Pub Date : 2024-12-18DOI: 10.1136/thorax-2024-221977
Gabriel Lavoie, Imran Howell, James Melhorn, Catherine Borg, Laura Bermejo-Sanchez, Jack Seymour, Maisha F. Jabeen, Anastasia Fries, Gareth Hynes, Ian D Pavord, Nayia Petousi, Timothy SC Hinks
Macrolides reduce exacerbations when added to inhaled therapy in severe asthma. However, there is little published evidence for effectiveness in patients treated with biologics. We conducted a retrospective audit of all patients who started azithromycin while on biologics in our centre. Compared with those that did not start azithromycin, these individuals had more exacerbations and a phenotype of chronic bronchitis and/or frequent purulent exacerbations. The addition of azithromycin to biologics was associated with reduced annual rates of steroid-treated and antibiotic-treated exacerbations and improved symptom scores (Asthma Control Questionnaire-5) but not with any improvement in lung function. Data support testing azithromycin in clinical trials in patients on biologics with residual exacerbations.
{"title":"Effects of azithromycin in severe eosinophilic asthma with concomitant monoclonal antibody treatment","authors":"Gabriel Lavoie, Imran Howell, James Melhorn, Catherine Borg, Laura Bermejo-Sanchez, Jack Seymour, Maisha F. Jabeen, Anastasia Fries, Gareth Hynes, Ian D Pavord, Nayia Petousi, Timothy SC Hinks","doi":"10.1136/thorax-2024-221977","DOIUrl":"https://doi.org/10.1136/thorax-2024-221977","url":null,"abstract":"Macrolides reduce exacerbations when added to inhaled therapy in severe asthma. However, there is little published evidence for effectiveness in patients treated with biologics. We conducted a retrospective audit of all patients who started azithromycin while on biologics in our centre. Compared with those that did not start azithromycin, these individuals had more exacerbations and a phenotype of chronic bronchitis and/or frequent purulent exacerbations. The addition of azithromycin to biologics was associated with reduced annual rates of steroid-treated and antibiotic-treated exacerbations and improved symptom scores (Asthma Control Questionnaire-5) but not with any improvement in lung function. Data support testing azithromycin in clinical trials in patients on biologics with residual exacerbations.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"12 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142841170","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 : 2024-12-16DOI: 10.1136/thorax-2024-222215
Frances Grudzinska, Aduragbemi A Faniyi, Kylie B R Belchamber, Celine Chen, Robert Stockley, Alice Jasper, Dhruv Parekh, Elizabeth Sapey, Aaron Scott, David R Thickett
Objective Community-acquired pneumonia (CAP) is a leading cause of hospitalisation in older adults and is associated with a high likelihood of adverse outcomes. Given the ageing population and lack of therapeutic advances in CAP, new strategies to manage the burden of this disease are needed. Neutrophil dysfunction has been widely demonstrated in CAP and is associated with poor outcomes. We hypothesised that impaired glycolytic metabolism was driving neutrophil dysfunction in older adults with CAP. Methods To investigate the mechanism underlying neutrophil dysfunction in CAP, we recruited older adults with CAP and sepsis, age-matched controls and healthy young adults to assess neutrophil function and glycolytic metabolism in peripheral blood neutrophils. Results We demonstrate that neutrophils from older donors with CAP display a broad range of functional defects, including inaccurate migration to interleukin 8, impaired respiratory burst in response to phorbol 12-myristate 13-acetate and increased spontaneous degranulation compared with age-matched controls. Glycolysis (assessed by extracellular flux and RNA-sequencing) was not significantly altered between age-matched groups; however, basal rates of neutrophil glycolysis were significantly higher in patients with CAP and older adult controls compared with healthy young adults, and stimulated glycolysis was significantly higher in young adults compared with older adults with and without CAP. Conclusions Our findings suggest that neutrophil dysfunction in older adults with CAP may be implicated in poor outcomes, irrespective of glycolytic metabolism. Data are available in a public, open access repository. Data are available upon reasonable request. RNA sequencing data generated by this study were deposited into the Gene Expression Omnibus database under accession number GSE261559. Data are freely available. Other data are available upon reasonable request.
