Lancet Respiratory Medicine最新文献

{"title":"Contributors to the heterogeneity of response to CFTR modulators","authors":"Prof Damian G Downey MD, Claire Houston PhD, Prof Nicole Mayer-Hamblett PhD, Jennifer L Taylor-Cousar MD, Prof Clifford C Taggart PhD","doi":"10.1016/s2213-2600(26)00060-3","DOIUrl":"https://doi.org/10.1016/s2213-2600(26)00060-3","url":null,"abstract":"Cystic fibrosis transmembrane conductance regulator (CFTR) modulators have transformed the management of cystic fibrosis; however, substantial interindividual variability in clinical response persists, even among people with identical CFTR genotypes. This variability challenges clinicians, regulators, and researchers in defining treatment success and optimising long-term outcomes. We synthesise evidence from clinical trials, real-world cohorts, and mechanistic studies to examine the contributors to heterogeneity in response to CFTR modulators, with a focus on triple therapy (elexacaftor–tezacaftor–ivacaftor). Treatment response varies across lung function, pulmonary exacerbations, sweat chloride, nutritional status, and quality of life, and is influenced by different factors, including disease stage, CFTR genotype and complex alleles, pharmacokinetic variability, adherence, side-effects, environmental exposures, and host modifiers. No single metric adequately captures individual response. Binary classifications of responder and non-responder are therefore overly reductive. A multidimensional and longitudinal approach integrating clinical outcomes with biomarkers and selected functional assessments is required to maximise benefit and guide future therapeutic strategies.","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"148 1","pages":""},"PeriodicalIF":76.2,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147736560","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":"Whole genome sequencing precision medicine strategy to shorten treatment for rifampicin-resistant tuberculosis (SMARTT): a pragmatic, randomised, single-blind phase 4 trial","authors":"Prof Annelies Van Rie PhD, Emilyn Costa Conceição PhD, Felex Ndebele MSc, Felicia Wells MSc, Astrid Paulse MSc, Eskedar Getie Mekonnen MSc, Miriam Ngarega MSc, Tu Pham Hien Trang MSc, Sthabiso Bohlela MSc, Zandile Sibeko MSc, Pulane Segwaba, Lennert Verboven PhD, Tim H Heupink PhD, Miguel De Diego Fuertes MSc, Vincent Rennie PhD, Anzaan Dippenaar PhD, Leen Rigouts PhD, Leole Setlhare BSc, Ayodeji Emmanuel Ogunbayo PhD, Anneke VanderSpoel Van Dyk MSc, Francesca Conradie MD, Prof Gary Maartens PhD, Samantha Potgieter MD, John Black MD, Boitumelo Fanampe PhD, Prof Steven Abrams PhD, Prof Gavin Churchyard PhD, Prof Robin Warren PhD, Salome Charalambous PhD","doi":"10.1016/s2213-2600(26)00095-0","DOIUrl":"https://doi.org/10.1016/s2213-2600(26)00095-0","url":null,"abstract":"All patients with rifampicin-resistant tuberculosis should receive a short course of effective treatment. We aimed to evaluate the effectiveness of whole genome sequencing (WGS)-guided treatment in shortening duration of treatment for rifampicin-resistant tuberculosis.","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"303 1","pages":""},"PeriodicalIF":76.2,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147736562","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":"SCCM 2026 guidelines: caring for older adults in the ICU","authors":"Priya Venkatesan","doi":"10.1016/s2213-2600(26)00124-4","DOIUrl":"https://doi.org/10.1016/s2213-2600(26)00124-4","url":null,"abstract":"","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"46 1","pages":""},"PeriodicalIF":76.2,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147736563","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":"Precision medicine—a new era for the management of drug-resistant tuberculosis","authors":"Christoph Lange, Tara Ness, Francesca Saluzzo, Bavesh Kana","doi":"10.1016/s2213-2600(26)00119-0","DOIUrl":"https://doi.org/10.1016/s2213-2600(26)00119-0","url":null,"abstract":"","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"101 1","pages":""},"PeriodicalIF":76.2,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147736564","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":"Local coalitions track pollution in neglected US communities.","authors":"Bryant Furlow","doi":"10.1016/S2213-2600(26)00122-0","DOIUrl":"https://doi.org/10.1016/S2213-2600(26)00122-0","url":null,"abstract":"","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":" ","pages":""},"PeriodicalIF":32.8,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147718932","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":"Campaigning to improve sepsis recognition and outcomes","authors":"The Lancet Respiratory Medicine","doi":"10.1016/s2213-2600(26)00121-9","DOIUrl":"https://doi.org/10.1016/s2213-2600(26)00121-9","url":null,"abstract":"","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"67 1","pages":""},"PeriodicalIF":76.2,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147680920","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":"Rilzabrutinib and the evolving landscape of oral therapies for uncontrolled asthma","authors":"Silvano Dragonieri","doi":"10.1016/s2213-2600(26)00001-9","DOIUrl":"https://doi.org/10.1016/s2213-2600(26)00001-9","url":null,"abstract":"","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"18 