Thorax最新文献

{"title":"Neuropsychiatric side effects of montelukast: time to change prescribing practice?","authors":"David Lo, Jennifer K Quint","doi":"10.1136/thorax-2024-222643","DOIUrl":"https://doi.org/10.1136/thorax-2024-222643","url":null,"abstract":"Since 1998, montelukast has been licensed for the treatment of seasonal allergic rhinitis and asthma in people aged over 6 months. In children in particular, montelukast was welcomed as a steroid-sparing alternative to traditional asthma-preventer drugs, which could be taken just once daily, and which did not require the use of an inhaler. Although recent systematic reviews have shown regular inhaled corticosteroids (ICS) to be more effective than montelukast in controlling asthma symptoms, some children do demonstrate preferential response to montelukast.1 2 Consequently, current asthma guidelines still recommend montelukast as an optional alternative to ICS for mild-to-moderate asthma as monotherapy in children.3 While several studies and even prescribing information cite a wide range of potential neuropsychiatric side effects, the frequency of occurrence and exact nature of these side effects are not well defined and unfortunately not always well understood or recognised by healthcare professionals.4 In 2019 and then again in 2024, the UK Medicines and Healthcare products Regulatory Agency issued warnings and advice drawing attention to these problems.5 6 Similarly, in the USA, the Food and Drug Administration (FDA) issued a ‘black box warning’ for montelukast in 2020, drawing attention to documented mental and behavioural health risks associated with the use of the drug.7 More recently in 2024, the New York State district attorney called on the FDA to take urgent action to protect children from the risks of montelukast, including writing to …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"2 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142690944","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":"Neuropsychiatric diagnoses after montelukast initiation in paediatric patients with asthma","authors":"Tapio Paljarvi, Julian T Forton, Courtney Thompson, Sierra Luciano, Kimmo Herttua, Seena Fazel","doi":"10.1136/thorax-2024-221590","DOIUrl":"https://doi.org/10.1136/thorax-2024-221590","url":null,"abstract":"Background The evidence base on montelukast-associated adverse outcomes is inconclusive in children and young persons (CYP) with asthma. We aimed to investigate 1-year incidence of neuropsychiatric diagnoses after initiation of montelukast as an adjunct therapy to inhaled corticosteroids (ICSs) in CYP aged 3–17 years with asthma. Methods This propensity score matched cohort study was conducted using electronic health records between 2015 and 2019 in the TriNetX Analytics Network patient repository in the USA. Neuropsychiatric diagnoses were identified using the International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes. We estimated risk ratios (RRs), absolute risk increase (ARI) and number needed to harm (NNH) with 95% CIs. Findings The mean age (SD) at index prescription in the 107 384 CYP with asthma was 8.7 (4.0) years (93 461 (87%) mild to moderate asthma; 62 301 (58%) male; 53 485 (50%) white; 33 107 (31%) black/African American). Montelukast was associated with excess incidence of any neuropsychiatric outcome (71 per 1000 persons with montelukast and 54 per 1000 persons with no montelukast; RR 1.32 (95% CI 1.25 to 1.39); ARI per 100 persons, 1.71 (95% CI 1.44 to 1.98); 1-year NNH, 58 patients (95% CI 51 to 69)). The highest excess risk in the montelukast group was for sleep disorders (RR 1.63 (95% CI 1.50 to 1.77); ARI per 100 persons 1.17 (95% CI 1.00 to 1.33); NNH, 85 patients (95% CI 75 to 100)). Montelukast use was also associated with excess incidence of anxiety disorders (RR 1.16 (95% CI 1.08 to 1.24)) and mood disorders (RR 1.16 (95% CI 1.05 to 1.29)). Conclusions In CYP with asthma who were treated with ICSs, adjunct treatment with montelukast was associated with a higher incidence of neuropsychiatric outcomes compared with those who were not exposed to montelukast. Data may be obtained from a third party and are not publicly available. Data were provided by TriNetX (www.trinetx.com), a federated data network. Access to TriNetX’s deidentified patient data is available for the purpose of healthcare research with an approved user license.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"5 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142690945","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":"A structural and metabolic framework for classifying pre-clinical tuberculosis infection phenotypes using 18F-FDG PET-CT: a prospective cohort analysis following <i>M. tuberculosis</i> exposure.","authors":"Jee Whang Kim, Sonam Vadera, Meedya Sharifpour, Amrita Bajaj, Anver Kamil, Pranabashis Haldar","doi":"10.1136/thorax-2024-221470","DOIUrl":"10.1136/thorax-2024-221470","url":null,"abstract":"<p><p>Tuberculosis (TB) control efforts are limited by ineffective characterisation of tuberculosis infection (TBI) -a heterogeneous spectrum of pre-clinical infection states, invisible to tools of routine clinical screening, that are associated with variable risk of progression to TB disease. In this prospective study, we use positron emission tomography-CT (PET-CT) as a high-resolution imaging modality to characterise and classify structural and metabolic features observed in 16 asymptomatic household TB contacts with normal chest radiographs. We identify four feature patterns that associate with distinct clinical and microbiological outcomes, supporting potential utility of PET-CT for objective classification of TBI phenotypes.