BMJ Open Respiratory Research最新文献

Background: Pulmonary rehabilitation (PR) is a highly effective intervention for people with chronic respiratory disease; however, it is not known how best to sustain its benefits. Clinical trials are needed to establish if participation in singing for lung health (SLH) groups following PR will improve health-related quality of life, healthcare utilisation and exercise capacity compared with usual care. A feasibility study would help to guide development of these trials.

Methods: In a multicentre, mixed-methods randomised controlled feasibility trial, PR participants at four sites were prescreened at baseline assessment. An SLH taster session was included routinely as part of the PR programmes. Eligible PR completers were invited to take part in the trial and randomised to usual care or a 12-week SLH course. Feasibility outcomes included recruitment rate, intervention compliance (at least 8/12 sessions) and health economic analysis. Interviews with participants and study personnel were undertaken and thematic analysis of the results was completed.

Results: Between October 2022 and November 2023, 1311 patients were assessed to start PR, 838 completed. Of those completing, 243 were ineligible to take part (predominantly due to vaccination status and excluded diagnoses for PR referral), and 531 declined. 64 people (33 female, mean (SD) age 69 (12), 41 ethnically white, 33 with chronic obstructive pulmonary disease, 16 with asthma, 9 with interstitial lung disease, 6 with bronchiectasis) were recruited, with 30 (93.8%) SLH and 29 (90.6%) controls completing the study. 20 (62.5%) of the SLH group completed at least 8/12 SLH sessions. There was enthusiasm for a definitive trial from participants, clinicians and singing group leaders' perspectives, based on positive experiences of trial involvement. Improvements to recruitment strategy, intervention structure, outcome measures and staffing were suggested.

Conclusions: A definitive randomised controlled trial of SLH post-PR appears feasible, with acceptable uptake and completion rates.

Trial registration number: ISRCTN11056049.

Introduction: Small-scale miners are known to experience high silica exposures, associated with high rates of silicosis and Tuberculosis (TB). TB has been shown to worsen underlying impairment of lung function in miners. We describe the spirometry outcomes, according to previous TB status, among a large cohort of small-scale miners attending a screening centre.

Methods: We collected cross-sectional spirometry and clinical data from consecutive miners and ex-miners, with negative Xpert TB results, attending a screening clinic in Northern Tanzania, between February 2018 and December 2020. Spirometry values assessed using the ATS/ERS 2019 quality criteria and compared with GLI 2022 global (GLIgl) reference values. We used multiple linear regression to model excess Forced Expiratory Volume in 1 s (FEV1) and Forced Vital Capacity (FVC) loss using an a priori interaction between duration of work and previous TB.

Results: Of 542 participants with spirometry results, 80 (15%) reported previous TB. At least moderate (z-score ≤-2.5) FEV1 reductions were present in 51% of participants with previous TB and 18% of those without previous TB. For FVC, respective values were 34% and 10%. A miner with TB and 10 years of work was modelled to have lost 1405 (95% CI 1134 to 1676) mls of FEV1 and 1342 (95% CI 1042 to 1641) mls of FVC compared with GLIgl reference values. For miners without previous TB, the corresponding excess FEV1 and FVC losses were 693 (95% CI 581 to 804) mls and 624 (95% CI 504 to 743) mls, respectively.

Discussion: Unmeasured silicosis may partially explain some of the observed effect of previous TB. However, this does not change our observation of a clinically significant burden of abnormal spirometry in a clinic-based population of small-scale miners. Reducing silica exposures and preventing TB are key to improving lung health in miners.

Introduction: Yoga is an emerging exercise choice for people with cystic fibrosis (CF), but evidence of its effect in this population is scarce, with a recent systematic review advocating for further research. Yoga Outcomes Get Assessed in CF (YOGA-CF) is a real-world multicentre randomised controlled trial (RCT) investigating a bespoke CF-specific online 12-week yoga intervention, vers usual care, to determine effectiveness for adults with CF.

