BMJ Open Respiratory Research最新文献

{"title":"Uptake and 4-week outcomes of an 'opt-out' smoking cessation referral strategy in a London-based lung cancer screening setting.","authors":"Amyn Bhamani, Evangelos Katsampouris, Fanta Bojang, Priyam Verghese, Andrew Creamer, Ruth Prendecki, Chuen R Khaw, Jennifer L Dickson, Carolyn Horst, Sophie Tisi, Helen Hall, John McCabe, Kylie Gyertson, Anne-Marie Hacker, Laura Farrelly, Neal Navani, Allan Hackshaw, Samuel M Janes, Samantha L Quaife","doi":"10.1136/bmjresp-2024-002337","DOIUrl":"10.1136/bmjresp-2024-002337","url":null,"abstract":"<p><strong>Introduction: </strong>Lung cancer screening (LCS) enables the delivery of smoking cessation interventions to a population experiencing long-term tobacco dependence, but the optimal delivery method remains unclear. Here, we report uptake and short-term outcomes of an 'opt-out' smoking cessation referral strategy in an LCS cohort.</p><p><strong>Methods: </strong>Individuals currently smoking tobacco who attended a face-to-face lung health check in the SUMMIT study (NCT03934866) were offered very brief advice on smoking cessation and where possible, an 'opt-out' referral to their local stop smoking service (SSS). Aggregate data on referral outcomes were obtained from each SSS individually.</p><p><strong>Results: </strong>33.7% (n=2090/6203) of individuals currently smoking tobacco consented to a practitioner-made 'opt-out' smoking cessation referral. 42.7% (n=893/2090) of these individuals resided in boroughs where SSS were not present or required self-referral. Males (adjusted OR (aOR) 1.16), younger individuals (55-59: aOR 1.70, 60-64: aOR 1.71 and 65-69: aOR 1.78) and those of ethnic minority backgrounds (Asian: aOR 1.31, Black: aOR 1.71 and Mixed: aOR 1.72) were more likely to consent, while individuals from the most deprived socioeconomic quintile were less likely to do so (aOR 0.65).High level of motivation to quit within a defined time frame (aOR 1.92), previous quit attempts in the past 12 months (1-4: aOR 1.65 and ≥5: aOR 1.54) and time to first cigarette of ≤60 min (<5: aOR 2.07, 6-30: aOR 1.55 and 31-60: aOR 1.56) were measures of tobacco dependence associated with a higher likelihood of providing consent.Outcomes were available for 742 referrals. An appointment with the service was accepted by 47.3% (n=351/742) of individuals, following which 65.5% (n=230/351) set a quit date. The 4-week quit rate among those setting a quit date and all individuals referred was 57.4% (n=132/230) and 17.8% (n=132/742), respectively.</p><p><strong>Conclusion: </strong>A proactive, 'opt-out' smoking cessation referral strategy for individuals currently smoking tobacco who interact with an LCS programme may be beneficial.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11804203/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363459","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":"Qualitative study of patients experiences and perceptions of stepping down asthma medication in primary care across England.","authors":"Chloe I Bloom, Jack Middleton, Adam Lewis","doi":"10.1136/bmjresp-2024-002898","DOIUrl":"10.1136/bmjresp-2024-002898","url":null,"abstract":"<p><strong>Background: </strong>Guidelines recommend that asthma medication should be stepped down to the minimally effective dose that achieves symptom control. Stepping down aims to prevent adverse medication effects and unnecessary costs but is often not implemented in primary care, where most patients with asthma are managed. Little is known about the experiences and views of patients regarding stepping down.</p><p><strong>Methods: </strong>Patients with stable asthma, with regular use of a preventer inhaler, from general practitioner practices across England, participated in a survey and/or semi-structured interview. Questions explored the patient's understanding of their asthma, views and knowledge of preventer inhalers, experiences and perceptions of stepping down asthma medication. Qualitative group-based multidisciplinary thematic analysis by two healthcare professionals and a patient were performed.</p><p><strong>Results: </strong>143 patients responded to the survey, 63% were female, between the ages 18-80 years and including geographical areas across the UK, 17 of whom participated in an interview. Half of these patients with stable asthma, most with asthma for more than 10 years, had never had a discussion regarding stepping down asthma medication. Most stepping down that had occurred was related to seasonal changes in asthma control. Four overarching themes from the interviews were identified, (1) experiences of living with asthma and needing inhalers, (2) insufficient education regarding preventer inhalers, (3) stepping down is agreeable and possible and (4) current asthma care is suboptimal.