BMJ Open Respiratory Research最新文献

{"title":"Use of supplemental oxygen therapy in idiopathic pulmonary fibrosis: an observational real-life study in 16 003 patients.","authors":"Claire Marant-Micallef, Manon Belhassen, Jean-Michel Fourrier, Maeva Nolin, Nadège Bornier, Stéphane Jouneau, Michael Kreuter, Katerina Samara, Vincent Cottin","doi":"10.1136/bmjresp-2025-003153","DOIUrl":"10.1136/bmjresp-2025-003153","url":null,"abstract":"<p><strong>Background and objectives: </strong>The use of long-term oxygen therapy (LTOT) in idiopathic pulmonary fibrosis (IPF) is poorly studied. We assessed the proportion of patients with IPF receiving LTOT and compared the risk of death according to LTOT exposure.</p><p><strong>Methods: </strong>Using the French national healthcare claims database, the use of LTOT and antifibrotics was studied in patients newly diagnosed with IPF from 1 January 2012 to 31 December 2019, followed until 31 December 2021. An adjusted Cox regression model was used to compare the risk of death by LTOT use, using exposure to antifibrotics and LTOT as time-dependent variables.</p><p><strong>Results: </strong>Among 16 003 patients newly diagnosed with IPF, 4559 (28.5%) initiated LTOT during follow-up: median time to initiation was 273 days and median duration was 336 days. The proportion of patients initiating LTOT was 23.2% among those not receiving antifibrotics (78.5% of study population) and 42.0% in those treated by antifibrotics at inclusion (7.7%), with respective median time to LTOT initiation of 110 and 590 days, and respective median LTOT duration of 308 and 294 days. Patients exposed to LTOT had a significantly higher risk of death compared with those who were not (HR: 2.9 (95% CI: 2.8 to 3.0) among those without antifibrotics; 2.1 (95% CI 1.9 to 2.3) among those with concomitant antifibrotics).</p><p><strong>Conclusions: </strong>The use of LTOT is limited among patients with IPF, even those receiving antifibrotics. The association between LTOT and mortality suggests that LTOT use is a marker of severity. Guidelines dissemination would help clinicians adopt appropriate LTOT management in patients with IPF and chronic respiratory failure.</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/PMC12516998/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145273761","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":"Unravelling telemonitoring data to predict good NIV quality: the E-QualiNIV study.","authors":"Arnaud Prigent, Clément Blanloeil, Dany Jaffuel, Frederic Gagnadoux, Léo Grassion","doi":"10.1136/bmjresp-2024-003066","DOIUrl":"10.1136/bmjresp-2024-003066","url":null,"abstract":"<p><strong>Background and objective: </strong>High treatment quality, defined by mean adherence >4 hours per day, unintentional leaks <24 L/min and a residual Apnoea-Hypopnoea Index <5 events per hour, is associated with better outcomes. Adherence variance may reflect behaviour linked to better treatment quality. This study aimed to assess whether monthly adherence variance is associated with improved treatment quality in patients treated with non-invasive ventilation (NIV) for more than 4 months.</p><p><strong>Methods: </strong>E-QualiNIV is a retrospective study evaluating treatment quality in 511 telemonitored patients with chronic respiratory failure, observed from 15 April to 31 October 2023. The study followed three steps: (1) hierarchical clustering based on individual adherence variance; (2) assessing whether monthly adherence variance in the preceding month predicted the proportion of alerts in the subsequent month and (3) evaluating treatment quality based on the number of months with low adherence variance.</p><p><strong>Results: </strong>Cluster 1, consisting of patients with adherence variance below 3, had a significantly higher proportion (57.93%) of patients achieving high-quality treatment compared with other clusters (43.1% for cluster 2 and 46.4% for cluster 3) (p=0.035). Patients with a low adherence variance in the preceding month were more likely to achieve high-quality treatment in the following month (except for May, significant differences every month from p=0.04 to p<0.01). Those with 6 or more months of low adherence variance had a significantly higher probability of receiving high-quality treatment over the entire period (coefficient: 0.2649, p value: 0.0028) compared with those who did not (non-significant).