Methods and analysis: A multicentre RCT of adults with CF across the UK. Participants are randomised to usual care or a 12-week online bespoke yoga programme with an expectation of two classes completed weekly. Assessments of lung function, 1 min sit-to-stand, the Cystic Fibrosis Questionnaire-Revised (CFQ-R) and other trial questionnaires are completed preintervention and postintervention (0 and 12 weeks) and after 12 weeks of follow-up (week 24). The primary outcome is the difference in respiratory-related quality of life measured using the CFQ-R before and after yoga/control. Sample size was calculated based on detecting a minimally clinically important difference of 4 for the CFQ-R respiratory domain, with power of 80% and 5% significance level (total target, n=314).

Ethics and dissemination: Ethics approval gained from the South Yorkshire and Humber Research Ethics Committee (REC) (reference: 23/YH/0270, project ID 303898). Dissemination to involve direct participant feedback and lay webinar, scientific conference presentation and publication in a peer-reviewed journal.

Trial registration number: NCT06120465.

Background: Chronic obstructive pulmonary disease (COPD) incurs significant mortality worldwide. Less is known about the burden in the last decade across Europe. We report trends and variations in mortality for patients with COPD across 27 European countries from 2011 to 2021.

Methods: COPD mortality was extracted from the EUROSTAT database, using the International Classification of Diseases 10 codes J43 and J44 for each country. Age-standardised and sex-standardised mortality rates (SMR) were calculated and joinpoint regression identified average annual percentage change (AAPC) in deaths from 2011 to 2021. Global Burden of Disease tobacco prevalence data were used to try and best contextualise the mortality.

Results: The overall SMR in Europe for this period was 32.1 (95% CI 32.0 to 32.1) per 100 000 person-years, with substantial geographical heterogeneity. There was a fivefold difference in mortality rates between the countries with the greatest versus the least deaths. Although there was an apparent 3% (95% CI -4.4% to -1.6%) decrease in average annual deaths from 2011 to 2021 across Europe, there was no significant change in deaths from 2011 to 2018, prior to the UK leaving the dataset (a noticeably high outlier in SMR) and the COVID-19 pandemic. A 2% reduction (95% CI -2.6% to -1.2%) in annual mortality rate was noted in males from 2011 to 2018, while females increased (AAPC 1.3% (95% CI 0.1% to 2.6)%) in the same time frame.

Conclusion: The plateau in COPD-related deaths across Europe from 2011 to 2018 demands focus. Geographical variation in mortality suggests under-reporting in some countries, which may underestimate the true burden.

Background: UK General Internal Medicine (GIM) registrars are traditionally expected to be able to perform pleural procedures out-of-hours (OOH) if required. Pleural exposure for GIM registrars has declined, with procedures increasingly performed by specialists in-hours. Pleural procedures can cause significant harm. We explored the role of the GIM registrar in performing OOH pleural procedures, with particular focus on competence and confidence.

Methods: An anonymous survey was distributed to GIM registrars and respiratory consultants across the UK.

Results: Responses were received from 391 non-respiratory GIM registrars and 93 respiratory consultants. 37% of registrars reported being 'signed-off' as independent in chest drain insertion for pneumothorax. 69% had not done a pleural procedure for at least a year. Regarding perceived confidence for OOH chest drain insertion for pneumothorax, 42% reported no confidence to perform the procedure even if directly supervised, with only 11% feeling confident to proceed unsupervised. Consultants rated the pleural competence of an average non-respiratory GIM registrar; only 4% felt they could perform the procedure unsupervised. Common themes in the free text included anxiety surrounding pleural procedures, patient safety concerns, insufficient available training opportunities to maintain competency and differing opinions on the evolving role of the medical registrar and who should be expected to perform OOH pleural procedures.

Conclusions: The majority of UK GIM registrars are neither confident nor perceived by trainers as competent to independently perform OOH chest drain insertion. This has implications for patient safety and service delivery, informing broader discussions regarding GIM training, curriculum and the need to establish local OOH pleural pathways.

Introduction: Since the inflammatory response increases the production and accumulation of mucus in the airways during respiratory infections, conventional and unconventional techniques of secretion removal are used. High-frequency chest wall oscillation is an effective strategy for secretion removal; however, it presents barriers due to the high cost. In Brazil, the Expector was developed using a kangaroo-vest interface as an accessible alternative; however, studies are needed to evaluate the use of Expector in infants. The aim of this study was to assess the feasibility and usability of the Expector device in healthy infants.

