BMJ Open Respiratory Research最新文献

{"title":"Frequency and severity of COPD exacerbations and future risk of exacerbations and mortality: an observational cohort study in Canada.","authors":"My Linh Duong, Christina Qian, Manisha Talukdar, Sheena Kayaniyil, Johnston Karissa, Clementine Nordon, Erika D Penz","doi":"10.1136/bmjresp-2024-002976","DOIUrl":"10.1136/bmjresp-2024-002976","url":null,"abstract":"<p><strong>Objectives: </strong>To estimate the risk of subsequent exacerbations, in relation to history of exacerbations, in a cohort of older chronic obstructive pulmonary disease (COPD) patients in Canada.</p><p><strong>Methods: </strong>Using provincial claims data from Ontario, Canada, patients with COPD aged≥65 years (identified between 2004 and 2018; followed up to 2020) were categorised into one of four mutually exclusive groups: no exacerbation; only one moderate; only one severe; or two or more exacerbations of any severity (moderate or severe) during the baseline period. The index date was the first documentation of a COPD diagnosis code; the subsequent 12 months served as the baseline period. Adjusted risks of subsequent exacerbations (any severity and severe exacerbation, separately) by the end of postbaseline year 1, 2 and 3 were estimated, accounting for differences in patient and disease characteristics and competing risk of death.</p><p><strong>Results: </strong>A total of 591 686 patients were included. The majority (89.8%) had no exacerbation at baseline, 3.1% had one moderate exacerbation only, 3.6% had one severe exacerbation only and 3.6% had two or more exacerbations of any severity. Adjusted risks of a subsequent exacerbation of any severity by the end of year 3 were 28.6% (95% CI, 28.5% to 28.7%) with no baseline exacerbation; 56.6% (95% CI, 56.1% to 57.1%), one severe; 58.4% (95% CI, 58.0% to 58.8%), one moderate; and 77.5% (95% CI, 77.2% to 77.8%) two or more exacerbations. Adjusted risks of a subsequent severe exacerbation by the end of year 3 were 20.1% (95% CI, 20.0% to 20.2%) with no baseline exacerbation; 34.9% (95% CI, 34.5% to 35.4%), one moderate; 46.7% (95% CI, 46.2% to 47.2%), one severe; and 59.6% (95% CI, 59.3% to 60.0%) two or more exacerbations.</p><p><strong>Conclusions: </strong>Having a history of a single severe or two or more exacerbations of any severity is associated with a higher risk of future exacerbations, with observed exacerbation rates and severity that are constant over time. Even one moderate exacerbation over a year is associated with poorer outcomes, compared with the absence of exacerbation, and moderate exacerbations should be managed accordingly.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12481290/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145198177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single versus double lung transplantation outcomes in artificial stone silicosis: a single-centre retrospective cohort study.","authors":"Miri Dotan, Dror Rosengarten, Karam Azem, Shai Fein, Yael Shostak, Dorit Shitenberg, Yuri Peysakhovich, Yaron D Barac, Elizabeth Fireman, Paul Blanc, Osnat Shtraichman, Mordechai Reuven Kramer","doi":"10.1136/bmjresp-2024-002703","DOIUrl":"10.1136/bmjresp-2024-002703","url":null,"abstract":"<p><strong>Background: </strong>Silicosis, caused by inhaling crystalline silica, is a growing global health concern exacerbated by the increased use of artificial stone. In end-stage silicosis, lung transplantation may be the only available treatment. While double lung transplantation has long-term survival benefits over single lung transplantation, this issue was not assessed in patients with silicosis.</p><p><strong>Research question: </strong>Our study aimed to evaluate survival outcomes in silicosis patients undergoing lung transplantation, comparing single versus double lung transplants.</p><p><strong>Study design and methods: </strong>This is a single-centre retrospective cohort study of all patients who underwent lung transplantation for silicosis at our centre between March 2006 and March 2024.