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Journal articleOzoh O, Owusu SK, Nantanda R, et al., 2026,
Prevalence of asthma among African children and adolescents: findings from the chronic respiratory disease observatory for Africa (CHEST-Africa)
, Thorax, ISSN: 0040-6376 -
Journal articleCawthorne W, Zhang Y, Val N, et al., 2026,
Unmasking programmed cell death in rhinovirus-driven asthma pathology
, Biochemical Society Transactions, ISSN: 0300-5127 -
Journal articleMoffatt MF, Nishimura T, Cox MJ, et al., 2026,
Airway microbiome diversity, intra-mucosal bacteria, and spatial immunity in asthmatics and controls
, American Journal of Respiratory and Critical Care Medicine, Vol: 212, Pages: 1962-1974, ISSN: 1073-449XRationaleAsthma 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.ObjectivesWe investigated relationships between clinical measures, microbial communities, and the host mucosal transcriptome within different strata of bronchial biopsies in subjects with and without asthma.MethodsWe 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 resultsClinical 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.ConclusionsAsthma 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 articleMa J, Quintero Santofimio V, Potts J, et al., 2026,
Alcohol consumption and small airways obstruction
, Chest, Vol: 170, Pages: 752-754, ISSN: 0012-3692 -
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, Vol: 16, 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 54–91 years were invited from a general population cohort. 26 with prior OSA diagnosis were excluded. Of the remaining participants, 334 (88.4%) completed a technically adequate home sleep apnoea test.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 2 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 2 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 2-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 identify subgroups most li
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Journal articleJohannson KA, Barnes H, Peters CE, et al., 2026,
An Evidence-Based Exposure Questionnaire for Interstitial Lung Disease: EXPO-ILD.
, CHEST Pulm, Vol: 4BACKGROUND: Many interstitial lung diseases (ILDs) are associated directly or indirectly with inhaled environmental and/or occupational exposures; exposure identification is critical for diagnosis and clinical management. However, there are currently few evidence-informed exposure questionnaires for ILD, and none are in widespread systematic use. This study sought to develop an evidence-informed ILD exposure questionnaire, leveraging international expert-based consensus on exposures that present relevant risk for ILD development. RESEARCH QUESTION: What environmental and occupational exposures are risk factors for the development of ILD and should be included on ILD-specific exposure questionnaires? STUDY DESIGN AND METHODS: Participants with expertise in ILD, occupational respiratory medicine, or exposure assessment were invited to complete 2 rounds of a modified Delphi survey to identify relevant exposures associated with the risk of developing ILD. Items in the first Delphi round were informed by prior data, including a systematic review/meta-analysis and scoping review of questionnaires. Items not meeting consensus in the first round were carried over to the second round, with additional items added or modified as suggested by participants. Well-established causal exposures were not included. A priori definitions of consensus were applied, indicating response distribution. RESULTS: A total of 38 of 43 experts (88%) participated in the Delphi survey, with 37 of 38 (97%) completing both rounds. A total of 11 exposures met consensus for agreement as relevant risk factors for ILD, whereas 9 met consensus for disagreement as being irrelevant to ILD risk. Six exposures did not achieve consensus. Incorporating these findings with prior evidence syntheses, we developed 2 exposure questionnaires (EXPO-ILD-Short and EXPO-ILD-Long) for ILD for application in both clinical and research settings. INTERPRETATION: This international modified Delphi identified clinically releva
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Journal articleHowlett P, Durairaj A, Gan J, et al., 2026,
Adjusting for the diagnostic accuracy of CXR in the dose-response relationship between cumulative silica exposure and silicosis in miners.
