BMJ Open Respiratory Research最新文献

{"title":"Prevalence of loneliness and its associated factors in middle-aged and older adults with breathlessness: a nationally representative cohort study.","authors":"Ruth A Hackett, Sam Norton, Joseph Chilcot, Laura Cottrell, Matthew Maddocks, Irene J Higginson, Martha Canfield, Keir E J Philip, Lisa Jane Brighton","doi":"10.1136/bmjresp-2026-004357","DOIUrl":"10.1136/bmjresp-2026-004357","url":null,"abstract":"<p><strong>Background: </strong>Breathlessness has functional, psychological and social impacts. Loneliness is a health priority under-researched in relation to breathlessness, despite breathlessness impacting social interactions.</p><p><strong>Methods: </strong>We estimated the prevalence of loneliness and associated characteristics in adults (≥50 years) with breathlessness in the English Longitudinal Study of Ageing (ELSA, 2010-11). Breathlessness was assessed using the adapted modified Medical Research Council Dyspnoea Scale from grade 0 (none) to 3 (stops on level due to breathlessness). Grade 4 was not assessed in ELSA. Loneliness was measured using the 3-Item University of California, Los Angeles Loneliness Scale (scores ≥6 = lonely). Logistic regression was adjusted for age, sex and ethnicity.</p><p><strong>Results: </strong>Of the 8195 participants, 28.4% reported breathlessness and 19.3% were lonely. Greater breathlessness was associated with older age, female sex and lower wealth (p<0.001). Those with greater breathlessness were more likely to be lonely (16.3% for no breathlessness vs 34.9% for grade 3), live alone (18.2% vs 36.6%) and be unmarried (26.7% vs 45.7%) (all p<0.001). Greater breathlessness was associated with depressive symptoms, limiting longstanding illness, mobility issues (all p<0.001) and social isolation (p=0.012). Of those with worse breathlessness (graded 2-3, n=1149), 32.8% were lonely. Characteristics associated with loneliness in those with grade 2-3 breathlessness were female sex (OR 1.32, 95% CI 1.02 to 1.71), lower wealth (OR 2.75, 95% CI 1.63 to 4.64), no qualifications versus having a degree (OR 1.65, 95% CI 1.03 to 2.66), being unmarried (OR 3.45, 95% CI 2.64 to 4.52), living alone (OR 3.71, 95% CI 2.80 to 4.91), depressive symptoms (OR 1.58, 95% CI 1.47 to 1.69), limiting longstanding illness (OR 1.76, 95% CI 1.30 to 2.38), smoking (OR 1.42, 95% CI 1.04 to 1.97), difficulties with activities of daily living (OR 1.34, 95% CI 1.21 to 1.47) or mobility (OR 1.15, 95% CI 1.10 to 1.21). Age, ethnicity or social isolation was not significantly associated with loneliness in adults with breathlessness.</p><p><strong>Conclusions: </strong>Adults with breathlessness are more likely to be lonely, especially those with lower socio-economic status, who are unmarried or live alone or who have poorer physical function. Findings highlight priority groups for loneliness interventions among adults with breathlessness.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"13 1","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13423144/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148618003","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":"Pilot evaluation of 3D-designed custom-made integrated mask and headgear for children using non-invasive ventilation.","authors":"Mollie Broadbent, Sarah Shortland, Matt Willox, Peter Metherall, Jacob Branchflower, Vanessa E Craven, Heather E Elphick","doi":"10.1136/bmjresp-2025-003770","DOIUrl":"10.1136/bmjresp-2025-003770","url":null,"abstract":"<p><strong>Objectives: </strong>Use of long-term non-invasive ventilation (NIV) for children is increasing. Standard masks often fit poorly, causing significant complications. This pilot study aimed to evaluate a customised NIV mask/headgear.</p><p><strong>Setting: </strong>The evaluation took place in a single tertiary care centre.</p><p><strong>Participants: </strong>Five children aged 2-15 years using NIV for respiratory support and for whom a well-fitting commercial mask could not be found completed the study. Those requiring ventilation for rescue breaths or supplementary oxygen were excluded.</p><p><strong>Intervention: </strong>Each participant received a 3D-designed NIV mask and headgear, customised to the individual using 3D scanning and computer-aided design. The custom mask and headgear were compared with the child's usual mask and headgear for two nights each.