Thorax最新文献

{"title":"Journal club","authors":"Shannon Ferrie","doi":"10.1136/thorax-2025-223997","DOIUrl":"https://doi.org/10.1136/thorax-2025-223997","url":null,"abstract":"Chronic obstructive pulmonary disease (COPD) may originate in early life. Some individuals without airflow limitation, but with respiratory symptoms, or physiologic and radiologic abnormalities may be at risk of developing COPD later. Çolak et al (Am J Respir Crit Care Med. 2024;210(5):607–617. doi:10.1164/rccm.202308–1452OC) studied two large Danish population-based cohorts with up to 25 years of follow-up. They developed a COPD susceptibility score based on symptoms, smoking history, spirometry and medical history. After 10 years, 28% of individuals of those deemed susceptible developed COPD compared with 8% in those not deemed susceptible. At 25 years, 22%–26% of those deemed susceptible developed COPD, and 20% progressed to GOLD stage 2–4. Over half of those with COPD at final examination developed from a susceptible state. The COPD risk score gave a stepwise increased risk for COPD and was a better predictor than smoking alone. The results demonstrate a potential ‘pre-COPD state’, which could be used for identification of at-risk individuals. The existence of this state could be used to predict and prevent COPD in those at high risk. Inhaled corticosteroids (ICS) are a mainstay of asthma treatment and recommendations are to prescribe at the lowest possible …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"36 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145059338","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":"Safety, feasibility and efficacy of exercise as an airway clearance technique in cystic fibrosis: a randomised pilot feasibility trial","authors":"Don S Urquhart, Emily Taylor, Steve Cunningham, Steff Lewis, Aileen Rae Neilson, Dia Soilemezi, Hannah Ensor, Ioannis Vogiatzis, Lorna J Allen, Zoe Louise Saynor","doi":"10.1136/thorax-2025-223080","DOIUrl":"https://doi.org/10.1136/thorax-2025-223080","url":null,"abstract":"Objectives To test the feasibility and safety of exercise as an airway clearance technique (ExACT) for people with cystic fibrosis (pwCF) versus usual care (UC). Methods Dual-site, two-arm randomised pilot trial. Fifty pwCF (≥10 years, forced expiratory volume in 1 s (FEV1) ≥40% predicted), stable on Elexacaftor/Tezacaftor/Ivacaftor, were recruited, of whom 48 were randomly assigned (1:1 with minimisation) to daily ExACT (stopping all other airway clearance techniques) or UC. Feasibility was measured by recruitment, retention and adherence against preset progression criteria. Key measures of safety and signals of efficacy included spirometry (FEV1), lung clearance index (LCI2.5), pulmonary exacerbations, physical activity, treatment burden and quality of life across 28 days. Qualitative interview data and preliminary health economic data were also collected. Findings ExACT was safe over 28 days, measured by change in LCI2.5 (ExACT −0.1 (0.6) vs UC 0.2 (0.8), mean (SD)) and FEV1 (ExACT +2.1 (6.6) vs UC −0.8 (5.5), % predicted mean (SD)). Relative (ExACT/UC) differences of 0.97 (0.92, 1.02) for LCI2.5 and absolute differences (ExACT-UC) of 3.2 (−0.6, 6.9) % predicted for FEV1 suggest potential intervention efficacy. Few adverse events were reported; none serious. Recruitment and retention data suggest progression to a definitive trial, with 48/117 (41% of approached) randomised, 45/48 (92%) completing the study and a 60% overall adherence rate. Discussion Testing of our primary hypothesis within a feasibility trial showed ExACT to be a safe, acceptable and feasible intervention for pwCF. These data support advancement to a definitive, longer-term, multisite trial evaluating the safety, efficacy and cost-effectiveness of ExACT, following minor refinement. Trial registration number [NCT05482048][1]. Data are available upon reasonable request. All data generated or analysed during the current study are available from the Principal Investigators of the study (ZLS and DSU) on reasonable request. