Pub Date : 2024-09-18DOI: 10.1136/thorax-2024-221806
Christopher Barber
{"title":"Artificial stone silicosis arrives in the UK: a tragic case of history repeating.","authors":"Christopher Barber","doi":"10.1136/thorax-2024-221806","DOIUrl":"10.1136/thorax-2024-221806","url":null,"abstract":"","PeriodicalId":23284,"journal":{"name":"Thorax","volume":null,"pages":null},"PeriodicalIF":9.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141898342","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 : 2024-09-18DOI: 10.1136/thorax-2024-222071
Rachel Nadif
{"title":"Antenatal exposures to tobacco and biomass or fossil fuels and wheezing in early childhood in South Africa.","authors":"Rachel Nadif","doi":"10.1136/thorax-2024-222071","DOIUrl":"10.1136/thorax-2024-222071","url":null,"abstract":"","PeriodicalId":23284,"journal":{"name":"Thorax","volume":null,"pages":null},"PeriodicalIF":9.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141971893","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 : 2024-09-18DOI: 10.1136/thorax-2023-220036
M Elizabeth Wilcox, Lisa Burry, Marina Englesakis, Briar Coman, Marietou Daou, Frank Mp van Haren, E Wes Ely, Karen J Bosma, Melissa P Knauert
Rationale/objectives: Despite plausible pathophysiological mechanisms, research is needed to confirm the relationship between sleep, circadian rhythm and delirium in patients admitted to the intensive care unit (ICU). The objective of this review is to summarise existing studies promoting, in whole or in part, the normalisation of sleep and circadian biology and their impact on the incidence, prevalence, duration and/or severity of delirium in ICU.
Methods: A sensitive search of electronic databases and conference proceedings was completed in March 2023. Inclusion criteria were English-language studies of any design that evaluated in-ICU non-pharmacological, pharmacological or mixed intervention strategies for promoting sleep or circadian biology and their association with delirium, as assessed at least daily. Data were extracted and independently verified.
Results: Of 7886 citations, we included 50 articles. Commonly evaluated interventions include care bundles (n=20), regulation or administration of light therapy (n=5), eye masks and/or earplugs (n=5), one nursing care-focused intervention and pharmacological intervention (eg, melatonin and ramelteon; n=19). The association between these interventions and incident delirium or severity of delirium was mixed. As multiple interventions were incorporated in included studies of care bundles and given that there was variable reporting of compliance with individual elements, identifying which components might have an impact on delirium is challenging.
Conclusions: This scoping review summarises the existing literature as it relates to ICU sleep and circadian disruption (SCD) and delirium in ICU. Further studies are needed to better understand the role of ICU SCD promotion interventions in delirium mitigation.
{"title":"Intensive care unit interventions to promote sleep and circadian biology in reducing incident delirium: a scoping review.","authors":"M Elizabeth Wilcox, Lisa Burry, Marina Englesakis, Briar Coman, Marietou Daou, Frank Mp van Haren, E Wes Ely, Karen J Bosma, Melissa P Knauert","doi":"10.1136/thorax-2023-220036","DOIUrl":"10.1136/thorax-2023-220036","url":null,"abstract":"<p><strong>Rationale/objectives: </strong>Despite plausible pathophysiological mechanisms, research is needed to confirm the relationship between sleep, circadian rhythm and delirium in patients admitted to the intensive care unit (ICU). The objective of this review is to summarise existing studies promoting, in whole or in part, the normalisation of sleep and circadian biology and their impact on the incidence, prevalence, duration and/or severity of delirium in ICU.