Pub Date : 2025-01-29DOI: 10.1136/thorax-2024-222142
Rui Marçalo, Guilherme Rodrigues, Miguel Pinheiro, Sonya Neto, Sofia L Marques, Paula Simão, Vitória Martins, Lília Andrade, Maria Aurora Mendes, Manuel Santos, Vera Afreixo, Alda Marques, Gabriela Moura
Objective: Reduced functional capacity and muscle weakness are two major contributors to functional impairment in chronic obstructive pulmonary disease (COPD). The underlying causes of functional impairment are poorly understood and, therefore, we sought to investigate the contribution of genetic factors.
Methods: We conducted a cross-sectional analysis of sociodemographic, clinical and genetic information of people with COPD. Hierarchical clustering based on functional capacity (6-minute walk test and 1-minute sit-to-stand test) and muscle strength (quadriceps isometric muscle strength and handgrip muscle strength) was performed. A genome-wide association study (GWAS) was performed using cluster assignment as phenotype. Polygenic risk scores (PRSs) were calculated for each variable. Genomic-derived data was used to construct a model to predict functional impairment.
Results: Two clusters were identified among 245 individuals. Cluster 1 (n=104) was composed of younger, less symptomatic patients, with preserved functional capacity and muscle strength, whereas cluster 2 (n=141) included those older, more symptomatic, with reduced functional capacity and muscle weakness. GWAS identified two polymorphisms suggestively associated with functional impairment, mapped to xanthine dehydrogenase. Cluster 2 was enriched in individuals with risk alleles for rs1991541 and rs10524730, and lower PRSs for functional capacity and muscle strength. A prediction model using genomic-derived data was constructed (n=159) and tested (n=37), yielding an area under the curve of 0.87 (0.76-0.99).
Conclusion: Genetic factors are significantly associated with functional impairment in COPD. The incorporation of genetic information, particularly PRSs, into a predictive model offers a promising avenue for timely identifying individuals at greater risk of functional decline, potentially facilitating personalised and preventive interventions. Further studies on independent external cohorts are needed to validate our model.
{"title":"Functional impairment in COPD can be predicted using genomic-derived data.","authors":"Rui Marçalo, Guilherme Rodrigues, Miguel Pinheiro, Sonya Neto, Sofia L Marques, Paula Simão, Vitória Martins, Lília Andrade, Maria Aurora Mendes, Manuel Santos, Vera Afreixo, Alda Marques, Gabriela Moura","doi":"10.1136/thorax-2024-222142","DOIUrl":"https://doi.org/10.1136/thorax-2024-222142","url":null,"abstract":"<p><strong>Objective: </strong>Reduced functional capacity and muscle weakness are two major contributors to functional impairment in chronic obstructive pulmonary disease (COPD). The underlying causes of functional impairment are poorly understood and, therefore, we sought to investigate the contribution of genetic factors.</p><p><strong>Methods: </strong>We conducted a cross-sectional analysis of sociodemographic, clinical and genetic information of people with COPD. Hierarchical clustering based on functional capacity (6-minute walk test and 1-minute sit-to-stand test) and muscle strength (quadriceps isometric muscle strength and handgrip muscle strength) was performed. A genome-wide association study (GWAS) was performed using cluster assignment as phenotype. Polygenic risk scores (PRSs) were calculated for each variable. Genomic-derived data was used to construct a model to predict functional impairment.</p><p><strong>Results: </strong>Two clusters were identified among 245 individuals. Cluster 1 (n=104) was composed of younger, less symptomatic patients, with preserved functional capacity and muscle strength, whereas cluster 2 (n=141) included those older, more symptomatic, with reduced functional capacity and muscle weakness. GWAS identified two polymorphisms suggestively associated with functional impairment, mapped to <i>xanthine dehydrogenase</i>. Cluster 2 was enriched in individuals with risk alleles for rs1991541 and rs10524730, and lower PRSs for functional capacity and muscle strength. A prediction model using genomic-derived data was constructed (n=159) and tested (n=37), yielding an area under the curve of 0.87 (0.76-0.99).