Thorax最新文献

{"title":"Short-term effects of home-based pulmonary rehabilitation during outpatient-managed exacerbations of COPD: a randomised controlled trial","authors":"Ana Machado, Cíntia Dias, Cátia Paixão, António Pedro Gonçalves, Chris Burtin, Alda Marques","doi":"10.1136/thorax-2024-221760","DOIUrl":"https://doi.org/10.1136/thorax-2024-221760","url":null,"abstract":"Background Uncertainty exists about the beneficial effects of delivering pulmonary rehabilitation (PR) during exacerbations of chronic obstructive pulmonary disease (ECOPD). This study explored the short-term effects and self-reported impact of a home-based PR programme for people with outpatient-managed ECOPD. Methods We conducted a mixed-methods randomised controlled trial in people with outpatient-managed ECOPD. Participants were randomly assigned to the control (CG, ie, usual care) or experimental (EG, ie, usual care and 3-week home-based PR) group within 48 hours of the diagnosis (baseline). Assessments were performed at baseline and after 3 weeks (post). The COPD assessment test (CAT) was the primary outcome. Secondary outcomes included measures of symptoms and functional capacity. After PR, interviews were conducted. Analyses were performed using (non-)parametric mixed analysis of variance, deductive thematic analysis and narrative integration through joint displays. Results Fifty participants with outpatient-managed ECOPD (78% men, 70±11 years, forced expiratory volume in one second 47.4±16.4% pred) were included. Significant greater improvements in the EG compared with the CG were found for the CAT (EG Δ−12.5±7.2 vs CG Δ−5.9±7.2, p=0.002) and 12 of 13 other secondary outcome measures. A positive self-perceived impact of PR was found on symptoms, control of daily life, health, mental status and empowerment. No adverse events were reported. Conclusions A 3-week home-based PR programme is safe, meaningful and more effective than just standard medication in improving symptoms, functional capacity and health status, outcomes often associated with poor prognosis. This highlights the role of PR in improving the recovery process during outpatient-managed ECOPD and might contribute to a better prognosis in these individuals. Trial registration [NCT03751670][1]. Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. The authors confirm that the data supporting the findings of this study are available within the article (and/or) its supplementary materials. The dataset is available upon reasonable request from the corresponding author (ASM). [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT03751670&atom=%2Fthoraxjnl%2Fearly%2F2024%2F12%2F16%2Fthorax-2024-221760.atom","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"33 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142832090","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":"Pneumococcal pneumonia trends in adults hospitalised with community-acquired pneumonia over 10 years (2013–2023) and the role of serotype 3","authors":"Louise Lansbury, Tricia M McKeever, Hannah Lawrence, Harry Pick, Vadsala Baskaran, Rochelle Edwards-Pritchard, Laura Matthews, Helen Bailey, Deborah Ashton, Lesley Bendall, Chamira Rodrigo, Priya Daniel, David Litt, Seyi Eletu, Hanshi Parmar, Carmen Sheppard, Shamez N Ladhani, Caroline Trotter, Wei Shen Lim","doi":"10.1136/thorax-2024-221976","DOIUrl":"https://doi.org/10.1136/thorax-2024-221976","url":null,"abstract":"Background With higher valency pneumococcal vaccines on the horizon and new adult immunisation strategies under discussion, we aimed to evaluate the contribution of individual pneumococcal serotypes to the burden of pneumococcal community-acquired pneumonia (CAP). Over 10 years, trends in pneumococcal pneumonia epidemiology in adults hospitalised with CAP were assessed. The risk factors and severity associated with serotype 3 were examined. Methods We conducted a prospective cohort study of adults hospitalised with CAP between September 2013 and May 2023. Pneumococcal serotypes were identified using a serotype-specific 24-valent urinary-antigen assay. Trends in the proportion of CAP due to pneumococcus and causative serotypes were compared prepandemic and postpandemic. Risk factors and severity of serotype 3 pneumonia were compared with other serotypes using logistic regression. Results Of 5186 patients with CAP, 2193 (42.2%) had pneumococcal pneumonia. The proportion of CAP due to pneumococcus increased across all ages between 2013 and 2023 (36.4%–66.9%, p<0.001). The proportion due to serotype 3 increased significantly from 13.4% (2013) to 48.8% (2023). Serotype 3 pneumonia in adults was associated with older age (p<0.001), male sex (adjusted OR (aOR) 2.22, 95% CI 1.64 to 3.01) and chronic renal disease (aOR 1.81, 95% CI 1.09 to 3.02). Serotype 3 pneumonia was not observed to be associated with severity, critical care requirement, mortality or readmission. Interpretation Serotype 3 is the predominant serotype in adult pneumococcal CAP and has been increasing despite a mature infant pneumococcal immunisation programme, consistent with a lack of herd protection for this serotype. Data are available on reasonable request.