Thorax最新文献

{"title":"Nocturnal reflux: an untapped target in lung disease?","authors":"Amanda T Goodwin","doi":"10.1136/thorax-2025-223930","DOIUrl":"https://doi.org/10.1136/thorax-2025-223930","url":null,"abstract":"Gastro-oesophageal reflux disease (GORD) is a common condition that is known to have several extraintestinal impacts, including effects in the lung. Observational studies have found associations between GORD and asthma,1 lung cancer,2 respiratory infection,3 exacerbations of lung disease,4 5 and bronchiectasis.6 However, a causal relationship between GORD and lung disease has not been conclusively established. This link has been particularly contentious in idiopathic pulmonary fibrosis (IPF), where epidemiological studies and systematic reviews have suggested that GORD is associated with poor outcomes7–9, and that antiacid treatment may improve survival.10 11 However, other studies have contradicted these findings,12–17 and the overwhelming conclusion is that further work is needed in this area. Emilsson et al add another piece to the puzzle with their analysis of the Swedish CArdioPulmonary BioImage Study (SCAPIS), a large cohort study that comprehensively characterised over 28 000 individuals with questionnaires and chest imaging.18 Patients who self-reported heartburn or regurgitation after going to bed on at least one night per week were grouped as having nocturnal gastro-oesophageal reflux (termed nGER), and their chest imaging was reviewed for lung abnormalities including bronchial wall thickening, bronchiectasis, reticular abnormalities, honeycombing, cysts and ground glass opacities.18 Emilsson et al report an association between nGER and bronchial wall thickening and reticular abnormalities on CT chest, but only in a subgroup of patients with risk factors for the development of lung disease (eg, smoking history, …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"16 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145235909","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":"Is the provision of a national opt-out tobacco dependence treatment service in acute hospitals in England equitable? A national cohort study","authors":"Sanjay Agrawal, Paul Cilia La Corte, Tom Frost, Jack Hodgson, Rajun Phagura, Alexander Adamson, Jennifer K Quint","doi":"10.1136/thorax-2025-223890","DOIUrl":"https://doi.org/10.1136/thorax-2025-223890","url":null,"abstract":"Introduction People who smoke are a third more likely to be admitted to hospital than non-smokers. A disparity in smoking prevalence between the most and least deprived populations persists. Hospital-initiated treatment could reduce smoking-related inequalities if people admitted to hospital from more deprived populations have greater access and uptake of treatment and successfully quit. The National Health Service (NHS) in England has introduced ‘opt-out’ tobacco dependency treatment and in this study, we examined how treatment of tobacco dependency differed in relation to deprivation. Methods Data were available from 111 (84%) acute hospital trusts in England, describing 243 847 hospital admissions of people who smoked in 2024, a total of 185 147 individuals. We reviewed whether individuals had made a supported quit attempt and successful quits and used logistic regression to determine if these outcomes differed according to level of deprivation based on patient residence. Results Data adjusted for demographic characteristics and hospital clustering demonstrated that the proportion of those making quit attempts was higher in more deprived quintiles of deprivation, 24.8% in quintile 1 (most deprived) versus 18.3% in quintile 5 (least deprived); however, the proportion of people who quit smoking was highest in the least deprived quintile (25.3%) with a gradient to the most deprived quintile (16.0%). Conclusion The NHS opt-out inpatient tobacco dependency service provides treatment on an equitable basis across deprivation quintiles, with the greatest proportion of patients making a supported quit attempt in the most deprived quintile. However, there are opportunities to reduce inequalities by improving quit success in this group. Data are available upon reasonable request. The data are held within NHS England and can be requested through the Data Access Request Service (DARS—NHS England Digital).","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"6 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145228771","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":"Occupational asthma: still an underestimated burden?","authors":"Filippo Liviero","doi":"10.1136/thorax-2025-223499","DOIUrl":"https://doi.org/10.1136/thorax-2025-223499","url":null,"abstract":"Work-related asthma remains one of the most complex and underappreciated dimensions of adult-onset respiratory disease. Estimated to account for 25% of adult-onset cases,1 it encompasses a heterogeneous set of phenotypes, including immunologic occupational asthma, irritant-induced asthma and work-exacerbated asthma, each with distinct pathophysiological mechanisms