BMJ Open Respiratory Research最新文献

{"title":"Short-term exposure to heat associated with lower lung function in older adults: analysis of the Lung VITAL cohort.","authors":"Nicholas Nassikas, Wenli Ni, Heike Luttmann-Gibson, Vadim Bubes, Antonella Zanobetti, Brent Coull, Julie E Buring, JoAnn E Manson, Diane R Gold, Mary B Rice","doi":"10.1136/bmjresp-2026-004661","DOIUrl":"10.1136/bmjresp-2026-004661","url":null,"abstract":"<p><strong>Background: </strong>High temperatures are associated with respiratory symptoms, hospitalisations and mortality. Yet, the effects on lung function are not well described. The aim of this study was to determine associations of acute exposure to high temperatures with lung function in adults.</p><p><strong>Methods: </strong>We included 1923 study participants from Lung VITamin D and OmegA-3 TriaL (VITAL) cohort, an ancillary study of VITAL, who underwent spirometry (two per participant) between 2010 and 2018. We assigned daily mean temperature, relative humidity, air pollution to geocoded participant home addresses. Forced expiratory volume in 1 s (FEV₁), forced vital capacity (FVC) and forced expiratory flow (FEF_25-75) were obtained at baseline and 2-year follow-up across 11 US sites. We used distributed lag nonlinear models to examine potentially nonlinear associations of temperature with FEV₁ and FVC in primary analyses as well as FEF_25-75. Effect estimates reported as estimated mean difference in lung function for a contrast of 30°C vs 20°C. All models adjusted for age, sex, height, weight, trial intervention arm, current tobacco use, season, social vulnerability, relative humidity, PM_2.5 and O₃, testing site.</p><p><strong>Results: </strong>Median (IQR) daily mean temperature was 13.6°C (17.4°C) for the study population. Daily exposures moderately correlated (r_s-0.31 to 0.34). Cumulative short-term exposure to high temperature (lag 1-7 days) was associated with 49.96 mL (95% CI -96.32 to -3.61) lower FEV₁ and 89.74 mL (95% CI -157.07 to -22.42) lower FVC compared with reference temperature (30°C vs 20°C).</p><p><strong>Conclusions: </strong>Short-term exposure to high temperatures over the preceding 7 days was associated with lower lung function in older US adults. Increases in heat exposure warrant interventions to protect older adults.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"13 1","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13560994/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918410","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 experience: correlation of three dyspnoea questionnaires with measures of disease severity and progression in patients with interstitial lung diseases.","authors":"Andres Moran-MacDonald, Sami Alyami, Sharina Aldhaheri, Maxine Kish, Sean Davison, Onofre Moran-Mendoza","doi":"10.1136/bmjresp-2024-002726","DOIUrl":"10.1136/bmjresp-2024-002726","url":null,"abstract":"<p><strong>Background: </strong>Dyspnoea is an important clinical and research outcome in patients with interstitial lung diseases (ILD) and idiopathic pulmonary fibrosis (IPF).We evaluated the correlation of the British Medical Research Council (MRC) dyspnoea scale, University of California, San Diego Shortness of Breath (UCSD) questionnaire and St. George's Respiratory Questionnaire (SGRQ) with measures of disease severity and progression in patients with ILD and IPF.</p><p><strong>Methods: </strong>We applied the three questionnaires to all patients with ILD during initial assessment (baseline visit), at 3-6 months (visit 2) and 9-12 months (visit 3). We used univariate analyses and multiple regression adjusting for age, sex, pulmonary hypertension, ILD diagnosis and forced vital capacity (FVC) to estimate the correlations of questionnaires with pulmonary function tests, 6 min walk test (6MWT) parameters and perceived dyspnoea at baseline visit (disease severity). We assessed the correlation between change (Δ) in dyspnoea questionnaires with change in functional variables between baseline and follow-up visits (progression).</p><p><strong>Results: </strong>We enrolled 151 patients with ILD, 57 of them had IPF. At baseline, all questionnaires significantly correlated with FVC%, total lung capacity (TLC%), carbon monoxide diffusing capacity (DLCO%) and 6MWT metrics. Between visits 1 and 2, MRC-Δ correlated with TLC%-Δ and perceived dyspnoea-Δ and UCSD-Δ with perceived dyspnoea-Δ. Between visits 1 and 3, MRC-Δ correlated with FVC%-Δ and 6MWT distance-Δ; UCSD-Δ correlated with TLC%-Δ . SGRQ-Δ did not correlate with any variables in multivariable analyses.