BMJ Open Respiratory Research最新文献

{"title":"COVID-19 severity and risk of SARS-CoV-2-associated asthma exacerbation by time since booster vaccination: a longitudinal analysis of data from the COVIDENCE UK study.","authors":"Giulia Vivaldi, Mohammad Talaei, Paul E Pfeffer, Seif O Shaheen, Adrian R Martineau","doi":"10.1136/bmjresp-2025-003158","DOIUrl":"10.1136/bmjresp-2025-003158","url":null,"abstract":"<p><strong>Background: </strong>COVID-19 booster vaccinations are offered annually to priority groups, but many people have not been vaccinated in over a year. We therefore assessed the association between time since booster vaccination and breakthrough infection characteristics. We also explored whether incident COVID-19 associates with asthma exacerbations in boosted individuals with asthma and if the risk of COVID-19-associated exacerbation is affected by time since vaccination.</p><p><strong>Methods: </strong>COVIDENCE UK is a prospective, longitudinal, population-based study of COVID-19. We included adult participants who had received ≥1 booster vaccination. Time since vaccination was binarised at 6 or 12 months according to vaccine eligibility subgroup. We used regression models to obtain adjusted estimates for the association between time since vaccination and breakthrough infection severity (requiring bedrest vs milder symptoms), symptom duration, and impact on health-related quality of life (EQ-5D-3L Index). We then assessed the association of incident COVID-19 with asthma exacerbations using multilevel mixed models, by time since vaccination.</p><p><strong>Results: </strong>7391 boosted participants reported at least one breakthrough infection. Across all eligibility subgroups, greater time since vaccination associated with increased odds of severe symptoms (ORs ranging from 1.31 (95% CI 1.06 to 1.62) to 1.61 (1.29 to 2.01)). Not receiving a booster vaccination in the previous 12 months was associated with longer time to recovery overall (HR for recovery 0.90, 95% CI 0.81 to 0.99), but evidence for vaccination subgroups was weak. Greater time since vaccination was associated with a small decrease in EQ-5D-3L Index overall (-0.02, 95% CI -0.03 to -0.00) and among participants younger than 75 years, but did not reach our estimates for a minimum clinically important difference. Among 2100 participants with asthma, incident COVID-‍19 associated with increased risk of asthma exacerbation, both within 12 months of vaccination (OR 5.11 (95% CI 4.19 to 6.24)) and later (5.60 (2.98 to 10.53)), with a greater difference in point estimates when considering severe exacerbations (6.59 (4.70 to 9.22) vs 9.20 (3.56 to 23.78)).</p><p><strong>Conclusion: </strong>Longer time since booster vaccination consistently associates with more severe infections and may increase the risk of severe asthma exacerbations in people with asthma. These findings highlight the importance of ensuring those currently eligible receive their boosters, and the need for research on further vaccinations in people with asthma no longer eligible for boosters.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083257/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085896","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":"Safety and efficacy of inhalable ambroxol hydrochloride aerosol for adult patients with respiratory diseases: an open-label, single-arm, multicentre study.","authors":"Jinfang Ma, Jinping Zheng, Liping Chen, Zhengguang He, Zuke Xiao, Xiaohong Yang, Gang Chen, Changli Yu, Tianli Wang, Dan Zhu, Liangping Mao, Wei Wang, Zhenshan Wang, Xiaoju Zhang, Jie Meng, Xianwei Ye, Rui Chen, Jianqing Zhao, Ting Yang, Keying Xue, Zhiyi He, Baosong Xie, Xiaohong Chen, Ruifeng Zhang, Yuanlin Song, Weiquan Liang, Lin Su, Huili Zhu, Wanjun Yu, Yilan Sun, Jie Zhang, Xiaoping Ren, Faguang Jin, Shujuan Jiang, Tiantuo Zhang, Yi Hu, Zhancheng Gao, Gongping Chen","doi":"10.1136/bmjresp-2023-002096","DOIUrl":"10.1136/bmjresp-2023-002096","url":null,"abstract":"<p><strong>Background: </strong>Airway mucus hypersecretion is a key pathophysiological feature in many respiratory diseases and could lead to airway obstruction and repeated infections, consequently accelerating disease progression, which impacts on pulmonary function and quality of life (QoL), highlighting the importance of mucolytic therapy targeting airway mucus hypersecretion.</p><p><strong>Objectives: </strong>To investigate the safety and efficacy of inhalable ambroxol hydrochloride aerosol for adult patients with respiratory diseases.</p><p><strong>Design: </strong>An open-label, single-arm, multicentre postmarketing surveillance study.