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"29 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142815526","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":"Cost-related nonadherence to medication among people with asthma in the United States: findings that reinforce the relevance of history and healthcare reform","authors":"Emily L Graul, Christer Janson","doi":"10.1136/thorax-2024-222662","DOIUrl":"https://doi.org/10.1136/thorax-2024-222662","url":null,"abstract":"Asthma affects over 20 million (8%) of adults in the United States (US) each year.1 2 As with many chronic conditions, poor control can be attributed to low medication adherence and a reduced quality of life, and can translate into a high burden on the healthcare system and economy.3 4 Of importance is cost-related medication nonadherence, as people face heavy financial barriers to accessing US healthcare, on top of the chronic condition itself posing a major financial burden. Prescribed medications make up a considerable proportion of chronic disease spending in the US, particularly for asthma-related spending (~50% of asthma spending).4 Therefore, efforts to reduce cost-related medication nonadherence not only lessen the financial burden on the US health system but also support people’s ability to improve their disease symptoms. Recent research looking at cost-related medication nonadherence among people experiencing chronic disease has focused on coronary heart disease,5 liver disease,6 and chronic obstructive pulmonary disease (COPD)7 for example, but less so for asthma. Therefore in this issue of Thorax , Hung et al 8 fill the knowledge gap by conducting a study investigating the burden of cost-related medication nonadherence among a representative sample of 30 793 people with current asthma in the US. Using questionnaire data from the National Health Interview Survey (NHIS) from 2011 to 2022, the authors were specifically interested in examining the yearly trends in prevalence of cost-related medication nonadherence, the factors associated with cost-related medication nonadherence, and the association …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"9 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142797106","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":"Cost-related non-adherence to medications among adults with asthma in the USA, 2011–2022","authors":"Chun-Tse Hung, Steven R Erickson, Chung-Hsuen Wu","doi":"10.1136/thorax-2024-221778","DOIUrl":"https://doi.org/10.1136/thorax-2024-221778","url":null,"abstract":"Background Uncontrolled asthma is possibly caused by medication non-adherence, and financial hardship can be a major contributor to non-adherence. Since economic conditions and asthma management have changed over time, a comprehensive investigation of cost-related medication non-adherence (CRN) among adults with asthma is crucial. Objective To evaluate trends, prevalence and determinants of CRN, and its impact on asthma control among US adults with asthma. Methods Data from 2011 to 2022 National Health Interview Survey were used. Joinpoint regression analysis was used to evaluate trends in the prevalence of CRN. A multivariable logistic regression model was used to identify factors associated with CRN. Two additional multivariable logistic regression models were used to examine associations between CRN and asthma-related adverse events, including asthma attacks and emergency room (ER) visits for asthma. Results A total of 30 793 adults with asthma were included, representing 8.1% (19.38 million) of the US population. From 2011 to 2022, a declining trend in the prevalence of CRN among US adults with asthma was observed. Approximately every one in six adults with asthma was non-adherent to medications due to cost. Several factors, including demographics and comorbidities, were associated with CRN. Adults with asthma who had CRN were at an increased risk of experiencing asthma attacks (adjusted OR, 1.95; 95% CI 1.78 to 2.13) and ER visits for asthma (adjusted OR, 1.63; 95% CI 1.44 to 1.84). Conclusion Since asthma is one of the leading chronic diseases, the burden of cost-related non-adherence to medications highlights the need for appropriate policies and social supports to address such problems. No data are available.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"2 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142797107","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":"Advanced MicroRNA delivery for lung inflammatory therapy: surfactant protein A controls cellular internalisation and degradation of extracellular vesicles","authors":"Miji Kim, Sujeong Park, Nayoung Lee, Dohyun Kim, Dongwoo Kim, Yang Jin, Seon-Jin Lee, Jung Joo Hong, Heedoo Lee","doi":"10.1136/thorax-2024-221793","DOIUrl":"https://doi.org/10.1136/thorax-2024-221793","url":null,"abstract":"Introduction Alveolar macrophages (AMs) are the first line of defence against pathogens that initiate an inflammatory response in the lungs and exhibit a strong affinity for surfactant protein A (SP-A). Extracellular vesicles (EVs) have emerged as a promising drug delivery platform due to their minimal cytotoxicity. However, precise targeting of specific cell