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Journal articleMeghji J, 2026,
The ITARA research programme: investigating Integrated Tuberculosis and Respiratory care in Africa using transdisciplinary methods
, BMJ Open, ISSN: 2044-6055IntroductionPulmonary tuberculosis (PTB) and chronic respiratory diseases (CRDs) are closely linked. Affected groups present with similar symptoms, and share many risk factors (E.g. Poverty related factors, smoking, occupational exposures). PTB is itself an independent risk factor for chronic lung disease. However, in many high TB-incidence settings health services for these conditions are provided separately, with little integration of prevention, diagnosis, or care.Methods and analysisWe describe a transdisciplinary programme of research investigating strategies for integrated TB-CRD care in Arusha, Tanzania, Nairobi, Kenya and Lagos, Nigeria, using clinical, health economic, health systems, and qualitative research methods. A prospective clinical cohort study will describe the burden and impact of non-TB respiratory disease (E.g. Asthma, COPD, post-TB lung disease) amongst adolescents and adults presenting to primary and secondary health facilities with chronic cough, who would normally be managed via TB care pathways. Health economics methods will explore patient costs of non-TB respiratory disease, facility-level costs of integrated TB/respiratory diagnostics, and will develop a modelling framework to estimate the costs and consequences of integration more broadly. In-depth interviews, focus group discussions, observations and participatory methods will be used to explore lived experiences of chronic respiratory symptoms, disease and exposures amongst patients and providers, and to identify and address challenges around respiratory health and care. Lastly, existing TB and CRD health care services and systems in our three research sites will be described, and local, national, and policy level understandings of ‘integration’ of TB and CRD care will be explored. Together, the findings of this work will be used to develop context informed model(s) of integrated TB-CRD care, and a theory of change and framework for evaluation in future implementation st
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Journal articleQuintero Santofimio V, Ma J, Potts J, et al., 2026,
Association of respiratory health with occupational exposures in the Burden of Obstructive Lung Disease (BOLD) cohort: A multinational longitudinal study
, BMJ Open Respiratory Research, ISSN: 2052-4439 -
Journal articleBisson GP, Allwood B, Byrne A, et al., 2026,
Post-tuberculosis lung disease: a case definition for use in research studies.
, Lancet Infect Dis, Vol: 26, Pages: e315-e325Despite 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 articleThorarinsdottir E, Benediktsdóttir B, Aspelund T, et al., 2026,
Screening for obstructive sleep apnoea in the general population in Iceland and uptake of positive airway pressure treatment: a prospective cohort study
, BMJ Open, ISSN: 2044-6055Objectives: To estimate uptake of obstructive sleep apnoea (OSA) screening and initiation and long-term use of positive airway pressure (PAP) treatment in a middle-aged and older general population cohort.Design: Prospective population-based cohort study.Setting: Icelandic arm of the multinational Burden of Obstructive Lung Disease follow-up study II (2019 - 2021)Participants: 378 non-institutionalised adults aged 54 to 91 years were invited from a general population cohort. Twenty-six with prior OSA diagnosis were excluded. Of the remaining participants, 334 (88.4%) completed a technically adequate home sleep apnoea test (HSAT).Interventions: Those with an apnoea–hypopnoea index (AHI) ≥15 events/hour were invited for clinical evaluation and when appropriate, referred for PAP treatment. Adherence was assessed two years after PAP initiation. Main outcome measures: Primary outcomes were screening uptake and PAP initiation. Secondary outcomes included long-term PAP use and objective adherence two years after referral.Results: AHI ≥15 was identified in 132/334 participants (39.5%). Of these, 123 (93.2%) attended clinical evaluation and 99 (75.0%) were referred for PAP treatment. Of those not referred, six declined PAP and the remainder were advised alternative management or reassessment. At two-year follow-up, 53/99 (53.5%) were long-term PAP users, 43/99 (43.4%) had discontinued, and 3/99 (3.0%) never initiated PAP. Objective adherence data were available for 47/53 long-term users; 21/47 (44.7%) met adherence criteria (≥4 hours/night on ≥70% of nights in the preceding 30 days). Conclusions: Most adults accepted OSA screening when offered. Among those with moderate-to-severe OSA identified through population screening, most accepted evaluation and PAP treatment, with approximately half becoming long-term users. These findings suggest that population-based detection of OSA followed by routine clinical management is feasible. Future studies should identi
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Journal articleGandhi SA, Liu GY, Fazio JC, et al., 2026,
Silicosis in the Artificial Stone Countertop Industry: An Official American Thoracic Society Workshop Report.
