BMJ Open Respiratory Research最新文献

{"title":"Respiratory syncytial virus-induced SIGLEC1 upregulation inhibits macrophage autophagy and facilitates inflammatory mediator secretion.","authors":"Fuhuang Lai, Airong Liao, Kang Xia, Liping Zhang, Hua Yang, Wei Lin","doi":"10.1136/bmjresp-2025-003586","DOIUrl":"10.1136/bmjresp-2025-003586","url":null,"abstract":"<p><strong>Background: </strong>Respiratory syncytial virus (RSV) is a leading culprit behind respiratory infections in infants. As a cornerstone of the immune defence, macrophages are instrumental in warding off invading pathogens. This study examines the molecular pathways through which RSV modulates the immune functions of macrophages during infection.</p><p><strong>Methods: </strong>THP-1-derived macrophages were infected with RSV, and the infection was monitored using fluorescence microscopy. The viability of infected macrophages was measured using CCK-8, and SIGLEC1 expression was analysed by RT-qPCR and western blot (WB). Gene set enrichment analysis was performed to identify pathways associated with SIGLEC1 enrichment. SIGLEC1-knockdown macrophages were developed, and autophagy levels in these cells following RSV infection were examined using WB, immunofluorescence and monodansylcadaverine staining. The influence of RSV infection on macrophage phenotype and inflammatory responses was assessed through morphological observation, flow cytometry, ELISA and nitric oxide synthase expression analysis.</p><p><strong>Results: </strong>Following RSV infection, macrophage activity was significantly repressed, and SIGLEC1 expression was markedly upregulated. This upregulation of SIGLEC1 effectively suppressed the autophagy process in macrophages, as indicated by decreased levels of ATG5 and LC3II, and reduced autophagosome formation. RSV infection also drove macrophages towards the M1 phenotype, which was accompanied by increased secretion of proinflammatory cytokines. Importantly, these effects were reversible through SIGLEC1 knockdown or treatment with an autophagy activator, which restored autophagy levels and curbed the release of inflammatory mediators.</p><p><strong>Conclusion: </strong>By exposing how RSV exploits SIGLEC1 to inhibit macrophage autophagy, reinforce M1 polarisation and increase cytokine secretion, this study lays vital groundwork for new treatments targeting this viral scourge.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"13 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13110667/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147728355","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":"Comparing paper Letters in addition to Emailed Audit and feedback in Refining Asthma treatment to Improve clinical and environmental Results in primary care through a cluster randomised controlled trial: the CLEAR AIR study.","authors":"Owen Thomas, Bethan Copsey, Paul Carder, Imran Mohammed, Stella Johnson, Katherine Hickman, Toby Capstick, Robbie Foy, Sarah Alderson","doi":"10.1136/bmjresp-2025-003601","DOIUrl":"10.1136/bmjresp-2025-003601","url":null,"abstract":"<p><strong>Background: </strong>Suboptimal use of preventer inhalers and salbutamol reliever overprescribing are associated with preventable asthma deaths and are a major source of primary care carbon emissions. Audit and feedback produces modest behaviour change by assessing clinical performance and delivering feedback to encourage improvement. Although feedback is increasingly delivered digitally, clinicians may respond more to additional printed feedback reports. We evaluated whether combined digital and paper feedback was more effective than digital-only feedback in promoting safer and greener asthma prescribing at the practice level.</p><p><strong>Methods: </strong>In this parallel, cluster randomised controlled trial, all 273 primary care practices in West Yorkshire were assigned within their primary care network clusters by stratified, permuted block randomisation to receive seven bimonthly reports on asthma prescribing either in 'digital and paper' (intervention) or 'digital-only' (control) formats. The primary outcome was the proportion of preventer inhalers prescribed in pressurised metred-dose devices due to their high carbon footprint. Intervention group allocation was concealed. The intention-to-treat population was analysed and adjusted for both potential confounders and preintervention achievement.</p><p><strong>Results: </strong>Final analysis assessed 270 practices in 26 clusters per arm due to practice mergers within the control group. There was no significant difference between the intervention groups based on change in the primary outcome (intervention-0.15%; control-0.19%; risk ratio-1.00; 95% CI 0.98 to 1.03) nor any secondary outcome. Analysis of both interventions combined showed a background trend of mixed improvement following feedback.</p><p><strong>Conclusions: </strong>There was no evidence that combined paper and digital feedback was more effective than digital-only feedback, despite the background of mixed improvements following both interventions. Challenges remain to understanding the barriers to influencing the prescribing of preventer inhalers and transitioning inhaler devices towards low-carbon 'green' alternatives; however, this study demonstrated the value of an efficient 'real-world' trial embedded within an existing quality improvement initiative.