Pub Date : 2025-12-02DOI: 10.1136/thorax-2025-223718
Maja Popovic,Milena Maule,Chiara Moccia,Elena Isaevska,Demetris Avraam,Tim Cadman,Ahmed Elhakeem,Veit Grote,Kathrin Guerlich,Sido Haakma,Jennifer Ruth Harris,Pauline W Jansen,Johanna Lucia Thorbjørnsrud Nader,Angela Pinot de Moira,Katrine Strandberg-Larsen,Morris Swertz,Marieke Welten,Tiffany Yang,Vincent Jaddoe,Liesbeth Duijts,Lorenzo Richiardi
BACKGROUNDWhile maternal depression and anxiety have been linked to adverse childhood respiratory outcomes, the role of eating disorders (EDs) remains less understood. This study examined associations between maternal EDs and offspring respiratory outcomes, considering ED subtypes, exposure windows and comorbid depression/anxiety.METHODSData from 131 495 mother-child pairs across seven cohorts from the EU Child Cohort Network were analysed. Primary analyses assessed associations between maternal pre-pregnancy EDs and preschool wheezing and school-age asthma. Secondary analyses explored associations in women without comorbid depression/anxiety, specific ED subtypes (anorexia nervosa, bulimia nervosa), exposure periods (pregnancy, post-pregnancy) and - within two cohorts - school-age lung function. Logistic regression models were fitted for each cohort, and results pooled using random-effects meta-analysis.RESULTSMaternal pre-pregnancy ED prevalence ranged from 0.8% (health records) to 17.0% (self-reported lifetime EDs). Preschool wheezing prevalence ranged from 20.7% to 49.6%, and school-age asthma from 2.1% to 17.3%. Pre-pregnancy EDs were associated with preschool wheezing (OR: 1.25, 95% CI: 1.06 to 1.47, I2: 74%) and school-age asthma (OR: 1.26, 95% CI: 1.10 to 1.46, I2: 9%). These estimates were slightly attenuated but remained directionally consistent with the main analyses after exclusion of mothers with depression/anxiety. There was evidence of a weak positive association with lung function. Associations across ED subtypes were largely consistent with the pre-pregnancy any ED estimate, while no clear pattern emerged by timing of exposure.CONCLUSIONSMaternal EDs are associated with a higher risk of wheezing and asthma in children, independently of comorbid depression/anxiety. These findings highlight the need to understand mechanisms and long-term respiratory consequences of maternal EDs to inform interventions for improving offspring respiratory health.
{"title":"Maternal eating disorders and respiratory outcomes in childhood: findings from the EU Child Cohort Network.","authors":"Maja Popovic,Milena Maule,Chiara Moccia,Elena Isaevska,Demetris Avraam,Tim Cadman,Ahmed Elhakeem,Veit Grote,Kathrin Guerlich,Sido Haakma,Jennifer Ruth Harris,Pauline W Jansen,Johanna Lucia Thorbjørnsrud Nader,Angela Pinot de Moira,Katrine Strandberg-Larsen,Morris Swertz,Marieke Welten,Tiffany Yang,Vincent Jaddoe,Liesbeth Duijts,Lorenzo Richiardi","doi":"10.1136/thorax-2025-223718","DOIUrl":"https://doi.org/10.1136/thorax-2025-223718","url":null,"abstract":"BACKGROUNDWhile maternal depression and anxiety have been linked to adverse childhood respiratory outcomes, the role of eating disorders (EDs) remains less understood. This study examined associations between maternal EDs and offspring respiratory outcomes, considering ED subtypes, exposure windows and comorbid depression/anxiety.METHODSData from 131 495 mother-child pairs across seven cohorts from the EU Child Cohort Network were analysed. Primary analyses assessed associations between maternal pre-pregnancy EDs and preschool wheezing and school-age asthma. Secondary analyses explored associations in women without comorbid depression/anxiety, specific ED subtypes (anorexia nervosa, bulimia nervosa), exposure periods (pregnancy, post-pregnancy) and - within two cohorts - school-age lung function. Logistic regression models were fitted for each cohort, and results pooled using random-effects meta-analysis.RESULTSMaternal pre-pregnancy ED prevalence ranged from 0.8% (health