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Serum cytokine biosignatures for identification of tuberculosis among HIV-positive inpatients Thorax (IF 10.0) Pub Date : 2024-03-15 Huihua Zhang, LingHua Li, YanXia Liu, Wei Xiao, RuiYao Xu, MengRu Lu, WenBiao Hao, YuChi Gao, Xiaoping Tang, Youchao Dai
Background Serum cytokines correlate with tuberculosis (TB) progression and are predictors of TB recurrence in people living with HIV. We investigated whether serum cytokine biosignatures could diagnose TB among HIV-positive inpatients. Methods We recruited HIV-positive inpatients with symptoms of TB and measured serum levels of inflammation biomarkers including IL-2, IL-4, IL-6, IL-10, tumour necrosis
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Role of blood flow restriction strength training in chronic obstructive pulmonary disease Thorax (IF 10.0) Pub Date : 2024-04-01 Ioannis Vogiatzis
Blood flow restriction (BFR) training is a method partially restricting arterial inflow and fully restricting venous outflow in working musculature during exercise.1 The method uses a pneumatic tourniquet system and involves applying an external pressure, typically using a tourniquet cuff, to the most proximal region of the upper and/or lower limbs. When the cuff is inflated, there is gradual mechanical
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Type-2 inflammation: a key treatable trait associated with lung function decline in chronic airways disease Thorax (IF 10.0) Pub Date : 2024-04-01 Nayia Petousi, Ian D Pavord, Brian Daniel Kent
The chronic airways diseases, asthma and Chronic Obstructive Pulmonary Disease (COPD), are highly prevalent conditions causing significant morbidity and mortality worldwide. Both are acknowledged to be heterogeneous with respect to clinical presentation, prognosis and driving mechanisms.1 Type-2 airway inflammation is arguably the most important and treatable underlying mechanism to identify,1 as it
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Decoding pulmonary nodules: can machine learning enhance malignancy risk stratification? Thorax (IF 10.0) Pub Date : 2024-04-01 Colin Jacobs
Randomised controlled trials, with the National Lung Screening Trial and Dutch-Belgian NELSON trial being the two largest, have demonstrated that lung cancer screening of high-risk individuals using low-dose CT reduces lung cancer mortality compared with no screening or screening with chest X-ray. Fuelled by the positive results of these landmark trials, low-dose CT-based lung cancer screening of high-risk
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Use of inhaled treprostinil in patients with interstitial lung disease and pulmonary hypertension: to boldly go where no other pulmonary vasodilator has gone before? Thorax (IF 10.0) Pub Date : 2024-04-01 Lucilla Piccari, Stephen John Wort
Pulmonary hypertension (PH) is a feared complication in patients with any chronic lung disease,1 but those with lung fibrosis have an especially poor mortality and the morbidity burden is very high.2 3 Up to very recently, there has been an almost nihilistic attitude towards these patients, since the lack of treatment options restricted the indication of a definitive diagnosis through right heart catheterisation
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Blood eosinophils take centre stage in predicting the response to sublingual immunotherapy (SLIT): a familiar twist Thorax (IF 10.0) Pub Date : 2024-04-01 Carlos Andrés Celis-Preciado, Philippe Lachapelle, Simon Couillard
Sublingual immunotherapy (SLIT) represents a safer, more comfortable and more convenient allergen immunotherapy than its subcutaneous counterpart. There is an increasing body of evidence showing that SLIT for house dust mites (HDM), grass, ragweed and/or tree pollen improves allergic symptoms and asthma control.1 It is unclear whether SLIT consistently reduces the occurrence of asthma attacks.1–3 Published
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Post-pandemic tuberculosis incidence: potential success of active case finding? Thorax (IF 10.0) Pub Date : 2024-04-01 Catherine M Stein
Until 2020, tuberculosis (TB) was annually the number one infectious killer disease globally. When the COVID-19 pandemic started in 2020, TB took the number two seat in this said ranking, but a very close second.1 TB epidemiologists around the world became very concerned about what might happen with global TB burden in the wake of the pandemic, fearing that lockdowns of health systems and stay-at-home
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Survival analysis from the INCREASE study in PH-ILD: evaluating the impact of treatment crossover on overall mortality Thorax (IF 10.0) Pub Date : 2024-04-01 Steven D Nathan, Shilpa Johri, Joanna M Joly, Christopher S King, Amresh Raina, Colleen A McEvoy, Dasom Lee, Eric Shen, Peter Smith, Chunqin Deng, Aaron B Waxman
Objective A post-hoc analysis of the INCREASE trial and its open-label extension (OLE) was performed to evaluate whether inhaled treprostinil has a long-term survival benefit in patients with pulmonary hypertension associated with interstitial lung disease (PH-ILD). Methods Two different models of survival were employed; the inverse probability of censoring weighting (IPCW) and the rank-preserving
