BACKGROUND:Chronic cough affects approximately 10% of adults and is increasingly recognised as a distinct clinical condition. This symptom has increasingly been associated with significant outcomes such as pneumonia. Nevertheless, few large long-term population-based studies have been conducted. METHODS:This retrospective cohort study was performed using nationwide claims data from the Health Insurance Review and Assessment Service in South Korea from 2013 to 2020. Adult patients who visited outpatient clinics for cough (International Classification of Diseases, 10th Revision: R05) were enrolled. Chronic cough was defined as ≥8 visits or ≥56 days. Patients with pneumonia within 2 years before and 6 months after the index date were excluded. The main outcome was incident pneumonia during the 3 year follow-up period. The association between chronic cough and incident pneumonia was evaluated using Cox proportional hazards models, with HRs adjusted for age, sex, comorbidities and Charlson comorbidity index. Sensitivity analyses and subgroup analyses by sex and age were also performed. RESULTS:Among 385 417 participants (28 706 with chronic cough and 356 711 controls), the incidence of pneumonia was higher in the chronic cough group (18.87 vs 11.32 per 1000 person-years). Chronic cough was independently associated with an elevated risk of pneumonia (adjusted HR 1.13; 95% CI 1.06 to 1.19; p<0.001), and the association was robust across multiple sensitivity analyses with alternative exposures. The subgroup analysis showed a stronger association among men (HR 1.72) than among women (HR 1.39) and among adults aged 40-79 years, with the highest risk observed among adults aged 40-49 years (HR 1.37). CONCLUSIONS:Chronic cough was independently associated with increased pneumonia risk, especially in middle-aged and male patients. Clinicians should be aware that chronic cough may signal increased vulnerability to lower respiratory tract infections (eg, pneumonia) and consider preventive strategies, including vaccination and close monitoring, for high-risk individuals.
BACKGROUND:Dyspnoea is an important clinical and research outcome in patients with interstitial lung diseases (ILD) and idiopathic pulmonary fibrosis (IPF).We evaluated the correlation of the British Medical Research Council (MRC) dyspnoea scale, University of California, San Diego Shortness of Breath (UCSD) questionnaire and St. George's Respiratory Questionnaire (SGRQ) with measures of disease severity and progression in patients with ILD and IPF. METHODS:We applied the three questionnaires to all patients with ILD during initial assessment (baseline visit), at 3-6 months (visit 2) and 9-12 months (visit 3). We used univariate analyses and multiple regression adjusting for age, sex, pulmonary hypertension, ILD diagnosis and forced vital capacity (FVC) to estimate the correlations of questionnaires with pulmonary function tests, 6 min walk test (6MWT) parameters and perceived dyspnoea at baseline visit (disease severity). We assessed the correlation between change (Δ) in dyspnoea questionnaires with change in functional variables between baseline and follow-up visits (progression). RESULTS:We enrolled 151 patients with ILD, 57 of them had IPF. At baseline, all questionnaires significantly correlated with FVC%, total lung capacity (TLC%), carbon monoxide diffusing capacity (DLCO%) and 6MWT metrics. Between visits 1 and 2, MRC-Δ correlated with TLC%-Δ and perceived dyspnoea-Δ and UCSD-Δ with perceived dyspnoea-Δ. Between visits 1 and 3, MRC-Δ correlated with FVC%-Δ and 6MWT distance-Δ; UCSD-Δ correlated with TLC%-Δ . SGRQ-Δ did not correlate with any variables in multivariable analyses. CONCLUSIONS:All questionnaires correlated well with ILD/IPF disease severity at baseline but not with disease progression. Improved questionnaires are needed for patients with ILD.
