Daily Respiratory Research Analysis

BACKGROUND: Substitution of noncombustible tobacco products for cigarettes could improve respiratory symptoms. We hypothesized that complete cigarette-to-e-cigarette switching would improve respiratory symptoms compared to continued smoking. METHODS: Longitudinal analysis of data from waves 2-6 (W2-W6; 2014-2021) of the Population Assessment of Tobacco and Health (PATH) Study, an observational cohort study that surveyed 5653 US adults ≥18 years without COPD/chronic bronchitis/emphysema. We compiled 14,947 two-wave (1-2 year) observations with persons who smoked cigarettes at baseline and compared the relation between functionally important respiratory symptoms and switching to exclusive e-cigarette use or quitting tobacco versus continued cigarette use (reference). A 9-point wheezing/nighttime cough index was dichotomized based on index scores of ≥2 or ≥3, previously associated with poorer functional health. Multivariable models assessed how changes in cigarette use predicted worsening/improvement of symptoms. FINDINGS: Among those with an index score <2, 3.5% switched to e-cigarettes, and 11.1% quit all tobacco. Functionally important respiratory symptoms worsened (≥2 at follow-up) in 15.4%, 10.0% and 10.1% of those who continued cigarettes, switched to e-cigarettes, and quit, respectively. Adjusted relative risk (RR) for respiratory symptom worsening was 0.69 (95% confidence interval (CI), 0.52, 0.91) for e-cigarette switching and 0.73 (95% CI, 0.54, 0.97) for quitting. Of persons with index score ≥2, 2.8% switched to e-cigarettes, and 6.7% quit. Respiratory symptoms improved (<2 at follow-up) in 27.7%, 45.8% and 42.1% of those who continued cigarettes, switched to e-cigarettes, and quit, respectively. The RR for improving was 1.31 (95% CI, 1.05, 1.64) for e-cigarette switching and 1.36 (95% CI, 1.15, 1.62) for quitting. The RRs for exclusive e-cigarette use with a cutoff of ≥3 for respiratory symptom worsening and improvement were not significant (0.74 [0.53, 1.05] and 1.20 [0.95, 1.51] respectively) but were significant in an unweighted analysis that included partial data for individuals lost to follow-up (0.74 [0.57, 0.95] and 1.21 [1.06, 1.39] respectively). INTERPRETATION: Switching completely from past 30-day use of cigarettes to e-cigarettes had short-term beneficial associations with functionally important respiratory symptoms similar to quitting tobacco completely. FUNDING: This manuscript is supported with Federal funds from the National Institute on Drug Abuse (NIDA) at the National Institutes of Health (NIH), and the Center for Tobacco Products (CTP) at the Food and Drug Administration (FDA), Department of Health and Human Services, under contract to Westat (contract nos. HHSN271201100027C and HHSN271201600001C), and through an interagency agreement between NIH NIDA and FDA CTP. Heather L. Kimmel was substantially involved in the scientific management of and providing scientific expertise for contract nos. HHSN271201100027C and HHSN271201600001C.

