European Respiratory Journal最新文献

{"title":"Tuberculosis in adult migrants in Europe: a TBnet consensus statement.","authors":"Heinke Kunst, Berit Lange, Olga Hovardovska, Annabelle Bockey, Dominik Zenner, Aase B Andersen, Sally Hargreaves, Manish Pareek, Jon S Friedland, Chrsitain Wejse, Graham Bothamley, Lorenzo Guglielmetti, Dima Chesov, Simon Tiberi, Alberto Matteelli, Anna M Mandalakas, Jan Heyckendorf, Johannes Eimer, Akanksha Malhotra, Javier Zamora, Anca Vasiliu, Christoph Lange","doi":"10.1183/13993003.01612-2024","DOIUrl":"https://doi.org/10.1183/13993003.01612-2024","url":null,"abstract":"<p><strong>Introduction: </strong>Global migration has increased in recent decades due to war, conflict, persecutions, and natural disasters, but also secondary to increased opportunities related to work or study. Migrants' risk of tuberculosis (TB) differs by reasons for migration, socioeconomic status, mode of travel and TB risk in transit, TB incidence and healthcare provision in country of origin. Despite advances in TB care for migrants and new treatment strategies, decisions for the management of migrants at risk of TB often rely on expert opinions, rather than clinical evidence.</p><p><strong>Methods: </strong>A systematic literature search was conducted, studies were mapped to different recommendation groups and included studies were synthesized by meta-analysis where appropriate. Current evidence on diagnosis of active TB in migrants entering the European Union /European Economic Area (EU/EEA) &UK including the clinical presentation and diagnostic delay, treatment outcomes of drug susceptible TB, prevalence and treatment outcomes of multidrug/rifampicin-resistant (MDR/RR)-TB and TB/HIV co-infection was summarised. A consensus process was used based on the evidence.</p><p><strong>Results: </strong>We document a higher vulnerability of migrants for TB, including an increased risk of extrapulmonary TB, MDR/RR-TB, TB/HIV co-infection and worse TB treatment outcomes compared to host populations. Consensus recommendations include screening of migrants for TB/ latent TB infection (LTBI) according to country data; a minimal package for TB care in drug susceptible and MDR/RR-TB; implementation of migrant-sensitive strategies; free healthcare and preventive treatment for migrants with HIV co-infection.</p><p><strong>Conclusion: </strong>Dedicated care for TB prevention and treatment in migrant populations within the EU/EEA &UK is essential.</p>","PeriodicalId":12265,"journal":{"name":"European Respiratory Journal","volume":" ","pages":""},"PeriodicalIF":16.6,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The modified Baveno classification for obstructive sleep apnoea: development and evaluation based on the ESADA database.","authors":"Sandhya Matthes, Marcel Treml, Ludger Grote, Jan Hedner, Ding Zou, Maria R Bonsignore, Jean-Louis Pépin, Sébastien Bailly, Silke Ryan, Walter T McNicholas, Sofia E Schiza, Johan Verbraecken, Athanasia Pataka, Paweł Śliwiński, Özen K Basoglu, Carolina Lombardi, Gianfranco Parati, Winfried J Randerath","doi":"10.1183/13993003.01371-2024","DOIUrl":"10.1183/13993003.01371-2024","url":null,"abstract":"<p><strong>Background: </strong>The \"Baveno classification\" replaced the apnoea-hypopnoea index (AHI) with symptoms and comorbidities for treatment indication in obstructive sleep apnoea (OSA). This study evaluates a modified Baveno classification which adds a validated cardiovascular disease (CVD) risk score and acknowledges severe breathing disturbances.</p><p><strong>Method: </strong>OSA patients from the European Sleep Apnoea Database (ESADA) were retrospectively allocated into CVD risk groups 1-3 based on the SCORE2 risk prediction model and European Society of Cardiology guidelines. AHI ≥30 events·h^-1 conferred strong treatment indication. When AHI was <30 events·h^-1, symptoms and CVD risk dictated allocation to the weak, intermediate or strong treatment indication group. Changes in Epworth Sleepiness Scale (ESS) score and office systolic blood pressure (SBP) at follow-up (12-24 months) under positive airway pressure (PAP) were assessed.