BMJ Open Respiratory Research最新文献

{"title":"Bidirectional relationship between sleep problems and long COVID: a longitudinal analysis of data from the COVIDENCE UK study.","authors":"Giulia Vivaldi, Mohammad Talaei, John Blaikley, Callum Jackson, Paul E Pfeffer, Seif O Shaheen, Adrian R Martineau","doi":"10.1136/bmjresp-2024-002506","DOIUrl":"10.1136/bmjresp-2024-002506","url":null,"abstract":"<p><strong>Background: </strong>Studies into the bidirectional relationship between sleep and long COVID have been limited by retrospective pre-infection sleep data and infrequent post-infection follow-up. We therefore used prospectively collected monthly data to evaluate how pre-infection sleep characteristics affect risk of long COVID and to track changes in sleep duration during the year after SARS-CoV-2 infection.</p><p><strong>Methods: </strong>COVIDENCE UK is a prospective, population-based UK study of COVID-19 in adults. We included non-hospitalised participants with evidence of SARS-CoV-2 infection and used logistic regression to estimate adjusted ORs for the association between preinfection sleep characteristics and long COVID. We assessed post-infection sleep duration using multilevel mixed models. We collected sleep data from participants using a subset of questions from the Pittsburgh Sleep Quality Index. We defined long COVID as unresolved symptoms at least 12 weeks after infection. COVIDENCE UK is registered with ClinicalTrials.gov, NCT04330599.</p><p><strong>Results: </strong>We included 3994 participants in our long COVID risk analysis, of whom 327 (8.2%) reported long COVID. We found an inverse relationship between pre-infection sleep quality and risk of long COVID (medium vs good quality: OR 1.37, 95% CI 1.04 to 1.81; medium-low vs good: 1.55, 1.12 to 2.16; low vs good: 1.94, 1.11 to 3.38). Greater variability in pre-infection sleep efficiency was also associated with long COVID when adjusted for infection severity (OR per percentage-point increase 1.07, 1.02 to 1.12). We assessed post-infection sleep duration in 6860 participants, observing a 0.11 hour (95% CI 0.09 to 0.14) increase in the first month after infection compared with pre-infection, with larger increases for more severe infections. After 1 month, sleep duration largely returned to pre-infection levels, although fluctuations in duration lasted up to 6 months after infection among people reporting long COVID.</p><p><strong>Conclusions: </strong>While poor-quality sleep before SARS-CoV-2 infection associates with increased risk of long COVID thereafter, changes in sleep duration after infection in these non-hospitalised cases were modest and generally quick to resolve.</p><p><strong>Trial registration number: </strong>NCT04330599.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144301067","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":"Glycopyrrolate/formoterol fumarate MDI in mild-to-moderate chronic obstructive pulmonary disease (PIONEER): a protocol for a randomised, double-blind, placebo-controlled trial.","authors":"Feng-Yan Wang, Zi-Hui Wang, Jia-Xuan Xu, Zhen-Yu Liang, Pi-Xin Ran, Yu-Min Zhou, Yi Gao, Wei-Juan Shi, Wan-Yi Jiang, Yu-Qi Li, Dong-Ying Zhang, Rong-Chang Chen, Wei-Jie Guan, Nan-Shan Zhong, Jin-Ping Zheng","doi":"10.1136/bmjresp-2024-002656","DOIUrl":"https://doi.org/10.1136/bmjresp-2024-002656","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with mild-to-moderate chronic obstructive pulmonary disease (COPD) often experience rapid declines in lung function but are rarely treated early. The Prospect of early InterventiON in the managEment of chronic obstructivE pulmonaRy disease (PIONEER) study aims to evaluate the efficacy of long-term glycopyrrolate/formoterol fumarate (GFF) metered dose inhaler (MDI) as an initial therapy on lung function and disease progression in individuals with mild-to-moderate COPD.