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Journal articleSorano A, Buttini F, Dekhuijzen PNR, et al., 2025,
Profile of the Respimat soft mist inhaler for chronic obstructive pulmonary disease treatment: overview of its safety and efficacy
, EXPERT REVIEW OF MEDICAL DEVICES, ISSN: 1743-4440 -
Journal articleSunjaya A, Edwards GD, Harvey J, et al., 2025,
Validation of artificial intelligence spirometry diagnostic support software in primary care: a blinded diagnostic accuracy study
, ERJ Open Research, Vol: 11, ISSN: 2312-0541Objective and designThe objective of the present study was to assess the discriminative accuracy of artificial intelligence (AI) software to identify COPD and other chronic respiratory diseases from primary care spirometry. This was a diagnostic study with blinded analysis.MethodsRetrospective hand-held spirometry data from consecutive patients attending primary care clinics in Hillingdon (London, UK) between September 2015 and March 2019 were used. The index diagnosis was the “preferred” diagnosis determined by AI software (highest probability) using supervised random-forest machine learning to interpret raw spirometry data and basic demographics. The reference diagnosis was based on the consensus of expert pulmonologists with access to primary and secondary care medical notes and results of relevant investigations. Cross-tabulation of the index test results by the results of the reference standard for COPD and other respiratory disease categories provided the main outcome measures.ResultsIn this primary care spirometry dataset from 1113 patients, 543 (48.8%) had a reference diagnosis of COPD. AI preferred diagnosis detected 456, achieving a sensitivity of 84.0% (95% CI 80.6–87.0%), specificity of 86.8% (83.8–89.5%), accuracy of 85.4% (83.2–87.5%) with area under curve (AUC) of 0.914 (0.896–0.930). AI preferred diagnosis identified 187 out of 249 patients with reference diagnosis of interstitial lung disease and 59 out of 107 patients with asthma, with AUCs of 0.900 (0.880–0.916) and 0.814 (0.790–0.836), respectively.ConclusionAI software achieved high sensitivity and specificity in identifying COPD using spirometry and basic demographic data and may support accurate diagnosis of COPD in primary care. AI software performed less well for other chronic respiratory disease categories.
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Journal articleLee B, Rafarti-Fard AR, Wong E, et al., 2025,
Oral contraceptives and the risk of asthma attacks: a population-based cohort study
, ERJ Open Research, Vol: 11, ISSN: 2312-0541BackgroundThe role that sex hormones play in asthma remains unclear. The oral contraceptive pill (OCP), commonly used by younger women, acutely increases sex hormones providing an opportunity to observe their effect.ObjectiveEvaluate the association between OCP and asthma attacks.MethodsUsing the UK's Clinical Practice Research Datalink, linked to hospital admission and mortality data, 2004 to 2020, we observed women with asthma (18–50 years), comparing OCP never-users to new-users; separated into a combined oral contraceptive (COC) cohort and progestogen-only (POP) cohort. We applied inverse-probability of treatment weighting and Cox proportional hazards, accounting for demographics, asthma severity/control and comorbidities. Additionally, we stratified by potential modifiers: age, BMI, blood eosinophils (x109 cells·L−1, normal <0.3, eosinophilia ≥0.3) and corticosteroid use (lower use: ≤3 inhaled corticosteroids prescriptions, higher use: ≥4 inhaled and/or oral corticosteroids).Results132 676 and 129 151 were eligible for the COC and POP cohorts, respectively. There was no association between COC, or POP, and asthma attacks (weighted-HR, 95% CI: COC=1.00, 0.89–1.13; POP=1.11, 0.97–1.28). However, POP association was modified by asthma phenotype and corticosteroid use, but not BMI, after accounting for asthma severity/control, demographics and comorbidities. In the POP users, women who were younger than 35 years old (1.39, 1.12–1.72), those with eosinophilia (1.24, 0.97–1.58), or those with lower corticosteroid use (1.20, 1.03–1.40) had an elevated risk of asthma attacks.ConclusionsCommencing exogenous progesterone without an estrogen component (POP) was associated with increased asthma attacks in asthma phenotypes including in younger women, eosinophilic-asthma, and women with lower corticosteroid use.
