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Improving uptake of lung cancer screening: an observational study on the impact of timed appointments and reminders. Thorax (IF 9.0) Pub Date : 2025-02-13 Amyn Bhamani,Sindhu Bhaarrati Naidu,Tanya Patrick,Lavanya Anandan,Kiran Desai,Fanta Bojang,Priyam Verghese,Paul Robinson,Shivani Patel,Ricky Thakrar,Arjun Nair,Neal Navani,Sam M Janes
Lung cancer screening (LCS) reduces lung cancer-related mortality; however, uptake remains low compared with other cancer screening programmes. In this observational study, we report the impact of timed appointments and reminders on participation in our regional LCS programme.Initial uptake of timed appointments was 53.0% (n=17 274/32 593), higher than previously reported in the UK, while initial uptake
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Targeting daytime normocapnia with nocturnal NIV in chronic hypercapnic COPD: the new paradigm? Thorax (IF 9.0) Pub Date : 2025-02-12 Sarah Bettina Stanzel,Wolfram Windisch
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Invasive angiolipoma of the mediastinum and lung. Thorax (IF 9.0) Pub Date : 2025-02-12 Ziyin Shang,Yongjie Luo,Xiaoling Kang,Chun Hong,Yuan Si
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Effect of vitamin A on adult lung function: a triangulation of evidence approach. Thorax (IF 9.0) Pub Date : 2025-02-12 Róisín Mongey,Diana A van der Plaat,Seif O Shaheen,Laura Portas,James Potts,Matthew David Hind,Cosetta Minelli
BACKGROUND Vitamin A, an essential micronutrient obtained through the diet, plays a crucial role in lung development and contributes to lung regeneration. We aimed to investigate its effect on adult lung function using triangulation of evidence from both observational and genetic data. METHODS Using data on 150 000 individuals from UK Biobank and correcting for measurement error (generalised structural
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Pneumothorax and antibiotic use: a clue to aetiology of primary spontaneous pneumothorax? Thorax (IF 9.0) Pub Date : 2025-02-12 Rob Hallifax
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Inflammation in preschool cystic fibrosis is of mixed phenotype, extends beyond the lung and is differentially modified by CFTR modulators. Thorax (IF 9.0) Pub Date : 2025-02-10 Shivanthan Shanthikumar,Liam Gubbels,Anson Tsz Chun Wong,Hannah Walker,Sarath C Ranganathan,Melanie R Neeland
BACKGROUND Early-life inflammation has long been recognised as a key pathophysiological process in the evolution of cystic fibrosis (CF) lung disease. Despite this, no CF-specific anti-inflammatory treatments have been developed. This is crucial even in the era of highly effective modulator therapy as recent evidence suggests that modulators alter, but may not fully resolve, pulmonary inflammation
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Home-based pulmonary rehabilitation during outpatient-managed acute COPD exacerbation: the latest new PR model? Thorax (IF 9.0) Pub Date : 2025-02-10 Carolyn L Rochester
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Adult asthma hospitalisations decreased markedly in Finland and Sweden between 2006 and 2022. Thorax (IF 9.0) Pub Date : 2025-02-08 Juho E Kivistö,Jennifer L P Protudjer,Sandra Ekstrom,Jussi Karjalainen,Heini Huhtala,Lauri Lehtimäki,Inger Kull
A decreasing trend in asthma hospitalisations among Finnish and Swedish children has been reported. However, possible changes in asthma hospitalisations among adults are incompletely characterised. We aimed to investigate the incidence of adult asthma hospitalisations in Finland and Sweden from 2006 to 2022 using Finland's National Hospital Discharge Register and Sweden's National Patient Register
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Dietary nitrate supplementation enhances exercise capacity in WHO Group 3 pulmonary hypertension: a double-blind, placebo-controlled, randomised crossover study (EDEN-OX2). Thorax (IF 9.0) Pub Date : 2025-02-08 Abdullah S Alsulayyim,Ali M Alasmari,Laura C Price,Colm McCabe,Saeed M Alghamdi,Keir Elmslie James Philip,Sara C Buttery,Matthew J Pavitt,Michael I Polkey,Matthew J Rickman,Blerina Ahmetaj-Shala,Jane A Mitchell,Rami A Alyami,Nicholas S Hopkinson
Dietary nitrate supplementation, which improves skeletal muscle oxygen utilisation, vascular endothelial function and exercise capacity in people with chronic obstructive pulmonary disease, may benefit other lung conditions. In a double-blind, placebo-controlled, crossover study, in 19 adults with Group 3 pulmonary hypertension who desaturated during exercise, 140 mL of nitrate-rich beetroot juice