Methods and analysis: For this feasibility randomised controlled clinical trial, 30 participants aged 3-6 months will be divided into three groups. Two experimental groups will use the Expector device (kangaroo baby-carrier version) with different configurations of the minivibrating motors (ie, totally activated and upper half of motors activated). The device will be deactivated for the control group. The following parameters will be assessed before the test, every 5 min during 15 min of device use and for 15 min after its use: heart rate, respiratory rate, peripheral oxygen saturation, pulmonary auscultation, sleep/wakefulness state, pain and parental satisfaction. Data will be described using measures of central tendency and dispersion and absolute and relative frequencies. Statistical analysis will be performed using correlation and intra- and intergroup comparisons. This study will generate preliminary evidence regarding the feasibility of Expector (kangaroo baby-carrier version) for infants and allow randomised and controlled studies using this technology.

Ethics and dissemination: The Ethics Committee of the Faculty of Health Sciences of Trairi of the Federal University of Rio Grande do Norte approved this study (Number 5636504). Findings will be disseminated through peer-reviewed journal publications, scientific conference presentations and knowledge translation to the public via social media.

Trial registration number: This feasibility randomised controlled clinical trial was registered in the Brazilian Registry of Clinical Trials (REBEC) (Number RBR-5r8v8qz).

Background: The metabolic score of visceral fat (METS-VF) is linked to chronic obstructive pulmonary disease (COPD) incidence, while its association with mortality and adverse outcomes in patients with COPD remains unclear.

Materials and methods: We analysed 7246 participants with COPD from the UK Biobank and 869 from US National Health and Nutrition Examination Survey (US NHANES) (1999-2018). METS-VF was categorised into quartiles. In UK Biobank, outcomes included all-cause, cardiovascular disease (CVD), COPD-specific mortality, pulmonary heart disease (PHD), pulmonary embolism (PE) and heart failure (HF); in NHANES, only all-cause and CVD mortality were evaluated. UK Biobank analyses used Cox models, restricted cubic splines, Kaplan-Meier curves, time-dependent receiver operating characteristic (ROC) curves and mediation analysis (C reactive protein (CRP), white blood cell count (WBC), platelet count (PLT)). NHANES served as an external validation cohort using survey-weighted Cox models, subgroup and sensitivity analyses and time-dependent ROC for the two mortality outcomes.

Results: In UK Biobank, restricted cubic splines identified non-linear associations of METS-VF with all-cause and CVD mortality, with a common inflection point at 7.03, and linear associations with secondary outcomes. Compared with the lowest quartile, the highest METS-VF quartile showed significantly higher risks of all-cause mortality (HR 1.467), CVD mortality (HR 3.000), COPD-specific mortality (HR 1.952), PHD (HR 3.505), PE (HR 2.301) and HF (HR 2.567). Similar positive associations were observed in NHANES, where the highest METS-VF quartile remained significantly associated with all-cause mortality (HR 3.337) and CVD mortality (HR 3.011). Time-dependent ROC analyses demonstrated modest but stable discrimination across follow-up in both cohorts. Mediation analyses showed that CRP and WBC partially mediated the associations of METS-VF with mortality and cardiopulmonary outcomes, whereas PLT did not exhibit significant mediation effects.

Conclusions: Elevated METS-VF is consistently associated with increased long-term risks of mortality and cardiopulmonary complications in COPD across independent discovery and validation cohorts. METS-VF may serve as a practical prognostic biomarker for risk stratification in the clinical management of COPD.

Objectives: Paediatric acute respiratory distress syndrome (PARDS) is a heterogeneous condition and identifying a specific biomarker remains a challenge. We aimed to validate the association of plasma soluble receptor for advanced glycation end-products (sRAGE) and angiopoietin-2 (Ang-2) with PARDS diagnosis, and its prognostic performance.

Methods: This prospective observational study included children with PARDS and non-PARDS critical illness. Plasma sRAGE and Ang-2 levels were measured using enzyme-linked immunosorbent assays. Comparisons were made between PARDS versus non-PARDS critical illness and survivors versus non-survivors. Multivariable logistic regression was used to determine the association between biomarkers and intensive care unit (ICU) mortality after adjusting for age and the Pediatric Index of Mortality 3 score.

