BMJ Open Respiratory Research最新文献

{"title":"Differences in uni-dimensional breathlessness measures and thresholds for clinical response in a randomised controlled trial in people with chronic breathlessness: an exploratory study.","authors":"Diana Ferreira, Magnus Ekström, Sandra Louw, Philip McCloud, Miriam Johnson, Katherine Clark, David Currow","doi":"10.1136/bmjresp-2024-002370","DOIUrl":"10.1136/bmjresp-2024-002370","url":null,"abstract":"<p><strong>Introduction: </strong>Optimally measuring improvements in chronic breathlessness in clinical practice and research continues to evolve. The aim of this study was to consider the performance of uni-dimensional measures in <i>chronic breathlessness limiting exertion</i>.</p><p><strong>Methods: </strong>We report five measures of breathlessness (intensity: <i>worst, best</i> and <i>average</i> in the previous 24 hours; <i>breathlessness now</i>; and an affective component <i>unpleasantness now</i>) and two clinical thresholds over baseline on their 0-100 mm visual analogue scale (8.9 mm absolute improvement; and 15% relative improvement) collected in a multi-site, randomised, double-blind, parallel-arm, placebo-controlled trial of regular, low-dose, sustained-release morphine for people with <i>chronic breathlessness</i> with optimally treated underlying causes.</p><p><strong>Results: </strong>Participants (n=284) were mostly elderly men with severe, chronic breathlessness. <i>Worst breathlessness in the previous 24 hours</i> showed improvement in people with more severe breathlessness and chronic obstructive pulmonary disease. By contrast, <i>breathlessness now</i> and <i>average breathlessness in the previous 24 hours</i> generated similar patterns of response, as did <i>unpleasantness now</i> and <i>breathlessness now. Best breathles</i>sness added little value. The two clinical thresholds showed differing patterns of significance.</p><p><strong>Discussion: </strong>Consistent with other recent work, worst breathlessness may be an important uni-dimensional outcome in evaluating chronic breathlessness clinically and in research. This study does not support a differential between unpleasantness now and breathlessness now, previously observed in laboratory-generated, acute-on-chronic breathlessness. Timeframe for recall (now or the last 24 hours) and the threshold for a clinical meaningful improvement (absolute (8.9 mm) or relative (15%)) affect assessment performance.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"11 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11624816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142779167","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":"Dexamethasone alleviates acute lung injury in a rat model with venovenous extracorporeal membrane oxygenation support.","authors":"Shi-Lin Wei, Jun-Zhe Du, Ke-Rong Zhai, Jian-Bao Yang, Ran Zhang, Xiang-Yang Wu, Yongnan Li, Bin Li","doi":"10.1136/bmjresp-2024-002394","DOIUrl":"10.1136/bmjresp-2024-002394","url":null,"abstract":"<p><strong>Background: </strong>In recent years, dexamethasone (Dex) has been used to treat acute respiratory distress syndrome (ARDS) in patients with COVID-19 and achieved promising outcomes. Venovenous extracorporeal membrane oxygenation (VV ECMO) support for patients with ARDS has increased significantly worldwide. However, it remains unknown whether Dex could improve the efficiency of VV ECMO to reduce lung injury. Here, we investigate the combined efficiency of VV ECMO and Dex in rats with acute lung injury (ALI).</p><p><strong>Methods: </strong>We established VV ECMO in oleic acid (OA)-treated ALI rats and administered Dex. We conducted HE staining and evaluated lung and bronchoalveolar lavage (BAL) fluid cytokines to assess lung injury and inflammation. Furthermore, we investigated the activation of Hippo/YAP signalling in alveolar epithelial type II cell (AT2)-mediated alveolar epithelial repair using quantitative PCR, Western blotting and immunofluorescence. In vitro, the human alveolar epithelial cell line A549 was used to investigate the key role of YAP in alveolar epithelial cell differentiation.</p><p><strong>Results: </strong>VV ECMO combined with Dex alleviated OA-induced lung injury and pulmonary inflammation. Pulmonary oedema and exudation were significantly alleviated, and the lung and BAL levels of IL-6, IL-8 and TNF-α were significantly reduced compared with those observed with ECMO alone. In addition, VV ECMO combined with Dex treatment protected alveolar epithelial cells by activating Hippo/YAP signalling. In vitro, Dex promoted YAP expression and alveolar epithelial cell differentiation, whereas YAP knockdown inhibited YAP-mediated differentiation.