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CD206+ macrophages are relevant non-invasive imaging biomarkers and therapeutic targets in experimental lung fibrosis Thorax (IF 9.0) Pub Date : 2024-07-20 Lenny Pommerolle, Guillaume Beltramo, Leo Biziorek, Marin Truchi, Alexandre Magno Maneschy Dias, Lucile Dondaine, Julie Tanguy, Nicolas Pernet, Victor Goncalves, Alexanne Bouchard, Marie Monterrat, Grégoire Savary, Nicolas Pottier, Kjetil Ask, Martin R J Kolb, Bernard Mari, Carmen Garrido, Bertrand Collin, Philippe Bonniaud, Olivier Burgy, Françoise Goirand, Pierre-Simon Bellaye
Background Interstitial lung diseases (ILDs) include a large number of diseases associated with progressive pulmonary fibrosis (PPF), including idiopathic pulmonary fibrosis (IPF). Despite the rarity of each of the fibrotic ILDs individually, they cumulatively affect a considerable number of patients. PPF is characterised by an excessive collagen deposition leading to functional decline. Objectives
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Non-cigarette tobacco products, aryl-hydrocarbon receptor repressor gene methylation and smoking-related health outcomes Thorax (IF 9.0) Pub Date : 2024-07-20 Christina M Eckhardt, Pallavi Balte, Jack E Morris, Surya P Bhatt, David Couper, Jessica Fetterman, Neal Freedman, David R Jacobs, Lifang Hou, Ravi Kalhan, Yongmei Liu, Laura Loehr, Pamela L Lutsey, Joseph E Schwartz, Wendy White, Sachin Yende, Stephanie J London, Tiffany R Sanchez, Elizabeth C Oelsner
Introduction Cigarette smoking leads to altered DNA methylation at the aryl-hydrocarbon receptor repressor (AHRR) gene. However, it remains unknown whether pipe or cigar smoking is associated with AHRR methylation. We evaluated associations of non-cigarette tobacco use with AHRR methylation and determined if AHRR methylation was associated with smoking-related health outcomes. Methods Data were pooled
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Refractory granulomatous Pneumocystis jirovecii pneumonia masquerading as malignancy Thorax (IF 9.0) Pub Date : 2024-07-20 Chi Wan Koo, Ananya Panda, Jennifer Boland Froemming
An elderly female, lifelong non-smoker, with rheumatoid arthritis treated with methotrexate and prednisone for 10 years was referred for evaluation of incidentally detected, randomly distributed pulmonary nodules on a CT performed for pleuritic chest pain and dyspnoea (figure 1A). Subsequent [18F]fluoro-d-glucose (FDG)-positron emission tomography (PET) showed the nodules had increased in size and
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An exercise in relaxation: right ventricular diastolic function predicts exercise capacity in pulmonary arterial hypertension Eur. Respir. J. (IF 16.6) Pub Date : 2024-07-18 Michael T. Patterson, Kurt W. Prins
Extract Right ventricular (RV) dysfunction is a well-recognised contributor to exercise intolerance and poor long-term outcomes in pulmonary arterial hypertension (PAH) [1]; however, detailed evaluations of the RV's response to exercise in PAH are only beginning to be conducted [2]. Furthermore, there are both systolic and diastolic impairments in the pressure-overloaded right ventricle [3], but the
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Murder, she wrote: a long story on long COVID is being written Eur. Respir. J. (IF 16.6) Pub Date : 2024-07-18 Joan B. Soriano, Julio Ancochea
Extract In the TV series Murder, She Wrote, from 1984 and for more than a decade, a mystery writer and amateur detective, portrayed by Angela Lansbury (1925–2022), was involved in solving murders taking place across the USA and abroad (figure 1). We are doomed to learning to live with COVID-19 and long COVID, and while many findings and information are already available, many more mysteries are yet
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Automating detection of inspiratory flow limitation: the next frontier in assessing sleep disordered breathing in pregnancy and risk for adverse pregnancy outcomes? Eur. Respir. J. (IF 16.6) Pub Date : 2024-07-18 Sushmita Pamidi, Indu Ayappa
Extract Sleep disordered breathing (SDB) during pregnancy has been associated with various adverse pregnancy outcomes and is increasingly gaining recognition as a significant yet often overlooked aspect of maternal health. Notably, accumulating evidence from prospective cohort and clinical studies has shown robust associations between SDB during pregnancy and hypertensive disorders of pregnancy, pre-eclampsia
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Poor cardiac output reserve in pulmonary arterial hypertension is associated with right ventricular stiffness and impaired interventricular dependence Eur. Respir. J. (IF 16.6) Pub Date : 2024-07-18 Ilton M. Cubero Salazar, Andrew C. Lancaster, Vivek P. Jani, Margaret J. Montovano, Matthew Kauffman, Alexandra Weller, Bharath Ambale-Venkatesh, Stefan L. Zimmerman, Catherine E. Simpson, Todd M. Kolb, Rachel L. Damico, Stephen C. Mathai, Monica Mukherjee, Ryan J. Tedford, Paul M. Hassoun, Steven Hsu
Extract Pulmonary arterial hypertension (PAH) is characterised by adverse pulmonary vascular remodelling that results in a progressive pathological elevation of pulmonary pressures, right ventricular (RV) failure, worsening exertional limitation and premature death [1]. Declines in exercise capacity signal disease progression and portend poor prognosis [2–5]. Appropriately, exercise capacity and the