</p><p><strong>Conclusion: </strong>Patients with stable asthma were able to self-manage their asthma well. They had little awareness of medication adverse effects and minimal experience of having their medication stepped down by a healthcare professional. Most were inclined to step down, if clinically safe to do so, indeed some had reduced their medication doses themselves, without professional guidance.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11795401/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122126","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":"Risk of long covid in patients with pre-existing chronic respiratory diseases: a systematic review and meta-analysis.","authors":"Paul Terry, R Eric Heidel, Alexandria Q Wilson, Rajiv Dhand","doi":"10.1136/bmjresp-2024-002528","DOIUrl":"10.1136/bmjresp-2024-002528","url":null,"abstract":"<p><strong>Background: </strong>An estimated 10-30% of people with COVID-19 experience debilitating long-term symptoms or long covid. Underlying health conditions associated with chronic inflammation may increase the risk of long covid.</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis to examine whether long covid risk was altered by pre-existing asthma or chronic obstructive pulmonary disease (COPD) in adults. We identified studies by searching the PubMed and Embase databases from inception to 13 September 2024. We excluded studies that focused on children or defined long covid only in terms of respiratory symptoms. We used random-effects, restricted maximum likelihood models to analyse data pooled from 51 studies, which included 43 analyses of asthma and 30 analyses of COPD. The risk of bias was assessed using a ROBINS-E table.</p><p><strong>Results: </strong>We found 41% increased odds of long covid with pre-existing asthma (95% CI 1.29 to 1.54); pre-existing COPD was associated with 32% increased odds (95% CI 1.16 to 1.51). Pre-existing asthma, but not COPD, was associated with increased odds of long covid-associated fatigue. We observed heterogeneity in the results of studies of asthma related to hospitalisation status. Potential confounding and inconsistent measurement of exposure and outcome variables were among the identified limitations.</p><p><strong>Conclusions: </strong>Our findings support the hypothesis that pre-existing asthma and COPD increase the risk of long covid, including chronic fatigue outcomes in patients with asthma. Because COVID-19 targets the respiratory tract, these inflammatory conditions of the lower respiratory tract could provide mechanistic clues to a common pathway for the development of long-term sequelae in patients with long covid.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11784193/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063657","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":"Qualitative study exploring the views and perceptions of parents/carers of young children with CF regarding the introduction of CFTR modulator therapy (The REVEAL study; PaRents pErspectiVEs of KAftrio in chiLdren aged 2-5).","authors":"Sioned Haf Davies, Faye Wade, Heather Fogg, Adam Walsh, Kevin W Southern","doi":"10.1136/bmjresp-2024-002522","DOIUrl":"10.1136/bmjresp-2024-002522","url":null,"abstract":"<p><strong>Background: </strong>Cystic fibrosis (CF) is associated with a historically high treatment burden which causes anxiety and exhaustion for parents of children with CF, especially in the early years of a child's life. Recently, a new medication, elexacaftor/tezacaftor/ivacaftor (ETI), has become available to some people with CF, which has had a significant impact on the quality of life of older children and adults. This medication will soon be available for children ages 2-5 in the UK. This study investigated parents' perspectives before their children could start ETI.</p><p><strong>Method: </strong>10 parents of young children with CF participated in semistructured online focus groups. The data were analysed using thematic analysis to identify key themes.