, Ann Am Thorac SocArtificial stone-associated silicosis (AS silicosis) has emerged over the past decade as a severe, rapidly progressive, and preventable occupational lung disease affecting workers who manufacture, fabricate, and install artificial stone countertops. Characterized by short latency, accelerated progression, and high morbidity and mortality, AS silicosis disproportionately affects young workers employed in precarious conditions. In response to the growing global burden of disease, this American Thoracic Society workshop was convened in 2025 to review the current state of knowledge regarding AS silicosis, synthesize the current evidence, and identify priorities for research, clinical care, public health surveillance, and prevention. Workshop participants reviewed data spanning exposure science, epidemiology, clinical manifestations, health equity, and policy responses. Evidence demonstrates that artificial stone (AS) dust is highly toxic, containing high concentrations of respirable crystalline silica, resin-derived volatile compounds, and trace metals, resulting in exposures that routinely exceed occupational exposure limits. Despite widespread implementation of wet methods, ventilation, and respiratory protection, hazardous exposures persist across diverse settings globally, highlighting fundamental limitations of existing control strategies. Clinically, AS silicosis is associated with high rates of progressive massive fibrosis, autoimmune disease, infection, respiratory failure, and increasing need for lung transplantation. Treatment options remain limited, underscoring the importance of early detection and exposure cessation. The workshop identified critical gaps in medical screening and public health surveillance worldwide, with inconsistent regulatory frameworks, low compliance, underreporting, and delayed diagnoses. Case detection is often dependent on symptomatic presentation rather than proactive screening, exacerbating disease severity and inequities in care.
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Journal articleBurney P, Bagkeris E, Potts J, et al., 2026,
A cohort study of forced vital capacity, airway obstruction and survival in the multinational Burden of Obstructive Lung Disease (BOLD) study
, International Journal of Epidemiology, Vol: 55, ISSN: 0300-5771BackgroundIn the USA, higher forced vital capacity (FVC) is linked with longer survival, and FVC is associated with survival independently of ethnicity. The implications for the low FVC values in parts of Asia and Africa are unknown.MethodsWe used data from 16 sites of the multinational Burden of Obstructive Lung Disease (BOLD) study that completed follow-up of participants between 2019 and 2021 and reported at least five deaths between baseline and follow-up. We assessed the association between mortality and FVC and one-second Forced Expiratory Volume (FEV1)/FVC ratio within each site using Cox proportional hazards models. These models were adjusted for age, smoking, height and weight. Effect estimates from all sites were combined using meta-analysis. Systematic regional differences were investigated.ResultsOf 9,927 study participants with follow-up data, 1,120 (11.3%) had died (mean follow-up = 8.7 years, standard deviation (SD) = 3.3 years). Baseline post-bronchodilator FVC and FEV1/FVC were inversely associated with mortality. When both FVC and FEV1/FVC were mutually adjusted for each other, the decreased mortality rates were more pronounced for each standard deviation higher FVC at baseline (44% (95% confidence interval (CI): 25%, 58%) for men and 28% (95%CI: 11%, 41%) for women) than for FEV1/FVC at baseline (14% (95% CI: 8%, 20%) for men and 7% (95% -10%, 21%) for women). The probability of true regional differences was low.ConclusionsPeople with a higher FVC adjusted for age, sex and height have a longer survival. Regional adjustments to lung function standards are inappropriate when assessing prognosis.
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Journal articleBurney P, Knox-Brown B, Amaral A, 2026,
The use of spirometry to define airflow obstruction and diagnose COPD
, European Respiratory Journal, ISSN: 0903-1936 -
Journal articleMak J, Feary J, Amaral A, et al., 2026,
Mortality in a cohort of Transport for London workers
, Scientific Reports, Vol: 16, ISSN: 2045-2322Transport workers face various occupational hazards, however long-term effects on mortality are less understood. Transport for London (TfL) employs almost 30,000 workers across a wide range of transport-based jobs and working environments. This study aimed to characterise mortality among TfL employees, and investigate long-term health outcomes.A retrospective cohort was formed using cause of death data from the TfL pension fund for employees working between 1960 and 2010. Workers were grouped by job title and Cox proportional hazard models were used to assess all-cause, respiratory, cardiovascular, and cancer mortality. Bus (hazard ratio HR: 1.17, 95% confidence interval CI 1.09-1.25) and London Underground (LU) (HR: 1.23, 95% CI 1.15-1.32) workers had significantly higher risks of all-cause, as well as respiratory, cardiovascular, and cancer mortality when compared to office workers. Mortality rates did not differ significantly between bus and LU workers, potentially due to shared occupational or lifestyle risk factors.In this large subway cohort study, mortality rates over 50 years were greater among bus and LU workers compared to office employees. However, findings should be interpreted cautiously due to limitations in data availability and unmeasured confounders. Future prospective studies should address these limitations by collecting detailed health and exposure data.