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Journal articleMeng X, Lin Y, Gong J, et al., 2025,
Cardiac electrophysiological responses to traffic pollution in adults with or without chronic cardiopulmonary diseases
, ENVIRONMENT INTERNATIONAL, Vol: 203, ISSN: 0160-4120 -
Journal articleEsneau C, Bryant NE, Johnston SL, et al., 2025,
Opportunities for rhinovirus-targeted RNA therapeutics: A narrative review
, CMI Communications, Vol: 2, Pages: 105081-105081, ISSN: 2950-5909 -
Journal articleLee B, Wong E, Tan T, et al., 2025,
Pregnancy, asthma and exacerbations: a population-based cohort
, European Respiratory Journal, ISSN: 0903-1936BackgroundAsthma exacerbations during pregnancy are associated with adverse maternal and perinatal outcomes. Identifying modifiable risk factors are essential for improving health outcomes. We aimed to describe exacerbation patterns during pregnancy and identify exacerbation risk factors, particularly modifiable risk factors such as inhaled corticosteroid (ICS) use.MethodsA cohort study using UK primary care and hospital data (2004–2020) to identify pregnant women with asthma. Exacerbations were defined as a short course of oral corticosteroids, emergency department visit, or unscheduled hospital admission. Multivariable logistic regression was used to assess associations between maternal characteristics and exacerbations (primary outcome) and ICS use (secondary outcome).ResultsAmong 40 196 pregnant women with asthma, total exacerbations declined by ∼30% during pregnancy. However, exacerbations associated with hospital admission increased by 30–45% during the second and third trimesters, declining abruptly after delivery. ICS prescriptions were reduced in 31% of women during pregnancy. Decreased ICS use was associated with suboptimal asthma control pre-pregnancy, age, ethnicity and smoking. The strongest exacerbation risk factors were a history of exacerbations (adjusted-OR, 95% CI: 4.09, 3.81–4.39), reduced ICS during pregnancy (2.29, 2.12–2.47) and ≥4 prescriptions/year for ICS+another-preventer before pregnancy (2.11, 1.87–2.37). Additional risk factors included blood eosinophilia, smoking and obesity.ConclusionsDespite fewer total exacerbations, exacerbations associated with a hospital admission increased during pregnancy. One-third of women reduced ICS use during pregnancy, yet this was the second largest exacerbation risk factor, and completely modifiable. Other major risk factors were type-2 inflammation and another modifiable risk factor, suboptimal asthma control pre-pregnancy.
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Journal articlePham DD, Lee J-H, Kwon H-S, et al., 2025,
Biomarkers of type 2 inflammation as predictors of response to biologics for severe eosinophilic asthma
, ERJ OPEN RESEARCH, Vol: 11 -
Journal articleShahbazi Khamas S, Brinkman P, Neerincx AH, et al., 2025,
Complementary Predictors for Asthma Attack Prediction in Children: Salivary Microbiome, Serum Inflammatory Mediators, and Past Attack History
, ALLERGY, ISSN: 0105-4538 -
Journal articleOu C, Deng Z, Liao Y, et al., 2025,
C-BIOPRED severe asthma clinical phenotypes: link to complement and coagulation pathways and galectin 10
, ERJ OPEN RESEARCH, Vol: 11 -
Journal articleLo C-Y, Wang C-H, Lin C-Y, et al., 2025,
Corticosteroid insensitivity in asthma associated with obstructive sleep apnoea: Role of oxidative stress and histone acetylation
, BRITISH JOURNAL OF PHARMACOLOGY, ISSN: 0007-1188 -
Journal articleToumpanakis D, Karagiannis K, Paredi P, et al., 2025,
Contribution of peripheral airways dysfunction to poor quality of life in sarcoidosis
, CHEST, Vol: 168, Pages: 423-434, ISSN: 0012-3692BackgroundSarcoidosis is characterized by reduced quality of life (QoL), yet QoL is correlated poorly to conventional spirometric lung function tests.Research QuestionWhat is the relationship of a QoL measure with comprehensive lung function assessment using oscillometry in sarcoidosis?Study Design and MethodsSixty-two patients with pulmonary sarcoidosis completed the St. George’s Respiratory Questionnaire (SGRQ), a respiratory QoL measure, and underwent lung function assessment including oscillometry, spirometry, diffusion capacity, fractional exhaled nitric oxide (Feno), and body plethysmography. Relationships of lung function parameters with SGRQ results were determined with Spearman rank coefficient (ρ), and receiver operating characteristic curves were plotted. Logistic regression and hierarchy cluster analysis of parameters from multiple lung function techniques were performed.ResultsOscillometric indices describing peripheral lung dysfunction showed significant associations with SGRQ score (resistance at 5 Hz [R5], ρ = 0.43 [P < .01]; R5 minus resistance at 20 Hz [R20], ρ = 0.35 [P < .01]; reactance at 5 Hz [X5], ρ = –0.42 [P < .01]; reactance area under the curve [Ax], ρ = 0.44 [P < .01]), whereas FVC % predicted and residual volume to total lung capacity ratio, were related weakly to SGRQ score (ρ = –0.30 [P = .02] and ρ = 0.30 [P = .02], respectively). Oscillometry reactance, measuring elastic properties of the lung, predicted an impaired QoL (area under the receiver operating characteristic curve: Ax, 0.80 [P < .001] and X5, 0.78 [P < .001]), even in patients with absence of an obstructive or restrictive spirometry pattern. Ax remained associated significantly with SGRQ score even after adjustment for FVC and Scadding stage on multivariable analysis (P = .005). Feno was not associated with SGRQ score. Peripheral airway function parameters (R5 minus R20, Ax, and residual volume to total lung c
