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}
Pub Date : 2025-01-01DOI: 10.1136/thorax-2024-222742
Alexandra Hodge
There are no licensed pharmacological treatments for obstructive sleep apnoea (OSA). Obesity is a modifiable risk factor for OSA with existing pharmacological interventions. One such treatment is tirzepatide which is a long-acting glucose-dependent insulinotropic polypeptide (GIP) receptor agonist and glucagon-like peptide-1 (GLP-1) receptor agonist. Malhotra et al . (N Engl J Med 2024;391:1193–1205) reported the SURMONT-OSA phase three trials which evaluated the safety and efficacy of tirzepatide for the treatment of OSA in obese adults. SURMONT-OSA comprised of two multi-centre, international, double-blind, randomised, controlled trials conducted over 52 weeks. All participants had moderate-severe OSA. Participants were randomised to placebo or tirzepatide treatment arms. Trial one included participants unable or unwilling to use positive airway pressure (PAP) therapy (n=234) and trial two included participants using and continuing PAP therapy (n=235). The primary end-point was the change in apnoea-hypopnea index (AHI) from baseline. In trial one the mean change in AHI at week 52 was −25.3 events/hour (95% CI, −29.3 to −21.2) with tirzepatide and −5.3 events/hour (95% CI, −9.4 to −1.1) with placebo. In trial 2, after withdrawing PAP therapy, the mean change in AHI at week 52 with tirzepatide was −29.3 events/hour (95% CI, −33.2 to −25.4, p<0.001) and …
{"title":"Journal club","authors":"Alexandra Hodge","doi":"10.1136/thorax-2024-222742","DOIUrl":"https://doi.org/10.1136/thorax-2024-222742","url":null,"abstract":"There are no licensed pharmacological treatments for obstructive sleep apnoea (OSA). Obesity is a modifiable risk factor for OSA with existing pharmacological interventions. One such treatment is tirzepatide which is a long-acting glucose-dependent insulinotropic polypeptide (GIP) receptor agonist and glucagon-like peptide-1 (GLP-1) receptor agonist. Malhotra et al . (N Engl J Med 2024;391:1193–1205) reported the SURMONT-OSA phase three trials which evaluated the safety and efficacy of tirzepatide for the treatment of OSA in obese adults. SURMONT-OSA comprised of two multi-centre, international, double-blind, randomised, controlled trials conducted over 52 weeks. All participants had moderate-severe OSA. Participants were randomised to placebo or tirzepatide treatment arms. Trial one included participants unable or unwilling to use positive airway pressure (PAP) therapy (n=234) and trial two included participants using and continuing PAP therapy (n=235). The primary end-point was the change in apnoea-hypopnea index (AHI) from baseline. In trial one the mean change in AHI at week 52 was −25.3 events/hour (95% CI, −29.3 to −21.2) with tirzepatide and −5.3 events/hour (95% CI, −9.4 to −1.1) with placebo. In trial 2, after withdrawing PAP therapy, the mean change in AHI at week 52 with tirzepatide was −29.3 events/hour (95% CI, −33.2 to −25.4, p<0.001) and …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"36 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873869","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 : 2025-01-01DOI: 10.1136/thoraxjnl-2015-207694corr1
BMJ Publishing Group Ltd and British Thoracic Society
Higginson J. What’s hot that the other lot got. Thorax 2015;70:1010. This Journal club article was originally published with 2 citations missing. The relevant citations have been added to the text below. The editors would like to apologise for any inconvenience caused. Zhou et al (J Clin Oncol 2015 Jul 1;33(19):2197–204) have performed a randomised, …
{"title":"Correction: What’s hot that the other lot got","authors":"BMJ Publishing Group Ltd and British Thoracic Society","doi":"10.1136/thoraxjnl-2015-207694corr1","DOIUrl":"https://doi.org/10.1136/thoraxjnl-2015-207694corr1","url":null,"abstract":"Higginson J. What’s hot that the other lot got. Thorax 2015;70:1010. This Journal club article was originally published with 2 citations missing. The relevant citations have been added to the text below. The editors would like to apologise for any inconvenience caused. Zhou et al (J Clin Oncol 2015 Jul 1;33(19):2197–204) have performed a randomised, …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"11 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142874038","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 : 2024-12-31DOI: 10.1136/thorax-2024-222120
Simone Petrarulo, Claudia Ravaglia, Maria Giulia Disanto, Sara Piciucchi, Venerino Poletti