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Journal articleCookson W, Moffatt M, 2026,
Airway microbiome diversity, intra-mucosal bacteria, and spatial immunity in asthmatics and controls
, American Journal of Respiratory and Critical Care Medicine, ISSN: 1073-449XRationale: Asthma is characterized by disruption of the thoracic airway mucosae and loss of microbial diversity. Spatial profiling of the mucosal transcriptome may systematically discover mechanisms for microbial influences on immunity. Objectives: We investigated relationships between clinical measures, microbial communities, and the host mucosal transcriptome within different strata of bronchial biopsies in subjects with and without asthma. Methods: We bronchoscoped 65 adult asthmatics and 44 healthy controls, quantifying bacterial operational taxonomic units (OTUs) in bronchial brushings by 16S rRNA gene amplicon sequences. Biopsy histologic features were scored blind to diagnosis. Following 16S rRNA in situ hybridization of 44 biopsies, bacterial foci were scored in epithelium, basement membrane and stroma. Global human gene expression was quantified in epithelial and stromal compartments using Digital Spatial Profiling. Measurements and main results: Clinical asthma was independently predicted by basement membrane abnormalities (BaseMA), endobronchial bacterial diversity and circulating eosinophil counts, but not by specific OTU abundances. 16S rRNA staining revealed bacteria within epithelium and mucosa of all biopsies. Intra-mucosal bacteria (IMCBs) counts correlated negatively with spatially organized co-expression networks encoding antigen-specific immunity, neutrophil functions, and matrix activation, whereas BaseMA correlated positively with the adaptive immunity module. Eosinophil counts correlated with epithelial bacterial counts and senescence pathways. Clinical asthma was accompanied by upregulation of a Treg cell network. Conclusions: Asthma and its related phenotypes are accompanied by complex mucosal events that extend beyond eosinophilic pathways. Components of diverse airway microbiota may modify immunity by beneficial interactions within the mucosa.
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Journal articleBarsosio HC, Tangara B, Marlais T, et al., 2026,
Uncomplicated malaria as a risk factor for COVID-19 duration and severity in western Kenya and Burkina Faso (MALCOV): a prospective cohort study.
, Lancet Glob Health, Vol: 14, Pages: e793-e805BACKGROUND: The relationship between malaria and COVID-19 varies across different clinical scenarios; historical malaria exposure might protect against severe COVID-19, whereas co-infection in hospitalised patients with severe disease might increase mortality. Interactions between non-severe malaria and COVID-19 remain poorly understood. We conducted a cohort study among COVID-19 patients of all ages in western Kenya and Burkina Faso to assess the effects of acute, uncomplicated Plasmodium falciparum malaria co-infection on COVID-19 outcomes in ambulatory patients. METHODS: Participants with laboratory-confirmed SARS-CoV-2 infection (positive rapid antigen test or reverse transcription quantitative real-time PCR [RT-qPCR]) were tested for malaria by rapid antigen tests with confirmatory microscopy. Patients with COVID-19 and malaria co-infection received artemether-lumefantrine or pyronaridine-artesunate. COVID-19 symptom course was assessed daily using FLU-PRO Plus (a validated patient-reported outcome instrument) until day 14. Viral load was measured by RT-qPCR on days 0, 3, 7, 14, and 28. The primary endpoint was time to symptom resolution on the FLU-PRO Plus. Analyses were adjusted for country, age, disease severity, and viral load. FINDINGS: Between Jan 8, 2021 and Jan 24, 2022, we screened 5161 participants and recruited 756 with COVID-19. 742 participants with valid malaria tests were enrolled, of which 151 (20%) had malaria co-infection and the remaining 591 (80%) did not have malaria. Patients with malaria were younger (49 [32%] aged <15 years) than those without malaria (35 [6%]; p<0·0001). Time to symptom resolution was similar between those with malaria (median 9 days [IQR 5-13]) and those without (10 days [IQR 6-13]; adjusted hazard ratio [aHR] 1·14 [95% CI 0·91-1·42]; p=0·26). Three (2%) patients with malaria and nine (2%) without malaria were hospitalised; two (1%) with malaria and three (1%) without malaria di
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Book chapterChi S, Zhang Y, 2026,
ORMDL3 and Sphingolipid Metabolism in Human Airway Inflammatory Diseases
, Inflammation, Editors: WangSphingolipid species play important roles in maintaining the functions of human lungs. Genetic studies identified that the polymorphisms of the ORMDL3 gene on human chromosome 17 were strongly associated with airway inflammatory diseases. ORMDL3 has multiple functions in human epithelial cells: it regulates de novo sphingolipid synthesis, protein folding, glycolysis, and expression of human rhinovirus receptor intercellular adhesion molecule 1(ICAM-1). In this chapter, we will focus on sphingolipids’ metabolism in airway epithelium and illustrate how ORMDL3 regulates sphingolipid lipid metabolism, particularly on ceramides and sphingosine-1-prosphrate (S1P) for the signaling transduction in inflammatory response. We will explore the roles of sphingolipid species in airway diseases including asthma, chronic obstructive pulmonary disease (COPD), lung injury, lung fibrosis, and lung infections caused by viruses, bacteria, and fungi. Finally, we will discuss the potential therapeutic agents that work in sphingolipid pathways for lung inflammatory diseases.
