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Artificial stone silicosis arrives in the UK: a tragic case of history repeating Thorax (IF 9.0) Pub Date : 2024-10-01 Christopher Barber
Silicosis is the most ancient form of occupational lung disease, being known to have caused disability and the premature death of workers for many millennia.1 Despite this, silicosis continues to be a global health problem,2 accounting for almost 13 000 deaths worldwide in 2019.3 Those at risk of this disease commonly work in industries that involve either cutting through silica-containing material
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Implications of the hypobaric cabin environment during commercial air travel for passenger fitness to fly Thorax (IF 9.0) Pub Date : 2024-10-01 Peter D Hodkinson, Thomas G Smith
In 2019, a record 4.5 billion passengers travelled by air.1 This fell markedly during the COVID-19 pandemic, but in 2023, the industry’s measure of overall airline ‘traffic’, revenue passenger kilometres, was back to 94% of the 2019 figures, with predictions that 2024 will see new record passenger numbers (see figure 1).2 This highlights how common air travel is and reinforces the idea that it is highly
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Untangling the web between menopause and respiratory disease Thorax (IF 9.0) Pub Date : 2024-10-01 Hannah Whittaker
Over the last few decades, women’s health has slowly shifted closer to the forefront of research.1 There have been multiple major campaigns at academic, charity and government level, for the improvement of women’s health globally. In 2021, the UK government implemented the Women’s Health Strategy to improve the health of women in the UK over 10 years and Asthma and Lung UK published their report on
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Ageing and ivacaftor: unravelling the long-term effects Thorax (IF 9.0) Pub Date : 2024-10-01 Paul D Robinson
The cystic fibrosis transmembrane conductance regulator (CFTR) modulator compound, ivacaftor, reached its 10-year anniversary of US Food and Drug Administration (FDA) approval in 2022. This long-standing experience captured within US CF foundation patient registry (US CFFPR) data up to December 2019 was harnessed by Merlo and colleagues in this edition of the journal to provide further insight into
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Antenatal exposures to tobacco and biomass or fossil fuels and wheezing in early childhood in South Africa Thorax (IF 9.0) Pub Date : 2024-10-01 Rachel Nadif
Asthma is the most prevalent chronic disease of childhood. Based on the Global Burden of Diseases, Injuries and Risk Factors Study, the global incident cases of asthma in children increased by 7.07% from 1990 to 2019, the highest incidence being observed in children under 5 years old.1 Among these youngest children, asthma is difficult to diagnose, and is often defined by wheezing episodes characterised
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Nasal epithelial gene expression identifies relevant asthma endotypes in the ATLANTIS study Thorax (IF 9.0) Pub Date : 2024-10-01 Tatiana Karp, Alen Faiz, Jos van Nijnatten, Huib A M Kerstjens, Ilse Boudewijn, Monica Kraft, Judith M Vonk, Martijn C Nawijn, Irene H Heijink, Bianca Beghé, Klaus F Rabe, Alberto Papi, Chris Brightling, Dave Singh, Thys van der Molen, Salman Siddiqui, Stephanie Christenson, Victor Guryev, Maarten van den Berge
Introduction Asthma is an inflammatory airways disease encompassing multiple phenotypes and endotypes. Several studies suggested gene expression in nasal epithelium to serve as a proxy for bronchial epithelium, being a non-invasive approach to investigate lung diseases. We hypothesised that molecular differences in upper airway epithelium reflect asthma-associated differences in the lower airways and
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Impact of age at ivacaftor initiation on pulmonary outcomes among people with cystic fibrosis Thorax (IF 9.0) Pub Date : 2024-10-01 Christian A Merlo, Lisa J McGarry, Teja Thorat, Catherine Nguyen, Maral DerSarkissian, Aruna Muthukumar, Joe Healy, M Alan Brookhart, Jaime L Rubin
Background Ivacaftor (IVA) improves lung function and other extrapulmonary outcomes in people with cystic fibrosis (CF). However, the effect of initiating IVA at earlier versus later ages has not been studied. Methods We conducted an observational cohort study of people in the US CF Foundation Patient Registry aged ≥6 years with ≥1 CF transmembrane conductance regulator–gating mutation to compare the
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Long-term impact of ivacaftor on mortality rate and health outcomes in people with cystic fibrosis Thorax (IF 9.0) Pub Date : 2024-10-01 Christian A Merlo, Teja Thorat, Maral DerSarkissian, Lisa J McGarry, Catherine Nguyen, Yuqian M Gu, Joe Healy, Jaime L Rubin, M Alan Brookhart
Background Ivacaftor (IVA) has been shown to improve lung function and other clinical outcomes in people with cystic fibrosis (CF). A decade of real-world IVA availability has enabled the examination of long-term outcomes with this treatment. This retrospective, longitudinal cohort study investigated the impact of IVA on mortality rate and health outcomes among people with CF in the US. Methods Data
