BMJ Open Respiratory Research最新文献

{"title":"Radiomic 'Stress Test': exploration of a deep learning radiomic model in a high-risk prospective lung nodule cohort.","authors":"David Xiao, Yency Forero, Michael N Kammer, Heidi Chen, Rafael Paez, Brent E Heideman, Oreoluwa Owoseeni, Ian Johnson, Stephen A Deppen, Eric L Grogan, Fabien Maldonado","doi":"10.1136/bmjresp-2024-002687","DOIUrl":"https://doi.org/10.1136/bmjresp-2024-002687","url":null,"abstract":"<p><strong>Background: </strong>Indeterminate pulmonary nodules (IPNs) are commonly biopsied to ascertain a diagnosis of lung cancer, but many are ultimately benign. The Lung Cancer Prediction (LCP) score is a commercially available deep learning radiomic model with strong diagnostic performance in incidentally identified IPNs, but its potential use to reduce the need for invasive procedures has not been evaluated in patients with nodules for which a biopsy has been recommended.</p><p><strong>Methods: </strong>In this prospectively collected, retrospective blinded evaluation, the probability of cancer in consecutively biopsied IPNs at a tertiary care centre was calculated using the Mayo Clinic prediction model and categorised into low, intermediate and high-probability groups by applying <10% no-test and >70% treatment thresholds per British Thoracic Society guidelines. We evaluated the diagnostic performance of the Mayo Clinic model, the LCP radiomic model and an integrated model combining the LCP score with statistically selected clinical variables (age, spiculation and upper lobe location) using stepwise logistic regression. Performance was assessed using area under the receiver operating characteristic curve (AUC), F1 score and reclassification analysis based on the bias-corrected clinical net reclassification index.</p><p><strong>Results: </strong>The study population included 196 malignant and 125 benign IPNs (61% prevalence of malignancy). The Mayo Clinic model's AUC was 0.69 (0.63-0.75), LCP's AUC was 0.67 (0.61-0.73) and the integrated model combining LCP with statistically selected clinical variables (age, spiculation and upper lobe location) had the highest AUC of 0.75 (0.69-0.80). The integrated model demonstrated improved classification, with an F1 score of 0.645 (0.572-0.716) and a significantly higher AUC compared with the Mayo Clinic model (p=0.046). Reclassification analysis showed a clinical net reclassification index of 0.36 (0.21-0.53) for benign IPNs with eight correctly downgraded intermediate-risk benign nodules and no malignant nodules misclassified into the low-risk category.</p><p><strong>Conclusion: </strong>Incorporating LCP with select clinical variables results in an improvement in malignancy risk prediction and nodule classification and could reduce unnecessary invasive biopsies for IPNs.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144511511","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":"Comparing the CO₂ emissions of metered dose inhalers and dry powder inhalers: a cross-sectional environmental impact analysis of asthma and COPD therapies in South Tyrol, Italy.","authors":"Jonas Mairhofer, Katia Sangermano, Günther Morandell, Giuliano Piccoliori, Adolf Engl, Christian Josef Wiedermann","doi":"10.1136/bmjresp-2024-002977","DOIUrl":"https://doi.org/10.1136/bmjresp-2024-002977","url":null,"abstract":"<p><strong>Introduction: </strong>Inhalers for asthma and chronic obstructive pulmonary disease (COPD) are essential therapeutic interventions; however, they contribute significantly to healthcare-related CO₂-equivalent (CO₂eq) emissions, particularly currently used metered dose inhalers (MDIs), which use hydrofluoroalkane (HFA) propellants such as HFA-124a and HFA-227. This study quantifies the carbon footprint of inhaler utilisation in South Tyrol, Italy, and evaluates the potential CO₂eq reductions achievable through the transition from MDIs to dry powder inhalers (DPIs).</p><p><strong>Methods: </strong>This cross-sectional analysis used regional healthcare prescription data for inhalers dispensed in South Tyrol in 2021 and 2022, encompassing approximately 540 000 inhabitants. CO₂eq emissions were calculated based on HFA content in MDIs, employing established global warming potentials, while DPI emissions were estimated from current literature values.</p><p><strong>Findings: </strong>A total of 100 778 inhalers were dispensed in 2021 (45 031 MDIs, 55 747 DPIs) and 101 334 in 2022 (49 711 MDIs, 51 623 DPIs). MDIs were responsible for approximately 1000-1100 tonnes of CO₂eq annually, whereas DPIs accounted for less than 55 tonnes. A transition to DPIs could potentially result in significant CO₂eq reductions.</p><p><strong>Conclusions: </strong>Usage of DPIs over currently used MDIs in patients who can use them could mitigate healthcare-associated global warming potential, providing a viable strategy for climate change mitigation in respiratory care. Development of low-global warming potential MDIs is a complementary strategy.