NPJ Primary Care Respiratory Medicine最新文献

{"title":"Characteristics associated with regular attendance and quality of asthma annual reviews in adults with asthma in England.","authors":"Hannah Whittaker, Jennifer K Quint","doi":"10.1038/s41533-026-00514-5","DOIUrl":"10.1038/s41533-026-00514-5","url":null,"abstract":"<p><p>Routinely collected electronic healthcare records from the Clinical Practice Research Datalink Aurum were used to investigate patient characteristics associated with attendance and regular attendance of asthma annual reviews. Females, older age, ex-smokers, White ethnicity, lower socioeconomic deprivation, and comorbidities were associated with higher rates of asthma annual reviews however, females, ex-smokers, and depression were associated with less regularly reviews, indicating the sporadic nature of reviews, despite guidelines.</p>","PeriodicalId":19470,"journal":{"name":"NPJ Primary Care Respiratory Medicine","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13328552/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147777593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lung ultrasound performed by primary care physicians as a predictive and diagnostic tool in COVID-19 patients.","authors":"Bernardino Oliva-Fanlo, Magdalena Esteva, José Ignacio Ramírez-Manent, Antonio Albaladejo-Dávalos, Josep Corcoll-Reixach, Mª Cristina Gadea-Ruiz, Álvaro Morán-Bayón, Oana Bulilete","doi":"10.1038/s41533-026-00515-4","DOIUrl":"10.1038/s41533-026-00515-4","url":null,"abstract":"<p><p>To assess the value of abnormal findings of lung POCUS performed by PCPs in patients with SARS-CoV-2 virus infection in predicting hospitalisations, intensive care admissions, and mortality. Additionally, this study aims to assess the validity of lung POCUS performed by PCPs for COVID-19 pneumonia diagnosis. This prospective observational study, conducted in Mallorca and Salamanca, Spain, during 2021, assessed 624 consecutive adult patients with confirmed SARS-CoV-2 infection and worsening symptoms. Eight PCPs with 5-hour standardized training performed 12-zone lung POCUS. POCUS was considered positive if pleural abnormalities with ≥3 B-lines, subpleural consolidation, or lobar consolidation were present. Patients were followed for 30 days to confirm pneumonia diagnosis via chest X-ray or CT scan. Multivariate models using Poisson regression were performed to identify independent predictors for hospitalization and ICU admission/death. Abnormal POCUS findings were observed in 58.8% of patients, of whom 50.3% presented pleural abnormalities with 3 or more B-lines in at least one scanned area, 27.6% subpleural consolidations, and 3.4% lobar consolidations. Patients with positive POCUS were referred to the hospital more frequently (72.4% vs. 22.8%; OR = 8.83). Abnormal lung POCUS was independently associated with an increased risk of hospitalization (RR 1.34; 95% CI 1.07-1.67), along with age >50 years, SpO2 <95%, hypertension, and diabetes. POCUS was not independently associated with the composite outcome of ICU admission or death (RR 1.27; 95% CI 0.62-2.61). For the diagnosis of COVID-19 pneumonia, overall POCUS sensitivity was 68.3%, specificity 43.6%, positive predictive value 78.7%, and negative predictive value 31.1%. Lung POCUS performed by PCPs is a valuable independent predictor for hospitalization in COVID-19 patients within community settings. While its incremental prognostic benefit over simple clinical variables is modest and its diagnostic accuracy for pneumonia is limited compared to conventional imaging, it could remain as a useful tool for risk stratification in resource-limited environments or home-based care. These findings support its use in resource-limited environments and highlight the need for standardised scanning protocols and training.</p>","PeriodicalId":19470,"journal":{"name":"NPJ Primary Care Respiratory Medicine","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13470018/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147777599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Screening obstructive sleep apnea using clinical questionnaires and the triglyceride-glucose index: a cardiovascular risk-based approach.","authors":"Cristina García-Benito, Lucas Oxley-Babsky, Mario Crespo-Martín, Elisa Del-Molino-Serrano, Raquel Santos-Villanueva, Alba Olloqui-Fuentes, Laura Guillén-Lorenzo, Francisco García-Río","doi":"10.1038/s41533-026-00516-3","DOIUrl":"10.1038/s41533-026-00516-3","url":null,"abstract":"<p><p>Obstructive sleep apnea (OSA) is highly prevalent among patients with cardiovascular (CV) risk factors, yet early detection in primary care remains difficult, particularly in individuals with subtle or absent symptoms, in whom screening questionnaires may have limited accuracy. This study aimed to evaluate the diagnostic