Pub Date : 2025-11-05DOI: 10.1136/thorax-2024-222854
Jan Johnson, Simon R Johnson
Exercise-induced desaturation is poorly recognised in lymphangioleiomyomatosis (LAM) and its relationship to outcome is unknown. In a UK cohort study, 37% of 131 women with LAM experienced exercise-induced desaturation to <88% during a 6 min walk test. Forced expiratory volume in 1 s (FEV1) and DLCO were associated with walk parameters but had poor predictive accuracy for exercise-induced desaturation. A 5-year follow-up showed exercise-induced desaturation at baseline was associated with rapid FEV1 decline (p=0.008) and need for rapamycin treatment (p=0.00001). Women with LAM should be evaluated for exercise-induced desaturation to target ambulatory oxygen and improve identification of those at risk of poor outcomes.
{"title":"Prevalence and assessment of exercise-induced desaturation in lymphangioleiomyomatosis","authors":"Jan Johnson, Simon R Johnson","doi":"10.1136/thorax-2024-222854","DOIUrl":"https://doi.org/10.1136/thorax-2024-222854","url":null,"abstract":"Exercise-induced desaturation is poorly recognised in lymphangioleiomyomatosis (LAM) and its relationship to outcome is unknown. In a UK cohort study, 37% of 131 women with LAM experienced exercise-induced desaturation to <88% during a 6 min walk test. Forced expiratory volume in 1 s (FEV1) and DLCO were associated with walk parameters but had poor predictive accuracy for exercise-induced desaturation. A 5-year follow-up showed exercise-induced desaturation at baseline was associated with rapid FEV1 decline (p=0.008) and need for rapamycin treatment (p=0.00001). Women with LAM should be evaluated for exercise-induced desaturation to target ambulatory oxygen and improve identification of those at risk of poor outcomes.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"18 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145447172","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 : 2025-11-04DOI: 10.1136/thorax-2025-223427
Lainey Perry Smith, Maree T Izatt, Geoffrey N Askin, Miriam P L Cameron
A 15-year-old girl presented to a paediatric emergency department with a 4-week history of frank haemoptysis. This was occurring weekly, increasing in volume to an episode of approximately one-third of a cup of fresh blood (80–100 mL). She had no cough between haemoptysis episodes and the blood did not appear to be mixed with sputum. She had a background of 22q deletion, attention deficit hyperactivity disorder (ADHD), anxiety, inflammatory bowel disease (IBD) and had been diagnosed with early-onset idiopathic scoliosis (EOIS) at age 10. After initial management with bracing, her severe right thoracic curve (T5–12) had progressed to 63°. Given her skeletal immaturity and premenarchal state, surgical options were discussed and vertebral body tethering (VBT) was selected. When the patient presented with haemoptysis, it was 3.5 years post surgery. VBT represents an emerging surgical technique used to treat …
{"title":"Haemoptysis in an adolescent post vertebral body tethering surgery for scoliosis","authors":"Lainey Perry Smith, Maree T Izatt, Geoffrey N Askin, Miriam P L Cameron","doi":"10.1136/thorax-2025-223427","DOIUrl":"https://doi.org/10.1136/thorax-2025-223427","url":null,"abstract":"A 15-year-old girl presented to a paediatric emergency department with a 4-week history of frank haemoptysis. This was occurring weekly, increasing in volume to an episode of approximately one-third of a cup of fresh blood (80–100 mL). She had no cough between haemoptysis episodes and the blood did not appear to be mixed with sputum. She had a background of 22q deletion, attention deficit hyperactivity disorder (ADHD), anxiety, inflammatory bowel disease (IBD) and had been diagnosed with early-onset idiopathic scoliosis (EOIS) at age 10. After initial management with bracing, her severe right thoracic curve (T5–12) had progressed to 63°. Given her skeletal immaturity and premenarchal state, surgical options were discussed and vertebral body tethering (VBT) was selected. When the patient presented with haemoptysis, it was 3.5 years post surgery. VBT represents an emerging surgical technique used to treat …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"29 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145441228","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 : 2025-11-03DOI: 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}
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