BMJ Open Respiratory Research最新文献

{"title":"Impact of bronchitis variability on outcomes of COPD.","authors":"Joon Young Choi, Yun Seok Kim, Youlim Kim, Hyun Lee, Kyung Hoon Min, Hyunjung Kim, Chin Kook Rhee, Yong Bum Park, Kwang Ha Yoo, Ji-Yong Moon","doi":"10.1136/bmjresp-2024-002987","DOIUrl":"10.1136/bmjresp-2024-002987","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate the impact of serial bronchitic status over two consecutive years on clinical outcomes, including frequency of exacerbation and lung function decline rate.</p><p><strong>Methods: </strong>We analysed data from 1265 participants enrolled in the Korea COPD Subgroup Study, a nationwide prospective observational chronic obstructive pulmonary disease (COPD) cohort. Bronchitic status was determined using subquestionnaires of the COPD Assessment Test at baseline and after 1 year, classifying patients into three serial bronchitic groups of persistently not bronchitic (NB), intermittently bronchitic (IB) and chronic bronchitis (CB). Annualised exacerbation rates and longitudinal lung function decline rates were analysed.</p><p><strong>Results: </strong>The NB group consisted of 873 individuals, the IB group contained 272 and the CB group included 120. The analysis of baseline demographics showed a greater prevalence of current smokers in the CB and IB groups compared with the NB group. Patients with CB exhibited the worst baseline symptoms and lung function, while those with IB had worse clinical features compared with those with persistently NB. Patients with CB had the highest rate of moderate-to-severe exacerbations, followed by IB, compared with persistently NB. No significant differences in forced expiratory volume in 1 s or forced vital capacity decline rates were observed among the groups.</p><p><strong>Conclusions: </strong>Patients with CB and IB exhibit a greater risk of exacerbations than those with NB, whereas lung function decline rates did not significantly differ between groups.</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/PMC12410636/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144991518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving shared decision-making in bronchiectasis.","authors":"Paul McCallion, Judy M Bradley, Adam Lewis, Lisa Robinson, Joanne Lally, Anthony De Soyza","doi":"10.1136/bmjresp-2024-003049","DOIUrl":"10.1136/bmjresp-2024-003049","url":null,"abstract":"<p><p>Bronchiectasis is a heterogeneous lung disease. There is an increasing focus on personalised medicine in bronchiectasis, with targeted pharmacological interventions for inflammation, immunology and infection. Airway clearance techniques (ACTs) are non-pharmacological treatments used to manage bronchiectasis. Approximately half of patients with bronchiectasis perform ACTs. There have been attempts to personalise ACT prescriptions, including consideration of patient physiology, disease status and psychosocial factors. Guidelines suggest that patient preference or choice should be considered when prescribing ACTs. There is a lack of literature showing patient preference or choice being taken into consideration when prescribing ACTs in bronchiectasis. This article discusses the role of shared decision-making (SDM), the potential use of SDM for ACTs in bronchiectasis to support patient choice of and adherence to ACTs and the steps involved in designing an SDM intervention for ACTs in bronchiectasis for future research. Development and use of an SDM intervention to support patient choice of ACT in bronchiectasis may result in a patient-centred, pragmatic approach to empower patients to be actively involved in their care, improve their knowledge on the importance of ACTs and support improvement in adherence to this essential therapy.</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/PMC12410678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144991502","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":"Transpulmonary bubble transit in patients hospitalised with COVID-19 pneumonia.","authors":"Hooman Poor, Adeel Abbasi, Daniel Howell, Alexandra Reynolds, Kaitlin Reilly-Kit, Kevin Rurak, Maya Cohen, Grayson Baird, Lilian Worst, Elizabeth Shin, Paul Yu, Alison Lee, Corey E Ventetuolo","doi":"10.1136/bmjresp-2024-002912","DOIUrl":"10.1136/bmjresp-2024-002912","url":null,"abstract":"<p><strong>Background: </strong>We previously demonstrated a high prevalence of transpulmonary bubble transit (TPBT) using transcranial Doppler (TCD) in patients with COVID-19 pneumonia, but these observations require confirmation.</p><p><strong>Methods: </strong>Patients at two academic medical centres, hospitalised with COVID-19 pneumonia and requiring any form of respiratory support, were studied. The first TCD study was performed at the time of enrolment and repeated approximately 7 and 14 days later if participants remained hospitalised.