BMJ Open Respiratory Research最新文献

{"title":"Assessment of the right ventricular strain, left ventricular strain and left atrial strain using speckle tracking echocardiography in patients with chronic obstructive pulmonary disease.","authors":"Hai Nguyen Ngoc Dang, Thang Viet Luong, Nhi Thi Y Nguyen, Hung Khanh Tran, Hieu Thi Nguyen Tran, Hung Minh Vu, Thanh Van Ho, Ngoc Thi Minh Vo, Thanh Thien Tran, Toan Song Do, Van Thi Thuy Phan, Tien Anh Hoang, Phuoc Le Huu, Binh Anh Ho, Hung Minh Nguyen","doi":"10.1136/bmjresp-2024-002706","DOIUrl":"10.1136/bmjresp-2024-002706","url":null,"abstract":"<p><strong>Objectives: </strong>Cardiovascular disease is a prevalent comorbidity and leading cause of mortality in chronic obstructive pulmonary disease (COPD) patients. Early identification of cardiac abnormalities in COPD patients is crucial. Speckle tracking echocardiography (STE) is practical for assessing ventricular and atrial function, but its role in COPD patients is under-researched. This study aimed to examine right ventricular (RV), left ventricular (LV) and left atrial (LA) strain in COPD patients via STE.</p><p><strong>Methods: </strong>A cross-sectional study was conducted with two groups: COPD patients diagnosed per the 2017 Global Initiative for Chronic Obstructive Lung Disease criteria and healthy controls. All the participants underwent STE to evaluate the RV, LV, and LA strains.</p><p><strong>Results: </strong>RV strain indices (RV free wall longitudinal strain (RVFWSL) and RV 4-chamber longitudinal strain (RV4CSL)) were significantly lower in the COPD group (16.53±5.89% and 14.65±4.53%, respectively) than in the control group (21.39±7.78% and 18.34±6.38%, respectively) (p<0.001). LV global longitudinal strain was also lower in the COPD group (18.45% (17.16-19.51)) than in the control group (19.50% (18.63-21.46), p=0.018). No significant differences were found in LA strain indices (LA reservoir strain, LA conduit strain or LA contractile strain) between the two groups. Furthermore, RVFWSL and RV4CSL were significantly greater in the group with a modified Medical Research Council score <2 (p<0.05).</p><p><strong>Conclusion: </strong>Compared with healthy controls, COPD patients presented reduced RV and LV strain, with no significant differences in LA strain indices.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11887318/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143571608","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":"Pleural procedural safety in the UK: is everyone's house in order? Reflections from the BTS National Pleural Service Organisational Audit and a national review of patient safety incidents.","authors":"Andrew Ewing Stanton, Mark Juniper, Eihab Bedawi, Laura McNaughton, Amelia O Clive, Duneesha De Fonseka, Avinash Aujayeb, Matthew Evison","doi":"10.1136/bmjresp-2024-002840","DOIUrl":"10.1136/bmjresp-2024-002840","url":null,"abstract":"<p><strong>Introduction: </strong>The 2022 British Thoracic Society Pleural Services Organisational Audit highlighted evidence of ongoing risk of harm from pleural procedures. To better understand the underlying causes of these safety concerns we undertook a review of patient safety incidents from the National Reporting and Learning System (NRLS).</p><p><strong>Methods: </strong>Incident-level patient safety data from NRLS were requested from any level 3, 4 and 5 incidents describing harm resulting from pleural intervention, specifically chest drain insertion or pleural aspiration for pleural effusions (fluid), submitted between 1 April 2018 and 30 March 2022.</p><p><strong>Results: </strong>256 incidents were identified. Most of these did not directly relate to a pleural procedure or its concerns and so were excluded. Ultimately, 21 incidents (including 2 deaths) were relevant. 17 involved direct organ puncture, predominantly liver (n= 13). 11 incidents involved seldinger drains, 5 blunt dissection drains and 1 involved both (not specified in 4). In only four incidents was it clearly detailed that an ultrasound-assisted approach had been used. In the remainder, the use of ultrasound was largely not detailed at all, or the approach used was not clear or inappropriate. Most (19/21) events occurred out with respiratory environments.</p><p><strong>Discussion: </strong>These data raise concerns about pleural intervention for fluid occurring where lack of appropriate ultrasound use may have contributed in a variety of clinical areas. This should be highlighted at a national level by specialty groups and societies. We welcome an upcoming National Confidential Enquiry into Patient Outcome and Death study to help cement our understanding of factors underlying this ongoing risk of harm and to enable definitive action to be taken to reduce this risk.