BMJ Open Respiratory Research最新文献

Background: Birth weight has been reported to be associated with chronic obstructive pulmonary disease (COPD) in adulthood, but the results have not yet been determined. This study aims to analyse the potential association of birth weight with COPD risk in UK Biobank.

Methods: We conducted a prospective analysis for participants without baseline COPD in UK Biobank. The HRs and 95% CIs were calculated by multivariable Cox regression models, and dose-response relationship was evaluated by restricted cubic splines. Besides, we also calculated the interactions for covariates and further analysed the joint effects.

Results: A total of 251 172 participants with birth weight data were included in this study, and 5602 COPD cases were found during follow-up. According to Cox regression models, participants with the lowest quintile of birth weight (< 2.86 kg) had higher risk for COPD (HR=1.21, 95% CI 1.11 to 1.32). In addition, the dose‒response analysis showed a non-linear relationship between birth weight and COPD risk, which first decreased and then increased, and the interactions for age, passive smoking and maternal smoking were also found by stratified analysis. Furthermore, we also found the joint effects between COPD risk and maternal smoking in the lowest quintile group.

Conclusions: This study indicated that lower birth weight may increase the risk of COPD. The non-linear associations between birth weight and COPD risk for prospective cohort; as birth weight increased, the risk showed a trend of decreasing first and then increasing. Moreover, maternal smoking had a joint effect with low birth weight for COPD risk.

Introduction: Myocardial injury is a common complication of thoracoscopic surgery. The stellate ganglion block is believed to affect myocardial oxygen consumption. The Stellate Ganglion Block and Myocardial Injury (SGBMI) trial aims to test the hypothesis that stellate ganglion block can reduce the incidence of perioperative myocardial injury in patients undergoing thoracoscopic surgery for lung cancer.

Methods and analysis: The SGBMI trial is a double-blind, randomised trial comparing the effects of a stellate ganglion block and a sham procedure in patients with cardiovascular risk factors undergoing thoracoscopic surgery. The exclusion criteria include procedure-related contraindications and severe heart failure. The stellate ganglion block or sham procedures will be performed preoperatively. The primary outcome is myocardial injury within 30 days of the follow-up. The main safety outcomes are sepsis, infection and procedure-related complications. We will enrol 248 patients to ensure at least 80% power for the evaluation of the primary outcome. The primary results of the SGBMI trial are expected to be announced by the year 2027.

Ethics and dissemination: Ethical approval for the study is obtained from the Ethics Committee of the Shanghai Pulmonary Hospital (approval number: L22-394). Written informed consent will be obtained from all participating patients. The publication of results in a peer-reviewed journal and presentations at conferences are anticipated.

Trial registration number: ChiCTR2300071469 (registered on 16 May 2023).

Background: The sustainable development goal (SDG) 3.3.2 prompted India to devise the National Strategic Plan 2017-2025, targeting tuberculosis (TB) eradication by 2030. The prevention pillar of this plan emphasises on Tuberculosis Preventive Treatment (TPT) for those with TB infection (TBI). Healthcare workers (HCWs), identified as one of the high-risk groups by the WHO, show a higher refusal rate for TPT. We aimed to explore the reasons for TPT refusal among the HCWs identified with TBI in Puducherry, South India during 2023.

Methods: A qualitative descriptive study was conducted among 12 HCWs from a publicly funded tertiary care hospital, each with at least 5 years of experience. Participants were selected by maximum variation sampling, based on the department of work, current TBI status and subject expertise. The in-depth interviews, guided by the health belief model, lasted approximately 45 min each. Two researchers performed manual thematic analysis using the mixed approach for coding. Codes were grouped into categories and themes. Discrepancies were resolved through discussion with a third researcher, reaching a consensus.

Results: Three overarching themes emerged: perceived threats, beliefs regarding health interventions and empowering factors. Perceived threat elucidated the lower perceived vulnerability of contracting TB and minimal chance for progression of TBI to TB disease despite having continuous exposure and uncertainties in the workplace. Beliefs about health interventions included perceived obstacles and advantages, such as testing challenges and lack of awareness, as well as the benefits of prophylaxis and infection control measures. Empowering factors centred on prompting action and self-confidence, highlighting strategies to encourage TBI testing through administrative actions and endorsing shorter treatment plans.

