Thorax最新文献

{"title":"Oxygen therapy in early warning scores: a systematic review and meta-analysis.","authors":"Charlotte H Harrison,Phoebe Tupper,Stephen Gerry,Verena Michael,Jonathan P Bedford,Carolyn Smith,Chris Subbe,Oliver Redfern,Peter J Watkinson","doi":"10.1136/thorax-2024-222663","DOIUrl":"https://doi.org/10.1136/thorax-2024-222663","url":null,"abstract":"BACKGROUNDEarly warning systems (EWS) used across the world typically assign a fixed number of points to patients receiving supplemental oxygen, regardless of amount. This ordinal binary approach may fail to recognise deteriorating patients who have an increasing oxygen requirement with otherwise stable observations. It is unclear whether weighting oxygen beyond binary scoring improves recognition of deterioration.AIMSWe aimed to describe all general adult EWS that grade oxygen beyond binary scoring (part 1). Where reported, we summarised the performance of graded oxygen EWS in comparison to binary scoring (part 2).METHODSWe systematically reviewed the literature, searching Embase, MEDLINE, CINAHL, Cochrane Central and Web of Science. We included studies of vital-sign-only EWS, for adult inpatients, which included grades of oxygen therapy above binary weighting ('graded oxygen weighting'). We summarised methods of including graded oxygen therapy. We performed a random-effects meta-analysis of the effects of graded oxygen weighting inclusion in comparison to binary weighting. Risk of bias was assessed using the Prediction model Risk Of Bias ASsessment Tool.RESULTS15 studies reported the development of 16 EWS with graded oxygen weighting, classified by flow rate, delivery device and/or fraction of inspired oxygen. Four studies compared graded oxygen EWS to binary oxygen EWS. Meta-analysis showed a significant improvement in the performance of graded oxygen EWS over binary oxygen EWS (logit(AUROC)=0.19; 95% CI 0.094 to 0.285; p=0.002). 15/16 models were at high risk of bias.CONCLUSIONS16 EWS with graded oxygen weighting were identified. Graded oxygen models had improved recognition of deterioration. Future work should explore the optimal method of oxygen classification and how this could be integrated into future EWS.PROSPERO REGISTRATION NUMBERCRD42024443362.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"21 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143945284","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":"Serotype 3 associated invasive pneumococcal disease in children: analysis of 15 years of Australian national surveillance data.","authors":"Nusrat Homaira,Jahidur Rahman Khan,Adam Jaffé","doi":"10.1136/thorax-2025-223125","DOIUrl":"https://doi.org/10.1136/thorax-2025-223125","url":null,"abstract":"The 13-valent conjugate pneumococcal vaccine (13vPCV) replaced the 7vPCV in the Australian Immunisation Program in 2011 as a 3+0 schedule, updated to 2+1 schedule in 2018. We analysed national surveillance data to investigate the change in the incidence of pneumococcal serotype 3 (ST3) invasive pneumococcal disease (IPD) in preschool children. During 2009-2023 the incidence/100 000 children of ST3 IPD increased from 0.42 in 2009 to 3.65 in 2023. Compared with 2009-2011 (7vPCv), ST3 IPD incidence in 2012-2018 (13vPCV 3+0 dose) was almost four times higher and two times higher in 2019-2023 (13vPCV 2+1 dose) compared with 2012-2018 suggesting limited protection against ST3.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"3 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143945289","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":"Severe community-acquired pneumonia (sCAP): advances in management and future directions.","authors":"Ignacio Martin-Loeches,Luis Felipe Reyes,Alejandro Rodriguez","doi":"10.1136/thorax-2024-222296","DOIUrl":"https://doi.org/10.1136/thorax-2024-222296","url":null,"abstract":"Severe community-acquired pneumonia (sCAP) is a major global health challenge, with high morbidity and mortality, especially among patients requiring intensive care. Despite advancements in antimicrobial therapies and supportive care, sCAP remains a significant threat, particularly for those needing invasive mechanical ventilation or vasopressor support. Recent progress in diagnostics, therapeutics and management strategies offers hope for improved outcomes. Pathogen-specific management is now central to sCAP care, with molecular diagnostics enhancing pathogen detection accuracy and enabling tailored antimicrobial therapy. These tools help combat antimicrobial resistance by reducing unnecessary broad-spectrum antibiotic use.Host immune responses in sCAP vary widely and significantly impact outcomes. Some patients face an overwhelming pathogen burden, while others experience excessive immune responses, such as acute respiratory distress syndrome. This distinction is vital for guiding