</p><p><strong>Methods: </strong>A sensitive search of electronic databases and conference proceedings was completed in March 2023. Inclusion criteria were English-language studies of any design that evaluated in-ICU non-pharmacological, pharmacological or mixed intervention strategies for promoting sleep or circadian biology and their association with delirium, as assessed at least daily. Data were extracted and independently verified.</p><p><strong>Results: </strong>Of 7886 citations, we included 50 articles. Commonly evaluated interventions include care bundles (n=20), regulation or administration of light therapy (n=5), eye masks and/or earplugs (n=5), one nursing care-focused intervention and pharmacological intervention (eg, melatonin and ramelteon; n=19). The association between these interventions and incident delirium or severity of delirium was mixed. As multiple interventions were incorporated in included studies of care bundles and given that there was variable reporting of compliance with individual elements, identifying which components might have an impact on delirium is challenging.</p><p><strong>Conclusions: </strong>This scoping review summarises the existing literature as it relates to ICU sleep and circadian disruption (SCD) and delirium in ICU. Further studies are needed to better understand the role of ICU SCD promotion interventions in delirium mitigation.</p>","PeriodicalId":23284,"journal":{"name":"Thorax","volume":null,"pages":null},"PeriodicalIF":9.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139730589","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 : 2024-09-18DOI: 10.1136/thorax-2024-221856
Hannah Whittaker
{"title":"Untangling the web between menopause and respiratory disease.","authors":"Hannah Whittaker","doi":"10.1136/thorax-2024-221856","DOIUrl":"10.1136/thorax-2024-221856","url":null,"abstract":"","PeriodicalId":23284,"journal":{"name":"Thorax","volume":null,"pages":null},"PeriodicalIF":9.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141996579","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 : 2024-09-18DOI: 10.1136/thorax-2024-221447
Patrick Howlett, Jeffrey Gan, Maia Lesosky, Johanna Feary
Background: Silicosis, a chronic respiratory disease caused by crystalline silica exposure, is a persistent global lung health issue. No systematic review of the relationship between cumulative respirable crystalline silica (RCS) exposure and silicosis exists. UK exposure limits are currently under review. We therefore performed a systematic review and dose-response meta-analysis of this relationship.
Methods: Web of Science, Medline and Embase were searched on 24 February 2023. Studies of radiographic, autopsy or death certificate silicosis, with an estimated average follow-up of over 20 years since first employment, were included. Cumulative silicosis risk methods were compared. The relative risks (RR) of silicosis at increasing cumulative exposures were calculated and used to estimate the absolute risk reduction (ARR).
Results: Eight eligible studies, including 10 cohorts, contributed 8792 cases of silicosis among 65 977 participants. Substantial differences in cumulative risk estimates between methodologies exist. Using the same method, we observed higher cumulative silicosis risks among mining compared with non-mining cohorts. A reduction from 4 to 2 mg/m³-years in cumulative RCS exposure corresponded to substantial risk reductions among miners (RR 0.23 (95% CI 0.18 to 0.29, I2=92.9%) with an ARR of 323 (95% CI 298 to 344) per 1000) and non-miners (RR 0.55 (95% CI 0.36 to 0.83, I2=77.0%) with an ARR of 23 (95% CI 9 to 33) per 1000).
Conclusion: Despite significant heterogeneity, our findings support a reduction in permissible exposure limits from 0.1 mg/m3 to 0.05 mg/m³, particularly among mining populations. Further research is needed among non-miners as only two studies were eligible.
