Thorax最新文献

{"title":"Optimal timing, duration and sequencing of therapy for progressive pulmonary fibrosis: the urgent need to move beyond the 'wait-to-fail' paradigm.","authors":"Adhnan Omar, Philip Evans, Nicola Hutchinson","doi":"10.1136/thorax-2026-225299","DOIUrl":"https://doi.org/10.1136/thorax-2026-225299","url":null,"abstract":"","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148689920","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":"Body composition is associated with nintedanib-related diarrhoea: risk stratification in idiopathic pulmonary fibrosis.","authors":"Ilaria Bassi, Marco Carpano, Gilda Giancotti, Anna Guerrieri, Dino Gibertoni, Stefano Nava","doi":"10.1136/thorax-2026-225408","DOIUrl":"https://doi.org/10.1136/thorax-2026-225408","url":null,"abstract":"<p><p>Diarrhoea is the primary cause of nintedanib discontinuation in idiopathic pulmonary fibrosis. We investigated predictors in 100 prospective patients; 46% experienced diarrhoea, defined as common terminology criteria for adverse events V.5.0 grade ≥1. In a multivariable model (area under the curve 0.9056), lower standardised body surface area (adjusted OR 0.20, 95% CI 0.06 to 0.55, p=0.004) emerged as a significant independent predictor. A linear mixed model showed that dose adjustments managed symptoms without compromising 12-month forced vital capacity or diffusing capacity of the lungs for carbon monoxide trajectories (p>0.05). Small body size influences drug tolerability, suggesting that simple anthropometric measures can aid in baseline risk stratification to improve adherence.</p>","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148689852","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":"Unsupervised home spirometry versus supervised clinic spirometry: analysis of longitudinal participant-level data from the CLEAR trial in patients with bronchiectasis.","authors":"Ryan McChrystal, Rebecca H McLeese, Brenda O'Neill, Daniel F McAuley, J Stuart Elborn, Mike Clarke, John Norrie, Dermot Linden, Jonathan Stewart, Andrew Jackson, William D-C Man, Anthony De Soyza, James D Chalmers, Rohan Anand, Fiona Copeland, Judy M Bradley","doi":"10.1136/thorax-2026-225189","DOIUrl":"https://doi.org/10.1136/thorax-2026-225189","url":null,"abstract":"<p><strong>Background: </strong>Lung function measurement is central to assessing disease severity and monitoring progression in bronchiectasis. Although home spirometry is convenient for remote monitoring, there is limited evidence for its performance.</p><p><strong>Aims: </strong>In an a priori defined substudy in the CLEAR trial (a multicentre, randomised, open-label study of hypertonic saline and carbocisteine versus usual care in bronchiectasis), we assessed the performance of home spirometry in adults with bronchiectasis using the PANACEA framework (seven domains: test Performance, disease mANAgement, Cost, patient Experience, clinician Experience, researcher Experience, and Access).</p><p><strong>Methods: </strong>Participants performed supervised 'clinic' spirometry at five visits and unsupervised 'home' spirometry weekly and during exacerbations over 52 weeks. Analyses evaluated agreement, longitudinal variation, changes in lung function across exacerbations, measurement quality, adherence and patient experience. Agreement was evaluated using Bland-Altman analysis; other outcomes were summarised descriptively.</p><p><strong>Results: </strong>257 participants had home spirometry data. Clinic and home spirometry demonstrated close agreement, with a mean forced expiratory volume in 1 s (FEV₁) difference of 20 mL (95% CI -130 to 170). Variability decreased over time (coefficient of variation 12.25% to 8.81%). Among 462 exacerbations, 195 had spirometry data within 7 days of exacerbation start/end dates. A >100 mL decline in FEV₁ occurred in 48% of exacerbations; 35% returned to within 100 mL of pre-exacerbation stable values by exacerbation end. Most spirometry sessions met American Thoracic Society/European Respiratory Society quality criteria, adherence declined over time while patient experience was generally positive.</p><p><strong>Conclusion: </strong>Home spirometry demonstrates good agreement with clinic spirometry, with variability between measurements decreasing over time. Home spirometry detected changes in lung function across exacerbations, although variability may limit interpretation at the individual patient level. With appropriate patient support to maintain adherence, home spirometry has potential as a tool for remote monitoring and decentralised clinical trials in bronchiectasis.</p><p><strong>Trial registration number: </strong>ISRCTN89040295.</p>","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148680077","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":"Breathing immunity into in vitro lung models.","authors":"Ali Doryab, Motaharehsadat Heydarian, Clare Bryant, Andrew Conway Morris","doi":"10.1136/thorax-2026-225369","DOIUrl":"https://doi.org/10.1136/thorax-2026-225369","url":null,"abstract":"<p><strong>Background: </strong>The human lung hosts a highly specialised immune microenvironment responsible for defence, repair and responses to pathogens and environmental insults. Animal models insufficiently recapitulate human-specific immune pathways, limiting translational insight into both acute and chronic respiratory diseases. Advances in organoids, organ-on-chip technologies and biofabrication have enabled increasingly realistic in vitro lung models; however, many systems still lack immune components and the complexity required to capture dynamic host-immune interactions.