{"title":"Hospitalised older adults with community-acquired pneumonia and sepsis have dysregulated neutrophil function but preserved glycolysis","authors":"Frances Grudzinska, Aduragbemi A Faniyi, Kylie B R Belchamber, Celine Chen, Robert Stockley, Alice Jasper, Dhruv Parekh, Elizabeth Sapey, Aaron Scott, David R Thickett","doi":"10.1136/thorax-2024-222215","DOIUrl":"https://doi.org/10.1136/thorax-2024-222215","url":null,"abstract":"Objective Community-acquired pneumonia (CAP) is a leading cause of hospitalisation in older adults and is associated with a high likelihood of adverse outcomes. Given the ageing population and lack of therapeutic advances in CAP, new strategies to manage the burden of this disease are needed. Neutrophil dysfunction has been widely demonstrated in CAP and is associated with poor outcomes. We hypothesised that impaired glycolytic metabolism was driving neutrophil dysfunction in older adults with CAP. Methods To investigate the mechanism underlying neutrophil dysfunction in CAP, we recruited older adults with CAP and sepsis, age-matched controls and healthy young adults to assess neutrophil function and glycolytic metabolism in peripheral blood neutrophils. Results We demonstrate that neutrophils from older donors with CAP display a broad range of functional defects, including inaccurate migration to interleukin 8, impaired respiratory burst in response to phorbol 12-myristate 13-acetate and increased spontaneous degranulation compared with age-matched controls. Glycolysis (assessed by extracellular flux and RNA-sequencing) was not significantly altered between age-matched groups; however, basal rates of neutrophil glycolysis were significantly higher in patients with CAP and older adult controls compared with healthy young adults, and stimulated glycolysis was significantly higher in young adults compared with older adults with and without CAP. Conclusions Our findings suggest that neutrophil dysfunction in older adults with CAP may be implicated in poor outcomes, irrespective of glycolytic metabolism. Data are available in a public, open access repository. Data are available upon reasonable request. RNA sequencing data generated by this study were deposited into the Gene Expression Omnibus database under accession number GSE261559. Data are freely available. Other data are available upon reasonable request.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"51 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142832144","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 : 2024-12-16DOI: 10.1136/thorax-2024-221760
Ana Machado, Cíntia Dias, Cátia Paixão, António Pedro Gonçalves, Chris Burtin, Alda Marques
Background Uncertainty exists about the beneficial effects of delivering pulmonary rehabilitation (PR) during exacerbations of chronic obstructive pulmonary disease (ECOPD). This study explored the short-term effects and self-reported impact of a home-based PR programme for people with outpatient-managed ECOPD. Methods We conducted a mixed-methods randomised controlled trial in people with outpatient-managed ECOPD. Participants were randomly assigned to the control (CG, ie, usual care) or experimental (EG, ie, usual care and 3-week home-based PR) group within 48 hours of the diagnosis (baseline). Assessments were performed at baseline and after 3 weeks (post). The COPD assessment test (CAT) was the primary outcome. Secondary outcomes included measures of symptoms and functional capacity. After PR, interviews were conducted. Analyses were performed using (non-)parametric mixed analysis of variance, deductive thematic analysis and narrative integration through joint displays. Results Fifty participants with outpatient-managed ECOPD (78% men, 70±11 years, forced expiratory volume in one second 47.4±16.4% pred) were included. Significant greater improvements in the EG compared with the CG were found for the CAT (EG Δ−12.5±7.2 vs CG Δ−5.9±7.2, p=0.002) and 12 of 13 other secondary outcome measures. A positive self-perceived impact of PR was found on symptoms, control of daily life, health, mental status and empowerment. No adverse events were reported. Conclusions A 3-week home-based PR programme is safe, meaningful and more effective than just standard medication in improving symptoms, functional capacity and health status, outcomes often associated with poor prognosis. This highlights the role of PR in improving the recovery process during outpatient-managed ECOPD and might contribute to a better prognosis in these individuals. Trial registration [NCT03751670][1]. Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. The authors confirm that the data supporting the findings of this study are available within the article (and/or) its supplementary materials. The dataset is available upon reasonable request from the corresponding author (ASM). [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT03751670&atom=%2Fthoraxjnl%2Fearly%2F2024%2F12%2F16%2Fthorax-2024-221760.atom
{"title":"Short-term effects of home-based pulmonary rehabilitation during outpatient-managed exacerbations of COPD: a randomised controlled trial","authors":"Ana Machado, Cíntia Dias, Cátia Paixão, António Pedro Gonçalves, Chris Burtin, Alda Marques","doi":"10.1136/thorax-2024-221760","DOIUrl":"https://doi.org/10.1136/thorax-2024-221760","url":null,"abstract":"Background Uncertainty exists about the beneficial effects of delivering pulmonary rehabilitation (PR) during exacerbations of chronic obstructive pulmonary disease (ECOPD). This study explored the short-term effects and self-reported impact of a home-based PR programme for people with outpatient-managed ECOPD. Methods We conducted a mixed-methods randomised controlled trial in people with outpatient-managed ECOPD. Participants were randomly assigned to the control (CG, ie, usual care) or experimental (EG, ie, usual care and 3-week home-based PR) group within 48 hours of the