types and the rapid lysosomal degradation of EVs within recipient cells remain persistent challenges. Method In this study, we explored the biological significance of SP-A-EVs as novel drug delivery systems for combating lung inflammation. We first verified that respiratory EVs express SP-A receptor (SP-R210), facilitating the conjugation of SP-A with EVs. The delivery efficiency, cellular internalisation pathways and therapeutic effects were evaluated using an in vivo mouse model. Results SP-A-EVs were robustly internalised into AMs both in vitro and in vivo. Furthermore, our investigation revealed that the toll-like receptor 4-mediated endocytosis pathway was employed for the uptake of SP-A-EVs, significantly delaying their degradation compared with natural EVs, which primarily followed the conventional lysosomal degradation pathway within AMs. In a functional study, we successfully loaded anti-inflammatory microRNA ( let-7b ) into SP-A-EVs, leading to the suppression of AM activation and the alleviation of lung inflammation induced by lipopolysaccharide. Conclusion These findings underscore the potential of SP-A-EVs as highly effective drug delivery systems for targeted therapeutics in lung-related disorders, capitalising on the strong affinity between AMs and SP-A and the modulation of cellular internalisation. All data relevant to the study are included in the article or uploaded as supplementary information.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"31 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142776552","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":"Rare occurrence of tracheal acinic cell carcinoma causing central airway obstruction in a young adult","authors":"Jun Hyung Park, Myoung Ja Chung, Jong Hun Kim, Jae Seok Jeong, Yong Chul Lee","doi":"10.1136/thorax-2024-221426","DOIUrl":"https://doi.org/10.1136/thorax-2024-221426","url":null,"abstract":"A 22-year-old woman presented with intermittent blood-tinged sputum for about 3 years. She reported experiencing exertional dyspnoea and had no history of chronic disease, family history or smoking. On physical examination, mild coarse breathing sounds and wheezing on the upper sternum were auscultated. Lab results were non-specific. Chest CT scan (figure 1A,B) revealed a heterogeneous enhancing endotracheal mass of approximately 1.9 cm at mid-trachea extending to the boundary of the right tracheal wall or through the tracheal wall but not invading adjacent structures. The bronchoscopy showed a tracheal mass characterised by a lobulated surface with hypervascularity (figure 1C). 2-Deoxy-2-[18F]-fluorodeoxyglucose (FDG) positron emission tomography (PET)-CT demonstrated mild to moderate uptake increase of FDG (figure 1D) and no definitive invasion to the neighbouring structures was observed on images (figure 1E). The tracheal mass was resected with a sufficient resection margin via uniportal video-assisted thoracic surgery and was reconstructed by end-to-end anastomosis. Figure 1 (A, B) Images on contrast-enhanced chest CT showing a 1.9×1 cm endotracheal mass with heterogeneous enhancement at mid-trachea (yellow arrow). (C) Initial diagnostic flexible fibreoptic …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"8 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752878","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":"Assessing causal relationships between diabetes mellitus and idiopathic pulmonary fibrosis: a Mendelian randomisation study","authors":"Samuel T Moss, Cosetta Minelli, Olivia C Leavy, Richard J Allen, Nick Oliver, Louise V Wain, Gisli Jenkins, Iain Stewart","doi":"10.1136/thorax-2024-221472","DOIUrl":"https://doi.org/10.1136/thorax-2024-221472","url":null,"abstract":"Background Idiopathic pulmonary fibrosis (IPF) is a disease of progressive lung scarring. There is a known association between diabetes mellitus (DM) and IPF, but it is unclear whether a causal relationship exists between these traits. Objectives The objectives of this study are to examine causal relationships among DM, diabetes-associated traits and IPF using a Mendelian randomisation approach. Methods Two-sample MR approaches, including bidirectional inverse-variance weighted random effects and routine sensitivity models, used genetic variants identified from genome-wide association studies for type 1 diabetes (T1D), type 2 diabetes (T2D), glycated haemoglobin level (HbA1c), fasting insulin level and body mass index (BMI) to assess for causal effects of these traits on IPF. Further analyses using pleiotropy-robust and multivariable MR (MVMR) methods were additionally performed to account for trait complexity. Results Results did not suggest that either T1D (OR=1.00, 95% CI 0.93 to 1.07, p=0.90) or T2D (1.02, 0.93 to 1.11, p=0.69) are in the causal pathway of IPF. No effects were suggested of HbA1c (1.19, 0.63 to 2.22, p=0.59) or fasting insulin level (0.60, 0.31 to 1.15, p=0.12) on IPF, but potential effects of BMI on IPF were indicated (1.44, 1.12 to 1.85, p=4.00×10−3). Results were consistent in MVMR, although no independent effects of T2D (0.91, 0.68 to 1.21, p=0.51) or BMI (1.01, 0.94 to 1.09, p=0.82) on IPF were observed when modelled