</p><p><strong>Conclusion: </strong>Genetic factors are significantly associated with functional impairment in COPD. The incorporation of genetic information, particularly PRSs, into a predictive model offers a promising avenue for timely identifying individuals at greater risk of functional decline, potentially facilitating personalised and preventive interventions. Further studies on independent external cohorts are needed to validate our model.</p>","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068148","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 : 2025-01-29DOI: 10.1136/thorax-2024-222873
Daniil Lisik,Ding Zou
{"title":"Mind the sleep: how does obstructive sleep apnoea syndrome relate to risk of dementia?","authors":"Daniil Lisik,Ding Zou","doi":"10.1136/thorax-2024-222873","DOIUrl":"https://doi.org/10.1136/thorax-2024-222873","url":null,"abstract":"","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"74 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143062019","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 : 2025-01-22DOI: 10.1136/thorax-2024-222754
Ugochukwu Ebubechukwu, Patrick Geraghty
Management and treatment of respiratory, mental health conditions, diabetes mellitus (DM), vascular diseases and cancer represent some of the greatest costs in global health.1 These conditions frequently manifest with multiple coexisting diseases. The frequency of the prevalence of multimorbidity in adults aged 50 years and over ranges from 20% to 50%.2 Investigating the effect of the comorbidity is complicated due to the lack of consensus about how primary conditions directly or indirectly impact these comorbidities. When looking at the complexity of the comorbidities, researchers look at the nature of the health condition, the importance of the co-occurring conditions, the chronology of the presentation of the conditions and the total burden of the combined diseases.3 The nature of the first diagnosed pulmonary disease could play a major role in the establishment of comorbidities and their progression. Patients diagnosed with DM are reported to be at a significantly increased risk of developing several pulmonary diseases, including idiopathic pulmonary fibrosis (IPF), asthma, chronic obstructive pulmonary disease and pneumonia.4 This may be due to the impact of DM on blood vessel function (such as endothelial dysfunction, vascular remodelling and reduced pulmonary vascular reactivity) that could impair lung function and increase susceptibility to infections.5 DM and IPF have similar …
{"title":"Genesis of concurrent diseases: do diabetes mellitus and idiopathic pulmonary fibrosis have a direct relationship?","authors":"Ugochukwu Ebubechukwu, Patrick Geraghty","doi":"10.1136/thorax-2024-222754","DOIUrl":"https://doi.org/10.1136/thorax-2024-222754","url":null,"abstract":"Management and treatment of respiratory, mental health conditions, diabetes mellitus (DM), vascular diseases and cancer represent some of the greatest costs in global health.1 These conditions frequently manifest with multiple coexisting diseases. The frequency of the prevalence of multimorbidity in adults aged 50 years and over ranges from 20% to 50%.2 Investigating the effect of the comorbidity is complicated due to the lack of consensus about how primary conditions directly or indirectly impact these comorbidities. When looking at the complexity of the comorbidities, researchers look at the nature of the health condition, the importance of the co-occurring conditions, the chronology of the presentation of the conditions and the total burden of the combined diseases.3 The nature of the first diagnosed pulmonary disease could play a major role in the establishment of comorbidities and their progression. Patients diagnosed with DM are reported to be at a significantly increased risk of developing several pulmonary diseases, including idiopathic pulmonary fibrosis (IPF), asthma, chronic obstructive pulmonary disease and pneumonia.4 This may be due to the impact of DM on blood vessel function (such as endothelial dysfunction, vascular remodelling and reduced pulmonary vascular reactivity) that could impair lung function and increase susceptibility to infections.5 DM and IPF have similar …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"3 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143020360","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 : 2025-01-20DOI: 10.1136/thorax-2024-222502