records) to 17.0% (self-reported lifetime EDs). Preschool wheezing prevalence ranged from 20.7% to 49.6%, and school-age asthma from 2.1% to 17.3%. Pre-pregnancy EDs were associated with preschool wheezing (OR: 1.25, 95% CI: 1.06 to 1.47, I2: 74%) and school-age asthma (OR: 1.26, 95% CI: 1.10 to 1.46, I2: 9%). These estimates were slightly attenuated but remained directionally consistent with the main analyses after exclusion of mothers with depression/anxiety. There was evidence of a weak positive association with lung function. Associations across ED subtypes were largely consistent with the pre-pregnancy any ED estimate, while no clear pattern emerged by timing of exposure.CONCLUSIONSMaternal EDs are associated with a higher risk of wheezing and asthma in children, independently of comorbid depression/anxiety. These findings highlight the need to understand mechanisms and long-term respiratory consequences of maternal EDs to inform interventions for improving offspring respiratory health.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"6 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145656838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1136/thorax-2025-224421
Andrew Harries
Following critical illness requiring intubation, a key step in recovery is liberation from mechanical ventilation. There is a risk during this process of developing postextubation acute respiratory failure (PRF) leading to reintubation. The WIN IN WEAN multicentre randomised controlled trial (Rouby et al. JAMA 2025 doi:10.1001/jama.2024.15815) used a lung ultrasound score (LUS) to characterise the risk of PRF. They identified high risk patients (lung ultrasound score>14) and randomised to receiving intermittent HFNO and NIV (intervention) or conventional oxygen (control) on extubation in the hope of preventing PRF. Importantly the authors excluded patients with known COPD and attempted to optimise other patient characteristics that are known to influence extubation success (successful spontaneous breathing trial, pleural effusion management, fluid balance management, suction of secretions and analysis for bacterial infection.) The intervention arm included 134 patients with 106 in the control group. The primary outcome was met and the incidence of PRF was significantly reduced in the intervention group (28% vs 19%, p = 0.01). The secondary outcomes of reduction in intubation rates and mortality were not met; the study was powered to see a difference in PRF and may have been underpowered to see differences in these outcomes. Rescue …
在需要插管的危重疾病之后，恢复的关键步骤是从机械通气中解放出来。在此过程中存在发生拔管后急性呼吸衰竭（PRF）导致重新插管的风险。WIN IN断奶多中心随机对照试验（Rouby et al.）。JAMA 2025 doi:10.1001/ JAMA .2024.15815)使用肺超声评分（LUS）来表征PRF的风险。他们确定了高风险患者（肺超声评分为bbbb14），并随机分为两组，在拔管时接受间歇性HFNO和NIV（干预）或常规氧（控制），以期预防PRF。重要的是，作者排除了已知的COPD患者，并试图优化已知影响拔管成功的其他患者特征（成功的自主呼吸试验、胸腔积液管理、液体平衡管理、分泌物吸引和细菌感染分析）。干预组包括134例患者，对照组106例。干预组达到主要终点，PRF发生率显著降低（28% vs 19%, p = 0.01）。降低插管率和死亡率的次要结局未达到；这项研究被用来观察PRF的差异，但可能没有足够的证据来观察这些结果的差异。救援……
{"title":"Journal club","authors":"Andrew Harries","doi":"10.1136/thorax-2025-224421","DOIUrl":"https://doi.org/10.1136/thorax-2025-224421","url":null,"abstract":"Following critical illness requiring intubation, a key step in recovery is liberation from mechanical ventilation. There is a risk during this process of developing postextubation acute respiratory failure (PRF) leading to reintubation. The WIN IN WEAN multicentre randomised controlled trial (Rouby et al. JAMA 2025 doi:10.1001/jama.2024.15815) used a lung ultrasound score (LUS) to characterise the risk of PRF. They identified high risk patients (lung ultrasound score>14) and randomised to receiving intermittent HFNO and NIV (intervention) or conventional oxygen (control) on extubation in the hope of preventing PRF. Importantly the authors excluded patients with known COPD and attempted to optimise other patient characteristics that are known to influence extubation success (successful