Pulmonary emphysema subtypes defined by unsupervised machine learning on CT scans
Conclusion
Large-scale unsupervised machine learning on CT scans defined six reproducible, familiar CT emphysema subtypes that suggest paths to specific diagnosis and personalised therapies in COPD and pre-COPD. (Source: Thorax)
Source: Thorax - October 17, 2023 Category: Respiratory Medicine Authors: Angelini, E. D., Yang, J., Balte, P. P., Hoffman, E. A., Manichaikul, A. W., Sun, Y., Shen, W., Austin, J. H. M., Allen, N. B., Bleecker, E. R., Bowler, R., Cho, M. H., Cooper, C. S., Couper, D., Dransfield, M. T., Garcia, C. K., Han, M. K., Hansel, N. N. Tags: Thorax Chronic obstructive pulmonary disease Source Type: research
Searching, again, for answers in all the wrong places
It was 1980 when Johnny Lee’s recording of ‘Lookin’ for Love (in all the wrong places)’ was released with the soundtrack of Urban Cowboy. In 1993, Dans paraphrased the title in ‘Looking for Answers in All the Wrong Places’ with an editorial that expounded on the discrepancies between a well-curated clinical data set and an ICD-9-CM (international classification of diseases, ninth revision, clinical modification) administrative data set.1 Responding to a report comparing clinical and administrative data to identify 12 straight-forward adult cardiovascular conditions, he added analyses and...
Source: Thorax - October 17, 2023 Category: Respiratory Medicine Authors: Fackler, J. Tags: Thorax Editorial Source Type: research
Reimagining emphysema for a computational age
Emphysema remains an enigma. Visual classification of emphysema on CT imaging has remained unchanged for over 30 years and essentially constitutes the identification of three disease patterns: centrilobular,1 2 paraseptal3 or panlobular4 emphysema. This classification originates from anatomical descriptions dating from the 1950s specifying the location of airspace destruction within the acinus or lobule and the proximity of emphysema to the visceral pleura. The extrapolation of histopathological scale features of damage5 6 to the clinical CT scale was a key milestone in the early years of lung CT interpretation. Yet, when ...
Source: Thorax - October 17, 2023 Category: Respiratory Medicine Authors: Jacob, J. Tags: Thorax Editorial Source Type: research
'Let Africa Breath: air pollution, environmental exposures and lung health - an ongoing challenge
Air pollution, a recognised global health emergency, that disproportionately affects low-income and middle-income countries (LMICs)1 and has increasingly been implicated in a range of respiratory illnesses and other adverse health outcomes.2 In sub-Saharan Africa, this has been compounded by the challenging socioeconomic and environmental conditions that many communities live in due to rapid urbanisation and burgeoning informal settlements.3 Despite the high burden of infectious diseases in Africa, asthma is the most common non-communicable disease with an increasing prevalence in children and adolescents.4 Understanding t...
Source: Thorax - October 17, 2023 Category: Respiratory Medicine Authors: Vanker, A. Tags: Thorax Editorial Source Type: research
Pirfenidone in fibrotic hypersensitivity pneumonitis: is it ready for prime time?
The diagnosis and treatment of fibrotic hypersensitivity pneumonitis (fHP) poses significant challenges. Its differentiation from idiopathic interstitial pneumonias can be problematic, but is important as fHP, especially the presence of fibrosis, has been associated with significant morbidity and mortality.1 The challenges posed by accurate diagnosis have been highlighted in a multicentre study demonstrating poor multidisciplinary agreement in the diagnoses of HP compared with idiopathic pulmonary fibrosis (IPF).2 A consensus-based diagnostic approach has been established,3 with the subsequent development of an internation...
Source: Thorax - October 17, 2023 Category: Respiratory Medicine Authors: Assayag, D., Chaudhuri, N. Tags: Thorax Editorial Source Type: research
Whats new in pleural disease?
