BMJ Open Respiratory Research最新文献

{"title":"Machine learning-based model for predicting all-cause mortality in severe pneumonia.","authors":"Weichao Zhao, Xuyan Li, Lianjun Gao, Zhuang Ai, Yaping Lu, Jiachen Li, Dong Wang, Xinlou Li, Nan Song, Xuan Huang, Zhao-Hui Tong","doi":"10.1136/bmjresp-2023-001983","DOIUrl":"10.1136/bmjresp-2023-001983","url":null,"abstract":"<p><strong>Background: </strong>Severe pneumonia has a poor prognosis and high mortality. Current severity scores such as Acute Physiology and Chronic Health Evaluation (APACHE-II) and Sequential Organ Failure Assessment (SOFA), have limited ability to help clinicians in classification and management decisions. The goal of this study was to analyse the clinical characteristics of severe pneumonia and develop a machine learning-based mortality-prediction model for patients with severe pneumonia.</p><p><strong>Methods: </strong>Consecutive patients with severe pneumonia between 2013 and 2022 admitted to Beijing Chaoyang Hospital affiliated with Capital Medical University were included. In-hospital all-cause mortality was the outcome of this study. We performed a retrospective analysis of the cohort, stratifying patients into survival and non-survival groups, using mainstream machine learning algorithms (light gradient boosting machine, support vector classifier and random forest). We aimed to construct a mortality-prediction model for patients with severe pneumonia based on their accessible clinical and laboratory data. The discriminative ability was evaluated using the area under the receiver operating characteristic curve (AUC). The calibration curve was used to assess the fit goodness of the model, and decision curve analysis was performed to quantify clinical utility. By means of logistic regression, independent risk factors for death in severe pneumonia were figured out to provide an important basis for clinical decision-making.</p><p><strong>Results: </strong>A total of 875 patients were included in the development and validation cohorts, with the in-hospital mortality rate of 14.6%. The AUC of the model in the internal validation set was 0.8779 (95% CI, 0.738 to 0.974), showing a competitive discrimination ability that outperformed those of traditional clinical scoring systems, that is, APACHE-II, SOFA, CURB-65 (confusion, urea, respiratory rate, blood pressure, age ≥65 years), Pneumonia Severity Index. The calibration curve showed that the in-hospital mortality in severe pneumonia predicted by the model fit reasonably with the actual hospital mortality. In addition, the decision curve showed that the net clinical benefit was positive in both training and validation sets of hospitalised patients with severe pneumonia. Based on ensemble machine learning algorithms and logistic regression technique, the level of ferritin, lactic acid, blood urea nitrogen, creatine kinase, eosinophil and the requirement of vasopressors were identified as top independent predictors of in-hospital mortality with severe pneumonia.</p><p><strong>Conclusion: </strong>A robust clinical model for predicting the risk of in-hospital mortality after severe pneumonia was successfully developed using machine learning techniques. The performance of this model demonstrates the effectiveness of these techniques in creating accurate predictive models, and the use of this model","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934410/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143690935","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":"Head-to-head comparison of anterior nares and nasopharyngeal swabs for SARS-CoV-2 antigen detection in a community drive-through test centre in the UK.","authors":"Rachel L Byrne, Ghaith Aljayyoussi, Konstantina Kontogianni, Karina Clerkin, Mathew McIntyre, Jahanara Wardale, Christopher T Williams, Richard Body, Emily R Adams, Margaretha de Vos, Camille Escadafal, Ana I Cubas Atienzar","doi":"10.1136/bmjresp-2023-001747","DOIUrl":"10.1136/bmjresp-2023-001747","url":null,"abstract":"<p><strong>Objective: </strong>To conduct a head-to-head diagnostic accuracy evaluation of anterior nares (AN) and nasopharyngeal (NP) swabs for SARS-CoV-2 antigen detection using two brands of rapid diagnostic tests (Ag-RDT).