BMJ Open Respiratory Research最新文献

{"title":"Performance against quality indicators in the initial assessment of patients with respiratory infections in acute medicine services.","authors":"Catherine Atkin, Mark Holland, Tim Cooksley, Ragit Varia, Christian P Subbe, Tom Wilkinson, Daniel Lasserson, Elizabeth Sapey","doi":"10.1136/bmjresp-2025-003207","DOIUrl":"https://doi.org/10.1136/bmjresp-2025-003207","url":null,"abstract":"<p><strong>Introduction: </strong>Hospital attendances due to respiratory infection peak in winter, contributing to pressures within acute services. We assessed the prevalence of suspected respiratory infection within acute medical admissions during winter and evaluated performance against recommendations for initial assessment.</p><p><strong>Methods: </strong>Data were collected through the Society for Acute Medicine (SAM) Benchmarking Audit, comprising a hospital-level survey and 24-hour patient-level data collection for unplanned acute medical attendances on 22 February 2024. Performance metrics assessed included those from the SAM's clinical quality indicators (CQI) for medical admissions, and British Thoracic Society (BTS) guidelines for community acquired pneumonia.</p><p><strong>Results: </strong>Data were available for 4390 patients at 76 hospitals. Suspected respiratory infections accounted for 22.8% of all unplanned medical attendances; these patients were older (age ≥70 years: 58.2% vs 44.7%, p<0.001) and had higher National Early Warning Score 2 (NEWS2) scores (NEWS2 ≥3: 63.8% vs 23.8%, p<0.001) than those without respiratory infection; they were more likely to be assessed in the emergency department (80.8% vs 63.7%, p<0.001), and had lower rates of discharge without overnight admission (14.9% vs 35.9%, p<0.001). 71.0% of patients underwent a chest X-ray within 4 hours of arrival; 27.0% were reported within 12 hours. Antibiotics were administered ≥4 hours from arrival in 32.9%. Performance against these indicators varied between hospitals. Nine hospitals (12.7%) had a separate respiratory admission service; this was not associated with improved performance against SAM CQIs or BTS guidance.</p><p><strong>Conclusion: </strong>Respiratory infections contribute significantly to acute medical attendances via the emergency department. There remains significant scope to improve key steps in initial assessment and management.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12382532/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144942186","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":"Enhanced detection of patients with previous COVID-19: superiority of the double diffusion technique.","authors":"Gerald Stanley Zavorsky, Giovanni Barisione, Thomas Gille, Roberto W Dal Negro, Marta Núñez-Fernández, Leigh Seccombe, Gianluca Imeri, Fabiano Di Marco, Jann Mortensen, Elisabetta Salvioni, Piergiuseppe Agostoni, Vito Brusasco","doi":"10.1136/bmjresp-2024-002561","DOIUrl":"10.1136/bmjresp-2024-002561","url":null,"abstract":"<p><strong>Background: </strong>Persistent pulmonary dysfunction is common after COVID-19, yet traditional assessments using carbon monoxide diffusing capacity (DLCO) alone may miss alveolar-capillary impairment.</p><p><strong>Objective: </strong>To determine whether combining nitric oxide (DLNO_5s) and carbon monoxide (DLCO_5s) diffusing capacities enhances detection of post-COVID-19 lung impairment and whether summed <i>z</i>-scores outperform individual measures in classifying affected individuals.</p><p><strong>Design and methods: </strong>We conducted an individual participant data meta-analysis using hierarchical mixed-effects modelling. The dataset included 572 COVID-19 survivors and 72 matched controls from six European centres. Lung function metrics-including spirometry, total lung capacity, DLNO_5s and DLCO_5s-were standardised into <i>z</i>-scores. Logistic models were compared using Bayesian Information Criterion and Leave-One-Out Information Criterion. Classification accuracy was assessed with Matthews Correlation Coefficient (MCC) and net reclassification improvement (NRI). Principal Component Analysis examined score structures, and dyspnoea severity was correlated with z-scores. Assessments were conducted 32-575 days post-infection (median=130 days).