spontaneous breathing trial, pleural effusion management, fluid balance management, suction of secretions and analysis for bacterial infection.) The intervention arm included 134 patients with 106 in the control group. The primary outcome was met and the incidence of PRF was significantly reduced in the intervention group (28% vs 19%, p = 0.01). The secondary outcomes of reduction in intubation rates and mortality were not met; the study was powered to see a difference in PRF and may have been underpowered to see differences in these outcomes. Rescue …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"54 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145509296","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 : 2025-11-27DOI: 10.1136/thorax-2025-223457
Tracy A Smith,Mary M Roberts,Tim Luckett,Jin-Gun Cho,Ester Klimkeit,Heather Stephenson,Nicola McCaffery,Adrienne Kirby,John R Wheatley
BACKGROUNDChronic obstructive pulmonary disease (COPD) is an often-progressive respiratory disease associated with disabling breathlessness. Breathlessness intervention services (BIS), which coach patients to self-manage breathlessness using non-pharmacological strategies, are effective in a variety of populations, including those with cancer and serious respiratory disease. This study aimed to compare the impact of the Westmead Breathlessness Service in people with moderate to severe COPD.METHODSWe analysed 113 participants randomised (1:1) with moderate/severe COPD (forced expiratory volume in 1 s (FEV1)/forced vital capacity <0.70 and FEV1 ≤60% predicted) and disabling breathlessness (modified Medical Research Council (mMRC) Breathlessness Score ≥2) to either an 8-week intervention involving breathing techniques, handheld fan use, exercise, energy conservation, dietetic advice (n=54) or 8-week wait-list control group (n=59). The primary outcome was change in Chronic Respiratory Questionnaire (CRQ) Mastery of breathlessness subscale. Secondary outcomes included change in other CRQ subscales (Fatigue, Emotion and Dyspnoea), exertional breathlessness intensity/unpleasantness (0-10 Numerical Rating Scale Score), anxiety and depression. Difference in change over 8 weeks between groups was compared using ANCOVA; p<0.05 statistically significant.FINDINGSParticipants were aged 70.9 (±8.5) years, 50% female, mean FEV1 =0.8 L (±0.3 L; 34% predicted), mMRC Breathlessness Score 3 (IQR 3-4). CRQ-Mastery improved following intervention compared with control (between-group difference 0.5 units; 95% CI 0.2 to 0.8; p=0.0262) using modified intention-to-treat analysis. Better CRQ-Dyspnoea and CRQ-Fatigue were seen in the intervention group (between-group difference-CRQ-Dyspnoea 0.4 units; CI 0.1 to 0.7; p=0.005, and CRQ-Fatigue 0.4 units; CI 0.1 to 0.7; p=0.014). Exertional breathlessness intensity (difference -0.8 units; CI -1.4 to -0.2; p=0.013) and breathlessness unpleasantness (difference -1.2 units; CI -1.7 to -0.6; p=0.001) also improved.INTERPRETATIONAn 8-week BIS improved CRQ-Mastery, Dyspnoea and Fatigue, exertional breathlessness intensity and unpleasantness in people with severe COPD.
{"title":"Multidisciplinary, non-pharmacological breathlessness intervention service for patients with moderately severe to severe COPD: a randomised controlled trial.","authors":"Tracy A Smith,Mary M Roberts,Tim Luckett,Jin-Gun Cho,Ester Klimkeit,Heather Stephenson,Nicola McCaffery,Adrienne Kirby,John R Wheatley","doi":"10.1136/thorax-2025-223457","DOIUrl":"https://doi.org/10.1136/thorax-2025-223457","url":null,"abstract":"BACKGROUNDChronic obstructive pulmonary disease (COPD) is an often-progressive respiratory disease associated with disabling breathlessness. Breathlessness intervention services (BIS), which coach patients to self-manage breathlessness using non-pharmacological strategies, are effective in a variety of populations, including those with cancer and serious respiratory disease. This study aimed to compare