</p><p><strong>Methods and analysis: </strong>This is a multicentre, randomised, double-blind, placebo-controlled, parallel-group study. Approximately 318 patients with COPD in Global Initiative for Chronic Obstructive Lung Disease stages 1 (mild) or 2 (early moderate), with no history of severe exacerbations in the previous year, will be randomised in a 2:1 ratio to receive two times per day GFF MDI (14.4/10 µg) or placebo for 52 weeks. Clinical assessments will include pulmonary function tests, symptom scores, quality-of-life measures, recording of COPD exacerbations and chest CT. The primary endpoint is the between-group difference in the change from baseline in forced expiratory volume in 1 s (FEV₁) after 2 hours of bronchodilator over 24 weeks. Secondary endpoints include the between-group difference in the change from baseline in morning pre-dose trough FEV₁ over 24 weeks, morning post-dose 2 hour FEV₁ over 52 weeks and time to minimal clinically important deterioration. The safety endpoint is the incidence of adverse events. An extension study with rerandomisation will follow the PIONEER study to explore the long-term need for GFF MDI use.</p><p><strong>Trial registration number: </strong>ChiCTR2200064765; Chinese Clinical Trial Registry, www.chictr.org.cn.</p><p><strong>Ethics and dissemination: </strong>The study protocol has been approved by the Ethics Committee of The First Affiliated Hospital, Guangzhou Medical University (2022-23、2024-K-005), and all collaborating centres have obtained approval from their respective ethics committees. Results will be presented at national and international meetings and submitted for publication in peer-reviewed journals within the field.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144301068","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":"Patients' experiences of, and psychological responses to, surveillance for pulmonary nodules detected through lung cancer screening.","authors":"Evangelos Katsampouris, Andrew W Creamer, Ruth Prendecki, Elizabeth Clark, Jennifer L Dickson, Richard Lee, Samuel M Janes, Stephen W Duffy, Samantha L Quaife","doi":"10.1136/bmjresp-2024-002498","DOIUrl":"10.1136/bmjresp-2024-002498","url":null,"abstract":"<p><strong>Introduction: </strong>Low-dose CT screening reduces lung cancer mortality among high-risk populations, and detects indeterminate pulmonary nodules that require subsequent surveillance. This period of uncertainty could result in patients experiencing lung cancer-related distress, anxiety and worry. This multicentre qualitative study explored patients' experiences and psychological responses to disclosing and communicating nodule surveillance.</p><p><strong>Methods: </strong>Eligible participants were purposively sampled from four lung cancer screening sites in England to ensure diversity with respect to region, service setting, individual characteristics and surveillance pathways. Thirty-nine patients (23 females), aged 55-80 years, who had undergone their first nodule surveillance scan, participated in one-to-one remote semi-structured interviews. Audio-recorded interviews were transcribed verbatim and analysed using applied thematic analysis.</p><p><strong>Results: </strong>Participants reported a broad spectrum of psychological responses to the way their nodule finding was communicated and their experiences of undergoing surveillance. Understanding what a nodule is and what a surveillance process entails was important for explaining patient psychological reactions and behavioural outcomes. Perceived support and effective communication with healthcare professionals were instrumental in decreasing patients' distress, uncertainty and concern, and increasing reassurance, knowledge about nodules and psychological preparation for the possibility of surveillance.</p><p><strong>Conclusions: </strong>While current letter-based means of nodule disclosure and communication were acceptable to patients, there is a need to improve the way nodules are communicated using lay language. Brief verbal consultations with healthcare professionals could provide clearer guidance to patients undergoing surveillance and increase their understanding about the surveillance process and subsequent scans, resulting in improved affective, behavioural and cognitive outcomes.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12164620/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293279","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 multidimensional patient-centred outcomes after hospitalisation for COVID-19: do not only focus on disease severity.","authors":"Martine Bek, Yasemin Türk, Matthijs L Janssen, Gemma Weijsters, Julia C Berentschot, Rita J G van den Berg-Emons, Majanka H Heijenbrok-Kal, Gerard M Ribbers, Joachim Aerts, Wessel E J J Hanselaar, Henrik Endeman, Merel E Hellemons, Evert-Jan Wils","doi":"10.1136/bmjresp-2024-002789","DOIUrl":"10.1136/bmjresp-2024-002789","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the association between COVID-19 disease severity during hospitalisation for COVID-19 and long-term multidimensional patient-centred outcomes up to 12 months post-hospitalisation. The secondary objective was to identify other risk factors for these long-term outcomes.