Thorax最新文献

{"title":"Congenital bronchial atresia","authors":"Akshaya Moorthy, Amanpreet Kaur, Aneri H Parekh, Manoj Kumar Panigrahi","doi":"10.1136/thorax-2025-223763","DOIUrl":"https://doi.org/10.1136/thorax-2025-223763","url":null,"abstract":"A 36-year-old woman presented with complaints of diffuse chest pain persisting for one and a half years. A chest radiograph 6 months prior to this visit showed a smoothly marginated, homogenous opacity silhouetting the right cardiac border (figure 1A). She received a course of antibiotics for suspected pneumonia; however, her symptoms persisted. 2 weeks later, a CT scan of the thorax showed a well-defined soft tissue density lesion of size 4.1×3.3 cm in the medial segment of the right middle lobe with punctate calcifications (figure 1B) and a normal lung parenchyma (figure 1C). She received another course of antibiotics prescribed by her physician. Figure 1 (A) Initial chest radiograph showing a radiopacity with a smooth margin silhouetting the right cardiac border (arrows). (B) Axial CT scan mediastinal window showing the lesion with punctate calcification. (C) Coronal image in lung window showing the well-defined, rounded lesion abutting the right cardiac border. (D) …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"1 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145077409","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":"IgG4-related disease with central airway involvement diagnosed by cryobiopsy","authors":"Kohei Minekawa, Kentaro Tamura, Motoki Kawai, Hiromichi Hara, Jun Araya","doi":"10.1136/thorax-2025-223727","DOIUrl":"https://doi.org/10.1136/thorax-2025-223727","url":null,"abstract":"A 70-year-old woman, previously treated with triple-inhalation therapy for bronchial asthma, presented to an ophthalmologist with diplopia. She had no history of smoking. MRI revealed an enlarged infraorbital nerve and nodular lesions in the lacrimal gland. Serum IgG4 levels were markedly elevated at 2158 mg/dL. Whole-body CT demonstrated thickened tracheal and bronchial walls, accompanied by multiple localised nodules in both bronchi (figure 1a,b). In addition, swelling of bilateral submandibular glands and pancreatic enlargement were observed. 18F-fluorodeoxyglucose positron emission tomography CT showed increased fluorodeoxyglucose uptake in the enlarged lesions, including the bronchial walls (figure 1c). White-light bronchoscopy (1T260, Olympus) revealed diffuse oedematous narrowing of the trachea and segmental bronchi, with numerous localised elevated nodules (figure 1d–f). Transbronchial biopsy (TBB) was performed using 1.9 mm forceps (FB-231-D, Olympus), and cryobiopsy was concomitantly performed using a 1.7 mm cryoprobe (20 402–410, Erbe Elektromedizin GmbH) targeting elevated nodular lesions. TBB specimens were small and exhibited significant crush artefacts, hindering assessment of inflammatory cell infiltrates (figure 2a, right). In contrast, cryobiopsy specimens were larger, with minimal crush artefacts, and demonstrated subepithelial infiltration of plasma cells and lymphocytes, along with fibrotic …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"51 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145077410","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":"Enhancing home oxygen therapy: automation to facilitate ambulation","authors":"Richard D Branson","doi":"10.1136/thorax-2025-223695","DOIUrl":"https://doi.org/10.1136/thorax-2025-223695","url":null,"abstract":"Long-term oxygen therapy (LTOT) is provided in the home for patients with chronic obstructive pulmonary disease (COPD) who present with resting hypoxaemia (SpO2 <88%, PaO2 <60 mm Hg (8 kPa)). In the USA, LTOT is provided to approximately 1.5 million adults at an annual cost of ~$2 billion.1 The evidence base for LTOT remains two landmark studies from four decades ago, demonstrating an apparent dose–response relationship between the daily duration of therapy and mortality.2 3 LTOT is commonly referred to as ‘home’ oxygen therapy which belies the fact that while the modality is provided in the home, the intent is to allow subjects mobility, a return to a more active life and travel outside the home.4 Patients express a desire to be mobile and participate in activities of daily living (ADL).5 Activities, however, are often limited by fatigue, hypoxaemia and dyspnoea. In addition, portable oxygen systems may limit activity owing to insufficient flow, short duration of supply, constant output and portability.4 5 The goals of increased ambulation, however, have to be balanced against the findings that LTOT for moderate exertional hypoxaemia fails to impart a mortality or other patient-important benefit.6 