ERJ Open Research

Our medical research library holds 14 studies published in ERJ Open Research (2017–2026). Each entry links to the study's record on PubMed and, where there is one, to the publisher's page and a free full text. 14 have an abstract, the authors' own summary as PubMed records it: open "Abstract" to read it.

About the journal

• Publisher: European Respiratory Society
• Published: 2015 to the present, England
• Language: English
• ISSN: 2312-0541 (electronic)
• Its record in the NLM Catalog

2020s

• Epidemiology of asbestosis in the Netherlands: a 10-year cohort analysis. I. Smesseim, H. Schouwink, J.C. Grutters, et al. 2026;12(4). PubMed · Publisher · Free full text

  Abstract

  Background: Asbestosis is a progressive interstitial lung disease caused by inhalation of asbestos fibres. Although asbestos use was banned in the Netherlands in 1993, new cases continue to be diagnosed. Since 2014, a national compensation system has enabled systematic assessment of asbestosis incidence and outcomes. This population-based study examined national trends in asbestosis incidence from 2014-2024 and evaluated survival and prognostic factors.

  Methods: We conducted a retrospective national cohort study including all adults (≥18 years) diagnosed with asbestosis between 2014-2024 according to Dutch Health Council criteria used for compensation. Diagnoses were established by consensus of three independent pulmonologists based on radiological evidence of diffuse pulmonary fibrosis, ≥5 fibre-years of exposure, and lung function impairment according to American Medical Association (AMA) criteria. Demographic data, lung function, work history and overall survival were collected. Incidence per 100 000 persons per year was calculated.

  Results: Of 1004 applicants, 476 (47.4%) met criteria for asbestosis. Median age at diagnosis was 77 years, and 98.9% were male. Annual incidence ranged from 0.115 to 0.347 per 100 000, with no significant temporal trend (Spearman rho 0.41; p=0.214). AMA class 4 was most common (44.5%) and strongly associated with mortality (hazard ratio 2.52, 95% CI 1.81-3.49). Older age also predicted poorer survival. Median survival ranged from 25.5 months (AMA 4) to 83.4 months (AMA 0-2). Time-dependent modelling showed increasing hazard over time for AMA class 4.

  Conclusions: More than two decades after the asbestos ban, asbestosis incidence remains stable. AMA class and age are key predictors of survival.

  Copyright ©The authors 2026.

• Exhaled breath profiling for early silicosis detection in workers at risk: a pilot study. N. Van Loon, D. Ruttens, M. Verbrugghe, et al. 2026;12(5). PubMed · Publisher · Free full text

  Abstract

  Background: Silicosis remains a major occupational health concern in respirable crystalline silica (RCS)-exposed workers. Exhaled breath analysis using volatile organic compound (VOC) profiling has emerged as a promising noninvasive approach for early disease detection. This feasibility study evaluated multicapillary column/ion mobility spectrometry (MCC/IMS)-based VOC profiling for differentiating silicosis from other respiratory conditions and healthy controls in an occupational health setting.

  Methods: We conducted a multicentre, cross-sectional observational study employing MCC/IMS to identify VOC patterns. Breath data were reduced to principal components and used in logistic lasso regression to develop predictive models. Internal and external validation assessed model performance, and subgroup analyses explored the impact of comorbidities and spirometry abnormalities.

  Results: A total of 185 participants were enrolled, including 24 COPD patients, 26 with benign asbestos-related diseases (BARD) and 32 with confirmed silicosis, alongside 25 healthy controls and 78 RCS-exposed controls. Silicosis was distinguished from BARD and COPD with 100% and 87.5% accuracy (area under the receiver operating characteristic curve (AUCROC) 1.00 and 0.89), respectively. Comparison with healthy RCS-exposed controls yielded 87.8% accuracy with 98.5% sensitivity (AUCROC 0.58), improving to 82.8% accuracy and AUCROC 0.90 when considering spirometry abnormalities. Eight VOCs, notably P13 and P14, were identified as key discriminators.

  Conclusion: MCC/IMS-based breath analysis shows promise as a rapid, portable and noninvasive technique for early detection of silicosis in RCS-exposed workers. Future research should validate these findings in larger cohorts, integrate cross-validation of candidate biomarkers across analytical platforms and establish standardised protocols to enable routine implementation in occupational health surveillance.

  Copyright ©The authors 2026.

• Ki67 proliferation index augments two-tier tumour grade in prediction of survival and progression-free survival in epithelioid pleural mesothelioma. G.A. Lynch, Y.Z. Zhang, N. Bhatt, et al. 2026;12(3). PubMed · Publisher · Free full text

  Abstract

  Background: Pleural mesothelioma (PM) is a fatal asbestos-related cancer with a poor and often uncertain prognosis. This study validates the histological proliferation marker Ki67 and evaluates whether its integration into the two-tier tumour grading system can improve prognostication in epithelioid PM.

  Methods: Patients with epithelioid PM were recruited from two longitudinal cohort studies from 2010-2023. Diagnostic biopsies were analysed by three pulmonary pathologists. Cox regression determined the relationship between covariables and outcomes. Pearson correlation assessed the association between Ki67 and two-tier grade. A prognostic model combining Ki67 and tumour grade was internally validated using bootstrapping.