Background Bronchial washing can be inefficient or unsafe due to aerosolisation, poor yield and loss of sample. The setup and connectivity of sampling containers is often challenging. Furthermore, the process of bronchoscopy in the intensive care unit is inadequately reported.We tested whether a novel closed bronchoscopy sampling system is safer and more efficient than the standard sampling technique. We recorded variation in bronchoscopy practice in mechanically ventilated patients.Methods A multicentre randomised controlled trial saw 188 bronchoscopies performed in mechanically ventilated patients requiring diagnostic sampling. The closed-system Ambu bronchosampler (ABS) was compared to standard sampling containers (SSC) with single-use bronchoscopes (Ambu A4) for primary outcomes of safety (spill, unplanned disconnection) and efficiency (ease of connectivity, setup, loss of sample and % volume retrieved), secondary efficiency outcomes and the tertiary outcomes of the bronchoscopy process.Results ABS was safer than SSC; spills 0% versus 23.7% (0/94 vs 22/93), p<0.001; unplanned tube disconnections 5.3% vs 21.3% (5/95 vs 20/93), p<0.001; unplanned container disconnections 2.1% vs 7.5% (2/95 vs 7/93), p=0.08. Efficiency was significantly higher in ABS than SSC (acceptable/(very) easy) setup 98.9% vs 82.8% (94/95 vs 77/93), connectivity 100% vs 54.7% (88/88 vs 47/86), upright 98.9% vs 10.8% (94/95 vs 10/93) and sample loss 11.6% vs 48.4% (11/95 vs 45/93), all p<0.001. Volume retrieved percentage unchanged (33.0% vs 35.4%, p>0.2).Bronchoscopy for infection in 80.9%, therapeutic lavage in 51% and infrequently otherwise. Prior imaging in 93.2%, preprocedural checklists/timeouts in 83.5% and post-procedure chest X-rays in 78.2%.Mandatory ventilation was most common peribronchoscopy. Neuromuscular blockade in 73.8% and recruitment manoeuvres in 34.7%. The bronchoscope was not removed intraprocedurally in 80.2% of cases. Positive microbiology was found in 45.7% of samples. Adverse events were rare (<5%).Conclusions Closed-system bronchoscopic sampling was safer (less spill and unplanned disconnections) and more efficient (setup, connectivity and loss prevention) than standard containers. Closed-system diagnostic sampling devices should be the standard during bronchoscopy.Trial registration number ClinicalTrials.gov NCT05964075.
INTRODUCTION:Continuous positive airway pressure (CPAP) is the first-line treatment for obstructive sleep apnoea (OSA) but long-term adherence is limited. This study evaluates the implementation and outcomes of a multidisciplinary team approach to managing CPAP-intolerant patients using alternative therapies. METHODS:A retrospective review was conducted on 'difficult-to-treat' OSA cases discussed at multidisciplinary team meetings at the Guy's and St Thomas' NHS Foundation Trust Sleep Disorders Centre (project number 17 160). Patient demographics, comorbidities, OSA severity (Apnoea-Hypopnoea Index (AHI), Epworth Sleepiness Scale (ESS), 3% Oxygen Desaturation Index (ODI)), management plans and outcomes were extracted from meeting minutes and clinical records. Statistical analysis included analysis of variance (ANOVA) to compare baseline characteristics (AHI, age, body mass index (BMI)) across treatment groups and paired t-tests to assess pre-treatment and post-treatment changes in OSA indices (p<0.05). RESULTS:We reviewed a cohort of 138 patients (103/138 male, age 51 (17) years, BMI 29.5 (5.1) kg/m2) with severe OSA (AHI 37.7 (21.4)/hour). Common comorbidities included hypertension (29.0%), anxiety/depression (25.4%), history of previous Otorhinolaryngology (ENT) intervention (17.4%) and cardiac diseases (16.7%). Treatment selection was guided by predefined criteria, including OSA severity, BMI, patient preferences, anatomical abnormalities and comorbidities. Treatment recommendations included mandibular advancement devices (27.5%), hypoglossal nerve stimulation pathway (24.6%), weight management (23.9%), CPAP retrial (13.8%), other ENT surgery (10.9%) and BiPAP/ASV (10.1%). Follow-up data from patients with postintervention data demonstrated significant reductions in AHI (-44.1%, n=29), ESS (-32.9%, n=13) and ODI (-67.2%, n=12) post-treatment (p<0.05). CONCLUSION:A multidisciplinary approach enables structured delivery of evidence-based treatment selection for patients with OSA who failed first-line therapy. Observed improvements in a subset of patients suggest potential benefit of tailored non-CPAP strategies and super-regional accessibility.