</p><p><strong>Methods: </strong>Two prospective diagnostic evaluations were carried out at different time points and participant cohorts to evaluate the performance of paired AN and NP swabs in two Ag-RDT brands: Sure-Status (PMC, India) and Biocredit (RapiGEN, South Korea). The sensitivity and specificity of AN and NP swabs for each of the index test cohorts were calculated against the reverse transcription quantitative PCR (RT-qPCR) TaqPath COVID-19 (ThermoFisher, UK) using NP swabs as reference standard.</p><p><strong>Results: </strong>A total of 372 participants were recruited for the Sure-Status cohort and 232 for the Biocredit, of which 119 (32.1%) and 122 (53.7%) were SARS-CoV-2 positive by RT-qPCR, respectively. Sensitivity and specificity of AN swabs were equivalent to those obtained with NP swabs in both cohorts: 83.9% (95% CI 76.0-90.0) and 98.8% (95% CI 96.6-9.8) using NP swabs and 85.6% (95% CI 77.1-91.4) and 99.2% (95% CI 97.1-99.9) with AN swabs for Sure-Status and; 81.2% (95% CI 73.1-87.7) and 99.0% (95% CI 94.7-86.5) with NP swabs and 79.5% (95% CI 71.3-86.3) and 100% (95% CI 96.5-100) with AN swabs for Biocredit. The agreement of the AN and NP swabs was high for both brands with an inter-rater reliability (κ) of 0.918 and 0.833 for Sure-Status and Biocredit, respectively. The overall 50% limits of detection (LoD50) and 95% LoD (LoD95) were 0.9-2.4×10⁴ and 3.0-3.2×10⁸ RNA copies/mL for NP swabs and 0.3-1.1×10⁵ and 0.7-7.9×10⁷ RNA copies/mL for AN swabs, with no significant difference in LoD for any of the swab types or test brands.</p><p><strong>Conclusions: </strong>The diagnostic accuracy of the two SARS-CoV-2 Ag-RDT brands evaluated in this study was equivalent using AN swabs than NP swabs. However, test line intensity was lower when using AN swabs, which could negatively influence the interpretation of the Ag-RDT results by lay users.</p><p><strong>Trail registration number: </strong>NCT04408170.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934397/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143690933","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":"Complex breathlessness intervention in idiopathic pulmonary fibrosis (BREEZE-IPF): a feasibility, wait-list design randomised controlled trial.","authors":"Michael George Crooks, Caroline Wright, Simon Hart, Victoria Allgar, Anne English, Flavia Swan, Judith Dyson, Gerry Richardson, Maureen Twiddy, Judith Cohen, Andrew Simpson, Chao Huang, Dominic L Sykes, Miriam Johnson","doi":"10.1136/bmjresp-2024-002327","DOIUrl":"10.1136/bmjresp-2024-002327","url":null,"abstract":"<p><strong>Introduction: </strong>Breathlessness is common and impairs the quality of life of people with idiopathic pulmonary fibrosis (IPF) and non-IPF fibrotic interstitial lung diseases (ILD). We report the findings of a multicentre, fast-track (wait-list), mixed-methods, randomised controlled, feasibility study of a complex breathlessness intervention in breathless IPF and non-IPF fibrotic ILD patients.</p><p><strong>Methods: </strong>Breathless IPF and non-IPF fibrotic ILD patients were randomised to receive the intervention within 1 week (fast-track) or after 8 weeks (wait-list). The intervention comprised two face-to-face and one telephone appointment during a 3-week period covering breathing control, handheld fan-use, pacing and breathlessness management techniques, and techniques to manage anxiety. Feasibility and clinical outcomes were assessed to inform progression to, and optimal design for, a definitive trial. A qualitative substudy explored barriers and facilitators to trial and intervention delivery.</p><p><strong>Results: </strong>47 patients (M:F 38:9, mean (SD) age 73.9 (7.2)) were randomised with a recruitment rate of 2.5 participants per month across three sites. The adjusted mean differences (95% CI) for key clinical outcomes at 4 weeks post randomisation were as follows: Chronic Respiratory Questionnaire breathlessness mastery domain (0.45 (-0.07, 0.97)); and numerical rating scales for 'worst' (-0.93 (-1.95, 0.10)), 'best' (-0.19 (-1.38, 1.00)), 'distress caused by' (-1.84 (-3.29, -0.39)) and 'ability to cope with' (0.71 (-0.57, 1.99)) breathlessness within the past 24 hours. The qualitative substudy confirmed intervention acceptability and informed feasibility and acceptability of study outcome measures.</p><p><strong>Conclusion: </strong>A definitive trial of a complex breathlessness intervention in patients with IPF and non-IPF fibrotic ILD is feasible with preliminary data supporting intervention effectiveness.</p><p><strong>Trial registration number: </strong>ISRCTN13784514.