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RESPIRATORY DISEASES (103 journals)                     

Showing 1 - 104 of 104 Journals sorted alphabetically
Advances in Respiratory Medicine     Open Access   (Followers: 7)
Advances in Thoracic Diseases     Open Access  
American Journal of Respiratory and Critical Care Medicine     Full-text available via subscription   (Followers: 257)
American Journal of Respiratory Cell and Molecular Biology     Full-text available via subscription   (Followers: 20)
American Review of Respiratory Disease     Full-text available via subscription   (Followers: 4)
Angiologia e Cirurgia Vascular     Open Access   (Followers: 1)
Annals of the American Thoracic Society     Full-text available via subscription   (Followers: 17)
Annals of Thoracic Medicine     Open Access   (Followers: 6)
Archives of Pulmonology and Respiratory Care     Open Access   (Followers: 1)
Archivos de Bronconeumología     Full-text available via subscription  
Archivos de Bronconeumología (English Edition)     Full-text available via subscription   (Followers: 1)
Asthma Research and Practice     Open Access   (Followers: 2)
BMC Pulmonary Medicine     Open Access   (Followers: 5)
BMJ Open Respiratory Research     Open Access   (Followers: 7)
Breathe     Open Access   (Followers: 5)
Canadian Journal of Respiratory, Critical Care, and Sleep Medicine     Hybrid Journal   (Followers: 1)
Canadian Respiratory Journal     Open Access   (Followers: 3)
Case Reports in Pulmonology     Open Access   (Followers: 3)
Chest     Full-text available via subscription   (Followers: 102)
Chest Disease Reports     Open Access   (Followers: 2)
Chronic Respiratory Disease     Hybrid Journal   (Followers: 9)
Clinical Lung Cancer     Hybrid Journal   (Followers: 6)
Clinical Medicine Insights : Circulatory, Respiratory and Pulmonary Medicine     Open Access   (Followers: 3)
Clinical Pulmonary Medicine     Hybrid Journal   (Followers: 2)
COPD Research and Practice     Open Access   (Followers: 1)
COPD: Journal of Chronic Obstructive Pulmonary Disease     Hybrid Journal   (Followers: 16)
Current Opinion in Pulmonary Medicine     Hybrid Journal   (Followers: 10)
Current Pulmonology Reports     Hybrid Journal  
Current Research in Tuberculosis     Open Access   (Followers: 3)
Current Respiratory Care Reports     Hybrid Journal   (Followers: 2)
Current Respiratory Medicine Reviews     Hybrid Journal   (Followers: 5)
Der Pneumologe     Hybrid Journal   (Followers: 1)
Egyptian Journal of Chest Diseases and Tuberculosis     Open Access   (Followers: 3)
ERJ Open Research     Open Access   (Followers: 3)
Eurasian Journal of Pulmonology     Open Access  
European Clinical Respiratory Journal     Open Access   (Followers: 4)
European Respiratory Journal     Full-text available via subscription   (Followers: 39)
European Respiratory Review     Open Access   (Followers: 7)
Experimental Lung Research     Hybrid Journal   (Followers: 1)
Expert Review of Respiratory Medicine     Hybrid Journal   (Followers: 5)
Heart & Lung: The Journal of Acute and Critical Care     Hybrid Journal   (Followers: 14)
Heart, Lung and Circulation     Full-text available via subscription   (Followers: 9)
Indian Journal of Respiratory Care     Open Access   (Followers: 3)
Indian Journal of Tuberculosis     Full-text available via subscription  
Influenza and Other Respiratory Viruses     Open Access   (Followers: 3)
International Journal of Chronic Obstructive Pulmonary Disease     Open Access   (Followers: 3)
Journal of Association of Chest Physicians     Open Access   (Followers: 2)
Journal of Asthma     Hybrid Journal   (Followers: 5)
Journal of Asthma Allergy Educators     Hybrid Journal   (Followers: 5)
Journal of Bronchology & Interventional Pulmonology     Hybrid Journal   (Followers: 5)
Journal of Clinical Tuberculosis and Other Mycobacterial Diseases     Open Access  
Journal of Heart and Lung Transplantation     Hybrid Journal   (Followers: 12)
Journal of Respiratory Medicine     Open Access   (Followers: 5)
Journal of Respiratory Research     Open Access   (Followers: 2)
Journal of Tuberculosis Research     Open Access   (Followers: 1)
Jurnal Respirasi     Open Access  
Karger Kompass Pneumologie     Full-text available via subscription   (Followers: 1)
Kindheit und Entwicklung     Hybrid Journal  
Lung     Hybrid Journal   (Followers: 3)
Lung Cancer     Hybrid Journal   (Followers: 16)
Lung Cancer International     Open Access   (Followers: 2)
Lung Cancer: Targets and Therapy     Open Access   (Followers: 3)
Lung India     Open Access   (Followers: 1)
Multidisciplinary Respiratory Medicine     Open Access   (Followers: 4)
npj Primary Care Respiratory Medicine     Open Access   (Followers: 2)
Open Journal of Respiratory Diseases     Open Access   (Followers: 2)
Open Respiratory Medicine Journal     Open Access   (Followers: 2)
Paediatric Respiratory Reviews     Hybrid Journal   (Followers: 11)
Pediatric Quality & Safety     Open Access  
Pediatric Respirology and Critical Care Medicine     Open Access   (Followers: 1)
Pulmonary Circulation     Open Access   (Followers: 4)
Pulmonary Medicine     Open Access   (Followers: 3)
Pulmonary Pharmacology & Therapeutics     Hybrid Journal   (Followers: 2)
Pulmonary Therapy     Open Access   (Followers: 2)
Pulmonology and Respiratory Research     Open Access   (Followers: 2)
Respiratory Care     Full-text available via subscription   (Followers: 11)
Respiratory Investigation     Full-text available via subscription   (Followers: 1)
Respiratory Medicine     Hybrid Journal   (Followers: 18)
Respiratory Medicine : X     Open Access  
Respiratory Medicine Case Reports     Open Access  
Respiratory Medicine CME     Hybrid Journal  
Respiratory Medicine Extra     Full-text available via subscription   (Followers: 1)
Respiratory Physiology & Neurobiology     Hybrid Journal   (Followers: 4)
Respiratory Research     Open Access   (Followers: 1)
Respirology     Hybrid Journal   (Followers: 5)
Respirology Case Reports     Open Access  
Revista Americana de Medicina Respiratoria     Open Access  
Revista Chilena de Enfermedades Respiratorias     Open Access  
Revista Inspirar     Open Access  
Revista ORL     Open Access  
Revista Portuguesa de Pneumologia     Open Access  
Sarcoidosis Vasculitis and Diffuse Lung Disese     Full-text available via subscription   (Followers: 3)
Seminars in Respiratory and Critical Care Medicine     Hybrid Journal   (Followers: 14)
Sleep Medicine Reviews     Hybrid Journal   (Followers: 17)
The Clinical Respiratory Journal     Hybrid Journal   (Followers: 3)
The International Journal of Tuberculosis and Lung Disease     Full-text available via subscription   (Followers: 8)
The Lancet Respiratory Medicine     Full-text available via subscription   (Followers: 35)
Therapeutic Advances in Chronic Disease     Open Access   (Followers: 7)
Therapeutic Advances in Respiratory Disease     Open Access   (Followers: 1)
Thorax     Hybrid Journal   (Followers: 38)
Translational Respiratory Medicine     Open Access   (Followers: 1)
Tuberculosis     Hybrid Journal   (Followers: 12)
Tuberculosis Research and Treatment     Open Access   (Followers: 3)
Пульмонология     Full-text available via subscription  