</p><p><strong>Conclusions: </strong>All questionnaires correlated well with ILD/IPF disease severity at baseline but not with disease progression. Improved questionnaires are needed for patients with ILD.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"13 1","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13536161/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148872858","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 pneumonia in adults with chronic cough: a nationwide cohort study.","authors":"Man Young Park, Beom-Joon Lee, Kwan-Il Kim, Jun-Hwan Lee","doi":"10.1136/bmjresp-2025-003484","DOIUrl":"10.1136/bmjresp-2025-003484","url":null,"abstract":"<p><strong>Background: </strong>Chronic cough affects approximately 10% of adults and is increasingly recognised as a distinct clinical condition. This symptom has increasingly been associated with significant outcomes such as pneumonia. Nevertheless, few large long-term population-based studies have been conducted.</p><p><strong>Methods: </strong>This retrospective cohort study was performed using nationwide claims data from the Health Insurance Review and Assessment Service in South Korea from 2013 to 2020. Adult patients who visited outpatient clinics for cough (International Classification of Diseases, 10th Revision: R05) were enrolled. Chronic cough was defined as ≥8 visits or ≥56 days. Patients with pneumonia within 2 years before and 6 months after the index date were excluded. The main outcome was incident pneumonia during the 3 year follow-up period. The association between chronic cough and incident pneumonia was evaluated using Cox proportional hazards models, with HRs adjusted for age, sex, comorbidities and Charlson comorbidity index. Sensitivity analyses and subgroup analyses by sex and age were also performed.</p><p><strong>Results: </strong>Among 385 417 participants (28 706 with chronic cough and 356 711 controls), the incidence of pneumonia was higher in the chronic cough group (18.87 vs 11.32 per 1000 person-years). Chronic cough was independently associated with an elevated risk of pneumonia (adjusted HR 1.13; 95% CI 1.06 to 1.19; p<0.001), and the association was robust across multiple sensitivity analyses with alternative exposures. The subgroup analysis showed a stronger association among men (HR 1.72) than among women (HR 1.39) and among adults aged 40-79 years, with the highest risk observed among adults aged 40-49 years (HR 1.37).</p><p><strong>Conclusions: </strong>Chronic cough was independently associated with increased pneumonia risk, especially in middle-aged and male patients. Clinicians should be aware that chronic cough may signal increased vulnerability to lower respiratory tract infections (eg, pneumonia) and consider preventive strategies, including vaccination and close monitoring, for high-risk individuals.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"13 1","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13536032/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148872891","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":"Randomised controlled trial to assess the safety and efficiency of a self-contained sampling device/disposable bronchoscope system versus usual sampling procedure (RASECAL).","authors":"Suveer Singh, Sanjeet Chana, James Mcentee, Kaladerhan Agbontaen, Andre Athayde, Ben Creagh-Brown, Dilshad Valliani, Jaime Carungcong, Laura Martins, Patricia Costa, Ahmed Al Hindawi, Vimal Grover, David Robert Woods, David Benjamin Antcliffe, Christopher Smart, Hisham Said, Monica Popescu, Benjamin Garfield, Dennis Ong, Matteo Cangialosi, Ricardo Leal, Clare Russell, Victoria Templeman, Alice Sissons, Jagdish Sokhi, Linsey Christie, Roger Davies","doi":"10.1136/bmjresp-2026-004249","DOIUrl":"10.1136/bmjresp-2026-004249","url":null,"abstract":"<p><strong>Background: </strong>Bronchial washing can be inefficient or unsafe due to aerosolisation, poor yield and loss of sample. The setup and connectivity of sampling containers is often challenging. Furthermore, the process of bronchoscopy in the intensive care unit is inadequately reported.We tested whether a novel closed bronchoscopy sampling system is safer and more efficient than the standard sampling technique. We recorded variation in bronchoscopy practice in mechanically ventilated patients.</p><p><strong>Methods: </strong>A multicentre randomised controlled trial saw 188 bronchoscopies performed in mechanically ventilated patients requiring diagnostic sampling. The closed-system Ambu bronchosampler (ABS) was compared to standard sampling containers (SSC) with single-use bronchoscopes (Ambu A4) for primary outcomes of safety (spill, unplanned disconnection) and efficiency (ease of connectivity, setup, loss of sample and % volume retrieved), secondary efficiency outcomes and the tertiary outcomes of the bronchoscopy process.