Thorax最新文献

{"title":"Impact of COPD on cardiovascular risk factors and outcomes in people with established cardiovascular disease","authors":"Eunice Eunae Cho, Laura C Maclagan, Anna Chu, Ruth Croxford, Don D Sin, Jacob A Udell, Douglas Lee, Peter C Austin, Andrea S Gershon","doi":"10.1136/thorax-2023-220991","DOIUrl":"https://doi.org/10.1136/thorax-2023-220991","url":null,"abstract":"Background Little is known about the association between chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD) in people with established CVD. Knowing if COPD is associated with a higher risk of cardiovascular events would guide appropriate secondary prevention. Objective To examine the risk of COPD on major adverse cardiac events (MACEs, acute myocardial infarction, stroke and cardiovascular death) in a complete real-world population of a large province, with known CVD. Methods We conducted a retrospective population cohort study using health administration, medication, laboratory, electronic medical record and other data from Ontario, Canada. All people with a history of CVD with and without physician-diagnosed COPD as of 2008 were followed until 2016 and cardiac risk factors, sociodemographic factors, comorbidities and other factors were compared. Sequential cause-specific hazard models adjusting for these factors determined the risk of MACE in people with COPD. Results Of 496 056 individuals with CVD in Ontario on 1 January 2008, 69 161 (13.9%) had COPD. MACE occurred more frequently among those with CVD (45.3 per 1000 person-years) and COPD compared with those with CVD alone (28.6 per 1000 person-years) (HR 1.24, 95% CI 1.21–1.26) after adjustment for cardiac risk factors, comorbidities, socioeconomic status and other factors. People with COPD were less likely to receive preventive CVD medications or see a cardiologist. Conclusion In a large, real-world population of people with established CVD, COPD was associated with a higher rate of cardiovascular events but a lower rate of preventive therapy. Strategies are needed to improve secondary CVD prevention in the COPD population. Data are available upon reasonable request. The dataset from this study is held securely in coded form at ICES. While legal data sharing agreements between ICES and data providers (eg, healthcare organisations and government) prohibit ICES from making the dataset publicly available, access may be granted to those who meet prespecified criteria for confidential access, available at [www.ices.on.ca/DAS][1] (email: das@ices.on.ca). The full dataset creation plan and underlying analytic code are available from the authors upon request, understanding that the computer programs may rely upon coding templates or macros that are unique to ICES and are therefore either inaccessible or may require modification. [1]: http://www.ices.on.ca/DAS","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"1 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143539209","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":"Improving uptake of lung cancer screening: an observational study on the impact of timed appointments and reminders.","authors":"Amyn Bhamani, Sindhu Bhaarrati Naidu, Tanya Patrick, Lavanya Anandan, Kiran Desai, Fanta Bojang, Priyam Verghese, Paul Robinson, Shivani Patel, Ricky Thakrar, Arjun Nair, Neal Navani, Sam M Janes","doi":"10.1136/thorax-2024-222433","DOIUrl":"10.1136/thorax-2024-222433","url":null,"abstract":"<p><p>Lung cancer screening (LCS) reduces lung cancer-related mortality; however, uptake remains low compared with other cancer screening programmes. In this observational study, we report the impact of timed appointments and reminders on participation in our regional LCS programme.Initial uptake of timed appointments was 53.0% (n=17 274/32 593), higher than previously reported in the UK, while initial uptake of open invitations was 29.8% (n=10 246/34 371). Among initial non-responders, 17.5% (n=4263/24 400) completed triage following a reminder. The increased participation following reminders only partially offset the significant difference in initial uptake between the two appointment types.Timed appointments and reminders are strongly advocated to increase participation in national LCS programmes.