Skip to main content

Main menu

  • Home
  • Current issue
  • Early View
  • Archive
  • Authors/reviewers
    • Instructions for authors
    • Submit a manuscript
    • Institutional open access agreements
    • Peer reviewer login
  • Alerts
  • Subscriptions
  • ERS Publications
    • European Respiratory Journal
    • ERJ Open Research
    • European Respiratory Review
    • Breathe
    • ERS Books
    • ERS publications home

User menu

  • Log in
  • Subscribe
  • Contact Us
  • My Cart

Search

  • Advanced search
  • ERS Publications
    • European Respiratory Journal
    • ERJ Open Research
    • European Respiratory Review
    • Breathe
    • ERS Books
    • ERS publications home

Login

European Respiratory Society

Advanced Search

  • Home
  • Current issue
  • Early View
  • Archive
  • Authors/reviewers
    • Instructions for authors
    • Submit a manuscript
    • Institutional open access agreements
    • Peer reviewer login
  • Alerts
  • Subscriptions

Predictors of non-cystic fibrosis bronchiectasis in Indigenous adult residents of central Australia: results of a case–control study

Lloyd Einsiedel, Hai Pham, Virginia Au, Saba Hatami, Kim Wilson, Tim Spelman, Hubertus Jersmann
ERJ Open Research 2019 5: 00001-2019; DOI: 10.1183/23120541.00001-2019
Lloyd Einsiedel
1Baker Heart and Diabetes Institute, Alice Springs, Australia
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Lloyd Einsiedel
  • For correspondence: lloyd.einsiedel@nt.gov.au
Hai Pham
1Baker Heart and Diabetes Institute, Alice Springs, Australia
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Virginia Au
2Flinders Medical Centre, Adelaide, Australia
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Saba Hatami
2Flinders Medical Centre, Adelaide, Australia
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Kim Wilson
3National Serology Reference Laboratory, Melbourne, Australia
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Tim Spelman
4Burnet Institute, Melbourne, Australia
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Hubertus Jersmann
5Dept of Respiratory Medicine, Royal Adelaide Hospital, Adelaide, Australia
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
  • PDF
Loading

Figures

  • Tables
  • Supplementary Materials
  • FIGURE 1
    • Download figure
    • Open in new tab
    • Download powerpoint
    FIGURE 1

    Recruitment flowchart for cases and matching to controls: recruitment was based on discharge diagnosis. Among 106 subjects with a discharge diagnosis of bronchiectasis, 104 were examined by chest high-resolution computed tomography (HRCT), which confirmed the diagnosis in 78 cases. Chest HRCT was not available for two cases for which diagnosis was confirmed by chest radiography findings of cystic bronchiectasis and by bronchography. Each case was then matched to two controls who were admitted during the study period with 1) no lower respiratory tract infection on admission, 2) no evidence of chronic lung disease on chest radiography and 3) no discharge diagnosis of either bronchiectasis or a human T-cell leukaemia virus type 1-associated disease. Reasons for admission of controls included: 1) surgical management n=121 (75.6%) (skin and soft tissue infections n=45, orthopaedic n=22, general surgical n=20, trauma n=27, pancreatitis n=3, burns n=3, tonsillectomy n=1), 2) medical reasons n=36 (22.5%) (heart disease n=11, renal disease n=8, neurological disease n=6, gastroenterological disorders n=4, diabetic ketoacidosis n=1, constipation n=2, pelvic inflammatory disease n=1, alcohol withdrawal n=1, malnutrition n=1, acute rheumatic fever n=1) and 3) to care for other patients n=3 (1.9%).

  • FIGURE 2
    • Download figure
    • Open in new tab
    • Download powerpoint
    FIGURE 2

    Dot plots with median (interquartile range (IQR)) comparing human T-cell leukaemia virus type 1 (HTLV-1) pro-viral load (PVL) for controls (n=53), cases with HTLV-1 and risk factors for bronchiectasis (n=10), and cases with no risk factors predisposing to bronchiectasis other than HTLV-1 infection (n=32). Risk factors for bronchiectasis included severe pneumonia (n=5), empyema (n=2), pulmonary abscess (n=1), pulmonary tuberculosis (n=1) and severe childhood bronchiolitis (n=1). Median (IQR) HTLV-1 PVLs for controls, cases with other risk factors and cases without risk factors were 3.28 (0.49–5.89), 6.01 (2.98–7.58) and 5.35 (3.01–8.32) log unit copies per 105 peripheral blood leukocytes (PBLs), respectively. HTLV-1 PVLs were significantly higher for cases with (p=0.0178) and without (p=0.0108) risk factors for bronchiectasis when compared with controls (Mann–Whitney test). There was no difference in HTLV-1 PVLs between groups for cases.