</p><p><strong>Results: </strong>91 participants were enrolled. At the first TCD, 14 participants (15%) were receiving oxygen by nasal cannula, 41 participants (45%) were receiving oxygen by high flow nasal cannula, 8 participants (9%) were receiving non-invasive positive pressure, 28 participants (31%) were receiving mechanical ventilation and 2 participants (2%) were receiving extracorporeal membrane oxygenation. 33 participants (36%) demonstrated TPBT at the first TCD. There was evidence that the presence of TPBT and increased heart rate together was associated with in-hospital death (p=0.02). For every one-unit increase in heart rate, the odds of death increased 11% (OR 1.11, 95% CI 1.02 to 1.20, p=0.01) for those with TPBT; however, there was no evidence of this increase for those without TPBT (OR 1.01, 95% CI 0.97 to 1.05, p=0.76). For participants with subsequent TCD assessments, 55% demonstrated TPBT during the second TCD assessment, and 85% demonstrated TPBT at the third TCD assessment.</p><p><strong>Conclusions: </strong>The prevalence of TPBT in hospitalised patients with COVID-19 pneumonia is higher than expected and the presence of TPBT increases over time in those that remained alive and hospitalised. In patients with TPBT, increased heart rate, a marker of hyperdynamic circulation, is associated with increased mortality.</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/PMC12410680/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144991495","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":"Trends in inhaler use and associated carbon footprint: a sales data-based study in Europe.","authors":"Ville Vartiainen, Christer Janson, Hanna Hisinger-Mölkänen, Lauri Lehtimäki, Alexander Wilkinson","doi":"10.1136/bmjresp-2024-002424","DOIUrl":"10.1136/bmjresp-2024-002424","url":null,"abstract":"<p><strong>Background: </strong>Physicians are being encouraged to favour dry powder inhalers (DPI) over pressurised metered dose inhalers (pMDI) on environmental grounds. The EU is reviewing the F-gas regulation to accelerate emission phase-down targets. Thoughtful use of inhalers can reduce emissions while promoting positive clinical outcomes. We aim to describe the trends of pMDI and DPI use and associated carbon footprint in Europe.</p><p><strong>Methods: </strong>DPI and pMDI sales data between 2011 and 2021 were extracted from IQVIA MIDAS Quarterly 2022 as total sold doses in 10 European countries. Carbon footprint calculations were based on the Medical and Chemicals Technical Options Committee 2022 assessment report.</p><p><strong>Results: </strong>Between 2011 and 2021, the carbon footprint of pMDI-based inhalation therapy increased from 3368 to 3891 kilotons (kt) CO₂ equivalents (CO₂e) because of a 16% increase in the number of sold doses of pMDI. Replacing pMDIs with low-carbon inhalers such as DPIs over this period would have produced 92% lower CO₂ emissions. The UK was the largest source of pMDI-related emissions in 2021 with 1235 kt CO₂e (31% of all emissions) in Europe. Short-acting beta-2 agonist (SABA) dose sales were associated with 1642 kt CO₂e emissions in 2021, 94% from pMDIs.</p><p><strong>Conclusions: </strong>The carbon footprint of inhaler therapy in Europe grew due to an increased use of pMDIs in many European countries. Greater focus on guideline-based controller therapy will potentially improve patient outcomes and decrease SABA over-reliance. Prioritising DPIs or soft mist inhalers when clinically appropriate can lower inhaler greenhouse gas emissions.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12406821/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144942253","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":"Trends and determinants of unfavourable outcomes in paediatric tuberculosis: insights from a 20-year cohort in Cameroon.","authors":"Virginie Poka-Mayap, Reine Charlye Dombu-Guiafaing, Adamou Dodo Balkissou, Laurent-Mireille Endale Mangamba, Alain Kuaban, Abdou Wouliyou Nsounfon, Massongo Massongo, Marie Elisabeth Ngah Komo, Arnaud Laurel Ntyo'o Nkoumou, Eric Walter Pefura-Yone","doi":"10.1136/bmjresp-2025-003292","DOIUrl":"10.1136/bmjresp-2025-003292","url":null,"abstract":"<p><strong>Background: </strong>Tuberculosis (TB) remains a leading cause of childhood morbidity and mortality in resource-limited settings. Despite progress in TB care, unfavourable treatment outcome persists, highlighting the need to identify determinants and address gaps in paediatric TB management. This study aimed to assess treatment outcomes and identify determinants of unfavourable outcomes in children treated for TB at a referral centre in Cameroon.</p><p><strong>Methods: </strong>This retrospective cohort study included children aged <15 years diagnosed with TB and followed at the Jamot Hospital of Yaoundé from 2001 to 2020. Treatment outcome was classified as favourable (cured or treatment completed) or unfavourable (death, treatment failure or loss to follow-up). Sociodemographic and clinical data were recorded. A Poisson regression model was applied to evaluate temporal trends in the annual incidence of unfavourable outcomes. Logistic regression was used to identify determinants of unfavourable outcome.