European Respiratory Journal最新文献

{"title":"Clinical review of non-invasive ventilation.","authors":"Gerard J Criner, Shameek Gayen, Massa Zantah, Eduardo Dominguez Castillo, Mario Naranjo, Bilal Lashari, Seyedmohammad Pourshahid, Andrew Gangemi","doi":"10.1183/13993003.00396-2024","DOIUrl":"10.1183/13993003.00396-2024","url":null,"abstract":"<p><p>Non-invasive ventilation (NIV) is the mainstay to treat patients who need augmentation of ventilation for acute and chronic forms of respiratory failure. The last several decades have witnessed an extension of the indications for NIV to a variety of acute and chronic lung diseases. Evolving advancements in technology and personalised approaches to patient care make it feasible to prioritise patient-centred care models that deliver home-based management using telemonitoring and telemedicine systems support. These trends may improve patient outcomes, reduce healthcare costs and improve the quality of life for patients who suffer from chronic diseases that precipitate respiratory failure.</p>","PeriodicalId":12265,"journal":{"name":"European Respiratory Journal","volume":null,"pages":null},"PeriodicalIF":16.6,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11540995/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142125251","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":"Association between a recalled positive airway pressure device and incident cancer: a population-based study.","authors":"Tetyana Kendzerska, Sachin R Pendharkar, Robert Talarico, Kenneth Blades, Constance Mackenzie, Andrea S Gershon, Najib Ayas, Marta Kaminska, Mark Fenton, Kerry A McBrien, Steven Hawken, Diana Ratycz, Vadym Lishchenko, Robert L Owens, Marcus Povitz","doi":"10.1183/13993003.00560-2024","DOIUrl":"10.1183/13993003.00560-2024","url":null,"abstract":"<p><strong>Background: </strong>The real-world consequences of a Philips Respironics recall for positive airway pressure (PAP) devices distributed between 2009 and 2021 are unknown.</p><p><strong>Methods: </strong>We conducted a retrospective population-based study using health administrative databases (Ontario, Canada) on all new adult PAP users identified through the provincial funding system, free of cancer at baseline, who initiated (claimed) PAP treatment between 2012 and 2018. Everyone was followed from the PAP claim date to the earliest of incident cancer diagnosis, death or end of follow-up (March 2022). We used inverse probability of treatment weighting to balance baseline characteristics between individuals on recalled devices and those on devices from other manufacturers. Weighted hazard ratios of incident cancer were compared between groups.</p><p><strong>Results: </strong>Of 231 692 individuals identified, 58 204 (25.1%) claimed recalled devices and 173 488 (74.9%) claimed devices from other manufacturers. A meaningful baseline difference between groups (standardised difference ≥0.10) was noted only by location-relevant covariates; other variables were mostly equally distributed (standardised differences ≤0.06). Over a median (interquartile range) follow-up of 6.3 (4.9-8.0) years, 11 166 (4.8%) developed cancer: unadjusted rates per 10 000 person-years of 78.8 (95% CI 76.0-81.7) in the recall group <i>versus</i> 74.0 (95% CI 72.4-75.6) in others (p=0.0034). Propensity score weighting achieved excellent balance in baseline characteristics between groups (standardised differences ≤0.07). On a weighted sample, there was no statistical difference in the hazard of incident cancer between groups: cause-specific hazard ratio (recalled <i>versus</i> others) 0.97 (95% CI 0.89-1.06).</p><p><strong>Conclusion: </strong>In our real-world population study, compared to other manufacturers and adjusting for confounders, recalled Philips Respironics PAP devices do not appear to be independently associated with developing cancer.</p>","PeriodicalId":12265,"journal":{"name":"European Respiratory Journal","volume":null,"pages":null},"PeriodicalIF":16.6,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141987793","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":"Reassessing Halm's clinical stability criteria in community-acquired pneumonia management.","authors":"Simone Bastrup Israelsen, Markus Fally, Pernille Brok Nielsen, Lilian Kolte, Kasper Karmark Iversen, Pernille Ravn, Thomas Benfield","doi":"10.1183/13993003.00054-2024","DOIUrl":"10.1183/13993003.00054-2024","url":null,"abstract":"<p><strong>Background: </strong>Halm's clinical stability criteria have long guided antibiotic treatment and hospital discharge decisions for patients hospitalised with community-acquired pneumonia (CAP). Originally introduced in 1998, these criteria were established based on a relatively small and select patient population. Consequently, our study aims to reassess their applicability in the management of CAP in a contemporary real-world setting.