Thorax最新文献

{"title":"Lung adenocarcinoma with multiple cavitary lung lesions","authors":"Tomohiro Bando, Wataru Koike, Kazuko Watanabe, Tadayoshi Hirano, Yumiko Sasaki","doi":"10.1136/thorax-2024-222221","DOIUrl":"https://doi.org/10.1136/thorax-2024-222221","url":null,"abstract":"A 68-year-old Asian woman was referred to our department because of an abnormal chest X-ray showing multiple patchy consolidative nodules and cavitary lesions, suggestive of a wide range of differential diagnoses, including infection, metastatic tumour, connective tissue disease and vasculitis. The patient had no relevant medical, medication or smoking histories. Chest CT revealed multiple diffuse, thick-walled, cavitary lung lesions with nodules and surrounding consolidation in both lung fields (figure 1, upper row). The laboratory findings revealed white blood cell, 8000/µL (Neu, 69.2%; Lym, 22.2%; Mono, 7.0%); C-reactive protein, 3.59 mg/dL; lactate dehydrogenase, 177 U/L; Beta-D-Glucan, <5 pg/mL; Aspergillus antigen, (−); perinuclear/cytoplasmic antineutrophil cytoplasmic antibody, (−); and interferon-gamma release assay for tuberculosis, (−). The only tumour marker significantly elevated was carbohydrate antigen 19–9 (CA19-9; 1072.7 U/mL; reference range: 0–37 U/mL). The bilateral cavitary lesions and laboratory findings suggested metastasis of an intra-abdominal cancer such as pancreatic cancer. However, contrast-enhanced abdominopelvic CT and whole-body positron emission tomography (PET-CT) revealed no evidence of abdominal, retroperitoneal or gynaecological tumours (figure 1, right). Transbronchial lung biopsy from right segment 6, the largest, most accessible lesion with intense uptake on PET-CT, revealed a lung adenocarcinoma (Napsin A positive; thyroid transcription factor 1 negative) with …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"94 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143805839","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":"Incidence and prevalence of asthma, chronic obstructive pulmonary disease and interstitial lung disease between 2004 and 2023: harmonised analyses of longitudinal cohorts across England, Wales, South-East Scotland and Northern Ireland","authors":"Hannah Whittaker, Adriana Kramer Fiala Machado, Sara Hatam, Sarah Cook, Sean Scully, Hywel Turner T Evans, Thomas Bolton, Constantinos Kallis, John Busby, Liam G Heaney, Aziz Sheikh, Jennifer K Quint","doi":"10.1136/thorax-2024-222699","DOIUrl":"https://doi.org/10.1136/thorax-2024-222699","url":null,"abstract":"Background We describe the epidemiology of asthma, chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD) from 2004 to 2023 in England, Wales, Scotland and Northern Ireland (NI) using a harmonised approach. Methods Data from the National Health Service England (NHSE), Clinical Practice Research Datalink Aurum in England, Secure Anonymised Information Linkage Databank in Wales, DataLoch in South-East Scotland and the Honest Broker Service in NI were used. A harmonised approach to COPD, asthma and ILD case definitions, study designs and study populations across the four nations was performed. Age-sex-standardised incidence rates and point prevalence were calculated between 2004 and 2023 depending on data availability. Logistic and negative binomial regression compared incidence and prevalence rates between the start and end of each study period. Linear extrapolation projected incidence rates between 2020 and 2023 to illustrate how observed and projected rates differed. Results Incidence rates were lower in 2019 versus 2005 for asthma (England: incidence rate ratio 0.89, 95% CI 0.88 to 0.90; Wales: 0.66, 0.65 to 0.68; Scotland: 0.67, 0.64 to 0.71; NI: 0.84, 0.81 to 0.86), COPD (England: 0.83, 0.82 to 0.85; Wales: 0.67, 0.65 to 0.69) and higher for ILD (England: 3.27, 3.05 to 3.50; Wales: 1.39, 1.27 to 1.53; Scotland: 1.63, 1.36 to 1.95; NI: 3.03, 2.47 to 3.72). In NHSE, the incidence of asthma was similar in June 2023 versus November 2019, but lower for COPD and higher for ILD. Prevalence of asthma in 2019 in England, Wales, Scotland and NI was 9.7%, 15.9%, 13.2% and 7.0%, respectively, for COPD 4.5%, 5.1%, 4.4% and 3.0%, and for ILD 0.4%, 0.5%, 0.6% and 0.3%. Projected incidence rates were 2.8, 3.4 and 1.8 times lower for asthma, COPD and ILD compared with observed rates at the height of the pandemic. Interpretation Asthma, COPD and ILD affect over 10 million people across the four nations, and a substantial number of diagnoses were missed during the pandemic. All data relevant to the study are included in the article or uploaded as supplementary information. The data used in this study are available in NHS England’s Secure Data Environment (SDE) service for England, but as restrictions apply, they are