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Radiomics analysis to predict pulmonary nodule malignancy using machine learning approaches Thorax (IF 10.0) Pub Date : 2024-04-01 Matthew T Warkentin, Hamad Al-Sawaihey, Stephen Lam, Geoffrey Liu, Brenda Diergaarde, Jian-Min Yuan, David O Wilson, Sukhinder Atkar-Khattra, Benjamin Grant, Yonathan Brhane, Elham Khodayari-Moez, Kiera R Murison, Martin C Tammemagi, Kieran R Campbell, Rayjean J Hung
Background Low-dose CT screening can reduce lung cancer-related mortality. However, most screen-detected pulmonary abnormalities do not develop into cancer and it often remains challenging to identify malignant nodules, particularly among indeterminate nodules. We aimed to develop and assess prediction models based on radiological features to discriminate between benign and malignant pulmonary lesions
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Protective effect of height on long-term survival of resectable lung cancer: a new feature of the lung cancer paradox Thorax (IF 10.0) Pub Date : 2024-04-01 Elisa Daffré, Raphaël Porcher, Antonio Iannelli, Mathilde Prieto, Laurent Brouchet, Pierre Emmanuel Falcoz, Françoise Le Pimpec Barthes, Pierre Benoit Pages, Pascal Alexandre Thomas, Marcel Dahan, Marco Alifano
Introduction Unlike most malignancies, higher body mass index (BMI) is associated with a reduced risk of lung cancer and improved prognosis after surgery. However, it remains controversial whether height, one of determinants of BMI, is associated with survival independently of BMI and other confounders. Methods We extracted data on all consecutive patients with resectable non-small cell lung cancer
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Decline in prevalence of tuberculosis following an intensive case finding campaign and the COVID-19 pandemic in an urban Ugandan community Thorax (IF 10.0) Pub Date : 2024-04-01 Emily A Kendall, Peter J Kitonsa, Annet Nalutaaya, Katherine O Robsky, Kamoga Caleb Erisa, James Mukiibi, Adithya Cattamanchi, Midori Kato-Maeda, Achilles Katamba, David Dowdy
Background Systematic screening is a potential tool for reducing the prevalence of tuberculosis (TB) and counteracting COVID-19-related disruptions in care. Repeated community-wide screening can also measure changes in the prevalence of TB over time. Methods We conducted serial, cross-sectional TB case finding campaigns in one community in Kampala, Uganda, in 2019 and 2021. Both campaigns sought sputum
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Genetic and T2 biomarkers linked to the efficacy of HDM sublingual immunotherapy in asthma Thorax (IF 10.0) Pub Date : 2024-04-01 Ilka Hoof, Klaus Bønnelykke, Thomas Stranzl, Stephanie Brand, Xingnan Li, Mohamed H Shamji, Deborah A Meyers, Eric D Bateman, Eugene Bleecker, Peter Sejer Andersen
Background Hypersensitivity to house dust mite (HDM) allergens is a common cause of allergic asthma symptoms and can be effectively treated with allergy immunotherapy (AIT). Objective To investigate whether genetic and type 2 (T2) inflammatory biomarkers correlate with disease severity in subjects with allergic asthma, and whether this can be modified by AIT. Methods MITRA ([NCT01433523][1]) was a
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Low-load blood flow restriction strength training in patients with COPD: a randomised single-blind pilot study Thorax (IF 10.0) Pub Date : 2024-04-01 Dario Kohlbrenner, Manuel Kuhn, Anastasios Manettas, Céline Aregger, Matthias Peterer, Nicola Greco, Noriane A Sievi, Christian Clarenbach
Objective The objective of this study is to compare the effectiveness of lower limb low-load blood flow restriction training (LL-BFRT) with high-load strength training (HL-ST) as part of an outpatient pulmonary rehabilitation programme on leg strength in patients with chronic obstructive pulmonary disease (COPD). Methods Participants were randomised to LL-BFRT or HL-ST (24 sessions). LL-BFRT was done
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Type-2 inflammation and lung function decline in chronic airway disease in the general population Thorax (IF 10.0) Pub Date : 2024-04-01 Yunus Çolak, Shoaib Afzal, Jacob Louis Marott, Jørgen Vestbo, Børge Grønne Nordestgaard, Peter Lange
Background It is unclear if type-2 inflammation is associated with accelerated lung function decline in individuals with asthma and chronic obstructive pulmonary disease (COPD). We tested the hypothesis that type-2 inflammation indicated by elevated blood eosinophils (BE) and fraction of exhaled nitric oxide (FeNO) is associated with accelerated lung function decline in the general population. Methods
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Airway smooth muscle and long-term clinical efficacy following bronchial thermoplasty in severe asthma Thorax (IF 10.0) Pub Date : 2024-04-01 Pieta C Wijsman, Annika W M Goorsenberg, Julia N S d’Hooghe, Nick H T ten Hacken, Joris J T H Roelofs, Thais Mauad, Els J M Weersink, Pallav Shah, Jouke T Annema, Peter I Bonta
