-2024-221755","DOIUrl":"https://doi.org/10.1136/thorax-2024-221755","url":null,"abstract":"Aims Spirometry is used by many clinicians to monitor asthma in children but relatively little is understood about its variability over time. The aim of this study was to determine the variability of forced expiratory volume in 1 s (FEV1) in children with symptomatically well-controlled asthma by applying three different methods of expressing change in FEV1 over 3-month intervals. Methods Data from five longitudinal studies of children with asthma which measured FEV1 at 3-month intervals over 6 or 12 months were used. We analysed paired FEV1 measurements when asthma symptoms were controlled. The variability of FEV1% predicted (FEV1%), FEV1 z-score (FEV1z) and conditional z score for change (Zc) in FEV1 was expressed as limits of agreement. Results A total of 881 children had 3338 FEV1 measurements on occasions when asthma was controlled; 5184 pairs of FEV1 measurements made at 3-month intervals were available. Each unit change in FEV1 z score was equivalent to a Zc 1.45 and an absolute change in FEV1% of 11.6%. The limits of agreement for change in FEV1% were −20 and +21, absolute change in FEV1 z were −1.7 and +1.7 and Zc were −2.6 and +2.1. Regression to the mean and increased variability in younger children were present for change in FEV1% and FEV1z comparisons, but not Zc. Conclusion Given the wide limits of agreement of paired FEV1 measurements in symptomatically well-controlled children, asthma treatment should primarily be guided by symptoms and not by a change in spirometry. Data may be obtained from a third party and are not publicly available. Original data may be obtained by contacting the lead for each of the five study populations whose data contributed to the present analysis.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"40 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142328863","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 : 2024-09-25DOI: 10.1136/thorax-2024-222026
Tom D Y Reijnders, Pierre-François Laterre, Bruno François, Miguel Sánchez García, Tjitske S R van Engelen, Daoud Sie, Brendon P Scicluna, Dmitry V Ostanin, Kevin J Galinsky, Joe M Butler, Eleuterio Lombardo, Tom van der Poll
Mesenchymal stem cells (MSC) have immune regulatory properties that may ameliorate pathophysiological processes in sepsis. We determined the effect of allogeneic adipose-derived MSCs (Cx611) on the host response during sepsis due to community-acquired bacterial pneumonia (CABP) by measuring 29 plasma biomarkers and blood transcriptomes at six time points in 82 patients randomised to two intravenous infusions of Cx611 or placebo. Cx611 treatment enhanced several endothelial cell and procoagulant response plasma biomarkers, and led to increased expression of pathways related to innate immunity, haemostasis and apoptosis. Cx611 infusion in sepsis due to CABP is associated with broad host response alterations. RNAseq data are available from the NCBI Sequence Read Archive (SRA) under the BioProject accession PRJNA1097551. Other data generated and/or analysed during the current study are available on reasonable request.
{"title":"Effect of mesenchymal stem cells on the host response in severe community-acquired pneumonia","authors":"Tom D Y Reijnders, Pierre-François Laterre, Bruno François, Miguel Sánchez García, Tjitske S R van Engelen, Daoud Sie, Brendon P Scicluna, Dmitry V Ostanin, Kevin J Galinsky, Joe M Butler, Eleuterio Lombardo, Tom van der Poll","doi":"10.1136/thorax-2024-222026","DOIUrl":"https://doi.org/10.1136/thorax-2024-222026","url":null,"abstract":"Mesenchymal stem cells (MSC) have immune regulatory properties that may ameliorate pathophysiological processes in sepsis. We determined the effect of allogeneic adipose-derived MSCs (Cx611) on the host response during sepsis due to community-acquired bacterial pneumonia (CABP) by measuring 29 plasma biomarkers and blood transcriptomes at six time points in 82 patients randomised to two intravenous infusions of Cx611 or placebo. Cx611 treatment enhanced several endothelial cell and procoagulant response plasma biomarkers, and led to increased expression of pathways related to innate immunity, haemostasis and apoptosis. Cx611 infusion in sepsis due to CABP is associated with broad host response alterations. RNAseq data are available from the NCBI Sequence Read Archive (SRA) under the BioProject accession PRJNA1097551. Other data generated and/or analysed during the current study are available on reasonable request.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"120 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142321560","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 : 2024-09-25DOI: 10.1136/thorax-2024-222356
Tomoo Kishaba