not publicly available (&lt;https://digital.nhs.uk/coronavirus/coronavirus-data-services-updates/trusted-research-environment-service-for-england&gt;; &lt;https://digital.nhs.uk/services/secure-data-environment-service&gt;). The CVD-COVID-UK/COVID-IMPACT programme led by the BHF Data Science Centre (&lt;https://bhfdatasciencecentre.org/&gt;; &lt;https://www.hdruk.ac.uk/helping-with-health-data/bhf-data-science-centre/&gt;) received approval to access data in NHS England’s SDE service for England from the Independent Group Advising on the Release of Data (IGARD) (&lt;https://digital.nhs.uk/about-nhs-digital/corporate-information-and-documents/independent-group-advising-on-the-release-of-data&gt;) via an application made in the Data Access Request Service ","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"242 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143805841","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":"Forty-five-year-old man with small nodular and ground-glass opacities on CT","authors":"Jiping Liao, Xiaoquan Chen, Guichuan Qiu, Zhuoma Nima, Yan Xiong, Zhuoga Pubu, Deji Suolang, Meilang ChuTso","doi":"10.1136/thorax-2024-222806","DOIUrl":"https://doi.org/10.1136/thorax-2024-222806","url":null,"abstract":"We present the case of a 45-year-old man who reported 2 years of cough and expectoration and 1 year of dyspnoea. He had a history of dry nasal snuff inhalation 15 times/day for 10 years, worked as a herdsman with an unremarkable medical history and lived in a high-altitude region (altitude, 4700 m). His oxygen saturation was 86% on room air (altitude, 3650 m). The laboratory results were normal except those for polycythaemia (haemoglobin, 209 g/L) and hyperglobulinaemia (immunoglobulin G, 20.71 g/L), the antinuclear antibody (ANA) was 1:100, and lymphocytes and calcium levels were normal. Spirometry results were within normal limits with forced expiratory volume in one second (FEV1) of 82%, forced vital capacity (FVC) of 84%, total lung capacity (TLC) of 80% and diffusion capacity of the lung for carbon monoxide (DLCO) of 93% predicted values. His chest CT revealed small solid nodules in the upper lobes, diffuse bilateral ground-glass opacities (GGOs) …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"14 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143805840","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":"Sex differences in COPD in relation to smoking exposure: a population-based cohort study","authors":"Yunus Çolak, Børge G Nordestgaard, Peter Lange, Shoaib Afzal","doi":"10.1136/thorax-2024-222682","DOIUrl":"https://doi.org/10.1136/thorax-2024-222682","url":null,"abstract":"Background Sex discrepancies in the association between smoking and development and prognosis of chronic obstructive pulmonary disease (COPD) are controversial. We tested the hypothesis that females compared with males are more susceptible to the detrimental effects of smoking in relation to COPD. Methods We identified 47 231 males and 57 806 females from the Copenhagen General Population Study. Smoking amount was assessed with sex interaction against COPD-related outcomes, including the cross-sectional association with airway obstruction, chronic bronchitis and dyspnoea, assessed using logistic regression analyses, and longitudinal association with exacerbation and mortality, assessed using Cox proportional hazard regression adjusted for potential confounders. Results The increase in risk of airway obstruction (N=7367), chronic bronchitis (N=9206) and dyspnoea (N=8541) with higher smoking amount was greater in females compared with males. During 15 years’ follow-up (median 9.3 years), the increase in risk of exacerbation (events=2756), respiratory mortality (events=711) and all-cause mortality (events=10 658) with higher smoking was greater for females compared with males. Compared with never-smokers, adjusted HRs for exacerbation increased from 4.64 (95% CI 2.83 to 7.61) in females with 10 pack-years to 41.6 (95% CI 28.8 to 60.2) in females with ≥50 pack-years, and from 2.21 (95% CI 0.92 to 5.32) in males with 10 pack-years to 23.7 (95% CI 12.9 to 43.5) in males with ≥50 pack-years. Corresponding HR increases for respiratory mortality were 2.04 (95% CI 1.27 to 3.26) to 11.1 (95% CI 7.39 to 16.8) in females and 1.09 (95% CI 0.62 to 1.92) to 5.66 (95% CI 3.96 to 8.11) in males, and for all-cause mortality, HR increases were 1.50 (95% CI 1.34 to 1.67) to 3.53 (95% CI 3.11 to 4.00) in females and 1.62 (1.45–1.81) to 2.94 (2.69–3.21) in males, respectively. Conclusions Females seem more susceptible to the detrimental effects of smoking in development and prognosis of COPD compared with males. Data are available upon reasonable request. Data are available on reasonable request. Data access for further analyses is possible through direct collaborative agreement or through locally managed access arranged through the study’s principal investigators.