Pub Date : 2026-01-02DOI: 10.1136/thorax-2024-222169
Joanne McKenzie, Charlotte Carter, Millie May Jackson, Aran Singanayagam, Anand Shah
Background: Exacerbations are major causes of morbidity in individuals with chronic respiratory diseases such as chronic obstructive pulmonary disease, asthma and bronchiectasis. Increasing evidence implicates respiratory viruses as predominant triggers, though the underlying immunopathogenic mechanisms remain poorly understood.
Narrative: This review synthesises current knowledge on the interplay between viral pathogens at the airway epithelial barrier, including structural and immunological mechanisms that may dysregulate antiviral immunity in chronic respiratory diseases. Furthermore, we discuss how perturbations in the respiratory microbiome, characterised by reduced microbial diversity, can modulate host antiviral immune defences.
Conclusions: Collectively, these interconnected factors create a permissive environment predisposing to viral infection and exacerbations in chronic respiratory diseases. Understanding the complex interactions between airway structure, interferon-mediated antiviral responses, inflammation and microbiota is essential for developing targeted therapies to effectively manage virus-induced exacerbations and reduce disease burden.
{"title":"Mechanisms driving immunopathogenesis of viral exacerbations in chronic respiratory disease.","authors":"Joanne McKenzie, Charlotte Carter, Millie May Jackson, Aran Singanayagam, Anand Shah","doi":"10.1136/thorax-2024-222169","DOIUrl":"https://doi.org/10.1136/thorax-2024-222169","url":null,"abstract":"<p><strong>Background: </strong>Exacerbations are major causes of morbidity in individuals with chronic respiratory diseases such as chronic obstructive pulmonary disease, asthma and bronchiectasis. Increasing evidence implicates respiratory viruses as predominant triggers, though the underlying immunopathogenic mechanisms remain poorly understood.</p><p><strong>Narrative: </strong>This review synthesises current knowledge on the interplay between viral pathogens at the airway epithelial barrier, including structural and immunological mechanisms that may dysregulate antiviral immunity in chronic respiratory diseases. Furthermore, we discuss how perturbations in the respiratory microbiome, characterised by reduced microbial diversity, can modulate host antiviral immune defences.</p><p><strong>Conclusions: </strong>Collectively, these interconnected factors create a permissive environment predisposing to viral infection and exacerbations in chronic respiratory diseases. Understanding the complex interactions between airway structure, interferon-mediated antiviral responses, inflammation and microbiota is essential for developing targeted therapies to effectively manage virus-induced exacerbations and reduce disease burden.</p>","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145893343","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 : 2025-12-31DOI: 10.1136/thorax-2025-224250
Denise Battaglini, Marcus J Schultz
{"title":"Global ARDS subphenotyping: separating apples from oranges.","authors":"Denise Battaglini, Marcus J Schultz","doi":"10.1136/thorax-2025-224250","DOIUrl":"https://doi.org/10.1136/thorax-2025-224250","url":null,"abstract":"","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145879055","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 : 2025-12-31DOI: 10.1136/thorax-2025-223770
Mohsen Sadatsafavi, Marc Miravitlles, Jennifer K Quint, Valeria Perugini, Hamid Tavakoli, Joseph Emil Amegadzie, Bernardino Alcazar Navarrete
Objectives: In patients with chronic obstructive pulmonary disease (COPD), severe exacerbations (ECOPDs) impose significant morbidity and mortality. Current guidelines emphasise using ECOPD history to inform preventive treatments but offer limited guidance for risk stratification for the first severe ECOPD.
Methods: We developed and validated PRECISE-X using a cohort of newly diagnosed COPD patients from the UK's Clinical Practice Research Datalink (2004-2022), to predict first severe ECOPD over 5 years (primary outcome) and 12 months (secondary outcome). Predictors were selected via clinical expertise and data-driven methods. Internal-external cross-validation was performed across practice regions to evaluate the model's out-of-sample performance in terms of discrimination (c-statistic), calibration and net benefit.
