Thorax最新文献

{"title":"Association between asthma and type 2 diabetes in a Swedish adult population: a register-based cross-sectional study","authors":"Mwenya Mubanga, Tong Gong, Awad I Smew, Amanda Wikström, Emma Caffrey Osvald, Katarina Eeg-Olofsson, Christer Janson, Cecilia Lundholm, Catarina Almqvist","doi":"10.1136/thorax-2024-222819","DOIUrl":"https://doi.org/10.1136/thorax-2024-222819","url":null,"abstract":"Objective Asthma and type 2 diabetes are two important causes of morbidity globally. We examined both the association of type 2 diabetes with asthma in Swedish adults and the familial co-aggregation of the diseases. Methods We conducted a cross-sectional study of all adults aged 25–85 in Sweden between 2009 and 2013. Asthma and type 2 diabetes status were ascertained from the health registers. Models were adjusted for sex, age, education level, income and country of birth and in a subset, for body mass index (BMI). We further conducted a familial coaggregation analysis to determine if shared familial factors could explain any observed findings. Results The study included 5 299 245 participants, 25 292 (0.5%) had both asthma and type 2 diabetes. In the total population, the OR for the association between type 2 diabetes and asthma was 1.47 (95% CI 1.45 to 1.49); in the population of men (1.30 (95% CI 1.27 to 1.32)) and women (1.63 (95% CI 1.60 to 1.66)). The ORs were slightly higher among men (1.51 (95% CI 1.45 to 1.56)) and women (2.04 (95% CI 1.96 to 2.11)) for whom BMI measurements were available but attenuated with adjustment for BMI (1.45 (95% CI 1.40 to 1.51)) and (1.76 (95% CI 1.68 to 1.84)). Diabetes was more likely if a full sibling had asthma than if the sibling did not (1.13 (95% CI 1.10 to 1.15)). Conclusions We found an association between asthma and type 2 diabetes that was sustained after adjusting for BMI, indicating that BMI alone does not explain this relationship. We also found that the two conditions coaggregate in siblings, indicating that the association is partly due to shared familial genetic and environmental risk factors. Data are available on reasonable request. Original data are held by Swedish National Board of Health and Welfare and Statistics Sweden. Due to Swedish data storage laws, we cannot make the data publicly available. However, any researcher can access the data by obtaining an ethical approval from the Swedish Ethical Review Authority and thereafter asking the registers for the original data. Pseudonymised data can also be provided from the principal investigator of this study on request after providing a reasonable proposal and if an appropriate data sharing agreement with Karolinska Institutet can be established.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"28 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143677945","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":"Short-term efficacy of inhaled short-acting beta-2-agonists for acute wheeze/asthma symptoms in preschool-aged children: a systematic review and meta-analysis","authors":"Rosa Storgaard Petersen, Henrik Hallas, Nicklas Brustad, Bo Chawes","doi":"10.1136/thorax-2024-222760","DOIUrl":"https://doi.org/10.1136/thorax-2024-222760","url":null,"abstract":"Background Inhaled short-acting β2-agonists (SABA) is recognised as an effective treatment in adults and older children with asthma, but the effect in young children and infants is still up for debate. We examine the efficacy of inhaled SABA for preschool-aged children presenting with acute wheeze/asthma in this systematic review and meta-analysis. Methods PubMed and Embase were searched through August 2024. Clinical trials investigating the effect of inhaled SABA on acute wheeze/asthma symptoms in children below age 6 years were included. The study followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Summary standardised mean differences, 95% CIs and p values were derived from random effects meta-analyses to analyse the effect on clinical composite respiratory score, respiratory rate, oxygen saturation, respiratory work and degree of wheezing. Results A total of 19 studies including 1022 children were included. Treatment with inhaled SABA showed decreased respiratory score within 60 min (10 studies, N=523): standardised mean difference −2.05 points (95% CI −2.50; −1.59), I2=86%, p<0.001, decreased respiratory rate (8 studies, N=319): −0.86 (95% CI −1.30; −0.41), I2=87%, p<0.001, increased oxygen saturation (7 studies, N=190): 0.56 (95% CI 0.16; 0.95), I2=71%, p<0.01, decreased respiratory work (3 studies, N=68): −0.80 (95% CI −1.60; −0.00), I2=74%, p=0.05 and decreased wheezing score (3 studies, N=68): −1.07 (95% CI −1.80; −0.33), I2=72%, p<0.01. Subgroup analyses of children below age 2 years showed similar significant effects for all outcomes. Conclusions Inhaled SABA treatment for acute wheeze/asthma symptoms showed beneficial effects in young children and infants. Findings from this study may provide evidence to support inhaled SABA in future treatment guidelines for acute wheeze/asthma among young children and infants; however, an overall high heterogeneity and small sample size of the studies were a limitation. PROSPERO registration number CRD42023429381. No data are available.