BMJ Open Respiratory Research最新文献

{"title":"Independent and joint relationships of physical activity and pulmonary function with the risk of all-cause mortality.","authors":"Jingxin Ma, Can Shen, Yu Jia, Rong Yang, Shanye Yi, Yiheng Zhou, Rui Zeng, Zhi Wan, Qian Zhao, Yi Lei, Xiaoyang Liao","doi":"10.1136/bmjresp-2024-002818","DOIUrl":"10.1136/bmjresp-2024-002818","url":null,"abstract":"<p><strong>Background: </strong>Physical activity (PA) plays a crucial protective role in the overall health outcomes of individuals with chronic obstructive pulmonary disease. However, accurate recommendations for amount and categories of PA are still unclear for individuals with impaired pulmonary function (PF) in community environments. Thus, this study aims to investigate the independent and joint relationships of PA and PF with mortality.</p><p><strong>Methods: </strong>In a prospective UK Biobank cohort study, PA was collected by touchscreen questionnaires, and metabolic equivalents of task (MET)-minutes/week of total exercise was calculated by walking plus moderate-intensity PA plus vigorous-intensity PA. According to the standard of the Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) 2024, GOLD stage 1, GOLD stage 2 and GOLD stages 3-4 were classified as mild, medium and severe PF impairment, respectively. Cox regression was established to analyse the association between PA, PF and the risk of all-cause mortality.</p><p><strong>Results: </strong>A total of 354 572 participants were included with mean age of 56.0 years. Compared with lowest quintile of PA, highest quintile of PA was associated with lower risk of mortality in individuals with normal PF (HR=0.828), mild (HR=0.768), medium (HR=0.697) and severe PF impairment (HR=0.588). Generally, PF impairment related to mortality, and this relationship was independent of PA (p<0.05), except for individuals adhering to third quintile (1378-2340 MET-minutes/week) of PA (p>0.05). In joint analysis, more severe PF impairment and lower PA had a dose-response relationship with mortality. Moreover, highest quintile of walking/total exercise was associated with elevated mortality, while adhering to high level of vigorous-intensity PA/total exercise ratio achieved lowest risk of mortality, regardless of individuals with or without PF impairment.</p><p><strong>Conclusions: </strong>There were significant independent and joint relationships of lower PA and PF impairment with the elevated risk of mortality. However, engaging in appropriate total exercise weekly can mitigate adverse effects associated with mild PF decline.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12458715/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145084893","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":"IPDMA - RADICAL - NSCLC: individual participant data meta-analysis and systematic review of radical local therapy for oligometastatic NSCLC.","authors":"Krishna Tiwari, Muhammad Aaqib Shamim, Isha Yadav, Rakesh Dodiya, Ajay Kumar Kondeti, Naveen Dutt, Parmod Kumar, Sonali Kar, Vikas Tiwari, Pradeep Dwivedi, Surjit Singh, Shoban Babu Varthya","doi":"10.1136/bmjresp-2025-003276","DOIUrl":"10.1136/bmjresp-2025-003276","url":null,"abstract":"<p><strong>Introduction: </strong>The role of radical local therapy in oligometastatic non-small cell lung cancer (NSCLC) is rapidly evolving and has shown mixed results. We assessed the effect of add-on radical local therapy versus systemic therapy alone on overall survival (OS), progression-free survival (PFS) and safety in oligometastatic NSCLC.</p><p><strong>Methods: </strong>In this systematic review and individual participant data (IPD) meta-analysis, we screened PubMed, Embase, Scopus and CENTRAL until 20 April 2025 for randomised controlled trials (RCTs) answering our research question. We retrieved IPD from survival curves of published reports and used one-stage IPD meta-analysis. We also estimated the more clinically intuitive restricted mean survival time difference (RMSTD). We assessed between-study heterogeneity using the median HR (MHR). We assessed risk of bias using the Risk of Bias 2 tool and rated the evidence certainty using the Grading of Recommendations, Assessment, Development and Evaluations framework.</p><p><strong>Findings: </strong>We screened 1004 records to include ten RCTs (mostly at a low risk of bias) with 752 participants (338 males), predominantly using radiotherapy as radical local therapy. Add-on radical local therapy improved OS by 38% [HR: 0.62, 95% CI 0.50 to 0.76; high certainty of evidence]. Between-trial heterogeneity does not affect the results, only leading to 3% difference [MHR 1.03]. Add-on radical local therapy leads to longer OS by 0.47 month (0.21-0.72), 2.18 months (0.74-3.63), 4.20 months (1.95-6.45) and 6.65 months (4.05-9.24) over 1, 2, 3 and 4 years. Add-on radical local therapy possibly improved PFS by 40% (HR: 0.60, 95% CI 0.45 to 0.80; low certainty of evidence). Radical local therapy was well tolerated with no major safety concerns.