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT05482048&atom=%2Fthoraxjnl%2Fearly%2F2025%2F09%2F30%2Fthorax-2025-223080.atom","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"78 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145195180","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":"Proteomics-based risk prediction and drug targets identification for chronic obstructive pulmonary disease","authors":"Yuanyuan Zhang, Ziliang Ye, Sisi Yang, Yanjun Zhang, Yu Huang, Hao Xiang, Yiting Wu, Yiwei Zhang, Xiaoqin Gan, Xianhui Qin","doi":"10.1136/thorax-2024-222397","DOIUrl":"https://doi.org/10.1136/thorax-2024-222397","url":null,"abstract":"Background Chronic obstructive pulmonary disease (COPD) is a leading cause of global mortality, yet existing risk prediction models remain limited. This study aimed to develop and validate a protein-based risk score for COPD, comparing its performance against COPD polygenic risk scores (PRSs) and clinical risk factors, while exploring underlying biological pathways and causal protein-disease associations. Methods The study analysed 27 796 UK Biobank participants from England (70% training and 30% testing set) and 3534 from Scotland/Wales (validation cohort). Least absolute shrinkage and selection operator regression identified predictive proteins in the training set, with model performance assessed using Harrell’s C-index, Net Reclassification Improvement (NRI) and Integrated Discrimination Improvement Index (IDI). Pathway and Mendelian randomisation (MR) analyses explored biological mechanisms and causal effects. Results In the testing set, a developed 32-protein risk score strongly predicted incident COPD with high accuracy (C-index 0.826, 95% CI 0.803 to 0.849). It outperformed PRS (C-index 0.510, 95% CI 0.478 to 0.542) and matched clinical models (C-index 0.845, 95% CI 0.823 to 0.867). A simplified 10-protein panel retained robust performance (C-index 0.816, 95% CI 0.792 to 0.840). Adding the protein scores to clinical factors improved risk reclassification (NRI 0.251–0.318; IDI: 0.042–0.064). MR analysis identified ADM and SCGB1A1 as protective, while MMP12 and TNFRSF10A increased risk. Pathway analysis implicated inflammation and extracellular remodelling. Chitinase-3-like protein 1 and matrix metalloproteinase-9 were central players in the protein–protein interaction network. Similar results were found in the validation cohort. Conclusion Protein biomarkers outperform genetic risk scores and complement clinical factors for COPD prediction, with a streamlined 10-protein panel offering clinical feasibility. The study identifies novel pathways and causal therapeutic targets. Further validation is needed prior to routine clinical implementation. Data may be obtained from a third party and are not publicly available. Data may be obtained from a third party and are not publicly available (UK Biobank, <https://www.ukbiobank.ac.uk/>). The analytical methods supporting the findings of this study can be obtained from the corresponding authors upon reasonable request.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"22 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145133599","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":"Maternal antibiotic use during pregnancy increases the risk of offspring airway infections: a systematic review and meta-analysis","authors":"Kareen Alon, Marie Hauerslev, Bo L K Chawes, Nicklas Brustad","doi":"10.1136/thorax-2025-223634","DOIUrl":"https://doi.org/10.1136/thorax-2025-223634","url":null,"abstract":"Background Antibiotics are widely prescribed during pregnancy, yet their impact on offspring infection risk remains unclear. This study synthesises all available data and evaluates the association between maternal antibiotic use during pregnancy and the risk of infections in offspring during childhood. Methods We conducted a systematic review and meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, registered with PROSPERO. We searched PubMed, Embase, Ovid, ISRCTN registry, ClinicalTrials.gov and Cochrane Library for English language studies without publication date restrictions. Studies reporting quantitative data on prenatal antibiotic exposure and childhood infections after the neonatal period were included. Two authors screened and extracted data from published reports. Risk of bias was evaluated using the Newcastle-Ottawa Scale. The primary outcome was any childhood infection risk, analysed using random-effects meta-analyses with sensitivity analyses by infection type and study quality. Certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results From 7317 records, 14 cohort studies (n=5 011 183 children) were included, of which 12 (n=4 