Pub Date : 2022-05-31DOI: 10.1016/S2213-2600(22)00167-9
Jian Luo, I. Pavlov, E. Tavernier, J. Laffey, C. Guérin, D. Vines, Y. Perez, O. Roca, A. Kharat, B. McNicholas, M. Ibarra-Estrada, Wei Tan, S. Ehrmann, Jie Li
{"title":"Rethinking the efficacy of awake prone positioning in COVID-19-related acute hypoxaemic respiratory failure – Authors' reply","authors":"Jian Luo, I. Pavlov, E. Tavernier, J. Laffey, C. Guérin, D. Vines, Y. Perez, O. Roca, A. Kharat, B. McNicholas, M. Ibarra-Estrada, Wei Tan, S. Ehrmann, Jie Li","doi":"10.1016/S2213-2600(22)00167-9","DOIUrl":"https://doi.org/10.1016/S2213-2600(22)00167-9","url":null,"abstract":"","PeriodicalId":326030,"journal":{"name":"The Lancet. Respiratory medicine","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128122179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-01Epub Date: 2022-02-18DOI: 10.1016/S2213-2600(21)00508-7
Dinh S Bui, Jennifer L Perret, E Haydn Walters, Caroline J Lodge, Gayan Bowatte, Garun S Hamilton, Bruce R Thompson, Peter Frith, Bircan Erbas, Paul S Thomas, David P Johns, Richard Wood-Baker, John L Hopper, Peter G Davis, Michael J Abramson, Adrian J Lowe, Shyamali C Dharmage
<p><strong>Background: </strong>Prematurity has been linked to reduced lung function up to age 33 years, but its long-term effects on lung function and chronic obstructive pulmonary disease (COPD) are unknown. To address this question, we investigated associations between prematurity, lung function, and COPD in the sixth decade of life using data from the Tasmanian Longitudinal Health Study (TAHS).</p><p><strong>Methods: </strong>Data were analysed from 1445 participants in the TAHS. Lung function was measured at 53 years of age. Gestational ages were very preterm (28 weeks to <32 weeks), moderate preterm (32 weeks to <34 weeks), late preterm (34 weeks to <37 weeks) and term (≥37 weeks). Linear and logistic regression models were fitted to investigate associations of prematurity with lung function measures (FEV<sub>1</sub>, forced vital capacity [FVC], FEV<sub>1</sub>/FVC ratio, forced expiratory flow at 25-75% of FVC [FEF<sub>25-75%</sub>], diffusing capacity for carbon monoxide [DLCO]) and COPD (post-bronchodilator FEV<sub>1</sub>/FVC less than the lower limit of normal), adjusting for sex, age, height, parental smoking during pregnancy, number of older siblings, maternal age at birth, and childhood socioeconomic status. Interactions with smoking and asthma were also investigated.</p><p><strong>Results: </strong>Of 3565 individuals with available data on gestational age from the TAHS cohort, 1445 (41%) participants were included in this study, 740 (51%) of whom were female. Compared with term birth, very to moderate preterm birth was significantly associated with an increased risk of COPD at age 53 years (odds ratio 2·9 [95% CI 1·1-7·7]). Very-to-moderate preterm birth was also associated with lower post-bronchodilator FEV<sub>1</sub>/FVC ratio (beta-coefficient -2·9% [95% CI -4·9 to -0·81]), FEV<sub>1</sub> (-190 mL [-339 to -40]), DLCO (-0·55 mmol/min/kPa [-0·97 to -0·13]), and FEF<sub>25-75%</sub> (-339 mL/s [-664 to -14]). The association between very-to-moderate preterm birth and FEV<sub>1</sub>/FVC ratio was only significant among smokers (p<sub>interaction</sub>=0·0082). Similar findings were observed for moderate preterm birth when analysed as a separate group. Compared with term birth, late preterm birth was not associated with lower FEV<sub>1</sub>/FVC ratio or COPD.</p><p><strong>Interpretation: </strong>This is the first study to investigate the effect of prematurity on lung function into middle-age. Data show that very-to-moderate prematurity is associated with obstructive lung function deficits including COPD well into the sixth decade of life and that this effect is compounded by personal smoking.</p><p><strong>Funding: </strong>National Health and Medical Research Council (NHMRC) of Australia, European Union's Horizon 2020, The University of Melbourne, Clifford Craig Medical Research Trust of Tasmania, The Victorian, Queensland & Tasmanian Asthma Foundations, The Royal Hobart Hospital, Helen MacPherson Smith Trust, and GlaxoSmit