</p><p><strong>Content: </strong>This review outlines the existing impact of immune-competent lung models on clinical drug development and disease mechanistic studies, as well as the future potential and the technical challenges with integrating immune cells into in vitro lung models that need to be overcome to maximise clinical relevance. We discuss major bottlenecks and corresponding potential solutions, including immune cell viability and phenotype maintenance, microenvironmental compatibility, recruitment dynamics and the reproducibility-complexity trade-off. We further explore how cutting-edge biofabrication approaches, including tunable extracellular matrices, bioprinting and engineered microvascular networks, enable physiologically relevant interactions between immune and resident lung cell populations.</p><p><strong>Conclusion: </strong>Collectively, these advances pave the way for improved immune-competent lung models to accelerate therapeutic discovery and enhance model translational relevance.</p>","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148680053","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":"Implementation and outcomes of drug response assessments for inhaled hypertonic saline in bronchiectasis: a post hoc analysis of the CLEAR trial.","authors":"Rebecca H McLeese, Brenda O'Neill, Daniel F McAuley, Mike Clarke, Andrew Jackson, Christina Campbell, Kathryn Ferguson, Ryan McChrystal, Anthony De Soyza, James D Chalmers, Fiona Copeland, J Stuart Elborn, Judy M Bradley","doi":"10.1136/thorax-2025-224572","DOIUrl":"https://doi.org/10.1136/thorax-2025-224572","url":null,"abstract":"<p><strong>Introduction: </strong>A drug response assessment (DRA) is recommended before starting patients on hypertonic saline (HTS) due to the risk of bronchoconstriction. As part of the CLEAR trial (a randomised, open-label trial of HTS and/or carbocisteine versus usual care in bronchiectasis), we performed a post hoc analysis to explore the implementation and outcomes of DRAs. We aimed to remotely train/assess research coordinators in performing DRAs and determine patient safety/tolerability with HTS.</p><p><strong>Methods: </strong>Research coordinators were remotely trained/deemed DRA competent. DRAs were conducted only in patients assigned HTS. Failure was classified as ≥15% forced expiratory volume in 1 s (FEV₁) drop or 10%-15% drop with respiratory symptoms.</p><p><strong>Results: </strong>54 research coordinators (20 sites) were remotely trained/deemed competent, and 52 conducted at least one DRA. 145 patients completed DRAs: 144 were correctly classified, one was misclassified as pass (found during quality checks). 12 were classified as fail in the first DRA: seven had ≥15% FEV₁ drop, two had 10%-15% FEV₁ drop with symptoms, one had severe coughing (clinical team did not recruit) and the reason was not documented for two. 11 repeated the DRA; nine passed and continued in the trial, two failed and were excluded. 142/145 were classified as pass and entered the trial. Of 142 patients who continued in the trial, 46 later withdrew from HTS. 17 withdrawals were related to issues with HTS tolerance despite passing the first DRA.</p><p><strong>Discussion: </strong>DRA failure rate was low and did not identify medium-term/long-term tolerance to HTS, indicating that its utility as a screening tool for tolerability in this population is limited.</p><p><strong>Trial registration number: </strong>ISRCTN89040295.</p>","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148680084","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":"Minimum important difference for the incremental shuttle walk test in long covid rehabilitation.","authors":"Molly M Baldwin, Enya Daynes, Rachael A Evans, Sally J Singh","doi":"10.1136/thorax-2026-225151","DOIUrl":"https://doi.org/10.1136/thorax-2026-225151","url":null,"abstract":"<p><p>The minimum important difference (MID) for the incremental shuttle walk test (ISWT) in individuals with long covid was estimated using anchor-based and distribution-based methods. 397 participants (56 ± 13 years; 63.7% male) with long covid completed a 6-week rehabilitation programme and rated perceived change using the Global Rating of Change Scale (GRCS). Change in ISWT distance differed across GCRS categories (p<0.05); participants reporting slight improvement increased ISWT distance by 60.7±85.9 m. Receiver operating characteristic analysis identified an optimal cut-off of 35 m (area under the curve 0.70, 95% CI 0.61 to 0.79; p<0.05). Distribution-based methods yielded MID estimates of 40.1 m and 52.5 m, supporting an MID range of 35-60.7 m.</p>","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148680082","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":"Inhaled and oral corticosteroid use and the risk of pulmonary aspergillosis: a Danish population-based case-control study.","authors":"Alexander Jordan, Louise Lindhardt Toennesen, Bård-Emil Vang Gundersen, Jens-Ulrik Stæhr Jensen","doi":"10.1136/thorax-2026-225007","DOIUrl":"https://doi.org/10.1136/thorax-2026-225007","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary aspergillosis is a rare, high mortality lung infection caused by the <i>Aspergillus</i> sp. Chronic lung diseases and immunosuppression are known risk factors, but data on the impact of corticosteroids and their route of administration are limited.