           

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BMJ Open Respiratory Research
Journal Prestige (SJR): 1.188
Citation Impact (citeScore): 2
Number of Followers: 7  

  This is an Open Access Journal Open Access journal
ISSN (Online) 2052-4439
Published by BMJ Publishing Group Homepage  [68 journals]
  • Understanding changes in dyspnoea perception in obstructive lung disease
           after mindfulness training

    • Authors: Malpass, A; Feder, G, Dodd, J. W.
      Abstract: IntroductionDyspnoea has been defined as a ‘subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity’. However, the majority of available dyspnoea measures treat it as a single entity and rely on quantitative methodology. We propose that qualitative research can enhance our understanding of dyspnoea, in particular, how perception varies so much among patients with similar disease states. In this paper, we focus on how a specific type of inner attention—mindfulness—may alter perceptions of dyspnoea. The aim is to characterise mindfulness attention, which impacts on perceptions of dyspnoea and relate these to the multidimensional model of dyspnoea. We explore how an individual can change their perception and therefore relationship to similar disease states.Method22 patients with asthma or chronic obstructive pulmonary disease were recruited from primary and secondary care to an 8-week course in mindfulness-based cognitive therapy (MBCT). 12 patients took part in an in-depth qualitative interview 2 months after completing the MBCT course. Data were recorded, transcribed and then analysed using a framework approach, drawing on components of the multidimensional model of dyspnoea (multidimensional dyspnoea profile, MDP).ResultsWe found that MBCT training involves developing three types of mindful attention (broad attention, informative attention and re-directive attention), which impact on perceptions of the sensory dimension of dyspnoea. MBCT appears to target affective and sensory perceptions articulated in the MDP model.ConclusionMore research is needed into how mindfulness-based interventions may mediate the relationship between affective experience and the sensory perception of dyspnoea symptoms.
      Keywords: Respiratory research
      PubDate: 2018-06-23T04:27:29-07:00
      DOI: 10.1136/bmjresp-2018-000309
      Issue No: Vol. 5, No. 1 (2018)
       
  • British Thoracic Society Guideline for the initial outpatient management
           of pulmonary embolism

    • Authors: Howard, L. S; Barden, S, Condliffe, R, Connolly, V, Davies, C, Donaldson, J, Everett, B, Free, C, Horner, D, Hunter, L, Kaler, J, Nelson-Piercy, C, ODowd, E, Patel, R, Preston, W, Sheares, K, Tait, C.
      Abstract: The following is a summary of the recommendations and good practice points for the BTS Guideline for the initial outpatient management of pulmonary embolism. Please refer to the full guideline for full information about each section.
      PubDate: 2018-06-13T05:18:42-07:00
      DOI: 10.1136/bmjresp-2018-000281
      Issue No: Vol. 5, No. 1 (2018)
       
  • Risk and temporal order of disease diagnosis of comorbidities in patients
           with COPD: a population health perspective

    • Authors: Tenyi, A; Vela, E, Cano, I, Cleries, M, Monterde, D, Gomez-Cabrero, D, Roca, J.
      Abstract: IntroductionComorbidities in patients with chronic obstructive pulmonary disease (COPD) generate a major burden on healthcare. Identification of cost-effective strategies aiming at preventing and enhancing management of comorbid conditions in patients with COPD requires deeper knowledge on epidemiological patterns and on shared biological pathways explaining co-occurrence of diseases.MethodsThe study assesses the co-occurrence of several chronic conditions in patients with COPD using two different datasets: Catalan Healthcare Surveillance System (CHSS) (ES, 1.4 million registries) and Medicare (USA, 13 million registries). Temporal order of disease diagnosis was analysed in the CHSS dataset.ResultsThe results demonstrate higher prevalence of most of the diseases, as comorbid conditions, in elderly (>65) patients with COPD compared with non-COPD subjects, an effect observed in both CHSS and Medicare datasets. Analysis of temporal order of disease diagnosis showed that comorbid conditions in elderly patients with COPD tend to appear after the diagnosis of the obstructive disease, rather than before it.ConclusionThe results provide a population health perspective of the comorbidity challenge in patients with COPD, indicating the increased risk of developing comorbid conditions in these patients. The research reinforces the need for novel approaches in the prevention and management of comorbidities in patients with COPD to effectively reduce the overall burden of the disease on these patients.
      Keywords: Chronic obstructive pulmonary disease
      PubDate: 2018-06-13T05:18:42-07:00
      DOI: 10.1136/bmjresp-2018-000302
      Issue No: Vol. 5, No. 1 (2018)
       
  • Impact of the introduction of a universal childhood influenza vaccination
           programme on influenza-related admissions to paediatric intensive care
           units in England

    • Authors: Hardelid, P; Kapetanstrataki, M, Norman, L, Fleming, S. J, Lister, P, Gilbert, R, Parslow, R. C.
      Abstract: IntroductionA universal childhood influenza vaccination programme was introduced in the UK in September 2013. We examine the impact of the gradual introduction of this programme on influenza-related paediatric intensive care unit (PICU) admission rates in England.MethodsWe extracted data on all influenza-related admissions to PICUs in England in resident children aged 0–15 years old between October 2003 and March 2017 from the Paediatric Intensive Care Audit Network (PICANet) database. We estimated influenza-associated PICU admission rates per 100 000 children by age group, sex and winter season (October to March), and used Poisson regression models to estimate incidence rate ratios (IRRs) in the winter seasons since the introduction of universal childhood vaccination compared with the two winters before the introduction of the programme (2011–2013).ResultsWe identified 929 influenza-related PICU admissions among 873 children. 48.3% of admissions were among children aged less than 2 years old. The influenza-associated PICU admission rate was 1.32 per 100 000 children (95% CI 1.23 to 1.40). We identified a significant increase in influenza PICU admissions in the winters following the introduction of the universal childhood vaccination programme compared with the winters of 2010/2011–2012/2013 among children aged
      Keywords: Respiratory infection
      PubDate: 2018-06-09T06:28:14-07:00
      DOI: 10.1136/bmjresp-2018-000297
      Issue No: Vol. 5, No. 1 (2018)
       