Results: The study included 2 19 015 patients (mean age 66.0; 42.4% female). Observed risk of first severe ECOPD was 29.5% at 5 years (4.2% at 1 year). The final model included four mandatory predictors (sex, age, Medical Research Council dyspnoea score and forced expiratory volume in 1 second) and 28 optional predictors. In internal-external cross-validation, the average out-of-sample c-statistic was 0.836 (95% CI 0.827 to 0.846) for 5-year prediction and 0.756 (95% CI 0.746 to 0.766) for 1-year prediction. Calibration across regions was robust, and the model showed positive NB across a wide range of risk thresholds. In a secondary validation assessment among those with available spirometry data with confirmed airflow obstruction, the model was well calibrated and had only a modest decline in discriminatory performance.
Conclusions: PRECISE-X accurately predicts the first severe COPD exacerbation using routine clinical data, supporting earlier risk stratification and proactive disease management.
目的：在慢性阻塞性肺疾病（COPD）患者中，严重恶化（ECOPDs）会导致显著的发病率和死亡率。目前的指南强调使用ECOPD病史来告知预防性治疗，但对首次严重ECOPD的风险分层提供的指导有限。方法：我们使用来自英国临床实践研究数据链（2004-2022）的新诊断COPD患者队列开发并验证了precision - x，以预测5年（主要结局）和12个月（次要结局）的首次严重ECOPD。通过临床专业知识和数据驱动方法选择预测因子。跨实践区域进行内部-外部交叉验证，以评估模型在鉴别（c-statistic），校准和净效益方面的样本外性能。结果：纳入患者2 19015例，平均年龄66.0岁，女性占42.4%。首次发生严重ECOPD的观察风险在5年时为29.5%（1年时为4.2%）。最终模型包括4个强制性预测因子（性别、年龄、医学研究委员会呼吸困难评分和1秒用力呼气量）和28个可选预测因子。在内外交叉验证中，5年预测的平均样本外c统计量为0.836 (95% CI 0.827 ~ 0.846)， 1年预测的平均样本外c统计量为0.756 （95% CI 0.746 ~ 0.766）。跨区域的校准是稳健的，并且模型在广泛的风险阈值范围内显示为正NB。在二次验证评估中，在有可用的肺活量测量数据并确认有气流阻塞的患者中，该模型得到了很好的校准，并且在区分性能上只有适度的下降。结论：precision - x使用常规临床数据准确预测首次严重COPD恶化，支持早期风险分层和主动疾病管理。
{"title":"Development and validation of PRECISE-X model: predicting first severe exacerbation in COPD.","authors":"Mohsen Sadatsafavi, Marc Miravitlles, Jennifer K Quint, Valeria Perugini, Hamid Tavakoli, Joseph Emil Amegadzie, Bernardino Alcazar Navarrete","doi":"10.1136/thorax-2025-223770","DOIUrl":"https://doi.org/10.1136/thorax-2025-223770","url":null,"abstract":"<p><strong>Objectives: </strong>In patients with chronic obstructive pulmonary disease (COPD), severe exacerbations (ECOPDs) impose significant morbidity and mortality. Current guidelines emphasise using ECOPD history to inform preventive treatments but offer limited guidance for risk stratification for the first severe ECOPD.</p><p><strong>Methods: </strong>We developed and validated PRECISE-X using a cohort of newly diagnosed COPD patients from the UK's Clinical Practice Research Datalink (2004-2022), to predict first severe ECOPD over 5 years (primary outcome) and 12 months (secondary outcome). Predictors were selected via clinical expertise and data-driven methods. Internal-external cross-validation was performed across practice regions to evaluate the model's out-of-sample performance in terms of discrimination (c-statistic), calibration and net benefit.</p><p><strong>Results: </strong>The study included 2 19 015 patients (mean age 66.0; 42.4% female). Observed risk of first severe ECOPD was 29.5% at 5 years (4.2% at 1 year). The final model included four mandatory predictors (sex, age, Medical Research Council dyspnoea score and forced expiratory volume in 1 second) and 28 optional predictors. In internal-external cross-validation, the average out-of-sample c-statistic was 0.836 (95% CI 0.827 to 0.846) for 5-year prediction and 0.756 (95% CI 0.746 to 0.766) for 1-year prediction. Calibration across regions was robust, and the model showed positive NB across a wide range of risk thresholds. In a secondary validation assessment among those with available spirometry data with confirmed airflow obstruction, the model was well calibrated and had only a modest decline in discriminatory performance.