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Accumulating evidence supports advanced bronchoscopy as a modality of choice for difficult-to-reach peripheral lung nodules, but questions remain. Thorax (IF 9.0) Pub Date : 2025-02-08 Rafael Paez,Fabien Maldonado
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Incidental finding of leukaemic pulmonary infiltration confirmed by flow cytometry of BAL fluid. Thorax (IF 9.0) Pub Date : 2025-02-08 Matthew Wells,Aaron Morjaria,William Cooper,Sophie Otton,Huzaifa I Adamali
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Is NEWS2 the optimal evidence-based surveillance tool for all respiratory patients or does it just represent the beginning of an iterative development process? Thorax (IF 9.0) Pub Date : 2025-02-08 Dominick Shaw,Andrew W Fogarty
Medical practice is built on the foundations of evidence-based medicine. Hence, the more common the clinical intervention, the more comprehensive the evidence on which that intervention should be based. Although the widespread adoption of a national early warning score in the UK has led to improvements in the delivery of care, it should be considered as providing a foundation that can be refined and
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Extracellular vesicles offer enticing opportunities to target and treat lung inflammation. Thorax (IF 9.0) Pub Date : 2025-02-03 Sally Yunsun Kim
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Availability, cost and affordability of essential medicines for smoking cessation in low-income and middle-income countries: a cross-sectional study. Thorax (IF 9.0) Pub Date : 2025-02-03 Catherine Plum,Marie Stolbrink,Obianuju Ozoh,Shamanthi Jayasooriya,Rebecca Nightingale,Kevin Mortimer,David Halpin
Smoking cessation is more effective when supported by medicines. Data on the availability, cost and affordability of these treatments in low-income and middle-income countries (LMIC) are limited. Cross-sectional data for smoking cessation medications were collected from pharmacies, healthcare facilities and central medicine stores in 60 LMIC (2022-2023). Medications had varying availability, large
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Pulmonary rehabilitation: one size does not fit all. Thorax (IF 9.0) Pub Date : 2025-02-03 Narelle S Cox,Anne E Holland
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Role of inflammasomes in acute respiratory distress syndrome. Thorax (IF 9.0) Pub Date : 2025-01-30 Luke Flower,Emilio G Vozza,Clare E Bryant,Charlotte Summers
Acute respiratory distress syndrome (ARDS) is present in >10% of all people admitted to critical care and is associated with severe morbidity and mortality. Despite more than half a century since its first description, no efficacious pharmacological therapies have been developed, and little progress has been made in improving clinical outcomes. Neutrophils are the principal drivers of ARDS, with their
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Mind the sleep: how does obstructive sleep apnoea syndrome relate to risk of dementia? Thorax (IF 9.0) Pub Date : 2025-01-29 Daniil Lisik,Ding Zou
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Functional impairment in COPD can be predicted using genomic-derived data. Thorax (IF 9.0) Pub Date : 2025-01-29 Rui Marçalo,Guilherme Rodrigues,Miguel Pinheiro,Sonya Neto,Sofia L Marques,Paula Simão,Vitória Martins,Lília Andrade,Maria Aurora Mendes,Manuel Santos,Vera Afreixo,Alda Marques,Gabriela Moura
OBJECTIVE Reduced functional capacity and muscle weakness are two major contributors to functional impairment in chronic obstructive pulmonary disease (COPD). The underlying causes of functional impairment are poorly understood and, therefore, we sought to investigate the contribution of genetic factors. METHODS We conducted a cross-sectional analysis of sociodemographic, clinical and genetic information
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Genesis of concurrent diseases: do diabetes mellitus and idiopathic pulmonary fibrosis have a direct relationship? Thorax (IF 9.0) Pub Date : 2025-01-22 Ugochukwu Ebubechukwu, Patrick Geraghty
Management and treatment of respiratory, mental health conditions, diabetes mellitus (DM), vascular diseases and cancer represent some of the greatest costs in global health.1 These conditions frequently manifest with multiple coexisting diseases. The frequency of the prevalence of multimorbidity in adults aged 50 years and over ranges from 20% to 50%.2 Investigating the effect of the comorbidity is
