Guideline concordance for timely chest imaging after new presentations of dyspnoea or haemoptysis in primary care: a retrospective cohort study
Conclusion
The likelihood of receiving urgent imaging concords with the risk of subsequent cancer diagnosis. Nevertheless, large proportions of dyspnoea and haemoptysis presenters do not receive prompt chest imaging despite being eligible, indicating opportunities for earlier lung cancer diagnosis. (Source: Thorax)
Source: Thorax - February 15, 2024 Category: Respiratory Medicine Authors: Koo, M. M., Mounce, L. T. A., Rafiq, M., Callister, M. E. J., Singh, H., Abel, G. A., Lyratzopoulos, G. Tags: Open access, Thorax Lung cancer Source Type: research
Elevated ferritin, mediated by IL-18 is associated with systemic inflammation and mortality in acute respiratory distress syndrome (ARDS)
Conclusions
Ferritin is a clinically useful biomarker in ARDS and is associated with worse patient outcomes. These results provide support for prospective interventional trials of immunomodulatory agents targeting IL-18 in this hyperferritinaemic subgroup of patients with ARDS. (Source: Thorax)
Source: Thorax - February 15, 2024 Category: Respiratory Medicine Authors: Mehta, P., Samanta, R. J., Wick, K., Coll, R. C., Mawhinney, T., McAleavey, P. G., Boyle, A. J., Conlon, J., Shankar-Hari, M., Rogers, A., Calfee, C. S., Matthay, M. A., Summers, C., Chambers, R. C., McAuley, D. F., O'Kane, C. M. Tags: Thorax Critical care Source Type: research
Lower airway microbiota in COPD and healthy controls
Conclusion
The lower airway microbiota is equal in richness in patients with COPD to controls, but less even. Genera from the Firmicutes phylum thrive particularly in COPD airways. Smoking has different effects on diversity and taxonomic abundance in patients with COPD compared with controls. COPD severity and ICS use were not linked to the lower airway microbiota. (Source: Thorax)
Source: Thorax - February 15, 2024 Category: Respiratory Medicine Authors: Tangedal, S., Nielsen, R., Aanerud, M., Drengenes, C., Husebo, G. R., Lehmann, S., Knudsen, K. S., Hiemstra, P. S., Eagan, T. M. Tags: Thorax Chronic obstructive pulmonary disease Source Type: research
Cluster randomised controlled trial of specialist-led integrated COPD care (INTEGR COPD)
Conclusion
This is the first study to demonstrate that guideline adherence is improved through the integration of respiratory specialists into GP practices to deliver annual COPD reviews. To facilitate changes in current healthcare practice and policy, the findings of this paper need to be viewed in combination with qualitative research exploring the acceptability of specialist integration.
Trial registration number
NCT03482700. (Source: Thorax)
Source: Thorax - February 15, 2024 Category: Respiratory Medicine Authors: Patel, K., Pye, A., Edgar, R. G., Beadle, H., Ellis, P. R., Sitch, A., Dickens, A. P., Turner, A. M. Tags: Open access, Thorax Chronic obstructive pulmonary disease Source Type: research
Cause-specific mortality in COPD subpopulations: a cohort study of 339 647 people in England
Conclusion
Poorer airflow limitation, worse functional status and exacerbations had substantial associations with risk of all-cause mortality. Differing results for CV and COPD-related mortality suggests interventions to prevent mortality may need to target particular characteristics or time points in the disease course. (Source: Thorax)
Source: Thorax - February 15, 2024 Category: Respiratory Medicine Authors: Whittaker, H., Rothnie, K. J., Quint, J. K. Tags: Open access, Thorax Chronic obstructive pulmonary disease Source Type: research
Identifying a hyperinflammatory subphenotype of ARDS associated with worse outcomes: may ferritin help?
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 have led to elucidation of the role of respiratory microbiome4 and to identification both in patients at risk of ARDS5 and in patients with ARDS6 of reproducible subphenotypes, such as the ‘hypoinflammatory’ and &...
Source: Thorax - February 15, 2024 Category: Respiratory Medicine Authors: Torres, L. K., Siempos, I. I. Tags: Thorax Editorial Source Type: research
Integrated stop smoking interventions are essential to maximise the health benefits from lung cancer screening
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 a targeted lung cancer screening programme and within their recommendations, proposed that smoking cessation service provision should be integrated. The roll-out of such a programme has the potential to not only improve lun...
Source: Thorax - February 15, 2024 Category: Respiratory Medicine Authors: Smith, P., Murray, R. L., Crosbie, P. A. Tags: Thorax Editorial Source Type: research
Lung function as independent predictor of cardiovascular disease risk: implications for practice and policy
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 disease (COPD) have 2–5 times higher CVD risk.3 The association between respiratory impairment and CVD is not restricted to individuals with diagnosed respiratory conditions. Indeed, several studies have shown that im...
Source: Thorax - February 15, 2024 Category: Respiratory Medicine Authors: Lee, T. Y., Sadatsafavi, M. Tags: Thorax Editorial Source Type: research
Unmasking delays: bridging the gap in timely lung cancer diagnosis for UK primary care
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 to fatigue and burnout.2 In short, life as a general practitioner (GP) in the UK is not easy, the pressures are real and ultimately, patients will suffer. Patients presenting with symptoms of potential lung cancer is just one...
