Pub Date : 2025-11-03DOI: 10.1136/thorax-2025-224151
Anne Elizabeth Ioannides,Jennifer K Quint
{"title":"Feast of data and methods: how advancing epidemiology brings COPD, diet and plasma proteomics to the table.","authors":"Anne Elizabeth Ioannides,Jennifer K Quint","doi":"10.1136/thorax-2025-224151","DOIUrl":"https://doi.org/10.1136/thorax-2025-224151","url":null,"abstract":"","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"35 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145434019","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 : 2025-11-01DOI: 10.1136/thorax-2025-224248
Inês Duarte
High-flow nasal therapy (HFT) is a non-invasive respiratory support widely used in hypoxemic respiratory failure. However, evidence of HFT in hypercapnic patients, particularly in chronic obstructive pulmonary disease (COPD) exacerbations, remains limited. A recent prospective, randomised, single-centre study by Haciosman et al (Am J Emerg Med 2025; DOI:10.1016 /j.ajem.2024.10.043) compared HFT at 30 L/min, HFT at 50 L/min, and non-invasive ventilation (NIV) in 137 patients admitted to the emergency department with acute COPD exacerbation, hypercapnic respiratory failure with respiratory acidosis, and no response to initial bronchodilators and corticosteroids. Primary outcomes were blood gas changes (pH, PaCO₂, lactate, bicarbonate) at baseline, 30, 60, and 120 min. Secondary outcomes included the need for intubation, ICU admission, hospital stay, and 28-day mortality. All modalities showed comparable efficacy in reducing PaCO₂ and improving pH at 30 and 120 min. However, HFT at 30 L/min led to a significantly greater reduction in PaCO₂ at 60 min (p=0.042), contrasting with previous studies where HFT showed no superiority. No significant differences were observed in intubation rates, mortality, or bicarbonate levels (possibly due to short follow-up). Use of HFT at 30 L/min was associated with higher patient satisfaction and greater emergency department discharge rates than NIV (p=0.018 and p=0.002, respectively), …
{"title":"Journal club","authors":"Inês Duarte","doi":"10.1136/thorax-2025-224248","DOIUrl":"https://doi.org/10.1136/thorax-2025-224248","url":null,"abstract":"High-flow nasal therapy (HFT) is a non-invasive respiratory support widely used in hypoxemic respiratory failure. However, evidence of HFT in hypercapnic patients, particularly in chronic obstructive pulmonary disease (COPD) exacerbations, remains limited. A recent prospective, randomised, single-centre study by Haciosman et al (Am J Emerg Med 2025; DOI:10.1016 /j.ajem.2024.10.043) compared HFT at 30 L/min, HFT at 50 L/min, and non-invasive ventilation (NIV) in 137 patients admitted to the emergency department with acute COPD exacerbation, hypercapnic respiratory failure with respiratory acidosis, and no response to initial bronchodilators and corticosteroids. Primary outcomes were blood gas changes (pH, PaCO₂, lactate, bicarbonate) at baseline, 30, 60, and 120 min. Secondary outcomes included the need for intubation, ICU admission, hospital stay, and 28-day mortality. All modalities showed comparable efficacy in reducing PaCO₂ and improving pH at 30 and 120 min. However, HFT at 30 L/min led to a significantly greater reduction in PaCO₂ at 60 min (p=0.042), contrasting with previous studies where HFT showed no superiority. No significant differences were observed in intubation rates, mortality, or bicarbonate levels (possibly due to short follow-up). Use of HFT at 30 L/min was associated with higher patient satisfaction and greater emergency department discharge rates than NIV (p=0.018 and p=0.002, respectively), …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"63 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145288245","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 : 2025-10-31DOI: 10.1136/thorax-2024-222052
Maya Arnould, Mark D J Neilly, Kevin G Blyth, Didier Jean
Background Pleural mesothelioma (PM) is characterised by marked heterogeneity, both clinically in terms of survival and response to treatment, and in terms of histology and molecular status. Development of novel therapies, stratified treatment pathways and a better understanding of resistance mechanisms are urgently needed. This requires an in-depth understanding of the multiple sources of heterogeneity affecting tumour cells and the tumour microenvironment. Methods and results This review, which synthesises the key studies available in the literature, provides a detailed description of the current state of the art regarding heterogeneity in PM. After an overview of the general molecular landscape and a summary of heterogeneity between patients (intertumour heterogeneity), we review sources of variation within an individual patient’s tumour (intratumour heterogeneity). This section covers both the local heterogeneity classically reported in other tumours and the anatomical heterogeneity, which is more profound in PM given the large pleural surface area over which the disease develops and progresses. We also synthesise the available data on changes that develop over time (temporal heterogeneity). The various cellular and molecular sources of heterogeneity are also highlighted throughout each section, including histological variations, genomic and non-genomic molecular changes and variations in tumour, stromal and immune compartments. Conclusions The solid understanding of intertumour heterogeneity recently achieved has highlighted diverse molecular and cellular landscapes. However, this knowledge has yet to be effectively translated into clinical practice (eg, diagnostic classification, treatment allocation, trial design). Further research is needed for a better comprehension of intratumour heterogeneity, including characterisation of local tumour-immune-stromal interactions, including those based on anatomical position on the pleural surface. Efforts should also include dissection of intratumour heterogeneity in patients treated by immunotherapy, development of preclinical models that adequately capture heterogeneity and the investigation of clonality and tumour evolution over time.