</p><p><strong>Methods: </strong>In this multicentre prospective cohort study, we categorised COVID-19 disease severity using the maximal level of respiratory support as proxy into (1) conventional oxygen therapy (COT), (2) high-flow nasal oxygen (HFNO) and (3) invasive mechanical ventilation (IMV). The primary outcome health-related quality of life (HRQoL), and the secondary outcomes self-reported symptoms and recovery were collected at 6 and 12 months post-hospitalisation.</p><p><strong>Results: </strong>Data from 777 patients were analysed, with 226 (29%) receiving COT, 273 (35%) HFNO and 278 (36%) IMV. Patients reported impaired HRQoL, persistence of symptoms and poor recovery. Multivariable generalised estimating equations analysis showed that COVID-19 disease severity was not associated with HRQoL and inconsistently with symptoms; the HFNO group reported poorer recovery. Overall, female sex, younger age and pulmonary history were independent risk factors for outcomes.</p><p><strong>Conclusions: </strong>COVID-19 disease severity was associated with self-perceived recovery, but not with HRQoL and inconsistently with symptoms. Our findings suggest that age, sex and pulmonary history are more consistent risk factors for long-term multidimensional outcomes and offer better guidance for aftercare strategies.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12161316/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246355","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":"Associations between cancer survivorship and subsequent respiratory disease: a systematic literature review.","authors":"Kirsty Andresen, Helena Carreira, Ruchika Jain, Harriet Forbes, Elizabeth Williamson, Jennifer K Quint, Krishnan Bhaskaran","doi":"10.1136/bmjresp-2024-002681","DOIUrl":"10.1136/bmjresp-2024-002681","url":null,"abstract":"<p><strong>Background: </strong>The population of cancer survivors is growing. Some cancers and their treatments may lead to long-term adverse respiratory issues. This systematic review aims to summarise the evidence on the association between cancer survivorship and long-term respiratory health, across a range of cancer types.</p><p><strong>Methods: </strong>We searched Cochrane, Embase and MEDLINE up until 23 February 2025 for cohort or nested case-control studies comparing incident respiratory outcomes in people with a history of cancer versus population-based cancer-free controls. We required studies to include follow-up time beyond the period of active cancer treatment. Outcomes included acute respiratory infections and chronic respiratory conditions. Study quality was assessed using The Scottish Intercollegiate Guidelines Network methodology checklists.</p><p><strong>Results: </strong>We identified 34 eligible cohort studies. Cancer survivors' cohort sizes ranged from 1325 to >8 million. Only 4 out of 34 studies adjusted for smoking, leading to most studies being rated as low quality. Four of the 21 studies of acute respiratory infections were rated as acceptable/high quality, and of these, all observed raised risks, notably among survivors of haematological, head and neck, lung and oesophageal cancers. Of 19 studies of chronic respiratory conditions, 1 was rated as high quality, finding increased risks of chronic obstructive pulmonary disease (COPD) and pneumonitis in survivors of head and neck cancer. The remaining studies found increased risks of adverse outcomes from acute respiratory infections in 17 of 21 cancer types for which data were available, and of COPD in cervical, head and neck, lung, oesophageal, oral, stomach, thyroid and vulva cancers.</p><p><strong>Discussion: </strong>These findings suggest increased risks of a range of respiratory conditions in survivors of some cancers. Much of the evidence is compromised by a lack of control for key potential confounders, like smoking. Future studies should address this limitation and investigate the drivers of respiratory risks in cancer survivors. Improved evidence could inform mitigation strategies and lead to better survivorship care plans.