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Journal articleMqadi L, Bedwell GJ, Msolo N, et al., 2026,
Distress is positively associated with induced secondary hyperalgesia in people with suppressed HIV☆
, JOURNAL OF PAIN, Vol: 39, ISSN: 1526-5900 -
Journal articleKnox-Brown B, Sibomana J-P, Sylvester K, et al., 2026,
Lung capacity is a determinant of cardiovascular disease and myocardial infarction
, Respiratory Research, ISSN: 1465-9921 -
Journal articleAdriouch S, Belda E, Swartz TD, et al., 2025,
Prominent mediatory role of gut microbiome in the effect of lifestyle on host metabolic phenotypes
, GUT MICROBES, Vol: 17, ISSN: 1949-0976 -
Journal articleBartlett-Pestell S, Quintero Santofimio V, Potts J, et al., 2025,
Small airways obstruction predicts cardiovascular disease incidence: a longitudinal study of UK Biobank
, ERJ Open Research, ISSN: 2312-0541Background: Isolated small airways obstruction (SAO) is common, a precursor of chronic obstructive pulmonary disease, and is associated with increased cardiovascular disease (CVD) mortality. Whether isolated SAO predicts CVD incidence is unknown. Methods: Using longitudinal data on 139,568 UK Biobank participants (median age 58 years), we calculated CVD incidence in those with, versus without, isolated SAO defined as FEV3/FEV6<LLN with a normal FEV1/FEV6 ratio. A second analysis was performed where isolated SAO was defined as FEF25-75% <LLN with a normal FEV1/FEV6 ratio. Using mixed effects quasi-Poisson regression models, we assessed the association between isolated SAO and CVD, investigating differences in association by sex and smoking status.Results: At baseline, 10,480 participants (7.5%) had isolated SAO. During follow-up (median 9.2 years), CVD was diagnosed in 30,763 (22%) participants, more commonly among those with isolated SAO at baseline (RR = 1.05, 95% CI 1.01-1.09). This association was not significant in males (RR = 1.03, 95%CI 0.98-1.08) nor in never smokers (RR 1.02, 95%CI 0.97–1.09). The risk of CVD was increased when isolated SAO was defined using FEF25-75%.Conclusions: Adults with isolated SAO have a modest increased risk of developing CVD. However, this association is potentially driven by smoking. Further research should explore underlying mechanisms for this increased risk and how best this can be mitigated.
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Journal articleKnox-Brown B, Robertson L, Amaral A, et al., 2025,
Physiological quotients and mortality: redefining lung function interpretation beyond FEV1
, European Respiratory Journal, ISSN: 0903-1936 -
Journal articleAhmed R, Mulupi S, Taegtmeyer M, et al., 2025,
“People here live in denial”: A qualitative study of the pervasive impact of stigma on asthma diagnosis and care in Kenya and Sudan
, Plos Global Public Health, Vol: 5Epidemiological studies show a global increase in asthma, straining healthcare systems in low- and middle-income countries. There are multiple barriers to accessing diagnosis and treatment in Sub-Saharan African countries like Kenya and Sudan such as healthcare infrastructure, diagnostic tools, healthcare workers’ capacities, and cost. Asthma can be well controlled using safe and cost-effective treatments such as inhalers. Stigma related to asthma negatively impacts treatment-seeking and adherence in higher-income settings, with limited information about such impacts in Sub-Saharan Africa. We conducted qualitative interviews and Focus Group Discussions in Kenya and Sudan to explore health systems aspects of diagnosis and management of chronic respiratory diseases. Participants included patients, primary care healthcare workers, hospitals, and community actors. Data were analysed through a framework approach; our initial analysis showed that asthma stigma was prevalent in both countries. Further analysis was using the Health, Stigma, and Discrimination Framework by Stangl. Negative perceptions about the aetiology and prognosis of asthma contribute to stigma. Anticipated, internalized stigma, and enacted stigma affects individuals with asthma, encouraging them to hide their symptoms and resist diagnosis. This contributes to delayed healthcare seeking and treatment uptake, impacting both individuals with asthma and health professionals. Overall, stigma exacerbates challenges in communicating diagnosis, managing the illness, and maintaining psychosocial health and well-being for those with asthma. Poor asthma control can exacerbate fear and stigma. Improving asthma control has the potential to reduce fear and positively influence community norms. The rollout of inhalers and spacers for asthma treatment should be accompanied by deliberate stigma reduction strategies and awareness raising at all levels of the system.
