Pub Date : 2025-10-15DOI: 10.1136/thorax-2025-223678
Camille Menut, Armand Charlot, Bertrand Richard de Latour, François Bénézit, Erwan Le Tallec
A 45-year-old male patient presented to the emergency department with sharp chest pain, dyspnoea, fever, night sweats and overall health deterioration over the past 2 weeks. He had no significant medical or surgical history. He did not smoke and has been abstinent from alcohol since 2017. He had no pets but had been caring for a friend’s ferrets in her absence. Further history revealed that symptoms began 24 hours after being bitten by a ferret and were initially limited to isolated anorexia without weight loss. Vital signs revealed a temperature of 38.9°C, tachycardia at 112 beats/min, saturation of 92% and a blood pressure of 117/72 mm Hg. Chest auscultation revealed decreased right lung sounds but no other abnormalities. No skin lesions were noted at the bite. Blood tests revealed an elevated C-reactive protein level of 91 mg/L, leucocytosis of 19 G/L and fibrinogen level of 10.56 g/L. CT pulmonary angiography (figure 1A,B) revealed …
45岁男性患者，过去2周因剧烈胸痛、呼吸困难、发热、盗汗及整体健康状况恶化就诊于急诊科。他没有明显的病史或手术史。他不吸烟，自2017年以来一直戒酒。他没有宠物，但在朋友不在的时候照顾她的雪貂。进一步的病史显示，症状在被雪貂咬伤24小时后出现，最初仅限于孤立的厌食症，没有体重减轻。生命体征：体温38.9℃，心动过速112次/分，饱和度92%，血压117/72 mm Hg，胸部听诊右肺音减少，未见其他异常。咬伤处未见皮肤损伤。血液检查显示c反应蛋白水平升高91 mg/L，白细胞增多19 G/L，纤维蛋白原水平升高10.56 G/L。CT肺血管造影（图1A、B）显示……
{"title":"Bronchogenic cyst infected by Pasteurella multocida following a ferret bite","authors":"Camille Menut, Armand Charlot, Bertrand Richard de Latour, François Bénézit, Erwan Le Tallec","doi":"10.1136/thorax-2025-223678","DOIUrl":"https://doi.org/10.1136/thorax-2025-223678","url":null,"abstract":"A 45-year-old male patient presented to the emergency department with sharp chest pain, dyspnoea, fever, night sweats and overall health deterioration over the past 2 weeks. He had no significant medical or surgical history. He did not smoke and has been abstinent from alcohol since 2017. He had no pets but had been caring for a friend’s ferrets in her absence. Further history revealed that symptoms began 24 hours after being bitten by a ferret and were initially limited to isolated anorexia without weight loss. Vital signs revealed a temperature of 38.9°C, tachycardia at 112 beats/min, saturation of 92% and a blood pressure of 117/72 mm Hg. Chest auscultation revealed decreased right lung sounds but no other abnormalities. No skin lesions were noted at the bite. Blood tests revealed an elevated C-reactive protein level of 91 mg/L, leucocytosis of 19 G/L and fibrinogen level of 10.56 g/L. CT pulmonary angiography (figure 1A,B) revealed …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"96 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145295804","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 Compared with cytotoxic chemotherapy, the efficacy and safety of immune checkpoint inhibitors (ICIs) for patients with interstitial lung disease and non-small cell lung cancer (ILD-NSCLC) are unclear. Methods Data of patients in a Japanese nationwide insurance claims database with ILD-NSCLC who received ICIs (ICI group, n=1748) and those who received only chemotherapy without ICIs (chemotherapy group, n=6362) were extracted. Landmark analyses were performed to compare overall survival (OS) between the two groups. Propensity-score matching was performed to compare 753 patients who received ICI as the first-line treatment (first-ICI group) and 753 from the chemotherapy group with matched backgrounds (matched chemotherapy group). Results The ICI group had a significantly longer median OS of 19.7 months than the chemotherapy group (9.9 months; HR 0.51, 95% CI 0.47 to 0.54, p<0.001). In landmark analyses at 3, 6, 9 and 12 months, the ICI group had a significantly longer OS than the chemotherapy group (all p<0.001). The incidence of drug-induced ILD (DIILD) was significantly higher in the ICI group than in the chemotherapy group (p<0.001). In the ICI group, there was no significant difference in OS between patients with and without DIILD (p=0.784). A propensity score-matched analysis indicated that the first-ICI group had a significantly longer OS than the matched chemotherapy group (p<0.001). Conclusions In patients with ILD-NSCLC, ICIs were associated with significantly longer OS compared with cytotoxic chemotherapy, despite the increased risk of DIILD. Data may be obtained from a third party and are not publicly available. The data that support the findings of this study are available from the Japan Ministry of Health, Labour and Welfare. Restrictions apply to the availability of these data, which were used under license for this study.