the impact of the Westmead Breathlessness Service in people with moderate to severe COPD.METHODSWe analysed 113 participants randomised (1:1) with moderate/severe COPD (forced expiratory volume in 1 s (FEV1)/forced vital capacity <0.70 and FEV1 ≤60% predicted) and disabling breathlessness (modified Medical Research Council (mMRC) Breathlessness Score ≥2) to either an 8-week intervention involving breathing techniques, handheld fan use, exercise, energy conservation, dietetic advice (n=54) or 8-week wait-list control group (n=59). The primary outcome was change in Chronic Respiratory Questionnaire (CRQ) Mastery of breathlessness subscale. Secondary outcomes included change in other CRQ subscales (Fatigue, Emotion and Dyspnoea), exertional breathlessness intensity/unpleasantness (0-10 Numerical Rating Scale Score), anxiety and depression. Difference in change over 8 weeks between groups was compared using ANCOVA; p<0.05 statistically significant.FINDINGSParticipants were aged 70.9 (±8.5) years, 50% female, mean FEV1 =0.8 L (±0.3 L; 34% predicted), mMRC Breathlessness Score 3 (IQR 3-4). CRQ-Mastery improved following intervention compared with control (between-group difference 0.5 units; 95% CI 0.2 to 0.8; p=0.0262) using modified intention-to-treat analysis. Better CRQ-Dyspnoea and CRQ-Fatigue were seen in the intervention group (between-group difference-CRQ-Dyspnoea 0.4 units; CI 0.1 to 0.7; p=0.005, and CRQ-Fatigue 0.4 units; CI 0.1 to 0.7; p=0.014). Exertional breathlessness intensity (difference -0.8 units; CI -1.4 to -0.2; p=0.013) and breathlessness unpleasantness (difference -1.2 units; CI -1.7 to -0.6; p=0.001) also improved.INTERPRETATIONAn 8-week BIS improved CRQ-Mastery, Dyspnoea and Fatigue, exertional breathlessness intensity and unpleasantness in people with severe COPD.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"146 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145613255","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 : 2025-11-27DOI: 10.1136/thorax-2025-223921
Aparna Balasubramanian,Anna R Hemnes,Evan L Brittain,Jeffrey Annis,Ashraf Fawzy,Nirupama Putcha,Anil Singh,Robert A Wise,Nadia N Hansel,Catherine Simpson,Todd M Kolb,Paul M Hassoun,Meredith C McCormack,Stephen C Mathai
BACKGROUNDCurrent guidelines for the evaluation of chronic obstructive pulmonary disease (COPD) do not recommend screening for pulmonary hypertension (PH), despite the high prevalence and impact on outcomes. A simple screening tool to identify patients with an elevated pulmonary vascular resistance (PVR) is urgently needed, as they may benefit from PH-specific therapy and more urgent referral for lung transplantation.RESEARCH QUESTIONWe sought to examine whether a ratio of forced expiratory volume in 1 s (FEV1) to diffusing capacity (DLCO) predicts haemodynamic patterns in COPD.STUDY DESIGN AND METHODSIndividuals with COPD who underwent right heart catheterisation from two academic medical centres were included. Adjusted multinomial models tested associations between FEV1/DLCO and haemodynamic patterns. Receiver operating curves were generated to assess the discriminative performance of the FEV1/DLCO ratio in predicting PH with an elevated PVR.RESULTSApproximately 40% of the 411 individuals included had PH with an elevated PVR. For every 0.1 increase in the FEV1/DLCO ratio, there was a 12-14% increased rate of PH with an elevated PVR compared with No PH. FEV1/DLCO ratio had moderate discriminative performance (C-statistic 0.68-0.72), which was strengthened when combined in a model with elevated tricuspid regurgitant jet velocity on echocardiography (C-statistic 0.78-0.82). Above a threshold of 1.4, FEV1/DLCO demonstrated good specificity (75%) in predicting PH with an elevated PVR.INTERPRETATIONThese findings suggest that disproportionate reductions in DLCO predict PH with an elevated PVR in a COPD population. The FEV1/DLCO ratio should be considered in the evaluation of PH in COPD.