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Relationship between cumulative silica exposure and silicosis: a systematic review and dose-response meta-analysis Thorax (IF 9.0) Pub Date : 2024-10-01 Patrick Howlett, Jeffrey Gan, Maia Lesosky, Johanna Feary
Background Silicosis, a chronic respiratory disease caused by crystalline silica exposure, is a persistent global lung health issue. No systematic review of the relationship between cumulative respirable crystalline silica (RCS) exposure and silicosis exists. UK exposure limits are currently under review. We therefore performed a systematic review and dose-response meta-analysis of this relationship
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Urban metabolic and airway immune profiles increase the risk of infections in early childhood Thorax (IF 9.0) Pub Date : 2024-10-01 Nicklas Brustad, Jonathan Thorsen, Casper Emil Tingskov Pedersen, Mina Ali, Julie Kyvsgaard, Sarah Brandt, Jenni Lehtimäki, Nicole Prince, Nilofar V Følsgaard, Jessica Lasky-Su, Jakob Stokholm, Klaus Bønnelykke, Bo Chawes
Background Infections in childhood remain a leading global cause of child mortality and environmental exposures seem crucial. We investigated whether urbanicity at birth was associated with the risk of infections and explored underlying mechanisms. Methods Children (n=633) from the COPSAC2010 mother–child cohort were monitored daily with symptom diaries of infection episodes during the first 3 years
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Environmental exposures associated with early childhood recurrent wheezing in the mother and child in the environment birth cohort: a time-to-event study Thorax (IF 9.0) Pub Date : 2024-10-01 Kareshma Asharam, Aweke A Abebaw Mitku, Lisa Ramsay, Prakash Mohan Jeena, Rajen N Naidoo
Background Antenatal factors and environmental exposures contribute to recurrent wheezing in early childhood. Aim To identify antenatal and environmental factors associated with recurrent wheezing in children from birth to 48 months in the mother and child in the environment cohort, using time-to-event analysis. Method Maternal interviews were administered during pregnancy and postnatally and children
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Early menopause and hormone therapy as determinants for lung health outcomes: a secondary analysis using the PLCO trial Thorax (IF 9.0) Pub Date : 2024-10-01 Xiaochun Gai, Yue Feng, Tessa M Flores, Huining Kang, Hui Yu, Kimberly K Leslie, Yiliang Zhu, Jennifer A Doherty, Yan Guo, Steven A Belinsky, Linda S Cook, Shuguang Leng
Rationale Early natural menopause (early-M; <45 years of age) increases the risk of lung morbidities and mortalities in smokers. However, it is largely unknown whether early-M due to surgery demonstrates similar effects and whether menopausal hormone therapy (MHT) is protective against lung diseases. Objectives To assess the associations of early-M and MHT with lung morbidities and mortalities using
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Effects of moderate alcohol consumption and hypobaric hypoxia: implications for passengers’ sleep, oxygen saturation and heart rate on long-haul flights Thorax (IF 9.0) Pub Date : 2024-10-01 Rabea Antonia Trammer, Daniel Rooney, Sibylle Benderoth, Martin Wittkowski, Juergen Wenzel, Eva-Maria Elmenhorst
Background Passengers on long-haul flights frequently consume alcohol. Inflight sleep exacerbates the fall in blood oxygen saturation (SpO2) caused by the decreased oxygen partial pressure in the cabin. We investigated the combined influence of alcohol and hypobaric hypoxia on sleep, SpO2 and heart rate. Methods Two groups of healthy individuals spent either two nights with a 4-hour sleep opportunity
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Artificial stone silicosis: a UK case series Thorax (IF 9.0) Pub Date : 2024-10-01 Johanna Feary, Anand Devaraj, Matthew Burton, Felix Chua, Robina K Coker, Arnab Datta, Richard J Hewitt, Maria Kokosi, Vaslis Kouranos, Carl Jonathan Reynolds, Clare L Ross, Veronica Smith, Katie Ward, Melissa Wickremasinghe, Joanna Szram
Silicosis due to artificial stone (AS) has emerged over the last decade as an increasing global issue. We report the first eight UK cases. All were men; median age was 34 years (range 27–56) and median stone dust exposure was 12.5 years (range 4–40) but in 4 cases was 4–8 years. One is deceased; two were referred for lung transplant assessment. All cases were dry cutting and polishing AS worktops with
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Pulmonary fibrosis and lung cancer: an analysis of the Clinical Practice Research Datalink linked to the National Cancer Registration Dataset Thorax (IF 9.0) Pub Date : 2024-10-01 Francesca Gonnelli, Jaspreet Kaur, Martina Bonifazi, David Baldwin, Emma O’Dowd, Richard Hubbard
We quantified the proportion of diagnoses of pulmonary fibrosis (PF) among 25 136 people with lung cancer and 250 583 matched controls and compared the natural history of lung cancer in people with and without PF. Diagnoses of PF were more common in people with lung cancer than those without (1.5% vs 0.8%, OR 1.97; 95% CI 1.77 to 2.21). Within people with PF, squamous cell carcinoma was more (22.9% vs