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"215 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143677942","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":"Effects of long-term oxygen therapy on acute exacerbation and hospital burden: the national DISCOVERY study","authors":"Yet Hong Khor, Andreas Palm, Alyson W Wong, Sabina A Guler, Filip Björklund, Zainab Ahmadi, Josefin Sundh, Christopher J Ryerson, Magnus Ekström","doi":"10.1136/thorax-2023-221063","DOIUrl":"https://doi.org/10.1136/thorax-2023-221063","url":null,"abstract":"Background Long-term oxygen therapy (LTOT) improves survival in patients with chronic severe resting hypoxaemia, but effects on hospitalisation are unknown. This study evaluated the potential impact of starting LTOT on acute exacerbation and hospital burden in patients with chronic obstructive pulmonary disease (COPD), interstitial lung disease (ILD) and pulmonary hypertension (PH). Methods Longitudinal analysis of consecutive patients in the population-based Swedish DISCOVERY cohort who started LTOT between 2000 and 2018 with a follow-up duration≥3 months. Total and hospitalised acute exacerbations of the underlying disease, all-cause hospitalisations, and all-cause outpatient visits were annualised and compared between the year before and after LTOT initiation for each disease cohort, and by hypercapnic status in patients with COPD. Results Patients with COPD (n=10 134) had significant reduction in annualised rates of total and hospitalised acute exacerbations, as well as all-cause hospitalisations, following LTOT initiation, with increment in those with ILD (n=2507) and PH (n=850). All-cause outpatient visits increased across all cohorts following LTOT initiation. Similar findings were observed in patients with hypercapnic and non-hypercapnic COPD. Sensitivity analyses of patients with 12 months of follow-up showed reduced acute exacerbations and all-cause hospitalisations in the ILD and PH cohorts. Conclusion LTOT is associated with reduced rates of both total and hospitalised acute exacerbations and all-cause hospitalisations in patients with COPD, as well as patients with ILD and PH with 12 months of follow-up. There is increased all-cause outpatient visits in all disease groups following LTOT initiation. Data are available upon reasonable request.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"70 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143666227","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":"Targeting daytime normocapnia with nocturnal NIV in chronic hypercapnic COPD: the new paradigm?","authors":"Sarah Bettina Stanzel, Wolfram Windisch","doi":"10.1136/thorax-2024-222734","DOIUrl":"10.1136/thorax-2024-222734","url":null,"abstract":"","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":"191-192"},"PeriodicalIF":9.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143410856","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":"Home-based pulmonary rehabilitation during outpatient-managed acute COPD exacerbation: the latest new PR model?","authors":"Carolyn L Rochester","doi":"10.1136/thorax-2024-222805","DOIUrl":"10.1136/thorax-2024-222805","url":null,"abstract":"","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":"193-194"},"PeriodicalIF":9.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392005","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":"Complex coexistence of COPD and cardiovascular disease","authors":"Rita Pavasini, Gianluca Campo","doi":"10.1136/thorax-2025-223054","DOIUrl":"https://doi.org/10.1136/thorax-2025-223054","url":null,"abstract":"Cardiovascular disease (CVD) and chronic obstructive pulmonary disease (COPD) are two of the leading causes of morbidity and mortality worldwide, ranking first and third, respectively, among causes of death.1 These two diseases are linked by an important modifiable risk factor: smoking. Data from previous studies indicate that the prevalence of COPD among patients with CVD ranges from 7% to 28%.1 Notably, COPD in patients with CVD has historically been underdiagnosed. In 2009, Soriano et al demonstrated that the prevalence of airflow limitation ranged from 60% in patients with CVD to 87% in those hospitalised with coronary artery disease.2 Supporting this, another study found that among smokers or former smokers hospitalised for acute coronary syndrome and undergoing spirometry, the diagnosis of COPD reached 29%.3 Cho et al analysed a large retrospective, population-based study involving 496 056 patients with a history of CVD (encompassing not only ischaemic heart disease and heart failure but also stroke). In this real-world population, only 16% had a