Source: Thorax - February 15, 2024 Category: Respiratory Medicine Authors: Hickman, K. Tags: Thorax Editorial Source Type: research
Journal club
Follow the stars: blood eosinophil-directed treatment of COPD exacerbations Oral corticosteroids (OCS) have been the acute treatment for COPD exacerbations for decades based on small trials primarily conducted in inpatients. But OCS have devastating long-term risks that increase cumulatively with dose. Ramakrishnan and colleagues (Lancet Respiratory Medicine 2023, DOI: 10.1016 /S2213-2600(23)00298-9) tested whether blood eosinophil-directed prednisolone treatment (BET) was non-inferior to standard treatment with prednisolone (ST) in this multicentre, double-blind, randomised, placebo-controlled trial (STARR2). In 14 UK-bas...
Source: Thorax - January 18, 2024 Category: Respiratory Medicine Authors: Howell, I. Tags: Thorax Journal club Source Type: research
Diffuse hyperdense micronodular airspace opacities in pulmonary alveolar microlithiasis
A 44-year-old woman with a childhood history of pulmonary tuberculosis presented with mild exertional dyspnoea and abnormal chest radiographic imaging (figure 1) obtained at an external facility, which showed diffuse, fine calcific micronodules throughout the lung parenchyma. She was informed of an incidental finding of ‘lung disease’ 15 years prior after a motor vehicle accident, for which she was unable to obtain follow-up. She had no other symptoms; physical examination and laboratory results were unremarkable. Chest CT imaging (figure 2) demonstrated diffuse hyperdense micronodular airspace opacities indica...
Source: Thorax - January 18, 2024 Category: Respiratory Medicine Authors: Mathavan, A., Mathavan, A., Witten, C., Ataya, A. Tags: Images in Thorax, Thorax Source Type: research
Ethnic variation in asthma phenotypic presentation and outcomes: a cross-sectional analysis of the UK Biobank
We described demographic and clinical characteristics by ethnicity and country of birth within the UK Biobank. Lung function and asthma hospitalisations were similar for white, black and North-East Asian participants, however, South-East (SE) Asians more commonly had an FEV1 below the lower limits of normal (LLN; 53.8% vs 32.3%, p<0.001), blood eosinophilia (38.6% vs 23.8%, p<0.001) and asthma hospitalisation (12.5% vs 8.3%, p<0.001) than white participants. First-generation SE Asian immigrants had poorer lung function (57.7% vs 27.7% FEV1 below LLN, p<0.001) than UK/Ireland born participants. These data demons...
Source: Thorax - January 18, 2024 Category: Respiratory Medicine Authors: Busby, J., McDowell, P. J., Pfeffer, P. E., Mansur, A. H., Heaney, L. G. Tags: Thorax Short report Source Type: research
Short peripheral blood leukocyte telomere length in rheumatoid arthritis-interstitial lung disease
Shortened telomere lengths (TLs) can be caused by single nucleotide polymorphisms and loss-of-function mutations in telomere-related genes (TRG), as well as ageing and lifestyle factors such as smoking. Our objective was to determine if shortened TL is associated with interstitial lung disease (ILD) in individuals with rheumatoid arthritis (RA). This is the largest study to demonstrate and replicate that shortened peripheral blood leukocytes-TL is associated with ILD in patients with RA compared with RA without ILD in a multinational cohort, and short PBL-TL was associated with baseline disease severity in RA-ILD as measur...
Source: Thorax - January 18, 2024 Category: Respiratory Medicine Authors: Doyle, T. J., Juge, P.-A., Peljto, A. L., Lee, S., Walts, A. D., Esposito, A. J., Poli, S., Gill, R., Hatabu, H., Nishino, M., Dellaripa, P. F., Weinblatt, M. E., Shadick, N. A., Demoruelle, M. K., Sparks, J. A., Rosas, I. O., Granger, B., Deane, K. D., C Tags: Thorax Short report Source Type: research
Appraising the causal role of smoking in idiopathic pulmonary fibrosis: a Mendelian randomization study
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 variants) were associated with a higher risk of IPF. Our study suggests a potential causal effect of smoking on increasing IPF risk from a genetic perspective. (Source: Thorax)
Source: Thorax - January 18, 2024 Category: Respiratory Medicine Authors: Zhu, J., Zhou, D., Yu, M., Li, Y. Tags: Thorax Short report Source Type: research
Association of indicators of extensive disease and rifampin-resistant tuberculosis treatment outcomes: an individual participant data meta-analysis
Conclusion
Only the combination of AFB smear-positivity and lung cavitation was associated with unfavourable outcomes, suggesting they may benefit from stronger regimens. (Source: Thorax)
Source: Thorax - January 18, 2024 Category: Respiratory Medicine Authors: Campbell, J. R., Brode, S. K., Barry, P., Bastos, M. L., Bonnet, M., Guglielmetti, L., Kempker, R., Klimuk, D., Laborin, R. L., Milanov, V., Singla, R., Skrahina, A., Trajman, A., van der Werf, T. S., Viiklepp, P., Menzies, D. Tags: Editor's choice, Thorax Tuberculosis Source Type: research