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Symptoms before and after COVID-19: a population and case–control study using prospective data Eur. Respir. J. (IF 16.6) Pub Date : 2024-07-18 Carole H. Sudre, Michela Antonelli, Nathan J. Cheetham, Erika Molteni, Liane S. Canas, Vicky Bowyer, Ben Murray, Khaled Rjoob, Marc Modat, Joan Capdevila Pujol, Christina Hu, Jonathan Wolf, Tim D. Spector, Alexander Hammers, Claire J. Steves, Sebastien Ourselin, Emma L. Duncan
Background Some individuals experience prolonged illness after acute coronavirus disease 2019 (COVID-19). We assessed whether pre-infection symptoms affected post-acute COVID illness duration. Methods Survival analysis was performed in adults (n=23 452) with community-managed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection prospectively self-logging data through the ZOE COVID
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Adverse pregnancy outcomes and pharyngeal flow limitation during sleep: Nulliparous Pregnancy Outcomes Study Monitoring Mothers-to-be (nuMoM2b) Eur. Respir. J. (IF 16.6) Pub Date : 2024-07-18 Raichel M. Alex, Dwayne L. Mann, Ali Azarbarzin, Daniel Vena, Laura K. Gell, Andrew Wellman, William A. Grobman, Francesca L. Facco, Robert M. Silver, Grace W. Pien, Judette M. Louis, Phyllis C. Zee, Michael Rueschman, Tamar Sofer, Susan Redline, Scott A. Sands
Background Pharyngeal flow limitation during pregnancy may be a risk factor for adverse pregnancy outcomes but was previously challenging to quantify. Our objective was to determine whether a novel objective measure of flow limitation identifies an increased risk of pre-eclampsia (primary outcome) and other adverse outcomes in a prospective cohort: Nulliparous Pregnancy Outcomes Study Monitoring Mothers-to-be
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Long-term radiological and pulmonary function abnormalities at 3 years after COVID-19 hospitalisation: a longitudinal cohort study Eur. Respir. J. (IF 16.6) Pub Date : 2024-07-18 Xiaoyu Han, Lu Chen, Liyan Guo, Linxia Wu, Osamah Alwalid, Jie Liu, Yuting Zheng, Leqing Chen, Wenlong Wu, Hanting Li, Qinyue Luo, Huangxuan Zhao, Lijie Zhang, Yaowei Bai, Bo Sun, Tao Sun, Yuxi Gui, Tong Nie, Lei Chen, Fan Yang, Yanqing Fan, Heshui Shi, Chuansheng Zheng
Extract On 3 May 2023, the World Health Organization (WHO) released the coronavirus disease 2019 (COVID-19) strategic preparedness and response plan for 2023–2025 that emphasises the significance of establishing an evidence base regarding the post-COVID condition [1, 2]. Emerging data show that ~50% of COVID-19 survivors experience long-term respiratory sequelae, such as chronic dyspnoea, cough and
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Unusual cause of trepopnea Thorax (IF 9.0) Pub Date : 2024-07-18 Suat Yee Lee, Juo-Hau Su, Chia-Chen Chang, Fatt Yang Chew
A 19-year-old female presented with a 6-month history of progressive shortness of breath. She reported a new onset of palpitations preceding her shortness of breath, which progressed progressively into dull chest pain and trepopnea, and she experienced dyspnoea while lying on her right side. With wheezing and rhinorrhoea, the symptoms became more prominent. She had no previous history of haemoptysis
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Rectal organoid morphometric analysis (ROMA): reoptimising measurements automatically Thorax (IF 9.0) Pub Date : 2024-07-17 Shafagh Waters, Peter G Middleton
Quantification of the physiological changes in people with cystic fibrosis (pwCF) has long been important for clinical diagnosis. Since the original discovery of abnormal sweat electrolytes in pwCF, the standardised pilocarpine iontophoresis sweat test was developed1 to clearly distinguish those with CF. While the sweat chloride test remains an important early step in the diagnostic algorithm, complementary
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Human mesenchymal stromal cells inhibit Mycobacterium avium replication in clinically relevant models of lung infection Thorax (IF 9.0) Pub Date : 2024-08-01 Timothy D Shaw, Anna D Krasnodembskaya, Gunnar N Schroeder, Declan F Doherty, Johnatas Dutra Silva, Shikha M Tandel, Yue Su, David Butler, Rebecca J Ingram, Cecilia M O'Kane
Introduction Novel therapeutic strategies are urgently needed for Mycobacterium avium complex pulmonary disease (MAC-PD). Human mesenchymal stromal cells (MSCs) can directly inhibit MAC growth, but their effect on intracellular bacilli is unknown. We investigated the ability of human MSCs to reduce bacterial replication and inflammation in MAC-infected macrophages and in a murine model of MAC-PD. Methods
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Children’s interstitial lung disease (chILD): less rare than we thought? Thorax (IF 9.0) Pub Date : 2024-07-16 Andrew Bush, Lawrence Nogee
The presentation of childhood interstitial lung disease (chILD) is non-specific,1 and chILD is usually low on the list of diagnoses in children with combinations of respiratory symptoms, feeding difficulties and failure to thrive. However, if a diagnosis is not considered, it will never be made. In this issue of the Journal , Fletcher et al describe nearly 800 French children, suggesting that chILD