</p><p><strong>Results: </strong>During the study period, our centre conducted 778 lung transplantations, 40 of them (5.14%) were for silicosis, 25 single lung transplants and 15 double lung transplants. Double lung transplantation recipients experienced a more challenging surgical course due to adhesions and difficulty in explantation, associated with a significantly higher volume of blood products (8.00±15.13 units vs 24.85±24.41 units, p=0.023) and longer ischaemic times (243.63±85.36 min vs 327.67±95.23 min, p=0.009). There was no significant difference in the risk of death or re-transplantation in the single lung versus the double lung group (HR 1.163, 95% CI 0.473 to 2.861; p=0.74). Additionally, the two groups had no significant disparities in pulmonary function test results at 1 and 3 years post-transplant (51.93±22.43 vs 66.67±32.09 forced expiratory volume in the first second percent predicted at 36 months follow-up, p=0.25).</p><p><strong>Conclusion: </strong>Given the intricate surgical procedure required for transplanting lungs in cases of silicosis, longer ischaemic times, increased need for blood products and the absence of definitive evidence supporting double lung transplantation in this population, it may be prudent to contemplate prioritising single lung transplantation for these patients.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12481386/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145198257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"'And the stick to fight TB is TPT': nurse-identified barriers and facilitators of tuberculosis preventive therapy implementation in rural South Africa.","authors":"Megan A Grammatico, Anthony P Moll, Amiya Ahmed, Lauretta E Grau, Sipho Nsele, Philile Makhunga, Justin Jones, Sheela V Shenoi","doi":"10.1136/bmjresp-2024-002663","DOIUrl":"https://doi.org/10.1136/bmjresp-2024-002663","url":null,"abstract":"<p><strong>Background: </strong>A decade after South Africa adopted tuberculosis preventive therapy (TPT), uptake remains sub-optimal.</p><p><strong>Methods: </strong>Senior nurses at primary care clinics participated in semistructured individual interviews. Transcripts were thematically analysed to assess knowledge and attitudes towards TPT in rural South Africa.</p><p><strong>Results: </strong>Among 22 senior nurses, 86% were female, with the median age of 39 years, and mean of 13.3 years' experience. Participants identified key individual-level barriers among nurses, interpersonal barriers that nurses observed among their patients and organisational barriers. While the nurses' belief in TPT efficacy was strong, their perceived barriers to TPT implementation included inflexible clinical guidelines, insufficient training and time to counsel patients, pill burden, patients' perceived HIV stigma and patients' alcohol use. Nurses believed implementation could be facilitated with task-shifting and integrating TPT into the antiretroviral (ART) infrastructure in primary care clinics and into chronic medication dispensing programmes. Shorter TPT regimens (eg, 12 weeks weekly INH/rifapentine: 3HP) were considered advantageous.</p><p><strong>Conclusions: </strong>Nurses identified multiple barriers to TPT implementation, including insufficient training and time to counsel patients, pill burden, HIV stigma and alcohol use. Nurses suggested task-shifting, TPT/ART integration and rollout of 3HP as potential facilitators of TPT implementation in rural South Africa. Nurses' perspectives are essential to informing TPT implementation efforts in resource-limited settings.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145173549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of socioeconomic status with respiratory mortality and hospitalisations in COPD: a nationwide cohort study.","authors":"Hyewon Lee, Bo Young Lee, Jiyun Jung, Jinwoo Seok, Jung-Hyun Kim, So-My Koo, Hee-Young Yoon","doi":"10.1136/bmjresp-2024-003128","DOIUrl":"10.1136/bmjresp-2024-003128","url":null,"abstract":"<p><strong>Background: </strong>Socioeconomic status (SES) and air pollution are independently associated with adverse outcomes in patients with chronic obstructive pulmonary disease (COPD). This study investigated the association of SES with respiratory mortality and hospitalisation, while adjusting for air pollution.</p><p><strong>Methods: </strong>This retrospective cohort study analysed the individual-level and area-level SES indicators, as well as long-term air pollution exposure, associated with COPD in the Korean National Health Insurance Service-National Sample Cohort. The associations of SES with respiratory mortality and hospitalisation were evaluated using Cox proportional hazards models after adjusting for clinical factors and air pollution.