{"title":"Disproportionate impairment in diffusing capacity predicts pulmonary hypertension with an elevated pulmonary vascular resistance in COPD.","authors":"Aparna Balasubramanian,Anna R Hemnes,Evan L Brittain,Jeffrey Annis,Ashraf Fawzy,Nirupama Putcha,Anil Singh,Robert A Wise,Nadia N Hansel,Catherine Simpson,Todd M Kolb,Paul M Hassoun,Meredith C McCormack,Stephen C Mathai","doi":"10.1136/thorax-2025-223921","DOIUrl":"https://doi.org/10.1136/thorax-2025-223921","url":null,"abstract":"BACKGROUNDCurrent guidelines for the evaluation of chronic obstructive pulmonary disease (COPD) do not recommend screening for pulmonary hypertension (PH), despite the high prevalence and impact on outcomes. A simple screening tool to identify patients with an elevated pulmonary vascular resistance (PVR) is urgently needed, as they may benefit from PH-specific therapy and more urgent referral for lung transplantation.RESEARCH QUESTIONWe sought to examine whether a ratio of forced expiratory volume in 1 s (FEV1) to diffusing capacity (DLCO) predicts haemodynamic patterns in COPD.STUDY DESIGN AND METHODSIndividuals with COPD who underwent right heart catheterisation from two academic medical centres were included. Adjusted multinomial models tested associations between FEV1/DLCO and haemodynamic patterns. Receiver operating curves were generated to assess the discriminative performance of the FEV1/DLCO ratio in predicting PH with an elevated PVR.RESULTSApproximately 40% of the 411 individuals included had PH with an elevated PVR. For every 0.1 increase in the FEV1/DLCO ratio, there was a 12-14% increased rate of PH with an elevated PVR compared with No PH. FEV1/DLCO ratio had moderate discriminative performance (C-statistic 0.68-0.72), which was strengthened when combined in a model with elevated tricuspid regurgitant jet velocity on echocardiography (C-statistic 0.78-0.82). Above a threshold of 1.4, FEV1/DLCO demonstrated good specificity (75%) in predicting PH with an elevated PVR.INTERPRETATIONThese findings suggest that disproportionate reductions in DLCO predict PH with an elevated PVR in a COPD population. The FEV1/DLCO ratio should be considered in the evaluation of PH in COPD.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"9 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145613254","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 : 2025-11-24DOI: 10.1136/thorax-2024-222795
Urvee Karsanji, Claire A Lawson, Emily Petherick, Kamlesh Khunti, Gillian Doe, Jennifer K Quint, Alex Bottle, Michael C Steiner, Rachael A Evans
Background The impact of delays to diagnosis for individuals presenting with chronic breathlessness is unknown. We investigated the time to diagnosis after presenting with chronic breathlessness and associations with future unplanned hospitalisation and mortality. Methods A retrospective cohort study using the UK Clinical Practice Research Datalink involving adults with a first recorded code for breathlessness and no pre-existing cardiorespiratory disease. Adjusted Cox regression was used to investigate the associations with unplanned hospitalisation and mortality during all follow-up and within 2 years after the first code of breathlessness between those with and without a diagnosis, and using landmark analysis for time to diagnosis. Results 66 909/101 369 (66%) of adults with a first recorded code for breathlessness received an explanatory diagnosis during a median 5 years of follow-up. 43 394 (43%) of adults received an explanatory diagnosis within 2 years and had a higher risk (HR (95% CI)) of unplanned hospitalisation (1.25, 1.19 to 1.31) and mortality (1.84, 1.42 to 2.38) in the subsequent 2 years compared with adults without a diagnosis. In those with a recorded diagnosis, waiting ≥6 months was associated with increased mortality (6–24 months: 3.33 (2.13 to 5.20); ≥24 months: 13.30 (8.98 to 19.80)). Conclusion We describe better outcomes in adults coded for breathlessness without subsequent explanatory diagnoses. In adults with an explanatory diagnosis, waiting ≥6 months for a diagnosis was associated with reduced survival. Diagnostic pathways for chronic breathlessness need to differentiate between these two groups and achieve earlier diagnosis in those at higher risk. Data may be obtained from a third party and are not publicly available.
