Chronic breathlessness is a highly prevalent, distressing symptom among people with chronic respiratory disease (CRD), often persisting despite optimal treatment. Primary care clinicians are well-positioned to offer early access to self-management support, however, many report limited knowledge, resources and confidence in managing breathlessness. The PrimaryBreathe Australia clinical trial is an ongoing partnership with PrimaryBreathe UK. In partnership with people with CRD, primary healthcare workers (HCWs), and additional stakeholders, we aimed to co-design a technology-supported, evidence-based, breathlessness self-management intervention, to be delivered to Australians with CRD enrolled in the PrimaryBreathe Australia clinical trial. Using a cyclical co-design approach, we conducted two rounds of semi-structured interviews and a consensus-building focus group to design/develop a feasible and acceptable intervention ahead of trial implementation. Data were transcribed and analysed according to the Theoretical Domains Framework. A total of 39 participants contributed to the co-design process, including 17 patients, 20 HCWs, and 2 stakeholders. Key overarching themes included: patient engagement in care; primary HCWs' approach to management; and healthcare structures, and the impacts of these domains on access to healthcare and breathlessness management. Tailored implementation strategies to address the concerns raised included: clinician-supported, self-management education for patients; flexible, multimodal, intervention delivery; and continuity of care within familiar settings. Our newly co-designed, evidence-based, breathlessness, self-management intervention was collaboratively developed with HCWs, people living with CRD, and additional stakeholders. This participatory approach ensures the intervention is patient-focused, contextually relevant, and fit for purpose when deployed in the PrimaryBreathe Australia clinical trial from 2025.
Bronchiectasis is a common chronic respiratory disease with rising prevalence, hospitalisation rates, and mortality. It is estimated to affect approximately 1 in 200 adults, imposing a substantial symptom burden and significant healthcare costs, largely driven by exacerbations. Although diagnosis and long-term management are usually led by respiratory specialists, most patient care interactions occur in primary care, including the management of multimorbidity and acute exacerbations. In December 2025, the European Respiratory Society (ERS) published updated global clinical practice guidelines for adult bronchiectasis. This article summarises the 2025 ERS recommendations with a specific focus on their implementation in primary care practice. Key priorities include improving early recognition and reducing diagnostic delay, undertaking standardised investigations to identify underlying causes and treatable traits, and recognising features associated with poor outcomes that warrant specialist referral. The guidance emphasises the importance of sputum microbiology, including testing for non-tuberculous mycobacteria, and targeted blood investigations such as immunoglobulins and allergic bronchopulmonary aspergillosis serology. Core management strategies relevant to primary care are reviewed, including airway clearance techniques, pulmonary rehabilitation, and evidence-based use of inhaled therapies. The article outlines best practice for the management of acute exacerbations, highlights differences from asthma and COPD care, and clarifies the limited role of inhaled corticosteroids in bronchiectasis. The identification and monitoring of patients who may benefit from long-term antibiotic therapy, including those with Pseudomonas aeruginosa infection, are also discussed. By translating specialist guideline recommendations into a primary care context, this summary aims to support timely diagnosis, optimise ongoing management, and improve outcomes for adults with bronchiectasis.
Chronic respiratory diseases (CRDs), particularly asthma and chronic obstructive pulmonary disease (COPD), impose significant burdens on patients and their families in low- and middle-income countries (LMICs). Little is known about the experience of living with CRD in low- and middle-income countries (LMIC), and the impact of systemic inequities in primary care settings. To explore patient experiences of systemic inequities in CRD care in Klang District, Malaysia. We employed an adapted qualitative Photovoice study conducted between December 2023 and October 2024. The study involved adult patients with self-reported CRDs from five primary care clinics in Klang District, Malaysia. In-depth interviews were conducted at two time points using an interview guide and focused on the topics chosen by participants in their photographs. We transcribed audio-recordings verbatim, checked for accuracy and analysed them thematically. Patient and public involvement (PPI) was integral throughout the study, enhancing cultural relevance and ethical oversight. Fourteen participants (mean age 54 years; 57.1% men, 42.9% Malay, 50% diagnosed with asthma) completed the study. Four interconnected themes emerged: (1) indoor and outdoor air pollution (e.g. smoking and haze) worsened respiratory symptoms; (2) financial strain due to out-of-pocket expenses despite provision of universal healthcare; (3) occupational vulnerabilities, including transitions to precarious informal work due to health limitations; and (4) gendered caregiving burdens, including caring responsibilities while ill, pregnancy-related vulnerability, stigma, and household misunderstanding. Participants consistently showed resilience, proactively adopting coping strategies despite systemic barriers. This study highlights intersectional inequities faced by people with CRDs in Klang, Malaysia, emphasising environmental, financial, occupational, and gender-specific challenges. The use of participatory visual methodologies like Photovoice gives voice to people, allowing their narratives to advocate for culturally sensitive change to the lived environment supported by equitable provision of healthcare.
