BMJ Open Respiratory Research最新文献

{"title":"Lung function impairment at pulmonary TB and HIV/TB diagnosis: a South African cross-sectional cohort analysis.","authors":"Michael Marll, Tlhago Ngwanto, Nomsa Mofokeng, Lydia Mngomezulu, Sally El Sammak, Anisha Rajaratnam, Fay Willis, Matthew Magee, Lungile Gabuza, Hardy Kornfeld, Yun Li, Pholo Maenetje, Gregory P Bisson, Sara Auld","doi":"10.1136/bmjresp-2026-004248","DOIUrl":"10.1136/bmjresp-2026-004248","url":null,"abstract":"<p><strong>Objectives: </strong>To characterise the patterns and severity of impaired lung function at pulmonary tuberculosis (TB) diagnosis and assess the impact of HIV co-infection on TB-associated lung injury.</p><p><strong>Setting: </strong>A cross-sectional analysis of adults with and without HIV who presented with newly diagnosed drug-susceptible pulmonary TB in Johannesburg, South Africa.</p><p><strong>Participants: </strong>A total of 258 adults who were newly diagnosed with drug-susceptible pulmonary TB underwent comprehensive pulmonary function tests (PFT).</p><p><strong>Primary and secondary outcome measures: </strong>Five key PFT manoeuvres were evaluated: forced expiratory volume in one second (FEV1), forced vital capacity (FVC), FEV1/FVC, total lung capacity (TLC) and haemoglobin-corrected diffusion capacity of the lungs for carbon monoxide (DLCO). Three primary outcomes were modelled: (1) normal versus abnormal lung function, defined as any key PFT manoeuvre z-score < lower limit of normal, (2) continuous z-scores for each PFT and (3) clinical patterns of lung function (normal, restriction, obstruction, mixed disorder and isolated low DLCO). Secondary outcomes included respiratory health-related quality-of-life measures assessed using the St. George's Respiratory Questionnaire (SGRQ).</p><p><strong>Results: </strong>HIV/TB co-infection was associated with lower odds of any abnormal lung function (adjusted OR (aOR) 0.43, 95% CI 0.24 to 0.74) and lower odds of restrictive (aOR 0.46, 95% CI 0.24 to 0.87) and mixed patterns (aOR 0.22, 95% CI 0.07 to 0.66) compared with those with TB alone. HIV co-infection was also associated with better FEV1, FVC, FEV1/FVC and TLC z-scores. While those with HIV had less severe radiographic disease, respiratory symptoms were similar between groups (SGRQ total score: HIV-negative 22 (IQR: 13-38) vs HIV-positive 26 (IQR: 8-44), p>0.9).</p><p><strong>Conclusions: </strong>Adults with HIV/TB co-infection demonstrated a distinct clinical phenotype of TB-associated lung injury at TB diagnosis characterised by less severe radiographic and lung function impairment compared with those without HIV.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"13 1","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13289194/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148275572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical outcomes and costs associated with viral lower respiratory tract disease hospitalisations.","authors":"Ekaterina Maslova, Malin Fagerås, Trung Tran, Benjamin Emmanuel, Mina Khezrian, Neil Branscombe, Susan Johnson, Gopal Dalal, Hashmath Ulla Syed, Nadir Yehya","doi":"10.1136/bmjresp-2025-003552","DOIUrl":"10.1136/bmjresp-2025-003552","url":null,"abstract":"<p><strong>Background: </strong>An updated comprehensive assessment of the burden of hospitalised viral lower respiratory tract disease (LRTD) is especially salient after the COVID-19 pandemic. Therefore, we aimed to comprehensively describe clinical characteristics and outcomes of US adults hospitalised with viral LRTD between 2015 and 2023.</p><p><strong>Methods: </strong>In this retrospective analysis, adults hospitalised between 1 January 2015 and 31 March 2023 were identified using Optum's deidentified Clinformatics Data Mart Database. Index date was the first <i>International Classification of Diseases, 9th/10th Revision</i> (ICD-9/10) code for viral LRTD hospitalisation. Outcomes included intensive care unit (ICU) admission, non-invasive ventilation (NIV), invasive mechanical ventilation/extracorporeal membrane oxygenation (IMV/ECMO), costs, 30-day mortality and 30-day readmissions. Outcomes were stratified by viral aetiology (<i>ICD-9/10</i>), clinical severity and time period (2015-2019; 2020-2021; 2022-2023). Time-to-event data were assessed using Kaplan-Meier estimates.