Breathe最新文献

In this early career forum, the 2023 ECM awardee shares her insights into research, her career path, her personal life and collaborations (@Mkg_Lehmann) https://bit.ly/4f0AiVY.

Tuberculosis (TB) is a major global health threat and demands improved diagnostic and treatment monitoring methods. Conventional diagnostics, such as sputum smear microscopy and culture, are limited by slow results and low sensitivity, particularly in certain patient groups. Recent advances in biomarker research offer promising solutions in three key areas: risk of disease, diagnosis of active disease and monitoring of treatment response. For risk assessment, novel genetic signatures and metabolites show potential in predicting the progression from TB infection to active TB. A 16-gene signature, for example, predicts this progression with significant accuracy. In diagnosing active TB, RNA-based transcriptomic signatures provide higher diagnostic accuracy than traditional methods. These signatures, such as a three-gene RNA sequence, effectively differentiate active TB from other diseases and infections, addressing issues of specificity and sensitivity. Monitoring treatment response is crucial, given the varying response rates in treating TB. Emerging biomarkers focus on bacterial burden and host response. They offer more precise and timely assessments of treatment efficacy, enhance personalised treatment approaches and potentially improve patient outcomes. These advancements in biomarkers for TB risk, diagnosis and treatment response represent significant steps towards more effective TB management and control, aligning with global efforts to decrease the burden of TB. Here we aim to highlight several promising biomarkers used to predict risk of disease progression, active TB disease and treatment success.

Volume reduction is a disease-modifying treatment that aims to reshape the diseased lung towards a more normal total lung capacity by removing severely damaged and overinflated lung parenchyma. It is an effective therapeutic strategy in well-selected patients, resulting in improvements in exercise tolerance, lung function, quality of life and survival. The most widespread strategies for volume reduction are either video-assisted thoracoscopic surgery or bronchoscopic lung volume reduction. It is crucial to decide which approach would be more suitable for specific patients, as this is related to the outcome of the procedure. Factors like emphysema distribution on computed tomography, the presence or absence of collateral ventilation, the patient's pulmonary function tests, a history of other comorbidities and previous interventions might all influence the choice of procedure. It is crucial that this decision is taken by a multidisciplinary expert team to have the best outcome and fewer complications.

Weaning from invasive mechanical ventilation is an important part of the management of respiratory failure patients. Patients can be classified into those who wean on the first attempt (simple weaning), those who require up to three attempts (difficult weaning) and those who require more than three attempts (prolonged weaning). The process of weaning includes adequately treating the underlying cause of respiratory failure, assessing the readiness to wean, evaluating the response to a reduction in ventilatory support, and eventually liberation from mechanical ventilation and extubation or decannulation. Post-extubation respiratory failure is a contributor to poorer outcomes. Identifying and addressing modifiable risk factors for post-extubation respiratory failure is important; noninvasive ventilation and high-flow nasal cannulae may be useful bridging aids after extubation. Factors to consider in the pathophysiology of prolonged mechanical ventilation include increased respiratory muscle load, reduced respiratory muscle capacity and reduced respiratory drive. Management of these patients involves a multidisciplinary team, to first identify the cause of failed weaning attempts, and subsequently optimise the patient's physiology to improve the likelihood of being successfully weaned from invasive mechanical ventilation.

Inhaled therapies, primarily the inhaled corticosteroid (ICS), have been the cornerstone of asthma treatment since the 1960s. They have been shown to reduce symptom burden, morbidity and mortality, and potentially avoid unnecessary and unscheduled healthcare. However, some people have severe asthma, defined by an inability to gain or maintain consistent disease control despite appropriate use of high dose ICS-containing inhalers. In this review, we discuss whether it is appropriate to demand adherence to a treatment this cohort are demonstrably resistant to.

This is the first case report detailing co-infection with both PJP and disseminated histoplasmosis in a patient without HIV infection, and it highlights the immune-suppressive potential of poorly controlled diabetes and liver cirrhosis https://bit.ly/4dXUOX4.

One of the respiratory complications of rheumatoid arthritis (RA) is formation of lung nodules, which can rupture to cause pneumothoraces. We present a case of recurrent pneumothoraces due to accelerated RA nodulosis, secondary to biologic therapy. https://bit.ly/3WBhgOe.

The challenges to effective tuberculosis (TB) disease control are considerable, and the current global targets for reductions in disease burden seem unattainable. The combination of complex pathophysiology and technical limitations results in difficulties in achieving consistent, reliable diagnoses, and long treatment regimens imply serious physiological and socioeconomic consequences for patients. Artificial intelligence (AI) applications in healthcare have significantly improved patient care regarding diagnostics, treatment and basic research. However, their success relies on infrastructures prioritising comprehensive data generation and collaborative research environments to foster stakeholder engagement. This viewpoint article briefly outlines the current and potential applications of advanced AI models in global TB control and the considerations and implications of adopting these tools within the public health community.

High-flow nasal cannula (HFNC) is now a commonly used noninvasive method of providing respiratory support to children and young people. Its rapid spread into varied clinical applications has often left assessment of the evidence of its mechanism of action and clinical benefit lagging behind its uptake. This review will discuss the proposed mechanisms of action of HFNC, review the evidence base for its use, cover its applications in paediatrics and outline its limitations.

Central sleep apnoea (CSA) is characterised by recurrent episodes of airway cessation or reduction in the absence of respiratory effort. Although CSA is less common than obstructive sleep apnoea, it shares similar symptoms. CSA can be secondary to various medical conditions, high altitude and medication exposure. CSA can also emerge during obstructive sleep apnoea therapy. There are a range of treatment options and selecting the right therapy requires an understanding of the pathophysiology of CSA. This review explores the aetiology, pathophysiology and clinical management of non-hypercapnic CSA.