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Journal articleCanizales J, Schofield S, Shamji MH, et al., 2026,
Patterns of mouse allergen–specific IgE and IgG4 in contemporary animal research environments
, Clinical and Experimental Allergy, ISSN: 0954-7894 -
Journal articleOosterwegel MJ, Ibi D, Portengen L, et al., 2026,
Correction to "Variability of the Human Serum Metabolome over 3 Months in the EXPOsOMICS Personal Exposure Monitoring Study".
, Environ Sci Technol, Vol: 60 -
Journal articleMa J, Quintero Santofimio V, Potts J, et al., 2026,
Alcohol consumption and small airways obstruction
, Chest, ISSN: 0012-3692 -
Journal articleKagima JW, Ozoh OB, Mpagama S, et al., 2026,
Challenges in respiratory medicine: the need for integrated tuberculosis and respiratory care in low-resource settings
, Thorax, Vol: 81, Pages: 294-297, 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 articleSymes R, Whitaker HJ, Ahmad S, et al., 2026,
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 Dis, Vol: 26, Pages: 229-238BACKGROUND: 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 articleLiatsikos K, Hyder-Wright A, Davies K, et al., 2026,
The effect of pneumococcal conjugate vaccine and pneumococcal polysaccharide vaccine on nasopharyngeal colonisation following human infection challenge with serotype 3 and serotype 6B (PREVENTING PNEUMO 2): a double-masked, randomised, controlled, phase 4 trial.
, Lancet Microbe, Vol: 7BACKGROUND: Although evidence suggests some direct protection from the 13-valent pneumococcal conjugate vaccine (PCV13) against Streptococcus pneumoniae serotype 3 (Spn3), Spn3 remains a frequent cause of pneumococcal disease in the UK, potentially due to lower vaccine effect on colonisation, shorter duration of protection, or the emergence of more successful Spn3 clades. To test these hypotheses, we compared PCV13 and 23-valent pneumococcal polysaccharide vaccine (PPV23) protection against prevalent Spn3 clades. Additionally, we assessed the long-term protection offered by pneumococcal vaccines against colonisation using S pneumoniae serotype 6B (Spn6B), a serotype PCV13 protects against in the short term. METHODS: This double-masked, randomised, controlled, phase 4 trial recruited healthy participants aged 18-50 years in Liverpool, UK, and assigned them (2:1:2) to PCV13, PPV23, or placebo (0·9% NaCl). Participants assigned to the PPV23 group were challenged with clade Iα, and participants in PCV13 and placebo groups were subsequently randomly assigned to receive clade Iα or II Spn3. Nasal challenge with Spn3 was at 1 month and with Spn6B in a subgroup at 6 months after vaccination. Selection for this subgroup was conducted on a first-come-first-served basis, with participants who enrolled earliest being offered participation in both challenges. Recruitment for the second challenge was discontinued once the target number of participants was reached. The primary outcome was the acquisition risk of the challenge strain as detected by nasal wash culture at 2 days, 7 days, 14 days, or 23 days in the vaccine versus the placebo groups. The analysis was performed in a modified intention-to-treat population, defined as all participants who received vaccination, underwent challenge, and had at least one nasal wash sample collected after the challenge. Randomisation used a computer-generated schedule that only the unmasked team could access. The unmasked t
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Journal articleO'Reilly A, Martin CA, Cox SE, et al., 2026,
Post-TB care in the UK: a national survey of existing practice
, BMJ Open Respiratory Research, Vol: 13, ISSN: 2052-4439BackgroundTB survivors experience high mortality and long-term morbidity, contributing substantially to the global TB burden. In the UK, where TB incidence is rising, the scale of post-TB health needs is unknown and current guidelines do not recommend follow-up. We conducted the first nationwide survey of UK TB services to assess approaches to post-TB care.MethodsWe conducted a digital survey between February and May 2025 across NHS TB services in all four nations, targeting specialist clinicians. The questionnaire captured data on types of post-TB morbidity encountered and current practice. We analysed descriptively and stratified by caseload.ResultsWe received responses from 113 of 135 TB services (84%). Most respondents were lead clinicians (81%), and