</p><p><strong>Results: </strong>Among 12 820 patients (mean age: 63.5 years, 47.2% male), 115 (0.9%) and 1870 (14.6%) experienced respiratory mortality and respiratory-related hospitalisation, respectively. Self-employed members had higher mortality risks than self-employed heads (HR=2.397, 95% CI=1.044 to 5.501). Regions with older adults constituting 20-50% of the population exhibited reduced mortality risks (HR=0.516, 95% CI 0.269 to 0.991). The area-level covariates significant in the clinically adjusted models lost significance after adjusting for air pollution. Income level (HR=0.979, 95% CI 0.965 to 0.993) exhibited a negative association with respiratory hospitalisation risks. Suburban (HR=1.321, 95% CI 1.141 to 1.530) and rural (HR=1.398, 95% CI 1.202 to 1.626) residential status was associated with a higher hospitalisation risk. A higher older-adult population was positively associated with hospitalisation risk (HR=1.023, 95% CI 1.014 to 1.033). Higher education level and gross regional domestic product quartiles exhibited reduced hospitalisation risk.</p><p><strong>Conclusions: </strong>The associations between SES and mortality and hospitalisation risks remained attenuated and persistent, respectively, after adjusting for air pollution.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12481353/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145173482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characterisation of nasopharyngeal colonisation by <i>Staphylococcus aureus</i> and the factors associated with colonisation in comorbid adults in a low- and middle-income country.","authors":"Juan Olivella-Gómez, Natalia Sanabria-Herrera, Paula O Narvaez-Ramirez, Lina Méndez, Cristian C Serrano-Mayorga, Julian Lozada, Ingrid G Bustos, Lina Fernanda Martínez, Erika Y García-García, Nury N Olaya-Galán, Diego Jaimes, Ignacio Martin-Loeches, Luis F Reyes","doi":"10.1136/bmjresp-2025-003476","DOIUrl":"10.1136/bmjresp-2025-003476","url":null,"abstract":"<p><strong>Introduction: </strong><i>Staphylococcus aureus</i> is a major cause of pneumonia globally, with a particularly high burden in low- and middle-income countries (LMICs). Nasopharyngeal colonisation (NPC) by <i>S. aureus</i> plays a critical role in the pathogenesis of respiratory infections. However, existing research has predominantly focused on paediatric and immunocompromised populations. Data on general adult populations, especially in LMICs, are limited. This study aimed to determine the prevalence of <i>S. aureus</i> NPC in adults with chronic comorbidities and identify associated risk factors.</p><p><strong>Methods: </strong>Participants with chronic comorbidities were recruited from community-based settings. Samples were processed using conventional culture techniques to isolate <i>S. aureus</i>. Bacterial identification was confirmed by matrix-assisted laser desorption ionisation-time of flight mass spectrometry. To characterise antimicrobial resistance profiles, cefoxitin disc diffusion and D-zone tests were performed in accordance with standardised clinical microbiology protocols. Participants were longitudinally followed and resampled at 6, 12 and 18 months postenrolment to evaluate colonisation dynamics over time.</p><p><strong>Results: </strong>A total of 810 adults were enrolled. Baseline <i>S. aureus</i> NPC prevalence was 15.3% (124/810), with 11.2% (14/124) of isolates being methicillin-resistant <i>S. aureus</i> (MRSA) and 6.4% (8/124) showing clindamycin resistance. At 6-month follow-up, the cumulative incidence of <i>S. aureus</i> colonisation was 14.2%. In multivariable logistic regression, active smoking (OR 1.73, 95% CI 1.06 to 2.85, p=0.02) and rheumatoid arthritis (OR 3.03, 95% CI 1.38 to 6.67, p<0.01) were independently associated with colonisation. Influenza vaccination was associated with reduced risk (OR 0.60, 95% CI 0.38 to 0.94, p=0.02).</p><p><strong>Conclusion: </strong><i>S. aureus</i> NPC, including MRSA, was common among adults with chronic comorbidities. Active smoking and autoimmune diseases, particularly rheumatoid arthritis, were independently associated with increased colonisation risk. These findings have direct implications for community-acquired pneumonia management, supporting consideration of empiric anti-MRSA therapy in high-risk patients. Preventive strategies, including smoking cessation and targeted vaccination, should be prioritised in this population.