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Multiple intrathoracic extramedullary haematopoiesis as visualised on medical thoracoscopy Thorax (IF 9.0) Pub Date : 2024-10-01 Jiun Hang Lee, Larry Ellee Nyanti, Nai-Chien Huan, Hema Yamini Ramarmuty, Kunji Kannan Sivaraman Kannan
A 38-year-old man with underlying transfusion-dependent beta-thalassemia and a history of splenectomy in August 2023 presented in December of the same year, complaining of one month of dyspnoea and orthopnoea. The chest radiograph revealed bilateral pleural effusion, with a left-sided predominance. Diagnostic and therapeutic thoracentesis demonstrated straw-coloured serous pleural fluid (pf) with an
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Intensive care unit interventions to promote sleep and circadian biology in reducing incident delirium: a scoping review Thorax (IF 9.0) Pub Date : 2024-10-01 M Elizabeth Wilcox, Lisa Burry, Marina Englesakis, Briar Coman, Marietou Daou, Frank MP van Haren, E Wes Ely, Karen J Bosma, Melissa P Knauert
Rationale/Objectives Despite plausible pathophysiological mechanisms, research is needed to confirm the relationship between sleep, circadian rhythm and delirium in patients admitted to the intensive care unit (ICU). The objective of this review is to summarise existing studies promoting, in whole or in part, the normalisation of sleep and circadian biology and their impact on the incidence, prevalence
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Journal club Thorax (IF 9.0) Pub Date : 2024-10-01 Ewan Christopher Mackay
Household air pollution has been estimated to be responsible for 3.2 million preventable deaths every year globally. With biomass exposure and environmental pollution linked to exacerbations of airways disease, this health impact disproportionately affects low and middle income countries. Puzzolo et al ( Lancet Resp Med 2024;12(4):281–293) undertook a systematic review and included 116 studies in the
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Harm from tobacco: a common thread Thorax (IF 9.0) Pub Date : 2024-09-11 Sanjay Agrawal
Industry uses market segmentation of products to attract and retain consumers from a variety of groups based on demographics, interests, behavioural factors and common needs. This approach is used across many commercial sectors selling a diverse range of commodities including cleaning, beauty, food, automobile and electronic products. Consumers may be attracted to goods based on a number of characteristics
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Consolidation with pseudocavitation Thorax (IF 9.0) Pub Date : 2024-08-30 Tanzil Rahaman, Kavitha Venkatnarayan, Chitra Veluthat, Priya Ramachandran
A 48-year-old man, non-smoker, with no known comorbidities, presented with shortness of breath, cough with mucoid expectoration, loss of appetite and loss of weight for 6 weeks. There was no history of fever, hemoptysis or wheezing. He had received multiple courses of antibiotics from elsewhere before presenting to our centre with no relief of symptoms. On examination, crepitations were audible in
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Impact of TAS2R38 polymorphisms on nasal nitric oxide and Pseudomonas infections in primary ciliary dyskinesia: relation to genotype Thorax (IF 9.0) Pub Date : 2024-08-24 Massimo Pifferi, Attilio Boner, Debora Maj, Angela Michelucci, Gabriele Donzelli, Angela M Cangiotti, Raffaella Guazzo, Giulia Bertolucci, Veronica Bertini, Chiara Doccioli, Michele Piazza, Angelo Valetto, Maria Adelaide Caligo, Diego Peroni, Andrew Bush
Objective Primary ciliary dyskinesia (PCD) severity has been related to genotype and levels of nasal nitric oxide (nNO). The most common TAS2R38 haplotypes (PAV/PAV, PAV/AVI, AVI/AVI) encoding the bitter taste receptor can affect nNO levels and thus could play a role in the susceptibility to respiratory infections. We assessed the impact of these polymorphisms on nNO production and Pseudomonas aeruginosa
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Atypical radiological manifestation of sarcoidosis presenting with an anterior mediastinal mass Thorax (IF 9.0) Pub Date : 2024-08-22 Wan-Ting Tao, Hao-Yu Huang, Wen-Chiuan Tsai, Kai-Hsiung Ko
A 44-year-old woman presented with a persistent diffuse skin rash for 3 months, along with progressively worsening dyspnoea, cough and fatigue over the past 2 weeks. Laboratory results and physical examination were unremarkable, except for decreased breath sounds over the right lung and multiple palpable nodular skin lesions over the chest, abdomen and limbs (figure 1). Chest radiograph revealed a
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Consensus palliative care referral criteria for people with chronic obstructive pulmonary disease Thorax (IF 9.0) Pub Date : 2024-08-22 Jennifer Philip, Yuchieh Kathryn Chang, Anna Collins, Natasha Smallwood, Donald Richard Sullivan, Barbara P Yawn, Richard Mularski, Magnus Ekström, Ian A Yang, Christine F McDonald, Masanori Mori, Pedro Perez-Cruz, David M G Halpin, Shao-Yi Cheng, David Hui