{"title":"Time to diagnosis and long-term outcomes for adults presenting with breathlessness","authors":"Urvee Karsanji, Claire A Lawson, Emily Petherick, Kamlesh Khunti, Gillian Doe, Jennifer K Quint, Alex Bottle, Michael C Steiner, Rachael A Evans","doi":"10.1136/thorax-2024-222795","DOIUrl":"https://doi.org/10.1136/thorax-2024-222795","url":null,"abstract":"Background The impact of delays to diagnosis for individuals presenting with chronic breathlessness is unknown. We investigated the time to diagnosis after presenting with chronic breathlessness and associations with future unplanned hospitalisation and mortality. Methods A retrospective cohort study using the UK Clinical Practice Research Datalink involving adults with a first recorded code for breathlessness and no pre-existing cardiorespiratory disease. Adjusted Cox regression was used to investigate the associations with unplanned hospitalisation and mortality during all follow-up and within 2 years after the first code of breathlessness between those with and without a diagnosis, and using landmark analysis for time to diagnosis. Results 66 909/101 369 (66%) of adults with a first recorded code for breathlessness received an explanatory diagnosis during a median 5 years of follow-up. 43 394 (43%) of adults received an explanatory diagnosis within 2 years and had a higher risk (HR (95% CI)) of unplanned hospitalisation (1.25, 1.19 to 1.31) and mortality (1.84, 1.42 to 2.38) in the subsequent 2 years compared with adults without a diagnosis. In those with a recorded diagnosis, waiting ≥6 months was associated with increased mortality (6–24 months: 3.33 (2.13 to 5.20); ≥24 months: 13.30 (8.98 to 19.80)). Conclusion We describe better outcomes in adults coded for breathlessness without subsequent explanatory diagnoses. In adults with an explanatory diagnosis, waiting ≥6 months for a diagnosis was associated with reduced survival. Diagnostic pathways for chronic breathlessness need to differentiate between these two groups and achieve earlier diagnosis in those at higher risk. Data may be obtained from a third party and are not publicly available.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"20 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145583571","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 : 2025-11-24DOI: 10.1136/thorax-2025-223534
Jeremiah Chakaya
Tuberculosis (TB) remains a global public health threat, occurring in more than 10 million people and killing over 1.2 million humans each year.1 The world ushered in a new era for TB care and prevention in 2015 when the end TB strategy, with its ambitious goal of ending TB as a global public health threat by 2035, was adopted by the World Health Assembly. While progress is being made, the pace of change in the burden of TB is unfortunately too slow and it is doubtful that the end of TB will be reached by 2035.2 In 2023, after the devastating shocks of the COVID-19 pandemic on TB care and prevention, there was a rekindling of the rays of hope: TB notifications increased to the highest level ever observed, reducing the number of missing people with TB. At the global level, the proportion of people with new and relapse TB who are successfully treated reached 88% in 2022.1 This should be a reason for celebration; however, TB treatment success rate alone is not a holistic way of gauging how well TB care and prevention programmes are influencing the lives of people experiencing TB disease. This indicator ignores the proportion of people who, despite successfully completing treatment for TB, develop post-TB lung disease (PTLD) and continue to experience symptoms, have persistent radiological abnormalities on lung imaging and/or have lung function abnormalities and physical disability following the TB episode. Unfortunately, the burden of PTLD is not small.3 Recent systematic reviews of the prevalence of PTLD have provided worrying estimates. These reviews have estimated that imaging …
{"title":"Post-tuberculosis lung disease: understanding risk factors and mechanisms to target interventions","authors":"Jeremiah Chakaya","doi":"10.1136/thorax-2025-223534","DOIUrl":"https://doi.org/10.1136/thorax-2025-223534","url":null,"abstract":"Tuberculosis (TB) remains a global public health threat, occurring in more than 10 million people and killing over 1.2 million humans each year.1 The world ushered in a new era for TB care and prevention in 2015 when the end TB strategy, with its ambitious goal of ending TB as a global public health threat by 2035, was adopted by the World Health Assembly. While progress is being made, the pace of change in the burden of TB is unfortunately too slow and it is doubtful that