performance of five validated questionnaires and the triglyceride-glucose (TyG) index, alone and in combination, for detecting moderate-to-severe OSA in primary care patients stratified by CV risk. In this prospective study, 189 adults aged 18-75 years with hypertension, type 2 diabetes, or dyslipidemia were consecutively recruited from a primary care center in Spain. Participants completed the Berlin, STOP, STOP-BANG, NoSAS, and BASH-GN questionnaires, and the TyG index was calculated from fasting glucose and triglyceride levels. OSA was assessed using home sleep apnea testing, with moderate-to-severe OSA defined as an apnea-hypopnea index (AHI) ≥ 15 events/h. CV risk was categorized using SCORE charts. Overall OSA prevalence was 57.7%, and 23.8% of participants had moderate-to-severe disease. Individually, questionnaires and TyG showed modest discrimination (AUC range 0.575-0.675). Diagnostic accuracy improved when strategies were tailored to CV risk: in low-to-moderate CV risk patients, TyG combined with the Berlin questionnaire achieved the best performance (AUC 0.740), whereas in high-to-very-high CV risk patients, the TyG plus STOP-BANG combination performed best (AUC 0.732). Notably, high-risk patients had more severe OSA but fewer typical symptoms, suggesting a \"silent\" phenotype. Integrating TyG with selected questionnaires may modestly enhance detection of clinically significant OSA in primary care, particularly when adapted to CV risk.</p>","PeriodicalId":19470,"journal":{"name":"NPJ Primary Care Respiratory Medicine","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13319263/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147777642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Co-designing a primary care delivered, breathlessness, self-management intervention for people with chronic respiratory disease.","authors":"Natasha Smallwood, Amy Pascoe, Lena Ly, Anna Spathis, Sarah Hoare, Lindsey Berends, Jonathan Mant, Jennifer Philip, Rebecca Disler, Anne E Holland, Yet Khor, Christian Osadnik, Lena Sanci","doi":"10.1038/s41533-026-00511-8","DOIUrl":"10.1038/s41533-026-00511-8","url":null,"abstract":"<p><p>Chronic breathlessness is a highly prevalent, distressing symptom among people with chronic respiratory disease (CRD), often persisting despite optimal treatment. Primary care clinicians are well-positioned to offer early access to self-management support, however, many report limited knowledge, resources and confidence in managing breathlessness. The PrimaryBreathe Australia clinical trial is an ongoing partnership with PrimaryBreathe UK. In partnership with people with CRD, primary healthcare workers (HCWs), and additional stakeholders, we aimed to co-design a technology-supported, evidence-based, breathlessness self-management intervention, to be delivered to Australians with CRD enrolled in the PrimaryBreathe Australia clinical trial. Using a cyclical co-design approach, we conducted two rounds of semi-structured interviews and a consensus-building focus group to design/develop a feasible and acceptable intervention ahead of trial implementation. Data were transcribed and analysed according to the Theoretical Domains Framework. A total of 39 participants contributed to the co-design process, including 17 patients, 20 HCWs, and 2 stakeholders. Key overarching themes included: patient engagement in care; primary HCWs' approach to management; and healthcare structures, and the impacts of these domains on access to healthcare and breathlessness management. Tailored implementation strategies to address the concerns raised included: clinician-supported, self-management education for patients; flexible, multimodal, intervention delivery; and continuity of care within familiar settings. Our newly co-designed, evidence-based, breathlessness, self-management intervention was collaboratively developed with HCWs, people living with CRD, and additional stakeholders. This participatory approach ensures the intervention is patient-focused, contextually relevant, and fit for purpose when deployed in the PrimaryBreathe Australia clinical trial from 2025.