Objective People with advanced chronic obstructive pulmonary disease (COPD) have substantial palliative care needs, but uncertainty exists around appropriate identification of patients for palliative care referral. We conducted a Delphi study of international experts to identify consensus referral criteria for specialist outpatient palliative care for people with COPD. Methods Clinicians in the fields
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Xpert Ultra for diagnosing tuberculosis at bronchoscopy: thoughts on practical applications Thorax (IF 9.0) Pub Date : 2024-09-01 Graham Bothamley
Tests based on polymerase chain reactions are increasingly important in the microbiological diagnosis of tuberculosis (TB). Park et al1 have extended the use of Xpert Ultra to include material obtained at bronchoscopy, and particularly its use for samples obtained by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). In addition, immediate cytology with rapid onsite evaluation
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Rectal organoid morphometric analysis (ROMA)—re: optimising measurements automatically Thorax (IF 9.0) Pub Date : 2024-09-01 Shafagh Waters, Peter G Middleton
Quantification of the physiological changes in people with cystic fibrosis (pwCF) has long been important for clinical diagnosis. Since the original discovery of abnormal sweat electrolytes in pwCF, the standardised pilocarpine iontophoresis sweat test was developed1 to clearly distinguish those with CF. While the sweat chloride test remains an important early step in the diagnostic algorithm, complementary
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Cause or consequence in idiopathic pulmonary fibrosis: using genetic data to back the right horse Thorax (IF 9.0) Pub Date : 2024-09-01 Louise V Wain
The task is clear: we need better treatments for pulmonary fibrosis (PF). The two antifibrotic therapies licensed for idiopathic pulmonary fibrosis (IPF) have shown efficacy in other forms of PF but do not meet the needs of people living with PF; drugs that can halt or even reverse progression and, importantly, improve quality of life. Although a number of new potential therapies are now reaching late-stage
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Unveiling the occupational hazards: exploring the association between organic dust exposure and hypersensitivity pneumonitis and other interstitial lung diseases Thorax (IF 9.0) Pub Date : 2024-09-01 Sheikh M Alif, Geza Benke
Organic dusts are mixtures of particles originating from plants, animals and often endotoxins from gram-negative bacteria. Several occupations, including farming (where exposures can occur during grain, animal handling and feeding), woodworking (where exposures can occur from wood dust) and textile work (during cotton processing), are the primary sources of occupational exposure to organic dust.1 2
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Children’s interstitial lung disease (chILD): less rare than we thought? Thorax (IF 9.0) Pub Date : 2024-09-01 Andrew Bush, Lawrence Nogee
The presentation of childhood interstitial lung disease (chILD) is non-specific,1 and chILD is usually low on the list of diagnoses in children with combinations of respiratory symptoms, feeding difficulties and failure to thrive. However, if a diagnosis is not considered, it will never be made. In this issue of the Journal , Fletcher et al describe nearly 800 French children, suggesting that chILD
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Fixing lung health in the UK: accelerating respiratory research and innovation Thorax (IF 9.0) Pub Date : 2024-09-01 Cheryl Routley, Samantha Walker, Eric WFW Alton, Ian P Hall
Lung conditions are the third biggest killer in the UK1 and poor lung health costs the UK £188 billion every year.2 Involvement in clinical translational research improves clinical outcomes.3 4 However, while respiratory health was identified as a government priority in the Life Science Vision missions in 2021,5 it has not yet received any additional funding. Given the acknowledged respiratory research
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Airway epithelial cell response to RSV is mostly impaired in goblet and multiciliated cells in asthma Thorax (IF 9.0) Pub Date : 2024-09-01 Aurore C A Gay, Martin Banchero, Orestes Carpaij, Tessa M Kole, Leonie Apperloo, Djoke van Gosliga, Putri Ayu Fajar, Gerard H Koppelman, Louis Bont, Rudi W Hendriks, Maarten van den Berge, Martijn C Nawijn
Background In patients with asthma, respiratory syncytial virus (RSV) infections can cause disease exacerbation by infecting the epithelial layer of the airways, inducing subsequent immune response. The type I interferon antiviral response of epithelial cells upon RSV infection is found to be reduced in asthma in most—but not all—studies. Moreover, the molecular mechanisms causing the differences in
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Monocyte NLRP3 inflammasome and interleukin-1β activation modulated by alpha-1 antitrypsin therapy in deficient individuals Thorax (IF 9.0) Pub Date : 2024-09-01 Debananda Gogoi, Howard Yu, Michelle Casey, Rory Baird, Azeez Yusuf, Luke Forde, Michael E O' Brien, Jesse R West, Tammy Flagg, Noel G McElvaney, Edward Eden, Christian Mueller, Mark L Brantly, Patrick Geraghty, Emer P Reeves