diagnosis (baseline). Assessments were performed at baseline and after 3 weeks (post). The COPD assessment test (CAT) was the primary outcome. Secondary outcomes included measures of symptoms and functional capacity. After PR, interviews were conducted. Analyses were performed using (non-)parametric mixed analysis of variance, deductive thematic analysis and narrative integration through joint displays. Results Fifty participants with outpatient-managed ECOPD (78% men, 70±11 years, forced expiratory volume in one second 47.4±16.4% pred) were included. Significant greater improvements in the EG compared with the CG were found for the CAT (EG Δ−12.5±7.2 vs CG Δ−5.9±7.2, p=0.002) and 12 of 13 other secondary outcome measures. A positive self-perceived impact of PR was found on symptoms, control of daily life, health, mental status and empowerment. No adverse events were reported. Conclusions A 3-week home-based PR programme is safe, meaningful and more effective than just standard medication in improving symptoms, functional capacity and health status, outcomes often associated with poor prognosis. This highlights the role of PR in improving the recovery process during outpatient-managed ECOPD and might contribute to a better prognosis in these individuals. Trial registration [NCT03751670][1]. Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. The authors confirm that the data supporting the findings of this study are available within the article (and/or) its supplementary materials. The dataset is available upon reasonable request from the corresponding author (ASM). [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT03751670&atom=%2Fthoraxjnl%2Fearly%2F2024%2F12%2F16%2Fthorax-2024-221760.atom","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"33 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142832090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background Obstructive sleep apnoea syndrome (OSAS) has been recognised as a potential risk factor for cognitive decline, yet its precise relationship with dementia remains uncertain. This study aimed to determine the risk of dementia among individuals with and without OSAS. Methods Data derived from 2.3 million adults (aged ≥18 years) were extracted from the Clinical Practice Research Datalink (2000–2022), a nationally representative primary care electronic health records database in the UK. 193 600 individuals with OSAS were propensity score-matched to 536 701 individuals without OSAS. Cox proportional hazard regression models were applied to quantify the risk of developing all-cause dementia, vascular dementia and Alzheimer’s disease between individuals with and without OSAS. Results With a median follow-up of 4.0 (IQR 1.8–7.5) years, 2802 and 6211 individuals developed all-cause dementia in those with and without OSAS, corresponding to crude incidence rates of 2.47 and 2.34 per 1000 person-years, respectively. The presence of OSAS was associated with higher risks of all-cause dementia (adjusted HR (aHR) 1.12, 95% CI 1.07 to 1.17), vascular dementia (1.29, 95% CI 1.19 to 1.41) and unchanged risk of Alzheimer’s disease (1.07, 95% CI 0.99 to 1.16). Individuals with OSAS who had received continuous positive airway pressure (CPAP) treatment exhibited a similar risk of all-cause dementia as their matched counterparts (0.99, 95% CI 0.74 to 1.32). Conclusion OSAS is associated with higher risks of all-cause dementia and some of its subtypes. Further investigation is needed to investigate the clinical benefits of screening for cognitive impairment in people with OSAS and to further evaluate the impact of CPAP on cognitive decline and dementia risk. Data may be obtained from a third party and are not publicly available. All data relevant to the study are included in the article or uploaded as supplementary information. The data underlying this article were provided by the Clinical Practice Research Datalink (CPRD) under license. Data will be shared on request to the corresponding author with permission of the CPRD.
阻塞性睡眠呼吸暂停综合征（OSAS）已被认为是认知能力下降的潜在危险因素，但其与痴呆的确切关系仍不确定。这项研究旨在确定有和没有OSAS的人患痴呆的风险。方法从临床实践研究数据链（2000-2022）中提取230万成年人（年龄≥18岁）的数据，该数据链是英国具有全国代表性的初级保健电子健康记录数据库。有OSAS者193 600例，无OSAS者536 701例。应用Cox比例风险回归模型量化osa患者和非osa患者发生全因痴呆、血管性痴呆和阿尔茨海默病的风险。结果中位随访时间为4.0 （IQR 1.8-7.5）年，有和没有OSAS的患者中分别有2802人和6211人发生了全因痴呆，对应的粗发病率分别为2.47和2.34 / 1000人年。OSAS的存在与全因痴呆（校正HR (aHR) 1.12, 95% CI 1.07 - 1.17）、血管性痴呆（1.29,95% CI 1.19 - 1.41）和阿尔茨海默病（1.07,95% CI 0.99 - 1.16）的高风险相关。接受持续气道正压通气（CPAP）治疗的OSAS患者患全因痴呆的风险与对照组相似（0.99,95% CI 0.74至1.32）。结论OSAS与全因痴呆及其部分亚型的高危相关。需要进一步的研究来调查筛查OSAS患者认知功能障碍的临床益处，并进一步评估CPAP对认知功能下降和痴呆风险的影响。数据可能会从第三方获得，并且不会公开提供。所有与研究相关的数据都包含在文章中或作为补充信息上传。本文背后的数据由临床实践研究数据链（CPRD）在许可下提供。本署会在获得本署许可的情况下，向通讯作者提供有关资料。
{"title":"Obstructive sleep apnoea syndrome and future risk of dementia among individuals managed in UK general practice","authors":"Jingya Wang, Anuradhaa Subramanian, Neil Cockburn, Jingyi Xiao, Krishnarajah Nirantharakumar, Shamil Haroon","doi":"10.1136/thorax-2024-221810","DOIUrl":"https://doi.org/10.1136/thorax-2024-221810","url":null,"abstract":"Background Obstructive sleep apnoea syndrome (OSAS) has been recognised as a potential risk factor for cognitive decline, yet its precise relationship with dementia remains uncertain. This study aimed to determine the risk of dementia among individuals with and without OSAS. Methods Data derived from 2.3 million adults (aged ≥18 years) were extracted from the Clinical Practice Research Datalink (2000–2022), a nationally representative primary care electronic health records database in the UK. 193 600 individuals with OSAS were propensity score-matched to 536 701 individuals without OSAS. Cox proportional hazard regression models were applied to quantify the risk of developing all-cause dementia, vascular dementia and Alzheimer’s disease between individuals with and without OSAS. Results With a median follow-up of 4.0 (IQR 1.8–7.5) years, 2802 and 