</p><p><strong>Results: </strong>ABS was safer than SSC; spills 0% versus 23.7% (0/94 vs 22/93), p<0.001; unplanned tube disconnections 5.3% vs 21.3% (5/95 vs 20/93), p<0.001; unplanned container disconnections 2.1% vs 7.5% (2/95 vs 7/93), p=0.08. Efficiency was significantly higher in ABS than SSC (acceptable/(very) easy) setup 98.9% vs 82.8% (94/95 vs 77/93), connectivity 100% vs 54.7% (88/88 vs 47/86), upright 98.9% vs 10.8% (94/95 vs 10/93) and sample loss 11.6% vs 48.4% (11/95 vs 45/93), all p<0.001. Volume retrieved percentage unchanged (33.0% vs 35.4%, p>0.2).Bronchoscopy for infection in 80.9%, therapeutic lavage in 51% and infrequently otherwise. Prior imaging in 93.2%, preprocedural checklists/timeouts in 83.5% and post-procedure chest X-rays in 78.2%.Mandatory ventilation was most common peribronchoscopy. Neuromuscular blockade in 73.8% and recruitment manoeuvres in 34.7%. The bronchoscope was not removed intraprocedurally in 80.2% of cases. Positive microbiology was found in 45.7% of samples. Adverse events were rare (<5%).</p><p><strong>Conclusions: </strong>Closed-system bronchoscopic sampling was safer (less spill and unplanned disconnections) and more efficient (setup, connectivity and loss prevention) than standard containers. Closed-system diagnostic sampling devices should be the standard during bronchoscopy.</p><p><strong>Trial registration number: </strong>ClinicalTrials.gov NCT05964075.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"13 1","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13536103/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863583","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":"Therapeutic options for patients with obstructive sleep apnoea: a retrospective review of difficult-to-treat cases in a multidisciplinary approach.","authors":"Oscar Sing Him Ho, Richard Brown, Yakubu Karagama, Aditi Desai, Alanna Hare, Kalpesh Bavisha, Kathy Fan, Johan Meurling, Joerg Sebastian Steier","doi":"10.1136/bmjresp-2026-004233","DOIUrl":"10.1136/bmjresp-2026-004233","url":null,"abstract":"<p><strong>Introduction: </strong>Continuous positive airway pressure (CPAP) is the first-line treatment for obstructive sleep apnoea (OSA) but long-term adherence is limited. This study evaluates the implementation and outcomes of a multidisciplinary team approach to managing CPAP-intolerant patients using alternative therapies.</p><p><strong>Methods: </strong>A retrospective review was conducted on 'difficult-to-treat' OSA cases discussed at multidisciplinary team meetings at the Guy's and St Thomas' NHS Foundation Trust Sleep Disorders Centre (project number 17 160). Patient demographics, comorbidities, OSA severity (Apnoea-Hypopnoea Index (AHI), Epworth Sleepiness Scale (ESS), 3% Oxygen Desaturation Index (ODI)), management plans and outcomes were extracted from meeting minutes and clinical records. Statistical analysis included analysis of variance (ANOVA) to compare baseline characteristics (AHI, age, body mass index (BMI)) across treatment groups and paired t-tests to assess pre-treatment and post-treatment changes in OSA indices (p<0.05).</p><p><strong>Results: </strong>We reviewed a cohort of 138 patients (103/138 male, age 51 (17) years, BMI 29.5 (5.1) kg/m²) with severe OSA (AHI 37.7 (21.4)/hour). Common comorbidities included hypertension (29.0%), anxiety/depression (25.4%), history of previous Otorhinolaryngology (ENT) intervention (17.4%) and cardiac diseases (16.7%). Treatment selection was guided by predefined criteria, including OSA severity, BMI, patient preferences, anatomical abnormalities and comorbidities. Treatment recommendations included mandibular advancement devices (27.5%), hypoglossal nerve stimulation pathway (24.6%), weight management (23.9%), CPAP retrial (13.8%), other ENT surgery (10.9%) and BiPAP/ASV (10.1%). Follow-up data from patients with postintervention data demonstrated significant reductions in AHI (-44.1%, n=29), ESS (-32.9%, n=13) and ODI (-67.2%, n=12) post-treatment (p<0.05).</p><p><strong>Conclusion: </strong>A multidisciplinary approach enables structured delivery of evidence-based treatment selection for patients with OSA who failed first-line therapy. Observed improvements in a subset of patients suggest potential benefit of tailored non-CPAP strategies and super-regional accessibility.