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Diagnostic performance of shape-sensing robotic-assisted bronchoscopy for pleural-based and fissure-based pulmonary lesions Thorax (IF 9.0) Pub Date : 2025-01-20 Sebastian Fernandez-Bussy, Alejandra Yu Lee-Mateus, Alanna Barrios-Ruiz, Sofia Valdes-Camacho, Katherine Lin, Mohamed I Ibrahim, Bryan F Vaca-Cartagena, Rodrigo Funes-Ferrada, Janani Reisenauer, Kelly S Robertson, Britney N Hazelett, Ryan M Chadha, David Abia-Trujillo
Background Sampling of peripheral pulmonary lesions (PPLs) abutting the pleura carries a higher risk of pneumothorax and complications. Although typically performed with image-guided transthoracic biopsy, the advent of shape-sensing robotic-assisted bronchoscopy (ssRAB) provides an alternative diagnostic procedure for this subtype of lesions. Methods A retrospective study on PPL attached to the peripheral
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Residual sleepiness and impaired alertness in treated obstructive sleep apnoea: role of hypoxic burden and sleep fragmentation Thorax (IF 9.0) Pub Date : 2025-01-19 Pierre Tankéré, Jacques Tailliard, Thierry PetitJean, Pierre Le-Cam, François Ricordeau, Margaux Blanchard, Jade Vanbuis, Anice Nofal, Renaud Tamisier, Laure Peter-Derex, Emeric Stauffer
The pathophysiology of residual sleepiness in treated obstructive sleep apnoea (OSA) remains poorly understood. Animal models suggest that it may involve neuronal damage due to intermittent hypoxia and sleep fragmentation. In a cohort of 122 continuous positive airway pressure (CPAP) treated OSA patients referred for maintenance of wakefulness test, we explored the determinants of (objective) alertness
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Life’s Essential 8 and risks of mortality and cardiovascular morbidity in individuals with PRISm and its associations with transition trajectories of PRISm Thorax (IF 9.0) Pub Date : 2025-01-19 Yang Geng, Yi Ding, Xujia Lu, Yalong Pei, Matthew D Jankowich, Chaofu Ke
Background Although morbidity and mortality are reportedly increased in individuals with preserved ratio impaired spirometry (PRISm), little is known about how to optimise PRISm-related health. Aims Is Life’s Essential 8 (LE8) associated with mortality and cardiovascular morbidity in individuals with PRISm and with PRISm transition trajectories? Methods Participants with PRISm (n=31 943) with complete
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Streptococcus pneumoniae pneumonia: the clinical relevance of capsular serotype Thorax (IF 9.0) Pub Date : 2025-02-01 Jeremy Stuart Brown
Lower respiratory tract infections (LRTIs) remain a common cause of respiratory mortality, responsible annually for approximately 40 000 deaths in the UK and 2.7 million globally.1 The most severe common LRTI in the UK is community-acquired pneumonia (CAP), which for hospitalised patients has a mortality of 8%2 and the incidence of which is increasing as the population ages.3 Despite being the only
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Do inhaled corticosteroids decrease the risk of cardiovascular outcomes in patients with chronic obstructive pulmonary disease? Thorax (IF 9.0) Pub Date : 2025-02-01 David M Mannino
Polymorbidity is an important component of chronic obstructive pulmonary disease (COPD), with cardiovascular diseases being among the most important comorbidities.1 The development of both incident and recurrent cardiovascular events is related to the degree of lung function impairment in COPD.2 Acute exacerbations of COPD (AECOPD) are associated with a higher risk of developing an acute cardiovascular
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Inhaled corticosteroids and major cardiovascular events in people with chronic obstructive pulmonary disease Thorax (IF 9.0) Pub Date : 2025-02-01 Anne E Ioannides, Constantinos Kallis, Hannah R Whittaker, Jennifer K Quint
Background Whether inhaled corticosteroids (ICSs) reduce major adverse cardiovascular events (MACEs) in people with chronic obstructive pulmonary disease (COPD) is debated. Objectives To establish, within people with COPD, (1) whether ICS reduced MACE rates (acute coronary syndrome (ACS), heart failure (HF), ischaemic strokes or cardiovascular-specific death) compared with long-acting bronchodilators;
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Diameter thresholds for pure ground-glass pulmonary nodules at low-dose CT screening: Chinese experience Thorax (IF 9.0) Pub Date : 2025-02-01 Wenjun Ye, Wenhai Fu, Caichen Li, Jianfu Li, Shan Xiong, Bo Cheng, Bin Xu, Qixia Wang, Yi Feng, Peiling Chen, Jianxing He, Wenhua Liang