</p><p><strong>Primary and secondary outcome measures: </strong>The primary outcome measure was comfort, measured using a 7-point Likert scale; secondary outcome measures were facial skin marks, measured using a diary card; ventilator efficacy, measured by 4% oxygen desaturation index (ODI₄) and sleep quality, measured by actigraphy recordings of overnight 'Actual Wake'.</p><p><strong>Results: </strong>Compared with the usual mask/headgear, the median discomfort score using the custom mask/headgear reduced from 5 Likert points (IQR 0) to 3 (IQR 2), and facial skin sores reduced from 1.5 (IQR 3) to 1 (IQR 0). Median Oxygen Desaturation Index (ODI₄) was similar: 0.76 (IQR 0.8) with standard mask/headgear and 0.77 (IQR 0.71) with the custom mask/headgear and median Actual Wake % was 2.95 (IQR 2.31) with standard mask/headgear and 3.70 (IQR 4.85) with the custom mask/headgear.</p><p><strong>Conclusions: </strong>Customisation of NIV masks and headgear using 3D printing may provide a valuable solution for children for whom a well-fitting commercial mask cannot be found. A multicentre study will seek to clarify definitive outcomes.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"13 1","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13423150/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148618058","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 insights into patient and carer perspectives of malignant pleural effusion management: an embedded study within the TACTIC trial.","authors":"Alice Milne, Alexandra Dipper, Rahul Bhatnagar, Anand Sundaralingam, Najib M Rahman, Nick Maskell, Andrew J Moore","doi":"10.1136/bmjresp-2026-004098","DOIUrl":"10.1136/bmjresp-2026-004098","url":null,"abstract":"<p><strong>Background: </strong>Malignant pleural effusion (MPE) is a condition characterised by excessive fluid build-up in the pleural cavity caused by cancer. Management options focus on drainage of fluid from the pleural cavity with a common aim of minimising symptoms and improving quality of life. Definitive pleural intervention is recommended for most patients with MPE to achieve longer-term symptom control. A patient-centred approach is also emphasised. However, little is known about the patient and carer experiences of MPE management. Therefore, this study sought to examine patient and carer experiences of differing procedural interventions within a trial setting.</p><p><strong>Methods: </strong>Patients with MPE and their carers who were taking part in the TACTIC trial in hospitals across the UK were invited to take part in a one-off interview. Thirty-two participants were recruited, and 22 semistructured interviews were conducted. Interview formats were either patient only, carer only or patient and carer dyad interviews. Interviews were audio recorded, transcribed verbatim and analysed using a generalised thematic analysis approach.</p><p><strong>Results: </strong>Initial findings demonstrated that patients and carers were generally satisfied with the MPE management and care received. No significant differences in acceptability were found between the two management strategies. Further analysis led to the development of four overarching themes: experiences of MPE beyond the trial, experiences of pain, preferences in MPE care and measuring MPE: rethinking patient relevance. These findings underscore the importance of greater consideration of pain management during MPE care, as well as improved communication and information prior to procedures.</p><p><strong>Conclusion: </strong>Patients and carers found the TACTIC combined procedure tolerable and acceptable. Echoing the growing evidence of research in this field, authors emphasise the importance of outcome measure selection in MPE trials and suggest a need for a Core Outcome Set to establish fundamental priorities in MPE management.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"13 1","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13409097/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148599062","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":"EASE-CF: dietitian-led weight-loss intervention for adults with cystic fibrosis and excess weight: protocol for a feasibility randomised controlled trial.","authors":"Joanna Snowball, Amanda Adler, Phillippa Lally, Nick P Talbot, Emma Hedley, Dimitrios A Koutoukidis","doi":"10.1136/bmjresp-2026-004328","DOIUrl":"10.1136/bmjresp-2026-004328","url":null,"abstract":"<p><strong>Introduction: </strong>Advances in cystic fibrosis (CF) care have coincided with an increasing prevalence of excess body weight in this population, which may contribute to cardiometabolic and respiratory morbidity. However, evidence to guide intentional weight loss in this population is limited and safety concerns remain due to the established positive association between body weight and lung function. Delivering weight-loss interventions in CF is likely to be complex because of CF-specific factors, high treatment burden and embedded dietary advice focused on high-energy, high-fat diets for weight gain. To inform the design of a future definitive randomised controlled trial (RCT), we plan to test the feasibility, acceptability and safety of a dietitian supported weight-loss intervention compared with routine care.