Introduction Altered complement component 3 (C3) activation in patients with alpha-1 antitrypsin (AAT) deficiency (AATD) has been reported. To understand the potential impact on course of inflammation, the aim of this study was to investigate whether C3d, a cleavage-product of C3, triggers interleukin (IL)-1β secretion via activation of NOD-, LRR- and pyrin domain-containing protein 3 (NLRP3) inflammasome
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Rectal organoid morphology analysis (ROMA) as a novel physiological assay for diagnostic classification in cystic fibrosis Thorax (IF 9.0) Pub Date : 2024-09-01 Senne Cuyx, Anabela Santo Ramalho, Steffen Fieuws, Nikky Corthout, Marijke Proesmans, Mieke Boon, Kaline Arnauts, Marianne S Carlon, Sebastian Munck, Lieven Dupont, Kris De Boeck, François Vermeulen
Background Diagnosing cystic fibrosis (CF) is not always straightforward, in particular when sweat chloride concentration (SCC) is intermediate and <2 CF-causing CFTR variants are identified. The physiological CFTR assays proposed in the guidelines, nasal potential difference and intestinal current measurement, are not readily available nor feasible at all ages. Rectal organoid morphology analysis
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Epidemiology of childhood interstitial lung disease in France: the RespiRare cohort Thorax (IF 9.0) Pub Date : 2024-09-01 Camille Fletcher, Alice Hadchouel, Caroline Thumerelle, Julie Mazenq, Manon Fleury, Harriet Corvol, Nouha Jedidi, Myriam Benhamida, Katia Bessaci, Tiphaine Bilhouee, Raphael Borie, Jacques Brouard, Aurélie Cantais, Annick Clement, Laurianne Coutier, Camille Cisterne, Pierrick Cros, Marie-Laure Dalphin, Christophe Delacourt, Eric Deneuville, Jean-Christophe Dubus, Carole Egron, Ralph Epaud, Michael
Introduction Interstitial lung disease in children (chILD) are rare and mostly severe lung diseases. Very few epidemiological data are available in limited series of patients. The aim of this study was to assess the prevalence and incidence of chILD in France. Methods We performed within the RespiRare network a multicentre retrospective observational study in patients with chILD from 2000 to 2022 and
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Risk of hypersensitivity pneumonitis and other interstitial lung diseases following organic dust exposure Thorax (IF 9.0) Pub Date : 2024-09-01 Inge Brosbøl Iversen, Jesper Medom Vestergaard, Ioannis Basinas, Johan Ohlander, Susan Peters, Elisabeth Bendstrup, Jens Peter Ellekilde Bonde, Vivi Schlünssen, Finn Rasmussen, Zara Ann Stokholm, Michael Brun Andersen, Hans Kromhout, Henrik Albert Kolstad
Background Organic dust is associated with hypersensitivity pneumonitis, and associations with other types of interstitial lung disease (ILD) have been suggested. We examined the association between occupational organic dust exposure and hypersensitivity pneumonitis and other ILDs in a cohort study. Methods The study population included all residents of Denmark born in 1956 or later with at least 1
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Indirect impact of childhood 13-valent pneumococcal conjugate vaccine (PCV13) in Canadian older adults: a Canadian Immunization Research Network (CIRN) retrospective observational study Thorax (IF 9.0) Pub Date : 2024-09-01 Sharifa Nasreen, Jun Wang, Fawziah Marra, Jeffrey C Kwong, Allison McGeer, Manish Sadarangani, Sarah E Wilson, Shaza A Fadel
Background 13-valent pneumococcal conjugate vaccine (PCV13) has been part of publicly funded childhood immunisation programmes in Ontario and British Columbia (BC) since 2010. We assessed the indirect impact of infant PCV13 programmes on invasive pneumococcal disease (IPD) and all-cause pneumonia hospitalisation in older adults (aged ≥65 years) using a retrospective observational study. Methods We
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TB PCR in BAL and EBUS-TBNA samples for the diagnosis of pulmonary and mediastinal lymph node TB: retrospective TRiBE study Thorax (IF 9.0) Pub Date : 2024-09-01 Mirae Park, Kartik Kumar, Meg Coleman, Laura Martin, Georgina Russell, Pauline Scheelbeek, Ajit Lalvani, Giovanni Satta, Onn Min Kon
Introduction The role of Xpert Ultra in bronchoalveolar lavage (BAL) and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) samples for pulmonary and mediastinal lymph node tuberculosis (TB) remains unclear. Methods This was a retrospective observational service evaluation at a tertiary TB centre in a low-incidence setting. The diagnostic indices of Xpert Ultra, smear and
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Genetic-informed proteome-wide scan reveals potential causal plasma proteins for idiopathic pulmonary fibrosis Thorax (IF 9.0) Pub Date : 2024-09-01 Jiahao Zhu, Houpu Liu, Rui Gao, Ruicheng Gong, Jing Wang, Dan Zhou, Min Yu, Yingjun Li
Idiopathic pulmonary fibrosis (IPF) is a lethal lung disease for which there are no reliable biomarkers or disease-modifying drugs. Here, we integrated human genomics and proteomics to investigate the causal associations between 2769 plasma proteins and IPF. Our Mendelian randomisation analysis identified nine proteins associated with IPF, of which three (FUT3, ADAM15 and USP28) were colocalised. ADAM15