Tables

  • Figures
  • Supplementary Materials
  • TABLE 1

    Demographic and clinical characteristics of cases and controls

    CasesControlsp-value
    Subjects80160
    Demographics
     Male48 (60.0)96 (60.0)1.000
     Remote residence childhood53 (93.0)82 (85.4)0.237
     Remote residence adulthood48 (60.0)99 (61.9)0.449
     Tobacco#51 (63.8)114 (71.3)0.237
     Alcohol¶54 (67.5)103 (64.4)0.631
    Comorbidities
     COPD+8 (10.0)6 (3.8)0.051
     Asthma§1 (1.3)0 (0.0)0.333
     Heart disease19 (23.8)38 (23.8)1.000
      CCF7 (8.8)11 (6.9)0.603
      IHD11 (13.8)22 (13.8)1.000
      RHD1 (1.3)5 (3.1)0.380
     Diabetes23 (28.8)67 (41.9)0.048
     Chronic kidney diseaseƒ11 (13.8)38 (23.8)0.161
     Chronic liver disease9 (11.3)5 (3.1)0.011
    HTLV-1 infection
     HTLV-1 infected##42 (52.5)53 (33.1)0.004
     HTLV-1 PVL copies per 105 PBLs213.8 (19.7–3776)26.6 (0.9–361)0.002
    Admission details¶¶
     Childhood admissions
      Any admission++55 (68.8)72 (45.0)0.035
      Any LRTI admission§§40 (50.0)52 (32.5)0.009
      ICU LRTI admissions0.04±0.190.01±0.110.317
      LRTI admissions1 (0–3)1 (0–2)0.041
     Adulthood admissions
      Any admission++49 (61.3)68 (42.5)0.005
      Any LRTI admission§§49 (61.3)67 (41.9)0.005
      ICU LRTI admissions0.14±0.470.06±0.330.1166
      LRTI admissions4 (1–10)0 (0–1)<0.001
     Severe LRTIƒƒ21 (26.3)3 (1.9)<0.001
     Mortality
      Died31 (38.8)18 (11.3)<0.001
      Age at death years50 (36–59)58.5 (44–63)0.0579

    Data are presented as n, n (%), median (interquartile range) or mean±sd, unless otherwise stated. COPD: chronic obstructive pulmonary disease; CCF: congestive cardiac failure; IHD: ischaemic heart disease; RHD: rheumatic heart disease; HTLV-1: human T-cell leukaemia virus type 1; PVL: pro-viral load; PBL: peripheral blood leukocyte; LRTI: lower respiratory tract infection; ICU: intensive care unit. #: any history of tobacco smoking recorded in medical records; ¶: any history of harmful alcohol use recorded in medical records; +: history of COPD recorded in case notes with chest radiography findings consistent with this diagnosis (prior to bronchiectasis diagnosis for cases); §: clinical diagnosis of asthma recorded in case notes with an increased forced expiratory volume in 1 s >12% and >200 mL after administration of bronchodilators; ƒ: stage ≥2; ##: HTLV-1 Western blot or HTLV-1c PCR positive; ¶¶: prior to diagnosis for cases and to time of recruitment for controls; ++: admission for any reason; §§: admission for LRTI; ƒƒ: LRTI due to severe pneumonia, severe bronchiolitis or tuberculosis at any age (see Methods).