</p><p><strong>Interpretation: </strong>Add-on radical local therapy-chiefly radiotherapy-is beneficial in oligometastatic NSCLC. Inconsistent reporting of safety limited quantitative synthesis. Future studies may address the role of surgery as radical local therapy, and the role of programmed death ligand 1 expression.</p><p><strong>Prospero registration number: </strong>CRD42024576829.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12458624/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145084940","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":"Increased in-hospital mortality and readmission risk associated with cardiovascular and cerebrovascular comorbidities in acute exacerbation of COPD patients.","authors":"Lin Feng, Jiachen Li, Jian Su, Zhaohui Tong, Lirong Liang","doi":"10.1136/bmjresp-2024-003110","DOIUrl":"10.1136/bmjresp-2024-003110","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular and cerebrovascular comorbidities are prevalent in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), but their impact on in-hospital outcomes and the risk of readmission remains unclear. This study aimed to describe the proportions of these comorbidities and assess their influence on patient outcomes.</p><p><strong>Methods: </strong>Hospital admission records from 2013 to 2020 with a primary discharge diagnosis of AECOPD were retrieved from Beijing Public Health Information Centre database. Comorbidities were identified through discharge diagnoses, while in-hospital outcomes and subsequent readmissions were tracked. Logistic regression model, generalised linear model and subdistributional hazard model were used to evaluate the associations between comorbidities and adverse outcomes.</p><p><strong>Results: </strong>Among 98 127 patients, cardiovascular comorbidities were present in 78.3% of cases and cerebrovascular comorbidities were present in 30.3% of cases. Patients with cardiovascular comorbidities or cerebrovascular comorbidities or both had prolonged length of stay (ORs: 1.29, 95% CI: 1.23 to 1.35; 1.20, 95% CI: 1.10 to 1.32; 1.52, 95% CI: 1.44 to 1.60) and higher in-hospital mortality (ORs: 1.39, 95% CI: 1.19 to 1.62; 1.34, 95% CI: 1.04 to 1.75; 1.25, 95% CI: 1.06 to 1.48) compared with those without these conditions. Patients with cardiovascular comorbidities and those with both cardiovascular and cerebrovascular comorbidities were at increased risk of readmission (HRs: 1.14, 95% CI: 1.10 to 1.19; 1.19, 95% CI: 1.14 to 1.25), whereas cerebrovascular comorbidities alone were not. The impact of individual comorbidity varied, with heart failure, ischaemic heart disease, arrhythmia, hypertension, ischaemic stroke and cerebrovascular sequelae showing positive associations with adverse outcomes, but the opposite was observed for peripheral arterial disease, arterial stenosis and other cerebrovascular diseases.</p><p><strong>Conclusion: </strong>Most cardiovascular comorbidities and major cerebrovascular comorbidities are significant predictors of length of stay, in-hospital mortality and readmission in AECOPD patients. These findings highlight the need for targeted management strategies to improve outcomes in this high-risk population. Further research is needed to explore the mechanisms underlying these associations.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12439156/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069011","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":"High BMI and smoking jointly cause COPD: a Mendelian randomisation study.","authors":"Heidi Mikkelsen, Eskild Morten Landt, Sarah Caroline Weisenfeldt Marott, Marianne Benn, Børge Grønne Nordestgaard, Morten Dahl","doi":"10.1136/bmjresp-2024-002825","DOIUrl":"10.1136/bmjresp-2024-002825","url":null,"abstract":"<p><strong>Background: </strong>We tested the hypothesis that genetically high body mass index (BMI) and genetically high tobacco smoking jointly are causally associated with a higher risk of chronic obstructive pulmonary disease (COPD) than each risk factor alone.</p><p><strong>Methods: </strong>We used two large Danish population-based cohort studies, The Copenhagen City Heart Study and the Copenhagen General Population Study linked to national Danish patient discharge and death registries. For the genetic analysis, we included 112 943 adults genotyped for five BMI and one tobacco smoking increasing gene variant. Risk ratios with 95% CIs for COPD were estimated for the risk factors in combination and individually by use of allele scores for BMI and smoking.</p><p><strong>Results: </strong>Separately, both high BMI and tobacco smoking increased the risk for COPD (Ps<0.001), yet the highest risk was observed in the group of individuals with a combination of high allele scores for both high BMI and tobacco smoking (Ps≤0.04). Observationally, the highest risk for COPD was observed in the groups of people having high cumulative use of tobacco smoking, irrespective of BMI.