Pub Date : 2025-02-12DOI: 10.1016/s2213-2600(25)00017-7
Tony Kirby
No Abstract
{"title":"Patient with cystic fibrosis not diagnosed until age 23 years now treated with the new triple therapy Trikafta","authors":"Tony Kirby","doi":"10.1016/s2213-2600(25)00017-7","DOIUrl":"https://doi.org/10.1016/s2213-2600(25)00017-7","url":null,"abstract":"No Abstract","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"63 1","pages":""},"PeriodicalIF":76.2,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143401654","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 : 2025-02-10DOI: 10.1016/s2213-2600(24)00362-x
Mario Castro, Alberto Papi, Celeste Porsbjerg, Njira L Lugogo, Christopher E Brightling, Francisco-Javier González-Barcala, Arnaud Bourdin, Mykola Ostrovskyy, Maria Staevska, Pai-Chien Chou, Liliana Duca, Ana Margarida Pereira, Charles Fogarty, Rufai Nadama, Mei Zhang, Amelie Rodrigues, Xavier Soler, Harry J Sacks, Yamo Deniz, Paul J Rowe, Juby A Jacob-Nara
<h3>Background</h3>Asthma is a respiratory disease characterised by chronic airway inflammation and mucus hypersecretion. VESTIGE used functional respiratory imaging to assess changes in airway structure and function, including mucus plugging, in response to dupilumab.<h3>Methods</h3>VESTIGE was a randomised, double-blind, placebo-controlled, phase 4 trial done at 72 research sites or academic centres in 14 countries. We recruited adult patients (aged 18–70 years) with physician-diagnosed, uncontrolled, moderate-to-severe type 2 asthma (blood eosinophil count ≥300 cells/μL and fractional exhaled nitric oxide [FeNO] ≥25 parts per billion [ppb]) being treated with medium-dose to high-dose inhaled corticosteroids combined with other controller medications. Patients were randomly assigned (2:1; block size of 6) via interactive voice–web response technology to receive add-on dupilumab 300 mg subcutaneously once every 2 weeks or volume-matched placebo up to week 24. Randomisation was stratified by inhaled corticosteroids dose level and region (USA <em>vs</em> non-USA). Participants and investigators, including those assessing outcomes, were masked to group assignment. The primary endpoints were the proportion of patients with a FeNO concentration below 25 ppb at week 24, and percentage change from baseline to week 24 in airway volumes (specific regional airway volumes corrected for lung volume, [s]iV<sub><em>aw</em></sub>) at total lung capacity (TLC), both assessed in the intention-to-treat population. Safety was assessed in all patients who received at least one dose of study drug or placebo. The trial is registered with <span><span>ClinicalTrials.gov</span><svg aria-label="Opens in new window" focusable="false" height="20" viewbox="0 0 8 8"><path d="M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z"></path></svg></span>, <span><span>NCT04400318</span><svg aria-label="Opens in new window" focusable="false" height="20" viewbox="0 0 8 8"><path d="M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z"></path></svg></span>, and is completed.<h3>Findings</h3>Patient recruitment occurred from July 18, 2020, to Jan 6, 2023. Patients (mean age 50·4 years [SD 12·6]; 68 [62%] female and 41 [38%] male) were randomly assigned to receive dupilumab 300 mg (n<em>=</em>72) or placebo (n<em>=</em>37). At week 24, patients in the dupilumab group were significantly more likely than those in the placebo group to have a FeNO concentration below 25 ppb (41 [57%] of 72 patients <em>vs</em> four [11%] of 37; odds ratio: 9·8 [95% CI 3·1 to 30·8]; p<0·001). Treatment with dupilumab versus placebo led to a numerical increase in (s)iV<sub><em>aw</em></sub> at TLC from baseline to week 24, although the difference was not significant (least squares [LS] mean percentage change from baseline to week 24: 19·7% [SE 8·1] for dupilumab and −2·0% [11·5] for placebo; LS mean difference <em>vs</em> placebo: 21·8%