</p><p><strong>Methods: </strong>Adult patients with acute or chronic respiratory diseases were eligible to receive aerosol inhalation of ambroxol hydrochloride (3 mL and 7.5 mg/mL) using a nebuliser two times per day given at least 6 hours apart between doses. The treatment lasted for a maximum of 7 days. The primary safety outcome was the frequency and severity of adverse events (AEs), and the primary efficacy outcome was changes in sputum scale scores.</p><p><strong>Results: </strong>Among 1201 eligible patients, 1192 received study medication and were included in the full analysis set and the safety set. Any grade AEs occurred in 16.3% of the patients, including serious AEs in four (0.3%) patients. The three most frequent AEs were respiratory symptoms and signs (1.5%), nausea and vomiting (0.8%) and digestive tract symptoms and signs (0.7%). In the full analysis set, the patients showed a mean reduction of 77.6% (95% CI, 75.9% to 79.3%) in the sputum scale score at the end of treatment, with a mean difference of -1.7±0.7 from baseline (p<0.001).</p><p><strong>Conclusion: </strong>Inhalable ambroxol hydrochloride aerosol is well tolerated and effective in easing expectoration and alleviating cough, reducing sputum and improving the QoL of adult patients with acute and chronic respiratory diseases.</p><p><strong>Trial registration number: </strong>ChiCTR2100043736.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083361/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143953689","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":"Predictive machine learning algorithm for COPD exacerbations using a digital inhaler with integrated sensors.","authors":"Laurie D Snyder, Michael DePietro, Michael Reich, Megan L Neely, Njira Lugogo, Roy Pleasants, Thomas Li, Lena Granovsky, Randall Brown, Guilherme Safioti","doi":"10.1136/bmjresp-2024-002577","DOIUrl":"10.1136/bmjresp-2024-002577","url":null,"abstract":"<p><strong>Purpose: </strong>By using data obtained with digital inhalers, machine learning models have the potential to detect early signs of deterioration and predict impending exacerbations of chronic obstructive pulmonary disease (COPD) for individual patients. This analysis aimed to determine if a machine learning algorithm capable of predicting impending exacerbations could be developed using data from an integrated digital inhaler.</p><p><strong>Patients and methods: </strong>A 12-week, open-label clinical study enrolled patients (≥40 years old) with COPD to use ProAir Digihaler, a digital dry powder inhaler with integrated sensors, to deliver their reliever medication (albuterol, 90 µg/dose; 1-2 inhalations every 4 hours, as needed). The Digihaler recorded inhaler use through timestamps, peak inspiratory flow (PIF), inhalation volume, inhalation duration, and time to PIF throughout the study. By applying machine learning methodology to data downloaded from the inhalers after study completion, along with clinical and demographic information, a model predictive of impending exacerbations was generated.</p><p><strong>Results: </strong>The predictive analysis included 336 patients, 98 of whom experienced a total of 111 exacerbations. PIF and inhalation volume were observed to decline in the days preceding an exacerbation. Using gradient-boosting trees with data from the Digihaler and baseline patient characteristics, the machine learning model was able to predict an exacerbation over the following 5 days with a receiver operating characteristic area under curve of 0.77 (95% CI: 0.71-0.83). Features of the model with the highest weight were baseline inhalation parameters and changes in inhalation parameters before an exacerbation compared with baseline.</p><p><strong>Conclusion: </strong>We demonstrated the development of a proof-of-concept machine learning model predictive of impending COPD exacerbations using data from the integrated digital reliever inhaler. This approach may potentially support patient monitoring, help improve disease management, and enable pre-emptive interventions to minimise exacerbations.</p><p><strong>Clinical trial registration number: </strong>NCT03256695.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083419/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143975516","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":"Uncertainty and decision-making in critical care: lessons from managing COVID-19 ARDS in preparation for the next pandemic.","authors":"Kenki Matsumoto, John R Prowle, Zudin Puthucheary, Maurizio Cecconi, Brigitta Fazzini, Hannah Malcolm, Peter Nydahl, Magda Osman, Alessandro Santini, Stefan J Schaller, William Thomson, Danielle van den Berke, Marcel Poll, Timothy Stephens","doi":"10.1136/bmjresp-2024-002637","DOIUrl":"10.1136/bmjresp-2024-002637","url":null,"abstract":"<p><strong>Purpose: </strong>Coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS) was an emergent syndrome that led to high volumes of critically ill ventilated patients. We explored influences on decision-making regarding management of COVID-19 ARDS mechanical ventilation to identify modifiable factors to improve preparedness for future pandemics.