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Epigenetic clock as the new hand of time for lung cancer in never smokers Thorax (IF 9.0) Pub Date : 2024-08-01 David C Christiani
Estimates of lung cancer among persons who never smoked are 10%–20% in the USA, translating into 20–40 000 cases annually. Globally, and especially in East Asia, the incidence of lung cancer among non-tobacco users is considerably higher than in the USA, especially in women.1 The causes of lung cancer in lifelong never-smokers are not well understood. Possibilities include exposure to other carcinogens
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MAC attack: MSCs and macrophages join forces against chronic lung infection Thorax (IF 9.0) Pub Date : 2024-08-01 Hazel Dunbar, Ian James Hawthorne, Karen English
Mesenchymal stromal cells (MSCs) possess several characteristics that make them attractive as a potential adjunct therapy for acute and chronic infectious diseases. MSCs are well known for their impressive immunomodulatory,1 2 pro-repair effects1 3 and clinical safety profile,4 5 however, the efficacy of MSCs in controlling bacterial infections, at least directly, remains unclear.6 Mycobacterium avium
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Lifetime lung function trajectories: insights into risk factors, consequences and implications Thorax (IF 9.0) Pub Date : 2024-08-01 Dinh S Bui, Nur S Idrose, Shyamali C Dharmage
Maintaining optimal lung function throughout life is important not only for respiratory health but also for overall health and longevity. With emerging evidence on the clinical significance of lung function at multiple windows throughout life, there has been an increasing number of studies on lung function trajectories1 including by Zhang et al in this issue.2 The term ‘lung function trajectory’ refers
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Lung allocation: a vexed, complex multifaceted challenge Thorax (IF 9.0) Pub Date : 2024-08-01 Andrew Fisher, Jasvir Parmar
We read with interest the paper from Roussel et al .1 In this study, the authors examine the outcomes for lung transplant recipients who were allocated donor organs in two very different healthcare systems. Their findings raise the complex and vexed question of what the fairest system for the allocation donor lungs is, especially for those candidates identified as being at the highest risk of waiting
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Reinforcing the benefits of children’s physical activity on lung health Thorax (IF 9.0) Pub Date : 2024-08-01 Gang Wang, Erik Melén
Lung development starts already in utero whereas lung function development can be conceived to begin shortly after birth, marked by the infant’s first cry. This development progresses through adolescence until reaching its peak during early adulthood (typically between 20 and 25 years of age). However, a notable portion of the general population (4%–12%) experiences suboptimal lung development, failing
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Undertreating cardiovascular disease in people with chronic obstructive pulmonary disease (COPD) Thorax (IF 9.0) Pub Date : 2024-08-01 Andrea S Gershon, Alina Blazer, Dennis Ko
Chronic obstructive pulmonary disease (COPD) is the third-leading cause of death globally following ischaemic heart disease and stroke.1 Cardiovascular disease (CVD) is one of the most common comorbidities experienced by people with COPD and is a leading cause of death. People with COPD account for about 40% of all cardiovascular hospitalisations.2 3 This is believed to be because of the direct effects
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Respiratory rescue is the new frontier Thorax (IF 9.0) Pub Date : 2024-08-01 Sarath Ranganathan
The cost of delivering healthcare is increasing in many countries, while at the same time, populations are ageing and fertility rates falling. These factors are pushing policy-makers to consider alternative strategies for health service delivery. The recent pandemic has confirmed that many of the impacts of acute infectious diseases can be mitigated through vaccination and other forms of prevention
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Integrated disease management: good news but more work to do Thorax (IF 9.0) Pub Date : 2024-08-01 Christine R Jenkins
Despite regularly updated guidelines, new evidence generation and a growing awareness of the prevalence and burden of asthma and chronic obstructive pulmonary disease (COPD) in the community, both diseases place a major strain on healthcare resources, particularly in causing hospital admissions, demands on urgent healthcare resources and at a personal level, significant impact on school and work attendance
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Improvements of the shape and strength of the diaphragm after endoscopic lung volume reduction Thorax (IF 9.0) Pub Date : 2024-08-01 Olivier Taton, Pierre Alain Gevenois, Alain Van Muylem, Benjamin Bondue, Sébastien Van Laethem, Dimitri Leduc