  • Initiation, scale-up and outcomes of the Cambodian National MDR-TB
           programme 2006-2016: hospital and community-based treatment through an
           NGO-NTP partnership

    • Authors: Sam, S; Shapiro, A. E, Sok, T, Khann, S, So, R, Khem, S, Chhun, S, Noun, S, Koy, B, Sayouen, P. C, Im Sin, C, Bunsieth, H, Mao, T. E, Goldfeld, A. E.
      Abstract: IntroductionProlonged inpatient multidrug-resistant tuberculosis (MDR-TB) treatment for all patients is not sustainable for high-burden settings, but there is limited information on community-based treatment programme outcomes for MDR-TB.MethodsThe Cambodian Health Committee, a non-governmental organisation (NGO), launched the Cambodian MDR-TB programme in 2006 in cooperation with the National Tuberculosis Program (NTP) including a community-based treatment option as a key programme component. The programme was transferred to NTP oversight in 2011 with NGO clinical management continuing. Patients electing to receive home-based treatment were followed by a dedicated adherence supporter and a multidisciplinary outpatient team of nurses, physicians and community health workers. Patients hospitalised for>1 month of treatment (hospital based) received similar management after discharge. All patients received a standardised second-line MDR-TB regimen and were provided nutritional and adherence support. Outcomes were reviewed for patients completing 24 months of treatment and predictors of treatment success were evaluated using logistic regression.ResultsOf 582 patients with MDR-TB who initiated treatment between September 2006 and June 2016, 20% were HIV coinfected, 288 (49%) initiated community-based treatment and 294 (51%) received hospital-based treatment. Of 486 patients with outcomes available, 364 (75%) were cured, 10 (2%) completed, 28 (6%) were lost to follow-up, 3 (0.6%) failed and 77 (16%) died. There was no difference between treatment success in community versus hospital-based groups (adjusted OR (aOR) 1.0, p=0.99). HIV infection, older age and body mass index
      Keywords: Tuberculosis
      PubDate: 2018-06-04T03:51:22-07:00
      DOI: 10.1136/bmjresp-2017-000256
      Issue No: Vol. 5, No. 1 (2018)
       
  • Pre-EDIT: protocol for a randomised feasibility trial of
           elastance-directed intrapleural catheter or talc pleurodesis (EDIT) in
           malignant pleural effusion

    • Authors: Martin, G. A; Tsim, S, Kidd, A. C, Foster, J. E, McLoone, P, Chalmers, A, Blyth, K. G.
      Abstract: IntroductionNon-expansile lung (NEL) is a common cause of talc pleurodesis (TP) failure in malignant pleural effusion (MPE), but is often occult prior to drainage. Reliable detection of NEL would allow patients to be allocated between intrapleural catheter (IPC) and TP. High pleural elastance (PEL) has been associated with NEL in observational studies. Pre-EDIT is a randomised feasibility trial of elastance-directed IPC or TP (EDIT) management using a novel, purpose-built digital pleural manometer (Rocket Medical, UK).Methods and analysisConsecutive patients with MPE without prior evidence of NEL or preference for IPC will be randomised 1:1 between EDIT management and standard care (an attempt at TP). The primary objective is to determine whether sufficient numbers of patients (defined as 30 within 12 months (or 15 over 6 months)) can be recruited and randomised to justify a subsequent phase III trial testing the efficacy of EDIT management. Secondary objectives include safety, technical feasibility and validation of study design elements, including the definition of PEL using 4D pleural MRI before and after fluid aspiration. EDIT involves PEL assessment during a large volume pleural fluid aspiration, followed by an attempt at TP or placement of an IPC within 24 hours. Patients will be allocated to IPC if the rolling average PEL sustained over at least 250 mL fluid aspirated (PEL250) is ≥ 14.5 cm H2O/L.Ethics and disseminationPre-EDIT was approved by the West of Scotland Regional Ethics Committee on 8 March 2017 (Ref: 17/WS/0042). Results will be presented at scientific meetings and published in peer-reviewed journals.Trial registration numberNCT03319186; Pre-results.
      PubDate: 2018-05-29T02:28:25-07:00
      DOI: 10.1136/bmjresp-2018-000293
      Issue No: Vol. 5, No. 1 (2018)
       
  • Psychometric properties of the St Georges Respiratory Questionnaire in
           patients with idiopathic pulmonary fibrosis: insights from the INPULSIS
           trials

    • Authors: Swigris, J. J; Wilson, H, Esser, D, Conoscenti, C. S, Stansen, W, Kline Leidy, N, Brown, K. K.
      Abstract: IntroductionWe evaluated the psychometric properties of the St George’s Respiratory Questionnaire (SGRQ) in patients with idiopathic pulmonary fibrosis (IPF) using data from the two INPULSIS trials.MethodsData from 1061 patients treated with nintedanib or placebo were pooled. Internal consistency, test–retest reliability, construct validity, known-groups validity, responsiveness and responder thresholds were examined.ResultsCronbach’s α was 0.93 for SGRQ total score and>0.75 for domain scores. In patients with stable disease based on change in forced vital capacity (FVC) ≤5% predicted or ‘no change’ on Patient’s Global Impression of Change, intraclass correlation coefficients for the SGRQ total score were 0.72 or 0.76, respectively. Moderate to strong correlations were observed between SGRQ total and domain scores and the Cough and Sputum Assessment Questionnaire cough domains (–0.34 to –0.65), University of California San Diego Shortness of Breath Questionnaire (0.56 to 0.83) and EuroQol 5-Dimensional Quality of Life Questionnaire Visual Analogue Scale (–0.41 to –0.55); correlations with FVC % predicted were weak (–0.24 to –0.30). Longitudinal correlations between changes in SGRQ total score and these patient-reported outcomes over 52 weeks were moderate. Changes in SGRQ total, impact and activity scores were sensitive to detecting improvement or deterioration in FVC>10% predicted at week 52. Collectively, distribution-based and anchor-based approaches suggested using a change of 4–5 points in SGRQ total score as a starting point for responder analyses.ConclusionsThe psychometric properties of the SGRQ support its use as a measure of health-related quality of life in patients with IPF.
      Keywords: Interstitial lung disease
      PubDate: 2018-05-18T23:42:54-07:00
      DOI: 10.1136/bmjresp-2018-000278
      Issue No: Vol. 5, No. 1 (2018)
       
  • Image enhancement technology in bronchoscopy: a prospective multicentre
           study in lung cancer