</p><p><strong>Methods: </strong>A systematic review and small group interviews informed the development of an international questionnaire (UK, Italy, Germany and Netherlands) on factors influencing COVID-19 ARDS ventilation decision-making in critical care professionals. Participants ranked four themes in order of importance: disease (uncertainties around COVID-19 ARDS), contextual (cognitive strain), environmental (structural logistics) and team factors. Participants also ranked the subthemes within each theme. Thematic analysis was used to derive findings from qualitative data. Kruskal-Wallis, Mann-Whitney U and Kendall's tau were used for quantitative data analysis.</p><p><strong>Results: </strong>Patient factors (comorbidities, clinical/biochemical parameters) were the most studied influences in the extant literature on decision-making; uncertainty was one of the least studied. 371 critical care professionals responded to the questionnaire. Disease uncertainty (lack of applicable guidelines, unfamiliarity with pathophysiology) was ranked as the most important influence on ventilation decision-making for COVID-19 ARDS across regions, professions and experience levels (p<0.001). Participants expressed underconfidence in their decision-making (median score: 9/20); this was unaffected by experience (p=0.79) or profession (p=0.58). Qualitative findings supported and extended the initial proposed influences, including the impact of team factors (+ve) and resource limitations (-ve) on disease uncertainty.</p><p><strong>Conclusion: </strong>Future pandemic preparedness programmes should target modifiable influences such as information sharing, teamworking and resource limitations to mitigate against the negative influence of uncertainty and thereby improve decision-making overall.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067812/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143959904","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":"Cross-sectional study of preventive treatment for students with latent tuberculosis infection in Shanghai, China.","authors":"Xiao Xiao, Zhipeng Li, Haoyue Zhang, Xin Xin, Lili Chen, Jing Chen, Xin Shen, Xin Chen","doi":"10.1136/bmjresp-2024-002799","DOIUrl":"https://doi.org/10.1136/bmjresp-2024-002799","url":null,"abstract":"<p><strong>Introduction: </strong>Tuberculosis preventive treatment (TPT) has been initiated systematically in Shanghai supported by a public health project. This study aimed to evaluate the acceptance of TPT, identify the factors related to its refusal, and find an optimal way to promote TPT among student tuberculosis (TB) contacts.</p><p><strong>Methods: </strong>We screened contacts of the TB index case from a TB outbreak on campus. A two-step approach of first conducting a lecture of TB health literacy, followed by one-on-one TPT consultations was used to mobilise TPT among students with latent TB infection (LTBI). A semistructured questionnaire was designed between the lecture and the one-on-one TPT consultations, covering general demographic information, awareness of core TB knowledge and willingness to accept TPT, along with the reasons for refusal. Logistic regression analysis was used to identify the risk factors for refusing TPT.</p><p><strong>Results: </strong>A total of 52 contacts were identified with LTBI. After the lecture on TB health literacy, their scores on the core TB knowledge was 14.0±2.3. Students had a poor awareness rate of TB knowledge in the part of TB treatment and policy (70.2%) and <i>Mycobacterium tuberculosis</i> infection preventive measures and LTBI (67.3%) compared with the average rate (84.3%). The acceptance rate of TPT reached 42.3% at the end of the two-step promotion. The main reasons for refusing TPT included: (1) the duration for TPT was too long and follow-up management was too cumbersome; (2) the confidence in their own immunity and belief in their low risk of TB and (3) the fear of side effects of TPT.</p><p><strong>Conclusions: </strong>The two-step approach of first conducting a lecture of TB health literacy, followed by one-on-one TPT consultations, is effective for mobilising TPT. To further implement TPT, we recommend making the scientific popularisation for LTBI in a more easy-to-understand way and optimising the management of TPT.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067769/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143956785","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":"Gender, tobacco and chronic obstructive pulmonary disease: analysis of the 2020 National Health Interview Survey.","authors":"Alexander W Steinberg, Jenny E Ozga, Zhiqun Tang, Cassandra A Stanton, James D Sargent, Laura M Paulin","doi":"10.1136/bmjresp-2024-002462","DOIUrl":"https://doi.org/10.1136/bmjresp-2024-002462","url":null,"abstract":"<p><strong>Rationale: </strong>Recent studies describe an increasing prevalence of chronic obstructive pulmonary disease (COPD) and higher COPD exacerbation rates among women compared with men despite lower average cigarette use, which has raised the question of whether women are more susceptible to the effects of tobacco smoke. We examined associations between gender, cigarette smoking and COPD in a national dataset.