Rationale Endoscopic lung volume reduction improves lung function, quality of life and exercise capacity in severe emphysema patients. However, its effect on the diaphragm function is not well understood. We hypothesised that endoscopic lung volume reduction increases its strength by modifying its shape. Objectives To investigate changes in both diaphragm shape and strength induced by the insertion
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QRISK3 underestimates the risk of cardiovascular events in patients with COPD Thorax (IF 9.0) Pub Date : 2024-08-01 Joseph Emil Amegadzie, Zhiwei Gao, Jennifer K Quint, Richard Russell, John R Hurst, Tae Yoon Lee, Don D Sin, Wenjia Chen, Mona Bafadhel, Mohsen Sadatsafavi
Background Patients with chronic obstructive pulmonary disease (COPD) are at increased risk of cardiovascular disease (CVD). The extent to which the excess CVD risk is captured by risk factors in QRISK, a widely used CVD risk scoring tool, is not well studied. Methods We created an incidence cohort of diagnosed COPD patients from the United Kingdom (UK) Clinical Practice Research Datalink GOLD database
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Quantifying sustained health system benefits of primary care-based integrated disease management for COPD: a 6-year interrupted time series study Thorax (IF 9.0) Pub Date : 2024-08-01 Christopher Licskai, Anna Hussey, Véronique Rowley, Madonna Ferrone, Zihang Lu, Kimball Zhang, Emilie Terebessy, Andrew Scarffe, Shannon Sibbald, Cathy Faulds, Tim O'Callahan, Teresa To
Background Severe exacerbation of chronic obstructive pulmonary disease (COPD) is a trajectory-changing life event for patients and a major contributor to health system costs. This study evaluates the real-world impact of a primary care, integrated disease management (IDM) programme on acute health service utilisation (HSU) in the Canadian health system. Methods Interrupted time series analysis using
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Epigenome-wide association study of lung cancer among never smokers in two prospective cohorts in Shanghai, China Thorax (IF 9.0) Pub Date : 2024-08-01 Mohammad L Rahman, Charles E Breeze, Xiao-Ou Shu, Jason Y Y Wong, Batel Blechter, Andres Cardenas, Xuting Wang, Bu-Tian Ji, Wei Hu, Qiuyin Cai, H Dean Hosgood, Gong Yang, Jianxin Shi, Jirong Long, Yu-Tang Gao, Douglas A Bell, Wei Zheng, Nathaniel Rothman, Qing Lan
Background The aetiology of lung cancer among individuals who never smoked remains elusive, despite 15% of lung cancer cases in men and 53% in women worldwide being unrelated to smoking. Epigenetic alterations, particularly DNA methylation (DNAm) changes, have emerged as potential drivers. Yet, few prospective epigenome-wide association studies (EWAS), primarily focusing on peripheral blood DNAm with
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Survival outcomes following urgent lung transplantation in France and the USA Thorax (IF 9.0) Pub Date : 2024-08-01 Arnaud Roussel, Edouard Sage, Pierre-Emmanuel Falcoz, Pascal Alexandre Thomas, Yves Castier, Elie Fadel, Françoise Le Pimpec-Barthes, François Tronc, Jacques Jougon, Philippe Lacoste, Johanna Claustre, Laurent Brouchet, Richard Dorent, Edward Cantu, Michael Harhay, Raphaël Porcher, Pierre Mordant
Introduction Lung graft allocation can be based on a score (Lung Allocation Score) as in the USA or sequential proposals combined with a discrete priority model as in France. We aimed to analyse the impact of allocation policy on the outcome of urgent lung transplantation (LT). Methods US United Network for Organ Sharing (UNOS) and French Cristal databases were retrospectively reviewed to analyse LT
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Distinct trajectories of lung function from childhood to mid-adulthood Thorax (IF 9.0) Pub Date : 2024-08-01 Xian Zhang, Andrew R Gray, Robert J Hancox
Rationale Life course trajectories of lung function development and decline influence the risk for lung disease but are poorly documented. Objective To document lung function trajectories from childhood to mid-adult life. Methods We modelled forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and FEV1/FVC at ages 9, 11, 13, 15, 18, 21, 26, 32, 38 and 45 years from a population-based
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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 9.0) Pub Date : 2024-08-01 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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Lung function trajectories from school age to adulthood and their relationship with markers of cardiovascular disease risk Thorax (IF 9.0) Pub Date : 2024-08-01 Raquel Granell, Sadia Haider, Matea Deliu, Anhar Ullah, Osama Mahmoud, Sara Fontanella, Lesley Lowe, Angela Simpson, James William Dodd, Seyed Hasan Arshad, Clare S Murray, Graham Roberts, Alun Hughes, Chloe Park, John W Holloway, Adnan Custovic
Rationale Lung function in early adulthood is associated with subsequent adverse health outcomes. Objectives To ascertain whether stable and reproducible lung function trajectories can be derived in different populations and investigate their association with objective measures of cardiovascular structure and function. Methods Using latent profile modelling, we studied three population-based birth