</p><p><strong>Prospero registration number: </strong>CRD42022311557.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12142105/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144233091","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":"Predictors of sleep-disordered breathing and chronic hypoventilation in obese women and men: a cross-sectional observational study.","authors":"Michelle Mollet, Lara Benning, Joel J Herzig, Matteo Bradicich, Zoe Bousraou, Silvia Ulrich, Esther Irene Schwarz","doi":"10.1136/bmjresp-2024-002632","DOIUrl":"10.1136/bmjresp-2024-002632","url":null,"abstract":"<p><strong>Background and aim: </strong>Obesity is associated with an increased risk of sleep-disordered breathing (SDB)-obstructive sleep apnoea (OSA) and sleep hypoventilation-and obesity hypoventilation syndrome (OHS). The aim was to assess the impact of obesity on lung volumes and the prevalence of SDB and OHS and to identify predictors of these.</p><p><strong>Methods: </strong>In a cross-sectional analysis, obese patients (body mass index ≥30 kg/m²) who underwent an in-laboratory sleep study, arterial blood gas analysis and pulmonary function tests between 2018 and 2023 were included. Analysis of variance and multivariate regression analysis were used to compare obesity groups and identify predictors of SDB and OHS.</p><p><strong>Results: </strong>In 1065 obese adults (39% female; 48% obesity WHO I, 24% WHO II, 28% WHO III), the prevalence of OSA (apnoea hypopnoea index (AHI) ≥5/hour), severe OSA (AHI ≥30/hour), sleep hypoventilation and OHS was 77%, 29%, 21% and 8%, respectively. The likelihood of OSA, severe OSA and sleep hypoventilation increased with obesity class, while the presence of OHS did not differ between groups. In multivariate regression models including body mass index, neck circumference, age, sex, AHI, bicarbonate and expiratory reserve volume, bicarbonate and forced vital capacity were independent predictors of both sleep hypoventilation and OHS and neck circumference of severe OSA. The area under the receiver operating characteristics curve of bicarbonate for OHS and sleep hypoventilation was 0.92 and 0.72, respectively.</p><p><strong>Conclusions: </strong>Three quarter of obese patients have OSA, and the likelihood of OSA, severe OSA and sleep hypoventilation increase across obesity severity groups. Bicarbonate has a high diagnostic accuracy for OHS.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12142134/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144233093","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":"Bronchoscopic lung volume reduction: model for assisted target lobe selection.","authors":"Logan Hostetter, Leah M Brown, Srinivasan Rajagopalan, Megan M Dulohery-Scrodin, Eric S Edell, Michael G Lester, Fabien Maldonado, Robert Lentz, Brian J Bartholmai, Tobias Peikert","doi":"10.1136/bmjresp-2024-002903","DOIUrl":"10.1136/bmjresp-2024-002903","url":null,"abstract":"<p><strong>Introduction: </strong>Bronchoscopic lung volume reduction with endobronchial valves (EBV) is an effective procedure for patient with severe emphysema to improve lung function, exercise tolerance, dyspnoea and quality of life. Optimisation of patient and treatment lobe selection is essential for successful EBV outcomes. While clinical selection criteria are rigorous, many centres use a multidisciplinary team and rely on previous clinical experience for the selection process. To aid objective clinical decision making, we present a mathematical model to facilitate patient and target lobe selection.</p><p><strong>Methods: </strong>A multidisciplinary team reviewed quantitative high-resolution computed tomography (HRCT) analysis from 119 patients to select candidates for EBV and to select a treatment lobe. Two logistic regression models, (1) candidacy for EBV placement and (2) target-lobe selection, were developed based on the normalised distributions of the four quantitative HRCT variables (fissure completeness score, per cent of voxel density with HU < -910 and HU < -950, and lobar volumes) across all five lung lobes. An external cohort of 50 patients (25 candidates and 25 non-candidates) was used to validate the prediction model.