</p><p><strong>Methods: </strong>This cohort study included 2918 immunocompetent patients hospitalised with CAP from three hospitals in Denmark between 2017 and 2020. The primary outcome was time to achieve clinical stability as defined by Halm's criteria. Additionally, we examined recurrence of clinical instability and severe complications. Cumulative incidence function or Kaplan-Meier survival curves were used to analyse these outcomes, considering competing risks.</p><p><strong>Results: </strong>The study population primarily comprised elderly individuals (median age 75 years) with significant comorbidities. The median time to clinical stability according to Halm's criteria was 4 days, with one-fifth experiencing recurrence of instability after early clinical response (stability within 3 days). Severe complications within 30 days mainly comprised mortality, with rates of 5.1% (64/1257) overall in those with early clinical response, 1.7% (18/1045) in the subgroup without do-not-resuscitate orders and 17.3% (276/1595) among the rest.</p><p><strong>Conclusion: </strong>Halm's clinical stability criteria effectively classify CAP patients with different disease courses, yet achieving stability required more time in this ageing population with substantial comorbidities and more severe disease. Early clinical response indicates reduced risk of complications, especially in those without do-not-resuscitate orders.</p>","PeriodicalId":12265,"journal":{"name":"European Respiratory Journal","volume":null,"pages":null},"PeriodicalIF":16.6,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11540983/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142035603","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":"Accuracy of CAD4TB (Computer-Aided Detection for Tuberculosis) on paediatric chest radiographs.","authors":"Victory Fabian Edem, Esin Nkereuwem, Schadrac C Agbla, Sheila A Owusu, Abdou K Sillah, Binta Saidy, Musa B Jallow, Audrey G Forson, Uzochukwu Egere, Beate Kampmann, Toyin Togun","doi":"10.1183/13993003.00811-2024","DOIUrl":"10.1183/13993003.00811-2024","url":null,"abstract":"<p><strong>Background: </strong>Computer-aided detection (CAD) systems hold promise for improving tuberculosis (TB) detection on digital chest radiographs. However, data on their performance in exclusively paediatric populations are scarce.</p><p><strong>Methods: </strong>We conducted a retrospective diagnostic accuracy study evaluating the performance of CAD4TBv7 (Computer-Aided Detection for Tuberculosis version 7) using digital chest radiographs from well-characterised cohorts of Gambian children aged <15 years with presumed pulmonary TB. The children were consecutively recruited between 2012 and 2022. We measured CAD4TBv7 performance against a microbiological reference standard (MRS) of confirmed TB, and also performed Bayesian latent class analysis (LCA) to address the inherent limitations of the MRS in children. Diagnostic performance was assessed using the area under the receiver operating characteristic curve (AUROC) and point estimates of sensitivity and specificity.</p><p><strong>Results: </strong>A total of 724 children were included in the analysis, with confirmed TB in 58 (8%), unconfirmed TB in 145 (20%) and unlikely TB in 521 (72%). Using the MRS, CAD4TBv7 showed an AUROC of 0.70 (95% CI 0.60-0.79), and demonstrated sensitivity and specificity of 19.0% (95% CI 11-31%) and 99.0% (95% CI 98.0-100.0%), respectively. Applying Bayesian LCA with the assumption of conditional independence between tests, sensitivity and specificity estimates for CAD4TBv7 were 42.7% (95% CrI 29.2-57.5%) and 97.9% (95% CrI 96.6-98.8%), respectively. When allowing for conditional dependence between culture and Xpert assay, CAD4TBv7 demonstrated a sensitivity of 50.3% (95% CrI 32.9-70.0%) and specificity of 98.0% (95% CrI 96.7-98.9%).</p><p><strong>Conclusion: </strong>Although CAD4TBv7 demonstrated high specificity, its suboptimal sensitivity underscores the crucial need for optimisation of CAD4TBv7 for detecting TB in children.