</p><p><strong>Results: </strong>Three reviewers identified four main themes: (1) The 'roller coaster' of parental emotions: Shock, hope, uncertainty and anticipation, (2) The dark side of the unknown, side effects and burden of decision making, (3) The value of simple pleasures in a life with CF; treatment burden, normality, future, family life and (4) Reforming clinical care in the new era of CF care; support, communication and the future.</p><p><strong>Conclusion: </strong>Parents experience a range of emotions from the day of diagnosis. While ETI brings hope and positivity, parents are concerned about the medication's safety. Parents have clear hopes and wishes for their child's future and reflect on the need for clinicians to consider reforming clinical care in the new era of CF for those eligible for new therapies.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11784110/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063651","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":"Twelve barriers to COPD diagnosis in France: a comparative qualitative study.","authors":"Guillaume Roucoux, Elisabetta Scanferla, Mathieu Delorme, Laurie Fraticelli, Lize Kiakouama Maleka, Cécilia Nocent-Ejnaini, Annaig Ozier, Maxime Patout, Olivier Le Rouzic, Maéva Zysman","doi":"10.1136/bmjresp-2024-002708","DOIUrl":"10.1136/bmjresp-2024-002708","url":null,"abstract":"<p><strong>Background: </strong>Chronic obstructive pulmonary disease (COPD) is a common treatable disease often diagnosed in patients with risk factors after a prolonged period with suggestive symptoms. Our qualitative study aimed to identify barriers to establishing diagnosis in the natural history of this condition.</p><p><strong>Methods: </strong>An inductive thematic analysis was performed on structured interviews with patients, general practitioners (GPs) and pulmonologists in France. Inclusion depended on criteria to generate two purposive samples (patients and physicians). Recruitment occurred online. Data collection proceeded until 15 patients and 15 physicians (eight pulmonologists, seven GPs) were interviewed. Data saturation was checked and achieved. The interviews were transcribed and coded in NVivo and triangulated between two researchers. The article respects the consolidated criteria for reporting qualitative research guidelines.</p><p><strong>Results: </strong>Three phases in the patients' clinical pathway to diagnosis and 12 barriers were found: Phase 1 (symptoms before consultation; n=4), lack of COPD knowledge, symptom denial, fear of lung cancer, and delayed general practice consultations; Phase 2 (primary care; n=3), letting bronchitis become chronic, priority to diseases with similar symptoms and/or more serious diseases, lack of COPD screening devices, time and curative treatments; Phase 3 (specialised medicine; n=5), treatment before diagnosis, late referral to pulmonologists, difficulty in accessing specialists and examination results, patient's reluctance to undergo further examinations, and need for additional tests to confirm a diagnosis.</p><p><strong>Conclusion: </strong>People unaware of their COPD condition can encounter up to 12 barriers, which may combine before obtaining a formal diagnosis. Patients, GPs, pulmonologists and the state health authorities share responsibility for addressing these barriers and enhancing the care pathway.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11759880/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143021580","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":"Retrospective cross-sectional study on bronchiectasis in adult Aboriginal Australians: disease characteristics and comparison with ethnically diverse global bronchiectasis registry cohorts.","authors":"Subash Heraganahally, Claire Gibbs, Shiidheshwar J Ravichandran, Davaadorj Erdenebayar, Winnie Chen, Asanga Abeyaratne, Hubertus Jersmann, Lata Jayaram, Timothy Howarth","doi":"10.1136/bmjresp-2023-002139","DOIUrl":"10.1136/bmjresp-2023-002139","url":null,"abstract":"<p><strong>Background: </strong>Globally, adult Indigenous people, including Aboriginal Australians, have a high burden of chronic respiratory disorders, and bronchiectasis is no exception. However, literature detailing bronchiectasis disease characteristics among adult Indigenous people is sparse. This study assessed the clinical profile of bronchiectasis among adult Aboriginal Australians and compared against previously published international bronchiectasis registry reports.