{"title":"Effect of dupilumab on exhaled nitric oxide, mucus plugs, and functional respiratory imaging in patients with type 2 asthma (VESTIGE): a randomised, double-blind, placebo-controlled, phase 4 trial","authors":"Mario Castro, Alberto Papi, Celeste Porsbjerg, Njira L Lugogo, Christopher E Brightling, Francisco-Javier González-Barcala, Arnaud Bourdin, Mykola Ostrovskyy, Maria Staevska, Pai-Chien Chou, Liliana Duca, Ana Margarida Pereira, Charles Fogarty, Rufai Nadama, Mei Zhang, Amelie Rodrigues, Xavier Soler, Harry J Sacks, Yamo Deniz, Paul J Rowe, Juby A Jacob-Nara","doi":"10.1016/s2213-2600(24)00362-x","DOIUrl":"https://doi.org/10.1016/s2213-2600(24)00362-x","url":null,"abstract":"<h3>Background</h3>Asthma is a respiratory disease characterised by chronic airway inflammation and mucus hypersecretion. VESTIGE used functional respiratory imaging to assess changes in airway structure and function, including mucus plugging, in response to dupilumab.<h3>Methods</h3>VESTIGE was a randomised, double-blind, placebo-controlled, phase 4 trial done at 72 research sites or academic centres in 14 countries. We recruited adult patients (aged 18–70 years) with physician-diagnosed, uncontrolled, moderate-to-severe type 2 asthma (blood eosinophil count ≥300 cells/μL and fractional exhaled nitric oxide [FeNO] ≥25 parts per billion [ppb]) being treated with medium-dose to high-dose inhaled corticosteroids combined with other controller medications. Patients were randomly assigned (2:1; block size of 6) via interactive voice–web response technology to receive add-on dupilumab 300 mg subcutaneously once every 2 weeks or volume-matched placebo up to week 24. Randomisation was stratified by inhaled corticosteroids dose level and region (USA <em>vs</em> non-USA). Participants and investigators, including those assessing outcomes, were masked to group assignment. The primary endpoints were the proportion of patients with a FeNO concentration below 25 ppb at week 24, and percentage change from baseline to week 24 in airway volumes (specific regional airway volumes corrected for lung volume, [s]iV<sub><em>aw</em></sub>) at total lung capacity (TLC), both assessed in the intention-to-treat population. Safety was assessed in all patients who received at least one dose of study drug or placebo. The trial is registered with <span><span>ClinicalTrials.gov</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span>, <span><span>NCT04400318</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span>, and is completed.<h3>Findings</h3>Patient recruitment occurred from July 18, 2020, to Jan 6, 2023. Patients (mean age 50·4 years [SD 12·6]; 68 [62%] female and 41 [38%] male) were randomly assigned to receive dupilumab 300 mg (n<em>=</em>72) or placebo (n<em>=</em>37). At week 24, patients in the dupilumab group were significantly more likely than those in the placebo group to have a FeNO concentration below 25 ppb (41 [57%] of 72 patients <em>vs</em> four [11%] of 37; odds ratio: 9·8 [95% CI 3·1 to 30·8]; p<0·001). Treatment with dupilumab versus placebo led to a numerical increase in (s)iV<sub><em>aw</em></sub> at TLC from baseline to week 24, although the difference was not significant (least squares [LS] mean percentage change from baseline to week 24: 19·7% [SE 8·1] for dupilumab and −2·0% [11·5] for placebo; LS mean difference <em>vs</em> placebo: 21·8%","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"41 1","pages":""},"PeriodicalIF":76.2,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143385476","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 : 2025-02-10DOI: 10.1016/s2213-2600(24)00380-1
Richard E K Russell
No Abstract