BACKGROUND:Although tuberculosis (TB) treatment success rates are high globally, growing evidence indicates that many TB survivors experience persistent respiratory symptoms, impaired quality of life and reduced well-being after treatment completion. Delayed TB diagnosis may exacerbate these long-term consequences by prolonging untreated disease and lung injury. However, longitudinal evidence linking diagnosis delay to longer-term outcomes remains limited. This study examines the association between TB diagnosis delay and respiratory health, quality of life and mental health among TB survivors in Cambodia. METHODS:A prospective cohort study of adults with newly diagnosed TB was conducted with a baseline in 2022 and 1 year and 2 year follow-ups. TB diagnosis delay was defined as the time from symptom onset to diagnosis and categorised as short or long using the median (64 days). Outcome variables included respiratory health, quality of life and depressive symptoms, assessed with the St George's Respiratory Questionnaire for Chronic Obstructive Pulmonary Disease (SGRQ-C), WHO Quality of Life-Brief (WHOQOL-BREF) and Centre for Epidemiologic Studies Depression Scale, 10-item version (CES-D-10), respectively. Linear mixed-effects models, adjusted for potential confounders, were applied. RESULTS:Among 712 participants at baseline, the long-delay group had worse respiratory health before treatment completion and over 2 years, with higher SGRQ-C total (β=4.37, 95% CI 1.10 to 7.64), symptom (β=5.83, 95% CI 2.34 to 9.31) and activity scores (β=6.95, 95% CI 2.67 to 11.23) than the short-delay group. Long delay was also associated with poorer psychological (β=-3.17, 95% CI -5.31 to -1.03) and environmental domains (β=-1.74, 95% CI -3.07 to -0.4) of the quality of life but not with its physical and social domains or depressive symptoms. The differences between the groups remained relatively stable over time. CONCLUSIONS:TB diagnosis delay may influence recovery beyond treatment success, highlighting the importance of early case detection and integrated post-treatment support in high-burden settings.
Introduction Intensive care unit-acquired weakness (ICU-AW) in patients with acute respiratory failure requiring invasive mechanical ventilation (IMV) is associated with reduced functional exercise capacity and increased mortality. Early mobilisation in the ICU may improve functional outcomes and reduce length of stay; however, evidence remains limited, protocols are heterogeneous and post-discharge rehabilitation is frequently lacking. This study aims to evaluate the effects of a continuous care programme combining early intensive ICU mobilisation with post-hospitalisation rehabilitation on functional exercise capacity, with inflammation, quality of life, mortality and cost-effectiveness as secondary outcomes in critically ill patients receiving IMV. Methods and analysis This blinded, multicentre, randomised controlled trial will include adult patients undergoing invasive MV for at least 24 hours. Participants will be randomly allocated to one of four groups: intervention group (IG)-Rehab, control group (CG)-Rehab, IG-Home or CG-Home. During hospitalisation, the IG will receive an intensive mobilisation protocol (30–60 minutes/day), while the CG will receive routine care (up to 10 min/day). After hospital discharge, participants will undergo either 8 weeks of face-to-face rehabilitation (Rehab) or a home-based programme (Home), with follow-up for 6 months. Exploratory analyses will evaluate clinical parameters, severity indices, functional status, pulmonary function and mechanics, additional measures of functional exercise capacity, muscle strength and mass, energy expenditure, and symptoms of anxiety and depression. The 2×2 factorial design will allow for the evaluation of the independent effects of in-hospital mobilisation intensity and post-discharge rehabilitation strategy. Statistical analyses will use appropriate parametric or non-parametric tests, with significance set at p<0.05. Ethics and dissemination The study will follow the Brazilian National Health Council guidelines, the Brazilian General Data Protection Law and Research Electronic Data Capture standards. Results will be disseminated through peer-reviewed journals, scientific meetings and social media. The trial is registered at ClinicalTrials.gov ( NCT06405529 ; 8 May 2024) and follows Consolidated Standards of Reporting Trials guidelines.
OBJECTIVES: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. Furthermore, they would not be eligible for Nirsevimab under UK guidance, which supports consideration of broadening eligibility to include these children.
Objectives Interstitial lung abnormalities (ILAs) are an important incidental finding in lung screening. Quantitative CT (qCT) offers a promising approach to standardising ILA assessment; however, its adoption into routine clinical practice remains limited, largely due to the need for further clinical validation.Setting We evaluated the performance of e-Lung (Brainomix), a commercially available qCT tool in assessing ILAs for participants attending a lung cancer screening programme.Participants All participants invited to attend the West London lung cancer screening pilot programme between 2018 and 2020.Primary outcome measures To define the optimal qCT biomarker thresholds that identified ILA as defined by expert thoracic radiologists.Results e-Lung qCT biomarkers had an area under the curve of between 0.82 and 0.88, and between 0.84 and 0.87 for visually quantified ILA extent thresholds of at least 5% and >10%, respectively.Conclusion e-Lung is a qCT tool with potential utility in the automated identification of ILA in participants undergoing lung screening.
