BMJ Open Respiratory Research最新文献

{"title":"Assessment of the clinical prognosis of patients with chronic obstructive pulmonary disease using combined blood and sputum eosinophil counts.","authors":"Jieqi Peng, Xiaohui Wu, Xiang Wen, Zhishan Deng, Fan Wu, Qi Wan, Gaoying Tang, Kunning Zhou, Lifei Lu, Cuiqiong Dai, Shengtang Chen, Changli Yang, Yongqing Huang, Shuqing Yu, Pixin Ran, Yumin Zhou","doi":"10.1136/bmjresp-2025-003161","DOIUrl":"https://doi.org/10.1136/bmjresp-2025-003161","url":null,"abstract":"<p><strong>Background: </strong>High blood or sputum eosinophil counts are linked to poor clinical outcomes in chronic obstructive pulmonary disease (COPD), yet the value of combining both for the assessment of clinical prognosis remains unclear. In this study, we explore the value of combined blood and sputum eosinophil counts for assessing COPD outcomes.</p><p><strong>Methods: </strong>Patients were divided into four groups by blood (≥300 cells/µL) and sputum (≥3%) eosinophil counts (low blood and low sputum, low blood and high sputum, high blood and low sputum, high blood and high sputum). Spirometry, questionnaires, CT scans, impulse oscillometry, blood laboratory tests and induced sputum tests were performed at baseline. Spirometry and follow-up questionnaires were performed annually. Poisson regression was used to compute the relative risk (RR) for acute exacerbation. The mixed-effects model was used to assess annual lung function decline.</p><p><strong>Results: </strong>Compared with the low blood and low sputum eosinophils group, the high blood and high sputum eosinophils group had poorer lung function, more severe airway resistance and worse emphysema and air trapping at baseline. The high blood and high sputum eosinophils group had higher risks of cough (adjusted OR=1.87, 95% CI 1.20 to 2.92, p=0.006) and wheezing (adjusted OR=2.19, 95% CI 1.32 to 3.64, p=0.002). The low blood and high sputum eosinophils group had higher risks of phlegm (adjusted OR=1.53, 95% CI 1.04 to 2.24, p=0.029) and dyspnoea (adjusted OR=1.68, 95% CI 1.13 to 2.50, p=0.010). The high blood and high sputum eosinophils group demonstrated higher total (adjusted RR=1.36, 95% CI 1.15 to 1.60, p<0.001) and moderate-to-severe (adjusted RR=1.42, 95% CI 1.14 to 1.76, p=0.001) exacerbation risks. There was no significant difference in annual lung function decline among the groups.</p><p><strong>Conclusion: </strong>Elevated blood and sputum eosinophil counts are linked to worse lung function and a higher exacerbation risk in patients with COPD.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145343156","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":"Real-world effectiveness of antibiotics in addition to oral corticosteroids for managing asthma exacerbations in adults.","authors":"Irene Mommers, Sumaira Mubarik, Job F M van Boven, Jens H Bos, Maarten J Bijlsma, Eelko Hak","doi":"10.1136/bmjresp-2025-003506","DOIUrl":"https://doi.org/10.1136/bmjresp-2025-003506","url":null,"abstract":"<p><strong>Background: </strong>Antibiotics are widely used to manage acute asthma exacerbations, despite little evidence for their effectiveness. This study assesses the added value of antibiotics alongside oral corticosteroids (OCSs) in treating asthma exacerbations.</p><p><strong>Methods: </strong>This retrospective cohort study included individuals from the Netherlands between 1994 and 2022 from the IADB.nl pharmacy dispensing database. Individuals had to be 16-45 years old, use inhaled asthma medication and have a first recorded prednisone/prednisolone (OCS) dispense of ≥30 mg/day for 3-14 days. Patients were compared regarding treatment failure (a new dispense of OCS or antibiotics, 15-30 days after initial dispense), based on whether or not they were dispensed antibiotics (AB) alongside their first recorded OCS dispense. Regression analyses with inverse probability of treatment weighting were used to adjust for various confounders.</p><p><strong>Results: </strong>Of the 5401 individuals included, 38% received antibiotics alongside the first-recorded OCS dispense, with a decreasing trend from 47% in 2009 to 24% in 2020. The OR for treatment failure was 1.36 (95% CI 0.81 to 2.16) for AB+OCS versus OCS-only. The HR for a new exacerbation within 31-365 days of follow-up was 1.20 (95% CI 0.92 to 1.56) for AB+OCS versus OCS-only. The lack of beneficial effect of AB was consistent across subcohorts.</p><p><strong>Conclusions: </strong>This study found no reduction in treatment failure, nor in risk of subsequent exacerbation, from adding AB to OCS for treating acute asthma exacerbations. We suggest that antibiotics should not be used in primary care settings to treat acute asthma exacerbation unless there are clear signs of bacterial infection.