In this issue …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"18 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145077408","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":"Cytisinicline for smoking cessation in individuals with self-reported COPD: a post hoc analysis of the ORCA-2 and ORCA-3 trials","authors":"Judith Prochaska, Mark Rubinstein, Renee Perdok, Brent Blumenstein, Cindy Jacobs","doi":"10.1136/thorax-2025-223880","DOIUrl":"https://doi.org/10.1136/thorax-2025-223880","url":null,"abstract":"Importance Quitting smoking is essential for stabilising and improving respiratory function in people with chronic obstructive pulmonary disease (COPD). Objective To evaluate the efficacy and safety of cytisinicline versus placebo for cessation among smokers with and without COPD. Methods This post hoc analysis used combined data from the phase 3 ORCA-2 (Ongoing Research of Cytisinicline for Addiction) and ORCA-3 double-blind, placebo-controlled trials. Participants received 6 or 12 weeks of cytisinicline or placebo. Of 1602 participants, 145 (9.3%) self-reported COPD. Interventions Participants received 3 mg of cytisinicline three times daily (6 weeks: n=532; 12 weeks: n=534) or placebo (12 weeks: n=536), plus behavioural support. Outcome Biochemically verified continuous smoking abstinence during the last 4 treatment weeks. Results COPD participants were older, smoked longer and had greater nicotine dependence. Cytisinicline was associated with significantly higher smoking abstinence compared with placebo in both COPD and non-COPD subgroups. There was no statistical evidence of heterogeneity in treatment effect between arms. In the 6-week arm, quit estimates were 17.3% versus 2.1% (OR 9.7, p=0.03) for COPD and 19.3% versus 5.5% (OR 4.1, p<0.0001) for non-COPD. In the 12-week arm, quit estimates were 19.1% versus 4.3% (OR 5.3, p=0.04) for COPD and 32.6% versus 8.6% (OR 5.2, p<0.0001) for non-COPD. Cytisinicline was well tolerated with no serious treatment-related events. Conclusion Cytisinicline significantly increased quitting for smokers with and without COPD and was well tolerated. The findings support cytisinicline as a viable treatment for smokers with COPD who want to quit. Trial registration number ORCA-2 ([NCT04576949][1]) and ORCA-3 ([NCT05206370][2]). No data are available. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT04576949&atom=%2Fthoraxjnl%2Fearly%2F2025%2F09%2F17%2Fthorax-2025-223880.atom [2]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT05206370&atom=%2Fthoraxjnl%2Fearly%2F2025%2F09%2F17%2Fthorax-2025-223880.atom","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"1 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145078029","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":"Acute breathlessness as a cause of hospitalisation in Malawi: a prospective, patient-centred study to evaluate causes and outcomes","authors":"Stephen A Spencer, Florence Malowa, David McCarty, Elizabeth Joekes, Jacob Phulusa, Beatrice Chinoko, Sylvester Kaimba, Lucy Keyala, Peter Mandala, Mercy Mkandawire, Albert Mukatipa, Mulinda Nyirenda, Hendry R Sawe, Sarah A White, Marc Y R Henrion, Daniel X Augustine, David Oxborough, Eve Worrall, Felix Limbani, Paul Dark, Jamie Rylance, Stephen B Gordon, Ben Morton","doi":"10.1136/thorax-2025-223623","DOIUrl":"https://doi.org/10.1136/thorax-2025-223623","url":null,"abstract":"Introduction Breathlessness is a common cause of hospital admission globally and is associated with high mortality, particularly in low-income countries. In sub-Saharan Africa, there is a paucity of data on breathlessness, with existing data focused on individual diseases. There is a need for patient-centred approaches to understand interactions between multiple conditions to address population needs and inform health system responses. This multicentre prospective study in Malawi aimed to characterise the aetiologies, outcomes and biomarker accuracy for breathless patients. Methods Adults (aged ≥18 years) admitted to medical wards were consecutively recruited within 24 hours of hospital presentation and followed up for 1 year. Participants with breathlessness (defined as a composite of patient-reported shortness of breath; tachypnoea (respiratory rate ≥25/min); hypoxaemia (SpO2 <94%) or treatment with oxygen) were systematically screened against internationally accepted diagnostic criteria. We estimated disease prevalence, survival, health-related quality of life and functional status. We also evaluated diagnostic accuracy of natriuretic peptides for heart failure, and procalcitonin (PCT) and C reactive peptide (CRP) for pneumonia. Results Of 751 participants, 44% (n=334) had