</p>","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143415354","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 embolism on endobronchial ultrasound","authors":"Sze Shyang Kho, Swee Kim Chan","doi":"10.1136/thorax-2024-221866","DOIUrl":"https://doi.org/10.1136/thorax-2024-221866","url":null,"abstract":"A 33-year-old ex-smoker, morbidly obese man presented with symptoms of orthopnoea, oedema and blood-tinged sputum. On physical examination, he exhibited signs consistent with acute pulmonary oedema, necessitating oxygen supplementation. He has a history of percutaneous coronary intervention to the left anterior descending coronary artery, performed a few years ago. A clinical diagnosis of congestive heart failure was confirmed after echocardiography showed a left ventricular (LV) ejection fraction of 15%. CT of the thorax performed for blood-tinged sputum showed cardiomegaly and mediastinal lymphadenopathy without suspicious lung lesions. Diuresis was initiated, resulting in symptom improvement, and the patient was discharged without complications. An endobronchial ultrasound (EBUS) performed a month later for investigation of isolated mediastinal lymphadenopathy showed significant regression in lymph node size, with a benign appearance likely related to underlying congestive heart failure. However, on examination at the right hilar region, an intravascular hyperechoic mass was noted within the lumen of the right pulmonary artery ( arrow, figure 1A). The Doppler signal was positive surrounding the mass, raising suspicion of an intravascular thrombus (figure 1B and online supplemental video 1). An urgent CT of the pulmonary artery (CTPA) was arranged, confirming pulmonary embolism (PE) of the right main …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"11 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143518069","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":"Six early CPAP-usage behavioural patterns determine peak CPAP adherence and permit tailored intervention, in patients with obstructive sleep apnoea","authors":"Julia Dielesen, Lesedi J Ledwaba-Chapman, Pragna Kasetti, Noori Fatima Husain, Timothy C Skinner, Martino F Pengo, Teresa Whiteman, Koula Asimakopoulou, Simon Merritt, David Jones, Peter Dickel, Siddiq Pulakal, Neil R Ward, Justin Pepperell, Joerg Steier, S Amanda Sathyapala","doi":"10.1136/thorax-2024-221763","DOIUrl":"https://doi.org/10.1136/thorax-2024-221763","url":null,"abstract":"Background High rates of non-adherence to continuous positive airway pressure (CPAP) in obstructive sleep apnoea hamper good clinical outcomes. Current recommendations assumes two behaviours (adherence and non-adherence) and days 7–90 follow-up post-CPAP initiation mitigates against non-adherence. Objectives To investigate associations between early CPAP-usage behaviours and (1) CPAP adherence at month 3 of treatment and (2) sleep centres’ treatment pathways (the procedures patients undergo that may affect barriers or facilitators of CPAP adherence). Methods We conducted growth mixture modelling (GMM) on retrospective data from 1000 patients at 5 UK sleep centres. Night 1 to month 3 telemonitored CPAP-usage data were downloaded from 200 patients per centre who started CPAP in 2019 (100) or 2020 (100). Adherence was defined using accepted criteria (mean CPAP-usage ≥4 hours/night for ≥70% of nights). Results GMM identified six distinct CPAP-usage behaviour patterns over month 1. In four (54% of patients), CPAP-usage increased or decreased, in two (remaining 46%), CPAP-usage/non-usage was consistent. 62% of the cohort were non-adherent by month 3, despite pathways following current recommendations. 98% of patients who were non-adherent by month 3 were already non-adherent by month 1. Regression analysis with a separate dataset demonstrated that early CPAP-usage behaviour explained 86% of the variance in CPAP non-adherence at month 3. Conclusions These data, supported by previous work, indicate that recommended day 30–90 follow-up is too late to prevent CPAP non-adherence. Determining CPAP-usage behavioural pattern in week 2 identifies risk of CPAP non-adherence at month 3 and permits the possibility of tailored interventions. Data are available on reasonable request.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"35 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143518019","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":"Vasodilator-induced selective pulmonary oedema in sarcoidosis-associated pulmonary hypertension with pulmonary venous stenosis","authors":"Takatoyo Kiko, Akihiro Tsuji, Jin Ueda, Keiko Ohta-Ogo, Takeshi Ogo","doi":"10.1136/thorax-2024-222190","DOIUrl":"https://doi.org/10.1136/thorax-2024-222190","url":null,"abstract":"A 43-year-old woman was diagnosed with sarcoidosis-associated pulmonary hypertension (SAPH) based on transbronchial lymph node and lung biopsy (figure 1A) and right heart catheterisation. Contrast-enhanced CT revealed no signs of pulmonary embolism. Based on the medical history, laboratory examination and imaging modalities, other potential causes of pulmonary hypertension (PH) were excluded. The diffusion capacity of carbon monoxide was 81% of the predicted value; arterial haemoglobin