    • TABLE 2

      Radiological abnormality scores for cases without alternative causes of bronchiectasis according to human T-cell leukaemia virus type 1 (HTLV-1) pro-viral load (PVL)

      Low PVL (<1000 copies per 105 PBLs)High PVL (≥1000 copies per 105 PBLs)p-value#
      Subjects1912
      Bronchiectasis score4.53±3.677.25±3.860.039
      Bronchial wall thickening3.74±3.146.17±3.010.038
      Cystic bronchiectasis0.68±1.251.67±1.370.028
      Saccular bronchiectasis0.50±0.991.47±1.550.025
      Ground-glass opacities0.85±0.961.75±1.710.144
      Mucus plugging/centrilobular nodules1.21±1.471.83±1.580.248
      Total radiology abnormality score¶11.68±8.5620.33±9.780.022

      Data are presented as n or mean±sd, unless otherwise stated. PBL: peripheral blood leukocyte. Combined radiological scores for all lobes for cases with HTLV-1 for which no alternative cause of bronchiectasis was found. Each lobe was scored separately by radiologists blinded to HTLV-1 status (see Methods). The lingular segment of the left upper lobe was regarded as a separate lobe. One case (HTLV-1 PVL 242 copies per 105 PBLs) for which high-resolution computed tomography was not available for review was not included in this analysis. 10 cases with alternative causes were excluded (severe pneumonia n=5; empyema n=2; pulmonary abscess n=1; pulmonary tuberculosis n=1; severe childhood bronchiolitis n=1). #: rank-sum test; ¶: a composite score comprising those for all other radiological parameters (bronchiectasis, bronchial wall thickening, cystic bronchiectasis, saccular bronchiectasis, mucus plugging/centrilobular nodules and ground-glass opacities).

      • TABLE 3

        Predictors of bronchiectasis among 80 cases and their 160 controls

        Unadjusted OR (95% CI)p-valueAdjusted OR (95% CI)p-value
        Age#1.01 (0.99–1.03)0.355
        Remote residence in adulthood¶1.25 (0.59–2.65)0.556
        Admitted in childhood1.88 (1.06–3.32)0.031
        Any LRTI+
         Childhood2.08 (1.20–3.60)0.0091.90 (0.93–3.86)0.078
         Adulthood2.19 (1.27–3.80)0.005
        Number of LRTIs§
         Childhood1.15 (0.95–1.40)0.151
         Adulthood1.24 (1.14–1.36)<0.001
        Number of ICU LRTIsƒ1.28 (0.56–2.95)0.558
        Severe LRTI##18.63 (5.36–64.77)<0.00117.83 (4.51–70.49)<0.001
        HTLV-1 infected¶¶2.23 (1.29–3.86)0.004
        HTLV-1 PVL (categorical)++
         UninfectedReferenceReference
         Low HTLV-1 PVL1.50 (0.81–2.76)0.1941.92 (0.88–4.19)0.101
         High HTLV-1 PVL7.98 (2.93–21.72)<0.00112.41 (3.84–40.15)<0.001
        Sputum cultures
         Yield§§2.23 (1.29–3.87)0.0041.46 (0.65–3.29)0.359
         Haemophilus influenzae1.47 (1.18–1.83)0.0012.07 (1.35–3.16)0.001
         Streptococcus pneumoniae1.56 (1.09–2.24)0.0140.47 (0.21–1.04)0.064
         Pseudomonas aeruginosa2.79 (0.76–10.32)0.124
         NTMƒƒ12.89 (1.52–109.01)0.01944.78 (2.10–952.84)0.015
        Eosinophilia###2.88 (1.65–5.03)<0.001
        Strongyloides¶¶¶2.23 (1.29–3.89)0.0041.81 (0.80–4.09)0.153
        Cellulitis/skin abscess0.81 (0.68–0.99)0.0280.60 (0.45–0.80)0.001
        Infective dermatitis+++2.70 (1.28–5.70)0.009
        Scabies§§§6.06 (1.93–19.02)0.002
        Tobaccoƒƒƒ0.71 (0.40–1.25)0.238
        Alcohol####1.15 (0.65–2.03)0.631

