Thorax最新文献

{"title":"Rising burden of second primary lung cancers: from survivorship to secondary prevention.","authors":"António Araujo, Ana Rodrigues","doi":"10.1136/thorax-2025-224612","DOIUrl":"10.1136/thorax-2025-224612","url":null,"abstract":"","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":"935-936"},"PeriodicalIF":9.1,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147310391","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":"Beyond age: comorbidity-informed stratification for RSV hospital outcomes.","authors":"Paul Loubet, Harish Nair","doi":"10.1136/thorax-2026-224843","DOIUrl":"10.1136/thorax-2026-224843","url":null,"abstract":"","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":"937-938"},"PeriodicalIF":9.1,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147310477","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":"Think globally, act locally: inhalational exposure questionnaires in interstitial lung disease.","authors":"Dylan Douglas, Cathryn T Lee","doi":"10.1136/thorax-2026-225088","DOIUrl":"10.1136/thorax-2026-225088","url":null,"abstract":"","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":"931-932"},"PeriodicalIF":9.1,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147782239","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":"Prevalence of asthma among African children and adolescents: findings from the Chronic Respiratory Disease Observatory for Africa (CHEST-Africa).","authors":"Obianuju B Ozoh, Sandra Kwarteng Kwarteng Owusu, Rebecca Nantanda, Jibril Mohammed, Tony Kayembe-Kitenge, Andre F S Amaral, Maia Lesosky, Khuthadzo Hlongwane, Abdoul R Ouédraogo, Jean P Sibomana, Suliaman Lakoh, Tochukwu Ayo-Olagunju, Joseph B Kamara, Emmanuel Okafor, Jean Claude Romaric Pingdwindé Ouédraogo, Phiona Ekyaruhanga, Ghislain Bougma, Naomi Dianne Adjetey, Ragnagnewendé Mohamed Ismael Tanguy Nikiema, Euginea Osei, Lindsay Zurba, Kevin Mortimer, Refiloe Masekela","doi":"10.1136/thorax-2026-225381","DOIUrl":"https://doi.org/10.1136/thorax-2026-225381","url":null,"abstract":"<p><strong>Introduction: </strong>Asthma prevalence is rising in Africa; yet reliable and contemporary prevalence data are unavailable for many countries. Moreover, prevalence estimates are typically based on symptom questionnaires, which may lead to misclassification of disease burden. This study aims to determine the prevalence, severity and treatment of asthma among African children and adolescents from four African countries using both symptom-based and diagnostic testing.</p><p><strong>Methods: </strong>We conducted a cross-sectional, school-based study among children aged 6-7 years and adolescents aged 13-14 years using standardised questionnaires. Participants with self-reported asthma (wheeze in the last 12 months and/or ever asthma) underwent spirometry and fractional exhaled nitric oxide testing. Objectively confirmed asthma was defined as self-reported asthma with at least one consistent diagnostic test.</p><p><strong>Results: </strong>A total of 4477 participants' data (2108 children and 2369 adolescents) were analysed. The prevalence of current wheeze was 7.2% in children and 4.3% in adolescents, while self-reported asthma was 8.1% and 4.8% respectively. Over half of the children (54.7%) and adolescents (61.4%) with self-reported asthma reported severe symptoms and 22.4% and 20.2%, respectively, had a prior diagnosis. Objective testing supported asthma in 41.6% of children and 61.0% of adolescents with self-reported asthma. Fewer than 5% of those with self-reported asthma used inhaled corticosteroids.</p><p><strong>Discussion: </strong>There is substantial underdiagnosis and undertreatment of asthma among African children and adolescents, with high rates of severe symptoms. Incorporating objective testing refines prevalence estimates, underscoring the need to integrate these tests into clinical and epidemiological practice to improve diagnostic accuracy.