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145342753","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":"Bronchial hyper-reactivity in young adults after hospitalisation for bronchiolitis in infancy.","authors":"Karen Galta Sørensen, Knut Øymar, Ingvild Dalen, Thomas Halvorsen, Ingvild Bruun Mikalsen","doi":"10.1136/bmjresp-2024-002881","DOIUrl":"https://doi.org/10.1136/bmjresp-2024-002881","url":null,"abstract":"<p><strong>Background: </strong>Bronchiolitis is associated with asthma persisting until adulthood. While bronchial hyper-reactivity (BHR) is a hallmark of asthma, its occurrence and characteristics after bronchiolitis have been less studied. We aimed to study if BHR differed between young adults hospitalised for bronchiolitis in infancy and control subjects with no such history. Further, we sought to study whether any association between asthma and BHR differed between these two groups.</p><p><strong>Methods: </strong>This Norwegian historical cohort study included 186 young adults hospitalised for respiratory syncytial virus positive or negative bronchiolitis in infancy during 1996-2001 and 139 matched control subjects. BHR was assessed at 17-20 years by methacholine provocation tests and recorded as dose-response slopes (DRS). Outcomes were analysed by mixed effects regression models.</p><p><strong>Results: </strong>DRS was higher in the post-bronchiolitis group than in the control group (regression coefficient (β) 0.37; 95% CI 0.01 to 0.73; p=0.045). In both groups combined, current asthma was positively associated with DRS (β 0.98; 95% CI 0.50 to 1.45; p<0.001). Stratified analyses showed that the effect (β) of asthma on BHR was 0.80 (95% CI 0.21 to 1.38; p=0.008) in the post-bronchiolitis group and 1.40 (95% CI 0.58 to 2.23; p=0.001) in the control group. The difference in the association between asthma and BHR across the two groups was not statistically significant (p=0.191 for interaction).</p><p><strong>Conclusions: </strong>BHR at age 17-20 years was higher in subjects hospitalised for bronchiolitis in infancy than in control subjects. The association between asthma and BHR was not found to differ between the post-bronchiolitis group and the control group, although a possible stronger association in the control group may warrant further study.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145343180","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":"Nationwide coverage of molecular drug susceptibility testing in patients with pulmonary multidrug/rifampicin-resistant tuberculosis in South Korea: a retrospective cohort study (2015-2021).","authors":"Jeongha Mok, Dawoon Jeong, Hojoon Sohn, Saerom Kim, Seung Won Lee, Young Ae Kang","doi":"10.1136/bmjresp-2025-003307","DOIUrl":"https://doi.org/10.1136/bmjresp-2025-003307","url":null,"abstract":"<p><strong>Background: </strong>We assessed the coverage of molecular drug susceptibility testing (mDST) among patients with pulmonary multidrug/rifampicin-resistant tuberculosis (MDR/RR-TB) in South Korea and identified factors influencing the lack of mDST implementation.</p><p><strong>Methods: </strong>This retrospective study included patients with pulmonary MDR/RR-TB who initiated tuberculosis (TB) treatment between January 2015 and September 2021. Data were obtained from the K-TB-N cohort, an integrated national TB database linking three datasets. We assessed mDST coverage, temporal trends and factors associated with the lack of mDST implementation. mDST was defined as the use of the Xpert MTB/RIF assay or line probe assay (LPA) for isoniazid and rifampicin (first-line LPA).</p><p><strong>Results: </strong>In total, 4637 patients were included in the analysis. Of the 4637 patients, 1342 (28.9%) did not undergo mDST; whereas, 3295 (71.1%) underwent mDST. Over the study period, a statistically significant annual increase in mDST coverage was observed, escalating from 49.1% in 2015 to 96.9% in 2021 (p<0.001). Throughout the study, the coverage of the Xpert MTB/RIF assay remained lower than that of LPA (22.1% vs 64.2%, p<0.001). Multivariable logistic regression analysis identified several factors independently associated with a decreased likelihood of mDST being conducted, including TB treatment initiation in secondary general hospitals, small hospitals or primary clinics, as well as in non-public-private mix (PPM) participating institutions. In addition, transfers between PPM-participating and non-participating institutions during the treatment period and sputum acid-fast bacilli smear-negative status were significantly associated with lower mDST uptake.</p><p><strong>Conclusion: </strong>Although the increasing mDST coverage is a positive development, further efforts are needed to achieve nationwide and universal implementation, particularly for the Xpert MTB/RIF assay, in South Korea.