        LRTI: lower respiratory tract infection; ICU: intensive care unit; HTLV-1: human T-cell leukaemia virus type 1; PVL: pro-viral load; NTM: nontuberculous mycobacteria. #: risk of bronchiectasis per 5 years. ¶: residence >80 km from Alice Springs documented in medical records. +: admitted with any non-severe LRTI prior to diagnosis (cases) or date of recruitment (controls). §: number of admissions with LRTIs prior to diagnosis (cases) or date of recruitment (controls). ƒ: number of ICU admissions for LRTI in childhood and adulthood combined prior to diagnosis for cases or to date of recruitment for controls. ##: severe pneumonia (n=16), severe bronchiolitis (n=4) and pulmonary tuberculosis (n=1) at any age (see Methods); includes one case with combined IgA and IgG deficiency; three controls had severe LRTI (pulmonary tuberculosis n=1, pulmonary abscess n=1, severe pneumonia n=1). ¶¶: HTLV-1 Western blot or HTLV-1c PCR positive. ++: low HTLV-1 PVL, <1000 copies per 105 peripheral blood leukocytes (PBLs); high HTLV-1 PVL, ≥1000 copies per 105 PBLs. §§: the number of pathogens isolated divided by the number of sputum samples collected, calculated once for each admission. ƒƒ: NTM isolated from six cases prior to diagnosis included 1) a novel species that could not be identified together with a scotochromogenic mycobacterium, 2) Mycobacterium avium complex in a patient with pulmonary tuberculosis and 3) Mycobacterium simiae (isolated once from one case and twice from another); mycobacteria were not identified to species level in two cases and one control from which an NTM was isolated only once. ###: eosinophilia recorded on at least two occasions 12 months apart (prior to diagnosis for cases). ¶¶¶: Strongyloides seropositive or larvae identified in stool at any time prior to date of recruitment. +++: infective dermatitis recorded in case notes (cases HTLV-1+ n=10, HTLV-1− n=2; controls HTLV-1+ n=1, HTLV-1− n=5). §§§: clinical diagnosis of scabies recorded in case notes (no case diagnosed by microscopy). ƒƒƒ: any history of tobacco smoking recorded in case notes. ####: any history of harmful alcohol consumption recorded in case notes.

        • TABLE 4

          Predictors of bronchiectasis among 95 human T-cell leukaemia virus type 1 (HTLV-1)-infected subjects

          Unadjusted OR (95% CI)p-valueAdjusted OR (95% CI)p-value
          Age#1.01 (0.88–1.16)0.870
          Remote residence¶1.14 (1.01–1.28)0.0342.30 (0.92–6.52)0.115
          Admitted in childhood1.78 (0.76–4.17)0.183
          Any LRTI admission+
           Childhood2.79 (1.18–6.58)0.0192.11 (1.11–4.02)0.023
           Adulthood3.02 (1.28–7.14)0.012
          Respiratory admissions§
           Childhood1.49 (1.03–2.16)0.032
           Adulthood1.41 (1.17–1.71)<0.001
          Severe LRTIƒ3.92 (0.97–15.85)0.0555.45 (1.78–16.71)0.003
          HTLV-1 PVL##1.07 (1.02–1.12)0.006
          HTLV-1 PVL (categorical)¶¶
           Low HTLV-1 PVLReferenceReference
           High HTLV-1 PVL5.33 (1.86–15.22)0.0025.68 (1.81–17.89)0.003
          Sputum cultures
           Yield++4.24 (1.55–11.60)0.005
           Haemophilus influenzae1.67 (1.16–2.42)0.006
           Streptococcus pneumoniae3.56 (1.36–9.29)0.010
           Pseudomonas aeruginosa1.27 (0.08–20.89)0.686
           NTM§§2.60 (0.23–29.70)0.442
          Eosinophiliaƒƒ2.54 (1.09–5.91)0.030
          Strongyloides###2.53 (1.40–4.58)0.0022.44 (1.22–4.89)0.012
          Infective dermatitis¶¶¶3.76 (1.15–12.34)0.029
          Scabies+++7.23 (1.49–35.09)0.014
          Tobacco§§§0.94 (0.40–2.24)0.897
          Alcoholƒƒƒ1.79 (0.72–4.42)0.208