</p><p><strong>Results: </strong>Of 387 449 patients hospitalised for viral LRTD, 38.1% were admitted to ICU within 30 days of index (84.6% of these were admitted on index date); 8.4% and 8.7%, respectively, received NIV and IMV/ECMO within 30 days of index and 30-day mortality was 15.1%. Median (IQR) length of stay and mean (SD) hospitalisation costs were 7 (4-15) days and $42 752 ($44 841), respectively. Admission to ICU, mortality and costs were substantial across all aetiologies but peaked from 2020 to 2021; readmissions and costs remained high even into 2022-2023.</p><p><strong>Conclusions: </strong>Severe viral LRTD incurred substantial burden for US healthcare systems across all viral aetiologies, even in non-pandemic years, with frequent ICU admission and ventilation use, and with considerable associated costs. Readmission rates and costs remain high even after the peak of COVID-19.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"13 1","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13289310/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148275588","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":"Antenatal environmental exposure to indoor air pollution and environmental tobacco smoke: association with birth outcomes in an African birth cohort.","authors":"Aneesa Vanker, Kirsty Brittain, Whitney Barnett, Heather J Zar","doi":"10.1136/bmjresp-2025-003721","DOIUrl":"10.1136/bmjresp-2025-003721","url":null,"abstract":"<p><p>Indoor air pollution (IAP) and environmental tobacco smoke exposure (ETS) are important antenatal environmental exposures that may adversely impact birth outcomes.</p><p><strong>Objectives: </strong>To investigate the impact of IAP and ETS during pregnancy on birth outcomes including respiratory distress in an African birth cohort, the Drakenstein Child Health Study.</p><p><strong>Setting: </strong>Prospective cohort study conducted in a periurban setting in sub-Saharan Africa within a large birth cohort.</p><p><strong>Participants: </strong>Consenting pregnant women (n=1137) enrolled between 20 and 28 weeks' gestation, with 1143 live births included in the analysis. Participants were recruited antenatally, with inclusion based on residency in the study area and availability of exposure and outcome data.</p><p><strong>Primary and secondary outcome measures: </strong>Primary exposures included antenatal IAP (particulate matter (PM10), carbon monoxide (CO), nitrogen dioxide, sulphur dioxide, volatile organic compounds) and ETS (maternal urine cotinine). Outcomes included birth anthropometry, prematurity, low birth weight and neonatal respiratory distress.</p><p><strong>Results: </strong>Among 1143 live births, 17% were premature, 15% had low birth weight and 7% had respiratory distress. Maternal active smoking was associated with reduced weight-for-age z-scores (WfAz; β -0.54; p<0.001). Babies exposed to PM₁₀ above ambient standards were 1.88 times more likely to experience respiratory distress compared with those with exposure below ambient standards (p=0.058). Similarly, exposure to CO above ambient standards was associated with a trend towards a doubled odds of respiratory distress in babies at birth (OR: 2.19 (0.97 to 4.98); p=0.061).</p><p><strong>Conclusions: </strong>Antenatal exposure to IAP and ETS is associated with adverse birth outcomes, including impaired growth and increased risk of respiratory distress. These findings support the need for targeted public health interventions to reduce exposure during pregnancy and highlight the importance of improving air quality to mitigate long-term respiratory health risks.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"13 1","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13289235/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148270229","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":"Developing low-carbon salbutamol MDI: assessment of relative bioavailability and pharmacodynamic relative potency of salbutamol MDI with propellant HFA-152a.","authors":"Sebastian Moreira, Laura Clow, Emily Coles-Piper, Alison Donald, Christer Janson, Dave Singh, David Slade, Pankaj Tiwari, Stephen Weng, Maximilian Plank","doi":"10.1136/bmjresp-2025-004036","DOIUrl":"10.1136/bmjresp-2025-004036","url":null,"abstract":"<p><strong>Introduction: </strong>Climate change is a global threat. Propellant hydrofluoroalkane (HFA)-134a in metered-dose inhalers (MDIs) contributes to healthcare-related greenhouse gas emissions. HFA-152a is a new propellant with ~90% lower global warming potential than HFA-134a. Two phase I studies (NCT06433908/NCT06433921) compared the pharmacokinetics (PK), pharmacodynamics (PD) and safety of salbutamol MDI with HFA-152a or HFA-134a.