1","pages":""},"PeriodicalIF":76.2,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147597980","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":"Rilzabrutinib for patients with moderate-to-severe asthma with uncontrolled symptoms: a double-blind, placebo-controlled, phase 2 study","authors":"Jorge F Maspero, Ian D Pavord, Michael E Wechsler, William Busse, Tanya M Laidlaw, Robert M Mróz, Tian Liu, Vincent Mikol, Benjamin T Suratt, Jessica Gereige, Leda Mannent, Renata Martincova","doi":"10.1016/s2213-2600(25)00439-4","DOIUrl":"https://doi.org/10.1016/s2213-2600(25)00439-4","url":null,"abstract":"","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"5 1","pages":""},"PeriodicalIF":76.2,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147597985","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":"Correction to Lancet Respir Med 2026; 14: 38-48.","authors":"","doi":"10.1016/S2213-2600(26)00079-2","DOIUrl":"10.1016/S2213-2600(26)00079-2","url":null,"abstract":"","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":" ","pages":"e30"},"PeriodicalIF":32.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147328132","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":"Medical thoracoscopy with talc poudrage and indwelling pleural catheter insertion versus medical thoracoscopy with talc poudrage alone for patients with symptomatic malignant pleural effusion (TACTIC): a randomised, controlled phase 3 trial.","authors":"Alexandra Dipper, Anand Sundaralingam, Emma Hedley, Sharada Gudur, Janet Mills, Sandra Sowden, John P Corcoran, Cyrus Daneshvar, Chris Craig, Andrew J Moore, Alice Milne, Amelia Clive, Rahul Bhatnagar, Mark E Roberts, Thapas Nagarajan, Farheen Kutubudin, Helen Wassal, Moustafa Aboushehata, Sana Iftikhar, Mohammed Haris, Manjumol Abraham, Rajini Sudhir, Rakesh K Panchal, Duneesha de Fonseka, Eihab O Bedawi, Beenish Iqbal, Dinesh Addala, John Wrightson, Daniel Menzies, Svetlana Ratushnyak, Ramon Luengo-Fernandez, Robert F Miller, Paul White, Mohammed Munavvar, Najib M Rahman, Nick Maskell","doi":"10.1016/S2213-2600(25)00409-6","DOIUrl":"10.1016/S2213-2600(25)00409-6","url":null,"abstract":"<p><strong>Background: </strong>Patients with suspected malignant pleural effusions (MPE) are often in need of both a confirmatory diagnosis and symptom control. Therapeutic options include talc pleurodesis via chest drain, poudrage during medical thoracoscopy, or alternatively an indwelling pleural catheter (IPC). Combining the diagnostic and therapeutic efficacy of medical thoracoscopy and poudrage with the ambulatory benefits of an IPC has not been studied within a randomised controlled trial. The aim of the TACTIC trial was to determine whether this approach resulted in a reduced length of hospital stay and improvements in dyspnoea.</p><p><strong>Methods: </strong>This unblinded, phase 3, randomised controlled trial was undertaken in 11 UK hospitals. Patients with MPE and confirmed malignancy (during medical thoracoscopy or beforehand) received talc poudrage and were randomly assigned by a centralised web-based system to an IPC at the time of medical thoracoscopy or usual care (ie, medical thoracoscopy, poudrage, and admission with large bore tube). Co-primary outcomes were time in hospital (including initial admission for trial procedure and any subsequent readmissions over 4 weeks post procedure) and average breathlessness assessed with visual analogue scale dyspnoea scores, measuring severity of dyspnoea from 0 mm to 100 mm, over a 4-week period. All randomised patients in whom an outcome was available were included in the analysis on a modified intention-to-treat basis. TACTIC was registered with ISRCTN on Aug 8, 2021 (ISRCTN11058680).</p><p><strong>Findings: </strong>Participants were recruited from between Dec 15, 2021, and Jan 3, 2024. 124 participants were randomised: 62 to the intervention and 62 to standard care. Leading diagnoses were pleural mesothelioma (46%), lung cancer (28%), and breast cancer (10%). Co-primary outcome data were available for 102 patients for total length of hospital stay (52 in intervention group vs 50 in standard care group) and 108 patients for breathlessness (57 vs 51). Median time in hospital was 1 day (IQR 1-3, 95% CI 1-2) in the intervention group versus 2 days (IQR 1-3, 95% CI 1-2) in standard care group (p=0·26). Median visual analogue scale dyspnoea scores did not differ between groups: 14·0 mm (IQR 8·8-32·4) in the intervention group versus 19·6 mm (8·1-38·7) in standard care group (p=0·26). Participants in the intervention group required fewer additional invasive pleural procedures by 12 weeks (two [3%] of 60 vs 19 [34%] of 56, p<0·0001) Trial related adverse events rates were similar in both groups (46 [74%] of 62 vs 44 [71%] of 62, p=0·84). Three related serious adverse events were recorded, all occurring in the intervention group.</p><p><strong>Interpretation: </strong>The combination of medical thoracoscopy, poudrage, and IPC did not result in shorter hospital stay but was safe and resulted in similar dyspnoea control compared with standard care. For patients with symptomatic MPE undergoing med","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":" ","pages":"341-349"},"PeriodicalIF":32.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147322700","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}