</p><p><strong>Conclusions: </strong>Our findings suggest that adjuvant Dex treatment during VV ECMO could alleviate ALI and pulmonary inflammation by activating the Hippo/YAP signalling pathway, which promoted alveolar regeneration and AT2 differentiation.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"11 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11624713/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142779077","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 pre-existing conditions with major driver mutations and PD-L1 expression in NSCLC.","authors":"Peiling Chen, Xin Zheng, Caichen Li, Jianfu Li, Chen Yang, Yi Feng, Bo Cheng, Hengrui Liang, Zhichao Liu, Yi Zhao, Shan Xiong, Feng Li, Ran Zhong, Shuting Zhan, Huiting Wang, Yang Xiang, Wenhai Fu, Wenjun Ye, Bo'ao Jiang, Xianzhe Fan, Jun Liu, Jianxing He, Wenhua Liang","doi":"10.1136/bmjresp-2024-002571","DOIUrl":"10.1136/bmjresp-2024-002571","url":null,"abstract":"<p><strong>Objectives: </strong>This study aims to explore how pre-existing conditions such as blood types, family history of cancer and comorbid diseases correlate with the genetic and programmed death-ligand 1 (PD-L1) expression that contributes to the heterogeneous biological behaviours of non-small cell lung cancer (NSCLC).</p><p><strong>Materials and methods: </strong>A cohort of 5507 NSCLC patients who underwent surgical resection between January 2014 and July 2018 was studied. Targeted next-generation sequencing was used to detect mutations in nine pivotal cancer-related genes, and immunohistochemical staining was applied to assess PD-L1 expression. Logistic regression analysis was employed to identify significant correlations.</p><p><strong>Results: </strong>All patients underwent NGS, with 1839 were also evaluated for PD-L1 expression. Several significant findings were found: ROS1 mutations were closely associated with a family history of lung cancer (OR 7.499, 95% CI 1.094 to 30.940, p=0.013). Epidermal growth factor receptor (EGFR) L858R mutations were common among patients with a family history of non-lung cancers and those with hypertension (OR 2.089, 95% CI 1.029 to 4.135, p=0.037 and OR 1.252, 95% CI 1.001 to 1.562, p=0.048, respectively). Pre-existing conditions such as diabetes and hepatitis B surface antigen positivity (OR 1.468, 95% CI 1.042 to 2.047, p=0.026 and OR 1.373, 95% CI 1.012 to 1.847, p=0.038, respectively) were correlated with EGFR exon 19 deletions. RhD negativity showed potential ties to BRAF mutations (OR 0.010, 95% CI 0.001 to 0.252, p=0.001). A history of tuberculosis linked to increased PD-L1 expression in immune cells (OR 3.597, 95% CI 1.295 to 14.957, p=0.034).</p><p><strong>Conclusion: </strong>This large-scale, cross-sectional study reveals a complex interplay between genetic mutations, immunological features and pre-existing conditions in NSCLC patients, offering insights that could inform personalised treatment strategies.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"11 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11624786/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142779038","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":"Compensatory function change by segment-counting method in predicted postoperative pulmonary function at 1 year after surgery: systematic review and meta-analysis.","authors":"Teng-Wei Wang, Qiang Zhang, Zhihong Cai, Qinhong Xu, Jinrong Lin, Huilong Yeh","doi":"10.1136/bmjresp-2023-001855","DOIUrl":"10.1136/bmjresp-2023-001855","url":null,"abstract":"<p><strong>Background: </strong>This systematic review aimed to assess the accuracy of the segment-counting method in predicting long-term pulmonary function recovery and investigate compensatory changes following different extents of lung resection.</p><p><strong>Methods: </strong>We included studies that measured forced expiratory volume at 1 s (FEV1) between 6 and 18 months postoperatively, comparing it to the predicted postoperative FEV1 (ppoFEV1) using the segment-counting method. The extent of lung resection was correlated with the ratio of postoperative FEV1 to ppoFEV1. A comprehensive search was conducted in Embase, MEDLINE and Web of Science using terms related to 'lung resection' and 'pulmonary function'. The final search was completed on 18 February 2022. Risk of bias was assessed using the Newcastle-Ottawa Scale.