6211 individuals developed all-cause dementia in those with and without OSAS, corresponding to crude incidence rates of 2.47 and 2.34 per 1000 person-years, respectively. The presence of OSAS was associated with higher risks of all-cause dementia (adjusted HR (aHR) 1.12, 95% CI 1.07 to 1.17), vascular dementia (1.29, 95% CI 1.19 to 1.41) and unchanged risk of Alzheimer’s disease (1.07, 95% CI 0.99 to 1.16). Individuals with OSAS who had received continuous positive airway pressure (CPAP) treatment exhibited a similar risk of all-cause dementia as their matched counterparts (0.99, 95% CI 0.74 to 1.32). Conclusion OSAS is associated with higher risks of all-cause dementia and some of its subtypes. Further investigation is needed to investigate the clinical benefits of screening for cognitive impairment in people with OSAS and to further evaluate the impact of CPAP on cognitive decline and dementia risk. Data may be obtained from a third party and are not publicly available. All data relevant to the study are included in the article or uploaded as supplementary information. The data underlying this article were provided by the Clinical Practice Research Datalink (CPRD) under license. Data will be shared on request to the corresponding author with permission of the CPRD.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"11 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142832091","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 : 2024-12-16DOI: 10.1136/thorax-2024-221642
Wenjun Ye, Wenhai Fu, Caichen Li, Jianfu Li, Shan Xiong, Bo Cheng, Bin Xu, Qixia Wang, Yi Feng, Peiling Chen, Jianxing He, Wenhua Liang
Background Limited research exists on screening thresholds for low-dose CT in detecting malignant pure ground-glass lung nodules (pGGNs) in the Chinese population. Materials and methods A retrospective analysis of the Guangzhou Lung-Care programme was conducted, retrieving average transverse diameter, location, histopathology, frequency and follow-up intervals. Diagnostic performances for ‘lung cancers’ were evaluated using areas under the curve (AUCs), decision curve analysis (DCA), sensitivities and specificities, with thresholds ranging from 5 mm to 10 mm. We divide malignant pGGNs into three groups: (1) minimally invasive adenocarcinoma (MIA) and invasive adenocarcinoma (IA), (2) atypical adenomatous hyperplasia (AAH) and adenocarcinoma in situ (AIS) and MIA and IA and (3) IA-only. Results In ‘MIA+IA’, increasing the threshold from 5 mm to 8 mm improved specificity (60.97% to 88.85%, p<0.001) and positive predictive values (PPVs; 5.87% to 14.88%, p<0.001), but decreased sensitivity (94.44% to 75.56%, p<0.001). Further raising threshold from 8 mm reduced sensitivity (75.56% to 60.00%, p<0.001), while slightly increasing specificity (88.85% to 93.47%, p<0.001) and PPVs (14.88% to 19.15%, p<0.001). Increasing threshold from 5 mm to 7 mm enhanced the AUC for ‘MIA+IA’ (from 0.711 to 0.829), ‘AAH+AIS+MIA+IA’ (from 0.748 to 0.804) and ‘IA-only’ (from 0.783 to 0.833). At 8 mm, the AUCs for these categories were similar. However, increasing the threshold from 7 mm to 10 mm resulted in reduced AUCs for ‘MIA+IA’ (0.829 to 0.767), ‘AAH+AIS+MIA+IA’ (0.804 to 0.744) and ‘IA-only’ (0.833 to 0.800). DCA reveals that the 8 mm predictive model demonstrates greater clinical utility compared with models with other thresholds. Conclusions Increasing the diameter threshold for positive results for pGGNs, up to 8 mm could enhance diagnostic performance. Trial registration number [NCT04938804][1]. Data are available upon reasonable request. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT04938804&atom=%2Fthoraxjnl%2Fearly%2F2024%2F12%2F16%2Fthorax-2024-221642.atom
{"title":"Diameter thresholds for pure ground-glass pulmonary nodules at low-dose CT screening: Chinese experience","authors":"Wenjun Ye, Wenhai Fu, Caichen Li, Jianfu Li, Shan Xiong, Bo Cheng, Bin Xu, Qixia Wang, Yi Feng, Peiling Chen, Jianxing He, Wenhua Liang","doi":"10.1136/thorax-2024-221642","DOIUrl":"https://doi.org/10.1136/thorax-2024-221642","url":null,"abstract":"Background Limited research exists on screening thresholds for low-dose CT in detecting malignant pure ground-glass lung nodules (pGGNs) in the Chinese population. Materials and methods A retrospective analysis of the Guangzhou Lung-Care programme was conducted, retrieving average transverse diameter, location, histopathology, frequency and follow-up intervals. Diagnostic performances for ‘lung cancers’ were evaluated using areas under the curve (AUCs), decision curve analysis (DCA), sensitivities and specificities, with thresholds ranging from 5 mm to 10 mm. We divide malignant pGGNs into three groups: (1) minimally invasive adenocarcinoma (MIA) and invasive adenocarcinoma (IA), (2) atypical adenomatous hyperplasia (AAH) and adenocarcinoma in situ (AIS) and MIA and IA and (3) IA-only. Results In ‘MIA+IA’, increasing the threshold from 5 mm to 8 mm improved specificity (60.97% to 88.85%, p<0.001) and positive predictive values (PPVs; 5.87% to 14.88%, p<0.001), but decreased sensitivity (94.44% to 75.56%, p<0.001). Further raising threshold from 8 mm reduced sensitivity (75.56% to 60.00%, p<0.001), while slightly increasing specificity (88.85% to 93.47%, p<0.001) and PPVs (14.88% to 19.15%, p<0.001). Increasing threshold from 5 mm to 7 mm enhanced the AUC for ‘MIA+IA’ (from 0.711 to 0.829), ‘AAH+AIS+MIA+IA’ (from 0.748 to 0.804) and ‘IA-only’ (from 0.783 to 0.833). At 8 mm, the AUCs for these categories were similar. However, increasing the threshold from 7 mm to 10 mm resulted in reduced AUCs for ‘MIA+IA’ (0.829 to 0.767), ‘AAH+AIS+MIA+IA’ (0.804 to 0.744) and ‘IA-only’ (0.833 to 0.800). DCA reveals that the 8 mm predictive model demonstrates greater clinical utility compared with models with other thresholds. Conclusions Increasing the diameter threshold for positive results for pGGNs, up to 8 mm could enhance diagnostic performance. Trial registration number [NCT04938804][1]. Data are available upon reasonable request. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT04938804&atom=%2Fthoraxjnl%2Fearly%2F2024%2F12%2F16%2Fthorax-2024-221642.atom","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"65 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142832092","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 : 2024-12-12DOI: 10.1136/thorax-2024-221976
