BMJ Open Respiratory Research最新文献

Background: A person's beliefs about treatment influence their engagement and adherence to that treatment. The Necessity-Concerns Framework suggests that adherence is influenced by a person's judgement of their own need for treatment (necessity beliefs) and concerns about the potential adverse consequences of taking the treatment. This study was conducted to explore the Necessity-Concerns Framework for elexacaftor-tezacaftor-ivacaftor (ETI) therapy (Kaftrio) in adults with cystic fibrosis (CF).

Methods: A total of 64 adults with CF were maintained on ETI therapy as part of their routine CF care, and completed the Beliefs about Medicines Questionnaire. Patient demographics, lung function, body mass index and quality of life using the Cystic Fibrosis Questionnaire Revised were collected as part of routine clinical care. Duration of ETI therapy along with medicines possession ratio was recorded.

Results: Patients reported strong beliefs about the necessity of ETI therapy. The majority of patients (78%) reported low concerns about ETI therapy while 22% of patients reported high concerns. A small number of patients (n=4) had concerns which were stronger than their beliefs about necessity.

Discussion: Patients reported strong beliefs in the necessity of ETI therapy. Although concerns were lower, a significant proportion of the sample had strong concerns about their ETI therapy. By being aware of people with CF's necessity and concerns beliefs around ETI therapy clinical teams will be better armed to engage them in treatment decisions and support optimal adherence.

Background: Respiratory virus infections are a major cause of morbidity in early life. During the SARS-CoV-2 pandemic, non-pharmaceutical interventions (NPIs) lead to worldwide changes in respiratory virus epidemiology. However, evidence regarding virus circulation in the outpatient setting remains largely unknown. The aim of this study is to longitudinally assess respiratory viruses in healthy infants before and during the SARS-CoV-2 pandemic in Switzerland.

Methods: In this prospective observational birth cohort study, we followed 34 infants throughout the first year of life before and during the SARS-CoV-2 pandemic. We analysed 648 biweekly nasal swabs for nine different respiratory viruses by Multiplex-PCR and assessed respiratory symptoms, COVID-19 infections of family members and childcare status in weekly interviews. 712 nasal swabs from 32 infants analysed before the pandemic and published previously served as control group.

Results: During the period with strict NPIs (pandemic I), most common respiratory viruses were not detected, with a rebound (driven by Adenovirus and Parainfluenza virus) after most NPIs were relaxed (pandemic II): prepandemic: 27%, pandemic I: 19%, pandemic II: 33%; historic: 36% of collected swabs per period, p<0.001. Human rhinovirus (HRV) prevalence persisted during NPIs presence, mainly in the form of asymptomatic HRV detection: prepandemic=24%, pandemic I=19%, pandemic II=25%, historic: 25%, p=0.3. SARS-CoV-2 detection (asymptomatic and symptomatic) was low, and only present after NPIs were relaxed: pandemic II=2.4%. No severe COVID-19 infections were reported.

Discussion: In our cohort, infants did not contribute largely to spread of SARS-CoV-2. The role of persisting asymptomatic HRV prevalence is still unclear, but it might help to maintain population immunity to prevent more severe infections. Our results underscore the importance of capturing asymptomatic viruses via longitudinal community-based data assessment to better understand virus transmission.

Background: SARS-CoV-2 infection is associated with protection against reinfection. This study analysed this protection across different reinfection symptoms and severities, comparing the preomicron and omicron eras.

Methods: A nationwide, matched, test-negative, case-control study was conducted in Qatar from 5 February 2020 to 12 March 2024. The preomicron analysis used a sample of 509 949 positive and 8 494 782 negative tests, while the omicron analysis included 682 257 positive and 6 904 044 negative tests. Data were sourced from Qatar's national databases for COVID-19 laboratory testing, vaccination, hospitalisation and death.