{"title":"Association between very to moderate preterm births, lung function deficits, and COPD at age 53 years: analysis of a prospective cohort study.","authors":"Dinh S Bui, Jennifer L Perret, E Haydn Walters, Caroline J Lodge, Gayan Bowatte, Garun S Hamilton, Bruce R Thompson, Peter Frith, Bircan Erbas, Paul S Thomas, David P Johns, Richard Wood-Baker, John L Hopper, Peter G Davis, Michael J Abramson, Adrian J Lowe, Shyamali C Dharmage","doi":"10.1016/S2213-2600(21)00508-7","DOIUrl":"https://doi.org/10.1016/S2213-2600(21)00508-7","url":null,"abstract":"<p><strong>Background: </strong>Prematurity has been linked to reduced lung function up to age 33 years, but its long-term effects on lung function and chronic obstructive pulmonary disease (COPD) are unknown. To address this question, we investigated associations between prematurity, lung function, and COPD in the sixth decade of life using data from the Tasmanian Longitudinal Health Study (TAHS).</p><p><strong>Methods: </strong>Data were analysed from 1445 participants in the TAHS. Lung function was measured at 53 years of age. Gestational ages were very preterm (28 weeks to <32 weeks), moderate preterm (32 weeks to <34 weeks), late preterm (34 weeks to <37 weeks) and term (≥37 weeks). Linear and logistic regression models were fitted to investigate associations of prematurity with lung function measures (FEV<sub>1</sub>, forced vital capacity [FVC], FEV<sub>1</sub>/FVC ratio, forced expiratory flow at 25-75% of FVC [FEF<sub>25-75%</sub>], diffusing capacity for carbon monoxide [DLCO]) and COPD (post-bronchodilator FEV<sub>1</sub>/FVC less than the lower limit of normal), adjusting for sex, age, height, parental smoking during pregnancy, number of older siblings, maternal age at birth, and childhood socioeconomic status. Interactions with smoking and asthma were also investigated.</p><p><strong>Results: </strong>Of 3565 individuals with available data on gestational age from the TAHS cohort, 1445 (41%) participants were included in this study, 740 (51%) of whom were female. Compared with term birth, very to moderate preterm birth was significantly associated with an increased risk of COPD at age 53 years (odds ratio 2·9 [95% CI 1·1-7·7]). Very-to-moderate preterm birth was also associated with lower post-bronchodilator FEV<sub>1</sub>/FVC ratio (beta-coefficient -2·9% [95% CI -4·9 to -0·81]), FEV<sub>1</sub> (-190 mL [-339 to -40]), DLCO (-0·55 mmol/min/kPa [-0·97 to -0·13]), and FEF<sub>25-75%</sub> (-339 mL/s [-664 to -14]). The association between very-to-moderate preterm birth and FEV<sub>1</sub>/FVC ratio was only significant among smokers (p<sub>interaction</sub>=0·0082). Similar findings were observed for moderate preterm birth when analysed as a separate group. Compared with term birth, late preterm birth was not associated with lower FEV<sub>1</sub>/FVC ratio or COPD.</p><p><strong>Interpretation: </strong>This is the first study to investigate the effect of prematurity on lung function into middle-age. Data show that very-to-moderate prematurity is associated with obstructive lung function deficits including COPD well into the sixth decade of life and that this effect is compounded by personal smoking.</p><p><strong>Funding: </strong>National Health and Medical Research Council (NHMRC) of Australia, European Union's Horizon 2020, The University of Melbourne, Clifford Craig Medical Research Trust of Tasmania, The Victorian, Queensland & Tasmanian Asthma Foundations, The Royal Hobart Hospital, Helen MacPherson Smith Trust, and GlaxoSmit","PeriodicalId":326030,"journal":{"name":"The Lancet. Respiratory medicine","volume":" ","pages":"478-484"},"PeriodicalIF":76.2,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39803615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-01Epub Date: 2022-01-10DOI: 10.1016/S2213-2600(21)00502-6
Stefan Andreas, Marco Testa, Laurent Boyer, Guy Brusselle, Wim Janssens, Edward Kerwin, Alberto Papi, Bonavuth Pek, Luis Puente-Maestu, Dinesh Saralaya, Henrik Watz, Tom M A Wilkinson, Daniela Casula, Gennaro Di Maro, Maria Lattanzi, Luca Moraschini, Sonia Schoonbroodt, Annaelisa Tasciotti, Ashwani K Arora, François Maltais