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11877191/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143536459","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":"Effectiveness of inhaled therapies in asthma among adults in Northern Sri Lanka, a low-income and middle-income country: a prospective observational study.","authors":"Yalini Guruparan, Thiyahiny S Navaratinaraja, Gowry Selvaratnam, Shalini Sri Ranganathan","doi":"10.1136/bmjresp-2024-002675","DOIUrl":"10.1136/bmjresp-2024-002675","url":null,"abstract":"<p><strong>Background: </strong>Inhaled corticosteroids (ICS) alone, or combined with long-acting beta₂-agonist (LABA), are recommended for chronic asthma. Limited access to inhaled medications hinders effective control of asthma in low-income and middle-income countries.</p><p><strong>Objective: </strong>This study aimed to compare the effectiveness of inhaled therapies in a cohort of adult patients with asthma who were receiving treatment in a tertiary hospital in Northern Sri Lanka.</p><p><strong>Methods: </strong>A prospective cohort study was conducted among adult patients with asthma on either ICS alone or ICS/LABA combination for at least 3 months. Participants were followed up for 6 months, with two follow-up interviews conducted 3 months apart. The primary outcome measure was asthma control, assessed by a locally validated asthma control patient-reported outcome measure. Secondary outcome measures included the use of short-acting beta₂-agonists (SABA) and the percentage of patients required nebulisations and hospitalisations. McNemar's test was used to determine the statistical significance. A p value≤0.05 was considered significant.</p><p><strong>Results: </strong>Of the 1094 participants, 827 (76%) were on ICS monotherapy and 267 (24%) were on ICS/LABA. Though there were no changes in the treatment, progressive improvement in asthma control was observed from baseline to second follow-up in both ICS (54%-72%) and ICS/LABA (76%-81%) groups. Significant improvement in asthma control (p<0.001) and SABA overuse (p<0.001) at both follow-ups and nebulisation (0.008) at the first follow-up were observed in the ICS group.</p><p><strong>Conclusion: </strong>Both ICS monotherapy and ICS/LABA were effective in controlling asthma. Though control was greater with ICS/LABA, the effect of additional monitoring during the follow-up was higher and significant in ICS monotherapy. Considering the low access to ICS/LABA, a treatment package comprising ICS plus non-pharmacological approaches could be a more realistic and cost-effective treatment strategy in the local context. ICS/LABA could be reserved for patients who fail to respond. However, this observation needs to be confirmed by interventional studies.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11873347/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143530853","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":"Characterising airway inflammation in Aboriginal and Torres Strait Islander and non-Aboriginal and Torres Strait Islander adults with asthma and COPD.","authors":"Nick Young, Winnie Chen, Shimul Chatterjee, Scott Gelzinnis, Aishath Lam'aan Latheef, Jodie Simpson, Peter A B Wark","doi":"10.1136/bmjresp-2024-002619","DOIUrl":"10.1136/bmjresp-2024-002619","url":null,"abstract":"<p><strong>Objective: </strong>To examine airway inflammatory cell profiles in Indigenous Australian adults with asthma and chronic obstructive pulmonary disease (COPD).</p><p><strong>Design/setting: </strong>A retrospective, cross-sectional study on data from a tertiary referral respiratory outpatient clinic.</p><p><strong>Participants: </strong>Indigenous (n=23) and non-Indigenous (n=71) adults were matched according to diagnosis, gender and age to the ratio of 1:3.</p><p><strong>Main outcome measures: </strong>Participants were defined by self-determined identification as Indigenous (Aboriginal) or non-Indigenous. A relevant history was taken, and lung function was measured by spirometry. In those with a diagnosis of asthma, symptom control was assessed by the Asthma Control Questionnaire, six items (ACQ6). In those with a diagnosis of COPD, symptoms were assessed by the COPD assessment test (CAT). Airway cell counts were obtained in all groups from bronchial lavage (BL) cell count.</p><p><strong>Results: </strong>Lung function and inhaled corticosteroid dose were similar between groups. Current smoking was three times more common in Indigenous people (35%) compared with non-Indigenous people (12%, p=0.009). In participants with asthma, ACQ6 scores were similar between Indigenous and non-Indigenous participants with asthma. In those with COPD, Indigenous participants had significantly higher total CAT scores as well as scores for cough and sputum with a score indicating a high impact on quality of life (CAT score ≥14, 85%-25%, p=0.017). There was no difference in BL cell differential counts.</p><p><strong>Conclusions: </strong>Indigenous people with COPD had higher smoking rates, worsened CAT scores and more symptoms of cough and sputum production. There were no differences between the groups in airway inflammation, but neutrophilic inflammation was associated with poorly-controlled asthma.