{"title":"Management and mechanisms of eosinophil action in asthma: mind the gap?","authors":"Richard E K Russell","doi":"10.1016/s2213-2600(24)00380-1","DOIUrl":"https://doi.org/10.1016/s2213-2600(24)00380-1","url":null,"abstract":"No Abstract","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"14 1","pages":""},"PeriodicalIF":76.2,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143385477","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 : 2025-02-04DOI: 10.1016/s2213-2600(24)00426-0
Rossa Brugha, Kavita Dave, Vicky Gerovasili, Amit Adlakha
No Abstract
{"title":"Expanding CFTR modulator access to benefit all patients who are waiting for a lung transplant","authors":"Rossa Brugha, Kavita Dave, Vicky Gerovasili, Amit Adlakha","doi":"10.1016/s2213-2600(24)00426-0","DOIUrl":"https://doi.org/10.1016/s2213-2600(24)00426-0","url":null,"abstract":"No Abstract","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"50 1","pages":""},"PeriodicalIF":76.2,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143124446","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 : 2025-02-04DOI: 10.1016/s2213-2600(24)00412-0
Simon Wolf, Luca Valerio, Nils Kucher, Stavros V Konstantinides, Irene L M Klaassen, C Heleen van Ommen, Cihan Ay, Frederikus A Klok, Suzanne C Cannegieter, Stefano Barco
Background
Epidemiological data on acute pulmonary embolism among children and adolescents are sparse and only date back to the 2000s. We aimed to establish annual estimates and age-stratified and sex-stratified indicators of acute pulmonary embolism among children and adolescents aged 0–19 years.
Methods
We did a retrospective, nationwide, patient-level analysis of the Kids’ Inpatient Database, including 5733 patients with acute pulmonary embolism aged 0–19 years admitted to hospital in the USA in 2016 and 2019. The database includes data of all children admitted to hospital during the 2 years available. We also accessed the US Multiple Cause of Death database and population data from the US Census Bureau for the same 2 years. We estimated the incidence, mortality, case fatality, and proportional mortality rates, provided data on the annual pulmonary embolism burden, and provided data on clinical events recorded during hospitalisation.
Findings
In the years 2016 and 2019, 5733 patients (3353 [58.5%] female and 2380 [41.5%] male) were admitted to hospital with acute pulmonary embolism as the primary diagnosis or a concomitant diagnosis. The annual incidence of acute pulmonary embolism was 3·5 (95% CI 3·4–3·6) per 100 000 people. Two peaks in the incidence rate were observed—one in infants younger than 1 year and one in adolescents aged 15–19 years. The in-hospital case fatality rate was 4·5% (4·0–5·1). The crude odds ratio for in-hospital death among patients with (vs without) acute pulmonary embolism was 9·3 (7·9–10·9). The association between acute pulmonary embolism and death persisted across different multivariable models. Patients with acute pulmonary embolism with high-risk (vs no high-risk) features had the highest risk of death: 25·3% (20·6–30·5) among patients aged 0–9 years and 13·9% (11·9–16·2) among patients aged 10–19 years. In patients without high-risk features, risk of death was 4·9% (3·1–7·6) among patients aged 0–9 years and 0·7% (0·5–1·0) among patients aged 10–19 years. The risk of intracranial bleeding was also highest in the presence of pulmonary embolism with high-risk features: 8·1% (5·5–11·7) among patients aged 0–9 years and 3·6% (2·6–4·9) among patients aged 10–19 years. In patients without high-risk features, the risk of intracranial bleeding was 2·5% (1·3–4·6) among those aged 0–9 years and 0·5% (0·3–0·8) in those aged 10–19 years. Reperfusion treatments beyond systemic thrombolysis were rarely used among children and adolescents with acute pulmonary embolism.
Interpretation
Acute pulmonary embolism is rare during childhood and adolescence. The high pulmonary embolism-related fatality among specific subgroups of patients can be interpreted in the context of severe comorbidities and pulmonary embolism events with high-risk features.