</p>","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148977996","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":"Randomised controlled trial of partitioned aerobic exercise training using one-leg cycling in patients with idiopathic pulmonary fibrosis.","authors":"Thomas E Dolmage, Shahram K Masouleh, Cindy Ellerton, Emma C Damiao, Diana Drazic, Mohamed Khalil, Ana Oliveira, Robert Varadi, Shane Shapera, Rachael A Evans, Roger S Goldstein","doi":"10.1136/thorax-2026-225333","DOIUrl":"https://doi.org/10.1136/thorax-2026-225333","url":null,"abstract":"<p><strong>Background: </strong>Although many individuals with idiopathic pulmonary fibrosis (IPF) are referred for pulmonary rehabilitation (PR), their breathlessness can be so severe as to prevent their tolerating the most effective aerobic training intensity for adequate time. Ventilation is less with one-leg cycling and a meaningful exposure to intensity can be achieved. This study aimed to determine if one-leg training improved exercise tolerance more than two-leg training in individuals with stable IPF.</p><p><strong>Methods: </strong>This was a prospective randomised controlled trial comparing one-leg versus two-leg cycle exercise training in the setting of PR. The primary outcome was the time to intolerance of exercise (t_limit). Participants completed conventional constant power endurance tests to t_limit before randomisation to one-leg (1Lgrp) or two-leg (2Lgrp) aerobic training on a stationary cycle. Training sessions were 30 min, 3 days/week for 6-8 weeks, with progression guided by tolerance. The 1Lgrp switched legs mid-training session. Tests were also completed midway and after PR.</p><p><strong>Results: </strong>40 individuals with IPF (mean±SD: forced vital capacity =61±16 %pred; Gender-Age-Physiology Index=4±1; 37 on pirfenidone or nintedanib) were included in the intent-to-treat analysis. Their t_limit at baseline was 6.5±2.2 min. After training, both groups (n=20) increased t_limit in accord with slower progression of heart rate during constant power exercise. There was a significant between-group difference in the change in t_limit (difference=10.5 (3.4 to 17.6) min) of the 1Lgrp (change=21.8 (16.0 to 27.6) min) versus the 2Lgrp (change=11.3 (5.8 to 16.8) min).</p><p><strong>Conclusion: </strong>Partitioning training to a smaller muscle volume (one-leg) improved exercise endurance more than two-leg cycle training in patients with stable moderate-to-severe IPF.</p><p><strong>Trial registration number: </strong>NCT03752892.</p>","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148978007","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":"Understanding risk of poor outcomes in adults hospitalised with respiratory syncytial virus infection: evidence from a multicentre UK cohort.","authors":"Tommaso Morelli, Martha Purcell, Jon Panaguiton, Rachel Patel, Sharon Weinberg, George Hulston, Hans Siy-Yap, Emma A Davies, Anluan Keating, Ida Saidy, Anna Freeman, Karl J Staples, Pedro Rodrigues, Abigail Jones, Alexander Allen, Aruna T Bansal, Stefan J Marciniak, Neil J Greening, Michael G Crooks, Philip Mitchelmore, Salman H Siddiqui, James Myerson, Matthew J Pavitt, Cyrus Daneshvar, James D Chalmers, Paul H Lee, Tom Lewis, Tristan W Clark, Sarah Denny, Dexter J Wiseman, Huw Ellis, Tom Ma Wilkinson","doi":"10.1136/thorax-2025-224192","DOIUrl":"10.1136/thorax-2025-224192","url":null,"abstract":"<p><strong>Background: </strong>Respiratory syncytial virus (RSV) causes substantial winter pressure on adult services. In the UK, RSV vaccination currently targets adults aged ≥75 years and care home residents; it remains uncertain whether this age criterion alone meaningfully discriminates risk of poor outcome among adults hospitalised with RSV.</p><p><strong>Methods: </strong>We pooled three UK hospital cohorts (one prospective, two retrospective) of adults admitted with acute respiratory infection (ARI) and PCR-confirmed RSV. The primary outcome was intensive care unit/high dependency unit (ICU/HDU) admission or all-cause mortality within 60 days. Prespecified predictors (age, sex and comorbidities) entered a least absolute shrinkage and selection operator (LASSO) penalised logistic regression; selected variables were refitted using standard logistic regression. Discrimination, calibration and decision-analytic performance were assessed using 1000-bootstrap internal validation and decision-curve analysis.</p><p><strong>Results: </strong>Among 334 adults, 37 (11.1%) experienced the primary outcome. An age-only rule mirroring current UK vaccine age-eligibility (≥75 years) demonstrated only modest discrimination (optimism-adjusted area under the receiver operating characteristic curve (AUC) 0.58, 95% CI 0.48 to 0.65) and a compressed distribution of predicted risks. A four-predictor model-including age, COPD, active/previous cancer and dementia-achieved higher discrimination AUC (0.77 (0.69 to 0.85)), a wider spread of predicted risks and the greatest net benefit across clinically plausible escalation thresholds (5-20%).