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The impact of poor housing and indoor air quality on respiratory health in children. 不良住房和室内空气质量对儿童呼吸系统健康的影响。
IF 2 Q3 Medicine Pub Date : 2023-06-01 DOI: 10.1183/20734735.0058-2023
Karl A Holden, Alice R Lee, Daniel B Hawcutt, Ian P Sinha

It is becoming increasingly apparent that poor housing quality affects indoor air quality, significantly impacting on respiratory health in children and young people. Exposure to damp and/or mould in the home, cold homes and the presence of pests and pollutants all have a significant detrimental impact on child respiratory health. There is a complex relationship between features of poor-quality housing, such as being in a state of disrepair, poor ventilation, overcrowding and being cold, that favour an environment resulting in poor indoor air quality. Children living in rented (private or public) housing are more likely to come from lower-income backgrounds and are most at risk of living in substandard housing posing a serious threat to respiratory health. Children have the right to safe and adequate housing, and research has shown that either rehousing or making modifications to poor-quality housing to improve indoor air quality results in improved respiratory health. Urgent action is needed to address this threat to health. All stakeholders should understand the relationship between poor-quality housing and respiratory health in children and act, working with families, to redress this modifiable risk factor.

Educational aims: The reader should understand how housing quality and indoor air quality affect respiratory health in children.The reader should understand which children are at most risk of living in poor-quality housing.The reader should understand what policy recommendations have been made and what actions need to be undertaken to improve housing quality and respiratory health in children and young people.

越来越明显的是,恶劣的住房质量影响室内空气质量,严重影响儿童和青年人的呼吸系统健康。暴露在潮湿和/或发霉的家中、寒冷的家中以及害虫和污染物的存在都对儿童的呼吸健康产生重大不利影响。劣质住房的特征之间存在复杂的关系,例如年久失修、通风不良、过度拥挤和寒冷,这些都有利于导致室内空气质量差的环境。住在租来的(私人或公共)住房中的儿童更有可能来自低收入家庭,而且最有可能生活在不合标准的住房中,对呼吸系统健康构成严重威胁。儿童有权获得安全和适足的住房,研究表明,重新安置或改造质量差的住房以改善室内空气质量,都会改善呼吸系统健康。需要采取紧急行动应对这一健康威胁。所有利益攸关方都应了解劣质住房与儿童呼吸系统健康之间的关系,并与家庭合作采取行动,纠正这一可改变的风险因素。教育目的:读者应该了解住房质量和室内空气质量如何影响儿童呼吸系统健康。读者应该了解哪些孩子生活在质量差的房子里的风险最大。读者应该了解已经提出了哪些政策建议,以及需要采取哪些行动来改善住房质量和儿童和年轻人的呼吸系统健康。
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引用次数: 2
The exposome in respiratory diseases: multiple preventable risk factors from early life to adulthood. 呼吸系统疾病的暴露:从生命早期到成年的多种可预防的危险因素。
IF 2 Q3 Medicine Pub Date : 2023-06-01 DOI: 10.1183/20734735.0034-2023
Marine Savouré, Katie Eminson, Lucile Sese, Orianne Dumas, Yutong Samuel Cai

The increasing global burden of respiratory diseases over the last decades raises questions about the impact of environmental factors during industrialisation and urbanisation. Although the knowledge of environmental epidemiology is growing, it is still unclear what the most critical exposure windows are for respiratory health. In addition, the relationships between different environmental exposures can be complex. The exposome approach investigating all non-genetic factors on health has been developed in recent years but has been little applied in respiratory health to date. This journal club article reviews three recent publications investigating the effects of environmental exposures, considered separately or in an exposome approach with different exposure windows, on respiratory health outcomes. These three studies highlight targets for action in primary and secondary prevention. Two studies, using data from the INMA and RHINESSA cohorts, support the regulation and reduction of phthalates and air pollution, respectively. Moreover, the exposome approach conducted in the NutriNet-Santé cohort emphasises that risk reduction must involve a multi-interventional approach targeting both specific early-life risk factors and promotion of a healthy lifestyle in adulthood. These three articles also present research perspectives in environmental epidemiology.