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144511510","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":"Breath profiles in paediatric allergic asthma by proton transfer reaction mass spectrometry.","authors":"Lamkaddam Houssni, Micic Srdjan, Bruderer Tobias, Baumann Yvette, Di Francesco Fabio, Koch Patricia, Lomonaco Tommaso, Prévôt André, Prince Tiwari, Reale Serena, Ripszam Matyas, Weber Ronja, Imad El Haddad, Alexander Moeller","doi":"10.1136/bmjresp-2025-003223","DOIUrl":"https://doi.org/10.1136/bmjresp-2025-003223","url":null,"abstract":"<p><strong>Introduction: </strong>Enhancing paediatric asthma diagnosis is crucial. Molecular analysis of exhaled breath is a rapidly evolving field aimed at harnessing established and innovative technologies for clinical applications. This study evaluates the feasibility of using online proton-transfer-reaction mass spectrometry (PTR-MS) to identify distinctive breath signatures in children with allergic asthma.</p><p><strong>Methods: </strong>Exhaled breath samples of 81 children (41 with allergic asthma and 40 healthy controls) were analysed using the Vocus CI-TOF mass spectrometer (Tofwerk AG, Switzerland), with mass spectra acquired in H₃O⁺ and NH₄ ⁺ ionisation modes. Significant mass-to-charge (m/z) features were extracted using the Wilcoxon rank-sum test. Molecular identification was conducted using two-dimensional gas chromatography time-of-flight mass spectrometry (GCxGC-Q-TOF).</p><p><strong>Results: </strong>Statistical analysis revealed 89 significant m/z features associated with paediatric allergic asthma, 66 in H₃O⁺ mode and 23 in NH₄ ⁺ mode. Supervised machine learning achieved an average accuracy of 74.7% in distinguishing between the groups. GCxGC-QTOF analysis identified a subset of significant features, including four previously reported asthma predictors in breath analysis studies. 16 novel asthma predictor candidates were additionally detected, including 7 likely endogenous, 4 unknowns and 3 exogenous. The main group of breath metabolites was structurally related fatty acids, methyl esters and aldehydes, including four known biomarkers of lipid peroxidation.</p><p><strong>Conclusion: </strong>Our findings demonstrate the suitability of PTR-MS for real-time breath analysis in paediatric populations. Moreover, the identification of distinct breath signatures exclusive to allergic asthma in children suggests the potential of leveraging such technology for non-invasive diagnostic applications.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144511509","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":"Can measures of small airway dysfunction aid with the diagnosis or management of asthma exacerbations? A systematic review.","authors":"Abdulrahman Alshehri, Mohammed Ibrahim Alshahrani, Elizabeth Sapey, Robert Andrew Stockley, Mohammed Almeshari","doi":"10.1136/bmjresp-2024-002926","DOIUrl":"https://doi.org/10.1136/bmjresp-2024-002926","url":null,"abstract":"<p><strong>Background: </strong>Asthma exacerbations are acute episodes with worsened symptoms and decreased lung function. Current diagnosis relies on clinical assessment and spirometry, lacking a gold standard test. Interest in small airways tests suggests they may identify treatable traits. This review examines evidence for using small airways tests in diagnosing and managing exacerbations.</p><p><strong>Methods: </strong>The protocol was prospectively registered on PROSPERO, and the systematic review followed standard methodology. Multiple electronic databases were searched, including MEDLINE (Ovid), EMBASE (Ovid), CINAHL (EBSCOhost) and Cochrane Central Register of Controlled Trials (Cochrane Library). The search strategy combined subject headings and keywords related to asthma exacerbations and small airway function tests. Observational studies and randomised controlled trials (RCTs) assessing these tests for detecting or monitoring exacerbations in adults (≥18 years) were included, without language or date restrictions. Risk of bias was evaluated using the Newcastle-Ottawa Scale (NOS) for observational studies and the Cochrane Risk of Bias 2 tool for RCTs.</p><p><strong>Results: </strong>Seven studies (six observational, one RCT) met the inclusion criteria. Five included forced expiratory flow between 25% and 75% of forced vital capacity (FEF25-75), also referred to as maximal mid-expiratory flow; one used isolated forced expiratory flow measures (FEF25, FEF50 and FEF75); and one included multiple breath washout (MBW). No study specifically tested whether small airway function tests improved the diagnosis or monitoring of exacerbations. However, all showed worsening small airway measures during exacerbations, which improved on recovery. FEF25-75 showed greater percentage change than forced expiratory volume in one second postrecovery. The MBW study reported increased acinar ventilation heterogeneity (Sacin) and conductive ventilation heterogeneity (Scond), suggesting small airway involvement.