BMJ Open Respiratory Research最新文献

{"title":"Determining what patients admitted with a chronic obstructive pulmonary disease (COPD) exacerbation will use for remote clinical monitoring: a patient engagement survey.","authors":"Robert Wu, Jansen Zhou, Alex Mariakakis, Eyal de Lara, Jeyani Jeyaparan, Andrea Gershon","doi":"10.1136/bmjresp-2024-002841","DOIUrl":"10.1136/bmjresp-2024-002841","url":null,"abstract":"<p><strong>Background: </strong>Remote monitoring may improve the health of people with chronic obstructive pulmonary disease (COPD) through earlier detection and intervention before conditions worsen, but there are major challenges in recruitment and retention in these research studies. There are also increasing technologies and the uptake of specific technologies in people with COPD is not well known.</p><p><strong>Objective: </strong>The objective of this study was to identify remote monitoring interventions that people admitted to hospital with an exacerbation of COPD would be willing to use upon discharge and to identify factors that influenced their preferences.</p><p><strong>Methods: </strong>We surveyed consecutive patients admitted to hospital with acute exacerbations of COPD. We asked participants how likely they would be willing to use 15 remote monitoring interventions and to explain the reasoning behind their preferences. We correlated demographic factors with willingness to use interventions.</p><p><strong>Results: </strong>Out of the 88 people with COPD approached, we recruited 50 (57%). The average age was 72.5 years, and 48% were women. Patients were most willing to use in-home visits by nurses, remote monitoring of vital signs and reporting oximeter values through an app or a website. Least popular interventions were in-home cough, speech and activity monitoring. Perceived usefulness and previous positive experiences were reasons why participants would accept various interventions. Increased willingness to use remote monitoring was seen in women (p=0.02), people who spoke English as a primary language (p=0.005), people who did not rely on others for support (p=0.04) and those followed by a respirologist (p=0.02).</p><p><strong>Conclusions: </strong>Our survey of patients admitted with COPD exacerbations provides insight into the types of remote monitoring interventions patients will accept and who are more interested in participating. We also provide insight into equity concerns of remote monitoring technology by identifying demographic factors that may influence intervention use that could widen the digital divide.</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/PMC12281319/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144688878","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":"How to culturally adapt the pulmonary rehabilitation programme for people living with COPD in Sri Lanka: a qualitative study.","authors":"Chamilya Perera, Akila Jayamaha, Mark Orme, Thamara Dilhani Amarasekara, Zainab Yusuf, Amy Barradell, James Manifield, Andy Barton, Ravini Karunathilake, Amitha Fernando, Savithri Wasundara Wimalasekera, Sally J Singh","doi":"10.1136/bmjresp-2024-002407","DOIUrl":"10.1136/bmjresp-2024-002407","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary rehabilitation (PR) is a low-cost, high-impact intervention for people living with chronic obstructive pulmonary disease (COPD). Despite the high prevalence of COPD, there are currently very limited facilities to provide PR in Sri Lanka. The views of people living with COPD, their caregivers and relevant healthcare professionals (HCPs) are essential to develop culturally appropriate PR, acceptable in a Sri Lankan setting.</p><p><strong>Objectives: </strong>We aimed to explore the lived experiences of key stakeholders on the development and implementation of culturally appropriate PR in Sri Lanka.</p><p><strong>Methodology: </strong>A qualitative study was conducted at the Central Chest Clinic (CCC), Sri Lanka. Focus group discussions (FGDs) and semistructured interviews (SSIs) were conducted with the three populations: people living with COPD, their caregivers and relevant HCPs. After audio recording, transcribing and translating, the data were analysed using thematic analysis.