Background Non-invasive ventilation (NIV) interface can generate carbon dioxide (CO2) rebreathing, potentially contributing to NIV failure. The impact of leaks and mask design remains unclear. This study evaluates how these factors influence CO2 rebreathing in oronasal face masks.Design, settings, participants A bench study was followed by a physiological study. The bench study used a mannequin head connected to a breathing simulator exhaling CO2. Six oronasal face masks designed for single-limb circuits with varying exhalation port positions were tested with three levels of fit. A CO2 rebreathing index was calculated, along with intentional and unintentional leaks. The best-performing mask was then compared with two clinically used masks in healthy volunteers. Ventilatory ratio (VR, reflecting dead space) was derived from transcutaneous CO2 (PtcCO2) and ventilation was assessed by electrical impedance tomography. Analyses used Friedman test and linear mixed-effects model.Results The bench study showed (1) mask design as a whole, rather than intentional leak flow rate, was the main determinant of CO2 rebreathing: exhalation ports situated on the mask body had lower CO2 rebreathing; (2) unintentional leaks decreased CO2 rebreathing only with poor mask design and (3) a new under-nose mask with nasal nozzles had the lowest CO2 rebreathing index. The latter was compared with two other masks in ten volunteers, median aged 32 (IQR 29–34): PtcCO2 decreased from 37.3 (33.7–39.5) mm Hg at baseline to 32.5 (28.9–35.4) with the new mask (p=0.023). VR with the new mask (0.96 (0.93–1.12)) was lower than with the classical masks (1.40 (1.20–1.50) and 1.38 (1.19–1.45); p<0.001 for both).Conclusions Mask design significantly influences CO2 rebreathing during NIV, with leaks’ effects dependent on exhalation port position. A novel under-nose hybrid mask with embedded nozzles reduces CO2 rebreathing and dead space when compared with classical masks.Trial registration number NCT03902639.
OBJECTIVE:To investigate associations between short-term fluctuations in urban background air pollution and the incidence of COVID-19 across three Swedish cities using detailed individual-level data. METHODS:A case-crossover analysis was conducted using individual-level data from a prospective cohort of adults across three Swedish cities (Stockholm, Gothenburg and Uppsala), including 3999 confirmed COVID-19 cases. Subjects were classified as cases on the date of their first positive PCR test, which occurred between 7 March 2020 and 26 January 2022. Exposure data for daily levels of PM2.5, PM10 and NO2 were obtained from urban background monitoring stations. Lag-specific and cumulative associations were examined using distributed lag models and distributed lag non-linear models, adjusting for meteorological variables. RESULTS:A significant association was observed between elevated PM2.5 levels and testing positive for COVID-19 on the same day (lag 0), with an OR of 1.084 (95% CI 1.011 to 1.162) per IQR (3.3 µg/m³) increase. Similar lag 0 effects were found across the three cities. For PM10, the most consistent associations were observed at lag 3. For NO2, significant effects at lag 0 emerged only after excluding the final COVID-19 wave. Subgroup analyses showed similar effects among individuals with pre-existing respiratory conditions, though results were less consistent. CONCLUSIONS:Our findings suggest that short-term fluctuations in air pollution, particularly for PM2.5, are associated with the timing of confirmed COVID-19 cases. A possible explanation for the short lag association is that air pollution exacerbates symptoms, prompting individuals to seek testing, rather than directly facilitating new infections.