</p><p><strong>Conclusion: </strong>Conducting physiological tests for small airway function appears feasible during an exacerbation. These tests may have utility in the diagnosis or monitoring of acute asthma exacerbations. However, existing studies are heterogeneous and further research is needed.</p><p><strong>Prospero registration number: </strong>CRD42024494994.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144504772","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 vaccination status and immunosuppression with mortality of SARS-CoV-2 infection in patients with fibrotic interstitial lung disease.","authors":"Kathryn Donohoe, Kerri A Johannson, Helene Manganas, Veronica Marcoux, Christopher J Ryerson","doi":"10.1136/bmjresp-2024-003008","DOIUrl":"10.1136/bmjresp-2024-003008","url":null,"abstract":"<p><strong>Background: </strong>There are limited data exploring the outcome following SARS-CoV-2 infection in fibrotic interstitial lung disease (fILD). Our goal was to determine the association of vaccination for SARS-CoV-2 with both SARS-CoV-2 infection and subsequent 90-day mortality in fILD. Our second objective was to determine the association of immunosuppressive use with both SARS-CoV-2 infection and subsequent 90-day mortality in fILD.</p><p><strong>Methods: </strong>Patients with fILD enrolled in the Canadian Registry for Pulmonary Fibrosis with comprehensive access to data on SARS-CoV-2 vaccination and PCR-confirmed infection were included. Associations of vaccination status and current immunosuppressant use with SARS-CoV-2 infection and subsequent 90-day mortality were tested using Fisher's exact test and subsequently multivariable logistic regression adjusting for age, sex, pre-identified comorbidities, forced vital capacity and diffusing capacity of the lung for carbon monoxide.</p><p><strong>Results: </strong>Of 1452 total patients with fILD, 138 tested positive for SARS-CoV-2. On adjusted analysis, vaccination for SARS-CoV-2 was associated with a 60% reduction in the odds of infection (OR 0.40, 95% CI 0.24 to 0.67 p<0.001) and a 97% reduction in the odds of 90-day mortality following infection (OR 0.03, 95% CI 0.0007 to 0.26, p=0.01). SARS-CoV-2 was diagnosed in 13% of patients on an immunosuppressant and 9% of those not (OR 1.4, 95% CI 1.0 to 2.1, p=0.04). Immunosuppressant use was not associated with 90-day mortality after SARS-CoV-2 infection on adjusted analysis.</p><p><strong>Conclusion: </strong>In patients with fILD, vaccination against SARS-CoV-2 was associated with decreased frequency of SARS-CoV-2 infection and subsequent 90-day mortality, while current use of immunosuppressive medication was associated with risk of infection but only a trend for subsequent 90-day mortality.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12198829/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144483115","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":"Pre-biologic assessment of adherence in severe asthma and association with biologic continuation: a UK Severe Asthma Registry Study.","authors":"Freda Yang, Ronald McDowell, John Busby, Anna Claire Murphy, Pujan H Patel, David Jackson, Adel H Mansur, Paul E Pfeffer, Thomas Pantin, Robin Gore, Thomas Brown, Shamsa Naveed, Hassan Burhan, Mitesh Patel, Elfatih Idris, Ian Pavord, Deepak Subramanian, James William Dodd, Hitasha Rupani, Rekha Chaudhuri, Aashish Vyas, Shoaib Faruqi, David Sammut, Simon Message, Matthew Masoli, Chloe I Bloom, Liam G Heaney, Salman Siddiqui","doi":"10.1136/bmjresp-2024-003019","DOIUrl":"10.1136/bmjresp-2024-003019","url":null,"abstract":"<p><strong>Background: </strong>Biologic therapies are approved for uncontrolled severe asthma despite good adherence to inhaled corticosteroids (ICS) and additional controllers. We examined the adherence assessments used across UK Severe Asthma Centres (SACs) and their relationship with biologic continuation and response.</p><p><strong>Methods: </strong>UK SACs completed a quantitative survey on adherence assessment practices in 2022. We included all adult patients with severe asthma patients on ICS starting biologic therapy from the UK Severe Asthma Registry, which collects pre-biologic adherence data, including medication possession ratio (MPR), fractional exhaled nitric oxide (FeNO) suppression testing and serum prednisolone levels. Biologic continuation and response were defined as continuation on any biologic and the same biologic after 1 year, respectively. Associations were determined using multivariable logistic regression.