</p><p><strong>Results: </strong>Of the 881 children included, 52.1% were female and 40.7% were ≤5 years. HIV status was unknown for 36.9% and positive for 10.1% of children. Extrapulmonary TB was found in 34.5% of children. The cumulative incidence of unfavourable outcome was 24.5% (95% CI 21.7% to 27.5%). Loss to follow-up (19.8%) was the most frequent unfavourable outcome, followed by death (4.5%) and treatment failure (0.2%). A decreasing trend in the annual proportion of unfavourable outcomes was observed. Determinants of unfavourable outcome included: residence out of Yaoundé (adjusted OR (aOR) 12.51; 95% CI 1.10 to 5.58; p=0.02), unknown HIV status (aOR 2.10; 95% CI 1.47 to 3.00; p<0.001) and retreatment status (aOR 7.25; 95% CI 1.98 to 29.45; p=0.003).</p><p><strong>Conclusions: </strong>Despite encouraging improvements over time, unfavourable outcomes remain high in paediatric TB. Strengthening HIV testing, follow-up systems and access to care for children in rural areas is essential to sustain and accelerate progress in TB treatment success.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12406847/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144942213","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":"Prognostic impacts of interstitial lung abnormalities on outcomes following resection for lung cancer.","authors":"Charles-Antoine Guay, Pierre-Emile Charest, Frederic-Thomas Caron, Louis Laflamme, Laurie Perreault, Anne-Sophie Laliberté, Elisabeth Albert, Genevieve Dion, Steeve Provencher","doi":"10.1136/bmjresp-2024-002981","DOIUrl":"10.1136/bmjresp-2024-002981","url":null,"abstract":"<p><strong>Introduction: </strong>The clinical significance of interstitial lung abnormalities in patients with lung cancer undergoing curative resection remains largely unstudied. This study aimed to evaluate the prevalence of these findings among patients with lung cancer undergoing resection and assess their impact on postoperative complications and long-term survival.</p><p><strong>Methods: </strong>This single-centre retrospective study included patients who underwent resection from 2008 to 2020. Patients with a history of lung cancer, previous lung resection or clinically evident interstitial lung disease before cancer detection were excluded. Preoperative chest scans were reviewed for interstitial lung abnormalities according to established criteria. Associations between these abnormalities and postoperative outcomes, as well as long-term survival, were analysed using multivariate models.</p><p><strong>Results: </strong>Among 1802 patients with available preoperative scans, 114 (6.3%) had interstitial lung abnormalities, including 17 (0.9%) with a usual interstitial pneumonia-like pattern. Interstitial lung abnormalities were associated with older age, female sex and smoking history. Although their presence did not significantly increase the risk of postoperative complications or 30-day mortality, interstitial lung abnormalities were linked to higher long-term mortality (92 vs 61 deaths/1000 person-years, HR 1.47; 95% CI 1.05 to 2.05). The usual interstitial pneumonia-like patterns were significantly associated with increased long-term mortality (HR 2.84; 95% CI 1.36 to 5.91), whereas other patterns were not (HR 0.98; 95% CI 0.63 to 1.54).</p><p><strong>Conclusions: </strong>Interstitial lung abnormalities are common in patients with lung cancer undergoing curative surgery and are linked to demographic and smoking-related factors. While they do not significantly impact short-term surgical outcomes, usual interstitial pneumonia-like pattern is associated with worse long-term survival.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12410612/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144942207","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":"Use of carbon dioxide production to detect bacterial superinfections in mechanically ventilated patients with acute respiratory distress syndrome: an exploratory prospective cohort study.","authors":"Nicole S Strickler, Daniel A Hofmaenner, Reto A Schuepbach, Thomas C Scheier, Philipp K Buehler, Jukka Takala, Silvio D Brugger, Pascal M Frey","doi":"10.1136/bmjresp-2024-002760","DOIUrl":"10.1136/bmjresp-2024-002760","url":null,"abstract":"<p><strong>Background: </strong>Bacterial superinfections are common in patients with acute respiratory distress syndrome (ARDS) but diagnosing them is challenging. Exhaled carbon dioxide (V'CO2) may be increased during bacterial infection, suggesting a potential marker for detecting bacterial superinfections in ARDS patients.