The mechanism of action of bronchial thermoplasty (BT) treatment for patients with severe asthma is incompletely understood. This study investigated the 2.5-year impact of BT on airway smooth muscle (ASM) mass and clinical parameters by paired data analysis in 22 patients. Our findings demonstrate the persistence of ASM mass reduction of >50% after 2.5 years. Furthermore, sustained improvement in asthma
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Remote vision-based digital patient monitoring of pulse and respiratory rates in acute medical wards Thorax (IF 10.0) Pub Date : 2024-04-01 Adam Lewis, Bindia Venugopal, Varsha Gandhi, Oliver Gibson, Laura Swanton, Malcolm Green, Jordan Bowen, Michael I Polkey
Remote Vision-Based digital Patient Monitoring (VBPM) of pulse (PR) and respiratory rate (RR) was set up in six single rooms in an acute medical and an orthopaedic ward. We compared 102 PR and 154 RR VBPM measurements (from 27 patients) with paired routine nurse measurements. VBPM measurements of RR were validated by reviewing video footage. Nurse measurements of RR were often 16–18 breaths/minute
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Diagnosis of cystic lung diseases: a position statement from the UK Cystic Lung Disease Rare Disease Collaborative Network Thorax (IF 10.0) Pub Date : 2024-04-01 Simon R Johnson, Dominick E Shaw, Michael Avoseh, Irshad Soomro, Kate S Pointon, Maria Kokosi, Andrew G Nicholson, Sujal R Desai, Peter M George
Background Rare cystic lung diseases are increasingly recognised due the wider application of CT scanning making cystic lung disease management a growing part of respiratory care. Cystic lung diseases tend to have extrapulmonary features that can both be diagnostic but also require surveillance and treatment in their own right. As some of these diseases now have specific treatments, making a precise
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Not all wheeze is asthma Thorax (IF 10.0) Pub Date : 2024-04-01 Kher Lik Ng, John Park, Elizabeth Belcher, Alastair J Moore
A 41-year-old man previously diagnosed with asthma presented with an influenza-like illness and breathlessness. He was treated for moderate-to-severe COVID-19 and exacerbation of asthma. CT pulmonary angiography (CTPA) revealed asymmetrical peribronchovascular ground-glass infiltrates consistent with COVID-19 and right main bronchial wall thickening with high-density material thought to be consistent
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Well-differentiated papillary mesothelial tumour: a rare finding on the pleura Thorax (IF 10.0) Pub Date : 2024-04-01 Lysann Rostock, Olaf Holotiuk, Till Ploenes
A 72-year-old woman presented to the emergency department with a history of non-specific intermittent abdominal pain. The patient experienced two episodes of diffuse continuous pain a few hours apart. Pain occurred in all four quadrants, and she felt constriction in the umbilical region. The first episode lasted approximately 2 hours. The second episode lasted more than 6 hours. Thereafter, the patient
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Massive thymoma mimicking a pleural mass Thorax (IF 10.0) Pub Date : 2024-04-01 Stefano Palazzo, Zaid Rahman, Federico Femia, Karen Harrison-Phipps, Thomas Simpson
A 37-year-old man presented with months of weight loss, dysphagia and fatigue. He was an infrequent smoker, had no medical history and did not take regular medications. Endoscopy revealed gastro-oesophageal reflux only. Two months later, he presented with persistent cough and chest-X-ray (figure 1) revealed a large right-sided opacity. Figure 1 Radiological appearances of the massive thymoma, showing
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Twenty-year-old patient with polyarthritis since childhood showing cysts and ground glass attenuation on HRCT Thorax (IF 10.0) Pub Date : 2024-04-01 Marília da Cruz Fagundes, Thais Bianco, Daniella Porfírio Nunes, Tayza Katelline Danilau Ostroski, Guilherme das Posses Bridi, Alexandre Melo Kawassaki, Carmen Silvia Valente Barbas, Leonardo Oliveira Mendonça, Samar Freschi Barros, Jorge Kalil, Anthony K Shum, Dante Luiz Escuissato
We present a case of a 20-year-old woman reporting polyarthritis, muscle weakness, dyspnoea and multiple intensive care unit admissions due to respiratory failure, without haemoptysis, since 4 months of age. The mother had systemic erythematous lupus. On physical examination, digital clubbing and mild desaturation were found. Laboratory tests demonstrated 1:640 nuclear homogeneous pattern antinuclear
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Journal club Thorax (IF 10.0) Pub Date : 2024-04-01 Prasanjanie Jayasinghe
While surgery remains the primary curative-intent treatment for early-stage NSCLC, 30 to 55% of patients have tumour recurrence within 5 years. Neoadjuvant or adjuvant chemotherapy offers only 5% improvement in 5 year survival as compared with surgery alone. The AEGEAN trial (N Eng J Med 2023;389(18):1672–1684) was a phase 3, double-blind, placebo-controlled trail to investigate durvalumab. Patients