</p><p><strong>Conclusions: </strong>PRECISE-X accurately predicts the first severe COPD exacerbation using routine clinical data, supporting earlier risk stratification and proactive disease management.</p>","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145879093","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 : 2025-12-25DOI: 10.1136/thorax-2025-224068
Lynn Decoster,Helena Van Damme,Anke Van Herck
{"title":"Lost and found: expectoration of a retained gallstone years after cholecystectomy.","authors":"Lynn Decoster,Helena Van Damme,Anke Van Herck","doi":"10.1136/thorax-2025-224068","DOIUrl":"https://doi.org/10.1136/thorax-2025-224068","url":null,"abstract":"","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"4 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145830324","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 : 2025-12-24DOI: 10.1136/thorax-2024-222790
Lex William Doyle,Anjali Haikerwal,Rheanna M Mainzer,Sarath Ranganathan,Jeanie Cheong
Expiratory airflow was measured by spirometry at ages 8 years, 18 years and 25 years in 297 survivors born extremely preterm (EP; <28 weeks' gestation) or extremely low birth weight (ELBW; <1000 g) and 260 normal birth weight (>2499 g) controls. At 8 years, expiratory airflows were similar between males and females in both EP/ELBW and control groups. Worsening expiratory airflows with increasing age were noted in the EP/ELBW group but not controls. Specifically, males born EP/ELBW had z-scores for forced expired volume in 1 s which were lower by a mean of -0.17 SD per decade (95% CI -0.27 to -0.07), p=0.001.
在297例极早产儿（EP; 2499 g）的对照组中，通过肺活量测定法测量了8岁、18岁和25岁时的呼气气流。8岁时，EP/ELBW组和对照组男性和女性的呼气气流相似。EP/ELBW组呼气气流随年龄增长而恶化，而对照组没有。具体来说，EP/ELBW出生的男性在1 s内的强迫过期体积的z-评分平均每十年低-0.17 SD (95% CI -0.27至-0.07),p=0.001。
{"title":"Sex differences in expiratory airflow among survivors born before 28 weeks' gestation or under 1000 g birthweight, and normal birthweight controls.","authors":"Lex William Doyle,Anjali Haikerwal,Rheanna M Mainzer,Sarath Ranganathan,Jeanie Cheong","doi":"10.1136/thorax-2024-222790","DOIUrl":"https://doi.org/10.1136/thorax-2024-222790","url":null,"abstract":"Expiratory airflow was measured by spirometry at ages 8 years, 18 years and 25 years in 297 survivors born extremely preterm (EP; <28 weeks' gestation) or extremely low birth weight (ELBW; <1000 g) and 260 normal birth weight (>2499 g) controls. At 8 years, expiratory airflows were similar between males and females in both EP/ELBW and control groups. Worsening expiratory airflows with increasing age were noted in the EP/ELBW group but not controls. Specifically, males born EP/ELBW had z-scores for forced expired volume in 1 s which were lower by a mean of -0.17 SD per decade (95% CI -0.27 to -0.07), p=0.001.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"18 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145823989","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 : 2025-12-15DOI: 10.1136/thorax-2025-223282
Alexander G Mathioudakis,Sebastian Bate,Victoria Chatzimavridou-Grigoriadou,Pradeesh Sivapalan,Jens-Ulrik Stæhr Jensen,Nawar Diar Bakerly,Jørgen Vestbo,Dave Singh