Background Timely diagnosis is critical for improving lung cancer outcomes, yet diagnostic pathways in England remain complex and variable. Real-world evidence examining imaging use, delays and emergency care during the diagnostic interval is limited. Methods We conducted a national retrospective cohort study using linked Hospital Episode Statistics and Diagnostic Imaging Dataset for adults newly diagnosed with lung cancer between April 2018 and March 2019. Diagnostic intervals were defined from first chest imaging to diagnosis. We assessed imaging utilisation, diagnostic pathways and A&E attendance, with subgroup analyses by ethnicity, deprivation and diagnostic interval. Results Among 21 052 patients, the median diagnostic interval was 56 days: 25% experienced intervals ≥113 days. Patients underwent a median of three chest scans, and 25% received four or more. Multimodality imaging was strongly associated with prolonged intervals. One-third of patients attended A&E during the diagnostic pathway, rising to 45% among those with the longest intervals. Asian patients experienced the longest diagnostic intervals (median: 67 days). Patterns were consistent across deprivation quintiles, with diagnostic intervals and high A&E attendance observed across all strata, indicating systemic gaps in coordinated diagnostic pathways. Conclusion A substantial proportion of patients with lung cancer in England experience prolonged diagnostic intervals, often accompanied by high emergency care utilisation. Prolonged diagnostic intervals may reflect underlying differences in patient pathways. Multimodality imaging was associated with longer diagnostic timelines, which could represent clinical complexity, diagnostic challenges or possibly fragmentation of diagnostic pathways. These findings highlight the need for streamlined imaging processes, timely follow-up after initial chest imaging and stronger primary care engagement to support earlier diagnosis and alignment with the National Optimal Lung Cancer Pathway.
INTRODUCTION:The mechanisms through which body mass index (BMI) influences the prognosis of chronic obstructive pulmonary disease (COPD) remain poorly understood. This study investigates whether BMI influences all-cause mortality in patients with COPD through mediating effects of exacerbations and cardiovascular events. METHODS:Data were obtained from a multicentre prospective COPD cohort (NCT02800499). BMI was assessed both continuously and categorically as <23 (low), 23-27 (normal) and >27 kg/m² (high). The primary outcome was all-cause mortality and secondary outcomes were moderate-to-severe exacerbations and cardiovascular events. Mediation analyses were applied to quantify the contribution of these events to the association between BMI and all-cause mortality. RESULTS:Among 3314 patients with COPD, those with low BMI had a higher risk of mortality (adjusted OR, 1.46; 95% CI 1.04 to 2.07), whereas no significant difference was observed among those with high BMI. Mediation analyses indicated that exacerbations partially mediated the relationship between BMI and all-cause mortality, explaining 11.9% of the increased mortality among patients with low BMI and 21.9% of the reduced mortality among those with high BMI. Meanwhile, cardiovascular events showed mediating effects in the opposite direction, contributing to 5.2% lower mortality among patients with low BMI and 11.5% higher mortality among those with high BMI. CONCLUSIONS:BMI was non-linearly associated with all-cause mortality in COPD. Exacerbations mediated the excess mortality risk among patients with low BMI, whereas the decreasing risk of cardiovascular events in this group contributed to a countervailing effect that tempered the overall association between low BMI and mortality.
Background Viral respiratory infections are highly contagious and associated with an increased risk of serious adverse health outcomes in vulnerable populations, including people with intellectual disabilities. However, little is known about the overall disease burden of viral respiratory infections among people with intellectual disabilities. Aim This scoping review aims to provide an overview of the existing literature on the disease burden of viral respiratory infections among people with intellectual disabilities. Methods Studies published between 1999 and 10 July 2024, were identified through PubMed, MEDLINE, Embase and Web of Science, and included if focused on adults with intellectual disabilities, viral respiratory infections and relevant health outcomes such as infection rate, mortality, hospitalisation, functional impairments or quality of life. Results 58 articles were included, of which the majority focused on COVID-19 (42/58) or influenza (13/58). Studies varied in their methodology and outcome measures. Evidence on COVID-19 and influenza showed that people with intellectual disabilities experience a higher disease burden from these infections compared with the general population. Particularly disproportionate effects were evident among people with Down syndrome, who had higher mortality estimates and an increased burden of comorbidities associated with severe disease and death. Conclusion Although available evidence appeared limited and diverse, this scoping review shows a higher disease burden in people with intellectual disabilities, in particular for COVID-19 and influenza-type viruses, which can be indicative of the impact of other viral respiratory infections as well. This highlights the importance of measures to prevent and control the spread of respiratory pathogens among this group.