Interstitial lung disease (ILD) is a heterogeneous parenchymal disorder.1 2 Patients with ILD often present with non-specific symptoms such as a non-productive cough and exertional dyspnoea. The differential diagnosis for ILD is broad and includes conditions such as connective tissue disease (CTD), hypersensitivity pneumonitis, drug-associated ILD and granulomatous diseases. Furthermore, the initial management depends on factors such as antigen exposure, causative drugs, inflammation and fibrosis. Accurate diagnosis requires a detailed medical history, chest high-resolution CT (HRCT) and pathology.3 4 From a physiological perspective, ILD manifests as a restrictive disorder with reduced diffusion capacity of the lungs for carbon monoxide (DLco).5–7 Many clinical trials on ILD have used forced vital capacity (FVC) as a surrogate marker for mortality.8 9 Additionally, trends in FVC and DLco have been shown to be useful predictors of mortality, particularly in idiopathic pulmonary fibrosis (IPF).10 11 In the management and prognosis of ILD, pulmonary function tests (PFT), including FVC and DLco, are crucial physiological indices.12–14 It is important to note that height, …
{"title":"Editorial of utility of the Global Lung Function Initiative (GLI) for ILD","authors":"Tomoo Kishaba","doi":"10.1136/thorax-2024-222356","DOIUrl":"https://doi.org/10.1136/thorax-2024-222356","url":null,"abstract":"Interstitial lung disease (ILD) is a heterogeneous parenchymal disorder.1 2 Patients with ILD often present with non-specific symptoms such as a non-productive cough and exertional dyspnoea. The differential diagnosis for ILD is broad and includes conditions such as connective tissue disease (CTD), hypersensitivity pneumonitis, drug-associated ILD and granulomatous diseases. Furthermore, the initial management depends on factors such as antigen exposure, causative drugs, inflammation and fibrosis. Accurate diagnosis requires a detailed medical history, chest high-resolution CT (HRCT) and pathology.3 4 From a physiological perspective, ILD manifests as a restrictive disorder with reduced diffusion capacity of the lungs for carbon monoxide (DLco).5–7 Many clinical trials on ILD have used forced vital capacity (FVC) as a surrogate marker for mortality.8 9 Additionally, trends in FVC and DLco have been shown to be useful predictors of mortality, particularly in idiopathic pulmonary fibrosis (IPF).10 11 In the management and prognosis of ILD, pulmonary function tests (PFT), including FVC and DLco, are crucial physiological indices.12–14 It is important to note that height, …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"9 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142321549","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 : 2024-09-25DOI: 10.1136/thorax-2024-221662
Julia Geppert, Asra Asgharzadeh, Anna Brown, Chris Stinton, Emma J Helm, Surangi Jayakody, Daniel Todkill, Daniel Gallacher, Hesam Ghiasvand, Mubarak Patel, Peter Auguste, Alexander Tsertsvadze, Yen-Fu Chen, Amy Grove, Bethany Shinkins, Aileen Clarke, Sian Taylor-Phillips
Objectives To examine the accuracy and impact of artificial intelligence (AI) software assistance in lung cancer screening using CT. Methods A systematic review of CE-marked, AI-based software for automated detection and analysis of nodules in CT lung cancer screening was conducted. Multiple databases including Medline, Embase and Cochrane CENTRAL were searched from 2012 to March 2023. Primary research reporting test accuracy or impact on reading time or clinical management was included. QUADAS-2 and QUADAS-C were used to assess risk of bias. We undertook narrative synthesis. Results Eleven studies evaluating six different AI-based software and reporting on 19 770 patients were eligible. All were at high risk of bias with multiple applicability concerns. Compared with unaided reading, AI-assisted reading was faster and generally improved sensitivity (+5% to +20% for detecting/categorising actionable nodules; +3% to +15% for detecting/categorising malignant nodules), with lower specificity (−7% to −3% for correctly detecting/categorising people without actionable nodules; −8% to −6% for correctly detecting/categorising people without malignant nodules). AI assistance tended to increase the proportion of nodules allocated to higher risk categories. Assuming 0.5% cancer prevalence, these results would translate into additional 150–750 cancers detected per million people attending screening but lead to an additional 59 700 to 79 600 people attending screening without cancer receiving unnecessary CT surveillance. Conclusions AI assistance in lung cancer screening may improve sensitivity but increases the number of false-positive results and unnecessary surveillance. Future research needs to increase the specificity of AI-assisted reading and minimise risk of bias and applicability concerns through improved study design. PROSPERO registration number CRD42021298449. All data relevant to the study are included in the article or uploaded as supplementary information.