</p><p><strong>Results: </strong>The number of days between SARS-CoV-2 diagnosis and testing did not affect any of the measured z-scores. Summed DLNO_5s + DLCO_5s <i>z</i>-scores consistently outperformed individual metrics. The combined model improved MCC by 0.06 (95% CI 0.01 to 0.11) and NRI by 37% (95% CI 13 to 62%) over DLCO_5s alone. The top model summed DLNO_5s + DLCO_5s model explained 10% of fixed and 59% of random variance. DLCO_5s alone failed to identify reduced membrane diffusion in approximately 16% of cases. Dyspnoea severity was significantly associated with all diffusion indices (p<0.001), though combined scores showed no stronger correlation than single predictors.</p><p><strong>Conclusion: </strong>Summed DLNO_5s + DLCO_5s <i>z</i>-scores enhance classification of post-COVID-19 pulmonary impairment beyond DLCO_5s alone. The NO-CO double diffusion approach offers improved diagnostic discrimination between previously infected individuals and controls and aligns with symptom severity. These findings support broader clinical integration of combined diffusion metrics in post-COVID assessment.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12382503/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144942242","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":"Evolution of cystic lung disease in Birt-Hogg-Dubé syndrome: assessment of older patients.","authors":"Vasilios Tzilas, Rui Wang, Wei Wei, Xiaowen Hu, Jay H Ryu","doi":"10.1136/bmjresp-2024-002629","DOIUrl":"https://doi.org/10.1136/bmjresp-2024-002629","url":null,"abstract":"<p><strong>Background: </strong>Birt-Hogg-Dubé syndrome (BHD) is a rare autosomal dominant disease characterised by the development of lung cysts, skin fibrofolliculomas and an increased risk for renal cancer. The progression of cystic lung disease with ageing in BHD has not been well characterised.</p><p><strong>Objectives: </strong>To assess the severity of lung involvement in patients with BHD aged 50 years or older.</p><p><strong>Methods: </strong>A retrospective computer-assisted search was performed to identify patients with BHD seen at Mayo Clinic in Rochester, Minnesota and the First Affiliated Hospital of University of Science and Technology of China from January 2000 to May 2023. Demographic, clinical, pulmonary function and radiological parameters were extracted and analysed.</p><p><strong>Results: </strong>Among 82 patients with BHD aged 50 years or older, 49 (59%) were female and the median age was 57 years (range, 50-79) at baseline. Pneumothorax occurred in 46 patients (56%). Lung cysts were observed on CT in 77 patients (94%) and were bilateral in nearly all cases. The number of cysts was≥10 for most patients (84%) and the median size of the largest cyst was 31 mm (range, 4-160 mm). Median (range) % predicted values of forced vital capacity, forced expiratory volume in 1 s and diffusion capacity of the lung for carbon monoxide were 98 (62-147), 92 (56-145) and 85 (61-133), respectively, for those with data available. During follow-up (median, 41 months; range, 3-259), 35% of patients manifested worsening in pulmonary function or cystic lung disease.</p><p><strong>Conclusion: </strong>Lung involvement in older patients with BHD manifests varying severity of cystic lung disease with relatively mild functional impairment, if any, and indolent progression.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12382499/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144942198","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":"Pleural fluid C-C class chemokines 22 and pleural effusion due to heart failure: a prospective and double-blind diagnostic accuracy test.","authors":"Li Yan, Su-Na Cha, Yan Niu, Jian-Xun Wen, Wen Zhao, Cheng Yan, Hong-Zhe Zhu, Ying-Jun Wang, Ling Hai, Ting-Wang Jiang, Qianghua Zhou, José M Porcel, Wen-Qi Zheng, Zhi-De Hu","doi":"10.1136/bmjresp-2024-002823","DOIUrl":"10.1136/bmjresp-2024-002823","url":null,"abstract":"<p><strong>Background: </strong>Previous studies have indicated that C-C class chemokine ligand 22 (CCL22) is involved in the pathogenesis of tuberculous pleural effusion and malignant pleural effusion. However, the diagnostic role of pleural fluid CCL22 levels in patients with undiagnosed pleural effusions remains to be elucidated.