BMJ Open Respiratory Research最新文献

{"title":"Parasternal electromyography in participants with mild or moderate chronic obstructive pulmonary disease in primary care: cohort study to assess technical and clinical application.","authors":"Timothy H Harries, Rebecca D'Cruz, Gill Gilworth, Chris Corrigan, Patrick Murphy, Nicholas Hart, Peter Schofield, Helen F Ashdown, Luke Daines, Patrick T White","doi":"10.1136/bmjresp-2025-003418","DOIUrl":"10.1136/bmjresp-2025-003418","url":null,"abstract":"<p><strong>Background: </strong>Neural respiratory drive (NRD) measurement, reflecting the balance between respiratory muscle load and capacity, is quantified using surface parasternal electromyography (EMG_para). EMG_para tracks recovery from severe exacerbations of chronic obstructive pulmonary disease (COPD). Among stable COPD participants, we hypothesised the existence of a relationship between NRD, breathlessness and airway obstruction.</p><p><strong>Study aims: </strong>(1) assessing the feasibility of measuring EMG_para in COPD participants with forced expiratory volume in 1 s (FEV₁) ≥50% predicted in primary care; (2) investigating relationships between NRD measures, self-reported breathlessness, airflow obstruction severity and health-related quality of life (HRQoL).</p><p><strong>Methods: </strong>Participants with stable mild/moderate COPD, using inhaled corticosteroid (ICS) therapy, were recruited from 20 general practices. Participants were randomly allocated to continue using ICS (maintenance group) or to withdraw ICS (withdrawal group) over 6 weeks. EMG_para, spirometry, self-reported breathlessness (modified Borg dyspnoea scale), COPD Assessment Test and Chronic Respiratory Disease Questionnaire Self-Administered Standardised were measured at baseline, 3- and 6-month follow-up. Bland-Altman plots examined agreement between serial measurements.</p><p><strong>Results: </strong>Forty COPD participants were recruited: age 70±9.2 years; body mass index 26±5.3 kg/m²; FEV₁ 1.74±0.54 L; and FEV₁% pred 69.6±14.0%. High-quality EMG_para data were obtained from 35 participants at baseline and 31 participants on three occasions. High intra-rater and inter-rater agreement for EMG_para (intraclass correlation coefficient >0.9) and moderate correlation between EMG_para and FEV₁% predicted (r=-0.42; p=0.01) were recorded. No correlation was observed between resting EMG_para and breathlessness or HRQoL measures across the three time points.</p><p><strong>Conclusions: </strong>EMG_para measurement is feasible in primary care. In this group of COPD patients, lung function was stable across the three time points and EMG_para was associated with the degree of airflow obstruction. In the resting stable state in mild/moderate disease, there was no association between EMG_para and participant-reported outcomes. Further work should investigate the utility of EMG_para in mild/moderate COPD participants during acute exacerbation and recovery.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"13 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13084930/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147653748","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":"What is the evidence for virtual wards or hospital-at-home care pathways for exacerbations of chronic obstructive pulmonary disease? A systematic review and meta-analysis.","authors":"Bushra Alenazi, Christopher Hatton, Elizabeth Sapey","doi":"10.1136/bmjresp-2025-003611","DOIUrl":"10.1136/bmjresp-2025-003611","url":null,"abstract":"<p><strong>Objectives: </strong>Given increasing interest in admission avoidance, we evaluated the evidence to support virtual wards (VW) and hospital at home (HaH) models of care during exacerbations of chronic obstructive pulmonary disease (ECOPD).</p><p><strong>Design: </strong>A systematic review and meta-analysis. A comprehensive search of MEDLINE (1946 to March 2024), Embase (1974 to March 2024) and CENTRAL (searched 22 March 2024) was conducted. Risk of bias and a random effects meta-analysis were performed.</p><p><strong>Population: </strong>Adults with an ECOPD presenting to the hospital or who require hospital-led care.</p><p><strong>Interventions: </strong>VW: defined as assessments and interventions delivered remotely or HaH (defined as assessments and interventions delivered by healthcare professionals in patient's homes) care pathways, compared with hospital admission.</p><p><strong>Primary and secondary objectives: </strong>Safety (mortality rate of all causes, in-patient, 7 days and 30 days) and readmission rate in 7 and 30 days. Length of stay in hospital and changes in pulmonary function tests.