</p><p><strong>Methods: </strong>To evaluate the association between corticosteroid use and pulmonary aspergillosis, we conducted a retrospective case-control study in all Danish citizens who redeemed at least one prescription for inhaled medicine between 1994 and 2025. We identified 1351 patients with aspergillosis other than allergic bronchopulmonary aspergillosis (ABPA) and matched them to controls (1:5) by age, sex and calendar year using risk set sampling. Conditional logistic regression was used to estimate adjusted incidence rate ratios (aIRRs) for chronic pulmonary aspergillosis (CPA) and invasive pulmonary aspergillosis (IPA) across dose categories and 90-day exposure windows. The use of risk-set sampling allowed for estimating IRRs.</p><p><strong>Results: </strong>Inhaled corticosteroids were associated with non-ABPA aspergillosis in a dose-dependent manner (aIRR 1.7 (95% CI 1.3 to 2.2) for use ≤640 µg/day, aIRR 2.8 (2.2 to 3.6) for use >640 µg/day, compared with no use) but only associated with IPA for higher doses. Oral corticosteroids (OCS) were similarly associated with non-ABPA aspergillosis (aIRR 3.0 (95% CI 2.2 to 4.1) for OCS use ≤5.6 mg/day, aIRR 4.0 (2.9 to 5.4) for OCS use >5.6 mg/day, both compared with no use), affecting both CPA and IPA. The risk decreased with increasing time since exposure.</p><p><strong>Conclusion: </strong>Our results demonstrate a strong and seemingly dose-dependent association between both systemic and inhaled corticosteroid use and aspergillosis.</p>","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148648998","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":"Corticosteroids in COPD carry the danger of fatal aspergillosis.","authors":"David W Denning","doi":"10.1136/thorax-2026-225545","DOIUrl":"https://doi.org/10.1136/thorax-2026-225545","url":null,"abstract":"","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148649044","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":"Secondary pulmonary alveolar proteinosis mimicking ILD progression in anti-MDA5 dermatomyositis.","authors":"Hirotoshi Yasui, Ko Ohara, Kaito Sano, Yasutaka Mori, Yasushi Makino","doi":"10.1136/thorax-2026-225260","DOIUrl":"https://doi.org/10.1136/thorax-2026-225260","url":null,"abstract":"","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148649045","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":"Familial associations of lung function between parents, offspring and siblings: a two-generation study of the ECRHS and RHINESSA cohorts.","authors":"Lucia Cestelli, Simone Accordini, Andrei Malinovschi, Bryndis Benediktsdóttir, Randi Jacobsen Bertelsen, Francisco Javier Callejas-González, Thórarinn Gíslason, Francisco Gómez Real, John W Holloway, Mathias Holm, Christer Janson, Nils Oskar Jõgi, Rain Jõgi, Ane Johannessen, Caroline Lodge, Anna Oudin, Vivi Schlünssen, Shyamali Dharmage, Cecilie Svanes","doi":"10.1136/thorax-2026-225219","DOIUrl":"https://doi.org/10.1136/thorax-2026-225219","url":null,"abstract":"<p><strong>Background: </strong>The familial aggregation of lung function is incompletely understood, as well as potential sex-specific patterns of associations within families. We aimed to investigate the associations of spirometry measures between parents and offspring and between siblings in two multicentre cohorts.</p><p><strong>Methods: </strong>We studied n=1203 parent-offspring pairs and n=254 sibling pairs from the European Community Respiratory Health Survey (parents, mean age 35 years) and Respiratory Health in Northern Europe, Spain and Australia (offspring, mean age 31 years) cohorts. We used multilevel mixed-effect regression models to assess parent-offspring and between-siblings associations of forced expiratory volume in the first second (FEV₁) and forced vital capacity (FVC) (litres), adjusted for sex, age, height, smoking and body mass index, accounting for clustering within centres and families.</p><p><strong>Results: </strong>FEV₁ and FVC were positively associated between parents and offspring (ß coef. (95% CI): FEV₁ 0.19 (0.14 to 0.25), FVC 0.19 (0.14 to 0.25)) and between first and second sibling (ß coef. (95% CI): FEV₁ 0.30 (0.17 to 0.43), FVC 0.20 (0.08 to 0.32)). The associations of FEV₁ and FVC between mothers and sons were significantly higher (p<0.05) than the other sex combinations. Between siblings, FEV₁ had greater concordance than FVC without evident sex-specific patterns. Results were consistent after exclusion of asthmatic participants. The proportion of variance explained within-family was 76% (95% CI 66% to 87%) for FEV₁ and 80% (95% CI 69% to 91%) for FVC, after adjustment for anthropometric factors. The between-family variance was 23% (95% CI 12% to 34%) for FEV₁ and 19% (95% CI 8% to 30%) for FVC.</p><p><strong>Conclusions: </strong>This study supports phenotypic concordance of lung function within families, with the strongest positive association observed between mothers and sons. Approximately 75-80% of the variance of FEV₁ and FVC was explained within-family.</p>","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148621518","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}