breathlessness, and 316 underwent enhanced diagnostic screening. One-year mortality was higher in breathless patients (51% (157/307)) than those without (26% (100/385)); adjusted HR 1.8 (95% CI 1.4 to 2.3). We identified high prevalence and mortality of heart failure (35% (112/316) prevalence; 69% (75/109) 1-year mortality), anaemia (40% (126/316); 57% (70/122)), pneumonia (41% (131/316); 53% (68/129)) and tuberculosis (29% (91/316); 47% (41/87)). Most participants (63% (199/316)) had multiple conditions. Diagnostic accuracy (area under the curve) for heart failure was 0.89 (brain natriuretic peptide) and 0.88 (N-terminal pro-B-type natriuretic peptide); for pneumonia, CRP was 0.77 and PCT was 0.69. Discussion Breathlessness-related hospital admissions in Malawi are common, multifactorial and associated with poor survival. This study demonstrates that co-existing conditions are common, highlighting the limitation of single-disease-focused health system responses. Integrated care pathways with context-sensitive diagnostic and treatment approaches are urgently needed to improve survival. Data are available on reasonable request. An anonymised study dataset can be shared within Malawi in line with local data sharing policies. Requests for data sharing outside Malawi can be presented to the MultiLink management committee via our programme manager, Amy Smith (Amy.Smith{at}lstmed.ac.uk).","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"42 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145031822","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 effectiveness and safety of nirsevimab, RSV maternal vaccine and RSV vaccines for older adults: a living systematic review and meta-analysis","authors":"Bohee Lee, Daira Trusinska, Sohail Ferdous, Ruonan Pei, Harley H Y Kwok, Jürgen Schwarze, Thomas Christie Williams, Cheryl Gibbons, Jennifer K Quint, Aziz Sheikh, Simon B Drysdale, Ting Shi","doi":"10.1136/thorax-2025-223376","DOIUrl":"https://doi.org/10.1136/thorax-2025-223376","url":null,"abstract":"Background The long-acting monoclonal antibody nirsevimab and respiratory syncytial virus (RSV) vaccines became available for prevention of severe RSV-associated disease in 2023. While clinical trials showed good efficacy and safety, their restrictive inclusion criteria, small sample sizes and short follow-up limit generalisability. We aimed to summarise real-world evidence on the effectiveness and safety of nirsevimab, RSV maternal vaccine and RSV vaccines for older adults. Methods A living systematic review and meta-analysis, with 5 monthly updated searches in three databases was performed. Eligible studies were published from 1 December 2022 to 10 March 2025. Meta-analyses for the effectiveness of nirsevimab and RSV vaccines were carried out using random-effects model. Safety data were summarised narratively. Results A total of 50 publications, covering approximately 7.6 million people, were included. Nirsevimab showed 80.7% effectiveness (95% CI: 75.7% to 85.7%; seven studies) against RSV-related emergency department visits, 80.7% (95% CI: 76.1% to 85.2%; 17 studies) against hospital admissions and 75.6% (95% CI: 63.3% to 87.9%; eight studies) against intensive care unit admissions. The effectiveness of RSV vaccines for older adults against RSV-related hospital admissions was 79.6% (95% CI: 73.8% to 85.3; three studies). No effectiveness data were available for RSV maternal vaccine. No severe adverse events were reported for nirsevimab, while RSV vaccines in older adults had fewer than 10 Guillain-Barré syndrome cases per million doses. No severe adverse events were reported for RSV maternal vaccine, although evidence was limited. Conclusions Our review demonstrated high effectiveness of nirsevimab in reducing RSV-related healthcare utilisation in infants and a favourable safety profile. More evidence is needed for evaluating RSV vaccines in pregnant people and older adults. PROSPERO registration number CRD42025643585. Data are available upon reasonable request.