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931949/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143690930","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":"Sex differences in asthma and COPD hospital admission, readmission and mortality.","authors":"Hannah Whittaker, Alexander Adamson, Philip Stone, Precious Olubori, James Calvert, James Dodd, Ian Sinha, Katherine Hickman, Sally Singh, Jennifer K Quint","doi":"10.1136/bmjresp-2024-002808","DOIUrl":"10.1136/bmjresp-2024-002808","url":null,"abstract":"<p><strong>Background: </strong>Asthma and chronic obstructive pulmonary disease (COPD) outcomes vary by sex. We investigated whether males and females with asthma or COPD are managed differently in-hospital when admitted for an exacerbation.</p><p><strong>Methods: </strong>Data from the National Asthma and COPD Audit Programme were used to determine three cohorts of people hospitalised for an exacerbation: (1) adults with asthma, (2) children and young people (CYP) with asthma, and (3) adults with COPD. Outcomes included the following in-hospital interventional measures: spirometry recording, respiratory specialist review, respiratory medication administration and discharge bundle recording. Linked hospital data were used to determine 30-day and 90-day readmissions and Office for National Statistics data for 90-day mortality. Random effects logistic regression was used to investigate the association between sex and in-hospital outcomes, readmission and mortality.</p><p><strong>Results: </strong>16 370 adults with asthma, 7156 CYP with asthma and 28 354 adults with COPD were included. Female adults with asthma had higher odds of being seen by a respiratory specialist (_aOR 0.1.13, 1.02-1.26) and higher odds of readmission within 30 and 90 days (_aOR 1.22, 1.10-1.37, _aOR 1.34, 1.23-1.46) compared with males. Female adults with COPD had higher odds of being seen by a respiratory specialist, (_aOR 1.10,1.02-1.19), being administered non-invasive ventilation (_aOR 1.18, 1.09-1.29), and receiving a discharge bundle (_aOR 1.07, 1.00-1.14), and lower odds of readmission within 90 days (_aOR 0.95, 0.90-1.01), or mortality within 90 days (_aOR 0.88, 0.81-0.96). Lastly, female CYP had higher odds of steroids administered within 1 hour (_aOR 1.13, 1.00-1.28) and higher 30-day and 90-day readmission compared with males (_aOR 1.21, 1.00-1.44 and 1.17, 1.03-1.34).</p><p><strong>Interpretation: </strong>Sex differences in in-hospital care exist in adults COPD, which may impact readmissions and mortality; however, little to no sex differences in in-hospital care were seen in people with asthma yet females were more likely to be readmitted to hospital.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11927479/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143646933","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":"Assessment of the right ventricular strain, left ventricular strain and left atrial strain using speckle tracking echocardiography in patients with chronic obstructive pulmonary disease.","authors":"Hai Nguyen Ngoc Dang, Thang Viet Luong, Nhi Thi Y Nguyen, Hung Khanh Tran, Hieu Thi Nguyen Tran, Hung Minh Vu, Thanh Van Ho, Ngoc Thi Minh Vo, Thanh Thien Tran, Toan Song Do, Van Thi Thuy Phan, Tien Anh Hoang, Phuoc Le Huu, Binh Anh Ho, Hung Minh Nguyen","doi":"10.1136/bmjresp-2024-002706","DOIUrl":"10.1136/bmjresp-2024-002706","url":null,"abstract":"<p><strong>Objectives: </strong>Cardiovascular disease is a prevalent comorbidity and leading cause of mortality in chronic obstructive pulmonary disease (COPD) patients. Early identification of cardiac abnormalities in COPD patients is crucial. Speckle tracking echocardiography (STE) is practical for assessing ventricular and atrial function, but its role in COPD patients is under-researched. This study aimed to examine right ventricular (RV), left ventricular (LV) and left atrial (LA) strain in COPD patients via STE.</p><p><strong>Methods: </strong>A cross-sectional study was conducted with two groups: COPD patients diagnosed per the 2017 Global Initiative for Chronic Obstructive Lung Disease criteria and healthy controls. All the participants underwent STE to evaluate the RV, LV, and LA strains.</p><p><strong>Results: </strong>RV strain indices (RV free wall longitudinal strain (RVFWSL) and RV 4-chamber longitudinal strain (RV4CSL)) were significantly lower in the COPD group (16.53±5.89% and 14.65±4.53%, respectively) than in the control group (21.39±7.78% and 18.34±6.38%, respectively) (p<0.001). LV global longitudinal strain was also lower in the COPD group (18.45% (17.16-19.51)) than in the control group (19.50% (18.63-21.46), p=0.018). No significant differences were found in LA strain indices (LA reservoir strain, LA conduit strain or LA contractile strain) between the two groups. Furthermore, RVFWSL and RV4CSL were significantly greater in the group with a modified Medical Research Council score <2 (p<0.05).