Funding
None.
{"title":"Acute pulmonary embolism in children and adolescents in the USA (2016 and 2019): a nationwide retrospective cohort study","authors":"Simon Wolf, Luca Valerio, Nils Kucher, Stavros V Konstantinides, Irene L M Klaassen, C Heleen van Ommen, Cihan Ay, Frederikus A Klok, Suzanne C Cannegieter, Stefano Barco","doi":"10.1016/s2213-2600(24)00412-0","DOIUrl":"https://doi.org/10.1016/s2213-2600(24)00412-0","url":null,"abstract":"<h3>Background</h3>Epidemiological data on acute pulmonary embolism among children and adolescents are sparse and only date back to the 2000s. We aimed to establish annual estimates and age-stratified and sex-stratified indicators of acute pulmonary embolism among children and adolescents aged 0–19 years.<h3>Methods</h3>We did a retrospective, nationwide, patient-level analysis of the Kids’ Inpatient Database, including 5733 patients with acute pulmonary embolism aged 0–19 years admitted to hospital in the USA in 2016 and 2019. The database includes data of all children admitted to hospital during the 2 years available. We also accessed the US Multiple Cause of Death database and population data from the US Census Bureau for the same 2 years. We estimated the incidence, mortality, case fatality, and proportional mortality rates, provided data on the annual pulmonary embolism burden, and provided data on clinical events recorded during hospitalisation.<h3>Findings</h3>In the years 2016 and 2019, 5733 patients (3353 [58.5%] female and 2380 [41.5%] male) were admitted to hospital with acute pulmonary embolism as the primary diagnosis or a concomitant diagnosis. The annual incidence of acute pulmonary embolism was 3·5 (95% CI 3·4–3·6) per 100 000 people. Two peaks in the incidence rate were observed—one in infants younger than 1 year and one in adolescents aged 15–19 years. The in-hospital case fatality rate was 4·5% (4·0–5·1). The crude odds ratio for in-hospital death among patients with (<em>vs</em> without) acute pulmonary embolism was 9·3 (7·9–10·9). The association between acute pulmonary embolism and death persisted across different multivariable models. Patients with acute pulmonary embolism with high-risk (<em>vs</em> no high-risk) features had the highest risk of death: 25·3% (20·6–30·5) among patients aged 0–9 years and 13·9% (11·9–16·2) among patients aged 10–19 years. In patients without high-risk features, risk of death was 4·9% (3·1–7·6) among patients aged 0–9 years and 0·7% (0·5–1·0) among patients aged 10–19 years. The risk of intracranial bleeding was also highest in the presence of pulmonary embolism with high-risk features: 8·1% (5·5–11·7) among patients aged 0–9 years and 3·6% (2·6–4·9) among patients aged 10–19 years. In patients without high-risk features, the risk of intracranial bleeding was 2·5% (1·3–4·6) among those aged 0–9 years and 0·5% (0·3–0·8) in those aged 10–19 years. Reperfusion treatments beyond systemic thrombolysis were rarely used among children and adolescents with acute pulmonary embolism.<h3>Interpretation</h3>Acute pulmonary embolism is rare during childhood and adolescence. The high pulmonary embolism-related fatality among specific subgroups of patients can be interpreted in the context of severe comorbidities and pulmonary embolism events with high-risk features.<h3>Funding</h3>None.","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"8 1","pages":""},"PeriodicalIF":76.2,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143124444","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 : 2025-02-04DOI: 10.1016/s2213-2600(25)00004-9
No Abstract
{"title":"Thank you to The Lancet Respiratory Medicine's clinical and statistical peer reviewers in 2024","authors":"","doi":"10.1016/s2213-2600(25)00004-9","DOIUrl":"https://doi.org/10.1016/s2213-2600(25)00004-9","url":null,"abstract":"No Abstract","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"14 1","pages":""},"PeriodicalIF":76.2,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143124825","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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