</p><p><strong>Results: </strong>Three FGDs comprising 11 adults with COPD (9 males, age range 39-83 years), three FGDs comprising five family caregivers (three females), three FGDs comprising 14 nurses and 12 SSIs with doctors and physiotherapists were conducted, representing diverse ethnic groups. Two overarching themes were generated: 'PR adaptations' and 'Barriers to PR implementation and adherence'. Within 'PR adaptations', four subthemes were generated: the educational component of PR, nutritional support, psychological support and the use of music during PR sessions. Under 'Barriers to PR implementation and adherence', three subthemes were generated: barriers and issues in participating, need for better medical facilities and difficulty in conducting exercises.</p><p><strong>Conclusion: </strong>Culturally tailoring PR for people living with COPD in Sri Lanka should include the integration of singing, music and nutritional support, as it may enhance acceptability. Barriers, including a lack of resources to deliver PR, difficulties encountered by patients attending PR sessions and perceived difficulties in performing standardised PR exercises, need to be addressed when developing a culturally appropriate programme in Sri Lanka.</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/PMC12281325/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144688880","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":"Occupational exposures in sarcoidosis: a protocol for a multicentre regional case-control study in the UK.","authors":"Christopher C Huntley, Alice Margaret Turner, Sherwood Burge, Gareth I Walters","doi":"10.1136/bmjresp-2025-003194","DOIUrl":"10.1136/bmjresp-2025-003194","url":null,"abstract":"<p><strong>Background: </strong>Sarcoidosis is a multisystem granulomatous disease of unclear cause. An environmental trigger in a genetically susceptible individual resulting in immune dysregulation is suspected. More than 90% of cases of sarcoidosis involve the lungs, suggesting that inhaled environmental antigens contribute to the onset of disease. Many potential environmental antigens have been proposed to date, although equipoise persists concerning occupational exposures.The SANDSTONE study (Silica and Sarcoidosis: a study of Occupational Exposures) is the first UK-based study that investigates the association between occupational exposures and a diagnosis of pulmonary sarcoidosis, with particular focus on respirable crystalline silica, metal dusts, inorganic dusts and organic dusts.</p><p><strong>Methods and analysis: </strong>The SANDSTONE study is a multicentre case-control study recruiting participants from across the West Midlands region of the UK. The study targets recruiting n=174 participants in each group (1:1 case: control study). Case participants are patients diagnosed with pulmonary sarcoidosis since 2010 while control participants are recruited from NHS secondary care outpatient clinics. All participants will complete a semistructured interview to obtain full lifetime occupational and environmental exposure histories, with limited retrospective clinical data collected. The primary outcome measure is the OR of silica, metal dusts and other prespecified occupational exposure in pulmonary sarcoidosis.</p><p><strong>Ethics and dissemination: </strong>The study is sponsored by University Hospitals Birmingham NHS Foundation Trust and has received ethical approval from the Cambridge East Research Ethics Committee (19/EE/0360).</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12278141/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144667071","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":"Screening tools for work-related asthma and their diagnostic accuracy: a systematic review.","authors":"Ngamjit Kongsupon, Peymane Adab, Rachel E Jordan, Christopher C Huntley, Siwanon Rattanakanokchai, Samuel Wallbanks, Shiyao Li, Gareth I Walters","doi":"10.1136/bmjresp-2025-003251","DOIUrl":"10.1136/bmjresp-2025-003251","url":null,"abstract":"<p><strong>Introduction: </strong>One in four cases of asthma in adults is caused or worsened by work (work-related asthma: WRA). Early detection of WRA could prevent poor health and employment outcomes, but clinical diagnosis is often missed or delayed. The standardisation and effectiveness of screening tools have not been well established. We aimed to summarise and compare the performance of screening tools for identifying WRA in both clinical settings and workplaces.