oxygen saturation was 92% on room air. First, she was prescribed prednisolone (15 mg daily) for 6 months, after which a phosphodiesterase type 5 inhibitor (tadalafil; 40 mg daily) was initiated. Despite treatment, her PH persisted, exhibiting a mean pulmonary artery pressure, 39 mm Hg; cardiac index, 1.9 L/min/m2; pulmonary artery wedge pressure, 4 mm Hg; and pulmonary vascular resistance, 13.0 Wood units. Consequently, an endothelin receptor antagonist (macitentan; 10 mg daily), was added to her regimen. After 4 days of macitentan initiation, her shortness of breath worsened with increased body weight, leading to heart failure. Chest radiography (figure 2A) and CT (figure 2B) revealed selective pulmonary oedema. Contrast-enhanced CT showed pulmonary venous stenosis due to sarcoidosis lesions (figure 2C). Pulmonary angiography confirmed severely localised pulmonary venous stenosis and occlusion (figure …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"30 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143518018","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":"Preserved ratio impaired spirometry (PRISm): prognostic, preventable and treatable?","authors":"Guy G Brusselle, Sebastian G Riemann","doi":"10.1136/thorax-2024-222923","DOIUrl":"https://doi.org/10.1136/thorax-2024-222923","url":null,"abstract":"Spirometry is a crucial lung function test, which is primarily aimed at identifying airway obstruction in subjects with chronic symptoms of shortness of breath or cough. An obstructive pattern is defined as an impaired ratio of forced expiratory volume in 1 s (FEV1) to forced vital capacity (FVC) (ie, FEV1/FVC less than the lower limit of normal (LLN)) (figure 1). It may be caused by asthma and/or chronic obstructive pulmonary disease (COPD) and warrants further testing including bronchodilator responsiveness. Spirometry is essential for diagnosing asthma and COPD, but also for monitoring the course of these highly prevalent chronic airway diseases, including the response to treatment, the level of short-term asthma control and the occurrence of long-term clinical remission. However, there is a second spirometric pattern which is important to discern in clinical practice: preserved ratio impaired spirometry (PRISm), defined as a preserved FEV1/FVC ratio but impaired FEV1 (ie, FEV1 less than 80% predicted). Only recently, PRISm has attracted more attention. Figure 1 The main spirometric patterns encompass an obstructive pattern, a normal spirometry and preserved ratio impaired spirometry (PRISm). BMI, body mass index; COPD, chronic obstructive pulmonary disease; FEV1, forced expiratory volume in 1 s; FVC, forced vital capacity; HDL, high-density lipoprotein; LE8: Life’s Essential 8; LLN, lower limit of normal. PRISm, affecting approximately 6%–18% of the adult general population and elicited by multiple conditions, is associated with …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"50 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143462610","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":"Natalie McLeod","doi":"10.1136/thorax-2025-223055","DOIUrl":"https://doi.org/10.1136/thorax-2025-223055","url":null,"abstract":"","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"80 3","pages":"188"},"PeriodicalIF":9.0,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442151","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":"Extracellular vesicles offer enticing opportunities to target and treat lung inflammation.","authors":"Sally Yunsun Kim","doi":"10.1136/thorax-2024-222696","DOIUrl":"10.1136/thorax-2024-222696","url":null,"abstract":"","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":"127-128"},"PeriodicalIF":9.0,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123578","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":"Accumulating evidence supports advanced bronchoscopy as a modality of choice for difficult-to-reach peripheral lung nodules, but questions remain.","authors":"Rafael Paez, Fabien Maldonado","doi":"10.1136/thorax-2024-222922","DOIUrl":"10.1136/thorax-2024-222922","url":null,"abstract":"","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":"131-132"},"PeriodicalIF":9.0,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374718","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":"Pneumothorax and antibiotic use: a clue to aetiology of primary spontaneous pneumothorax?","authors":"Rob Hallifax","doi":"10.1136/thorax-2024-222542","DOIUrl":"10.1136/thorax-2024-222542","url":null,"abstract":"","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":"129-130"},"PeriodicalIF":9.0,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143410735","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}