Thorax最新文献

{"title":"Associations between accelerated lung function decline and cardiovascular outcomes: a systematic review.","authors":"Jiaxin Li, Yaoyao Qian, Jennifer Perret, Jingwen Zhang, Nur Sabrina Idrose, Xin Dai, Anurika P De Silva, Shyamali C Dharmage, Caroline J Lodge, Dinh S Bui","doi":"10.1136/thorax-2026-225507","DOIUrl":"10.1136/thorax-2026-225507","url":null,"abstract":"<p><strong>Background: </strong>Emerging evidence suggests that lung function decline may be linked to cardiovascular disease (CVD), but this has not been synthesised to date. This review aims to synthesise the current evidence on accelerated lung function decline and cardiovascular outcomes.</p><p><strong>Methods: </strong>We systematically searched MEDLINE, Embase and PubMed from inception to May 2026 for studies evaluating longitudinal changes in lung function in adults in relation to CVD. Study quality was assessed using the Risk Of Bias In Non-randomised Studies of Exposure tool, and findings were synthesised narratively.</p><p><strong>Findings: </strong>Of 6772 studies identified from the search, 15 publications met the inclusion criteria: 12 general population cohorts, 2 occupational cohorts and 1 chronic obstructive pulmonary disease (COPD) cohort. In the general/occupational population, accelerated lung function decline was consistently associated with increased cardiovascular risk, with a uniformly positive directional trend and HRs ranging from 1.07 to 1.36 for forced expiratory volume in 1 s (FEV₁) and 1.06 to 1.33 for forced vital capacity. Similar trends were observed for CVD-related biomarkers, risk factors and subclinical cardiovascular phenotypes (eg, HRs 1.04-1.66 for accelerated FEV₁ decline). Potential effect modifiers of these associations such as smoking were reported. However, the association between accelerated lung function decline and CVD mortality in the general population remains inconclusive. In two occupational cohorts, lung function decline was associated with higher CVD mortality risk (HRs 2.05-2.59).</p><p><strong>Interpretation: </strong>In ageing populations, tracking the rate of lung function decline may help identify not only those at risk of COPD but also those at risk of CVD.</p>","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148921097","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":"International epidemiology of antimicrobial resistance in people living with chronic lung infection.","authors":"Ollie Pitts, Chiara Premuda, ZhiLing Yuan, Mattia Nigro, Till Othmer, Nikolas Johl, Arafa Aboelhassan, Safaa Eid, Sarah Hashem, Noha Khalil, Michael Behnke, Oto Melter, Pavel Drevinek, Rishi Dhillon, Irfan Shafiq, Nilüfer Acet-Öztürk, Ozge Aydin Guclu, Daniela Girelli, Jamie Duckers, Wang Chun Kwok, Stefano Aliberti, Andrea Gramegna, Stephanie Thee, Frederick Frost, Anand Shah","doi":"10.1136/thorax-2026-225527","DOIUrl":"https://doi.org/10.1136/thorax-2026-225527","url":null,"abstract":"<p><strong>Background: </strong>Antimicrobial resistance (AMR) is a global threat for people with chronic lung infection; however, international AMR epidemiology in bronchiectasis and cystic fibrosis (CF) is poorly characterised. In this study, we retrospectively analyse international longitudinal AMR epidemiology in bronchiectasis and CF.</p><p><strong>Methods: </strong>Microbiology data were analysed from 110 323 respiratory samples in 19 143 individuals with bronchiectasis or CF across 11 cities, eight countries, three continents between 2011 and 2024. Longitudinal AMR prevalence, multidrug-resistant (MDR) and extensively drug-resistant (XDR) prevalence and multiple antibiotic resistance (MAR) index were analysed by disease and country. Pilot analysis of concurrent/disjoint resistance in antimicrobial pairs and triplets in regional datasets was performed to inform combination or cyclical antimicrobial choice.