Daily Respiratory Research Analysis
Analyzed 228 papers and selected 3 impactful papers.
Summary
Three impactful studies span prevention, implementation science, and critical care. A multinational real-world analysis shows substantial reductions in infant bronchiolitis after nirsevimab rollout, whereas maternal RSV vaccination alone yielded limited early impact. A Cochrane review confirms that training health professionals significantly increases smoking cessation, and a multicenter ECMO cohort identifies serum KL-6 as a prognostic biomarker in severe ARDS.
Research Themes
- Population-level RSV prevention effectiveness
- Implementation of clinician training for smoking cessation
- Prognostic biomarkers in ECMO-treated ARDS
Selected Articles
1. Training health professionals in smoking cessation.
This Cochrane systematic review of 29 randomized trials (38,178 participants) shows that training healthcare professionals increases long-term smoking abstinence (RR 1.34, 95% CI 1.08–1.67). The evidence is high-certainty and supports integrating structured training into routine care to enhance cessation outcomes.
Impact: Smoking cessation is central to respiratory health. High-certainty evidence that clinician training improves abstinence provides a scalable, policy-relevant lever to reduce COPD, lung cancer, and cardiovascular disease burden.
Clinical Implications: Health systems should embed standardized smoking cessation training (content, delivery, and intensity) for clinicians, integrate prompts in EHRs, and pair training with access to pharmacotherapy to maximize quit rates.
Key Findings
- Across 16 trials versus no training, clinician training increased long-term abstinence (RR 1.34, 95% CI 1.08–1.67).
- 29 studies trained >4,030 clinicians and included 38,178 patients, with GRADE high-certainty for the primary outcome.
- Review highlights need to evaluate multi-component strategies combining clinician training with pharmacotherapies.
Methodological Strengths
- Cochrane-standard search, selection, RoB assessment, and GRADE rating
- Random-effects meta-analysis across randomized trials with long-term abstinence outcomes
Limitations
- Heterogeneity in training content, intensity, and settings
- Limited data on optimal combinations with modern pharmacotherapies and digital supports
Future Directions: Test multi-component implementation strategies (training plus EHR prompts, quitlines, and pharmacotherapy) with pragmatic cluster RCTs to define scalable models across diverse health systems.
RATIONALE: Cigarette smoking is one of the leading causes of preventable death worldwide. There is good evidence that brief interventions by health professionals can increase smoking cessation attempts. However, as new studies become available, the effectiveness of these training programmes needs to be re-assessed to inform public policy, clinical care, and guideline recommendations. This is an update of a Cochrane review first published in 2000, and previously updated in 2012. OBJECTIVES: To assess the effectiveness of training healthcare professionals to deliver smoking cessation interventions to their patients, and to assess the effects of training characteristics (such as content, setting, delivery, and intensity). SEARCH METHODS: We searched the following databases from inception to August 2024: Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; Embase; PsycINFO; ClinicalTrials.gov (through CENTRAL); and the World Health Organization International Clinical Trials Registry Platform (through CENTRAL). We also searched the references of eligible studies. ELIGIBILITY CRITERIA: We included randomised trials in which the intervention was training of healthcare professionals in smoking cessation. We considered trials for inclusion if they reported outcomes for patient smoking at least six months after the intervention. Process outcomes needed to be reported. However, we excluded trials that reported effects only on process outcomes and not smoking behaviour. OUTCOMES: The critical outcome measure was abstinence from smoking six months or more after baseline, using the strictest measure of abstinence available at the longest follow-up. Prolonged or continuous abstinence was preferred over point prevalence. Our important outcome was the number of participants who made a quit attempt. RISK OF BIAS: Working independently, two review authors evaluated the risk of bias using the Cochrane RoB 1 tool, following guidance from the Cochrane Tobacco Addiction Group. SYNTHESIS METHODS: Working independently, two review authors extracted information about the characteristics of each included study (i.e. interventions, participants, outcomes, and methods). We pooled studies using random-effects meta-analysis where possible and otherwise summarised findings using narrative synthesis in text and tables. We used the GRADE framework to assess the certainty of the evidence. INCLUDED STUDIES: We included 29 studies in the review, published between 1989 and 2024. Together, the studies provided training for over 4030 health professionals, and data for 38,178 participants. We assessed 10 studies to have an overall low risk of bias, 17 an unclear risk, and two to have an overall high risk of bias. SYNTHESIS OF RESULTS: Sixteen studies compared training of healthcare professionals in smoking cessation to no training, and assessed the effect on the number of participants abstinent at longest follow-up. High-certainty evidence indicates that smoking cessation training for healthcare professionals increases patient smoking cessation compared with no training (risk ratio (RR) 1.34, 95% confidence interval (CI) 1.08 to 1.67; I
2. Association of Serum KL-6 With Mortality in Patients With Acute Respiratory Distress Syndrome (ARDS) Requiring Extracorporeal Membrane Oxygenation (ECMO): A Multicenter Retrospective Cohort Study.