995 449) provided data for meta-analysis. Prenatal antibiotic exposure was associated with an increased risk of any offspring infection (OR 1.33, 95% CI 1.01 to 1.76, p=0.04). A sensitivity analysis (n=3 647 296) of six high-quality studies showed a stronger association (OR 1.48, 95% CI 1.13 to 1.95, p<0.01). Specifically, ear, nose and throat infections were significantly increased (n=2 841 644 children) (OR 1.40, 95% CI 1.18 to 1.65, p<0.0001). The risk of bias was low in the majority of the included studies and the certainty of evidence was high for any offspring infection from the GRADE assessment. Conclusions Prenatal antibiotic exposure was associated with increased offspring infection risk and in particular upper airway infections. These findings indicate a need for cautious antibiotic prescribing during pregnancy, although potential confounding cannot be excluded. PROSPERO registration number CRD42024599699. No data are available.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"12 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145133597","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":"Who gets in? Rethinking clinical trial access in the era of race-neutral pulmonary function","authors":"Marija Vukoja","doi":"10.1136/thorax-2025-223694","DOIUrl":"https://doi.org/10.1136/thorax-2025-223694","url":null,"abstract":"Pulmonary function tests are essential diagnostic tools in respiratory medicine, with interpretation dependent on predicted normal values derived from population-based reference equations. Historically, these equations included race as a variable, based on the assumption that individuals from different racial backgrounds have innate physiological differences in lung function. However, this practice has come under increasing scrutiny, as emerging evidence shows that observed racial differences are not due to inherent anatomical variation, such as chest size or airway diameter, but rather reflect the cumulative impact of structural inequities, including limited access to clean air, nutritious food, quality healthcare and safe housing.1 In 2022, the Global Lung Function Initiative (GLI) introduced new race-neutral reference equations for spirometry, developed using global, multiethnic data without race-based adjustment factors (GLI global).2 This marked a major departure from long-standing clinical practice and reflected growing recognition that race is a social construct—not a biological determinant—and should not be used to define physiological norms. In 2023 and 2024, the shift gained momentum, with endorsements from leading organisations including the American Thoracic Society and the European Respiratory Society.3 While eliminating race from predictive models is intended to enhance diagnostic accuracy and promote equity, this transition presents important clinical and research challenges. The use of race-neutral equations …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"58 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145133601","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":"Vibrotactile positional therapy for the treatment of positional obstructive sleep apnoea: a multicentre, randomised controlled trial","authors":"Julia L Kelly, Chris D Turnbull, Roger Newson, Melissa Dobson, Emma L Hedley, Abdullah S ALQarni, Ann Nevinson, David Dawson, Annabel Nickol, Sophie West, Nick P Talbot, Najib M Rahman, John Stradling, Mary J Morrell","doi":"10.1136/thorax-2024-222681","DOIUrl":"https://doi.org/10.1136/thorax-2024-222681","url":null,"abstract":"Background New generation positional therapy devices provide vibrotactile feedback to patients with positional obstructive sleep apnoea (POSA), reducing supine sleep time and sleep apnoea severity. Longer-term effects on POSA severity, sleepiness and quality of life (QoL) are unclear. Methods A randomised, parallel, double-blinded trial compared neck-worn positional therapy with sham-positional therapy over 3 months (ClinicalTrials.gov: [NCT04153240][1]). Adult patients with POSA (apnoea/hypopnoea index (AHI) >5 events/hour, 2:1 when supine vs non-supine) were randomised (1:1). The primary endpoint was AHI at 3 months, positional versus sham. Secondary analyses: interaction between the treatment effect and age; QoL, including Epworth Sleepiness Scale (ESS) and Pittsburgh Sleep Quality Index (PSQI). Results Between October 2019 