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"70 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145031823","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":"Multimodality curative-intent treatment in NSCLC: an unprecedented era of change 2017–2025","authors":"Matthew Evison, Tanya Ahmed, Meenali Chitnis, Rebecca Ward, Daniel Netto, Laura Cove-Smith, Riyaz Shah, Nicola Steele, Gerard Walls, Doug West, Neal Navani","doi":"10.1136/thorax-2025-223096","DOIUrl":"https://doi.org/10.1136/thorax-2025-223096","url":null,"abstract":"Curative-intent multimodality treatment—combining local treatments such as surgery or radiotherapy with systemic therapy—is the cornerstone of care in stage II–III non-small cell lung cancer (NSCLC). Since 2017, the systemic therapy backbones with multimodality treatment have undergone a dramatic transformation, driven by a series of pivotal, practice-changing clinical trials. Immunotherapy and targeted therapies, previously confined to the advanced/metastatic setting, are now firmly embedded in curative-intent regimens. Maintenance immunotherapy following chemoradiation in unresectable stage III disease, adjuvant tyrosine kinase inhibitors in resected epidermal growth factor receptor/anaplastic lymphoma kinase-positive tumours, neoadjuvant and perioperative chemoimmunotherapy in resectable stage II/III NSCLC and adjuvant chemoimmunotherapy following resection have all become new standards of care. This state-of-the-art review synthesises the key evidence underpinning these developments, highlights their clinical implications and identifies challenges to implementation—particularly the need for redefined clinical pathways, accurate pretreatment staging, timely biomarker testing and coordinated multidisciplinary decision-making. A novel treatment algorithm is proposed to support clinicians in navigating these complex treatment choices. We conclude that immunotherapy and targeted agents have irrevocably altered curative-intent NSCLC care, establishing multiple new standards that sometimes overlap and compete. In the surgical multimodality treatment pathway, neoadjuvant and perioperative chemoimmunotherapy offers the opportunity to increase the uptake of systemic therapy in comparison to adjuvant therapy and is considered by these authors to represent the optimal treatment path for most patients. In this unprecedented era of therapeutic expansion, the greatest challenge is no longer the absence of effective treatments, but the complexity of selecting, sequencing and delivering them, as well as patient optimisation. Lung cancer services must evolve through proactive pathway redesign, integrated diagnostics and new models of multidisciplinary care. High-quality, biomarker-driven and patient-centred care is now achievable for many patients with stage II–III NSCLC—but it will require system-level adaptation to deliver it.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"38 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145002808","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":"Spirometry thresholds for clinical trial eligibility: time for urgent re-evaluation","authors":"Idan Bokobza, Melanie Le Sayec, Cara Bossley, Rossa Brugha, Jane Carolyn Davies, Charlotte Dawson, Lucy Holt, Dominic A Hughes, Yasmine Needham, Caroline Pao, Gary Ruiz, Shahideh Safavi, Clare Saunders, Nadia Shafi, Nicholas J Simmonds, Michael D Waller, Danie Watson, Gwyneth Davies","doi":"10.1136/thorax-2024-222652","DOIUrl":"https://doi.org/10.1136/thorax-2024-222652","url":null,"abstract":"A common eligibility criterion in respiratory clinical trials is a per cent-predicted forced expiratory volume in 1 second (ppFEV1) between 40% and 90%, using the ethnicity-dependent Global Lung Function Initiative (GLI)-2012 spirometry reference equations. International societies now endorse the newer ‘race-neutral’ GLI-Global equations. We quantify the impact on trial eligibility of switching from GLI-2012 to GLI-Global for the UK Cystic Fibrosis Registry (n=8182). In a future trial with a maximum eligibility threshold of ppFEV1=90%, the changes in ppFEV1 would lead to over 700 people becoming newly ineligible. Urgent review of fixed ppFEV1 thresholds is required, with an initial recommendation to widen the range to 30–95% ppFEV1 when GLI-Global is implemented to ensure equitable access for people of all ethnicities. There is also a wider need to review the use of fixed ppFEV1 spirometry limits for trial eligibility.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"13 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144995358","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":"Early prediction of bronchopulmonary dysplasia by urinary metabolomics: a case-control study.","authors":"Luca Bonadies,Serena Calgaro,Matteo Stocchero,Paola Pirillo,Gabriele Poloniato,Lorenzo Zanetto,Laura Moschino,Giuseppe Giordano,Eugenio Baraldi","doi":"10.1136/thorax-2025-223090","DOIUrl":"https://doi.org/10.1136/thorax-2025-223090","url":null,"abstract":"OBJECTIVEBronchopulmonary dysplasia (BPD), the most frequent complication of extreme preterm birth, lacks not only of a comprehensive definition but also of effective treatments and predictive tools. Metabolomics is a valuable tool to unravel the underlying pathogenetic pathways of diseases and identify possible early markers. The objective of this study was to