</p><p><strong>Results: </strong>At 21 SACs, MPR for ICS was assessed at 19 (90%) centres, prednisolone and/or cortisol levels in patients on daily oral corticosteroids at 15 (71%), and FeNO suppression testing at 9 (43%). Of 3307 biologic-initiated patients, 1943 (59%) had MPR for ICS recorded, of which 1802 (93%) demonstrated good adherence (≥75% MPR). Only 110 (9%) and 272 (16%) had FeNO suppression and serum prednisolone results, respectively. Good ICS adherence was associated with 2.65-fold higher odds (95% CI 1.02 to 6.91) of biologic continuation, but not with biologic response (OR 1.37, 95% CI 0.50 to 3.76).</p><p><strong>Conclusion: </strong>Good pre-biologic ICS adherence, measured using MPR, is associated with biologic continuation at 1 year. Further research is needed to determine whether baseline adherence predicts biologic response based on clinical and biologic criteria.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12198807/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144483116","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":"Inspiratory muscle training for people with Parkinson's disease: a protocol for a mixed methods randomised controlled trial.","authors":"Juliana Fernandes Barreto de Mendonca, Elisabeth Preston, Allyson Flynn, Bernie Bissett","doi":"10.1136/bmjresp-2024-003120","DOIUrl":"10.1136/bmjresp-2024-003120","url":null,"abstract":"<p><strong>Introduction: </strong>Inspiratory muscle weakness is a known consequence of Parkinson's disease and could be a potential contributor to the dyspnoea experienced by many people living with the condition. Inspiratory muscle training is effective in improving inspiratory muscle strength and reducing dyspnoea in other chronic diseases. However, inspiratory muscle training has received little attention in people with Parkinson's disease, and it is unclear how this training affects inspiratory muscle strength, dyspnoea and quality of life.</p><p><strong>Methods and analysis: </strong>This mixed methods, randomised controlled trial will recruit 50 participants with idiopathic Parkinson's disease who will be randomly allocated to either the experimental group, for 8 weeks, or the control group. Inspiratory muscle strength (maximum inspiratory pressure) will be the primary outcome. The secondary outcomes include motor experience of daily living (Movement Disorder Society-Unified Parkinson's Disease Rating Scale part II), rate of perceived exertion (modified Borg Scale), exercise capacity (6-minute walk test) and quality of life (39-item Parkinson's Disease Questionnaire). Quantitative data will be analysed using descriptive statistics. Semi-structured interviews will be conducted with participants who underwent inspiratory muscle training. Inductive reflexive thematic analysis will be used to explore the participants' experiences of inspiratory muscle training and its impact on dyspnoea, activities of daily living and overall quality of life.</p><p><strong>Trial registration number: </strong>ACTRN12622000097741.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12184351/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144474005","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":"Chronic obstructive pulmonary disease is a risk factor for non-tuberculous mycobacterial pulmonary disease: a population-based matched cohort study.","authors":"Jong Geol Jang, Hyun Lee, Min Gu Kang, Youlim Kim, Kwang Ha Yoo, Kyung Hoon Min, June Hong Ahn, Kyung Soo Hong, Jong Seung Kim, Ji-Yong Moon","doi":"10.1136/bmjresp-2024-002373","DOIUrl":"10.1136/bmjresp-2024-002373","url":null,"abstract":"<p><strong>Background: </strong>Longitudinal studies comprehensively evaluating the direction of the relationship between chronic obstructive pulmonary disease (COPD) and non-tuberculous mycobacterial pulmonary disease (NTM-PD) are scarce. Therefore, this study aimed to evaluate whether COPD influences the development of NTM-PD even after considering various confounders by using a nationwide longitudinal cohort study.</p><p><strong>Methods: </strong>Data from the National Health Insurance Service National Sample Cohort between 2002 and 2019 were analysed. Participants≥20 years of age with COPD and no previous NTM diagnosis were included in the study. The incidence of NTM-PD was compared between participants with COPD (n=8939) and 1:4 fully matched control participants (n=32 355). Participants were followed until the date of NTM-PD incidence, death, or December 2019.</p><p><strong>Results: </strong>During a median follow-up of 9.0 years (IQR, 5.0-12.9 years), participants with COPD (55.5 per 100 000 person-years) had a higher incidence of NTM-PD than matched control cohorts (25.4 per 100 000 person-years), with a HR of 2.16 (95% CI, 1.45 to 3.23). Age, sex, smoking history, asthma, bronchiectasis and corticosteroid use did not affect the association between COPD and the risk of incident NTM-PD (<i>P</i> for interaction >0.05 for all). Among patients with COPD, being underweight and having bronchiectasis were significantly associated with NTM-PD development.