Previous studies often focused on single pollutant source, failing to replicate real-world exposure scenarios for chronic respiratory disease (CRD) risk. We aimed to explore the mixed exposure patterns of CRD risk factors and investigate interactions with smoking and genetic risk. We identified air pollution exposure modes using latent class analysis (LCA) in the UK Biobank. Cox model assessed associations between exposure modes and lung cancer (LC), idiopathic pulmonary fibrosis (IPF), chronic obstructive pulmonary disease (COPD) and asthma. Interactions among exposure modes, smoking and genetic risk were analyzed. LCA divided participants into five groups, and hazard ratios (HRs) for "High air pollution" group were 1.28 for LC (95% CI: 1.08-1.52), 1.23 for IPF (95% CI: 1.03-1.48), 1.28 for COPD (95% CI: 1.17-1.39) and 1.09 for asthma (95% CI: 1.01-1.18). Significant additive interactions between high air pollution and smoking were observed for LC and COPD. Individuals with high genetic risk exposed to both smoking and high air pollution showed the relative excess risk due to interaction (RERI) of 2.74 for LC, 3.93 for IPF, and 1.68 for COPD. Smoking and air pollution together accounted for over 40% of LC, IPF and COPD cases. Our findings highlight the complex interplay between environmental air pollution, smoking, and genetic risk in CRD development in real-world exposure scenarios.

Upper respiratory tract infections (URTIs) are among the most common diseases encountered in primary medical care. Recurrent URTIs (RURTIs) considerably affect patient health and quality of life. Recent evidence indicates that increased attention is being paid to symptom improvement in clinical practice. However, the therapeutic opportunities associated with using a vector for improving the immune status of patients remain underestimated. As the most common sources of URTI are viral infections, antiviral agents with the potential to enhance host immune responses can be considered auxiliary, effective, and safe for children and adults with URTIs and RURTIs. This review reports the current evidence and expert opinions on immunity-targeted approaches in the management of viral URTIs. Undelayed diagnosis and initiating treatment in the early stages of URTIs are crucial elements that can significantly improve disease evolution and the overall health of patients of any age group. An immunomodulatory remedy would be optimal for facilitating the healing of acute infections, reducing recurrence and complications, antibiotic consumption, and the consequences of antibiotic overuse. Maintaining and protecting the intestinal microbiota is also an important step toward effective URTI treatment. The findings of this review provide valuable insights into the effective management of URTIs and RURTIs based on the latest clinical evidence.

The relationship between systemic inflammation and centripedal obesity in predicting mortality risk among patients with Preserved Ratio Impaired Spirometry (PRISm) has garnered increasing interest. This study aims to elucidate the joint effects of these factors on mortality risk in this patient population. This study included data from the National Health and Nutrition Examination Survey (NHANES) of U.S. adults collected from 2007-2012, calculating both the systemic inflammation response index (SIRI) and the weight-adjusted waist index (WWI). Lung function parameters were used to define PRISm cases. Generalized linear models and logistic regression were used to assess the individual and combined effects of SIRI and WWI, and further explored the mediating role of the SIRI. A total of 1454 PRISm patients were included in this study, with a median follow-up period of 9.5 years, during which 10.9% died from all causes and 3.6% from cardiovascular diseases. The restricted cubic spline curves for SIRI and WWI showed J-shaped associations with mortality. Participants with both high WWI (≥11.18) and high Ln SIRI (≥0.13) had significantly higher all-cause and cardiovascular mortality compared with those with low WWI and low SIRI. In the discordant groups, high WWI with low SIRI was associated with increased all-cause mortality (HR = 1.795, 1.050-3.064), while low WWI with high SIRI was linked to higher cardiovascular mortality (HR = 4.844, 1.505-15.591). This effect was more pronounced in the smoking subgroup. Additionally, SIRI mediated 9% of the association between WWI and all-cause mortality, and 12.94% of the association with cardiovascular mortality. Our study provides evidence for the relationship between SIRI and WWI with mortality in PRISm patients. The joint association of these factors provide potential insights for additional information for prognostic prediction and may contribute to identifying risk stratification in PRISm.