BACKGROUND:Maternal asthma has been more strongly associated with asthma in offspring than paternal asthma, but the influence of parental asthma on distinct asthma phenotypes remains unclear. METHODS:We studied 16 055 children from the Norwegian Mother, Father and Child Cohort Study (MoBa). Parental asthma was reported at recruitment and classified as no parental asthma (reference), maternal asthma only, paternal asthma only or both parents with asthma. Offspring asthma was assessed at ages 3, 7 and 14 years through questionnaire-based parental reports, and four phenotypes were defined: never asthma, early-onset transient, early-onset persistent and late-onset asthma. Logistic regression was used to estimate associations between parental asthma status and offspring phenotypes, adjusting for sociodemographic, lifestyle and atopic factors, including atopic eczema and pollen/hay fever. RESULTS:Offspring asthma phenotypes were distributed as follows: never asthma 88.8%, early-onset transient asthma 3.3%, early-onset persistent asthma 2.7% and late-onset asthma 5.2%. Maternal asthma was associated with increased odds of all offspring asthma phenotypes: early-onset transient asthma (OR 2.09, 95% CI 1.52 to 2.88), early-onset persistent asthma (OR 3.47, 95% CI 2.56 to 4.71) and late-onset asthma (OR 2.18, 95% CI 1.69 to 2.81). Paternal asthma showed similar associations, although point estimates were generally smaller: early-onset transient asthma (OR 2.01, 95% CI 1.48 to 2.73), early-onset persistent asthma (OR 2.49, 95% CI 1.81 to 3.44) and late-onset asthma (OR 1.85, 95% CI 1.44 to 2.38). Asthma in both parents was most strongly associated with early-onset persistent asthma (OR 5.34, 95% CI 2.86 to 9.98), whereas associations with early-onset transient and late-onset asthma were smaller and accompanied by wider CIs. The overall pattern of associations was similar across analyses stratified by parental atopy. CONCLUSIONS:Associations with maternal asthma were more pronounced than those with paternal asthma, particularly for early-onset persistent and late-onset phenotypes, although CIs overlapped for most comparisons. In contrast, early-onset transient asthma showed less differentiation by parental asthma status.
Introduction Music interventions by listening to recorded music have been associated with the alleviation of breathlessness and the improvement of physical outcomes in the context of pulmonary rehabilitation. Results of these studies, however, should be interpreted carefully since study protocols have been heterogeneous and findings inconsistent. Studies are subject to selection bias and the effect of music interventions is assumed to depend partly on a placebo effect, increasing effectiveness when pre-treatment expectations are higher. In combination with low costs and negligible side effects, implementation of music interventions would be feasible, but they have not been structurally implemented in pulmonary rehabilitation settings yet. Before making efforts on implementing an appropriate music intervention, current use, demands and treatment expectations on music interventions of the target population and their healthcare professionals are to be explored. This study aims to explore the current use of music interventions among patients enrolled in pulmonary rehabilitation and gain insight into the expectations of patients and their caregivers regarding its effect on breathlessness and exercise tolerance. Methods and analysis This paper describes the protocol for a cross-sectional survey consisting of a single questionnaire among patients and their healthcare professionals. The questionnaire into expectations regarding music interventions was developed and validated through a systematic and iterative process. After data collection, descriptive statistics will be performed. Cronbach’s alpha will be calculated to measure the questionnaire's internal consistency. Correlation analysis will be performed between baseline characteristics and level of expectation for music interventions. Ethics and dissemination This study received approval of the institutional review board of the Erasmus Medical Center, The Netherlands (reference number MEC-2025-0703). Results will be disseminated through a peer-reviewed scientific publication, and raw data will be made available on reasonable request to support implementation.
The new National Institute for Health and Care Excellence (NICE) guidance on the use of dupilumab in chronic obstructive pulmonary disease (COPD) recommends using dupilumab as an add-on therapy for patients with uncontrolled COPD and raised blood eosinophils who either have one severe exacerbation or two moderate exacerbations despite triple therapy. This contrasts with the guidance for commencing and continuing monoclonal antibody therapy (MAb) in asthma and will have significant implications for severe asthma services caring for patients with coexisting asthma and COPD or those with asthma and a significant smoking history. Patients with asthma and COPD often experience poorer outcomes than patients with asthma or COPD alone. They are traditionally managed according to asthma pharmacotherapy guidelines; however, under the new guidance this may change. Our perspective is supported by local audit data helping us to reflect on our current practice as a large tertiary severe asthma service of initiating MAb in patients with coexisting asthma and COPD. Disparities in eligibility and access to dupilumab in asthma and COPD guidelines expose key challenges about the best clinical setting for managing patients with coexisting disease, the need for distinct treatment pathways and personalised definitions of treatment success, and whether the current positioning of dupilumab as a second-line therapy within severe asthma pathways in England remains appropriate. Addressing these issues will be critical to supporting equitable clinically appropriate access to monoclonal antibodies in patients with coexisting asthma and COPD in the future.