</p><p><strong>Conclusions: </strong>In adults hospitalised with RSV-associated ARI, simple age-based heuristics-including the UK ≥75-year threshold-showed only modest ability to discriminate risk of ICU/HDU admission/60-day mortality once hospitalised. Comorbidity-inclusive approaches may provide more informative hospital-level risk stratification and warrant evaluation in future RSV vaccine-effectiveness and outcome studies. Any application requires external validation, more systematic RSV testing and comparison with physiology-based scores in larger, vaccinated cohorts.</p>","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":"988-998"},"PeriodicalIF":9.1,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13638304/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146126681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increase in second primary lung cancers in a nation-wide cohort study from Sweden.","authors":"Frantisek Zitricky, Kristina Sundquist, Jan Sundquist, Asta Försti, Akseli Hemminki, Rudolf Kaaks, Kari Hemminki","doi":"10.1136/thorax-2025-223426","DOIUrl":"10.1136/thorax-2025-223426","url":null,"abstract":"<p><strong>Background: </strong>We describe the occurrence of second primary lung cancers (SPLCs) and their determinant in Sweden.</p><p><strong>Methods: </strong>Nation-wide cancer registry from years 1961 to 2021 identified a total of 853 SPLCs.</p><p><strong>Results: </strong>The incidence of SPLCs increased almost linearly from 1980 onwards, equally for women and men and approximately equally after the four main histological types. SPLC included adenocarcinoma 63.9%, squamous cell carcinoma (SCC) 19.4%, small cell carcinoma 9.6% and large cell carcinoma 9.1%. The female cumulative probability (CumP) of SPLC after first adenocarcinoma in 10 years reached 0.019, after SCC 0.015 and after small and large cell carcinoma 0.008. The respective CumP for men was 0.013, 0.012, 0.002 and 0.005. While adenocarcinoma was often followed by second adenocarcinoma, after first non-adenocarcinoma SPLCs presented in diverse histologies. Relative risk of SPLC compared with first lung cancer was overall 3.59, higher for women (4.16) than for men (2.99) and approximately equally high after adenocarcinoma and SCC. In patients diagnosed before age 55 years, the relative risk was 6.68 for all, but after female adenocarcinoma it was 9.95 compared with 6.77 for males. The highest relative risks, up to 20-fold, were found after early onset female adenocarcinoma diagnosed after defined T stages.</p><p><strong>Conclusions: </strong>Although SPLCs are still rare, their number is increasing rapidly and the relative risks compared with first lung cancer are substantial, qualifying selected groups of high-risk patients, such as patients with early onset adenocarcinoma for early detection by CT screening when/if such tests become available.</p>","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":"981-987"},"PeriodicalIF":9.1,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13638335/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147310471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Phase 1b ATMOS trial of the inhaled sGC activator mosliciguat in patients with PAH/CTEPH","authors":"Hossein-Ardeschir Ghofrani,Hanno H Leuchte,Hikmet Al-Hiti,Michael Halank,Pavel Jansa,Tobias Lange,Horst Olschewski,Khodr Tello,Eva Becker-Pelster,Sandra Ligges,Johannes Nagelschmitz,Sylvia Nikkho,Sudhir Penugonda,Soundos Saleh,Paula Vesterinen,Markus Woischnik,David Jung,Grzegorz Kopec","doi":"10.1136/thorax-2025-224583","DOIUrl":"https://doi.org/10.1136/thorax-2025-224583","url":null,"abstract":"Background Mosliciguat, a soluble guanylate cyclase (sGC) activator, is designed for lung-targeted delivery via dry powder inhalation. Nitric oxide (NO) binds sGC’s prosthetic heme group, catalysing cyclic guanosine monophosphate (cGMP) production, resulting in increased vasodilation, reduced inflammation/apoptosis, reverse vascular remodelling and antifibrotic effects. sGC is redox sensitive, losing heme in pulmonary hypertension (PH) oxidative stress conditions. Mosliciguat’s novel ‘activator’ mechanism directly binds the sGC heme-binding pocket to induce cGMP, allowing it to target NO-insensitive heme-free sGC, potentially rescuing additional enzymatic activity. Methods A Proof-of-Concept Trial of Inhaled Mosliciguat, a First-in-Class Soluble Guanylate Cyclase Activator (ATMOS; non-randomised, open-label phase 1b trial) assessed single-dose escalation of mosliciguat in participants with pulmonary arterial hypertension or chronic thromboembolic PH. 38 participants received mosliciguat. The per protocol set (PPS, n=20) included NO-non-responsive participants with baseline pulmonary vascular resistance (PVR) ≥5 Wood units (n=4/dose). The pharmacodynamic set (PDS, n=37) included NO-responsive participants. Five PPS participants underwent a ≥24-hour washout from background therapy. Results In the PPS, doses of 0.24, 0.48, 1.0, 2.0 and 4.0 mg resulted in mean peak per cent PVR reductions from baseline (95% CI) of 21.0% (31.6% to 10.4%), 16.1% (32.8% to −0.7%), 25.9% (60.3% to −8.4%), 38.1% (55.9% to 20.3%) and 36.3% (48.3% to 24.4%), respectively, and generally persisted over the 3-hour observation period. Similar effects were seen in the PDS. The majority of adverse events were mild; most frequently reported were headache (n=3/38; 7.9%), decreased oxygen saturation and fatigue (n=2/38; 5.3% each). No safety-relevant changes were seen in systemic vascular resistance or blood pressure. Conclusions Mosliciguat demonstrated a favourable safety profile and sustained, clinically meaningful reductions in PVR in participants with PH. Trial registration number NCT03754660 .","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"52 1","pages":"thorax-2025-224583"},"PeriodicalIF":10.0,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148923233","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":"Intergenerational lung function: maternal influences, familial risk and preventive opportunities","authors":"Anh Tuan Dinh-Xuan,Duy-Bo Nguyen","doi":"10.1136/thorax-2026-225756","DOIUrl":"https://doi.org/10.1136/thorax-2026-225756","url":null,"abstract":"","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"39 1","pages":"thorax-2026-225756"},"PeriodicalIF":10.0,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148923235","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":"Markers of microvascular instability predict severity and survival in idiopathic pulmonary fibrosis","authors":"David J Csordas,Shwu-Fan Ma,Yong Huang,Brody Receveur,Emma Strickland,Lily C Cucuzzella,Janelle Vu Pugashetti,Cathryn T Lee,Anna J Podolanczuk,Fernando J Martinez,Ayodeji Adegunsoye,Justin M Oldham,Imre Noth,John S Kim,Shayn M Peirce","doi":"10.1136/thorax-2026-225147","DOIUrl":"https://doi.org/10.1136/thorax-2026-225147","url":null,"abstract":"Introduction Most research on idiopathic pulmonary fibrosis (IPF) has focused on the interplay among fibroblasts, the immune system and epithelial cells. There is growing evidence that microvascular dysfunction also plays a role in disease progression, but large human translational studies are lacking. In this research, we aim to identify a proteomic signature of microvascular instability and assess the impact of current therapeutics on the microvasculature. Methods Olink proteomic data from patients with IPF were obtained from the Pulmonary Fibrosis Foundation Patient Registry (PFF-PR) (n=914) and an independent validation cohort (n=366). Among the PFF-PR, 640 patients also have whole-blood RNA sequencing data available. A subset of 79 microvascular-associated proteins was curated, and their associations with disease severity and transplant-free survival were examined. An adaptive least absolute shrinkage and selection operator was used to generate a novel microvascular risk score. Results Higher plasma levels of five microvascular-associated proteins (SDC1, MMP10, THBS2, HGF and SERPINA5) were associated with lung function and survival in both cohorts. Whole-blood RNA sequencing of patients with microvascular risk revealed enrichment of immune-mediated processes. Patients with higher microvascular risk who were subsequently put on nintedanib in the following year had significantly better 3-year transplant-free survival compared with patients who did not receive antifibrotic intervention (HR 0.56, 95% CI 0.35 to 0.89, p=0.0142). Discussion Integrative multi-omics analyses suggest that perturbations to microvascular remodelling contribute to disease severity and progression in IPF. This analysis offers a framework for a precision medicine approach for IPF.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"8 1","pages":"thorax-2026-225147"},"PeriodicalIF":10.0,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148923237","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}