</p><p><strong>Methods: </strong>Relative bioavailability (Study 1): healthy adults received single salbutamol doses (200/800 µg) via MDI with HFA-152a or HFA-134a. Primary PK endpoints were areas under the plasma concentration-time curve (0-30 min (AUC)_{0-30 min}, zero to infinity (AUC_0-∞) and maximum plasma concentration (C_max)). Relative PD potency via methacholine challenge (Study 2): patients with mild asthma received MDI placebo and salbutamol doses (100/200/400 µg) with HFA-152a or HFA-134a. The primary PD endpoint was provocative methacholine concentration (PC) causing ≥20% (PC₂₀) forced expiratory volume in 1 s reduction.</p><p><strong>Results: </strong>Study 1: 60 participants (30 per cohort) enrolled. In cohort 1 (200 µg), AUC_{0-30 min} was within the predefined PK bioequivalence (BE) range (0.80-1.25); in cohort 2 (800 µg), AUC_0-∞ and C_max were within the BE range. Study 2: 21 participants enrolled. PD relative potency of HFA-152a was within the predefined BE range (0.67-1.50). No serious treatment-related adverse events (AEs) were reported; all AEs were mild and occurred at similar frequencies with both propellants.</p><p><strong>Conclusions: </strong>Salbutamol with HFA-152a demonstrated equivalence in key PK and PD parameters, as well as a similar safety profile to salbutamol with HFA-134a, supporting salbutamol MDI with HFA-152a as a therapeutically equivalent, low-carbon replacement.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"13 1","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13289305/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148270257","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 indoor exposure to particulate matter on the progression of idiopathic pulmonary fibrosis: a prospective multicentre cohort study protocol.","authors":"Hee-Young Yoon, Ju Hyun Oh, Won-Il Choi, Sun Mi Choi, Jimyung Park, Yong Suk Jo, Sung Woo Park, Jae Ha Lee, Hyun-Kyung Lee, Song Yee Kim, Ala Woo, Yong Hyun Kim, Hongseok Yoo, Jong Sun Park, Hyung Koo Kang, Ji Eun Kang, Joo Hun Park, Woo Jin Kim, Kyoung-Nam Kim, Jin Woo Song","doi":"10.1136/bmjresp-2025-003486","DOIUrl":"10.1136/bmjresp-2025-003486","url":null,"abstract":"<p><strong>Background: </strong>Idiopathic pulmonary fibrosis (IPF) is a fatal lung disease characterised by progressive fibrosis. Environmental exposures, including fine particulate matter (PM_2.5), have been implicated in the progression of IPF; however, indoor data are limited. We aimed to evaluate the impact of indoor exposure to PM_2.5 on the progression of IPF.</p><p><strong>Methods and analysis: </strong>This prospective, multicentre cohort study involves 15 medical institutions across South Korea. A total of 120 patients with IPF have been recruited and will be followed for 1 year. The impact of indoor exposure to PM_2.5 on clinical outcomes, including progression of the disease (defined as a relative decline in forced vital capacity ≥10% or diffusing capacity for carbon monoxide ≥15%), hospitalisation, acute exacerbations and mortality, will be assessed. Pulmonary function tests will be conducted quarterly at institutions, with home-based spirometry performed daily in a subset of 50 participants. The indoor PM_2.5 level will be continuously measured using a scattering-based indoor air quality monitor (IAQ-CL; KWeather, Seoul, South Korea) and PM₁₀, volatile organic compounds and carbon dioxide will also be measured. Biomarker analysis of Krebs von den Lungen-6 and other related markers will be performed. Statistical analyses will use linear mixed-effects models and time-to-event models to evaluate the association between exposure to PM and clinical and biomarker outcomes.</p><p><strong>Ethics and dissemination: </strong>The study has been approved by the Institutional Review Boards of all institutions, including Asan Medical Center (S2021-1136-0051). Written informed consent was obtained from all participants prior to enrolment.