Pulmonology最新文献

Background: This systematic review assesses the current available evidence across the WHO European region on the effectiveness and cost-effectiveness of the different approaches used for TB screening and also explores the facilitators and barriers that migrants face during screening programmes.

Methods: We conducted an extensive, comprehensive, and systematic literature search across multiple databases, including MEDLINE, Cochrane, Scopus, and ISI Web of Knowledge, without any restrictions on publication date or language. In addition, we reviewed grey literature and reports. The data were meticulously analysed with a focus on screening of TB active disease and infection effectiveness indicators, and cost-effectiveness economic analyses as a primary objective and the comprehension of barriers and facilitators of screening as a secondary objective.

Findings: Our review included 43 studies covering over 8 million migrants from 11 countries. The findings demonstrate that while screening uptake was high, coverage varied, and completion rates for preventive treatments were low. Economic analyses supported the high cost-effectiveness of the screening programmes, particularly when integrating both active TB and TBI screening strategies.

Interpretation: This review underscores the cost-effectiveness and public health importance of TB screening in migrant populations within Europe. However, the disparities in screening practices highlight the urgent need for standardisation at the European level.

Background: High-flow nasal cannula (HFNC) is widely used in acute exacerbations of chronic obstructive pulmonary disease (AECOPD) treatment, but the optimal initial flow settings remain unclear. Research question Which initial HFNC flow rate provides the most effective and safe clinical outcomes for patients with AECOPD? Study design.

Methods: We searched 7 databases for studies published before January 2025. Network meta-analysis was conducted using R software (version 4.2.3) within a Bayesian framework. The primary outcome was intubation rate, and secondary outcomes included short-term mortality, PaCO₂, pH, PaO₂/FiO₂, and length of hospital stay.

Results: The analysis included 40 RCTs with 3597 patients. HFNC showed no significant difference from NIV in intubation rates. HFNC_Low (20 to 30 L/min) significantly reduced PaCO₂, improved pH, and lowered incidence of nasal and facial injuries. HFNC_Mod (30 to 50 L/min) significantly shortened hospital stay. SUCRA rankings indicated HFNC_Low as most effective for PaCO₂, pH, and injury prevention, while HFNC_Mod ranked highest for reducing hospital stay.

Conclusions: HFNC_Low demonstrates superior efficacy in lowering PaCO₂ levels, the incidence of nasal and facial injuries, and improving pH. Although HFNC_Mod may reduce hospital stay, low-flow settings are recommended as the preferred initial strategy for AECOPD.

Background: Respiratory syncytial virus (RSV) is an important cause of lower respiratory tract infection, hospitalisation and death in adults.

Methods: Based on evidence regarding the impact of RSV on adult populations at risk for severe infection and the efficacy and safety of RSV vaccines, the Portuguese Society of Pulmonology, the Portuguese Association of General and Family Medicine, the Portuguese Society of Cardiology, the Portuguese Society of Infectious Diseases and Clinical Microbiology, the Portuguese Society of Endocrinology, Diabetes and Metabolism, and the Portuguese Society of Internal Medicine endorses this position paper with recommendations to prevent RSV-associated disease and its complications in adults through vaccination.

Conclusion: The RSV vaccine is recommended for people aged ≥50 years with risk factors (chronic obstructive pulmonary disease, asthma, heart failure, coronary artery disease, diabetes, chronic kidney disease, chronic liver disease, immunocompromise, frailty, dementia, and residence in a nursing home) and all persons aged ≥60 years. If it cannot be made available to this population, then the vaccine should be prioritised for individuals aged ≥75 years and those aged ≥50 years with risk factors. The vaccine should preferably be given between September and November and can be co-administered with the influenza vaccine. Ongoing studies on RSV vaccines may justify extending these recommendations in the future.

Importance: Prior study in healthy subjects has shown a reduction of partial pressure of arterial oxygen (PaO₂) by -1.60 kPa/kilometre of altitude gain. However, the association of altitude-related change in PaO₂ and altitude-related adverse health effects (ARAHE) in patients with chronic obstructive pulmonary disease (COPD) remain unknown.

Objective: To provide an effect size estimate for the decline in PaO₂ with each kilometre of altitude gain and to identify ARAHE in relation to altitude in patients with COPD. www.crd.york.ac.uk/prospero: CRD42020217938.

Data sources: A systematic search of PubMed and Embase was performed from inception to May 30, 2023.

Study selection: Peer-reviewed and prospective studies in patients with COPD staying at altitudes >1500 m providing arterial blood gases within the first 3 days at the target altitude.

Data extraction and synthesis: Aggregate data (AD) on study characteristics were extracted, and individual patient data (IPD) were requested. Estimates were pooled using random-effects meta-analysis.

Main outcome and measures: Relative risk estimates and 95 % confidence intervals for the association between PaO₂ and altitude in patients with COPD.

Results: Thirteen studies were included in the AD analysis, of which 6 studies (222 patients, 45.2 % female) provided IPD, thus were included in the quantitative analysis. The estimated effect size of PaO₂ was -0.84 kPa [95 %CI, -0.92 to -0.76] per 1000 m of altitude gain (I²=65.0 %, P < 0.001). In multivariable regression analysis, COPD severity, baseline PaO₂, age and time spent at altitude were predictors for PaO₂ at altitude. Overall, 37.8 % of COPD patients experienced an ARAHE, whereas older age, female sex, COPD severity, baseline PaO_2, and target altitude were predictors for the occurrence of ARAHE (area under ROC curve: 0.9275, P < 0.001).

Conclusions and relevance: This meta-analysis, providing altitude-related decrease in PaO₂ and risk of ARAHE in patients with COPD ascending to altitudes >1500 m, revealed a lower altitude-related decrease in PaO₂ in COPD patients compared with healthy. However, these findings might improve patient care and facilitate decisions about initiating preventive measures against hypoxaemia and ARAHE in patients with COPD planning an altitude sojourn or intercontinental flight, i.e. supplemental oxygen or acetazolamide.