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Patient stratification using plasma cytokines and their regulators in sepsis: relationship to outcomes, treatment effect and leucocyte transcriptomic subphenotypes Thorax (IF 10.0) Pub Date : 2024-03-12 David Benjamin Antcliffe, Yuxin Mi, Shalini Santhakumaran, Katie L Burnham, A Toby Prevost, Josie K Ward, Timothy J Marshall, Claire Bradley, Farah Al-Beidh, Paula Hutton, Stuart McKechnie, Emma E Davenport, Charles J Hinds, Cecilia M O'Kane, Daniel Francis McAuley, Manu Shankar-Hari, Anthony C Gordon, Julian C Knight
Rationale Heterogeneity of the host response within sepsis, acute respiratory distress syndrome (ARDS) and more widely critical illness, limits discovery and targeting of immunomodulatory therapies. Clustering approaches using clinical and circulating biomarkers have defined hyper-inflammatory and hypo-inflammatory subphenotypes in ARDS associated with differential treatment response. It is unknown
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Impacts of sex and gender on severe asthma Thorax (IF 10.0) Pub Date : 2024-03-07 Kimberley C W Wang, John D Blakey
For decades, the unwritten rule for asthma management was ‘Keep it Simple’, with clinicians largely trying to apply a one-size-fits-all stepwise approach to hundreds of millions of people across the globe. More recently, our broader understanding, increasing array of targeted therapies, and relatively stagnant outcomes have led to a greater acknowledgement of the complexity that needs to be addressed
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Effects of testosterone and sex hormone binding globulin on lung function in males and females: a multivariable Mendelian Randomisation study Thorax (IF 10.0) Pub Date : 2024-03-07 Diana A van der Plaat, Alexandra Lenoir, Shyamali Dharmage, James Potts, Francisco Gómez Real, Seif O Shaheen, Debbie Jarvis, Cosetta Minelli, Bénédicte Leynaert
Background Observational studies suggest that total testosterone (TT) and sex hormone-binding globulin (SHBG) may have beneficial effects on lung function, but these findings might be spurious due to confounding and reverse causation. We addressed these limitations by using multivariable Mendelian randomisation (MVMR) to investigate the independent causal effects of TT and SHBG on lung function. Methods
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Unravelling the obesity–asthma connection in childhood and adolescence: does body shape matter? Thorax (IF 10.0) Pub Date : 2024-03-07 Ann D Morgan
Given the concurrent worldwide epidemics of childhood obesity and asthma, it is perhaps not surprising that the two have been inextricably linked in the minds of many. Indeed, there is good evidence to suggest that adiposity in childhood is associated with an increased risk of developing asthma.1 2 Several longitudinal studies conducted in population-based cohorts have demonstrated that childhood obesity
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Adaptive multi-interventional trial platform to improve patient care for fibrotic interstitial lung diseases Thorax (IF 10.0) Pub Date : 2024-03-06 Leticia Kawano-Dourado, Tejaswini Kulkarni, Christopher J Ryerson, Pilar Rivera-Ortega, Bruno Guedes Baldi, Nazia Chaudhuri, Manuela Funke-Chambour, Anna-Maria Hoffmann-Vold, Kerri A Johannson, Yet Hong Khor, Sydney B Montesi, Lucilla Piccari, Helmut Prosch, María Molina-Molina, Jacobo Sellares Torres, Iazsmin Bauer-Ventura, Sujeet Rajan, Joseph Jacob, Duncan Richards, Lisa G Spencer, Barbara Wendelberger
Background Fibrotic interstitial lung diseases (fILDs) are a heterogeneous group of lung diseases associated with significant morbidity and mortality. Despite a large increase in the number of clinical trials in the last 10 years, current regulatory-approved management approaches are limited to two therapies that prevent the progression of fibrosis. The drug development pipeline is long and there is
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Physical activity and body mass related to catch-up lung function growth in childhood: a population-based accelerated cohort study Thorax (IF 10.0) Pub Date : 2024-03-06 Sarah Koch, Gabriela Prado Peralta, Anne-Elie Carsin, Alicia Abellan, Celine Roda, Maties Torrent, Carmen Iñiguez, Ferran Ballester, Amparo Ferrero, Carlos Zabaleta, Aitana Lertxundi, Mònica Guxens, Martine Vrijheid, Jordi Sunyer, Maribel Casas, Judith Garcia-Aymerich
Objective The existence of catch-up lung function growth and its predictors is uncertain. We aimed to identify lung function trajectories and their predictors in a population-based birth cohort. Methods We applied group-based trajectory modelling to z-scores of forced expiratory volume in 1 second (zFEV1) and z-scores of forced vital capacity (zFVC) from 1151 children assessed at around 4, 7, 9, 10
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Monocyte NLRP3 inflammasome and interleukin-1β activation modulated by alpha-1 antitrypsin therapy in deficient individuals Thorax (IF 10.0) Pub Date : 2024-02-28 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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Greenhouse gas emissions associated with suboptimal asthma care in the UK: the SABINA healthCARe-Based envirONmental cost of treatment (CARBON) study Thorax (IF 10.0) Pub Date : 2024-02-27 Alexander J K Wilkinson, Ekaterina Maslova, Christer Janson, Vasanth Radhakrishnan, Jennifer K Quint, Nigel Budgen, Trung N Tran, Yang Xu, Andrew Menzies-Gow, John P Bell