背景与细胞毒性化疗相比，免疫检查点抑制剂（ICIs）治疗间质性肺疾病和非小细胞肺癌（ILD-NSCLC）患者的疗效和安全性尚不清楚。方法提取日本全国保险理赔数据库中接受ICIs的ILD-NSCLC患者（ICI组，n=1748）和仅接受化疗而不接受ICIs的患者（化疗组，n=6362）的数据。采用里程碑式分析比较两组的总生存期（OS）。对753例接受ICI作为一线治疗的患者（首次ICI组）和753例背景匹配的化疗组（匹配化疗组）进行倾向评分匹配。结果ICI组的中位OS（19.7个月）明显长于化疗组（9.9个月；HR 0.51, 95% CI 0.47 ~ 0.54, p<0.001）。在3、6、9和12个月的里程碑分析中，ICI组的OS明显长于化疗组（均p<0.001）。ICI组药物性ILD （DIILD）发生率明显高于化疗组（p<0.001）。在ICI组中，合并和未合并DIILD患者的OS无显著差异（p=0.784）。倾向评分匹配分析显示，首次ici组的OS明显长于匹配的化疗组（p<0.001）。结论：在ILD-NSCLC患者中，与细胞毒性化疗相比，ICIs与更长的生存期相关，尽管DIILD的风险增加。数据可能会从第三方获得，并且不会公开提供。支持这项研究结果的数据来自日本厚生劳动省。这些数据的可用性受到限制，这些数据是在本研究的许可下使用的。
{"title":"Survival benefit of immune checkpoint inhibitors for non-small cell lung cancer patients with interstitial lung diseases: a nationwide population-based study","authors":"Masato Karayama, Koichi Miyashita, Yusuke Inoue, Hideki Yasui, Hironao Hozumi, Yuzo Suzuki, Kazuki Furuhashi, Tomoyuki Fujisawa, Noriyuki Enomoto, Naoki Inui, Takafumi Suda","doi":"10.1136/thorax-2025-223430","DOIUrl":"https://doi.org/10.1136/thorax-2025-223430","url":null,"abstract":"Background Compared with cytotoxic chemotherapy, the efficacy and safety of immune checkpoint inhibitors (ICIs) for patients with interstitial lung disease and non-small cell lung cancer (ILD-NSCLC) are unclear. Methods Data of patients in a Japanese nationwide insurance claims database with ILD-NSCLC who received ICIs (ICI group, n=1748) and those who received only chemotherapy without ICIs (chemotherapy group, n=6362) were extracted. Landmark analyses were performed to compare overall survival (OS) between the two groups. Propensity-score matching was performed to compare 753 patients who received ICI as the first-line treatment (first-ICI group) and 753 from the chemotherapy group with matched backgrounds (matched chemotherapy group). Results The ICI group had a significantly longer median OS of 19.7 months than the chemotherapy group (9.9 months; HR 0.51, 95% CI 0.47 to 0.54, p<0.001). In landmark analyses at 3, 6, 9 and 12 months, the ICI group had a significantly longer OS than the chemotherapy group (all p<0.001). The incidence of drug-induced ILD (DIILD) was significantly higher in the ICI group than in the chemotherapy group (p<0.001). In the ICI group, there was no significant difference in OS between patients with and without DIILD (p=0.784). A propensity score-matched analysis indicated that the first-ICI group had a significantly longer OS than the matched chemotherapy group (p<0.001). Conclusions In patients with ILD-NSCLC, ICIs were associated with significantly longer OS compared with cytotoxic chemotherapy, despite the increased risk of DIILD. Data may be obtained from a third party and are not publicly available. The data that support the findings of this study are available from the Japan Ministry of Health, Labour and Welfare. Restrictions apply to the availability of these data, which were used under license for this study.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"67 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145295802","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 : 2025-10-09DOI: 10.1136/thorax-2025-223584
Massimo Pifferi, Attilio Boner, Debora Maj, Alessandro Cudazzo, Angela Michelucci, Gabriele Donzelli, Maria Di Cicco, Angelo Valetto, Diego Peroni, Andrew Bush
The diagnosis of primary ciliary dyskinesia (PCD) can be challenging in patients with mutations in the HYDIN gene, despite using electron microscopy tomography and ciliary motion analysis. Also, mutational analysis is hindered by a paralogous copy of the gene. Because there is a subtle reduction in bending capacity, occasionally a rotatory movement, but normal beat frequencies, we assessed if the combination of these changes could be diagnostic of PCD with HYDIN gene mutations. We developed a practical predictive tool using artificial intelligence which can be used to select patients who should be evaluated in detail for HYDIN mutations.
