Thorax最新文献

{"title":"Factors associated with guideline-concordant maintenance inhaled medication for COPD: a population-based, longitudinal cohort study.","authors":"Yiwei Yin, Jeenat Mehareen, Mohsen Sadatsafavi, Emily Brigham, Mary A De Vera, Kevin I Duan, Kate M Johnson","doi":"10.1136/thorax-2025-223544","DOIUrl":"10.1136/thorax-2025-223544","url":null,"abstract":"<p><strong>Background: </strong>Despite guideline recommendations, many patients with chronic obstructive pulmonary disease (COPD) do not receive or persist with guideline-concordant maintenance inhaled medications. We examined patient and health system factors associated with guideline concordance and persistence.</p><p><strong>Methods: </strong>We conducted a population-based cohort study using administrative data from British Columbia, Canada (2011-2022). Patients aged ≥40 years with newly diagnosed COPD were included. Patients were classified as having high risk (≥2 outpatient or ≥1 inpatient exacerbation in the prior year) or low risk (≤1 outpatient exacerbation) of exacerbations, which we used to determine whether dispensed medications were concordant with guidelines. We used separate generalised linear models to evaluate the association between patient, clinical and health system factors and the initiation of guideline-concordant medications and subsequent persistence.</p><p><strong>Results: </strong>We included 71 996 patients with a mean follow-up of 6.15 years (SD 2.65). 30.42% of patients initiated guideline-concordant treatment. Among those who initiated, the mean proportion of days covered (PDC) by guideline-concordant regimens was 31.93%. Patients at high risk of exacerbations initiated guideline-concordant regimens more often than those at low risk (mean 70.4% vs 13.3%) and had a higher mean PDC (57.33% vs 26.35%) per patient-year. Pulmonologist care and additional outpatient visits increased both initiation (OR 5.14, 95% CI 4.88 to 5.41 and OR 1.25, 95% CI 1.24 to 1.26, respectively) and persistence (OR 1.13, 95% CI 1.09 to 1.17 and OR 1.019, 95% CI 1.015 to 1.024, respectively) with guideline-concordant medications.</p><p><strong>Conclusion: </strong>Guideline-concordant use of maintenance inhaled medications is low. Increased access to outpatient and specialist care may support COPD management.</p>","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144883836","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 OSA endotypes with drug therapy: dream or reality?","authors":"Peter A Cistulli, Anna Mohammadieh","doi":"10.1136/thorax-2025-223409","DOIUrl":"10.1136/thorax-2025-223409","url":null,"abstract":"","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":"589-590"},"PeriodicalIF":7.7,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512538","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":"Efficacy and safety of novel airway balloon cryoablation system for malignant central airway obstruction: a prospective, multicentre, randomised, non-inferiority study","authors":"Jie Liu, Chun Li, Ye Gu, Yu Chen, Faguang Jin, Yan Dang, Enguo Chen, Yu-Chao Dong, Changhui Wang, Chao Cao, Yi Hu, Yunzhi Zhou, Xiaoqun Ye, Qiang Li, Hui Zhao, Shuliang Guo, Maosong Ye, Yuanlin Song, Xin Zhang, Shiyue Li","doi":"10.1136/thorax-2024-222745","DOIUrl":"https://doi.org/10.1136/thorax-2024-222745","url":null,"abstract":"Background A novel airway balloon cryoablation (ABC) system using liquid nitrogen as cryogen was developed for bronchoscopic intervention in malignant central airway obstruction (MCAO). This study aimed to evaluate the efficacy and safety of this system. Methods This was a prospective, randomised, controlled, non-inferiority study that enrolled MCAO patients at 15 sites in China. Patients were assigned to the ABC group and the ERBOKRYOCA Cryosurgical (EC) system group in a 1:1 ratio. Airway tumour debulking with multimodality was permitted before cryoablation. The primary outcome was the airway patency rate after 6 weeks of intervention with a non-inferiority margin of −10%. Secondary outcomes included modified Medical Research Council (mMRC) Dyspnoea Scale and Karnofsky Performance Scale (KPS) assessment, and the duration of cryoablation. Results 198 patients were randomised. After 6 weeks of intervention, the airway patency rate was 78.49% in the ABC group and 60.92% in the EC group, showing that the difference was over the non-inferiority margin of −10% at 17.58% (95% CI 4.35% to 30.80%), p<0.001. The mMRC and KPS scores were significantly improved after 3 and 6 weeks in both groups, with no difference. The duration of cryoablation was shortened remarkably in the ABC group (378.29±399.54 s vs 624.93±443.72 s, p<0.001). The prevalence of bleeding was similar in the two groups, without life-threatening events. Conclusions The ABC system provided non-inferior and subsequent superior effect in airway patency rate compared with traditional carbon dioxide-driven cryoprobe in MCAO. This study supports this novel system as an alternative to cryoablation via bronchoscope for MCAO patients. Trial registration number ChiCTR2100042051. Data are available on reasonable request.