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Journal articleMueller A, Wouters E, Burney P, et al., 2025,
Quality of life associated with breathlessness in the multinational Burden of Obstructive Lung Disease (BOLD) study: a cross-sectional analysis
, Pulmonology, Vol: 31, ISSN: 2531-0429IntroductionEvidence of an association between breathlessness and quality of life from population-based studies is limited. We aimed to investigate the association of both physical and mental quality of life with breathlessness across several low-, middle- and high-income countries.MethodsWe analysed data from 19 714 adults (31 sites, 25 countries) from the Burden of Obstructive Lung Disease (BOLD) study. We measured both mental and physical quality of life components using the SF-12 questionnaire, and defined breathlessness as grade ≥2 on the modified Medical Research Council scale. We used multivariable linear regression to assess the association of each quality-of-life component with breathlessness. We pooled site-specific estimates using random-effects meta-analysis.ResultsBoth physical and mental component scores were lower in participants with breathlessness compared to those without. This association was stronger for the physical component (coefficient = −7.59; 95%CI −8.60, −6.58; I2 = 78.5%) than for the mental component (coefficient = −3.50; 95%CI −4.36, −2.63; I2 = 71.4%). The association between physical component and breathlessness was stronger in high-income countries (coefficient = −8.82; 95%CI −10.15, −7.50). Heterogeneity across sites was partly explained by sex and tobacco smoking.ConclusionQuality of life is worse in people with breathlessness, but this association varies widely across the world.
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Journal articleLee CT, Ghandi SA, Elmrayed S, et al., 2025,
Inhalational exposures associated with risk of interstitial lung disease: a systematic review and meta-analysis
, Thorax, Vol: 80, Pages: 918-926, ISSN: 0040-6376Rationale: Inhalational exposures are associated with risk of developing interstitial lung disease (ILD), yet the relationship between specific exposures and ILD is poorly characterized. Objective: Identify inhalational exposures associated with ILD and estimate the effects of exposures on ILD risk.Methods: MEDLINE and EMBASE databases were searched from 1990 until 2022 to identify inhalational exposures associated with ILD diagnosis. ILDs where causality is well-established (hypersensitivity pneumonitis, pneumoconiosis) and sarcoidosis were excluded. Two independent reviewers screened abstracts with full-text review and data extraction of eligible studies. Where possible, data were pooled and multi-level meta-analysis was specified using a random effects model. Sources of heterogeneity and risk of bias were assessed. Main Results: Ninety-six studies were included in the systematic review, representing 40,819,116 subjects (295,167 had ILD, 40,523,949 controls). For the meta-analysis, fifty-four studies were included (40,490,793 subjects: 273,899 ILD, 40,216,894 controls). Exposures associated with significantly increased ILD risk included smoking (OR 1.69, 95% CI 1.47-1.94), organic exposures (OR 1.56, 95% CI 1.12-2.16), metals (OR 1.52, 95% CI 1.07-2.16), dust (OR 1.45, 95% CI 1.20-1.76), and asbestos (OR 1.53, 95% CI 1.08-2.15). Silica and fumes had positive associations with ILD that trended toward significance. Conclusions: This systematic review and multilevel meta-analysis is the first to comprehensively assess the effect of inhalational exposures on overall risk of ILD, with multiple putative exposures identified. Future work should investigate novel occupational exposures associated with ILD, characterize the gene-environment interaction, and develop preventative strategies.