</p><p><strong>Findings: </strong>Geographic AMR differences were noted across pathogens in bronchiectasis and CF with increased <i>Pseudomonas aeruginosa</i> resistance in central/southern Europe and increased <i>Klebsiella pneumoniae</i> resistance in Hong Kong. MDR burden was high in emergent pathogens <i>Escherichia coli</i> (CF: MDR 32.6%; XDR 12.4%; bronchiectasis: MDR 39.2%; XDR 4.9%) and <i>K. pneumoniae</i> (CF: MDR 22.7%; XDR 15.6%; bronchiectasis: MDR 13.4%; XDR 1.5%). A longitudinal rise in <i>P. aeruginosa</i> AMR was seen in bronchiectasis across four centres for antipseudomonal aminoglycosides (p<0.001; OR/year 1.44; 95% CI 1.24 to 1.67), fluoroquinolones (p=0.002; OR/year 1.13; 95% CI 1.05 to 1.23), cephalosporins (p=0.005; OR/year 1.17; 95% CI 1.05 to 1.30), penicillins with beta-lactamase inhibitor (p=0.02; OR/year 1.18; 95% CI 1.03 to 1.35) and carbapenems (p=0.048; OR/year 1.11; 95% CI 1.00 to 1.23). Rising longitudinal <i>K. pneumoniae</i> AMR was seen for cephalosporins (p=0.01; OR/year 1.32; 95% CI 1.06 to 1.65) and carbapenems (p=0.04; OR/year 1.64; 95% CI 1.03 to 2.62). A significant increase in AMR, as measured by the MAR index, was observed in individuals with residual culture-positive CF receiving triple cystic fibrosis transmembrane conductance regulator (CFTR) modulator therapy (p<0.001). Strong concurrent resistance was noted in bronchiectasis across regions with geographic variation in disjoint antimicrobial pair resistance.</p><p><strong>Conclusion: </strong>We show a significant increasing international AMR burden in bronchiectasis and CF, with geographic variation and persistence post-CFTR modulator therapy.</p>","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149017972","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":"Interplay between diaphragm thickening, force generation and lung volume change: a physiological study in health and diaphragm weakness.","authors":"Jeroen L M van Doorn, Joris S M van Doremalen, Baziel G M van Engelen, Nicol C Voermans, Chris L de Korte, Coen A C Ottenheijm, Jonne Doorduin","doi":"10.1136/thorax-2026-225036","DOIUrl":"https://doi.org/10.1136/thorax-2026-225036","url":null,"abstract":"<p><strong>Introduction: </strong>Diaphragm ultrasound is increasingly used to assess diaphragm function. Diaphragm thickening (DTF) is widely interpreted as a surrogate of diaphragm force generation. However, the independent contributions of force generation and lung volume change to diaphragm thickening remain unclear. This study aimed to determine the interplay between DTF, force generation and lung volume change.</p><p><strong>Methods: </strong>Healthy participants and patients with a congenital myopathy performed unloaded concentric contractions, isometric contractions and loaded concentric contractions. Mouth pressure (Pmo), volume and DTF were recorded and transdiaphragmatic pressure (Pdi) was measured in healthy participants. Leakage during isometric efforts was modelled to assess its impact on lung volume change.</p><p><strong>Results: </strong>20 healthy participants and 21 patients completed unloaded concentric contractions and isometric contractions. During isometric contractions, Pmo and Pdi increased without an increase in DTF in either group (5.2%; -13.5-23.9% to 5.0%; -12.6-22.4%, p=1.000 and -8.3%; -26.6-10.0% to -15.8%; -33.0-1.3%, p=0.999, respectively). However, DTF increased during unloaded concentric contractions (21.9%; 1.2-42.6% to 105.4%; 88.1-122.7%, p<0.001 and 7.9%; -12.1-27.9% to 84.5%; 67.6-101.5%, p<0.001, respectively). In an additional cohort (21 healthy participants and 21 patients) DTF increased with increasing lung volume (16.5%; 4.2-28.7%; to 134.9%; 123.1-146.7%, p<0.001 and 7.4%; -7.0-21.8% to 49.5%; 36.0-63.1%, p<0.001, respectively), but did not differ across inspiratory loading up to 50% of maximal inspiratory pressure. Modelling demonstrated that leakage during isometric efforts may induce lung volume changes sufficient to increase DTF.