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Journal articleKemp PR, Griffiths M, Polkey MI, et al., 2025,
Variability in sensitivity to inflammation in muscle and lung of patients with COPD may underlie susceptibility to lung function decline
, Thorax, Vol: 80, Pages: 520-529, ISSN: 0040-6376Background: Muscle wasting and weakness (sarcopenia) are commonly associated with COPD causing frailty and reduced quality of life. The contribution of inflammation to muscle loss and the susceptibility to rapid lung function decline is debated. We hypothesised that comparing the muscle transcriptome to circulating inflammatory cytokine profiles in patients would identify any contribution of systemic inflammation to muscle atrophy.Methods: Quadriceps differential gene expression was determined between mild-COPD (n=28) and severe-COPD (n=51) using GSE100281. These microarray data were compared by biweight mid-correlation with lung function and plasma cytokine levels from the same patients.Results: Patients with severe COPD had reduced fat-free mass index (a measurement of muscle mass) compared with patients with mild COPD despite similar physical activity and inflammatory cytokine levels. Gene sets associated with inflammation and epithelial mesenchymal transition (EMT) were elevated in severe COPD, suggesting that inflammation may contribute to the loss of muscle mass. In patients with severe COPD, EMT and inflammation gene sets were strongly associated with circulating proinflammatory and anti-inflammatory cytokines. However, in patients with mild COPD, anti-inflammatory cytokines showed negative associations with these gene sets and associations with proinflammatory cytokines were weak. In data from lung and blood samples, patients with severe COPD had elevated inflammatory and EMT gene expression compared with patients with mild COPD suggesting that this phenomenon is not muscle-specific.Conclusions: In patients at the severe end of the COPD spectrum, the proinflammatory response in muscle predominates, whereas in patients at the mild end of the spectrum, the anti-inflammatory response predominates. This suggestion needs confirming in a longitudinal cohort.
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Journal articleSoriano JB, Cao B, Barnes PJ, 2025,
No plan B, no planet B: confronting the rising global burden of chronic respiratory diseases
, LANCET RESPIRATORY MEDICINE, Vol: 13, ISSN: 2213-2600 -
Journal articleSantana MBRD, Cruz AA, Teixeira HMP, et al., 2025,
Chromosome 21 variants tied to severe asthma exacerbations: A genome-wide association study in a Brazilian population
, JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY: GLOBAL, Vol: 4 -
Journal articleToumpanakis D, Kim Y, Usmani OS, 2025,
Small Airways Disease in Patients With COPD: A Question-and-Answer Approach for Everyday Clinical Practice.
, ChestTOPIC IMPORTANCE: Small airways are recognized as the main site of disease progression and airflow limitation in patients with COPD. Whereas conventional lung function testing, for example spirometry, is nonspecific to small airways disease (SAD), the advent and wider availability of techniques sensitive to SAD, such as oscillometry, has improved our understanding of the clinical importance of small airways dysfunction. Despite this progress, a gap between the recent advances in knowledge of SAD and its implementation in daily clinical practice remains. We aimed to answer key questions that would allow practitioners (eg, family doctors, internists, pulmonologists) to introduce oscillometry into their clinical practice. REVIEW FINDINGS: COPD pathogenesis is characterized by SAD, with an increasing prevalence with more advanced disease. Evaluation of small airways dysfunction with sensitive techniques (eg, oscillometry, nitrogen washout) contributes to early disease detection and plays a significant role in almost every aspect of disease assessment, including confirmation of diagnosis, functional severity grading, and monitoring of lung function decline. Moreover, small airways dysfunction shows equivalent or even better correlation with patient-reported outcomes, including symptoms, quality of life, and exacerbations, compared with conventional lung function testing. This suggests a role for small airways assessment as a treatable trait in COPD to target and monitor therapeutic interventions. SUMMARY: Accumulating evidence and recent advances have delineated the role of small airways assessment in COPD and warrant its implementation in the management plan of patients with COPD in daily clinical practice.