Sebastian Fernandez-Bussy, Alejandra Yu Lee-Mateus, Alanna Barrios-Ruiz, Sofia Valdes-Camacho, Katherine Lin, Mohamed I Ibrahim, Bryan F Vaca-Cartagena, Rodrigo Funes-Ferrada, Janani Reisenauer, Kelly S Robertson, Britney N Hazelett, Ryan M Chadha, David Abia-Trujillo
Background Sampling of peripheral pulmonary lesions (PPLs) abutting the pleura carries a higher risk of pneumothorax and complications. Although typically performed with image-guided transthoracic biopsy, the advent of shape-sensing robotic-assisted bronchoscopy (ssRAB) provides an alternative diagnostic procedure for this subtype of lesions. Methods A retrospective study on PPL attached to the peripheral pleura (PP), comprising costal and diaphragmatic pleura, mediastinal pleura (MP), and fissural pleura (FP) sampled by ssRAB, from January 2020 to December 2023. Clinicodemographic data, PPL characteristics and procedure-related details were recorded. Primary outcome was diagnostic yield, defined as all conclusive diagnoses, malignant or benign, over the total number of procedures. Secondary outcomes were safety profile, defined as the number of procedure-related complications, and diagnostic yield with the use of mobile cone-beam CT (mCBCT) and by biopsy tool. Results 182 nodules were sampled from 178 patients. PPLs were grouped as: PP (n=95), MP (n=30) and FP (n=57). Overall diagnostic yield was 80.2% (146/182) and sensitivity for malignancy was 83.2% (104/125). Diagnostic yield was associated with upper location (OR 2.86; 95% CI 1.35 to 6.03, p = 0.006), mCBCT (OR 2.27; 95% CI 1.06 to 4.86, p = 0.036) and cryobiopsy (OR 2.90; 95% CI 1.31 to 6.47, p = 0.009). Pneumothorax requiring chest tube was reported in five patients (2.8%), and a Nashville Scale grade 3 bleeding occurred in one patient (0.6%). Conclusion For pleural-based and fissure-based nodules, ssRAB showed a high diagnostic yield with low complications. The addition of mCBCT and cryobiopsy improved the diagnostic performance for this subtype of lesions. Data are available on reasonable request. Data are available on reasonable request. The data that support the findings of this study are available from the corresponding author (SF-B), on reasonable request.
背景：对靠近胸膜的周围性肺病变（ppl）进行取样，有较高的气胸和并发症的风险。虽然通常采用图像引导的经胸活检，但形状传感机器人辅助支气管镜（ssRAB）的出现为这种亚型病变提供了另一种诊断方法。方法回顾性研究2020年1月至2023年12月ssRAB采集的外周胸膜（PP）附着PPL，包括肋膈胸膜、纵隔胸膜（MP）和裂胸膜（FP）。记录临床人口学数据、PPL特征和手术相关细节。主要转归是诊断率，定义为所有结论性诊断，无论恶性还是良性，超过手术总数。次要结果是安全性，定义为手术相关并发症的数量，以及使用移动锥束CT （mCBCT）和活检工具的诊断率。结果178例患者共检出182个结节。ppl分为：PP （n=95）、MP （n=30）和FP （n=57）。总体诊断率为80.2%(146/182)，恶性敏感性为83.2%（104/125）。诊断产率与上部位置相关(OR 2.86；95% CI 1.35 ~ 6.03, p = 0.006), mCBCT (OR 2.27；95% CI 1.06 ~ 4.86, p = 0.036)和冷冻活检(OR 2.90；95% CI 1.31 ~ 6.47, p = 0.009)。5例患者报告需要胸管的气胸（2.8%），1例患者发生纳什维尔量表3级出血（0.6%）。结论ssRAB对胸膜结节和肺裂隙结节的诊断率高，并发症少。mCBCT和冷冻活检的加入提高了对该亚型病变的诊断性能。如有合理要求，可提供资料。如有合理要求，可提供资料。支持本研究结果的数据可根据合理要求从通讯作者（SF-B）处获得。
{"title":"Diagnostic performance of shape-sensing robotic-assisted bronchoscopy for pleural-based and fissure-based pulmonary lesions","authors":"Sebastian Fernandez-Bussy, Alejandra Yu Lee-Mateus, Alanna Barrios-Ruiz, Sofia Valdes-Camacho, Katherine Lin, Mohamed I Ibrahim, Bryan F Vaca-Cartagena, Rodrigo Funes-Ferrada, Janani Reisenauer, Kelly S Robertson, Britney N Hazelett, Ryan M Chadha, David Abia-Trujillo","doi":"10.1136/thorax-2024-222502","DOIUrl":"https://doi.org/10.1136/thorax-2024-222502","url":null,"abstract":"Background Sampling of peripheral pulmonary lesions (PPLs) abutting the pleura carries a higher risk of pneumothorax and complications. Although typically performed with image-guided transthoracic