{"title":"Intratumour, anatomical and temporal heterogeneity in mesothelioma","authors":"Maya Arnould, Mark D J Neilly, Kevin G Blyth, Didier Jean","doi":"10.1136/thorax-2024-222052","DOIUrl":"https://doi.org/10.1136/thorax-2024-222052","url":null,"abstract":"Background Pleural mesothelioma (PM) is characterised by marked heterogeneity, both clinically in terms of survival and response to treatment, and in terms of histology and molecular status. Development of novel therapies, stratified treatment pathways and a better understanding of resistance mechanisms are urgently needed. This requires an in-depth understanding of the multiple sources of heterogeneity affecting tumour cells and the tumour microenvironment. Methods and results This review, which synthesises the key studies available in the literature, provides a detailed description of the current state of the art regarding heterogeneity in PM. After an overview of the general molecular landscape and a summary of heterogeneity between patients (intertumour heterogeneity), we review sources of variation within an individual patient’s tumour (intratumour heterogeneity). This section covers both the local heterogeneity classically reported in other tumours and the anatomical heterogeneity, which is more profound in PM given the large pleural surface area over which the disease develops and progresses. We also synthesise the available data on changes that develop over time (temporal heterogeneity). The various cellular and molecular sources of heterogeneity are also highlighted throughout each section, including histological variations, genomic and non-genomic molecular changes and variations in tumour, stromal and immune compartments. Conclusions The solid understanding of intertumour heterogeneity recently achieved has highlighted diverse molecular and cellular landscapes. However, this knowledge has yet to be effectively translated into clinical practice (eg, diagnostic classification, treatment allocation, trial design). Further research is needed for a better comprehension of intratumour heterogeneity, including characterisation of local tumour-immune-stromal interactions, including those based on anatomical position on the pleural surface. Efforts should also include dissection of intratumour heterogeneity in patients treated by immunotherapy, development of preclinical models that adequately capture heterogeneity and the investigation of clonality and tumour evolution over time.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"47 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145411799","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 : 2025-10-31DOI: 10.1136/thorax-2025-223941
Tiffany Dwyer
I first started working as a physiotherapist in an adult cystic fibrosis (CF) clinic 25 years ago. I am not sure if the first patient I saw questioned me about the relative merits of exercise for airway clearance, but I guarantee that one of the first 20 would have asked something along the lines of, “My lungs feel so much clearer on the days I exercise, do I really have to do chest physio on those days too?” Back then, I could not give them much of an answer, as there were only a handful of small and very short-term studies that compared exercise to traditional airway clearance techniques (ACTs), which we then termed ‘chest physiotherapy’. Collectively, those studies suggested that exercise alone (ie, without encouraged huffing or coughing) was less effective for sputum expectoration than traditional ACTs,1–3 though when huffing or coughing was included with exercise, there were no significant differences.4 5 Since then, several more studies have been published comparing exercise to traditional ACTs, and results have been summarised in two systematic reviews.6 7 Though sample sizes remain small (n≤32) and only one pilot study had a duration of more than 2 weeks,8 their …
{"title":"How ExACTly does exercise compare as an alternative to traditional airway clearance techniques in people with cystic fibrosis?","authors":"Tiffany Dwyer","doi":"10.1136/thorax-2025-223941","DOIUrl":"https://doi.org/10.1136/thorax-2025-223941","url":null,"abstract":"I first started working as a physiotherapist in an adult cystic fibrosis (CF) clinic 25 years ago. I am not sure if the first patient I saw questioned me about the relative merits of exercise for airway clearance, but I guarantee that one of the first 20 would have asked something along the lines of, “My lungs feel so much clearer on the days I exercise, do I really have to do chest physio on those days too?” Back then, I could not give them much of an answer, as there were only a handful of small and very short-term studies that compared exercise to traditional airway clearance techniques (ACTs), which we then termed ‘chest physiotherapy’. Collectively, those studies suggested that exercise alone (ie, without encouraged huffing or coughing) was less effective for sputum expectoration than traditional ACTs,1–3 though when huffing or coughing was included with exercise, there were no significant differences.4 5 Since then, several more studies have been published comparing exercise to traditional ACTs, and results have been summarised in two systematic reviews.6 7 Though sample sizes remain small (n≤32) and only one pilot study had a duration of more than 2 weeks,8 their …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"71 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145411808","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 : 2025-10-30DOI: 10.1136/thorax-2025-223995