Louise Lansbury, Tricia M McKeever, Hannah Lawrence, Harry Pick, Vadsala Baskaran, Rochelle Edwards-Pritchard, Laura Matthews, Helen Bailey, Deborah Ashton, Lesley Bendall, Chamira Rodrigo, Priya Daniel, David Litt, Seyi Eletu, Hanshi Parmar, Carmen Sheppard, Shamez N Ladhani, Caroline Trotter, Wei Shen Lim
Background With higher valency pneumococcal vaccines on the horizon and new adult immunisation strategies under discussion, we aimed to evaluate the contribution of individual pneumococcal serotypes to the burden of pneumococcal community-acquired pneumonia (CAP). Over 10 years, trends in pneumococcal pneumonia epidemiology in adults hospitalised with CAP were assessed. The risk factors and severity associated with serotype 3 were examined. Methods We conducted a prospective cohort study of adults hospitalised with CAP between September 2013 and May 2023. Pneumococcal serotypes were identified using a serotype-specific 24-valent urinary-antigen assay. Trends in the proportion of CAP due to pneumococcus and causative serotypes were compared prepandemic and postpandemic. Risk factors and severity of serotype 3 pneumonia were compared with other serotypes using logistic regression. Results Of 5186 patients with CAP, 2193 (42.2%) had pneumococcal pneumonia. The proportion of CAP due to pneumococcus increased across all ages between 2013 and 2023 (36.4%–66.9%, p<0.001). The proportion due to serotype 3 increased significantly from 13.4% (2013) to 48.8% (2023). Serotype 3 pneumonia in adults was associated with older age (p<0.001), male sex (adjusted OR (aOR) 2.22, 95% CI 1.64 to 3.01) and chronic renal disease (aOR 1.81, 95% CI 1.09 to 3.02). Serotype 3 pneumonia was not observed to be associated with severity, critical care requirement, mortality or readmission. Interpretation Serotype 3 is the predominant serotype in adult pneumococcal CAP and has been increasing despite a mature infant pneumococcal immunisation programme, consistent with a lack of herd protection for this serotype. Data are available on reasonable request.
背景：随着高价肺炎球菌疫苗的出现和新的成人免疫策略的讨论，我们旨在评估个体肺炎球菌血清型对肺炎球菌性社区获得性肺炎（CAP）负担的贡献。在过去的10年里，对CAP住院的成人肺炎球菌肺炎流行病学趋势进行了评估。检查与血清3型相关的危险因素和严重程度。方法：我们对2013年9月至2023年5月期间因CAP住院的成年人进行了一项前瞻性队列研究。采用血清型特异性24价尿抗原测定法鉴定肺炎球菌血清型。比较了大流行前和大流行后由肺炎球菌和致病血清型引起的CAP比例的趋势。采用logistic回归比较其他血清型肺炎的危险因素和严重程度。结果5186例CAP患者中，2193例（42.2%）为肺炎球菌性肺炎。2013 - 2023年间，肺炎球菌引起的CAP比例在所有年龄段均有所增加（36.4%-66.9%,p<0.001）。血清3型所占比例从2013年的13.4%显著上升至2023年的48.8%。成人血清3型肺炎与年龄较大（p<0.001）、男性（校正OR (aOR) 2.22, 95% CI 1.64 ~ 3.01）和慢性肾脏疾病（aOR 1.81, 95% CI 1.09 ~ 3.02）相关。血清3型肺炎未观察到与严重程度、重症监护要求、死亡率或再入院相关。血清型3是成人肺炎球菌CAP的主要血清型，尽管实施了成熟婴儿肺炎球菌免疫规划，但该血清型仍在增加，这与缺乏对该血清型的群体保护相一致。如有合理要求，可提供资料。
{"title":"Pneumococcal pneumonia trends in adults hospitalised with community-acquired pneumonia over 10 years (2013–2023) and the role of serotype 3","authors":"Louise Lansbury, Tricia M McKeever, Hannah Lawrence, Harry Pick, Vadsala Baskaran, Rochelle Edwards-Pritchard, Laura Matthews, Helen Bailey, Deborah Ashton, Lesley Bendall, Chamira Rodrigo, Priya Daniel, David Litt, Seyi Eletu, Hanshi Parmar, Carmen Sheppard, Shamez N Ladhani, Caroline Trotter, Wei Shen Lim","doi":"10.1136/thorax-2024-221976","DOIUrl":"https://doi.org/10.1136/thorax-2024-221976","url":null,"abstract":"Background With higher valency pneumococcal vaccines on the horizon and new adult immunisation strategies under discussion, we aimed to evaluate the contribution of individual pneumococcal serotypes to the burden of pneumococcal community-acquired pneumonia (CAP). Over 10 years, trends in pneumococcal pneumonia epidemiology in adults hospitalised with CAP were assessed. The risk factors and severity associated with serotype 3 were examined. Methods We conducted a prospective cohort study of adults hospitalised with CAP between September 2013 and May 2023. Pneumococcal serotypes were identified using a serotype-specific 24-valent urinary-antigen assay. Trends in the proportion of CAP due to pneumococcus and causative serotypes were compared prepandemic and postpandemic. Risk factors and severity of serotype 3 pneumonia were compared with other serotypes using logistic regression. Results Of 5186 patients with CAP, 2193 (42.2%) had pneumococcal pneumonia. The proportion of CAP due to pneumococcus increased across all ages between 2013 and 2023 (36.4%–66.9%, p<0.001). The proportion due to serotype 3 increased significantly from 13.4% (2013) to 48.8% (2023). Serotype 3 pneumonia in adults was associated with older age (p<0.001), male sex (adjusted OR (aOR) 2.22, 95% CI 1.64 to 3.01) and chronic renal disease (aOR 1.81, 95% CI 1.09 to 3.02). Serotype 3 pneumonia was not observed to be associated with severity, critical care requirement, mortality or readmission. Interpretation Serotype 3 is the predominant serotype in adult pneumococcal CAP and has been increasing despite a mature infant pneumococcal immunisation programme, consistent with a lack of herd protection for this serotype. Data are available on reasonable request.