    • Authors: van der Heijden, E. H. F. M; Candoli, P, Vasilev, I, Messi, A, Perez Pallares, J, Yablonskii, P, van der Vorm, A, Schuurbiers, O. C. J, Hoefsloot, W.
      Abstract: IntroductionPatients with lung cancer may present with additional lesions in the central airways. Earlier studies have shown a relationship between vessel diameter, pattern and grade of malignancy. High-definition (HD+) bronchoscopy with image enhancement techniques (i-scan) detected more vascular abnormalities but correlation with pathology has not yet been established.MethodsIn this investigator-initiated, randomised, controlled, crossover, multicentre study in patients with suspected lung cancer, a HD+ bronchoscopy was performed with i-scan1 and i-scan2 settings in random order. Biopsies, visual grade and vascular pattern classification were obtained by endoscopists and blinded evaluation.ResultsIn 107 patients, vascular patterns were classified in 48 tumours. Abrupt-ending vessels were predominantly found in squamous cell carcinoma but overall correlation between vessel pattern and histology was not significant (p=0.339). Additional lesions were detected in 35 patients (33%) with a correlation between vessel pattern and high-grade (pre-)invasive lesions (p
      Keywords: Lung cancer
      PubDate: 2018-05-18T23:42:54-07:00
      DOI: 10.1136/bmjresp-2018-000295
      Issue No: Vol. 5, No. 1 (2018)
       
  • Chlamydia pneumoniae-induced tumour necrosis factor alpha responses are
           lower in children with asthma compared with non-asthma

    • Authors: Smith-Norowitz, T. A; Chotikanatis, K, Weaver, D, Ditkowsky, J, Norowitz, Y. M, Hammerschlag, M. R, Joks, R, Kohlhoff, S.
      Abstract: Introduction Chlamydia pneumoniae respiratory tract infection has been implicated in the pathogenesis of reactive airway disease and asthma. Innate cytokine responses that are protective of infection with intracellular pathogens may be impaired in patients with asthma. Tumour necrosis factor alpha (TNF-α) is a cytokine related to functions of monocytes and may inhibit C. pneumoniae infection. We investigated TNF-α responses in C. pneumoniae-infected peripheral blood mononuclear cells (PBMCs) in patients with asthma and non-asthma, and whether ciprofloxacin, azithromycin or doxycycline affects TNF-α responses.MethodsPBMC (1.5x106) from paediatric patients with asthma (n=19) and non-asthmatic controls (n=6) were infected or mock infected for 1 hour with or without C. pneumoniae AR-39 at a multiplicity of infection=0.1, and cultured+ciprofloxacin, azithromycin or doxycycline (0.1 ug/mL) for 48 hours. TNF-α levels were measured in supernatants by ELISA.ResultsWhen PBMC from patients with asthma were infected with C. pneumoniae, levels of TNF-α were significantly lower than in subjects without asthma (48 hours) (5.5±5.6, 38.4±53.7; p=0.0113). However, baseline responses (no infection with C. pneumoniae) were similar in asthma and non-asthma (1.0±1.7, 1.1±1.2; p=0.89). When PBMC frompatiens with asthma were infected with C. pneumoniae+ciprofloxacin, azithromycin or doxycycline, TNF-α levels increased (25%–45%); this affect was not observed in PBMC from patients without asthma.ConclusionsWe identified differences in the quantity of TNF-α produced by C. pneumoniae-infected PBMC in asthma compared with non-asthma.
      PubDate: 2018-05-05T06:16:29-07:00
      DOI: 10.1136/bmjresp-2017-000239
      Issue No: Vol. 5, No. 1 (2018)
       
  • Lung volumes identify an at-risk group in persons with prolonged
           secondhand tobacco smoke exposure but without overt airflow obstruction

    • Authors: Arjomandi, M; Zeng, S, Geerts, J, Stiner, R. K, Bos, B, van Koeverden, I, Keene, J, Elicker, B, Blanc, P. D, Gold, W. M.
      Abstract: IntroductionExposure to secondhand smoke (SHS) is associated with occult obstructive lung disease as evident by abnormal airflow indices representing small airway disease despite having preserved spirometry (normal forced expiratory volume in 1 s-to-forced vital capacity ratio, FEV1/FVC). The significance of lung volumes that reflect air trapping in the presence of preserved spirometry is unclear.MethodsTo investigate whether lung volumes representing air trapping could determine susceptibility to respiratory morbidity in people with SHS exposure but without spirometric chronic obstructive pulmonary disease, we examined a cohort of 256 subjects with prolonged occupational SHS exposure and preserved spirometry. We elicited symptom prevalence by structured questionnaires, examined functional capacity (maximum oxygen uptake, VO2max) by exercise testing, and estimated associations of those outcomes with air trapping (plethysmography-measured residual volume-to-total lung capacity ratio, RV/TLC), and progressive air trapping with exertion (increase in fraction of tidal breathing that is flow limited on expiration during exercise (per cent of expiratory flow limitation, %EFL)).ResultsRV/TLC was within the predicted normal limits, but was highly variable spanning 22%±13% and 16%±8% across the increments of FEV1/FVC and FEV1, respectively. Respiratory complaints were prevalent (50.4%) with the most common symptom being ≥2 episodes of cough per year (44.5%). Higher RV/TLC was associated with higher OR of reporting respiratory symptoms (n=256; r2=0.03; p=0.011) and lower VO2max (n=179; r2=0.47; p=0.013), and %EFL was negatively associated with VO2max (n=32; r2=0.40; p=0.017).ConclusionsIn those at risk for obstruction due to SHS exposure but with preserved spirometry, higher RV/TLC identifies a subgroup with increased respiratory symptoms and lower exercise capacity.
      Keywords: Chronic obstructive pulmonary disease
      PubDate: 2018-05-05T06:16:29-07:00
      DOI: 10.1136/bmjresp-2018-000284
      Issue No: Vol. 5, No. 1 (2018)
       
  • Pulmonary involvement in Fabry disease: effect of plasma
           globotriaosylsphingosine and time to initiation of enzyme replacement
           therapy

    • Authors: Franzen, D; Haile, S. R, Kasper, D. C, Mechtler, T. P, Flammer, A. J, Krayenbühl, P. A, Nowak, A.
      Abstract: IntroductionAnderson-Fabry disease (AFD) is an X-linked lysosomal storage disorder caused by mutations of GLA gene leading to reduced α-galactosidase activity and resulting in a progressive accumulation of globotriaosylceramide (Gb3) and its deacylated derivative, globotriaosyl-sphingosine (Lyso-Gb3). Plasma Lyso-Gb3 levels serve as a disease severity and treatment monitoring marker during enzyme replacement therapy (ERT).MethodsAdult patients with AFD who had yearly pulmonary function tests between 1999 and 2015 were eligible for this observational study. Primary outcome measures were the change in z-score of forced expiratory volume in the first second (FEV1) and FEV1/FVC over time. Plasma Lyso-Gb3 levels and the age of ERT initiation were investigated for their association with lung function decline.ResultsFifty-three patients (42% male, median (range) age at diagnosis of AFD 34 (6–61) years in men, 34 (13–67) in women) were included. The greatest decrease of FEV1/FVC z-scores was observed in Classic men (–0.048 per year, 95% CI –0.081 to –0.014), compared with the Later-Onset men (+0.013,95% CI –0.055 to 0.082), Classic women (–0.008, 95% CI –0.035 to +0.020) and Later-Onset women (–0.013, 95% CI –0.084 to +0.058). Cigarette smoking (P=0.022) and late ERT initiation (P=0.041) were independently associated with faster FEV1 decline. FEV1/FVC z-score decrease was significantly reduced after initiation of ERT initiation (–0.045 compared with –0.015, P=0.014). Furthermore, there was a trend towards a relevant influence of Lyso-Gb3 (P=0.098) on airflow limitation with age.ConclusionEarly ERT initiation seems to preserve pulmonary function. Plasma Lyso-Gb3 is maybe a useful predictor for airflow limitation. Classic men need a closer monitoring of the lung function.
      Keywords: Orphan lung disease
      PubDate: 2018-04-21T01:47:34-07:00
      DOI: 10.1136/bmjresp-2018-000277
      Issue No: Vol. 5, No. 1 (2018)
       