</p><p><strong>Methods: </strong>We searched for studies that used structured questionnaires or prediction models (with/without physiological tests) to identify WRA in clinical settings or workplaces with individuals aged≥16 years in MEDLINE, Embase, other bibliographic databases and grey literature between 1975 and 2024. Two reviewers independently screened titles, abstracts and full texts for inclusion, extracted data and assessed risk of bias using QUADAS-2 tool (Quality Assessment of Diagnostic Test Accuracy 2) or PROBAST (Prediction Model Risk of Bias Assessment Tool). Screening tools and their indices of accuracy were summarised with paired forest plots of sensitivities and specificities.</p><p><strong>Results: </strong>Of 17 504 identified studies, 7 were included. All were implemented in tertiary hospitals (n=5) and specialist centres (n=2). The screening tools comprised questionnaires alone (individual questions n=3 and multiple questions n=2), questionnaire with methacholine challenge test (n=1) and diagnostic models (n=4). The question 'improvement off work' had sensitivity=74-87% and specificity=15-58% for identifying WRA. Multiple questions had sensitivity=80-100% and specificity=8-55%. Addition of the methacholine challenge test to one questionnaire improved specificity to 75% with sensitivity=65%. Diagnostic models reported area under the curve (AUC) between 0.69 and 0.89, and AUC was improved when adding demographic variables or objective tests.</p><p><strong>Discussion: </strong>A single item 'improvement off work' and multiple questions have high sensitivity but low specificity for WRA, which are sufficient for screening purposes to enhance WRA diagnosis. Adding demographic variables and objective tests can improve specificity or AUC. However, studies on screening tools for WRA are limited and inadequately reported; further evaluations of performance are needed in primary care populations and workplaces.</p><p><strong>Prospero registration number: </strong>CRD42021246031.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12265809/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144641740","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":"Concordance between FVC and FEV₆ for identifying chronic airflow obstruction and spirometric restriction in the Burden of Obstructive Lung Disease (BOLD) study.","authors":"Ben Knox-Brown, James Potts, Frits M E Franssen, Rune Nielsen, Meriam Denguezli, Anders Ørskov Rotevatn, Sanjay K Juvekar, Hamid Hacene Cherkaski, Michael Studnicka, Karl Peter Sylvester, Kevin Mortimer, Eric D Bateman, Christer Janson, Andrei Malinovschi, Terence Seemungal, Parvaiz Koul, David Mannino, Padukudru Anand Mahesh, Rain Jogi, Filip Mejza, Mohammed Al Ghobain, Stefanni Nonna M Paraguas, Tobias Welte, Emiel Wouters, Thorarinn Gislason, Imed Harrabi, Hermínia Dias, Daniel O Obaseki, Ali Kocabas, Cristina Barbara, Joao Cardoso, Dhiraj Agarwal, Asaad Ahmed Nafees, Fatima Rodrigues, Vanessa Garcia-Larsen, Gregory E Erhabor, Li-Cher Loh, Andre F S Amaral","doi":"10.1136/bmjresp-2024-002355","DOIUrl":"10.1136/bmjresp-2024-002355","url":null,"abstract":"<p><strong>Introduction: </strong>We investigated whether the forced expiratory volume in 6 s (FEV₆) can be used as a surrogate for the forced vital capacity (FVC).</p><p><strong>Methods: </strong>The Burden of Obstructive Lung Disease is a multinational cohort study. At baseline, data were collected from adults, aged 40 years or older, from 41 sites across 34 countries. Participants from 18 sites were followed-up after a median of 8.3 years. Participants who completed the study core questionnaire and had acceptable post-bronchodilator spirometry were included. We performed receiver operating characteristic analyses to measure the ability of FEV₁/FEV₆ less than the lower limit of normal (LLN) to correctly classify FEV₁/FVC less than the LLN, and FEV₆ less than the LLN to correctly classify FVC less than the LLN. We used multilevel regression analyses to assess the association of discordant measurements with respiratory symptoms, quality of life and lung function decline.</p><p><strong>Results: </strong>At baseline, 28 604 participants were included. 53% were female (15 060). 10% (2876) had chronic airflow obstruction for FEV₁/FVC, compared with 9% (2704) for FEV₁/FEV₆. 37% (10 637) had spirometric restriction for FVC, compared with 35% (9978) for FEV₆. The FEV₁/FEV₆ had excellent accuracy in identifying FEV₁/FVC less than the LLN (area under the curve (AUC): 0.90, 95% CI, 0.89 to 0.91, κ coefficient 0.82). The FEV₆ also had excellent agreement in identifying FVC less than the LLN (AUC: 0.95, 95% CI, 0.94 to 0.95, κ coefficient 0.90). Discordant reductions in FEV₁/FEV₆ (1%, 345) and FEV₆ (1%, 309) were associated with greater odds of having respiratory symptoms and a lower physical quality of life. 3870 participants were followed up. Those with discordant reductions in FEV₁/FEV₆ and FEV₆ were more likely to have chronic airflow obstruction and spirometric restriction at follow-up.