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145343217","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":"Chronic obstructive pulmonary disease mortality rate trends in Taiwan, 2002-2022: a joinpoint regression analysis.","authors":"Ching-Hsiung Lin, Yi-Rong Li, Shu-O Chiang, Hao-Chien Wang, Meng-Chih Lin, Shih-Lung Cheng, Chong-Jen Yu","doi":"10.1136/bmjresp-2024-002719","DOIUrl":"10.1136/bmjresp-2024-002719","url":null,"abstract":"<p><strong>Background: </strong>Chronic respiratory diseases, particularly chronic obstructive pulmonary disease (COPD), are the eighth leading cause of death in Taiwan. Although COPD management has advanced in the previous two decades, mortality trends remain unclear. The present study analysed COPD mortality rates in Taiwan from 2002 to 2022.</p><p><strong>Methods: </strong>COPD mortality and population data were obtained from Taiwan's National Health Statistics and the Ministry of the Interior's Demographic Yearbook. For comparison, global COPD mortality data were sourced from the WHO mortality database. A joinpoint analysis was conducted to assess trends in age-specific and age-standardised mortality rates across sex, region or country.</p><p><strong>Results: </strong>From 2002 to 2022, Taiwan had 100 147 deaths attributed to COPD. The age-standardised mortality rate decreased with an annual average percentage change (AAPC) of -3.79%, which was more pronounced in women (AAPC: -4.28%) than in men (AAPC: -3.79%). The largest decline occurred from 2016 to 2022, with an AAPC of -7.70%. Most COPD-related deaths occurred among older individuals, with significant reductions in mortality rates observed among men aged ≥60 years and among women aged ≥50 years. A downward trend in COPD mortality rates was noted in most counties from 2016 to 2022, although patterns varied. The overall COPD mortality rate has declined in most countries since 2002, including Taiwan, which ranks third in Asia in terms of reductions in COPD mortality rates during this period.</p><p><strong>Conclusion: </strong>From 2002 to 2022, COPD mortality rates in Taiwan declined considerably across sexes and regions, although patterns varied. In Asia, Taiwan's reduction in the rate of COPD mortality ranks third behind those of the Republic of Korea and Singapore. The reductions observed in COPD mortality rates in Taiwan may be attributable to tobacco control initiatives and nationwide COPD care programmes.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12530367/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145298323","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":"What is the relationship between population health and voting patterns: an ecological study in England.","authors":"Anthony A Laverty, Nicholas S Hopkinson","doi":"10.1136/bmjresp-2025-003526","DOIUrl":"https://doi.org/10.1136/bmjresp-2025-003526","url":null,"abstract":"<p><strong>Background: </strong>Health is a fundamental issue in politics and an area where governments hold significant levers of influence. Countries in Europe have seen increased support for populist political parties, with some evidence linking support for these parties to health metrics. We aimed to establish if there is an association between health metrics and patterns of voting in England, particularly in relation to a recently established political party, Reform UK, in the 2024 general election.</p><p><strong>Methods: </strong>We conducted a cross sectional ecological study with data from all constituencies in England (n=543). We conducted Pearson correlations and linear regression between the proportion of eligible votes for Reform UK and estimated prevalence of 20 common non-communicable diseases, including obesity, chronic obstructive pulmonary disease (COPD), asthma, type 2 diabetes and depression.</p><p><strong>Results: </strong>Constituencies electing Reform members of parliament (MPs) (n=5/543) had the highest average prevalence of asthma (7.44%) and COPD (2.85%). Across the country, adjusting for age, sex and deprivation, a 10% increase in the party's vote share was associated with a +0.261% (95% CI 0.213% to 0.309%) prevalence of COPD, a +0.113% (95% CI 0.026% to 0.201%) prevalence of asthma and a +1.479% (95% CI 1.239% to 1.720%) increase in obesity prevalence.</p><p><strong>Conclusions: </strong>At a constituency level, poor health, in particular conditions associated with breathlessness, was associated with a greater proportion of votes for Reform UK.