biopsy, the advent of shape-sensing robotic-assisted bronchoscopy (ssRAB) provides an alternative diagnostic procedure for this subtype of lesions. Methods A retrospective study on PPL attached to the peripheral pleura (PP), comprising costal and diaphragmatic pleura, mediastinal pleura (MP), and fissural pleura (FP) sampled by ssRAB, from January 2020 to December 2023. Clinicodemographic data, PPL characteristics and procedure-related details were recorded. Primary outcome was diagnostic yield, defined as all conclusive diagnoses, malignant or benign, over the total number of procedures. Secondary outcomes were safety profile, defined as the number of procedure-related complications, and diagnostic yield with the use of mobile cone-beam CT (mCBCT) and by biopsy tool. Results 182 nodules were sampled from 178 patients. PPLs were grouped as: PP (n=95), MP (n=30) and FP (n=57). Overall diagnostic yield was 80.2% (146/182) and sensitivity for malignancy was 83.2% (104/125). Diagnostic yield was associated with upper location (OR 2.86; 95% CI 1.35 to 6.03, p = 0.006), mCBCT (OR 2.27; 95% CI 1.06 to 4.86, p = 0.036) and cryobiopsy (OR 2.90; 95% CI 1.31 to 6.47, p = 0.009). Pneumothorax requiring chest tube was reported in five patients (2.8%), and a Nashville Scale grade 3 bleeding occurred in one patient (0.6%). Conclusion For pleural-based and fissure-based nodules, ssRAB showed a high diagnostic yield with low complications. The addition of mCBCT and cryobiopsy improved the diagnostic performance for this subtype of lesions. Data are available on reasonable request. Data are available on reasonable request. The data that support the findings of this study are available from the corresponding author (SF-B), on reasonable request.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"44 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991482","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 : 2025-01-19DOI: 10.1136/thorax-2024-222473
Yang Geng, Yi Ding, Xujia Lu, Yalong Pei, Matthew D Jankowich, Chaofu Ke
Background Although morbidity and mortality are reportedly increased in individuals with preserved ratio impaired spirometry (PRISm), little is known about how to optimise PRISm-related health. Aims Is Life’s Essential 8 (LE8) associated with mortality and cardiovascular morbidity in individuals with PRISm and with PRISm transition trajectories? Methods Participants with PRISm (n=31 943) with complete data on LE8 and 23 179 individuals with two spirometry measurements were included from the UK Biobank. Eight health components were used to create the LE8 score (0–100). Cox proportional hazards models were used to assess associations of LE8 with cardiovascular morbidity and all-cause, cardiovascular and respiratory mortality. Multinomial logistic regression models were conducted to assess associations between LE8 and transition trajectories of PRISm. Results Among participants with PRISm, 3113 (9.75%), 25 254 (79.06%) and 3576 (11.19%) were categorised as high (LE8≥80), moderate (50≤LE8<80) and low LE8 (LE8<50) score groups, respectively. Compared with the high LE8 group, the low LE8 group demonstrated higher risks of cardiovascular disease (HR: 2.702, 95% CI 2.391 to 3.054) and all-cause (2.496, 2.082 to 2.993), cardiovascular (4.165, 2.672 to 6.493) and respiratory mortality (4.103, 1.866 to 9.020). Individuals with low LE8 score (vs high LE8) had higher odds to transition from normal spirometry to PRISm (OR: 2.238, 95% CI 1.638 to 3.057) and lower odds to transition from PRISm to normal spirometry (OR: 0.506, 95% CI 0.339 to 0.757). Conclusion A lower LE8 score was associated with increased risks of cardiovascular morbidity and all-cause, cardiovascular and respiratory mortality in PRISm. A lower LE8 score was related to higher likelihood of developing PRISm and lower likelihood of PRISm recovery. Data may be obtained from a third party and are not publicly available. This research has been conducted using the UK Biobank Resource under Application Number 60651. The data that support the findings of this study are available on application to the UK Biobank team at .