</p><p><strong>Methods: </strong>In a prospective cohort study of mechanically ventilated adult patients with ARDS due to SARS-CoV-2 in a tertiary intensive care unit, we assessed V'CO2 measurements from continuous volumetric capnography and calculated daily median V'CO2 levels. The primary outcome was to determine if a first substantial increase in daily median V'CO2 was associated with a first bacterial superinfection. Protocolised microbiological sampling and adjudicated clinical interpretations were used to determine the onset of a first superinfection.</p><p><strong>Results: </strong>A total of 150 days of continuous volumetric capnography were analysed in 31 mechanically ventilated adult patients with ARDS due to SARS-CoV-2. We observed 10 patients (32%) with a first episode of substantial increase of daily median V'CO2, and 12 (39%) patients with a first bacterial superinfection. A V'CO2 increase was not associated with a superinfection on the same day (OR 3.47, 95% CI 0.64 to 18.92, p=0.15, adjusted for age and gender). Investigating all 150 test days of median V'CO2 revealed a poor sensitivity (17%, 95% CI 2% to 48%) for detecting superinfections. However, a first V'CO2 increase indicated superinfection with high specificity (94%, 95% CI 89% to 98%). Patients with superinfections showed higher daily median V'CO2 levels (210 mL/min) than those without (176 mL/min, p<0.001), even after adjusting for age and gender (OR 1.56, 95% CI 1.16 to 2.08, p=0.003).</p><p><strong>Conclusions: </strong>A sudden increase in daily median V'CO2 did not reliably detect bacterial superinfections, which was reflected in a poor sensitivity and inability to rule out superinfections in patients without V'CO2 increase. Nevertheless, high specificity suggests that V'CO2 may be useful to rule in superinfections in patients with ARDS.</p><p><strong>Trial registration number: </strong>NCT04410263.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12410624/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144942250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of C-reactive protein with cause, duration and severity of lower respiratory infections in primary care: a prospective cohort study.","authors":"Mark Ebell, Dan J Merenstein, Bruce Barrett, Michelle Buhr, Cassie Hulme, Caroline Hamer, Sarah Walters, Alea Sabry, Shari Barlow","doi":"10.1136/bmjresp-2025-003240","DOIUrl":"10.1136/bmjresp-2025-003240","url":null,"abstract":"<p><strong>Introduction: </strong>The association of C-reactive protein (CRP) with cough duration and severity has not been evaluated in a contemporary US population of patients with acute lower respiratory tract infection (LRTI).</p><p><strong>Methods: </strong>We identified outpatients with less than 2 weeks of cough plus at least one lower respiratory or systemic symptom. The duration of illness, demographics, signs, symptoms, CRP and PCR for 46 pathogens were assessed. Duration and severity of cough were tracked using a paper diary plus responses to text messages. We classified CRP as low (<5 mg/L), moderate (5-19 mg/L) and high (≥20 mg/L).</p><p><strong>Results: </strong>A total of 575 patients had valid CRP data and 503 had both valid CRP and PCR data. Patients with a CRP ≥20 mg/L were more likely (p<0.001) to have any bacterial detection (34.4%) or a mixed detection (37.7%) than viral infection (19.7%) or no detection (7.2%). Patients with elevated CRP were also more likely to have a likely bacterial pathogen detected (61.2% vs 37.8%, p<0.001) and were more likely to have a clinician label their illness as moderate or severe (53.7% vs 26.0%, p<0.001). Patients with a CRP ≥20 mg/L had a longer duration of illness than those with a lower CRP (18.5 vs 16.1 days, p=0.026) as well as a greater overall severity of cough (29.9 vs 23.0 points, p=0.001). In multivariable analysis, CRP ≥20 mg/L was the strongest independent predictor of a likely bacterial pathogen (adjusted OR 3.21, 95% CI 1.61 to 6.40).</p><p><strong>Discussion: </strong>CRP ≥20 mg/L has a strong, independent association with the presence of bacterial pathogen in patients with acute LRTI and predicts longer duration and severity of illness. Further research is warranted to understand the impact of CRP on antibiotic prescribing and patient outcomes.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12410646/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144942226","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":"Performance against quality indicators in the initial assessment of patients with respiratory infections in acute medicine services.","authors":"Catherine Atkin, Mark Holland, Tim Cooksley, Ragit Varia, Christian P Subbe, Tom Wilkinson, Daniel Lasserson, Elizabeth Sapey","doi":"10.1136/bmjresp-2025-003207","DOIUrl":"https://doi.org/10.1136/bmjresp-2025-003207","url":null,"abstract":"<p><strong>Introduction: </strong>Hospital attendances due to respiratory infection peak in winter, contributing to pressures within acute services. We assessed the prevalence of suspected respiratory infection within acute medical admissions during winter and evaluated performance against recommendations for initial assessment.