BACKGROUNDIn real-world chronic obstructive pulmonary disease (COPD) care, poor adherence often leads to treatment discontinuations. Discontinuing inhaled corticosteroids (ICS) can trigger withdrawal effects transiently increasing exacerbation risk; but evidence for long-acting muscarinic antagonists (LAMA) withdrawal remains limited.METHODSWe performed a post hoc analysis of the 52-week, double-blind, Effect of Indacaterol Glycopyrronium versus Fluticasone Salmeterol on COPD Exacerbations trial that compared long-acting beta-2 agonist (LABA)+LAMA with LABA+ICS in 3362 patients with moderate-to-severe COPD and exacerbation history. Potential withdrawal effects after discontinuing LAMA or ICS were suggested by monthly exacerbation incidence plots during the first quarter of follow-up. Participants were stratified by their baseline use of these therapies, and outcomes were compared between the first and subsequent quarters among those who continued versus discontinued each treatment. Multivariable mixed-effects models assessed differences in exacerbation rates, with temporal variation in treatment effects interpreted as indicative of withdrawal effects.RESULTSDiscontinuing LAMA was associated with a marked, transient increase in moderate-to-severe exacerbations during the first versus subsequent quarters (p=0.001; rate ratio up to 2.2 (95% CI 1.2 to 4.1) in the subgroup least influenced by concomitant ICS use). This observation was not confirmed for severe exacerbations, likely due to low event count. In contrast, discontinuing ICS was associated with a significant early rise in severe exacerbations (p=0.023), though the difference for moderate-to-severe events did not reach statistical significance. Importantly, ICS withdrawal effects appeared consistent regardless of baseline blood eosinophil count.CONCLUSIONOur findings suggest potent LAMA and ICS treatment withdrawal effects on exacerbations, highlighting the importance of treatment adherence and accounting for withdrawal effects in clinical trials.TRIAL REGISTRATION NUMBERNCT01782326.
背景：在现实世界的慢性阻塞性肺疾病（COPD）治疗中，依从性差经常导致治疗中断。停止吸入皮质类固醇（ICS）可触发短暂的戒断反应，增加病情恶化的风险；但长效毒蕈碱拮抗剂（LAMA）停药的证据仍然有限。方法：我们对一项为期52周的双盲试验进行了事后分析，该试验比较了3362例中重度COPD患者的长效β -2激动剂(LABA)+LAMA和LABA+ICS对慢性阻塞性肺病加重的影响。在第一季度的随访中，每月加重发生率图显示了停用LAMA或ICS后的潜在戒断效应。参与者根据他们对这些治疗的基线使用情况进行分层，并在第一季度和随后的季度中比较继续和停止每种治疗的患者的结果。多变量混合效应模型评估了加重率的差异，治疗效果的时间变化被解释为停药效应的指示。结果：在第一个季度和随后的几个季度中，停用LAMA与中度至重度急性发作的显着短暂增加相关(p=0.001；在受伴随使用ICS影响最小的亚组中，发生率比高达2.2 （95% CI 1.2至4.1）。这一观察结果未被证实为严重恶化，可能是由于低事件计数。相比之下，停止ICS与严重急性发作的早期显著上升相关（p=0.023），尽管中重度事件的差异没有达到统计学意义。重要的是，无论基线血嗜酸性粒细胞计数如何，ICS戒断效应都是一致的。结论：我们的研究结果表明，LAMA和ICS治疗对急性发作的停药效果显著，强调了治疗依从性的重要性，并在临床试验中考虑了停药效应。试验注册号：01782326。
{"title":"Disproportionate increase in COPD exacerbation risk for 3 months after discontinuing LAMA or ICS: insights from the FLAME trial.","authors":"Alexander G Mathioudakis,Sebastian Bate,Victoria Chatzimavridou-Grigoriadou,Pradeesh Sivapalan,Jens-Ulrik Stæhr Jensen,Nawar Diar Bakerly,Jørgen Vestbo,Dave Singh","doi":"10.1136/thorax-2025-223282","DOIUrl":"https://doi.org/10.1136/thorax-2025-223282","url":null,"abstract":"BACKGROUNDIn real-world chronic obstructive pulmonary disease (COPD) care, poor adherence often leads to treatment discontinuations. Discontinuing inhaled corticosteroids (ICS) can trigger withdrawal effects transiently increasing exacerbation risk; but evidence for long-acting muscarinic antagonists (LAMA) withdrawal remains limited.METHODSWe performed a post hoc analysis of the 52-week, double-blind, Effect of Indacaterol Glycopyrronium versus Fluticasone Salmeterol on COPD Exacerbations trial that compared long-acting beta-2 agonist (LABA)+LAMA with LABA+ICS in 3362 patients with moderate-to-severe COPD and exacerbation