</p><p><strong>Results: </strong>Performance measures of the training cohort demonstrated an area under the curve (AUC) of 0.91, accuracy of 81%, sensitivity of 93% and specificity of 78% compared with the multidisciplinary teams' target lobe selection. The validation cohort demonstrated an AUC of 0.89, accuracy of 84%, sensitivity of 88% and specificity of 83% compared with the multidisciplinary team decision making.</p><p><strong>Conclusions: </strong>Endobronchial valve lung volume reduction remains a potent palliative measure to improve quality of life in patients with hyperinflated emphysema. Our model for target lobe selection harnesses the multidisciplinary experience at a tertiary care centre to objectively select candidates and target lobes to assist clinicians' decision making. Future studies investigating prediction of lobar collapse and functional improvement after target lobe selection using our model are needed.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12142073/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144233092","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":"Bicarbonate from arterial blood gas analysis as predictor of sleep-related hypoventilation: a diagnostic accuracy study.","authors":"Sanja Pocrncic, Joel J Herzig, Lara Benning, Michelle Mollet, Matteo Bradicich, Mona Lichtblau, Laura Mayer, Malcolm Kohler, Silvia Ulrich, Esther Irene Schwarz","doi":"10.1136/bmjresp-2024-002591","DOIUrl":"10.1136/bmjresp-2024-002591","url":null,"abstract":"<p><strong>Background: </strong>Bicarbonate above the upper limit of normal is used as an indicator of sleep-related hypoventilation in patients with diseases frequently associated with hypoventilation, such as obesity or neuromuscular diseases.</p><p><strong>Research question: </strong>The aim was to evaluate the diagnostic accuracy of bicarbonate from daytime arterial blood gas analysis for sleep-related hypoventilation measured via transcutaneous nocturnal capnometry.</p><p><strong>Methods: </strong>In a diagnostic accuracy study, the sensitivity and specificity of bicarbonate concentration for detecting nocturnal hypoventilation were tested using a receiver operating curve (ROC) and logistic regression analysis in patients undergoing both an in-laboratory sleep study with transcutaneous capnometry and daytime arterial blood gas analysis.</p><p><strong>Results: </strong>In 510 patients (mean±SD age 52±15 years, BMI 34±10 kg/m²), the area under the ROC curve for bicarbonate (HCO_3-) and median nocturnal tcpCO₂ ≥50 mm Hg (45% yes, 55% no) was 0.70 (95% CI 0.65 to 0.75). Sensitivity of HCO_3- of 26.5 mmol/L and 27.0 mmol/L was 61.0% and 54.1%, specificity 71.3% and 79.6%, and the likelihood ratio for sleep-related hypoventilation (median tcpCO₂ ≥50 mm Hg) 2.1 and 2.6. HCO_3- was significantly higher in those with (n=231, 27.6±3.0 mmol/L) versus without (n=279, 25.8±1.9 mmol/L) sleep-related hypoventilation (p<0.001). Increasing awake HCO_3- was associated with a higher likelihood of nocturnal hypoventilation (OR 1.4 (95% CI 1.3 to 1.5), p<0.001).</p><p><strong>Conclusions: </strong>The sensitivity of elevated bicarbonate from awake arterial blood gas analysis using common cut-off values such as 27 mmol/L is only moderate, and bicarbonate as an integral part of the assessment of sleep hypoventilation (likelihood ratio) must be interpreted in the context of other assessments. A normal bicarbonate does not rule out sleep hypoventilation.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12142078/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144198257","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":"Biopsy decision for intermediate-high-risk lung nodules is significantly changed when guided by prior positron emission tomography/CT (PET/CT) results: results of the prospective PET-FIRST study.","authors":"David Fielding, Calvin Sidhu, Mahmoud Alkhater, Moayed Alawami, Stephan E P Kops, Erik H F M van der Heijden, Farzad Bashirzadeh, Morgan Windsor, Elizabeth Nixon, Jung Hwa Son, Niranjan Ananda Setty, David A Pattison, William Fong, Manoj Bhatt, Nattakorn Dhiantravan, Stuart Ramsay, Robert Boots, Michael Putt, Gary Pratt, Catherine Bettington, Roslyn Francis, Paul Thomas, Karin Steinke, Rajesh Thomas","doi":"10.1136/bmjresp-2024-002553","DOIUrl":"10.1136/bmjresp-2024-002553","url":null,"abstract":"<p><strong>Introduction: </strong>Positron emission tomography/CT (PET/CT) may have an important role in guiding decisions regarding biopsy of high-risk lung nodules suspicious for lung cancer. The PET-FIRST study aimed to assess the role of PET/CT prior to any biopsy of a high-risk lung nodule.