BMJ Open Respiratory Research最新文献

Background: Previous literature suggested that rheumatoid arthritis (RA) might be a risk factor for nontuberculous mycobacteria pulmonary disease (NTM-PD). However, longitudinal studies did not comprehensively consider potential confounders such as body mass index and smoking status. In addition, the impact of RA seropositivity has not been well elucidated. In this study, we aimed to evaluate the risk of incident NTM-PD in subjects with RA versus age-matched and sex-matched controls, while focusing on the impact of RA serologic status on this association.

Methods: From the Korean National Health Insurance Service data from 2010 to 2017, we identified 60 315 participants aged ≥20 years with RA and 301 575 without RA who were age-matched and sex-matched 1:5. The participants were followed up from 1 year after RA diagnosis (or the corresponding index date for matched controls) to the date of NTM-PD diagnosis, censored date or 31 December 2019, whichever occurred first.

Results: During a median 4.5 (IQR, 2.6-6.4) year follow-up, NTM-PD occurred in 0.23% and 0.06% of the RA and matched cohort (incidence: 0.54 and 0.14 per 1000 person-years), respectively. Compared with controls, participants with RA had a 3.11-fold (95% CI 2.50 to 3.88) higher risk of NTM-PD. In the subgroup analysis stratified by seropositivity, seropositive patients with RA had a 3.77-fold (95% CI 3.00 to 4.73) higher risk of NTM-PD than controls, whereas participants with seronegative RA did not have a significantly higher risk (adjusted HR 1.18, 95% CI 0.68 to 2.04). Stratified analyses showed a more prominent association of RA with NTM-PD in males, alcohol drinkers and obese individuals (p<0.05).

Conclusion: The risk of incident NTM-PD was approximately threefold higher in participants with RA than in matched controls, although the association was significant only for patients with seropositive RA.

Introduction: Diagnosing asthma requires confirmation by bronchodilator reversibility (BDR) with or without bronchial provocation testing (BPT). Despite being needed in 80% of suspected cases following BDR, BPT access remains limited in Canada. Type-2 (T2) inflammatory biomarkers (fractional exhaled nitric oxide (FeNO) and blood eosinophil count (BEC)) may be underutilised for BPT prioritisation and are insufficiently studied to support asthma diagnosis in real-world primary care, especially in children. We aimed to explore whether T2 biomarker-based prioritisation of BPT reduces diagnostic delays, and improves triage efficiency and guidance based on exacerbation risk.

Methods and analysis: Three academic centres in Québec will measure inflammatory biomarkers alongside BDR and/or BPT interpretation for patients with suspected asthma referred by primary care providers (PROPULSION SANTÉ, NCT06981169). Consenting patients aged ≥6 years will undergo FeNO, BEC and BDR testing. If BDR is non-diagnostic, subsequent BPT will be prioritised for patients with ≥1 elevated biomarker (BEC ≥300 /µL, (FeNO ≥25 ppb if ≥12 years or FeNO ≥20 ppb if <12 years)); others will follow usual timelines. Reports to the referring healthcare providers will include standard interpretation of BDR/BPT and biomarker results to state exacerbation risk and suggested corticosteroid dosage. Asthma control and quality of life will be assessed at baseline and remotely at 4, 8 and 12 months. The primary outcome will be the delay from the reception of test request for the diagnosis of asthma patients with versus without elevated biomarker(s). Secondary outcomes include biomarkers' diagnostic performance, asthma control, quality of life, health benefits, cost-effectiveness, environmental impact and patient satisfaction. We aim to recruit 1500 patients to PROPULSION SANTÉ, with optional biobanking for translational sub-studies for 123 adults (DIVE, NCT05992519) and 123 children (DIVE2, NCT07011394).

Ethics and dissemination: Study protocols were ethically approved CIUSSS de l'Estrie-CHUS #MP-31-2025-5593/MP-31-2024-5346; 2023-4791). Results will be communicated and submitted to peer-reviewed journals.

Trial registration number: ClinicalTrials.gov (NCT06981169; NCT05992519; NCT07011394).

Background: Fever in children with SARS-CoV-2 infection may increase the risk of intraoperative oxygen desaturation during surgery. This study seeks to find the optimal surgery timing by examining oxygen desaturation rates after fever resolution.