</p><p><strong>Discussion: </strong>In physiological breathing, diaphragm contraction results in diaphragm thickening and lung volume increase. Diaphragm thickening relates to lung volume change associated with muscle shortening during muscle contraction rather than force generation per se developed by the contraction.</p>","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149002576","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":"Generational changes in lung function in adults from several world regions: results from the Burden of Obstructive Lung Disease study.","authors":"Jixuan Ma, Peter G J Burney, David M Mannino, Christer Janson, Thorarinn Gíslason, Daniel O Obaseki, Rain Jõgi, Valentina Quintero Santofimio, James Potts, Abdul Rashid, Gregory E Erhabor, Rune Nielsen, Ali Kocabas, Asaad Nafees, Rana Ahmed, Meriam Denguezli, Cristina Barbara, Joao Cardoso, Herminia Brites Dias, Fátima Rodrigues, Dhiraj Agarwal, Sanjay Juvekar, Frits M E Franssen, Terence Seemungal, Kevin Mortimer, Mohammed El Biaze, Padukudru Anand Mahesh, Parvaiz Koul, Michael Studnicka, Andre F S Amaral","doi":"10.1136/thorax-2026-225173","DOIUrl":"https://doi.org/10.1136/thorax-2026-225173","url":null,"abstract":"<p><p>This study estimated birth cohort effects on lung function using BOLD (Burden of Obstructive Lung Disease) data from 28 569 adults born between 1902 and 1976 across 41 sites in 34 countries. Forced vital capacity (FVC), forced expiratory volume in 1 s (FEV₁) and the FEV₁/FVC increased across successive birth cohorts in both high-income countries (HICs) and low- and middle-income countries (LMICs), with mean values rising steadily with later birth year. In fully adjusted models, FVC increased by 21.4 mL, FEV₁ by 24.6 mL and FEV₁/FVC by 0.25% per birth year. These positive associations were consistent across sex, smoking status and country-income subgroups (HICs and LMICs).</p>","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149002557","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 fatigue in COPD with chronic respiratory failure undergoing pulmonary rehabilitation: a multicentre, randomised, placebo-controlled trial of L-arginine/liposomal vitamin C.","authors":"Mauro Maniscalco, Claudio Candia, Giuseppe Fiorentino, Luca Nicola Cesare Bianchi, Laura Fagetti, Sara Forlani, Giuseppe Emanuele La Piana, Clementina Misuraca, Matteo Vigna, Riccardo Buraschi, Mauro Carone, Valentina Trimarco, Michele Vitacca","doi":"10.1136/thorax-2026-225106","DOIUrl":"https://doi.org/10.1136/thorax-2026-225106","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary rehabilitation (PR) is the cornerstone of non-pharmacological treatment for chronic obstructive pulmonary disease (COPD), yet fatigue often persists despite rehabilitation. We conducted a multicentre, randomised, double-blind, placebo-controlled trial to evaluate whether oral L-arginine plus liposomal vitamin C improves fatigue in patients with advanced COPD and chronic respiratory failure (CRF) undergoing PR.</p><p><strong>Methods: </strong>Consecutive patients with stable COPD and CRF receiving long-term oxygen therapy were randomised to L-arginine/liposomal vitamin C or placebo during a standardised 28-day PR programme. Fatigue was assessed using the Fatigue Severity Scale (FSS). The primary analysis used a longitudinal linear mixed-effects model including repeated FSS measurements, treatment group, time, treatment-by-time interaction and prespecified covariates. Secondary outcomes included 6 min walk distance, sit-to-stand test, handgrip strength, COPD Assessment Test and modified Medical Research Council dyspnoea score.