Interstitial lung diseases (ILDs) are complex rare diseases that associate a delay in diagnosis and eventually poor prognosis. Early and accurate diagnosis could be crucial. This study aimed to evaluate the feasibility and benefits of a rapid diagnostic circuit for ILD. A training program for ILD identification and a direct referral diagnostic circuit to the ILD Unit of University Hospital of Bellvitge were established in primary care centers in the southern metropolitan area of Barcelona (Spain). ILD patients were diagnosed and followed-up until study completion, death or lung transplantation. Diagnostic, therapeutic and prognostic outcomes were compared to patients referred through the common circuit during the same period of time. Of 123 patients referred directly from the primary care, 112 had ILD. The most common diagnosis were idiopathic pulmonary fibrosis and fibrotic hypersensitivity pneumonitis. The main reasons for suspecting ILD were interstitial radiological features (74%) and abnormal lung auscultation (67%). Eighteen patients were asymptomatic. Compared with patients referred through the common circuit, there was a statistically significant reduction in the time from symptom onset to diagnosis (6 vs. 22.1 months, p < 0.01) and in the percentage of fibrosing ILD (55.9 vs 63.9%, p 0.36). Although patients from rapid circuit were older, they had better forced vital capacity and diffusing capacity for carbon monoxide at diagnosis (p 0.04) and lung biopsies were performed more frequently. More patients were elegible for lung transplant. Identifying potential patients with fibrotic ILD through rapid circuit working with primary care physicians is feasible and useful.

Medication adherence is critical for successful tuberculosis (TB) treatment, yet non-adherence remains a major barrier to TB control globally. Digital adherence technologies (DAT) have emerged as promising tools to support adherence, but their effectiveness remains variably reported across settings and intervention types. To evaluate the effectiveness of DAT compared to directly observed therapy (DOT) in improving TB medication adherence through a systematic review and meta-analysis of randomized controlled trials (RCTs). A comprehensive literature search was conducted across PubMed, Scopus, EBSCO, and ScienceDirect from inception through November 7, 2024. RCTs comparing DAT (e.g., SMS reminders, video-observed therapy [VOT], medication event reminder monitors [MERM], biometric monitoring systems [BMS], ingestion sensors [IS]) with DOT were included. Study selection, data extraction, and quality appraisal were performed independently by multiple reviewers. Meta-analyses were conducted using a random-effects model, with subgroup and sensitivity analyses. This review followed the PRISMA 2020 reporting guidelines. Nineteen RCTs involving over 10,000 TB patients were included. Overall, DAT significantly improved medication adherence compared to DOT, with a pooled odds ratio (OR) of 2.853 (95% CI: 2.144-3.796; p < 0.001). Subgroup analyses indicated that VOT, MERM, and SMS reminder were consistently effective, while the highest effect sizes were seen in IS and BMS, albeit with wider confidence intervals. Effectiveness varied by country income level: DAT were more effective in high- and upper-middle-income countries, while findings in lower-income settings remained inconclusive, partly due to the limited number of studies. Sensitivity analysis confirmed the robustness of findings, and no significant publication bias was detected (Egger's test p = 0.979). DAT are significantly more effective than DOT in improving medication adherence among TB patients. Tailored implementation strategies are needed to ensure optimal selection and integration of DATs across diverse health systems. These findings support the scaling-up of context-appropriate digital tools as part of global TB control efforts.

When high-risk patients present lung cancer symptoms (LCSs) in general practice, Computed Tomography of the thorax (CT thorax) is recommended, but chest X-ray (CXR) may still be used often. This population-based study aims to 1) compare the proportion of patients who completed diagnostic evaluation, and 2) analyse the associations between smoking status, symptom burden and first choice of imaging among patients who presented LCS to their general practitioner (GP) in 2012 and 2022.