</p><p><strong>Results: </strong>8625 patients were analysed (29% female; median (interquartile range) age 56 (49-64) years and body mass index 31.9 (28.4-36.3) kg·m^-2). Treatment indication was weak in 501 (6%), intermediate in 2085 (24%) and strong in 6039 (70%). There was a continuous increase in age, SBP, C-reactive protein and glycosylated haemoglobin from weak to strong (p<0.001). PAP prescription increased from 52% to 64% to 93% (weak to strong; p<0.001). The change in ESS score was -2, -4 and -5, respectively (p<0.001). Reductions of ≥3 mmHg median SBP occurred when AHI was ≥30 events·h^-1 and in symptomatic patients with CVD risk levels >1 when AHI was <30 events·h^-1.</p><p><strong>Conclusion: </strong>This analysis provides supporting evidence for the key role of CVD risk assessment and severe breathing disturbances in the identification of OSA patients most likely to benefit from treatment.</p>","PeriodicalId":12265,"journal":{"name":"European Respiratory Journal","volume":" ","pages":""},"PeriodicalIF":16.6,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142557506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bacterial misappropriation of host glucose in pneumococcal pneumonia.","authors":"Clark D Russell, David H Dockrell","doi":"10.1183/13993003.01841-2024","DOIUrl":"https://doi.org/10.1183/13993003.01841-2024","url":null,"abstract":"","PeriodicalId":12265,"journal":{"name":"European Respiratory Journal","volume":"64 6","pages":""},"PeriodicalIF":16.6,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142817728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treating sleep disordered breathing for cardiovascular outcomes: observational and randomised trial evidence.","authors":"T Douglas Bradley, Alexander G Logan, John S Floras","doi":"10.1183/13993003.01033-2024","DOIUrl":"10.1183/13993003.01033-2024","url":null,"abstract":"<p><p>Sleep disordered breathing (SDB) is considered a risk factor for cardiovascular disease (CVD). Obstructive sleep apnoea (OSA) can be treated with continuous positive airway pressure (CPAP), and central sleep apnoea (CSA), in patients with heart failure with reduced ejection fraction (HFrEF), by peak flow-triggered adaptive servo-ventilation. Presently, there is equipoise as to whether treating SDB prevents cardiovascular events. Some propose treatment for this indication, based on observational data, while others argue against because of the lack of randomised trial evidence. This review evaluates literature concerning the cardiovascular effects of treating SDB with PAP devices in individuals with and without CVDs. Nine observational studies report significantly lower cardiovascular event rates in those treated, than in those not treated, for SDB. Conversely, 12 randomised trials in which excessive daytime sleepiness was generally an exclusion criterion showed no reduction in cardiovascular event rates. The SERVE-HF trial showed an increase in mortality with use of minute ventilation-triggered adaptive servo-ventilation for CSA in patients with HFrEF. In the ADVENT-HF trial, treating HFrEF patients with coexisting OSA or CSA using peak flow-triggered adaptive servo-ventilation was safe and improved sleep structure and heart failure-related quality of life but did not reduce all-cause mortality or cardiovascular events. More evidence is required to determine whether treating CSA in patients with HFrEF prevents cardiovascular events and improves survival. Presently, the rationale for treating SDB with PAP remains improving sleep structure and quality of life, as well as relieving excessive daytime sleepiness, but not reducing cardiovascular events.</p>","PeriodicalId":12265,"journal":{"name":"European Respiratory Journal","volume":" ","pages":""},"PeriodicalIF":16.6,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142784536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lung structure and longitudinal change in cardiac structure and function: the MESA COPD Study.","authors":"Emilia A Hermann, Yifei Sun, Eric A Hoffman, Norrina B Allen, Bharath Ambale-Venkatesh, David A Bluemke, J Jeffrey Carr, Steven M Kawut, Martin R Prince, Sanjiv J Shah, Benjamin M Smith, Karol E Watson, Joao A C Lima, R Graham Barr","doi":"10.1183/13993003.00820-2024","DOIUrl":"10.1183/13993003.00820-2024","url":null,"abstract":"<p><strong>Background: </strong>Lung structure and cardiac structure and function are associated cross-sectionally. The classic literature suggests relationships of airways disease to cor pulmonale and emphysema to reduced cardiac output (CO) but longitudinal data are lacking.