</p><p><strong>Results: </strong>39 studies comprising 78 observation cohorts met the inclusion criteria. The analysis showed significant differences in pulmonary function in patients with ≥3 resected segments. Meta-regression indicated that the number of resected segments significantly impacted the postoperative FEV1/ppoFEV1 ratio, explaining 57% of the variance (R²=0. 57), with moderate heterogeneity (I²=61. 87%) across studies. Other variables, including patient age, body mass index, video-assisted thoracoscopic surgery use and tumour stage, did not show significant effects.</p><p><strong>Discussion: </strong>Limitations of the review included moderate heterogeneity between studies and potential selection bias related to the stage of cancer and lung volume reduction effects. The findings suggest that the extent of lung resection correlates with better-than-expected pulmonary function, potentially due to compensatory mechanisms.</p><p><strong>Prospero registration number: </strong>This review was registered on PROSPERO (CRD42021293608).</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"11 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11624756/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142766150","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":"Adherence to COVID-19 preventive measures and associated factors among high school students in Northwest Ethiopia: a cross-sectional study.","authors":"Habtamu Tadesse Gudeta, Yordanos Jemberu, Shelema Likassa Nagari","doi":"10.1136/bmjresp-2023-001960","DOIUrl":"10.1136/bmjresp-2023-001960","url":null,"abstract":"<p><strong>Background: </strong>The novel coronavirus disease 2019 (COVID-19) is a respiratory infection that is spreading worldwide. The WHO has recommended public health preventive measures for COVID-19 prevention and control. Adherence to COVID-19 preventive measures is important for disease prevention and control of the disease's spread. So, implementing preventive measures plays an essential role in reducing the spread of COVID-19 infection. This study aimed to assess the adherence status toward COVID-19 preventive measures and associated factors among high school students.</p><p><strong>Methods: </strong>528 high school students participated in an institutional-based cross-sectional study. A multistage sampling technique and a systematic random sampling method were applied to select the study participants. The data was entered into EpiData V.3.1 and then exported to SPSS V.23 for analysis. Bivariate and multivariable logistic regressions were computed. The significance of the association was declared by a 95% CI of adjusted OR (AOR) and a p value<0.05 in the multivariate model.</p><p><strong>Result: </strong>A total of 528 respondents participated in the study, with a 100% response rate. The overall adherence level of high school students toward COVID-19 prevention measures was 110 (20.8%, 95% CI: 17.4%, 24.6%). The mean(±SD) age of the respondents was 18 (SD 11±2) years, which ranges from 16 to 24 years, and 387 (73.3%) were in the age group of 19-20 years, The majority of the students (418; 79.2%, 95% CI: 75.4, 82.6) had poor adherence to COVID-19 preventive measures. 345 (65.3%) had good knowledge, 328 (62.1%) had unfavourable attitudes and 390 (73.9%) had poor risk perception for COVID-19 preventive measures. This study revealed that most (89.9%) of the high school students did not maintain a physical distance of 2 m away, 84.4% of the students had no regular handwashing practice, majority 71.4% of the students did not use facemasks/covered their face during coughing and 62.9% of the students had no face mask and 54% of the students did not use sanitiser or alcohol per recommendation. This study revealed that sex (AOR: 2.42, 95% CI: 1.46, 4.02), attitude (AOR: 4.04, 95% CI: 2.45, 6.68) and risk perception (AOR: 7.60, 95% CI: 4.62, 12.54) were significantly associated with poor adherence toward COVID-19 prevention measures.</p><p><strong>Conclusion: </strong>This study's findings revealed that adherence to COVID-19 preventive measures among high school students was very low. Therefore, promoting adherence to COVID-19 preventive measures demands awareness creation and risk communication to build an appropriate level of knowledge, attitude and risk perception.