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Antibiotic pharmacokinetics in infected pleural effusions Thorax (IF 9.0) Pub Date : 2024-09-01 David T Arnold, Liam Read, Oliver Waddington, Fergus W Hamilton, Sonia Patole, Jessica Hughes, Alice Milne, Alan Noel, Mark Bayliss, Nicholas A Maskell, Alasdair MacGowan
Pleural infection is usually treated with empirical broad-spectrum antibiotics, but limited data exist on their penetrance into the infected pleural space. We performed a pharmacokinetic study analysing the concentration of five intravenous antibiotics across 146 separate time points in 35 patients (amoxicillin, metronidazole, piperacillin-tazobactam, clindamycin and cotrimoxazole). All antibiotics
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IgG and plasma viscosity as markers of disease activity in primary Sjogren’s syndrome-related lymphocytic interstitial pneumonia Thorax (IF 9.0) Pub Date : 2024-09-01 Sughra Alawi, Giles Dixon, Nidhi Bhatt, Huzaifa I Adamali, Harsha Gunawardena
A 33-year-old woman presented with an 8-month history of dry cough and progressive dyspnoea. Two months later, she developed dry eyes and mouth, petechial rash over both feet, left jaw pain and weight loss. She had no significant medical, medication, smoking or occupational history. Her father had Raynaud’s disease and paternal uncle had systemic lupus erythematosus. Her physical examination revealed
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When is an AVM not an AVM? Thorax (IF 9.0) Pub Date : 2024-09-01 Alice Parry, Amir Awwad, Geoffrey Lie, Matt Matson, William Martin Ricketts
Pulmonary arteriovenous malformations (pAVMs) are abnormal connections between branches of the pulmonary artery and vein resulting in right-to-left shunting of blood. They are the most common pulmonary vascular malformations, with an estimated incidence of 1 in 2600, and typically congenital.1 There is a 30% lifetime risk of shunt related complications, such as stroke or cerebral abscess, secondary
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Angiosarcoma of the pulmonary artery as an unexpected evolution of an apparent pulmonary thromboembolism Thorax (IF 9.0) Pub Date : 2024-09-01 Angela Bronte, Sofia González-Ibán, Elia Lecumberri de Fuentes, Héctor Lajusticia
A 70-year-old woman, non-smoker, with previous SARS-CoV-2 infection 6 months ago and 1-month history of cough and expectoration, presented with acute left pleuritic pain and progressive dyspnoea. She was referred to the emergency department, where a chest X-ray showed a left pleural effusion. To exclude a pulmonary embolism (PE), a CT pulmonary angiogram (CTPA) was performed. It demonstrated a filling
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Journal club Thorax (IF 9.0) Pub Date : 2024-09-01 Marta Duarte-Silva
Chronic obstructive pulmonary disease (COPD) is characterised by reduced lung function and frequent exacerbations, which can worsen symptoms, increasing the risk of further health decline and mortality. Although COPD has long been recognised as involving an amplified innate immune response, recent findings suggest that type two inflammation, present in 20–40% of COPD patients, could be a therapeutic
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Pulmonary fibrosis may begin in infancy: from childhood to adult interstitial lung disease Thorax (IF 9.0) Pub Date : 2024-08-17 Matthias Griese, Geoffrey Kurland, Michal Cidon, Robin R Deterding, Ralph Epaud, Nadia Nathan, Nicolaus Schwerk, David Warburton, Jason P Weinman, Lisa R Young, Gail H Deutsch
Background Childhood interstitial lung disease (chILD) encompasses a group of rare heterogeneous respiratory conditions associated with significant morbidity and mortality. Reports suggest that many patients diagnosed with chILD continue to have potentially progressive or fibrosing disease into adulthood. Over the last decade, the spectrum of conditions within chILD has widened substantially, with
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Inequalities in care and the burden of wheeze and asthma in young children from diverse socioeconomic and ethnic backgrounds Thorax (IF 9.0) Pub Date : 2024-08-17 Björn Nordlund
Worldwide inequalities in care significantly impact respiratory health outcomes.1 2 Despite this, there are few studies examining how wheeze and asthma outcomes, including healthcare use and treatment decisions, vary with socioeconomic status and ethnicity in young children. Therefore, it is highly relevant to acknowledge the paper by D Lo et al , ‘Association between socioeconomic deprivation, ethnicity
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Chronic berylliosis disease: uncommon pulmonary granulomas beyond sarcoidosis Thorax (IF 9.0) Pub Date : 2024-08-15 Ahmed Ehab, Axel T Kempa, Liubov Yurkul, Ahmad Shalabi
A 47-year-old male presented with chronic cough, which has worsened over the last 5–6 months. Dyspnoea, fever and significant weight loss were denied. The patient had no history of smoking or vaping. The patient worked as an automotive technician in a car manufacturing plant specialised in aluminium-based vehicle bodies with frequent exposure to metallic fumes during polishing and welding of aluminium/beryllium