Conclusions: Addressing the identified knowledge gaps and false perception through targeted interventions, healthcare institutions can improve TPT uptake. Implementing a comprehensive strategy that combines hospital policies to initiate screening and treatment, a supportive environment and shorter TPT regimens is essential to prevent TB among HCWs.

Introduction: Optimally measuring improvements in chronic breathlessness in clinical practice and research continues to evolve. The aim of this study was to consider the performance of uni-dimensional measures in chronic breathlessness limiting exertion.

Methods: We report five measures of breathlessness (intensity: worst, best and average in the previous 24 hours; breathlessness now; and an affective component unpleasantness now) and two clinical thresholds over baseline on their 0-100 mm visual analogue scale (8.9 mm absolute improvement; and 15% relative improvement) collected in a multi-site, randomised, double-blind, parallel-arm, placebo-controlled trial of regular, low-dose, sustained-release morphine for people with chronic breathlessness with optimally treated underlying causes.

Results: Participants (n=284) were mostly elderly men with severe, chronic breathlessness. Worst breathlessness in the previous 24 hours showed improvement in people with more severe breathlessness and chronic obstructive pulmonary disease. By contrast, breathlessness now and average breathlessness in the previous 24 hours generated similar patterns of response, as did unpleasantness now and breathlessness now. Best breathlessness added little value. The two clinical thresholds showed differing patterns of significance.

Discussion: Consistent with other recent work, worst breathlessness may be an important uni-dimensional outcome in evaluating chronic breathlessness clinically and in research. This study does not support a differential between unpleasantness now and breathlessness now, previously observed in laboratory-generated, acute-on-chronic breathlessness. Timeframe for recall (now or the last 24 hours) and the threshold for a clinical meaningful improvement (absolute (8.9 mm) or relative (15%)) affect assessment performance.

Background: In recent years, dexamethasone (Dex) has been used to treat acute respiratory distress syndrome (ARDS) in patients with COVID-19 and achieved promising outcomes. Venovenous extracorporeal membrane oxygenation (VV ECMO) support for patients with ARDS has increased significantly worldwide. However, it remains unknown whether Dex could improve the efficiency of VV ECMO to reduce lung injury. Here, we investigate the combined efficiency of VV ECMO and Dex in rats with acute lung injury (ALI).

Methods: We established VV ECMO in oleic acid (OA)-treated ALI rats and administered Dex. We conducted HE staining and evaluated lung and bronchoalveolar lavage (BAL) fluid cytokines to assess lung injury and inflammation. Furthermore, we investigated the activation of Hippo/YAP signalling in alveolar epithelial type II cell (AT2)-mediated alveolar epithelial repair using quantitative PCR, Western blotting and immunofluorescence. In vitro, the human alveolar epithelial cell line A549 was used to investigate the key role of YAP in alveolar epithelial cell differentiation.

Results: VV ECMO combined with Dex alleviated OA-induced lung injury and pulmonary inflammation. Pulmonary oedema and exudation were significantly alleviated, and the lung and BAL levels of IL-6, IL-8 and TNF-α were significantly reduced compared with those observed with ECMO alone. In addition, VV ECMO combined with Dex treatment protected alveolar epithelial cells by activating Hippo/YAP signalling. In vitro, Dex promoted YAP expression and alveolar epithelial cell differentiation, whereas YAP knockdown inhibited YAP-mediated differentiation.

Conclusions: Our findings suggest that adjuvant Dex treatment during VV ECMO could alleviate ALI and pulmonary inflammation by activating the Hippo/YAP signalling pathway, which promoted alveolar regeneration and AT2 differentiation.

Objectives: This study aims to explore how pre-existing conditions such as blood types, family history of cancer and comorbid diseases correlate with the genetic and programmed death-ligand 1 (PD-L1) expression that contributes to the heterogeneous biological behaviours of non-small cell lung cancer (NSCLC).

Materials and methods: A cohort of 5507 NSCLC patients who underwent surgical resection between January 2014 and July 2018 was studied. Targeted next-generation sequencing was used to detect mutations in nine pivotal cancer-related genes, and immunohistochemical staining was applied to assess PD-L1 expression. Logistic regression analysis was employed to identify significant correlations.