</p><p><strong>Conclusions: </strong>There is strong agreement between the FVC and FEV₆ in the identification of chronic airflow obstruction and spirometric restriction.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12258291/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144636090","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":"Psychosocial impact of living with an indwelling pleural catheter in patients with malignant pleural effusions: a thematic analysis.","authors":"Junyi Zhang, Janeth Liang, Laletha Agoramoorthy, Shanik Montalvo, Owais Kadwani, Gillian Radcliffe, Parthipan Sivakumar","doi":"10.1136/bmjresp-2024-002993","DOIUrl":"10.1136/bmjresp-2024-002993","url":null,"abstract":"<p><strong>Background: </strong>Breathlessness is a frequent and debilitating symptom experienced by patients with malignant pleural effusions (MPEs). Indwelling pleural catheters (IPCs) are a recommended first line treatment option, but the psychological and social impact of living with one is poorly understood.</p><p><strong>Objectives: </strong>To determine the psychosocial impact of living with an IPC among patients with MPEs.</p><p><strong>Methods: </strong>18 adult English-speaking patients undergoing IPC management for MPEs were recruited at a single pleural centre in London, UK, between May 2022 and 2023. 23 semi-structured interviews were conducted at 2 weeks and 6-8 weeks post IPC insertion. Inductive thematic analysis of the interview transcripts was used to identify key psychosocial impacts and modulatory factors.</p><p><strong>Results: </strong>13 participants completed the semi-structured interviews, mean age 67, 54% female. Seven themes relating to the psychosocial impacts experienced by individuals living with an IPC were identified: anxiety, activities, relationships, independence and control, expectations and adjustments to IPC, acceptance and confidence. These evolved over time, with both positive and negative effects. The effects of the psychosocial impacts were further mediated by three modulatory factors: IPC mediated changes, challenges of IPC care and the overarching impact of cancer. These exerted varying degrees of influence on individuals' psychosocial wellbeing.</p><p><strong>Conclusions: </strong>This qualitative study highlights for the first time the range of psychosocial impacts experienced by individuals living with an IPC. Identifying the modulatory factors and understanding how these impact patient experience can help to direct future interventions aiming to improve the psychosocial wellbeing for this population.</p><p><strong>Trial registration number: </strong>NCT05372055.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12243593/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144590452","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":"Optimising long-term management in acute asthma presentations to the emergency department: an interview study on patient beliefs.","authors":"Imogen P Skene, Raine Astin-Chamberlain, Katharine C Pike, Chris Griffiths, Liz Steed, Paul E Pfeffer","doi":"10.1136/bmjresp-2024-002962","DOIUrl":"10.1136/bmjresp-2024-002962","url":null,"abstract":"<p><strong>Background: </strong>Emergency department (ED) attendances with acute asthma are an opportunity for simple medication changes to improve long-term self-management, but patients' beliefs and behaviours need to be considered for interventions to be successful. We explored the health beliefs and behaviours of adult patients who have presented to the ED with asthma and considered their attitudes to ED-based interventions designed to improve long-term asthma control.</p><p><strong>Methods: </strong>19 semi-structured face-to-face or online patient interviews were conducted in 2021/2022. Eligible participants were patients over age 16 who had attended and were discharged from the ED with an asthma exacerbation. Purposive sampling was undertaken to ensure representation of patients of different ages, ethnicity and gender. Interviews were analysed with reflective thematic analysis.