</p>","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":"1156-1159"},"PeriodicalIF":9.0,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141447181","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":"Imaging in early tuberculosis.","authors":"Robert Wilkinson","doi":"10.1136/thorax-2024-221993","DOIUrl":"10.1136/thorax-2024-221993","url":null,"abstract":"","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":"1114-1115"},"PeriodicalIF":11.3,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576653","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":"Multiple lung cyst formation caused by metastatic bladder cancer.","authors":"Noriaki Nakagaki, Masashi Komori, Tatsuro Shimokama, Eiji Iwama","doi":"10.1136/thorax-2023-220573","DOIUrl":"10.1136/thorax-2023-220573","url":null,"abstract":"","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":"1160-1161"},"PeriodicalIF":9.0,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142354546","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":"Pulmonary fibrosis may begin in infancy: from childhood to adult interstitial lung disease.","authors":"Matthias Griese, Geoffrey Kurland, Michal Cidon, Robin R Deterding, Ralph Epaud, Nadia Nathan, Nicolaus Schwerk, David Warburton, Jason P Weinman, Lisa R Young, Gail H Deutsch","doi":"10.1136/thorax-2024-221772","DOIUrl":"10.1136/thorax-2024-221772","url":null,"abstract":"<p><strong>Background: </strong>Childhood interstitial lung disease (chILD) encompasses a group of rare heterogeneous respiratory conditions associated with significant morbidity and mortality. Reports suggest that many patients diagnosed with chILD continue to have potentially progressive or fibrosing disease into adulthood. Over the last decade, the spectrum of conditions within chILD has widened substantially, with the discovery of novel entities through advanced genetic testing. However, most evidence is often limited to small case series, with reports disseminated across an array of subspecialty, clinical and molecular journals. In particular, the frequency, management and outcome of paediatric pulmonary fibrosis is not well characterised, unlike in adults, where clear diagnosis and treatment guidelines are available.</p><p><strong>Methods and results: </strong>This review assesses the current understanding of pulmonary fibrosis in chILD. Based on registry data, we have provisionally estimated the occurrence of fibrosis in various manifestations of chILD, with 47 different potentially fibrotic chILD entities identified. Published evidence for fibrosis in the spectrum of chILD entities is assessed, and current and future issues in management of pulmonary fibrosis in childhood, continuing into adulthood, are considered.</p><p><strong>Conclusions: </strong>There is a need for improved knowledge of chILD among pulmonologists to optimise the transition of care from paediatric to adult facilities. Updated evidence-based guidelines are needed that incorporate recommendations for the diagnosis and management of immune-mediated disorders, as well as chILD in older children approaching adulthood.</p>","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":"1162-1172"},"PeriodicalIF":9.0,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141996578","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":"Associations of pulmonary microvascular blood volume with per cent emphysema and CT emphysema subtypes in the community: the MESA Lung study.","authors":"Emilia A Hermann, Amin Motahari, Eric A Hoffman, Yifei Sun, Norrina Allen, Elsa D Angelini, Alain G Bertoni, David A Bluemke, Sarah E Gerard, Junfeng Guo, David W Kaczka, Andrew Laine, Erin Michos, Prashant Nagpal, James S Pankow, Coralynn S Sack, Benjamin Smith, Karen Hinckley Stukovsky, Karol E Watson, Artur Wysoczanski, R Graham Barr","doi":"10.1136/thorax-2024-222002","DOIUrl":"10.1136/thorax-2024-222002","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary microvasculature alterations are implicated in emphysema pathogenesis, but the association between pulmonary microvascular blood volume (PMBV) and emphysema has not been directly assessed at scale, and prior studies have used non-specific measures of emphysema.</p><p><strong>Methods: </strong>The Multi-Ethnic Study of Atherosclerosis Lung Study invited participants recruited from the community without renal impairment to undergo contrast-enhanced dual-energy CT. Pulmonary blood volume was calculated by material decomposition; PMBV was defined as blood volume in the peripheral 2 cm of the lung. Non-contrast CT was acquired to assess per cent emphysema and novel CT emphysema subtypes, which include the diffuse emphysema subtype and small-airways-related combined bronchitic-apical emphysema subtype. Generalised linear regression models included age, sex, race/ethnicity, body size, smoking, total lung volume and small airway count.</p><p><strong>Results: </strong>Among 495 participants, 53% were never-smokers and the race/ethnic distribution was 35% white, 31% black, 15% Hispanic and 18% Asian. Mean PMBV was 352±120 mL; mean per cent emphysema was 4.95±4.75%. Lower PMBV was associated with greater per cent emphysema (-0.90% per 100 mL PMBV, 95% CI: -1.29 to -0.51). The association was of larger magnitude in participants with 10 or more pack-years smoking and airflow obstruction, but present among participants with no smoking history or airflow limitation, and was specific to the diffuse CT emphysema subtype (-1.48% per 100 mL PMBV, 95% CI: -2.31 to -0.55).