</p>","PeriodicalId":19470,"journal":{"name":"NPJ Primary Care Respiratory Medicine","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13315910/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147777572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pelargonium sidoides extract (EPs® 7630) versus usual care for acute bronchitis in Swiss primary care (PHYTOBRONCH): a pragmatic, open-label, randomised controlled trial.","authors":"Angélique Bourqui, Océane Corpataux, Federico Bonofiglio, Julie Dubois, Nazanin Abolhassani, Stéphanie Baggio, Chantal Csajka, Pierre-Yves Rodondi, Clara Podmore","doi":"10.1038/s41533-026-00499-1","DOIUrl":"10.1038/s41533-026-00499-1","url":null,"abstract":"<p><p>We aimed to assess whether Pelargonium sidoides extract (EPs®7630) reduces symptom duration or antibiotic use compared with usual care in adults with acute bronchitis. We conducted a pragmatic randomised-controlled trial across 36 primary care practices and five walk-in clinics in Switzerland. Adults ( ≥ 18 years) consulting a general practitioner for the first time for a new episode of acute bronchitis, with a cough of up to eight days' duration, were eligible for inclusion. The co-primary outcomes were (1) number of days required to achieve a 50% reduction in symptoms from the peak value, assessed using the Acute Bronchitis Severity Score (ABSS), and (2) the proportion of participants who used antibiotics. Missing data in intention-to-treat (ITT) analyses were multiply imputed. 332 participants were enrolled and randomly assigned: 155 to EPs®7630 and 177 to usual care. Neither co-primary outcomes showed a statistically significant difference between groups. No significant difference in time to 50% reduction of symptoms between the EPs®7630 and usual care groups was observed (adjusted regression coefficient 0.05 [95% CI - 0.13-0.23]; p = 0.578). Antibiotic use was 7 percentage points lower (31% relative reduction) in the EPs®7630 group (17.4%, 20 of 155) than in the usual care group (25.2%, 33 of 177), although the difference was not statistically significant (adjusted risk ratio 0.78 [95% CI 0.49-1.26]; p = 0.309). Adverse events were reported more frequently in the EPs®7630 group (32.3%, 50 of 155) than in the usual care group (21.5%, 38 of 177; hazard ratio 1.40 [95% CI 1.03-1.89]; p = 0.030); all adverse drug events were mild. EPs®7630 did not reduce symptom duration or antibiotic use significantly and was associated with more frequent events, that were all mild and previously described. Despite the absence of statistical significance, the observed reduction in antibiotic use warrants further investigation in larger trials to clarify its potential role within antimicrobial stewardship strategies.</p>","PeriodicalId":19470,"journal":{"name":"NPJ Primary Care Respiratory Medicine","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13284306/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147777611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gender differences in sleep apnea: a study of the catalan population.","authors":"Brenda Biaani León-Gómez, Maria Del Mar Rodriguez Alvarez, Jesús Pujol Salud, Eulàlia Borrell Thio, Susana Erazo, Josep Roca Antonio, Pere Torán-Monserrat","doi":"10.1038/s41533-026-00512-7","DOIUrl":"10.1038/s41533-026-00512-7","url":null,"abstract":"<p><p>To analyse sex differences in the distribution and comorbidity profile of adults with diagnosed obstructive sleep apnoea (OSA) and no prior cardiovascular disease, stratified by body mass index (BMI). We conducted a retrospective cross-sectional study of 3886 adults with diagnosed OSA. Data were obtained from the SIDIAP database and included individuals with OSA recorded between 1 January 2009 and 31 December 2016 and no previous cardiovascular disease. Analyses were stratified by sex. Variables included age, socioeconomic deprivation (MEDEA index), BMI, smoking, alcohol consumption, cardiometabolic comorbidities, and cardiovascular risk estimated with the REGICOR function. Chi-square tests were used to compare variables by sex and across BMI categories within each sex. Of the 3886 individuals included, 28.8% were women. Most participants were older than 40 years (92.6%). Men had higher proportions of alcohol consumption, smoking, hypertriglyceridaemia, hyperuricaemia, and less favourable REGICOR cardiovascular risk categories. Women showed higher proportions of hypertension, diabetes mellitus, and HbA1c ≥ 6.5%. Among those with available BMI data, women were more frequently represented in the highest BMI category, whereas men were more often represented in the lowest BMI category. Relevant sex-related differences were observed in the clinical profile, comorbidities, cardiometabolic risk factors, and health behaviours of adults with diagnosed OSA. These findings support the need for sex-sensitive approaches to the diagnosis and management of OSA, particularly to improve identification and care in women.