</p><p><strong>Trial registration number: </strong>KCT0008638.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"13 1","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13289416/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148263291","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":"Beyond PVR: dynamic physiologic assessment enhances prognostic evaluation in pulmonary hypertension associated with chronic obstructive pulmonary disease.","authors":"Elizabeth S Tarras, Xiting Yan, Christopher Gange, Sebastian Kurz, Phillip Joseph, Inderjit Singh","doi":"10.1136/bmjresp-2026-004192","DOIUrl":"10.1136/bmjresp-2026-004192","url":null,"abstract":"<p><strong>Objectives: </strong>Pulmonary hypertension associated with chronic obstructive pulmonary disease (PH-COPD) is associated with poor outcomes, yet resting haemodynamics incompletely capture disease severity. We evaluated whether integrating submaximal cardiopulmonary exercise testing variables with transthoracic echocardiographic and pulmonary function test parameters improves prognostic assessment in PH-COPD beyond resting haemodynamics alone.</p><p><strong>Setting: </strong>Single-tertiary pulmonary vascular disease referral centre in the USA.</p><p><strong>Participants: </strong>67 patients with PH-COPD who underwent right heart catheterisation and complementary non-invasive testing between 2019 and 2024.</p><p><strong>Primary outcome measures: </strong>The primary outcome was a composite of heart failure hospitalisation or all-cause mortality.</p><p><strong>Methods: </strong>Associations between physiologic variables and outcomes were assessed using Cox proportional hazards models and survival tree analysis.</p><p><strong>Results: </strong>The composite outcome occurred in 47.1% of patients over a median follow-up of 518 (229-897) days. Several non-invasive dynamic physiologic variables were associated with adverse outcomes, including lower gas exchange-derived pulmonary vascular capacitance (Gx_CAP) (HR 0.997, 95% CI 0.995 to 0.999; p=0.013), lower oxygen uptake efficiency slope (HR 0.983, 95% CI 0.968 to 0.998; p=0.030), lower submaximal VO₂ (HR 0.978, 95% CI 0.959 to 0.997; p=0.022) and lower ETCO₂ (HR 0.886, 95% CI 0.820 to 0.957; p=0.002). Higher estimated right ventricular systolic pressure (eRVSP) on echocardiogram (HR 1.015, 95% CI 1.001 to 1.029; p=0.032) and pulmonary vascular resistance (PVR) on right heart catheterisation (HR 1.087, 95% CI 1.005 to 1.176; p=0.038) were also associated with adverse outcomes, although no optimal prognostic PVR threshold was identified. In the survival tree model, Gx_CAP<243 mL/mm Hg provided the initial and most influential split. Patients with both Gx_CAP<243 mL/mm Hg and eRVSP>45 mm Hg represented the highest-risk subgroup (relative HR 4.4). Including PVR did not improve prognostic performance of the analysis.</p><p><strong>Conclusions: </strong>Dynamic exercise-derived physiologic markers provide prognostic information complementary to resting haemodynamic assessment in PH-COPD and may improve risk stratification across this heterogeneous population.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"13 1","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13289187/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148263223","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":"Training in pleural interventions: not just a matter of 'rights'?","authors":"Andrew E Stanton, Avinash Aujayeb, Anthony W Martinelli, Eihab O Bedawi, Najib M Rahman","doi":"10.1136/bmjresp-2026-004257","DOIUrl":"10.1136/bmjresp-2026-004257","url":null,"abstract":"","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"13 1","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13289256/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148262633","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":"Development and validation of LPCPIS: an integrated clinical, biomarker and lung ultrasound score for the diagnosis of ventilator-associated pneumonia.","authors":"Ashish Sharma, Mukesh Bairwa, Yudhanshu Angural, Khushboo Heera Lal, Akshita Makkar, Prakhar Sharma, Ravi Kant","doi":"10.1136/bmjresp-2025-004085","DOIUrl":"10.1136/bmjresp-2025-004085","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate whether the performance of the modified Clinical Pulmonary Infection Score (CPIS) for diagnosis of ventilator-associated pneumonia (VAP) could be improved by incorporating procalcitonin (PCT), lactate and a standardised lung ultrasound score (LUS).