{"title":"Towards a practical tool to identify HYDIN genotype using high-speed videomicroscopy","authors":"Massimo Pifferi, Attilio Boner, Debora Maj, Alessandro Cudazzo, Angela Michelucci, Gabriele Donzelli, Maria Di Cicco, Angelo Valetto, Diego Peroni, Andrew Bush","doi":"10.1136/thorax-2025-223584","DOIUrl":"https://doi.org/10.1136/thorax-2025-223584","url":null,"abstract":"The diagnosis of primary ciliary dyskinesia (PCD) can be challenging in patients with mutations in the HYDIN gene, despite using electron microscopy tomography and ciliary motion analysis. Also, mutational analysis is hindered by a paralogous copy of the gene. Because there is a subtle reduction in bending capacity, occasionally a rotatory movement, but normal beat frequencies, we assessed if the combination of these changes could be diagnostic of PCD with HYDIN gene mutations. We developed a practical predictive tool using artificial intelligence which can be used to select patients who should be evaluated in detail for HYDIN mutations.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"12 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145255689","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 : 2025-10-09DOI: 10.1136/thorax-2025-223708
Karl Peter Sylvester
Airways dysanapsis, a mismatch between airway calibre and lung volume, has long been observed as a physiological variant first described in healthy individuals by Green and Mead in the 1970s.1 While initially a conceptual curiosity, the phenomenon has evolved into a biomarker of potential clinical importance, particularly in the context of obstructive lung diseases like asthma and chronic obstructive pulmonary disease (COPD). However, its true significance, especially when defined by spirometry rather than anatomical imaging, has remained unclear. In their study published in this issue of Thorax, Smith and colleagues2 provide new insights using advanced functional imaging techniques, demonstrating that spirometric dysanapsis is associated with measurable lung pathology. With the use of data acquired from the NOVELTY ADPro substudy, the authors used hyperpolarised xenon-129 MRI (129Xe-MRI) to examine regional lung function in a population of clinically stable individuals with a physician-assigned diagnosis of asthma and/or COPD. The participants were recruited from UK primary care settings, where spirometry is often the most widely used assessment to guide diagnostic and management decisions. The authors focused on those with a preserved forced expiratory volume in 1 s (FEV1) but a reduced FEV1 to forced vital capacity ratio (FEV1/FVC) ratio, a spirometric pattern traditionally regarded as either a non-pathological variant or, at most, an early indicator of airflow obstruction. The findings …
{"title":"Rethinking ‘normal’: what 129Xe-MRI reveals about spirometric dysanapsis in airway disease","authors":"Karl Peter Sylvester","doi":"10.1136/thorax-2025-223708","DOIUrl":"https://doi.org/10.1136/thorax-2025-223708","url":null,"abstract":"Airways dysanapsis, a mismatch between airway calibre and lung volume, has long been observed as a physiological variant first described in healthy individuals by Green and Mead in the 1970s.1 While initially a conceptual curiosity, the phenomenon has evolved into a biomarker of potential clinical importance, particularly in the context of obstructive lung diseases like asthma and chronic obstructive pulmonary disease (COPD). However, its true significance, especially when defined by spirometry rather than anatomical imaging, has remained unclear. In their study published in this issue of Thorax, Smith and colleagues2 provide new insights using advanced functional imaging techniques, demonstrating that spirometric dysanapsis is associated with measurable lung pathology. With the use of data acquired from the NOVELTY ADPro substudy, the authors used hyperpolarised xenon-129 MRI (129Xe-MRI) to examine regional lung function in a population of clinically stable individuals with a physician-assigned diagnosis of asthma and/or COPD. The participants were recruited from UK primary care settings, where spirometry is often the most widely used assessment to guide diagnostic and management decisions. The authors focused on those with a preserved forced expiratory volume in 1 s (FEV1) but a reduced FEV1 to forced vital capacity ratio (FEV1/FVC) ratio, a spirometric pattern traditionally regarded as either a non-pathological variant or, at most, an early indicator of airflow obstruction. The findings …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"49 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145255595","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 : 2025-10-08DOI: 10.1136/thorax-2025-223533
