BMJ Open Respiratory Research最新文献

{"title":"Daily SARS-CoV-2 testing after travel-related close contact notifications during elite sporting events hosted in the UK: a longitudinal study.","authors":"Madeleine Davies, Jerry Hill, Luke Goggins, Nicholas Peirce, Jenifer Smith, Matthew Boulter, Tom Alan Fowler, Iain Buchan, James D F Calder","doi":"10.1136/bmjresp-2023-001912","DOIUrl":"10.1136/bmjresp-2023-001912","url":null,"abstract":"<p><p>Isolation requirements for COVID-19 close contacts risked discouraging elite athletes and support staff from travelling to international sports events hosted in the UK during 2021.</p><p><strong>Objectives: </strong>The purpose of this study, in collaboration with the UK Health Security Agency, was to develop and implement a risk assessment and workplace daily testing approach in elite sporting events, for individuals who would otherwise be excluded by quarantine.</p><p><strong>Methods: </strong>Longitudinal study of athletes and staff identified as close contacts during travel (ie, flights, train) to specific international sports events. A risk assessment was undertaken, and participants were categorised as at 'low' or 'high' risk of developing SARS-CoV-2 based on their exposure circumstances. High-risk individuals remained in 10-day isolation, whereas those of low risk underwent daily symptom and lateral flow testing, enhanced workplace mitigation and selected work activities were permitted.</p><p><strong>Results: </strong>Of 29 514 event personnel, 202 travel-related close contacts were reported to the study team, of which 126 were eligible from 40 events in 7 sports. Of the individuals assessed, 105 (83.3%) were classified as low risk, while 21 (16.7%) were classified as high risk. No low-risk individuals tested positive in over 280 rapid antigen tests.</p><p><strong>Conclusion: </strong>International sports events rely on athlete and support staff availability, with economic consequences of event cancellation or postponement. Our study showed no detection of SARS-CoV-2 in low-risk close contacts, and enabled their sustained participation. This multidisciplinary intervention appears to have been effective, enabling large-scale event continuation, while minimising risk to athletes, employees and the wider public.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11822419/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143405673","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":"Psychosocial and mental health in cystic fibrosis in the modern era of care: time to evolve.","authors":"Maggie Harrigan, Anna M Georgiopoulos, Alexandra L Quittner, Beth Smith, Tonia A Douglas","doi":"10.1136/bmjresp-2024-002606","DOIUrl":"10.1136/bmjresp-2024-002606","url":null,"abstract":"<p><p>Cystic fibrosis (CF) treatment has revolutionised care over the past three decades with major advances in survival. Despite these advances, CF continues to create psychological and social challenges for people with CF (PWCF) throughout their life and is associated with worse health outcomes and higher healthcare costs. Anxiety and depression screening and management protocols are widely implemented within CF care; however, a much broader scope of psychosocial challenges exist which lack a standardised screening and management approach. The advent of CF transmembrane conductance regulator modulator therapies is transforming the psychosocial landscape for PWCF with new challenges and evolving psychosocial needs. What it means to have CF, the expectations, hopes and stressors are rapidly changing, and psychosocial care must keep pace if health outcomes are to be fully optimised. A symposium of international CF and psychosocial experts was convened in November 2022 to explore current and emerging issues in psychosocial health and identify opportunities and approaches to optimise psychosocial care. This state-of-the-art review summarises key symposium proceedings and highlights priorities for clinical practice and research in psychosocial health across the lifespan among PWCF. It also summarises state-of-the-art initiatives for screening and intervention to optimise CF psychosocial healthcare and patient outcomes.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11815457/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143389998","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":"Radiological abnormalities persist following COVID-19 and correlate with impaired health-related quality of life: a prospective cohort study of hospitalised patients.","authors":"Robert Sykes, Andrew J Morrow, Kenneth Mangion, Alex McConnachie, Alasdair McIntosh, Giles Roditi, Liam Peng, Claire Rooney, Kathryn Scott, David Barrie Stobo, Colin Berry, Colin Church, Hannah Bayes","doi":"10.1136/bmjresp-2023-001985","DOIUrl":"10.1136/bmjresp-2023-001985","url":null,"abstract":"<p><strong>Background: </strong>The radiological trajectory of post-COVID-19 is uncertain. We present a prospective, observational, multicentre cohort study using multimodality imaging to describe the pulmonary sequelae of patients hospitalised with COVID-19, predictors of persistent abnormal radiology and implications on health status.