{"title":"Software using artificial intelligence for nodule and cancer detection in CT lung cancer screening: systematic review of test accuracy studies","authors":"Julia Geppert, Asra Asgharzadeh, Anna Brown, Chris Stinton, Emma J Helm, Surangi Jayakody, Daniel Todkill, Daniel Gallacher, Hesam Ghiasvand, Mubarak Patel, Peter Auguste, Alexander Tsertsvadze, Yen-Fu Chen, Amy Grove, Bethany Shinkins, Aileen Clarke, Sian Taylor-Phillips","doi":"10.1136/thorax-2024-221662","DOIUrl":"https://doi.org/10.1136/thorax-2024-221662","url":null,"abstract":"Objectives To examine the accuracy and impact of artificial intelligence (AI) software assistance in lung cancer screening using CT. Methods A systematic review of CE-marked, AI-based software for automated detection and analysis of nodules in CT lung cancer screening was conducted. Multiple databases including Medline, Embase and Cochrane CENTRAL were searched from 2012 to March 2023. Primary research reporting test accuracy or impact on reading time or clinical management was included. QUADAS-2 and QUADAS-C were used to assess risk of bias. We undertook narrative synthesis. Results Eleven studies evaluating six different AI-based software and reporting on 19 770 patients were eligible. All were at high risk of bias with multiple applicability concerns. Compared with unaided reading, AI-assisted reading was faster and generally improved sensitivity (+5% to +20% for detecting/categorising actionable nodules; +3% to +15% for detecting/categorising malignant nodules), with lower specificity (−7% to −3% for correctly detecting/categorising people without actionable nodules; −8% to −6% for correctly detecting/categorising people without malignant nodules). AI assistance tended to increase the proportion of nodules allocated to higher risk categories. Assuming 0.5% cancer prevalence, these results would translate into additional 150–750 cancers detected per million people attending screening but lead to an additional 59 700 to 79 600 people attending screening without cancer receiving unnecessary CT surveillance. Conclusions AI assistance in lung cancer screening may improve sensitivity but increases the number of false-positive results and unnecessary surveillance. Future research needs to increase the specificity of AI-assisted reading and minimise risk of bias and applicability concerns through improved study design. PROSPERO registration number CRD42021298449. All data relevant to the study are included in the article or uploaded as supplementary information.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"2 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142321598","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 : 2024-09-24DOI: 10.1136/thorax-2024-221813
Andrew Li, Alan Teoh, Lauren Troy, Ian Glaspole, Margaret L Wilsher, Sally de Boer, Jeremy Wrobel, Yuben P Moodley, Francis Thien, Henry Gallagher, Michelle Galbraith, Daniel C Chambers, John Mackintosh, Nicole Goh, Yet Hong Khor, Adrienne Edwards, Karen Royals, Christopher Grainge, Benjamin Kwan, Gregory J Keir, Chong Ong, Paul N Reynolds, Elizabeth Veitch, Gin Tsen Chai, Ziqin Ng, Geak Poh Tan, Dan Jackson, Tamera Corte, Helen Jo
Background Lung function testing remains a cornerstone in the assessment and management of interstitial lung disease (ILD) patients. The clinical implications of the Global Lung function Initiative (GLI) reference equations and the updated interpretation strategies remain uncertain. Methods Adult patients with ILD with baseline forced vital capacity (FVC) were included from the Australasian ILD registry and the National Healthcare Group ILD registry, Singapore. The European Coal and Steel Community and Miller reference equations were compared with the GLI reference equations to assess (a) differences in lung function percent predicted values; (b) ILD risk prediction models and (c) eligibility for ILD clinical trial enrolment. Results Among 2219 patients with ILD, 1712 (77.2%) were