the end of TB will be reached by 2035.2 In 2023, after the devastating shocks of the COVID-19 pandemic on TB care and prevention, there was a rekindling of the rays of hope: TB notifications increased to the highest level ever observed, reducing the number of missing people with TB. At the global level, the proportion of people with new and relapse TB who are successfully treated reached 88% in 2022.1 This should be a reason for celebration; however, TB treatment success rate alone is not a holistic way of gauging how well TB care and prevention programmes are influencing the lives of people experiencing TB disease. This indicator ignores the proportion of people who, despite successfully completing treatment for TB, develop post-TB lung disease (PTLD) and continue to experience symptoms, have persistent radiological abnormalities on lung imaging and/or have lung function abnormalities and physical disability following the TB episode. Unfortunately, the burden of PTLD is not small.3 Recent systematic reviews of the prevalence of PTLD have provided worrying estimates. These reviews have estimated that imaging …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"190 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145594056","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 : 2025-11-20DOI: 10.1136/thorax-2025-224148
Christine F McDonald
{"title":"Smartphones: a useful option for the pulmonary rehab toolkit?","authors":"Christine F McDonald","doi":"10.1136/thorax-2025-224148","DOIUrl":"https://doi.org/10.1136/thorax-2025-224148","url":null,"abstract":"","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"1 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145559112","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}
BACKGROUNDAsbestos, mineral wool (MW), refractory ceramic fibres (RCF) and silica are among the most common exposures to mineral particles in the workplace.OBJECTIVETo study the effect of coexposure to asbestos and MW, crystalline silica or RCFs and the risk of lung cancer and mesothelioma.METHODSThe Asbestos-Related Diseases Cohort is a surveillance programme in retired workers exposed to asbestos during their working life. Complete job histories were collected and occupational exposure to asbestos was assessed by an expert, while occupational exposure to MW, RCFs and silica was assessed using French job-exposure matrices. Cox proportional hazards models were used to estimate HR and 95% CI for lung cancer mortality and lung cancer incidence and for mesothelioma mortality or mesothelioma incidence.RESULTSIn this population of workers exposed to asbestos, in the mortality study, exposures to MW, crystalline silica and RCFs were not found to be associated with lung cancer after adjustment for smoking and asbestos, nor with mesothelioma after adjustment for asbestos. In the incidence study, there was an association between exposure to crystalline silica (ever exposed) and mesothelioma (HRa=1.75, 95% CI 1.17 to 2.62).CONCLUSIONCrystalline silica is not known to induce mesothelioma but coexposure to asbestos could increase the effect of asbestos on the mesothelial cells.
石棉、矿棉（MW）、耐火陶瓷纤维（RCF）和二氧化硅是工作场所最常见的矿物颗粒暴露物。目的探讨石棉与MW、结晶二氧化硅或rcf共暴露对肺癌和间皮瘤发病的影响。方法石棉相关疾病队列是对工作期间接触石棉的退休工人的监测项目。收集了完整的工作经历，由专家评估了石棉的职业暴露，而使用法国工作暴露矩阵评估了MW， rcf和二氧化硅的职业暴露。使用Cox比例风险模型来估计肺癌死亡率和肺癌发病率以及间皮瘤死亡率或间皮瘤发病率的HR和95% CI。结果在死亡率研究中，暴露于MW、结晶二氧化硅和rcf与吸烟和石棉调整后的肺癌无关，也与石棉调整后的间皮瘤无关。在发病率研究中，暴露于结晶二氧化硅（曾经暴露）和间皮瘤之间存在关联（HRa=1.75, 95% CI 1.17至2.62）。结论结晶二氧化硅虽未诱发间皮瘤，但与石棉共暴露可增加间皮瘤对间皮瘤细胞的影响。
{"title":"Coexposure to asbestos, mineral wool, crystalline silica and refractory ceramic fibres and risk of lung cancer and mesothelioma.","authors":"Fleur Delva,Céline Gramond,Isabelle Thaon,Aude Lacourt,Patrick Brochard,Julia Benoist,Antoine Gislard,Francois Laurent,Christophe Paris,Pascal Andujar,Bénédicte Clin,Jean-Claude Pairon","doi":"10.1136/thorax-2024-222020","DOIUrl":"https://doi.org/10.1136/thorax-2024-222020","url":null,"abstract":"BACKGROUNDAsbestos, mineral wool (MW), refractory ceramic fibres (RCF) and silica are among the most common exposures to mineral particles in the workplace.OBJECTIVETo study the effect of coexposure to asbestos and MW, crystalline silica or RCFs and the risk of lung cancer and mesothelioma.METHODSThe Asbestos-Related Diseases Cohort is a surveillance programme in retired workers exposed to asbestos during their working life. Complete job histories were collected and occupational exposure to asbestos was assessed by an expert, while occupational exposure to MW, RCFs and silica was assessed using French job-exposure matrices. Cox proportional hazards models were used to estimate HR and 95% CI for lung cancer mortality and lung cancer incidence and for mesothelioma mortality or mesothelioma incidence.RESULTSIn this population of workers exposed to asbestos, in the mortality study, exposures to MW, crystalline silica and RCFs were not found to be associated with lung cancer after adjustment for smoking and asbestos, nor with mesothelioma after adjustment for asbestos. In the incidence study, there was an association between exposure to crystalline silica (ever exposed) and mesothelioma (HRa=1.75, 95% CI 1.17 to 2.62).CONCLUSIONCrystalline silica is not known to induce mesothelioma but coexposure to asbestos could increase the effect of asbestos on the mesothelial cells.