</p><p><strong>Methods: </strong>The Multi-Ethnic Study of Atherosclerosis (MESA) COPD Study was a multicentre longitudinal COPD case-control study of participants 50-79 years with ≥10 pack-years smoking without clinical cardiovascular disease. Segmental airway wall area (WA) and percent emphysema were measured on computed tomography. Right and left ventricle parameters were assessed on cardiac magnetic resonance imaging (cMRI) in exams 6 years apart. Longitudinal and period cross-sectional associations were evaluated with mixed models adjusted for demographics, body size and smoking.</p><p><strong>Results: </strong>The 187 participants with repeated cMRI were 67±7 years old; 42% had COPD; 22% currently smoked; and the race/ethnicity distribution was 54% White, 30% Black, 14% Hispanic and 3% Asian. Greater WA at enrolment was associated with longitudinal increase in right ventricular (RV) mass (3.5 (95% CI 1.1-5.9) g per 10 mm² WA). Greater percent emphysema was associated with stably lower left ventricular (LV) end-diastolic volume (-7.8 (95% CI -10.3- -3.0) mL per 5% emphysema) and CO (-0.2 (95% CI -0.4- -0.1) L·min^-1 per 5% emphysema).</p><p><strong>Conclusion: </strong>Cardiac associations varied by lung structure over 6 years in this multi-ethnic study. Greater WA at enrolment was associated with longitudinal increases in RV mass, whereas greater percent emphysema was associated with stable decrements in LV filling and CO.</p>","PeriodicalId":12265,"journal":{"name":"European Respiratory Journal","volume":" ","pages":""},"PeriodicalIF":16.6,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142371415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to: Is there a kindling effect in COPD exacerbations?","authors":"David M G Halpin, Heath Heatley, David Price","doi":"10.1183/13993003.02055-2024","DOIUrl":"10.1183/13993003.02055-2024","url":null,"abstract":"","PeriodicalId":12265,"journal":{"name":"European Respiratory Journal","volume":"64 6","pages":""},"PeriodicalIF":16.6,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11635379/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142817731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular Benefits and Safety Profile of Macrolide Maintenance Therapy in Patients with Bronchiectasis.","authors":"Ran Guo, Dennis Wat, Steven Ho Man Lam, Tommaso Bucci, Christopher Tze-Wei Tsang, An-Ping Cai, Yap-Hang Chan, Qing-Wen Ren, Jia-Yi Huang, Jing-Nan Zhang, Wen-Li Gu, Ching-Yan Zhu, Yik-Ming Hung, Freddy Frost, Gregory Y H Lip, Kai-Hang Yiu","doi":"10.1183/13993003.01574-2024","DOIUrl":"10.1183/13993003.01574-2024","url":null,"abstract":"<p><strong>Background: </strong>Macrolide maintenance therapy (MMT) has demonstrated notable efficacy in reducing exacerbation in patients with bronchiectasis, which is a major risk factor for cardiovascular events. However, a comprehensive assessment of the cardiovascular benefits and safety profile of MMT in this population is lacking.</p><p><strong>Methods: </strong>This territory-wide cohort study analyzed patients diagnosed with bronchiectasis in Hong Kong between 2001 and 2018. Patients were classified as MMT receivers or macrolide non-receivers based on the administration of MMT. Propensity score (PS) matching was employed for confounding factors adjustment. The primary outcome of interest was major adverse cardiovascular events (MACE), a composite of cardiovascular death, myocardial infarction and stroke. The safety outcome was the occurrence of ventricular arrhythmias or sudden cardiac death. Cox proportional hazard regression analysis was utilized to compare the incidence of outcomes across the two groups.</p><p><strong>Results: </strong>A total of 22 895 patients with bronchiectasis were identified. Following 1:2 PS matching, the final cohort consisted of 3137 individuals, with 1123 MMT receivers and 2014 macrolide non-receivers. MMT administration was associated with a significant reduced risk of MACE (16.38 <i>versus</i> 24.11 events per 1000 person years; HR 0.68; 95% CI 0.52-0.90). Importantly, the use of MMT was not associated with elevated risk of ventricular arrhythmias or sudden cardiac death (7.17 <i>versus</i> 7.67 events per 1000 person years; HR 0.93; 95% CI 0.60-1.44).