</p><p><strong>Methods: </strong>We prospectively recruited patients with undiagnosed pleural effusion who visited two centres (Hohhot and Changshu) in China. Pleural biopsy, microbiological culture and effusion cytology were used to verify the cause of pleural effusion. Pleural fluid CCL22 levels were measured using an ELISA. The diagnostic accuracy of CCL22 for identifying heart failure (HF) was evaluated using a receiver operating characteristic (ROC) curve, and the net benefit of CCL22 was evaluated using decision curve analysis (DCA). Net benefit was defined as the benefit associated with true positives minus the harms associated with false positives at various threshold probabilities.</p><p><strong>Results: </strong>We enrolled 153 and 58 patients in the Hohhot and Changshu cohorts, respectively. The cohort included 28 patients with HF and 183 patients with non-HF. Patients with HF had significantly lower pleural fluid CCL22 levels than non-HF patients. The area under the ROC curve (AUC) of CCL22 was 0.85 (95% CI: 0.77 to 0.93) in the Hohhot cohort and 0.87 (95% CI: 0.75 to 0.98) in the Changshu cohort. The AUC in the combined cohort was 0.85 (95% CI: 0.79 to 0.92), with a sensitivity of 0.82 (95% CI: 0.68 to 0.93) and a specificity of 0.73 (95% CI: 0.67 to 0.79) at the threshold of 150 ng/mL. DCA revealed a potential net benefit of pleural CCL22 determination in patients with undiagnosed pleural effusions.</p><p><strong>Conclusions: </strong>Pleural fluid CCL22 may be a potential diagnostic marker for HF-related pleural effusion. Owing to the small sample size of this study, further studies with larger sample sizes are needed to validate our findings.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12366591/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882071","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":"ARDS during haematopoietic reconstruction after allogeneic haematopoietic stem cell transplantation (allo-HSCT) in non-child patients: based on the new global definition.","authors":"Chang Gao, Ying Wang, Di Yin, Daxiong Zeng, Ye Gao, Yu He, Yuanyuan Yang, Haiyan Wang, Depei Wu, Qiang Guo","doi":"10.1136/bmjresp-2024-002691","DOIUrl":"10.1136/bmjresp-2024-002691","url":null,"abstract":"<p><strong>Background: </strong>Haematopoietic reconstitution is marked by immunosuppression and pancytopenia, representing the initial high-risk period following allogeneic haematopoietic stem cell transplantation (allo-HSCT). However, little is known about the occurrence of acute respiratory distress syndrome (ARDS) during haematopoietic reconstitution.</p><p><strong>Methods: </strong>This retrospective cohort study included 1024 patients who underwent allo-HSCT in Suzhou from 2016 to 2019. Clinical data and follow-up information were collected from medical records. ARDS was defined according to the new global definition established in 2023. The primary outcomes were the incidence of ARDS during haematopoietic reconstitution after allo-HSCT and 1 year post-transplantation mortality.</p><p><strong>Results: </strong>Among the 1024 patients, 58 (5.6%) died within 1 year after HSCT. ARDS during haematopoietic reconstitution occurred in 45 patients (4.4%), of whom 29 were treated with high-flow nasal oxygen only. The median onset of ARDS was 9.0 days post-transplantation. Patients who developed ARDS had a significantly higher risk of 1-year mortality after HSCT (HR 7.99, 95% CI 4.13 to 15.44). Independent risk factors for ARDS during haematopoietic reconstitution included longer intervals between disease onset and transplantation (OR 1.01, 95% CI 1.00 to 1.02), a greater number of previous HSCTs (OR 1.82, 95% CI 1.04 to 3.19), and higher red cell distribution width at admission (OR 1.12, 95% CI 1.02 to 1.22).</p><p><strong>Conclusions: </strong>According to the new 2023 global definition, ARDS during haematopoietic reconstitution is independently associated with increased 1-year mortality after allo-HSCT. Early identification of ARDS during this period is particularly important, and recognising its risk factors may aid in timely diagnosis and intervention.