Results: Effectiveness of preomicron infection against preomicron reinfection was estimated at 80.9% (95% CI: 79.1% to 82.6%) for asymptomatic reinfection, 87.5% (95% CI: 86.1% to 88.9%) for symptomatic reinfection, 97.8% (95% CI: 95.7% to 98.9%) for severe COVID-19 reinfection, 100.0% (95% CI: 97.5% to 100.0%) for critical COVID-19 reinfection and 88.1% (95% CI: 50.3% to 97.2%) for fatal COVID-19 reinfection. For omicron infection against omicron reinfection, the estimates were 46.4% (95% CI: 36.9% to 54.4%) for asymptomatic reinfection, 52.8% (95% CI: 44.4% to 60.0%) for symptomatic reinfection, 100.0% (95% CI: 55.4% to 100.0%) for severe COVID-19 reinfection, 100.0% (95% CI: 15.1% to 100.0%) for critical COVID-19 reinfection, and 75.2% (95% CI: -58.8% to 97.5%) for fatal COVID-19 reinfection. Effectiveness over time since previous infection showed no discernible decline in protection against all forms of reinfection in the preomicron era, but a rapid decline against asymptomatic and symptomatic reinfections in the omicron era.

Conclusions: A gradient of protection against reinfection is evident, with the highest protection observed against severe forms of COVID-19. Over time, this gradient becomes more pronounced, as protection against asymptomatic and symptomatic reinfections decreases, while protection against severe outcomes remains strong.

Background: Living with severe and uncontrolled asthma can negatively impact on well-being, yet little is known about the psychosocial impact on young adults (age 12-25).

Aim: To identify, appraise and synthesise current literature pertaining to the psychosocial experience of living with severe and uncontrolled asthma as a young adult, to generate new knowledge, further conceptual understanding and provide recommendations to help improve long-term outcomes.

Methods: We followed a predefined protocol, registered on PROSPERO. We systematically searched for qualitative research which captured the psychosocial impact of living with severe and uncontrolled asthma as a young adult. Using thematic synthesis, data was coded and developed into descriptive and analytical themes.

Results: 10 studies with 219 participants were identified and included in the synthesis. 73 codes were then developed into 17 descriptive themes, subsequently forming 5 analytical themes: 'Living with a constant uncertainty', 'The deleterious impact of asthma', 'Acquiescence', 'A need for support & understanding' and 'The constraints of living with asthma'.Young adults with severe and uncontrolled asthma live with a significant negative impact on their psychosocial well-being. Reported emotions described living with a burden of shame, embarrassment, anxiety, isolation, uncertainty, fear, conflict, lack of control, restriction on life choices and a perceived desire to be normal. These emotions influenced lifestyle choices and adherence to treatment, compounding on physical symptomology. This resulted in a cyclical interplay between the physical and psychological impact of living with severe and uncontrolled asthma.

Conclusion: There is clear evidence of a negative psychosocial impact of living with severe and uncontrolled asthma as a young adult. We have also highlighted the paucity of recent literature and provide the rationale for further research, to increase our understanding of the impact and support requirements of young adults with severe asthma to help improve long-term outcomes and quality of life.

Prospero registration number: CRD42022363201.

Objective: To conduct a head-to-head diagnostic accuracy evaluation of anterior nares (AN) and nasopharyngeal (NP) swabs for SARS-CoV-2 antigen detection using two brands of rapid diagnostic tests (Ag-RDT).

Methods: Two prospective diagnostic evaluations were carried out at different time points and participant cohorts to evaluate the performance of paired AN and NP swabs in two Ag-RDT brands: Sure-Status (PMC, India) and Biocredit (RapiGEN, South Korea). The sensitivity and specificity of AN and NP swabs for each of the index test cohorts were calculated against the reverse transcription quantitative PCR (RT-qPCR) TaqPath COVID-19 (ThermoFisher, UK) using NP swabs as reference standard.