{"title":"Life’s Essential 8 and risks of mortality and cardiovascular morbidity in individuals with PRISm and its associations with transition trajectories of PRISm","authors":"Yang Geng, Yi Ding, Xujia Lu, Yalong Pei, Matthew D Jankowich, Chaofu Ke","doi":"10.1136/thorax-2024-222473","DOIUrl":"https://doi.org/10.1136/thorax-2024-222473","url":null,"abstract":"Background Although morbidity and mortality are reportedly increased in individuals with preserved ratio impaired spirometry (PRISm), little is known about how to optimise PRISm-related health. Aims Is Life’s Essential 8 (LE8) associated with mortality and cardiovascular morbidity in individuals with PRISm and with PRISm transition trajectories? Methods Participants with PRISm (n=31 943) with complete data on LE8 and 23 179 individuals with two spirometry measurements were included from the UK Biobank. Eight health components were used to create the LE8 score (0–100). Cox proportional hazards models were used to assess associations of LE8 with cardiovascular morbidity and all-cause, cardiovascular and respiratory mortality. Multinomial logistic regression models were conducted to assess associations between LE8 and transition trajectories of PRISm. Results Among participants with PRISm, 3113 (9.75%), 25 254 (79.06%) and 3576 (11.19%) were categorised as high (LE8≥80), moderate (50≤LE8<80) and low LE8 (LE8<50) score groups, respectively. Compared with the high LE8 group, the low LE8 group demonstrated higher risks of cardiovascular disease (HR: 2.702, 95% CI 2.391 to 3.054) and all-cause (2.496, 2.082 to 2.993), cardiovascular (4.165, 2.672 to 6.493) and respiratory mortality (4.103, 1.866 to 9.020). Individuals with low LE8 score (vs high LE8) had higher odds to transition from normal spirometry to PRISm (OR: 2.238, 95% CI 1.638 to 3.057) and lower odds to transition from PRISm to normal spirometry (OR: 0.506, 95% CI 0.339 to 0.757). Conclusion A lower LE8 score was associated with increased risks of cardiovascular morbidity and all-cause, cardiovascular and respiratory mortality in PRISm. A lower LE8 score was related to higher likelihood of developing PRISm and lower likelihood of PRISm recovery. Data may be obtained from a third party and are not publicly available. This research has been conducted using the UK Biobank Resource under Application Number 60651. The data that support the findings of this study are available on application to the UK Biobank team at <http://www.ukbiobank.ac.uk/>.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"74 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991489","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 : 2025-01-19DOI: 10.1136/thorax-2024-222462
Pierre Tankéré, Jacques Tailliard, Thierry PetitJean, Pierre Le-Cam, François Ricordeau, Margaux Blanchard, Jade Vanbuis, Anice Nofal, Renaud Tamisier, Laure Peter-Derex, Emeric Stauffer
The pathophysiology of residual sleepiness in treated obstructive sleep apnoea (OSA) remains poorly understood. Animal models suggest that it may involve neuronal damage due to intermittent hypoxia and sleep fragmentation. In a cohort of 122 continuous positive airway pressure (CPAP) treated OSA patients referred for maintenance of wakefulness test, we explored the determinants of (objective) alertness and those of (subjective) sleepiness assessed by Epworth Sleepiness Scale. We found that in logistic models, residual hypoxic burden was significatively associated with objective impaired alertness (OR=1.005, 95% CI 1.002 to 1.008), p=0.003), whereas arousal index >25/h was significatively associated with subjective residual sleepiness (OR=1.23, 95% CI 1.05to 1.43, p=0.02). This suggests that hypoxia and sleep fragmentation may be involved in different dimensions of residual hypersomnolence in treated OSA.