</p><p><strong>Methods: </strong>We used cross-sectional data for US respondents aged ≥40 years from the 2020 National Health Interview Survey (NHIS). Weighted multivariable logistic regressions assessed the relationship between gender and respondent-reported physician-diagnosed COPD, adjusting for tobacco use and sociodemographic covariates. Additional analyses were performed to determine if the relationship between cigarette smoking and COPD was modified by gender.</p><p><strong>Results: </strong>Women had a higher COPD prevalence (7.8%) than men (6.5%) despite lower cigarette smoke exposure. Women were less likely to have ever smoked, and among respondents who had smoked, women had a lower average pack-year history compared with men. In multivariable regressions, female gender was associated with a higher risk of COPD (adjusted risk ratio 1.47, 95% CI 1.30 to 1.65) and the relative risk was similar for respondents both with and without a history of smoking. Moreover, there was no significant interaction between gender and smoking status or gender and pack-year exposure relating to COPD prevalence.</p><p><strong>Conclusions: </strong>Among adults aged ≥40 years, women had a roughly 50% greater risk of COPD than men. Higher susceptibility to cigarette smoking in women did not explain the difference.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143973188","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":"Regional comparison of efficacy and safety for vilobelimab in critically ill, invasively mechanically ventilated COVID-19 patients.","authors":"Endry H T Lim, Diederik van de Beek, Sanne de Bruin, Simon Rückinger, Claus Thielert, Renfeng Guo, Bruce P Burnett, Matthijs C Brouwer, Robert Zerbib, Camilla Chong, Niels C Riedemann, Alexander P Vlaar","doi":"10.1136/bmjresp-2023-002206","DOIUrl":"https://doi.org/10.1136/bmjresp-2023-002206","url":null,"abstract":"<p><strong>Background: </strong>Vilobelimab, a first in class C5a-specific monoclonal antibody, improved 28-day and 60-day mortality in intubated COVID-19 patients in PANAMO, a phase 3 randomised, double-blind, placebo-controlled multicentre study. All-cause mortality was pre-specified to be analysed pooling by region (western Europe, South America, South Africa/Russia).</p><p><strong>Methods: </strong>Critically ill, invasively mechanically ventilated COVID-19 patients were randomised in a 1:1 ratio within 48 hours of intubation to receive vilobelimab treatment (six, 800 mg intravenous infusions) or placebo on top of standard of care. We analysed the efficacy and safety of vilobelimab based on prespecified geographic regions.</p><p><strong>Results: </strong>368 patients were randomised and analysed: 177 in the vilobelimab group and 191 in the placebo group. In western Europe (n=209), 28-day all-cause mortality was significantly lower in the vilobelimab group (21%) compared with placebo (37%) (HR 0.51 (95% CI: 0.30, 0.87), p=0.014). In South America (n=126), mortality was similar between groups (40% vs 37%; HR 0.94 (95% CI: 0.53, 1.67), p=0.83). In South Africa/Russia (n=33), mortality was 69% in the vilobelimab group and 87% in the placebo group (HR 0.62 (95% CI: 0.28, 1.38), p=0.25). Within the Brazilian subpopulation (n=74), a significant age imbalance between the vilobelimab and placebo group was detected (median 53.5 years in the vilobelimab group vs 44.5 years in the placebo group). Occurrence of treatment-emergent adverse events between regions was similar.</p><p><strong>Conclusion: </strong>The most apparent 28-day all-cause mortality benefit for vilobelimab was in western Europe. Age imbalance between treatment groups in Brazil may have resulted in a lower efficacy signal for vilobelimab in South America compared with other regions. Overall, vilobelimab demonstrated a favourable safety profile and reduced mortality in critically ill, intubated COVID-19 patients, with regional variations influencing outcomes.