In a 24-center cohort of 373 VV-ECMO ARDS patients, higher serum KL-6 measured within ±3 days of ECMO initiation was associated with increased 90-day mortality, while lower KL-6 predicted successful ECMO liberation. Findings support KL-6 as a prognostic biomarker to inform risk stratification at ECMO initiation.
Impact: Provides multicenter evidence for a timely, clinically accessible biomarker to guide prognostication and decision-making in one of critical care’s highest-risk populations.
Clinical Implications: Consider measuring KL-6 around ECMO initiation to refine mortality risk and likelihood of liberation; may inform communication with families, resource allocation, and trial stratification.
Key Findings
- Among 373 VV-ECMO ARDS patients, 90-day mortality was 29.0%; higher KL-6 was associated with increased mortality (multivariable Cox with RCS, p=0.004).
- Lower KL-6 values were significantly associated with successful ECMO liberation (p<0.001).
- KL-6 was measured within ±3 days of ECMO initiation across 24 hospitals, supporting feasibility and generalizability within the studied setting.
Methodological Strengths
- Large multicenter cohort (24 hospitals) with prespecified outcomes and multivariable Cox models using restricted cubic splines
- Clinically timed biomarker window (±3 days around ECMO initiation) enhances interpretability
Limitations
- Retrospective design with potential residual confounding
- Single-country cohort (Japan) may limit generalizability to other systems and ECMO practices
Future Directions: Prospective validation and KL-6-guided risk algorithms, including integration with imaging/physiology, and interventional trials stratified by KL-6 to test tailored weaning or adjunctive therapies.
Identifying reliable biomarkers associated with clinical outcomes in patients with acute respiratory distress syndrome (ARDS) receiving extracorporeal membrane oxygenation (ECMO) is essential. Elevated serum Krebs von den Lungen-6 (KL-6) has been linked to increased mortality in ARDS; however, its prognostic utility in ECMO remains unclear. This multicenter retrospective cohort study analyzed adult patients with severe ARDS who received veno-venous ECMO in 24 Japanese hospitals between 2012 and 2022. Serum KL-6 was measured within 3 days before or after ECMO initiation. The primary outcome was 90 day in-hospital mortality, and the secondary outcome was successful ECMO liberation. Among 373 patients, 265 (71.0%) survived, and 108 (29.0%) died. In multivariable Cox proportional hazards models using restricted cubic splines, higher KL-6 levels were significantly associated with increased 90 day mortality (p = 0.004), whereas lower KL-6 levels were significantly associated with successful liberation from ECMO (p < 0.001). These findings suggest that serum KL-6 measured around the time of ECMO initiation is associated with mortality and liberation outcomes in patients with, supporting its potential as a biomarker of disease severity.
3. Real-world impact of nirsevimab immunisation and maternal RSV vaccination against respiratory disease on emergency department attendances and admissions: a multinational retrospective analysis.