diagnosis of COPD.4 The authors noted that COPD diagnoses were determined by evidence of COPD-related hospital admissions and/or at least three outpatient visits for COPD within 2 years.4 Although this definition is limited by not …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"214 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143653329","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":"Role of inflammasomes in acute respiratory distress syndrome.","authors":"Luke Flower, Emilio G Vozza, Clare E Bryant, Charlotte Summers","doi":"10.1136/thorax-2024-222596","DOIUrl":"10.1136/thorax-2024-222596","url":null,"abstract":"<p><p>Acute respiratory distress syndrome (ARDS) is present in >10% of all people admitted to critical care and is associated with severe morbidity and mortality. Despite more than half a century since its first description, no efficacious pharmacological therapies have been developed, and little progress has been made in improving clinical outcomes. Neutrophils are the principal drivers of ARDS, with their priming and subsequent aberrant downstream functions, including interleukin (IL) 1β and IL-18 secretion, central to the disease pathogenesis. The dominant pathways through which IL-1β and IL-18 are believed to be elaborated are multimeric protein structures called inflammasomes that consist of sensor proteins, adaptor proteins and an effector enzyme. The inflammasome's initial activation depends on one of a variety of damage-associated (DAMP) or pathogen-associated (PAMP) molecular patterns. However, once activated, a common downstream inflammatory pathway is initiated regardless of the specific DAMP or PAMP involved. Several inflammasomes exist in humans. The nucleotide-binding domain leucine-rich repeat (NLR) family, pyrin domain-containing 3 (NLRP3), inflammasome is the best described in the context of ARDS and is known to be activated in both infective and sterile cases. The NLR family, caspase activation and recruitment domain-containing 4 (NLRC4) and absent in melanoma 2 (AIM2) inflammasomes have also been implicated in various ARDS settings, as have inflammasome-independent pathways. Further work is required to understand human biology as much of our knowledge is extrapolated from rodent experimental models. Experimental lung injury models have demonstrated beneficial responses to inflammasome, IL-1β and IL-18 blockade. However, findings have yet to be successfully translated into humans with ARDS, likely due to an underappreciation of the central role of the neutrophil inflammasome. A thorough understanding of inflammasome pathways is vital for critical care clinicians and researchers and for the development of beneficial therapies. In this review, we describe the central role of the inflammasome in the development of ARDS and its potential for immunomodulation, highlighting key areas for future research.</p>","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":"255-263"},"PeriodicalIF":9.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068163","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":"Is NEWS2 the optimal evidence-based surveillance tool for all respiratory patients or does it just represent the beginning of an iterative development process?","authors":"Dominick Shaw, Andrew W Fogarty","doi":"10.1136/thorax-2024-222335","DOIUrl":"10.1136/thorax-2024-222335","url":null,"abstract":"<p><p>Medical practice is built on the foundations of evidence-based medicine. Hence, the more common the clinical intervention, the more comprehensive the evidence on which that intervention should be based. Although the widespread adoption of a national early warning score in the UK has led to improvements in the delivery of care, it should be considered as providing a foundation that can be refined and developed, and there is still a need for critical reflection and evaluation of early warning scores, particularly for individuals with chronic respiratory disease, in order to optimise patient monitoring, predict deterioration and guide intervention.</p>","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":"197-201"},"PeriodicalIF":9.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374767","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: one size does not fit all.","authors":"Narelle S Cox, Anne E Holland","doi":"10.1136/thorax-2024-222680","DOIUrl":"10.1136/thorax-2024-222680","url":null,"abstract":"","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":"189-190"},"PeriodicalIF":9.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123589","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":"Filipa Canedo","doi":"10.1136/thorax-2025-223213","DOIUrl":"https://doi.org/10.1136/thorax-2025-223213","url":null,"abstract":"","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"80 4","pages":"264"},"PeriodicalIF":9.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658686","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}