Background Poorly controlled asthma is associated with increased morbidity and healthcare resource utilisation (HCRU). Therefore, to quantify the environmental impact of asthma care, this retrospective, cohort, healthCARe-Based envirONmental cost of treatment (CARBON) study estimated greenhouse gas (GHG) emissions in the UK associated with the management of well-controlled versus poorly controlled
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Mildly elevated pulmonary vascular resistance and worsened survival in PH-ILD: an opportunity for earlier diagnosis and intervention? Thorax (IF 10.0) Pub Date : 2024-02-27 Steven J Cassady, Bradley A Maron
Pulmonary hypertension (PH) is a feared complication of interstitial lung disease (ILD) owing to increased risk for hospitalisation and mortality among affected patients. The development of PH in ILD is attributed to several pathobiological mechanisms that often converge to remodel pulmonary arterioles including hypoxic pulmonary vasoconstriction, endothelial dysfunction, inflammation, increased oxidant
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Improved childhood asthma control after exposure reduction interventions for desert dust and anthropogenic air pollution: the MEDEA randomised controlled trial Thorax (IF 10.0) Pub Date : 2024-02-22 Panayiotis Kouis, Emmanouil Galanakis, Eleni Michaelidou, Paraskevi Kinni, Antonis Michanikou, Constantinos Pitsios, Julietta Perez, Souzana Achilleos, Nicos Middleton, Pinelopi Anagnostopoulou, Helen Dimitriou, Efstathios Revvas, Gerasimos Stamatelatos, Haris Zacharatos, Chrysanthos Savvides, Emily Vasiliadou, Nikos Kalivitis, Andreas Chrysanthou, Filippos Tymvios, Stefania I Papatheodorou, Petros
Introduction Elevated particulate matter (PM) concentrations of anthropogenic and/or desert dust origin are associated with increased morbidity among children with asthma. Objective The Mitigating the Health Effects of Desert Dust Storms Using Exposure-Reduction Approaches randomised controlled trial assessed the impact of exposure reduction recommendations, including indoor air filtration, on childhood
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Does ICS treatment increase the risk of pneumonia in asthma? Thorax (IF 10.0) Pub Date : 2024-02-22 Christer Janson
Patients with asthma have an increased risk of being hospitalised for pneumonia. For example, in a study based on the Respiratory Health In Northern Europe data set, Ekbom et al found that adults with asthma had a more than three times higher risk (HR (3.35 (95% CI 1.97 to 5.02)) of hospitalisation for pneumonia than non-asthmatics.1 Kankaanranta et al also found a high incidence of pneumonia in people
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Comprehensive analysis of environmental exposure to hazardous trace elements and lung function: a national cross-sectional study Thorax (IF 10.0) Pub Date : 2024-02-22 Yun-Jiang Yu, Tong Zheng, Jennifer L Perret, Yajing Han, Hongyan Li, Wenjie Meng, Dinh Bui, Qi-Zhen Wu, Chenyin Dong, Qiu-Ling Fang, Zhenchi Li, Hongxuan Kuang, Xiaowen Chen, Mingdeng Xiang, Xiaodi Qin, Shyamali C Dharmage, Guang-Hui Dong, Yang Zhou
Background There is growing interest in the joint effects of hazardous trace elements (HTEs) on lung function deficits, but the data are limited. This is a critical research gap given increased global industrialisation. Methods A national cross-sectional study including spirometry was performed among 2112 adults across 11 provinces in China between 2020 and 2021. A total of 27 HTEs were quantified
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Impact of ambient air pollution on lung function in preterm-born school-aged children Thorax (IF 10.0) Pub Date : 2024-02-22 William John Watkins, Christopher William Course, Michael Cousins, Kylie Hart, Sarah J Kotecha, Sailesh Kotecha
Rationale Increased outdoor air pollution worsens lung function in children. However, these associations are less well studied in preterm-born individuals. Objectives We assessed associations between ambient air pollutants and spirometry measures in preterm-born children. Methods The Respiratory Health Outcomes in Neonates study recruited preterm-born children aged 7–12 years who were born at ≤34 week's
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Neutrophils and RSV: differences with age Thorax (IF 10.0) Pub Date : 2024-02-22 Zoe Rooke, Noreen Zainal Abidin, Caroline Harris, Malcolm Brodlie
Respiratory syncytial virus (RSV) remains the leading cause of bronchiolitis in infants and young children.1 RSV is highly transmissible, and in temperate climate zones, seasonal epidemics occur during autumn and winter months.2 Worldwide bronchiolitis places a substantial burden on healthcare resources.1 Each year, RSV is estimated to cause 30 million cases of lower respiratory tract infection in