</p>","PeriodicalId":19470,"journal":{"name":"NPJ Primary Care Respiratory Medicine","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13270092/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147691283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"External validation of an IOS-derived model for airflow obstruction and COPD in a community-based cohort.","authors":"Lifei Lu, Jieqi Peng, Si Li, Gaoying Tang, Fan Wu, Qi Wan, Zhishan Deng, Cuiqiong Dai, Kunning Zhou, Xiaohui Wu, Heshen Tian, Xiangqing Hou, Guannan Cai, Junfeng Lin, Suyin Huang, Shuqing Yu, Yongqing Huang, Changli Yang, Shengtang Chen, Pixin Ran, Yumin Zhou","doi":"10.1038/s41533-026-00506-5","DOIUrl":"10.1038/s41533-026-00506-5","url":null,"abstract":"<p><p>A model based on impulse oscillometry (IOS) predicting airflow limitation and chronic obstructive pulmonary disease (COPD) has been developed in hospital-based populations. However, its diagnostic performance in community-recruited cohorts and its potential complementary value when combined with commonly used questionnaire-based tools remain to be evaluated. To externally validate the IOS-derived model for airflow obstruction (AO) and COPD in a community-based cohort, and to assess whether combining it with the COPD Screening Questionnaire (COPD-SQ) improves diagnostic accuracy compared to either tool alone. This was a cross-sectional analysis of baseline data from the ongoing Early Chronic Obstructive Pulmonary Disease (ECOPD) prospective cohort study. Participants completed pre-bronchodilator IOS tests, pre- and post-bronchodilator spirometry tests. The previously developed IOS-derived model (incorporating age, sex, height, weight, and IOS parameters) was applied to this Chinese population cohort. The COPD-SQ (7 items) was also administered. We defined a pre-bronchodilator FEV₁/FVC < 0.70 as airflow obstruction (AO) and a post-bronchodilator FEV₁/FVC < 0.70 as COPD. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic performance of the IOS-derived model, COPD-SQ, and their combination for AO and COPD. Differences in area under the curve (AUC) were compared using DeLong's test. A total of 1858 participants with complete IOS parameters were analyzed. The IOS-derived model showed acceptable diagnostic accuracy for AO (AUC 0.826, 95% CI 0.808-0.844, sensitivity 67.4%, specificity 80.6%) and COPD (AUC 0.836, 95% CI 0.818-0.854, sensitivity 71.6%, specificity 78.1%) in this community-based cohort. The combination of the IOS-derived model and COPD-SQ demonstrated modestly higher diagnostic accuracy for AO (AUC 0.839 vs 0.826 for IOS-derived model or 0.784 for COPD-SQ, all P < 0.001) and COPD (AUC 0.851 vs 0.836 or 0.795, all P < 0.001) compared to either tool alone. In this community-recruited cohort with a relatively high prevalence of airflow limitation and COPD, the IOS-derived model exhibited good diagnostic performance and, when combined with the COPD-SQ, showed modestly improved accuracy for identifying AO and COPD compared to single-modality approaches. These findings support further evaluation of the model in unselected general populations and real-world primary care settings.</p>","PeriodicalId":19470,"journal":{"name":"NPJ Primary Care Respiratory Medicine","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13270139/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147691291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive performance of the PUMA questionnaire as an opportunistic COPD case-finding tool in Singapore primary care.","authors":"Vicky Mengqi Qin, Kenneth Tan, Geak Poh Tan, Valery Ho, Zeyuan Yin, Susie Wong, Dingding Wang, Jo-Anne Manski-Nankervis, Eng Sing Lee","doi":"10.1038/s41533-026-00510-9","DOIUrl":"10.1038/s41533-026-00510-9","url":null,"abstract":"<p><p>The PUMA scale has shown good discrimination in identifying people with COPD in primary care. We evaluated the predictive performance of PUMA for opportunistic case-finding and assessed the prevalence of COPD in at-risk primary care patients in Singapore. This is a multicentre cross-sectional study of participants aged ≥40 years and current/former smokers. Participants completed the PUMA scale and spirometry. Predictive performance of PUMA was assessed using AUC-ROC; optimal cutoff was determined by Youden's index. 359 participants were included in final analysis; 12.5% had COPD confirmed on spirometry. PUMA showed acceptable discrimination with AUC-ROC of 0.75 (95% CI:0.67-0.83). Optimal cutoff maximising sensitivity and specificity was ≥5 (Se 62.2%, Sp 79.3%; PPV 30.1%, NPV 93.6%); cutoff of ≥4 increased sensitivity to 80.0% (Sp of 56.7%; PPV 20.9%, NPV 95.2%.). The PUMA scale demonstrated acceptable predictive performance for opportunistic COPD case-finding in Singapore's primary care setting. A cutoff of ≥4 enhanced case identification.