</p><p><strong>Methods and analysis: </strong>This multicentre feasibility RCT with an embedded qualitative study, will recruit 30 adults with CF and body mass index ≥27 kg/m² from four UK specialist centres. Participants will be randomised 2:1 to the EASE-CF intervention or routine dietetic consultations, with follow-up over 24 weeks. The remotely delivered, theory-informed intervention combines structured dietary energy restriction, meal replacements and behavioural support from specialist CF dietitians. Participants randomised to routine care will continue to receive standard CF dietetic input. The primary objective is to assess the feasibility of progression to a definitive RCT based on pre-specified criteria on recruitment, engagement, adherence, retention and safety. Assessment of intervention acceptability and fidelity will be explored through process measures and qualitative interviews with participants and healthcare professionals. Exploratory outcomes include changes in body weight and composition, lung function, quality of life, physical function and metabolic markers.</p><p><strong>Ethics and dissemination: </strong>Ethical approval has been granted by the National Research Ethics Service South Central B Research Ethics Committee (ref: 25/SC/0323). Findings will be disseminated through stakeholder engagement, conference presentations and publication in open-access, peer-reviewed journals.</p><p><strong>Trial registration number: </strong>ISRCTN17298282.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"13 1","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13409102/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148599074","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":"Accuracy of prognostic scoring tools for ICU triage and mortality among patients in low- and middle-income countries: a systematic review and meta-analysis.","authors":"Thong Huu Tran, Hien Thi Thu Nguyen, Trung Huu Tran","doi":"10.1136/bmjresp-2026-004244","DOIUrl":"10.1136/bmjresp-2026-004244","url":null,"abstract":"<p><strong>Background: </strong>Early warning and severity scores are widely used to support triage and predict clinical deterioration. Their diagnostic performance in low- and middle-income countries (LMICs) however remains uncertain due to differences in patient populations and healthcare resources compared with high-income settings.</p><p><strong>Objectives: </strong>This study aimed to evaluate and compare the diagnostic accuracy of commonly used scoring systems for predicting intensive care unit (ICU) admission and in-hospital mortality among adults presenting to emergency departments in LMICs.</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis of PubMed, Science Direct, Web of Science and the Cochrane Library. Observational studies assessing the accuracy of early warning or severity scores for ICU admission or in-hospital mortality of patient admitted to the emergency department were included. Data were pooled using a bivariate random-effects model to estimate sensitivity, specificity and area under the curve (AUC). Study quality was appraised using QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies 2).</p><p><strong>Results: </strong>Twenty-six studies comprising over 45 000 patients from LMICs were analysed. For in-hospital mortality, quick Sequential Organ Failure Assessment (qSOFA) showed sensitivity of 0.61 and specificity of 0.73 (AUC=0.67); National Early Warning Score (NEWS)-family had higher sensitivity (0.80) but lower specificity (0.56, AUC=0.68); Modified Early Warning Score (MEWS) provided high specificity (0.83) but lower sensitivity (0.53, AUC=0.68). For ICU admission, NEWS demonstrated balanced performance (sensitivity 0.74, specificity 0.77, AUC=0.76), while Rapid Emergency Medicine Score (REMS) achieved the highest overall accuracy (sensitivity 0.79, specificity 0.85, AUC=0.81). Considerable heterogeneity was observed across studies.