This month sees publication of the new BTS guideline for pleural disease,1 the first update since 2010. In parallel, advice on pleural interventions is covered by the first BTS Clinical Statement on Pleural Procedures.2 Over the last decade, there has been a burgeoning interest in this subspeciality area and with this have come a number of advances driven by high-quality practice changing studies. For the 2023 update, rather than covering every aspect of pleural disease, the review committee has chosen to focus on spontaneous pneumothorax, undiagnosed unilateral pleural effusion, pleural infection and pleural malignancy (e...
Source: Thorax - October 17, 2023 Category: Respiratory Medicine Authors: Rintoul, R. C., Marciniak, S. J. Tags: Thorax Editorial Source Type: research
Journal club
Dupilumab for patients with COPD and blood eosinophilia reduces exacerbation frequency There is increasing interest in phenotypes of patients with COPD that may indicate different response to treatments. Patients with COPD and type 2 inflammation have been shown to have a different response to glucocorticoids and so may also respond to other anti-inflammatory medications. The BOREAS trial (NEJM 2023: DOI 10.1056/NEJMoa2303951) was a phase 3, international, multicentre, randomised, double-blind, placebo-controlled study designed to investigate the safety and the efficacy of dupilumab (a fully human monoclonal antibody that ...
Source: Thorax - September 15, 2023 Category: Respiratory Medicine Authors: Rodrigues, J. O. Tags: Thorax Journal club Source Type: research
Fibrosing mediastinitis: 'haemoptysis in the Heartland
Fibrosing mediastinitis (FM) is an uncommon cause of haemoptysis, characterised by sclerosis of the mediastinum that may occur as an inflammatory sequela of histoplasmosis, lymphoma, sarcoidosis or an idiopathic process. Bleeding is predominantly due to concomitant collateral vessels and engorgement. However, the endobronchial findings obtained via flexible bronchoscopy are not clearly defined in the literature.1 Here, we present the case of a 41-year-old woman with no prior medical history who presented with a 2-month history of exertional dyspnoea and recurrent haemoptysis. Chest CT showed complete obstruction of the rig...
Source: Thorax - September 15, 2023 Category: Respiratory Medicine Authors: Ntiamoah, P., Shah, J. R., Ghosh, S., Mehta, A. Tags: Images in Thorax, Thorax Source Type: research
British Thoracic Society Guideline for diagnosing and monitoring paediatric sleep-disordered breathing
Introduction The following is a summary of the British Thoracic Society (BTS) Guideline for diagnosing and monitoring paediatric sleep-disordered breathing (SDB) and includes a summary of the recommendations and good practice points (GPPs). The full guideline is published as a separate Thorax Supplement1 and is available from the BTS website.52 Please refer to the full guideline for full information about each section.1 All online supplemental appendices are also available via the BTS website.2 Background The aim of the guideline was to provide clarification on the use of diagnostic tools and recordings in the diagnosis an...
Source: Thorax - September 15, 2023 Category: Respiratory Medicine Authors: Evans, H. J., Gibson, N. A., Bennett, J., Chan, S. Y., Gavlak, J., Harman, K., Ismail-Koch, H., Kingshott, R. N., Langley, R., Morley, A., Opstad, K. S., Russo, K., Samuels, M. P., Tan, H. L., Tweedie, D., Yanney, M., Whitney, A. Tags: Thorax Guideline summary Source Type: research
Pulmonary telerehabilitation vs. conventional pulmonary rehabilitation - a secondary responder analysis
Home-based pulmonary telerehabilitation (PTR) has been proposed to be equivalent to supervised outpatient pulmonary rehabilitation (PR) but available randomised trials have failed to reach the minimal important changes (MIC). The purpose of this study was to analyse the proportion of MIC responders and non-responders on short-term (10 weeks from baseline) and long-term (62 weeks from baseline) in total and between groups in 134 patients with COPD randomised (1:1) to either home-based PTR or traditional hospital-based outpatient PR. Difference between PTR and PR on 6MWD response proportion could not be shown at 10 (OR=0.72,...
