Thorax最新文献

{"title":"Effect of maintenance macrolide de-escalation during the Australian summer on exacerbations of obstructive airway diseases: a randomised, double-blind, placebo-controlled trial.","authors":"Dennis Thomas, Vanessa McDonald, Peter Ab Wark, Shyamala Pradeepan, Scott Twaddell, Andrew Gillman, Mark Hew, Eve Denton, Joy Lee, Jimmy Chien, Madeleine Hinwood, Erin S Harvey, Gijo Thomas, Amber Smith, David Arnold, Peter G Gibson","doi":"10.1136/thorax-2025-224164","DOIUrl":"https://doi.org/10.1136/thorax-2025-224164","url":null,"abstract":"<p><strong>Background: </strong>The optimal duration of maintenance macrolide antibiotic therapy in obstructive airway disease (OAD) remains unclear. This study evaluated the impact of de-escalating maintenance macrolide therapy during the Australian summer on OAD exacerbations.</p><p><strong>Methods: </strong>This double-blind, placebo-controlled, non-inferiority trial recruited 82 participants (mean age: 67.33±13.13; 55% female) undergoing maintenance macrolide therapy for the management of asthma, chronic obstructive pulmonary disease or bronchiectasis. They were randomised to continue (continuation arm) or de-escalate macrolide therapy (de-escalation arm) at the start of the summer (December-February). Follow-up interviews were conducted at 3, 6 and 9 months. The primary outcome was acute exacerbations during the summer. Secondary outcomes included symptom control scores and time to first exacerbation. The non-inferiority margin was 20%.</p><p><strong>Results: </strong>The acute exacerbation rates were 33.3% (14/42) for the continuation arm and 50% (19/38) for the de-escalation arm during the summer season. The primary analysis did not demonstrate non-inferiority (risk difference 16.2%; 95% CI -4.9% to 37.2%, with the upper bound exceeding the 20% non-inferiority margin). Symptom control was maintained and did not differ between arms. The time to first exacerbation was longer in the continuation arm (median 206 vs 90 days; HR 1.98, 95% CI 1.15 to 3.42; p=0.012).</p><p><strong>Conclusion: </strong>Macrolide de-escalation was not found to be non-inferior to continued treatment in individuals with OAD. While some patients may be able to discontinue long-term macrolide therapy during the summer, there remains a risk of exacerbation recurrence.</p><p><strong>Trial registration number: </strong>ACTRN12620001263987.</p>","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148607967","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":"Bidirectional association between visceral adiposity and obstructive sleep apnoea: longitudinal findings from the Wisconsin Sleep Cohort.","authors":"Dandan Zheng, Jun Wu, Yanyuan Dai, Le Chen, Baixin Chen, Bin Zhou, Nikolaos Athanasiou, Alexandros N Vgontzas, Yun Li","doi":"10.1136/thorax-2025-224400","DOIUrl":"https://doi.org/10.1136/thorax-2025-224400","url":null,"abstract":"<p><strong>Background: </strong>Obstructive sleep apnoea (OSA) is a prevalent sleep disorder strongly associated with metabolic syndrome. Visceral adiposity is the principal culprit of the metabolic syndrome leading to the development of OSA. The longitudinal relation between visceral adiposity and OSA remains unknown.</p><p><strong>Methods: </strong>We included 311 subjects without OSA at baseline to examine the association between visceral adiposity and incident OSA and 559 subjects without visceral obesity at baseline to examine the association between OSA and incident visceral obesity in a general population sample. OSA was defined as an Apnoea-Hypopnoea Index (AHI) ≥5 events/hour or having been diagnosed or received treatment for OSA. Visceral obesity was defined as a lipid accumulation product (LAP) level higher than the 75th percentile of the overall sample.</p><p><strong>Results: </strong>After a median follow-up duration of 9 years, higher LAP values at baseline predicted higher AHI at follow-up (<i>β</i>=0.19, p=0.001) and visceral obesity at baseline was associated with higher odds of incident OSA (OR 7.10, 95% CI 3.05 to 16.51) after adjusting for confounders. Furthermore, higher AHI values at baseline predicted higher LAP values at follow-up (<i>β</i>=0.09, p=0.002) and OSA at baseline was associated with incident visceral obesity (OR 2.87, 95% CI 1.28 to 6.43) after adjusting for confounders. This bidirectional association was only observed in adults younger than 55 years.</p><p><strong>Conclusions: </strong>The association between visceral adiposity and OSA is bidirectional and significant in young and middle-aged but not in older adults. Our findings suggest that visceral adiposity might be the target of preventative and therapeutic strategies for OSA.