Gabriel Navarrete Fernandez, Joao Sakuray Pais, Eduardo Kaiser Ururahy Nunes Fonseca, Rogerio Souza
A 35-year-old female patient presented with a 3-month history of progressive dyspnoea. The patient reported that since the onset of symptoms, she experienced tachycardia, cyanosis and presyncope after light exertion. At that time, the patient underwent a chest CT angiography, which was positive for pulmonary thromboembolism. Following this diagnosis, the patient started anticoagulation with rivaroxaban. However, after 2 months of anticoagulation, she reported no improvement and looked for a second opinion. At our institution, repeat chest CT angiography demonstrated a nodular lesion in the region of the pulmonary valve (figure 1A, B), located along its left lateral aspect, measuring up to 3.2 cm and causing significant obstruction of the right ventricular outflow tract. The lesion extended to the left lateral wall of the pulmonary artery, where a small nodular component was identified at the origin of the left main pulmonary branch, …
{"title":"Pulmonary artery angiosarcoma","authors":"Gabriel Navarrete Fernandez, Joao Sakuray Pais, Eduardo Kaiser Ururahy Nunes Fonseca, Rogerio Souza","doi":"10.1136/thorax-2025-223995","DOIUrl":"https://doi.org/10.1136/thorax-2025-223995","url":null,"abstract":"A 35-year-old female patient presented with a 3-month history of progressive dyspnoea. The patient reported that since the onset of symptoms, she experienced tachycardia, cyanosis and presyncope after light exertion. At that time, the patient underwent a chest CT angiography, which was positive for pulmonary thromboembolism. Following this diagnosis, the patient started anticoagulation with rivaroxaban. However, after 2 months of anticoagulation, she reported no improvement and looked for a second opinion. At our institution, repeat chest CT angiography demonstrated a nodular lesion in the region of the pulmonary valve (figure 1A, B), located along its left lateral aspect, measuring up to 3.2 cm and causing significant obstruction of the right ventricular outflow tract. The lesion extended to the left lateral wall of the pulmonary artery, where a small nodular component was identified at the origin of the left main pulmonary branch, …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"158 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145404720","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 : 2025-10-30DOI: 10.1136/thorax-2025-223508
Giovanni Viegi,Stefania La Grutta
{"title":"Passive smoke exposure as an intergenerational risk factor for lung health.","authors":"Giovanni Viegi,Stefania La Grutta","doi":"10.1136/thorax-2025-223508","DOIUrl":"https://doi.org/10.1136/thorax-2025-223508","url":null,"abstract":"","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"80 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145403764","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 : 2025-10-30DOI: 10.1136/thorax-2025-224162
Donald P Tashkin,Kathryn H Melamed
{"title":"Comparative efficacy in smokers with versus without COPD: a new addition of an old drug to approved pharmacotherapy for smoking cessation.","authors":"Donald P Tashkin,Kathryn H Melamed","doi":"10.1136/thorax-2025-224162","DOIUrl":"https://doi.org/10.1136/thorax-2025-224162","url":null,"abstract":"","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"113 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145403766","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 : 2025-10-29DOI: 10.1136/thorax-2025-223421
Haopu Yang, Jingen Xia, Xu Huang, Yu Bai, Dan Jin, Seyed Mehdi Nouraie, Bryan J McVerry, Alison Morris, Georgios D Kitsios, Chen Wang, Qingyuan Zhan
Purpose Subphenotype classifiers for acute respiratory distress syndrome (ARDS) dichotomise patients into hyperinflammatory versus hypoinflammatory subgroups. These models demonstrated prognostic and predictive values but were developed primarily in Caucasian populations. Generalisability of these models in Asian patients, who experience worse clinical outcomes, has not been established. We aimed to profile host responses in Asian patients with ARDS and evaluate the generalisability of established classifiers in this understudied population compared with a Caucasian cohort. Methods We prospectively enrolled patients with ARDS from medical intensive care units in Beijing, China, and Pittsburgh, Pennsylvania, USA. In the Beijing cohort, 37 protein biomarkers were measured, with 10 overlapping biomarkers measured in the Pittsburgh cohort. Six established subphenotype models were assessed for generalisability and intermodel agreement. Sensitivity analyses, including latent class analysis, were conducted to explore biological heterogeneity within Asians. Results Between 2011 and 2020, a total of 356 patients with ARDS (83% meeting the Berlin Definition; the rest on high-flow nasal cannula (HFNC) meeting the New Global Definition) were enrolled across Beijing (97% Han Asian) and Pittsburgh (90% Caucasian) sites, with comparable baseline hypoxaemia severity but disparate outcome. While the proportion of hyperinflammatory versus hypoinflammatory subphenotypes was predicted to be overall similar across different cohorts per each model, we observed poor intermodel agreement. We observed heightened inflammation in Berlin patients with ARDS compared with HFNC-ARDS within our Asian cohort. Conclusion Established subphenotype classifiers demonstrated similar distribution of subphenotypes in Asian patients with ARDS. However, poor intermodel agreement highlights the need for further investigation into model variability with models coming closer to bedside implementation. Trial registration number [NCT02975908][1]. Data are available upon reasonable request. Desensitised data for Beijing cohort, including demographics, biomarker measurement, as well as code for analyses, are available upon reasonable request (QZ (drzhanqy{at}163.com)). Pittsburgh cohort data availability as previously described. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT02975908&atom=%2Fthoraxjnl%2Fearly%2F2025%2F10%2F29%2Fthorax-2025-223421.atom