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Journal articleManeechotesuwan K, Assawabhumi J, Chankham J, et al., 2025,
Increased eosinophils after oral corticosteroid treatment for asthma exacerbation correlated with longer ER stays and persisting thymic stromal lymphopoietin and increased Park2
, SCIENTIFIC REPORTS, Vol: 15, ISSN: 2045-2322 -
Conference paperDailey P, Siagat R, Kumar A, et al., 2025,
Clinical predictors of asthma remission: A<i> post</i><i> hoc</i> analysis of the ATLANTIS study
, Publisher: OCEAN SIDE PUBLICATIONS INC, ISSN: 1088-5412 -
Journal articleDoe G, Banya W, Edwards G, et al., 2025,
AI-assisted spirometry interpretation in primary care: a randomized controlled trial
, NEJM AI, Vol: 2, ISSN: 2836-9386BackgroundSpirometry quality and confidence in spirometry interpretation are highly variable in primary care, contributing to underdiagnosis, overdiagnosis, and misdiagnosis of chronic respiratory diseases worldwide. Artificial intelligence (AI) decision support software has been shown to improve the accuracy of lung function interpretation in specialist care, but its applicability to primary care remains unknown.MethodsWe conducted a parallel-group, randomized, controlled superiority trial to evaluate whether AI decision support software improves spirometry interpretation performance by primary care clinicians. Clinicians working in primary care who refer for, perform, or interpret spirometry assessed 50 real-world patient spirometry records, providing the most likely diagnosis (“preferred diagnosis”) through an online platform either with (intervention) or without (control) AI decision support software. The primary outcome was the preferred diagnosis prediction performance, measured as the percentage of cases in which the preferred diagnosis agreed with the reference diagnosis predetermined by expert pulmonologists. A planned subgroup analysis focused on cases with a diagnosis of chronic obstructive pulmonary disease (COPD). Secondary outcomes were performance in differential diagnosis prediction, technical quality assessment, pattern interpretation, and self-rated confidence in interpretation.ResultsOut of 400 clinicians assessed for eligibility, 234 were randomly assigned, with 133 (57%) completing the assessment (intervention, n=67; control, n=66) — 73% female, 42% general practitioners, and 50% nurses. Compared with the control group, the addition of AI decision support software led to improvements in preferred diagnosis prediction performance in all cases (mean difference, 9.0; 95% confidence interval [CI], 4.5 to 13.3%; P=0.001) and in COPD cases (15.9; 95% CI, 9.0 to 22.7%; P<0.001). Differential diagnosis prediction and technical quali
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Journal articlePatrick T, Naidu SB, Bhamani A, et al., 2025,
Supporting clinical trial recruitment in COPD by leveraging lung cancer screening: an observational study
, ERJ OPEN RESEARCH, Vol: 11 -
Journal articleJackson SE, Tattan-Birch H, Hopkinson NS, et al., 2025,
Estimating young adult uptake of smoking by area across the United Kingdom
, Nicotine and Tobacco Research, Vol: 27, Pages: 1300-1305, ISSN: 1462-2203IntroductionThere is majority support in parliament and across the United Kingdom to implement a “smoke-free generation” policy which would mean people born on or after January 1, 2009, could never legally be sold tobacco. To explore the potential impact this policy could have, we estimated the number of young adults (18–25 years) currently taking up smoking each year by area across the United Kingdom.MethodsUsing data from the Office for National Statistics (ONS), Annual Population Survey (APS), and Smoking Toolkit Study (STS), we estimated the total number of 18- to 25-year-olds taking up smoking each year, based on national estimates of population size (ONS) and the proportion who reported ever having regularly smoked (STS). We used local data on adult smoking rates (APS) to apportion the national estimated number of young adults taking up smoking to specific areas.ResultsAround 127 500 18- to 25-year-olds in the United Kingdom start smoking regularly each year (~350 each day); 105 700 each year in England, 11 500 in Scotland, 6500 in Wales, and 3800 in Northern Ireland. Uptake estimates varied across localities: for example, North East Lincolnshire had the highest proportion of young adults taking up smoking each year (3.9%) and Wokingham had the lowest (0.9%).ConclusionsDespite reductions in smoking prevalence over recent decades, hundreds of young adults in the United Kingdom start smoking every day.ImplicationsData on rates of uptake among individual local authorities can be used to focus attention locally prior to the introduction of new age of sale laws.
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