Methods: A prospective cohort study from March to August 2023 included children with SARS-CoV-2 infection who were scheduled for surgery after fever resolution. The primary outcome was the incidence of intraoperative oxygen desaturation. Logistic regression models were used to calculate the adjusted incidence of oxygen desaturation, stratified by time intervals from fever resolution to the day of surgery: 0-2 weeks, 3-4 weeks, 5-6 weeks, 7-8 weeks and ≥3 months.

Results: The intraoperative oxygen desaturation rate was 7.96%. It was highest in the 0-2 weeks group (18.3%), lower in the 3-4 weeks group (11.5%), and further decreased in the 5-6 weeks (6.8%), 7-8 weeks (4.7%) and ≥3 months (4.9%) groups. Adjusted analysis showed significantly higher oxygen desaturation risk in the 0-2 weeks (adjusted OR (aOR), 5.56; 95% CI 3.76 to 8.21) and 3-4 weeks (aOR, 3.31; 95% CI 2.15 to 5.09) groups compared with the ≥3 months group. Risk factors for intraoperative oxygen desaturation included younger age, higher Body Mass Index (BMI), an abnormal chest radiograph and ongoing symptoms (all p<0.05).

Conclusions: To minimise the risk of intraoperative oxygen desaturation, elective surgeries in paediatric patients should be scheduled no earlier than 4 weeks after fever resolution.

Trial registration number: The study was registered at Chinese Clinical Trial Registry http//www.chictr.org.cn/ (Registration date 13/03/23 Trial ID ChiCTR2300069293).

Introduction: Pleural infection is a common problem associated with a high mortality. The aim of this study is to address current knowledge gaps in this condition by describing the global burden of disease and assessing the regional and seasonal variation in causative organisms, demographic characteristics, clinical presentation, comorbidities, pleural effusion characteristics, management strategies and outcomes. These data will inform future research and management guidelines.

Methods and analysis: We will conduct an international multicentre point prevalence survey at two seasonal time points during the year. At each seasonal time point, data will be collected for 4 weeks on every episode of pleural infection presenting to the sites. Important demographic characteristics, medical history, clinical and imaging features, laboratory results, treatments and outcomes will be collected and analysed with a combination of descriptive and inferential statistics.

Ethics and dissemination: The study will be performed in accordance with the Declaration of Helsinki and the International Conference on Harmonisation/Good Clinical Practice. This trial received ethical approval from the Comitato Etico Regione March, Italy, Prot. 2024 266. Institutional approvals will be acquired at all sites. All data will be treated confidentially and collected anonymously into an access-controlled electronic database. Results will be disseminated at conferences and in peer-reviewed publications.

Objective: Alpha-1-antitrypsin deficiency (AATD) is a hereditary condition associated with the risk of developing chronic lung and liver disease. We aimed for a patient-reported outcome measure (PROM) that addresses generic, lung-specific and liver-specific aspects of quality of life (QoL) in individuals with AATD. Rather than developing a new PROM, we evaluated existing PROMs.

Method: An extensive literature search and eligibility assessment, accompanied by standardised group processes including patient representatives, were conducted in accordance with the guidelines in this research area (COnsensus-based Standards for the selection of health Measurement INstruments, COSMIN; Preferred Reporting Items for Systematic Reviews and Meta-Analyses, Prisma; Peer Review of Electronic Search Strategies, PRESS).

Results: Over 1200 records were identified and screened. In total, 427 PROMs were obtained and assessed for eligibility. 15 of the 247 PROMs fulfilled the predefined eligibility criteria. The final selection of the three PROMs-EuroQoL 5 Dimension 5 Level (generic), COPD Assessment Test (lung-specific) and Chronic Liver Disease Quality of Life (liver-specific)-was guided by factors such as brevity, ease of use, interpretability, strong content validity, availability of minimal clinically important differences, sensitivity to change, ability to differentiate disease severity and availability of reference data. A questionnaire was assembled that incorporated the three selected PROMs, as well as additional QoL issues not covered by them, to ensure a comprehensive assessment of patient-reported outcomes.

Conclusion: The PROM named Assessment of Lung, Liver and Patient Health in Alpha-1 (ALPHA) was designed to address generic, lung-specific as well as liver-specific QoL issues in patients with AATD. As a next step, the validity and feasibility in clinical practice of the designed questionnaire will be evaluated.

Prospero registration number: CRD42021265360.

Background: Pulmonary vessel-related structural (PVRS) abnormalities have been implicated in usual interstitial pneumonia; however, their significance in idiopathic inflammatory myopathy-associated interstitial lung disease (IIM-ILD) remains unclear. In this two-centre study, we evaluated the associations between PVRS parameters on high-resolution computed tomography (HRCT) and rapid progression and prognosis in patients with IIM-ILD.

