The Lancet Respiratory Medicine

BackgroundMulti-system impacts of long COVID remain unknown. We compared multi-system deficits between people with long COVID and controls. MethodsA case-control study recruited from the Avon Longitudinal Study of Parents and Children and TwinsUK population cohorts. Cases (141) had long COVID (evidence of COVID-19 infection and persistent symptoms [&ge;]4 weeks post infection); controls (280) included people making a full recovery in <4 weeks, people self-reporting long COVID like symptoms but ...

RationalePatients receiving prolonged mechanical ventilation are often discharged to long-term acute care hospitals (LTACHs) with hopes of recovery and ultimately return to the community. Among those who survive and undergo tracheostomy, little is known about their quality of life and social outcomes after LTACH discharge. ObjectiveMeasure health related quality of life in a cohort of critical illness survivors who underwent tracheostomy and an LTACH stay MethodsSingle center, prospective obse...

IntroductionAs antibiotic resistant organisms and infections continue to proliferate globally, it becomes increasingly difficult to select empiric antibiotic therapy, particularly in patients who stand to benefit from early adequate treatment. The inappropriate treatment of suspected infection, including sepsis, can be both too narrow and too broad. There is a need to optimize and tailor selection of antibiotic therapy to each patient, such that those at risk for infections due to antibiotic res...

Mucociliary clearance is a key component of the pathophysiology of bronchiectasis but cilia function is poorly defined. This study aims to characterize nasal ciliary function in bronchiectasis and examine associations with disease severity, infection, inflammation and outcome. Adults with bronchiectasis and healthy volunteers were recruited to the international observational study EMBARC-BRIDGE. Individuals with a known diagnosis of Primary Ciliary Dyskinesia (PCD) were excluded. Nasal respira...

BackgroundSymptom diaries are widely used in acute respiratory infection trials to capture patient-reported symptom severity and recovery. Longer questionnaires may provide a more complete clinical picture but can increase participant burden and reduce adherence. Evidence directly comparing long and short formats within the same trial is limited. ObjectiveTo compare adherence, symptom trajectories, agreement between recovery measures, and predictive performance for recovery-related outcomes bet...

BackgroundThough a normal forced vital capacity (FVC) is typically thought to imply the absence of restriction, recent data suggest that restriction may in fact be common among patients with normal spirometry. However, the clinical significance of restriction with normal spirometry is unknown. Research QuestionWhat clinical characteristics and outcomes are associated with restriction with normal spirometry? Study Design and MethodsWe interpreted pulmonary function tests (PFTs) with both static...

Background and AimsThe prognosis of interstitial lung diseases (ILDs) other than idiopathic pulmonary fibrosis (IPF) has not been studied as extensively as IPF. This study aimed to evaluate baseline factors associated with mortality in non-IPF ILD, including demographic characteristics, respiratory function test (RFT), comorbidities, and ILD subtypes. MethodsThis retrospective cohort study analysed prospectively collected data of patients with non-IPF ILD at a single tertiary centre in Malaysia...

Background: Interstitial lung abnormalities (ILA) are radiologic findings of increased lung density or fibrosis in individuals without clinical interstitial lung disease (ILD) and are associated with increased mortality and progression to ILD. Understanding physiologic trajectories of lung function preceding ILA diagnosis may illuminate early mechanisms of lung injury. Methods: We recruited participants from the Coronary Artery Risk Development in Young Adults (CARDIA) Lung Study, a prospective ...

Chronic obstructive pulmonary disease (COPD) and idiopathic pulmonary fibrosis (IPF) are phenotypically divergent disorders arising from similar exposures (including cigarette smoke). Differences in DNA methylation may drive the exposed lung towards COPD vs. IPF. To characterize differential methylation in COPD and IPF lung tissue relative to controls, we conducted epigenome-wide association studies of COPD and IPF in lung tissue from the Lung Tissue Research Consortium (N=1029), adjusting for a...

Pulmonary arterial hypertension (PAH) is a rare, life-limiting disease where deficiency of the TGF/BMP pathways have causal roles in hereditary and idiopathic forms. It is an attractive candidate for therapeutic intervention but there is an unmet need for clinically-relevant and practical biomarkers that can measure target engagement. A major challenge has been the inaccessibility of lung tissue in disease for molecular profiling. Here we explore the surrogate capacity of peripheral blood BMP pa...