阻塞性睡眠呼吸暂停（OSA）治疗后残留嗜睡的病理生理机制尚不清楚。动物模型表明，这可能涉及到间歇性缺氧和睡眠断裂造成的神经元损伤。在122例接受持续气道正压通气（CPAP）治疗的OSA患者中，我们通过Epworth嗜睡量表（Epworth sleepiness Scale）评估了（客观）警觉性和（主观）嗜睡的决定因素。我们发现，在logistic模型中，残余缺氧负担与客观警觉性受损显著相关（OR=1.005, 95% CI 1.002至1.008），p=0.003)，而唤醒指数bbb25 /h与主观残余嗜睡显著相关（OR=1.23, 95% CI 1.05至1.43,p=0.02）。这表明缺氧和睡眠片段化可能在OSA治疗后不同程度的残余嗜睡中起作用。
{"title":"Residual sleepiness and impaired alertness in treated obstructive sleep apnoea: role of hypoxic burden and sleep fragmentation","authors":"Pierre Tankéré, Jacques Tailliard, Thierry PetitJean, Pierre Le-Cam, François Ricordeau, Margaux Blanchard, Jade Vanbuis, Anice Nofal, Renaud Tamisier, Laure Peter-Derex, Emeric Stauffer","doi":"10.1136/thorax-2024-222462","DOIUrl":"https://doi.org/10.1136/thorax-2024-222462","url":null,"abstract":"The pathophysiology of residual sleepiness in treated obstructive sleep apnoea (OSA) remains poorly understood. Animal models suggest that it may involve neuronal damage due to intermittent hypoxia and sleep fragmentation. In a cohort of 122 continuous positive airway pressure (CPAP) treated OSA patients referred for maintenance of wakefulness test, we explored the determinants of (objective) alertness and those of (subjective) sleepiness assessed by Epworth Sleepiness Scale. We found that in logistic models, residual hypoxic burden was significatively associated with objective impaired alertness (OR=1.005, 95% CI 1.002 to 1.008), p=0.003), whereas arousal index >25/h was significatively associated with subjective residual sleepiness (OR=1.23, 95% CI 1.05to 1.43, p=0.02). This suggests that hypoxia and sleep fragmentation may be involved in different dimensions of residual hypersomnolence in treated OSA.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"32 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991490","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 : 2025-01-17DOI: 10.1136/thorax-2024-221953
Daniella Draicchio, Alexander Fox, Louise Haine, Robert Berg, Judith Hampson
{"title":"Two thoracic surgeries and no diagnosis: is it lung cancer?","authors":"Daniella Draicchio, Alexander Fox, Louise Haine, Robert Berg, Judith Hampson","doi":"10.1136/thorax-2024-221953","DOIUrl":"10.1136/thorax-2024-221953","url":null,"abstract":"","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":"117-118"},"PeriodicalIF":9.0,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792587","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 : 2025-01-06DOI: 10.1136/thorax-2024-222099
George Doumat, Joumane El Zein, Geneva D Mehta, Zhaozhong Zhu, Janice A Espinola, Ashley F Sullivan, Kohei Hasegawa, Carlos A Camargo
The association between early childhood serum 25-hydroxyvitamin D (25(OH)D) and eosinophilic asthma remains unclear. We investigated this association using multicentre prospective data from 584 children with a history of bronchiolitis requiring hospitalisation (high-risk population). Low serum 25(OH)D levels (<20 ng/mL) were associated with increased odds of developing eosinophilic asthma (adjusted OR 2.33; 95% CI 1.23, 4.40; p=0.01) as compared with children with serum 25(OH)D of 20–39.9 ng/mL. Our data facilitate further investigation into the potential role of early-life vitamin D supplementation among children with a history of severe bronchiolitis and eosinophilia for preventing childhood asthma.