, Occup Environ Med, Vol: 83, Pages: 287-290INTRODUCTION: A recent meta-analysis confirmed that chest X-ray (CXR) has low sensitivity for diagnosing silicosis. We re-estimated previously published dose-response relationships between cumulative respirable crystalline silica (RCS) exposure and silicosis risk, under the assumptions that sensitivity was either fixed or relative to the population proportion of severe silicosis. METHODS: We combined unpublished logistic regression models from Scottish coal miners with meta-analysis results to model how CXR sensitivity changed according to cumulative RCS exposure. We assumed specificity was 0.95. Among mining cohorts, we calculated the difference in the cumulative risk of silicosis between the unadjusted and fixed and relative scenarios. Finally, we re-estimated a published dose-response meta-analysis and associated absolute risk reductions (ARR). RESULTS: The cumulative risk of silicosis was substantially higher in both the fixed and relative sensitivity scenarios compared with the unadjusted estimate in all mining cohorts. This was most pronounced in the relative scenario and when cumulative RCS exposures were below approximately 6 mg/m³-years. A reduction in cumulative RCS exposure from 4 to 2mg/m³-years corresponded to larger ARRs in the fixed and relative scenarios than the unadjusted scenario; 382 (95% CI 361 to 399) and 529 (95% CI 353 to 592) cases per 1000 miners compared with 313 (95% CI 288 to 333) cases per 1000 miners, respectively. DISCUSSION: We relied on a single estimate of the proportion of severe disease to link sensitivity and cumulative RCS exposure. Nevertheless, adjusting for the reduced diagnostic accuracy of CXR for silicosis suggests the burden of silicosis is underestimated in published mining cohorts.
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Journal articleMa J, Burney P, Mannino D, et al., 2026,
Generational changes in lung function in adults from several world regions: results from the burden of obstructive lung disease study
, Thorax, ISSN: 0040-6376This study estimated birth cohort effects on lung function using BOLD data from 28,569 adults born between 1902 and 1976 across 41 sites in 34 countries. Forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and the FEV1/FVC increased across successive birth cohorts in both high-income countries (HICs) and low- and middle-income countries (LMICs), with mean values rising steadily with later birth year. In fully adjusted models, FVC increased by 21.4 mL, FEV1 by 24.6 mL, and FEV1/FVC by 0.25% per birth year. These positive associations were consistent across sex, smoking status, and country-income subgroups (HICs and LMICs).
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Journal articleCarter EC, Hill H, Solórzano C, et al., 2026,
High respiratory syncytial virus burden in children under 3 years of age across all care levels in England.
, BMJ Open Respir Res, Vol: 13OBJECTIVES: This prospective surveillance study aimed to estimate the burden of laboratory-confirmed respiratory syncytial virus (RSV) in under 3-year-olds in the United Kingdom. SETTING: The study was implemented in Merseyside and Bristol, encompassing 11 primary care sites, 5 walk-in centres, 2 secondary care hospitals and 2 tertiary care hospitals. PARTICIPANTS: Children aged under 3 years presenting with lower respiratory tract infection (LRTI) symptoms were included, with a substudy in primary care recruiting children with upper respiratory tract infection (URTI). PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome of the study was the prevalence of RSV infection in primary, secondary and tertiary healthcare settings. Secondary outcomes included severity outcomes (rates of hospitalisation and high dependency care admissions), risk factors for severe disease, economic burden of disease and coinfection prevalence. RESULTS: 2000 children were included in the analysis (410 primary care and 1590 secondary/tertiary care). 318 were included in the URTI substudy. RSV prevalence was 50.0% (95% CI 46.7% to 53.3%) in children admitted to hospital via emergency departments (ED), 36.3% (95% CI 31.7% to 41.0%) in ED discharges, 36.5% (95% CI 24.7% to 49.6%) in primary care (LRTI) and 12.7% (95% CI 8.6% to 17.9%) in primary care URTI. Healthy term-born children accounted for 70.1% of RSV hospitalisations. Risk factors for severe disease included any level of prematurity, age <3 months and congenital cardiac disease. RSV-positive cases incurred a higher mean cost per participant (£1811, 95% CI £1720 to £1903) than RSV-negative cases (£1295, 95% CI £1220 to £1370). CONCLUSIONS: The findings revealed a substantial burden associated with RSV. Even moderate prematurity was a risk factor for severe disease, and these children may not benefit from maternal RSV vaccination due to missed late gestation antibody transfer. Fur