</p><p><strong>Conclusions: </strong>The combination of causal, genetically high BMI and tobacco smoking resulted in a higher risk for COPD than the two risk factors alone.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12434778/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069045","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":"Estimated costs of tuberculosis services in Brazil, 2023.","authors":"Elias Jabbour, Marcia Pinto, Ricardo E Steffen, Fernanda Dockhorn, Daniele M Pelissari, Nicole M de Souza, Eduardo de Souza Alves, Anete Trajman, Jonathon R Campbell","doi":"10.1136/bmjresp-2024-002661","DOIUrl":"10.1136/bmjresp-2024-002661","url":null,"abstract":"<p><strong>Introduction: </strong>To eliminate tuberculosis (TB) in Brazil, scaling up screening and prevention strategies will be essential. We estimated costs of TB services in Brazil to support budgeting, cost-effectiveness analysis and inform the implementation of these strategies.</p><p><strong>Methods: </strong>We leveraged databases from five large cities in Brazil (Manaus, Recife, Porto Alegre, São Paulo and Rio de Janeiro) to estimate costs of TB services in 2023 US dollars. We estimated mean costs and 95% uncertainty ranges (95% UR) for specific components and combined these components according to national algorithms for TB diagnosis and treatment in adults and children to estimate costs for different services. We leveraged these outputs to estimate the costs of household contact investigation.</p><p><strong>Results: </strong>We estimated the mean (95% UR) cost of testing children for TB infection with a tuberculin skin test (TST) or interferon-gamma release assay and providing 3 months of once-weekly isoniazid and rifapentine (3HP) was US$48 ($25-$82) and US$67 ($43-$101), respectively. Providing 6 months of treatment for drug-susceptible tuberculosis (DS-TB) to children was US$557 ($163-$1195). In adults, costs were similar to the cost of TST and 3HP costing US$49 ($25-$86) and 6 months of DS-TB treatment being $583 ($175-$1252). For both children and adults, costs of newer, 6-month treatment regimens for rifampin-resistant tuberculosis (RR-TB) were less expensive than 18-month regimens. In children, the cost was US$4807 ($1559-$10 066) for the 6-month regimen and US$9212 ($2756-$19 567) for the 18-month regimen. Corresponding costs in adults were US$3518 ($1169-$7330) and US$7910 ($2533-$16 717). Across 10 000 households with an index TB patient, we estimated use of a TST and 3HP for TB infection screening and treatment and 6-month regimens for DS-TB and RR-TB disease to cost $1 093 531 (95% UR $409 349-$2 217 054).</p><p><strong>Conclusion: </strong>There are important cost differences in TB services depending on diagnostic and treatment choices. These data are essential inputs for budgeting and cost-effectiveness.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12434782/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069029","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":"Review of the British Thoracic Society Winter Meeting 2024.","authors":"Anthony W Martinelli, Chloe Hughes, Matthew Steward, Max Thomas, Steven P Walker, James D Chalmers","doi":"10.1136/bmjresp-2025-003167","DOIUrl":"10.1136/bmjresp-2025-003167","url":null,"abstract":"","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12434776/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069001","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":"Differentiating clinically important interstitial lung abnormalities in lung cancer screening.","authors":"Brintha Selvarajah, Amyn Bhamani, Mehran Azimbagirad, Burcu Ozaltin, Ryoko Egashira, Daisuke Yamuda, John McCabe, Nicola Smallcombe, Priyam Verghese, Ruth Prendecki, Andrew Creamer, Jennifer L Dickson, Carolyn Horst, Sophie Tisi, Helen Hall, Chuen R Khaw, Monica L Mullin, Kylie Gyertson, Anne-Marie Hacker, Laura Farrelly, Anand Devaraj, Arjun Nair, Mariia Yuneva, Neal Navani, Daniel C Alexander, Rachel Clare Chambers, Joanna Porter, Allan Hackshaw, Gisli Jenkins, Sam M Janes, Joseph Jacob","doi":"10.1136/bmjresp-2025-003298","DOIUrl":"10.1136/bmjresp-2025-003298","url":null,"abstract":"<p><strong>Background: </strong>Interstitial lung abnormalities (ILAs) are common incidental findings in lung cancer screening (LCS). However, challenges remain in identifying clinically relevant ILAs as highlighted in a joint statement by a European multidisciplinary task force led by the European Respiratory Society (ERS). To address these challenges, we analysed ILAs identified in one of Europe's largest LCS studies.