and diagnostic challenges.2 This diversity complicates not only diagnosis and management but also surveillance efforts and preventive strategies across different occupations and settings. Nevertheless, surveillance systems remain fragmented and many cases go unrecognised in clinical practice, especially in non-specialist settings.3 Despite increasing awareness of occupational exposures as contributors to airway inflammation and sensitisation, definitive longitudinal evidence linking workplace conditions to asthma incidence remains limited. In this context, the study by Alif and colleagues,4 published in this issue of Thorax , offers a significant advancement. Using data from the European Community Respiratory Health Survey (ECRHS), the authors provide 20-year longitudinal evidence of persistent occupational risk for asthma across Europe. Initiated in the early 1990s, ECRHS has helped define the role of environmental and occupational exposures in adult asthma. ECRHS I included over 15 000 adults in 12 countries, assessing asthma through questionnaires and methacholine challenge. It identified increased risks in occupations like farming, painting and cleaning, with 5–10% of cases attributable to occupational exposures.5 ECRHS II followed symptom-free participants, confirming significant roles for high and low-molecular-weight agents, biocides and cleaning …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"24 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145228772","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":"Current strategies and future directions to enhance recovery following critical illness","authors":"Mark Andonovic, Martin Shaw, Peter Hartley, Snigdha Jain, Leanne Boehm, Kelly Toth, Richard Bourne, Kimberley Joy Haines, Valerie Danesh, Pamela MacTavish, Thomas Valley, Regis Goulart Rosa, Christie Docherty, Kevin Garrity, Philip McCall, Alexander Tracy, Nazir I Lone, Joanne McPeake","doi":"10.1136/thorax-2024-221997","DOIUrl":"https://doi.org/10.1136/thorax-2024-221997","url":null,"abstract":"Improvements in critical care treatments have led to an increased number of survivors of critical illness and an enhanced recognition of the problems which these patients encounter. Despite this, the ideal strategies to both prevent and manage the problems which people face are yet to be fully elucidated. This review explores the current methods employed to help mitigate problems encountered by survivors of critical illnesses and current barriers that limit their implementation. We will explore the effect of these issues on under-represented communities and the feasibility of delivering these strategies globally, as well as recent advances in mechanistic research and methodological innovation as promising areas for further work. In doing so, it summarises the potential avenues for future research with a view to advancing clinical care and outcomes in survivors of critical illness.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"77 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145228775","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":"Home monitoring of asthma using oscillometry: seeking the signal in the noise","authors":"David A Kaminsky","doi":"10.1136/thorax-2025-223595","DOIUrl":"https://doi.org/10.1136/thorax-2025-223595","url":null,"abstract":"Asthma is defined physiologically as airways hyperresponsiveness that results in variable airflow obstruction. Usually, these physiological features are assessed by spirometry, but spirometry is typically performed in the pulmonary function laboratory or office as a one-time procedure and cannot capture the variability in obstruction over time. While spirometry can be done at more regular intervals at home, it takes significant training and consistent technique to produce reliable results. An appealing alternative is oscillometry, which can also be done at home, is much easier to do and provides even more detail about airflow obstruction than spirometry. Various methods have been used to measure and monitor variability of airflow obstruction over time. Studies have shown that peak flow (PEF) variability is increased during a period of loss of asthma control characterised by worse symptoms and lung function.1 2 This increased variability is also seen preceding a clinical exacerbation, leading to the idea of monitoring PEF variability to detect an increase that may signal an impending loss of asthma control.3 4 But measuring PEF reliably can be difficult, as can measuring spirometry, since both are effort dependent. However, variability in lung function is easily measured by oscillometry5 6 and may allow early prediction of an exacerbation of disease.7 8 In this issue …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"39 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145228770","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 Research Grand Challenges: transforming respiratory research","authors":"Ellen J Forty, Samantha M Walker, Eric W F W Alton, Ian P