</p><p><strong>Results: </strong>One study assessed VWs (reported in two publications) and 10 assessed HaH. There were no changes in survival or short-term readmission rates attributable to the interventions and no evidence that VW or HaH care pathways reduced the total time a patient spent under hospital-led care, whether at home or in the hospital.</p><p><strong>Conclusions: </strong>More evidence is needed to support the widespread roll-out of HaH and especially VW pathways for ECOPD. PROSPERO REGISTRATION NUMBER: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024517565.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"13 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13084816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147653697","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":"Occupational exposure to toxic particles and risk of pulmonary sarcoidosis: a systematic review and meta-analysis.","authors":"Nada Kotti, Amel Kchaou, Walid Feki, Asma Daoud, Feriel Dhouib, Nehla Rmadi, Wiem Feki, Mouna Snoussi, Rim Kammoun, Faten Omrane, Slim Charfi, Nadia Moussa, Rym Sahnoun, Mounira Hajjaji, Kaouthar Jmal Hammami","doi":"10.1136/bmjresp-2025-003961","DOIUrl":"10.1136/bmjresp-2025-003961","url":null,"abstract":"<p><strong>Introduction: </strong>The onset of sarcoidosis is likely the result of a complex genetic-environment-immunological interaction. This systematic review and meta-analysis aimed to identify occupational toxic particles associated with an increased risk of developing pulmonary sarcoidosis.</p><p><strong>Methods: </strong>Publications in English, published from January 2000 to January 2025, were searched in PubMed, Scopus and JSTOR. The risk of bias was assessed for all included studies. Sensitivity analyses stratified by study quality were conducted to evaluate the robustness of the findings and potential bias. To assess publication bias, a funnel plot was used when more than six studies were included in the analysis.</p><p><strong>Results: </strong>Five categories of toxic particles were identified to be associated with increased risk of the onset of sarcoidosis: chemicals, inorganic dusts, metals, mixed dusts and fumes and organic dusts. The quantitative analysis includes data from 13 studies. The results suggested that occupational silica, pesticides, mould/mildew and World Trade Center ((WTC) dust exposures were associated with increased odds of pulmonary sarcoidosis. Sensitivity analysis confirmed the robustness of the association for WTC dust and mould, whereas the risk associated with silica appeared attenuated in high-quality studies. However, gold exposure was identified as a protective factor.</p><p><strong>Conclusion: </strong>Pulmonary sarcoidosis is associated with occupational silica, pesticides, WTC dust and mould. Future research should prioritise gene-environment interactions and granuloma mineralogy to refine preventive strategies and disease management.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"13 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13084919/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147653758","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 bronchoalveolar lavage cellular analysis and radiological findings in fibrotic interstitial lung diseases.","authors":"Punchalee Kaenmuang, Joseph L Barnett, Toby M Maher, Jennifer K Quint, Alexander Adamson, Zhe Wu, David J F Smith, Bhavin Rawal, Arjun Nair, Simon L F Walsh, Sujal R Desai, Peter M George, Maria Kokosi, Vasilis Kouranos, Elisabetta A Renzoni, Alexandra Rice, Andrew G Nicholson, Felix Chua, Athol U Wells, Philip L Molyneaux, Anand Devaraj, R Gisli Jenkins, Iain D Stewart","doi":"10.1136/bmjresp-2025-003579","DOIUrl":"10.1136/bmjresp-2025-003579","url":null,"abstract":"<p><strong>Background and aims: </strong>Inflammation may play a role in driving interstitial lung diseases (ILD). Radiological ground-glass opacity (GGO) may not reliably distinguish fine intralobular fibrosis from inflammatory processes in fibrotic ILD. We therefore investigated the relationship between GGO, fibrosis and leukocytes in bronchoalveolar lavage (BAL).</p><p><strong>Methods: </strong>We recruited patients with fibrotic ILD at a single centre between May 2014 and February 2018. The extent of GGO and fibrosis was evaluated by two radiologists. Linear regression examined the association between leucocyte numbers in BAL obtained from the right middle lobe and GGO/fibrosis extent in whole lung, adjusting for age, sex and smoking. A Z-test was used to compare the association between BAL and GGO/fibrosis.