过去几十年来,全球呼吸系统疾病负担不断增加,这引发了人们对工业化和城市化过程中环境因素影响的质疑。虽然环境流行病学的知识在不断增长,但对于呼吸系统健康来说,最关键的暴露窗口是什么仍不清楚。此外,不同环境暴露之间的关系可能是复杂的。近年来,研究所有非遗传健康因素的暴露体方法得到了发展,但迄今为止在呼吸系统健康方面的应用很少。这篇期刊俱乐部的文章回顾了最近三篇调查环境暴露影响的出版物,分别考虑或在不同暴露窗口的暴露方法中考虑对呼吸健康结果的影响。这三项研究突出了一级和二级预防方面的行动目标。使用INMA和RHINESSA队列数据的两项研究分别支持管制和减少邻苯二甲酸盐和空气污染。此外,在nutrinet - sant队列中进行的暴露方法强调,降低风险必须涉及针对特定的早期生活风险因素和促进成年期健康生活方式的多干预方法。这三篇文章也提出了环境流行病学的研究前景。
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引用次数: 1
Experience of being chair and co-chair of the ECMC and reasons why you should be the NEXT. 担任ECMC主席和联合主席的经历,以及为什么你应该成为NEXT的原因。
IF 2 Q3 Medicine Pub Date : 2023-06-01 DOI: 10.1183/20734735.0089-2023
James Parkin, Justine Devulder, Susanne J H Vijverberg, Niki Ubags, Maxime Patout, Sara Cuevas Ocaña, Thomas Gille, Joana Cruz

This article provides testimonials of the past and current chairs and co-chairs of the ECMC (@EarlyCareerERS) and a glimpse of the NEXT programme, along with participants' experiences. https://bit.ly/3LzvqKf.

本文提供了ECMC前任和现任主席和联合主席的感言(@EarlyCareerERS),以及NEXT项目的一瞥,以及参与者的经历。https://bit.ly/3LzvqKf。
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引用次数: 3
Current and future developments in the pharmacology of asthma and COPD: ERS seminar, Naples 2022. 哮喘和慢性阻塞性肺病药理学的当前和未来发展:ERS研讨会,那不勒斯2022。
IF 2 Q3 Medicine Pub Date : 2023-06-01 DOI: 10.1183/20734735.0267-2022
Daiana Stolz, Maria Gabriella Matera, Paola Rogliani, Maarten van den Berge, Eleni Papakonstantinou, Reinoud Gosens, Dave Singh, Nicola Hanania, Mario Cazzola, Anke-Hilse Maitland-van der Zee, Laura Fregonese, Alexander G Mathioudakis, Jørgen Vestbo, Maia Rukhadze, Clive P Page

Pharmacological management of airway obstructive diseases is a fast-evolving field. Several advances in unravelling disease mechanisms as well as intracellular and molecular pathways of drug action have been accomplished. While the clinical translation and implementation of in vitro results to the bedside remains challenging, advances in comprehending the mechanisms of respiratory medication are expected to assist clinicians and scientists in identifying meaningful read-outs and designing clinical studies. This European Respiratory Society Research Seminar, held in Naples, Italy, 5-6 May 2022, focused on current and future developments of the drugs used to treat asthma and COPD; on mechanisms of drug action, steroid resistance, comorbidities and drug interactions; on prognostic and therapeutic biomarkers; on developing novel drug targets based on tissue remodelling and regeneration; and on pharmacogenomics and emerging biosimilars. Related European Medicines Agency regulations are also discussed, as well as the seminar's position on the above aspects.