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"6 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144825546","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 phenotypes at 8 years in children born extremely preterm or with extremely low birth weight","authors":"Tugba Alarcon-Martinez, Rheanna M Mainzer, Sarath Ranganathan, Lex William Doyle, Jeanie L Y Cheong","doi":"10.1136/thorax-2024-222602","DOIUrl":"https://doi.org/10.1136/thorax-2024-222602","url":null,"abstract":"Introduction Preterm birth is associated with poor expiratory airflow, but spirometry phenotypes are not well-described. Objectives To characterise abnormal spirometry phenotypes at age 8 years in children born either extremely preterm (EP; <28 weeks’ gestation) or extremely low birth weight (ELBW; <1000 g birth weight), and to describe the early-life (perinatal and early growth) variables associated with each phenotype. Methods Participants comprised survivors born EP/ELBW in Victoria, Australia, in three eras (1991–1992, 1997 and 2005) and contemporaneous term-born controls with spirometry data at 8 years. Abnormal spirometry phenotypes included: prematurity-associated obstructive lung disease (POLD), prematurity-associated preserved ratio of impaired spirometry (pPRISm) and prematurity-associated dysanapsis (pDysanapsis). Lung volumes measured by plethysmography and early-life variables were compared between each abnormal and the normal spirometry phenotype. Results Overall, 29% (156/544) of children born EP/ELBW had an abnormal spirometry phenotype compared with 9% (47/524) term-born controls (OR 4.06, 95% CI 2.85 to 5.79; p<0.001). Compared with children born EP/ELBW with normal spirometry (71%), children born EP/ELBW with pPRISm (11%) had reduced total lung volume. Both POLD (8%) and pPRISm phenotypes showed evidence of air trapping. Bronchopulmonary dysplasia was associated with both POLD and pPRISm. Lower gestational age and poorer weight gain between birth and 2 years were associated with pPRISm. No early life variables were associated with pDysanapsis (9%). Conclusion Over one-quarter of children born EP/ELBW have abnormal spirometry phenotypes. Abnormal spirometry phenotypes differ in their associations with perinatal or early growth variables. Data are available upon reasonable request. De-identified data that support the article are potentially available from the authors for valid research, subject to signed research agreements and ethical approval.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"19 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144819223","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":"Nocturnal gastro-oesophageal reflux and pulmonary abnormalities on chest CT in a general population: the Swedish CArdioPulmonary BioImage Study.","authors":"Össur Ingi Emilsson,Andrei Malinovschi,Åse Johnsson,Mirjam Ljunggren,Anders Blomberg,Ida Pesonen,Magnus Sköld,Zainab Ahmadi,Anna Moberg,Tomas Hansen","doi":"10.1136/thorax-2024-222570","DOIUrl":"https://doi.org/10.1136/thorax-2024-222570","url":null,"abstract":"BACKGROUNDNocturnal gastro-oesophageal reflux (nGER) is common in people with respiratory diseases, but its association with pulmonary abnormalities is not known.AIMInvestigate the association between nGER and pulmonary abnormalities on chest CT in an adult general population.METHODSIn total, 28 846 individuals from the general population aged 50-64 years completed questionnaires and underwent chest CT, in the Swedish CArdioPulmonary BioImage Study (www.scapis.org). Participants with nGER symptoms on ≥1 night per week were defined as having nGER. Chest CT was evaluated for bronchial wall thickening, bronchiectasis, reticular abnormalities, honeycombing, cysts and ground glass opacities. Ever-smoking, current asthma, inflammatory bowel disease and autoimmune disease were defined as risk factors for pulmonary abnormalities. Analyses were adjusted for sex, age, body mass index, education level and study centre.RESULTSThe prevalence of nGER was 9.4%. Among participants with risk factors for pulmonary abnormalities (n=4004), having nGER was positively associated with bronchial wall thickening (adjusted OR (aOR) (95% CI): 1.25 (1.07 to 1.48)) and reticular abnormalities (aOR (95% CI): 1.51 (1.04 to 2.17)), but negatively associated with cysts (aOR (95% CI): 0.68 (0.48 to 0.97)). Among participants without risk factors for CT abnormalities (n=2555), nGER did not relate with pulmonary abnormalities.CONCLUSIONSIn a middle-aged general population, nGER was not associated with pulmonary abnormalities on chest CT. However, in the presence of other risk factors for pulmonary abnormalities, nGER was associated with bronchial wall thickening and reticular abnormalities. Persons with nGER and risk factors for pulmonary abnormalities should, therefore, be evaluated for respiratory disease and treated appropriately.