</p><p><strong>Trial registration number: </strong>NCT05761873.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"13 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13110629/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147715921","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":"Incidence, risk factors and viral aetiology of lower respiratory infections among older adults: a 5-year multicentric cohort study in India.","authors":"Rakesh Kumar, Ritvik Amarchand, Lalit Dar, Suman Kanungo, Prabu Rajkumar, Sumit Dutt Bhardwaj, Kusum Shekhawat, Aashish Choudhary, Varsha Potdar, Girish Kumar Cp, Alok Kumar Chakrabarty, Giridara Gopal Parameswaran, Avinash Choudekar, Wajihul Khan, Shivram Dhakad, Anand Krishnan","doi":"10.1136/bmjresp-2025-003851","DOIUrl":"10.1136/bmjresp-2025-003851","url":null,"abstract":"<p><strong>Background: </strong>We estimated the incidence, viral aetiology and risk factors of acute lower respiratory infection (ALRI) and severe ALRI among community-dwelling older adults at four sites in India.</p><p><strong>Methods: </strong>Adults ≥60 years were recruited and followed between July 2018 and March 2023. Each week, trained nurses screened all participants for ALRI using modified British Thoracic Society criteria. ALRI was further categorised as severe ALRI if the respiratory rate was >30 breaths per minute or the SPO₂ was <94% or the patient was hospitalised with respiratory symptoms. Combined nasal and throat swabs from ALRI cases were tested for multiple viral pathogens. The incidence of ALRI, severe ALRI and respiratory hospitalisation per 1000 person-years (TPY) was estimated. Adjusted rate ratios (aRR) were calculated by multilevel Poisson regression to identify risk factors for ALRI and severe ALRI.</p><p><strong>Results: </strong>We followed 7240 participants for 19 914 person-years; 59.5% were women. Their mean age was 66.2 years. The incidence of ALRI, severe ALRI and respiratory hospitalisation was 98.0/TPYs, 22.1/TPYs and 12.1/TPYs, respectively. Males (aRR: 1.2), those with body mass index <18.5 kg/m² (aRR: 1.6) or ≥30 (aRR: 1.5), coronary artery disease (aRR: 1.5), current or past tuberculosis (aRR: 2.4), chronic respiratory disease (aRR: 5.4) and the use of solid fuel in the household (aRR: 2.0) had higher risk of severe ALRI. Viruses were detected in 16.8% of ALRI cases, influenza (8.8%) was the most detected viral pathogen followed by rhinovirus (2.7%).</p><p><strong>Conclusion: </strong>Rates of ALRI and severe ALRI were high; malnutrition, chronic morbidities and the use of solid fuel were important risk factors for severe ALRI.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"13 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13110679/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147716012","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":"Improving asthma case detection among children and adolescents through clinic-based screening in primary care health facilities in Uganda: a cluster randomised trial.","authors":"Rebecca Nantanda, Andrew Ssemata Sentoogo, Sarah Namusoko, Phiona Ekyaruhanga, Mary Goretty Kuteesa, Fred Matovu, Levicatus Mugenyi, Jonathan Grigg","doi":"10.1136/bmjresp-2025-003368","DOIUrl":"10.1136/bmjresp-2025-003368","url":null,"abstract":"<p><strong>Introduction: </strong>Underdiagnosis of asthma in children and adolescents is a major challenge, particularly in low-resource settings. We aim to assess the clinical and cost-effectiveness of screening for asthma symptoms among children and adolescents with respiratory symptoms presenting at primary care health facilities in Uganda. The feasibility and acceptability of routine screening will also be explored.</p><p><strong>Methods and analysis: </strong>A cluster-randomised trial, using screening for asthma symptoms as the intervention, will be conducted in health centres in Jinja region, Eastern Uganda. We hypothesise that screening for asthma symptoms at clinical care points will lead to an increase in the proportion of children diagnosed with asthma. The health centres will be randomised into intervention and control arms. In the intervention sites, 1050 children aged 2 months to 17 years with respiratory symptoms will be screened for asthma symptoms using the International Study on Asthma and Allergies in Children verbal questionnaire. History and physical examination will be conducted among the screen positives to identify those with asthma. Data on asthma diagnoses 12 months before the intervention and during the intervention will be collected from both the control and intervention health centres. Data on direct and indirect costs of screening will be collected prospectively. Focus group discussions (FGDs) will be conducted among health workers and key informant interviews (KII) among facility in-charges at the intervention sites to assess the feasibility and acceptability of the intervention. The primary outcome will be the proportion of asthma diagnoses. A random-effects logistic regression model, adjusting for baseline data while accounting for facility level clustering, will be used to assess the effectiveness of screening. Cost-effectiveness will be assessed by computing the incremental cost-effectiveness ratio. Framework analysis will be used to analyse data from the FGDs and KIIs.