气道阻塞性疾病的药理治疗是一个快速发展的领域。在揭示疾病机制以及药物作用的细胞内和分子途径方面取得了一些进展。虽然体外实验结果的临床转化和临床应用仍然具有挑战性,但在理解呼吸系统药物机制方面的进展有望帮助临床医生和科学家识别有意义的结果并设计临床研究。本次欧洲呼吸学会研究研讨会于2022年5月5日至6日在意大利那不勒斯举行,重点关注用于治疗哮喘和COPD的药物的当前和未来发展;药物作用机制,类固醇耐药,合并症和药物相互作用;关于预后和治疗生物标志物;基于组织重塑与再生的新型药物靶点研究药物基因组学和新兴生物仿制药。还讨论了相关的欧洲药品管理局法规,以及研讨会对上述方面的立场。
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引用次数: 0
Rolling out new anti-tuberculosis drugs without diagnostic capacity. 在没有诊断能力的情况下推出新的抗结核药物。
IF 2.3 Q2 RESPIRATORY SYSTEM Pub Date : 2023-06-01 Epub Date: 2023-07-11 DOI: 10.1183/20734735.0084-2023
Tara Ness, Le Hong Van, Ilze Petermane, Raquel Duarte, Christoph Lange, Dick Menzies, Daniela Maria Cirillo

Deaths from tuberculosis (TB) reached over 1.6 million in 2021 with 10.6 million people becoming ill. Multidrug-resistant TB, defined as the Mycobacterium tuberculosis organism having resistance to at least isoniazid and rifampicin, represented 3.9% of new TB cases and 18% of previously treated cases. While new drug regimens continue to be developed and introduced to improve treatment of drug-resistant forms of TB, diagnostic capability to identify drug resistance lags woefully behind. While significant mortality benefits exist for these newer drug regimens, implementing them without proper drug resistance diagnostic capacity could lead to development of more drug resistances and exhaust these new therapeutic tools. Moving forward, the roll-out of new TB drugs and regimens must be paired with implementation of diagnostics to ensure judicious use of resources and the best chance for improving TB worldwide.

2021 年,死于结核病(TB)的人数超过 160 万,患病人数达 1060 万。耐多药结核病是指结核分枝杆菌至少对异烟肼和利福平产生耐药性,占结核病新病例的 3.9%,占曾接受过治疗病例的 18%。虽然新的药物治疗方案不断被开发和引进,以改善对耐药性结核病的治疗,但识别耐药性的诊断能力却严重滞后。虽然这些较新的药物治疗方案能大大降低死亡率,但在没有适当的耐药性诊断能力的情况下实施这些方案,可能会导致更多耐药性的产生,并耗尽这些新的治疗工具。展望未来,结核病新药和新疗法的推广必须与诊断技术的实施相配合,以确保资源的合理使用和改善全球结核病状况的最佳机会。
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引用次数: 0
Air quality and respiratory health in children. 儿童的空气质量和呼吸系统健康。
IF 2 Q3 Medicine Pub Date : 2023-06-01 DOI: 10.1183/20734735.0040-2023
Sathya Swarup Aithal, Ishaan Sachdeva, Om P Kurmi

Air pollution is a leading modifiable risk factor for various cardio-respiratory outcomes globally, both for children and for adults. Children are particularly susceptible to the adverse effects of air pollution due to various physiological and behavioural factors. Children are at a higher risk of outcomes such as acute respiratory infections, asthma and decreased lung function due to air pollution exposure; the risk varies in different geographical regions, depending on the source of air pollution, duration of exposures and concentration. Prenatal exposure to air pollution may also contribute to adverse respiratory outcomes later in life.

空气污染是全球范围内儿童和成人各种心肺疾病的主要可改变风险因素。由于各种生理和行为因素,儿童特别容易受到空气污染的不利影响。儿童因接触空气污染而面临急性呼吸道感染、哮喘和肺功能下降等后果的风险更高;不同地理区域的风险不同,取决于空气污染源、接触时间和浓度。产前暴露于空气污染也可能导致生命后期的不良呼吸结果。
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引用次数: 2
Routine FEV1 measurement is essential in diagnosis and monitoring of childhood asthma: myth or maxim? 常规FEV1测量对儿童哮喘的诊断和监测至关重要:神话还是格言?
IF 2 Q3 Medicine Pub Date : 2023-06-01 Epub Date: 2023-08-15 DOI: 10.1183/20734735.0048-2023
Maria Octavia Onisor, Steve Turner