</p><p><strong>Results: </strong>316 patients were included. Adjusting analyses for covariates, only BAL eosinophil and eosinophil-to-macrophage ratio were positively associated with GGO involvement (0.23 (95% CI 0.03 to 0.42) p=0.023 and 11.21 (95% CI 1.33 to 21.08) p=0.026). Lymphocyte percentages (fibrosis -0.17 vs GGO -0.02 p=0.046); neutrophil percentages (fibrosis 0.38 vs GGO 0.06 p=0.002); neutrophil-to-lymphocyte ratio (fibrosis 0.63 vs GGO -0.05 p=0.027); neutrophil-to-macrophage ratio (fibrosis 14.08 vs GGO 2.57 p=0.015) and neutrophilia (fibrosis 6.81 vs GGO -0.31 p=0.002) all demonstrated a significantly stronger association with fibrosis than GGO.</p><p><strong>Conclusions: </strong>Lack of relationships between radiological GGO and BAL leucocyte counts in fibrotic lung disease indicates that GGO may not always be inflammatory in nature. Higher levels of neutrophils were associated with more extensive fibrosis.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"13 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13084991/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147644093","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":"Understanding the burden of pulmonary arterial hypertension among patients and caregivers through narrative medicine: data from Italian multicentre observational INSPECTIO study.","authors":"Laura Scelsi, Roberto Badagliacca, Marco Vicenzi, Emma Di Poi, Fabiana Baldi, Pietro Ameri, Edoardo Airò, Francesca Bux, Dagna Lorenzo, Livio Giuliani, Gian Piero Perna, Edoardo Bonsante, Carlo D'Agostino, Claudia Raineri, Piergiuseppe Agostoni, Antonietta Cappuccio, Erika Greco, Maria Giulia Marini, Matteo Biancospino, Alessia Uglietti, Stefano De Santis","doi":"10.1136/bmjresp-2025-003377","DOIUrl":"10.1136/bmjresp-2025-003377","url":null,"abstract":"<p><strong>Introduction: </strong>A key challenge in pulmonary arterial hypertension (PAH) research is assessing the specific impact of this condition on health-related quality of life (HRQoL), also considering the patient's subjective experience and caregiving burden. The prospective, observational, multicentre Non-INterventional Study on Pulmonary arterial hypertension patients treated with macitentan and/or selexipag: ExperienCe from an ITalIan cOhort (INSPECTIO) study integrated narratives with patient-reported outcomes (PROs) and clinical data to gain deeper insight into patients' experiences of PAH, also involving caregivers' perspectives.</p><p><strong>Methods: </strong>The study was conducted across 29 Italian hospital-based centres and enrolled adult patients with PAH already on treatment with macitentan and/or selexipag as part of combination therapy. A dedicated narrative collection was carried out within the larger study. Patient and caregiver narratives were collected at enrolment (visit 1; V1) and at 12 months (visit 3; V3), then analysed through MAXQDA software and correlated with emPHasis-10 questionnaire scores and clinical data.</p><p><strong>Results: </strong>Out of the 186 patients enrolled in the overall INSPECTIO study, 96/186 (52%) completed the narrative at V1 and 58/186 (31%) at V3; 29/54 (54%) caregivers completed the narrative at V1 and 16/54 (30%) at V3. The analysis revealed an alignment between patient narratives and emPHasis-10 scores. Specifically, at V3, emPHasis-10 scores were higher for patients who did not mention their domestic life in narratives, reported feelings of shame or isolation, limitations or breathlessness also in daily activities and reported ongoing treatment-related issues. Nonetheless, at V3, 36/58 (62%) of patients described living with PAH as manageable. The care pathway showed a positive impact on caregivers: their narratives indicated a shift from V1 to V3, with improved perceptions of the care relationship and PAH therapies.</p><p><strong>Conclusion: </strong>INSPECTIO is the first study to integrate narratives, PROs and clinical data in PAH research. Findings suggested that appropriate support and therapeutic management are crucial to help patients cope with the condition. Narratives have proven to be a valuable tool for understanding the impact of PAH and improving its management, providing insights that can inform a more patient-centred approach.</p><p><strong>Trial registration number: </strong>NCT04567602.