</p><p><strong>Methods: </strong>Aboriginal Australians aged >18 years with chest CT confirmed bronchiectasis between 2011 and 2020 in the Top End Northern Territory of Australia were included. Demographics, chest CT findings, pulmonary function results, sputum microbiology, coexistent medical comorbidities, and pharmacotherapy use were assessed and compared against five published international bronchiectasis registry reports (Australian (ABR), European (European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC)-Europe), Indian (EMBARC-India), Korean (KMBARC) and the USA (USBRR)).</p><p><strong>Results: </strong>A total of 459 patients were assessed. In comparison with international and non-Aboriginal Australian national cohorts, Aboriginal Australians were younger (median 56 years (IQR (48, 65)); however, sex distribution (55% female) and body mass index (23 kg/m² (IQR 19.4-27)) were comparable . Smoking rates were higher at 85% compared with other registry cohorts (22-46%) as was the prevalence of comorbidities (97%): cardiovascular diseases (73%), diabetes mellitus (50%) and chronic obstructive pulmonary disease (83%) compared with other registry cohorts (4-32%; 6-14%; and 14-37%, respectively). Spirometry demonstrated forced expiratory volume in 1 s of 38% predicted in comparison with 61-77% in other cohorts. Sputum microbiology showed <i>Haemophilus influenzae</i> (57%) isolated at 3.4 to 6 times the rate of other registry cohorts and <i>Pseudomonas aeruginosa</i> in 31%. Chest CT demonstrated multilobar and lower lobes involvement in 73% and inhaled pharmacotherapy use was recorded in up to 62% and long-term antibiotics in 5%.</p><p><strong>Conclusion: </strong>The overall bronchiectasis disease burden is higher in Aboriginal Australian adults in comparison with global ethnically diverse non-Indigenous populations. Further efforts are required to address this disparity secondary to bronchiectasis among Indigenous people.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11784196/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143021646","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":"Protocol for the enhanced management of multimorbid patients with COPD and severe asthma: role of indoor air quality.","authors":"Alba Gómez-López, Ebymar Arismendi, Isaac Cano, Ramón Farre, María Figols, Carme Hernández, Antonio Montilla-Ibarra, Núria Sánchez-Ruano, Benigno Sánchez, Antoni Sisó-Almirall, Marta Sorribes, Emili Vela, Jordi Piera-Jiménez, Jaume Benavent, Jose Fermoso, Josep Roca, Rubèn González-Colom","doi":"10.1136/bmjresp-2024-002589","DOIUrl":"10.1136/bmjresp-2024-002589","url":null,"abstract":"<p><strong>Introduction: </strong>Reducing unplanned hospital admissions in chronic patients at risk is a key area for action due to the high healthcare and societal burden of the phenomenon. The inconclusive results of preventive strategies in patients with chronic obstructive respiratory disorders and comorbidities are explainable by multifactorial but actionable factors.The current protocol (January 2024-December 2025) relies on the hypothesis that intertwined actions in four dimensions: (1) management change, (2) personalisation of the interventions based on early detection/treatment of acute episodes and enhanced management of comorbidities, (3) mature digital support and (4) comprehensive assessment, can effectively overcome most of the limitations shown by previous preventive strategies. Accordingly, the main objective is to implement a novel integrated care preventive service for enhanced management of these patients, as well as to evaluate its potential for value generation.</p><p><strong>Methods and analysis: </strong>At the end of 2024, the specifics of the novel service will be defined through the articulation of its four main components: (1) enhanced lung function testing through oscillometry, (2) continuous monitoring of indoor air quality as a potential triggering factor, (3) digital support with an adaptive case management (ACM) approach and (4) predictive modelling for early identification and management of exacerbations. During 2025, the novel service will be assessed using a Quintuple Aim approach. Moreover, the Consolidated Framework for Implementation Research will be applied to assess the implementation. The service components will be articulated through four sequential 6-month plan-do-study-act cycles. Each cycle involves a targeted cocreation process following a mixed-methods approach with the active participation of patients, health professionals, managers and digital experts.