find metabolic signatures of subsequent BPD development, defined and stratified as per Jobe and Bancalari 2001 NHICD Consensus.METHODSIn this observational case-control study, we initially enrolled 161 very preterm unmatched infants, collected their urine samples during the first 24 hours of life and performed metabolomics evaluations on these samples. Patients were then followed until 36 weeks postmenstrual age. To reduce the influence of gestational age and other confounders on metabolome, we applied a nested case-control matching procedure that allowed the selection of 25 BPD cases and 25 non-BPD controls.RESULTSMultivariate and univariate data analysis led to the recognition of 17 metabolites related to BPD development in the first day of life, of which three were identified: L-Glutamic acid (p value=0.038), o-Hydroxyphenylacetic acid (p=0.039), L-Homoserine (p value=0.020). Some of these metabolites are known to play a role in the protection against oxidative stress and/or inflammatory response, two of the most known factors involved in BPD pathogenesis. In particular, L-Glutamic acid and its ionic form glutamate were increased in infants developing BPD suggesting a role as promising marker of the disease.CONCLUSIONSOur findings pave the way to better characterise early origin of BPD from a metabolic point of view towards a better biological framework of the disease and, eventually, its prediction and possible new treatments.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"29 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144960253","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":"Paternal prepubertal passive smoke exposure is related to impaired lung function trajectories from childhood to middle age in their offspring","authors":"Jiacheng Liu, Jennifer L Perret, Caroline J Lodge, Don Vicendese, Gayan Bowatte, Adrian J Lowe, Nur Sabrina Idrose, Peter Frith, Richard Wood-Baker, Gita D Mishra, John W Holloway, Cecilie Svanes, Michael J Abramson, Eugene Haydn Walters, Shyamali C Dharmage, Dinh S Bui","doi":"10.1136/thorax-2024-222482","DOIUrl":"https://doi.org/10.1136/thorax-2024-222482","url":null,"abstract":"Introduction Paternal prepubertal passive smoke exposure may increase the risk of childhood asthma. However, its association with impaired lung function trajectories at risk of chronic obstructive pulmonary disease in offspring was not investigated. We assessed the association between paternal prepubertal passive smoke exposure and lung function from childhood to middle age in their offspring. Methods Data were analysed from 890 father-offspring pairs from the Tasmanian Longitudinal Health Study. The offspring were probands in the original cohort who underwent spirometry at six time points from ages 7 to 53 years. Lung function (forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and FEV1/FVC) trajectories were previously derived using group-based trajectory modelling. Fathers reported their own passive smoke exposure before age 15 years. Multinomial logistic regressions assessed associations between paternal prepubertal passive smoke exposure and lung function trajectories in offspring. Potential mediations and interactions were assessed for active paternal smoking, offspring passive smoke exposure and respiratory illnesses during childhood, and subsequent active smoking. Results Paternal prepubertal passive smoke exposure was associated with the below average FEV1 (adjusted multinomial OR (aMOR) 1.56; 95% CI 1.05 to 2.31) and early low-rapid decline FEV1/FVC trajectories (aMOR 2.30; 95% CI 1.07 to 4.94) in offspring. The association with the below average FEV1 trajectory was augmented for offspring exposed to childhood passive smoke (aMOR 2.36; 95% CI 1.34 to 4.13; p-interaction=0.053). Observed associations partly mediated through smoking and respiratory illnesses in fathers and offspring (each contributing <15%). Conclusions Paternal prepubertal passive smoke exposure was associated with impaired lung function trajectories in offspring, which highlights the adverse impact of smoking on multiple generations. Data are available on reasonable request. Individual participant data can be provided on request to anyone with a suitable proposal. The proposal will be reviewed by the steering committee of the Tasmanian Longitudinal Health Study (TAHS). Requests can be directed to SCD, the principal investigator of the TAHS and the corresponding author of this paper. Individual deidentified data for all TAHS participants may be provided.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"162 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144930226","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}