</p><p><strong>Methods: </strong>In survivors of COVID-19, we performed convalescent CT pulmonary angiogram and high-resolution CT imaging as part of the CISCO-19 study (ClinicalTrials.gov ID NCT04403607). This included serial blood biomarkers and patient-reported outcomes 28-60 days following discharge from hospital.</p><p><strong>Results: </strong>Of the COVID-19 cohort, 88 (56%) patients of the COVID-19 cohort (n = 159; mean age, 55 years; 43% female) had persisting radiological abnormalities at 28-60 days postdischarge. This included ground-glass opacification (45%), reticulation/architectural distortion (30%) or mixed pattern (19%). These features were very infrequent among a group of age-matched, sex-matched and cardiovascular risk factor-matched controls (n=29). The majority of COVID-19 cohort (68%) had less than 20% persisting radiological abnormalities, with 67% demonstrating overall improvement compared with admission imaging. Older age, premorbid performance status, typical acute COVID-19 radiological features, markers of severe acute COVID-19, convalescent ICAM-1 and P-selectin were associated with persisting lung abnormalities (all p<0.05). Patients with persisting abnormalities were shown to have lower levels of physical activity and predicted maximal oxygen utilisation (derived VO₂) (both p<0.05). Higher percentage of abnormal lung parenchyma was associated with lower patient-assessed quality of life (EQ-5D-5L) score (p=0.03).</p><p><strong>Conclusions: </strong>Persistent radiological abnormalities post-COVID-19 were common at 28-60 days postdischarge from hospital, although most improved. Patients with persisting radiological abnormalities 28-60 days postdischarge are at risk of persisting health impairment in the longer term and represent a population for targeted intervention.</p><p><strong>Trial registration number: </strong>NCT04403607.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11815400/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143390009","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":"Effects of biologic therapy on novel indices of lung inhomogeneity in patients with severe type-2 high asthma.","authors":"Asma Alamoudi, Lorenzo Petralia, Nicholas M J Smith, Haopeng Xu, Dominic Sandhu, Graham Richmond, Nick P Talbot, Grant Ad Ritchie, Ian Pavord, Peter A Robbins, Nayia Petousi","doi":"10.1136/bmjresp-2024-002721","DOIUrl":"10.1136/bmjresp-2024-002721","url":null,"abstract":"<p><strong>Introduction/aim: </strong>Lung inhomogeneity measures obtained using computed cardiopulmonography (CCP) are sensitive to small-airways disease. Here, we assessed changes in lung inhomogeneity in patients with type-2 high asthma treated with biological therapy and explored the relationship between inhomogeneity measures and conventional asthma disease markers.</p><p><strong>Methods: </strong>This was an observational study of 91 severe type-2 high asthma patients recruited from a tertiary asthma clinic, of whom 67 subsequently started anti-IL5 or anti-IL5R biologics. Patients were evaluated at baseline and, 54 of those commencing biologics, at their fourth injection with either mepolizumab or benralizumab. Assessments included prebronchodilator and postbronchodilator CCP and spirometry, and measurements of blood eosinophil count (BEC), fractional exhaled nitric oxide and Asthma-Symptom Questionnaire (ACQ-5).</p><p><strong>Results: </strong>Bronchodilation significantly reduced σlnCl, a novel CCP-derived ventilation inhomogeneity index, (ΔσlnCl -0.08, 95% CI (-0.10 to -0.05), p<0.001). Baseline σlnCl, but not forced expiratory volume in 1 s (FEV₁) % predicted, was significantly associated with BEC (linear mixed-effects (LME) regression coefficient for BEC 0.18, 95% CI (0.04, 0.32), p=0.01). Following biologics, improvements in σlnCl were significantly dependent on BEC (LME regression coefficient +0.19, 95% CI (0.11, 0.27), p<0.001) whereas improvements in FEV₁ % predicted related to both BEC and ACQ-5 responses (LME coefficients: BEC -10.8 % pred, 95% CI (-16.1,-5.5); ACQ-5 -3.5 % pred, 95% CI (-5.1 to -1.9), p<0.001). Following biologics, the change in σlnCl followed a bimodal distribution that dichotomised patients into σlnCl-Responders and σlnCl-Non-Responders. Responders, unlike Non-Responders, experienced significant improvements in symptoms and FEV₁ % predicted (Δ pre-BD FEV₁15±15% pred, p<0.001) and included a higher proportion of patients in clinical remission at 1 year.</p><p><strong>Conclusion: </strong>σlnCl is strongly associated with systemic eosinophilic inflammation in severe type-2 high asthma. An early σlnCl response following anti-IL5 biologics identifies patients more likely to experience improvements in symptoms and lung function when systemic eosinophils are depleted. σlnCl may provide a sensitive route for tracking inflammation involving the small airways.