The popularity of electronic (e)-cigarettes, or ‘vapes’, has increased dramatically across the world in the last decade, with market shares now measured in billions of dollars. This has driven constant reinvention, creating new, ever more powerful devices and a wide variety of e-liquids. These e-liquids typically contain humectants such as propylene glycol and vegetable glycerine, which act as the

Background Treatment and preventative advances for chronic obstructive pulmonary disease (COPD) have been slow due, in part, to limited subphenotypes. We tested if unsupervised machine learning on CT images would discover CT emphysema subtypes with distinct characteristics, prognoses and genetic associations. Methods New CT emphysema subtypes were identified by unsupervised machine learning on only

Pulmonary rehabilitation programmes including aerobic training improve cardiorespiratory fitness in patients with COPD, but the optimal programme design is unclear. We used random effects additive component network meta-analysis to investigate the relative effectiveness of different programme components on fitness measured by V̇O2peak in COPD. The included 59 studies involving 2191 participants demonstrated

Background The COVID-19 pandemic resulted in a large number of critical care admissions. While national reports have described the outcomes of patients with COVID-19, there is limited international data of the pandemic impact on non-COVID-19 patients requiring intensive care treatment. Methods We conducted an international, retrospective cohort study using 2019 and 2020 data from 11 national clinical

Excess mortality risk imparted by acute respiratory failure in children is unknown. We determined excess mortality risk associated with mechanically ventilated acute respiratory failure in pediatric sepsis. Novel ICD10-based algorithms were derived and validated to identify a surrogate for acute respiratory distress syndrome to calculate excess mortality risk. Algorithm-identified ARDS was identified

Increasingly complex datasets of biomedical measurements offer an opportunity for discovering patient endotypes. These represent subtypes of a disease marked by distinct pathomechanisms—which can have enormous implications for prognosis and clinical management. Such datasets often include imaging, genomics and transcriptomics, proteomics, microbiotal composition, allergen/environmental exposures, and

Background Metabolic alkalosis may lead to respiratory inhibition and increased need for ventilatory support or prolongation of weaning from ventilation for patients with chronic respiratory disease. Acetazolamide can reduce alkalaemia and may reduce respiratory depression. Methods We searched Medline, EMBASE and CENTRAL from inception to March 2022 for randomised controlled trials comparing acetazolamide

Smoking has been considered a risk factor for idiopathic pulmonary fibrosis (IPF) in observational studies. To assess whether smoking plays a causal role in IPF, we performed a Mendelian randomization study using genetic association data of 10 382 cases with IPF and 968 080 controls. We found that genetic predisposition to smoking initiation (based on 378 variants) and lifetime smoking (based on 126

Obstructive sleep apnoea (OSA) was traditionally thought to be mainly caused by obesity and upper airway crowding, and hence OSA management was not personalised according to particular characteristics, with most symptomatic patients receiving continuous positive airway pressure therapy. Recent advances in our understanding have identified additional potential and distinct causes of OSA (endotypes)

Treatment with elexacaftor/tezacaftor/ivacaftor (ETI) has been shown to improve lung function in people with cystic fibrosis (PWCF). However, its biological effects remain incompletely understood. Here we describe alterations in pulmonary and systemic inflammation in PWCF following initiation of ETI. To address this, we collected spontaneously expectorated sputum and matching plasma from PWCF (n=30)

Rationale The respiratory outcomes for adult survivors of preterm birth in the postsurfactant era are wide-ranging with prognostic factors, especially those encountered after the neonatal period, poorly understood. Objectives To obtain comprehensive ‘peak’ lung health data from survivors of very preterm birth and identify neonatal and life-course risk factors for poorer respiratory outcomes in adulthood

Background Testing is critical for detecting SARS-CoV-2 infection, but the best sampling method remains unclear. Objectives To determine whether nasopharyngeal swab (NPS), oropharyngeal swab (OPS) or saliva specimen collection has the highest detection rate for SARS-CoV-2 molecular testing. Methods We conducted a randomised clinical trial at two COVID-19 outpatient test centres where NPS, OPS and saliva