</p><p><strong>Results: </strong>Themes that reflected the beliefs and behaviours of the patients were: (1) experiences of an asthma exacerbation-the emotional response and self-management during an episode; (2) discharge dilemma-expectations and communication on discharge from ED, impacted by time, language and capacity in the acute environment; (3) do what is best for me-openness to change such as of medication, if rationale and support is provided; and (4) perceptions of asthma medication-reliance on salbutamol, concerns about inhaled corticosteroids, openness to maintenance and reliever therapy inhalers and device preferences.</p><p><strong>Conclusion: </strong>Patients do not expect longer-term care to be provided in the ED. However, patients trust healthcare professionals to recommend appropriate treatment and are willing to accept a change in medication or inhaler device in this context.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12258288/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144583042","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":"Real-world effectiveness study of guideline-directed COPD STANDARDized management in patients with chronic obstructive pulmonary disease: a cluster randomised trial design.","authors":"Fen Dong, Rui Su, Yu Ren, Ke Huang, Wei Li, Lulu Yang, Xuexin Li, Xiao Hu, Tao Ye, Dong Jin, Ting Yang, Paul W Jones, Chen Wang","doi":"10.1136/bmjresp-2024-002768","DOIUrl":"10.1136/bmjresp-2024-002768","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic obstructive pulmonary disease (COPD) affects the ageing population worldwide. Exacerbations worsen health status and increase health resource use. Existing guidelines recommend disease management, but they are not fully implemented in a clinical setting. Evidence regarding best practice and real-world effectiveness is limited.</p><p><strong>Methods and analysis: </strong>A nationwide multicentre clinical effectiveness trial is being performed between 2023 and 2027, involving 99 secondary hospitals in urban and rural areas in China. It is an open-label, adjudicator and assessor-blinded, parallel group, cluster randomised pragmatic trial. Hospitals are randomly allocated to standardised management (SM) or usual care. A total number of 3456 stable patients with COPD who are symptomatic (individuals in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) Group B) or have exacerbation risk (individuals with one moderate exacerbation history in Group A and individuals in Group E) using GOLD 2023 ABE classification will be enrolled. In the SM group, an integrated intervention comprising five components will be delivered using a physician and nurse model. These are: (1) long-term inhaled maintenance therapy, (2) periodic inhaler technique assessment and symptom monitoring, (3) annual pulmonary function testing, (4) COPD education session and (5) health behaviour adoption (smoking cessation, vaccination, pulmonary rehabilitation). In the control group, patients will receive routine care. The primary goal is to assess the real-world effectiveness of guideline-directed disease management on exacerbation prevention, with moderate-to-severe exacerbation as the primary outcome and hospital admission, mortality, health status and COPD self-management as secondary outcomes. It is the first pragmatic trial undertaken of this form in a developing country. It is anticipated that it will provide a feasible and effective COPD management model that can inform guidelines and be rolled out into secondary and primary care, with modification, to ensure standardised COPD care nationwide.</p><p><strong>Trial registration number: </strong>NCT04664491.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12232468/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144583043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of body mass index on outcomes of non-cystic fibrosis bronchiectasis.","authors":"Wan-Hsuan Hsu, Bo-Wen Shiau, Yu-Feng Wei, Chih-Cheng Lai, Ching-Yi Chen","doi":"10.1136/bmjresp-2024-002488","DOIUrl":"10.1136/bmjresp-2024-002488","url":null,"abstract":"<p><strong>Background: </strong>Low body mass index (BMI) is associated with poor prognosis in patients with non-cystic fibrosis (non-CF) bronchiectasis. However, the impact of being overweight or obese on clinical outcomes of these patients remains controversial.