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11808925/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143373761","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":"Uptake and 4-week outcomes of an 'opt-out' smoking cessation referral strategy in a London-based lung cancer screening setting.","authors":"Amyn Bhamani, Evangelos Katsampouris, Fanta Bojang, Priyam Verghese, Andrew Creamer, Ruth Prendecki, Chuen R Khaw, Jennifer L Dickson, Carolyn Horst, Sophie Tisi, Helen Hall, John McCabe, Kylie Gyertson, Anne-Marie Hacker, Laura Farrelly, Neal Navani, Allan Hackshaw, Samuel M Janes, Samantha L Quaife","doi":"10.1136/bmjresp-2024-002337","DOIUrl":"10.1136/bmjresp-2024-002337","url":null,"abstract":"<p><strong>Introduction: </strong>Lung cancer screening (LCS) enables the delivery of smoking cessation interventions to a population experiencing long-term tobacco dependence, but the optimal delivery method remains unclear. Here, we report uptake and short-term outcomes of an 'opt-out' smoking cessation referral strategy in an LCS cohort.</p><p><strong>Methods: </strong>Individuals currently smoking tobacco who attended a face-to-face lung health check in the SUMMIT study (NCT03934866) were offered very brief advice on smoking cessation and where possible, an 'opt-out' referral to their local stop smoking service (SSS). Aggregate data on referral outcomes were obtained from each SSS individually.</p><p><strong>Results: </strong>33.7% (n=2090/6203) of individuals currently smoking tobacco consented to a practitioner-made 'opt-out' smoking cessation referral. 42.7% (n=893/2090) of these individuals resided in boroughs where SSS were not present or required self-referral. Males (adjusted OR (aOR) 1.16), younger individuals (55-59: aOR 1.70, 60-64: aOR 1.71 and 65-69: aOR 1.78) and those of ethnic minority backgrounds (Asian: aOR 1.31, Black: aOR 1.71 and Mixed: aOR 1.72) were more likely to consent, while individuals from the most deprived socioeconomic quintile were less likely to do so (aOR 0.65).High level of motivation to quit within a defined time frame (aOR 1.92), previous quit attempts in the past 12 months (1-4: aOR 1.65 and ≥5: aOR 1.54) and time to first cigarette of ≤60 min (<5: aOR 2.07, 6-30: aOR 1.55 and 31-60: aOR 1.56) were measures of tobacco dependence associated with a higher likelihood of providing consent.Outcomes were available for 742 referrals. An appointment with the service was accepted by 47.3% (n=351/742) of individuals, following which 65.5% (n=230/351) set a quit date. The 4-week quit rate among those setting a quit date and all individuals referred was 57.4% (n=132/230) and 17.8% (n=132/742), respectively.</p><p><strong>Conclusion: </strong>A proactive, 'opt-out' smoking cessation referral strategy for individuals currently smoking tobacco who interact with an LCS programme may be beneficial.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11804203/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Qualitative study of patients experiences and perceptions of stepping down asthma medication in primary care across England.","authors":"Chloe I Bloom, Jack Middleton, Adam Lewis","doi":"10.1136/bmjresp-2024-002898","DOIUrl":"10.1136/bmjresp-2024-002898","url":null,"abstract":"<p><strong>Background: </strong>Guidelines recommend that asthma medication should be stepped down to the minimally effective dose that achieves symptom control. Stepping down aims to prevent adverse medication effects and unnecessary costs but is often not implemented in primary care, where most patients with asthma are managed. Little is known about the experiences and views of patients regarding stepping down.</p><p><strong>Methods: </strong>Patients with stable asthma, with regular use of a preventer inhaler, from general practitioner practices across England, participated in a survey and/or semi-structured interview. Questions explored the patient's understanding of their asthma, views and knowledge of preventer inhalers, experiences and perceptions of stepping down asthma medication. Qualitative group-based multidisciplinary thematic analysis by two healthcare professionals and a patient were performed.</p><p><strong>Results: </strong>143 patients responded to the survey, 63% were female, between the ages 18-80 years and including geographical areas across the UK, 17 of whom participated in an interview. Half of these patients with stable asthma, most with asthma for more than 10 years, had never had a discussion regarding stepping down asthma medication. Most stepping down that had occurred was related to seasonal changes in asthma control. Four overarching themes from the interviews were identified, (1) experiences of living with asthma and needing inhalers, (2) insufficient education regarding preventer inhalers, (3) stepping down is agreeable and possible and (4) current asthma care is suboptimal.</p><p><strong>Conclusion: </strong>Patients with stable asthma were able to self-manage their asthma well. They had little awareness of medication adverse effects and minimal experience of having their medication stepped down by a healthcare professional. Most were inclined to step down, if clinically safe to do so, indeed some had reduced their medication doses themselves, without professional guidance.