Rationale Vaping has become a popular method of inhaling various psychoactive substances. While evaluating respiratory effects of vaping have primarily focused on nicotine-containing products, cannabidiol (CBD)-vaping is increasingly becoming popular. It currently remains unknown whether the health effects of vaping nicotine and cannabinoids are similar. Objectives This study compares side by side

Accelerated lung function decline is relatively common from the late 20s and indicates chronic lung disease in many communities, including those living with HIV.1 2 The factors influencing and mechanisms of lung function decline in people living with HIV (PLWH) or without HIV are complex and multifactorial.2 This includes changes in the lungs and respiratory system, decreased muscle mass, and decreased

Finding the ‘missing millions’ of patients with COPD has become a mantra of health policy. In the UK, 1.4 million people have a diagnosis of COPD but it is estimated that 50%–65% of people living with COPD are undiagnosed. This has been made worse by the COVID pandemic when new diagnosis rates fell by over half. In a recent survey of patients with COPD, 22% reported waiting 5 years or more for a diagnosis

Pathogenic variants in the ATP binding cassette member A3 (ABCA3) gene were first described in newborn infants with lethal respiratory failure in 2004.1 Subsequent reports have expanded the clinical spectrum associated with biallelic ABCA3 variants to include infants with the phenotype of childhood interstitial lung disease (chILD), who presented after the newborn period and had prolonged survival

Introduction Chronic lung disease is common among people living with HIV (PLWH). We hypothesised that PLWH receiving antiretroviral therapy (ART) have faster lung function decline than matched controls. Methods We performed a prospective matched cohort study by including ART-treated PLWH from the Copenhagen Co-morbidity in HIV Infection Study (n=705) and the INSIGHT Strategic Timing of Antiretroviral

Introduction Incorporating spirometry into low-dose CT (LDCT) screening for lung cancer may help identify people with undiagnosed chronic obstructive pulmonary disease (COPD), although the downstream impacts are not well described. Methods Participants attending a Lung Health Check (LHC) as part of the Yorkshire Lung Screening Trial were offered spirometry alongside LDCT screening. Results were communicated

Background Considerable clinical heterogeneity in idiopathic pulmonary fibrosis (IPF) suggests the existence of multiple disease endotypes. Identifying these endotypes would improve our understanding of the pathogenesis of IPF and could allow for a biomarker-driven personalised medicine approach. We aimed to identify clinically distinct groups of patients with IPF that could represent distinct disease

Background Interstitial lung abnormalities (ILAs) are associated with increased mortality. It is unclear whether multimorbidity accounts for the mortality association or how strongly ILA is associated with mortality relative to other common age-associated diseases. We determined the association of ILA with all-cause mortality adjusted for multimorbidity, compared mortality associated with ILA and prevalent

Background The MUC5B promoter variant (rs35705950) and telomere length are linked to pulmonary fibrosis and CT-based qualitative assessments of interstitial abnormalities, but their associations with longitudinal quantitative changes of the lung interstitium among community-dwelling adults are unknown. Methods We used data from participants in the Multi-Ethnic Study of Atherosclerosis with high-attenuation

Background Lung cancer surgery is associated with a high incidence of postoperative pulmonary complications (PPCs). We evaluated whether enhanced recovery after surgery plus pulmonary rehabilitation was superior over enhanced recovery after surgery alone in reducing the incidence of postoperative PPCs and length of hospital stay. Methods In this pragmatic multicentre, randomised controlled, parallel-group

Background The majority of patients with childhood interstitial lung disease (chILD) caused by pathogenic variants in ATP binding cassette subfamily A member 3 (ABCA3) develop severe respiratory insufficiency within their first year of life and succumb to disease if not lung transplanted. This register-based cohort study reviews patients with ABCA3 lung disease who survived beyond the age of 1 year

Background This review aims to synthesise available evidence on the prevalence of chronic obstructive pulmonary disease (COPD), associated risk factors, hospitalisations and COPD readmissions in Africa. Method Using the Met-Analyses and Systematic Reviews of Observational Studies guideline, electronic databases were searched from inception to 1 October 2021. The quality of studies was assessed using