Background Limited research exists on screening thresholds for low-dose CT in detecting malignant pure ground-glass lung nodules (pGGNs) in the Chinese population. Materials and methods A retrospective analysis of the Guangzhou Lung-Care programme was conducted, retrieving average transverse diameter, location, histopathology, frequency and follow-up intervals. Diagnostic performances for ‘lung cancers’
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Pneumococcal pneumonia trends in adults hospitalised with community-acquired pneumonia over 10 years (2013–2023) and the role of serotype 3 Thorax (IF 9.0) Pub Date : 2025-02-01 Louise Lansbury, Tricia M McKeever, Hannah Lawrence, Harry Pick, Vadsala Baskaran, Rochelle Edwards-Pritchard, Laura Matthews, Helen Bailey, Deborah Ashton, Lesley Bendall, Chamira Rodrigo, Priya Daniel, David Litt, Seyi Eletu, Hanshi Parmar, Carmen Sheppard, Shamez N Ladhani, Caroline Trotter, Wei Shen Lim
Background With higher valency pneumococcal vaccines on the horizon and new adult immunisation strategies under discussion, we aimed to evaluate the contribution of individual pneumococcal serotypes to the burden of pneumococcal community-acquired pneumonia (CAP). Over 10 years, trends in pneumococcal pneumonia epidemiology in adults hospitalised with CAP were assessed. The risk factors and severity
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Hospitalised older adults with community-acquired pneumonia and sepsis have dysregulated neutrophil function but preserved glycolysis Thorax (IF 9.0) Pub Date : 2025-02-01 Frances Grudzinska, Aduragbemi A Faniyi, Kylie B R Belchamber, Celine Chen, Robert Stockley, Alice Jasper, Dhruv Parekh, Elizabeth Sapey, Aaron Scott, David R Thickett
Objective Community-acquired pneumonia (CAP) is a leading cause of hospitalisation in older adults and is associated with a high likelihood of adverse outcomes. Given the ageing population and lack of therapeutic advances in CAP, new strategies to manage the burden of this disease are needed. Neutrophil dysfunction has been widely demonstrated in CAP and is associated with poor outcomes. We hypothesised
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Association between automatic AI-based quantification of airway-occlusive mucus plugs and all-cause mortality in patients with COPD Thorax (IF 9.0) Pub Date : 2025-02-01 Tjeerd van der Veer, Eleni-Rosalina Andrinopoulou, Gert-Jan Braunstahl, Jean Paul Charbonnier, Victor Kim, Rudolfs Latisenko, David A Lynch, Harm Tiddens
In this cohort study involving 9399 current and former smokers from the Genetic Epidemiology of Chronic Obstructive Pulmonary Disease study, we assessed the relationship between artificial intelligence-quantified mucus plugs on chest CTs and all-cause mortality. Our results revealed a significant positive association, particularly for those with COPD GOLD stages 1–4, with HRs of 1.18 for 1–2 mucus-obstructed
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Surfactant protein B deficiency: the RespiRare cohort Thorax (IF 9.0) Pub Date : 2025-02-01 Manon Fleury, Céline Delestrain, Léa Roditis, Caroline Perisson, Marie-Catherine Renoux, Caroline Thumerelle, Ralph Epaud, Camille Fletcher, Nouha Jedidi, Aurore Coulomb L'Hermine, Harriet Corvol, Hubert Ducou le Pointe, Pascale Fanen, Chiara Sileo, Camille Louvrier, Alix de Becdelievre, Marie Legendre, Nadia Nathan
Childhood interstitial lung diseases (chILD) are rare and usually severe disorders. Among them, very rare cases of surfactant protein (SP)-B deficiencies have been reported so far and are usually associated with fatal forms of chILD. The RespiRare network allows the collection of precise phenotypic and genotypic information. This study that reports a series of 11 SP-B-deficient patients underscores
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Effects of azithromycin in severe eosinophilic asthma with concomitant monoclonal antibody treatment Thorax (IF 9.0) Pub Date : 2025-02-01 Gabriel Lavoie, Imran Howell, James Melhorn, Catherine Borg, Laura Bermejo-Sanchez, Jack Seymour, Maisha F. Jabeen, Anastasia Fries, Gareth Hynes, Ian D Pavord, Nayia Petousi, Timothy SC Hinks
Macrolides reduce exacerbations when added to inhaled therapy in severe asthma. However, there is little published evidence for effectiveness in patients treated with biologics. We conducted a retrospective audit of all patients who started azithromycin while on biologics in our centre. Compared with those that did not start azithromycin, these individuals had more exacerbations and a phenotype of
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Two thoracic surgeries and no diagnosis: is it lung cancer? Thorax (IF 9.0) Pub Date : 2025-02-01 Daniella Draicchio, Alexander Fox, Louise Haine, Robert Berg, Judith Hampson