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"59 5 1","pages":"thorax-2024-222682"},"PeriodicalIF":10.0,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143782571","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":"Real-world telemonitoring and remote support for home non-invasive ventilation to improve therapy effectiveness: the exploratory, multicentre randomised eVENT study","authors":"Arnaud Prigent, Joëlle B Texereau, Claude Schmitz, Cécile Ropars, Jean-Marc Degreef, Marion Teulier, Christian Darne, Franck Lavergne, Hélène Pasche, Capucine Morelot-Panzini","doi":"10.1136/thorax-2024-222033","DOIUrl":"https://doi.org/10.1136/thorax-2024-222033","url":null,"abstract":"Rationale Telemonitoring has shown benefits during the initiation of home non-invasive ventilation (NIV) but evidence is lacking regarding its use during follow-up. A French national telemonitoring programme incorporating remote support and therapeutic education is designed to improve patient pathways and reduce healthcare resource utilisation. This study investigated the impact of the telemonitoring programme versus usual follow-up on the effectiveness of home NIV. Methods The prospective, multicentre, open-label eVENT trial enrolled adults recently started on home NIV. Participants were randomised to the telemonitoring or usual follow-up group. In the telemonitoring group, a CE-marked algorithm generated alerts based on teletransmitted ventilator data. Specialised nurses managed alerts and provided therapeutic education. The primary outcome was mean nocturnal transcutaneous carbon dioxide level (PtCO2) on NIV after 6 months. Results 56 patients were randomised and 53 were analysed (telemonitoring: n=27, usual follow-up: n=26). At 6 months, mean PtCO2 did not differ significantly between the telemonitoring and usual follow-up groups (42.1±6.1 vs 43.9±6.4 mm Hg; p=0.352) but mean room air partial arterial carbon dioxide pressure (PaCO2) was significantly lower in the telemonitoring versus usual follow-up group (41.7±6.8 vs 46.2±3.5 mm Hg; p=0.003). The proportion of participants without diurnal or nocturnal hypercapnia at 6 months was 82.6% with telemonitoring and 27.3% with usual follow-up (p<0.001). Compared with usual follow-up, the telemonitoring group had greater NIV use, more days with NIV usage ≥4 hour and less non-intentional leaks. Conclusions In patients on home NIV, PtCO2 was similar with telemonitoring and usual follow-up, but PaCO2 levels and the quality of ventilatory support were significantly better with telemonitoring. Trial registration number [NCT04615078][1]. No data are available. The data are not publicly available due to privacy or ethical restrictions. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT04615078&atom=%2Fthoraxjnl%2Fearly%2F2025%2F04%2F01%2Fthorax-2024-222033.atom","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"107 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143758632","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":"Ambient formaldehyde combined with high temperature exposure and respiratory disease admissions among children: a time-series study across multiple cities","authors":"Yuting Cheng, Mingzhi Zhang, Hao Zheng, Qiurun Yu, Hongcheng Wei, Ruibin Xue, Shanshan Wang, Bo Hang, Atsuko Ikeda, Yuming Guo, Yankai Xia","doi":"10.1136/thorax-2024-222709","DOIUrl":"https://doi.org/10.1136/thorax-2024-222709","url":null,"abstract":"Introduction Ambient formaldehyde (HCHO) is globally distributed, posing significant exposure to vast populations, particularly vulnerable demographics such as children. Investigations into the correlation between ambient HCHO exposure and children’s respiratory ailments are deficient. Methods Ambient HCHO exposure was retrieved from the TROPOspheric Monitoring Instrument. A two-stage time-series analysis was conducted to examine the relationship between HCHO exposure and hospital admission of respiratory diseases among 198 704 children in Jiangsu Province, China, from 2019 to 2021. Additionally, 12 exposure patterns were defined to further discern potential synergistic effects of HCHO and high temperature combined exposure. Results After controlling for relevant covariates, our findings revealed HCHO exposure was associated with respiratory-related hospital admissions. Specifically, we identified a pronounced effect at lag 3 day, demonstrating a 1.14% increase (95% CI: 0.60%, 1.69%). Subgroup analyses further identified that warm season, 3–7 years old group and disadvantaged economic areas showed higher admission risk. Moreover, we found HCHO combined with high temperature exposure would trigger the elevated risk of hospital admission. Notably, in specific exposure scenarios, the cumulative relative risk reached up to 1.051 (95% CI: 1.025, 1.078), highlighting the synergistic effect of combined exposure on the respiratory health of children. Conclusions Ambient HCHO exposure increased hospital admission risks for respiratory diseases in children, and high temperature could trigger the elevated risk. To have an in-depth understanding of ambient HCHO health impact is critical for intervention strategies aimed at mitigating ambient HCHO pollution and regarding adverse impacts on children under a changing climate. Data are available upon reasonable request.