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Journal articleKnox-Brown B, Sylvester K, Amaral A, 2026,
Physiological quotients for discriminating mortality and respiratory outcomes: a UK biobank cohort study
, ERJ Open Research, ISSN: 2312-0541BackgroundSpirometry is traditionally interpreted using reference-based metrics derived from equations such as those from the Global Lung Function Initiative (GLI). Physiological quotients, which express lung function relative to a lower physiological boundary, have been proposed as an alternative approach. We aimed to compare the prognostic performance of physiological quotients with conventional reference-based metrics including both the GLI 2012 ethnicity-specific and the GLI 2023 Global equations, in a large population-based cohort.MethodsWe analysed data from 270,599 UK Biobank participants aged 40–69 years with baseline spirometry. Physiological quotients were calculated for FEV₁, FVC, and FEV₁/FVC using previously established first percentile boundaries. Associations with all-cause and cause-specific mortality, respiratory hospitalisation, respiratory symptoms, and self-reported respiratory diagnoses were examined using Cox proportional hazards and logistic regression models.ResultsOver a median follow-up of 15.7 years, 26,197 (10%) participants died. Lower physiological quotients were consistently associated with adverse outcomes. Each 1-SD decrement in FEV₁Q, FVCQ, and FEV₁/FVCQ was associated with higher all-cause mortality (HRs 1.06–1.09), cardiovascular mortality (HRs 1.06–1.20), respiratory mortality (HRs 1.28–1.77), and respiratory hospitalisation (HRs 1.04–1.41). Discrimination for all-cause mortality was modest (C-statistics 0.64–0.65), moderate for cardiovascular mortality (0.72–0.73), and good for respiratory mortality (0.76–0.79). Discrimination of respiratory hospitalisation was modest but slightly higher for FEV₁Q and FVCQ (0.65) than for percent predicted values and z-scores (0.61–0.62). Across mortality outcomes, discriminative performance was similar between physiological quotients, percent predicted values, and z-scores. ConclusionPhysiological quotients demonstrated prognostic performanc
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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, Vol: 56, Pages: 983-985, ISSN: 0954-7894 -
Journal articleBurney P, Knox-Brown B, Amaral A, 2026,
The use of spirometry to define airflow obstruction and diagnose COPD
, European Respiratory Journal, Vol: 68, ISSN: 0903-1936The recent statement from GOLD/GLI on the use of spirometry is insufficient, particularly in the global South.
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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, Vol: 31, ISSN: 2052-4439Background: Occupational exposures are contributors to chronic respiratory diseases, particularly in low- and middle-income countries (LMICs), where regulatory policies are limited. We investigated associations between occupational exposures and respiratory outcomes using longitudinal data from the Burden of Obstructive Lung Disease study.Methods: We analysed data from 4,237 participants across 17 sites, mostly in LMICs. Occupational exposures were assessed by self-report (never vs ever) and the ALOHA+ Job Exposure Matrix for vapours, gases, dusts, fumes (VGDF), pesticides, solvents, and metals (cumulative exposure). Respiratory outcomes included: forced expiratory volume-in-1-second (FEV₁), forced vital capacity (FVC), the FEV₁/FVC, and respiratory symptoms. Associations were examined using multilevel linear and logistic regression models adjusted for age, sex, smoking, pack-years, education, body mass index, and baseline FVC. We further explored sex differences and non-linear relationships for symptoms.Results: Over a median 10 years of follow-up, FEV₁/FVC decline was associated with moderate (β=–1.34; 95%CI: –2.32, –0.35) and high (β=–1.79; 95%CI: –3.33, –0.20) exposure to VGDF and low (β=–1.11; 95%CI: –2.11, –0.08) and high (β =–2.16; 95%CI: –4.08, –0.24) exposure to pesticides. Increased risk of wheeze was associated with moderate (RR=1.45; 95%CI: 1.05-2.15) and high (RR=1.89; 95%CI: 1.100-3.26) exposure to pesticides. Associations did not differ by sex. There was weak evidence of non-linear exposure–response relationships, and no associations with solvents or metals.Conclusions: A significant decline in FEV1/FVC was associated with exposure to VGDF and pesticides. Increased risk wheeze was also associated with exposure to pesticides. These findings underscore the need for continued monitoring in high-exposure settings, particularly in LMICs.