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Adaptive multi-interventional trial platform to improve patient care for fibrotic interstitial lung diseases Thorax (IF 9.0) Pub Date : 2024-08-01 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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Bilateral mediastinal cysts with müllerian differentiation Thorax (IF 9.0) Pub Date : 2024-08-01 Nuria Domedel Puig, Marta Cufí Quintana, Vanessa Escobedo Rodriguez, Manuela Iglesias Sentís, Miguel Gallego
A chest X-ray was ordered in a 40-year-old woman due to an acute cough, showing an enlarged mediastinal silhouette (figure 1A). A physical examination showed a body mass index of 26 kg/m2. She reported prior use of hormonal contraception. CT scanning led to the detection of two posterior mediastinal, paravertebral and cystic images (figure 1B): a right, 28-mm-wide cyst at T5–T6 and a left, 24-mm-wide
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Journal club Thorax (IF 9.0) Pub Date : 2024-08-01 Zin Nge Nge Sein
Treatment recommendations for primary spontaneous pneumothorax (PSP) have changed significantly in recent years. The latest guideline by the British Thoracic Society (BTS) has shifted towards ambulatory and conservative management, following the publication of two robust randomised controlled trials (RCTs). Keijzers and colleagues have published a further post-hoc analysis from one of these RCTs, demonstrating
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IgG and plasma viscosity as markers of disease activity in primary Sjogren’s syndrome-related lymphocytic interstitial pneumonia Thorax (IF 9.0) Pub Date : 2024-07-15 Sughra Alawi, Giles Dixon, Nidhi Bhatt, Huzaifa I Adamali, Harsha Gunawardena
A 33-year-old woman presented with an 8-month history of dry cough and progressive dyspnoea. Two months later, she developed dry eyes and mouth, petechial rash over both feet, left jaw pain and weight loss. She had no significant medical, medication, smoking or occupational history. Her father had Raynaud’s disease and paternal uncle had systemic lupus erythematosus. Her physical examination revealed
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Nasal epithelial gene expression identifies relevant asthma endotypes in the ATLANTIS study Thorax (IF 9.0) Pub Date : 2024-07-15 Tatiana Karp, Alen Faiz, Jos van Nijnatten, Huib A M Kerstjens, Ilse Boudewijn, Monica Kraft, Judith M Vonk, Martijn C Nawijn, Irene H Heijink, Bianca Beghé, Klaus F Rabe, Alberto Papi, Chris Brightling, Dave Singh, Thys van der Molen, Salman Siddiqui, Stephanie Christenson, Victor Guryev, Maarten van den Berge
Introduction Asthma is an inflammatory airways disease encompassing multiple phenotypes and endotypes. Several studies suggested gene expression in nasal epithelium to serve as a proxy for bronchial epithelium, being a non-invasive approach to investigate lung diseases. We hypothesised that molecular differences in upper airway epithelium reflect asthma-associated differences in the lower airways and
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Rectal organoid morphology analysis (ROMA) as a novel physiological assay for diagnostic classification in cystic fibrosis Thorax (IF 9.0) Pub Date : 2024-07-14 Senne Cuyx, Anabela Santo Ramalho, Steffen Fieuws, Nikky Corthout, Marijke Proesmans, Mieke Boon, Kaline Arnauts, Marianne S Carlon, Sebastian Munck, Lieven Dupont, Kris De Boeck, François Vermeulen
Background Diagnosing cystic fibrosis (CF) is not always straightforward, in particular when sweat chloride concentration (SCC) is intermediate and <2 CF-causing CFTR variants are identified. The physiological CFTR assays proposed in the guidelines, nasal potential difference and intestinal current measurement, are not readily available nor feasible at all ages. Rectal organoid morphology analysis
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The casting of invasive cardiopulmonary exercise testing: towards a common goal Eur. Respir. J. (IF 16.6) Pub Date : 2024-07-11 Inderjit Singh, Aaron B. Waxman
Extract In the 1920s, on the backdrop of explosive industrial growth, the Harvard Fatigue Laboratory (1924–1947) performed extensive physiological and chemical studies in exercising individuals that helped shape our understanding of exercise physiology today [1]. Although its initial construct was designed to study the physiology of fatigue in the workplace [2], the innovative experimental techniques
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Reply to: Opioids for dyspnoea in interstitial lung disease: does the sequence and timing of therapy matter? Eur. Respir. J. (IF 16.6) Pub Date : 2024-07-11 Diana H. Ferreira, Magnus Ekström, Sabrina Bajwah, Daisy J.A. Janssen, Belinda Fazekas, David C. Currow
Extract M. Kalluri and co-workers make several important points in considering the recently published double-blind, placebo-controlled, randomised crossover study of regular, low-dose, sustained-release morphine in people with interstitial lung disease (ILD) [1]. While our study was designed more than a decade ago, based on the best evidence at the time, it included people with physician-diagnosed