</p><p><strong>Ethics and dissemination: </strong>Ethics approval was obtained from Makerere University School of Public Health Research and Ethics Committee (SPH-2024-552), Uganda National Council for Science and Technology (HS4136ES) and the Queen Mary University of London Research Ethics Committee in the UK (QME24.0514). All participants will provide written informed consent. Children aged 8 years and above will provide assent, in addition to consent by their parents/caregivers. The study results will be disseminated through publications in peer reviewed journals, conferences, participant feedback meetings and Makerere University Lung Institute website. Policy briefs will be shared with key stakeholders including the Ministry of Health and Jinja District/City administrators.</p><p><strong>Trial registration number: </strong>ISRCTN16018011.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"13 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13110669/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147715988","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":"Respiratory oscillometry identifies disease progression in interstitial lung disease.","authors":"Robert Dube, Osmin Am Duran, Ilan Azuelos, Maxime Cormier, Ronald J Dandurand, Deborah Assayag","doi":"10.1136/bmjresp-2025-003900","DOIUrl":"10.1136/bmjresp-2025-003900","url":null,"abstract":"<p><strong>Background: </strong>Respiratory oscillometry is an effort-independent method of evaluating lung function. Its role in the monitoring of interstitial lung disease (ILD) is unclear. This observational longitudinal study assessed the relationship between oscillometry and pulmonary function test (PFT) parameters in ILD over time and determined whether oscillometry can detect disease progression.</p><p><strong>Methods: </strong>Participants underwent PFT and oscillometry within the same visit at two time points. Oscillometry parameters of interest included resistance at 5 Hz (R₅), reactance at 5 Hz (X₅), resonant frequency (F_res) and area under the reactance curve (AX). Oscillometry and PFT parameters were compared using Spearman correlation and linear mixed-effects models. Participants were categorised as having progressed if they had interval symptomatic worsening, radiographic progression or treatment escalation. Temporal changes in lung function were evaluated using repeated measures analysis of variance.</p><p><strong>Results: </strong>Of the 43 participants enrolled, 17 (40%) demonstrated interval clinical worsening over a median follow-up of 384 days. Spirometry parameters displayed moderate-to-strong correlations with all oscillometry parameters, especially the reactance measures AX and X₅, at both time points, without a significant time interaction. When stratified by disease progression, AX, F_res and X₅ displayed significant time-by-outcome interactions. PFT parameters did not significantly differ between progressors and non-progressors.</p><p><strong>Conclusion: </strong>Reactance measures of oscillometry remained correlated with traditional lung function tests over time. Oscillometry parameters also showed significant temporal differences between participants with and without evidence of clinical worsening, unlike spirometry measures, which did not capture progression. These findings suggest that oscillometry may hold value in the longitudinal monitoring of ILD.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"13 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13110701/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147715957","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":"Long-term variability of impulse oscillometry defined small airway dysfunction in participants with and without chronic obstructive pulmonary disease.","authors":"Lifei Lu, Gaoying Tang, Qi Wan, Fan Wu, Zhishan Deng, Jieqi Peng, Cuiqiong Dai, Kunning Zhou, Xiaohui Wu, Si Li, Guannan Cai, Suyin Huang, Junfeng Lin, Shuqing Yu, Yongqing Huang, Changli Yang, Shengtang Chen, Pixin Ran, Yumin Zhou","doi":"10.1136/bmjresp-2025-003918","DOIUrl":"10.1136/bmjresp-2025-003918","url":null,"abstract":"<p><strong>Background: </strong>Small airway dysfunction (SAD), as assessed by impulse oscillometry (IOS) (IOS-SAD), exhibits temporal variability and its long-term fluctuations may be linked to distinct clinical phenotypes. We investigated the associations of long-term variability in IOS-SAD with adverse clinical outcomes among participants with and without chronic obstructive pulmonary disease (COPD).