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"13 1","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13536113/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148849720","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 between tuberculosis diagnosis delay and respiratory health and well-being among tuberculosis survivors in Cambodia: a prospective cohort study.","authors":"Sothearith Eng, Kiesha Prem, Alvin Kuo Jing Teo, Sovannary Tuot, Chamroen Pall, Sovanvorleak Tep, Siyan Yi, Masao Ichikawa","doi":"10.1136/bmjresp-2026-004413","DOIUrl":"10.1136/bmjresp-2026-004413","url":null,"abstract":"<p><strong>Background: </strong>Although tuberculosis (TB) treatment success rates are high globally, growing evidence indicates that many TB survivors experience persistent respiratory symptoms, impaired quality of life and reduced well-being after treatment completion. Delayed TB diagnosis may exacerbate these long-term consequences by prolonging untreated disease and lung injury. However, longitudinal evidence linking diagnosis delay to longer-term outcomes remains limited. This study examines the association between TB diagnosis delay and respiratory health, quality of life and mental health among TB survivors in Cambodia.</p><p><strong>Methods: </strong>A prospective cohort study of adults with newly diagnosed TB was conducted with a baseline in 2022 and 1 year and 2 year follow-ups. TB diagnosis delay was defined as the time from symptom onset to diagnosis and categorised as short or long using the median (64 days). Outcome variables included respiratory health, quality of life and depressive symptoms, assessed with the St George's Respiratory Questionnaire for Chronic Obstructive Pulmonary Disease (SGRQ-C), WHO Quality of Life-Brief (WHOQOL-BREF) and Centre for Epidemiologic Studies Depression Scale, 10-item version (CES-D-10), respectively. Linear mixed-effects models, adjusted for potential confounders, were applied.</p><p><strong>Results: </strong>Among 712 participants at baseline, the long-delay group had worse respiratory health before treatment completion and over 2 years, with higher SGRQ-C total (β=4.37, 95% CI 1.10 to 7.64), symptom (β=5.83, 95% CI 2.34 to 9.31) and activity scores (β=6.95, 95% CI 2.67 to 11.23) than the short-delay group. Long delay was also associated with poorer psychological (β=-3.17, 95% CI -5.31 to -1.03) and environmental domains (β=-1.74, 95% CI -3.07 to -0.4) of the quality of life but not with its physical and social domains or depressive symptoms. The differences between the groups remained relatively stable over time.</p><p><strong>Conclusions: </strong>TB diagnosis delay may influence recovery beyond treatment success, highlighting the importance of early case detection and integrated post-treatment support in high-burden settings.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"13 1","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13536014/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148849682","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":"A protocol for the rehabilitation of patients undergoing mechanical ventilation from the ICU to the post-hospital phase: the MOVE-ICUtoHOME, a multicentre randomised controlled trial.","authors":"Ada Clarice Gastaldi, Thaís Marina Pires de Campos Biazon, Aníbal Basíle-Filho, Daniele Oliveira Dos Santos, Joana Tambascio, Jéssica Perossi, Janne Marques Silveira, Marcos Gontijo da Silva, Esther Cecilia Wilches-Lunae, Omar Usmani, Anamaria Siriani de Oliveira","doi":"10.1136/bmjresp-2025-004039","DOIUrl":"10.1136/bmjresp-2025-004039","url":null,"abstract":"<p><strong>Introduction: </strong>Intensive care unit-acquired weakness (ICU-AW) in patients with acute respiratory failure requiring invasive mechanical ventilation (IMV) is associated with reduced functional exercise capacity and increased mortality. Early mobilisation in the ICU may improve functional outcomes and reduce length of stay; however, evidence remains limited, protocols are heterogeneous and post-discharge rehabilitation is frequently lacking. This study aims to evaluate the effects of a continuous care programme combining early intensive ICU mobilisation with post-hospitalisation rehabilitation on functional exercise capacity, with inflammation, quality of life, mortality and cost-effectiveness as secondary outcomes in critically ill patients receiving IMV.