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"94 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145559110","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 : 2025-11-17DOI: 10.1136/thorax-2025-223991
Krunoslav Budimir, Kristina Juzbašić, Ivana Kuhtic, Robert Režan, Maja Hrabak Paar
A 58-year-old male was diagnosed with a right upper lobe lung adenocarcinoma, stage IIIA (T4 N1 M0). Based on the multidisciplinary team’s conclusion, the patient underwent neoadjuvant chemoimmunotherapy (nivolumab, carboplatin and paclitaxel) followed by surgery (right thoracotomy with right upper lobectomy, atypical middle lobe resection, partial resection of the fourth and fifth ribs and mediastinal lymph node dissection). On the first postoperative day, chest X-ray revealed an opacity in the right middle lobe (figure 1A), and 950 mL of haemorrhagic fluid was evacuated through the chest drain. Laboratory findings showed a slight haemoglobin drop to 106 g/L, along with mild leucocytosis (10.4×10⁹/L) and elevated C-reactive protein (136 mg/L). The patient remained afebrile. On the second postoperative day, a chest X-ray demonstrated complete consolidation of the middle lobe that obtained an oval-shaped configuration, accompanied by a right-sided pneumothorax, pneumomediastinum and subcutaneous emphysema (figure 1B). Figure 1 The initial postoperative chest radiograph, obtained on the first postoperative day in the supine position in the intensive care unit, demonstrated a focal opacity in the region of the middle lobe, without definitive features to suggest lobar torsion at that time (A). On the second postoperative day, follow-up chest radiography demonstrated radiographic progression, with complete consolidation of the oval-shaped middle lobe (M), accompanied by a right-sided pneumothorax, pneumomediastinum and subcutaneous emphysema of the chest wall (B). The right-sided chest …
{"title":"Postoperative lung middle lobe torsion: early recognition and diagnostic approach","authors":"Krunoslav Budimir, Kristina Juzbašić, Ivana Kuhtic, Robert Režan, Maja Hrabak Paar","doi":"10.1136/thorax-2025-223991","DOIUrl":"https://doi.org/10.1136/thorax-2025-223991","url":null,"abstract":"A 58-year-old male was diagnosed with a right upper lobe lung adenocarcinoma, stage IIIA (T4 N1 M0). Based on the multidisciplinary team’s conclusion, the patient underwent neoadjuvant chemoimmunotherapy (nivolumab, carboplatin and paclitaxel) followed by surgery (right thoracotomy with right upper lobectomy, atypical middle lobe resection, partial resection of the fourth and fifth ribs and mediastinal lymph node dissection). On the first postoperative day, chest X-ray revealed an opacity in the right middle lobe (figure 1A), and 950 mL of haemorrhagic fluid was evacuated through the chest drain. Laboratory findings showed a slight haemoglobin drop to 106 g/L, along with mild leucocytosis (10.4×10⁹/L) and elevated C-reactive protein (136 mg/L). The patient remained afebrile. On the second postoperative day, a chest X-ray demonstrated complete consolidation of the middle lobe that obtained an oval-shaped configuration, accompanied by a right-sided pneumothorax, pneumomediastinum and subcutaneous emphysema (figure 1B). Figure 1 The initial postoperative chest radiograph, obtained on the first postoperative day in the supine position in the intensive care unit, demonstrated a focal opacity in the region of the middle lobe, without definitive features to suggest lobar torsion at that time (A). On the second postoperative day, follow-up chest radiography demonstrated radiographic progression, with complete consolidation of the oval-shaped middle lobe (M), accompanied by a right-sided pneumothorax, pneumomediastinum and subcutaneous emphysema of the chest wall (B). The right-sided chest …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"17 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145536476","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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