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11848662/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476002","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":"Idiopathic pulmonary fibrosis in the UK: findings from the British Thoracic Society UK Idiopathic Pulmonary Fibrosis Registry.","authors":"Ahmed Fahim, Maria Loughenbury, Iain Stewart, Sarah Agnew, Howard Almond, Leo Casimo, Nazia Chaudhuri, Sophie V Fletcher, Sarah Haney, Ling-Pei Ho, Clare Hodkinson, Paul Minnis, Evelyn Palmer, Andrew M Wilson","doi":"10.1136/bmjresp-2024-002773","DOIUrl":"10.1136/bmjresp-2024-002773","url":null,"abstract":"<p><strong>Objectives: </strong>Idiopathic pulmonary fibrosis (IPF) is a progressive interstitial lung disease (ILD) and the most common idiopathic interstitial pneumonia. The UK IPF Registry was established in 2013 to collect data pertaining to clinical features, therapeutic approaches and outcomes. From February 2023, the Registry expanded to include any ILD with evidence of fibrosis.</p><p><strong>Design: </strong>The UK IPF Registry is a national, multicentre observational registry, including both prospective and retrospective data of patients with IPF in secondary or tertiary care. Cases eligible for inclusion were those with a diagnosis of IPF, presenting at participating centres from January 2013.</p><p><strong>Results: </strong>Between January 2013 and February 2023, 5052 IPF cases were registered from 64 participating centres. There was a male preponderance (77.8%) with mean±SD age of 74±8.1 years, 66% were ex-smokers and 76% had at least one comorbidity. Over a third (36.7%) experienced symptoms for more than 24 months prior to their first clinic visit. The majority of cases were discussed at a multidisciplinary team (MDT) meeting and the most common radiological patterns at presentation were probable (54.6%) and definite (42.7%) usual interstitial pneumonia. There was a reduction in surgical lung biopsies from 14% in 2013 to 5.5% in 2022. Antifibrotic therapy prescription rose from 36.0% in 2013 to 55.9% in 2023. The use of nintedanib (approved by National Institute of Clinical Excellence in January 2016) rose from 6.7% in 2013 to 31.5% in 2022 and pirfenidone (approved in April 2013) was initially used in around a third of cases before dropping to between 16.8% and 24.9% after nintedanib was approved.</p><p><strong>Conclusion: </strong>These data reflect clinical practice across the UK and it is intended the data will have a role in informing the future of IPF care and providing a model for benchmarking, ultimately increasing knowledge and improving clinical care for this devastating disease.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11840905/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143456710","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":"Mechanical insufflation-exsufflation use in neuromuscular disease: a single centre cohort study.","authors":"Neeraj Mukesh Shah, Georgios Kaltsakas, Sophie Madden-Scott, Chloe Apps, Shauna Sheridan, Michelle Ramsay, Shelley Srivastava, Eui-Sik Suh, Rebecca D'Cruz, Mike Mackie, Nick Weston, Nicholas Hart, Patrick Murphy","doi":"10.1136/bmjresp-2024-002651","DOIUrl":"10.1136/bmjresp-2024-002651","url":null,"abstract":"<p><strong>Introduction: </strong>Mechanical insufflation-exsufflation (MIE) is a commonly used therapy to augment secretion clearance in individuals with neuromuscular disease. There are no clear evidence-based guidelines on the settings that should be used in different diagnostic groups and how they should be titrated. We report on the settings used in the largest cohort of individuals using domiciliary MIE in the literature.</p><p><strong>Methods: </strong>A retrospective observational study reporting on all individuals initiated on MIE for long-term domiciliary use at our centre, 2013-2019.</p><p><strong>Results: </strong>This study reports on 359 adults established on domiciliary MIE. The most common diagnostic groups were congenital neuromuscular disease (26%), spinal cord injury (23%) and amyotrophic lateral sclerosis (23%). Median age at initiation was 55 years. Median (IQR) insufflation pressure was 35 (30-40) cm H₂O and exsufflation pressure was 45 (40-50) cm H₂O. Inspiratory time was 2.5 (2.3-2.8) s, expiratory time was 2.7 (2.3-2.8) s, and pause between expiration and inspiration was 2.0 (1.2-2.0) s. Median (IQR) survival following the initiation of MIE was 66 (54-78) months. Increasing age and amyotrophic lateral sclerosis were significantly associated with shorter life expectancy, while the delivery of MIE via oronasal interface compared with tracheostomy was associated with longer life expectancy.</p><p><strong>Conclusion: </strong>This is the largest reported cohort of adults using domiciliary MIE. The most common groups using MIE were congenital neuromuscular disease, spinal cord injury patients and amyotrophic lateral sclerosis. The range of prescribed settings is narrow, reflecting the limited evidence base in this field and the need to better understand optimal targets for titration of different MIE settings.