</p><p><strong>Conclusion: </strong>Compared with healthy controls, COPD patients presented reduced RV and LV strain, with no significant differences in LA strain indices.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11887318/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143571608","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 procedural safety in the UK: is everyone's house in order? Reflections from the BTS National Pleural Service Organisational Audit and a national review of patient safety incidents.","authors":"Andrew Ewing Stanton, Mark Juniper, Eihab Bedawi, Laura McNaughton, Amelia O Clive, Duneesha De Fonseka, Avinash Aujayeb, Matthew Evison","doi":"10.1136/bmjresp-2024-002840","DOIUrl":"10.1136/bmjresp-2024-002840","url":null,"abstract":"<p><strong>Introduction: </strong>The 2022 British Thoracic Society Pleural Services Organisational Audit highlighted evidence of ongoing risk of harm from pleural procedures. To better understand the underlying causes of these safety concerns we undertook a review of patient safety incidents from the National Reporting and Learning System (NRLS).</p><p><strong>Methods: </strong>Incident-level patient safety data from NRLS were requested from any level 3, 4 and 5 incidents describing harm resulting from pleural intervention, specifically chest drain insertion or pleural aspiration for pleural effusions (fluid), submitted between 1 April 2018 and 30 March 2022.</p><p><strong>Results: </strong>256 incidents were identified. Most of these did not directly relate to a pleural procedure or its concerns and so were excluded. Ultimately, 21 incidents (including 2 deaths) were relevant. 17 involved direct organ puncture, predominantly liver (n= 13). 11 incidents involved seldinger drains, 5 blunt dissection drains and 1 involved both (not specified in 4). In only four incidents was it clearly detailed that an ultrasound-assisted approach had been used. In the remainder, the use of ultrasound was largely not detailed at all, or the approach used was not clear or inappropriate. Most (19/21) events occurred out with respiratory environments.</p><p><strong>Discussion: </strong>These data raise concerns about pleural intervention for fluid occurring where lack of appropriate ultrasound use may have contributed in a variety of clinical areas. This should be highlighted at a national level by specialty groups and societies. We welcome an upcoming National Confidential Enquiry into Patient Outcome and Death study to help cement our understanding of factors underlying this ongoing risk of harm and to enable definitive action to be taken to reduce this risk.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11877191/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143536459","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":"Effectiveness of inhaled therapies in asthma among adults in Northern Sri Lanka, a low-income and middle-income country: a prospective observational study.","authors":"Yalini Guruparan, Thiyahiny S Navaratinaraja, Gowry Selvaratnam, Shalini Sri Ranganathan","doi":"10.1136/bmjresp-2024-002675","DOIUrl":"10.1136/bmjresp-2024-002675","url":null,"abstract":"<p><strong>Background: </strong>Inhaled corticosteroids (ICS) alone, or combined with long-acting beta₂-agonist (LABA), are recommended for chronic asthma. Limited access to inhaled medications hinders effective control of asthma in low-income and middle-income countries.</p><p><strong>Objective: </strong>This study aimed to compare the effectiveness of inhaled therapies in a cohort of adult patients with asthma who were receiving treatment in a tertiary hospital in Northern Sri Lanka.</p><p><strong>Methods: </strong>A prospective cohort study was conducted among adult patients with asthma on either ICS alone or ICS/LABA combination for at least 3 months. Participants were followed up for 6 months, with two follow-up interviews conducted 3 months apart. The primary outcome measure was asthma control, assessed by a locally validated asthma control patient-reported outcome measure. Secondary outcome measures included the use of short-acting beta₂-agonists (SABA) and the percentage of patients required nebulisations and hospitalisations. McNemar's test was used to determine the statistical significance. A p value≤0.05 was considered significant.