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Mucus clears from the trachea in a helix: a new twist to understanding airway diseases Thorax (IF 10.0) Pub Date : 2024-02-20 David Abelson, James Di Michiel, Clayton Frater, Mark Pearson, Robert Russo, Martin Wechselberger, Alice Cottee, Lucy Morgan
Background Mucociliary clearance (MCC) is critical to lung health and is impaired in many diseases. The path of MCC may have an important impact on clearance but has never been rigorously studied. The objective of this study is to assess the three-dimensional path of human tracheal MCC in disease and health. Methods Tracheal MCC was imaged in 12 ex-smokers, 3 non-smokers (1 opportunistically imaged
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Airway epithelial cell response to RSV is mostly impaired in goblet and multiciliated cells in asthma Thorax (IF 10.0) Pub Date : 2024-02-19 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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Neutrophil responses to RSV infection show differences between infant and adult neutrophils Thorax (IF 10.0) Pub Date : 2024-02-16 Elisabeth Robinson, Shyam Sawhney, Mario Cortina-Borja, Anna L David, Claire M Smith, Rosalind L Smyth
Introduction Respiratory syncytial virus (RSV) causes a severe respiratory condition, bronchiolitis, in infants but not in adults. Bronchiolitis is characterised by neutrophilic infiltration in the airways, but whether neutrophils enhance recovery from infection or contribute to its pathology remains unknown. Methods We used a novel in-vitro model to compare term umbilical cord blood (infant) (n=17
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Invasive versus non-invasive paediatric home mechanical ventilation: review of the international evolution over the past 24 years Thorax (IF 10.0) Pub Date : 2024-02-16 Michel Toussaint, Olivier van Hove, Dimitri Leduc, Lise Ansay, Nicolas Deconinck, Brigitte Fauroux, Sonia Khirani
Background Home mechanical ventilation (HMV) is the treatment for chronic hypercapnic alveolar hypoventilation. The proportion and evolution of paediatric invasive (IMV) and non-invasive (NIV) HMV across the world is unknown, as well as the disorders and age of children using HMV. Methods Search of Medline/PubMed for publications of paediatric surveys on HMV from 2000 to 2023. Results Data from 32
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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 10.0) Pub Date : 2024-02-15 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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Unmasking delays: bridging the gap in timely lung cancer diagnosis for UK primary care Thorax (IF 10.0) Pub Date : 2024-03-01 Katherine Hickman
There is little room for debate regarding the fact that primary care in the UK is currently confronting one of its most substantial challenges to date. Access remains a constant problem, with lengthy wait times preventing timely care.1 The stretched workforce is contending with increasing patient demands which ultimately jeopardises the delivery of quality care. This burden is taking its toll, leading
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Lung function as independent predictor of cardiovascular disease risk: implications for practice and policy Thorax (IF 10.0) Pub Date : 2024-03-01 Tae Yoon Lee, Mohsen Sadatsafavi
The intimately connected physiology of the cardiovascular and pulmonary systems gives rise to numerous shared risk factors and disease pathways, contributing significantly to the high incidence of co-occurring heart and lung diseases.1 For example, individuals diagnosed with asthma are at 15%–53% higher risk of cardiovascular disease (CVD),2 while those diagnosed with chronic obstructive pulmonary
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Integrated stop smoking interventions are essential to maximise the health benefits from lung cancer screening Thorax (IF 10.0) Pub Date : 2024-03-01 Pamela Smith, Rachael L Murray, Philip A Crosbie
In the current issue of Thorax , Williams et al offer timely and much needed evidence regarding the optimal form of smoking cessation intervention in lung cancer screening. In 2022, the UK National Screening Committee recommended targeted screening for lung cancer for those individuals identified to be at high risk and aged 55–74 years. This year the UK Government announced the national roll-out of
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Identifying a hyperinflammatory subphenotype of ARDS associated with worse outcomes: may ferritin help? Thorax (IF 10.0) Pub Date : 2024-03-01 Lisa K Torres, Ilias I Siempos
Attributable mortality of acute respiratory distress syndrome (ARDS) is considerable.1 2 Yet, no survival benefit has been shown in randomised controlled trials (RCTs) of pharmacological strategies to treat ARDS. This is assumed to be a consequence of the heterogeneity of clinical and biological processes among patients meeting criteria for ARDS.3 In an attempt to address heterogeneity, recent efforts