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"13 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13084868/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147644148","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":"Mortality and diagnostic practice variation in interstitial lung disease admissions: insights from a multicentre UK cohort study.","authors":"Laura Jane White, Jonathon Shaw, Bethan Powell, Nyan M Kyi, Alicia Sou, Gareth Edward Hughes, Dilanka Tilakaratne, Conal Hayton, Trishala Raj, Vi Truong, Nashwah Ismail, Nawat Khanijoun, Rebecca Huang, Emma Hardy, Zainab Aslam, Mahum Sohail, Mahzaib Babar, Amsal Amjad, Naayaab Khan, Martin Regan, Oby Okpala, Ragavilasini Suresh, Jerome Mcintosh, Amy Gadoud, Timothy Gatheral, Georges Ng Man Kwong","doi":"10.1136/bmjresp-2025-004017","DOIUrl":"10.1136/bmjresp-2025-004017","url":null,"abstract":"<p><strong>Background: </strong>Interstitial lung diseases (ILDs) are a heterogeneous group of often progressive, unpredictable diseases. They frequently result in hospitalisations secondary to respiratory decompensation, termed ILD-related admissions. A proportion are due to an acute exacerbation of ILD (AEILD). All are associated with high mortality but are poorly characterised in real-world populations.</p><p><strong>Aim: </strong>To evaluate mortality outcomes and associated risk factors following ILD-related hospital admissions, including AEILD.</p><p><strong>Methods: </strong>We conducted a multicentre retrospective cohort study of primary International Classification of Diseases Version 10 coded admissions for ILD between 1 January 2017 and 31 December 2019 across 11 NHS hospitals in the North West of England. AEILD events were classified using clinical criteria: <30-day respiratory deterioration not secondary to cardiac failure, pulmonary embolism or pneumothorax. The AEILD subgroup was divided into those with CT confirmation (definite AEILD) and without CT confirmation (suspected AEILD). Primary outcome was time from admission to death. Statistical analyses included Kaplan-Meier and multivariate proportional hazards modelling.</p><p><strong>Results: </strong>Of 938 ILD-related admissions, 54.5% met study AEILD criteria. Overall, cumulative all-cause mortality to 90-days post-discharge was 40.2%. For the AEILD cohort, cumulative all-cause mortality to 90-days post-discharge was 47.6%. Median survival of the AEILD cohort was 107 days (95% CI 87.0 to 141.0 days) and the other ILD-related admission cohort 241.0 days (95% CI 208.0 to 308.0 days), with a statistically significant difference in survival (p<0.0001). 37.6% (192/511) of AEILD events had CT confirmation. Within the AEILD subgroup, median survival was higher in the CT group (144 days vs 100 days, p=0.027). AEILD was independently associated with mortality in a multivariate model. Preadmission oxygen, age and neutrophilia were associated with mortality in both ILD-admission and AEILD 90-day all-cause mortality models. 13.9% of admissions had documented palliative care input.</p><p><strong>Conclusions: </strong>Mortality associated with ILD-related admissions is high, with AEILD events independently associated with mortality. Findings highlight the need for improved education, access to palliative care and targeted AEILD research.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"13 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13052612/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147615864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations between respiratory diseases and lung cancer risk: a secondary analysis of the large-scale prospective UK biobank cohort.","authors":"Qiu Zhong, Yi Feng, Xiangyuan Zheng, Ying Deng, Juan He, Jianfu Li, Xinyi Wu, Zixun Wang, Runchen Wang, Ruixiang Sun, Xuanzhuang Lu, Jianxing He, Bo Cheng, Wenhua Liang","doi":"10.1136/bmjresp-2025-003571","DOIUrl":"10.1136/bmjresp-2025-003571","url":null,"abstract":"<p><strong>Introduction: </strong>Respiratory diseases are significant risk factors for lung cancer; however, the association between acute respiratory infections and lung cancer incidence requires further exploration.</p><p><strong>Methods: </strong>We performed a secondary analysis of the prospective UK Biobank cohort, including participants aged 37-73 years recruited from 22 assessment centres across the UK between 2006 and 2010. Cox proportional hazards models estimated HRs for incident lung cancer according to respiratory disease status, which was defined based on linked hospital inpatient records. Mediation analysis explored potential biomarkers, and Mendelian randomisation assessed causal relationships.