Asthma and chronic obstructive pulmonary disease (COPD) are the most prevalent chronic respiratory conditions globally, with management predominantly occurring in primary care settings. International guidelines from the Global Initiative for Asthma (GINA) and the Global Initiative for Chronic Obstructive Lung Disease (GOLD) have been instrumental in standardising care; however, these documents consistently use generic terminology such as "primary care physician" or "healthcare provider" without explicitly recognising the family physician as a distinct medical specialty. This omission creates a conceptual gap that may undermine guideline ownership, implementation fidelity, and coordinated care pathways-particularly in low- and middle-income countries where family physicians constitute the backbone of chronic respiratory disease management. This letter argues that explicit recognition of family physicians in future GINA and GOLD updates, alongside inclusion of family medicine representatives in guideline development committees and creation of implementation toolkits for primary care settings, would strengthen guideline relevance, enhance primary care engagement, and ultimately improve respiratory health outcomes worldwide.
Artificial intelligence (AI) is rapidly advancing respiratory disease management, from diagnosis to population lung health. This scoping review synthesizes the most promising uses of AI in respiratory medicine, with a particular focus on pulmonologists and family physicians interested in lung health. In diagnostics, deep-learning systems streamline chest-imaging workflows by triaging radiographs, detecting COVID-19 pneumonia, and classifying lung nodules on CT. In pulmonary function testing, algorithms detect technical errors and classify spirometric patterns, some claiming to outperforming pulmonologists. Acoustic analysis of cough, breathing, and speech captured on smartphones or wearables offers non-invasive decision support. For monitoring and prediction, AI helps shorten weaning from mechanical ventilation and guides closed-loop strategies for acute respiratory distress. In chronic care, connected devices integrated with environmental data help to forecast asthma and COPD exacerbations, while telehealth and predictive models enable earlier, more personalized interventions. Additional gains are emerging in paediatrics, sleep medicine, lung ultrasounds, and public health. Realizing these benefits will require rigorous multicentre validation and real-world evidence. It will also require proactive bias detection and mitigation with inclusive sampling and equity audits. High-quality, interoperable data and explainable models are needed to enable human oversight. Practical issues such as digital literacy, device access, and usability for children, older adults, and other vulnerable populations also matter for applications requiring patient interaction. With sustained collaboration among clinicians, engineers, AI experts, industry, regulators, and scientific societies, AI can increase the time invested in a satisfactory clinician-patient relationship. With all likelihood, AI can also measurably improve efficiency and accuracy across multiple domains of respiratory care.
The impact of climate change on chronic respiratory diseases such as asthma and chronic obstructive pulmonary disease is becoming ever more apparent, with extremes of heat and cold, increased humidity, and severe weather events worsening the risk of negative outcomes in these patients, including mortality. In turn, climate change is altering the patterns and types of aeroallergens and viruses that also impact the day-to-day lives of patients with respiratory diseases. As a consequence, physicians caring for patients with chronic respiratory diseases may be especially interested in how climate change impacts these conditions and, conversely, how management of these diseases may affect the environment. In this setting, it is of note that poorly controlled respiratory diseases have a higher carbon footprint than well-controlled diseases, especially if an individual is hospitalised. Effective therapy that reduces the occurrence of symptoms and prevents exacerbations will therefore minimise the impact of a respiratory disease on the environment, regardless of the type of device used for delivery of maintenance therapy. In addition, any inhaler choice should be personalised, considering a patient's preference for, and ability to use the inhaler device correctly, but it is also important to consider the overall lifecycle carbon footprint of an inhaler, not only of the gases emitted. This narrative review summarises evidence on how climate change is impacting individuals with chronic respiratory diseases, and discusses how respiratory clinical practice can impact climate change. Importantly, we propose that the main contribution to minimising the impact of chronic respiratory diseases on the climate is to optimise disease control and self-management.