Childhood asthma is a common condition in children. This review describes the evidence from seven asthma guidelines for using spirometry in the diagnosis and monitoring of childhood asthma. All guidelines recommend spirometry as the primary test to be performed for diagnosing asthma in children aged >5 years. Spirometry is often normal in children with asthma. Guidelines are not consistent with respect to whether forced expiratory volume in 1 s (FEV1) or FEV1/forced vital capacity (FVC) should be measured, or their threshold for "abnormal" spirometry, and we describe the sensitivity and specificity for these different cut-offs. The role of spirometry in monitoring asthma is less clear in the guidelines, and some do not suggest spirometry should be done. There is no consensus on what spirometric measurement should be used, how often it should be measured and what is a minimum clinically important change in spirometry. The role of spirometry in diagnosing asthma is more clearly established when compared to its role in monitoring asthma. The potential of spirometry to aid decision making for asthma diagnosis and monitoring in children remains to be fully evaluated.

Educational aims: To provide knowledge of the commonly used guidelines for asthma diagnosis and management.To give insight into the opportunities and challenges in using spirometry to diagnose and monitor asthma in children.To provide an understanding of the precision of spirometry for diagnosing asthma.

儿童哮喘是儿童的常见疾病。这篇综述描述了使用肺活量测定法诊断和监测儿童哮喘的七项哮喘指南的证据。所有指南都建议将肺活量测定作为诊断5岁以上儿童哮喘的主要检查 年。哮喘儿童的肺活量测定通常是正常的。关于1 s(FEV1)或FEV1/肺活量(FVC),或其“异常”肺活量测定的阈值,我们描述了这些不同截止值的敏感性和特异性。肺活量测定在监测哮喘中的作用在指南中不太明确,有些人不建议进行肺活量测量。对于应该使用什么样的肺活量测量,应该多久测量一次,以及肺活量的最小临床重要变化是什么,目前还没有达成共识。与监测哮喘的作用相比,肺活量测定在诊断哮喘中的作用更加明确。肺活量测定法在帮助儿童哮喘诊断和监测决策方面的潜力仍有待充分评估。教育目的:提供哮喘诊断和管理常用指南的知识。深入了解使用肺活量测定法诊断和监测儿童哮喘的机会和挑战。目的了解肺活量测定法诊断哮喘的准确性。
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引用次数: 0
The exposome concept: how has it changed our understanding of environmental causes of chronic respiratory diseases? 暴露概念:它如何改变了我们对慢性呼吸道疾病的环境原因的理解?
IF 2 Q3 Medicine Pub Date : 2023-06-01 DOI: 10.1183/20734735.0044-2023
Alicia Guillien, Manosij Ghosh, Thomas Gille, Orianne Dumas

The exposome approach can help us better understand multifactorial respiratory diseases through multidisciplinary collaboration, harmonised resources and use of sophisticated methods addressing combined exposures and longitudinal data. https://bit.ly/3Ng9MNn.

暴露方法可以通过多学科合作、协调资源和使用处理综合暴露和纵向数据的复杂方法,帮助我们更好地了解多因素呼吸系统疾病。https://bit.ly/3Ng9MNn。
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引用次数: 1
Greenness exposure: beneficial but multidimensional. 绿色暴露:有益但多维的。
IF 2 Q3 Medicine Pub Date : 2023-06-01 DOI: 10.1183/20734735.0221-2022
Ane Johannessen, Shanshan Xu, Achenyo Peace Abbah, Christer Janson

Many studies have shown that greenness has beneficial health effects, particularly on psychological and cardiovascular outcomes. In this narrative review, we provide a synthesis of knowledge regarding greenness exposure and respiratory health. The following outcomes were reviewed: respiratory mortality, lung cancer mortality, lung cancer incidence, respiratory hospitalisations, lung function, COPD, and asthma. We identified 174 articles through a literature search in PubMed, of which 42 were eligible for inclusion in this review. The most common marker for greenness exposure was the normalised difference vegetation index (NDVI), which was used in 29 out of 42 papers. Other markers used were tree canopy cover, landcover/land-use, plant diversity, density of tall trees and subjectively perceived greenness. We found beneficial effects of greenness in most studies regarding respiratory mortality, lung cancer incidence, respiratory hospitalisations and lung function. For lung cancer mortality, asthma and COPD, the effects of greenness were less clear cut. While many aspects of greenness are beneficial, some aspects may be harmful, and greenness may have different health effects in different population subgroups. Future studies of greenness and respiratory diseases should focus on asthma and COPD, on effects in different population subgroups and on disentangling the health effects of the various greenness dimensions.