</p><p><strong>Results: </strong>98 participants were randomised. A significant difference was found in FSS changes between groups (mean difference -0.90; 95% CI -1.50 to -0.29; p=0.004), confirmed by the adjusted treatment-by-time interaction analysis (adjusted between-group difference -0.72; 95% CI -1.25 to -0.20; p=0.009). The point estimate exceeded the prespecified minimal clinically important difference (0.6 points). A higher proportion of participants achieved an FSS score <4 in the intervention group versus placebo group (57% vs 36%; p=0.059). No significant between-group differences were observed for secondary outcomes.</p><p><strong>Conclusions: </strong>In patients with COPD and CRF undergoing PR, adjunctive oral L-arginine plus liposomal vitamin C was associated with a greater reduction in perceived fatigue, without significant improvements in functional or patient-reported secondary outcomes.</p><p><strong>Trial registration number: </strong>NCT06439875.</p>","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149002584","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":"Establishing the top 10 research priorities for lung volume reduction treatment for people with COPD.","authors":"Sara C Buttery, Richard Barraclough, Timothy J P Batchelor, Sofina Begum, Rocco Bilancia, Edward J Caruana, James W Dodd, Justin L Garner, Neil J Greening, Samuel V Kemp, Alan J B Kirk, Rod A Lawson, Babu Naidu, Christopher M Orton, Karen Redmond, Carole Ridge, Pallav L Shah, Jane S Watson, Nicholas S Hopkinson","doi":"10.1136/thorax-2026-224791","DOIUrl":"10.1136/thorax-2026-224791","url":null,"abstract":"<p><p>Lung volume reduction procedures are an established evidence-based aspect of chronic obstructive pulmonary disease (COPD) care. We conducted a research prioritisation exercise involving people with COPD and healthcare professionals across a range of disciplines, to identify a clear set of 10 questions to guide the development of research proposals in this area. Priorities were identified using an iterative approach based on the James Lind Alliance methodology. The final set of 10 priorities address the identification, assessment and optimisation of patients with COPD prior to any procedure, how lung volume reduction procedures are conducted and how care after the procedure has taken place should be organised.</p>","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148176832","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":"Knowing when to stop: the challenge of macrolide discontinuation in chronic airways disease.","authors":"Francesca Conway, Lydia Finney","doi":"10.1136/thorax-2026-225660","DOIUrl":"https://doi.org/10.1136/thorax-2026-225660","url":null,"abstract":"","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149002581","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":"A multisystem mystery….","authors":"Alicear Kablan, Alice Joyce, Owen Dempsey","doi":"10.1136/thorax-2026-225500","DOIUrl":"https://doi.org/10.1136/thorax-2026-225500","url":null,"abstract":"","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148983658","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":"Coordinated bronchial, vascular and lobation abnormalities associated with right upper lobe agenesis.","authors":"Kunihiko Shimizu, Atsunori Kozuka, Hideaki Suzuki, Nobuyuki Shiraga, Kozo Sato","doi":"10.1136/thorax-2026-225509","DOIUrl":"https://doi.org/10.1136/thorax-2026-225509","url":null,"abstract":"","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148983671","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":"2024 BTS/NICE/SIGN asthma guidelines have the potential to improve UK asthma outcomes, but we must act now.","authors":"Michael G Crooks, Dominic L Sykes, Robert R Horne, Helena Cummings, Kay Roy, Alex Fynney, Andrew Whittamore, Shoaib Faruqi, Daryl Freeman, Jennifer K Quint, Katherine Hickman, Bev Bostock, Joanne King, Judith Dyson","doi":"10.1136/thorax-2025-223465","DOIUrl":"10.1136/thorax-2025-223465","url":null,"abstract":"","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":"949-957"},"PeriodicalIF":9.1,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147318347","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}