</p><p><strong>Methods: </strong>Data were collected through the Society for Acute Medicine (SAM) Benchmarking Audit, comprising a hospital-level survey and 24-hour patient-level data collection for unplanned acute medical attendances on 22 February 2024. Performance metrics assessed included those from the SAM's clinical quality indicators (CQI) for medical admissions, and British Thoracic Society (BTS) guidelines for community acquired pneumonia.</p><p><strong>Results: </strong>Data were available for 4390 patients at 76 hospitals. Suspected respiratory infections accounted for 22.8% of all unplanned medical attendances; these patients were older (age ≥70 years: 58.2% vs 44.7%, p<0.001) and had higher National Early Warning Score 2 (NEWS2) scores (NEWS2 ≥3: 63.8% vs 23.8%, p<0.001) than those without respiratory infection; they were more likely to be assessed in the emergency department (80.8% vs 63.7%, p<0.001), and had lower rates of discharge without overnight admission (14.9% vs 35.9%, p<0.001). 71.0% of patients underwent a chest X-ray within 4 hours of arrival; 27.0% were reported within 12 hours. Antibiotics were administered ≥4 hours from arrival in 32.9%. Performance against these indicators varied between hospitals. Nine hospitals (12.7%) had a separate respiratory admission service; this was not associated with improved performance against SAM CQIs or BTS guidance.</p><p><strong>Conclusion: </strong>Respiratory infections contribute significantly to acute medical attendances via the emergency department. There remains significant scope to improve key steps in initial assessment and management.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12382532/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144942186","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":"Enhanced detection of patients with previous COVID-19: superiority of the double diffusion technique.","authors":"Gerald Stanley Zavorsky, Giovanni Barisione, Thomas Gille, Roberto W Dal Negro, Marta Núñez-Fernández, Leigh Seccombe, Gianluca Imeri, Fabiano Di Marco, Jann Mortensen, Elisabetta Salvioni, Piergiuseppe Agostoni, Vito Brusasco","doi":"10.1136/bmjresp-2024-002561","DOIUrl":"10.1136/bmjresp-2024-002561","url":null,"abstract":"<p><strong>Background: </strong>Persistent pulmonary dysfunction is common after COVID-19, yet traditional assessments using carbon monoxide diffusing capacity (DLCO) alone may miss alveolar-capillary impairment.</p><p><strong>Objective: </strong>To determine whether combining nitric oxide (DLNO_5s) and carbon monoxide (DLCO_5s) diffusing capacities enhances detection of post-COVID-19 lung impairment and whether summed <i>z</i>-scores outperform individual measures in classifying affected individuals.</p><p><strong>Design and methods: </strong>We conducted an individual participant data meta-analysis using hierarchical mixed-effects modelling. The dataset included 572 COVID-19 survivors and 72 matched controls from six European centres. Lung function metrics-including spirometry, total lung capacity, DLNO_5s and DLCO_5s-were standardised into <i>z</i>-scores. Logistic models were compared using Bayesian Information Criterion and Leave-One-Out Information Criterion. Classification accuracy was assessed with Matthews Correlation Coefficient (MCC) and net reclassification improvement (NRI). Principal Component Analysis examined score structures, and dyspnoea severity was correlated with z-scores. Assessments were conducted 32-575 days post-infection (median=130 days).</p><p><strong>Results: </strong>The number of days between SARS-CoV-2 diagnosis and testing did not affect any of the measured z-scores. Summed DLNO_5s + DLCO_5s <i>z</i>-scores consistently outperformed individual metrics. The combined model improved MCC by 0.06 (95% CI 0.01 to 0.11) and NRI by 37% (95% CI 13 to 62%) over DLCO_5s alone. The top model summed DLNO_5s + DLCO_5s model explained 10% of fixed and 59% of random variance. DLCO_5s alone failed to identify reduced membrane diffusion in approximately 16% of cases. Dyspnoea severity was significantly associated with all diffusion indices (p<0.001), though combined scores showed no stronger correlation than single predictors.</p><p><strong>Conclusion: </strong>Summed DLNO_5s + DLCO_5s <i>z</i>-scores enhance classification of post-COVID-19 pulmonary impairment beyond DLCO_5s alone. The NO-CO double diffusion approach offers improved diagnostic discrimination between previously infected individuals and controls and aligns with symptom severity. These findings support broader clinical integration of combined diffusion metrics in post-COVID assessment.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12382503/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144942242","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}