Hall","doi":"10.1136/thorax-2025-224029","DOIUrl":"https://doi.org/10.1136/thorax-2025-224029","url":null,"abstract":"Respiratory research in the UK is underfunded, undervalued and suboptimally coordinated. With poor lung health costing the economy ∼£190 billion per year1 and someone in the UK dying of a respiratory condition every 5 min,2 the economic and public health impact of respiratory conditions can and should no longer be ignored. Despite best efforts as a research community to deliver much needed advancements in the understanding and treatment of respiratory conditions, progress is hindered by inadequate funding. Respiratory research receives just 2.5% of public funding,3 a figure clearly disproportionate to the burden of disease as lung conditions are the UK’s third leading cause of death and will affect 12 million people during their lifetime.2 This discrepancy is striking when compared with the proportions of public funding allocated to other leading causes of death and harm, such as cancer (16.8%) and mental health (6.1%).3 The UK is not alone in its failure to prioritise respiratory health. Global underinvestment directly impacts research output, with publications in the field proportionally declining over the last 50 years.4 Additionally, fewer people are pursuing clinical and academic careers in respiratory medicine.5 Those who do are confronted with condition-specific siloes6 and limited data-sharing capabilities,7 limiting progress through collaboration. These barriers are stalling the research pipeline, an issue that has long been acknowledged by the respiratory research community. Nearly 20 years ago, the UK Respiratory Research Strategy Collaborative proposed a set of research priorities as a mechanism to focus investment and build research capacity.8 Yet, in 2024, the Lung Research and Innovation Group (LRIG; similarly comprising academics, patient and professional organisations and research …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"6 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145228769","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":"Are we pro-PRO-C4?","authors":"Kristopher P Clark, Daniel J Kass","doi":"10.1136/thorax-2025-223656","DOIUrl":"https://doi.org/10.1136/thorax-2025-223656","url":null,"abstract":"Fibroblastic foci—the cardinal feature of usual interstitial pneumonia (UIP)—are characterised by metaplastic alveolar epithelium overlying tufts of fibroblasts. UIP is further characterised by epithelial cell dropout and a denuded basement membrane.1 Can these histological features be measured as biomarkers of the severity of idiopathic pulmonary fibrosis (IPF)? The classic reference from 25 years ago suggests that the number of fibroblastic foci on histopathology predicts the prognosis in IPF.2 This, of course, requires a biopsy. In this issue of Thorax , Sand and colleagues have essentially reasked this old question.3 Instead of looking at the number of fibroblastic foci, the team has focused on the denuded basement membrane. The basement membrane is composed of collagen IV, which must be synthesised, broken down and resynthesised. Is the turnover of collagen IV in the basement membrane quantifiable? Capitalising on the unique assays available at Nordic Biosciences, the investigators determined if PRO-C4, a serologic marker of type IV collagen turnover, was associated with lung function decline in IPF. PRO-C4 levels were analysed in two prospective, multicentre, longitudinal cohorts of patients with IPF (NCT02755441, NCT01134822, NCT01110694 …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"37 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145228774","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":"Usual interstitial pneumonia on CT: same pattern, different prognosis","authors":"Fasihul Khan","doi":"10.1136/thorax-2025-223598","DOIUrl":"https://doi.org/10.1136/thorax-2025-223598","url":null,"abstract":"A radiological pattern of usual interstitial pneumonia (UIP) has long been recognised as a marker of poor prognosis in interstitial lung disease (ILD).1 While UIP is the defining pattern in idiopathic pulmonary fibrosis (IPF), it can also be seen in other ILDs, including connective tissue disease ILD (CTD-ILD) and fibrotic hypersensitivity pneumonitis (fHP).2–4 It is well understood that CTD-ILD typically follows a more indolent course than IPF, but the prognostic implications of a UIP pattern within these non-IPF diagnoses remain incompletely understood.5 6 Does the presence of UIP override disease-specific biology, or does diagnostic context remain paramount? Kim and colleagues7 explore this question using two large, well characterised multicentre cohorts—the Pulmonary Fibrosis Foundation (PFF) Patient Registry and an international meta-cohort drawn from four academic centres. Across more than 2500 participants, the authors evaluated lung function decline and transplant-free survival in patients with IPF, CTD-ILD or fHP, stratified by the presence or absence of a radiological UIP pattern. They also incorporated data-driven texture analysis (DTA), a machine-learning approach