history. Potential withdrawal effects after discontinuing LAMA or ICS were suggested by monthly exacerbation incidence plots during the first quarter of follow-up. Participants were stratified by their baseline use of these therapies, and outcomes were compared between the first and subsequent quarters among those who continued versus discontinued each treatment. Multivariable mixed-effects models assessed differences in exacerbation rates, with temporal variation in treatment effects interpreted as indicative of withdrawal effects.RESULTSDiscontinuing LAMA was associated with a marked, transient increase in moderate-to-severe exacerbations during the first versus subsequent quarters (p=0.001; rate ratio up to 2.2 (95% CI 1.2 to 4.1) in the subgroup least influenced by concomitant ICS use). This observation was not confirmed for severe exacerbations, likely due to low event count. In contrast, discontinuing ICS was associated with a significant early rise in severe exacerbations (p=0.023), though the difference for moderate-to-severe events did not reach statistical significance. Importantly, ICS withdrawal effects appeared consistent regardless of baseline blood eosinophil count.CONCLUSIONOur findings suggest potent LAMA and ICS treatment withdrawal effects on exacerbations, highlighting the importance of treatment adherence and accounting for withdrawal effects in clinical trials.TRIAL REGISTRATION NUMBERNCT01782326.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"93 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145765034","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 : 2025-12-14DOI: 10.1136/thorax-2025-223631
Ley Taing Chan,Kelvin Kar Wing Lau,Christopher Michael Orton,Kire Temov,Anand Tana,Ilecia Baboolal,Ashish Karir,Elif Agaoglu,Justin Garner,Aisha Kalyal,Maria Lapuente,Foteini Ttofia,Pallav L Shah
INTRODUCTIONOur aim was to evaluate the diagnostic and safety performance of shape-sensing robotic-assisted bronchoscopy (ssRAB) with cone beam CT (CBCT) for the biopsy of pulmonary nodules. Additional analysis was performed to assess outcomes for small nodules and those close to the fissure, pleura or mediastinum.METHODSThis single arm, multicentre prospective study enrolled 200 subjects with suspicious pulmonary nodules. Each subject underwent a ssRAB procedure with CBCT and was subsequently followed up. The primary outcome was tool-in-lesion (TIL) confirmed with CBCT. Further endpoints included diagnostic outcomes and rate of adverse events.RESULTSOf 200 subjects recruited, 198 subjects had a successful biopsy (whereby lesion was reached and sample was taken) and 97% completed the required follow-up. The median size of the nodules was 13 mm; 26.8% (60/224) have a positive bronchus sign and 181 (80.8%) were located in the outer two-thirds of the lung. TIL was obtained in 99.0% (198/200). The strict diagnostic yield was 85% (170/200) with diagnostic accuracy of 92.0% (184/200) and sensitivity for malignancy of 95.5% (147/154). Diagnostic accuracy for nodules under 20 mm size, within 5 mm from a critical structure (eg, heart, aorta or main pulmonary artery) or from the pleura was 88.2% (172/195), 100% (11/11) and 93.3% (56/60), respectively. There were four (2%) serious procedure-related adverse events, with one patient (0.5%) suffering a pneumothorax.CONCLUSIONssRAB with CBCT can effectively reach and biopsy small pulmonary nodules, including perifissural, peripleural and paramediastinal lesions with a strong safety profile.TRIAL REGISTRATION NUMBERNCT05867953.