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11795401/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk of long covid in patients with pre-existing chronic respiratory diseases: a systematic review and meta-analysis.","authors":"Paul Terry, R Eric Heidel, Alexandria Q Wilson, Rajiv Dhand","doi":"10.1136/bmjresp-2024-002528","DOIUrl":"10.1136/bmjresp-2024-002528","url":null,"abstract":"<p><strong>Background: </strong>An estimated 10-30% of people with COVID-19 experience debilitating long-term symptoms or long covid. Underlying health conditions associated with chronic inflammation may increase the risk of long covid.</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis to examine whether long covid risk was altered by pre-existing asthma or chronic obstructive pulmonary disease (COPD) in adults. We identified studies by searching the PubMed and Embase databases from inception to 13 September 2024. We excluded studies that focused on children or defined long covid only in terms of respiratory symptoms. We used random-effects, restricted maximum likelihood models to analyse data pooled from 51 studies, which included 43 analyses of asthma and 30 analyses of COPD. The risk of bias was assessed using a ROBINS-E table.</p><p><strong>Results: </strong>We found 41% increased odds of long covid with pre-existing asthma (95% CI 1.29 to 1.54); pre-existing COPD was associated with 32% increased odds (95% CI 1.16 to 1.51). Pre-existing asthma, but not COPD, was associated with increased odds of long covid-associated fatigue. We observed heterogeneity in the results of studies of asthma related to hospitalisation status. Potential confounding and inconsistent measurement of exposure and outcome variables were among the identified limitations.</p><p><strong>Conclusions: </strong>Our findings support the hypothesis that pre-existing asthma and COPD increase the risk of long covid, including chronic fatigue outcomes in patients with asthma. Because COVID-19 targets the respiratory tract, these inflammatory conditions of the lower respiratory tract could provide mechanistic clues to a common pathway for the development of long-term sequelae in patients with long covid.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11784193/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Qualitative study exploring the views and perceptions of parents/carers of young children with CF regarding the introduction of CFTR modulator therapy (The REVEAL study; PaRents pErspectiVEs of KAftrio in chiLdren aged 2-5).","authors":"Sioned Haf Davies, Faye Wade, Heather Fogg, Adam Walsh, Kevin W Southern","doi":"10.1136/bmjresp-2024-002522","DOIUrl":"10.1136/bmjresp-2024-002522","url":null,"abstract":"<p><strong>Background: </strong>Cystic fibrosis (CF) is associated with a historically high treatment burden which causes anxiety and exhaustion for parents of children with CF, especially in the early years of a child's life. Recently, a new medication, elexacaftor/tezacaftor/ivacaftor (ETI), has become available to some people with CF, which has had a significant impact on the quality of life of older children and adults. This medication will soon be available for children ages 2-5 in the UK. This study investigated parents' perspectives before their children could start ETI.</p><p><strong>Method: </strong>10 parents of young children with CF participated in semistructured online focus groups. The data were analysed using thematic analysis to identify key themes.</p><p><strong>Results: </strong>Three reviewers identified four main themes: (1) The 'roller coaster' of parental emotions: Shock, hope, uncertainty and anticipation, (2) The dark side of the unknown, side effects and burden of decision making, (3) The value of simple pleasures in a life with CF; treatment burden, normality, future, family life and (4) Reforming clinical care in the new era of CF care; support, communication and the future.</p><p><strong>Conclusion: </strong>Parents experience a range of emotions from the day of diagnosis. While ETI brings hope and positivity, parents are concerned about the medication's safety. Parents have clear hopes and wishes for their child's future and reflect on the need for clinicians to consider reforming clinical care in the new era of CF for those eligible for new therapies.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11784110/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Twelve barriers to COPD diagnosis in France: a comparative qualitative study.","authors":"Guillaume Roucoux, Elisabetta Scanferla, Mathieu Delorme, Laurie Fraticelli, Lize Kiakouama Maleka, Cécilia Nocent-Ejnaini, Annaig Ozier, Maxime Patout, Olivier Le Rouzic, Maéva Zysman","doi":"10.1136/bmjresp-2024-002708","DOIUrl":"10.1136/bmjresp-2024-002708","url":null,"abstract":"<p><strong>Background: </strong>Chronic obstructive pulmonary disease (COPD) is a common treatable disease often diagnosed in patients with risk factors after a prolonged period with suggestive symptoms. Our qualitative study aimed to identify barriers to establishing diagnosis in the natural history of this condition.