</p>","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148580045","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":"Yen Wen Phong","doi":"10.1136/thorax-2026-225718","DOIUrl":"https://doi.org/10.1136/thorax-2026-225718","url":null,"abstract":"","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148580067","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":"Air pollution and chronic obstructive pulmonary disease: beyond respiratory outcomes.","authors":"Huda Badri, Gordon McFiggans, Aristeidis Voliotis","doi":"10.1136/thorax-2026-224963","DOIUrl":"10.1136/thorax-2026-224963","url":null,"abstract":"","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":"1037-1038"},"PeriodicalIF":9.1,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148580114","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":"Changing face of lung monitoring in CF: from tracking decline to maintaining healthy lungs.","authors":"Alex Robert Horsley, Jim M Wild","doi":"10.1136/thorax-2026-225228","DOIUrl":"https://doi.org/10.1136/thorax-2026-225228","url":null,"abstract":"","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148550681","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 interstitial emphysema after hyperventilation.","authors":"Ryota Inokuchi, Tomoki Wada, Kent Doi","doi":"10.1136/thorax-2026-225248","DOIUrl":"https://doi.org/10.1136/thorax-2026-225248","url":null,"abstract":"","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148550642","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":"Thoracic vertebral osteophytes as a rare cause of focal bronchiectasis.","authors":"Arvindran Alaga, Sharimini Mani","doi":"10.1136/thorax-2026-225495","DOIUrl":"https://doi.org/10.1136/thorax-2026-225495","url":null,"abstract":"","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148550620","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":"Identification of distinct gene and miRNA expression profiles in severe early-onset COPD providing novel insights in disease pathogenesis.","authors":"Nicolaas Jacobus Bekker, Johannes Ll Van Nijnatten, Peter L Horvatovich, Justina C Wolters, Victor Guryev, Tatiana Karp, Wierd Kooistra, Marjan Reinders-Luinge, Roy R Woldhuis, Wim Timens, Alen Faiz, Maarten van den Berge, Corry-Anke Brandsma","doi":"10.1136/thorax-2025-224419","DOIUrl":"https://doi.org/10.1136/thorax-2025-224419","url":null,"abstract":"<p><strong>Objective: </strong>Severe early-onset-chronic obstructive pulmonary disease (SEO-COPD) represents the most severe form of COPD that manifests at an earlier age than common COPD. We hypothesise that this is driven by a partially different disease pathogenesis and investigated whether SEO-COPD has a distinct gene and miRNA expression profile.</p><p><strong>Methods: </strong>RNA and small RNA sequencing was performed on lung tissue from 18 SEO-COPD, 22 common COPD and 32 non-COPD control subjects. Differential gene expression analysis was performed to identify SEO-COPD-specific genes and miRNA signatures. This was followed by gene set enrichment analysis, pathway enrichment, genome-wide association studies catalog interrogation, expression quantitative trait loci (eQTL) analysis, immunohistochemical validation, mRNA-miRNA integration and cellular deconvolution.</p><p><strong>Results: </strong>We identified 105 SEO-COPD specific genes and three SEO-COPD specific miRNAs. Pathway analysis showed enrichment of B-cell-mediated adaptive immunity, chemotaxis and extracellular matrix (ECM) pathways among genes upregulated in SEO-COPD, including the B-cell marker CD79A and ECM component FBLN1 as leading-edge genes. More CD79A-positive infiltrates were observed in SEO-COPD lung tissue compared with control. For 15 SEO-COPD genes, COPD- or lung function-associated single nucleotide polymorphisms were identified, while eQTLs were identified for six SEO-COPD-associated genes. mRNA-miRNA integration identified miR331-3p as a potential regulator of the ECM-related gene expression changes in SEO-COPD.</p><p><strong>Conclusions: </strong>The identified lung tissue gene and miRNA expression profiles for SEO-COPD support the presence of a distinct pathogenetic phenotype of SEO-COPD characterised by B-cell-mediated immunity, ECM dysregulation as well as genetic pre-disposition.</p>","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148550599","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":"Monocytes on the move: from pulmonary checkpoint to tissue fate.","authors":"Joanna C Porter","doi":"10.1136/thorax-2026-225542","DOIUrl":"https://doi.org/10.1136/thorax-2026-225542","url":null,"abstract":"","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"52 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148521989","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":"Clearing the haze around familial interstitial lung abnormalities.","authors":"Ramey Bajwa,John Mackintosh","doi":"10.1136/thorax-2026-225326","DOIUrl":"https://doi.org/10.1136/thorax-2026-225326","url":null,"abstract":"","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"37 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148521986","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}