</p><p><strong>Ethics and dissemination: </strong>The Ethics Committee for Human Research at Hospital Clinic de Barcelona approved the protocol on 29 June 2023 (HCB/2023/0126). Before any procedure, all patients in the study must sign an informed consent form.</p><p><strong>Trial registration number: </strong>NCT06421402.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11752068/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999842","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":"Lung function and onset of cardiometabolic diseases in the longitudinal Burden of Obstructive Lung Disease study.","authors":"Christer Janson, James Potts, Andrei Malinovschi, Dhiraj Agarwal, Rana Ahmed, Althea Aquart-Stewart, Imed Harrabi, Meriam Denguezli, Graham Devereux, Gregory E Erhabor, Thorarinn Gislason, Rain Jogi, Sanjay K Juvekar, Ben Knox-Brown, Parvaiz Koul, Kevin Mortimer, Asaad Ahmed Nafees, Rune Nielsen, Padukudru Anand Mahesh, Stefanni Nonna M Paraguas, Anders Ørskov Rotevatn, Talant Sooronbaev, Peter G J Burney, Andre F S Amaral","doi":"10.1136/bmjresp-2024-002442","DOIUrl":"10.1136/bmjresp-2024-002442","url":null,"abstract":"<p><strong>Introduction: </strong>Previous population-based studies, mainly from high-income countries, have shown that a higher forced vital capacity (FVC) is associated with a lower risk of developing cardiometabolic diseases. The aim of this study was to assess the longitudinal association between spirometry measures and the onset of cardiometabolic diseases across sites in low-income, middle-income and high-income countries.</p><p><strong>Methods: </strong>The study population comprised 5916 individuals from 15 countries participating in the Burden of Obstructive Lung Disease baseline and follow-up assessments. Postbronchodilator forced expiratory volume in 1 s (FEV1), FVC and FEV1/FVC were measured at baseline. Participants who reported having doctor-diagnosed hypertension, diabetes, heart disease and stroke at follow-up but not at baseline were considered new cases of these diseases. The association between lung function and the onset of participant-reported cardiometabolic diseases was assessed in each site using regression models, and estimates were combined using random effects meta-analysis. Models were adjusted for sex, age, smoking, body mass index and educational level.</p><p><strong>Results: </strong>Participants with greater per cent predicted FVC were less likely to have new-onset diabetes (OR per 10%=0.91, 95% CI 0.84 to 0.99), heart disease (OR per 10%=0.86, 95% CI 0.80 to 0.92) and stroke (OR per 10%=0.81, 95% CI 0.73 to 0.89) during the follow-up period (mean±SD 9.5±3.6 years). A greater percentage of FEV₁ was associated with a lower risk of onset of heart disease and stroke. No significant association was found between FEV₁/FVC and onset of reported cardiometabolic diseases, except for a higher risk of diabetes (OR per 10%=1.21, 95% CI 1.08 to 1.35) in participants with higher FEV₁/FVC.</p><p><strong>Conclusions: </strong>The findings of this study suggest that a low FVC is more important than a low FEV₁/FVC as a risk factor for developing cardiometabolic diseases. The value of including FVC in risk score models to improve their precision in predicting the onset of cardiometabolic diseases should be explored.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11751964/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999830","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":"Real-world clinical utility of Xpert MTB/RIF Ultra in the assessment of tuberculosis in a low-TB-incidence, high-resource setting.","authors":"Jee Whang Kim, Hemu Patel, Richard Halliwell, Robert C Free, Alison Glimour-Caunt, Manish Pareek, Gerrit Woltmann, Raman Verma, Nelun Perera, Pranabashis Haldar","doi":"10.1136/bmjresp-2024-002624","DOIUrl":"10.1136/bmjresp-2024-002624","url":null,"abstract":"<p><strong>Background: </strong>Tuberculosis (TB) diagnosis in the UK is impacted by delay and suboptimal culture-based microbiological confirmation rates due to the high prevalence of paucibacillary disease. We examine the real-world clinical utility of Xpert MTB/RIF Ultra (Xpert-Ultra) as a diagnostic test and biomarker of transmissible infection in a UK TB service.