</p><p><strong>Conclusion: </strong>The E-QualiNIV study demonstrates that low adherence variance is associated with high-quality treatment and serves as a prognostic indicator of treatment stability and alert occurrence in the subsequent month.</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/PMC12517029/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145273748","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":"Bench evaluation of six non-invasive ventilation home ventilators: comparison with an ICU ventilator and unsupervised clustering.","authors":"Joris Pensier, Mathieu Capdevila, Dany Jaffuel, Abdelkebir Sabil, Fabrice Galia, Albert Prades, Aurélie Vonarb, Julien Boudjemaa, Audrey De Jong, Samir Jaber","doi":"10.1136/bmjresp-2025-003532","DOIUrl":"https://doi.org/10.1136/bmjresp-2025-003532","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic hypercapnic respiratory failure often necessitates non-invasive ventilation (NIV) at home. Our study aimed to assess the static and dynamic performance of six modern NIV home ventilators and one intensive care unit (ICU) ventilator and to identify performance clusters among the devices.</p><p><strong>Methods: </strong>A two-compartment lung model was connected to seven NIV ventilators (Sefam Stan, Philips A40, Philips DreamStation, Resmed Lumis 150, Löwenstein PrismaVent 30C, Löwenstein PrismaVent 40 and BellaVista 1000) in pressure-support mode. Static and dynamic (triggering and pressurisation) performances were assessed through three distinct clinical phenotypes and four levels of unintentional leak. Clustering analysis was performed using K-means.</p><p><strong>Results: </strong>For each of the seven ventilators, 144 conditions were tested, and a total of 3024 cycles were analysed. Static and dynamic performances were good to excellent across home ventilators, significantly higher than the ICU ventilator. Clustering analysis identified three performance clusters. Cluster 1 (Sefam Stan and Philips A40) showed significantly more precise accuracy of inspiratory pressure than Cluster 2 (Philips DreamStation, Resmed Lumis 150, Löwenstein PrismaVent 30C and Löwenstein PrismaVent 40) and Cluster 3 (BellaVista 1000): mean error=4.3%±5.1% versus 8.5%±6.7% versus 10.6%±14.7% respectively, p<0.001. For the triggering delay, Cluster 1 displayed shorter delays than Cluster 2 and Cluster 3 (41±5 ms vs 58±11 ms vs 67±13 ms, respectively, p<0.001). For the pressurisation delay, Cluster 1 displayed shorter delays than Cluster 2 and Cluster 3 (42±6 ms vs 64±14 ms vs 87±14 ms, respectively, p<0.001). For the pressure-time product at 300 ms, Cluster 1 displayed higher area under the curve for the first 300 ms than Cluster 2 and Cluster 3 (2.1±1.1 cmH₂O /s vs 1.6±0.8 cmH₂O/s vs 1.3±1.0 cmH₂O/s, respectively, p<0.001). Continuous unintentional leaks did not modify the pressurisation performances in Cluster 1 but altered them in Clusters 2 and 3.</p><p><strong>Conclusion: </strong>The six NIV home ventilators demonstrated superior performance compared with the tested ICU ventilator. The ventilators of Cluster 1 were identified as top performers in clustering analysis and compensated for unintentional continuous leaks.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145237949","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":"Mechanical power in patients receiving mechanical ventilation in the surgical intensive care unit and its association with increased mortality: a retrospective cohort study.","authors":"Annop Piriyapatsom, Ajana Trisukhonth, Ornin Chintabanyat, Chayanan Thanakiattiwibun","doi":"10.1136/bmjresp-2024-002843","DOIUrl":"10.1136/bmjresp-2024-002843","url":null,"abstract":"<p><strong>Introduction: </strong>A potential correlation between mechanical power (MP) and clinical outcomes in mechanically ventilated patients has been reported. Limited data exist regarding MP among patients admitted to surgical intensive care units (SICUs) who require mechanical ventilation (MV) support. The primary objective of this study was to determine MP in mechanically ventilated patients admitted to the SICU, and the secondary objective was to explore whether MP was associated with clinical outcomes.