Pulmonary rehabilitation (PR) is a key component in managing chronic respiratory diseases (CRDs). Primary care, often the first point of contact for people with CRD, is well-positioned to facilitate referral to PR, yet referral rates are low. This systematic review aimed to identify the key components of primary care interventions to support referral to PR and synthesise their effect on referral rate. Five electronic databases were searched to identify studies of any design that reported interventions implemented in primary care to support referral to PR for people with CRD. Interventions could target people with CRD and/or healthcare professionals. Screening, quality appraisal using the Downs and Black checklist, and data extraction were conducted independently by two reviewers. Interventions were mapped to the Expert Recommendations for Implementing Change (ERIC) taxonomy-a framework of 73 strategies seeking to enhance the adoption, implementation, and sustainability of evidence-based interventions. Thirteen studies were included, employing a range of quasi-experimental, observational, and randomised designs. Overall, the studies were of moderate quality (mean total score 14, range 10 to 25 out of 27). Interventions incorporated a mean of 12 ERIC strategies across five domains, most commonly education and training, interactive assistance, clinician support, and audit and feedback. Impact of interventions on referral rates was minimal (n = 3 randomised controlled trials, pooled mean difference 0%, 95% confidence interval -0.24 to 0.25). Multi-component interventions, including numerous implementation strategies, have achieved minimal improvement in PR referral rates from primary care. Understanding how strategies are delivered and applied, rather than simply the number of strategies or the combination they are used in, may be important for operationalisation of referral focussed interventions. Addressing the behavioural processes underpinning referral decisions, together with the use of theory-informed, context-specific approaches may enhance effectiveness of referral focussed interventions.
Wheeze is one of the most common respiratory conditions in early childhood. Despite available guidelines, treatment management in pre-school children remains challenging. We aim to describe prescribing patterns for pre-schoolers with wheeze in primary care settings. This retrospective population-based birth cohort study analyzed data from the Italian Pedianet primary care database. Children born between 2010 and 2017 and followed from birth to at least 5 years were included. Wheeze episodes were identified through ICD-9-CM codes and validated free-text searches in outpatient records. Prescribing patterns across successive episodes were analyzed using State Sequence Analysis (SSA), overall and stratified by age at first episode, to describe treatment trajectories in primary care from 2010 to 2023. Among 66,981 eligible children, 24.28% experienced at least one wheeze episode. Treatment was provided in 64.96% of episodes, with a median of two treated episodes per child. Initial prescribing showed considerable variation: inhaled beta2-agonists, oral corticosteroids, and inhaled corticosteroids were most commonly used, either alone or combined. Prescribing patterns varied by age, with greater use of inhaled therapies in older children. SSA showed declining numbers of children receiving subsequent treatments and a progressive consolidation toward a limited number of therapeutic regimens over successive episodes. In this primary care cohort, prescribing for pre-school wheeze was heterogeneous and influenced by age at first diagnosis. These findings highlight gaps between real-world practice and current guidelines, emphasizing the need for clearer guidance and targeted implementation strategies for managing wheeze in early childhood.
Seasonal respiratory viral infections are the major cause of increased pressure on national health systems such as the UK's national health service (NHS) during winter months. Emergency departments and hospitals are full as increasing numbers of patients require hospitalisation for lower respiratory tract infections and exacerbations of COPD, asthma, and other respiratory conditions. These winter pressures are largely predictable. Forecasting models give healthcare managers the chance to mitigate winter pressures by allocating resources more effectively. Despite this predictability and the production of NHS resilience plans, the UK is particularly susceptible to winter pressures. Communities facing social and environmental disadvantage are at increased risk of hospitalisation. Despite the focus on real-life research and guideline dissemination and implementation over the last 20-30 years, care of patients with respiratory conditions in the UK remains sub-optimal. To tackle winter pressures, a different approach is needed. The UK Centre for Applied Respiratory Research Innovation and Impact (CARRii) is a new UK-wide network which aims to drive policy change and use innovative ways of implementing research to achieve maximum impact on patient care. Its missions are to reduce NHS winter pressures and respiratory health inequalities, and its focus is on three areas: prevention; self-management and connected care; and optimisation of clinical care. CARRii unites leading experts across respiratory research, clinical medicine, data science, public health, industry innovation, and patient advocacy. CARRii's first Annual Scientific Meeting was held recently. Implementation of research is more likely to succeed if it is based on real-world data, there is multi-agency involvement in its design and implementation, it is patient-focussed, and policy makers are convinced of its benefits. By positioning implementation and impact as a central scientific goal, CARRii aims to show how healthcare systems can deliver respiratory solutions at scale. This requires investment and cross-sector collaboration. If successful, this approach will reduce winter pressures, improve health equity and strengthen system resilience.