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Journal articleMadden VJ, Mqadi L, Arendse G, et al., 2025,
Provoked cytokine response is not associated with distress or induced secondary hyperalgesia in people with suppressed HIV
, PAIN, Vol: 166, Pages: e830-e843, ISSN: 0304-3959 -
Journal articleChilloux J, Brial F, Everard A, et al., 2025,
Inhibition of IRAK4 by microbial trimethylamine blunts metabolic inflammation and ameliorates glycemic control.
, Nat Metab, Vol: 7, Pages: 2531-2547The global type 2 diabetes epidemic is a major health crisis. Although the microbiome has roles in the onset of insulin resistance (IR), low-grade inflammation and diabetes, the microbial compounds controlling these processes remain to be discovered. Here, we show that the microbial metabolite trimethylamine (TMA) decouples inflammation and IR from diet-induced obesity by inhibiting interleukin-1 receptor-associated kinase 4 (IRAK4), a central kinase in the Toll-like receptor pathway sensing danger signals. TMA blunts TLR4 signalling in primary human hepatocytes and peripheral blood monocytic cells and rescues mouse survival after lipopolysaccharide-induced septic shock. Genetic deletion and chemical inhibition of IRAK4 result in metabolic and immune improvements in high-fat diets. Remarkably, our results suggest that TMA-unlike its liver co-metabolite trimethylamine N-oxide, which is associated with cardiovascular disease-improves immune tone and glycemic control in diet-induced obesity. Altogether, this study supports the emerging role of the kinome in the microbial-mammalian chemical crosstalk.
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Journal articleMeghji J, 2025,
Post-TB care in the UK: A national survey of existing practice
, BMJ Open Respiratory Research, ISSN: 2052-4439 -
Journal articleBisson GP, Allwood B, Byrne A, et al., 2025,
Post-tuberculosis lung disease: a case definition for use in research studies.
, Lancet Infect DisDespite growing awareness of the substantial burden of long-term pulmonary impairment among tuberculosis survivors, marked variability in how post-tuberculosis lung disease is defined across research studies limits the comparison of findings and synthesis of evidence. To facilitate greater harmonisation within the field, we propose a case definition for post-tuberculosis lung disease for use in research studies. Conceptual aspects of this case definition were initially developed with input from a broad group of stakeholders at the 2nd International Post-Tuberculosis Symposium and were refined by the authors after the Symposium. Guiding principles for the definition include specificity, feasibility in settings with high tuberculosis disease burdens, probable relevance to long-term health outcomes, and applicability across the lifespan. The definition is designed to be used alongside, rather than instead of, study-specific definitions used to explore primary study hypotheses, and is accompanied by a reporting framework. The case definition has three components: that the individual had previous pulmonary or pleural tuberculosis disease and does not have tuberculosis disease at the time of evaluation; that the individual has, at the time of assessment, evidence of pulmonary disease with abnormalities in at least two of three clinical domains of lung function, respiratory symptoms, and chest imaging; and that the pulmonary disease manifestations should be attributable at least in part to previous tuberculosis disease. This definition is developed in the absence of data on long-term patient outcomes and will need to evolve over time in response to emerging evidence. However, we believe this proposed definition will lead to greater consistency and rigor across studies of post-tuberculosis lung disease with the goal of improving care and quality of life for millions of tuberculosis survivors worldwide.