</p><p><strong>Methods: </strong>A prospective study was performed in two tertiary hospitals. A study multidisciplinary team (MDT) was established (independent of the hospital Tumour Board) to review referrals of lung nodules with an intermediate-high (≥10%) risk of malignancy by Brock score. A two-stage consensus assessment was undertaken by the MDT regarding choice of biopsy: (1) based on the referral CT alone and then (2) after unblinding the results of PET/CT. The primary study outcome was change in biopsy decision.</p><p><strong>Results: </strong>168 patients were included in the study; of these, 53% of nodules were malignant, 44% were benign and 3% cases refused follow-up. In 59 of the 168 patients (35%), the initial recommended biopsy decision was changed based on PET/CT findings. Regarding whether to biopsy the nodule or not, in 42 cases (25%), the initial management decision was changed after PET/CT (p<0.01). Sensitivity analysis showed that the benefit of having PET/CT before nodule biopsy was observed across all ranges of Brock scores. There was an estimated total cost reduction by procedure avoidance of $AA60 796 ($AA362 per patient).</p><p><strong>Conclusions: </strong>In patients with lung nodules of intermediate-high risk for lung cancer, fluorodeoxyglucose PET/CT performed prior to any biopsy of the nodule has a significant effect in determining biopsy choice.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12142131/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144198258","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":"Influence of age on outcomes in prolonged weaning from mechanical ventilation.","authors":"Julia Dorothea Michels-Zetsche, Evelyn Röser, Hilal Ersöz, Benjamin Neetz, Jana C Dahlhoff, Biljana Joves, Frederik Trinkmann, Philipp Höger, Konstantina Kontogianni, Cornelia Weissmann, Max Barre, Sebastian Fähndrich, Florian Bornitz, Michael M Müller, Felix Herth, Franziska Trudzinski","doi":"10.1136/bmjresp-2024-002730","DOIUrl":"10.1136/bmjresp-2024-002730","url":null,"abstract":"<p><strong>Background: </strong>Older age has been identified in many studies as a predictor of poor outcomes in intensive care, including weaning failure. Age is a risk factor for prolonged weaning, resulting in an increased number of geriatric patients being referred to specialist weaning centres. The aim of our analysis was to investigate weaning outcomes in different age groups.</p><p><strong>Methods: </strong>We analysed patients in prolonged weaning at Thoraxklinik Heidelberg from 1 December 2008 to 31 December 2023. We classified three groups: ≤64, 65-79 and ≥80 years of age. The patients' characteristics and weaning success, as well as weaning failure (continued invasive mechanical ventilation (IMV) and death), were analysed using group comparisons and logistic regression analyses.</p><p><strong>Results: </strong>During the study period, 915 patients (64.9±13.7 years, 39.3% female) underwent prolonged weaning. 73.3% were successfully weaned, 20.2% were discharged with IMV and 6.6% died. 40.5% of the patients were ≤64 years, 49.7% were 65-79 years and 9.7% were ≥80 years old. There was a significant difference in weaning success: in the group ≤64 years the success rate was 79.0%, 65-79 years 70.3% and ≥80 years 64.0%, p=0002. The patients' characteristics differ in the age groups, with more postoperative patients, delirium and cardiovascular comorbidities and less neuromuscular disease and malignancy in ≥80 years old patients.</p><p><strong>Conclusions: </strong>64% of carefully selected patients ≥80 years of age could be successfully weaned in a specialised centre instead of being discharged from a general intensive care unit with continuing IMV in an outpatient intensive care setting.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12142164/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144198159","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}