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"4 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144813180","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":"Adolescent exercise capacity predicts higher exercise tolerance later in life when compounded by anaemia in patients with pulmonary arteriovenous malformations.","authors":"Hannah Das,Helena R Ironton,Nicola Ma Coote,Joe An Cabantug,Julie Ranger,Ali Alsafi,Claire L Shovlin","doi":"10.1136/thorax-2024-222274","DOIUrl":"https://doi.org/10.1136/thorax-2024-222274","url":null,"abstract":"Exercise tolerance predicts survival and mental health. To test benefits during adolescence for patients with pulmonary arteriovenous malformations (PAVMs) that cause hypoxaemia, we examined current and retrospective exercise tolerance aged 12 years and 19 years, linking to clinical records. In the 85 patients (65 female, mean age 56 years), current metabolic equivalents (METs) ranged from 1.75 to 14.8 (mean 7.85) kcal/kg/min. Oxygen saturation explained only 2.2% of the variability. There were stronger associations between current exercise tolerance and anaemia indices, particularly the need for blood transfusions. In univariate and multivariate analyses, the strongest anaemia-independent predictor was exercise tolerance aged 19 years. In this cohort, the benefit associated with modestly increased activity by 19 years (2.9 METs) was greater than the decrements from severe anaemia (~2.54 METs) or 3 decades of life (2.13 METs). The data support enhanced exercise for people with PAVMs, as for the general population, in preparation for later-life health challenges.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"15 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144777942","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":"Mohammed Azib Zahid","doi":"10.1136/thorax-2025-223733","DOIUrl":"https://doi.org/10.1136/thorax-2025-223733","url":null,"abstract":"Predicting response to omalizumab, an anti-IgE monoclonal, in severe allergic asthma is challenging. Djukanović et al (Am J Respir Crit Care Med. 2024;210(3):288–297. doi:10.1164/rccm.202310–1730OC) conducted the SoMOSA Study, to evaluate the clinical efficacy of omalizumab and to identify advanced omics biomarkers to guide therapy. The SoMOSA study was a 1 year, open-label, real-world study enrolling 216 patients with severe, uncontrolled atopic asthma, who were on high-dose inhaled corticosteroids (with or without maintenance oral corticosteroids) with at least two exacerbations in the previous year. Early response to omalizumab was assessed using the Global Evaluation of Treatment Effectiveness (GETE) score in the first 16 weeks. Early positive response was found in 63%, and 69% experienced a≥50% reduction in exacerbations over the full treatment period. Among those receiving maintenance oral corticosteroids, 57% were able to reduce their dose by at least half. Importantly, while conventional biomarkers (blood eosinophils, fractional exhaled nitric oxide, and total IgE) did not predict the response, analysis of exhaled breath via gas chromatography–mass spectrometry and plasma lipid profiling identified a distinct panel of volatile organic compounds and lipid markers that predicted clinical improvement with high accuracy (receiver …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"91 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144629683","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":"How deep can it go? Dangers of delayed diagnosis of teeth aspiration.","authors":"Pierre Goussard,Shyam Sunder Billapura Venkatakrishna,Savvas Andronikou,André Gie,Zane Ismail","doi":"10.1136/thorax-2025-223221","DOIUrl":"https://doi.org/10.1136/thorax-2025-223221","url":null,"abstract":"","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"14 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144756123","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":"Telemedicine in home mechanical ventilation: promise, pitfalls and path forward","authors":"Marieke L Duiverman, Claudia