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"29 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142815526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background The ever-increasing number of patients diagnosed with obstructive sleep apnoea (OSA) and treated by long-term continuous positive airway pressure (CPAP) overstretches conventional follow-up pathways. New approaches to the management of CPAP-treated patient follow-up are needed to strike a balance between remote monitoring through digital technologies and in-person patient-healthcare-professional contacts. Focusing on the reshaping of the management of care pathways of CPAP-treated patients, with a specific focus on telemonitoring platforms, we aimed to review the evidence on how digital medicine and artificial intelligence (AI) tools are facilitating patient phenotyping and triage, risk stratification and the allocation of resources between the various healthcare professionals for an optimal follow-up of CPAP-treated patients. Phenotyping OSA is a heterogeneous condition with diverse phenotypes differing in symptoms, comorbidities, demographics, lifestyle and socioeconomic context. Different phenotypes are associated with different CPAP adherence patterns and differing long-term prognosis. This diversity demands greater plurality in management pathways with different types and levels of support to ensure treatment adherence and risk reduction for patients while easing the burden on health services. In multidimensional phenotyping, we discuss alternatives to the apnoea hypopnoea index (AHI) as a measure of OSA severity. Then we consider risk stratification taking advantage of the wealth of CPAP monitoring data already available in databases that can now be exploited using AI and machine learning to direct (stratify) patients into appropriate follow-up management pathways. Integrated care clinics for high-risk patients We look at the role of integrated OSA care clinics particularly for the management of high-risk patients with low adherence and progression of comorbidities. Here, multidisciplinary teams might propose comorbidity management, and the use of connected wearable devices for long-term monitoring of physical activity, along with remote CPAP monitoring. Remote management pathways The pros and cons of remote management pathways to replace in-person follow-up visits are considered, including the need to re-evaluate CPAP-device reimbursement policies in some countries. While remote CPAP monitoring has become the cornerstone of follow-up providing information on adherence and efficacy, the processing of alerts needs to be improved, particularly regarding mask changes and early detection of CPAP failures. Challenges The implementation of CPAP monitoring alone, as well as its extension to multimodal monitoring, can present challenges that remain to be addressed (eg, access to digital care). The extent and components of remote follow-up must be adapted to each specific OSA phenotype. Finally, we give examples of certain patient phenotypes (eg, comorbid insomnia with OSA) with specific follow-up requirements, for which remote (even mult
{"title":"New management pathways for follow-up of CPAP-treated sleep apnoea patients including digital medicine and multimodal telemonitoring","authors":"Jean-Louis Pépin, Sébastien Baillieul, Sébastien Bailly, Renaud Tamisier","doi":"10.1136/thorax-2024-221422","DOIUrl":"https://doi.org/10.1136/thorax-2024-221422","url":null,"abstract":"Background The ever-increasing number of patients diagnosed with obstructive sleep apnoea (OSA) and treated by long-term continuous positive airway pressure (CPAP) overstretches conventional follow-up pathways. New approaches to the management of CPAP-treated patient follow-up are needed to strike a balance between remote monitoring through digital technologies and in-person patient-healthcare-professional contacts. Focusing on the reshaping of the management of care pathways of CPAP-treated patients, with a specific focus on telemonitoring platforms, we aimed to review the evidence on how digital medicine and artificial intelligence (AI) tools are facilitating patient phenotyping and triage, risk stratification and the allocation of resources between the various healthcare professionals for an optimal follow-up of CPAP-treated patients. Phenotyping OSA is a heterogeneous condition with diverse phenotypes differing in symptoms, comorbidities, demographics, lifestyle and socioeconomic context. Different phenotypes are associated with different CPAP adherence patterns and differing long-term prognosis. This diversity demands greater plurality in management pathways with different types and levels of support to ensure treatment adherence and risk reduction for patients while easing the burden on health services. In multidimensional phenotyping, we discuss alternatives to the apnoea hypopnoea index (AHI) as a measure of OSA severity. Then we consider risk stratification taking advantage of the wealth of CPAP monitoring data already available in databases that can now be exploited using AI and machine learning to direct (stratify) patients into appropriate follow-up management pathways. Integrated care clinics for high-risk patients We look at the role of integrated OSA care clinics particularly for the management of high-risk patients with low adherence and progression of comorbidities. Here, multidisciplinary teams might propose comorbidity management, and the use of connected wearable devices for long-term monitoring of physical activity, along with remote CPAP monitoring. Remote management pathways The pros and cons of remote management pathways to replace in-person follow-up visits are considered, including the need to re-evaluate CPAP-device reimbursement policies in some countries. While remote CPAP monitoring has become the cornerstone of follow-up providing information on adherence and efficacy, the processing of alerts needs to be improved, particularly regarding mask changes and early detection of CPAP failures. Challenges The implementation of CPAP monitoring alone, as well as its extension to multimodal monitoring, can present challenges that remain to be addressed (eg, access to digital care). The extent and components of remote follow-up must be adapted to each specific OSA phenotype. Finally, we give examples of certain patient phenotypes (eg, comorbid insomnia with OSA) with specific follow-up requirements, for which remote (even mult","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"29 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142815504","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 : 2024-12-09DOI: 10.1136/thorax-2024-222662