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12359526/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144871435","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":"T₂*-weighted oxygen-enhanced pulmonary MRI in COPD is linked to resting and exertional functional measurements.","authors":"Amany F Elbehairy, Josephine H Naish, Hossein Baghertash, Geoff J M Parker, Christopher A Miller, Jørgen Vestbo, Alex R Horsley","doi":"10.1136/bmjresp-2024-002784","DOIUrl":"10.1136/bmjresp-2024-002784","url":null,"abstract":"<p><strong>Background: </strong>T₂*-weighted oxygen-enhanced MRI (T₂*-OE-MRI) may directly assess pulmonary ventilation using oxygen as an inhaled tracer gas. It has shown promise in healthy volunteers (HVs) and cystic fibrosis but has yet to be demonstrated in patients with chronic obstructive pulmonary disease (COPD).</p><p><strong>Research question: </strong>To determine the feasibility and repeatability of T₂*-OE-MRI in patients with COPD. To assess correlations between T₂*-OE-MRI measurements of pulmonary ventilation, pulmonary function tests (PFTs) and measures of functional limitation.</p><p><strong>Study design and methods: </strong>13 patients with mild-to-severe COPD and 13 HVs underwent PFTs, lung clearance index (LCI) measurement, incremental exercise test (patients only) and two lung MRI scans at 3 T. For T₂*-OE-MRI, participants were fitted with a non-rebreathing face mask and given 100% oxygen during image acquisition.</p><p><strong>Results: </strong>Patients (age: 63 (55-72) years, forced expiratory volume in 1 s (FEV₁): 63 (36-79) %predicted, median (IQR)) had evidence of pulmonary gas trapping, small airway disease (SAD) and ventilation heterogeneity. During T₂*-OE-MRI, the magnitude of the percentage difference between mean signal intensity at normoxia and hyperoxia (percent signal enhancement (PSE)) and the enhancing fraction (EF) were lower in patients versus HVs (2.77 (2.19-4.19) vs 5.34 (4.33-5.61) % and 0.74 (0.66-0.77) vs 0.89 (0.82-0.94), respectively, both p<0.001). Intraclass correlation coefficient values indicated moderate (0.74) and good (0.80) repeatability for PSE and EF, respectively. PSE and EF significantly correlated with FEV₁, LCI and SAD indices, and in COPD, they correlated with measures of exercise capacity, dynamic hyperinflation and dyspnoea intensity during exercise.</p><p><strong>Interpretation: </strong>In patients with COPD, T₂*-OE-MRI is feasible and repeatable and provides regional information on pulmonary ventilation that is linked with physiological measures of disease severity, functional limitation and exertional dyspnoea.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12336524/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144803432","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":"Temporal complexity in missed doses of rifampicin-sensitive anti-tuberculosis treatment: a prospective cohort study in Tanzania.","authors":"Lilian Tuwabunze, Kassim Salim Msaji, Alphonce Liyoyo, Proma Paul, Stellah Mpagama, Helen R Stagg","doi":"10.1136/bmjresp-2024-003088","DOIUrl":"10.1136/bmjresp-2024-003088","url":null,"abstract":"<p><strong>Background: </strong>Non-adherence to anti-tuberculosis (TB) regimens is not simplistic; rather, doses are missed in complex patterns. In a cohort of individuals being treated for rifampicin-sensitive pulmonary TB in Tanzania, we sought to examine how doses were missed across the treatment course and within a day, as well as the reasons for missed dose periods.</p><p><strong>Methods: </strong>200 participants aged ≥18 years treated with the standard 6-month regimen were recruited from March 2022 to June 2023. Missed doses were measured using evriMED pillboxes and by pill count. The reasons for up to three missed dose periods per month were collected. Patterns of missed doses-across treatment and within a day-and their reasons were visualised and described.</p><p><strong>Findings: </strong>Two participants died early in treatment, leaving 198 with missed dose data. The increase in the percentage of participants that missed any given dose as time progressed was driven by early discontinuation (median doses missed 0.0% in month 1 vs 6.7% in month 6) from treatment, as opposed to sporadic missed doses (median doses missed 3.1% in month 1 vs 4.1% in month 6). There was a median of one sporadic missed dose period (ranging between 0 and 42 doses in length) per participant. Out of all the reported reasons for missed dose periods, forgetting or forgetting and inconvenience were the most common (59.6%).