</p><p><strong>Methods: </strong>Of 11 635 LCS individuals, 417 screen-detected ILAs were evaluated using a new visual classification system focused on traction bronchiolectasis: non-fibrotic ILA (no traction bronchiolectasis), fibrotic ILA (traction bronchiolectasis in ≤2 lobes); undiagnosed interstitial lung disease (traction bronchiolectasis in >2 lobes). Observer agreement was compared with Fleischner Society ILA classification using Cohen's Kappa. An age, sex and smoking history-matched control group allowed the examination of associations between baseline ILA/UILD and comorbidities, forced vital capacity (FVC), hospitalisations (Student's t-tests) and mortality (univariable and multivariable Cox proportional hazards models).</p><p><strong>Findings: </strong>Our visual ILA classification showed superior interobserver agreement (K=0.76) versus the Fleischner ILA classification (K=0.64). ILA/UILD subjects had more prevalent comorbidities, increasing (vs controls) approximately 10 years prior to ILA/UILD diagnosis. Compared with controls, mortality rates were 6-fold higher for UILD participants and 3-fold higher for fibrotic and non-fibrotic ILA subtypes. On multivariable Cox regression analysis, ILA/UILD presence (HR=4.90, 95% CI =2.36 to 10.10, p<0.001) showed stronger independent associations with mortality than baseline FVC (HR=0.98, 95% CI =0.96 to 1.00, p=0.04).</p><p><strong>Conclusion: </strong>We demonstrate a new reproducible classification of clinically important ILA/UILDs in LCS populations. We highlight that FVC shows limited associations with mortality in ILA/UILD subjects. Increased multiorgan comorbidity in ILA/UILD subjects highlights a need for comprehensive early multisystem evaluation.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145039038","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":"Lung Health Check pilot: Ireland's flagship lung cancer screening trial.","authors":"David O Reilly, Sandra Roche, Claire Noonan, Jack O'Shea, Sinead Toomey, Bryan T Hennessy, Gerard J Fitzmaurice, Keith Egan, Jasmine Dunne, Catriona M Dowling, Ian Counihan, Emmet O'Brien, Imran Sulaiman, Ross Morgan, Benjamin Jacob, Anne-Marie Baird, Seamus Cotter, Donal Bailey, Gavin Maguire, Kathleen Bennett, Jan Sorensen, Nuala A Healy, James Ryan, Patrick Redmond, Daniel J Ryan, Jarushka Naidoo","doi":"10.1136/bmjresp-2024-003035","DOIUrl":"10.1136/bmjresp-2024-003035","url":null,"abstract":"<p><strong>Introduction: </strong>Low-dose chest CT (LDCT) has demonstrated the ability to detect early-stage lung cancer (LC) and improve disease-specific mortality in high-risk individuals. Use of LC risk scores such as the Prostate, Lung, Colorectal, Ovarian Model Score (PLCO_M2012) improves the sensitivity, specificity and positive predictive value for LC screening. Screening programmes have identified that primary care participation, patient engagement and improved accessibility may enhance the success of LC screening. Currently, there is no LC screening programme in Ireland. This first pilot study of LC screening will investigate (1) the feasibility, including uptake, of LC screening in a community setting, based on primary care-based participant invitation with mobile CT scanning and (2) novel blood/breath biomarkers in high-risk individuals who participate in the LC screening trial, to identify biologic parameters that may supplement existing risk scores, to maximise LC early detection.</p><p><strong>Methods and analysis: </strong>In a pilot feasibility clinical trial, approximately 30 000 adults aged between 55 and 74 from participating general practitioner (GP) practices will be invited to a 'lung health check (LHC)' prescreening, involving a telephone assessment of eligibility and risk status, based on the PLCO_M2012/Liverpool Score V.2. High-risk individuals will be invited to the LHC, which will take place in a mobile unit strategically located in the community and include a respiratory disease assessment, baseline spirometry, smoking cessation advice, an LDCT and in a selected cohort, blood/breath/sputum biospecimen collection. Two rounds of screening will take place at an interval of 12 months.</p><p><strong>Ethics, dissemination and registration details: </strong>In this pilot feasibility trial, the uptake of LC screening using a community-based strategy among high-risk participants will be investigated. The study has been approved by Beaumont Hospital Research Ethics Committee and is registered with clinicaltrials.gov (NCT07099027). Novel features of our design include directly calling participants and our translational arm of the study, which will focus on blood/breath/sputum biomarkers associated with LC.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145039027","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":"Virtual reality in adults with respiratory diseases experiencing dyspnoea: a systematic review and meta-analysis.","authors":"Johan Wormser, Christophe Romanet, Marine Cachanado, Maëlle Youinou, Gilles Chatellier, Irene Torres Sánchez, François Philippart","doi":"10.1136/bmjresp-2024-002722","DOIUrl":"10.1136/bmjresp-2024-002722","url":null,"abstract":"<p><strong>Objectives: </strong>Our aim was to evaluate virtual reality's effects in dyspnoea's management.