{"title":"Generalisability of ARDS biological subphenotype models in Asians: an international, multicentre, prospective biomarker study","authors":"Haopu Yang, Jingen Xia, Xu Huang, Yu Bai, Dan Jin, Seyed Mehdi Nouraie, Bryan J McVerry, Alison Morris, Georgios D Kitsios, Chen Wang, Qingyuan Zhan","doi":"10.1136/thorax-2025-223421","DOIUrl":"https://doi.org/10.1136/thorax-2025-223421","url":null,"abstract":"Purpose Subphenotype classifiers for acute respiratory distress syndrome (ARDS) dichotomise patients into hyperinflammatory versus hypoinflammatory subgroups. These models demonstrated prognostic and predictive values but were developed primarily in Caucasian populations. Generalisability of these models in Asian patients, who experience worse clinical outcomes, has not been established. We aimed to profile host responses in Asian patients with ARDS and evaluate the generalisability of established classifiers in this understudied population compared with a Caucasian cohort. Methods We prospectively enrolled patients with ARDS from medical intensive care units in Beijing, China, and Pittsburgh, Pennsylvania, USA. In the Beijing cohort, 37 protein biomarkers were measured, with 10 overlapping biomarkers measured in the Pittsburgh cohort. Six established subphenotype models were assessed for generalisability and intermodel agreement. Sensitivity analyses, including latent class analysis, were conducted to explore biological heterogeneity within Asians. Results Between 2011 and 2020, a total of 356 patients with ARDS (83% meeting the Berlin Definition; the rest on high-flow nasal cannula (HFNC) meeting the New Global Definition) were enrolled across Beijing (97% Han Asian) and Pittsburgh (90% Caucasian) sites, with comparable baseline hypoxaemia severity but disparate outcome. While the proportion of hyperinflammatory versus hypoinflammatory subphenotypes was predicted to be overall similar across different cohorts per each model, we observed poor intermodel agreement. We observed heightened inflammation in Berlin patients with ARDS compared with HFNC-ARDS within our Asian cohort. Conclusion Established subphenotype classifiers demonstrated similar distribution of subphenotypes in Asian patients with ARDS. However, poor intermodel agreement highlights the need for further investigation into model variability with models coming closer to bedside implementation. Trial registration number [NCT02975908][1]. Data are available upon reasonable request. Desensitised data for Beijing cohort, including demographics, biomarker measurement, as well as code for analyses, are available upon reasonable request (QZ (drzhanqy{at}163.com)). Pittsburgh cohort data availability as previously described. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT02975908&atom=%2Fthoraxjnl%2Fearly%2F2025%2F10%2F29%2Fthorax-2025-223421.atom","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"61 30 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145396916","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}
BACKGROUNDNumerous studies have found associations between parental socio-economic position (SEP) and offspring asthma. Obesity and tobacco smoking during pregnancy (SDP) are more prevalent in lower SEP groups and have been identified as risk factors for childhood asthma.AIMThe aim of this study was to explore and quantify the role of the modifiable risk factors-obesity, body mass index (BMI) and SDP-in the association between maternal SEP and offspring asthma.METHODSThis Swedish register-based cohort study included n=1 265 933 children born between 2006 and 2018, with information on asthma during the third and sixth years of life obtained from the National Patient Register and the Swedish Prescribed Drug Register. Maternal education was used as a measure of SEP. We used logistic regression to estimate exposure-outcome associations and applied the counterfactual approach to mediation analysis to estimate the proportion of the maternal SEP-offspring asthma association that could be explained by maternal obesity, BMI and SDP, with and without adjustment for birth year.RESULTThe OR was 1.15 (95% CI 1.13 to 1.16) for the association between maternal education and asthma during the third year of life and slightly lower during the sixth year (OR 1.09, 95% CI 1.07 to 1.10). Out of the excess risks, 20%-30% could be explained by obesity or BMI through mediation and mediated interaction, while 15%-20% could be explained by SDP.CONCLUSIONOur results indicate that supporting young women and mothers-to-be to healthy weight and to abstain from tobacco smoking, in particular during pregnancy, could reduce child morbidity and improve health equity in childhood.