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Journal articleColak Y, Allinson JP, Van Den Berge M, et al., 2025,
Airflow obstruction among young adults in Europe: a Chronic Airway Diseases Early Stratification (CADSET) collaboration with 48 612 individuals across eight population-based cohorts
, ERJ OPEN RESEARCH, Vol: 11 -
Conference paperZhang Y, Tanro M, Chi S, et al., 2025,
P247 GSDMB mediates epithelial to mesenchymal transition (EMT) in human airway epithelial cells
, British Thoracic Society Winter Meeting 2025, QEII Centre, Broad Sanctuary, Westminster, London SW1P 3EE, 26 to 28 November 2025, Programme and Abstracts, Publisher: BMJ Publishing Group Ltd and British Thoracic Society, Pages: A300-A301 -
Conference paperZhang Y, Du H, Guo H, et al., 2025,
P249 Knockout of ORMDL3 renders airway epithelial cell resistance to human rhinovirus infection
, British Thoracic Society Winter Meeting 2025, QEII Centre, Broad Sanctuary, Westminster, London SW1P 3EE, 26 to 28 November 2025, Programme and Abstracts, Publisher: BMJ Publishing Group Ltd and British Thoracic Society, Pages: A301.2-A301 -
Conference paperChi S, Zhao H, Weinman J, et al., 2025,
P248 ORMDL3 influences ferroptosis through HMOX1 in human bronchial epithelial cells
, British Thoracic Society Winter Meeting 2025, QEII Centre, Broad Sanctuary, Westminster, London SW1P 3EE, 26 to 28 November 2025, Programme and Abstracts, Publisher: BMJ Publishing Group Ltd and British Thoracic Society, Pages: A301.1-A301 -
Conference paperDu H, Ma J, Lei M, et al., 2025,
P250 GSDMB regulates human rhinovirus replication and inflammation in airway epithelial cells
, British Thoracic Society Winter Meeting 2025, QEII Centre, Broad Sanctuary, Westminster, London SW1P 3EE, 26 to 28 November 2025, Programme and Abstracts, Publisher: BMJ Publishing Group Ltd and British Thoracic Society, Pages: A301.3-A302 -
Journal articleSymes R, Whitaker HJ, Ahmad S, et al., 2025,
Vaccine effectiveness of a bivalent respiratory syncytial virus (RSV) pre-F vaccine against RSV-associated hospital admission among adults aged 75-79 years in England: a multicentre, test-negative, case-control study.
, Lancet Infect DisBACKGROUND: A respiratory syncytial virus (RSV) vaccination programme for older adults using bivalent pre-F vaccine was introduced in England from Sept 1, 2024. Although vaccine effectiveness has been reported against all-cause RSV-associated respiratory hospital admissions, data are scarce on vaccine effectiveness against different presentations of RSV-associated illness, such as exacerbation of chronic illness. METHODS: This multicentre, test-negative, case-control study used data from a national, hospital-based, acute respiratory infection sentinel surveillance (HARISS) system across 14 hospitals in England. Eligibility criteria were vaccine-eligible adults aged 75-79 years admitted to hospital with acute respiratory infection (ARI) for ≥24 h and tested with molecular diagnostic assays within 48 h of admission. Cases were RSV positive, and controls were negative for RSV, influenza, and SARS-CoV-2. Vaccination status and data on sex were obtained from the National Immunisation Information System. The primary outcome was hospital admission due to RSV-associated ARI, which was tested for using nasopharyngeal or combined nose and throat swabs. Clinical data were collected using a structured questionnaire. FINDINGS: Between Oct 1, 2024, and March 31, 2025, 1006 older adults were admitted to hospital with ARI; 173 were RSV positive (cases) and 833 were RSV negative (controls). 526 (52·3%) of 1006 individuals were female and 480 (47·7%) were male. Mean age was 77·8 years (SD 1·4) in individuals who were RSV positive and 77·6 years (SD 1·3) in those who were negative for RSV, influenza, and SARS-CoV-2. Vaccine effectiveness was 82·3% (95% CI 70·6-90·0) against hospitalisation for any RSV-associated ARI and 86·7% (75·4-93·6) in those with severe disease including oxygen supplementation. Vaccine effectiveness was 88·6% (75·6-95·6) among individuals admitted due to lo