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145290921","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":"Previously treated latent tuberculosis infection is associated with less severe acute COVID-19: a cohort study.","authors":"Katie Scandrett, Scott Pallett, Yemisi Takwoingi, Adam F Cunningham, Martin Dedicoat, Matthew K O'Shea","doi":"10.1136/bmjresp-2024-003003","DOIUrl":"10.1136/bmjresp-2024-003003","url":null,"abstract":"<p><strong>Introduction: </strong>There is significant potential for respiratory infections, such as tuberculosis (TB) and COVID-19, to overlap but little is known about such co-infection. We aimed to study the impact of active TB and latent TB on the incidence of severe COVID-19 in a large cohort of individuals in a setting of low TB endemicity.</p><p><strong>Methods: </strong>Clinical data of patients admitted to hospital with acute SARS-CoV-2 were merged with a database of patients with a history of previous or current active TB, latent TB or healthy controls. We assessed the incidence of COVID-19 in these groups, length of hospital stay, admission to the intensive care unit (ICU) and in-hospital mortality.</p><p><strong>Results: </strong>COVID-19 incidence among individuals with current active TB was 6.2% (12/194) and previous active TB 0.67% (30/4496). In contrast, the incidence in previously treated latent TB was 0.09% (4/4542) and among TB contacts 0.24% (34/13 391). There were similar rates of ICU admission and mortality among individuals with COVID-19 and current active TB, TB contacts and other patients. No individuals with previously treated latent TB and COVID-19 were admitted to the ICU or died.</p><p><strong>Conclusions: </strong>Individuals with a history of latent TB seem to be at reduced risk of severe COVID-19 and have better outcomes than those with active TB and even uninfected controls. Further studies are required to understand the mechanistic basis of this observation.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12519662/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145285600","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":"Greater lung cancer polygenic risk score in higher air pollution areas linked to greater rate of lung adenocarcinoma: a single-centre study in East Asia.","authors":"Szu-Ling Chang, Peng-Min Chuan, Chih-Hung Lai, Hui-Wen Yang, Yi-Ming Chen, Han-Shui Hsu, I-Chieh Chen","doi":"10.1136/bmjresp-2024-002899","DOIUrl":"10.1136/bmjresp-2024-002899","url":null,"abstract":"<p><strong>Background: </strong>Lung cancer, a leading cause of cancer deaths, is influenced by smoking, air pollution and genetic factors. This study investigated the association between lung cancer polygenic risk score (PRS) and air pollution in lung adenocarcinoma (LUAD) cases in East Asia.</p><p><strong>Methods: </strong>This Taiwanese case-control study included 57 257 participants, of whom 1059 were diagnosed with lung cancer and 857 had LUAD. Excluding individuals with missing PRS data, the final study group comprised 648 LUAD patients and 6480 age- and gender-matched controls. Logistic regression models were employed to assess the association between PRS and LUAD risk, and interaction effects between PRS and particulate matter (PM2.5/PM10) exposure were evaluated.</p><p><strong>Results: </strong>PGS000070 demonstrated an OR of 2.796 (95% CI 2.236 to 3.497, p<0.001), while PGS000392 exhibited an OR of 1.938 (95% CI 1.559 to 2.409, p<0.001). Higher PM exposure increased LUAD risk among individuals in the highest quartile (Q4) of both PRSs compared with the lowest quartile (Q1). In the smoking subgroup, individuals in Q4 for PGS000070 showed significantly heightened LUAD risk when exposed to higher PM2.5 and PM10 levels, with ORs of 4.08 (p<0.0001) and 2.897 (p<0.0001), respectively. However, the interaction effect of PRS (PGS000070 and PGS000392) and PM exposure on LUAD risk was not statistically significant.</p><p><strong>Conclusion: </strong>This hospital-based study indicated that LUAD patients had higher PRSs and greater exposure to PM. However, the interaction effect between PRS (PGS000070 and PGS000392) and PM exposure on LUAD risk was not statistically significant, suggesting these factors act independently. The accumulation of air pollution did not show a gradual increase in LUAD risk. Notably, the association between PRS and air pollution was more pronounced in the smoking subgroup for PGS000070 but not for PGS000392.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12519728/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145285599","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":"Effects of pulmonary arterial hypertension therapies on arterial oxygenation in patients with pulmonary hypertension associated with lung disease: a systematic review and meta-analysis.","authors":"Isabel Blanco, Rodrigo Torres-Castro, Lucilla Piccari, Agustín Roberto Garcia, Elena Gimeno-Santos, Ana M Ramírez, Joan Albert Barberà","doi":"10.1136/bmjresp-2024-003086","DOIUrl":"10.1136/bmjresp-2024-003086","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary hypertension (PH) associated with lung disease entails a poor prognosis. There is concern about the potential deleterious effect on gas exchange of drugs approved for pulmonary arterial hypertension (PAH) in patients with lung disease. We conducted a systematic review on the effects of drugs approved for PAH on arterial oxygenation in randomised clinical trials (RCTs) conducted in patients with PH associated with lung disease.