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"103 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143745080","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":"Occlusive primary endobronchial amyloid tumour: a rare case","authors":"Joseph Michael Curran, Daniel Steinfort, Belinda Liu","doi":"10.1136/thorax-2023-221189","DOIUrl":"https://doi.org/10.1136/thorax-2023-221189","url":null,"abstract":"A female aged 69 year never smoker presented with 4 months of non-resolving productive cough and shortness of breath on exertion following mild COVID-19 infection. Her background history was significant for tuberculosis infection in 1996, for which she completed a full course of treatment. An initial CT scan of the chest found bulky left hilar and mediastinal lymphadenopathy with heterogeneous calcification. A subsequent fluorodeoxyglucose-positron emission tomography CT demonstrated intense metabolic activity in these lymph nodes. Further CT chest with contrast (figure 1a, c) showed interval development of new left upper lobe collapse with stable lymphadenopathy. Lung function was within normal limits. Bronchoscopic examination demonstrated a large obstructing mass in the left upper lobe bronchus (figure 2a), with subtotal occlusion of the left lower lobe bronchus (figure …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"25 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143723197","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":"Computational fluid dynamics model predictions of inhaled corticosteroid deposition in patients with severe asthma","authors":"Nandhitha Ragunayakam, Ashutosh Thakar, Hosein Sadafi, Carmen Venegas Garrido, Yonni Friedlander, Melanie Kjarsgaard, Kayla Zhang, Anna Dvorkin-Gheva, Manali Mukherjee, Myrna B Dolovich, Ben R Lavon, Mark Inman, Parameswaran Nair, Sarah Svenningsen","doi":"10.1136/thorax-2024-222444","DOIUrl":"https://doi.org/10.1136/thorax-2024-222444","url":null,"abstract":"Background Some patients with severe asthma have persistent type-2 inflammation despite being treated with high-dose inhaled corticosteroids (ICS). The variability in ICS deposition between patients with severe asthma is not well-understood and could contribute to this persistence. Objectives To characterise and compare model-predicted deposition of fine-particle and extrafine-particle ICS in patients with severe asthma based on biomarkers of type-2 inflammation, airway morphology and airway function. Methods Twenty-eight patients with severe asthma performed full-inspiration and full-expiration chest CT on the same day that biomarkers of type-2 inflammation were measured. Functional respiratory imaging and computational fluid dynamics were used to simulate and predict intrathoracic, central and peripheral airway deposition, and central-to-peripheral airway deposition (C:P) ratio of fine-particle ICS (fluticasone-propionate HFA) (ICSFP) and extrafine-particle ICS (beclomethasone-dipropionate HFA) (ICSEFP). CT-derived wall area percent (WA%), lumen area (LA) and mucus burden were quantified to characterise airway morphology. Results Simulated deposition of ICSEFP was higher than ICSFP in the intrathoracic, central and peripheral airways (all p<0.0001). Greater WA% and smaller LA were correlated with greater C:P ratio of ICSFP (r=0.60, p=0.0068; r=−0.60, p=0.0072) and ICSEFP (r=0.54, p=0.028; r=−0.54, p=0.026). Participants with elevated sputum eosinophils had a greater C:P ratio, irrespective of particle size (ICSFP, p=0.045; ICSEFP, p=0.021). Conclusions In severe asthma patients with thicker airway walls, narrower airway lumens and elevated biomarkers of type-2 inflammation, a smaller ratio of ICSFP reached the peripheral airways. ICSEFP did not fully mitigate this. Patient-specific airway morphology may impact regional ICS deposition and contribute to persistent inflammation. Data are available upon reasonable request.