Results: 93 and 117 patients with PARDS and non-PARDS critical illness, respectively, were included in this study. Plasma sRAGE was higher in PARDS versus non-PARDS critical illness (2981 (1027 to 6198) vs 1575 (864 to 2994) pg/mL; p=0.002) and in non-survivors vs survivors (5323 (1647 to 8261) vs 1601 (864 to 3572); p<0.001). Plasma Ang-2 was elevated in non-survivors versus survivors (3054 (1760 to 6808) vs 1748 (845 to 3868); p=0.002), though there was no difference between PARDS and non-PARDS groups. In the multivariable model, sRAGE demonstrated an independent association with PARDS diagnosis (adjusted OR (aOR) 1.01 95% CI 1.01 to 1.02; p=0.003) and ICU mortality (aOR 1.02 (95% CI 1.01 to 1.03); p<0.001), whereas there was no association observed with Ang-2.

Conclusion: Within an ICU cohort, only sRAGE demonstrated an association with the diagnosis of PARDS and ICU mortality, which remained after controlling for confounders.

Diagnosis of complicated parapneumonic pleural effusion (CPPE), empyema and uncomplicated parapneumonic pleural effusion (UPPE) is vital in therapeutic management.

Objective: To measure the pleural fluid concentrations of soluble triggering receptor expressed on myeloid cell-1 (sTREM-1), procalcitonin (PCT) and C reactive protein (CRP) to provide information for diagnosing and discriminating between CPPE and UPPE.

Methods: Retrospective data analysis from February 2016 to December 2017, focused on pleural fluid analysis of patients with infectious (PPE, empyema and tuberculosis) and non-infectious (malignant and transudates) effusions.

Results: Over 224 pleural fluid samples collected, 29 were empyema, 48 CPPE, 31 UPPE, 35 tuberculous, 47 malignant and 34 transudates. The levels of sTREM-1 and PCT were significantly higher in empyema (3658±1474 and 1704±1027) and CPPE (2651±1058 and 841±667) and lower in transudates (p<0.001). CRP levels were significantly higher in empyema (88.8±61.5) and CPPE (83.8±42.6) than in other groups (p<0.001), with no difference between them.

Conclusion: The study demonstrated higher sTREM-1, PCT and CRP levels in empyema and CPPE and lower levels in transudates. Both sTREM-1 and CRP showed a higher than 70% diagnostic accuracy between infectious and non-infectious pleural effusions and between CPPE and UPPE; however, not superior to LDH pleural fluid levels.

Introduction: Understanding the influence of environmental and socioeconomic factors, collectively known as the exposome, on severe exacerbation risks in chronic obstructive pulmonary disease (COPD) and asthma is crucial for enhancing patient care.

Methods: We assessed the impact of the exposome on COPD and asthma severe exacerbations in France between 2018 and 2022, combining data from the French National Hospital Discharge Programme de Médicalisation des Systèmes d'Information database and open data for multiple environmental exposition. Using a retrospective matched case-control design, 473 990 patients with COPD and 187 332 patients with asthma were matched for sex, birth year and date of first hospitalisation. Conditional logistic regressions were performed to quantify ORs of exacerbations within the studied population.

Results: In a multivariate model, exposure to extreme cold temperatures and exceeding WHO standards for nitrogen dioxide (NO₂), fine particulate matter and ozone increased the odds of COPD exacerbation. Only exceeding NO₂ was related to an increased risk of asthma exacerbation. Patients with COPD or asthma living in urban or artificial areas or near livestock farms were much more likely to have a severe exacerbation, whereas those living near water, wetlands or green spaces were protected from this risk. Higher poverty rates and long-term tobacco smoking were linked to a greater likelihood of COPD exacerbations.

Conclusions: The study highlights how exposome factors influence bronchial diseases and underscores the benefit of open-access data for advancing research. COPD and asthma exacerbations account for numerous deaths and cost billions and will increase with global warming, identifying modifiable environmental risk factors, improving patient care and helping shape valuable public health policies.