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Real world evidence in asthma: what to expect beyond randomised controlled trials? Eur. Respir. J. (IF 16.6) Pub Date : 2024-07-11 Thibaud Soumagne, Bruno Degano
Extract Randomised controlled trials (RCTs) are regarded as the gold standard for assessing the efficacy and safety of treatments, and thus for guiding medical decisions. Although they are an essential element in clinical research, they do not always reflect the reality of clinical practice. Indeed, because of their rigorous methodology, their strict selection criteria and the fact that patients are
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High-quality and low-carbon asthma care go hand in hand Eur. Respir. J. (IF 16.6) Pub Date : 2024-07-11 Alexander Wilkinson, Ashley Woodcock
Extract It is almost impossible to overstate the accelerating threats of the climate crisis to human health. In 2021, 127 million more people experienced food insecurity due to the climate crisis [1], 2022 saw a deadly summer heatwave that killed more than 60 000 people in Europe [2] and record wildfires in Canada in 2023 released greenhouse gases (GHGs) equivalent to 1.44 gigatonnes of CO2 and worsened
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Primary spontaneous pneumothorax: does size matter? Eur. Respir. J. (IF 16.6) Pub Date : 2024-07-11 Gerben Keijzers, Michaela Donaghy, Mark Weatherall, Richard Beasley, Emma L. Ball, Graham Simpson, Diana Egerton-Warburton, Y.C. Gary Lee, Simon G.A. Brown
Extract There is increasing evidence supporting conservative management for patients with primary spontaneous pneumothorax (PSP), regardless of size [1, 2], which is reflected in the recent British Thoracic Society guidelines [3]. However, the size of the pneumothorax on the radiograph likely still has an important influence on management decisions, as illustrated by a recent interactive clinical decision
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A composite reference standard is needed for bedaquiline antimicrobial susceptibility testing for Mycobacterium tuberculosis complex Eur. Respir. J. (IF 16.6) Pub Date : 2024-07-11 Claudio U. Köser, Paolo Miotto, Nabila Ismail, Richard M. Anthony, Christian Utpatel, Matthias Merker, Stefan Niemann, Sabira Tahseen, Leen Rigouts, Camilla Rodrigues, Shaheed V. Omar, Maha R. Farhat, Uladzimir Antonenka, Harald Hoffmann, Daniela M. Cirillo, Thomas Schön
Extract We echo the latest calls that have been made to increase the capacity for antimicrobial susceptibility testing (AST) for bedaquiline for the Mycobacterium tuberculosis complex [1, 2]. However, we would like to highlight the limitations of using insufficiently standardised or validated phenotypic AST methods and breakpoints as the reference standard for bedaquiline AST. Moreover, we advocate
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The effects of peripheral chemoreflex suppression on ventilatory efficiency and exercise duration in pulmonary arterial hypertension Eur. Respir. J. (IF 16.6) Pub Date : 2024-07-11 Michael J. Plunkett, Ana Luiza C. Sayegh, Tanya J. McWilliams, Sasiharan Sithamparanathan, Julian F.R. Paton, James P. Fisher
Extract Exercise intolerance is debilitating for people with pulmonary arterial hypertension (PAH), limiting their ability to undertake work and exercise, and impeding daily personal care and household tasks [1]. Dyspnoea limits exercise capacity in PAH and may arise due to ventilatory inefficiency secondary to heightened peripheral chemoreflex sensitivity (i.e. excessive hypoxic ventilatory response)
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Right heart function during and after pregnancy in women with pulmonary arterial hypertension Eur. Respir. J. (IF 16.6) Pub Date : 2024-07-11 Karen M. Olsson, Jan Fuge, Da-Hee Park, Jan C. Kamp, Dominik Berliner, Constantin von Kaisenberg, Marius M. Hoeper
Extract For many years, women diagnosed with pulmonary arterial hypertension (PAH) received advice against pregnancy due to a significant mortality risk [1, 2]. With therapeutic advancements, pregnancies in women with PAH continue to be associated with heightened risks, although uncomplicated pregnancies are increasingly being reported, particularly in women with well-controlled disease [3–6]. The
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Non-arterial line cardiac output calculation misclassifies exercise pulmonary hypertension and increases risk of data loss particularly in black, scleroderma and Raynaud's patients during invasive exercise testing Eur. Respir. J. (IF 16.6) Pub Date : 2024-07-11 Luiz Campedelli, S. Mehdi Nouraie, Michael G. Risbano
Background The direct Fick principle is the standard for calculating cardiac output (CO) to detect CO-dependent conditions like exercise pulmonary hypertension (ePH). Fick COarterial incorporates arterial haemoglobin (Hba) and oxygen saturation (SaO2) with oxygen consumption from exercise testing, while Fick COnon-arterial substitutes mixed venous haemoglobin (Hbmv) and peripheral oxygen saturation
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Opioids for dyspnoea in interstitial lung disease: does the sequence and timing of therapy matter? Eur. Respir. J. (IF 16.6) Pub Date : 2024-07-11 Meena Kalluri, Subhabrata Moitra, Janice Richman-Eisenstat, Giovanni Ferrara, Elisabeth Bendstrup, Kristoffer Maarsaa