Objective COVID-19 severity is correlated with granulocyte macrophage colony-stimulating factor (GM-CSF) and C reactive protein (CRP) levels. In the phase three LIVE-AIR trial, lenzilumab an anti-GM-CSF monoclonal antibody, improved the likelihood of survival without ventilation (SWOV) in COVID-19, with the greatest effect in participants having baseline CRP below a median of 79 mg/L. Herein, the utility

Rationale A better understanding of the mechanism of action of mesenchymal stromal cells (MSCs) and their extracellular vesicles (EVs) is needed to support their use as novel therapies for acute respiratory distress syndrome (ARDS). Macrophages are important mediators of ARDS inflammatory response. Suppressor of cytokine signalling (SOCS) proteins are key regulators of the macrophage phenotype switch

A 78-year-old man was referred to our hospital to study a pulmonary nodule in the left lower lobe, suspicious for malignancy. An endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) was carried out for the study, during the procedure samples were taken from lymph node stations 4R (lower paratracheal right), 7 (subcarinal) and 11 L (interlobar left) using a 22-gauge needle. The

A 38-year-old woman presented with a 1-month history of progressive cough and phlegm. She was an office worker. She denied the presence of comorbidities including diabetes, renal disease, malignancy and acquired immune deficiency syndrome. She underwent chest CT scan (figure 1A) 2 weeks before admission, having been taking moxifloxacin treatment for 12 days without improvement in symptoms. A repeat

The role of novel antihyperglycaemic drugs in cardiology and diabetes is well recognised, and laboratory studies have suggested possible mechanisms by which these drugs could reduce chronic obstructive pulmonary disease (COPD) exacerbations in patients with type 2 diabetes mellitus. A population-based cohort study by Pradhan et al ( BMJ 2022;379:e071380) used primary care and hospital databases to

Background Indwelling pleural catheters are an effective treatment option for patients with malignant pleural effusions. Despite their popularity, there remains a paucity of data on the patient experience and key patient-centred outcomes. Objective To investigate the experience of patients receiving an indwelling pleural catheter to better inform and identify potential areas for improvement in care

The evidence for pulmonary rehabilitation (PR) as a non-pharmacological management strategy for people with idiopathic pulmonary fibrosis (IPF) is consistent and continues to accrue. Meta-analysis has demonstrated that it effectively improves exercise capacity, dyspnoea and health-related quality of life,1 and preliminary data suggest that improved physical performance following PR is associated with

Background Infections are considered as leading causes of acute exacerbations of chronic obstructive pulmonary disease (COPD). Non-infectious risk factors such as short-term air pollution exposure may play a clinically important role. We sought to estimate the relationship between short-term air pollutant exposure and exacerbations in Canadian adults living with mild to moderate COPD. Methods In this

Introduction Patients with COVID-19-related acute respiratory distress syndrome (ARDS) show limited systemic hyperinflammation, but immunomodulatory treatments are effective. Little is known about the inflammatory response in the lungs and if this could be targeted using high-dose steroids (HDS). We aimed to characterise the alveolar immune response in patients with COVID-19-related ARDS, to determine

The value placed by patients and their caregivers on the components of composite outcomes in pulmonary arterial hypertension (PAH) remains unknown. We surveyed the importance of these outcomes from a patients’ and caregivers’ perspective, with participants (n=335, including 257 patients with PAH) rating individual components defining clinical worsening in PAH trials as of critical, major, mild-to-moderate

Background Despite the availability of COVID-19 vaccinations, there remains a need to investigate treatments to reduce the risk or severity of potentially fatal complications of COVID-19, such as acute respiratory distress syndrome (ARDS). This study evaluated the efficacy and safety of the transient receptor potential channel C6 (TRPC6) inhibitor, BI 764198, in reducing the risk and/or severity of

Background Previous studies have reported an association between warm temperature and asthma hospitalisation. They have reported different sex-related and age-related vulnerabilities; nevertheless, little is known about how this effect has changed over time and how it varies in space. This study aims to evaluate the association between asthma hospitalisation and warm temperature and investigate vulnerabilities