</p>","PeriodicalId":12265,"journal":{"name":"European Respiratory Journal","volume":null,"pages":null},"PeriodicalIF":16.6,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11540982/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142125249","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":"Treatment of latent tuberculosis infection in migrants in primary care <i>versus</i> secondary care.","authors":"Matthew Burman, Dominik Zenner, Andrew J Copas, Lara Goscé, Hassan Haghparast-Bidgoli, Peter J White, Vicky Hickson, Opal Greyson, Duncan Trathen, Richard Ashcroft, Adrian R Martineau, Ibrahim Abubakar, Christopher J Griffiths, Heinke Kunst","doi":"10.1183/13993003.01733-2023","DOIUrl":"10.1183/13993003.01733-2023","url":null,"abstract":"<p><strong>Background: </strong>Control of latent tuberculosis infection (LTBI) is a priority in the World Health Organization strategy to eliminate TB. Many high-income, low TB incidence countries have prioritised LTBI screening and treatment in recent migrants. We tested whether a novel model of care, based entirely within primary care, was effective and safe compared to secondary care.</p><p><strong>Methods: </strong>This was a pragmatic cluster-randomised, parallel group, superiority trial (ClinicalTrials.gov: NCT03069807) conducted in 34 general practices in London, UK, comparing LTBI treatment in recent migrants in primary care to secondary care. The primary outcome was treatment completion, defined as taking ≥90% of antibiotic doses. Secondary outcomes included treatment acceptance, adherence, adverse effects, patient satisfaction, TB incidence and a cost-effectiveness analysis. Analyses were performed on an intention-to-treat basis.</p><p><strong>Results: </strong>Between September 2016 and May 2019, 362 recent migrants with LTBI were offered treatment and 276 accepted. Treatment completion was similar in primary and secondary care (82.6% <i>versus</i> 86.0%; adjusted OR (aOR) 0.64, 95% CI 0.31-1.29). There was no difference in drug-induced liver injury between primary and secondary care (0.7% <i>versus</i> 2.3%; aOR 0.29, 95% CI 0.03-2.84). Treatment acceptance was lower in primary care (65.2% (146/224) <i>versus</i> 94.2% (130/138); aOR 0.10, 95% CI 0.03-0.30). The estimated cost per patient completing treatment was lower in primary care, with an incremental saving of GBP 315.27 (95% CI 313.47-317.07).</p><p><strong>Conclusions: </strong>The treatment of LTBI in recent migrants within primary care does not result in higher rates of treatment completion but is safe and costs less when compared to secondary care.</p>","PeriodicalId":12265,"journal":{"name":"European Respiratory Journal","volume":null,"pages":null},"PeriodicalIF":16.6,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11540984/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142035604","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":"Genome-wide association study of susceptibility to <i>Pseudomonas aeruginosa</i> infection in cystic fibrosis.","authors":"Boxi Lin, Jiafen Gong, Katherine Keenan, Fan Lin, Yu-Chung Lin, Julie Mésinèle, Claire Calmel, Badreddine Mohand Oumoussa, Pierre-Yves Boëlle, Loïc Guillot, Harriet Corvol, Valerie Waters, Lei Sun, Lisa J Strug","doi":"10.1183/13993003.00062-2024","DOIUrl":"10.1183/13993003.00062-2024","url":null,"abstract":"<p><strong>Background: </strong><i>Pseudomonas aeruginosa</i> is a common pathogen that contributes to progressive lung disease in cystic fibrosis (CF). Genetic factors other than CF-causing <i>CFTR</i> (CF transmembrane conductance regulator) variations contribute ∼85% of the variation in chronic <i>P. aeruginosa</i> infection age in CF according to twin studies, but the susceptibility loci remain unknown. Our objective is to advance understanding of the genetic basis of host susceptibility to <i>P. aeruginosa</i> infection.</p><p><strong>Materials and methods: </strong>We conducted a genome-wide association study of chronic <i>P. aeruginosa</i> infection age in 1037 Canadians with CF. We subsequently assessed the genetic correlation between chronic <i>P. aeruginosa</i> infection age and lung function through polygenic risk score (PRS) analysis and inferred their causal relationship through bidirectional Mendelian randomisation analysis.</p><p><strong>Results: </strong>Two novel genome-wide significant loci with lead single nucleotide polymorphisms (SNPs) rs62369766 (chr5p12; p=1.98×10^-8) and rs927553 (chr13q12.12; p=1.91×10^-8) were associated with chronic <i>P. aeruginosa</i> infection age. The rs62369766 locus was validated using an independent French cohort (n=501). Furthermore, the PRS constructed from CF lung function-associated SNPs was significantly associated with chronic <i>P. aeruginosa</i> infection age (p=0.002). Finally, our analysis presented evidence for a causal effect of lung function on chronic <i>P. aeruginosa</i> infection age (β=0.782 years, p=4.24×10^-4). In the reverse direction, we observed a moderate effect (β=0.002, p=0.012).