  • British Thoracic Society quality standards for the investigation and
           management of pulmonary nodules

    • Authors: Baldwin, D; Callister, M, Akram, A, Cane, P, Draffan, J, Franks, K, Gleeson, F, Graham, R, Malhotra, P, Pearson, P, Subesinghe, M, Waller, D, Woolhouse, I.
      Abstract: IntroductionThe purpose of the quality standards document is to provide healthcare professionals, commissioners, service providers and patients with a guide to standards of care that should be met for the investigation and management of pulmonary nodules in the UK, together with measurable markers of good practice.MethodsDevelopment of British Thoracic Society (BTS) Quality Standards follows the BTS process of quality standard production based on the National Institute for Health and Care Excellence process manual for the development of quality standards.Results7 quality statements have been developed, each describing a key marker of high-quality, cost-effective care for the investigation and management of pulmonary nodules, and each statement is supported by quality measures that aim to improve the structure, process and outcomes of healthcare.DiscussionBTS Quality Standards for the investigation and management of pulmonary nodules form a key part of the range of supporting materials that the Society produces to assist in the dissemination and implementation of guideline recommendations.
      PubDate: 2018-04-16T01:00:13-07:00
      DOI: 10.1136/bmjresp-2017-000273
      Issue No: Vol. 5, No. 1 (2018)
       
  • British Thoracic Society Quality Standards for acute non-invasive
           ventilation in adults

    • Authors: Davies, M; Allen, M, Bentley, A, Bourke, S. C, Creagh-Brown, B, DOliveiro, R, Glossop, A, Gray, A, Jacobs, P, Mahadeva, R, Moses, R, Setchfield, I.
      Abstract: IntroductionThe purpose of the quality standards document is to provide healthcare professionals, commissioners, service providers and patients with a guide to standards of care that should be met for the provision of acute non-invasive ventilation in adults together with measurable markers of good practice.MethodsDevelopment of British Thoracic Society (BTS) Quality Standards follows the BTS process of quality standard production based on the National Institute for Health and Care Excellence process manual for the development of quality standards.Results6 quality statements have been developed, each describing a standard of care for the provision of acute non-invasive ventilation in the UK, together with measurable markers of good practice.ConclusionBTS Quality Standards for acute non-invasive ventilation in adults form a key part of the range of supporting materials that the Society produces to assist in the dissemination and implementation of guideline’s recommendations.
      PubDate: 2018-04-05T01:00:17-07:00
      DOI: 10.1136/bmjresp-2018-000283
      Issue No: Vol. 5, No. 1 (2018)
       
  • Maternal iron status during pregnancy and respiratory and atopic outcomes
           in the offspring: a Mendelian randomisation study

    • Authors: Bedard, A; Lewis, S. J, Burgess, S, Henderson, A. J, Shaheen, S. O.
      Abstract: IntroductionLimited evidence from birth cohort studies suggests that lower prenatal iron status may be a risk factor for childhood respiratory and atopic outcomes, but these observational findings may be confounded. Mendelian randomisation (MR) can potentially provide unconfounded estimates of causal effects by using common genetic variants as instrumental variables. We aimed to study the relationship between prenatal iron status and respiratory and atopic outcomes in the offspring using MR.MethodsIn the Avon Longitudinal Study of Parents and Children birth cohort, we constructed four maternal genotypic risk scores by summing the total number of risk alleles (associated with lower iron status) across single nucleotide polymorphisms known to be associated with at least one of four iron biomarkers (serum iron, ferritin, transferrin and transferrin saturation). We used MR to study their associations with respiratory and atopic outcomes in children aged 7–9 years (n=6002).ResultsWhen analyses were restricted to mothers without iron supplementation during late pregnancy, negative associations were found between the maternal transferrin saturation score and childhood forced expiratory volume in 1 s and forced vital capacity (difference in age, height and gender-adjusted SD units per SD increase in genotypic score: –0.05 (–0.09, –0.01) p=0.03, and –0.04 (–0.08, 0.00) p=0.04, respectively).ConclusionUsing MR we have found weak evidence suggesting that low maternal iron status during pregnancy may cause impaired childhood lung function.
      Keywords: Respiratory epidemiology
      PubDate: 2018-03-30T05:00:39-07:00
      DOI: 10.1136/bmjresp-2018-000275
      Issue No: Vol. 5, No. 1 (2018)
       
  • Effect of idiopathic thoracic scoliosis on the tracheobronchial tree

    • Authors: Farrell, J; Garrido, E.
      Abstract: IntroductionHigh prevalence of obstructive lung disease has been reported in patients undergoing surgical correction of thoracic scoliosis. Airway narrowing due to spine morphology is analysed as a contributing factor.MethodsPreoperative surgical planning CTs of 34 patients with right-sided thoracic scoliosis (age: 17.6±9.0) were retrospectively analysed and compared with 15 non-scoliotic controls (age: 16.3±5.1). Three-dimensional models of spine and airway lumen were reconstructed. Based on thoracic sagittal profile, patients were divided into hypokyphosis (HypoS:
      Keywords: Paediatric lung disease
      PubDate: 2018-03-25T22:42:24-07:00
      DOI: 10.1136/bmjresp-2017-000264
      Issue No: Vol. 5, No. 1 (2018)
       
  • Correction: Differentiation of quantitative CT imaging phenotypes in
           asthma versus COPD

    • PubDate: 2018-03-06T05:08:31-08:00
      DOI: 10.1136/bmjresp-2017-000252corr1
      Issue No: Vol. 5, No. 1 (2018)
       
  • Using domiciliary non-invasive ventilator data downloads to inform
           clinical decision-making to optimise ventilation delivery and patient
           compliance