to quantify fibrosis on CT, highlighting the evolving role of artificial intelligence in ILD phenotyping.8–10 Their findings demonstrated that a UIP pattern does not carry the same clinical course across ILD subtypes. Despite sharing a …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"15 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145228776","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":"Improving lung cancer screening: the role and challenges of risk prediction models","authors":"Patrick Goodley, Philip A J Crosbie","doi":"10.1136/thorax-2025-223605","DOIUrl":"https://doi.org/10.1136/thorax-2025-223605","url":null,"abstract":"Targeted lung cancer screening saves lives by shifting diagnosis to earlier stages, when curative treatment is more likely to succeed. To improve the efficiency of screening and minimise associated harms, tools have been developed to identify individuals at elevated risk. Most major clinical trials defined eligibility using categorical criteria, typically based on age and cumulative smoking exposure—the method adopted in US guidelines since 2013.1 More recently, personalised risk prediction models have been developed to estimate an individual’s probability of developing lung cancer, with the aim of further enhancing screening performance. These models are now in clinical use in countries including England, Canada and Australia.2 The systematic review by Zhang et al offers a comprehensive analysis of performance measures for 21 risk models from 35 studies, with an appropriate emphasis on external validation to mitigate bias.3 Crucially, the review highlights substantial variation in how model performance is reported. In many cases, key metrics such as model calibration, often presented as the expected-to-observed ratio (E:O ratio), are missing altogether. Additional assessments such as calibration slope and decision curve analysis are reported even less frequently, which likely explains their exclusion from the review. The clinical utility …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"49 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145228842","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":"Cardiopulmonary exercise testing before lung resection surgery: still indicated? Evaluating predictive utility using machine learning","authors":"Ákos Filakovszky, Kristian Brat, Thomas Tschoellitsch, Stepan Bartos, Andrej Mazur, Jens Meier, Lyle Olson, Ivan Cundrle","doi":"10.1136/thorax-2024-221485","DOIUrl":"https://doi.org/10.1136/thorax-2024-221485","url":null,"abstract":"Rationale Despite significant advances in patient care and outcomes, criteria for cardiopulmonary exercise testing (CPET) in risk stratification guidelines for lung resection have not been updated in over a decade. We hypothesised that CPET no longer holds additional predictive value for postoperative complications. Methods In this secondary analysis, we included lung resection candidates from two prospective, multicentre studies eligible for CPET and assessed with preoperative pulmonary function tests (PFTs) and arterial blood gas analysis. Postoperative pulmonary (PPCs) and cardiovascular complications (PCCs) were documented during hospitalisation. We trained five types of machine learning models applying nested cross-validation to predict complications and compared predictive performance based on four metrics, including area under the receiver operating characteristic curve (AUC-ROC). Results A total of 497 patients were included. PPCs developed in 71 (14%) patients. Adding CPET parameters to PFTs and baseline clinical data did not improve the ability of models to predict PPCs in unselected patients (AUC-ROC=0.72–0.78; p=0.47), nor in those meeting American College of Chest Physicians (ACCPs) (n=236; AUC-ROC=0.64–0.78; p=0.70) or European Respiratory Society/European Society of Thoracic Surgery (ERS/ESTS) criteria (n=168; AUC-ROC=0.59–0.76; p=0.92). PCCs developed in 90 (18%) patients. CPET parameters likewise did not improve model performance for the prediction of PCCs in unselected patients (AUC-ROC=0.65–0.73; p=0.96), nor in the ACCP (AUC-ROC=0.61–0.73; p=0.82) or ERS/ESTS subgroups (AUC-ROC=0.62–0.69; p=0.87). Conclusions In contemporary surgical practice, CPET did not improve the predictive performance of machine learning models for PPCs or PCCs in patients with an indication based on established guidelines or in those without. The role of CPET in preoperative risk stratification for lung resection should be re-evaluated. Trial registration number [NCT03498352][1], [NCT04826575][2]. Data are available on reasonable request. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT03498352&atom=%2Fthoraxjnl%2Fearly%2F2025%2F10%2F02%2Fthorax-2024-221485.atom [2]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT04826575&atom=%2Fthoraxjnl%2Fearly%2F2025%2F10%2F02%2Fthorax-2024-221485.atom","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"54 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145209966","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}