We aimed to assess whether Pelargonium sidoides extract (EPs®7630) reduces symptom duration or antibiotic use compared with usual care in adults with acute bronchitis. We conducted a pragmatic randomised-controlled trial across 36 primary care practices and five walk-in clinics in Switzerland. Adults ( ≥ 18 years) consulting a general practitioner for the first time for a new episode of acute bronchitis, with a cough of up to eight days' duration, were eligible for inclusion. The co-primary outcomes were (1) number of days required to achieve a 50% reduction in symptoms from the peak value, assessed using the Acute Bronchitis Severity Score (ABSS), and (2) the proportion of participants who used antibiotics. Missing data in intention-to-treat (ITT) analyses were multiply imputed. 332 participants were enrolled and randomly assigned: 155 to EPs®7630 and 177 to usual care. Neither co-primary outcomes showed a statistically significant difference between groups. No significant difference in time to 50% reduction of symptoms between the EPs®7630 and usual care groups was observed (adjusted regression coefficient 0.05 [95% CI - 0.13-0.23]; p = 0.578). Antibiotic use was 7 percentage points lower (31% relative reduction) in the EPs®7630 group (17.4%, 20 of 155) than in the usual care group (25.2%, 33 of 177), although the difference was not statistically significant (adjusted risk ratio 0.78 [95% CI 0.49-1.26]; p = 0.309). Adverse events were reported more frequently in the EPs®7630 group (32.3%, 50 of 155) than in the usual care group (21.5%, 38 of 177; hazard ratio 1.40 [95% CI 1.03-1.89]; p = 0.030); all adverse drug events were mild. EPs®7630 did not reduce symptom duration or antibiotic use significantly and was associated with more frequent events, that were all mild and previously described. Despite the absence of statistical significance, the observed reduction in antibiotic use warrants further investigation in larger trials to clarify its potential role within antimicrobial stewardship strategies.
There are known delays to diagnosis for chronic respiratory disease and recognised health inequalities in outcomes. We therefore investigated the association between ethnicity and subsequent healthcare utilisation and receipt of an explanatory diagnosis after a first presentation with breathlessness. Clinical Practice Research Datalink (CPRD) GOLD data linked to Hospital Episode Statistics (HES) and death registries were used to identify adults with a first-recorded code for breathlessness (index-date). Ethnicity was determined using the Hemingway algorithm. Rates of primary care consultations, secondary care referrals and hospital admissions within six and 24 months after index-date were examined using negative binomial regression. Logistic regression was used to estimate odds of receiving an explanatory recorded diagnosis for breathlessness during these timeframes. Models were adjusted for age, sex, socioeconomic status and ≥ 2 pre-existing long-term conditions. Amongst 88,857 included patients, 3336 were of South Asian ethnicity and 1506 of Black ethnicity. Compared to patients of White ethnicity, South Asian patients had significantly increased rates of primary care consultations and unplanned hospital admissions within six and 24 months (24 months IRR 1.13 [1.10-1.16] and 1.34 [1.25-1.45] respectively). Conversely, patients of Black ethnicity had significantly lower rates of primary care consultations within 24 months (IRR 0.95 [0.92-0.99], but significantly increased rates of unplanned hospitalisations within six and 24 months (IRR 1.33 [1.19-1.50]). However, both groups had significantly lower odds of receiving an explanatory diagnosis for breathlessness. After a first presentation with breathlessness, we observed a higher rate of unplanned hospitalisations yet a lower rate of receiving an explanatory diagnosis in patients of non-white ethnicity. Understanding the reasons and implications of these differences is critical to reduce potential health inequalities.