A 25-year-old non-smoking caucasian woman, with no family history of interstitial lung disease (ILD) or consanguinity, presented with a 6-month history of progressive exertional dyspnoea, chest pain and episodes of mild haemoptysis. Her medical history was unremarkable. Physical examination revealed bibasilar crackles and digital clubbing. Blood tests showed neutrophilic leucocytosis (WBC 12 040/mm³ with neutrophils 9860/mm³) and CRP 3.8 mg/L. An autoimmunity panel and specific IgG tests for mould and avian antigens were all negative. Spirometry indicated a restrictive ventilatory defect with severe impairment of DLCO (FVC 57% predicted and DLCO 35% predicted). A high resolution CT revealed ground-glass attenuation in the peripheral regions of both lungs, with small cysts in the anterior segments of both upper lobes (figure 1). A bronchoalveolar lavage performed in the lingula showed 99% macrophages and 1% lymphocytes, and microbiology cultures for bacterial, fungal and viral pathogens were negative. After a multidisciplinary discussion, a transbronchial …
{"title":"ABCA3-related interstitial lung disease in a young woman","authors":"Simone Petrarulo, Claudia Ravaglia, Maria Giulia Disanto, Sara Piciucchi, Venerino Poletti","doi":"10.1136/thorax-2024-222120","DOIUrl":"https://doi.org/10.1136/thorax-2024-222120","url":null,"abstract":"A 25-year-old non-smoking caucasian woman, with no family history of interstitial lung disease (ILD) or consanguinity, presented with a 6-month history of progressive exertional dyspnoea, chest pain and episodes of mild haemoptysis. Her medical history was unremarkable. Physical examination revealed bibasilar crackles and digital clubbing. Blood tests showed neutrophilic leucocytosis (WBC 12 040/mm³ with neutrophils 9860/mm³) and CRP 3.8 mg/L. An autoimmunity panel and specific IgG tests for mould and avian antigens were all negative. Spirometry indicated a restrictive ventilatory defect with severe impairment of DLCO (FVC 57% predicted and DLCO 35% predicted). A high resolution CT revealed ground-glass attenuation in the peripheral regions of both lungs, with small cysts in the anterior segments of both upper lobes (figure 1). A bronchoalveolar lavage performed in the lingula showed 99% macrophages and 1% lymphocytes, and microbiology cultures for bacterial, fungal and viral pathogens were negative. After a multidisciplinary discussion, a transbronchial …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"87 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142908227","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 : 2024-12-31DOI: 10.1136/thorax-2024-222606
David M Mannino
Polymorbidity is an important component of chronic obstructive pulmonary disease (COPD), with cardiovascular diseases being among the most important comorbidities.1 The development of both incident and recurrent cardiovascular events is related to the degree of lung function impairment in COPD.2 Acute exacerbations of COPD (AECOPD) are associated with a higher risk of developing an acute cardiovascular event, particularly in the first 6 months following the AECOPD.3 4 Therapies that include inhaled corticosteroids (ICS) decrease the risk of exacerbations.5 6 Thus, it would follow that therapies that decrease exacerbations, such as those include ICS, would decrease cardiovascular events. This was the topic for the Study to Understand Mortality and Morbidity in COPD trial, a 3-year trial of over 16 000 patients randomised into four groups (placebo, fluticasone furoate, vilanterol and fluticasone/vilanterol).7 The ICS-containing groups had fewer exacerbations and less lung function decline but did not significantly decrease mortality or cardiovascular events. Cardiopulmonary events are the focus for ‘A Randomised, Double-Blind, Parallel Group, Multicentre, Phase III Study to Assess the Efficacy of Budesonide, Glycopyrronium and Formoterol Fumarate Metered Dose Inhaler Relative to Glycopyrronium and Formoterol Fumarate MDI on Cardiopulmonary Outcomes in COPD (THARROS)’, which is currently recruiting up to 5000 patients with an estimated completion in 2028.8 The …