Results: A total of 372 participants were recruited for the Sure-Status cohort and 232 for the Biocredit, of which 119 (32.1%) and 122 (53.7%) were SARS-CoV-2 positive by RT-qPCR, respectively. Sensitivity and specificity of AN swabs were equivalent to those obtained with NP swabs in both cohorts: 83.9% (95% CI 76.0-90.0) and 98.8% (95% CI 96.6-9.8) using NP swabs and 85.6% (95% CI 77.1-91.4) and 99.2% (95% CI 97.1-99.9) with AN swabs for Sure-Status and; 81.2% (95% CI 73.1-87.7) and 99.0% (95% CI 94.7-86.5) with NP swabs and 79.5% (95% CI 71.3-86.3) and 100% (95% CI 96.5-100) with AN swabs for Biocredit. The agreement of the AN and NP swabs was high for both brands with an inter-rater reliability (κ) of 0.918 and 0.833 for Sure-Status and Biocredit, respectively. The overall 50% limits of detection (LoD50) and 95% LoD (LoD95) were 0.9-2.4×10⁴ and 3.0-3.2×10⁸ RNA copies/mL for NP swabs and 0.3-1.1×10⁵ and 0.7-7.9×10⁷ RNA copies/mL for AN swabs, with no significant difference in LoD for any of the swab types or test brands.

Conclusions: The diagnostic accuracy of the two SARS-CoV-2 Ag-RDT brands evaluated in this study was equivalent using AN swabs than NP swabs. However, test line intensity was lower when using AN swabs, which could negatively influence the interpretation of the Ag-RDT results by lay users.

Trail registration number: NCT04408170.

Introduction: Breathlessness is common and impairs the quality of life of people with idiopathic pulmonary fibrosis (IPF) and non-IPF fibrotic interstitial lung diseases (ILD). We report the findings of a multicentre, fast-track (wait-list), mixed-methods, randomised controlled, feasibility study of a complex breathlessness intervention in breathless IPF and non-IPF fibrotic ILD patients.

Methods: Breathless IPF and non-IPF fibrotic ILD patients were randomised to receive the intervention within 1 week (fast-track) or after 8 weeks (wait-list). The intervention comprised two face-to-face and one telephone appointment during a 3-week period covering breathing control, handheld fan-use, pacing and breathlessness management techniques, and techniques to manage anxiety. Feasibility and clinical outcomes were assessed to inform progression to, and optimal design for, a definitive trial. A qualitative substudy explored barriers and facilitators to trial and intervention delivery.

Results: 47 patients (M:F 38:9, mean (SD) age 73.9 (7.2)) were randomised with a recruitment rate of 2.5 participants per month across three sites. The adjusted mean differences (95% CI) for key clinical outcomes at 4 weeks post randomisation were as follows: Chronic Respiratory Questionnaire breathlessness mastery domain (0.45 (-0.07, 0.97)); and numerical rating scales for 'worst' (-0.93 (-1.95, 0.10)), 'best' (-0.19 (-1.38, 1.00)), 'distress caused by' (-1.84 (-3.29, -0.39)) and 'ability to cope with' (0.71 (-0.57, 1.99)) breathlessness within the past 24 hours. The qualitative substudy confirmed intervention acceptability and informed feasibility and acceptability of study outcome measures.

Conclusion: A definitive trial of a complex breathlessness intervention in patients with IPF and non-IPF fibrotic ILD is feasible with preliminary data supporting intervention effectiveness.

Trial registration number: ISRCTN13784514.

Background: Asthma and chronic obstructive pulmonary disease (COPD) outcomes vary by sex. We investigated whether males and females with asthma or COPD are managed differently in-hospital when admitted for an exacerbation.

Methods: Data from the National Asthma and COPD Audit Programme were used to determine three cohorts of people hospitalised for an exacerbation: (1) adults with asthma, (2) children and young people (CYP) with asthma, and (3) adults with COPD. Outcomes included the following in-hospital interventional measures: spirometry recording, respiratory specialist review, respiratory medication administration and discharge bundle recording. Linked hospital data were used to determine 30-day and 90-day readmissions and Office for National Statistics data for 90-day mortality. Random effects logistic regression was used to investigate the association between sex and in-hospital outcomes, readmission and mortality.