</p>","PeriodicalId":19470,"journal":{"name":"NPJ Primary Care Respiratory Medicine","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13269459/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147691233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative effectiveness of water-based versus land-based rehabilitation in COPD: a systematic review and network meta-analysis of randomized controlled trials.","authors":"Eleuterio A Sánchez Romero, Ada Jacqueline Zubercová, Amélie Gran, Raphael Martins de Abreu, Francisco Xavier de Araujo, Pierluigi Sinatti, Juan Nicolás Cuenca-Zaldívar, Rob Sillevis, Camilo Corbellini","doi":"10.1038/s41533-026-00503-8","DOIUrl":"10.1038/s41533-026-00503-8","url":null,"abstract":"<p><p>Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality. Pulmonary rehabilitation (PR) is central to COPD management; however, individuals with musculoskeletal limitations, obesity, or reduced tolerance to land-based rehabilitation (LBR) may benefit from water-based rehabilitation (WBR). To evaluate the comparative effectiveness of WBR, LBR, and control interventions on exercise capacity (EC) and health-related quality of life (HRQoL) in adults with COPD using a systematic review and network meta-analysis (NMA). Randomized controlled trials (RCTs) involving adults with COPD were searched in PubMed, Cochrane Library, PEDro, and Bibliothèque nationale du Luxembourg from inception to July 13, 2025. The primary outcomes were EC, measured using the 6-Minute Walk Test (6MWT), Incremental Shuttle Walk Test (ISWT), and Endurance Shuttle Walk Test (ESWT), and HRQoL, assessed using the Chronic Respiratory Disease Questionnaire (CRDQ) and St. George's Respiratory Questionnaire (SGRQ). The Risk of bias was assessed using the Risk of Bias 2.0 tool (RoB 2.0). A frequentist NMA was used to estimate the comparative effects and intervention rankings. The certainty of the evidence was rated using the Grading of Recommendations, Assessment, Development, and Evaluations approach (GRADE). Nine RCTs (n = 323) were included in the analysis. WBR was associated with clinically meaningful improvements in EC, particularly in endurance performance (ESWT) and shuttle walking (ISWT), with several effects exceeding the established minimal clinically important difference (MCID) thresholds. HRQoL outcomes were heterogeneous: WBR improved selected CRDQ and SGRQ domains, whereas LBR ranked highest for overall HRQoL. The NMA ranking suggested that WBR had the highest probability of being the most effective intervention for EC and combined EC+HRQoL outcomes, whereas LBR ranked highest for HRQoL alone. Heterogeneity was low for EC, moderate for HRQoL, and high for the combined outcomes. The certainty of evidence ranged from moderate (EC) to low (combined outcomes). WBR is a viable alternative to LBR for improving EC in individuals with COPD and may be particularly beneficial for those with reduced mobility or limited tolerance to land-based training. However, given the limited number of trials and variability across studies, these findings should be interpreted with caution. High-quality and adequately powered RCTs are required to confirm the long-term effects and real-world applicability of these findings.</p>","PeriodicalId":19470,"journal":{"name":"NPJ Primary Care Respiratory Medicine","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13427819/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147662962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Asthma management in pregnancy and lactation: A review of current evidence and best practice recommendations.","authors":"Margaret Gleeson, Claire McCarthy, Fergal O' Shaughnessy, Joanna Carroll, Deirdre Long, Lauren Madden Doyle, Dorothy M Ryan","doi":"10.1038/s41533-026-00491-9","DOIUrl":"10.1038/s41533-026-00491-9","url":null,"abstract":"<p><p>This review will consider current evidence regarding asthma medications during pregnancy and lactation, combined with advice regarding the importance of diagnostic certainty and best practice asthma management. Data for this review were sourced from a comprehensive search of electronic databases including PubMed, Embase, and Cochrane Library. Additional sources such as clinical practice guidelines, systematic reviews, and relevant reference lists were also consulted. Studies selected for inclusion in this review encompassed observational, case-control, and cohort studies, as well as meta-analyses and reviews published in peer-reviewed journals. Discontinuation of asthma medications during pregnancy is common and compromises asthma control, increasing the risk of adverse maternal and fetal outcomes. Breastfeeding may be unnecessarily avoided when restarting medications post-partum. There is a lack of high-quality research on asthma and allergy medications during pregnancy and lactation. Expert consensus suggests that the benefit of adequate asthma control in pregnancy outweighs the potential risks of commonly used asthma medications. Confirming the diagnosis, ensuring close monitoring and collaborating with specialists is key to safe management of asthma in pregnancy.</p>","PeriodicalId":19470,"journal":{"name":"NPJ Primary Care Respiratory Medicine","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13270003/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147654277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}