Long COVID, defined by symptoms persisting three months post-SARS-CoV-2 infection, presents a significant global health and economic challenge, with global prevalence estimated at 36% (ranging from 1-92%). This brief communication consolidates current knowledge on its economic impacts, including macroeconomic, cost-of-illness, and microeconomic impacts, which are estimated at an average annual burden of $1 trillion globally and $9000 per patient in the USA, with some individuals covering substantial out-of-pocket expenses. Annual lost earnings in the USA alone are estimated at approximately $170 billion. Long COVID was associated with increased unemployment, financial distress, and work impairment for up to three years post-infection. This paper highlights discrepancies in impact estimation methodologies and calls for standardised metrics especially in emerging economies. Key research gaps include the absence of comprehensive longitudinal studies on individual and aggregated economic burden, specific long COVID phenotypes and biomarkers, and cost-effectiveness evaluations of interventions.

Asthma and intrinsic capacity (IC) decline were individually examined with mortality, yet the complex interplay between them remains largely unknown. This study aimed to examine the potential roles of IC decline in the association between asthma and all-cause mortality. We conducted a prospective cohort study using data from UK Biobank, where IC decline was defined as a decline in any domain of psychological, sensory, vitality, and locomotion. Cox proportional hazard models were used to examine the associations between asthma, IC decline, and all-cause mortality. The relative excess risk due to additive interaction (RERI) was calculated. Mediation analysis was performed to explore the mediating effect of IC decline. And a four-way decomposition method was utilized to quantify both the interaction and mediation role of IC decline. Among 439,973 participants, 51,558 (11.7%) had asthma, 290,964 (66.1%) experienced IC decline, and 37,204 deaths occurred during 5.92 million person-years follow-up. Significant multiplicative and additive interactions were observed between asthma and any IC domain decline on all-cause mortality (Multiplicative: HR = 1.14, 95% CI: 1.06-1.24; Additive: RERI = 0.20, 95% CI: 0.11-0.29). The proportion of the association between asthma and all-cause mortality mediated by decline in all four domains was 28.14% (95% CI: 23.84-34.92%). The results of four-way decomposition were similar. Asthma was associated with increased all-cause mortality, and this association may be partially accounted for by both the interaction and mediation effects of IC decline. These findings underscore the importance of comprehensive interventions that address both asthma management and preservation of IC function to enhance health outcomes in middle-late life.

Breathlessness is prevalent in societies worldwide, with widespread health and socioeconomic impacts. Breathlessness self-management interventions developed in high-income countries (HICs) are promising but require contextual adaptation for low- and middle-income countries (LMICs) like India, where cultural beliefs, language, and delivery systems differ. We co-designed breathlessness self-management resources for use in India using a programme theory approach and Community-Based Participatory Research methods. We convened three stakeholder groups (Doctors (n = 9), Nurses and allied health (n = 6) and lived experiences (n = 9)) and added a fourth group (community health workers (n = 6)) based on emerging findings. We re-analysed 104 academic and lay sources identified iteratively and systematically by the Breathe-India project and presented evidence to stakeholder groups for discussion and feedback. Three rounds of online/face-to-face stakeholder workshops. Stakeholders reviewed evidence, developed shared definitions, and iteratively co-designed intervention components. Stakeholder engagement and evidence synthesis led to identification of seven key domains informing the intervention: (1) Identifying breathlessness- teach the difference between acute and persistent breathlessness (and acute-on persistent breathlessness); (2) Developing shared language-emphasising lived experience of breathlessness in simple, translatable language; (3) Addressing fear-teaching accessible methods (e.g. facial cooling) for regaining control that build confidence; (4) Building resilience-reframing activity as safe and beneficial; (5) Daily coping strategies-aligning with local beliefs and behaviours, e.g. inclusion of nutritional 'dos and don'ts'; (6) Delivery through community infrastructure-teaching Accredited Social Health Activists (ASHAs) how to identify breathlessness in communities and challenge unhelpful beliefs-at the point of care. Outputs included training curricula, educational resources, and public-facing materials co-developed with ASHA trainers and stakeholders. We co-designed India's first multicomponent, community-deliverable breathlessness self-management intervention using participatory methods and theory-driven processes. Implementation-effectiveness hybrid evaluation is needed to test feasibility, acceptability, and impact on patients and families.

Over-reliance on short-acting beta-agonists (SABAs) has been identified as a predictor of poor asthma control and increased asthma-related mortality. The aim of the study was to assess SABA over-reliance and its association with asthma control and the utility of the Reliever Reliance Test (RRT) in addressing SABA over-reliance in primary care patients.