</p><p><strong>Design: </strong>Prospective observational study.</p><p><strong>Setting: </strong>Internal medicine and respiratory intensive care units (ICUs) of a tertiary care centre in India over 18 months.</p><p><strong>Participants: </strong>97 adult patients receiving invasive mechanical ventilation for 48 hours or more with suspected VAP.</p><p><strong>Primary and secondary outcome measures: </strong>The primary outcome was the diagnostic accuracy (area under the receiver operating characteristic curve (AUC)) of the integrated score compared with a reference standard of quantitative bronchoalveolar lavage culture (>10⁴ CFU/mL). Secondary outcomes included ICU length of stay and 14-day mortality.</p><p><strong>Results: </strong>Of the 97 patients, 70 (72.2%) were culture positive. The modified CPIS alone demonstrated limited diagnostic utility (AUC 0.686). In contrast, the novel 4-point Lactate-Lung Ultrasound-Procalcitonin-Clinical Pulmonary Infection Score (LPCPIS) score (integrating CPIS >5, lactate >2.15 mmol/L, PCT >1.3 ng/mL and LUS >14) achieved excellent discriminatory ability (AUC 0.919, 95% CI 0.844 to 0.976). At a cut-off of ≥2, the score yielded 95.7% sensitivity and 77.8% specificity. Crucially, a 4-point LPCPIS bedside score of ≤1 was associated with a highly diminished probability of VAP, yielding a negative predictive value of 100% in this cohort. In comparison, a score ≥3 strongly indicated a high likelihood of VAP, with a positive predictive value of 96.5% and specificity of 92.6%, pending definitive microbiological confirmation.</p><p><strong>Conclusions: </strong>The novel 4-point LPCPIS bedside score demonstrates significant diagnostic superiority over the traditional modified CPIS (AUC 0.919 vs 0.686). By integrating bedside lung ultrasound with biomarkers, this simplified pragmatic tool provides impressive discriminatory power, allowing clinicians in resource-limited settings to reliably assess probability of VAP and guide early antimicrobial decision-making while awaiting definitive microbiological cultures.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"13 1","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13289337/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148263289","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":"Fissios and postoperative complications (FPoC trial): a multicentre, randomised, controlled clinical trial.","authors":"Carlos Alfredo Fraile Olivero, Lidia Sotillo Valenzuela, Verónica Albarrán Vidal, José Gabriel Barceló Cal, Verónica Alen Villamayor, Florentino Hernando Trancho, Elena Fernández Martín, Joaquín Calatayud Gastardi, Ana María Gómez Martínez, Pedro Daniel Arribas Manzanal, Passio Santos, Raquel Fernández Blanco, María Isabel Cal Vázquez, Lucia Milla Collado, María Rodríguez, Valerio Perna, Alejandra Romero Roman, Carlos Andrés Ordonez, José Ramón Jarabo Sarceda","doi":"10.1136/bmjresp-2025-003269","DOIUrl":"10.1136/bmjresp-2025-003269","url":null,"abstract":"<p><strong>Introduction: </strong>Respiratory physiotherapy as a part of a perioperative physical training programme may reduce the risk of developing postoperative complications in patients diagnosed with non-small cell lung carcinoma (NSCLC) scheduled for surgery. However, there is heterogeneity in the design, implementation and evaluation of respiratory physiotherapy programmes.Fissios App contains a standardised respiratory physiotherapy programme. Analysing the usage data, the patient's personal history, the surgical procedure and the postoperative course, we will establish the relationship between compliance with a standardised respiratory physiotherapy programme and the development of postoperative complications in a group of patients diagnosed with NSCLC who underwent lung resection surgery.