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Plasma collagen neoepitopes are associated with multiorgan disease in the ACCESS and GRADS sarcoidosis cohorts Thorax (IF 9.0) Pub Date : 2024-08-07 Jannie Marie Bülow Sand, Henrik Jessen, Diana Julie Leeming, Sheeline Yu, Chris J Lee, Buqu Hu, Ying Sun, Taylor Adams, Taylor Pivarnik, Angela Liu, Samuel Woo, John R McGovern, Vitória Fiorini, Tina Saber, Jean Paul Higuero-Sevilla, Mridu Gulati, Naftali Kaminski, William Damsky, Albert C Shaw, Subhasis Mohanty, Gillian Goobie, Yingze Zhang, Erica Lyndrup Herzog, Changwan Ryu
Introduction The pathogenesis of sarcoidosis involves tissue remodelling mediated by the accumulation of abnormal extracellular matrix, which is partly the result of an imbalance in collagen synthesis, cross-linking and degradation. During this process, collagen fragments or neoepitopes, are released into the circulation. The significance of these circulating collagen neoepitopes in sarcoidosis remains
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Association of positive airway pressure termination with mortality and non-fatal cardiovascular events in patients with obstructive sleep apnoea Thorax (IF 9.0) Pub Date : 2024-08-02 AbdelKebir Sabil, Claire Launois, Wojchiech Trzepizur, François Goupil, Thierry Pigeanne, Sandrine Launois, Laurène Leclair-Visonneau, Philippe Masson, Acya Bizieux-Thaminy, Sandrine Kerbat, Sebastien Bailly, Frédéric Gagnadoux
Background and aims The recurrence of obstructive sleep apnoea (OSA) after positive airway pressure (PAP) therapy termination has physiological consequences that may increase cardiovascular (CV) risk. We aimed to determine whether PAP termination is associated with an increased incidence of major adverse CV events (MACE) compared with adherent PAP continuation. Methods Data from the Pays de la Loire
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Perivascular epithelioid cell neoplasm of lung Thorax (IF 9.0) Pub Date : 2024-07-22 Hong Yang, Binglin Lai
A 73-year-old woman was found to have a pulmonary mass on a CT scan of the chest 10 years ago, but did not receive any treatment. Approximately 2 years ago, she started experiencing chest tightness and bloating, without other discomfort. These symptoms worsened half a month ago and were accompanied by dyspnoea. A CT scan (figure 1A,D) revealed a spherical mass in the left upper lobe lingular segment
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CD206+ macrophages are relevant non-invasive imaging biomarkers and therapeutic targets in experimental lung fibrosis Thorax (IF 9.0) Pub Date : 2024-07-20 Lenny Pommerolle, Guillaume Beltramo, Leo Biziorek, Marin Truchi, Alexandre Magno Maneschy Dias, Lucile Dondaine, Julie Tanguy, Nicolas Pernet, Victor Goncalves, Alexanne Bouchard, Marie Monterrat, Grégoire Savary, Nicolas Pottier, Kjetil Ask, Martin R J Kolb, Bernard Mari, Carmen Garrido, Bertrand Collin, Philippe Bonniaud, Olivier Burgy, Françoise Goirand, Pierre-Simon Bellaye
Background Interstitial lung diseases (ILDs) include a large number of diseases associated with progressive pulmonary fibrosis (PPF), including idiopathic pulmonary fibrosis (IPF). Despite the rarity of each of the fibrotic ILDs individually, they cumulatively affect a considerable number of patients. PPF is characterised by an excessive collagen deposition leading to functional decline. Objectives
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Non-cigarette tobacco products, aryl-hydrocarbon receptor repressor gene methylation and smoking-related health outcomes Thorax (IF 9.0) Pub Date : 2024-07-20 Christina M Eckhardt, Pallavi Balte, Jack E Morris, Surya P Bhatt, David Couper, Jessica Fetterman, Neal Freedman, David R Jacobs, Lifang Hou, Ravi Kalhan, Yongmei Liu, Laura Loehr, Pamela L Lutsey, Joseph E Schwartz, Wendy White, Sachin Yende, Stephanie J London, Tiffany R Sanchez, Elizabeth C Oelsner
Introduction Cigarette smoking leads to altered DNA methylation at the aryl-hydrocarbon receptor repressor (AHRR) gene. However, it remains unknown whether pipe or cigar smoking is associated with AHRR methylation. We evaluated associations of non-cigarette tobacco use with AHRR methylation and determined if AHRR methylation was associated with smoking-related health outcomes. Methods Data were pooled
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Refractory granulomatous Pneumocystis jirovecii pneumonia masquerading as malignancy Thorax (IF 9.0) Pub Date : 2024-07-20 Chi Wan Koo, Ananya Panda, Jennifer Boland Froemming
An elderly female, lifelong non-smoker, with rheumatoid arthritis treated with methotrexate and prednisone for 10 years was referred for evaluation of incidentally detected, randomly distributed pulmonary nodules on a CT performed for pleuritic chest pain and dyspnoea (figure 1A). Subsequent [18F]fluoro-d-glucose (FDG)-positron emission tomography (PET) showed the nodules had increased in size and
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Unusual cause of trepopnea Thorax (IF 9.0) Pub Date : 2024-07-18 Suat Yee Lee, Juo-Hau Su, Chia-Chen Chang, Fatt Yang Chew