The association between loneliness and chronic obstructive pulmonary disease (COPD) is unclear. This study aimed to investigate this association and, in particular, analyze the role of loneliness dynamics in COPD. The study population was middle-aged and older (≥45 years) participants without COPD from the China Health and Retirement Longitudinal Study (CHARLS), and the study outcome was the occurrence of COPD during follow-up. Loneliness was assessed by a single-item question score (0-3) addressing loneliness. We collected four loneliness values from 2011-2018 and used group-based trajectory modeling (GBTM) to identify loneliness trajectories. COX proportional risk regression modeling calculated the hazard ratios (HRs) of baseline loneliness and different loneliness trajectories to COPD incidence. In addition, we performed subgroup analyses and sensitivity analyses. A total of 8006 participants were included in this study, with a mean age of 57.4 years and 54.5% female. GBTM analysis identified three trajectories of loneliness: consistently low (76.14%), consistently high (10.60%), and increasing loneliness (13.26%). Participants in the consistently high (HR = 1.66, 95CI%: 1.29-2.12, P < 0.001) and increasing loneliness (HR = 1.65, 95CI%: 1.34-2.04, P < 0.001) groups had a significantly increased risk of COPD compared to the consistently low group. Lonely participants (scores 1-3) at baseline had a 24% increased risk of COPD compared with those not lonely (score 0). Both subgroup and sensitivity analyses confirmed the stability of the results. This study found a significant association between loneliness trajectories and risk of developing COPD, suggesting the importance of psychosocial factors in developing chronic respiratory diseases.

National asthma prevalence data in Canada typically come from health surveys or administrative records. Since most asthma care is provided by family physicians, primary care electronic medical records (EMRs) may offer valuable insights into asthma epidemiology and treatment patterns. This study aimed to estimate the prevalence of adult asthma across Canada using national EMR data, examine the demographics and comorbidities of asthma patients, and review national prescribing practices. We used a validated EMR case definition for adult asthma applied to the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) database, which includes data from 12 networks across Canada. We identified patients with at least one encounter in a two-year period and estimated asthma prevalence, stratified by age, sex, and BMI. Comorbidity rates and medication prescriptions were assessed in patients with asthma. Among 854,567 adults, 94,410 were identified with confirmed/suspected asthma (11% prevalence). Asthma was more common in females (12 vs. 10%, p < 0.0001), across all age brackets except 18-29 years old. A chi-square test for trend showed a decrease in prevalence with increasing age (p < 0.0001). Females with asthma had a higher prevalence of ≥4 comorbidities than males (33 vs. 30%, p < 0.0001). Additionally, 13% of asthma patients were prescribed only as-needed short-acting bronchodilators, without a controller. The 11% asthma prevalence found in this study aligns with national survey estimates, providing support for the use of EMRs in disease and practice surveillance. Future efforts should focus on integrating tools within EMR to support asthma diagnosis and treatment adherence.

This study explored the application of Machine Learning (ML) techniques to cluster patients with suspected sleep apnea (SA), based on clinical-demographic data, with the aim of optimizing diagnostic pathways and enabling more personalized management.

Many patients with COPD use inhaled corticosteroids (ICS) without proper indication. We developed a multifaceted tailor-made de-implementation strategy-including a toolbox, communication plan, and training-to reduce inappropriate ICS use in general practice. We evaluated its effectiveness (i.e. decline in percentage of patients with COPD that use ICS) and other outcomes during a 15-month study in Drenthe, the Netherlands. Less patients (-4.7%,95%CI: 2.6-6.7%) used ICS at the end of follow-up and the percentage of ICS-users declined by 8.2% (95%CI: 2.9-13.4%) across the 14 practices that fully participated in the project. ICS user percentages declined significantly moreover time in the fully participation group than in the control group (beta-regression, β = -0.041,SE = 0.011, p < 0.01). While these findings are promising, further research is needed to assess additional penetration and sustainability of the strategy in the region and to explore the applicability of comparable regional ICS de-implementation plans.