A 69-year-old never-smoker was referred to a lung cancer assessment clinic in June 2022 with 4 weeks of exertional breathlessness, haemoptysis and fever, persisting despite three antibiotic courses. Medical history included a kyphoplasty and paroxysmal atrial fibrillation (PAF) requiring radiofrequency catheter ablations in July 2019 and February 2022. He had a previous episode of fever and haemoptysis
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Consolidation with pseudocavitation Thorax (IF 9.0) Pub Date : 2025-02-01 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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Rare occurrence of tracheal acinic cell carcinoma causing central airway obstruction in a young adult Thorax (IF 9.0) Pub Date : 2025-02-01 Jun Hyung Park, Myoung Ja Chung, Jong Hun Kim, Jae Seok Jeong, Yong Chul Lee
A 22-year-old woman presented with intermittent blood-tinged sputum for about 3 years. She reported experiencing exertional dyspnoea and had no history of chronic disease, family history or smoking. On physical examination, mild coarse breathing sounds and wheezing on the upper sternum were auscultated. Lab results were non-specific. Chest CT scan (figure 1A,B) revealed a heterogeneous enhancing endotracheal
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Journal club Thorax (IF 9.0) Pub Date : 2025-02-01 Joseph Willis
Established biologic therapies for eosinophilic asthma are given weekly. The SWIFT-1 and SWIFT-2 trials ( NEJM 2024; doi: 10.1056/NEJMoa2406673) investigated the efficacy safety of depemokimab, an ultra-long-acting biologic targeting interleukin-5, in patients with severe eosinophilic asthma. These phase 3A, randomised, placebo-controlled studies involved 792 patients (pooled across SWIFT-1 and SWIFT
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Association between vitamin D status at 3 years and eosinophilic asthma in 6-year-old children with a history of severe bronchiolitis Thorax (IF 9.0) Pub Date : 2025-01-06 George Doumat, Joumane El Zein, Geneva D Mehta, Zhaozhong Zhu, Janice A Espinola, Ashley F Sullivan, Kohei Hasegawa, Carlos A Camargo
The association between early childhood serum 25-hydroxyvitamin D (25(OH)D) and eosinophilic asthma remains unclear. We investigated this association using multicentre prospective data from 584 children with a history of bronchiolitis requiring hospitalisation (high-risk population). Low serum 25(OH)D levels (<20 ng/mL) were associated with increased odds of developing eosinophilic asthma (adjusted
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Clinical benefit of chronic non-invasive ventilation in severe stable COPD: a matter of persistent hypercapnia improvement Thorax (IF 9.0) Pub Date : 2025-01-02 Tim Raveling, Renzo Boersma, Peter J Wijkstra, Marieke L Duiverman
Purpose In patients with chronic obstructive pulmonary disease (COPD) treated with chronic non-invasive ventilation (NIV), the relation between improvements in nocturnal transcutaneous partial pressure of CO2 (PtcCO2) and daytime arterial partial pressure of CO2 (PaCO2) remains uncertain. Also, to what extent improvements in nocturnal PtcCO2 result in better health-related quality of life (HRQL), exercise
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Unexpected radiological presentation in allergic bronchopulmonary aspergillosis: multiple lung masses Thorax (IF 9.0) Pub Date : 2025-01-02 Celia Cabrero Rodríguez, Ana Belén Gámiz Molina, Francisco Rodríguez Jerez
We present the case of a 56-year-old woman, which presented to the emergency department with a 2-week history marked by progressive dyspnoea, a productive cough, self-reported wheezing and she had no fever (36.7 °C). The patient had a prior medical history of severe persistent asthma, managed with Mepolizumab, bronchiectasis predominantly in the upper lobes, allergic bronchopulmonary aspergillosis
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ABCA3-related interstitial lung disease in a young woman Thorax (IF 9.0) Pub Date : 2024-12-31 Simone Petrarulo, Claudia Ravaglia, Maria Giulia Disanto, Sara Piciucchi, Venerino Poletti
A 25-year-old non-smoking caucasian woman, with no family history of interstitial lung disease (ILD) or consanguinity, presented with a 6-month history of progressive exertional dyspnoea, chest pain and episodes of mild haemoptysis. Her medical history was unremarkable. Physical examination revealed bibasilar crackles and digital clubbing. Blood tests showed neutrophilic leucocytosis (WBC 12 040/mm³