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"11 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11624821/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142766140","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":"Factors associated with undiagnosed COPD in patients hospitalised for severe COPD exacerbation.","authors":"Marina Guecamburu, Emilie Klein, Guillaume Verdy, Cécilia Nocent-Ejnaini, Julie Macey, Laurent Portel, Léo Grassion, Thibaud Soumagne, Maéva Zysman","doi":"10.1136/bmjresp-2024-002620","DOIUrl":"10.1136/bmjresp-2024-002620","url":null,"abstract":"<p><strong>Background: </strong>Studies suggest that up to 70% of chronic obstructive pulmonary disease (COPD) cases globally are undiagnosed worldwide. Some of these undiagnosed patients may present with severe exacerbation and factors associated with underdiagnosis in this population are unknown. We investigated the key factors associated with underdiagnosis in two cohorts of patients hospitalised for severe COPD exacerbation at different time points.</p><p><strong>Methods: </strong>This retrospective, multicentre study analysed data from patients hospitalised for COPD exacerbation at two independent centres during two distinct time periods: between 1 January 2017 and 31 December 2018 in the Aquitaine region and between 1 January and 31 December 2022 in Paris. Undiagnosed COPD was defined as the absence of pulmonary function testing before the index exacerbation. Multivariate logistic regression was used to evaluate associations between underdiagnosis and patient characteristics.</p><p><strong>Results: </strong>Among the 424 patients, 93 (21.9%) were undiagnosed before hospitalisation, with a stable rate over time (22% in 2017-2018 and 21% in 2022). Multivariate analysis revealed that underdiagnosis was related to higher forced expiratory volume in one second (FEV₁; adjusted OR (aOR)=1.02, p=0.043) and female sex (aOR=1.91, p=0.015). Patients with undiagnosed COPD had significantly lower rehospitalisation and mortality rates. After the initial severe exacerbation, higher mortality was associated with a higher Charlson Comorbidity Index (HR=1.24, p=0.007) and older age (HR=1.05, p=0.008).</p><p><strong>Conclusion: </strong>This retrospective, multicentre study demonstrated that about 20% of patients admitted with severe exacerbation were undiagnosed for COPD. Higher FEV₁ and female sex were associated with underdiagnosis, emphasising the need for special attention to this population. These findings highlight the need to improve training and access to spirometry and develop new diagnostic tools that facilitate earlier detection and management of COPD.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"11 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11603825/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142749845","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":"Chronic obstructive pulmonary disease as a risk factor for cognitive impairment: a systematic review and meta-analysis.","authors":"Xia Chen, Zhenjie Yu, Yong Liu, Yang Zhao, Shu Li, Lan Wang","doi":"10.1136/bmjresp-2023-001709","DOIUrl":"10.1136/bmjresp-2023-001709","url":null,"abstract":"<p><strong>Background: </strong>Cognitive impairment is affecting plenty of patients with chronic obstructive pulmonary disease (COPD), and it is the main leading cause of quality of life to varying degrees. However, there are still wide discrepancies in these prevalence rates can be attributed to the diversity in study designs, participant age ranges, inclusion criteria and the methodologies used for assessment. Previous studies revealed the association between COPD and cognitive impairment, but the conclusions remain controversial.</p><p><strong>Objectives: </strong>The current systematic review aimed to investigate whether COPD is an independent risk factor for cognitive impairment.</p><p><strong>Study design: </strong>A systematic review and meta-analysis.</p><p><strong>Data sources: </strong>PubMed, Cochrane Library, MEDLINE, Embase, Web of Science, China Knowledge Resource Integrated Database, Wanfang Database, Chinese Biomedical Database and Weipu Database were searched from inception to 1 December 2022.</p><p><strong>Eligibility criteria: </strong>The inclusion criteria involved studies that reported cognitive impairment in COPD. We just included cohort designs, published in English or Chinese language.