</p><p><strong>Results: </strong>Of the 1094 participants, 827 (76%) were on ICS monotherapy and 267 (24%) were on ICS/LABA. Though there were no changes in the treatment, progressive improvement in asthma control was observed from baseline to second follow-up in both ICS (54%-72%) and ICS/LABA (76%-81%) groups. Significant improvement in asthma control (p<0.001) and SABA overuse (p<0.001) at both follow-ups and nebulisation (0.008) at the first follow-up were observed in the ICS group.</p><p><strong>Conclusion: </strong>Both ICS monotherapy and ICS/LABA were effective in controlling asthma. Though control was greater with ICS/LABA, the effect of additional monitoring during the follow-up was higher and significant in ICS monotherapy. Considering the low access to ICS/LABA, a treatment package comprising ICS plus non-pharmacological approaches could be a more realistic and cost-effective treatment strategy in the local context. ICS/LABA could be reserved for patients who fail to respond. However, this observation needs to be confirmed by interventional studies.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11873347/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143530853","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":"Characterising airway inflammation in Aboriginal and Torres Strait Islander and non-Aboriginal and Torres Strait Islander adults with asthma and COPD.","authors":"Nick Young, Winnie Chen, Shimul Chatterjee, Scott Gelzinnis, Aishath Lam'aan Latheef, Jodie Simpson, Peter A B Wark","doi":"10.1136/bmjresp-2024-002619","DOIUrl":"10.1136/bmjresp-2024-002619","url":null,"abstract":"<p><strong>Objective: </strong>To examine airway inflammatory cell profiles in Indigenous Australian adults with asthma and chronic obstructive pulmonary disease (COPD).</p><p><strong>Design/setting: </strong>A retrospective, cross-sectional study on data from a tertiary referral respiratory outpatient clinic.</p><p><strong>Participants: </strong>Indigenous (n=23) and non-Indigenous (n=71) adults were matched according to diagnosis, gender and age to the ratio of 1:3.</p><p><strong>Main outcome measures: </strong>Participants were defined by self-determined identification as Indigenous (Aboriginal) or non-Indigenous. A relevant history was taken, and lung function was measured by spirometry. In those with a diagnosis of asthma, symptom control was assessed by the Asthma Control Questionnaire, six items (ACQ6). In those with a diagnosis of COPD, symptoms were assessed by the COPD assessment test (CAT). Airway cell counts were obtained in all groups from bronchial lavage (BL) cell count.</p><p><strong>Results: </strong>Lung function and inhaled corticosteroid dose were similar between groups. Current smoking was three times more common in Indigenous people (35%) compared with non-Indigenous people (12%, p=0.009). In participants with asthma, ACQ6 scores were similar between Indigenous and non-Indigenous participants with asthma. In those with COPD, Indigenous participants had significantly higher total CAT scores as well as scores for cough and sputum with a score indicating a high impact on quality of life (CAT score ≥14, 85%-25%, p=0.017). There was no difference in BL cell differential counts.</p><p><strong>Conclusions: </strong>Indigenous people with COPD had higher smoking rates, worsened CAT scores and more symptoms of cough and sputum production. There were no differences between the groups in airway inflammation, but neutrophilic inflammation was associated with poorly-controlled asthma.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11848662/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476002","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":"Idiopathic pulmonary fibrosis in the UK: findings from the British Thoracic Society UK Idiopathic Pulmonary Fibrosis Registry.","authors":"Ahmed Fahim, Maria Loughenbury, Iain Stewart, Sarah Agnew, Howard Almond, Leo Casimo, Nazia Chaudhuri, Sophie V Fletcher, Sarah Haney, Ling-Pei Ho, Clare Hodkinson, Paul Minnis, Evelyn Palmer, Andrew M Wilson","doi":"10.1136/bmjresp-2024-002773","DOIUrl":"10.1136/bmjresp-2024-002773","url":null,"abstract":"<p><strong>Objectives: </strong>Idiopathic pulmonary fibrosis (IPF) is a progressive interstitial lung disease (ILD) and the most common idiopathic interstitial pneumonia. The UK IPF Registry was established in 2013 to collect data pertaining to clinical features, therapeutic approaches and outcomes. From February 2023, the Registry expanded to include any ILD with evidence of fibrosis.