The UK National Screening Committee recently approved a national programme for lung cancer screening (LCS) by low-dose CT (LDCT).1 Measures that will reduce burden on downstream clinical care in the National Health Service (NHS) are therefore greatly welcomed. This need is further amplified in the postpandemic era where services are already stretched and waiting times are higher than ever.2 In the

Rare paediatric lung diseases have been a challenge over years for paediatric pulmonologists. There has been growing attention to rare lung diseases in paediatrics in recent years. Especially, childhood interstitial lung disease (chILD) became an area of special interest since comprehensive classification systems1 and clinical network2 have been steadily developed. chILD is an umbrella term representing

In moderate and severe asthma, the use of inhaled corticosteroid (ICS)/formoterol maintenance and reliever therapy (MART) reduces the risk of severe exacerbation by about one-third compared with the equivalent dose of ICS/long-acting beta2-agonist (LABA) maintenance plus short-acting beta2-agonist (SABA) reliever therapy.1 This efficacy has not only been demonstrated in populations with tightly defined

Introduction Older adults have the greatest burden of asthma and poorest outcomes. The pharmacogenetics of inhaled corticosteroid (ICS) treatment response is not well studied in older adults. Methods A genome-wide association study of ICS response was performed in asthmatics of European ancestry in Genetic Epidemiology Research on Adult Health and Aging (GERA) by fitting Cox proportional hazards regression

Background Evidence suggests that patients with COPD struggle to maintain improved physical activity (PA) after completing pulmonary rehabilitation (PR). Smartphone applications (apps) providing a comprehensive training programme have conferred healthy benefits. This study was conducted to determine whether regular usage of an app maintains PA following PR. Methods Patients with stage II–IV COPD were

Background Maintenance and reliever therapy (MART) with inhaled corticosteroid (ICS)/formoterol effectively reduces exacerbations in asthma. We aimed to investigate its efficacy compared with fixed-dose fluticasone/salmeterol in chronic obstructive pulmonary disease (COPD). Methods Patients with COPD and ≥1 exacerbation in the previous 2 years were randomly assigned to open-label MART (Spiromax budesonide/formoterol

Background Ambient air pollution is thought to contribute to increased risk of COVID-19, but the evidence is controversial. Objective To evaluate the associations between short-term variations in outdoor concentrations of ambient air pollution and COVID-19 emergency department (ED) visits. Methods We conducted a case-crossover study of 78 255 COVID-19 ED visits in Alberta and Ontario, Canada between

Background The assumption that more rapid treatment improves survival of advanced non-small cell lung cancer (NSCLC) has not yet been proven. We studied the relation between time-to-treatment and survival in advanced stage NSCLC patients in a large multicentric nationwide retrospective cohort. Additionally, we identified factors associated with delay. Method We selected 10 306 patients, diagnosed and

Background Monitoring disease progression in childhood interstitial lung diseases (chILD) is essential. No information for the minimal important difference (MID), which is defined as the smallest change in a parameter that is perceived as important prompting a clinician to change the treatment, is available. We calculated MIDs for vital signs (respiratory rate, peripheral oxygen saturation in room

Background It is unclear if bronchopulmonary dysplasia (BPD) is independently associated with reduced expiratory airflow at school age. Objective To determine the independent associations of moderate–severe BPD, mild BPD, gestational age and birth weight z-score with expiratory airflow in children born extremely preterm (EP; <28 weeks’ gestation). Methods All EP survivors born in Victoria, Australia

Background In advanced disease, breathlessness becomes severe, increasing health services use. Breathlessness triggered services demonstrate effectiveness in trials and meta-analyses but lack health economic assessment. Methods Our economic study included a discrete choice experiment (DCE), followed by a cost-effectiveness analysis modelling. The DCE comprised face-to-face interviews with older patients

Rationale Eosinophils are associated with airway inflammation in respiratory disease. Eosinophil production and survival is controlled partly by interleukin-5: anti-interleukin-5 agents reduce asthma and response correlates with baseline eosinophil counts. However, whether raised eosinophils are causally related to chronic obstructive pulmonary disease (COPD) and other respiratory phenotypes is not