    • Authors: Mansell, S. K; Cutts, S, Hackney, I, Wood, M. J, Hawksworth, K, Creer, D. D, Kilbride, C, Mandal, S.
      Abstract: IntroductionVentilation parameter data from patients receiving home mechanical ventilation can be collected via secure data cards and modem technology. This can then be reviewed by clinicians and ventilator prescriptions adjusted. Typically available measures include tidal volume (VT), leak, respiratory rate, minute ventilation, patient triggered breaths, achieved pressures and patient compliance. This study aimed to assess the potential impact of ventilator data downloads on management of patients requiring home non-invasive ventilation (NIV).MethodsA longitudinal within-group design with repeated measurements was used. Baseline ventilator data were downloaded, reviewed and adjustments made to optimise ventilation. Leak, VT and compliance data were collected for comparison at the first review and 3–7 weeks later. Ventilator data were monitored and amended remotely via a modem by a consultant physiotherapist between the first review and second appointment.ResultsAnalysis of data from 52 patients showed increased patient compliance (% days used >4 hours) from 90% to 96% (p=0.007), increased usage from 6.53 to 6.94 hours (p=0.211) and a change in VT(9.4 vs 8.7 mL/kg/ideal body weight, p=0.022). There was no change in leak following review of NIV prescriptions (mean (SD): 43 (23.4) L/min vs 45 (19.9)L/min, p=0.272).ConclusionVentilator data downloads, via early remote assessment, can help optimise patient ventilation through identification of modifiable factors, in particular interface leak and ventilator prescriptions. However, a prospective study is required to assess whether using ventilator data downloads provides value in terms of patient outcomes and cost-effectiveness. The presented data will help to inform the design of such a study.
      Keywords: Non-invasive ventilation
      PubDate: 2018-03-03T02:21:31-08:00
      DOI: 10.1136/bmjresp-2017-000238
      Issue No: Vol. 5, No. 1 (2018)
       
  • Symptom severity and its effect on health-related quality of life over
           time in patients with pulmonary hypertension: a multisite longitudinal
           cohort study

    • Authors: Yorke, J; Deaton, C, Campbell, M, McGowen, L, Sephton, P, Kiely, D. G, Armstrong, I.
      Abstract: IntroductionThe aim of this cohort study was to examine health-related quality of life (HRQoL) and symptomatology in patients with pulmonary hypertension (PH) and explore factors that influence its evolution over time.MethodsA prospective longitudinal multisite cohort study. Participants were recruited from specialist UK PH centres and completed a questionnaire pack at baseline, 6, 12 and 18 months to assess HRQoL (emPHasis-10), dyspnoea, fatigue, sleep, anxiety and depression.Results185 patients entered the study at baseline and 126 (68%) completed month 18. At baseline, patients had significant impairment of HRQoL, anxiety, depression, dyspnoea and severe fatigue. No significant changes, apart from a reduction in the Hospital Anxiety and Depression Scale-Anxiety score (P=0.04), were observed over 18 months. Depression and dyspnoea were predictors of HRQoL (P=0.002 and P=0.03, respectively). Oxygen use was also associated with diminished HRQoL and increased symptom severity.ConclusionPatients with PH experience high levels of symptom severity and the negative impact on HRQoL was unchanged over time. The use of oxygen therapy, in particular, was associated with a significant impact on HRQoL. Further study of factors impacting HRQoL and interventions that target a combination of physiological and psychosocial consequences of living with PH are needed.
      Keywords: Pulmonary vasculature
      PubDate: 2018-03-01T06:23:04-08:00
      DOI: 10.1136/bmjresp-2017-000263
      Issue No: Vol. 5, No. 1 (2018)
       
  • Is childhood wheeze and asthma in Latin America associated with poor
           hygiene and infection' A systematic review

    • Authors: Ardura-Garcia, C; Garner, P, Cooper, P. J.
      Abstract: IntroductionHigh asthma prevalence in Latin-American cities is thought to be caused by poor hygiene and infections. This contradicts the widely accepted ‘hygiene hypothesis’ for asthma aetiology.MethodsSystematic review of observational studies evaluating the association between poor hygiene exposures or infections and asthma/wheeze among Latin-American children aged 4–16 years. MEDLINE, EMBASE, LILACS and CINAHL electronic databases were searched following a predefined strategy to 18 December 2017. We quantified outcomes measured and reported, assessed risk of bias and tabulated the results.ResultsForty-five studies included: 6 cohort, 30 cross-sectional and 9 case–control studies. 26 cross-sectional studies were school-based surveys (14 of over 3000 children), whereas 5 case–control studies were hospital/health centre-based. Exposures measured and reported varied substantially between studies, and current wheeze was the most common outcome reported. Data showed selective reporting based on statistical significance (P value
      Keywords: Respiratory epidemiology
      PubDate: 2018-02-22T05:57:30-08:00
      DOI: 10.1136/bmjresp-2017-000249
      Issue No: Vol. 5, No. 1 (2018)
       
  • Patterns and management of chronic obstructive pulmonary disease in urban
           and rural China: a community-based survey of 25 000 adults across 10
           regions

    • Authors: Kurmi, O. P; Davis, K. J, Hubert Lam, K. B, Guo, Y, Vaucher, J, Bennett, D, Wang, J, Bian, Z, Du, H, Li, L, Clarke, R, Chen, Z, for the China Kadoorie Biobank Collaborative Group
      Abstract: IntroductionChronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide, with COPD deaths in China accounting for one-third of all such deaths. However, there is limited available evidence on the management of COPD in China.MethodsA random sample of 25 011 participants in the China Kadoorie Biobank, aged 38–87 years, from 10 regions in China was surveyed in 2013–2014. Data were collected using interviewer-administered questionnaires on the diagnosis (‘doctor-diagnosed’ or ‘symptoms-based’) and management of COPD (including use of medication and other healthcare resources), awareness of diagnosis and severity of symptoms in COPD cases.ResultsOverall, 6.3% of the study population were identified as COPD cases (doctor-diagnosed cases: 4.8% and symptom-based cases: 2.4%). The proportion having COPD was higher in men than in women (7.9% vs 5.3%) and varied by about threefold (3.7%–10.0%) across the 10 regions. Among those with COPD, 54% sought medical advice during the last 12 months, but
      Keywords: Respiratory epidemiology
      PubDate: 2018-02-19T05:39:39-08:00
      DOI: 10.1136/bmjresp-2017-000267
      Issue No: Vol. 5, No. 1 (2018)
       
  • Randomised controlled trial to compare the diagnostic yield of positron
           emission tomography CT (PET-CT) TARGETed pleural biopsy versus CT-guided
           pleural biopsy in suspected pleural malignancy (TARGET trial)