and August 2022, 120 patients with median baseline AHI of 12.8 events/hour (IQR 9.2–18.5) were randomised; 59 to positional therapy and 61 to sham; 92 (77%) completed the trial. Positional therapy significantly reduced the AHI by −4.41 events/hour (95% CI −7.77 to –1.06; p=0.011) compared with sham, a 34% improvement. There was a significant improvement in PSQI: −1.0 (95% CI −2.1 to 0.0; p=0.04), but not ESS: −0.6 (95% CI −1.8 to 0.6; p=0.3), with positional therapy compared with sham (baseline ESS 8.8). Similar results were seen in younger (18–64) and older (≥65) age groups. Patients’ bed partners reported improvements in snoring and sleep quality for the patient and themselves. Over half of participants using the active device opted to continue. Conclusion Neck-worn positional therapy reduced the severity of OSA and improved sleep quality but not sleepiness, over 3 months. Bed partner’s reported improvements in snoring and sleep quality. Trial registration number [NCT04153240][1]. Data are available upon reasonable request. Anonymised data may be provided upon reasonable request within the scope of the ethical committee approval. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT04153240&atom=%2Fthoraxjnl%2Fearly%2F2025%2F09%2F24%2Fthorax-2024-222681.atom","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"10 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145133605","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":"Mobile health pulmonary rehabilitation (m-PR): a randomised controlled equivalence trial","authors":"Sarah E Brown, Sally Wootton, Marita T Dale, Jennifer A Alison, Andrew S L Chan, Marlien Varnfield, Ian Yang, Michelle Cunich, Zoe J McKeough","doi":"10.1136/thorax-2024-222823","DOIUrl":"https://doi.org/10.1136/thorax-2024-222823","url":null,"abstract":"Background Mobile health (mHealth) is a novel model of care that may overcome barriers to pulmonary rehabilitation (PR) access. This study determined if mHealth PR was equivalent to centre-based PR (CB-PR) in improving exercise capacity and health status in people with chronic obstructive pulmonary disease (COPD). Method Single-blinded, multicentre, randomised controlled equivalence trial using an intention-to-treat analysis. Participants completed 8 weeks of either mHealth PR, using the mobile PR (m-PR) application and supported by telephone calls, or CB-PR. Co-primary outcomes, measured at baseline and end-intervention, were change in 6 minute walk distance (6MWD) and COPD assessment test (CAT) score, with an equivalence margin of 30 m and 2 points, respectively. Results 90 participants were randomised (mean (SD), m-PR n = 44: age 75 (7) years; forced expiratory volume in one second (FEV1) 58 (15) % predicted; CB-PR n = 46: age 75 (6) years; FEV1 55 (14) % predicted) with 38 m-PR participants and 42 CB-PR participants completing at least one primary outcome. At end-intervention, there was no between-group difference in 6MWD (mean difference (MD) 13 m, 95% CI −6 to 31), indicating equivalence of m-PR to CB-PR. There was a significant between-group difference in CAT score (MD −4.9 points, 95% CI −7.2 to −2.6), with both limits of the CI exceeding the equivalence margin, indicating superiority of m-PR. Conclusion An mHealth PR programme resulted in equivalent improvements in exercise capacity and superior improvements in health status when compared with CB-PR in people with COPD. mHealth PR could be effective as a management option for people with COPD with adequate digital literacy. Trial registration number ACTRN12619001253190. No data are available. The participants of this study did not give written consent for their data to be shared publicly. Further ethics approval would be required for data release after contacting the corresponding author.