大量研究发现父母社会经济地位（SEP）与后代哮喘之间存在关联。妊娠期肥胖和吸烟（SDP）在低SEP组中更为普遍，并已被确定为儿童哮喘的危险因素。目的探讨肥胖、体重指数（BMI）和sdp这三个可改变的危险因素在母亲SEP与后代哮喘的关系中所起的作用。方法：这项以瑞典登记为基础的队列研究纳入了2006年至2018年间出生的n= 1265933名儿童，其生命第3年和第6年的哮喘信息来自国家患者登记和瑞典处方药登记。我们使用母亲受教育程度作为SEP的衡量标准。我们使用逻辑回归来估计暴露与结果的关联，并应用反事实方法进行中介分析，以估计母亲肥胖、BMI和SDP可以解释的母亲SEP与后代哮喘的关联比例，无论是否对出生年份进行调整。结果母亲教育程度与出生后第3年哮喘相关的OR为1.15 (95% CI 1.13 ~ 1.16)，第6年的OR略低（OR 1.09, 95% CI 1.07 ~ 1.10）。在过量风险中，20%-30%可由肥胖或BMI通过中介和介导的相互作用解释，15%-20%可由SDP解释。结论支持年轻妇女和准妈妈保持健康体重和戒烟，特别是在怀孕期间，可以降低儿童发病率，改善儿童健康公平。
{"title":"Maternal BMI and smoking partly explain the association between maternal socio-economic position and offspring asthma.","authors":"Cecilia Lundholm,Emma Caffrey Osvald,Samuel Rhedin,Catarina Almqvist","doi":"10.1136/thorax-2025-223330","DOIUrl":"https://doi.org/10.1136/thorax-2025-223330","url":null,"abstract":"BACKGROUNDNumerous studies have found associations between parental socio-economic position (SEP) and offspring asthma. Obesity and tobacco smoking during pregnancy (SDP) are more prevalent in lower SEP groups and have been identified as risk factors for childhood asthma.AIMThe aim of this study was to explore and quantify the role of the modifiable risk factors-obesity, body mass index (BMI) and SDP-in the association between maternal SEP and offspring asthma.METHODSThis Swedish register-based cohort study included n=1 265 933 children born between 2006 and 2018, with information on asthma during the third and sixth years of life obtained from the National Patient Register and the Swedish Prescribed Drug Register. Maternal education was used as a measure of SEP. We used logistic regression to estimate exposure-outcome associations and applied the counterfactual approach to mediation analysis to estimate the proportion of the maternal SEP-offspring asthma association that could be explained by maternal obesity, BMI and SDP, with and without adjustment for birth year.RESULTThe OR was 1.15 (95% CI 1.13 to 1.16) for the association between maternal education and asthma during the third year of life and slightly lower during the sixth year (OR 1.09, 95% CI 1.07 to 1.10). Out of the excess risks, 20%-30% could be explained by obesity or BMI through mediation and mediated interaction, while 15%-20% could be explained by SDP.CONCLUSIONOur results indicate that supporting young women and mothers-to-be to healthy weight and to abstain from tobacco smoking, in particular during pregnancy, could reduce child morbidity and improve health equity in childhood.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"356 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145381209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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