Background Treatment-induced clinical remission is an emerging therapeutic goal in severe asthma. Despite this, the perspectives of people with severe eosinophilic asthma (SEA) on remission remain unexplored. Objective We sought to understand how people with SEA treated with mepolizumab perceive remission and to compare the perspectives of those who have achieved remission with those who have not. Methods A qualitative study using one-to-one semi-structured interviews with 30 purposively sampled adult participants. Interview recordings were transcribed, audio verified and thematically analysed. Results Participants were mostly female (60%), with a mean± sd age of 64.8±11.02 years in the remission group and 68.6±8.66 years in the non-remission group. Four themes emerged: (i) making sense of remission: participants perceived asthma remission as a discernible point where the disease progression stopped/ceased; (ii) getting my life back: described perceived improvements in daily functioning, psychological well-being and quality of life; (iii) treatment goals and discontinuation: participants expressed preference to be symptom-free over being off-treatment; (iv) communication and timing: shared their ideal timing to discuss remission and their views on the role of multidisciplinary team in the remission discourse. Conclusion People with SEA defined asthma remission using individual metrics, including functional and emotional outcomes, highlighting restoration, normality and holistic well-being. Both groups consistently equated remission with freedom from OCS use and its negative consequences. Participants who achieved clinical remission described substantial perceived improvements in daily functioning, psychological well-being and quality of life. These findings can inform patient-clinician remission conversations, ensuring that it is discussed not only as a clinical outcome but also as a therapeutic goal shaped by patient priorities and expectations.
Background Frequent oral corticosteroid (OCS) use for asthma causes serious side effects. International guidelines recommend steroid-sparing strategies such as biologics, but the geographical and sociodemographic variation of OCS and biologic use in difficult-to-treat (DTT) asthma across New Zealand is unknown. Methods We conducted a retrospective population-based cohort study using national datasets to map regional variation in DTT asthma, OCS burden, and biologic use. We also explored how sociodemographic factors affect OCS exposure. Individuals with DTT asthma were identified from community dispensing and hospitalisation data, where DTT was defined as high-dosage inhaled corticosteroids plus long-acting beta-agonist dispensings covering ≥90 days over 6 months. Individuals were defined as having uncontrolled DTT asthma if, in addition, they received ≥2 OCS dispensings or ≥1 asthma hospitalisation in 6 months. We mapped prevalence and OCS burden across geographic areas, adjusting for demographics using a zero-inflated negative binomial model that positioned DTT classification as an operational proxy for baseline disease severity. Findings Of 625 450 individuals with asthma, 100 017 (16·0%) had DTT asthma and 9261 uncontrolled DTT (9.3% of the DTT population). The uncontrolled DTT population was 66% female, 46% from low socioeconomic areas, 22% Māori, and 9% Pasifika. Among the overall population, 4.7% received ≥500 mg and 1.8% received ≥1 g cumulative OCS over a 12-month period; biologics use was 1·0% within this group. Small but consistent sociodemographic disparities persisted in OCS burden even after adjusting for disease severity. Rural areas had a lower likelihood of any OCS exposure but similar total OCS exposure. Interpretation This high-resolution geographical and sociodemographic analysis of DTT asthma, OCS burden and biologic use across New Zealand found marked regional disparities and a mismatch between disease prevalence and treatment. This suggests inequities in asthma care with a concerningly high rate of OCS use and a low rate of biologic use among those eligible.