Methods: A total of 578 IIM-ILD patients (412 females; median age, 53 years) were included from retrospective ILD cohorts of two centres. Artificial intelligence (AI)-based quantification was performed on baseline HRCT to assess PVRS and interstitial lesions. The value of PVRS for rapid progression and prognosis was first evaluated in the cohort from the first centre using logistic regression, Kaplan-Meier analysis and Cox models. An independent cohort of 64 patients (43 female; median age, 54 years) from the second centre then served to validate the generalisability of the PVRS-based model of IIM-ILD progression.

Results: In the first-centre cohort, 249 patients with rapidly progressive ILD (RP-ILD) showed significantly elevated mean pulmonary vascular diameter (mPVD) (p<0.05), shorter vascular-pleural distances, greater PVRS volume and higher standard deviation of pulmonary vascular diameter (sdPVD) (p<0.001) compared with non-RP-ILD patients. Multivariate analysis identified age (HR 1.03, 95% CI 1.01 to 1.06), ground glass opacity percentage (HR 1.04, 95% CI 1.02 to 1.06) and sdPVD at 6 mm and 18 mm from the pleura as independent risk factors for poor prognosis in antisynthetase syndrome (ASS) patients (concordance index (C-index)=0.819). In contrast, for patients with antimelanoma differentiation-associated gene 5 antibody-positive dermatomyositis (MDA5+DM), the independent risk factors were age (HR 1.06, 95% CI 1.02 to 1.11), mPVD at 6 mm from the pleura and lactic dehydrogenase levels (C-index=0.835). When applied to the external validation cohort, the respective multivariate Cox models yielded C-indices of 0.841 for ASS and 0.814 for MDA5+DM, confirming their generalisability.

Conclusions: Our study demonstrates that baseline PVRS parameters on HRCT are robust imaging biomarkers associated with rapid progression and poor prognosis in IIM-ILD. These findings underscore the clinical relevance of PVRS assessment in risk stratification and management.

Introduction: The recognition of breathlessness in clinical practice appears suboptimal, despite its prevalence and impact. This study aimed to explore the content of clinical conversations about breathlessness and patients' level of self-reported openness when discussing their breathlessness.

Methods: A cross-sectional, online survey of Australian adults (≥18 years) stratified to the 2016 National Census for age, sex, state/territory of residence and rurality. Assessments based on self-report included demographics, breathlessness (modified Medical Research Council (mMRC) breathlessness scale), breathlessness duration (months/years) and underlying condition (multiple-choice question), breathlessness-related topics discussed (multiple-choice question) and patients' openness about breathlessness (multiple-choice question).

Results: Of 4245 respondents with mMRC ≥1 2311 (54%) reported discussing breathlessness with their clinician. The majority were patient-initiated conversations (94%; n=2179) where the proportion discussing >1 topic was higher with each mMRC level (34% mMRC1; 40% mMRC2; 50% mMRC3-4) in contrast with clinician-initiated conversations (32% mMRC1; 5% mMRC2; 22% mMRC3-4).Patient-initiated conversations prioritised discussing the topics 'how the person feels' (mMRC1) and 'breathlessness' impacts' (mMRC2-4); clinician-initiated consultations prioritised 'breathlessness' impacts' (mMRC1-2) and 'how the person feels' and 'doubts/fears' (mMRC3-4).Compared with clinician-initiated conversations, patient-initiated ones had a higher proportion of respondents reporting being completely open (73% vs 56%, mMRC1; 58% vs 7%, mMRC2; 75% vs 22%, mMRC3-4). Increasing openness was associated with increasing age, gender (women), smoking status (non-smokers) and underlying condition (lung disease).

Conclusions: Many patients are willing to discuss multiple aspects of their breathlessness but may not disclose the full extent of the symptom's presence or impacts.

Introduction: High-flow nasal cannula (HFNC) is an important treatment option for acute hypoxic respiratory failure and can improve outcomes. However, patients on a prolonged duration of HFNC have worse clinical outcomes and increased mortality. It is difficult to determine which patients will fail HFNC support at the time of initiation.

Research question: Does an externally validated machine learning model predict HFNC failure with greater discrimination compared with the ROX Index?

