A recent Respiratory Medicine digest,
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Study Type: Serial cross-sectional screening programme analysis (three annual rounds, uncontrolled, no comparison group)

Key Question: Is repeated annual community chest X-ray screening of older adults associated with declining TB prevalence and fewer asymptomatic cases at successive rounds?

Key Findings:

• Across 214,948 screening encounters (adults ≥60 years, Lanxi City, China), overall TB yield fell from 233.1 to 146.3 per 100,000 (Round 1 to 3); bacteriologically confirmed TB fell from 162.1 to 108.6 per 100,000.
• Asymptomatic TB declined from 111.5 to 38.9 per 100,000 screened, and from 47.8% to 26.6% of detected cases.
• Prevalence fell 28.1% (95% CI -44.0 to -7.5) by Round 2 and 37.2% (-51.2 to -19.2) by Round 3 versus Round 1; Round 2 to 3 change was not significant (-12.8%; -31.7 to 11.4).

Clinical Relevance: Supports a prevalent-case-clearance effect from systematic screening in a high-burden elderly population, though it offers limited direct transferability to low-incidence UK settings, where it may inform thinking on targeted case-finding in high-risk groups.

Limitations: Without a control arm, declining yield cannot be attributed to screening itself rather than secular trends, changing participation, or prevalent-case depletion, and no incidence or mortality outcomes are reported.

Study Type: International cross-sectional survey of ICU structure and organisation (data collected January 2018 to July 2020).

Key Question: How do ICU resources and organisation vary by country income group, between countries, and within countries?

Key Findings:

• 1,225 ICUs analysed (58% high-income, 20% upper-middle-income, 22% low/lower-middle-income countries). 93% of variables differed significantly by income group, with 88% higher in high-income settings.
• Largest disparities were in extracorporeal support, respiratory support, emergency interventional radiology/surgery access, neurology/trauma care, and monitoring. By Marshall classification, 79% of high-income ICUs were level III versus 55% of LLMIC ICUs at level I.
• Higher-scoring domains varied mainly between countries; lower-scoring domains varied more between ICUs within the same country. Income adjustment reduced but did not remove country-level clustering.

Clinical Relevance: Provides a benchmark for ICU structure and organisation that UK units can use for comparison and capacity planning, and highlights global inequity in respiratory support and ECMO access relevant to international collaboration and training.

Limitations: Self-reported structural data from a convenience sample of mostly urban referral centres, with no link to patient outcomes, limits generalisability and inference on clinical impact.

Study Type: Multicentre retrospective cohort study (EMBARC-affiliated centres) with a parallel international patient survey.

Key Question: What are the fertility characteristics, pregnancy outcomes and patient-reported reproductive health experiences of women with bronchiectasis?

Key Findings:

• 83 women, 121 pregnancies: exacerbations in 58.6%; lung function stable during and after pregnancy; mean gestational age 38 weeks, mean birth weight 2.99 kg.
• Assisted reproduction was used in 32.1% of pregnancies, far more often in PCD than other aetiologies (48.5% vs 8.7%, P=0.004). Pre-pregnancy FEV1 correlated with birth weight (ρ=0.42) and gestational age (ρ=0.25).
• Survey (n=629): earlier menopause in those diagnosed before age 50; PCD associated with more reported conception difficulty.

Clinical Relevance: Supports pre-conception counselling, FEV1 optimisation and multidisciplinary antenatal planning for women with bronchiectasis, with early fertility referral for those with PCD.

Limitations: Retrospective design with no comparator group, so conclusions that non-PCD fertility resembles the general population are inferred rather than directly tested, and survey data are vulnerable to selection and recall bias.

Study Type: Qualitative study (semi-structured interviews with thematic analysis), n=20, US-based.

Key Question: What do Black/African American and Hispanic/Latino(a) adults with CF perceive as barriers and facilitators to clinical research participation?

Key Findings:

• Barriers: narrow eligibility criteria (genotype, health status) and logistical burdens (time, cost).
• Participants described isolation as people of colour with CF, which reduced trust in CF care and research. Experiences of doubt about their CF diagnosis strongly affected willingness to participate.
• Proposed solutions: community peer support and transparent information on study design and intent, with marginalised communities involved at all stages of trial design and delivery.

Clinical Relevance: CF remains under-diagnosed and under-recognised in non-White UK populations, so these themes (diagnostic doubt, eligibility restrictions, trust) may inform equitable recruitment to UK CF trials and service design.