{"title":"Tool in lesion verification of shape-sensing robotic-assisted bronchoscopy with cone beam CT in sampling peripheral pulmonary nodules.","authors":"Ley Taing Chan,Kelvin Kar Wing Lau,Christopher Michael Orton,Kire Temov,Anand Tana,Ilecia Baboolal,Ashish Karir,Elif Agaoglu,Justin Garner,Aisha Kalyal,Maria Lapuente,Foteini Ttofia,Pallav L Shah","doi":"10.1136/thorax-2025-223631","DOIUrl":"https://doi.org/10.1136/thorax-2025-223631","url":null,"abstract":"INTRODUCTIONOur aim was to evaluate the diagnostic and safety performance of shape-sensing robotic-assisted bronchoscopy (ssRAB) with cone beam CT (CBCT) for the biopsy of pulmonary nodules. Additional analysis was performed to assess outcomes for small nodules and those close to the fissure, pleura or mediastinum.METHODSThis single arm, multicentre prospective study enrolled 200 subjects with suspicious pulmonary nodules. Each subject underwent a ssRAB procedure with CBCT and was subsequently followed up. The primary outcome was tool-in-lesion (TIL) confirmed with CBCT. Further endpoints included diagnostic outcomes and rate of adverse events.RESULTSOf 200 subjects recruited, 198 subjects had a successful biopsy (whereby lesion was reached and sample was taken) and 97% completed the required follow-up. The median size of the nodules was 13 mm; 26.8% (60/224) have a positive bronchus sign and 181 (80.8%) were located in the outer two-thirds of the lung. TIL was obtained in 99.0% (198/200). The strict diagnostic yield was 85% (170/200) with diagnostic accuracy of 92.0% (184/200) and sensitivity for malignancy of 95.5% (147/154). Diagnostic accuracy for nodules under 20 mm size, within 5 mm from a critical structure (eg, heart, aorta or main pulmonary artery) or from the pleura was 88.2% (172/195), 100% (11/11) and 93.3% (56/60), respectively. There were four (2%) serious procedure-related adverse events, with one patient (0.5%) suffering a pneumothorax.CONCLUSIONssRAB with CBCT can effectively reach and biopsy small pulmonary nodules, including perifissural, peripleural and paramediastinal lesions with a strong safety profile.TRIAL REGISTRATION NUMBERNCT05867953.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"145 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145752666","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}
{"title":"British Thoracic Society trainee survey 2024: what are the trainees saying and how will this impact the future workforce?","authors":"Abigail MacKintosh,Anthony Martinelli,Arun Brahmanya,Nicola Read,Aaron Braddy-Green","doi":"10.1136/thorax-2025-223235","DOIUrl":"https://doi.org/10.1136/thorax-2025-223235","url":null,"abstract":"","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"16 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145752667","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 : 2025-12-14DOI: 10.1136/thorax-2025-223738
Richard E K Russell,
{"title":"Commentary on the 2024 British Thoracic Society Specialty Trainee Survey report.","authors":"Richard E K Russell, ","doi":"10.1136/thorax-2025-223738","DOIUrl":"https://doi.org/10.1136/thorax-2025-223738","url":null,"abstract":"","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"68 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145752665","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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