</p><p><strong>Conclusions: </strong>Early warning scores show moderate accuracy in predicting ICU admission and in-hospital mortality in LMIC emergency departments. qSOFA and MEWS may be most useful when high specificity is required, while NEWS and REMS provide more balanced performance, with REMS showing the best overall accuracy. No single score was optimal across settings, underscoring the need for local validation and adaptation in resource-limited environments.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"13 1","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13410911/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148583475","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 respiratory health with occupational exposures in the Burden of Obstructive Lung Disease (BOLD) cohort: a multinational longitudinal study.","authors":"Valentina Quintero-Santofimio, Jixuan Ma, James Potts, Hans Kromhout, Johanna Feary, Christer Janson, Magnus Svartengren, Mahesh Padukudru Anand, Rain Jõgi, Thorarinn Gíslason, Sanjay Kamlakar Juvekar, Rune Nielsen, Gregory Erhabor, Imed Harrabi, Graham Devereux, Andrei Malinovschi, Dhiraj Agarwal, Rana Ahmed, Vanessa Garcia-Larsen, Asaad Nafees, Peter Burney, Andre F S Amaral","doi":"10.1136/bmjresp-2026-004213","DOIUrl":"10.1136/bmjresp-2026-004213","url":null,"abstract":"<p><strong>Background: </strong>Occupational exposures are contributors to chronic respiratory diseases, particularly in low- and middle-income countries (LMICs), where regulatory policies are limited. We investigated associations between occupational exposures and respiratory outcomes using longitudinal data from the Burden of Obstructive Lung Disease study.</p><p><strong>Methods: </strong>We analysed data from 4237 participants across 17 sites, mostly in LMICs. Occupational exposures were assessed by self-report (never vs ever) and the ALOHA+Job Exposure Matrix for vapours, gases, dusts, fumes (VGDF), pesticides, solvents and metals (cumulative exposure). Respiratory outcomes included: forced expiratory volume in 1 s (FEV₁), forced vital capacity (FVC), the FEV₁/FVC and respiratory symptoms. Associations were examined using multilevel linear and logistic regression models adjusted for age, sex, smoking, pack-years, education, body mass index and baseline FVC. We further explored sex differences and non-linear relationships for symptoms.</p><p><strong>Results: </strong>Over a median 10 years of follow-up, FEV₁/FVC decline was associated with moderate (β=-1.34; 95% CI -2.32 to -0.35) and high (β=-1.79; 95% CI -3.33 to -0.20) exposure to VGDF and low (β=-1.11; 95% CI -2.11 to -0.08) and high (β=-2.16; 95% CI -4.08 to -0.24) exposure to pesticides. Increased risk of wheeze was associated with moderate (Relative Risk (RR) =1.45; 95% CI 1.05 to 2.15) and high (RR=1.89; 95% CI 1.100 to 3.26) exposure to pesticides. Associations did not differ by sex. There was weak evidence of non-linear exposure-response relationships and no associations with solvents or metals.</p><p><strong>Conclusions: </strong>A significant decline in FEV₁/FVC was associated with exposure to VGDF and pesticides. Increased risk of wheeze was also associated with exposure to pesticides. These findings underscore the need for continued monitoring in high-exposure settings, particularly in LMICs.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"13 1","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13410711/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148583502","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":"Clinical presentations of familial sarcoidosis: a retrospective cohort study from Finland.","authors":"Sini Koivu, Aino Puhakka, Jari Huovinen, Inna Wathén, Joakim Hulkkonen, Terttu Harju, Hannu Vähänikkilä, Hanna Jaula, Riitta Kaarteenaho, Johanna Leppänen","doi":"10.1136/bmjresp-2026-004128","DOIUrl":"10.1136/bmjresp-2026-004128","url":null,"abstract":"<p><strong>Background: </strong>Familial sarcoidosis, a rare form of sarcoidosis involving multiple affected family members, is associated with a genetic predisposition.</p><p><strong>Aim: </strong>This retrospective cohort study aimed to compare the clinical features, organ involvement, treatment and outcomes between familial and sporadic sarcoidosis in a well-defined Finnish population.</p><p><strong>Methods: </strong>Data from 1130 patients with confirmed sarcoidosis diagnosed between 2008 and 2022 at Oulu University Hospital and Oulaskangas Hospital were analysed. Familial sarcoidosis was defined as disease occurring in at least one first-degree, second-degree or third-degree relative. Clinical characteristics, medication use and pulmonary function were compared between familial (n=68) and sporadic (n=1062) cases, with additional sex-specific analyses performed.