Extract We read the report of Ferreira et al. [1] entitled "Regular, low-dose, sustained-release morphine for persisting breathlessness in interstitial lung disease: a randomised, double-blind, placebo-controlled, crossover trial" with great interest and would like to share our experience and address some limitations of this prospective trial. Dyspnoea assessment and management is undoubtedly challenging
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ERJ Advances: interventional bronchoscopy Eur. Respir. J. (IF 16.6) Pub Date : 2024-07-11 Justin L. Garner, Pallav L. Shah, Felix Herth, Dirk-Jan Slebos
Extract The field of interventional bronchoscopy is rapidly growing, with the development of minimally invasive approaches and innovative devices to diagnose and treat a spectrum of respiratory diseases (figure 1), often as outpatient procedures, and supported by high quality collaborative research. This short review covers aspects related to COPD, peripheral pulmonary nodules, interstitial lung disease
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The carbon footprint of as-needed budesonide/formoterol in mild asthma: a post hoc analysis Eur. Respir. J. (IF 16.6) Pub Date : 2024-07-11 Lee Hatter, Mark Holliday, Allie Eathorne, Pepa Bruce, Ian D. Pavord, Helen K. Reddel, Robert J. Hancox, Alberto Papi, Mark Weatherall, Richard Beasley
Introduction The use of pressurised metered-dose inhalers (pMDIs) and asthma exacerbations necessitating healthcare reviews contribute substantially to the global carbon footprint of healthcare. It is possible that a reduction in carbon footprint could be achieved by switching patients with mild asthma from salbutamol pMDI reliever-based therapy to inhaled corticosteroid-formoterol dry powder inhaler
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Benralizumab in severe eosinophilic asthma by previous biologic use and key clinical subgroups: real-world XALOC-1 programme Eur. Respir. J. (IF 16.6) Pub Date : 2024-07-11 David J. Jackson, Girolamo Pelaia, Benjamin Emmanuel, Trung N. Tran, David Cohen, Vivian H. Shih, Anat Shavit, Douglas Arbetter, Rohit Katial, Adrian Paul J. Rabe, Esther Garcia Gil, Marisa Pardal, Javier Nuevo, Michael Watt, Silvia Boarino, Sheena Kayaniyil, Cláudia Chaves Loureiro, Alicia Padilla-Galo, Parameswaran Nair
Background Pivotal phase 3 trials and real-world studies have demonstrated benralizumab's overall efficacy and safety in severe eosinophilic asthma (SEA). Additional large-cohort data are needed to confirm its real-world effectiveness in SEA according to previous biologic use and key baseline characteristics important for treatment selection. Methods XALOC-1 is a large, multinational, retrospective
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TB PCR in BAL and EBUS-TBNA samples for the diagnosis of pulmonary and mediastinal lymph node TB: retrospective TRiBE study Thorax (IF 9.0) Pub Date : 2024-07-08 Mirae Park, Kartik Kumar, Meg Coleman, Laura Martin, Georgina Russell, Pauline Scheelbeek, Ajit Lalvani, Giovanni Satta, Onn Min Kon
Introduction The role of Xpert Ultra in bronchoalveolar lavage (BAL) and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) samples for pulmonary and mediastinal lymph node tuberculosis (TB) remains unclear. Methods This was a retrospective observational service evaluation at a tertiary TB centre in a low-incidence setting. The diagnostic indices of Xpert Ultra, smear and
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Angiosarcoma of the pulmonary artery as an unexpected evolution of an apparent pulmonary thromboembolism Thorax (IF 9.0) Pub Date : 2024-07-08 Angela Bronte, Sofia González-Ibán, Elia Lecumberri de Fuentes, Héctor Lajusticia
A 70-year-old woman, non-smoker, with previous SARS-CoV-2 infection 6 months ago and 1-month history of cough and expectoration, presented with acute left pleuritic pain and progressive dyspnoea. She was referred to the emergency department, where a chest X-ray showed a left pleural effusion. To exclude a pulmonary embolism (PE), a CT pulmonary angiogram (CTPA) was performed. It demonstrated a filling
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Xpert Ultra for diagnosing tuberculosis at bronchoscopy: thoughts on practical applications Thorax (IF 9.0) Pub Date : 2024-07-08 Graham Bothamley
Tests based on polymerase chain reactions are increasingly important in the microbiological diagnosis of tuberculosis (TB). Park et al1 have extended the use of Xpert Ultra to include material obtained at bronchoscopy, and particularly its use for samples obtained by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). In addition, immediate cytology with rapid onsite evaluation
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Multiple intrathoracic extramedullary haematopoiesis as visualised on medical thoracoscopy Thorax (IF 9.0) Pub Date : 2024-07-05 Jiun Hang Lee, Larry Ellee Nyanti, Nai-Chien Huan, Hema Yamini Ramarmuty, Kunji Kannan Sivaraman Kannan
A 38-year-old man with underlying transfusion-dependent beta-thalassemia and a history of splenectomy in August 2023 presented in December of the same year, complaining of one month of dyspnoea and orthopnoea. The chest radiograph revealed bilateral pleural effusion, with a left-sided predominance. Diagnostic and therapeutic thoracentesis demonstrated straw-coloured serous pleural fluid (pf) with an