</p><p><strong>Data extraction and synthesis: </strong>Two reviewers independently extracted and assessed the quality of data using Newcastle-Ottawa Quality Assessment Scale. The outcomes were assessed with random-effects model and reported as the HR with 95% CI using the Review Manager software.</p><p><strong>Results: </strong>12 studies from 10 articles reporting on 625 644 people were included. The findings indicated that compared with those without COPD at baseline, patients with COPD were associated with an increased risk of cognitive impairment. Subgroup analysis showed the association was not significantly different in sex and age, and the subgroup supports that COPD has a higher risk of non-amnestic mild cognitive impairment (na-MCI) than amnestic MCI.</p><p><strong>Conclusions: </strong>Patients with COPD have a higher risk of developing cognitive impairment and are more likely to cause na-MCI compared with those without COPD, and this risk is not affected by gender or age. Therefore, continuous monitoring of cognitive function in COPD is critical.</p><p><strong>Prospero registration number: </strong>CRD42021285913.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"11 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11603807/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142749832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends of mortality from chronic respiratory diseases by sex and ethnicity in the USA: a secular analysis from 1979 to 2021 using data from death certificates.","authors":"Yaxian Meng, Xiaojie Han, Qianqian Ji, Aijie Zhang, Yiqiang Zhan, Xiaoliang Chen","doi":"10.1136/bmjresp-2024-002296","DOIUrl":"10.1136/bmjresp-2024-002296","url":null,"abstract":"<p><strong>Background: </strong>Over the past decades, the prevalence of chronic respiratory diseases (CRDs) has undergone significant changes. Analysing long-term mortality trends by sex and ethnicity can inform more targeted public health interventions.</p><p><strong>Methods: </strong>Using data from death certificates, we calculated age-standardised mortality rates of chronic obstructive pulmonary disease (COPD), interstitial lung disease (ILD), asthma and pneumoconiosis among the US population from 1979 to 2021, stratified by sex and ethnicity. Trend analyses of mortality rates were conducted using joinpoint regression models.</p><p><strong>Results: </strong>Mortality trends varied significantly by demographic groups and disease types. Specifically, COPD mortality exhibited an overall increasing trend among females and white individuals throughout the study period while remaining stable among males and black individuals. ILD mortality showed an overall increasing trends for both males and females as well as individuals of white ethnicity. Asthma mortality showed an increase before 1996 followed by a consistent decline across all populations from about 1996 to 2021. In contrast, pneumoconiosis mortality has risen among white individuals since 2001 with a notable increase among females after 2009.</p><p><strong>Conclusion: </strong>Our analysis reveals fluctuating trends in CRD mortality rates from 1979 to 2021 with varying patterns across sex, ethnicity and disease types. These findings underscore the need for ongoing research and tailored interventions to address these disparities.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"11 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11590864/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142709070","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":"Firefighters' occupational exposure to air pollution: impact on COPD and asthma-study protocol.","authors":"Joana V Barbosa, Pedro T B S Branco, Maria C M Alvim-Ferraz, Fernando G Martins, Sofia I V Sousa","doi":"10.1136/bmjresp-2023-001951","DOIUrl":"10.1136/bmjresp-2023-001951","url":null,"abstract":"<p><strong>Introduction: </strong>Firefighting continues to be among the most hazardous yet least studied occupations in terms of the impact of exposure to occupational disease. In particular, firefighters are at increased risk of adverse health effects due to exposure to significant levels of potentially harmful substances, namely carbon monoxide, particulate matter and formaldehyde, during their professional duties.This paper reports an epidemiologic study aiming to reduce the gaps in assessing the long-term effects of air pollution exposure to forest fires' combat on firefighters, namely regarding chronic obstructive pulmonary Disease (COPD) and asthma.