</p><p><strong>Result: </strong>Familial sarcoidosis accounted for 6.0% of all confirmed cases and was more common in women and first-degree relatives. Compared with sporadic cases, familial sarcoidosis was associated with higher rates of ocular and renal involvement and more frequent multiorgan disease. Thoracic manifestations were equally common in both groups and pulmonary function over time was comparable between familial and sporadic sarcoidosis. Within the familial group, women had a trend towards more diverse extrapulmonary manifestations whereas men more frequently presented with concurrent pulmonary and lymph node involvement. There were no major sex-specific differences between familial and sporadic sarcoidosis patients.</p><p><strong>Conclusion: </strong>These findings indicate that familial sarcoidosis in the Oulu region constitutes a clinically recognisable subtype within the disease spectrum, warranting systematic family history assessment and further clinical and genetic research.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"13 1","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13405015/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148547722","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":"Bronchiectasis in renal transplant patients: a narrative review.","authors":"Sandra Dury, Julien Ancel, Pauline Mulette, Julie Malet, Alexandre Vivien, Valerian Dormoy, Thomas Guillard, Anaëlle Muggeo, Vincent Vuiblet, Charlotte Colosio, Claire Launois, Jeanne-Marie Perotin, Gaëtan Deslee","doi":"10.1136/bmjresp-2026-004247","DOIUrl":"10.1136/bmjresp-2026-004247","url":null,"abstract":"<p><p>Non-cystic fibrosis bronchiectasis is associated with many causes including post-infectious damage, immunodeficiency, connective tissue disease and ciliary dysfunction and can also overlap with chronic obstructive pulmonary disease and asthma. Renal transplantation (RT) is the most common solid-organ transplantation worldwide. Since 2004, bronchiectasis associated with RT has been described in case reports and series involving children and adult patients. The pathogenesis remains unclear and may combine underlying renal diseases, immunodeficiency, direct toxicity of immunosuppressive drugs and lower tract infections. This narrative review, supported by the extensive literature in PubMed, Cochrane Library and Web of Science, provides a state-of-the-art of current knowledge regarding the epidemiology, pathophysiology and clinical impact of bronchiectasis in renal transplant patients. Finally, we provide management proposals for RT-associated bronchiectasis in clinical practice.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"13 1","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13404418/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148547707","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":"Phase III LUNA clinical programme: design of four randomised, double-blind, placebo-controlled studies assessing the efficacy and safety of tozorakimab in patients with symptomatic COPD and a high risk of exacerbations.","authors":"Henrik Watz, Frank C Sciurba, Matteo Bonini, Anahi Yañez, Arnaud Bourdin, Jinping Zheng, Anthony De Soyza, Wim Janssens, Maarten van den Berge, Jin-Fu Xu, Gabriela Luporini Saraiva, Martin Jenkins, Eulalia Jimenez, Magnus Lofdahl, Jia Li, Marta Mikosz, Natsuko Kishishita, Sonya Jackson, Susan Johnson, Rajesh Patel, Malin Fagerås, Ioannis Psallidas","doi":"10.1136/bmjresp-2026-004145","DOIUrl":"10.1136/bmjresp-2026-004145","url":null,"abstract":"<p><strong>Introduction: </strong>The dysregulation of both reduced (IL-33^red) and oxidised (IL-33^ox) interleukin (IL)-33 has been implicated in chronic obstructive pulmonary disease (COPD) inflammation and remodelling processes. Tozorakimab, an anti-IL-33 monoclonal antibody, inhibits both IL-33^red and IL-33^ox activity.