Daily Respiratory Research Analysis

Chronic respiratory diseases, including chronic obstructive pulmonary disease (COPD), asthma, pneumoconiosis, interstitial lung disease (ILD) and pulmonary sarcoidosis, are major global causes of mortality and morbidity. Although the COVID-19 pandemic has influenced acute respiratory health, its impact on chronic respiratory conditions remains unclear. We estimated the global, regional and national burden of chronic respiratory diseases from 1990 to 2023, including risk factors, and evaluated how these burdens have shifted during the COVID-19 pandemic using the Global Burden of Disease Study 2023. In 2023, chronic respiratory diseases accounted for 569.2 million (95% uncertainty interval (UI), 508.8-639.8) cases and 4.2 million (3.6-5.1) deaths. The age-standardized death rate declined by 25.7% globally from 1990 to 2023 despite an increase in ILD and pulmonary sarcoidosis. Mortality declined in younger males, especially for asthma, whereas older adults experienced a rise in ILD and pulmonary sarcoidosis. Smoking was the primary risk factor for COPD, whereas high body mass index and silica exposure were key risk factors for asthma and pneumoconiosis. During the pandemic, the incidence of chronic respiratory diseases increased modestly, but the decline in mortality rates became more pronounced, highlighting the need for sustained global attention and action to address their long-term burden.

INTRODUCTION: Integrating smoking cessation supports into lung cancer screening can improve abstinence rates. However, healthcare decision-makers need evidence of cost-effectiveness to understand the cost/benefit of adopting this approach. METHODS: To evaluate the cost-effectiveness of smoking cessation interventions, and service delivery, we used a cohort-based Markov model, adapted from previous National Institute for Health and Care Excellence (NICE) guidelines on smoking cessation. This uses long-term epidemiological data to capture the prevalence of the smoking-related illnesses, updated through targeted literature searches as required from the core NICE model, with costs extracted from publicly recognised UK sources. RESULTS: All smoking cessation interventions appeared cost-effective at a threshold of £20 000 per quality-adjusted life year, compared with no intervention or behavioural support alone. Offering immediate smoking cessation as part of lung cancer screening appointments, compared with usual care (onward referral to stop smoking services), was also estimated to be cost-effective with a net monetary benefit of £2198 per person, and a saving of between £34 and £79 per person in reduced workplace absenteeism among working age attendees. Estimated healthcare cost savings were more than four times greater in the most deprived quintile compared with the least deprived, alongside a fivefold increase in quality adjusted life years accrued. CONCLUSIONS: Smoking cessation interventions within lung cancer screening are cost-effective and should be integrated, so that treatment is initiated during screening visits. This is likely to reduce overall costs to the health service, and wider integrated care systems, improve quality and length of life, and may lessen health inequalities.

BACKGROUND: Invasive ventilation saves lives but carries major risks, including ventilation-associated lung damage and long-term functional impairment. Data from recent studies compel reassessment of the evidence for every step of the clinical treatment pathway. METHODS: This updated clinical practice guideline is based on pertinent publications retrieved by a systematic search in Medline, Embase, and the Cochrane Library up to April 2023, supplemented by further high-quality studies published up to June 2024. The recommendations were developed in evidence-to-decision-frameworks (EtDF) according to GRADE, with the participation of intensive-care nurses and early career clinician-scientists. RESULTS: For patients in acute respiratory failure, it is suggested that noninvasive respiratory support techniques should be used so that intubation can be avoided. It is further suggested that spontaneous breathing should be enabled early on during invasive ventilation. For the first time, the use of various techniques for titrating the positive end-expiratory pressure (PEEP) is suggested for patients with moderate to severe acute respiratory distress syndrome (ARDS). In such patients, techniques aiming at a higher PEEP can lower mortality by 9% in absolute terms (95% confidence interval [1; 16]) compared to lower-PEEP strategies. Strong recommendations are given against the routine use of muscle relaxation or corticosteroid therapy in moderate to severe ARDS. For patients with ARDS with a persistent, severe gas exchange disturbance after conservative options have been exhausted, veno-venous extracorporeal membrane oxygenation should be considered. VvECMO for patients with severe ARDS should be carried out at centers that are experienced in treating patients with severe ARDS and that fulfill specific structural requirements. CONCLUSION: The goals of ventilator therapy should be to enable spontaneous breathing as soon as possible, keep respiratory parameters in the protective range, and adjust PEEP individually. Muscle relaxation or corticosteroids should not be part of the routine treatment of moderately severe ARDS.