A 19-year-old female presented with a 6-month history of progressive shortness of breath. She reported a new onset of palpitations preceding her shortness of breath, which progressed progressively into dull chest pain and trepopnea, and she experienced dyspnoea while lying on her right side. With wheezing and rhinorrhoea, the symptoms became more prominent. She had no previous history of haemoptysis
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Human mesenchymal stromal cells inhibit Mycobacterium avium replication in clinically relevant models of lung infection Thorax (IF 9.0) Pub Date : 2024-08-01 Timothy D Shaw, Anna D Krasnodembskaya, Gunnar N Schroeder, Declan F Doherty, Johnatas Dutra Silva, Shikha M Tandel, Yue Su, David Butler, Rebecca J Ingram, Cecilia M O'Kane
Introduction Novel therapeutic strategies are urgently needed for Mycobacterium avium complex pulmonary disease (MAC-PD). Human mesenchymal stromal cells (MSCs) can directly inhibit MAC growth, but their effect on intracellular bacilli is unknown. We investigated the ability of human MSCs to reduce bacterial replication and inflammation in MAC-infected macrophages and in a murine model of MAC-PD. Methods
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Epigenetic clock as the new hand of time for lung cancer in never smokers Thorax (IF 9.0) Pub Date : 2024-08-01 David C Christiani
Estimates of lung cancer among persons who never smoked are 10%–20% in the USA, translating into 20–40 000 cases annually. Globally, and especially in East Asia, the incidence of lung cancer among non-tobacco users is considerably higher than in the USA, especially in women.1 The causes of lung cancer in lifelong never-smokers are not well understood. Possibilities include exposure to other carcinogens
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MAC attack: MSCs and macrophages join forces against chronic lung infection Thorax (IF 9.0) Pub Date : 2024-08-01 Hazel Dunbar, Ian James Hawthorne, Karen English
Mesenchymal stromal cells (MSCs) possess several characteristics that make them attractive as a potential adjunct therapy for acute and chronic infectious diseases. MSCs are well known for their impressive immunomodulatory,1 2 pro-repair effects1 3 and clinical safety profile,4 5 however, the efficacy of MSCs in controlling bacterial infections, at least directly, remains unclear.6 Mycobacterium avium
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Lifetime lung function trajectories: insights into risk factors, consequences and implications Thorax (IF 9.0) Pub Date : 2024-08-01 Dinh S Bui, Nur S Idrose, Shyamali C Dharmage
Maintaining optimal lung function throughout life is important not only for respiratory health but also for overall health and longevity. With emerging evidence on the clinical significance of lung function at multiple windows throughout life, there has been an increasing number of studies on lung function trajectories1 including by Zhang et al in this issue.2 The term ‘lung function trajectory’ refers
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Lung allocation: a vexed, complex multifaceted challenge Thorax (IF 9.0) Pub Date : 2024-08-01 Andrew Fisher, Jasvir Parmar
We read with interest the paper from Roussel et al .1 In this study, the authors examine the outcomes for lung transplant recipients who were allocated donor organs in two very different healthcare systems. Their findings raise the complex and vexed question of what the fairest system for the allocation donor lungs is, especially for those candidates identified as being at the highest risk of waiting
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Reinforcing the benefits of children’s physical activity on lung health Thorax (IF 9.0) Pub Date : 2024-08-01 Gang Wang, Erik Melén
Lung development starts already in utero whereas lung function development can be conceived to begin shortly after birth, marked by the infant’s first cry. This development progresses through adolescence until reaching its peak during early adulthood (typically between 20 and 25 years of age). However, a notable portion of the general population (4%–12%) experiences suboptimal lung development, failing
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Undertreating cardiovascular disease in people with chronic obstructive pulmonary disease (COPD) Thorax (IF 9.0) Pub Date : 2024-08-01 Andrea S Gershon, Alina Blazer, Dennis Ko
Chronic obstructive pulmonary disease (COPD) is the third-leading cause of death globally following ischaemic heart disease and stroke.1 Cardiovascular disease (CVD) is one of the most common comorbidities experienced by people with COPD and is a leading cause of death. People with COPD account for about 40% of all cardiovascular hospitalisations.2 3 This is believed to be because of the direct effects
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Respiratory rescue is the new frontier Thorax (IF 9.0) Pub Date : 2024-08-01 Sarath Ranganathan
The cost of delivering healthcare is increasing in many countries, while at the same time, populations are ageing and fertility rates falling. These factors are pushing policy-makers to consider alternative strategies for health service delivery. The recent pandemic has confirmed that many of the impacts of acute infectious diseases can be mitigated through vaccination and other forms of prevention