背景:矽肺病是一种由接触结晶二氧化硅引起的慢性呼吸道疾病,是一个长期存在的全球性肺部健康问题。目前还没有关于累积接触可吸入结晶二氧化硅(RCS)与矽肺之间关系的系统性研究。英国目前正在审查暴露限值。因此,我们对这种关系进行了系统回顾和剂量反应荟萃分析:方法:于 2023 年 2 月 24 日对 Web of Science、Medline 和 Embase 进行了检索。方法:于 2023 年 2 月 24 日检索了 Web Science、Medline 和 Embase,纳入了自首次就业起平均随访 20 年以上的放射学、尸检或死亡证明矽肺研究。比较了累积性矽肺风险方法。计算累积暴露量增加时矽肺病的相对风险(RR),并以此估算绝对风险降低率(ARR):结果:8 项符合条件的研究(包括 10 个队列)在 65 977 名参与者中发现了 8792 例矽肺病。不同方法的累积风险估计值存在很大差异。使用相同的方法,我们观察到采矿业队列的累积矽肺风险高于非采矿业队列。将累积 RCS 暴露从 4 毫克/立方米-年减少到 2 毫克/立方米-年可大幅降低矿工(RR 0.23 (95% CI 0.18 to 0.29, I2=92.9%),ARR 为 323 (95% CI 298 to 344) per 1000)和非矿工(RR 0.55 (95% CI 0.36 to 0.83, I2=77.0%),ARR 为 23 (95% CI 9 to 33) per 1000)的风险:尽管存在明显的异质性,但我们的研究结果支持将允许接触限值从 0.1 mg/m3 降至 0.05 mg/m³,尤其是在采矿人群中。由于只有两项研究符合条件,因此需要在非矿工中开展进一步研究。
{"title":"Relationship between cumulative silica exposure and silicosis: a systematic review and dose-response meta-analysis.","authors":"Patrick Howlett, Jeffrey Gan, Maia Lesosky, Johanna Feary","doi":"10.1136/thorax-2024-221447","DOIUrl":"10.1136/thorax-2024-221447","url":null,"abstract":"<p><strong>Background: </strong>Silicosis, a chronic respiratory disease caused by crystalline silica exposure, is a persistent global lung health issue. No systematic review of the relationship between cumulative respirable crystalline silica (RCS) exposure and silicosis exists. UK exposure limits are currently under review. We therefore performed a systematic review and dose-response meta-analysis of this relationship.</p><p><strong>Methods: </strong>Web of Science, Medline and Embase were searched on 24 February 2023. Studies of radiographic, autopsy or death certificate silicosis, with an estimated average follow-up of over 20 years since first employment, were included. Cumulative silicosis risk methods were compared. The relative risks (RR) of silicosis at increasing cumulative exposures were calculated and used to estimate the absolute risk reduction (ARR).</p><p><strong>Results: </strong>Eight eligible studies, including 10 cohorts, contributed 8792 cases of silicosis among 65 977 participants. Substantial differences in cumulative risk estimates between methodologies exist. Using the same method, we observed higher cumulative silicosis risks among mining compared with non-mining cohorts. A reduction from 4 to 2 mg/m³-years in cumulative RCS exposure corresponded to substantial risk reductions among miners (RR 0.23 (95% CI 0.18 to 0.29, I<sup>2</sup>=92.9%) with an ARR of 323 (95% CI 298 to 344) per 1000) and non-miners (RR 0.55 (95% CI 0.36 to 0.83, I<sup>2</sup>=77.0%) with an ARR of 23 (95% CI 9 to 33) per 1000).</p><p><strong>Conclusion: </strong>Despite significant heterogeneity, our findings support a reduction in permissible exposure limits from 0.1 mg/m<sup>3</sup> to 0.05 mg/m³, particularly among mining populations. Further research is needed among non-miners as only two studies were eligible.</p>","PeriodicalId":23284,"journal":{"name":"Thorax","volume":null,"pages":null},"PeriodicalIF":9.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11503121/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141898344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-18DOI: 10.1136/thorax-2024-221593
Jiun Hang Lee, Larry Ellee Nyanti, Nai-Chien Huan, Hema Yamini Ramarmuty, Kunji Kannan Sivaraman Kannan
{"title":"Multiple intrathoracic extramedullary haematopoiesis as visualised on medical thoracoscopy.","authors":"Jiun Hang Lee, Larry Ellee Nyanti, Nai-Chien Huan, Hema Yamini Ramarmuty, Kunji Kannan Sivaraman Kannan","doi":"10.1136/thorax-2024-221593","DOIUrl":"10.1136/thorax-2024-221593","url":null,"abstract":"","PeriodicalId":23284,"journal":{"name":"Thorax","volume":null,"pages":null},"PeriodicalIF":9.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141538659","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 : 2024-09-18DOI: 10.1136/thorax-2024-221923
Paul D Robinson
{"title":"Ageing and ivacaftor: unravelling the long-term effects.","authors":"Paul D Robinson","doi":"10.1136/thorax-2024-221923","DOIUrl":"10.1136/thorax-2024-221923","url":null,"abstract":"","PeriodicalId":23284,"journal":{"name":"Thorax","volume":null,"pages":null},"PeriodicalIF":9.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141898341","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 : 2024-09-18DOI: 10.1136/thorax-2023-221150
Kareshma Asharam, Aweke A Abebaw Mitku, Lisa Ramsay, Prakash Mohan Jeena, Rajen N Naidoo
Background: Antenatal factors and environmental exposures contribute to recurrent wheezing in early childhood.