</p><p><strong>Materials and methods: </strong>This retrospective cohort study was conducted using TriNetX. Patients diagnosed with non-CF bronchiectasis between 2012 and 2022 were identified. The eligible population was divided into four groups based on their BM. Propensity score matching (PSM) was used to balance baseline demographic and clinical characteristics between study groups. The primary outcome of interest was all-cause mortality during a 5-year follow-up period.</p><p><strong>Results: </strong>A total of 14 469 patients were included in the analysis. After PSM, the underweight group exhibited significantly higher all-cause mortality compared with those with a normal BMI (24.3% vs 15.3%; HR 1.83; 95% CI 1.49 to 2.25; p=0.0150). Conversely, both the overweight (16.6% vs 21.4%; HR 0.77; 95% CI 0.68 to 0.88; p=0.0138) and obese groups (16.8% vs 20.2%; HR 0.79; 95% CI 0.71 to 0.87; p=0.0356) demonstrated lower all-cause mortality rates. In addition, consistently higher risks in the underweight group and lower risks in the overweight and obese groups were observed for several critical health outcomes, including the need for critical care service, incidence of pneumonia, tuberculosis or non-tuberculous mycobacterial infection, acute exacerbation of bronchiectasis, acute respiratory failure and ventilator use.</p><p><strong>Conclusions: </strong>Being underweight is a risk factor for all-cause mortality in patients with non-CF bronchiectasis and the aforementioned clinical outcomes. Conversely, overweight and obesity are associated with lower all-cause mortality rates and better outcomes.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12228436/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144567047","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":"Radiomic 'Stress Test': exploration of a deep learning radiomic model in a high-risk prospective lung nodule cohort.","authors":"David Xiao, Yency Forero, Michael N Kammer, Heidi Chen, Rafael Paez, Brent E Heideman, Oreoluwa Owoseeni, Ian Johnson, Stephen A Deppen, Eric L Grogan, Fabien Maldonado","doi":"10.1136/bmjresp-2024-002687","DOIUrl":"10.1136/bmjresp-2024-002687","url":null,"abstract":"<p><strong>Background: </strong>Indeterminate pulmonary nodules (IPNs) are commonly biopsied to ascertain a diagnosis of lung cancer, but many are ultimately benign. The Lung Cancer Prediction (LCP) score is a commercially available deep learning radiomic model with strong diagnostic performance in incidentally identified IPNs, but its potential use to reduce the need for invasive procedures has not been evaluated in patients with nodules for which a biopsy has been recommended.</p><p><strong>Methods: </strong>In this prospectively collected, retrospective blinded evaluation, the probability of cancer in consecutively biopsied IPNs at a tertiary care centre was calculated using the Mayo Clinic prediction model and categorised into low, intermediate and high-probability groups by applying <10% no-test and >70% treatment thresholds per British Thoracic Society guidelines. We evaluated the diagnostic performance of the Mayo Clinic model, the LCP radiomic model and an integrated model combining the LCP score with statistically selected clinical variables (age, spiculation and upper lobe location) using stepwise logistic regression. Performance was assessed using area under the receiver operating characteristic curve (AUC), F1 score and reclassification analysis based on the bias-corrected clinical net reclassification index.</p><p><strong>Results: </strong>The study population included 196 malignant and 125 benign IPNs (61% prevalence of malignancy). The Mayo Clinic model's AUC was 0.69 (0.63-0.75), LCP's AUC was 0.67 (0.61-0.73) and the integrated model combining LCP with statistically selected clinical variables (age, spiculation and upper lobe location) had the highest AUC of 0.75 (0.69-0.80). The integrated model demonstrated improved classification, with an F1 score of 0.645 (0.572-0.716) and a significantly higher AUC compared with the Mayo Clinic model (p=0.046). Reclassification analysis showed a clinical net reclassification index of 0.36 (0.21-0.53) for benign IPNs with eight correctly downgraded intermediate-risk benign nodules and no malignant nodules misclassified into the low-risk category.</p><p><strong>Conclusion: </strong>Incorporating LCP with select clinical variables results in an improvement in malignancy risk prediction and nodule classification and could reduce unnecessary invasive biopsies for IPNs.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12207176/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144511511","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}