immunomodulatory therapies, as immunosuppression may benefit hyperinflammatory states but harm those overwhelmed by infection. Corticosteroids, though controversial, show potential benefits in select populations but carry risks like secondary infections and hyperglycaemia, requiring a nuanced approach.Non-invasive respiratory support strategies, such as high-flow nasal oxygen, have transformed care by improving oxygenation and reducing the need for invasive ventilation. However, their efficacy depends on timing, patient tolerance and disease severity, necessitating careful monitoring.Global disparities in sCAP management, particularly in low-income and middle-income countries, highlight the need for region-specific guidelines and scalable solutions. Limited access to advanced diagnostics and critical care resources exacerbates poor outcomes, underscoring the importance of investments in affordable diagnostics, infection control and multidisciplinary training. Emerging technologies, such as artificial intelligence and advanced imaging, promise to revolutionise sCAP management by enabling precision medicine and real-time insights into disease severity. A holistic, multidisciplinary approach integrating these advancements is essential to improving outcomes and advancing personalised care for this life-threatening condition.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"29 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143945287","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":"Effect of viloxazine and trazodone in obstructive sleep apnoea: a randomised, placebo-controlled, cross-over study.","authors":"Atqiya Aishah,Molly Kim,Laura Gell,Daniel Vena,Ali Azarbarzin,Huy Pho,Daniel Norman,Joseph Ojile,Neda Esmaeili,Luigi Taranto-Montemurro,Andrew Wellman,Scott Sands,Ludovico Messineo","doi":"10.1136/thorax-2024-222513","DOIUrl":"https://doi.org/10.1136/thorax-2024-222513","url":null,"abstract":"INTRODUCTIONCombination of the noradrenergic atomoxetine with either the antimuscarinic aroxybutynin or trazodone has been shown to improve obstructive sleep apnoea (OSA) severity. However, atomoxetine may contribute to apnoea-cycling and reduced drug tolerability due to wake-promoting, especially in a subgroup (poor cytochrome 2D6 metabolisers leading to higher blood concentration of medication). We investigated the effect of a potentially more manageable noradrenergic, viloxazine, with and without trazodone, on OSA severity.METHODSIn this double-blind, placebo-controlled, cross-over study, 24 patients with OSA (18-75 years) were analysed and randomised to 500 mg viloxazine, 500/75 mg viloxazine-trazodone (vilo-trazo) or placebo; taken before bed for 2 weeks with 1-week washout between treatments. In-laboratory polysomnography was performed at the end of each cross-over period. Mixed-model analyses compared the effect of vilo-trazo versus placebo on AHI4 (apnoea-hypopnoea index with 4% desaturations; primary outcome) and hypoxic burden (secondary outcome). Additional outcomes examined the effects of vilo-trazo versus viloxazine on total sleep time (TST) and wake-after-sleep-onset (WASO). Safety endpoints (patient-reported outcomes, heart rate and adverse events) were also assessed.RESULTSVilo-trazo reduced AHI4 (mean difference (95% CI): 10.5 (6.6, 13.6) events/hour, p<0.001) and hypoxic burden (16.7 (9.6, 21.8) %min/hr, p<0.001) versus placebo. Compared with viloxazine, TST tended to be longer on vilo-trazo (22.3 (-1.4, 46.0) min, p<0.065), while WASO was unchanged. TST and WASO remained significantly reduced on vilo-trazo versus placebo. Both interventions worsened patient-reported outcomes, although to a lesser extent on vilo-trazo, and increased heart rate versus placebo. Commonly reported adverse events were insomnia, constipation, headache and xerostomia.CONCLUSIONSViloxazine-trazodone reduced OSA severity. Potential deleterious effects of viloxazine on sleep quality appeared partly attenuated by trazodone.TRIAL REGISTRATION NUMBERNCT05793684.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"113 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143945235","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":"Tocilizumab, sarilumab and anakinra in critically ill patients with COVID-19: a randomised, controlled, open-label, adaptive platform trial.","authors":"Lennie Derde,Anthony C Gordon,Paul R Mouncey,Farah Al-Beidh,Kathryn M Rowan,Alistair D Nichol,Yaseen M Arabi,Djillali Annane,Abigail Beane,Richard Beasley,Marc J M Bonten,Charlotte A Bradbury,Frank M Brunkhorst,Adrian Buzgau,Meredith Buxton,Allen C Cheng,Nicola Cooper,Matthew Cove,Olaf L Cremer,Michelle A Detry,Eamon J Duffy,Lise J Estcourt,Mark Fitzgerald,James Galea,Herman Goossens,Rashan Haniffa,Thomas E Hills,David T Huang,Nao Ichihara,Andrew King,François Lamontagne,Patrick R Lawler,Helen L Leavis,Roger