Results: All patients underwent NGS, with 1839 were also evaluated for PD-L1 expression. Several significant findings were found: ROS1 mutations were closely associated with a family history of lung cancer (OR 7.499, 95% CI 1.094 to 30.940, p=0.013). Epidermal growth factor receptor (EGFR) L858R mutations were common among patients with a family history of non-lung cancers and those with hypertension (OR 2.089, 95% CI 1.029 to 4.135, p=0.037 and OR 1.252, 95% CI 1.001 to 1.562, p=0.048, respectively). Pre-existing conditions such as diabetes and hepatitis B surface antigen positivity (OR 1.468, 95% CI 1.042 to 2.047, p=0.026 and OR 1.373, 95% CI 1.012 to 1.847, p=0.038, respectively) were correlated with EGFR exon 19 deletions. RhD negativity showed potential ties to BRAF mutations (OR 0.010, 95% CI 0.001 to 0.252, p=0.001). A history of tuberculosis linked to increased PD-L1 expression in immune cells (OR 3.597, 95% CI 1.295 to 14.957, p=0.034).

Conclusion: This large-scale, cross-sectional study reveals a complex interplay between genetic mutations, immunological features and pre-existing conditions in NSCLC patients, offering insights that could inform personalised treatment strategies.

Background: This systematic review aimed to assess the accuracy of the segment-counting method in predicting long-term pulmonary function recovery and investigate compensatory changes following different extents of lung resection.

Methods: We included studies that measured forced expiratory volume at 1 s (FEV1) between 6 and 18 months postoperatively, comparing it to the predicted postoperative FEV1 (ppoFEV1) using the segment-counting method. The extent of lung resection was correlated with the ratio of postoperative FEV1 to ppoFEV1. A comprehensive search was conducted in Embase, MEDLINE and Web of Science using terms related to 'lung resection' and 'pulmonary function'. The final search was completed on 18 February 2022. Risk of bias was assessed using the Newcastle-Ottawa Scale.

Results: 39 studies comprising 78 observation cohorts met the inclusion criteria. The analysis showed significant differences in pulmonary function in patients with ≥3 resected segments. Meta-regression indicated that the number of resected segments significantly impacted the postoperative FEV1/ppoFEV1 ratio, explaining 57% of the variance (R²=0. 57), with moderate heterogeneity (I²=61. 87%) across studies. Other variables, including patient age, body mass index, video-assisted thoracoscopic surgery use and tumour stage, did not show significant effects.

Discussion: Limitations of the review included moderate heterogeneity between studies and potential selection bias related to the stage of cancer and lung volume reduction effects. The findings suggest that the extent of lung resection correlates with better-than-expected pulmonary function, potentially due to compensatory mechanisms.

Prospero registration number: This review was registered on PROSPERO (CRD42021293608).

Background: The novel coronavirus disease 2019 (COVID-19) is a respiratory infection that is spreading worldwide. The WHO has recommended public health preventive measures for COVID-19 prevention and control. Adherence to COVID-19 preventive measures is important for disease prevention and control of the disease's spread. So, implementing preventive measures plays an essential role in reducing the spread of COVID-19 infection. This study aimed to assess the adherence status toward COVID-19 preventive measures and associated factors among high school students.

Methods: 528 high school students participated in an institutional-based cross-sectional study. A multistage sampling technique and a systematic random sampling method were applied to select the study participants. The data was entered into EpiData V.3.1 and then exported to SPSS V.23 for analysis. Bivariate and multivariable logistic regressions were computed. The significance of the association was declared by a 95% CI of adjusted OR (AOR) and a p value<0.05 in the multivariate model.

Result: A total of 528 respondents participated in the study, with a 100% response rate. The overall adherence level of high school students toward COVID-19 prevention measures was 110 (20.8%, 95% CI: 17.4%, 24.6%). The mean(±SD) age of the respondents was 18 (SD 11±2) years, which ranges from 16 to 24 years, and 387 (73.3%) were in the age group of 19-20 years, The majority of the students (418; 79.2%, 95% CI: 75.4, 82.6) had poor adherence to COVID-19 preventive measures. 345 (65.3%) had good knowledge, 328 (62.1%) had unfavourable attitudes and 390 (73.9%) had poor risk perception for COVID-19 preventive measures. This study revealed that most (89.9%) of the high school students did not maintain a physical distance of 2 m away, 84.4% of the students had no regular handwashing practice, majority 71.4% of the students did not use facemasks/covered their face during coughing and 62.9% of the students had no face mask and 54% of the students did not use sanitiser or alcohol per recommendation. This study revealed that sex (AOR: 2.42, 95% CI: 1.46, 4.02), attitude (AOR: 4.04, 95% CI: 2.45, 6.68) and risk perception (AOR: 7.60, 95% CI: 4.62, 12.54) were significantly associated with poor adherence toward COVID-19 prevention measures.