Study design and methods: Adult inpatients hospitalised at seven hospitals in four health systems who received HFNC were eligible for inclusion. Patients were excluded if they were intubated before first HFNC initiation, experienced the primary outcome <1 hour after HFNC initiation, unable to calculate the ROX Index or began HFNC or experienced intubation or death in a location other than the studied locations. A gradient boosting model was used to predict the primary composite outcome of intubation or death within the next 24 hours at the time of HFNC initiation. The model was compared with the previously published ROX index.

Results: Of the 11 618 patients included in the study, 6787 were in the training cohort and 4831 were in the testing cohort. The primary outcome occurred in 1410 of 11 618 (12.1%) patients at 24 hours. In external validation, the area under the operating curve of the model for predicting HFNC failure within 24 hours was 0.760, which was significantly higher than the ROX index (0.696; p value <0.001). This improvement in performance was consistent at all studied time periods, including 2, 6 and 12 hours after HFNC initiation.

Interpretation: In this study, we developed and externally validated a novel machine learning algorithm that outperforms the ROX Index in predicting failure of HFNC in patients with acute hypoxic respiratory failure. This model could augment clinical decision-making when treating patients with this morbid condition.

Introduction: Sex and ethnicity influence sarcoidosis internationally, but UK data are limited. We analysed the British Thoracic Society Interstitial Lung Disease Registry to assess whether gender or ethnic differences affect presentation and management of pulmonary sarcoidosis in the UK.

Methods: A retrospective study included adults with confirmed pulmonary sarcoidosis recorded between January 2013 and December 2024. Demographics, symptoms, comorbidities, investigations, radiology, treatment and Index of Multiple Deprivation were extracted. Group comparisons used χ², t-tests or Mann-Whitney U tests; multivariable logistic regression identified factors associated with immunosuppressive initiation.

Results: Among 1071 patients, 55.5% were male; median age 54 years (SD 13). Ethnicity was documented in 918 (85.7%): 55.4% white, 14.2% non-white (black, South Asian, mixed).Gender: Women presented older than men (56 vs 52 years; p=0.002) and reported more fatigue, higher erythrocyte sedimentation rate and prior tuberculosis. Men had more lymphopenia, elevated ACE and arrhythmia. Lung function and CT patterns were similar, but methotrexate use was higher in men (4.9% vs 2.3%; p=0.017).Non-white patients presented younger (52 vs 54 years; p<0.001) with greater symptom burden (breathlessness 46% vs 33%; cough 44% vs 27%) and more comorbidities (hypertension, diabetes, tuberculosis). Physiology was comparable, but CT nodularity (54% vs 36%) and abnormal liver tests (16% vs 9%) were more frequent, and mycophenolate was prescribed more often (3.7% vs 0.3%; p=0.036).In multivariable analysis, male sex (OR 2.34), non-white ethnicity (OR 3.20), breathlessness (OR 2.05) and lower forced vital capacity (OR 0.97 per % predicted) were independently associated with immunosuppressive treatment (all p≤0.031).

Conclusions: In this UK cohort, treatment decisions were more influenced by sex and ethnicity than by lung function or imaging. Male and non-white patients received immunosuppression more frequently, suggesting possible biological, socioeconomic or practice-related differences.

Background: Various forms of deprivation have been linked to poor health. Emergency and unplanned healthcare utilisation (EUHU) is inefficient and represents suboptimal chronic disease management. Understanding the relationship between material deprivation-the inability to afford certain basic items of living-and EUHU in chronic obstructive pulmonary disease (COPD) may identify intervention targets. However, research is limited. This study investigates the relationship between material deprivation and the frequency of EUHU.

Methods: Data were analysed from 3472 individuals with COPD who completed an online Asthma+Lung UK survey (January-March 2024). The relationship was assessed between material deprivation (nine-item European Union Statistics on Income and Living Conditions survey) and self-reported frequency of EUHU in the preceding year in five categories.

Results: People experiencing material deprivation had higher odds of reporting a higher frequency of EUHU compared with those who were not (OR 1.27, 95% CI 1.08 to 1.49, p=0.005), independent of identified confounders. Associations were also seen with six of the nine individual items including not being able to afford mortgage/rent/utility bills, cars, unexpected expenses, heating, decent meal or a holiday. Living in cold or damp housing was associated with increased EUHU.

Discussion and conclusion: Material deprivation is associated with more frequent emergency and unplanned healthcare utilisation in COPD. Interventions targeting material deprivation may improve health outcomes and reduce EUHU.