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Journal articleQuintero Santofimio V, van der Plaat D, Fuertes E, et al., 2025,
Gene-occupational exposure interactions in small airways obstruction in the UK Biobank: a cross-sectional study
, Occupational and Environmental Medicine, ISSN: 1351-0711Objectives: Small airways obstruction (SAO) has been associated with lifetime exposure to several agents in the workplace. Whether this association is modified by genetic variants is unknown. Methods: Using data from 147,317 adults (33,552 with SAO; 108,762 without SAO) participating in the UK Biobank, we conducted a genome-wide association analysis to identify genetic variants associated with SAO at baseline, defined as the forced expiratory volume in 3 seconds to 6 seconds ratio (FEV3/FEV6) below the lower limit of normal. We assigned occupational exposures using the ALOHA+ job exposure matrix. Using cross-sectional data from 38,911 participants (8,363 with SAO; 30,548 without SAO), who had complete job histories, we assessed whether the identified genetic variants interacted with occupational exposure on SAO using logistic regression models adjusted for confounders. Additionally, we investigated whether gene-occupational exposure signals were associated with gene expression in lung tissue. Results: We identified 36 genetic variants significantly associated with SAO. Eight of these significantly modified the association of SAO with pesticides, vapour, gases, dusts, fumes (VGDF), and metals, with participants homozygous for the reference allele being at increased risk of SAO when exposed to these agents. Only two of these genetic variants (rs9273529 and rs644045) appeared to affect gene expression in lung tissue. We found no significant interactions with solvents.Conclusions: Using a large population-based cohort, we identified genetic variants that interact and modify the association between SAO and several common workplace exposures. Further research is needed to confirm these effect modifications results and clarify potential biological mechanisms.
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Journal articlePortas L, Talaei M, Dean C, et al., 2025,
Lung development genes, adult lung function and cardiovascular comorbidities
, Thorax, Vol: 80, Pages: 738-747, ISSN: 0040-6376Background: The association between lower adult lung function and increased cardiovascular comorbidity has not been adequately explained. We investigated whether shared developmental signalling pathways, critical to lung development and repair, could partly explain it.Methods: In UK Biobank (UKB), we performed pairwise colocalisation analysis of variants in 55 lung development genes associated with adult forced vital capacity (FVC) or forced expiratory volume in 1 s (FEV1)/FVC, to see if these are also associated with coronary heart disease (CHD), blood pressure (systolic, diastolic, hypertension), pulse pressure, Arterial Stiffness index and carotid intima-media thickness. For CHD, we meta-analysed data from UKB and the CARDIoGRAM consortium.Results: We found that 12 of the 55 genes shared the same variant between one (or more) lung function trait and one (or more) cardiovascular trait (H4colocalisation). The direction of effects was always in keeping with our hypothesis (lower lung function–higher cardiovascular risk) for FVC, but not always for FEV1/FVC. The seven signals for hypertension and CHD all replicated nominally in the FinnGen study, while replication was poor in the China Kadoorie Biobank (CKB) study. In addition, we found a further 10 genes where genetic associations with lung function and cardiovascular traits were within the same gene but involved different variants (H3 colocalisation). Interestingly, six of all 22 genes (H4 and H3 colocalisation) were novel for cardiovascular traits; four replicated in FinnGen, three in CKB.Conclusion: Lung function and cardiovascular traits have shared developmental pathways that may partly explain why lower lung function, especially FVC, is associated with increased cardiovascular risk.