Conclusion: This study's findings revealed that adherence to COVID-19 preventive measures among high school students was very low. Therefore, promoting adherence to COVID-19 preventive measures demands awareness creation and risk communication to build an appropriate level of knowledge, attitude and risk perception.

Background: Studies suggest that up to 70% of chronic obstructive pulmonary disease (COPD) cases globally are undiagnosed worldwide. Some of these undiagnosed patients may present with severe exacerbation and factors associated with underdiagnosis in this population are unknown. We investigated the key factors associated with underdiagnosis in two cohorts of patients hospitalised for severe COPD exacerbation at different time points.

Methods: This retrospective, multicentre study analysed data from patients hospitalised for COPD exacerbation at two independent centres during two distinct time periods: between 1 January 2017 and 31 December 2018 in the Aquitaine region and between 1 January and 31 December 2022 in Paris. Undiagnosed COPD was defined as the absence of pulmonary function testing before the index exacerbation. Multivariate logistic regression was used to evaluate associations between underdiagnosis and patient characteristics.

Results: Among the 424 patients, 93 (21.9%) were undiagnosed before hospitalisation, with a stable rate over time (22% in 2017-2018 and 21% in 2022). Multivariate analysis revealed that underdiagnosis was related to higher forced expiratory volume in one second (FEV₁; adjusted OR (aOR)=1.02, p=0.043) and female sex (aOR=1.91, p=0.015). Patients with undiagnosed COPD had significantly lower rehospitalisation and mortality rates. After the initial severe exacerbation, higher mortality was associated with a higher Charlson Comorbidity Index (HR=1.24, p=0.007) and older age (HR=1.05, p=0.008).

Conclusion: This retrospective, multicentre study demonstrated that about 20% of patients admitted with severe exacerbation were undiagnosed for COPD. Higher FEV₁ and female sex were associated with underdiagnosis, emphasising the need for special attention to this population. These findings highlight the need to improve training and access to spirometry and develop new diagnostic tools that facilitate earlier detection and management of COPD.

Background: Cognitive impairment is affecting plenty of patients with chronic obstructive pulmonary disease (COPD), and it is the main leading cause of quality of life to varying degrees. However, there are still wide discrepancies in these prevalence rates can be attributed to the diversity in study designs, participant age ranges, inclusion criteria and the methodologies used for assessment. Previous studies revealed the association between COPD and cognitive impairment, but the conclusions remain controversial.

Objectives: The current systematic review aimed to investigate whether COPD is an independent risk factor for cognitive impairment.

Study design: A systematic review and meta-analysis.

Data sources: PubMed, Cochrane Library, MEDLINE, Embase, Web of Science, China Knowledge Resource Integrated Database, Wanfang Database, Chinese Biomedical Database and Weipu Database were searched from inception to 1 December 2022.

Eligibility criteria: The inclusion criteria involved studies that reported cognitive impairment in COPD. We just included cohort designs, published in English or Chinese language.

Data extraction and synthesis: Two reviewers independently extracted and assessed the quality of data using Newcastle-Ottawa Quality Assessment Scale. The outcomes were assessed with random-effects model and reported as the HR with 95% CI using the Review Manager software.

Results: 12 studies from 10 articles reporting on 625 644 people were included. The findings indicated that compared with those without COPD at baseline, patients with COPD were associated with an increased risk of cognitive impairment. Subgroup analysis showed the association was not significantly different in sex and age, and the subgroup supports that COPD has a higher risk of non-amnestic mild cognitive impairment (na-MCI) than amnestic MCI.

Conclusions: Patients with COPD have a higher risk of developing cognitive impairment and are more likely to cause na-MCI compared with those without COPD, and this risk is not affected by gender or age. Therefore, continuous monitoring of cognitive function in COPD is critical.

Prospero registration number: CRD42021285913.