<p><strong>Background: </strong>Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are associated with changes in the sputum microbiome, including an increased prevalence of pathogenic bacteria. Vaccination against the most frequent bacteria identified in AECOPD might reduce exacerbation frequency. We assessed the efficacy, safety, and immunogenicity of a candidate vaccine containing surface proteins from non-typeable Haemophilus influenzae (NTHi) and Moraxella catarrhalis (Mcat) in patients with COPD.</p><p><strong>Methods: </strong>This multicentre, randomised, observer-blinded, placebo-controlled, proof-of-concept, phase 2b trial recruited patients with stable COPD, moderate-to-very severe airflow limitation (Global Initiative for Chronic Obstructive Lung Disease [GOLD] stage 2, 3, or 4), at 67 clinical sites in Belgium, Canada, France, Germany, Italy, Spain, UK, and USA. Eligible patients were aged 40-80 years and had a history of at least one moderate or severe exacerbation in the previous year. Patients were allocated (1:1) using a minimisation algorithm to receive two intramuscular injections of NTHi-Mcat vaccine or placebo 60 days apart, in addition to standard care. The allocation algorithm considered age category, number of previous exacerbations, COPD severity at study entry, and country as minimisation factors, to guarantee treatment balance within each factor. Vaccine recipients and those responsible for evaluating study endpoints were masked to group allocation. In the analysis of efficacy, the primary outcome was the rate of any moderate or severe AECOPD occurring within a 1-year period, starting 1 month after the second dose in patients who received two vaccine doses (modified total vaccinated cohort). Safety was assessed in the total vaccinated cohort. The trial is registered with ClinicalTrials.gov, number NCT03281876, and is complete.</p><p><strong>Findings: </strong>Between Nov 27, 2017, and Nov 30, 2018, 606 adults were enrolled and included in the total vaccinated cohort (304 in the NTHi-Mcat vaccine group, 302 in the placebo group); 571 received two doses and were included in the primary efficacy analysis (279 in the NTHi-Mcat vaccine group, 292 in the placebo group). 23 participants dropped-out in the NTHi-Mcat vaccine group and 39 in the placebo group; this included 4 patients in the NTHi-Mcat vaccine group and 15 in the placebo group who withdrew from the study because of an adverse event. The primary analysis included 340 exacerbations (in follow-up time 102 123 days) in the NTHi-Mcat vaccine group and 333 (in 104 443 days) in the placebo group, with a yearly rate of moderate or severe AECOPD of 1·22 in the NTHi-Mcat vaccine group and 1·17 in the placebo group, with vaccine efficacy in reducing the yearly rate of moderate or severe AECOPD estimated to be zero (vaccine efficacy point estimate 2·26% [87% CI -18·27 to 11·58]; p=0·82). Solicited local adverse events were more frequent in the NTHi-Mcat vac
{"title":"Non-typeable Haemophilus influenzae-Moraxella catarrhalis vaccine for the prevention of exacerbations in chronic obstructive pulmonary disease: a multicentre, randomised, placebo-controlled, observer-blinded, proof-of-concept, phase 2b trial.","authors":"Stefan Andreas, Marco Testa, Laurent Boyer, Guy Brusselle, Wim Janssens, Edward Kerwin, Alberto Papi, Bonavuth Pek, Luis Puente-Maestu, Dinesh Saralaya, Henrik Watz, Tom M A Wilkinson, Daniela Casula, Gennaro Di Maro, Maria Lattanzi, Luca Moraschini, Sonia Schoonbroodt, Annaelisa Tasciotti, Ashwani K Arora, François Maltais","doi":"10.1016/S2213-2600(21)00502-6","DOIUrl":"https://doi.org/10.1016/S2213-2600(21)00502-6","url":null,"abstract":"<p><strong>Background: </strong>Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are associated with changes in the sputum microbiome, including an increased prevalence of pathogenic bacteria. Vaccination against the most frequent bacteria identified in AECOPD might reduce exacerbation frequency. We assessed the efficacy, safety, and immunogenicity of a candidate vaccine containing surface proteins from non-typeable Haemophilus influenzae (NTHi) and Moraxella catarrhalis (Mcat) in patients with COPD.