Asthma is the most common chronic childhood illness, however, many young children with asthma symptoms remain undiagnosed and/or misdiagnosed as pneumonia. We explored caregivers' and health care providers' understanding and practices around diagnosis and management of asthma in children less than 5 years. We conducted a cross-sectional study in primary care facilities in Uganda between June and August 2016. In-depth interviews with 25 participants, including caregivers (CGs) of young children with recurrent respiratory symptoms, healthcare workers (HCWs) and herbalists were triangulated. The findings indicated that all CGs described recurrent cough, wheeze and breathing difficulties in their children, which is suggestive of asthma, but were primarily diagnosed with pneumonia, bronchiolitis or bronchitis, and treated with antibiotics. This was in conformity with the HCWs' responses regarding their (HCWs) practices in management of children with respiratory illnesses. HCWs indicated that they did not diagnose asthma in young children but used terms like hyper-reactive airways disease or allergic cough. Caregivers were frustrated with the healthcare system due to lack of clear diagnoses and ineffective treatments. HCWs expressed frustration with unavailability of inhaled asthma medicines. The study highlighted major gaps in HCWs' practices in the management of asthma in young children leading to under-diagnosis of asthma and over-diagnosis of pneumonia., and overuse of antibiotics. Despite caregivers seeking care, their children did not get the right care, partly due to health system challenges including HCW competencies. Strategies for health system strengthening including improving HCWs' competences and availability of inhaled asthma medicines are urgently needed.
The PUMA scale has shown good discrimination in identifying people with COPD in primary care. We evaluated the predictive performance of PUMA for opportunistic case-finding and assessed the prevalence of COPD in at-risk primary care patients in Singapore. This is a multicentre cross-sectional study of participants aged ≥40 years and current/former smokers. Participants completed the PUMA scale and spirometry. Predictive performance of PUMA was assessed using AUC-ROC; optimal cutoff was determined by Youden's index. 359 participants were included in final analysis; 12.5% had COPD confirmed on spirometry. PUMA showed acceptable discrimination with AUC-ROC of 0.75 (95% CI:0.67-0.83). Optimal cutoff maximising sensitivity and specificity was ≥5 (Se 62.2%, Sp 79.3%; PPV 30.1%, NPV 93.6%); cutoff of ≥4 increased sensitivity to 80.0% (Sp of 56.7%; PPV 20.9%, NPV 95.2%.). The PUMA scale demonstrated acceptable predictive performance for opportunistic COPD case-finding in Singapore's primary care setting. A cutoff of ≥4 enhanced case identification.
Asthma and chronic obstructive pulmonary disease (COPD) incur significant comorbidity and healthcare burden. However, their future economic burden remain unclear. To project 20-year (2024-2043) asthma and COPD multimorbidity costs in Singapore, illustrating broader Southeast Asian trends. Patients with asthma (all ages) or COPD (≥40 years) were identified from Singapore's health administrative data (2002-2019). Age- and sex-specific, disease-specific per-episode costs and annual healthcare utilisation rates (hospitalisation, emergency department, and outpatient) were estimated using generalised linear models and projected using change-point analysis. Population-level costs were projected using a probabilistic simulation model incorporating population forecasts. Costs were reported in 2023 Singaporean dollars (SGD$1 = US$0.76 = ₤0.60 = €0.69). Asthma cases are projected to triple from 64,338 in 2019 to 192,409 by 2043 (95% confidence interval [CI]: 165,493-225,141), incurring $7.8 billion (95% CI: 4.4-17.1) from 2024-2043. Apart from asthma (16.4%), costs are driven by metabolic (20.0%), circulatory (14.3%), and other respiratory (9.2%) diseases, with children bearing the highest burden (girls: 39.9%; boys: 22.6%). COPD cases would grow from 8,988 in 2019 to 11,038 (95% CI: 8395-13,326) in 2043, incurring $2.4 billion (95% CI: 1.6-4.5) from 2024-2043. Apart from COPD (20.3%), metabolic (17.4%), circulatory (17.0%), and other respiratory diseases (9.8%) are the largest cost components, with elderly and adult males bearing the highest burdens (47.8% and 40.1%). In both cohorts, 20-year projected costs are dominated by outpatient (55%) and hospitalisation costs (30-40%). The 20-year multimorbidity costs of asthma and COPD are significant, especially in cardiometabolic comorbidities, underscoring the need for holistic, value-based care.