Aim: To identify antenatal and environmental factors associated with recurrent wheezing in children from birth to 48 months in the mother and child in the environment cohort, using time-to-event analysis.
Method: Maternal interviews were administered during pregnancy and postnatally and children were followed up from birth to 48 months (May 2013-October 2019). Hybrid land-use regression and dispersion modelling described residential antenatal exposure to nitrogen dioxide (NO2) and particulate matter of 2.5 µm diameter (PM2.5). Wheezing status was assessed by a clinician. The Kaplan-Meier hazard function and Cox-proportional hazard models provided estimates of risk, adjusting for exposure to environmental tobacco smoke (ETS), maternal smoking, biomass fuel use and indoor environmental factors.
Results: Among 520 mother-child pairs, 85 (16%) children, had a single wheeze episode and 57 (11%) had recurrent wheeze. Time to recurrent wheeze (42.9 months) and single wheeze (37.8 months) among children exposed to biomass cooking fuels was significantly shorter compared with children with mothers using electricity (45.9 and 38.9 months, respectively (p=0.03)). Children with mothers exposed to antenatal ETS were 3.8 times more likely to have had recurrent wheeze compared with those not exposed (adjusted HR 3.8, 95% CI 1.3 to 10.7). Mean birth month NO2 was significantly higher among the recurrent wheeze category compared with those without wheeze. NO2 and PM2.5 were associated with a 2%-4% adjusted increased wheezing risk.
Conclusion: Control of exposure to ETS and biomass fuels in the antenatal period is likely to delay the onset of recurrent wheeze in children from birth to 48 months.
{"title":"Environmental exposures associated with early childhood recurrent wheezing in the mother and child in the environment birth cohort: a time-to-event study.","authors":"Kareshma Asharam, Aweke A Abebaw Mitku, Lisa Ramsay, Prakash Mohan Jeena, Rajen N Naidoo","doi":"10.1136/thorax-2023-221150","DOIUrl":"10.1136/thorax-2023-221150","url":null,"abstract":"<p><strong>Background: </strong>Antenatal factors and environmental exposures contribute to recurrent wheezing in early childhood.</p><p><strong>Aim: </strong>To identify antenatal and environmental factors associated with recurrent wheezing in children from birth to 48 months in the mother and child in the environment cohort, using time-to-event analysis.</p><p><strong>Method: </strong>Maternal interviews were administered during pregnancy and postnatally and children were followed up from birth to 48 months (May 2013-October 2019). Hybrid land-use regression and dispersion modelling described residential antenatal exposure to nitrogen dioxide (NO<sub>2</sub>) and particulate matter of 2.5 µm diameter (PM<sub>2.5</sub>). Wheezing status was assessed by a clinician. The Kaplan-Meier hazard function and Cox-proportional hazard models provided estimates of risk, adjusting for exposure to environmental tobacco smoke (ETS), maternal smoking, biomass fuel use and indoor environmental factors.