    • Authors: de Fonseka, D; Underwood, W, Stadon, L, Rahman, N, Edey, A, Rogers, C, Maskell, N. A.
      Abstract: IntroductionPleural malignancy, particularly malignant pleural mesothelioma (MPM) is increasing in incidence due to the long latency period from exposure to asbestos to development of the disease. MPM can be challenging to diagnose. For patients presenting without a pleural effusion, CT-guided biopsy remains the primary choice of biopsy, but the diagnostic sensitivity of this investigation is 70%–75%. Therefore, a proportion of patients will go on to require further biopsies. If the first biopsy is non-diagnostic, the chances of further non-diagnostic biopsies are high in MPM.MethodsTarget is a multicentre randomised controlled trial, aiming to recruit 78 patients over a 30-month period, from 10 centres in the UK. Patients will be randomised to either the standard arm which is a second CT-guided biopsy, or the interventional arm, a positron emission tomography-CT scan followed by a targeted CT-guided biopsy. Patients will be followed up for 12 months (patients recruited in the last 6 months of recruitment will have 6 months of follow-up). MPM biomarker mesothelin will be checked at baseline, 6 month and 12 month follow-up appointments where patients are able to attend these appointments.Ethics and disseminationEthical approval for this trial was granted by the South West—Exeter research and ethics committee (reference number 15/SW/0156). Results of the trial will be published in a peer-reviewed journal and presented at an international conference.Trial registration numberISRCTN 14024829; Pre-results.
      PubDate: 2018-02-19T05:39:39-08:00
      DOI: 10.1136/bmjresp-2017-000270
      Issue No: Vol. 5, No. 1 (2018)
       
  • Randomised clinical trial of an early palliative care intervention
           (SUPPORT) for patients with idiopathic pulmonary fibrosis (IPF) and their
           caregivers: protocol and key design considerations

    • Authors: Lindell, K. O; Nouraie, M, Klesen, M. J, Klein, S, Gibson, K. F, Kass, D. J, Rosenzweig, M. Q.
      Abstract: IntroductionIdiopathic pulmonary fibrosis (IPF), a progressive life-limiting lung disease affects approximately 128 000 newly diagnosed individuals in the USA annually. IPF, a disease of ageing associated with intense medical and financial burden, is expected to grow in incidence globally. Median survival from diagnosis is 3.8 years, and many of these patients succumb to a rapid death within 6 months. Despite the fatal prognosis, we have found that patients and caregivers often fail to understand the poor prognosis as the disease relentlessly progresses. Based on feedback from patients and families living with IPF, we developed the S-Symptom Management, U-Understanding the Disease, P-Pulmonary Rehabilitation, P-Palliative Care, O-Oxygen Therapy, R-Research Considerations and T-Transplantation (‘SUPPORT') intervention to increase knowledge of the disease, teach self-management strategies and facilitate preparedness with end of life (EOL) planning.MethodsThis study is a randomised trial to test the efficacy of SUPPORT intervention compared with routine care in patients with IPF and their caregivers delivered after three clinical visits. We are recruiting a cohort of 64 new IPF patient/caregiver dyads (32 for each dyad).ResultsThe trial will evaluate whether the SUPPORT intervention decreases stress, improves symptom burden, quality of life, preparedness and advance care planning for patients and caregivers, quality of dying and death for caregivers if the patient dies during the course of the study, as well as assess the impact of primary palliative care on healthcare resource use near the EOL.ConclusionBy increasing knowledge of the disease, teaching self-management strategies and facilitating preparedness with EOL planning, we will address a critical gap in the care of patients with IPF.Trial registration numberNCT02929017; Pre-results.
      Keywords: Interstitial lung disease
      PubDate: 2018-02-19T05:39:39-08:00
      DOI: 10.1136/bmjresp-2017-000272
      Issue No: Vol. 5, No. 1 (2018)
       
  • BTS guideline for the investigation and management of malignant pleural
           mesothelioma

    • Authors: Woolhouse, I; Bishop, L, Darlison, L, Fonseka, D. d, Edey, A, Edwards, J, Faivre-Finn, C, Fennell, D. A, Holmes, S, Kerr, K. M, Nakas, A, Peel, T, Rahman, N. M, Slade, M, Steele, J, Tsim, S, Maskell, N. A.
      Abstract: The full guideline for the investigation and management of malignant pleural mesothelioma is published in Thorax. The following is a summary of the recommendations and good practice points. The sections referred to in the summary refer to the full guideline.
      PubDate: 2018-02-14T04:30:17-08:00
      DOI: 10.1136/bmjresp-2017-000266
      Issue No: Vol. 5, No. 1 (2018)
       
  • Survival prediction in mesothelioma using a scalable Lasso regression
           model: instructions for use and initial performance using clinical
           predictors

    • Authors: Kidd, A. C; McGettrick, M, Tsim, S, Halligan, D. L, Bylesjo, M, Blyth, K. G.
      Abstract: IntroductionAccurate prognostication is difficult in malignant pleural mesothelioma (MPM). We developed a set of robust computational models to quantify the prognostic value of routinely available clinical data, which form the basis of published MPM prognostic models.MethodsData regarding 269 patients with MPM were allocated to balanced training (n=169) and validation sets (n=100). Prognostic signatures (minimal length best performing multivariate trained models) were generated by least absolute shrinkage and selection operator regression for overall survival (OS), OS
      PubDate: 2018-01-30T05:20:58-08:00
      DOI: 10.1136/bmjresp-2017-000240
      Issue No: Vol. 5, No. 1 (2018)
       
  • Development of a patient-centred, evidence-based and consensus-based
           discharge care bundle for patients with acute exacerbation of chronic
           obstructive pulmonary disease

    • Authors: Ospina, M. B; Michas, M, Deuchar, L, Leigh, R, Bhutani, M, Rowe, B. H, Marciniuk, D, Goodridge, D, Dechman, G, Bourbeau, J, Balter, M, Camp, P, Hernandez, P, Goldstein, R. S, Stickland, M. K, for the COPD PRIHS-2 Group
      Abstract: IntroductionHospital and emergency department discharge for patients with chronic obstructive pulmonary disease (COPD) is often poorly organised. We developed a patient-centred, evidence-based and consensus-based discharge care bundle for patients with acute exacerbations of COPD.MethodsA purposeful sample of clinicians and patients were invited to participate in a two-round Delphi study (July–November 2015). In round 1, participants rated on a seven-point Likert scale (1=not at all important; 7=extremely important) the importance of 29 unique COPD care actions. Round 2 comprised items selected from round 1 based on consensus (>80% endorsement for Likert values 5–7). A list of 18 care items from round 2 was discussed in a face-to-face nominal group meeting.ResultsSeven care items were included in the COPD discharge bundle based on clinician and patient input: (1) ensure adequate inhaler technique is demonstrated; (2) send discharge summary to family physician and arrange follow-up; (3) optimise and reconcile prescription of respiratory medications; (4) provide a written discharge management plan and assess patient’s and caregiver’s comprehension of discharge instructions; (5) refer to pulmonary rehabilitation; (6) screen for frailty and comorbidities; and (7) assess smoking status, provide counselling and refer to smoking cessation programme.ConclusionWe present a seven-item, patient-centred, evidence-based and consensus-based discharge bundle for patients with acute exacerbations of COPD. Alignment with clinical practice guidelines and feasibility of local adaptations of the bundle should be explored to facilitate wide applicability and evaluation of the effectiveness of the COPD discharge bundle.
      Keywords: Chronic obstructive pulmonary disease
      PubDate: 2018-01-30T05:20:58-08:00
      DOI: 10.1136/bmjresp-2017-000265
      Issue No: Vol. 5, No. 1 (2018)
       