Despite advances in digital health technologies, the integration of clinical decision support systems (CDSSs) into routine primary care for asthma has been extremely limited. Asthma CDSSs employ diverse approaches, from prescribing support to risk prediction, but it remains unclear which are most likely to achieve sustained, real-world impact. Our objectives were to determine the mechanisms of action, clinical practice integration approaches, outputs and outcomes of asthma CDSSs in recent literature. Five electronic databases (Embase via Ovid, PubMed, CENTRAL, the Health Technology Assessment (HTA) Database, and the ISRCTN registry of clinical trials) were searched to identify papers published between 2012 and 2024 describing pilot studies, feasibility studies, or clinical trials, of primary care-based asthma CDSS. Two independent reviewers screened the retrieved literature and extracted the data on study designs, interventions, outcomes and mechanisms of action, and results. Across 18 included trials, interventions demonstrated substantial heterogeneity in mechanisms, integration methods, and targeted clinical behaviours. Although some studies showed improvements in adherence to prescribing best practices and the delivery of personalised action plans, most reported modest or declining system use over time and inconsistent effects on asthma control or severe attack outcomes. Continued progress will depend on integrating behavioural theory, improving workflow compatibility, and generating rigorous evidence to guide the development of CDSSs with genuine potential for sustainable impact.
We aimed to assess an obstructive sleep apnoea (OSA) diagnostic approach performed solely in primary care centres (PCC) with the support of an autoscoring home sleep apnoea testing (aHSAT, ApneaLinkTM Air) device and compare the diagnoses with those undertaken by the manual analysis of home sleep apnoea testing (mHSAT), and polysomnography (PSG) if necessary, of a certified sleep specialist. This multicentre, cross-sectional study was undertaken between April 2016 and November 2020. We randomly selected patients aged 30-70 years with a high probability of OSA (≥ 3 points on the STOP-Bang questionnaire) who were visiting any of the four PCCs assigned for referral to the University Hospital Doctor Josep Trueta, Girona, Spain. 2599 patients were assessed for eligibility; 403 provided a high probability of OSA and 329 could be compared between PCC and hospital. 210 (63.8%) patients were male and the mean age was 56.5 (SD: 9.2) years. The global agreement between PCC and hospital diagnoses was 41.6% and severe OSA showed the highest level of agreement (96.2%). The Kappa index for severe OSA was 0.46 (95% CI: 0.37, 0.55) and the specificity was 0.99 (95% CI: 0.97, 1.00). The ApneaLinkTM Air device showed high specificity for severe OSA in a high-risk primary care population with a high pre-test probability of OSA. When aHSAT indicates severe OSA, hospital confirmation may be unnecessary, whereas negative or moderate findings may still require specialist assessment.
In asthma, suboptimal disease control is common due to limited knowledge about self-management, undertreatment and infrequent follow-up visits. Most patients are treated in primary care where asthma/COPD clinics (ACC) are recommended in Sweden, but evidence of the effects is limited. The aim was to compare certified ACCs with clinics providing regular care in terms of adherence to asthma management guidelines, and the associations with asthma symptom control, healthcare consumption, and mortality in adults with asthma. In this cohort study, we extracted data from the Swedish National Airway Register, on 84230 adults with asthma, cared for at certified ACCs (n = 17 primary care centres) and regular care clinics (n = 650 primary care centres) in Sweden. Data were linked to other national registers in order to obtain data about pharmaceuticals, healthcare consumption, and mortality. The index date was the years 2015-2017, and the study ended in 2022. A binary logistic regression was used to assess morbidity and mortality associations at the study's end. A higher proportion of patients at certified ACCs received interventions such as patient education, written asthma action plan, smoking cessation, Asthma Control Test, spirometry, and inhaled corticosteroids than patients at regular care clinics. Certified ACCs were associated with a lower probability of uncontrolled asthma (OR 0.76, 95% CI 0.67-0.87), need of specialist/emergency care (OR 0.69, 95% CI 0.51-0.92) and death (OR 0.69, 95% CI 0.55-0.86). In conclusion, adherence to asthma management guidelines was higher in certified ACCs which were associated with a more well-controlled asthma, less secondary healthcare visits and lower all-cause mortality, but not with frequent exacerbations. Our findings highlight the importance of ACCs in providing evidence-based care in accordance with asthma management guidelines.