</p><p><strong>Methods: </strong>This retrospective cohort study conducted at the SICU of the tertiary university-based hospital included 283 postoperative patients admitted to the SICU who required MV support for ≥12 hours. Ventilator parameters were recorded at MV initiation and 24 hours, and MP was subsequently computed. Cox regression analysis was employed to assess the association between MP and 90-day mortality.</p><p><strong>Results: </strong>MP at MV initiation and 24 hours were median 11.9 (IQR 8.6-17.1) J/min and 11.9 (8.9-16.8) J/min, respectively. MP was significantly higher in non-survivors both at MV initiation and 24 hours (15.4 (12.5-21.2) J/min vs 11 (8.3-15.6) J/min, p<0.001 and 15.9 (10.6-20.2) J/min vs 10.9 (8.5-15.4) J/min, p=0.001, respectively). MP ≥12 J/min at MV initiation was associated with increased 90-day mortality (HR 2.21, 95% CI 1.09 to 4.48), particularly among patients with high acuity, those at a high risk of acute lung injury and those who did not receive lung protective ventilation. In patients with MP ≥12 J/min at MV initiation, a subsequent rise in MP of ≥5 J/min at 24 hours was correlated with accentuated 90-day mortality.</p><p><strong>Conclusion: </strong>Among mechanically ventilated patients in the SICU, MP at the initiation and at 24 hours of MV support was approximately 12 J/min. An elevated MP was an independent predictor of elevated 90-day mortality, especially in cases with high illness acuity. Alterations in MP during MV support could impact the 90-day mortality in these individuals.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12506055/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145237927","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":"Modelling the climate impact of inhalers and mitigation strategies: a population-based study in British Columbia, Canada (2015-2032).","authors":"Solmaz Setayeshgar, Kevin E Liang, Valeria Stoynova, Gillian Frosst, Kate Smolina","doi":"10.1136/bmjresp-2025-003218","DOIUrl":"10.1136/bmjresp-2025-003218","url":null,"abstract":"<p><strong>Background: </strong>Canada has one of the highest per capita greenhouse gas (GHG) emissions, with healthcare contributing ~5% of the total. Pressurised metered-dose inhalers (pMDIs) are significant contributors due to their use of hydrofluorocarbon propellants. While propellant-free dry powder inhalers (DPIs) and soft mist inhalers (SMIs) are available, their adoption remains limited. This population-based study evaluates inhaler dispensation trends in British Columbia (BC), Canada, projects future dispensation and emissions over the next decade, and explores mitigation strategies through pMDI substitution.</p><p><strong>Methods: </strong>Historical inhaler dispensation data (2015-2022) from BC were analysed using negative binomial models to assess trends, project future usage and emissions (2023-2032) and evaluate four substitution scenarios replacing pMDIs with low-GHG alternatives or DPIs/SMIs. Emissions were estimated by inhaler type, sex, age and health region, with uncertainties addressed through Monte Carlo simulation for the projected values.</p><p><strong>Results: </strong>An average of 2.1 million inhalers are dispensed annually in BC, with pMDIs comprising 64% of total inhaler use but contributing 98% of the ~30 000 tonnes of GHG emissions. There was regional variation and older populations contributed disproportionately, reflecting burden of disease. From 2015 to 2022 (excluding 2020 and 2021, the COVID-19 years), pMDI dispensations decreased by 1% annually while DPI/SMI dispensations increased by 5%. Projections show that, without intervention, emissions could rise to ~37 000 tonnes by 2032, varying by age group. All substitution scenarios, by replacing pMDIs with DPIs/SMIs, could reduce emissions by up to 42%.