</p><p><strong>Methods: </strong>The baseline and 2-year follow-up data from the early COPD cohort were retrospectively analysed. SAD was defined based on the following criteria: difference from R5 to R20 (R5-R20) >upper limit of normal (ULN) (R5-R20-SAD), or reactance at 5 Hz (X5) <lower limits of normal, or area under the reactance curve (AX) >ULN. Individuals were classified into three groups based on SAD variability over three visits at 2-year follow-up: (1) consistent SAD (SAD at every visit), (2) inconsistent SAD (SAD at some, but not all, visits) and (3) never SAD (no SAD at any visit). Differences in the rate of spirometric lung function decline and exacerbation rate were compared across long-term IOS-SAD variability groups in participants with and without COPD.</p><p><strong>Results: </strong>In individuals with COPD, the consistent and inconsistent SAD groups assessed were associated with a faster spirometric lung function decline and a higher risk of exacerbations. In individuals without COPD, the consistent R5-R20-SAD group was associated with a faster decline in spirometric lung function and progression towards COPD.</p><p><strong>Conclusions: </strong>SAD, even diagnosed once, characterises an airway behaviour with a higher proportion of higher risk of moderate or severe exacerbations. Consistent SAD was associated with accelerated spirometric lung function decline, increased exacerbation risk and progression to spirometry-defined COPD.</p><p><strong>Trial registration number: </strong>ChiCTR1900024643.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"13 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13110685/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147697574","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":"Pulmonary artery floating sign: a novel predictor of fatal haemoptysis in pulmonary mucormycosis and its early intervention strategy.","authors":"Mingjing Yu, Faming Jiang, Li Guo, Hongxia Wu, Xiang Tong, Hao Wang, Lijuan Gao, Yina Li, Jiangang Wang, Hong Fan, Ye Wang","doi":"10.1136/bmjresp-2025-003803","DOIUrl":"10.1136/bmjresp-2025-003803","url":null,"abstract":"<p><strong>Background: </strong>Massive haemoptysis is a life-threatening complication of pulmonary mucormycosis, often resulting from invasive destruction of pulmonary arteries. Early predictors and preventive strategies remain poorly defined.</p><p><strong>Methods: </strong>We retrospectively enrolled all hospitalised patients with pulmonary mucormycosis regardless of haemoptysis between 2019 and 2024. Patients were stratified into non-massive and massive haemoptysis groups. Clinical and radiological variables were compared between groups, and univariable and multivariable logistic regression analyses were performed. Given the limited number of events and separation, Firth's penalised logistic regression and reduced multivariable models were used to identify robust predictors of massive haemoptysis. Additionally, we explored the feasibility of prophylactic pulmonary artery embolisation (PPAE) in a subset of high-risk patients to evaluate its potential role in preventing fatal haemorrhage.</p><p><strong>Results: </strong>Fifty-seven patients with pulmonary mucormycosis were enrolled, and 22 (38.6%) patients had massive haemoptysis, with a mortality rate of 72.7% (16/22). Cavity (68.2% vs 34.3%, p=0.026) and central necrosis (100% vs 74.3%, p=0.009) were significantly more common in the massive haemoptysis group. The pulmonary artery floating sign (PAFS) was observed in 81.8% (18/22) of the massive haemoptysis group versus 31.4% (11/35) of the non-massive haemoptysis group (p<0.001), and was the only independent predictor (adjusted OR 6.20, 95% CI 1.68 to 28.49). Five high-risk patients, including three with floating sign, underwent PPAE; only one subsequently died of bleeding.</p><p><strong>Conclusion: </strong>The PAFS is a novel and independent predictor of massive haemoptysis in pulmonary mucormycosis. Its early identification may support early risk stratification and inform consideration of PPAE in selected high-risk patients.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"13 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13084916/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147688039","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":"Personalised management of community-acquired pneumonia and the role of Clinical Decision Support Software.","authors":"Christopher Hatton, Catherine Atkin, Suzy Gallier, Elizabeth Sapey","doi":"10.1136/bmjresp-2024-003096","DOIUrl":"10.1136/bmjresp-2024-003096","url":null,"abstract":"<p><p>Community-acquired pneumonia (CAP) is one of the most common causes of hospital admission and is associated with significant morbidity and mortality. National and international guidelines are available to guide the management of CAP, including antibiotic prescribing. However, these guidelines are often not adhered to and there is significant overprescribing of broad-spectrum antibiotics, contributing to the growing pandemic of antimicrobial resistance. Clinical Decision Support Software (CDSS) are electronic tools that use individual patient data to generate patient specific assessments or recommendations, that can then be acted on by the patient or clinical decision maker. This article reviews the evidence surrounding the initial management of CAP in hospital and considers the potential of CDSS to support CAP management.