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11836793/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143439949","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":"COVID-19 and risk of long-term mortality in COPD: a nationwide population-based cohort study.","authors":"Hyun Lee, Sang Hyuk Kim, Cho Yun Jeong, Jee-Eun Chung, Youlim Kim, Kyung Hoon Min, Kwang Ha Yoo, Jong Seung Kim, Ji-Yong Moon","doi":"10.1136/bmjresp-2024-002694","DOIUrl":"10.1136/bmjresp-2024-002694","url":null,"abstract":"<p><strong>Background: </strong>Chronic obstructive pulmonary disease (COPD) is a risk factor for severe COVID-19. However, mortality after COVID-19 recovery in this population remains unclear.</p><p><strong>Methods: </strong>We retrospectively enrolled individuals with COPD from the Korean National Health Insurance database. We compared the mortality rate in individuals with COPD who recovered from COVID-19 between 8 October 2020 and 31 December 2021 (COVID-19 cohort, n=2499) with that in 1:1 propensity score-matched controls (n=2499). The study population was followed until either death or 30 September 2022, whichever came first.</p><p><strong>Results: </strong>The COVID-19 cohort had a 4.8% mortality rate vs 2.7% in matched controls during a median follow-up of 319 days (IQR, 293-422 days), including 14 days of recovery time. The COVID-19 cohort had a higher risk of death than matched controls (adjusted HR (aHR)=1.81, 95% CI=1.35 to 2.45). The risk of mortality was notably higher in individuals with severe COVID-19 (aHR=5.05, 95% CI=3.65 to 6.97), especially during the first 180 days of recovery (highest during the first 30 days (aHR=20.25, 95% CI=7.79 to 52.64)). Non-severe COVID-19 does not increase the risk of mortality compared with controls (aHR=0.85, 95% CI=0.57 to 1.28).</p><p><strong>Conclusion: </strong>Individuals with COPD recovering from COVID-19 showed an increased risk of long-term mortality, particularly within the first 180 days post-recovery, especially those who experienced severe COVID-19.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11836811/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143439948","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":"Investigating a structured diagnostic approach for chronic breathlessness in primary care: a mixed-methods feasibility cluster randomised controlled trial.","authors":"Gillian Doe, Jill Clanchy, Simon Wathall, Shaun Barber, Sarah A Edwards, Helen Evans, Darren Jackson, Natalie Armstrong, Michael C Steiner, Rachael A Evans","doi":"10.1136/bmjresp-2024-002716","DOIUrl":"10.1136/bmjresp-2024-002716","url":null,"abstract":"<p><strong>Background: </strong>There is a need to reduce delays to diagnosis for chronic breathlessness to improve patient outcomes.</p><p><strong>Objective: </strong>To conduct a mixed-methods feasibility study of a larger cluster randomised controlled trial (cRCT) investigating a structured symptom-based diagnostic approach versus usual care for chronic breathlessness in primary care.</p><p><strong>Methods: </strong>10 general practitioner practices were cluster randomised to a structured diagnostic approach for chronic breathlessness including early parallel investigations (intervention) or usual care. Adults over 40 years old at participating practices were eligible if presenting with chronic breathlessness without an existing explanatory diagnosis. The primary feasibility outcomes were participant recruitment and retention rate at 1 year. Secondary outcomes included number of investigations at 3 months, and investigations, diagnoses and patient-reported outcome measures (PROMs) at 1 year. Semistructured interviews were completed with patients and clinicians, and analysed using thematic analysis.</p><p><strong>Results: </strong>Recruitment rate was 32% (48/150): 65% female, mean (SD) age 66 (11) years, body mass index 31.2 kg/m² (6.5), median (IQR) Medical Research Council dyspnoea 2 (2-3). Retention rate was 85% (41/48). At 3 months, the intervention group had a median (IQR) of 8 (7-9) investigations compared with 5 (3-6) investigations with usual care. 11/25 (44%) patients in the intervention group had coded diagnosis for breathlessness at 12 months compared with 6/23 (26%) with usual care. Potential improvements in symptom burden and quality of life were observed in the intervention group above usual care.</p><p><strong>Conclusions: </strong>A cRCT investigating a symptom-based diagnostic approach for chronic breathlessness is feasible in primary care showing potential for timely investigations and diagnoses, with PROMs potentially indicating patient-level benefit. A further refined fully powered cRCT with health economic analysis is needed.