</p><p><strong>Methods and analysis: </strong>The Fissios and postoperative complications trial is a multicentre, prospective, randomised, parallel two-group, controlled, open-label, superiority study of the use of only face-to-face respiratory physiotherapy or the use of Fissios App as a complement to respiratory physiotherapy. Based on the percentage of postoperative respiratory complications and the anticipated reduction, a total of 560 patients will be required. Patients will be electronically randomised to the intervention or control group before the surgery with a proportion of 1:1 in blocks of six for each centre.All patients will attend face-to-face respiratory physiotherapy sessions at the place and times established in each centre. In addition, patients in the intervention group will use the Fissios App freely and without restrictions in terms of hour of the day, usage time or location. The primary clinical endpoint is postoperative complications during hospital admission and the estimated duration of the study is 12 months.</p><p><strong>Ethics and dissemination: </strong>This protocol was reviewed and approved by the Clinical Research and Clinical Trials Unit of Hospital Clínico San Carlos (Madrid, Spain) and complies with the ethics principles for medical research on humans stipulated in the Declaration of Helsinki of the World Medical Association.</p><p><strong>Trial registration number: </strong>NCT06732193.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"13 1","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13289354/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148263239","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":"Estimated plasma volume for predicting sepsis-associated ARDS risk: a multicentre retrospective cohort study.","authors":"Lina Zhao, Lei Zong, Wei Wei, Yuehao Shen, Haiying Liu, Xuguang Li, Dongxue Huang, Daihua Yu, Fei Yang, Yunying Wang, Xiaopeng Shi, Yun Li, Yi Wang, Keliang Xie","doi":"10.1136/bmjresp-2025-003471","DOIUrl":"10.1136/bmjresp-2025-003471","url":null,"abstract":"<p><strong>Background: </strong>Sepsis-associated acute respiratory distress syndrome (SA-ARDS) is a lethal complication demanding early predictors. This study assessed estimated plasma volume status (ePVS) for predicting SA-ARDS development.</p><p><strong>Methods: </strong>This multicentre cohort study analysed 3854 adult patients with sepsis 3.0 from China. The primary outcome was the incidence of SA-ARDS. Multivariate logistic regression, propensity score matching (PSM) and inverse probability weighting (IPW) were used to assess associations between ePVS and SA-ARDS.</p><p><strong>Results: </strong>Elevated ePVS was independently associated with SA-ARDS incidence across all models (multivariate OR: 1.56, 95% CI 1.50 to 1.63; PSM OR: 1.72, 1.63 to 1.81; IPW OR: 1.58, 1.49 to 1.69; p<0.001). Receiver operating characteristic analysis demonstrated a strong discriminative ability of ePVS for SA-ARDS incidence (area under the curve (AUC): 0.772, 95% CI 0.757 to 0.788). SA-ARDS patients exhibited higher mortality (31.8% vs 23.1%, p<0.001), mechanical ventilation (MV) use (82.3% vs 48.4%, p<0.001) and continuous renal replacement therapy (CRRT) requirements (7.7% vs 4.7%, p<0.001). Generalised additive model analysis revealed a significant linear association between ePVS >8.0 dL/g and SA-ARDS mortality (p<0.001). Although ePVS >8.0 dL/g alone showed limited predictive value for in-hospital mortality in SA-ARDS patients (AUC: 0.549), its combination with acute physiology and chronic health evaluation II significantly improved discrimination (AUC: 0.823). This synergistic effect persisted even after excluding early deaths (≤72 hours), reinforcing ePVS's complementary role alongside established severity scores in mortality risk stratification. Stratified analysis revealed ePVS levels strongly correlated with acute respiratory distress syndrome (ARDS) severity (p<0.001), particularly distinguishing mild from moderate cases. Patients with pulmonary infections exhibited higher ePVS than non-pulmonary sources (p<0.001).</p><p><strong>Conclusions: </strong>These findings highlight ePVS is strongly associated with ARDS onset, disease severity and mortality risk, supporting its utility as a prognostic marker in risk stratification.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"13 1","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13264873/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148216139","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}