</p><p><strong>Methods: </strong>This multicentre, randomised, observer-blinded, placebo-controlled, proof-of-concept, phase 2b trial recruited patients with stable COPD, moderate-to-very severe airflow limitation (Global Initiative for Chronic Obstructive Lung Disease [GOLD] stage 2, 3, or 4), at 67 clinical sites in Belgium, Canada, France, Germany, Italy, Spain, UK, and USA. Eligible patients were aged 40-80 years and had a history of at least one moderate or severe exacerbation in the previous year. Patients were allocated (1:1) using a minimisation algorithm to receive two intramuscular injections of NTHi-Mcat vaccine or placebo 60 days apart, in addition to standard care. The allocation algorithm considered age category, number of previous exacerbations, COPD severity at study entry, and country as minimisation factors, to guarantee treatment balance within each factor. Vaccine recipients and those responsible for evaluating study endpoints were masked to group allocation. In the analysis of efficacy, the primary outcome was the rate of any moderate or severe AECOPD occurring within a 1-year period, starting 1 month after the second dose in patients who received two vaccine doses (modified total vaccinated cohort). Safety was assessed in the total vaccinated cohort. The trial is registered with ClinicalTrials.gov, number NCT03281876, and is complete.</p><p><strong>Findings: </strong>Between Nov 27, 2017, and Nov 30, 2018, 606 adults were enrolled and included in the total vaccinated cohort (304 in the NTHi-Mcat vaccine group, 302 in the placebo group); 571 received two doses and were included in the primary efficacy analysis (279 in the NTHi-Mcat vaccine group, 292 in the placebo group). 23 participants dropped-out in the NTHi-Mcat vaccine group and 39 in the placebo group; this included 4 patients in the NTHi-Mcat vaccine group and 15 in the placebo group who withdrew from the study because of an adverse event. The primary analysis included 340 exacerbations (in follow-up time 102 123 days) in the NTHi-Mcat vaccine group and 333 (in 104 443 days) in the placebo group, with a yearly rate of moderate or severe AECOPD of 1·22 in the NTHi-Mcat vaccine group and 1·17 in the placebo group, with vaccine efficacy in reducing the yearly rate of moderate or severe AECOPD estimated to be zero (vaccine efficacy point estimate 2·26% [87% CI -18·27 to 11·58]; p=0·82). Solicited local adverse events were more frequent in the NTHi-Mcat vac","PeriodicalId":326030,"journal":{"name":"The Lancet. Respiratory medicine","volume":" ","pages":"435-446"},"PeriodicalIF":76.2,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39817769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-01Epub Date: 2022-01-17DOI: 10.1016/S2213-2600(22)00009-1
Hannah M Mitchison, Damian Smedley
{"title":"Primary ciliary dyskinesia: a big data genomics approach.","authors":"Hannah M Mitchison, Damian Smedley","doi":"10.1016/S2213-2600(22)00009-1","DOIUrl":"https://doi.org/10.1016/S2213-2600(22)00009-1","url":null,"abstract":"","PeriodicalId":326030,"journal":{"name":"The Lancet. Respiratory medicine","volume":" ","pages":"423-425"},"PeriodicalIF":76.2,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39838739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-01DOI: 10.1016/S2213-2600(22)00135-7
D. Munblit, M. O'Hara, A. Akrami, E. Perego, P. Olliaro, D. Needham
{"title":"Long COVID: aiming for a consensus","authors":"D. Munblit, M. O'Hara, A. Akrami, E. Perego, P. Olliaro, D. Needham","doi":"10.1016/S2213-2600(22)00135-7","DOIUrl":"https://doi.org/10.1016/S2213-2600(22)00135-7","url":null,"abstract":"","PeriodicalId":326030,"journal":{"name":"The Lancet. Respiratory medicine","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115705042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-01DOI: 10.1016/s2213-2600(22)00095-9
Chiagozie I. Pickens, R. Wunderink
{"title":"Clinical impact of bacterial syndromic testing in pneumonia.","authors":"Chiagozie I. Pickens, R. Wunderink","doi":"10.1016/s2213-2600(22)00095-9","DOIUrl":"https://doi.org/10.1016/s2213-2600(22)00095-9","url":null,"abstract":"","PeriodicalId":326030,"journal":{"name":"The Lancet. Respiratory medicine","volume":"65 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122508328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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