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11831280/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143413175","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 <u>H</u>yperox<u>i</u>a on <u>P</u>ulmonary <u>I</u>nflammation and organ injury in a human in vivo model (HIPI): study protocol of a randomised, double-blind, placebo-controlled trial.","authors":"Dermot Linden, Delia Dorrian, Shikha Tandel, Michael McKelvey, Melanie Bailey, John Conlon, David Moore, Sharon Carr, Clifford C Taggart, Judy M Bradley, Joseph Kidney, Cecilia M OKane, Daniel Francis McAuley","doi":"10.1136/bmjresp-2024-002393","DOIUrl":"10.1136/bmjresp-2024-002393","url":null,"abstract":"<p><strong>Introduction: </strong>Liberal administration of supplemental oxygen (O₂) is ubiquitous across numerous healthcare settings. However, appropriate O₂ titration targets remain controversial and despite numerous large-scale randomised trials, there is an ongoing lack of consensus regarding optimal oxygenation strategies and the absence of high-quality mechanistic data pertaining to the potential proinflammatory effects of hyperoxia.</p><p><strong>Methods and analysis: </strong>We hypothesise that (1) short-term exposure to hyperoxia will induce mild pulmonary inflammation and cellular injury and that (2) hyperoxia will accentuate pulmonary inflammation and cellular injury in the setting of inhaled lipopolysaccharide challenge. To test our hypotheses, we will conduct a randomised, double-blind, placebo-controlled study of hyperoxia administered via a high-flow nasal O₂ delivery system (fractional inspired oxygen 1.0, 60 L/min flow rate) compared with synthetic medical air. Blocked randomisation will be undertaken by an independent clinical trials statistician. Healthy non-smoking adult volunteers (<45 years of age), taking no regular medications will be recruited. Bronchoalveolar lavage (BAL) will be performed at 6 hours. The study outcome measures will include BAL markers of inflammation and injury (including but not limited to interleukin (IL)-8, IL-6, tumour necrosis factor alpha), BAL differential cell counts, BAL markers of oxidative stress (superoxide dismutase and glutathione), alveolar epithelial cell injury (SP-D, vWF, RAGE) and markers of systemic inflammation (neutrophils and plasma C-reactive protein).</p><p><strong>Ethics and dissemination: </strong>Dissemination of the research findings will be achieved in the following ways: (1) Our findings will be presented at national and international meetings with open-access abstracts online and (2) in accordance with the open-access policies proposed by the leading research funding bodies we aim to publish the findings in high quality peer-reviewed open-access journals.</p><p><strong>Trial registration number: </strong>NCT05414370.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11822437/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143405574","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":"Daily SARS-CoV-2 testing after travel-related close contact notifications during elite sporting events hosted in the UK: a longitudinal study.","authors":"Madeleine Davies, Jerry Hill, Luke Goggins, Nicholas Peirce, Jenifer Smith, Matthew Boulter, Tom Alan Fowler, Iain Buchan, James D F Calder","doi":"10.1136/bmjresp-2023-001912","DOIUrl":"10.1136/bmjresp-2023-001912","url":null,"abstract":"<p><p>Isolation requirements for COVID-19 close contacts risked discouraging elite athletes and support staff from travelling to international sports events hosted in the UK during 2021.</p><p><strong>Objectives: </strong>The purpose of this study, in collaboration with the UK Health Security Agency, was to develop and implement a risk assessment and workplace daily testing approach in elite sporting events, for individuals who would otherwise be excluded by quarantine.</p><p><strong>Methods: </strong>Longitudinal study of athletes and staff identified as close contacts during travel (ie, flights, train) to specific international sports events. A risk assessment was undertaken, and participants were categorised as at 'low' or 'high' risk of developing SARS-CoV-2 based on their exposure circumstances. High-risk individuals remained in 10-day isolation, whereas those of low risk underwent daily symptom and lateral flow testing, enhanced workplace mitigation and selected work activities were permitted.</p><p><strong>Results: </strong>Of 29 514 event personnel, 202 travel-related close contacts were reported to the study team, of which 126 were eligible from 40 events in 7 sports. Of the individuals assessed, 105 (83.3%) were classified as low risk, while 21 (16.7%) were classified as high risk. No low-risk individuals tested positive in over 280 rapid antigen tests.</p><p><strong>Conclusion: </strong>International sports events rely on athlete and support staff availability, with economic consequences of event cancellation or postponement. Our study showed no detection of SARS-CoV-2 in low-risk close contacts, and enabled their sustained participation. This multidisciplinary intervention appears to have been effective, enabling large-scale event continuation, while minimising risk to athletes, employees and the wider public.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11822419/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143405673","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}