</p><p><strong>Interpretation: </strong>Missing doses of anti-TB treatment is a temporally complex phenomenon and the result of the intersection of multifaceted day-to-day events in an individual's life, with complicated implications for effective drug levels across the treatment course. This complexity limits our ability to predict an individual's missed doses at the start of treatment.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12315038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144764498","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":"Breathlessness intensity recorded in general practice is associated with shorter times to unplanned hospital admissions and longer lengths of stay: a UK cohort study.","authors":"Urvee Karsanji, Vanessa N Brunelli, Claire A Lawson, Alex Bottle, Magnus Ekström, Irina Kinchin, Slavica Kochovska, Diana Ferreira, Jennifer K Quint, Michael C Steiner, Rachael A Evans, David C Currow","doi":"10.1136/bmjresp-2024-003000","DOIUrl":"10.1136/bmjresp-2024-003000","url":null,"abstract":"<p><strong>Background and objective: </strong>Breathlessness is associated with higher rates of unplanned health service utilisation. We aimed to evaluate any associations between the severity of <i>breathlessness limiting exertion</i> (hereafter <i>breathlessness</i>), time between <i>breathlessness</i> recording and subsequent unplanned hospital admissions, and length of stay.</p><p><strong>Methods: </strong>A retrospective cohort study of adults seen in general practice (UK Clinical Practice Research Datalink) with <i>breathlessness</i> (Medical Research Council (MRC) breathlessness scale; 1-5; 5 is most intense), no pre-existing cardio-respiratory disease and a subsequent unplanned hospital admission. Data from 2007 to 2017 were used. By intensity of <i>breathlessness</i>, time to first unplanned admission and hospital length of stay were evaluated, the latter using negative binomial regression.</p><p><strong>Results: </strong>103 917 adults had breathlessness scores recorded, of which 16 948 used MRC. 11 911 (70%) adults had a subsequent unplanned hospital admission (median (IQR) of 1538 days (846-2258)) later. More intense <i>breathlessness</i> was associated with higher age, higher body mass index and being a smoker/ex-smoker.Length of time between a first-recorded <i>breathlessness</i> score and the first unplanned hospital admission decreased significantly with higher MRC scores (MRC 1: 1167 days; MRC 5: 615 days).Negative binomial regression showed an association between higher MRC scores and an increased length of inpatient stay (p<0.001; Akaike information criterion=20 817), controlling for key demographic factors.</p><p><strong>Conclusion: </strong>This is the first study to identify an association between recording <i>breathlessness</i> intensity and time to a person's first unplanned hospital admission and longer inpatient length of stay. Future work must focus on whether interventions can change people's health service use.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12314997/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144752304","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":"Global, regional and national burden of asthma from 1990 to 2021: a systematic analysis for the Global Burden of Disease Study 2021.","authors":"Liwen Zhang, Hejun Jiang, Guijun Yang, Jing Zhang, Shuhua Yuan, Jiande Chen, Mingyu Tang, Jilei Lin, Jiajun Yuan, Yong Yin","doi":"10.1136/bmjresp-2025-003144","DOIUrl":"10.1136/bmjresp-2025-003144","url":null,"abstract":"<p><strong>Background: </strong>Asthma represents a significant global health challenge, exhibiting considerable variation in prevalence, incidence, mortality and disability-adjusted life years (DALYs) across regions and countries. This study evaluates global, regional and national trends in asthma burden from 1990 to 2021, analysing associations with temporal, geographical and demographical factors.