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"183 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143723198","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":"Inhaled corticosteroids may be useful in bronchiectasis with peripheral blood eosinophilia","authors":"Cassandra Thompson, Peter G Middleton","doi":"10.1136/thorax-2025-223053","DOIUrl":"https://doi.org/10.1136/thorax-2025-223053","url":null,"abstract":"Bronchiectasis, a clinical syndrome of recurrent cough and sputum production, can be diagnosed when high-resolution CT (HRCT) scans show pathological airway enlargement. Obstructive airway diseases, including asthma and chronic obstructive pulmonary disease (COPD), are diagnosed by the presence of obstructive spirometry with a ratio of forced expiratory volume in 1 s (FEV1) over forced vital capacity (FVC) of <0.7 or the lower limit of normal. People with both obstructive spirometry and HRCT changes are then given the diagnosis of bronchiectasis+asthma overlap or bronchiectasis+COPD overlap. While inhaled corticosteroids (ICS) are the mainstay of treatment for asthma1 and are recommended for use in people with COPD who have frequent exacerbations,2 there is still limited evidence concerning the use of ICS in people with bronchiectasis without asthma or COPD.3 Previous population-based surveys have found that people with bronchiectasis who are prescribed ICS have an increased risk of exacerbations and hospitalisations, with a trend towards increased mortality.4 Thus, the recent European Respiratory Society guidelines for bronchiectasis management recommend against the indiscriminate use of ICS in those with bronchiectasis who do not have asthma or …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"71 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143677944","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":"Use of inhaled corticosteroids in bronchiectasis: data from the European Bronchiectasis Registry (EMBARC)","authors":"Jennifer Pollock, Eva Polverino, Raja Dhar, Katerina Dimakou, Letizia Traversi, Apostolos Bossios, Charles Haworth, Michael R Loebinger, Anthony De Soyza, Montserrat Vendrell, Pierre Regis Burgel, Pontus Mertsch, Melissa Jane McDonnell, Sabina Skgrat, Luis Maiz-Carro, Oriol Sibila, Menno van der Eerden, Paula Kauppi, Adam T Hill, Robert Wilson, Branislava Milenkovic, Rosario Menéndez, Marlene Murris, Megan L Crichton, Sermin Borecki, Dusanka Obradovic, Muhammed Irfan, Venera Eshenkulova, Adam Nowinski, Adelina Amorim, Antoni Torres, Natalie Lorent, Tobias Welte, Francesco Blasi, Eva Van Braeckel, Josje Altenburg, Michal Shteinberg, Wim Boersma, Joseph Stuart Elborn, Stefano Aliberti, Felix C Ringshausen, Pieter Goeminne, James D Chalmers","doi":"10.1136/thorax-2024-221825","DOIUrl":"https://doi.org/10.1136/thorax-2024-221825","url":null,"abstract":"Introduction Current bronchiectasis guidelines advise against the use of inhaled corticosteroids (ICS) except in patients with associated asthma, allergic bronchopulmonary aspergillosis (ABPA) and/or chronic obstructive pulmonary disease (COPD). This study aimed to describe the use of ICS in patients with bronchiectasis across Europe. Methods Patients with bronchiectasis were enrolled into the European Bronchiectasis Registry from 2015 to 2022. Patients were grouped into ICS users and non-users at baseline and clinical characteristics associated with ICS use were investigated. Patients were followed up for clinical outcomes of exacerbation, hospitalisation and mortality for up to 5 years. We evaluated if elevated blood eosinophil counts (above the laboratory upper limit of normal) modified the effect of ICS on exacerbations. Results 19 324 patients were included for analysis and 10 109 (52.3%) were recorded as being prescribed ICS at baseline. After exclusion of patients with a history of asthma, COPD and/or ABPA, 3174/9715 (32.7%) patients with bronchiectasis were prescribed ICS. Frequency of ICS use varied across countries, ranging from 17% to 85% of included patients. ICS users had more severe disease, with significantly worse lung function, higher Bronchiectasis Severity Index scores and more frequent exacerbations at baseline (p<0.0001). Overall, ICS users did not have a reduced risk of exacerbation or hospitalisation during follow-up, but a significant reduction in exacerbation frequency was observed in the subgroup of ICS users with elevated blood eosinophil counts (relative risk 0.70, 95% CI 0.59 to 0.84, p<0.001). Conclusion ICS use is common in bronchiectasis, including in those not currently recommended ICS according to bronchiectasis guidelines. ICS use may be associated with reduced exacerbation frequency in patients with elevated blood eosinophils. Data are available on reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"57 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143677941","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}