Crimi","doi":"10.1136/thorax-2025-223348","DOIUrl":"https://doi.org/10.1136/thorax-2025-223348","url":null,"abstract":"Home mechanical ventilation (HMV) is a life-saving treatment for patients with chronic respiratory failure due to different underlying diseases.1–4 Striving for value-based care, that is, high-quality care with optimal use of resources, telemedicine for ventilator-dependent patients holds promise.5 Telemedicine might improve efficiency and quality of HMV care, empower patients and informal caregivers,6–8 enable care at home and broaden access to care, particularly in resource-constrained settings. Telemedicine ideally offers the potential to reduce inpatient care needs,9–11 lower healthcare costs10 11 and foster a more patient-centred approach. Yet, as its adoption increases, important questions arise regarding its actual effectiveness, feasibility and generalisability in chronic respiratory care. In this issue of Thorax , Prigent and colleagues report the results of the eVENT study, a randomised controlled trial evaluating the role of telemonitoring and remote support in the long-term follow-up of patients with obesity hypoventilation syndrome (OHS) and overlap syndrome with chronic obstructive pulmonary disease (COPD) treated with home non-invasive ventilation (NIV).12 Their work highlights both the potential and limitations of integrating telemedicine into ventilatory care. Interestingly, although mean nocturnal transcutaneous carbon dioxide pressure (PtCO2) on home NIV at 6 months ( primary outcome ) did not differ significantly between the telemonitoring and usual care groups, daytime arterial partial pressure of carbon dioxide (PaCO2) was significantly lower in the telemonitoring versus the usual care follow-up group (41.7±6.8 vs 46.2±3.5 mm Hg). The discrepancy between nocturnal PtCO₂ and daytime PaCO₂ warrants important consideration. While PtCO₂ is a direct …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"20 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144747239","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":"Association between ultra-processed food consumption and lung cancer risk: a population-based cohort study","authors":"Kanran Wang, Junhan Zhao, Dingyi Yang, Mao Sun, Wei Zhou, Yongzhong Wu","doi":"10.1136/thorax-2024-222100","DOIUrl":"https://doi.org/10.1136/thorax-2024-222100","url":null,"abstract":"Background The evidence on associations between ultra-processed foods (UPF) and lung cancer risk is limited and inconsistent. Research question Are UPF associated with an increased risk of lung cancer, non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC)？ Methods Data of participants in this study were collected from the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial. Dietary intakes were assessed through a validated diet history questionnaire. These foods were categorised using the NOVA classification according to the degree of processing in the PLCO Cancer Screening Cohort. All cases of incident lung cancer were pathologically verified. Multivariable Cox regression was used to assess the association between consumption of UPF and lung cancer after adjustment for various potential confounders, including key risk factors related to lung cancer and overall diet quality. Results A total of 1706 cases of lung cancer cases, including 1473 NSCLC and 233 SCLC, were identified during a mean follow-up of 12.2 years among 101 732 adults (mean age 62.5 years). After multivariable adjustments, individuals in the highest quarters for UPF consumption had a higher risk of lung cancer (HR=1.41, 95% CI 1.22 to 1.60), NSCLC (HR=1.37, 95% CI 1.20 to 1.58) and SCLC (HR=1.44, 95% CI 1.03 to 2.10) compared with those in the lowest quarter. These results remained statistically significant after a large range of subgroup and sensitivity analyses. Conclusions Higher consumption of UPF is associated with an increased risk of lung cancer, NSCLC and SCLC. Although additional research in other populations and settings is warranted, these findings suggest the healthy benefits of limiting UPF. Data may be obtained from a third party and are not publicly available. Data described in the manuscript, code book and analytic code will not be made available because the authors are prohibited from distributing or transferring the data and code books on which their research was based to any other individual or entity under the terms of an approved NCI Research Proposal and Data and Materials Distribution Agreement through which the authors obtained these data.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"26 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144736789","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}