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Molecular phenotypes of critical illness confer prognostic and biological enrichment in sub-Saharan Africa: a prospective cohort study from Uganda Thorax (IF 9.0) Pub Date : 2024-12-25 Matthew J Cummings, Julius J Lutwama, Alin S Tomoiaga, Nicholas Owor, Xuan Lu, Jesse E Ross, Moses Muwanga, Christopher Nsereko, Irene Nayiga, Kai Nie, John Kayiwa, Xiaoyu Che, Misaki Wayengera, Seunghee Kim-Schulze, W Ian Lipkin, Max R O’Donnell, Barnabas Bakamutumaho
The generalisability of critical illness molecular phenotypes to low- and middle-income countries (LMICs) is unknown. We show that molecular phenotypes derived in high-income countries (hyperinflammatory and hypoinflammatory, reactive and uninflamed) stratify sepsis patients in Uganda by physiological severity, mortality risk and dysregulation of key pathobiological domains. A classifier model including
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Corticosteroid therapy for treating acute exacerbation of interstitial lung diseases: a systematic review Thorax (IF 9.0) Pub Date : 2024-12-25 Narat Srivali, Federica De Giacomi, Teng Moua, Jay H Ryu
Introduction Acute exacerbation of interstitial lung disease (AE-ILD) often results in death and poses significant challenges in clinical management. While corticosteroids are frequently employed, the optimal regimen and their clinical efficacy remain uncertain. To address this knowledge gap, we undertook a systematic review to evaluate the impact of steroid therapy on clinical outcomes in patients
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Advanced MicroRNA delivery for lung inflammatory therapy: surfactant protein A controls cellular internalisation and degradation of extracellular vesicles Thorax (IF 9.0) Pub Date : 2024-12-25 Miji Kim, Sujeong Park, Nayoung Lee, Dohyun Kim, Dongwoo Kim, Yang Jin, Seon-Jin Lee, Jung Joo Hong, Heedoo Lee
Introduction Alveolar macrophages (AMs) are the first line of defence against pathogens that initiate an inflammatory response in the lungs and exhibit a strong affinity for surfactant protein A (SP-A). Extracellular vesicles (EVs) have emerged as a promising drug delivery platform due to their minimal cytotoxicity. However, precise targeting of specific cell types and the rapid lysosomal degradation
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Endobronchial obstruction of the left middle lobe Thorax (IF 9.0) Pub Date : 2024-12-25 Hardeep Singh Kalsi, Rimsha Khan, Reena Khiroya, Neal Navani, Ricky Thakrar
A 48-year-old woman reported a 1-year history of breathlessness, persistent cough and recurrent chest infections. She was a former smoker with a medical history of nasal polyps and asthma since childhood. She was managed as a case of worsening bronchial asthma, until a CT scan was performed to investigate anaemia, incidentally identified an obstructing lesion in her left main bronchus (figure 1). She
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Neuropsychiatric side effects of montelukast: time to change prescribing practice? Thorax (IF 9.0) Pub Date : 2025-01-01 David Lo, Jennifer K Quint
Since 1998, montelukast has been licensed for the treatment of seasonal allergic rhinitis and asthma in people aged over 6 months. In children in particular, montelukast was welcomed as a steroid-sparing alternative to traditional asthma-preventer drugs, which could be taken just once daily, and which did not require the use of an inhaler. Although recent systematic reviews have shown regular inhaled
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Cost-related nonadherence to medication among people with asthma in the United States: findings that reinforce the relevance of history and healthcare reform Thorax (IF 9.0) Pub Date : 2025-01-01 Emily L Graul, Christer Janson
Asthma affects over 20 million (8%) of adults in the United States (US) each year.1 2 As with many chronic conditions, poor control can be attributed to low medication adherence and a reduced quality of life, and can translate into a high burden on the healthcare system and economy.3 4 Of importance is cost-related medication nonadherence, as people face heavy financial barriers to accessing US healthcare
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Beyond glycaemic control: reduced pneumonia and sepsis risk with GLP-1 RAs and SGLT2 inhibitors in patients with type 2 diabetes Thorax (IF 9.0) Pub Date : 2025-01-01 Ramin Rezaeianzadeh, Mohsen Sadatsafavi
As of 2021, 537 million adults are living with diabetes, globally. This is expected to reach 800 million in 20 years.1 Patients with diabetes live with a significantly heightened risk of morbidity and mortality from various causes.2 Among such causes are infections. Diabetes is associated with a significantly increased risk of infections like pneumonia and sepsis, due to immune system impairments from