In Catalonia, nirsevimab rollout was associated with large reductions in bronchiolitis ED attendances (RR 0.45) and admissions (RR 0.40) among infants <6 months, whereas Rome showed no reduction and UK sites showed modest or inconsistent effects. Early real-world effectiveness appears strongly dependent on program uptake.
Impact: Provides timely population-level effectiveness data informing RSV prevention policy and program design, highlighting the critical importance of high uptake for impact.
Clinical Implications: Health systems should prioritize high coverage nirsevimab programs for infants, integrate maternal vaccination where feasible, and monitor uptake and outcomes to optimize reduction in bronchiolitis burden.
Key Findings
- Catalonia observed RR 0.45 (95% CI 0.43–0.47) for bronchiolitis ED attendances and RR 0.40 (95% CI 0.37–0.43) for admissions in infants <6 months post-nirsevimab introduction.
- Rome showed no reduction (ED RR 1.09; admissions RR 1.12), and UK hospitals showed modest or site-specific reductions.
- Differences likely reflect varying uptake of RSV prevention strategies across regions.
Methodological Strengths
- Multi-country, multi-year analysis with Poisson regression and historical controls
- Use of comparator regions without intervention to contextualize trends
Limitations
- Retrospective ecological design susceptible to confounding and secular trends
- Heterogeneity in coding, testing, and healthcare utilization across sites
Future Directions: Link uptake data to individual-level outcomes, assess cost-effectiveness, and compare combined infant and maternal strategies in pragmatic designs to optimize RSV prevention portfolios.
BACKGROUND: Nirsevimab, a long-acting monoclonal antibody against respiratory syncytial virus (RSV), was recently introduced in Catalonia (Spain, 2023-2024 season onwards) and Italy (2024-2025 season). The United Kingdom (UK) instead introduced maternal RSV vaccination (RSVpreF) in the 2024-2025 season. Our aim was to analyse emergency department (ED) attendances and admissions to hospital following RSVpreF and nirsevimab introduction, with hospitals in Iceland and Romania, where no intervention was introduced, used as comparators. METHODS: Multi-national retrospective analysis of ED attendances and admissions for all diagnoses, respiratory diagnoses excluding bronchiolitis, and bronchiolitis from all hospitals in Catalonia (Spain), four UK hospitals (Bristol, Edinburgh, Glasgow, and Leicester), and one hospital in Italy (Rome), Romania (Bucharest), and Iceland (Reykjavík) from April 2018 to March 2025. Bronchiolitis diagnoses in the 2024-2025 season were compared to previous pre-intervention seasons (2018-2023, excluding the 2020-2021 COVID-19 year) by applying a generalised linear model in Poisson regression to obtain risk ratios (RR) and 95% confidence intervals (95% CI). FINDINGS: In the 2024-2025 season, in Catalonia, there was a reduction in the RR for bronchiolitis ED attendances and admissions in infants of age <6 months (RR 0.45; 95% CI 0.43-0.47 and RR 0.40; 95% CI 0.37-0.43, respectively). This was not seen in Rome, where the RR for ED attendances with bronchiolitis in infants of age <6 months was 1.09 (95% CI 0.92-1.30) and the RR for admissions was 1.12 (95% CI 0.83-1.52). In the UK, for infants of age <6 months with bronchiolitis, there was a significant but modest reduction in 1 out of 4 hospitals for ED attendances (Leicester; RR 0.91, 95% CI 0.85-0.97) and in 2 out of 4 hospitals for admissions (Leicester; RR 0.80, 95% CI 0.69-0.94 and Edinburgh; RR 0.85, 95% CI 0.76-0.95). INTERPRETATION: In Catalonia, there was a sustained reduction in bronchiolitis ED attendances and admissions for infants in the 2024-2025 season. However, no substantial reduction in bronchiolitis ED attendances or admissions was observed in Rome or the UK. These differences are likely to relate to the reduced uptake of RSV prevention products in these settings compared to Catalonia. FUNDING: None.