Limitations: Small, US-only sample from CF centres and one advocacy organisation, limiting transferability to the UK, and the abstract does not report whether thematic saturation was reached.

Study Type: Prospective controlled observational study (n=13 adult CCHS patients, 18 healthy controls; convenience sample from a national cohort).

Key Question: Do adults with genetically confirmed CCHS experience dyspnoea at rest and during CO2 rebreathing, and in which perceptual dimensions?

Key Findings:

• At rest, 9/13 patients reported breathing unpleasantness versus 0/18 controls (p<0.0001), and 12/13 met dyspnoea criteria (breathing awareness with negative affect), despite none spontaneously reporting symptoms beforehand.
• During CO2 rebreathing, ventilatory responses stayed profoundly blunted but unpleasantness still increased. Patients rated lower sensory and affective intensity than controls, with air hunger less frequent (p=0.0108).
• MDP ratings did not correlate with ventilatory CO2 response or genotype.

Clinical Relevance: Adults with CCHS, managed in UK highly specialised home ventilation services, may have unreported dyspnoea, supporting proactive multidimensional symptom assessment.

Limitations: Small convenience sample of an ultra-rare condition limits power and generalisability, particularly for genotype-based comparisons.

Study Type: Prospective pilot diagnostic study (n=15), single-arm, with blinded pathologist interpretation and two independent MDD sessions.

Key Question: Does endobronchial optical coherence tomography (EB-OCT) add diagnostic value and confidence at ILD multidisciplinary discussion when combined with TBLC and Envisia Genomic Classifier?

Key Findings:

• EB-OCT findings agreed with the final MDD diagnosis in 15/15 patients, including all 6 (40%) where TBLC was non-diagnostic.
• Where TBLC was diagnostic (9/15), EB-OCT agreed in every case.
• Adding EB-OCT to TBLC/EGC increased diagnostic confidence and/or narrowed the differential in all patients, replicated at both MDD sites.

Clinical Relevance: EB-OCT may offer a lower-risk way to resolve low-confidence ILD cases when TBLC is non-diagnostic, reducing reliance on surgical lung biopsy, though it is not currently established in NHS practice.

Limitations: Very small sample with no comparator arm; MDD diagnoses were not independently validated against surgical biopsy, so "agreement" may reflect incorporation bias.

Study Type: Qualitative multi-case study (rapid ethnographic assessment plus semi-structured interviews), nested within the ACCELL pre-post pragmatic intervention trial.

Key Question: What barriers and facilitators affect adherence to lung cancer screening (LCS) follow-up in community healthcare settings?

Key Findings:

• Data came from three Washington state community health systems: 28 leaders/providers/staff (ethnographic assessment) and 31 patients and 15 providers (interviews at the two intervention sites).
• Key determinants: LCS process complexity and care fragmentation, role of primary care, EHR use, radiology support, social determinants (including socioeconomic status and language), shared belief in LCS value, and clinical champions with performance metrics.
• Authors suggest centralised models may address complexity and fragmentation, while EHR tools, education and standardised metrics may support decentralised delivery.

Clinical Relevance: Findings may inform follow-up and tracking design in the NHS Targeted Lung Health Check programme and national rollout, where fragmentation across primary, secondary and imaging services is a comparable risk.

Limitations: Qualitative data from a single US state's community systems limit generalisability to the NHS, and the abstract reports no outcome data on whether addressing these determinants improves follow-up.

Study Type: Retrospective longitudinal cohort study (Ontario, Canada; linked telemonitoring and health administrative data).

Key Question: What are the patterns of, and factors associated with, home NIV adherence in children?

Key Findings:

• In 237 children (mean age 12.9 years), mean adherence was 69.6% of person-months using the adult ≥4 h/day definition. Child-level monthly mean was 59% (SD 32%), or 68% for any use. Mean use on days used was 7.5 h.
• Monthly "days not used" averaged 5.1 and "no data" days 4.4.
• Higher adherence was associated with younger age (−2 percentage points per year of age; 95% CI 1–3), ≥3 complex chronic conditions versus none (+14 points; 95% CI 3–26), and longer time on NIV (+2 points per year; 95% CI 1–3).

Clinical Relevance: Adherence was moderate and no validated paediatric threshold exists, so this supports targeted review of adolescents and those with fewer comorbidities in UK home NIV services.

Limitations: Telemonitoring-only data cannot establish clinical effectiveness of any adherence threshold, and the Canadian context may limit generalisability to NHS service models.