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Cause-specific mortality in COPD subpopulations: a cohort study of 339 647 people in England Thorax (IF 10.0) Pub Date : 2024-03-01 Hannah Whittaker, Kieran J Rothnie, Jennifer K Quint
Background Identifying correlates of cause-specific mortality in patients with chronic obstructive pulmonary disease (COPD) may aid the targeting of therapies to reduce mortality. We determined factors associated with causes of death in a primary care COPD population. Methods Clinical Practice Research Datalink Aurum was linked to Hospital Episode Statistics and death certificate data. People with
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Cluster randomised controlled trial of specialist-led integrated COPD care (INTEGR COPD) Thorax (IF 10.0) Pub Date : 2024-03-01 Ketan Patel, Anita Pye, Ross G Edgar, Helen Beadle, Paul R Ellis, Alice Sitch, Andrew P Dickens, Alice M Turner
Objective Studies in hospital settings demonstrate that there is greater guideline adherence when care is delivered by a respiratory specialist, however, this has not been explored in primary care. The aim of this study is to determine the impact integrating respiratory specialists into primary care has on the delivery of guideline adherent chronic obstructive pulmonary disease (COPD) care. Methods
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Lower airway microbiota in COPD and healthy controls Thorax (IF 10.0) Pub Date : 2024-03-01 Solveig Tangedal, Rune Nielsen, Marianne Aanerud, Christine Drengenes, Gunnar R Husebø, Sverre Lehmann, Kristel S Knudsen, Pieter S Hiemstra, Tomas ML Eagan
Background The lower airway microbiota in patients with chronic obstructive pulmonary disease (COPD) are likely altered compared with the microbiota in healthy individuals. Information on how the microbiota is affected by smoking, use of inhaled corticosteroids (ICS) and COPD severity is still scarce. Methods In the MicroCOPD Study, participant characteristics were obtained through standardised questionnaires
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Elevated ferritin, mediated by IL-18 is associated with systemic inflammation and mortality in acute respiratory distress syndrome (ARDS) Thorax (IF 10.0) Pub Date : 2024-03-01 Puja Mehta, Romit J Samanta, Katherine Wick, Rebecca C Coll, Thea Mawhinney, Patrick G McAleavey, Andrew J Boyle, John Conlon, Manu Shankar-Hari, Angela Rogers, Carolyn S Calfee, Michael A Matthay, Charlotte Summers, Rachel Clare Chambers, Daniel Francis McAuley, Cecilia M O'Kane
Background Inflammatory subphenotypes have been identified in acute respiratory distress syndrome (ARDS). Hyperferritinaemia in sepsis is associated with hyperinflammation, worse clinical outcomes, and may predict benefit with immunomodulation. Our aim was to determine if raised ferritin identified a subphenotype in patients with ARDS. Methods Baseline plasma ferritin concentrations were measured in
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Guideline concordance for timely chest imaging after new presentations of dyspnoea or haemoptysis in primary care: a retrospective cohort study Thorax (IF 10.0) Pub Date : 2024-03-01 Minjoung Monica Koo, Luke T A Mounce, Meena Rafiq, Matthew E J Callister, Hardeep Singh, Gary A Abel, Georgios Lyratzopoulos
Background Guidelines recommend urgent chest X-ray for newly presenting dyspnoea or haemoptysis but there is little evidence about their implementation. Methods We analysed linked primary care and hospital imaging data for patients aged 30+ years newly presenting with dyspnoea or haemoptysis in primary care during April 2012 to March 2017. We examined guideline-concordant management, defined as General
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Retrospective analysis of referrals for hypoxic challenge testing in children born preterm Thorax (IF 10.0) Pub Date : 2024-03-01 Anna Howells, Mollie Riley, Martin Samuels, Paul Aurora
Introduction Children with a history of bronchopulmonary dysplasia (BPD) may be at risk of hypoxaemia at altitude, such as during air travel. We have performed preflight hypoxic challenge testing (HCT) since 2006, incorporating British Thoracic Society (BTS) guidance since 2011, to determine which children may require oxygen during air travel. Aims We aimed to compare the outcome of HCTs in children
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Predictive value of lung function measures for cardiovascular risk: a large prospective cohort study Thorax (IF 10.0) Pub Date : 2024-03-01 Lihui Zhou, Hongxi Yang, Yuan Zhang, Yuan Wang, Xin Zhou, Tong Liu, Qing Yang, Yaogang Wang
Introduction Although lung function measures are associated with cardiovascular disease (CVD), the added predictive values of these measures remain unclear. Methods From the UK Biobank, 308 415 participants free of CVD with spirometry parameters were included. The CVD outcomes included were defined by QRISK3, the American College of Cardiology/American Heart Association (ACC/AHA) and the European Systematic