Chronic obstructive pulmonary disease (COPD) is a respiratory disease which may significantly impact health status. To reduce symptoms and improve quality of life, pharmacological treatment should be complemented by addressing extrapulmonary traits and lifestyle- and psychosocial factors, such as physical deconditioning, decrease in muscle mass, smoking or depression. Treatment of these non-pharmacological traits is commonly conducted in a primary care setting and often requires multiple healthcare providers (HCPs). To provide complementary care, high quality interprofessional collaboration (IPC) is required. Therefore, our aim was to develop an IPC model for COPD patients treated in primary care. To achieve our aims, we used co-creation sessions (CCS), a recognised method within the participatory action research (PAR) approach. Co-creation, characterised by collaboration and a bottom-up strategy, has repeatedly shown to be suitable for developing care improvements. We recruited two independent groups of stakeholders to participate in six CCS in parallel. They were purposefully sampled and included patients and HCPs from both primary and secondary/tertiary care. Given the considerable overlap in results between the two independent teams, we developed a joint model which is ready to be pilot tested. Our model is based on current and local work methods and can be implemented in existing local contexts and structures. We noted some differences between the teams: the choice of the routing and timing of IPC commencement, and the choice for the communication platform. Using the PAR approach and co-creation, we developed an actionable IPC model in primary care for COPD patients.

Asthma is a leading chronic illness in children worldwide, and school staff are often the first responders when asthma emergencies occur at school. Despite their crucial role, many school staff lack adequate training in asthma management. Online training has emerged as a standardised and scalable solution, but its broader effectiveness remains uncertain. This systematic review aimed to evaluate the effectiveness of online asthma training programmes for school staff. A comprehensive search was conducted across six databases (PubMed, CINAHL, Scopus, Web of Science, ProQuest, and Education Research Complete) in June 2024. Eligible studies included those that evaluated online asthma training programmes targeting school staff (teachers, classroom assistants, and school nurses). The effectiveness of interventions was assessed using the Kirkpatrick evaluation model, which categorises outcomes into four levels: reaction, learning, behaviour, and results. Methodological quality was appraised using the Mixed Methods Appraisal Tool (MMAT). Eight studies met the inclusion criteria with quality scores ranging from 40 to 80%. Interventions identified included web-based modules (n = 4), online classrooms (n = 2), an eBook (n = 1), and a PowerPoint presentation (n = 1). All reported participants' positive satisfaction with the training and improvements in asthma knowledge (levels 1 and 2). However, none of the studies evaluated behavioural change or organisational outcomes (levels 3 and 4). Most studies had small sample sizes and lacked long-term follow-up, limiting assessment of real-world impact. Online asthma training programmes improve school staff's knowledge and satisfaction, and appear to be as effective as face-to-face training. However, their impact on behavioural or organisational change remains lacking. Future research should explore long-term effects to support real-world implementation.

To achieve progression criteria for a definitive phase three randomised controlled trial (RCT). Prospective phase two multicentre parallel-group RCT. Participants recruited from secondary care respiratory clinics in two health boards in Scotland, United Kingdom. 110 adults with moderate-severe COPD and co-morbidities. Tailored Intervention for COPD and Co-morbidities by Pharmacists and Consultant Physicians (TICC-PCP): home visits (for a year) by generalist prescribing pharmacists collaborating with consultant respiratory physicians. Pharmacists assessed, prescribed, de-prescribed, and referred participants to health and social care services as appropriate, in addition to Usual Care (UC). Recruit ≥100 participants; deliver TICC-PCP to ≥70% intervention-arm participants; collect ≥90% in-person data; retain ≥80% participants until 21-months. Secondary outcomes include clinical and health service utilisation. Recruitment, data collection, retention and participant retention targets were achieved over 21 months. TICC-PCP delivery: the median number of contacts, nine per participant in one year, matched the a-priori target although fewer than expected (13 (27%)) received the planned schedule of contacts (monthly for six months then every other month for six months). Secondary outcomes included increased prescribing of bone strengthening medicines, de-prescribing of medicines associated with increasing falls risk; delayed time to emergency health care contacts, fewer exacerbations; improved health related quality of life and longer duration of hospitalisation. A definitive phase three RCT of TICC-PCP may improve outcomes for people with moderate-severe COPD and co-morbidities. Trial registration: The trial is registered with the UK Clinical Trials Registry ( https://doi.org/10.1186/ISRCTN43508703 ). Registration date: 3/1/2020.