</p><p><strong>Design: </strong>The UK IPF Registry is a national, multicentre observational registry, including both prospective and retrospective data of patients with IPF in secondary or tertiary care. Cases eligible for inclusion were those with a diagnosis of IPF, presenting at participating centres from January 2013.</p><p><strong>Results: </strong>Between January 2013 and February 2023, 5052 IPF cases were registered from 64 participating centres. There was a male preponderance (77.8%) with mean±SD age of 74±8.1 years, 66% were ex-smokers and 76% had at least one comorbidity. Over a third (36.7%) experienced symptoms for more than 24 months prior to their first clinic visit. The majority of cases were discussed at a multidisciplinary team (MDT) meeting and the most common radiological patterns at presentation were probable (54.6%) and definite (42.7%) usual interstitial pneumonia. There was a reduction in surgical lung biopsies from 14% in 2013 to 5.5% in 2022. Antifibrotic therapy prescription rose from 36.0% in 2013 to 55.9% in 2023. The use of nintedanib (approved by National Institute of Clinical Excellence in January 2016) rose from 6.7% in 2013 to 31.5% in 2022 and pirfenidone (approved in April 2013) was initially used in around a third of cases before dropping to between 16.8% and 24.9% after nintedanib was approved.</p><p><strong>Conclusion: </strong>These data reflect clinical practice across the UK and it is intended the data will have a role in informing the future of IPF care and providing a model for benchmarking, ultimately increasing knowledge and improving clinical care for this devastating disease.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11840905/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143456710","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":"Mechanical insufflation-exsufflation use in neuromuscular disease: a single centre cohort study.","authors":"Neeraj Mukesh Shah, Georgios Kaltsakas, Sophie Madden-Scott, Chloe Apps, Shauna Sheridan, Michelle Ramsay, Shelley Srivastava, Eui-Sik Suh, Rebecca D'Cruz, Mike Mackie, Nick Weston, Nicholas Hart, Patrick Murphy","doi":"10.1136/bmjresp-2024-002651","DOIUrl":"10.1136/bmjresp-2024-002651","url":null,"abstract":"<p><strong>Introduction: </strong>Mechanical insufflation-exsufflation (MIE) is a commonly used therapy to augment secretion clearance in individuals with neuromuscular disease. There are no clear evidence-based guidelines on the settings that should be used in different diagnostic groups and how they should be titrated. We report on the settings used in the largest cohort of individuals using domiciliary MIE in the literature.</p><p><strong>Methods: </strong>A retrospective observational study reporting on all individuals initiated on MIE for long-term domiciliary use at our centre, 2013-2019.</p><p><strong>Results: </strong>This study reports on 359 adults established on domiciliary MIE. The most common diagnostic groups were congenital neuromuscular disease (26%), spinal cord injury (23%) and amyotrophic lateral sclerosis (23%). Median age at initiation was 55 years. Median (IQR) insufflation pressure was 35 (30-40) cm H₂O and exsufflation pressure was 45 (40-50) cm H₂O. Inspiratory time was 2.5 (2.3-2.8) s, expiratory time was 2.7 (2.3-2.8) s, and pause between expiration and inspiration was 2.0 (1.2-2.0) s. Median (IQR) survival following the initiation of MIE was 66 (54-78) months. Increasing age and amyotrophic lateral sclerosis were significantly associated with shorter life expectancy, while the delivery of MIE via oronasal interface compared with tracheostomy was associated with longer life expectancy.</p><p><strong>Conclusion: </strong>This is the largest reported cohort of adults using domiciliary MIE. The most common groups using MIE were congenital neuromuscular disease, spinal cord injury patients and amyotrophic lateral sclerosis. The range of prescribed settings is narrow, reflecting the limited evidence base in this field and the need to better understand optimal targets for titration of different MIE settings.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11836793/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143439949","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}