Emily L Graul, Christer Janson
Asthma affects over 20 million (8%) of adults in the United States (US) each year.1 2 As with many chronic conditions, poor control can be attributed to low medication adherence and a reduced quality of life, and can translate into a high burden on the healthcare system and economy.3 4 Of importance is cost-related medication nonadherence, as people face heavy financial barriers to accessing US healthcare, on top of the chronic condition itself posing a major financial burden. Prescribed medications make up a considerable proportion of chronic disease spending in the US, particularly for asthma-related spending (~50% of asthma spending).4 Therefore, efforts to reduce cost-related medication nonadherence not only lessen the financial burden on the US health system but also support people’s ability to improve their disease symptoms. Recent research looking at cost-related medication nonadherence among people experiencing chronic disease has focused on coronary heart disease,5 liver disease,6 and chronic obstructive pulmonary disease (COPD)7 for example, but less so for asthma. Therefore in this issue of Thorax , Hung et al 8 fill the knowledge gap by conducting a study investigating the burden of cost-related medication nonadherence among a representative sample of 30 793 people with current asthma in the US. Using questionnaire data from the National Health Interview Survey (NHIS) from 2011 to 2022, the authors were specifically interested in examining the yearly trends in prevalence of cost-related medication nonadherence, the factors associated with cost-related medication nonadherence, and the association …
{"title":"Cost-related nonadherence to medication among people with asthma in the United States: findings that reinforce the relevance of history and healthcare reform","authors":"Emily L Graul, Christer Janson","doi":"10.1136/thorax-2024-222662","DOIUrl":"https://doi.org/10.1136/thorax-2024-222662","url":null,"abstract":"Asthma affects over 20 million (8%) of adults in the United States (US) each year.1 2 As with many chronic conditions, poor control can be attributed to low medication adherence and a reduced quality of life, and can translate into a high burden on the healthcare system and economy.3 4 Of importance is cost-related medication nonadherence, as people face heavy financial barriers to accessing US healthcare, on top of the chronic condition itself posing a major financial burden. Prescribed medications make up a considerable proportion of chronic disease spending in the US, particularly for asthma-related spending (~50% of asthma spending).4 Therefore, efforts to reduce cost-related medication nonadherence not only lessen the financial burden on the US health system but also support people’s ability to improve their disease symptoms. Recent research looking at cost-related medication nonadherence among people experiencing chronic disease has focused on coronary heart disease,5 liver disease,6 and chronic obstructive pulmonary disease (COPD)7 for example, but less so for asthma. Therefore in this issue of Thorax , Hung et al 8 fill the knowledge gap by conducting a study investigating the burden of cost-related medication nonadherence among a representative sample of 30 793 people with current asthma in the US. Using questionnaire data from the National Health Interview Survey (NHIS) from 2011 to 2022, the authors were specifically interested in examining the yearly trends in prevalence of cost-related medication nonadherence, the factors associated with cost-related medication nonadherence, and the association …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"9 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142797106","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 : 2024-12-09DOI: 10.1136/thorax-2024-221778
Chun-Tse Hung, Steven R Erickson, Chung-Hsuen Wu
Background Uncontrolled asthma is possibly caused by medication non-adherence, and financial hardship can be a major contributor to non-adherence. Since economic conditions and asthma management have changed over time, a comprehensive investigation of cost-related medication non-adherence (CRN) among adults with asthma is crucial. Objective To evaluate trends, prevalence and determinants of CRN, and its impact on asthma control among US adults with asthma. Methods Data from 2011 to 2022 National Health Interview Survey were used. Joinpoint regression analysis was used to evaluate trends in the prevalence of CRN. A multivariable logistic regression model was used to identify factors associated with CRN. Two additional multivariable logistic regression models were used to examine associations between CRN and asthma-related adverse events, including asthma attacks and emergency room (ER) visits for asthma. Results A total of 30 793 adults with asthma were included, representing 8.1% (19.38 million) of the US population. From 2011 to 2022, a declining trend in the prevalence of CRN among US adults with asthma was observed. Approximately every one in six adults with asthma was non-adherent to medications due to cost. Several factors, including demographics and comorbidities, were associated with CRN. Adults with asthma who had CRN were at an increased risk of experiencing asthma attacks (adjusted OR, 1.95; 95% CI 1.78 to 2.13) and ER visits for asthma (adjusted OR, 1.63; 95% CI 1.44 to 1.84). Conclusion Since asthma is one of the leading chronic diseases, the burden of cost-related non-adherence to medications highlights the need for appropriate policies and social supports to address such problems. No data are available.