Background Obesity hypoventilation syndrome (OHS) is defined by daytime hypercapnia in obese individuals and is often considered the consequence of progressive nocturnal hypoventilation. However, the natural history of obesity-related nocturnal hypoventilation (ONH) and its progression toward OHS remain poorly understood. Methods COHYPOB is a prospective multicentre cohort study including obese adults without daytime hypercapnia or obstructive sleep apnoea requiring CPAP at baseline. Participants underwent comprehensive clinical, respiratory, metabolic and sleep assessments at inclusion and during a 3-year follow-up. ONH was defined using elevated morning serum bicarbonate (≥27 mmol·L⁻ 1 ) in the absence of daytime hypercapnia, according to current ERS Task Force recommendations. The primary outcome was the occurrence of OHS, defined by daytime PaCO₂ ≥45 mmHg. Results A total of 162 participants were included (74% women, mean age 48±14 years, mean BMI 37.3±4.9 kg·m⁻ 2 ). Among the 144 participants with available baseline serum bicarbonate measurements, 67 (46.5%) met the criterion for bicarbonate-defined ONH. Compared with those without ONH, affected individuals were older and showed mild alterations in daytime gas exchange and nocturnal oxygenation despite similar body mass index. Over the 3-year follow-up, body weight remained stable, whereas bicarbonate-defined ONH demonstrated marked temporal variability. Five participants developed OHS, corresponding to an incidence of 5.4% among those completing follow-up. Conclusions In this prospective cohort of obese adults without daytime hypercapnia and without OSA requiring CPAP, bicarbonate-defined ONH was common and showed substantial temporal variability over three years, whereas incident OHS remained uncommon. These observations suggest that the evolution towards OHS may be more heterogeneous than traditionally proposed. Because ONH was defined using morning serum bicarbonate, longitudinal studies incorporating direct nocturnal CO₂ monitoring are required.
Background Randomised trials have shown that nintedanib slows decline in lung function in progressive pulmonary fibrosis (PPF), but real-world outcomes remain limited. We evaluated long-term lung function trajectories, survival, and predictors of survival in a nationwide cohort initiating nintedanib. Methods This nationwide retrospective cohort study included all patients initiating nintedanib for PPF at the four tertiary Danish interstitial lung disease (ILD) centres between 2022 and 2024. Longitudinal changes in forced vital capacity (FVC) before and after treatment initiation were analysed using linear mixed-effects models. Survival was estimated using Kaplan-Meier analysis and Cox proportional hazards were used to identify predictors of mortality Results We included 359 patients (median age 72 years; 58% male). Median baseline FVC was 2.31 L (69% predicted) and diffusing capacity for carbon monoxide (D LCO ) 42% predicted. A usual interstitial pneumonia (UIP) pattern was present in 45%. The most frequent diagnoses were systemic autoimmune rheumatic disease-associated ILD (38%) and fibrotic hypersensitivity pneumonitis (28%). FVC decline decreased from 224 mL/year (95% CI 198–250) before treatment to 92 mL/year (95% CI 49–135) after initiation, a difference of 132 mL/year (95% CI 80–184; p<0.001). During a median follow-up of 25.2 months, 115 deaths occurred. Survival was 94.1% at 6 months, 84.8% at 12 months, and 70.7% at 24 months. Higher age and lower baseline FVC and DLCO were associated with increased mortality. Conclusion In this nationwide real-world PPF cohort, nintedanib was associated with reduced lung function decline, but mortality remained substantial, highlighting the aggressive nature of PPF.
Aim To evaluate the impact of adding spirometry metrics to the American Heart Association Predicting Risk of Cardiovascular Disease Events (PREVENT) equations model on CVD mortality. Methods This study used data from a nationally representative sample of U.S. adults without prevalent atherosclerotic CVD or pulmonary disease who underwent spirometry in the National Health and Nutrition Examination Survey (NHANES) 2007 to 2012 data cycles. The association of forced vital capacity (FVC) and forced expired volume in 1-second (FEV 1 ) with composite CVD-related mortality was assessed. Cox proportional hazard models were used to estimate hazard ratios (HR). Harrell's c-statistic, net reclassification improvement, area under the receiver operator characteristic curve (ROC-AUC), and precision-recall analyses were used to compare incremental contributions of each spirometry measure when added to PREVENT. Results The study cohort included 5019 adult individuals, when accounting for NHANES complex survey design, represented 72.8 million individuals. At 10 years of follow-up, composite CVD occurred in 2% of the cohort. In adjusted analyses, higher FVC and FEV 1 were associated with lower CVD mortality (HR: 0.85, 95%CI: 0.79–0.90 and HR: 0.81, 95%CI: 0.74–0.90, respectively). Adding FVC to PREVENT predicted CVD mortality (HR: 1.06, 95%CI: 1.05–1.07). The addition of FVC to PREVENT enhanced discrimination (0.005, 95%CI: 0.001–0.009), ROC-AUC, reclassification (0.086, 95%CI: 0.018–0.156), and positive prediction value (0.004, 95%CI: 0.018–0.156) compared to using the PREVENT model as reference. Conclusions The inclusion of spirometry in the PREVENT model may enhance accuracy of CVD mortality risk.