</p><p><strong>Methods: </strong>Five databases were searched until May 2025. We included RCTs with PAH therapies in patients with PH associated with lung disease that reported measurements of arterial oxygenation, either the partial pressure of arterial oxygen (PaO₂) or the arterial oxygen saturation (SpO₂). For analysis purposes, both measurements were merged into one single variable called 'overall oxygenation'. As secondary outcomes, we analysed the use of supplemental oxygen and the presence of adverse events related to oxygenation.</p><p><strong>Results: </strong>Of the 393 reports returned by the initial search, nine articles, reporting 827 patients (64.6% male), were included. The overall oxygenation at the end of the trial in the intervention group (IG), treated with a PAH therapy, was similar to the control group (standard mean difference (SMD) -0.00; 95% CI -0.17 to 0.18; p=0.98). Similarly, the change in overall oxygenation postintervention in the IG was similar to the control group (SMD 0.01; 95% CI -0.22 to 0.24; p=0.91). Reported adverse events related to oxygenation were similar in the treatment and control arms.</p><p><strong>Conclusion: </strong>There is currently no consistent evidence from RCTs to suggest a deleterious effect of PAH therapies on arterial oxygenation in patients with PH associated with lung disease.</p><p><strong>Prospero registration number: </strong>CRD42022349299.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12519707/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145273702","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":"Sputum colour charts to guide antibiotic self-treatment of acute exacerbation of chronic obstructive pulmonary disease: the Colour-COPD RCT.","authors":"Eleni Gkini, Joshua De Soyza, Daniella A Spittle, Paul Robert Ellis, Sarah Tearne, Peymane Adab, Rachel Jordan, Nawar Diar Bakerly, Alice Margaret Turner","doi":"10.1136/bmjresp-2025-003615","DOIUrl":"10.1136/bmjresp-2025-003615","url":null,"abstract":"<p><strong>Background: </strong>Chronic obstructive pulmonary disease (COPD) patients are encouraged to manage exacerbations (acute exacerbation of COPD (AECOPD)) through self-management (SM) plans. Since only around half of AECOPD are bacterial, and sputum colour correlates with bacterial load, it may help guide antibiotic use. This pragmatic randomised controlled trial (RCT) assessed the safety and effectiveness of using a sputum colour chart in UK primary care.</p><p><strong>Methods: </strong>The multicentre RCT, Colour COPD randomised COPD adults who had ≥2 AECOPD or ≥1 AECOPD hospital admission in the preceding year. The primary objective was to assess the non-inferiority of the Bronkotest sputum colour chart compared with usual care, with hospital admission for AECOPD at 12 months as the primary outcome. Secondary outcomes included second courses of treatment requirement and quality of life (CAT score). Nested substudies examined daily symptoms via e-diaries and sputum culture.</p><p><strong>Results: </strong>115 severe COPD patients (global obstructive lung disease(GOLD) D, 54% Medical Research Council (MRC) 4 or 5, CAT score 24) were randomised. A trend towards more hospital admissions (32% vs 16%, relative risk (RR) 1.95 (0.92-4.18)) and increased antibiotic use within 14 days (34% vs 18%, adjusted relative risk (aRR) 1.80 (0.85-3.79)) was seen in the colour chart group. From 38 sputum substudy patients, 57 samples were received (42 stable, 15 during AECOPD), with 30% containing potentially pathogenic bacterium (PPB). Purulent sputum was more frequent in bronchiectasis, independent of disease state (stable vs exacerbation) or PPB presence, suggesting sputum colour alone does not reliably guide antibiotic use.</p><p><strong>Conclusion: </strong>Under-recruitment precluded definitive conclusions. However, sputum colour is unlikely to be a useful addition to COPD SM in primary care.</p><p><strong>Trial registration number: </strong>The UK's Clinical Study Registry: ISRCTN14955629 (https://doi.org/10.1186/ISRCTN14955629; registration date: 11 Number 2020).</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12517013/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145273765","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}