Chronic obstructive pulmonary disease (COPD) is a debilitating and progressive lung disease that affects millions of people worldwide. There is a continuing clinical need to characterize COPD at the molecular level to be able to identify the multi-omic biomarkers of its pathogenesis and to enable more accurate diagnoses and more effective treatment. We used Multi-Omics Factor Analysis (MOFA) to jointly analyze genomic, blood transcriptomic, and plasma proteomic data collected from 1,872 particip...

BackgroundClimate change is increasingly recognised as a threat to population health and healthcare systems, yet the effects of environmental variability on pharmaceutical prescribing remain poorly characterised in the UK. Using a wide array of open-source datasets, we examine the effect of environmental, geographic and socioeconomic factors on prescribing habits in England. MethodsWe linked monthly, practice-level prescribing data for England (2010-2025) to meteorological, air-quality, floodin...

IntroductionFibrosis can affect organs throughout the body and is present in a wide range of diseases. Recent research has suggested that there could be shared biological mechanisms that lead to fibrosis in different organs. MethodsWe performed genome-wide association studies using UK Biobank for fibrosis in 12 different organ-systems and meta-analysed results with previously published studies of fibrotic diseases. We considered genetic associations that colocalised across [&ge;]3 organs as tho...

BackgroundHousehold contact investigation for tuberculosis (TB) is limited by referral for clinic-based testing services. We evaluated the performance of in-home tongue swab (TS) testing among symptom-agnostic household contacts (HHC) to inform HCI screening strategies. MethodsWe conducted a prospective cohort study among HHC of TB patients in Eastern Cape, South Africa. In-home testing of sputum and TSs, with TSs pooled from up to three HHCs, was performed using Xpert Ultra on portable GeneExp...

ObjectivesThere is a deficit of information available to guide longer-term healthcare planning in meeting health needs and ensuring financial sustainability. This study attempts to address this gap through projecting future population health state and demographics and associated healthcare resources required to satisfy expected demands over the next two decades. MethodsA mathematical model is developed for projecting a populations future age and health state, subject to births, deaths, immigrat...

ObjectivesThe coronavirus disease 2019 (COVID-19) pandemic has necessitated the urgent investigation of effective long-term therapeutic agents. This study aimed to evaluate the definitive, long-term causal effect of N-acetylcysteine (NAC) treatment on patient-reported outcomes (PRO) in patients with COVID-19 from hospital admission to six months after discharge. DesignProspective, multi-center, randomized, double-blind, placebo-controlled trial (RCT). SettingFive COVID-19-designated hospitals,...

ObjectiveThe objective was to estimate unique patterns of change in fatigue in people with the Post-Covid Syndrome (PCS) over 15 months. Design/SubjectsThe Quebec Action for Post-COVID (QAPC) study was a prospective study designed to provide a patient-centered understanding of symptoms, function, and quality of life in a self-identified Quebec sample. MethodsParticipants were queried every 3 months about symptoms and function. Fatigue was measured with the 10-item Post-COVID Syndrome Fatigue S...

BackgroundMedication-related morbidity due to inappropriate prescribing, delays in appropriate treatment, and adverse drug events are major contributors to mortality in acutely hospitalized adults. Comprehensive medication management (CMM) is a standard for medication therapy care provided by pharmacists in collaboration with the interprofessional rounding team. Optimization of CMM via appropriate pharmacist staffing practices may reduce mortality. MethodsAdults admitted to an intensive care un...

ObjectiveDespite substantial variability in the severity of post-anoxic encephalopathy, all comatose patients after cardiac arrest are usually treated according to the same standardized intensive care protocol, including sedation, mechanical ventilation, and targeted temperature management (TTM). We hypothesize that patients with a favourable EEG pattern (continuous EEG within 12 hours after cardiac arrest) may not benefit from prolonged sedation and TTM. We studied the feasibility and safety of...

Functional capacity, muscle strength, and patient-reported outcome measures are important indicators of health. In chronic obstructive pulmonary disease (COPD), these traits are often impaired beyond normal age-related decline. Substantial variability exists in both COPD and healthy populations, the biological basis of which remains poorly understood. Given the known contribution of genetics to complex traits, genetic factors may partly explain this variability. This study aimed to identify gene...