</p><p><strong>Methods and analysis: </strong>Based on the implementation in an area with high forest fires (in Portugal), the study will analyse firefighters' exposure to fire emissions by measuring air pollutants with personal exposure monitors during forest fire combat through a retrospective cohort study (exposed vs non-exposed). Moreover, based on answers to validated questionnaires and medical examinations to be performed by medical doctors, the study will assess the prevalence, incidence and exacerbation of COPD and asthma in firefighters, thus considering both short-term and long-term effects. Based on the results above referred, the study aims to evaluate the impact of exposure and inhalation dose of air pollutants during forest fires' combat on the development of the above-referred chronic diseases. The approximate number of participants in the study will never be less than 186, guaranteeing 80% of study power (significant at a 5% level).</p><p><strong>Ethics and dissemination: </strong>The study has been approved by the Ethical Committee of Centro Hospitalar Universitário São João. The results will be published in international and national journals and conferences, allowing the results obtained to be communicated to the scientific community. Moreover, up-to-date data will be disseminated to stakeholders and decision-makers to help them decide on triggering official control measures.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"11 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11580236/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142685892","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 factors for incidence of interstitial lung disease in patients with rheumatoid arthritis: a systematic review and meta-analysis.","authors":"Chen Yu, Yupei Zhang, Shangyi Jin, Yanhong Wang, Qian Wang, Mengtao Li, Xiaofeng Zeng, Xinping Tian, Nan Jiang","doi":"10.1136/bmjresp-2023-001817","DOIUrl":"10.1136/bmjresp-2023-001817","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed at identifying risk factors for the incidence of interstitial lung disease in patients with rheumatoid arthritis (RA-ILD) by a systematic review and meta-analysis.</p><p><strong>Methods: </strong><i>Information sources</i>: studies published by March 2021 were searched in PubMed, Web of Science, MEDLINE, EMBASE, Cochrane Library and Scopus databases. <i>Eligibility criteria</i>: cohort studies or nested case-control studies that reported OR or HR of risk factors for RA-ILD were included. Two researchers independently screened the studies and extracted data. <i>Synthesis of results</i>: the relative risks (RRs) were introduced to measure the association across studies. <i>Risk bias</i>: quality assessments of included studies were performed using the Newcastle-Ottawa Scale. Based on the result of heterogeneity, the random-effects model or fixed-effects model was chosen in the meta-analysis. Furthermore, a sensitivity analysis was conducted to identify the origins of heterogeneity, and publication bias was evaluated for the factors with no less than five included studies by funnel plots and Egger's test.</p><p><strong>Results: </strong>Among 3075 identified articles, 12 studies met the inclusion criteria. 17 risk factors were included in the meta-analysis. Male (RR 1.94, 95% CI 1.33 to 2.85, p<0.001), elder age (>60 years, RR 1.42, 95% CI 1.05 to 1.94, p=0.02), older RA onset age (RR 1.05, 95% CI 1.01 to 1.10, p=0.02), smoking (RR 1.37, 95% CI 1.09 to 1.71, p=0.006), lung complications (RR 2.72, 95% CI 1.24 to 5.95, p=0.01), rheumatoid nodule (RR 1.85, 95% CI 1.36 to 2.51, p<0.001), leflunomide usage (RR 1.41, 95% CI 1.02 to 1.96, p=0.04) were identified as risk factors of RA-ILD.</p><p><strong>Conclusion: </strong>Physicians should be aware that patients with RA with the above risk factors are likely to develop RA-ILD, and perform close ILD screening during follow-ups so that the patients can be early diagnosed and treated, and achieve improved prognosis.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"11 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11574421/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142646055","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}