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Epidemiology of childhood interstitial lung disease in France: the RespiRare cohort Thorax (IF 9.0) Pub Date : 2024-07-04 Camille Fletcher, Alice Hadchouel, Caroline Thumerelle, Julie Mazenq, Manon Fleury, Harriet Corvol, Nouha Jedidi, Myriam Benhamida, Katia Bessaci, Tiphaine Bilhouee, Raphael Borie, Jacques Brouard, Aurélie Cantais, Annick Clement, Laurianne Coutier, Camille Cisterne, Pierrick Cros, Marie-Laure Dalphin, Christophe Delacourt, Eric Deneuville, Jean-Christophe Dubus, Carole Egron, Ralph Epaud, Michael
Introduction Interstitial lung disease in children (chILD) are rare and mostly severe lung diseases. Very few epidemiological data are available in limited series of patients. The aim of this study was to assess the prevalence and incidence of chILD in France. Methods We performed within the RespiRare network a multicentre retrospective observational study in patients with chILD from 2000 to 2022 and
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Environmental exposures associated with early childhood recurrent wheezing in the mother and child in the environment birth cohort: a time-to-event study Thorax (IF 9.0) Pub Date : 2024-07-04 Kareshma Asharam, Aweke A Abebaw Mitku, Lisa Ramsay, Prakash Mohan Jeena, Rajen N Naidoo
Background Antenatal factors and environmental exposures contribute to recurrent wheezing in early childhood. Aim To identify antenatal and environmental factors associated with recurrent wheezing in children from birth to 48 months in the mother and child in the environment cohort, using time-to-event analysis. Method Maternal interviews were administered during pregnancy and postnatally and children
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Antibiotic pharmacokinetics in infected pleural effusions Thorax (IF 9.0) Pub Date : 2024-07-04 David T Arnold, Liam Read, Oliver Waddington, Fergus W Hamilton, Sonia Patole, Jessica Hughes, Alice Milne, Alan Noel, Mark Bayliss, Nicholas A Maskell, Alasdair MacGowan
Pleural infection is usually treated with empirical broad-spectrum antibiotics, but limited data exist on their penetrance into the infected pleural space. We performed a pharmacokinetic study analysing the concentration of five intravenous antibiotics across 146 separate time points in 35 patients (amoxicillin, metronidazole, piperacillin-tazobactam, clindamycin and cotrimoxazole). All antibiotics
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When is an AVM not an AVM? Thorax (IF 9.0) Pub Date : 2024-07-02 Alice Parry, Amir Awwad, Geoffrey Lie, Matt Matson, William Martin Ricketts
Pulmonary arteriovenous malformations (pAVMs) are abnormal connections between branches of the pulmonary artery and vein resulting in right-to-left shunting of blood. They are the most common pulmonary vascular malformations, with an estimated incidence of 1 in 2600, and typically congenital.1 There is a 30% lifetime risk of shunt related complications, such as stroke or cerebral abscess, secondary
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Association between socioeconomic deprivation, ethnicity and health outcomes in preschool children with recurrent wheeze in England: a retrospective cohort study Thorax (IF 9.0) Pub Date : 2024-07-02 David Lo, Claire Lawson, Clare Gillies, Sharmin Shabnam, Erol A Gaillard, Hilary Pinnock, Jennifer K Quint
Background Preschool-aged children have among the highest burden of acute wheeze. We investigated differences in healthcare use, treatment and outcomes for recurrent wheeze/asthma in preschoolers from different ethno-socioeconomic backgrounds. Methods Retrospective cohort study using data from the Clinical Practice Research Datalink linked to Hospital Episode Statistics in England. We reported number
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Unveiling the occupational hazards: exploring the association between organic dust exposure and hypersensitivity pneumonitis and other interstitial lung diseases Thorax (IF 9.0) Pub Date : 2024-06-29 Sheikh M Alif, Geza Benke
Organic dusts are mixtures of particles originating from plants, animals and often endotoxins from gram-negative bacteria. Several occupations, including farming (where exposures can occur during grain, animal handling and feeding), woodworking (where exposures can occur from wood dust) and textile work (during cotton processing), are the primary sources of occupational exposure to organic dust.1 2
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Moving the needle on proteasome inhibitor-induced pulmonary arterial hypertension: a definite maybe Eur. Respir. J. (IF 16.6) Pub Date : 2024-06-28 Brandon Budhram, Roham T. Zamanian, Jason Weatherald
Extract Drug- or toxin-induced pulmonary arterial hypertension (DPAH) is a rare form of group 1 pulmonary arterial hypertension (PAH). In the current PAH classification, the association between drugs or toxins and PAH can either be categorised as "definite" or "possible", with definite associations requiring data from outbreaks, epidemiological case–control studies, and/or large multicentre cohort