together. Conclusions This study suggests that DM and IPF are unlikely to be causally linked. This comorbid relationship may instead be driven by shared risk factors or treatment effects. Data are available upon reasonable request. Summary results for the GWAS of IPF susceptibility were requested through the collaborative genetic studies of idiopathic pulmonary fibrosis GitHub page: (<https://github.com/genomicsITER/PFgenetics>). Summary data for all other GWAS studies were retrieved from GWAS catalog (<https://www.ebi.ac.uk/gwas/>).","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"21 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752875","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":"Optimising bronchoalveolar lavage: lessons from alpha-1 antitrypsin deficiency","authors":"Malcolm Herron, Suzanne Roche, Daniel D Fraughen, Ronan C Heeney, Lasya Kanchi, Emma J Leacy, Michelle Casey, Cedric Gunaratnam, Tomás P Carroll, Mark P Murphy, Noel G McElvaney","doi":"10.1136/thorax-2024-221797","DOIUrl":"https://doi.org/10.1136/thorax-2024-221797","url":null,"abstract":"Background Bronchoalveolar lavage (BAL) is essential in determining the efficacy of novel therapies in alpha-1 antitrypsin deficiency (AATD). These require initial proof-of-concept demonstration that treatment administration increases alpha-1 antitrypsin (AAT) levels and/or anti-neutrophil elastase inhibitory capacity (ANEC) in the lung. Early-phase studies often encounter high interindividual variability of BAL results, primarily stemming from the inherent dilution characteristics of returned BAL fluid. A BAL protocol that minimises this variability is needed for reliable comparison of biochemical endpoints in the lung. Methods The study population included 21 severe AATD (ZZ), 22 moderate AATD (MZ) and 23 non-AATD (MM) individuals, further categorised as healthy, unobstructed current smokers or patients with chronic obstructive pulmonary disease (COPD). An additional six ZZ individuals were receiving intravenous alpha-1 augmentation therapy. We compared common BAL correction methods—albumin, total protein and epithelial lining fluid (ELF) volume measured by urea—when reporting early-phase biochemical endpoints, AAT and ANEC. Results BAL performed with a paediatric bronchoscope (PB) improved alveolar sampling compared with a traditional adult bronchoscope. Both uncorrected and ELF-corrected BAL demonstrated high interindividual variability regardless of lung health status. BAL total protein correction minimised interindividual variability, producing significant differences in AAT and ANEC between all genotypes, the strongest relationship with plasma AAT levels (r2=0.83), greatest inter-lobar concordance in AAT levels (r2=0.76) and strong correlation between BAL AAT and ANEC (r2=0.88). Conclusions By capitalising on the marked consistency in AAT levels between AAT genotypes, and the close relationship between plasma and lung AAT levels, we demonstrate reliable alveolar sampling that aligns closely with plasma. Data are available upon reasonable request.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"13 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142712533","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":"Quantitative BAL: a suitable method for the assessment of epithelial lining fluid in alpha-1 antitrypsin deficiency?","authors":"David G Parr","doi":"10.1136/thorax-2024-221966","DOIUrl":"https://doi.org/10.1136/thorax-2024-221966","url":null,"abstract":"Measurements on biological fluids form the mainstay of routine clinical investigations. Samples of blood, urine, etc are, generally, easily obtainable and measurements can be interpreted directly. On the other hand, alveolar epithelial lining fluid (ELF) is relatively inaccessible but offers valuable insight into pathogenesis and pharmacokinetics relating to diseases affecting the alveolus. The lung is frequently described as having the surface area of a tennis court. When folded up to fit into the volume of an average thorax, it creates a complex maze that represents a significant obstacle to accessing ELF. The difficulty of gaining access safely and without disrupting the alveolar milieu is complicated by the delicate structure and function of the gas exchange membrane. Different approaches have been adopted including the use of a bronchoscopic microsample (PMS) probe,1 which allows direct measurements from ELF, or bronchoalveolar lavage (BAL), which requires a correction method to adjust for the dilutional effects of the lavage fluid. Urea (or albumin or creatinine) has been commonly used as an endogenous marker to estimate the volume of ELF2–5: by measuring the urea in BAL aspirate and plasma, a ratio can be calculated allowing an estimate of the dilution of apparent volume of ELF. ‘Contamination’ from lavage of the larger airways is also an issue that is influenced by the method of BAL sampling. This is not particularly important in routine clinical BAL, and guidelines do not stipulate the order of …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"66 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142712593","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}