</p><p><strong>Methods and analysis: </strong>The tozorakimab LUNA programme comprises four ongoing, multicentre, randomised, double-blind, parallel-group, placebo-controlled, phase III studies evaluating the efficacy and safety of tozorakimab in participants with symptomatic COPD and a history of exacerbations receiving optimised inhaled therapy. In OBERON (NCT05166889) and TITANIA (NCT05158387), 1132 and 1172 participants, respectively, were randomised to receive tozorakimab 300 mg every 4 or 8 weeks or placebo for 52 weeks. In MIRANDA (NCT06040086), 1454 participants were randomised 3:2 to tozorakimab 300 mg every 2 weeks or placebo for ≥52 weeks. In PROSPERO (NCT05742802), participants who completed treatment with tozorakimab in OBERON or TITANIA will continue treatment for an additional 28 weeks or 52 weeks; participants recruited from the placebo arm will be re-randomised 1:1 to tozorakimab or placebo. The primary endpoint in OBERON, TITANIA and MIRANDA is the annualised rate of moderate-to-severe COPD exacerbations; the primary endpoint in PROSPERO is the annualised rate of severe COPD exacerbations. For all studies, the primary endpoint will be first assessed in former smokers, then in current and former smokers. Secondary key endpoints include measures of lung function, respiratory symptoms, health status and safety. The tozorakimab LUNA programme is assessing the efficacy and safety of tozorakimab in participants with COPD. It is the largest pivotal programme of any biologic therapy in COPD to date.</p><p><strong>Ethics and dissemination: </strong>The protocols were approved by independent ethics committees and institutional review boards. Results of the studies will be submitted to the EU Clinical Trials Information System within a year from the global end of trial data in all participating countries and will be published or presented at scientific meetings.</p><p><strong>Trial registration number: </strong>OBERON: NCT05166889; TITANIA: NCT05158387; MIRANDA: NCT06040086; PROSPERO: NCT05742802.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"13 1","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13386067/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148535122","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":"Longitudinal analysis of inspiratory support requirements in obesity hypoventilation syndrome: is NIV de-escalation warranted?","authors":"Vivien Moro, Zsuzsanna Takacs, Szabolcs Baglyas, Eszter Podmaniczky, Laura Takacs, Andras Lorx, Luca Valko","doi":"10.1136/bmjresp-2025-003980","DOIUrl":"10.1136/bmjresp-2025-003980","url":null,"abstract":"<p><strong>Background: </strong>Optimal long-term management and inspiratory support requirements remain debated in obesity hypoventilation syndrome (OHS).</p><p><strong>Objectives: </strong>This prospective, observational study assessed inspiratory support requirements in OHS patients initiating noninvasive ventilation (NIV) after acute hypercapnic respiratory failure, using a volume-assured mode targeting normocapnia.</p><p><strong>Methods: </strong>Ventilator data and clinical parameters were collected at baseline, 1 month, 3 months, 6 months and 12 months after initiation of NIV. Inspiratory support requirements were assessed using driving pressure and apparent respiratory system compliance and compared over time using the Wilcoxon test and Friedman analysis of variance. Groups with persistent and minimal inspiratory support needs at 1 year were compared using Mann-Whitney, χ² and Cochran Q tests.</p><p><strong>Results: </strong>Of 40 enrolled patients, 39 completed the study. Therapeutic adherence (37 (94.9%)) and efficacy (35 (89.7%)) were high. Inspiratory support requirements decreased over the study period (12.1 (9.6-14.9) to 9.9 (6.3-12.2) cmH₂O, p<0.001), though 84.6% of patients still required >5 cmH₂O driving pressure. Initial driving pressure, higher minute ventilation and higher apparent respiratory system compliance were associated with reduced support requirements after 1 year, but no baseline parameter reliably predicted minimal support need. Reduced ventilatory support at 6 months demonstrated the strongest correlation with maintaining lower driving pressure at 12 months.</p><p><strong>Conclusions: </strong>Inspiratory support needs reduce over 12 months in OHS patients acutely initiated on long-term NIV, but few patients showed only minimal inspiratory support requirements to maintain normocapnia. Reliable reduction was apparent after 6 months of treatment, suggesting that respiratory muscle recovery is slower than previously assumed. Further studies are needed to verify whether an initial 'hit hard' approach with sequential de-escalation of ventilatory support results in optimal outcome.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"13 1","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13384130/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148468836","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}