</p><p><strong>Conclusion: </strong>In this community-based study, lower PMBV was associated with greater per cent emphysema, including in participants without a smoking history or airflow limitation, and was specific to the diffuse CT emphysema subtype.</p>","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":""},"PeriodicalIF":9.0,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576663","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":"Journal club","authors":"Anthony W Martinelli","doi":"10.1136/thorax-2024-222463","DOIUrl":"https://doi.org/10.1136/thorax-2024-222463","url":null,"abstract":"The ACCESS trial ( Lancet Respir Med 2024;12(4):294–304) provides new evidence supporting the use of macrolides in community-acquired pneumonia (CAP). In this prospective, double-blind study, Giamarellos-Bourboulis and colleagues randomised patients admitted with CAP and receiving intravenous antibiotics to addition of either oral clarithromycin or placebo for 7 days. Participants from 18 Greek hospitals were enrolled, with CAP defined as consolidation on chest radiograph with compatible auscultatory findings or consolidation on CT, though a pathogen was only identified in 55% of the study population (most commonly Staphylococcus aureus ). Inclusion criteria limited the study to a subset of hospital patients with systemic inflammation, requiring two positive criteria of systemic inflammatory response syndrome, a sequential organ failure assessment (SOFA) score of≥2, and a procalcitonin of≥0.25 ng/mL. The primary outcome was achievement at day 4 of both an ‘early clinical response’ (≥50% decrease in respiratory symptom score) and an ‘early inflammatory response’ (≥30% decrease in SOFA score and/or procalcitonin decrease by≥80% or to<0.25 ng/mL). This endpoint was met in 68% (n=91) of patients treated with clarithromycin, compared with 38% (n=51) in the placebo group (OR 3.40 (95% CI 2.06 to 5.63), p<0.0001). Secondary analyses revealed that clarithromycin significantly reduced the rate of progression to organ dysfunction and recurrent sepsis, and shortened time to hospital …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"10 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142440243","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":"Community-based approaches to improve tuberculosis services: observations from preintervention and postintervention surveys in a high TB burden disadvantaged community in India","authors":"Jyothi Bhat, Ravendra Kumar Sharma, Rajiv Yadav, M Muniyandi, Prashant Mishra, Samridhi Nigam, Mercy Aparna Latha Lingala, Vikas Gangadhar Rao","doi":"10.1136/thorax-2024-221446","DOIUrl":"https://doi.org/10.1136/thorax-2024-221446","url":null,"abstract":"An alarmingly high prevalence of tuberculosis (TB) was reported among the Saharia tribe in Madhya Pradesh, India. A community-based intervention study was undertaken to improve TB case finding during 2018–2021. The interventions mainly comprised active case detection through village TB volunteers using advocacy, communication and social mobilisation activities. A preintervention and postintervention survey design was adopted to assess the impact of intervention. The prevalence declined from 1357 (95% CI 1206 to 1527) to 752 (95% CI 646 to 875) per 100 000 population (p<0.001). The study findings highlight the importance of innovative community-based approaches in controlling TB in high burden areas.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"6 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142490492","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":"Collagen neoepitopes in sarcoidosis: what do they tell us?","authors":"Daniel A Culver, Pauline Teresa Lukey","doi":"10.1136/thorax-2024-222276","DOIUrl":"https://doi.org/10.1136/thorax-2024-222276","url":null,"abstract":"Fibrosis is scarring due to the replacement of tissue architecture by extracellular matrix (ECM), which consists largely of collagen. Scarring progressively destroys organ structure and thereby impairs function. Accumulation of collagen is thought to be due to an increase in production, a reduction in degradation of collagen or a combination of both.1 If so, we might expect the ratio of production to degradation to increase with increasing fibrosis. Biomarkers of type III and VI collagen production (PRO-C3 and PRO-C6) and degradation (C3M and C6M), called neoepitopes, have been developed to measure these processes.1 In diseases such as idiopathic pulmonary fibrosis, where fibrosis is the dominant pathophysiological feature, neoepitope levels align closely with disease progression.2 Whether these collagen markers are relevant in other diseases has been less well explored. In sarcoidosis, fibrosis in affected organs, especially the lungs and heart, accounts for most of the long-term morbidity and mortality that is directly attributable to sarcoidosis itself (rather than due to attempts to treat the disease). Fibrosis in sarcoidosis is thought to occur in the setting of persistent granulomatous inflammation but is likely modulated by other factors besides duration of disease alone since not all patients with chronic sarcoidosis develop substantial fibrosis. A major clinical challenge is to identify whether the dysfunction of an affected organ is predominantly due to granulomatous inflammation or fibrosis. Thus, a blood marker of sarcoidosis fibrosis would be an extremely helpful clinical tool. Recently, Sand and co-workers3 hypothesised that patients with sarcoidosis may have increased plasma levels of collagen neoepitopes and that …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"1 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142487508","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}