</p><p><strong>Results: </strong>Among 520 mother-child pairs, 85 (16%) children, had a single wheeze episode and 57 (11%) had recurrent wheeze. Time to recurrent wheeze (42.9 months) and single wheeze (37.8 months) among children exposed to biomass cooking fuels was significantly shorter compared with children with mothers using electricity (45.9 and 38.9 months, respectively (p=0.03)). Children with mothers exposed to antenatal ETS were 3.8 times more likely to have had recurrent wheeze compared with those not exposed (adjusted HR 3.8, 95% CI 1.3 to 10.7). Mean birth month NO<sub>2</sub> was significantly higher among the recurrent wheeze category compared with those without wheeze. NO<sub>2</sub> and PM<sub>2.5</sub> were associated with a 2%-4% adjusted increased wheezing risk.</p><p><strong>Conclusion: </strong>Control of exposure to ETS and biomass fuels in the antenatal period is likely to delay the onset of recurrent wheeze in children from birth to 48 months.</p>","PeriodicalId":23284,"journal":{"name":"Thorax","volume":null,"pages":null},"PeriodicalIF":9.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11503139/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141535395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-18DOI: 10.1136/thorax-2023-221230
Tatiana Karp, Alen Faiz, Jos van Nijnatten, Huib A M Kerstjens, Ilse Boudewijn, Monica Kraft, Judith M Vonk, Martijn C Nawijn, Irene H Heijink, Bianca Beghé, Klaus F Rabe, Alberto Papi, Chris Brightling, Dave Singh, Thys van der Molen, Salman Siddiqui, Stephanie Christenson, Victor Guryev, Maarten van den Berge
Introduction: Asthma is an inflammatory airways disease encompassing multiple phenotypes and endotypes. Several studies suggested gene expression in nasal epithelium to serve as a proxy for bronchial epithelium, being a non-invasive approach to investigate lung diseases. We hypothesised that molecular differences in upper airway epithelium reflect asthma-associated differences in the lower airways and are associated with clinical expression of asthma.
Methods: We analysed nasal epithelial gene expression data from 369 patients with asthma and 58 non-asthmatic controls from the Assessment of Small Airways Involvement in Asthma study. Unsupervised hierarchical clustering was performed on asthma-associated genes. Asthma-associated gene signatures were replicated in independent cohorts with nasal and bronchial brushes data by comparing Gene Set Variation Analysis scores between asthma patients and non-asthmatic controls.
Results: We identified 67 higher expressed and 59 lower expressed genes in nasal epithelium from asthma patients compared with controls (false discovery rate<0.05), including CLCA1, CST1 and POSTN, genes well known to reflect asthma in bronchial airway epithelium. Hierarchical clustering revealed several molecular asthma endotypes with distinct clinical characteristics, including an endotype with higher blood and sputum eosinophils, high fractional exhaled nitric oxide, and more severe small airway dysfunction, as reflected by lower forced expiratory flow at 50%. In an independent cohort, we demonstrated that genes higher expressed in the nasal epithelium reflect asthma-associated changes in the lower airways.
Conclusion: Our results show that the nasal epithelial gene expression profile reflects asthma-related processes in the lower airways. We suggest that nasal epithelium may be a useful non-invasive tool to identify asthma endotypes and may advance personalised management of the disease.