</p><p><strong>Methods: </strong>An inductive thematic analysis was performed on structured interviews with patients, general practitioners (GPs) and pulmonologists in France. Inclusion depended on criteria to generate two purposive samples (patients and physicians). Recruitment occurred online. Data collection proceeded until 15 patients and 15 physicians (eight pulmonologists, seven GPs) were interviewed. Data saturation was checked and achieved. The interviews were transcribed and coded in NVivo and triangulated between two researchers. The article respects the consolidated criteria for reporting qualitative research guidelines.</p><p><strong>Results: </strong>Three phases in the patients' clinical pathway to diagnosis and 12 barriers were found: Phase 1 (symptoms before consultation; n=4), lack of COPD knowledge, symptom denial, fear of lung cancer, and delayed general practice consultations; Phase 2 (primary care; n=3), letting bronchitis become chronic, priority to diseases with similar symptoms and/or more serious diseases, lack of COPD screening devices, time and curative treatments; Phase 3 (specialised medicine; n=5), treatment before diagnosis, late referral to pulmonologists, difficulty in accessing specialists and examination results, patient's reluctance to undergo further examinations, and need for additional tests to confirm a diagnosis.</p><p><strong>Conclusion: </strong>People unaware of their COPD condition can encounter up to 12 barriers, which may combine before obtaining a formal diagnosis. Patients, GPs, pulmonologists and the state health authorities share responsibility for addressing these barriers and enhancing the care pathway.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11759880/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143021580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retrospective cross-sectional study on bronchiectasis in adult Aboriginal Australians: disease characteristics and comparison with ethnically diverse global bronchiectasis registry cohorts.","authors":"Subash Heraganahally, Claire Gibbs, Shiidheshwar J Ravichandran, Davaadorj Erdenebayar, Winnie Chen, Asanga Abeyaratne, Hubertus Jersmann, Lata Jayaram, Timothy Howarth","doi":"10.1136/bmjresp-2023-002139","DOIUrl":"10.1136/bmjresp-2023-002139","url":null,"abstract":"<p><strong>Background: </strong>Globally, adult Indigenous people, including Aboriginal Australians, have a high burden of chronic respiratory disorders, and bronchiectasis is no exception. However, literature detailing bronchiectasis disease characteristics among adult Indigenous people is sparse. This study assessed the clinical profile of bronchiectasis among adult Aboriginal Australians and compared against previously published international bronchiectasis registry reports.</p><p><strong>Methods: </strong>Aboriginal Australians aged >18 years with chest CT confirmed bronchiectasis between 2011 and 2020 in the Top End Northern Territory of Australia were included. Demographics, chest CT findings, pulmonary function results, sputum microbiology, coexistent medical comorbidities, and pharmacotherapy use were assessed and compared against five published international bronchiectasis registry reports (Australian (ABR), European (European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC)-Europe), Indian (EMBARC-India), Korean (KMBARC) and the USA (USBRR)).</p><p><strong>Results: </strong>A total of 459 patients were assessed. In comparison with international and non-Aboriginal Australian national cohorts, Aboriginal Australians were younger (median 56 years (IQR (48, 65)); however, sex distribution (55% female) and body mass index (23 kg/m² (IQR 19.4-27)) were comparable . Smoking rates were higher at 85% compared with other registry cohorts (22-46%) as was the prevalence of comorbidities (97%): cardiovascular diseases (73%), diabetes mellitus (50%) and chronic obstructive pulmonary disease (83%) compared with other registry cohorts (4-32%; 6-14%; and 14-37%, respectively). Spirometry demonstrated forced expiratory volume in 1 s of 38% predicted in comparison with 61-77% in other cohorts. Sputum microbiology showed <i>Haemophilus influenzae</i> (57%) isolated at 3.4 to 6 times the rate of other registry cohorts and <i>Pseudomonas aeruginosa</i> in 31%. Chest CT demonstrated multilobar and lower lobes involvement in 73% and inhaled pharmacotherapy use was recorded in up to 62% and long-term antibiotics in 5%.</p><p><strong>Conclusion: </strong>The overall bronchiectasis disease burden is higher in Aboriginal Australian adults in comparison with global ethnically diverse non-Indigenous populations. Further efforts are required to address this disparity secondary to bronchiectasis among Indigenous people.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11784196/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143021646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}