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"8 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145133598","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":"Delayed presentation of pulmonary Echinococcus in a patient with no major risk factors","authors":"Kirsty Hancock, Bethan Harris, Sidharth Kharbanda, Christopher Warren Howard Davies","doi":"10.1136/thorax-2025-223358","DOIUrl":"https://doi.org/10.1136/thorax-2025-223358","url":null,"abstract":"A teacher in his 50s was referred urgently following an abnormal chest X-ray and a 4-week history of dark-green, blood-speckled productive cough, left-sided pleuritic pain, fevers, night sweats and unintentional weight loss with reduced appetite. He had received antibiotics from his general practitioner prior to referral. Born in the UK, he had no comorbidities, was an ex-smoker, had no recent foreign travel and reported no contact with animals. Examination showed reduced air entry at left lung base. Initial chest X-ray showed a left lower lobe cavitating lesion, with separate consolidation (figure 1a), concerning for pneumonia with underlying lung abscess or malignancy; however, blood results were not supportive of an inflammatory process. Sputum cultures were negative. CT scan showed a cavitating mass containing fluid, supportive of a lung abscess (figure 1d). Figure 1 Progression of the left lower lobe cavitating lesion on serial chest imaging. Chest X-ray at (a) initial presentation and (d) CT thorax at 2 weeks demonstrate a cavitating lesion with air-fluid level in the left lower lobe (yellow arrows). Follow-up imaging with chest X-ray at (b) 2 weeks and (c) 4 weeks, alongside interval …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"53 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145133600","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 rehabilitation and quality of life in alpha-1 antitrypsin deficiency: findings from a retrospective cohort study.","authors":"Fawaz Alwadani,Paul R Ellis,Michael Newnham,Joshua de Soyza,Aisha Butt,Anita Pye,Alice M Turner","doi":"10.1136/thorax-2025-223273","DOIUrl":"https://doi.org/10.1136/thorax-2025-223273","url":null,"abstract":"Alpha-1 antitrypsin deficiency (AATD) is a rare genetic disorder associated with early-onset chronic obstructive pulmonary disease and impaired quality of life (QoL). This retrospective study evaluated the impact of pulmonary rehabilitation (PR) on QoL using repeated St George's Respiratory Questionnaire (SGRQ) scores. Among 274 patients, PR participants had more severe disease but showed no greater QoL improvement over time. Dyspnoea and exacerbation frequency were the strongest predictors of poorer outcomes. PR was not associated with significantly improved SGRQ trajectories. These findings highlight the need for personalised, disease-specific rehabilitation strategies in AATD to address limitations of conventional PR programmes in this population.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"78 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145083342","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":"Ultrafine particles and health: the next frontier in understanding air pollution hazards","authors":"Laura Nicolaou, William Checkley","doi":"10.1136/thorax-2025-223178","DOIUrl":"https://doi.org/10.1136/thorax-2025-223178","url":null,"abstract":"Ambient air pollution is a major risk factor for morbidity and mortality worldwide. Among the pollutants, fine particulate matter (PM2.5)—particles ≤2.5 µm in aerodynamic diameter—is recognised to cause the largest health impacts. Indeed, in 2021, ambient PM2.5 was estimated to be responsible for 4.7 million deaths and 120 million disability-adjusted life years lost worldwide.1 PM2.5 adversely affects health as it penetrates deep into the lungs and can enter the bloodstream, leading to the development or exacerbation of respiratory and cardiovascular diseases.2 Studies have also linked ambient PM2.5 exposure to other health conditions such as the development of diabetes mellitus and adverse birth outcomes.2 In many cities, ambient PM2.5 can frequently exceed 35 µg/m³, a level considered unhealthy for sensitive groups by the World Health Organization.3 Indeed, 41% of cities with a minimum population of 50 000 experienced population-weighted annual average PM2.5 concentrations above 35 µg/m³ in 2019.4 There is growing early evidence suggesting that ultrafine particles (UFP, <0.1 µm in aerodynamic diameter) are the most hazardous component of PM2.5, as these can penetrate even deeper into the lungs, are retained longer and enter the bloodstream more readily.5 Moreover, UFPs have a higher surface area per unit mass, allowing them to carry higher amounts of adsorbed materials, resulting in potentially higher toxicity.6 In contrast to ambient …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"73 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145077407","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}