nearly all (96%) had encountered post-TB morbidity in their patient populations, including lung disease (82%), social vulnerabilities (79%), and financial issues (66%). High caseload services (≥30 cases/year) reported more types of morbidity (mean 4.2 vs 2.9; p<0.001). While end of treatment symptom screening and chest X-rays are routine (>95%), fewer than half of services perform assessments for broader post-TB sequelae and comorbidities, or provide direct ongoing medical care (41%). Most services cited staffing (78%), clinic capacity (70%), and funding (59%) as challenges to post-TB care.ConclusionsA high proportion of UK TB clinicians recognise post-TB morbidity among their patient groups. TB services are introducing elements of post-TB care, but provision is heterogenous and often informal, with multiple resource-related challenges. Robust UK-specific data, stakeholder engagement, and clear guidance are needed to support post-TB care pathways.
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Journal articleQuintero Santofimio V, Ma J, Vinnikov D, et al., 2026,
Job exposure matrices for use in respiratory health in low- and middle-income countries: a commentary on relevance and future direction
, Annals of Work Exposures and Health, ISSN: 2398-7308Occupational exposures are critical yet often overlooked contributors to chronic respiratory disease. Job Exposure Matrices (JEMs) are widely used to assign occupational exposures where direct measurement is not feasible, particularly in large epidemiological studies. However, their applicability in low- and middle-income countries (LMICs) is limited by contextual, structural, and methodological challenges. Drawing on insights from a focus group of occupational respiratory health and exposure assessment experts, this commentary examines key limitations in applying existing JEMs to LMIC contextsincluding high prevalence of informal employment, job variability, and higher exposure levels. The group identified priority areas for future refinement, including temporal and geographical calibration, and integration of mixed-role employment. While JEMs remain the most practical approach for large-scale exposure assessment, their contextual adaptation is essential to ensure valid exposure–response estimation, improve disease burden attribution, and promote greater equity in global occupational health research.
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Journal articleHowlett P, Durairaj A, Lesosky M, et al., 2026,
The diagnostic accuracy of chest Xray screening for silicosis: a systematic review, meta-analysis and modelling study
, Occupational and Environmental Medicine, Vol: 82, Pages: 614-620, ISSN: 1351-0711Chest X-ray (CXR) is widely used for silicosis diagnosis, despite concerns regarding sensitivity. We investigated the diagnostic accuracy of CXR for silicosis screening compared with CT, high-resolution CT (HRCT) and autopsy, and modelled the relationship between CXR sensitivity and disease severity.Medline, Embase, Scopus and Web of Science databases were searched on 2 July 2024 (PROSPERO registration: CRD42024513830). Meta-analyses were performed by reference standard and at increasing reference test severity cut-offs. The Quality Assessment of Diagnostic Accuracy Studies-2 tool assessed risk of bias. In scenarios of fixed and relative sensitivity, according to disease severity, we estimated missed silicosis cases and the number needed to screen (NNS) in hypothetical populations of low (5%), medium (15%) and high (30%) silicosis prevalence.Twenty studies included 2156 participants and 1105 silicosis cases. CXR had moderate sensitivity (0.76; 95% CI 0.63 to 0.86, I2=84%) and high specificity (0.89, 95% CI 0.77 to 0.95, I2=57%) compared with HRCT in 12 studies, and low sensitivity (0.50, 95% CI 0.45 to 0.55, I2=0%) and high specificity (0.91, 95% CI 0.87 to 0.93, I2=20%) compared with autopsy in two studies. CXR sensitivity increased with higher reference test severity cut-offs. Clinically relevant numbers of cases were missed in fixed and relative sensitivity scenarios; increased prevalence and less severe disease resulted in more missed cases and a lower NNS.Silicosis severity and reference test type both plausibly influence CXR sensitivity. Assuming either fixed or relative sensitivity results in missed silicosis cases. Judicious HRCT screening is likely to improve case detection.