</p><p><strong>Methods and analysis: </strong>This blinded, multicentre, randomised controlled trial will include adult patients undergoing invasive MV for at least 24 hours. Participants will be randomly allocated to one of four groups: intervention group (IG)-Rehab, control group (CG)-Rehab, IG-Home or CG-Home. During hospitalisation, the IG will receive an intensive mobilisation protocol (30-60 minutes/day), while the CG will receive routine care (up to 10 min/day). After hospital discharge, participants will undergo either 8 weeks of face-to-face rehabilitation (Rehab) or a home-based programme (Home), with follow-up for 6 months. Exploratory analyses will evaluate clinical parameters, severity indices, functional status, pulmonary function and mechanics, additional measures of functional exercise capacity, muscle strength and mass, energy expenditure, and symptoms of anxiety and depression. The 2×2 factorial design will allow for the evaluation of the independent effects of in-hospital mobilisation intensity and post-discharge rehabilitation strategy. Statistical analyses will use appropriate parametric or non-parametric tests, with significance set at p<0.05.</p><p><strong>Ethics and dissemination: </strong>The study will follow the Brazilian National Health Council guidelines, the Brazilian General Data Protection Law and Research Electronic Data Capture standards. Results will be disseminated through peer-reviewed journals, scientific meetings and social media. The trial is registered at ClinicalTrials.gov (NCT06405529; 8 May 2024) and follows Consolidated Standards of Reporting Trials guidelines.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"13 1","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504909/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787991","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 respiratory syncytial virus burden in children under 3 years of age across all care levels in England.","authors":"Emma C Carter, Helen Hill, Carla Solórzano, Lauren Kerruish, Lauren McLellan, James Dodd, Adam B Smith, Andria Joseph, Damian Lewis, Fred Fyles, Simon B Drysdale, Patricia Gonzalez-Dias, Gregory S J Duncan, Kelly Davies, Paula Saunderson, Mathieu Bangert, Rolf Kramer, Natalya Vassilouthis, Maia Lesosky, Shrouk Messahel, Caroline Burchett, Stephen Brearey, Jolanta Bernatoniene, Hayley King, Sudeshna Bhowmik, James Perry, Rebecca Sinfield, Pat Mottram, Raqib Huq, Paul S McNamara, Nadja van Ginneken, David Lewis, Daniela M Ferreira, Andrea M Collins","doi":"10.1136/bmjresp-2025-003996","DOIUrl":"10.1136/bmjresp-2025-003996","url":null,"abstract":"<p><strong>Objectives: </strong>This prospective surveillance study aimed to estimate the burden of laboratory-confirmed respiratory syncytial virus (RSV) in under 3-year-olds in the United Kingdom.</p><p><strong>Setting: </strong>The study was implemented in Merseyside and Bristol, encompassing 11 primary care sites, 5 walk-in centres, 2 secondary care hospitals and 2 tertiary care hospitals.</p><p><strong>Participants: </strong>Children aged under 3 years presenting with lower respiratory tract infection (LRTI) symptoms were included, with a substudy in primary care recruiting children with upper respiratory tract infection (URTI).</p><p><strong>Primary and secondary outcome measures: </strong>The primary outcome of the study was the prevalence of RSV infection in primary, secondary and tertiary healthcare settings. Secondary outcomes included severity outcomes (rates of hospitalisation and high dependency care admissions), risk factors for severe disease, economic burden of disease and coinfection prevalence.</p><p><strong>Results: </strong>2000 children were included in the analysis (410 primary care and 1590 secondary/tertiary care). 318 were included in the URTI substudy. RSV prevalence was 50.0% (95% CI 46.7% to 53.3%) in children admitted to hospital via emergency departments (ED), 36.3% (95% CI 31.7% to 41.0%) in ED discharges, 36.5% (95% CI 24.7% to 49.6%) in primary care (LRTI) and 12.7% (95% CI 8.6% to 17.9%) in primary care URTI. Healthy term-born children accounted for 70.1% of RSV hospitalisations. Risk factors for severe disease included any level of prematurity, age <3 months and congenital cardiac disease. RSV-positive cases incurred a higher mean cost per participant (£1811, 95% CI £1720 to £1903) than RSV-negative cases (£1295, 95% CI £1220 to £1370).</p><p><strong>Conclusions: </strong>The findings revealed a substantial burden associated with RSV. Even moderate prematurity was a risk factor for severe disease, and these children may not benefit from maternal RSV vaccination due to missed late gestation antibody transfer. Furthermore, they would not be eligible for Nirsevimab under UK guidance, which supports consideration of broadening eligibility to include these children.