Results: 16 370 adults with asthma, 7156 CYP with asthma and 28 354 adults with COPD were included. Female adults with asthma had higher odds of being seen by a respiratory specialist (_aOR 0.1.13, 1.02-1.26) and higher odds of readmission within 30 and 90 days (_aOR 1.22, 1.10-1.37, _aOR 1.34, 1.23-1.46) compared with males. Female adults with COPD had higher odds of being seen by a respiratory specialist, (_aOR 1.10,1.02-1.19), being administered non-invasive ventilation (_aOR 1.18, 1.09-1.29), and receiving a discharge bundle (_aOR 1.07, 1.00-1.14), and lower odds of readmission within 90 days (_aOR 0.95, 0.90-1.01), or mortality within 90 days (_aOR 0.88, 0.81-0.96). Lastly, female CYP had higher odds of steroids administered within 1 hour (_aOR 1.13, 1.00-1.28) and higher 30-day and 90-day readmission compared with males (_aOR 1.21, 1.00-1.44 and 1.17, 1.03-1.34).

Interpretation: Sex differences in in-hospital care exist in adults COPD, which may impact readmissions and mortality; however, little to no sex differences in in-hospital care were seen in people with asthma yet females were more likely to be readmitted to hospital.

Objectives: Cardiovascular disease is a prevalent comorbidity and leading cause of mortality in chronic obstructive pulmonary disease (COPD) patients. Early identification of cardiac abnormalities in COPD patients is crucial. Speckle tracking echocardiography (STE) is practical for assessing ventricular and atrial function, but its role in COPD patients is under-researched. This study aimed to examine right ventricular (RV), left ventricular (LV) and left atrial (LA) strain in COPD patients via STE.

Methods: A cross-sectional study was conducted with two groups: COPD patients diagnosed per the 2017 Global Initiative for Chronic Obstructive Lung Disease criteria and healthy controls. All the participants underwent STE to evaluate the RV, LV, and LA strains.

Results: RV strain indices (RV free wall longitudinal strain (RVFWSL) and RV 4-chamber longitudinal strain (RV4CSL)) were significantly lower in the COPD group (16.53±5.89% and 14.65±4.53%, respectively) than in the control group (21.39±7.78% and 18.34±6.38%, respectively) (p<0.001). LV global longitudinal strain was also lower in the COPD group (18.45% (17.16-19.51)) than in the control group (19.50% (18.63-21.46), p=0.018). No significant differences were found in LA strain indices (LA reservoir strain, LA conduit strain or LA contractile strain) between the two groups. Furthermore, RVFWSL and RV4CSL were significantly greater in the group with a modified Medical Research Council score <2 (p<0.05).

Conclusion: Compared with healthy controls, COPD patients presented reduced RV and LV strain, with no significant differences in LA strain indices.

Introduction: The 2022 British Thoracic Society Pleural Services Organisational Audit highlighted evidence of ongoing risk of harm from pleural procedures. To better understand the underlying causes of these safety concerns we undertook a review of patient safety incidents from the National Reporting and Learning System (NRLS).

Methods: Incident-level patient safety data from NRLS were requested from any level 3, 4 and 5 incidents describing harm resulting from pleural intervention, specifically chest drain insertion or pleural aspiration for pleural effusions (fluid), submitted between 1 April 2018 and 30 March 2022.

Results: 256 incidents were identified. Most of these did not directly relate to a pleural procedure or its concerns and so were excluded. Ultimately, 21 incidents (including 2 deaths) were relevant. 17 involved direct organ puncture, predominantly liver (n= 13). 11 incidents involved seldinger drains, 5 blunt dissection drains and 1 involved both (not specified in 4). In only four incidents was it clearly detailed that an ultrasound-assisted approach had been used. In the remainder, the use of ultrasound was largely not detailed at all, or the approach used was not clear or inappropriate. Most (19/21) events occurred out with respiratory environments.

Discussion: These data raise concerns about pleural intervention for fluid occurring where lack of appropriate ultrasound use may have contributed in a variety of clinical areas. This should be highlighted at a national level by specialty groups and societies. We welcome an upcoming National Confidential Enquiry into Patient Outcome and Death study to help cement our understanding of factors underlying this ongoing risk of harm and to enable definitive action to be taken to reduce this risk.