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Quantitative BAL: a suitable method for the assessment of epithelial lining fluid in alpha-1 antitrypsin deficiency? Thorax (IF 9.0) Pub Date : 2025-01-01 David G Parr
Measurements on biological fluids form the mainstay of routine clinical investigations. Samples of blood, urine, etc are, generally, easily obtainable and measurements can be interpreted directly. On the other hand, alveolar epithelial lining fluid (ELF) is relatively inaccessible but offers valuable insight into pathogenesis and pharmacokinetics relating to diseases affecting the alveolus. The lung
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Neuropsychiatric diagnoses after montelukast initiation in paediatric patients with asthma Thorax (IF 9.0) Pub Date : 2025-01-01 Tapio Paljarvi, Julian T Forton, Courtney Thompson, Sierra Luciano, Kimmo Herttua, Seena Fazel
Background The evidence base on montelukast-associated adverse outcomes is inconclusive in children and young persons (CYP) with asthma. We aimed to investigate 1-year incidence of neuropsychiatric diagnoses after initiation of montelukast as an adjunct therapy to inhaled corticosteroids (ICSs) in CYP aged 3–17 years with asthma. Methods This propensity score matched cohort study was conducted using
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Cost-related non-adherence to medications among adults with asthma in the USA, 2011–2022 Thorax (IF 9.0) Pub Date : 2025-01-01 Chun-Tse Hung, Steven R Erickson, Chung-Hsuen Wu
Background Uncontrolled asthma is possibly caused by medication non-adherence, and financial hardship can be a major contributor to non-adherence. Since economic conditions and asthma management have changed over time, a comprehensive investigation of cost-related medication non-adherence (CRN) among adults with asthma is crucial. Objective To evaluate trends, prevalence and determinants of CRN, and
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Optimising bronchoalveolar lavage: lessons from alpha-1 antitrypsin deficiency Thorax (IF 9.0) Pub Date : 2025-01-01 Malcolm Herron, Suzanne Roche, Daniel D Fraughen, Ronan C Heeney, Lasya Kanchi, Emma J Leacy, Michelle Casey, Cedric Gunaratnam, Tomás P Carroll, Mark P Murphy, Noel G McElvaney
Background Bronchoalveolar lavage (BAL) is essential in determining the efficacy of novel therapies in alpha-1 antitrypsin deficiency (AATD). These require initial proof-of-concept demonstration that treatment administration increases alpha-1 antitrypsin (AAT) levels and/or anti-neutrophil elastase inhibitory capacity (ANEC) in the lung. Early-phase studies often encounter high interindividual variability
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Comparative estimate of glucose-lowering therapies on risk of incident pneumonia and severe sepsis: an analysis of real-world cohort data Thorax (IF 9.0) Pub Date : 2025-01-01 Alex E Henney, David R Riley, Theresa J Hydes, Matthew Anson, Gema H Ibarburu, Frederick Frost, Uazman Alam, Daniel J Cuthbertson
Background Sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are treatments for type 2 diabetes (T2D). Beyond glucose-lowering and cardiorenal protection, these drugs may protect against pneumonia and sepsis. Aims This study assesses the impact of SGLT2i and GLP-1 RAs on the risk of incident pneumonia and severe sepsis. Methods A retrospective
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Effect of nostril occlusion and mouth sealing in the measurement of sniff nasal inspiratory pressure Thorax (IF 9.0) Pub Date : 2025-01-01 Neeraj M Shah, Anne Rossel, Bawan Abdulaziz, Shauna Sheridan, Sophie Madden-Scott, Gillian Radcliffe, Rebecca D’Cruz, Eui-Sik Suh, Joerg Steier, Nicholas Hart, Patrick Brian Murphy, Michelle Ramsay, Georgios Kaltsakas
Sniff nasal inspiratory pressure (SNIP) is used to assess respiratory muscle strength in neuromuscular diseases like amyotrophic lateral sclerosis (ALS). The effect of contralateral nostril occlusion and mouth sealing on SNIP measurement are unclear. 81 participants were included (16 healthy, 39 patients with limb-onset ALS and 26 patients with bulbar-onset ALS). SNIP was obtained with combinations
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Community-based approaches to improve tuberculosis services: observations from preintervention and postintervention surveys in a high TB burden disadvantaged community in India Thorax (IF 9.0) Pub Date : 2025-01-01 Jyothi Bhat, Ravendra Kumar Sharma, Rajiv Yadav, M Muniyandi, Prashant Mishra, Samridhi Nigam, Mercy Aparna Latha Lingala, Vikas Gangadhar Rao