幼儿血清25-羟基维生素D （25(OH)D）与嗜酸性哮喘之间的关系尚不清楚。我们使用584例需要住院治疗的毛细支气管炎患儿（高危人群）的多中心前瞻性数据调查了这种关联。低血清25(OH)D水平（<20 ng/mL）与发生嗜酸性粒细胞哮喘的几率增加相关(调整OR为2.33；95% ci 1.23, 4.40；p=0.01)，与血清25(OH)D为20 ~ 39.9 ng/mL的儿童比较。我们的数据有助于进一步研究有严重细支气管炎和嗜酸性粒细胞增多病史的儿童在早期补充维生素D预防儿童哮喘的潜在作用。
{"title":"Association between vitamin D status at 3 years and eosinophilic asthma in 6-year-old children with a history of severe bronchiolitis","authors":"George Doumat, Joumane El Zein, Geneva D Mehta, Zhaozhong Zhu, Janice A Espinola, Ashley F Sullivan, Kohei Hasegawa, Carlos A Camargo","doi":"10.1136/thorax-2024-222099","DOIUrl":"https://doi.org/10.1136/thorax-2024-222099","url":null,"abstract":"The association between early childhood serum 25-hydroxyvitamin D (25(OH)D) and eosinophilic asthma remains unclear. We investigated this association using multicentre prospective data from 584 children with a history of bronchiolitis requiring hospitalisation (high-risk population). Low serum 25(OH)D levels (<20 ng/mL) were associated with increased odds of developing eosinophilic asthma (adjusted OR 2.33; 95% CI 1.23, 4.40; p=0.01) as compared with children with serum 25(OH)D of 20–39.9 ng/mL. Our data facilitate further investigation into the potential role of early-life vitamin D supplementation among children with a history of severe bronchiolitis and eosinophilia for preventing childhood asthma.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"2 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142935145","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 : 2025-01-02DOI: 10.1136/thorax-2024-222087
Celia Cabrero Rodríguez, Ana Belén Gámiz Molina, Francisco Rodríguez Jerez
We present the case of a 56-year-old woman, which presented to the emergency department with a 2-week history marked by progressive dyspnoea, a productive cough, self-reported wheezing and she had no fever (36.7 °C). The patient had a prior medical history of severe persistent asthma, managed with Mepolizumab, bronchiectasis predominantly in the upper lobes, allergic bronchopulmonary aspergillosis (ABPA) treated in 2016, acquired IgG1 and IgG2 deficiency under regular treatment with intravenous immunoglobulins and a chronic bronchial infection due to pseudomonas aeruginosa. Cystic fibrosis was ruled out in 2015. A sweat test result was 30 mEq/L (normal values up to 40 mEq/L), and a genetic study, which included 54 possible mutations associated with this disease, was also negative. The patient was initially admitted …
{"title":"Unexpected radiological presentation in allergic bronchopulmonary aspergillosis: multiple lung masses","authors":"Celia Cabrero Rodríguez, Ana Belén Gámiz Molina, Francisco Rodríguez Jerez","doi":"10.1136/thorax-2024-222087","DOIUrl":"https://doi.org/10.1136/thorax-2024-222087","url":null,"abstract":"We present the case of a 56-year-old woman, which presented to the emergency department with a 2-week history marked by progressive dyspnoea, a productive cough, self-reported wheezing and she had no fever (36.7 °C). The patient had a prior medical history of severe persistent asthma, managed with Mepolizumab, bronchiectasis predominantly in the upper lobes, allergic bronchopulmonary aspergillosis (ABPA) treated in 2016, acquired IgG1 and IgG2 deficiency under regular treatment with intravenous immunoglobulins and a chronic bronchial infection due to pseudomonas aeruginosa. Cystic fibrosis was ruled out in 2015. A sweat test result was 30 mEq/L (normal values up to 40 mEq/L), and a genetic study, which included 54 possible mutations associated with this disease, was also negative. The patient was initially admitted …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"25 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142917107","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 : 2025-01-02DOI: 10.1136/thorax-2024-221899
Tim Raveling, Renzo Boersma, Peter J Wijkstra, Marieke L Duiverman
Purpose In patients with chronic obstructive pulmonary disease (COPD) treated with chronic non-invasive ventilation (NIV), the relation between improvements in nocturnal transcutaneous partial pressure of CO2 (PtcCO2) and daytime arterial partial pressure of CO2 (PaCO2) remains uncertain. Also, to what extent improvements in nocturnal PtcCO2 result in better health-related quality of life (HRQL), exercise capacity, lung function and survival has not been investigated. Patients and methods Patients with COPD who were initiated on chronic NIV were prospectively followed for 6 months. Daytime PaCO2 and nocturnal PtcCO2 were measured before NIV initiation. NIV targeted normocapnia (PaCO2/mean PtcCO2<6.0 kPa) or to reduce baseline values >20%. HRQL was measured with the Severe Respiratory Insufficiency questionnaire (SRI) and exercise capacity with the 6-min walk test (6MWT). Patients were divided into three groups: group 1: neither PtcCO2 nor PaCO2 reductions reached the target; group 2: both PtcCO2 and PaCO2 targets were reached; group 3: only PtcCO2 target was reached. Results 177 participants were included with both transcutaneous and daytime gas exchange data. In total, 66% reached nocturnal gas exchange targets. However, in only 17%, this also resulted in substantial daytime PaCO2 reduction (group 2). Compared with group 1, these patients had higher baseline PtcCO2 (7.4±0.7 vs 8.2±1.9 kPa, p=0.012) and better NIV usage (6.2±2.8 vs 8.3±2.4 hours, p=0.010). Despite comparable NIV settings, the forced expiratory volume in 1 s and 6MWT improved only in group 2, and only these participants reached a clinically relevant improvement on the SRI and experienced improved survival. Conclusion Patients with COPD who can maintain improved ventilation by nocturnal NIV during daytime spontaneous breathing are most likely to experience relevant benefits on HRQL, exercise capacity, lung function and survival. No data are available. The data used for this analysis were obtained from two clinical trials ([NCT02652559][1] and [NCT03053973][2]). Request for data sharing should be directed to the principal investigators of those trials. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT02652559&atom=%2Fthoraxjnl%2Fearly%2F2025%2F01%2F01%2Fthorax-2024-221899.atom [2]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT03053973&atom=%2Fthoraxjnl%2Fearly%2F2025%2F01%2F01%2Fthorax-2024-221899.atom
{"title":"Clinical benefit of chronic non-invasive ventilation in severe stable COPD: a matter of persistent hypercapnia improvement","authors":"Tim Raveling, Renzo Boersma, Peter J Wijkstra, Marieke L Duiverman","doi":"10.1136/thorax-2024-221899","DOIUrl":"https://doi.org/10.1136/thorax-2024-221899","url":null,"abstract":"Purpose In patients with chronic obstructive pulmonary disease (COPD) treated with chronic non-invasive ventilation (NIV), the relation between improvements in nocturnal transcutaneous partial pressure of CO2 (PtcCO2) and daytime arterial partial pressure of CO2 (PaCO2) remains uncertain. Also, to what extent improvements in nocturnal PtcCO2 result in better health-related quality of life (HRQL), exercise capacity, lung function and survival has not been investigated. Patients and methods Patients with COPD who were initiated on chronic NIV were prospectively followed for 6 months. Daytime PaCO2 and nocturnal PtcCO2 were measured before NIV initiation. NIV targeted normocapnia (PaCO2/mean PtcCO2<6.0 kPa) or to reduce baseline values >20%. HRQL was measured with the Severe Respiratory Insufficiency questionnaire (SRI) and exercise capacity with the 6-min walk test (6MWT). Patients were divided into three groups: group 1: neither PtcCO2 nor PaCO2 reductions reached the target; group 2: both PtcCO2 and PaCO2 targets were reached; group 3: only PtcCO2 target was reached. Results 177 participants were included with both transcutaneous and daytime gas exchange data. In total, 66% reached nocturnal gas exchange targets. However, in only 17%, this also resulted in substantial daytime PaCO2 reduction (group 2). Compared with group 1, these patients had higher baseline PtcCO2 (7.4±0.7 vs 8.2±1.9 kPa, p=0.012) and better NIV usage (6.2±2.8 vs 8.3±2.4 hours, p=0.010). Despite comparable NIV settings, the forced expiratory volume in 1 s and 6MWT improved only in group 2, and only these participants reached a clinically relevant improvement on the SRI and experienced improved survival. Conclusion Patients with COPD who can maintain improved ventilation by nocturnal NIV during daytime spontaneous breathing are most likely to experience relevant benefits on HRQL, exercise capacity, lung function and survival. No data are available. The data used for this analysis were obtained from two clinical trials ([NCT02652559][1] and [NCT03053973][2]). Request for data sharing should be directed to the principal investigators of those trials. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT02652559&atom=%2Fthoraxjnl%2Fearly%2F2025%2F01%2F01%2Fthorax-2024-221899.atom [2]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT03053973&atom=%2Fthoraxjnl%2Fearly%2F2025%2F01%2F01%2Fthorax-2024-221899.atom","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"17 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142917108","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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