</p><p><strong>Methods: </strong>Using open data from the Global Burden of Disease (GBD) database (1990-2021), we analysed changes in asthma prevalence, incidence, mortality and DALYs by gender, age and Socio-Demographic Index (SDI) groups. Joinpoint regression analysis calculated the average annual percentage change (AAPC) and annual percentage change (APC).</p><p><strong>Results: </strong>From 1990 to 2021, the age-standardised prevalence and incidence rates of asthma declined by 40.01% and 29.89%, respectively. While asthma deaths increased slightly, the age-standardised mortality rate (ASMR) declined by 46.01%. The highest prevalence was observed in South Asia, East Asia and high-income North America, while low-SDI regions exhibited elevated mortality and DALYs. The age and sex-specific patterns indicated a higher asthma burden among females. The results of the joinpoint analysis indicated a global age-standardised incidence rate increase between 2005 and 2010 for both males and females. The ASMR exhibited a statistically significant decline from 1990 to 2021.</p><p><strong>Conclusions: </strong>The global age-standardised rate of asthma burden declined from 1990 to 2021. However, asthma remains a significant public health issue, particularly in regions with lower socioeconomic development. Understanding global and regional trends in asthma can inform future policies and interventions, aiming to promote more equitable prevention, diagnosis and treatment worldwide.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12306235/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144706291","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":"Liberation from invasive mechanical ventilation: a nationwide survey among intensive care units in the Netherlands.","authors":"Carline N L Groenland, Matthijs L Janssen, Kim S van den Bosch, Vivan J M Baggen, Leo Heunks, Henrik Endeman, Evert-Jan Wils","doi":"10.1136/bmjresp-2024-002868","DOIUrl":"10.1136/bmjresp-2024-002868","url":null,"abstract":"<p><strong>Background: </strong>Liberation from invasive mechanical ventilation is a milestone in critical care, but approaches vary. This survey aimed to describe current ventilator liberation practices, relate them to available evidence, and identify areas for improvement.</p><p><strong>Methods: </strong>A survey was performed among Dutch intensive care unit (ICU) sites. The survey evaluated practice in seven domains of ventilator liberation: protocol availability, transition from controlled to assisted ventilation, spontaneous breathing trials (SBT), cuff-leak test, postextubation support, weaning failure and tracheostomised weaning.</p><p><strong>Results: </strong>The survey response rate was 93% (132/142), representing 97% (69/71) of Dutch ICUs. Protocols for postextubation support and weaning failure were available in less than half of the ICUs (44% and 49%, respectively). The transition from controlled to assisted ventilation is regularly evaluated daily in 78% of ICUs. Assisted ventilation tolerance is mainly assessed by clinical signs, respiratory parameters and non-invasive manoeuvres that assess respiratory drive (P_0.1). SBTs are regularly performed in 58% of ICUs, using one or more of the following methods: T-piece (52%), pressure support+positive end expiratory pressure (32%) and continuous positive airway pressure (28%). Cuff-leak tests are seldom performed (1.4%), predominantly in cases of intubation for upper-airway obstruction (92%). Postextubation respiratory support with high-flow nasal oxygen or non-invasive ventilation is used at least as often with therapeutic (43%/13%) rather than preventive (35%/4%) of facilitative intent (29%/3%). Delirium screening (87%) and reconsidering sedation (84%) are frequently assessed in case of weaning failure. Regular use of closed-loop ventilation is reported in a minority of ICUs throughout the process of ventilator liberation (3-9%).</p><p><strong>Conclusions: </strong>Various aspects of ventilator liberation practices show only limited alignment with existing guidelines. The results of this survey pinpoint areas to prioritise in guideline and practice improvement.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12281335/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144688881","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}