</p><p><strong>Conclusion: </strong>High quality, guideline-directed diagnosis and management of respiratory disease is known to improve health and reduce emissions. Building on these benefits, our analysis shows that substituting pMDIs with lower-emission inhalers, when guided by policy and clinical decisions that prioritise patient safety and preference, can significantly reduce healthcare-related GHG emissions.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12496060/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145224865","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":"Non-cystic fibrosis bronchiectasis in Taiwan.","authors":"Chia-Ling Chang, Chau-Chyun Sheu, Ping-Huai Wang, Meng-Heng Hsieh, Wu-Huei Hsu, Ming-Tsung Chen, Wei-Fan Ou, Yu-Feng Wei, Tsung-Ming Yang, Chou-Chin Lan, Cheng-Yi Wang, Chih-Bin Lin, Ming-Shian Lin, Yao-Tung Wang, Ching-Hsiung Lin, Shih-Feng Liu, Meng-Hsuan Cheng, Yen-Fu Chen, Wen-Chien Cheng, Chung-Kan Peng, Ming-Cheng Chan, Ching-Yi Chen, Lun-Yu Jao, Ya-Hui Wang, Chi-Jui Chen, Shih-Pin Chen, Yi-Hsuan Tsai, Shih-Lung Cheng, Horng-Chyuan Lin, Jung-Yien Chien, Hao-Chien Wang","doi":"10.1136/bmjresp-2024-003100","DOIUrl":"10.1136/bmjresp-2024-003100","url":null,"abstract":"<p><strong>Introduction: </strong>Bronchiectasis exhibits substantial heterogeneity across geographic locations and includes a diverse range of aetiologies. Limited large-scale data are available for Southeast Asian countries.</p><p><strong>Methods: </strong>This was a multicentre, retrospective, observational cohort study. Between January 2017 and June 2020, comprehensive clinical data were collected on enrolment, and 1-year follow-ups were conducted using an electronic case report form.</p><p><strong>Results: </strong>A total of 2753 patients were enrolled. The mean age of the patients was 67 years. Forty-two per cent (1150/2753) of patients were male. The mean modified Reiff score was 5.0±3.3. The proportions of bacteria, tuberculosis and nontuberculous mycobacteria cultured from sputum within 1 year of follow-up were 46% (381/829), 1% (10/829) and 24% (202/829), respectively. The most prevalent bacterial isolate was <i>Pseudomonas aeruginosa</i> (22%), followed by <i>Klebsiella pneumoniae</i> (11%). Airflow obstruction was observed in 32% of patients, and 39% used inhaled bronchodilators. A substantial proportion (57%) of the patients were prescribed mucolytics. Seventeen per cent of the patients experienced severe exacerbations within a year. One-year all-cause mortality rate was 2% (52 of 2563 patients). Female patients demonstrated more severe imaging findings than male patients (modified Reiff score, 5.2 vs 4.6, p<0.001). However, they exhibited less obstructive lung function impairment (26% vs 40%, p<0.001), experienced fewer severe exacerbations (15% vs 20%, p=0.002) and had lower mortality rates (2% vs 5%, p<0.001). The risk of severe exacerbation and mortality increased significantly among patients older than 80 years.</p><p><strong>Conclusion: </strong>Although female patients with bronchiectasis exhibited more severe imaging findings, their prognoses were better in Taiwan. Elderly patients older than 80 years had worse prognosis.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12496070/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145224870","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":"Frequency and severity of COPD exacerbations and future risk of exacerbations and mortality: an observational cohort study in Canada.","authors":"My Linh Duong, Christina Qian, Manisha Talukdar, Sheena Kayaniyil, Johnston Karissa, Clementine Nordon, Erika D Penz","doi":"10.1136/bmjresp-2024-002976","DOIUrl":"10.1136/bmjresp-2024-002976","url":null,"abstract":"<p><strong>Objectives: </strong>To estimate the risk of subsequent exacerbations, in relation to history of exacerbations, in a cohort of older chronic obstructive pulmonary disease (COPD) patients in Canada.