Akihiro Shiroshita
Various lifestyle and environmental exposures have been suggested as risk factors for childhood asthma development. However, the evidence on atopic and non-atopic asthma phenotypes has been limited.1 The word atopic here refers specifically to IgE-mediated immune system over-reaction to common allergens, as detected by skin prick tests (also known as allergic asthma), rather than genetic predisposition (ie, inherent tendency) to develop allergic conditions. Because different underlying pathophysiology may require distinct preventive measures and treatment strategies, it is important to explore asthma phenotypes and endotypes, rather than treating asthma as a single, homogeneous condition. However, the inconsistent definitions of asthma subtypes have resulted in substantial heterogeneity in study findings.1 The study, ‘Risk factors for atopic and non-atopic asthma in school-aged children from high-, and low-and-middle-income countries’, conducted by Rutter and colleagues, advanced this topic further from a methodological aspect.2 Given the high prevalence of atopy, its presence among children with asthma does not necessarily imply an allergic mechanism underlying asthma development.3 The authors distinguished asthma-specific risk factors from atopy-related ones by stratifying their population into four subgroups: ‘no atopy and no asthma’, ‘those with atopy but no asthma’, …
{"title":"Clarifying the distinct risk factors of atopy and asthma in childhood","authors":"Akihiro Shiroshita","doi":"10.1136/thorax-2025-223533","DOIUrl":"https://doi.org/10.1136/thorax-2025-223533","url":null,"abstract":"Various lifestyle and environmental exposures have been suggested as risk factors for childhood asthma development. However, the evidence on atopic and non-atopic asthma phenotypes has been limited.1 The word atopic here refers specifically to IgE-mediated immune system over-reaction to common allergens, as detected by skin prick tests (also known as allergic asthma), rather than genetic predisposition (ie, inherent tendency) to develop allergic conditions. Because different underlying pathophysiology may require distinct preventive measures and treatment strategies, it is important to explore asthma phenotypes and endotypes, rather than treating asthma as a single, homogeneous condition. However, the inconsistent definitions of asthma subtypes have resulted in substantial heterogeneity in study findings.1 The study, ‘Risk factors for atopic and non-atopic asthma in school-aged children from high-, and low-and-middle-income countries’, conducted by Rutter and colleagues, advanced this topic further from a methodological aspect.2 Given the high prevalence of atopy, its presence among children with asthma does not necessarily imply an allergic mechanism underlying asthma development.3 The authors distinguished asthma-specific risk factors from atopy-related ones by stratifying their population into four subgroups: ‘no atopy and no asthma’, ‘those with atopy but no asthma’, …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"60 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145246805","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 : 2025-10-08DOI: 10.1136/thorax-2025-223844
Gabriella Tikellis, Tamera J Corte, Alison J Hey-Cunningham, Allison Jaure, Yet Hong Khor, Tania Hyde, Anne E Holland
In 2019, we published the top 10 research priorities for pulmonary fibrosis (PF) as identified by people living with PF, carers and healthcare professionals. Five years on, we report on the updated research priorities. The study involved an online questionnaire (181 respondents); an in-person workshop (25 participants) to discuss priorities and establish final list for ranking, and a second online questionnaire with 31 research questions for ranking (252 respondents). Preservation of lung health and alleviating symptom burden remained important. New priorities included achieving a rapid diagnosis and developing biomarkers. The updated priorities will guide research efforts to ensure alignment with important needs.