{"title":"Nasal epithelial gene expression identifies relevant asthma endotypes in the ATLANTIS study.","authors":"Tatiana Karp, Alen Faiz, Jos van Nijnatten, Huib A M Kerstjens, Ilse Boudewijn, Monica Kraft, Judith M Vonk, Martijn C Nawijn, Irene H Heijink, Bianca Beghé, Klaus F Rabe, Alberto Papi, Chris Brightling, Dave Singh, Thys van der Molen, Salman Siddiqui, Stephanie Christenson, Victor Guryev, Maarten van den Berge","doi":"10.1136/thorax-2023-221230","DOIUrl":"10.1136/thorax-2023-221230","url":null,"abstract":"<p><strong>Introduction: </strong>Asthma is an inflammatory airways disease encompassing multiple phenotypes and endotypes. Several studies suggested gene expression in nasal epithelium to serve as a proxy for bronchial epithelium, being a non-invasive approach to investigate lung diseases. We hypothesised that molecular differences in upper airway epithelium reflect asthma-associated differences in the lower airways and are associated with clinical expression of asthma.</p><p><strong>Methods: </strong>We analysed nasal epithelial gene expression data from 369 patients with asthma and 58 non-asthmatic controls from the Assessment of Small Airways Involvement in Asthma study. Unsupervised hierarchical clustering was performed on asthma-associated genes. Asthma-associated gene signatures were replicated in independent cohorts with nasal and bronchial brushes data by comparing Gene Set Variation Analysis scores between asthma patients and non-asthmatic controls.</p><p><strong>Results: </strong>We identified 67 higher expressed and 59 lower expressed genes in nasal epithelium from asthma patients compared with controls (false discovery rate<0.05), including <i>CLCA1, CST1</i> and <i>POSTN</i>, genes well known to reflect asthma in bronchial airway epithelium. Hierarchical clustering revealed several molecular asthma endotypes with distinct clinical characteristics, including an endotype with higher blood and sputum eosinophils, high fractional exhaled nitric oxide, and more severe small airway dysfunction, as reflected by lower forced expiratory flow at 50%. In an independent cohort, we demonstrated that genes higher expressed in the nasal epithelium reflect asthma-associated changes in the lower airways.</p><p><strong>Conclusion: </strong>Our results show that the nasal epithelial gene expression profile reflects asthma-related processes in the lower airways. We suggest that nasal epithelium may be a useful non-invasive tool to identify asthma endotypes and may advance personalised management of the disease.</p>","PeriodicalId":23284,"journal":{"name":"Thorax","volume":null,"pages":null},"PeriodicalIF":9.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141620979","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 : 2024-09-18DOI: 10.1136/thorax-2023-220956
Xiaochun Gai, Yue Feng, Tessa M Flores, Huining Kang, Hui Yu, Kimberly K Leslie, Yiliang Zhu, Jennifer A Doherty, Yan Guo, Steven A Belinsky, Linda S Cook, Shuguang Leng
Rationale: Early natural menopause (early-M; <45 years of age) increases the risk of lung morbidities and mortalities in smokers. However, it is largely unknown whether early-M due to surgery demonstrates similar effects and whether menopausal hormone therapy (MHT) is protective against lung diseases.
Objectives: To assess the associations of early-M and MHT with lung morbidities and mortalities using the prospective Prostate, Lung, Colorectal and Ovarian (PLCO) trial.
Methods: We estimated the risk among 69 706 postmenopausal women in the PLCO trial, stratified by menopausal types and smoking status.
Results: Early-M was associated with an increased risk of most lung disease and mortality outcomes in ever smokers with the highest risk seen for respiratory mortality (HR 1.98, 95% CI 1.34 to 2.92) in those with bilateral oophorectomy (BO). Early-M was positively associated with chronic bronchitis, and all-cause, non-cancer and respiratory mortality in never smokers with natural menopause or BO, with the highest risk seen for BO- respiratory mortality (HR 1.91, 95% CI 1.16 to 3.12). Ever MHT was associated with reduced all-cause, non-cancer and cardiovascular mortality across menopause types regardless of smoking status and was additionally associated with reduced risk of non-ovarian cancer, lung cancer (LC) and respiratory mortality in ever smokers. Among smokers, ever MHT use was associated with a reduction in HR for all-cause, non-cancer and cardiovascular mortality in a duration-dependent manner.
Conclusions: Smokers with early-M should be targeted for smoking cessation and LC screening regardless of menopause types. MHT users had a lower likelihood of dying from LC and respiratory diseases in ever smokers.