背景：不受控制的哮喘可能是由不坚持服药引起的，而经济困难可能是不坚持服药的主要原因。由于经济条件和哮喘管理随着时间的推移发生了变化，因此对成人哮喘患者中与费用相关的药物依从性（CRN）进行全面调查至关重要。目的评估美国成人哮喘患者CRN的趋势、患病率和决定因素及其对哮喘控制的影响。方法采用2011 ~ 2022年全国健康访谈调查资料。采用联合点回归分析评估CRN患病率的趋势。采用多变量logistic回归模型确定与CRN相关的因素。另外两个多变量logistic回归模型用于检验CRN与哮喘相关不良事件（包括哮喘发作和哮喘急诊室就诊）之间的关系。结果共纳入30793例成人哮喘患者，占美国人口的8.1%（1938万）。从2011年到2022年，观察到美国成人哮喘患者中CRN患病率呈下降趋势。大约六分之一的成人哮喘患者由于费用原因不坚持服药。包括人口统计学和合并症在内的几个因素与CRN有关。患有CRN的成人哮喘患者发生哮喘发作的风险增加(校正OR， 1.95；95% CI 1.78 - 2.13)和哮喘病急诊室就诊(调整OR为1.63；95% CI 1.44 - 1.84)。结论由于哮喘是主要的慢性疾病之一，与费用相关的药物依从性负担突出表明需要适当的政策和社会支持来解决这一问题。无数据。
{"title":"Cost-related non-adherence to medications among adults with asthma in the USA, 2011–2022","authors":"Chun-Tse Hung, Steven R Erickson, Chung-Hsuen Wu","doi":"10.1136/thorax-2024-221778","DOIUrl":"https://doi.org/10.1136/thorax-2024-221778","url":null,"abstract":"Background Uncontrolled asthma is possibly caused by medication non-adherence, and financial hardship can be a major contributor to non-adherence. Since economic conditions and asthma management have changed over time, a comprehensive investigation of cost-related medication non-adherence (CRN) among adults with asthma is crucial. Objective To evaluate trends, prevalence and determinants of CRN, and its impact on asthma control among US adults with asthma. Methods Data from 2011 to 2022 National Health Interview Survey were used. Joinpoint regression analysis was used to evaluate trends in the prevalence of CRN. A multivariable logistic regression model was used to identify factors associated with CRN. Two additional multivariable logistic regression models were used to examine associations between CRN and asthma-related adverse events, including asthma attacks and emergency room (ER) visits for asthma. Results A total of 30 793 adults with asthma were included, representing 8.1% (19.38 million) of the US population. From 2011 to 2022, a declining trend in the prevalence of CRN among US adults with asthma was observed. Approximately every one in six adults with asthma was non-adherent to medications due to cost. Several factors, including demographics and comorbidities, were associated with CRN. Adults with asthma who had CRN were at an increased risk of experiencing asthma attacks (adjusted OR, 1.95; 95% CI 1.78 to 2.13) and ER visits for asthma (adjusted OR, 1.63; 95% CI 1.44 to 1.84). Conclusion Since asthma is one of the leading chronic diseases, the burden of cost-related non-adherence to medications highlights the need for appropriate policies and social supports to address such problems. No data are available.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"2 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142797107","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 : 2024-12-05DOI: 10.1136/thorax-2024-221928
Tjeerd van der Veer, Eleni-Rosalina Andrinopoulou, Gert-Jan Braunstahl, Jean Paul Charbonnier, Victor Kim, Rudolfs Latisenko, David A Lynch, Harm Tiddens
In this cohort study involving 9399 current and former smokers from the Genetic Epidemiology of Chronic Obstructive Pulmonary Disease study, we assessed the relationship between artificial intelligence-quantified mucus plugs on chest CTs and all-cause mortality. Our results revealed a significant positive association, particularly for those with COPD GOLD stages 1–4, with HRs of 1.18 for 1–2 mucus-obstructed bronchial segments and 1.27 for ≥3 obstructed segments. This corroborates previous visual mucus plug counting research and demonstrates the relevance of mucus plugs in COPD pathology and as a marker for risk assessment. Automated mucus plug quantification methods may provide an efficient tool for both clinical evaluations and research.
{"title":"Association between automatic AI-based quantification of airway-occlusive mucus plugs and all-cause mortality in patients with COPD","authors":"Tjeerd van der Veer, Eleni-Rosalina Andrinopoulou, Gert-Jan Braunstahl, Jean Paul Charbonnier, Victor Kim, Rudolfs Latisenko, David A Lynch, Harm Tiddens","doi":"10.1136/thorax-2024-221928","DOIUrl":"https://doi.org/10.1136/thorax-2024-221928","url":null,"abstract":"In this cohort study involving 9399 current and former smokers from the Genetic Epidemiology of Chronic Obstructive Pulmonary Disease study, we assessed the relationship between artificial intelligence-quantified mucus plugs on chest CTs and all-cause mortality. Our results revealed a significant positive association, particularly for those with COPD GOLD stages 1–4, with HRs of 1.18 for 1–2 mucus-obstructed bronchial segments and 1.27 for ≥3 obstructed segments. This corroborates previous visual mucus plug counting research and demonstrates the relevance of mucus plugs in COPD pathology and as a marker for risk assessment. Automated mucus plug quantification methods may provide an efficient tool for both clinical evaluations and research.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"22 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142783319","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：