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12010313/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143964959","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":"Does the airway circulation influence airflow obstruction in asthma?","authors":"Adam Wanner","doi":"10.1136/bmjresp-2024-002575","DOIUrl":"https://doi.org/10.1136/bmjresp-2024-002575","url":null,"abstract":"<p><p>The airway wall is thickened in asthma and the airway microvasculature participates in the remodelling. It has been assumed but not convincingly demonstrated that the remodelled airway vasculature has a mechanical role in asthma-associated airflow obstruction by contributing to the thickening of the airway wall and narrowing of the airway. This review examines the literature providing information in support of and against this assumption and raises questions about therapeutically targeting the airway circulation directly in patients with asthma.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12007055/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143959615","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":"Under the weather: an epidemic thunderstorm asthma event in Leicester, June 2023.","authors":"Sarah Diver, Fiona Symon, Jack Satchwell, Heather Lipscombe, Ruth H Green, Gerrit Woltmann, Damian Roland, Erol A Gaillard, Anna Hansell, Chris Brightling, Leah Cuthbertson","doi":"10.1136/bmjresp-2024-002588","DOIUrl":"https://doi.org/10.1136/bmjresp-2024-002588","url":null,"abstract":"<p><p>In the context of climate change and increasing global populations, thunderstorm asthma may become a greater threat at both individual and population levels. The unpredictable nature of epidemic thunderstorm asthma events makes them challenging to study; however, they can have devastating consequences. Novel approaches are required to characterise the mechanisms driving these events to allow researchers and other stakeholders to understand who is at risk and when. This will support the development of interventions that protect patients and healthcare services. In this commentary, we provide an overview of thunderstorm asthma and briefly describe an epidemic affecting Leicester, UK in June 2023. Our analysis highlights <i>Cladosporium</i> spores as a key player in mediating UK thunderstorm asthma. Low levels of background treatment in adults and an increase in emergency assessments but not hospitalisations in children suggest that epidemics could be prevented by improving awareness and ensuring access to standard inhaled therapies. Finally, we consider future risk and suggest research priorities with an ultimate goal of minimising the adverse impact related to thunderstorm asthma going forward.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12007050/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143953634","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":"Impact of cycling cadence on physiological response during a cardiopulmonary exercise test.","authors":"Ben Knox-Brown, Chris Harding, Shabana Chowdhury, Andrew Pritchard, Joanna Shakespeare, Karl Peter Sylvester","doi":"10.1136/bmjresp-2024-002824","DOIUrl":"https://doi.org/10.1136/bmjresp-2024-002824","url":null,"abstract":"<p><strong>Introduction: </strong>The impact of cycling at different cadences on cardiopulmonary exercise test (CPET) measurements is poorly understood. We aimed to investigate whether higher cadences of pedalling led to meaningful changes in physiological endpoints.</p><p><strong>Methods: </strong>Study participants were recruited from healthy staff members working within three NHS trusts across England. At baseline, all participants completed a CPET at 60 rpm and then subsequently completed CPETs at cadences of 70, 80 and 90 rpm, allocated in a random order. To evaluate the mean differences in CPET measurements across the cadences, we used a one-way repeated measures analysis of variance. We then performed post hoc pairwise comparisons with Tukey correction to account for multiple testing.</p><p><strong>Results: </strong>Data collection took place between the 19 September 2023 and 9 April 2024. 25 participants had complete data at each cadence. 48% (12 of 25) were female, with a median (IQR) age of 30 years (27-41). There was no significant difference in peak V̇O₂ across the cadences. Maximum achieved work rate was significantly different across the cadences (p=<0.001). The highest wattage was achieved at 60 rpm (221.2 watts±71.4) and lowest at 90 rpm (210.4 watts, ±77.2). End exercise ventilation increased with increasing cadence (p=0.013), with a mean of 97.6 L/min (±28.3) at 60 prm and 107.0 L/min (±33.9) at 90 prm. Breathing reserve decreased with increasing cadence (p=0.009), with a mean of 45.6 L/min (±28.8) at 60 rpm and 35.1 L/min (±23.5) at 90 rpm. There were minimal differences in other CPET parameters.</p><p><strong>Conclusion: </strong>In a healthy population, higher cycling cadences increased ventilatory demand and reduced maximum work rate. This could have implications for CPETs in the clinical setting, where physiological responses to higher cadences may be more exaggerated.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12001355/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143981786","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}