Rationale Acute respiratory distress syndrome (ARDS) is a lethal complication of severe bacterial pneumonia due to the inability to dampen overexuberant immune responses without compromising pathogen clearance. Both of these processes involve tissue-resident and bone marrow (BM)–recruited macrophage (MΦ) populations which can be polarised to have divergent functions. Surprisingly, despite the known

Background Chest CT displays chest pathology better than chest X-ray (CXR). We evaluated the effects on health outcomes of replacing CXR by ultra-low-dose chest-CT (ULDCT) in the diagnostic work-up of patients suspected of non-traumatic pulmonary disease at the emergency department. Methods Pragmatic, multicentre, non-inferiority randomised clinical trial in patients suspected of non-traumatic pulmonary

Home non-invasive mechanical ventilation (HMV) with home oxygen therapy (HOT) in patients with persistent hypercapnia following an acute exacerbation of chronic obstructive pulmonary disease delays hospital readmission. The economic impact of this treatment is unknown. We evaluated the cost-effectiveness of HMV in the UK healthcare system using data from a previously published efficacy trial. Quality-adjusted

A 23-year-old woman presented with gradual-onset left chest and back pain. She had at medical history of asthma. She was a never smoker with no significant family history. Her observations and examination were normal. Blood tests performed revealed a raised C reactive protein of 119 mg/L and high white cell count of 12.81×109/L. A chest radiograph showed left hilar consolidation (figure 1A). She was

Persistent airflow limitation (PAL) is an asthma phenotype defined as airflow obstruction that remains after the use of a β2-agonist. Past studies on PAL have included small populations and were mostly restricted to severe asthma. Kole et al ( Lancet Respir Med 2023;11:55) conducted a post hoc analysis to investigate the determinants and outcomes of PAL in patients with asthma who were included in

Background Fibrotic hypersensitivity pneumonitis (FHP) is an irreversible lung disease with high morbidity and mortality. We sought to evaluate the safety and effect of pirfenidone on disease progression in such patients. Methods We conducted a single-centre, randomised, double-blinded, placebo-controlled trial in adults with FHP and disease progression. Patients were assigned in a 2:1 ratio to receive

Rationale Estimating the causal effect of an intervention at individual level, also called individual treatment effect (ITE), may help in identifying response prior to the intervention. Objectives We aimed to develop machine learning (ML) models which estimate ITE of an intervention using data from randomised controlled trials and illustrate this approach with prediction of ITE on annual chronic obstructive

The Global Burden of Disease Study has estimated that over 500 million subjects, around 7% of the global population, are affected by chronic respiratory diseases, with substantial individual and societal costs concerning morbidity, disability and mortality.1 Identifying and mitigating potentially modifiable risk factors are crucial in preventing the associated public health burden. Extensive literature

Background Idiopathic pulmonary fibrosis (IPF) is characterised by worsening dyspnoea and exercise intolerance. Research question Does a long-term pulmonary rehabilitation improve exercise tolerance in patients with IPF treated with standard antifibrotic drugs, which are expected to reduce disease progression? Methods This open-label randomised controlled trial was performed at 19 institutions. Stable

Limited but encouraging outcomes have been reported with patient-specific stents, designed and manufactured based on the patient’s corrected anatomy.1–4 These personalised stents will probably benefit most if bifurcated and/or of complex shape with multiple angles, diameters and lengths to consider. From our (still limited) experience, anastomotic strictures following airway surgeries may represent

Introduction Oral pirfenidone reduces lung function decline and mortality in patients with idiopathic pulmonary fibrosis (IPF). Systemic exposure can have significant side effects, including nausea, rash, photosensitivity, weight loss and fatigue. Reduced doses may be suboptimal in slowing disease progression. Methods This phase 1b, randomised, open-label, dose–response trial at 25 sites in six countries

Background Obesity is associated with more severe asthma, however, the mechanisms responsible are poorly understood. Obesity is also associated with low-grade systemic inflammation; it is possible that this inflammation extends to the airways of adults with asthma, contributing to worse asthma outcomes. Accordingly, the aim of this review was to examine whether obesity is associated with increased