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12481271/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145147716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk of pneumonia in individuals with rheumatoid arthritis: a nationwide cohort study.","authors":"Seong Mi Moon, Kyungdo Han, Jin-Hyung Jung, Junhee Park, Bumhee Yang, Yeonghee Eun, Hayoung Choi, Hyungjin Kim, Dong Wook Shin, Hyun Lee","doi":"10.1136/bmjresp-2024-002664","DOIUrl":"10.1136/bmjresp-2024-002664","url":null,"abstract":"<p><strong>Background: </strong>Limited information is available on the influence of serologic status and different types of disease-modifying antirheumatic drugs (DMARDs) on risk of pneumonia. This study aimed to evaluate the risk of pneumonia according to rheumatoid arthritis (RA) seropositivity and type of DMARD.</p><p><strong>Methods: </strong>This population-based cohort study enrolled individuals with RA (RA cohort, n=41 187) and 1:5 age-matched and sex-matched controls (n=205 935) between 2010 and 2017. Participants were followed from 1 year after RA diagnosis or matched control date until the first occurrence of pneumonia, pneumonia-related hospitalisation, death or 31 December 2019. The risks of pneumonia and related hospitalisation were evaluated according to serological status and type of DMARD.</p><p><strong>Results: </strong>During a median follow-up duration of 4.2 years, increased risks of pneumonia (adjusted HR (aHR) (95% CI)=1.73 (1.69 to 1.78)) and related hospitalisation (2.26 (95% CI 2.15 to 2.37)) were observed in individuals of the RA cohort compared with controls. Compared with the controls, individuals with seropositive RA showed the highest risk of pneumonia (1.86 (95% CI 1.80 to 1.92)) and related hospitalisation (2.52 (95% CI 2.39 to 2.65)), followed by those with seronegative RA (1.43 (95% CI 1.36 to 1.50) for pneumonia; 1.60 (95% CI 1.46 to 1.76) for related hospitalisation). Individuals in the RA cohort showed a higher risk of pneumonia/related hospitalisation compared with controls, with an aHR (95% CI) of 1.77 (95% CI 1.62 to 1.94)/3.23 (95% CI 2.82 to 3.69), respectively, for biological DMARD-exposed RA, and 1.74 (95% CI 1.69 to 1.79)/2.22 (95% CI 2.11 to 2.33), respectively, for conventional synthetic DMARD-exposed RA. In contrast, targeted synthetic type did not show a significantly increased risk of pneumonia/related hospitalisation (0.93 (95% CI 0.66 to 1.31)/1.21 (95% CI 0.67 to 2.18), respectively).</p><p><strong>Conclusions: </strong>Individuals with RA showed increased risk of pneumonia and related hospitalisation, and this was especially higher in those with seropositive RA. Except for targeted synthetic DMARDs, all other types were associated with increased risk of pneumonia. These findings emphasise the need for heightened awareness of pneumonia risk in the management of RA.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12481257/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145147723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differences in disease characteristics and outcomes as determined by biological sex in a large UK idiopathic pulmonary fibrosis population: analysis from the British Thoracic Society, Interstitial Lung Disease registry data.","authors":"Sarah Mulholland, Giles Dixon, Matthew Wells, Sam Harding, Paul White, Anne-Marie Russell, Shaney L Barratt","doi":"10.1136/bmjresp-2025-003301","DOIUrl":"10.1136/bmjresp-2025-003301","url":null,"abstract":"<p><strong>Introduction: </strong>Growing evidence suggests that biological sex influences the incidence, presentation, diagnosis and outcomes of many lung diseases. Understanding these differences is the first step towards precision medicine to improve patient care.</p><p><strong>Methods: </strong>In this cross-sectional study, idiopathic pulmonary fibrosis (IPF) patients enrolled in a national (UK), multicentre registry were categorised by sex and analysed for differences in demographics, pulmonary function tests, high resolution CT radiological pattern, eligibility/uptake of antifibrotics and survival.