</p><p><strong>Conclusions: </strong>Individuals with COPD had approximately a twofold increased risk of developing NTM-PD compared with matched controls. Being underweight and having bronchiectasis were identified as risk factors for developing NTM-PD.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12182194/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144336306","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":"Which clinical factors are predictive of outcome in primary spontaneous pneumothorax management?","authors":"Mohammed Zain Raza, Beenish Iqbal, Anand Sundaralingam, Dinesh Addala, Alguili Elsheikh, Rob Hallifax","doi":"10.1136/bmjresp-2024-003089","DOIUrl":"10.1136/bmjresp-2024-003089","url":null,"abstract":"<p><strong>Background: </strong>Primary spontaneous pneumothorax (PSP) occurs when air leaks into the pleural space in patients without known underlying lung disease, causing pain and breathlessness. Optimal management of PSP is not defined and we are unable to predict who will fail medical treatment (ongoing pneumothorax with prolonged air leak). We hypothesised that patients with longer symptom duration and higher symptom scores would be more likely to fail treatment.</p><p><strong>Methods: </strong>Prospectively collected data from the Randomised Ambulatory Management of Primary Pneumothorax randomised controlled trial of ambulatory management were used to determine which clinical factors are associated with treatment failure including symptom scores, time from symptom onset to presentation, treatment allocation, vital signs, history of prior pneumothorax and size of initial pneumothorax.</p><p><strong>Results: </strong>Overall, 63/236 patients (26.7%) failed treatment. On average, symptoms started 1 day before admission. Multivariable analysis found that patients who presented at least 1 day after symptoms began had a lower risk of treatment failure than those presenting on the day symptoms began (ORs 0.39 (0.18 to 0.81)).</p><p><strong>Conclusion: </strong>Further work is required to determine psychological drivers of PSP presentation and risks of prolonged air leak.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12182152/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144336307","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":"Asthma and extrapulmonary comorbidities in a middle-aged general population: results from the SCAPIS study.","authors":"Juan Wang, Anders Blomberg, Magnus Ekström, Hans Lennart Persson, Magnus Sköld, Kjell Torén, Xingwu Zhou, Andrei Malinovschi, Christer Janson","doi":"10.1136/bmjresp-2024-003020","DOIUrl":"10.1136/bmjresp-2024-003020","url":null,"abstract":"<p><strong>Introduction: </strong>Asthma may increase the risk of comorbidities and systemic inflammation, but population data are scarce. This study aimed to compare comorbidities and systemic inflammation between those with and without current asthma and to identify characteristics linked to comorbidities and biomarkers.</p><p><strong>Methods: </strong>In a cross-sectional analysis of 28 828 people aged 50-64 in the Swedish CArdioPulmonary bioImage Study, assessments included postbronchodilator forced expiratory volume in 1 s (FEV₁), forced vital capacity (FVC), serum levels of C reactive protein (CRP) and haemoglobin A1c (HbA1c). Data on current physician-diagnosed asthma, respiratory symptoms and comorbidities were obtained via a questionnaire.</p><p><strong>Results: </strong>The prevalence of current asthma was 6.3%. Current asthma was independently associated with a higher prevalence of hypertension (OR=1.30; 95% CI 1.16 to 1.46), hyperlipidaemia (OR=1.20; 95% CI 1.04 to 1.39), diabetes (OR=1.42; 95% CI 1.16 to 1.75), coeliac disease (OR=2.52; 95% CI 1.61 to 3.95) and rheumatic disease (OR=1.43; 95% CI 1.16 to 1.78). Asthma was also associated with higher levels of CRP (beta=0.25; 95% CI 0.06 to 0.44) and HbA1c (beta=0.47; 95% CI 0.18 to 0.77). In those with asthma, lower FVC % predicted was associated with a higher likelihood of hypertension (OR=1.10; 95% CI 1.01 to 1.19), diabetes (OR=1.47; 95% CI 1.26 to 1.71) and rheumatic disease (OR=1.22; 95% CI 1.05 to 1.42). Lower FEV₁ % predicted was associated with a higher likelihood of diabetes (OR=1.27; 95% CI 1.12 to 1.44). FVC % and FEV₁ % predicted were negatively associated with CRP and HbA1c.</p><p><strong>Conclusions: </strong>Our findings suggest that in middle-aged people, asthma is independently associated with common comorbidities such as hypertension, diabetes and rheumatic disease, as well as elevated CRP and blood glucose. Our data suggest that some associations are connected with lung function impairment in those with asthma.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12182154/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144336305","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}