</p><p><strong>Results: </strong>During a mean follow-up of 10.44 years (4 790 738 person-years), 2189 participants developed lung cancer. Among 107 007 individuals with respiratory diseases, 1322 cases occurred (incidence rate 27.6 per 10 000 person-years), compared with 867 cases among 351 876 participants without respiratory diseases (7.9 per 10 000 person-years). Overall, respiratory diseases were associated with increased lung cancer risk (HR 2.97, 95% CI 2.75 to 3.21). Acute respiratory infections, including acute nasopharyngitis (HR 3.41; 95% CI 1.83 to 6.34), influenza (HR 3.90; 95% CI 2.53 to 6.01), viral pneumonia (HR 9.86; 95% CI 6.55 to 14.85) and bacterial pneumonia (HR 6.28; 95% CI 4.40 to 8.96), showed strong associations with lung cancer incidence. In subtype analyses, squamous cell carcinoma exhibited the highest risk elevation (HR 3.65; 95% CI 3.06 to 4.36). Mediation analysis indicated that neutrophil counts partially mediated these associations (proportion mediated up to 8%).</p><p><strong>Conclusion: </strong>Acute respiratory infections were associated with higher lung cancer incidence, providing hypothesis-generating evidence that may inform future risk stratification research.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"13 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13052546/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147615851","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":"Relationship between serum cystatin C and long-term mortality in patients with self-reported COPD: evidence from two large population-based surveys.","authors":"Zhishen Ruan, Beibei Wang, Bo Xu, Dan Li, Yuchen Wei, Jinli Kong, Sheng Cao, Bo Bian, Qing Miao","doi":"10.1136/bmjresp-2025-003354","DOIUrl":"10.1136/bmjresp-2025-003354","url":null,"abstract":"<p><strong>Introduction: </strong>Serum cystatin C (Cys-C) is an indicator of ageing, and its connection with the long-term prognosis in patients with chronic obstructive pulmonary disease (COPD) is poorly understood. We aimed to examine the association between Cys-C levels and long-term mortality in patients with COPD.</p><p><strong>Methods: </strong>This cohort study used data from the China Health and Retirement Longitudinal Study (CHARLS) and the National Health and Nutrition Examination Survey (NHANES). We included patients with COPD with Cys-C data from 2011 in CHARLS and 1999-2004 in NHANES. We analysed the association between Cys-C and long-term mortality in COPD using multivariate logistic regression and Cox regression. Multiple models were adjusted to reduce potential bias. Fitted curves were used to analyse the dose-response relationship between Cys-C and long-term mortality. Receiver operating characteristic (ROC) curve and subgroup analyses were also performed.</p><p><strong>Results: </strong>1030 patients with COPD from two cohorts were included in our study. When grouped by Cys-C quartiles, the high Cys-C Q4 group was older and had higher proportions of males and a higher mortality rate. Regression analysis showed a positive association between Cys-C and long-term mortality in COPD after adjusting for covariates (CHARLS: OR=3.34, 95% CI 1.51 to 7.38, p=0.003; NHANES: HR=1.35, 95% CI 1.02 to 1.75, p=0.033). Analysing the data in a categorical fashion using quartiles, the Q4 group (CHARLS: OR=2.80, 95% CI 1.07 to 7.33, p=0.036; NHANES: HR=2.12, 95% CI 1.08 to 4.19, p=0.030) had a higher mortality rate compared with the Q1 group. The area under the curve for ROC was 73.7% (CHARLS) and 73.3% (NHANES). The results of subgroup analyses showed an interaction of sex in Cys-C and COPD mortality (p for interaction=0.035 in CHARLS and 0.042 in NHANES), with a more pronounced effect on females.</p><p><strong>Conclusions: </strong>Our study found that high Cys-C was related to increased long-term mortality in patients with COPD. This association appears more pronounced in females.