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"13 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13084861/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147688050","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":"In vitro characterisation of fluticasone propionate and ciclesonide delivered with and without valved holding chambers using cascade impaction and an adult simulated breathing profile.","authors":"Leon L Csonka, Lauri Lehtimäki, Péter Csonka","doi":"10.1136/bmjresp-2025-003963","DOIUrl":"10.1136/bmjresp-2025-003963","url":null,"abstract":"<p><strong>Background: </strong>Valved holding chambers (VHCs) are not interchangeable. Because VHC design and formulation type influence aerosol behaviour, each VHC-drug combination should be evaluated to inform clinical use and device selection.</p><p><strong>Aim: </strong>To compare the aerodynamic particle size distribution (APSD) of two inhaled corticosteroids delivered from pressurised metered dose inhalers with and without commonly used VHCs under realistic, adult-representative breathing.</p><p><strong>Methods: </strong>We assessed fluticasone propionate (FP, suspension) and ciclesonide (CIC, solution) using no VHC and three VHCs (AeroChamber, EasyChamber and OptiChamber Diamond). A Next Generation Impactor was connected to an anatomically representative adult throat model and a breathing simulator generating an adult-type inhalation profile.</p><p><strong>Results: </strong>Without a VHC, throat deposition was high. With any VHC, throat deposition fell to only a few per cent of the label claim for both FP and CIC. The 1-5 µm respirable fraction was approximately one-third of the label claim for both drugs, irrespective of VHC use, while CIC generated a larger submicron fraction than FP. Small statistically significant differences between VHCs were observed, but absolute differences in APSD and throat deposition were modest.</p><p><strong>Conclusions: </strong>In adult-representative conditions, VHCs substantially reduce oropharyngeal deposition but do not influence fine-particle delivery. Differences between the tested VHCs were minor and unlikely to be clinically meaningful, whereas FP and CIC showed distinct APSD profiles consistent with formulation type. These findings support performance-based, drug-specific evaluation of VHCs and underscore the value of systematic in vitro testing to guide evidence-based spacer-drug selection and to reduce throat deposition in clinical practice.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"13 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13084801/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147688122","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":"Characteristics of small airway disease in patients with HIV infection: insights from spirometry and impulse oscillometry.","authors":"Ilgim Vardaloglu, Buket Caliskaner Ozturk, Hazal Cansu Culpan, Bilgul Mete, Fehmi Tabak, Ersan Atahan","doi":"10.1136/bmjresp-2025-003719","DOIUrl":"10.1136/bmjresp-2025-003719","url":null,"abstract":"<p><strong>Background: </strong>Airway diseases that are independent of smoking behaviour are frequent in people living with HIV (PLWH). Spirometry, the gold standard for diagnosing airway diseases, may not detect small airway disease (SAD) when forced expiratory volume in 1 s/forced vital capacity is normal. However, impulse oscillometry (IOS) can detect SAD even when the spirometry is normal. This study aims to evaluate characteristics of SAD in PLWH by using IOS and exploring the diagnostic performance of IOS measurements to detect SAD.</p><p><strong>Methods: </strong>This cross-sectional study included 127 PLWH on antiretroviral therapy without known airway disease. IOS was done first, followed by spirometry. Patients whose maximal mid-expiratory flow (MMEF) value was below 65% were defined as having spirometric SAD. Clinical characteristics and IOS measures were compared between those who had and those who did not have SAD. A receiver operating characteristic analysis was done to determine the diagnostic performance of IOS measures to diagnose spirometric SAD.</p><p><strong>Results: </strong>Mean age was 43.5±12.5 years and 60 patients were non-smokers. Spirometric SAD was observed in 34% of all patients. R5, R5-R20, AX and Fres were significantly higher in the patients who had spirometric SAD. Smoking history, duration of antiretroviral therapy and history of pneumonia were significantly associated with SAD. The optimal cut-off value for R5-R20 was 0.08 for SAD (sensitivity of 71.8% and specificity of 58.1%) and the optimal cut-off value for AX was 0.55 (sensitivity of 51.2% specificity of 91.7%).</p><p><strong>Conclusion: </strong>SAD is common in PLWH and IOS may serve as a supportive tool for the clinical assessment of small airway involvement.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"13 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13084963/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147688036","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}