An alarmingly high prevalence of tuberculosis (TB) was reported among the Saharia tribe in Madhya Pradesh, India. A community-based intervention study was undertaken to improve TB case finding during 2018–2021. The interventions mainly comprised active case detection through village TB volunteers using advocacy, communication and social mobilisation activities. A preintervention and postintervention
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Pulmonary infection caused by Talaromyces amestolkiae Thorax (IF 9.0) Pub Date : 2025-01-01 Chiqing Ying, Lvjun Zhang, Xuehang Jin, Hui Chen, Dan Zhu
A 38-year-old woman was admitted for uterine fibroid surgery. A routine preoperative CT chest scan identified bilateral patchy, high-density shadows, with unclear boundaries, more evident in the upper lobes (figure 1A). She had no respiratory symptoms, such as coughing or expectoration, and was an office worker with allergies to seafood and mango. She denied having comorbidities including diabetes
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Atypical radiological manifestation of sarcoidosis presenting with an anterior mediastinal mass Thorax (IF 9.0) Pub Date : 2025-01-01 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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New management pathways for follow-up of CPAP-treated sleep apnoea patients including digital medicine and multimodal telemonitoring Thorax (IF 9.0) Pub Date : 2025-01-01 Jean-Louis Pépin, Sébastien Baillieul, Sébastien Bailly, Renaud Tamisier
Background The ever-increasing number of patients diagnosed with obstructive sleep apnoea (OSA) and treated by long-term continuous positive airway pressure (CPAP) overstretches conventional follow-up pathways. New approaches to the management of CPAP-treated patient follow-up are needed to strike a balance between remote monitoring through digital technologies and in-person patient-healthcare-professional
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Journal club Thorax (IF 9.0) Pub Date : 2025-01-01 Alexandra Hodge
There are no licensed pharmacological treatments for obstructive sleep apnoea (OSA). Obesity is a modifiable risk factor for OSA with existing pharmacological interventions. One such treatment is tirzepatide which is a long-acting glucose-dependent insulinotropic polypeptide (GIP) receptor agonist and glucagon-like peptide-1 (GLP-1) receptor agonist. Malhotra et al . (N Engl J Med 2024;391:1193–1205)
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Correction: What’s hot that the other lot got Thorax (IF 9.0) Pub Date : 2025-01-01 BMJ Publishing Group Ltd and British Thoracic Society
Higginson J. What’s hot that the other lot got. Thorax 2015;70:1010. This Journal club article was originally published with 2 citations missing. The relevant citations have been added to the text below. The editors would like to apologise for any inconvenience caused. Zhou et al (J Clin Oncol 2015 Jul 1;33(19):2197–204) have performed a randomised, …
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Smartphone application-based pulmonary rehabilitation in COPD: a multicentre randomised controlled trial Thorax (IF 9.0) Pub Date : 2024-12-20 Rainer Gloeckl, Marc Spielmanns, Asta Stankeviciene, Anne Plidschun, Daniela Kroll, Inga Jarosch, Tessa Schneeberger, Bernhard Ulm, Claus F Vogelmeier, Andreas Rembert Koczulla
Background Pulmonary rehabilitation (PR) is an essential element of chronic obstructive pulmonary disease (COPD) management. However, access to conventional face-to-face PR programmes is limited. Methods This multicentre, randomised controlled trial recruited patients with COPD from 18 sites in Germany and Switzerland, aiming to evaluate the impact of 12 weeks of a mobile app (intervention group; IVG)
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Short-term effects of home-based pulmonary rehabilitation during outpatient-managed exacerbations of COPD: a randomised controlled trial Thorax (IF 9.0) Pub Date : 2024-12-16 Ana Machado, Cíntia Dias, Cátia Paixão, António Pedro Gonçalves, Chris Burtin, Alda Marques
Background Uncertainty exists about the beneficial effects of delivering pulmonary rehabilitation (PR) during exacerbations of chronic obstructive pulmonary disease (ECOPD). This study explored the short-term effects and self-reported impact of a home-based PR programme for people with outpatient-managed ECOPD. Methods We conducted a mixed-methods randomised controlled trial in people with outpatient-managed