</p><p><strong>Conclusions: </strong>The administration of MMT in patients with bronchiectasis was associated with a significant reduction in the risk of MACE, without any evidence suggesting an increased risk of severe arrhythmia-related adverse events.</p>","PeriodicalId":12265,"journal":{"name":"European Respiratory Journal","volume":" ","pages":""},"PeriodicalIF":16.6,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142738945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pathogenic variants in <i>CFAP46</i>, <i>CFAP54</i>, <i>CFAP74</i> and <i>CFAP221</i> cause primary ciliary dyskinesia with a defective C1d projection of the central apparatus.","authors":"Kai Wohlgemuth, Niklas Hoersting, Julia Koenig, Niki Tomas Loges, Johanna Raidt, Sebastian George, Sandra Cindrić, Andre Schramm, Luisa Biebach, Simon Lay, Gerard W Dougherty, Heike Olbrich, Petra Pennekamp, Bernd Dworniczak, Heymut Omran","doi":"10.1183/13993003.00790-2024","DOIUrl":"10.1183/13993003.00790-2024","url":null,"abstract":"<p><strong>Background: </strong>Primary ciliary dyskinesia is a rare genetic disorder caused by insufficient mucociliary clearance leading to chronic airway infections. The diagnostic guideline of the European Respiratory Society primarily recommends an evaluation of the clinical history (<i>e.g.</i> by the PICADAR prediction tool), nasal nitric oxide production rate measurements, high-speed videomicroscopy analysis of ciliary beating and an assessment of ciliary axonemes <i>via</i> transmission electron microscopy. Genetic testing can be implemented as a last step.</p><p><strong>Aims: </strong>In this study, we aimed to characterise primary ciliary dyskinesia with a defective C1d projection of the ciliary central apparatus and we evaluated the applicability of the European Respiratory Society diagnostic guideline to this primary ciliary dyskinesia type.</p><p><strong>Methods: </strong>Using a high-throughput sequencing approach of genes encoding C1d components, we identified pathogenic variants in the novel primary ciliary dyskinesia genes <i>CFAP46</i> and <i>CFAP54</i>, and the known primary ciliary dyskinesia gene <i>CFAP221</i>. To fully assess this primary ciliary dyskinesia type, we also analysed individuals with pathogenic variants in <i>CFAP74</i>.</p><p><strong>Results: </strong>Careful evaluation revealed that C1d-defective primary ciliary dyskinesia is associated with normal situs composition, normal nasal nitric oxide production rates, normal ciliary ultrastructure by transmission electron microscopy and normal ciliary beating by high-speed videomicroscopy analysis. Despite chronic respiratory disease, PICADAR does not reliably detect this primary ciliary dyskinesia type. However, we could show by <i>in vitro</i> ciliary transport assays that affected individuals exhibit insufficient ciliary clearance.</p><p><strong>Conclusions: </strong>Overall, this study extends the spectrum of primary ciliary dyskinesia genes and highlights that individuals with C1d-defective primary ciliary dyskinesia elude diagnosis when using the current diagnostic algorithm. To enable diagnosis, genetic testing should be prioritised in future diagnostic guidelines.</p>","PeriodicalId":12265,"journal":{"name":"European Respiratory Journal","volume":" ","pages":""},"PeriodicalIF":16.6,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142371416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genes take the lead: genetic testing becomes the gold standard for diagnosing primary ciliary dyskinesia.","authors":"Adam J Shapiro, Christina S Thornton","doi":"10.1183/13993003.01888-2024","DOIUrl":"https://doi.org/10.1183/13993003.01888-2024","url":null,"abstract":"","PeriodicalId":12265,"journal":{"name":"European Respiratory Journal","volume":"64 6","pages":""},"PeriodicalIF":16.6,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142817729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The lung that rules the heart.","authors":"Anton Vonk Noordegraaf, Harm Jan Bogaard","doi":"10.1183/13993003.01922-2024","DOIUrl":"https://doi.org/10.1183/13993003.01922-2024","url":null,"abstract":"","PeriodicalId":12265,"journal":{"name":"European Respiratory Journal","volume":"64 6","pages":""},"PeriodicalIF":16.6,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142817732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}