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"13 1","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504892/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787996","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":"Automated identification of interstitial lung abnormalities in lung screening using quantitative CT.","authors":"Niamh Logan, Sujal R Desai, Emily C Bartlett, Richard Hewitt, Peter M George, Anand Devaraj","doi":"10.1136/bmjresp-2025-003974","DOIUrl":"10.1136/bmjresp-2025-003974","url":null,"abstract":"<p><strong>Objectives: </strong>Interstitial lung abnormalities (ILAs) are an important incidental finding in lung screening. Quantitative CT (qCT) offers a promising approach to standardising ILA assessment; however, its adoption into routine clinical practice remains limited, largely due to the need for further clinical validation.</p><p><strong>Setting: </strong>We evaluated the performance of e-Lung (Brainomix), a commercially available qCT tool in assessing ILAs for participants attending a lung cancer screening programme.</p><p><strong>Participants: </strong>All participants invited to attend the West London lung cancer screening pilot programme between 2018 and 2020.</p><p><strong>Primary outcome measures: </strong>To define the optimal qCT biomarker thresholds that identified ILA as defined by expert thoracic radiologists.</p><p><strong>Results: </strong>e-Lung qCT biomarkers had an area under the curve of between 0.82 and 0.88, and between 0.84 and 0.87 for visually quantified ILA extent thresholds of at least 5% and >10%, respectively.</p><p><strong>Conclusion: </strong>e-Lung is a qCT tool with potential utility in the automated identification of ILA in participants undergoing lung screening.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"13 1","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504916/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787975","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 leaks and mask design on CO₂ clearance during non-invasive ventilation: a combined bench and physiological study.","authors":"Nattapat Wongtirawit, Rosie Butterworth, Fernando Vieira, Annia Schreiber, Matthew Ko, Laurent Brochard","doi":"10.1136/bmjresp-2026-004135","DOIUrl":"10.1136/bmjresp-2026-004135","url":null,"abstract":"<p><strong>Background: </strong>Non-invasive ventilation (NIV) interface can generate carbon dioxide (CO₂) rebreathing, potentially contributing to NIV failure. The impact of leaks and mask design remains unclear. This study evaluates how these factors influence CO₂ rebreathing in oronasal face masks.</p><p><strong>Design, settings, participants: </strong>A bench study was followed by a physiological study. The bench study used a mannequin head connected to a breathing simulator exhaling CO₂. Six oronasal face masks designed for single-limb circuits with varying exhalation port positions were tested with three levels of fit. A CO₂ rebreathing index was calculated, along with intentional and unintentional leaks. The best-performing mask was then compared with two clinically used masks in healthy volunteers. Ventilatory ratio (VR, reflecting dead space) was derived from transcutaneous CO₂ (PtcCO₂) and ventilation was assessed by electrical impedance tomography. Analyses used Friedman test and linear mixed-effects model.</p><p><strong>Results: </strong>The bench study showed (1) mask design as a whole, rather than intentional leak flow rate, was the main determinant of CO₂ rebreathing: exhalation ports situated on the mask body had lower CO₂ rebreathing; (2) unintentional leaks decreased CO₂ rebreathing only with poor mask design and (3) a new under-nose mask with nasal nozzles had the lowest CO₂ rebreathing index. The latter was compared with two other masks in ten volunteers, median aged 32 (IQR 29-34): PtcCO₂ decreased from 37.3 (33.7-39.5) mm Hg at baseline to 32.5 (28.9-35.4) with the new mask (p=0.023). VR with the new mask (0.96 (0.93-1.12)) was lower than with the classical masks (1.40 (1.20-1.50) and 1.38 (1.19-1.45); p<0.001 for both).</p><p><strong>Conclusions: </strong>Mask design significantly influences CO₂ rebreathing during NIV, with leaks' effects dependent on exhalation port position. A novel under-nose hybrid mask with embedded nozzles reduces CO₂ rebreathing and dead space when compared with classical masks.</p><p><strong>Trial registration number: </strong>NCT03902639.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"13 1","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504840/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787972","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}