          LRTI: lower respiratory tract infection; PVL: pro-viral load; NTM: nontuberculous mycobacteria. #: risk of bronchiectasis per 5 years. ¶: residence >80 km from Alice Springs in adulthood. +: admitted with any non-severe LRTI prior to diagnosis (cases) or date of recruitment (controls). §: number of LRTI admissions prior to diagnosis (cases) or date of recruitment (controls). ƒ: severe pneumonia (n=8), severe bronchiolitis (n=1), and pulmonary tuberculosis (n=1) at any age (see Methods); three controls with HTLV-1 had a severe LRTI (pulmonary tuberculosis n=1, pulmonary abscess n=1, severe pneumonia n=1). ##: odds of bronchiectasis per 100 unit increase in HTLV-1 copies per 105 peripheral blood leukocytes (PBLs). ¶¶: low HTLV-1 PVL, <1000 copies per 105 PBLs; high HTLV-1 PVL, ≥1000 copies per 105 PBLs. ++: the number of pathogens isolated divided by the number of sputum samples collected, calculated once for each admission. §§: NTM isolated from four cases prior to diagnosis included 1) Mycobacterium avium complex in a patient with pulmonary TB and 2) Mycobacterium simiae (isolated twice); NTM were not identified to species level in two cases from which an NTM was isolated only once. ƒƒ: peripheral blood eosinophilia recorded on at least two occasions 12 months apart (prior to diagnosis for cases). ###: Strongyloides seropositive or larvae identified in stool at any time prior to date of recruitment (cases n=18 (Strongyloides seropositive n=18, larvae in stool n=0); controls n=6 (Strongyloides seropositive n=5, larvae in stool n=1)). ¶¶¶: infective dermatitis recorded in case notes (cases HTLV-1+ n=10, HTLV-1− n=2; controls HTLV-1+ n=1, HTLV-1− n=5). +++: clinical diagnosis of scabies recorded in case notes (no case diagnosed by microscopy). §§§: any history of tobacco smoking recorded in case notes. ƒƒƒ: any history of harmful alcohol consumption recorded in case notes.

          • TABLE 5

            Predictors of any death among cases and their controls

            Unadjusted OR (95% CI)p-valueAdjusted OR (95% CI)p-value
            Male1.61 (0.82–3.15)0.169
            HTLV-1 infected#1.00 (0.52–1.90)1.000
            HTLV-1 infection (categorical)¶
             UninfectedReferenceReference
             Low HTLV-1 PVL0.75 (0.35–1.62)0.4672.27 (0.93–5.54)0.071
             High HTLV-1 PVL3.21 (1.28–8.08)0.0133.69 (1.11–12.27)0.033
            Age+1.20 (1.07–1.35)0.0021.15 (1.00–1.32)0.051
            Remote residence§0.68 (0.30–1.55)0.354
            Bronchiectasis4.73 (2.43–9.23)<0.0014.27 (2.04–8.94)<0.001
            COPDƒ6.20 (2.04–18.85)0.0013.97 (1.06–14.87)0.040
            CCF2.81 (1.03–7.69)0.0442.27 (0.73–7.03)0.155
            IHD1.93 (0.85–4.40)0.116
            RHD0.80 (0.09–6.97)0.837
            Diabetes0.89 (0.46–1.73)0.739
            Haemodialysis##0.85 (0.23–3.08)0.802
            Chronic liver disease1.10 (0.29–4.10)0.891
            Malignancy2.74 (0.44–16.87)0.277
            Alcohol¶¶0.96 (0.49–1.85)0.892
            Tobacco++1.13 (0.57–2.26)0.728
            Eosinophilia§§2.17 (1.15–4.13)0.018
            Strongyloidesƒƒ1.36 (0.68–2.72)0.380
            Bronchiectasis complications
             Respiratory failure12.01 (4.55–31.71)<0.001
             Right heart failure5.73 (1.24–26.52)0.026
             Haemoptysis4.27 (1.03–17.75)0.046

            HTLV-1: human T-cell leukaemia virus type 1; PVL: pro-viral load; COPD: chronic obstructive pulmonary disease; CCF: congestive cardiac failure; IHD: ischaemic heart disease; RHD: rheumatic heart disease. 31 cases and 18 controls died during follow-up. 28 cases, but no controls, died as a result of respiratory disease. Major causes of death among controls were cardiovascular disease (n=7), malignancy (n=3) and nonrespiratory sepsis (n=3). #: HTLV-1 Western blot or HTLV-1c PCR positive; ¶: stratified by HTLV-1 PVL (low HTLV-1 PVL, <1000 copies per 105 peripheral blood leukocytes (PBLs); high HTLV-1 PVL, ≥1000 copies per 105 PBLs); +: risk per 5 years; §: documented residence >80 km from Alice Springs in adulthood; ƒ: diagnosis recorded in case notes with chest radiography findings consistent with diagnosis (cases diagnosed before bronchiectasis, controls to date of recruitment); ##: six cases (HTLV-1+ n=3) and 12 controls (HTLV-1+ n=5) were receiving haemodialysis at time of recruitment; ¶¶: any history of harmful alcohol consumption recorded in case notes; ++: any history of tobacco smoking recorded in case notes; §§: peripheral blood eosinophilia recorded on at least two occasions 12 months apart (prior to diagnosis for cases); ƒƒ: Strongyloides seropositive or larvae identified in stool at any time prior to date of recruitment.