</p><p><strong>Results: </strong>Of 7177 cases, 77.8% (n=5587) were male, median age 75 years (IQR 69.5-80.5) for both sexes (p=0.83). Males were more likely to have a history of smoking (males 72.9% vs females 60.5%, p<0.001) and lower baseline median forced vital capacity (FVC) % predicted (males 76.4%, IQR 66.2-86.7 vs females 78.8%, IQR 68.6-89.1, p<0.001). Diabetes (males 22.8% vs females 15.1%) and cardiovascular disease (males 58.9% vs females 47.8%) were statistically more common in males (p<0.001), while gastro-oesophageal reflux disease (males 20% vs females 24.6%) and major depressive illness (males 0.8% vs females 2.5%) were more common in females (p<0.001). Significantly, more females experienced symptoms for >24 months prior to first clinic appointment (females 40.1% vs males 36.6%, p=0.03). While more males in the cohort met eligibility criteria for antifibrotics at baseline (pirfenidone FVC 50%-80% males 54.7% vs females 47.6%, nintedanib FVC 50%-80% males 47.0% vs females 41.5%, p<0.001), a larger proportion chose not to commence antifibrotic treatment (males 47.0% vs females 29.6%, p<0.001). Female sex was associated with longer survival; for females, the 75% Kaplan-Meier survival quartile is 7.6 years (95% CI 5.51 to 9.68 years) versus 4.3 years (95% CI 3.82 to 4.78) for males (p<0.001). Male sex (HR 1.76 (95% CI 1.22 to 2.54), p=0.002), higher age (HR 1.042 (95% CI 1.02 to 1.06), p<0.001), lower baseline FVC % predicted (HR 0.98 (95% CI 0.97 to 0.98), p<0.001) and coexistent lung cancer (HR 9.3 (95% CI 2.86 to 30.24), p<0.001) were all independently associated with worse survival.</p><p><strong>Conclusion: </strong>This is the first UK study to use national registry data to systematically evaluate IPF disease characteristics stratifying by biological sex and highlights distinct characteristics between groups. Future clinical trials should explicitly explore sex-specific targeted interventions and analyses to optimise future IPF patient care.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12481391/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145147699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of peak inspiratory flow in patients with chronic obstructive pulmonary disease: a multicentre, observational, prospective, real-life study.","authors":"Valeria Perugini, Chin Kook Rhee, Ji-Yong Moon, Tiew Pei Yee, Seung Won Ra, Pietro Pirina, Kwang Ha Yoo, Bernardino Alcázar Navarrete, Caroline Gouder, Almadana Pacheco, Annie Navarro-Rolon, Matevz Harlander, Therese Lapperre, Sean Chee Hong Loh, David Fole, Elsa Naval, Pedro Jose Romero Palacios, Marc Miravitlles, Omar Usmani","doi":"10.1136/bmjresp-2024-002408","DOIUrl":"10.1136/bmjresp-2024-002408","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with chronic obstructive pulmonary disease (COPD) use dry powder inhalers (DPIs) for disease management. DPI effectiveness relies on the patient's peak inspiratory flow (PIF), which may not always be optimal. We conducted an observational multicentre, prospective, real-life cohort study to determine the prevalence of suboptimal PIF in patients with COPD.</p><p><strong>Methods: </strong>415 participants (11%, n=47 women, mean age=70±8.7 years, mean forced expiratory volume in 1 s (predicted %)=48.1%) recruited from 17 international centres had baseline PIF recorded with an In-Check Dial device at three resistance levels: (1) low, (2) high and (3) the participant's maintenance device. We also recorded PIF from participants as they would do at home to verify their proper inhalation technique. Participants underwent spirometry and completed questionnaires (COPD Assessment Test (CAT), Test of Adherence to Inhalers (TAI)-12).</p><p><strong>Results: </strong>Of the 415 participants, 18% of DPI users (n=75) exhibited suboptimal values of PIF (as typical PIF <than what was required for tested inhalers in the study) when evaluated across DPI resistance groups ranging from low (R1) to high (R5) resistance, compared with 14% of participants (n=60) using devices without resistance (R0). Additionally, 14% of study participants were incapable of producing an optimal PIF or unwilling to do so (27%), impacting medication effectiveness. Participants with suboptimal PIF values had higher mean total CAT score (17.7±7) compared with those with optimal PIF values (12.1±7.6). When assessed globally, 37% (n=56) of participants with suboptimal PIF values did not adhere to treatment, highlighting the need for improved patient education and support.</p><p><strong>Conclusion: </strong>Suboptimal PIF is common in COPD, requiring regular assessment and tailored inhalers.