  • Reasons for Accident and Emergency department attendance by people with
           chronic obstructive pulmonary disease or heart failure: recipients and
           providers perspectives. An exploratory study

    • Authors: Lee, J. S; Lempp, H, Srivastava, V, Barley, E.
      Abstract: IntroductionFifteen million people are affected by one or more long-term conditions in England. The cost of caring for this patient group increases every year. Several studies have been conducted to find out why people with those conditions choose to access Accident and Emergency (A&E) frequently. To our knowledge, there is no study that compares the three groups (patients, family members and hospital clinicians), and this approach may enhance understanding of A&E admissions in England. Therefore, an exploratory study was undertaken to identify key factors that contribute to A&E admissions as perceived by patients with chronic obstructive pulmonary disease (COPD) and heart failure (HF), their family members (or carers) and hospital clinicians.MethodsA mixed methods approach was undertaken: (1) semistructured interviews with patients and their family members (or carers) and (2) a self-developed survey with hospital clinicians. A purposive sample of 15 patients (9 COPD, 6 HF), 6 family members and carers (2 COPD, 4 HF) and 13 hospital clinicians (5 doctors, 8 nurses) participated in the study.ResultsThe patients’ main reason for A&E admission was severe exacerbation of their symptoms and all three parties (patients, family members or carers, hospital clinicians) agreed with this decision. Three key factors were highlighted in relation to A&E attendance: (1) patients’ health-seeking behaviour, (2) perceptions about general practitioner (GP) and A&E services by patients and (3) patients’ attitudes towards managing their own conditions.ConclusionsImproving patients’ perceptions of GP services in the management of exacerbations of HF and COPD will be important to increase patients’ trust in GP services so that patients will access primary care in a timely manner to prevent exacerbations of symptoms that require A&E admission. This may be achieved by developing a close collaboration between the patients, family members (carers) and hospital clinicians over time.
      Keywords: Chronic obstructive pulmonary disease
      PubDate: 2018-01-24T06:32:15-08:00
      DOI: 10.1136/bmjresp-2017-000244
      Issue No: Vol. 5, No. 1 (2018)
       
  • Chronic obstructive pulmonary disease associated with biomass fuel use in
           women: a systematic review and meta-analysis

    • Authors: Sana, A; Somda, S. M. A, Meda, N, Bouland, C.
      Abstract: IntroductionChronic obstructive pulmonary disease (COPD) is a major and growing cause of morbidity and mortality worldwide. The global prevalence of COPD is growing faster in women than in men. Women are often exposed to indoor pollutants produced by biomass fuels burning during household activities.MethodsWe conducted a meta-analysis to establish the association between COPD and exposure to biomass smoke in women.Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched MEDLINE and Scopus databases in 31December 2016, with the terms: "wood", "charcoal", "biomass", "solid fuels", "organic fuel", "biofuel", "female", "women", "COPD", "chronic bronchitis", "emphysema", "chronic obstructive pulmonary disease". Studies were eligible if they were case–control or cross-sectional studies involving exposure to indoor biomass smoke, conducted at any time and in any geographic location. Fixed-effects or random-effects meta-analysis was used to generate pooled OR.Results24 studies were included: 5 case–control studies and 19 cross-sectional studies. Biomass-exposed individuals were 1.38 times more likely to be diagnosed with COPD than non-exposed (OR 1.38, 95% CI 1.28 to 1.57).Spirometry-diagnosed COPD studies failed to show a significant association (OR 1.20, 95% CI 0.99 to 1.40). Nevertheless, the summary estimate of OR for chronic bronchitis (CB) was significant (OR 2.11, 95% CI 1.70 to 2.52). The pooled OR for cross-sectional studies and case–control studies were respectively 1.82 (95% CI 1.54 to 2.10) and 1.05 (95% CI 0.81 to 1.30). Significant association was found between COPD and biomass smoke exposure for women living as well in rural as in urban areas.ConclusionsThis study showed that biomass smoke exposure is associated with COPD in rural and urban women.In many developing countries, modern fuels are more and more used alongside traditional ones, mainly in urban area. Data are needed to further explore the benefit of the use of mixed fuels for cooking on respiratory health, particularly on COPD reduction.
      Keywords: Chronic obstructive pulmonary disease
      PubDate: 2018-01-12T18:16:18-08:00
      DOI: 10.1136/bmjresp-2017-000246
      Issue No: Vol. 5, No. 1 (2018)
       
  • Childhood asthma prevalence: cross-sectional record linkage study
           comparing parent-reported wheeze with general practitioner-recorded asthma
           diagnoses from primary care electronic health records in Wales

    • Authors: Griffiths, L. J; Lyons, R. A, Bandyopadhyay, A, Tingay, K. S, Walton, S, Cortina-Borja, M, Akbari, A, Bedford, H, Dezateux, C.
      Abstract: IntroductionElectronic health records (EHRs) are increasingly used to estimate the prevalence of childhood asthma. The relation of these estimates to those obtained from parent-reported wheezing suggestive of asthma is unclear. We hypothesised that parent-reported wheezing would be more prevalent than general practitioner (GP)-recorded asthma diagnoses in preschool-aged children.Methods1529 of 1840 (83%) Millennium Cohort Study children registered with GPs in the Welsh Secure Anonymised Information Linkage databank were linked. Prevalences of parent-reported wheezing and GP-recorded asthma diagnoses in the previous 12 months were estimated, respectively, from parent report at ages 3, 5, 7 and 11 years, and from Read codes for asthma diagnoses and prescriptions based on GP EHRs over the same time period. Prevalences were weighted to account for clustered survey design and non-response. Cohen’s kappa statistics were used to assess agreement.ResultsParent-reported wheezing was more prevalent than GP-recorded asthma diagnoses at 3 and 5 years. Both diminished with age: by age 11, prevalences of parent-reported wheezing and GP-recorded asthma diagnosis were 12.9% (95% CI 10.6 to 15.4) and 10.9% (8.8 to 13.3), respectively (difference: 2% (–0.5 to 4.5)). Other GP-recorded respiratory diagnoses accounted for 45.7% (95% CI 37.7 to 53.9) and 44.8% (33.9 to 56.2) of the excess in parent-reported wheezing at ages 3 and 5 years, respectively.ConclusionParent-reported wheezing is more prevalent than GP-recorded asthma diagnoses in the preschool years, and this difference diminishes in primary school-aged children. Further research is needed to evaluate the implications of these differences for the characterisation of longitudinal childhood asthma phenotypes from EHRs.
      Keywords: Respiratory epidemiology
      PubDate: 2018-01-08T20:16:01-08:00
      DOI: 10.1136/bmjresp-2017-000260
      Issue No: Vol. 5, No. 1 (2018)
       
 
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