            Supplementary Materials

            • Figures
            • Tables
            • Supplementary Material

              Please note: supplementary material is not edited by the Editorial Office, and is uploaded as it has been supplied by the author.

              Supplementary tables 00001-2019.supp

            PreviousNext
            Back to top
            Vol 5 Issue 4 Table of Contents
            ERJ Open Research: 5 (4)
            • Table of Contents
            • Index by author
            Email

            Thank you for your interest in spreading the word on European Respiratory Society .

            NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

            Enter multiple addresses on separate lines or separate them with commas.
            Predictors of non-cystic fibrosis bronchiectasis in Indigenous adult residents of central Australia: results of a case–control study
            (Your Name) has sent you a message from European Respiratory Society
            (Your Name) thought you would like to see the European Respiratory Society web site.
            CAPTCHA
            This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
            Print
            Citation Tools
            Predictors of non-cystic fibrosis bronchiectasis in Indigenous adult residents of central Australia: results of a case–control study
            Lloyd Einsiedel, Hai Pham, Virginia Au, Saba Hatami, Kim Wilson, Tim Spelman, Hubertus Jersmann
            ERJ Open Research Oct 2019, 5 (4) 00001-2019; DOI: 10.1183/23120541.00001-2019

            Citation Manager Formats

            • BibTeX
            • Bookends
            • EasyBib
            • EndNote (tagged)
            • EndNote 8 (xml)
            • Medlars
            • Mendeley
            • Papers
            • RefWorks Tagged
            • Ref Manager
            • RIS
            • Zotero
            Share
            Predictors of non-cystic fibrosis bronchiectasis in Indigenous adult residents of central Australia: results of a case–control study
            Lloyd Einsiedel, Hai Pham, Virginia Au, Saba Hatami, Kim Wilson, Tim Spelman, Hubertus Jersmann
            ERJ Open Research Oct 2019, 5 (4) 00001-2019; DOI: 10.1183/23120541.00001-2019
            del.icio.us logo Digg logo Reddit logo Technorati logo Twitter logo CiteULike logo Connotea logo Facebook logo Google logo Mendeley logo
            Full Text (PDF)

            Jump To

            • Article
              • Abstract
              • Abstract
              • Introduction
              • Methods
              • Results
              • Discussion
              • Supplementary material
              • Acknowledgements
              • Footnotes
              • References
            • Figures & Data
            • Info & Metrics
            • PDF

            Subjects

            • CF and non-CF bronchiectasis
            • Tweet Widget
            • Facebook Like
            • Google Plus One

            More in this TOC Section

            Original articles

            • Endobronchial autologous BM-MSCs in IPF patients
            • Effect of β-blockers on the risk of COPD exacerbations
            • Recurrence of symptoms after childhood LRTI
            Show more Original articles

            Bronchiectasis

            • Patient attitudes to nebulised antibiotics in bronchiectasis
            • The Bronchiectasis Exacerbation Diary
            • Airway clearance treatments in bronchiectasis
            Show more Bronchiectasis

            Related Articles

            Navigate

            • Home
            • Current issue
            • Archive

            About ERJ Open Research

            • Editorial board
            • Journal information
            • Press
            • Permissions and reprints
            • Advertising

            The European Respiratory Society

            • Society home
            • myERS
            • Privacy policy
            • Accessibility

            ERS publications

            • European Respiratory Journal
            • ERJ Open Research
            • European Respiratory Review
            • Breathe
            • ERS books online
            • ERS Bookshop

            Help

            • Feedback

            For authors

            • Instructions for authors
            • Publication ethics and malpractice
            • Submit a manuscript

            For readers

            • Alerts
            • Subjects
            • RSS

            Subscriptions

            • Accessing the ERS publications

            Contact us

            European Respiratory Society
            442 Glossop Road
            Sheffield S10 2PX
            United Kingdom
            Tel: +44 114 2672860
            Email: journals@ersnet.org

            ISSN

            Online ISSN: 2312-0541

            Copyright © 2023 by the European Respiratory Society