许多研究表明,绿色对健康有益,尤其是对心理和心血管疾病的影响。在这叙述性审查,我们提供了一个关于绿色暴露和呼吸健康的知识的综合。回顾了以下结果:呼吸系统死亡率、肺癌死亡率、肺癌发病率、呼吸系统住院、肺功能、慢性阻塞性肺病和哮喘。我们通过PubMed的文献检索确定了174篇文章,其中42篇符合纳入本综述的条件。最常见的绿色暴露标记是归一化植被指数(NDVI), 42篇论文中有29篇使用了它。使用的其他标记包括树冠覆盖、土地覆盖/土地利用、植物多样性、高大树木密度和主观感知的绿化率。我们在大多数关于呼吸系统死亡率、肺癌发病率、呼吸系统住院率和肺功能的研究中发现了绿色的有益作用。对于肺癌死亡率、哮喘和慢性阻塞性肺病,绿化的影响不那么明显。虽然绿色的许多方面是有益的,但有些方面可能是有害的,并且绿色可能对不同的人群亚群产生不同的健康影响。未来关于绿色度和呼吸系统疾病的研究应该关注哮喘和慢性阻塞性肺病,不同人群亚群的影响,以及不同绿色度维度对健康的影响。
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引用次数: 2
Does one size fit all? An update on chronic ventilatory support in different respiratory illnesses. 一个尺码适合所有人吗?不同呼吸系统疾病的慢性呼吸支持的最新进展。
IF 2 Q3 Medicine Pub Date : 2023-06-01 DOI: 10.1183/20734735.0046-2023
Annalisa Carlucci, Maxime Patout, João Carlos Winck

Home noninvasive ventilation (HNIV) improves outcomes in different disease categories. In this article, we discuss indications for when and how to initiate HNIV in COPD, obesity hypoventilation syndrome (OHS) and neuromuscular disorders (NMD). While in COPD, significant diurnal hypercapnia and high-intensity HNIV are essential ingredients for success, in NMD and OHS, early respiratory changes are best detected during sleep through oxy-capnography associated (or not) with respiratory polygraphy. In COPD and OHS, it is crucial to consider the coexistence of obstructive sleep apnoea because treatment with continuous positive airway pressure may be the simplest and most effective treatment that should be proposed even in hypercapnic patients as first-line therapy. In NMD, the need for continuous HNIV and eventual switching to tracheostomy ventilation makes this group's management more challenging. Achieving successful HNIV by improving quality of sleep, quality of life and keeping a good adherence to the therapy is a challenge, above all in COPD patients. In OHS patients, on top of HNIV, initiation of other interventions such as weight loss management is crucial. More resources should be invested in improving all these aspects. Telemonitoring represents a promising method to improve titration and follow-up of HNIV.

家庭无创通气(HNIV)可改善不同疾病类别的预后。在本文中,我们讨论了在慢性阻塞性肺病、肥胖低通气综合征(OHS)和神经肌肉疾病(NMD)中何时以及如何启动hiv的适应症。在慢性阻塞性肺病中,明显的昼夜高碳酸血症和高强度hiv是成功的必要因素,而在NMD和OHS中,早期呼吸变化最好在睡眠期间通过与呼吸测波术相关(或不相关)的氧摄血仪检测。在COPD和OHS中,考虑阻塞性睡眠呼吸暂停共存是至关重要的,因为持续气道正压治疗可能是最简单和最有效的治疗方法,即使在高碳酸血症患者中也应作为一线治疗。在NMD中,需要持续的hiv和最终切换到气管造口通气使得该组的管理更具挑战性。通过改善睡眠质量、生活质量和保持良好的治疗依从性来实现hiv的成功治疗是一项挑战,尤其是对慢性阻塞性肺病患者。在职业健康和服务患者中,除艾滋病毒外,开始其他干预措施,如减肥管理至关重要。应该投入更多的资源来改善所有这些方面。远程监测是改善hiv滴定和随访的一种很有前途的方法。
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引用次数: 1
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