IMPORTANCE: Two interventions to prevent severe respiratory syncytial virus (RSV) in infants were approved in 2023-a bivalent prenatal RSV prefusion F protein-based (RSVpreF) vaccine and an infant monoclonal antibody (nirsevimab). Understanding their uptake and clinical outcomes is essential for public health planning. OBJECTIVE: To describe uptake of the prenatal RSVpreF vaccine and infant nirsevimab. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study was conducted at a single academic center among 647 pregnant individuals eligible for RSVpreF vaccination (32-36 weeks' gestation between October 15, 2023, and January 31, 2024) and infants eligible for nirsevimab (no prenatal RSVpreF vaccination >14 days before delivery). EXPOSURE: Pregnancy or birth during the 2023-2024 RSV season. MAIN OUTCOMES AND MEASURES: RSVpreF vaccination among eligible pregnant individuals and nirsevimab administration prior to hospital discharge among eligible infants. RESULTS: Of 647 eligible pregnant individuals (mean [SD] age, 34.6 [6.2] years; 355 nulliparous [54.9%]; 558 privately insured [86.2%]), 414 (64.0%) received the RSVpreF vaccine. Factors associated with higher RSVpreF uptake included older birthing parent age (adjusted odds ratio [AOR], 1.09; 95% CI, 1.05-1.12), nulliparity (AOR, 1.84; 95% CI, 1.31-2.60), private insurance (AOR, 2.19; 95% CI, 1.27-3.80), non-Hispanic ethnicity (AOR, 2.36; 95% CI 1.57-3.55; reference: Hispanic), receipt of any COVID-19 vaccine (AOR, 7.12; 95% CI, 3.91-13.70), 2023-2024 formula COVID-19 booster vaccine (AOR, 5.62; 95% CI, 3.80-8.48), influenza vaccine (AOR, 8.14; 95% CI, 5.38-12.50), or tetanus-diphtheria-pertussis vaccine (AOR, 6.86; 95% CI, 3.79-13.10). Factors associated with lower RSVpreF uptake included non-English language preference (AOR, 0.24; 95% CI, 0.10-0.52), Black race (AOR, 0.30; 95% CI, 0.16-0.57; reference: Asian), other or unknown race (AOR, 0.48; 95% CI, 0.30-0.76), and multiple gestation (AOR, 0.27; 95% CI, 0.07-0.88). Nirsevimab was administered to 183 of 261 eligible infants (70.1%) prior to hospital discharge. Among those who did not receive RSVpreF or standard prenatal vaccines, 40.4% of their neonates (19 of 47) received nirsevimab; among those who declined infant hepatitis B vaccination, 34.0% of their neonates (17 of 50) received nirsevimab. Respiratory syncytial virus coverage exceeded 80% during all months of the study period except October 2023, the first month during which prenatal RSV vaccination and infant nirsevimab were available. Preterm delivery occurred in 35 of 414 RSVpreF-vaccinated individuals (8.5%) and 43 of 233 unvaccinated individuals (18.5%). In a nested case-control analysis with preterm birth as the outcome, there was no significant association between RSVpreF vaccination and preterm birth (AOR, 1.03; 95% CI, 0.55-1.93). CONCLUSIONS AND RELEVANCE: In this cohort study, uptake of the RSVpreF vaccine and infant nirsevimab was high. Nirsevimab uptake was high even among individuals who did not receive routine prenatal or infant vaccines. There was no significant association between RSVpreF vaccination and preterm birth. This study suggests that an RSV prevention strategy that included both prenatal vaccination and infant monoclonal antibody administration had high uptake and reassuring perinatal outcomes.

OBJECTIVES: To estimate the associations between body mass index (BMI) and mortality and between BMI and complications in patients receiving venovenous extracorporeal membrane oxygenation (ECMO) and to estimate if any mortality association was mediated by complications. DESIGN: Retrospective analysis of an international, multicenter registry. SETTING: ICUs. PATIENTS: Adults in the Extracorporeal Life Support Organization database who received venovenous ECMO between January 1, 2015, and December 31, 2021. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Logistic regression with BMI transformed using fractional polynomials was used to estimate the association between BMI and hospital mortality and between BMI and complications. Mediation analysis was used to estimate if the association between BMI and mortality was a direct effect or was mediated by complications. Of the 24,796 patient runs, 10,361 patients died (48%). After adjusting for confounders, we found nonlinear associations between BMI and mortality. Compared with BMI = 25 kg/m 2 , a BMI = 20 had an 11% higher risk of dying, odds ratio (OR) =1.11 (95% CI, 1.08-1.15); a BMI = 30 had an 8% lower risk, OR = 0.92 (95% CI, 0.90-0.95); and a BMI = 40 kg/m 2 had an 18% lower risk of death OR = 0.82 (95% CI, 0.78-0.87). BMI was also associated with mechanical, renal, pulmonary, and neurologic complications. The association between BMI and mortality was both a direct effect and mediated via pulmonary complications, while mechanical, renal replacement therapy, and neurologic complications were suppressors having a negative association with improved mortality in patients with higher BMI. CONCLUSIONS: We confirmed that patients with higher BMI requiring venovenous ECMO were less likely to die. This finding was partially mediated by pulmonary complications and partially via a direct association between BMI and mortality. BMI was also associated with mechanical, renal replacement therapy, and neurologic complications that acted as suppressing mediators and were associated with increased mortality for increasing BMI despite the overall trend of improved survival.