{"title":"Top 10 research priorities for pulmonary fibrosis in Australia: an update","authors":"Gabriella Tikellis, Tamera J Corte, Alison J Hey-Cunningham, Allison Jaure, Yet Hong Khor, Tania Hyde, Anne E Holland","doi":"10.1136/thorax-2025-223844","DOIUrl":"https://doi.org/10.1136/thorax-2025-223844","url":null,"abstract":"In 2019, we published the top 10 research priorities for pulmonary fibrosis (PF) as identified by people living with PF, carers and healthcare professionals. Five years on, we report on the updated research priorities. The study involved an online questionnaire (181 respondents); an in-person workshop (25 participants) to discuss priorities and establish final list for ranking, and a second online questionnaire with 31 research questions for ranking (252 respondents). Preservation of lung health and alleviating symptom burden remained important. New priorities included achieving a rapid diagnosis and developing biomarkers. The updated priorities will guide research efforts to ensure alignment with important needs.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"19 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145246562","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 : 2025-10-06DOI: 10.1136/thorax-2025-223930
Amanda T Goodwin
Gastro-oesophageal reflux disease (GORD) is a common condition that is known to have several extraintestinal impacts, including effects in the lung. Observational studies have found associations between GORD and asthma,1 lung cancer,2 respiratory infection,3 exacerbations of lung disease,4 5 and bronchiectasis.6 However, a causal relationship between GORD and lung disease has not been conclusively established. This link has been particularly contentious in idiopathic pulmonary fibrosis (IPF), where epidemiological studies and systematic reviews have suggested that GORD is associated with poor outcomes7–9, and that antiacid treatment may improve survival.10 11 However, other studies have contradicted these findings,12–17 and the overwhelming conclusion is that further work is needed in this area. Emilsson et al add another piece to the puzzle with their analysis of the Swedish CArdioPulmonary BioImage Study (SCAPIS), a large cohort study that comprehensively characterised over 28 000 individuals with questionnaires and chest imaging.18 Patients who self-reported heartburn or regurgitation after going to bed on at least one night per week were grouped as having nocturnal gastro-oesophageal reflux (termed nGER), and their chest imaging was reviewed for lung abnormalities including bronchial wall thickening, bronchiectasis, reticular abnormalities, honeycombing, cysts and ground glass opacities.18 Emilsson et al report an association between nGER and bronchial wall thickening and reticular abnormalities on CT chest, but only in a subgroup of patients with risk factors for the development of lung disease (eg, smoking history, …
{"title":"Nocturnal reflux: an untapped target in lung disease?","authors":"Amanda T Goodwin","doi":"10.1136/thorax-2025-223930","DOIUrl":"https://doi.org/10.1136/thorax-2025-223930","url":null,"abstract":"Gastro-oesophageal reflux disease (GORD) is a common condition that is known to have several extraintestinal impacts, including effects in the lung. Observational studies have found associations between GORD and asthma,1 lung cancer,2 respiratory infection,3 exacerbations of lung disease,4 5 and bronchiectasis.6 However, a causal relationship between GORD and lung disease has not been conclusively established. This link has been particularly contentious in idiopathic pulmonary fibrosis (IPF), where epidemiological studies and systematic reviews have suggested that GORD is associated with poor outcomes7–9, and that antiacid treatment may improve survival.10 11 However, other studies have contradicted these findings,12–17 and the overwhelming conclusion is that further work is needed in this area. Emilsson et al add another piece to the puzzle with their analysis of the Swedish CArdioPulmonary BioImage Study (SCAPIS), a large cohort study that comprehensively characterised over 28 000 individuals with questionnaires and chest imaging.18 Patients who self-reported heartburn or regurgitation after going to bed on at least one night per week were grouped as having nocturnal gastro-oesophageal reflux (termed nGER), and their chest imaging was reviewed for lung abnormalities including bronchial wall thickening, bronchiectasis, reticular abnormalities, honeycombing, cysts and ground glass opacities.18 Emilsson et al report an association between nGER and bronchial wall thickening and reticular abnormalities on CT chest, but only in a subgroup of patients with risk factors for the development of lung disease (eg, smoking history, …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"16 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145235909","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 : 2025-10-05DOI: 10.1136/thorax-2025-223890