J Lewis,Edward Litton,John C Marshall,Florian B Mayr,Daniel F McAuley,Anna McGlothlin,Shay P McGuinness,Bryan J McVerry,Susan C Morpeth,Srinivas Murthy,Mihai G Netea,Kayode Ogungbenro,Katrina Orr,Rachael L Parke,Jane C Parker,Asad E Patanwala,Ville Pettila,Luis Felipe Reyes,Hiroki Saito,Marlene S Santos,Christina T Saunders,Christopher W Seymour,Manu Shankar-Hari,Wendy I Sligl,Alexis F Turgeon,Anne M Turner,Steven Y C Tong,Suvi Vaara,Taryn Youngstein,Ryan Zarychanski,Cameron Green,Alisa M Higgins,Colin J McArthur,Lindsay R Berry,Elizabeth Lorenzi,Scott Berry,Steve A Webb,Derek C Angus,Frank L van de Veerdonk","doi":"10.1136/thorax-2024-222488","DOIUrl":"https://doi.org/10.1136/thorax-2024-222488","url":null,"abstract":"INTRODUCTIONTocilizumab improves outcomes in critically ill patients with COVID-19. Whether other immune-modulator strategies are equally effective or better is unknown.METHODSWe investigated treatment with tocilizumab, sarilumab, anakinra and no immune modulator in these patients. In this ongoing, adaptive platform trial in 133 sites in 9 countries, we randomly assigned patients with allocation ratios dependent on the number of interventions available at each site. The primary outcome was an ordinal scale combining in-hospital mortality (assigned -1) and days free of organ support to day 21 in survivors. The trial used a Bayesian statistical model with predefined triggers for superiority, inferiority, efficacy, equivalence or futility.RESULTSOf 2274 critically ill participants enrolled between 25 March 2020 and 10 April 2021, 972 were assigned to tocilizumab, 485 to sarilumab, 378 to anakinra and 418 to control. Median organ support-free days were 7 (IQR -1, 16), 9 (IQR -1, 17), 0 (IQR -1, 15) and 0 (IQR -1, 15) for tocilizumab, sarilumab, anakinra and control, respectively. Median adjusted ORs were 1.46 (95% credible intervals (CrI) 1.13, 1.87), 1.50 (95% CrI 1.13, 2.00) and 0.99 (95% CrI 0.74, 1.35) for tocilizumab, sarilumab and anakinra relative to control, yielding 99.8%, 99.8% and 46.6% posterior probabilities of superiority, respectively, compared with control. All treatments appeared safe.CONCLUSIONSIn critically ill patients with COVID-19, tocilizumab and sarilumab have equivalent effectiveness at reducing duration of organ support and death. Anakinra is not effective in this population.TRIAL REGISTRATION NUMBERNCT02735707.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"20 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143945286","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":"Green respiratory healthcare: what really matters.","authors":"Gary Connett,Mary Slingo,Ian Sinha,Dame Julia Slingo","doi":"10.1136/thorax-2025-223195","DOIUrl":"https://doi.org/10.1136/thorax-2025-223195","url":null,"abstract":"","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"3 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143932911","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":"Reduced treatment response to inhaled corticosteroids in current smokers with COPD, regardless of blood eosinophil count: insights from the FLAME trial.","authors":"Alexander G Mathioudakis,Andrew Higham,Sebastian Bate,Victoria Chatzimavridou-Grigoriadou,Pradeesh Sivapalan,Jens-Ulrik Stæhr Jensen,Tim Felton,Jørgen Vestbo,Dave Singh","doi":"10.1136/thorax-2024-222547","DOIUrl":"https://doi.org/10.1136/thorax-2024-222547","url":null,"abstract":"Inhaled corticosteroids (ICSs) benefit patients with chronic obstructive pulmonary disease at high risk of exacerbations with raised blood eosinophil count (BEC). Emerging evidence suggests current smokers show a reduced response to ICS. This post-hoc analysis of the FLAME trial explored the impact of smoking status on the efficacy of long-acting beta-2 agonist (LABA)+ICS versus LABA+long-acting muscarinic antagonist (LAMA) for preventing exacerbations. Our findings indicate that LABA+LAMA is superior to LABA+ICS in preventing moderate to severe exacerbations in current smokers and inferior in ex-smokers with BEC ≥200 cells/µL. Smoking status significantly modifies ICS treatment effects on exacerbation outcomes, suggesting reduced ICS efficacy in current smokers, regardless of BEC.