Source: Thorax - September 15, 2023 Category: Respiratory Medicine Authors: Hansen, H., Torre, A., Kallemose, T., Ulrik, C. S., Godtfredsen, N. S. Tags: Open access, Thorax Short report Source Type: research
Understanding the effectiveness of different exercise training programme designs on VO2peak in COPD: a component network meta-analysis
Pulmonary rehabilitation programmes including aerobic training improve cardiorespiratory fitness in patients with COPD, but the optimal programme design is unclear. We used random effects additive component network meta-analysis to investigate the relative effectiveness of different programme components on fitness measured by VO2peak in COPD. The included 59 studies involving 2191 participants demonstrated that VO2peak increased after aerobic training of at least moderate intensity with the greatest improvement seen following high intensity training. Lower limb aerobic training (SMD 0.56 95% CI 0.32;0.81, intervention arms...
Source: Thorax - September 15, 2023 Category: Respiratory Medicine Authors: Ward, T. J., Plumptre, C. D., Fraser-Pye, A. V., Dolmage, T. E., Jones, A. V., Trethewey, R., Latimer, L., Singh, S. J., Lindley, M. R., Steiner, M. C., Evans, R. A. Tags: Thorax Short report Source Type: research
Higher SARS-CoV-2 detection of oropharyngeal compared with nasopharyngeal or saliva specimen for molecular testing: a multicentre randomised comparative accuracy study
Conclusions
OPSs were associated with higher SARS-CoV-2 detection and lower test-related discomfort than NPSs for SARS-CoV-2 testing. Saliva sampling had the lowest SARS-CoV-2 detection but was the least costly strategy for mass testing.
Trial registration number
NCT04715607. (Source: Thorax)
Source: Thorax - September 15, 2023 Category: Respiratory Medicine Authors: Todsen, T., Tolsgaard, M. G., Benfield, T., Folke, F., Jakobsen, K. K., Gredal, N. T., Ersboll, A. K., von Buchwald, C., Kirkby, N. Tags: Open access, Thorax, COVID-19 Respiratory infection Source Type: research
Tracheostomy in children is associated with neutrophilic airway inflammation
Conclusions
Long-term childhood tracheostomy is associated with a inflammatory tracheal phenotype characterised by neutrophilic inflammation and the ongoing presence of potential respiratory pathogens. These findings suggest neutrophil recruitment and activation as potential exploratory targets in seeking to prevent recurrent airway complications in this vulnerable group of patients. (Source: Thorax)
Source: Thorax - September 15, 2023 Category: Respiratory Medicine Authors: Powell, J., Powell, S., Mather, M. W., Beck, L., Nelson, A., Palmowski, P., Porter, A., Coxhead, J., Hedley, A., Scott, J., Rostron, A. J., Hellyer, T. P., Zaidi, F., Davey, T., Garnett, J. P., Agbeko, R., Ward, C., Stewart, C. J., Taggart, C. C., Brodlie Tags: Open access, Thorax Paediatric lung disease Source Type: research
Emulated trial investigating effects of multiple treatments: estimating combined effects of mucoactive nebulisers in cystic fibrosis using registry data
Conclusion
For individuals with CF prescribed DNase, we found no evidence that adding HS had an effect on FEV1% or prescription of intravenous antibiotics. Our study illustrates the emulated target trial approach using CF Registry data. (Source: Thorax)
Source: Thorax - September 15, 2023 Category: Respiratory Medicine Authors: Granger, E., Davies, G., Keogh, R. H. Tags: Open access, Thorax Cystic fibrosis Source Type: research
Acetazolamide for metabolic alkalosis complicating respiratory failure with chronic obstructive pulmonary disease or obesity hypoventilation syndrome: a systematic review
Conclusion
Acetazolamide may have little impact on respiratory failure with metabolic alkalosis in patients with chronic respiratory diseases. However, clinically significant benefits or harms are unable to be excluded, and larger trials are required.
PROSPERO registration number
CRD42021278757. (Source: Thorax)
Source: Thorax - September 15, 2023 Category: Respiratory Medicine Authors: Bemand, T. J., Chatoor, R., Natale, P., Strippoli, G., Delaney, A. Tags: Thorax Critical care Source Type: research