Sanjay Agrawal, Paul Cilia La Corte, Tom Frost, Jack Hodgson, Rajun Phagura, Alexander Adamson, Jennifer K Quint
Introduction People who smoke are a third more likely to be admitted to hospital than non-smokers. A disparity in smoking prevalence between the most and least deprived populations persists. Hospital-initiated treatment could reduce smoking-related inequalities if people admitted to hospital from more deprived populations have greater access and uptake of treatment and successfully quit. The National Health Service (NHS) in England has introduced ‘opt-out’ tobacco dependency treatment and in this study, we examined how treatment of tobacco dependency differed in relation to deprivation. Methods Data were available from 111 (84%) acute hospital trusts in England, describing 243 847 hospital admissions of people who smoked in 2024, a total of 185 147 individuals. We reviewed whether individuals had made a supported quit attempt and successful quits and used logistic regression to determine if these outcomes differed according to level of deprivation based on patient residence. Results Data adjusted for demographic characteristics and hospital clustering demonstrated that the proportion of those making quit attempts was higher in more deprived quintiles of deprivation, 24.8% in quintile 1 (most deprived) versus 18.3% in quintile 5 (least deprived); however, the proportion of people who quit smoking was highest in the least deprived quintile (25.3%) with a gradient to the most deprived quintile (16.0%). Conclusion The NHS opt-out inpatient tobacco dependency service provides treatment on an equitable basis across deprivation quintiles, with the greatest proportion of patients making a supported quit attempt in the most deprived quintile. However, there are opportunities to reduce inequalities by improving quit success in this group. Data are available upon reasonable request. The data are held within NHS England and can be requested through the Data Access Request Service (DARS—NHS England Digital).
{"title":"Is the provision of a national opt-out tobacco dependence treatment service in acute hospitals in England equitable? A national cohort study","authors":"Sanjay Agrawal, Paul Cilia La Corte, Tom Frost, Jack Hodgson, Rajun Phagura, Alexander Adamson, Jennifer K Quint","doi":"10.1136/thorax-2025-223890","DOIUrl":"https://doi.org/10.1136/thorax-2025-223890","url":null,"abstract":"Introduction People who smoke are a third more likely to be admitted to hospital than non-smokers. A disparity in smoking prevalence between the most and least deprived populations persists. Hospital-initiated treatment could reduce smoking-related inequalities if people admitted to hospital from more deprived populations have greater access and uptake of treatment and successfully quit. The National Health Service (NHS) in England has introduced ‘opt-out’ tobacco dependency treatment and in this study, we examined how treatment of tobacco dependency differed in relation to deprivation. Methods Data were available from 111 (84%) acute hospital trusts in England, describing 243 847 hospital admissions of people who smoked in 2024, a total of 185 147 individuals. We reviewed whether individuals had made a supported quit attempt and successful quits and used logistic regression to determine if these outcomes differed according to level of deprivation based on patient residence. Results Data adjusted for demographic characteristics and hospital clustering demonstrated that the proportion of those making quit attempts was higher in more deprived quintiles of deprivation, 24.8% in quintile 1 (most deprived) versus 18.3% in quintile 5 (least deprived); however, the proportion of people who quit smoking was highest in the least deprived quintile (25.3%) with a gradient to the most deprived quintile (16.0%). Conclusion The NHS opt-out inpatient tobacco dependency service provides treatment on an equitable basis across deprivation quintiles, with the greatest proportion of patients making a supported quit attempt in the most deprived quintile. However, there are opportunities to reduce inequalities by improving quit success in this group. Data are available upon reasonable request. The data are held within NHS England and can be requested through the Data Access Request Service (DARS—NHS England Digital).","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"6 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145228771","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 : 2025-10-05DOI: 10.1136/thorax-2025-223499