</p><p><strong>Conclusions: </strong>We identified two novel loci that are associated with chronic <i>P. aeruginosa</i> infection age in individuals with CF. Additionally, we provided evidence of common genetic contributors and a potential causal relationship between <i>P. aeruginosa</i> infection susceptibility and lung function in CF. Therapeutics targeting these genetic factors may delay the onset of chronic infections, which account for significant remaining morbidity in CF.</p>","PeriodicalId":12265,"journal":{"name":"European Respiratory Journal","volume":null,"pages":null},"PeriodicalIF":16.6,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11540985/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141906376","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":"Exploring the patient perspective in pulmonary hypertension.","authors":"H James Ford, Colleen Brunetti, Pisana Ferrari, Gergely Meszaros, Victor M Moles, Hall Skaara, Adam Torbicki, J Simon R Gibbs","doi":"10.1183/13993003.01129-2024","DOIUrl":"10.1183/13993003.01129-2024","url":null,"abstract":"<p><p>The global impacts of pulmonary hypertension (PH) were formally recognised in 1973 at the 1st World Health Organization meeting dedicated to primary pulmonary hypertension, held in Geneva. Investigations into disease pathogenesis and classification led to the development of numerous therapies over the ensuing decades. While the impacts of the disease have been lessened due to treatments, the symptoms and adverse effects of PH and its therapies on patients' wellbeing and mental health remain significant. As such, there is a critical need to enhance understanding of the challenges patients face on a global scale with respect to care access, multidimensional patient support and advocacy. In addition, thoughtful analysis of the potential benefits and utilisation of mechanisms for the incorporation of patient-reported outcomes into diagnosis and treatment plans is needed. A summary of these areas is included here. We present a report of global surveys of patient and provider experiences and challenges regarding care access and discuss possible solutions. Also addressed is the current state of PH patient associations around the world. Potential ways to enhance patient associations and enable them to provide the utmost support are discussed. A summary of relevant patient-reported outcome measures to assess health-related quality of life in PH is presented, with suggestions regarding incorporation of these tools in patient care and research. Finally, information on how current global threats such as pandemics, climate change and armed conflict may impact PH patients is offered, along with insights as to how they may be mitigated with advanced contingency planning.</p>","PeriodicalId":12265,"journal":{"name":"European Respiratory Journal","volume":null,"pages":null},"PeriodicalIF":16.6,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11525333/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142105944","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":"The Seventh World Symposium on Pulmonary Hypertension: our journey to Barcelona.","authors":"Marc Humbert, Nazzareno Galiè, Lewis J Rubin, Gérald Simonneau, Vallerie V McLaughlin","doi":"10.1183/13993003.01222-2024","DOIUrl":"10.1183/13993003.01222-2024","url":null,"abstract":"","PeriodicalId":12265,"journal":{"name":"European Respiratory Journal","volume":null,"pages":null},"PeriodicalIF":16.6,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11525342/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142105952","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":"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":"https://doi.org/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 Data Base (ESADA) were retrospectively allocated into CVD risk groups 1-3 based on SCORE-2 and the ESC guidelines. AHI ≥30 /h conferred strong treatment indication. When AHI was <30/h, symptoms and CVD risk dictated allocation to weak, intermediate or strong treatment indication group. Change in Epworth Sleepiness Scale (ESS) 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, age 56 [49;64] years, BMI 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 of median SBP occurred when AHI was ≥30/h and in symptomatic patients with CVD risk levels>1 when AHI was <30/h.</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":null,"pages":null},"PeriodicalIF":16.6,"publicationDate":"2024-10-31","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":"<i>ERJ</i> Podcast October 2024: World Symposium on Pulmonary Hypertension.","authors":"","doi":"10.1183/13993003.E6404-2024","DOIUrl":"https://doi.org/10.1183/13993003.E6404-2024","url":null,"abstract":"","PeriodicalId":12265,"journal":{"name":"European Respiratory Journal","volume":null,"pages":null},"PeriodicalIF":16.6,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142557507","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}