</p><p><strong>Trial registration number: </strong>NCT04606394. Encepp EUPAS34689.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12481310/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145147911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Practical guide to management after an acute pulmonary embolism.","authors":"Raza Alikhan, Luke S Howard, Martin Johnson, Shruti Sweeney, David G Kiely, Joanna Pepke-Zaba","doi":"10.1136/bmjresp-2024-003028","DOIUrl":"10.1136/bmjresp-2024-003028","url":null,"abstract":"<p><p>Follow-up after acute pulmonary embolism (PE) is important to assess recovery, consider the need for on-going anticoagulation and identify chronic thromboembolic pulmonary hypertension (CTEPH), a rare but serious complication of PE. 16 dilemmas in the follow-up of acute PE were identified by a steering committee of four pulmonologists and a haematologist with interest in PE and/or CTEPH. Current literature was reviewed and a practical approach suggested based on expert consensus. Dilemmas discussed included: (1) how to manage a breathless patient; (2) what to do if CTEPH is suspected; (3) the difference between CTEPH and post-PE syndrome, (4) testing for thrombophilia, (5) when to investigate for cancer, (6) anticoagulation duration and dose, (7) approaches to discussions and decision-making with respect to anticoagulation, (8) use of aspirin and whether antiplatelet therapy should be stopped during anticoagulation and (9) advice for patients on discharge from hospital at 3 months and information for first-degree relatives. Given the occurrence of complications that may require assessment, follow-up of patients post-PE should be systematic and consider the individual needs of the patient.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12458777/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145136527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pharmacokinetics and pharmacodynamics of inhaled molgramostim in healthy people.","authors":"Bruce C Trapnell, Brenna C Carey, Brian R Robinson","doi":"10.1136/bmjresp-2024-002832","DOIUrl":"10.1136/bmjresp-2024-002832","url":null,"abstract":"<p><strong>Background: </strong>Inhaled molgramostim, a form of recombinant human granulocyte-macrophage colony stimulating factor (GM-CSF), is a promising investigational pharmacotherapy for autoimmune pulmonary alveolar proteinosis (aPAP); however, its pharmacology in healthy subjects has not been reported.</p><p><strong>Methods: </strong>This randomised, double-blind, placebo-controlled, single-centre, phase 1 clinical trial assessed the safety, tolerability, pharmacokinetics and pharmacodynamics of inhaled molgramostim in healthy adults in single ascending dose (SAD) and multiple ascending dose (MAD) studies: one 150, 300 or 600 µg administration or six consecutive daily 300 or 600 µg administrations with evaluations over 28 or 34 days, respectively. The primary endpoint was safety, which was evaluated based on the number and severity of treatment-emergent AEs following single and multiple inhaled doses of molgramostim.</p><p><strong>Results: </strong>42 subjects were enrolled including 18 in the SAD study and 24 in the MAD study; all completed the study. Inhaled molgramostim in healthy people was well tolerated and no dose-limiting safety concerns or anti-drug antibody formation were observed in either study. GM-CSF was measurable in serum 30 min after administration of inhaled molgramostim, peaked at 2 hours for all three doses and had an elimination half-life of 1.7±0.0 to 5.9±0.9 hours in the SAD and MAD studies. Systemic GM-CSF exposure was non-linear in both the SAD and MAD studies. Inhaled molgramostim caused a rapid increase in white blood cells (WBC) counts and leucocyte subsets that normalised by 8 hours (SAD) or 15-21 days (MAD). Fractional exhaled nitric oxide remained within the normal range at all doses but was numerically, but not significantly, increased at the 600 μg dose.</p><p><strong>Conclusions: </strong>In healthy people, inhaled molgramostim was well-tolerated and resulted in systemic exposure at picogram levels, which had the expected PD effects on blood leucocyte levels that mostly remained within normal ranges.</p><p><strong>Trial registration number: </strong>NCT02468908; EudraCT No. 2013-001687-32.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12458661/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}