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Combination pharmacological therapy targeting multiple mechanisms of sleep apnoea: a randomised controlled cross-over trial Thorax (IF 10.0) Pub Date : 2024-03-01 Scott A Sands, Jinny Collet, Laura K Gell, Nicole Calianese, Lauren B Hess, Daniel Vena, Ali Azarbarzin, Suzanne M Bertisch, Shane Landry, Luke Thomson, Simon A Joosten, Garun S Hamilton, Bradley A Edwards
Rationale Acetazolamide and atomoxetine-plus-oxybutynin (‘AtoOxy’) can improve obstructive sleep apnoea (OSA) by stabilising ventilatory control and improving dilator muscle responsiveness respectively. Given the different pathophysiological mechanisms targeted by each intervention, we tested whether AtoOxy-plus-acetazolamide would be more efficacious than AtoOxy alone. Methods In a multicentre randomised
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Immediate smoking cessation support during lung cancer screening: long-term outcomes from two randomised controlled trials Thorax (IF 10.0) Pub Date : 2024-03-01 Parris J Williams, Keir E J Philip, Sara C Buttery, Alexis Perkins, Ley Chan, Emily C Bartlett, Anand Devaraj, Samuel V Kemp, James Addis, Jane Derbyshire, Michelle Chen, Michael I Polkey, Anthony A Laverty, Nicholas S Hopkinson
Background Immediate smoking cessation interventions delivered alongside targeted lung health checks (TLHCs) to screen for lung cancer increase self-reported abstinence at 3 months. The impact on longer term, objectively confirmed quit rates remains to be established. Methods We followed up participants from two clinical trials in people aged 55–75 years who smoked and took part in a TLHC. These randomised
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Phenotypic and genetically predicted leucocyte telomere length and lung cancer risk in the prospective UK Biobank Thorax (IF 10.0) Pub Date : 2024-03-01 Jason YY Wong, Batel Blechter, Aubrey K Hubbard, Mitchell J Machiela, Jianxin Shi, Shahinaz M Gadalla, Wei Hu, Mohammad L Rahman, Nathaniel Rothman, Qing Lan
We investigated phenotypic leucocyte telomere length (LTL), genetically predicted LTL (gTL), and lung cancer risk among 371 890 participants, including 2829 incident cases, from the UK Biobank. Using multivariable Cox regression, we found dose-response relationships between longer phenotypic LTL (p-trendcontinuous=2.6×10-5), longer gTL predicted using a polygenic score with 130 genetic instruments
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Dry cough with abnormal airway connection Thorax (IF 10.0) Pub Date : 2024-03-01 Sumeet Vimal Kishor Singhania, Abhijit Raut
A 69-year-old man of Indian origin presented to the chest clinic with an excessive dry cough for 3 months. He did not report any weight loss, haemoptysis or fever. He had no history of recurrent cough, asthma, tuberculosis (TB) or close TB contact. He denied any nasal symptoms or significant reflux-related symptoms. He was known to have diabetes, hypertension and dyslipidaemia. Systemic examination
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Effects of non-invasive ventilation on sleep in chronic hypercapnic respiratory failure Thorax (IF 10.0) Pub Date : 2024-03-01 Neeraj M Shah, Joerg Steier, Nicholas Hart, Georgios Kaltsakas
Chronic respiratory disease can exacerbate the normal physiological changes in ventilation observed in healthy individuals during sleep, leading to sleep-disordered breathing, nocturnal hypoventilation, sleep disruption and chronic respiratory failure. Therefore, patients with obesity, slowly and rapidly progressive neuromuscular disease and chronic obstructive airways disease report poor sleep quality
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Female reproductive histories and the risk of chronic obstructive pulmonary disease Thorax (IF 10.0) Pub Date : 2024-02-13 Chen Liang, Hsin-Fang Chung, Annette Dobson, Sven Sandin, Elisabete Weiderpass, Gita D Mishra
Background Female reproductive factors may influence the development of chronic obstructive pulmonary disease (COPD) through the female hormonal environment, but studies on this topic are limited. This study aimed to assess whether age at menarche, number of children, infertility, miscarriage, stillbirth and age at natural menopause were associated with the risk of COPD. Methods Women from three cohorts
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Intensive care unit interventions to promote sleep and circadian biology in reducing incident delirium: a scoping review Thorax (IF 10.0) Pub Date : 2024-02-13 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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Do pulmonary rehabilitation programmes improve outcomes in patients with COPD posthospital discharge for exacerbation: a systematic review and meta-analysis Thorax (IF 10.0) Pub Date : 2024-02-13 Alex R Jenkins, Chris Burtin, Pat G Camp, Peter Lindenauer, Brian Carlin, Jennifer A Alison, Carolyn Rochester, Anne E Holland
Introduction Previous systematic reviews have provided heterogeneous and differing estimates for the efficacy of pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease (COPD). The aim of this review was to examine the efficacy of pulmonary rehabilitation programmes initiated within 3 weeks of hospital discharge following an exacerbation of COPD. Methods An update