Filippo Liviero
Work-related asthma remains one of the most complex and underappreciated dimensions of adult-onset respiratory disease. Estimated to account for 25% of adult-onset cases,1 it encompasses a heterogeneous set of phenotypes, including immunologic occupational asthma, irritant-induced asthma and work-exacerbated asthma, each with distinct pathophysiological mechanisms and diagnostic challenges.2 This diversity complicates not only diagnosis and management but also surveillance efforts and preventive strategies across different occupations and settings. Nevertheless, surveillance systems remain fragmented and many cases go unrecognised in clinical practice, especially in non-specialist settings.3 Despite increasing awareness of occupational exposures as contributors to airway inflammation and sensitisation, definitive longitudinal evidence linking workplace conditions to asthma incidence remains limited. In this context, the study by Alif and colleagues,4 published in this issue of Thorax , offers a significant advancement. Using data from the European Community Respiratory Health Survey (ECRHS), the authors provide 20-year longitudinal evidence of persistent occupational risk for asthma across Europe. Initiated in the early 1990s, ECRHS has helped define the role of environmental and occupational exposures in adult asthma. ECRHS I included over 15 000 adults in 12 countries, assessing asthma through questionnaires and methacholine challenge. It identified increased risks in occupations like farming, painting and cleaning, with 5–10% of cases attributable to occupational exposures.5 ECRHS II followed symptom-free participants, confirming significant roles for high and low-molecular-weight agents, biocides and cleaning …
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Pub Date : 2025-10-05DOI: 10.1136/thorax-2024-221997
Mark Andonovic, Martin Shaw, Peter Hartley, Snigdha Jain, Leanne Boehm, Kelly Toth, Richard Bourne, Kimberley Joy Haines, Valerie Danesh, Pamela MacTavish, Thomas Valley, Regis Goulart Rosa, Christie Docherty, Kevin Garrity, Philip McCall, Alexander Tracy, Nazir I Lone, Joanne McPeake
Improvements in critical care treatments have led to an increased number of survivors of critical illness and an enhanced recognition of the problems which these patients encounter. Despite this, the ideal strategies to both prevent and manage the problems which people face are yet to be fully elucidated. This review explores the current methods employed to help mitigate problems encountered by survivors of critical illnesses and current barriers that limit their implementation. We will explore the effect of these issues on under-represented communities and the feasibility of delivering these strategies globally, as well as recent advances in mechanistic research and methodological innovation as promising areas for further work. In doing so, it summarises the potential avenues for future research with a view to advancing clinical care and outcomes in survivors of critical illness.
{"title":"Current strategies and future directions to enhance recovery following critical illness","authors":"Mark Andonovic, Martin Shaw, Peter Hartley, Snigdha Jain, Leanne Boehm, Kelly Toth, Richard Bourne, Kimberley Joy Haines, Valerie Danesh, Pamela MacTavish, Thomas Valley, Regis Goulart Rosa, Christie Docherty, Kevin Garrity, Philip McCall, Alexander Tracy, Nazir I Lone, Joanne McPeake","doi":"10.1136/thorax-2024-221997","DOIUrl":"https://doi.org/10.1136/thorax-2024-221997","url":null,"abstract":"Improvements in critical care treatments have led to an increased number of survivors of critical illness and an enhanced recognition of the problems which these patients encounter. Despite this, the ideal strategies to both prevent and manage the problems which people face are yet to be fully elucidated. This review explores the current methods employed to help mitigate problems encountered by survivors of critical illnesses and current barriers that limit their implementation. We will explore the effect of these issues on under-represented communities and the feasibility of delivering these strategies globally, as well as recent advances in mechanistic research and methodological innovation as promising areas for further work. In doing so, it summarises the potential avenues for future research with a view to advancing clinical care and outcomes in survivors of critical illness.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"77 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145228775","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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