The utility of fractional exhaled nitric oxide (FeNO) was evaluated alongside blood eosinophils in phenotyping mild asthma. Inclusion of FeNO improved classification accuracy and calibration in an adapted ISAR-based model; however, its predictive improvement was modest and its susceptibility to transient elevations suggests limited added value for routine clinical classification. Simplified algorithms may offer more accurate phenotyping in population-based settings with real-world constraints.

This study aims to investigate the association between lung function and various types of sensory impairments (specifically visual and hearing impairments) in the elderly population in the middle-aged and older adults in China. This study utilizes data from the China Health and Retirement Longitudinal Study (CHARLS) from the 2011 and 2015 waves of interviews. Participants aged 45 and older with complete data were included in the study. Lung function was assessed using peak expiratory flow (PEF). Multivariable logistic regression and trend regression models analyzed the cross-sectional relationships between PEF, predicted PEF values, and various sensory impairments (SI) The study also examined the prospective relationship between baseline PEF and sensory impairment deterioration using restricted cubic splines for visualization. Finally, subgroup analyses were performed to validate the results' stability. The cross-sectional analysis, after adjusting for confounders, revealed that higher baseline and predicted PEF values were associated with a lower prevalence of SI. This inverse relationship was consistent across various types of impairments, including visual impairment, distance vision impairment, near vision impairment, and hearing impairment. The trend ORs were as follows: (Baseline PEF: 0.894 [0.846, 0.945], 0.881 [0.839, 0.926], 0.922 [0.878, 0.969], and 0.916 [0.873, 0.961]; Predicted PEF %: 0.829 [0.786, 0.874], 0.755 [0.719, 0.791], 0.872 [0.831, 0.914], and 0.770 [0.735, 0.806]). In the combined analysis of sensory impairment types, including single sensory impairment (SSI) and dual sensory impairment (DSI), higher PEF values were also linked to lower prevalence rates. The trend ORs for baseline PEF were 0.924 [0.862, 0.990] and 0.884 [0.826, 0.945], and for predicted PEF % values, the trend ORs were 0.915[0.853, 0.981] and 0.775 [0.725, 0.829]. During follow-up, baseline PEF was significantly associated with the deterioration of Non-SI to DSI. Specifically, the adjusted OR for Q4 relative to Q1 was 0.609 [0.397, 0.933], with a trend OR of 0.862 [0.751, 0.988]. Changes in PEF and predicted PEF percentage values during follow-up were not significantly associated with worsening SI. Subgroup analyses indicated that the inverse relationship between PEF and sensory impairments was significant across various age groups, genders, smoking statuses, and lung disease backgrounds, though the correlation was weaker in non-smokers and individuals with lung diseases. Higher PEF values are associated with a lower prevalence of various sensory impairments and a reduced risk of worsening these impairments in middle-aged and older adults. This study supports the effective screening of SI, particularly in identifying high-risk individuals who may experience the progression of DSI.

At-home spirometry could provide added value for the diagnosis and monitoring of obstructive pulmonary disease in primary care. However, it is unknown whether implementation in a real-world setting is practicable and produces good quality spirometry. We studied feasibility, quality and added value of at-home spirometry in primary care practices in the Netherlands and Sweden. Adults with an asthma- or COPD-related spirometry indication were provided with equipment to perform unsupervised spirometry at-home. Differences in FEV and FVC-values from home and general practice were compared, and questionnaires on feasibility were completed by participants and healthcare professionals (HCPs). Of 140 participants, 89.3% completed a home spirometry session, of whom 59.2% produced acceptable spirometry. Overall, HCPs and participants rated home spirometry as feasible and of added value for asthma and COPD monitoring in primary care, though less helpful for diagnostic purposes. A small mean difference in spirometry results was observed, with FEV and FVC at-home being 0.076 and 0.094 L higher than at the GP office, respectively.