</p><p><strong>Methods: </strong>Information sources: Trials were identified through a systematic search carried out on MEDLINE, Web of Science, Scopus and CINAHL until 17 March 2025.</p><p><strong>Eligibility criteria: </strong>Eligible studies were controlled trials including adults with dyspnoea associated with respiratory diseases, for whom virtual reality was implemented and compared with another intervention. Risk of bias: Risk of bias (ROB) was assessed using the ROB 2 tool.</p><p><strong>Synthesis of results: </strong>The primary outcome was dyspnoea. Secondary outcomes included exercise capacity, health-related quality of life (HRQOL) and muscle function. Effect size was expressed using standardised mean difference (SMD) or MD for primary and secondary outcomes, respectively (random-effects model). We used the Grading of Recommendations Assessment, Development and Evaluation approach to judge the certainty of evidence.</p><p><strong>Results: </strong>Included studies: 13 studies were selected, including 483 adults and using non-immersive tools (n=7) or immersive tools (n=6). Risk of bias in these studies was low (n=1), some concerns (n=8) and high risk (n=4).</p><p><strong>Synthesis of results: </strong>No difference was found in dyspnoea (8 studies, 224 participants; SMD 0.02, 95% CI -0.82 to 0.86, I²=88.2%), exercise capacity (5 studies, 183 participants; MD 3.62, 95% CI -19.39 to 26.63, I²=39.8%) and in HRQOL (4 studies, 127 participants; MD -11.81, 95% CI -42.95 to 19.33, I²=98.9%). The data available were insufficient to conduct a pooled analysis for muscle function.</p><p><strong>Conclusions: </strong>Limitations of evidence: The evidence is very uncertain about virtual reality's effects on dyspnoea due to risk of bias, imprecision and heterogeneity.</p><p><strong>Interpretation: </strong>Further studies are needed and should explore various aspects of the application of immersive virtual reality.</p><p><strong>Prospero registration number: </strong>CRD42023443280.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145039139","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":"Health system-related barriers and facilitators to tuberculosis preventive treatment: a qualitative case study comparing implementation in the Republic of Moldova and Georgia.","authors":"Zaruhi Mkrtchyan, Valentina Vilc, Maka Danelia, Askar Yedilbayev, Anna M Foss, Patrick Nguipdop-Djomo, Andrei Dadu","doi":"10.1136/bmjresp-2024-002802","DOIUrl":"10.1136/bmjresp-2024-002802","url":null,"abstract":"<p><strong>Introduction: </strong>Despite WHO's recommendations and the 2023-2030 Tuberculosis (TB) action plan, uptake of TB preventive treatment (TPT) remains suboptimal. In this paper, we use two countries of the WHO Europe Region, the Republic of Moldova and Georgia, that are at different stages of implementation of TB prevention policies, as a case study to examine health system barriers and facilitators to TPT scale-up.</p><p><strong>Methods: </strong>In this case study, we used methods of qualitative research-interviews with three stakeholder groups: health service providers and National TB Programme staff; civil society organisations and international partners or donors. The data were collected via videoconference, transcribed, then coded and analysed using NVivo V.14. Thematic analysis was conducted.</p><p><strong>Results: </strong>Facilitators for TPT delivery in both settings include an established TB clinical network, well-functioning communication systems and an uninterrupted supply of TPT medicines.In both settings, healthcare providers generally exhibit positive attitudes towards treating TB infection; however, some remain sceptical and cautious, particularly regarding prescribing TPT without confirmation of TB infection, a challenge compounded by limited access to testing for TB infection. Evidence of TB infection is also important for patients' decisions on initiation and adherence to treatment. Other barriers to effective service delivery of TPT include shortages and high workload of primary healthcare personnel, ambiguity in the role of family doctors in the management of TPT and low prioritisation of TPT during regular monitoring visits.</p><p><strong>Conclusions: </strong>The case study identified similar challenges in the rollout of TPT across both settings, highlighting common barriers hindering effective implementation. For optimal TPT rollout, enhancing provider confidence, improving access to testing for TB infection and strengthening integration with primary healthcare with refined roles of family doctors are essential. Both settings would also benefit from improved monitoring and evaluation systems and prioritisation of TB prevention in monitoring.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12410615/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144991492","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}