{"title":"Do inhaled corticosteroids decrease the risk of cardiovascular outcomes in patients with chronic obstructive pulmonary disease?","authors":"David M Mannino","doi":"10.1136/thorax-2024-222606","DOIUrl":"https://doi.org/10.1136/thorax-2024-222606","url":null,"abstract":"Polymorbidity is an important component of chronic obstructive pulmonary disease (COPD), with cardiovascular diseases being among the most important comorbidities.1 The development of both incident and recurrent cardiovascular events is related to the degree of lung function impairment in COPD.2 Acute exacerbations of COPD (AECOPD) are associated with a higher risk of developing an acute cardiovascular event, particularly in the first 6 months following the AECOPD.3 4 Therapies that include inhaled corticosteroids (ICS) decrease the risk of exacerbations.5 6 Thus, it would follow that therapies that decrease exacerbations, such as those include ICS, would decrease cardiovascular events. This was the topic for the Study to Understand Mortality and Morbidity in COPD trial, a 3-year trial of over 16 000 patients randomised into four groups (placebo, fluticasone furoate, vilanterol and fluticasone/vilanterol).7 The ICS-containing groups had fewer exacerbations and less lung function decline but did not significantly decrease mortality or cardiovascular events. Cardiopulmonary events are the focus for ‘A Randomised, Double-Blind, Parallel Group, Multicentre, Phase III Study to Assess the Efficacy of Budesonide, Glycopyrronium and Formoterol Fumarate Metered Dose Inhaler Relative to Glycopyrronium and Formoterol Fumarate MDI on Cardiopulmonary Outcomes in COPD (THARROS)’, which is currently recruiting up to 5000 patients with an estimated completion in 2028.8 The …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"71 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142908225","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 : 2024-12-25DOI: 10.1136/thorax-2024-222636
Narat Srivali, Federica De Giacomi, Teng Moua, Jay H Ryu
Introduction Acute exacerbation of interstitial lung disease (AE-ILD) often results in death and poses significant challenges in clinical management. While corticosteroids are frequently employed, the optimal regimen and their clinical efficacy remain uncertain. To address this knowledge gap, we undertook a systematic review to evaluate the impact of steroid therapy on clinical outcomes in patients experiencing AE-ILD. Method Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we systematically searched multiple databases, identifying 12 454 articles. After removing duplicates and screening titles and abstracts, 447 articles were selected for full-text review. Ultimately, nine studies met inclusion criteria, comparing high-dose corticosteroids with low-dose or non-steroidal interventions in treating AE-ILD. Key outcomes included in-hospital and long-term mortality, as well as AE recurrence. Results Analysis of nine studies (total n=18 509) revealed differential treatment effects based on the ILD subtype. In non-idiopathic pulmonary fibrosis (IPF) ILD, high-dose corticosteroid therapy (>1.0 mg/kg prednisolone) demonstrated improved survival (adjusted HR 0.221, 95% CI 0.102 to 0.480, p<0.001) and reduced 90-day mortality. Early tapering of high-dose corticosteroids (>10% reduction within 2 weeks) reduced in-hospital mortality (adjusted HR 0.37, 95% CI 0.14 to 0.99). Higher cumulative doses in the first 30 days (5185±2414 mg/month vs 3133±1990 mg/month) were associated with lower recurrence rates (adjusted HR 0.61, 95% CI 0.41 to 0.90, p=0.02). In IPF patients, however, high-dose therapy showed inconsistent benefits, with some studies reporting increased mortality risk (OR 1.075, 95% CI 1.044 to 1.107, p<0.001). Conclusion This review emphasises the potential benefits of individualised treatment approaches for AE-ILD but highlights the need for caution in making definitive recommendations. Although high-dose corticosteroids may show promise, particularly in non-IPF cases, the current evidence is inconsistent, and the lack of robust supporting literature makes it difficult to draw firm conclusions. Further research through randomised controlled trials is necessary to refine and optimise therapeutic strategies for AE-ILD. Data sharing not applicable as no datasets generated and/or analysed for this study.
肺间质性疾病（AE-ILD）急性加重常导致死亡，给临床治疗带来重大挑战。虽然经常使用皮质类固醇，但最佳方案及其临床疗效仍不确定。为了解决这一知识差距，我们进行了一项系统综述，以评估类固醇治疗对AE-ILD患者临床结果的影响。方法根据系统评价和荟萃分析指南的首选报告项目，我们系统地检索了多个数据库，确定了12454篇文章。在剔除重复、筛选标题和摘要后，我们选择了447篇文章进行全文审查。最终，9项研究符合纳入标准，比较了高剂量皮质类固醇与低剂量或非类固醇干预治疗AE-ILD的效果。主要结局包括住院和长期死亡率，以及AE复发。结果9项研究（总n= 18509）的分析揭示了基于ILD亚型的不同治疗效果。在非特发性肺纤维化（IPF） ILD中，高剂量皮质类固醇治疗（bbb1.0 mg/kg泼尼松龙）可改善生存率（调整后危险度0.221,95% CI 0.102至0.480,2周内降低10%）降低住院死亡率（调整后危险度0.37,95% CI 0.14至0.99）。前30天较高的累积剂量（5185±2414 mg/月vs 3133±1990 mg/月）与较低的复发率相关（调整后危险度0.61,95% CI 0.41 ~ 0.90, p=0.02）。然而，在IPF患者中，高剂量治疗显示出不一致的益处，一些研究报告死亡风险增加（OR 1.075, 95% CI 1.044至1.107,p<0.001）。结论：本综述强调了AE-ILD个体化治疗方法的潜在益处，但也强调了在提出明确建议时需要谨慎。尽管大剂量皮质类固醇可能显示出希望，特别是在非ipf病例中，但目前的证据并不一致，而且缺乏有力的支持文献，因此很难得出确切的结论。有必要通过随机对照试验进行进一步研究，以完善和优化AE-ILD的治疗策略。数据共享不适用，因为没有为本研究生成和/或分析数据集。
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