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Journal articleMeghji J, Engel N, Kagima W, et al., 2026,
The ITARA research programme: investigating Integrated Tuberculosis and Respiratory care in Africa using transdisciplinary methods
, BMJ Open, Vol: 16, ISSN: 2044-6055Introduction Pulmonary tuberculosis (PTB) and chronic respiratory diseases (CRDs) are closely linked. Affected groups present with similar symptoms and share many risk factors (eg, 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 analysis We 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 (eg, asthma, chronic obstructive pulmonary disease, post-TB lung disease) among 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 among patients and providers, and to identify and address challenges around respiratory health and care. Lastly, existing TB and CRD healthcare 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 futu
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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 articleMeme H, Matu S, Orina F, et al., 2026,
Lung function across the life course in Kenya: a series of cross-sectional surveys.
, ERJ Open Res, Vol: 12, ISSN: 2312-0541BACKGROUND: The high prevalence of COPD in sub-Saharan Africa is poorly understood. In high-income countries, COPD is the consequence of suboptimal lung growth during childhood and/or accelerated lung function decline in adult life. We have conducted cross-sectional studies to measure the lung function of children and adults in Kenya and to identify associations with age. METHODS: We performed spirometry in three groups in Kenya: a random sample of schoolchildren in two districts of urban Nairobi and age/sex-stratified representative community samples of adults in Nairobi and rural Machakos. Forced expiratory volume in 1 s (FEV1) and forced vital capacity were expressed as z-scores using race-neutral GLI-Global reference equations. RESULTS: The mean (95% CI) FEV1 z-score in Nairobi schoolchildren (n=2373, median age 10 years (IQR 8-13) 52% girls) was -0.60 (-0.64- -0.55); in Nairobi adults (n=2936, median age 32 years (24-43), 62% female) -0.49 (-0.53- -0.45); and in Machakos adults (n=1607, median age 46 years (35-59), 65% female) -0.67 (-0.72- -0.61). In adults, FEV1 was negatively associated with age (FEV1 z-score regression coefficient β -0.005/year (95% CI -0.009- -0.002) p=0.005, and there was a negative interaction between residence in Nairobi and age, β -0.006/year (95% CI -0.011- -0.001), p=0.020. CONCLUSION: The lung function of children and adults in Kenya was lower than predicted by race-neutral Global Lung Function Initiative (GLI)-Global reference equations. In adults, a negative association between lung function and age was greater in urban, than in rural, settings. Further work is required to identify and mitigate relevant influences.
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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 articleNabisere A, Wakasiaka S, Dodd J, et al., 2026,
Translation and evaluation of the Perinatal Grief Intensity Scale in Kenya and Uganda.
, BMC Pregnancy Childbirth, Vol: 26BACKGROUND AND AIM: Stillbirth or neonatal death are distressing life experiences for parents. In many sub-Saharan African countries, bereavement care and support are inadequate. Context-appropriate interventions are needed to improve perinatal bereavement care. To assess whether these interventions work, reliable assessment tools are required. This study aimed to translate and evaluate the Perinatal Grief Intensity Scale [PGIS] for use among bereaved women in Kenya and Uganda. METHODS: A mixed-methods study, involving cross cultural translation, adaptation and psychometric evaluation in Kenya and Uganda. The PGIS was translated into Kiswahili and Luganda with input from community engagement groups and stakeholders. Pilot-testing was conducted in 2 stages; 'Think aloud' interviews (n = 16) and test-retest (n = 20). The finalised tools were tested with 160 women who had experienced stillbirth or neonatal death, 20 in the test-retest phase and 140 in wider testing. Analyses included test-retest reliability, internal consistency and exploratory associations with participant characteristics using single variable linear regression. RESULTS: Agreed translations of the PGIS in Kiswahili and Luganda were produced. In pilot testing, test-retest consistency was high with an intraclass correlation coefficient of 0.840 (95% CI, 0.590-0.937). Wider testing demonstrated acceptable internal consistency, Cronbach's alpha of the total PGIS score was 0.737, confirming overall reliability, with similar results in the pilot testing and wider testing subgroups. Single variable linear regression showed that PGIS scores were higher for women in Uganda (coefficient 0.123, 95% Confidence Interval (CI) 0.042 to 0.205, p value = 0.003) compared to Kenya, and higher for caesarean births (coefficient 0.113, 95% CI 0.014 to 0.211, p value = 0.025) compared to vaginal births. CONCLUSION: Preliminary evaluation of the Kiswahili and Luganda ve
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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 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 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, Vol: 12, Pages: 01190-2025, 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 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 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 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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