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"13 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13052728/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147615880","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":"Measurement of lung clearance index (LCI_2.5) by nitrogen multiple breath washout (N₂-MBW) is feasible and well‍-‍tolerated by adults and children with cystic fibrosis.","authors":"Don S Urquhart, Emily J Taylor, Debbie Miller, Donna Bowens, Ellen Lacey, Mary Abkir, Clare J Saunders, Steve Cunningham, Zoe Louise Saynor","doi":"10.1136/bmjresp-2025-003905","DOIUrl":"10.1136/bmjresp-2025-003905","url":null,"abstract":"<p><strong>Background: </strong>Lung clearance index (LCI_2.5), measured by nitrogen-multiple breath washout (N₂-MBW), is a sensitive measure of ventilatory inhomogeneity that can be performed awake/unsedated from aged 3 years. However, concerns have been raised about the feasibility of LCI_2.5 measurement by N₂-MBW in adults with cystic fibrosis (CF), especially those with advanced lung disease, due to prolonged test durations. We assessed the feasibility, technical acceptability and patient perception of N₂-MBW in adults and children/adolescents with CF within the exercise as an airway clearance technique-CF feasibility trial.</p><p><strong>Methods: </strong>N₂-MBW (Exhalyzer-D, EcoMedics, Switzerland) was performed on two separate occasions, by multidisciplinary trial staff. Data were centrally over-read (European Cystic Fibrosis Society LCI Core Facility). Outcomes included the proportion of technically acceptable tests, numbers of trials per test, times per trial and total time to perform N₂-MBW. Comparisons were made according to age group and forced expiratory volume in 1 s (FEV₁) category (<u>></u>70% vs <70% predicted). Participants also completed a questionnaire assessing acceptability and willingness to repeat testing.</p><p><strong>Results: </strong>49 participants (21 female; age: 10-55 years, FEV₁: 38%-113% predicted) completed N₂-MBW. Median (IQR) test durations were similar for adults (42 (27-55) min) and children (37 (26-44) min) with CF. Technically acceptable LCI_2.5 results were obtained for 90/94 (95.8%) tests. Most participants rated the test easy to perform (87%) and comfortable (93%), with none reporting unwillingness to repeat N₂-MBW testing.</p><p><strong>Conclusions: </strong>N₂-MBW testing is feasible, technically acceptable and well-tolerated in people with CF across a wide age and disease severity spectrum. With appropriate standardised training and over-reading, LCI_2.5 represents a robust outcome measure for consideration in CF clinical trials.</p><p><strong>Trial registration number: </strong>NCT05482048.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"13 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13052781/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147615935","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":"Implementing shorter all-oral treatment durations for multidrug-resistant tuberculosis in the UK: from concept to application.","authors":"Aneeka Chavda, Mark Gilchrist, Toby Capstick, Christabelle Chen, Onn Min Kon","doi":"10.1136/bmjresp-2025-003861","DOIUrl":"10.1136/bmjresp-2025-003861","url":null,"abstract":"<p><p>Multidrug-resistant tuberculosis (MDR-TB) is a global public health threat associated with high mortality and challenging treatment regimens. The UK, like many countries, faces a growing incidence of MDR-TB, with 105 (1.9% of all notified cases) treated as MDR-resistant or rifampicin-resistant TB in 2024. Recent clinical trials have demonstrated the efficacy and safety of shorter, all-oral regimens such as BPaLM (bedaquiline, pretomanid, linezolid, moxifloxacin), yet their implementation in the UK presents unique challenges, particularly around the antimicrobial stewardship (AMS) agenda, such as the lack of licensed drugs, pharmacokinetic/dynamic concerns, fragile supply chains and high cost of second-line antituberculosis drugs. This narrative review outlines how the UK has addressed implementation hurdles through coordinated efforts by the British Thoracic Society MDR-TB Clinical Advice Service and National Health Service England. This collaboration has facilitated the adoption of new regimens, with 54 out of 60 requests for using pretomanid-containing regimens approved in the UK up to January 2026. Furthermore, resources like the TB Drug Monographs and the shift to video-observed therapy have streamlined care delivery. The UK has effectively navigated the transition to shorter, all-oral MDR-TB regimens, significantly enhancing patient care and operational efficiency. The integration of clinical guidance, AMS principles, policy reform and specialised monitoring tools provides a robust framework for managing evolving treatment landscapes and delivering patient-centred care.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"13 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13052542/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147608059","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}