white individuals. Idiopathic pulmonary fibrosis (IPF), connective tissue disease-associated ILD and unclassifiable ILD predominated. Median FVC was 2.60 (2.01–3.36) L, forced expiratory volume in 1 s was 2.09 (1.67–2.66) L and diffusing capacity of the lungs for carbon monoxide (DLCO) was 13.60 (10.16–17.60) mL/min/mm Hg. When applying the GLI reference equations, the mean FVC percentage predicted was 8.8% lower (87.7% vs 78.9%, p<0.01) while the mean DLCO percentage predicted was 4.9% higher (58.5% vs 63.4%, p<0.01). There was a decrease in 19 IPF and 119 non-IPF patients who qualified for the nintedanib clinical trials when the GLI reference equations were applied. Risk prediction models performed similarly in predicting mortality using both reference equations. Conclusion Applying the GLI reference equations in patients with ILD leads to higher DLCO percentage predicted values and smaller lung volume percentage predicted values. While applying the GLI reference equations did not impact on prognostication, fewer patients met the clinical trial criteria for antifibrotic agents. Data are available on reasonable request.
{"title":"Implications of the 2022 lung function update and GLI global reference equations among patients with interstitial lung disease","authors":"Andrew Li, Alan Teoh, Lauren Troy, Ian Glaspole, Margaret L Wilsher, Sally de Boer, Jeremy Wrobel, Yuben P Moodley, Francis Thien, Henry Gallagher, Michelle Galbraith, Daniel C Chambers, John Mackintosh, Nicole Goh, Yet Hong Khor, Adrienne Edwards, Karen Royals, Christopher Grainge, Benjamin Kwan, Gregory J Keir, Chong Ong, Paul N Reynolds, Elizabeth Veitch, Gin Tsen Chai, Ziqin Ng, Geak Poh Tan, Dan Jackson, Tamera Corte, Helen Jo","doi":"10.1136/thorax-2024-221813","DOIUrl":"https://doi.org/10.1136/thorax-2024-221813","url":null,"abstract":"Background Lung function testing remains a cornerstone in the assessment and management of interstitial lung disease (ILD) patients. The clinical implications of the Global Lung function Initiative (GLI) reference equations and the updated interpretation strategies remain uncertain. Methods Adult patients with ILD with baseline forced vital capacity (FVC) were included from the Australasian ILD registry and the National Healthcare Group ILD registry, Singapore. The European Coal and Steel Community and Miller reference equations were compared with the GLI reference equations to assess (a) differences in lung function percent predicted values; (b) ILD risk prediction models and (c) eligibility for ILD clinical trial enrolment. Results Among 2219 patients with ILD, 1712 (77.2%) were white individuals. Idiopathic pulmonary fibrosis (IPF), connective tissue disease-associated ILD and unclassifiable ILD predominated. Median FVC was 2.60 (2.01–3.36) L, forced expiratory volume in 1 s was 2.09 (1.67–2.66) L and diffusing capacity of the lungs for carbon monoxide (DLCO) was 13.60 (10.16–17.60) mL/min/mm Hg. When applying the GLI reference equations, the mean FVC percentage predicted was 8.8% lower (87.7% vs 78.9%, p<0.01) while the mean DLCO percentage predicted was 4.9% higher (58.5% vs 63.4%, p<0.01). There was a decrease in 19 IPF and 119 non-IPF patients who qualified for the nintedanib clinical trials when the GLI reference equations were applied. Risk prediction models performed similarly in predicting mortality using both reference equations. Conclusion Applying the GLI reference equations in patients with ILD leads to higher DLCO percentage predicted values and smaller lung volume percentage predicted values. While applying the GLI reference equations did not impact on prognostication, fewer patients met the clinical trial criteria for antifibrotic agents. Data are available on reasonable request.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"2 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142317607","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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