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Journal articleTomeny EM, Tran PB, Kazibwe J, et al., 2025,
A broader lens on tuberculosis cost-effectiveness analysis: How patient-incurred costs and post-tuberculosis outcomes reshape estimates in a multi-country study
, PLOS GLOBAL PUBLIC HEALTH, Vol: 5 -
Journal articleKagima JW, Ozoh OB, Mpagama S, et al., 2025,
Challenges in respiratory medicine: the need for integrated tuberculosis and respiratory care in low-resource settings
, Thorax, ISSN: 0040-6376Background Pulmonary tuberculosis (PTB) and chronic respiratory diseases (CRDs) are intricately linked. People with PTB and CRDs experience similar symptoms, including breathlessness, cough and chest pain. They may have similar risk factors for disease, including smoking and occupational exposures. PTB is also a direct cause of lung damage in the form of post-TB lung disease. However, despite the overlap in risk factors, symptoms and sequelae, public health and clinical care pathways for TB and CRDs remain almost entirely separate in many low- and middle-income countries (LMICs). Those with respiratory symptoms are directed to TB services as a first point of contact where they are known as ‘people with presumptive TB’, and pathways to respiratory diagnosis and care remain largely inadequate.Aim In this opinion piece we describe opportunities for the integration of tuberculosis (TB) and respiratory care, as a means of improving patient outcomes in LMICs. Strategies may include upstream public health interventions to address shared risk factors, the use of shared diagnostic pathways, the provision of decentralised access to both TB and CRD care, and coordinated information provision about the risk factors and symptoms of both conditions. Health-related benefits may include more timely diagnosis of CRDs, improved CRD treatment and care, and reduced inappropriate empirical TB treatment or retreatment. We highlight the need for pilot models of integrated care, with robust design and evaluation, and we note that an integrated approach may be particularly timely given the increasing scarcity of global health donor funding.
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Journal articleCestelli L, Amaral A, Benediktsdottir B, et al., 2025,
The association between systemic inflammation, lung function and respiratory symptoms in the BOLD study in Northern Europe
, Scientific Reports, Vol: 15, ISSN: 2045-2322The role of systemic inflammation in the pathogenesis of respiratory diseases is increasingly recognized, but the relationship between individual inflammatory markers, lung function and respiratory symptoms is not well established. We studied 1,238 adults participating in the first follow-up of the Burden of Obstructive Lung Disease (BOLD) cohort study in Sweden, Norway, Iceland, and Estonia in 2019–2021. Systemic inflammation was assessed using total white blood cell (WBC) count and WBC sub-populations (neutrophils, lymphocytes, monocytes, eosinophils, basophils and neutrophil-to-lymphocyte ratio (NLR)). In regression models adjusted for gender, age, smoking status, body mass index and study site, all WBC sub-populations, except for lymphocytes, were associated with chronic airflow obstruction (CAO) and wheeze. In never smokers, increased neutrophils were associated with reduced lung volumes (FEV1 β coef. with 95%CI -1.95 (-3.33, -0.57) p = 0.006; FVC − 1.94 (-3.18, -0.69) p = 0.002), but not CAO. Only increased basophils were associated with CAO in never smokers (OR with 95%CI 2.70 (1.28, 5.72) p = 0.009). In former smokers, increased neutrophils, monocytes and eosinophils were significantly associated with reduced FEV1, reduced FVC, CAO and wheeze. In current smokers, inflammatory markers were associated with cough (neutrophils OR with 95%CI 1.49 (1.10, 2.01) p = 0.010; monocytes 1.24 (0.99, 1.55) p = 0.058; basophils 2.56 (1.12, 5.86) p = 0.026). Systemic inflammation may be related to both obstructive and restrictive respiratory impairment in the general population, with associations that vary by smoking status.
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Journal articleIto K, 2025,
Can inhaled antifungals provide a viable solution for treatment-refractory pulmonary fungal infections?
, EXPERT REVIEW OF ANTI-INFECTIVE THERAPY, Vol: 23, Pages: 537-540, ISSN: 1478-7210 -
Journal articleKhan AA, Vernugopan V, Wallis G, et al., 2025,
Artificial stone silicosis presenting as suspected Tuberculosis: A series of 3 cases at a district general hospital
, Clinical Infection in Practice, Vol: 27Silicosis is an ancient condition re-emerging globally due to outbreaks of accelerated disease related to the use of artificial stone. The initial presentations of three patients with silicosis due to artificial stone exposure at a district general hospital in London, all of whom presented with clinical symptoms and radiological features assumed to be tuberculosis, are reported. The associations between silica exposure and this infection are also described. This series aims to highlight that artificial stone silicosis is now a significant occupational lung disease in the UK of which clinicians working in infectious diseases should be aware of.
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