</p><p><strong>Methods: </strong>Clinical specimens from suspected TB cases triple tested (smear microscopy, mycobacterial culture and Xpert-Ultra) at University Hospitals of Leicester NHS Trust (1 March 2018-28 February 2019) were retrospectively analysed. Diagnostic sensitivity and specificity were calculated using positive MTB culture and clinical TB diagnosis as reference standards. The QuantiFERON (QFT) positive proportion of pulmonary TB (PTB) contacts was used as a metric of transmitted infection to evaluate Xpert-Ultra and smear grade as markers of infectiousness.</p><p><strong>Results: </strong>251 samples (188 respiratory) from 231 patients (86 TB) were analysed. Compared with microscopy, Xpert-Ultra had higher diagnostic sensitivity (24.7% vs 78.7%, p<0.001) and comparable specificity (97.5% vs 99.4%). Xpert-Ultra and culture had comparable sensitivity (78.7% vs 71.9%) and specificity (99.4% vs 100.0%). Incorporating Xpert-Ultra with culture increased microbiologically verified diagnosis to 91.7% for PTB and 75.9% for extrapulmonary TB, compared with 85.0% and 44.8%, using culture alone. In PTB, both smear and Xpert-Ultra grade were positively associated with the proportion of contacts testing QFT positive. However, Xpert-Ultra had a higher negative predictive value than smear (QFT-positive contacts 6.7% vs 17.7%).</p><p><strong>Conclusion: </strong>In low-TB-burden settings, systematic adoption of Xpert-Ultra for clinical assessment of suspected TB can improve the proportion of microbiologically verified diagnoses and improve the stratification of transmission risk.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11751901/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999845","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":"Cluster randomised controlled trial on the effects of long-term home-based exercise for patients with chronic obstructive pulmonary disease with recent exacerbation: research protocol of the <i>COPDtoParis</i> Project.","authors":"Anna Lei Stoustrup, Lars Pilegaard Thomsen, Jane Andreasen, Thorvaldur S Palsson, Ulla Møller Weinreich","doi":"10.1136/bmjresp-2024-002573","DOIUrl":"10.1136/bmjresp-2024-002573","url":null,"abstract":"<p><strong>Background: </strong>Chronic obstructive pulmonary disease (COPD) is a highly prevalent respiratory disease associated with significant health decline and economic burdens. Pulmonary rehabilitation is an effective intervention, but securing adherence to exercise is difficult, particularly for frail and disabled patients, challenged by leaving their home. Home-based exercise is an emerging alternative for persons with COPD, but long-term adherence is unclear. This study aims to investigate the effects, experiences and acceptability of long-term home-based cycling for patients with COPD post exacerbation.</p><p><strong>Methods and analyses: </strong>This cluster randomised controlled trial will recruit hospitalised patients with COPD following hospitalisation following exacerbation of COPD. Participants will be referred to acute rehabilitation for 8 weeks at discharge. After rehabilitation, participants are randomised in clusters of five into 1 year of home-based cycling with the goal of cycling from Aalborg to Paris, or into the control group, who will receive standard care. Data will be collected at baseline, postrehabilitation/intervention initiation, at 6 and 12 months. Primary outcome is physical performance, while secondary outcomes include daily activity levels, lung function, mobility, frailty, symptom severity, health-related quality of life, survival rates and readmissions. A qualitative substudy will uncover experiences from participants. Daily activity levels will be measured using leg-mounted triaxial accelerometers. Other parameters will be tested with physical tests, questionnaires and interviews. The study aims to include 50 patients, with 25 participants in each group. A cost-effectiveness analysis will assess the impact on disease prevention and hospitalisation.</p><p><strong>Ethics and dissemination: </strong>This study, approved by The North Denmark Region Committee on Health Research Ethics (N-20230008) and compliant with the Helsinki Declaration, includes annual safety and progress reporting of potential adverse events. Results will be disseminated through peer-reviewed publications, conference presentations and community outreach to ensure accessibility to participants, healthcare professionals and the public.</p><p><strong>Trial registration number: </strong>NCT06235502 and Northern Jutland trial register (F2023-066).</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11751790/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999829","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}