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"37 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143932912","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":"High rates of post-tuberculosis lung disease among persons successfully treated for drug-susceptible and resistant tuberculosis","authors":"Russell R Kempker, Argita D Salindri, Teona Avaliani, Hardy Kornfeld, Sara C Auld, Nino Jakobia, Cheryl L Day, Arijita Subuddhi, Krista N Krish, Sergo Vashakidze, Zaza Avaliani, Leila Goginashvili, Cassandra Bryan, Adam Bernheim, Maia Kipiani, Matthew J Magee","doi":"10.1136/thorax-2024-222350","DOIUrl":"https://doi.org/10.1136/thorax-2024-222350","url":null,"abstract":"Introduction Tuberculosis (TB) remains a critical global public health challenge, and there is an urgent need to improve the diagnosis and management of post-TB lung disease (PTLD). We aimed to compare end of treatment prevalence of PTLD among participants with and without drug-resistant TB and to evaluate the association between plasma cytokines and matrix metalloproteinases with lung damage. Methods We conducted a prospective cohort study among individuals with microbial cure status for drug-susceptible or multidrug-resistant pulmonary TB in Tbilisi, Georgia during 2020–2021. Eligible participants were ≥16 years without prior TB treatment history, microbiologically confirmed disease at baseline and who had a favourable treatment outcome (cured or completed treatment). The study outcome was the presence of PTLD defined as abnormalities on either chest CT, spirometry or Saint George’s Respiratory Questionnaire. Results Among 123 participants, the prevalence of PTLD was 74% (n=91) with 53 participants meeting one criteria, 27 two criteria and 11 all three criteria. The prevalence of impaired respiratory health (47%) and lung damage on imaging (46%) was higher than abnormal lung function (21%). PTLD was not associated with drug resistance (adjusted OR 0.91, 95% CI 0.42 to 1.99). Persistent cavitary disease at the end of treatment was associated with higher matrix metalloproteinase 8 and lower matrix metalloproteinase 2, interleukin-17A and interleukin-1ß. Conclusion Using comprehensive criteria, we found nearly three in four individuals with microbial cure status for TB disease had prevalent PTLD regardless of drug resistance status. Persistent cavitary disease was associated with serum markers of inflammation and lung tissue remodelling. Data are available upon reasonable request. The data that support the findings of this study are available from the corresponding author, MM, upon reasonable request.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"103 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143920171","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":"Future of academic respiratory medicine: near crisis point","authors":"Steven Walker, Nick Maskell","doi":"10.1136/thorax-2025-223184","DOIUrl":"https://doi.org/10.1136/thorax-2025-223184","url":null,"abstract":"A crisis is a time of intense difficulty, a turning point when an important change needs to take place. Here, we argue that the UK is approaching a critical point in clinical research capacity, following years of decline in medically trained research staff.1 The British Thoracic Society (BTS) respiratory consultant and trainee surveys (2024) highlighted the problems facing respiratory research. The surveys identified a strong interest in research, but also a lack of opportunities. This editorial outlines the results of these surveys and several initiatives the BTS, National Institute for Health and Care Research (NIHR) and Asthma+Lung UK are taking to revitalise respiratory research. Rates of chronic lung diseases are increasing, with respiratory diseases now responsible for 5 of the top 10 causes of death.2 Despite these challenges, the medical research workforce has diminished. 24% fewer medically trained research staff have been appointed over the last decade. As an overall proportion of the consultant workforce, the number of clinical academic consultants has almost halved to 3%.1 The problem is particularly pronounced in respiratory medicine. Compared with other Western European countries, the UK is an outlier, spending the least on respiratory research. Respiratory medicine accounted for only 4% of the NIHR fellowships (PhD and mid-career) and 3% of NIHR grant awarded in 2023. No respiratory doctors were recipients of the 58 NIHR Senior Investigator awards in 2024.3 The future feels bleak, with more clinical academics over 65 than under 36. This decline is anticipated to accelerate, exacerbated by the challenging financial position that most UK universities are …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"24 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143920257","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":"Correction: Serum cytokine biosignatures for identification of tuberculosis among HIV-positive inpatients","authors":"BMJ Publishing Group Ltd and British Thoracic Society","doi":"10.1136/thorax-2023-220782corr1","DOIUrl":"https://doi.org/10.1136/thorax-2023-220782corr1","url":null,"abstract":"Zhang H, Li L, Liu Y , et al . Serum cytokine biosignatures for identification of tuberculosis among HIV-positive inpatients. Thorax 2024;79:465–471. The …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"218 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143836707","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}