To assess the value of abnormal findings of lung POCUS performed by PCPs in patients with SARS-CoV-2 virus infection in predicting hospitalisations, intensive care admissions, and mortality. Additionally, this study aims to assess the validity of lung POCUS performed by PCPs for COVID-19 pneumonia diagnosis. This prospective observational study, conducted in Mallorca and Salamanca, Spain, during 2021, assessed 624 consecutive adult patients with confirmed SARS-CoV-2 infection and worsening symptoms. Eight PCPs with 5-hour standardized training performed 12-zone lung POCUS. POCUS was considered positive if pleural abnormalities with ≥3 B-lines, subpleural consolidation, or lobar consolidation were present. Patients were followed for 30 days to confirm pneumonia diagnosis via chest X-ray or CT scan. Multivariate models using Poisson regression were performed to identify independent predictors for hospitalization and ICU admission/death. Abnormal POCUS findings were observed in 58.8% of patients, of whom 50.3% presented pleural abnormalities with 3 or more B-lines in at least one scanned area, 27.6% subpleural consolidations, and 3.4% lobar consolidations. Patients with positive POCUS were referred to the hospital more frequently (72.4% vs. 22.8%; OR = 8.83). Abnormal lung POCUS was independently associated with an increased risk of hospitalization (RR 1.34; 95% CI 1.07-1.67), along with age >50 years, SpO2 <95%, hypertension, and diabetes. POCUS was not independently associated with the composite outcome of ICU admission or death (RR 1.27; 95% CI 0.62-2.61). For the diagnosis of COVID-19 pneumonia, overall POCUS sensitivity was 68.3%, specificity 43.6%, positive predictive value 78.7%, and negative predictive value 31.1%. Lung POCUS performed by PCPs is a valuable independent predictor for hospitalization in COVID-19 patients within community settings. While its incremental prognostic benefit over simple clinical variables is modest and its diagnostic accuracy for pneumonia is limited compared to conventional imaging, it could remain as a useful tool for risk stratification in resource-limited environments or home-based care. These findings support its use in resource-limited environments and highlight the need for standardised scanning protocols and training.
Tropospheric ozone (O₃) is a secondary air pollutant associated with respiratory morbidity. Lleida is an inland Mediterranean city with a continentalized climate, frequent winter thermal inversions and hot, dry summers, where ozone episodes and high humidity often co-occur under stagnant atmospheric conditions. This study explores the association between air pollutants, weather variables, and respiratory emergency admissions in Lleida, Spain. We conducted a time-series analysis using distributed lag non-linear models (DLNM) on hospital emergency room admissions for acute respiratory conditions in Lleida (2010-2019). Data on weather (temperature, humidity, solar radiation) and air pollution (O₃, NO₂, PM10, SO₂) were obtained from local monitoring stations. The primary outcome was the daily number of admissions for respiratory conditions (ICD-10 codes J09-J18, J20-J22, J44.1, J45.9). A total of 19,428 respiratory admissions were recorded. High O₃ concentrations and elevated relative humidity were significantly associated with increased admissions, even after adjusting for temperature and solar radiation. The strongest effects were observed with delayed lags (up to 21 days). NO₂, PM10, CO and SO₂ levels did not show a significant association. Our findings support a significant and independent association between elevated ozone concentrations, high humidity, and respiratory emergencies. These results highlight the need for public health strategies and policy interventions focused on environmental risk forecasting and air quality management, particularly in vulnerable inland Mediterranean regions.
Limited evidence exists on age-related differences in health-related quality of life (HRQoL) and patient-reported outcome and experience measures (PROMs/PREMs) among asthma patients. This study analysed data from 765 adults in the German PROMchronic trial, comparing generic HRQoL, asthma-control, and PREMs across age groups (18-44, 45-64, 65-74, ≥75 years), with analyses stratified by gender. Older adults, particularly women aged 65-74 years, reported slightly higher HRQoL (p = 0.004, η² = 0.017), and ≥75 aged reported better asthma control scores (p = 0.012, Cliffs Delta = 0.261). Categorical asthma control and most PREM domains did not differ significantly. Organisational aspects of care were rated more favourably by adults aged 65-74 years (p = 0.040, Cramér's V = 0.104), especially women. Age-related differences in PROMs and PREMs were small. These findings suggest subtle but relevant patterns in patient-reported quality of asthma care and support age-sensitive, patient-centred approaches in primary care.