理由:早期自然绝经(early-M;Objectives:利用前瞻性的前列腺、肺、结直肠和卵巢(PLCO)试验,评估早期自然绝经和MHT与肺部疾病和死亡率的关系:我们估算了 PLCO 试验中 69 706 名绝经后妇女的风险,并按绝经类型和吸烟状况进行了分层:结果:在曾经吸烟的妇女中,早期绝经与大多数肺部疾病和死亡风险的增加有关,其中双侧输卵管切除术(BO)妇女的呼吸系统死亡风险最高(HR 1.98,95% CI 1.34 至 2.92)。在自然绝经或双侧输卵管切除术的从不吸烟者中,早期M与慢性支气管炎、全因、非癌症和呼吸系统死亡率呈正相关,其中双侧输卵管切除术-呼吸系统死亡率的风险最高(HR 1.91,95% CI 1.16 至 3.12)。无论吸烟与否,曾经使用过MHT均可降低各种更年期类型的全因死亡率、非癌症死亡率和心血管死亡率,而且还可降低曾经吸烟者罹患非卵巢癌、肺癌(LC)和呼吸系统疾病的风险。在吸烟者中,曾经使用 MHT 与全因死亡率、非癌症死亡率和心血管死亡率的降低有关,其降低与持续时间有关:结论:无论更年期类型如何,都应针对早期M吸烟者进行戒烟和LC筛查。在曾经吸烟的人群中,MHT使用者死于低密度脂蛋白血症和呼吸系统疾病的可能性较低。
{"title":"Early menopause and hormone therapy as determinants for lung health outcomes: a secondary analysis using the PLCO trial.","authors":"Xiaochun Gai, Yue Feng, Tessa M Flores, Huining Kang, Hui Yu, Kimberly K Leslie, Yiliang Zhu, Jennifer A Doherty, Yan Guo, Steven A Belinsky, Linda S Cook, Shuguang Leng","doi":"10.1136/thorax-2023-220956","DOIUrl":"10.1136/thorax-2023-220956","url":null,"abstract":"<p><strong>Rationale: </strong>Early natural menopause (early-M; <45 years of age) increases the risk of lung morbidities and mortalities in smokers. However, it is largely unknown whether early-M due to surgery demonstrates similar effects and whether menopausal hormone therapy (MHT) is protective against lung diseases.</p><p><strong>Objectives: </strong>To assess the associations of early-M and MHT with lung morbidities and mortalities using the prospective Prostate, Lung, Colorectal and Ovarian (PLCO) trial.</p><p><strong>Methods: </strong>We estimated the risk among 69 706 postmenopausal women in the PLCO trial, stratified by menopausal types and smoking status.</p><p><strong>Results: </strong>Early-M was associated with an increased risk of most lung disease and mortality outcomes in ever smokers with the highest risk seen for respiratory mortality (HR 1.98, 95% CI 1.34 to 2.92) in those with bilateral oophorectomy (BO). Early-M was positively associated with chronic bronchitis, and all-cause, non-cancer and respiratory mortality in never smokers with natural menopause or BO, with the highest risk seen for BO- respiratory mortality (HR 1.91, 95% CI 1.16 to 3.12). Ever MHT was associated with reduced all-cause, non-cancer and cardiovascular mortality across menopause types regardless of smoking status and was additionally associated with reduced risk of non-ovarian cancer, lung cancer (LC) and respiratory mortality in ever smokers. Among smokers, ever MHT use was associated with a reduction in HR for all-cause, non-cancer and cardiovascular mortality in a duration-dependent manner.</p><p><strong>Conclusions: </strong>Smokers with early-M should be targeted for smoking cessation and LC screening regardless of menopause types. MHT users had a lower likelihood of dying from LC and respiratory diseases in ever smokers.</p>","PeriodicalId":23284,"journal":{"name":"Thorax","volume":null,"pages":null},"PeriodicalIF":9.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141318408","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}