</p><p><strong>Methods: </strong>Using provincial claims data from Ontario, Canada, patients with COPD aged≥65 years (identified between 2004 and 2018; followed up to 2020) were categorised into one of four mutually exclusive groups: no exacerbation; only one moderate; only one severe; or two or more exacerbations of any severity (moderate or severe) during the baseline period. The index date was the first documentation of a COPD diagnosis code; the subsequent 12 months served as the baseline period. Adjusted risks of subsequent exacerbations (any severity and severe exacerbation, separately) by the end of postbaseline year 1, 2 and 3 were estimated, accounting for differences in patient and disease characteristics and competing risk of death.</p><p><strong>Results: </strong>A total of 591 686 patients were included. The majority (89.8%) had no exacerbation at baseline, 3.1% had one moderate exacerbation only, 3.6% had one severe exacerbation only and 3.6% had two or more exacerbations of any severity. Adjusted risks of a subsequent exacerbation of any severity by the end of year 3 were 28.6% (95% CI, 28.5% to 28.7%) with no baseline exacerbation; 56.6% (95% CI, 56.1% to 57.1%), one severe; 58.4% (95% CI, 58.0% to 58.8%), one moderate; and 77.5% (95% CI, 77.2% to 77.8%) two or more exacerbations. Adjusted risks of a subsequent severe exacerbation by the end of year 3 were 20.1% (95% CI, 20.0% to 20.2%) with no baseline exacerbation; 34.9% (95% CI, 34.5% to 35.4%), one moderate; 46.7% (95% CI, 46.2% to 47.2%), one severe; and 59.6% (95% CI, 59.3% to 60.0%) two or more exacerbations.</p><p><strong>Conclusions: </strong>Having a history of a single severe or two or more exacerbations of any severity is associated with a higher risk of future exacerbations, with observed exacerbation rates and severity that are constant over time. Even one moderate exacerbation over a year is associated with poorer outcomes, compared with the absence of exacerbation, and moderate exacerbations should be managed accordingly.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12481290/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145198177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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

{"title":"'And the stick to fight TB is TPT': nurse-identified barriers and facilitators of tuberculosis preventive therapy implementation in rural South Africa.","authors":"Megan A Grammatico, Anthony P Moll, Amiya Ahmed, Lauretta E Grau, Sipho Nsele, Philile Makhunga, Justin Jones, Sheela V Shenoi","doi":"10.1136/bmjresp-2024-002663","DOIUrl":"10.1136/bmjresp-2024-002663","url":null,"abstract":"<p><strong>Background: </strong>A decade after South Africa adopted tuberculosis preventive therapy (TPT), uptake remains sub-optimal.</p><p><strong>Methods: </strong>Senior nurses at primary care clinics participated in semistructured individual interviews. Transcripts were thematically analysed to assess knowledge and attitudes towards TPT in rural South Africa.</p><p><strong>Results: </strong>Among 22 senior nurses, 86% were female, with the median age of 39 years, and mean of 13.3 years' experience. Participants identified key individual-level barriers among nurses, interpersonal barriers that nurses observed among their patients and organisational barriers. While the nurses' belief in TPT efficacy was strong, their perceived barriers to TPT implementation included inflexible clinical guidelines, insufficient training and time to counsel patients, pill burden, patients' perceived HIV stigma and patients' alcohol use. Nurses believed implementation could be facilitated with task-shifting and integrating TPT into the antiretroviral (ART) infrastructure in primary care clinics and into chronic medication dispensing programmes. Shorter TPT regimens (eg, 12 weeks weekly INH/rifapentine: 3HP) were considered advantageous.</p><p><strong>Conclusions: </strong>Nurses identified multiple barriers to TPT implementation, including insufficient training and time to counsel patients, pill burden, HIV stigma and alcohol use. Nurses suggested task-shifting, TPT/ART integration and rollout of 3HP as potential facilitators of TPT implementation in rural South Africa. Nurses' perspectives are essential to informing TPT implementation efforts in resource-limited settings.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12506236/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145173549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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