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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, Vol: 27, ISSN: 1465-9921Introduction: There is growing evidence suggesting that lung capacity is associated with risk of cardiometabolic disease. However, most studies rely on spirometric measures of lung capacity and self-reported cardiometabolic disease. We aimed to investigate the association of total lung capacity (TLC) with cardiometabolic disease defined using ICD-10 codes.Methods: Data from adult patients referred to Cambridge University Hospitals between 2016 and 2024 were used if spirometry, single breath gas transfer, and body plethysmography were performed in the same session. GLI reference equations were used to generate z-scores for lung function measures. ICD-10 codes for cardiovascular disease, hypertension, and diabetes were extracted from medical records. We used multi-level (mixed-effects) Cox regression analysis to investigate the association between lung function measurements and incident cardiometabolic disease.Results: 5628 patients were included, 51% were female, with a median age of 62 (IQR 50-70) years. 60% reported a smoking history. Mean follow-up time was 5.7 (SD 2.3) years, during which time 5% received a cardiovascular disease code, 7% a hypertension code, and 3% a diabetes code. A 1-unit increment in TLC z-score was associated with a 12% lower risk of cardiovascular disease (HR: 0.88, 95%CI 0.80-0.97) later in life. The same was seen for FVC (HR: 0.88, 95%CI 0.77-0.99) but not FEV1/FVC or DLCO. A larger TLC was also associated with lower risk of myocardial infarction. We found no association of lung function measures with incident hypertension or diabetes.Conclusion: Lung capacity is a determinant for cardiovascular disease and myocardial infarction, with larger lungs being protective. TLC and FVC should be considered by clinicians along with other factors, when evaluating a person’s risk of cardiovascular disease.
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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 articleBartlett-Pestell S, Quintero Santofimio V, Potts J, et al., 2026,
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., 2026,
Physiological quotients and mortality: redefining lung function interpretation beyond FEV1
, European Respiratory Journal, ISSN: 0903-1936 -
Journal articleTangara B, Barsosio HC, Marlais T, et al., 2026,
Artemether-lumefantrine versus pyronaridine-artesunate for the treatment of malaria in patients with mild to moderate COVID-19 in Kenya and Burkina Faso: a randomised open-label trial (MALCOV).
, EClinicalMedicine, Vol: 91BACKGROUND: It is unknown whether the choice of malaria treatment for uncomplicated malaria affects coronavirus disease 2019 (COVID-19) severity, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral load, or duration of viral shedding. Several antimalarials exhibit antiviral activity against SARS-CoV-2 in vitro and have been suggested as potential therapeutic candidates for COVID-19, particularly pyronaridine-artesunate (PA), despite disappointing clinical results with chloroquine and hydroxychloroquine. METHODS: We conducted an open-label randomised trial comparing standard 3-day treatment with PA and artemether-lumefantrine (AL) in newly diagnosed SARS-CoV-2 infected patients aged ≥6 months with rapid diagnostic test or microscopy-confirmed non-severe malaria in Kenya and Burkina Faso. SARS-CoV-2 was assessed by RT-PCR on days 3, 7, 14, and 28, and symptom resolution was assessed daily for 14 days using FLU-PRO Plus. The primary endpoint was the proportion of participants with SARS-CoV-2 clearance by day 7. Secondary endpoints included SARS-CoV-2 clearance by days 14, 21, and 28, time to SARS-CoV-2 clearance over 28 days, median viral load on day 7, and time to symptom resolution. Complete case analysis was conducted using log-binomial regression for binary outcomes, Cox-regression for time-to-event outcomes, and negative binomial regression for count outcomes, all adjusted for disease severity and viral load at enrolment. The trial is registered with ClinicalTrials.gov NCT04695197. FINDINGS: From January 2021 to January 2022, 143 participants were randomised (PA = 69, AL = 74, intention-to-treat [ITT] population), including 117 with reverse transcription polymerase chain reaction (RT-PCR) confirmed (PA = 58, AL = 59, modified intention-to-treat [mITT] population) and 26 with rapid-antigen test confirmed SARS-CoV-2 infection. The median age was 19 years (interquartile range [IQR] 13-38), 66% were aged ≥15 years. Baseline characteristics were co
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