  Results: 98 patients were recruited. Ki67 was strongly predictive of overall survival (OS) and progression-free survival (PFS) and correlated with two-tier tumour grade. 30% was the optimal cut-off, with Ki67 more strongly predictive of OS (hazard ratio (HR) 2.37, 95% CI 1.51-3.71) and PFS (HR 2.09, 1.35-3.23) than two-tier grade (HR 1.83, 1.13-2.97 and HR 1.70, 1.08-2.66, respectively). Combining Ki67 and two-tier grade improved prediction of OS and PFS compared with two-tier grade alone. Ki67 stratified patients within each tumour grade, with median survival in the lowest risk group (low Ki67, low grade) of 660.5 days (IQR 329-1297) and 300 days (IQR 124-366) in the highest risk group (high Ki67, high grade).

  Conclusion: Ki67 is a valid surrogate for tumour grade with an optimal cut-off at 30%. Integrating Ki67 into the two-tier grading system enhances prognostic accuracy, improves outcome prediction and would reduce uncertainty for patients and clinicians.

  Copyright ©The authors 2026.

• Optimal follow-up duration for nonspecific pleuritis: how long is long enough?. S. Ozyavuz, G. Ak, S. Metintas, et al. 2026;12(2). Letter PubMed · Publisher · Free full text

  Abstract

  NSP is often benign but some cases may later reveal malignancy, especially mesothelioma. Most are diagnosed within 12 months, yet delayed cases exist. Structured follow-up beyond 12 months is advised for high-risk patients. https://bit.ly/47ECu4Y.

  Copyright ©The authors 2026.

• Pleural plaques and interstitial lung abnormalities in AGES-Reykjavik study. Y. Ko, G. Gudmundsson, T. Fukuda, et al. 2026;12(5). Letter PubMed · Publisher · Free full text

  Abstract

  Pleural plaques are frequent in Iceland and independently associated with interstitial lung abnormalities, highlighting the persistent threat of asbestos-related disease and stressing the urgent need for continued monitoring https://bit.ly/4u4riGW.

  Copyright ©The authors 2026.

• Reply: Optimal follow-up duration for nonspecific pleuritis: how long is long enough?. A. Sundaralingam, R. Bhatnagar. 2026;12(2). Letter PubMed · Publisher · Free full text

  Abstract

  ∼8% of patients with nonspecific pleuritis histology at time of thoracoscopy develop a pleural malignancy. 12-month follow-up may not be adequate when there is a risk of pleural mesothelioma. In such cases, follow-up duration should be extended. https://bit.ly/47blcuA.

  Copyright ©The authors 2026.

• The epidemiological burden and societal cost of 14 respiratory conditions in the World Health Organization European region: systematic evidence map and economic analysis. S. Harnan, M. Franklin, C. Angus, et al. 2026;12(3). PubMed · Publisher · Free full text

  Abstract

  Introduction: Our systematic evidence map aimed to identify lung-related epidemiological estimates to populate the International Respiratory Coalition's Lung Facts website. We highlight important evidence gaps, suggest how they could be filled, and provide bespoke societal cost estimates to inform resource allocation.

  Methods: We examined 14 lung conditions across 53 World Health Organization Europe countries, seeking incidence, prevalence, mortality, years of life lost, years lived with disability, and disability-adjusted life year (DALY) estimates by age/sex. Global Burden of Disease (GBD) study estimates were obtained for nine GBD-included lung conditions: asthma, COPD, interstitial lung disease and pulmonary sarcoidosis, lower respiratory infections, lung cancer/tracheal, bronchus and lung cancer, tuberculosis, mesothelioma, COVID-19 and pulmonary arterial hypertension. Systematic searches of bibliographic databases were necessary for five non-GBD-included lung conditions: cystic fibrosis, obstructive sleep apnoea (OSA), influenza, alpha-1 antitrypsin deficiency (A1AD) and bronchiectasis. All-age country-specific DALY estimates were multiplied by gross domestic product per capita as a proxy for a country's wealth and prosperity to estimate societal costs.

  Results: Complete data for nine lung conditions for all countries were extracted from GBD, enabling societal cost estimation. Significant gaps were found for A1AD (only prevalence for 24 countries) and bronchiectasis (incidence, prevalence and mortality for between one and five countries), with more, but incomplete, estimates for cystic fibrosis, OSA and influenza.

  Conclusions: More epidemiological evidence is required for A1AD, bronchiectasis, cystic fibrosis, OSA, and influenza. Inclusion in the GDB study could help address these gaps. Lung Facts provides comprehensive lung-related epidemiological and societal cost estimates covering 53 countries to support policy-makers advocating for respiratory interventions.

  Copyright ©The authors 2026.

• The effect of pirfenidone on disease progression in asbestosis patients: a real-world Dutch cohort study. I. Smesseim, A.E. Wind, J.R. Miedema, et al. 2025;11(6). Letter PubMed · Publisher · Free full text

  Abstract

  Findings based on asbestosis patients treated between 2004 and 2024 reveal a modest reduction in the rate of FVC decline (mean (95% CI) difference 7.0 (-5.8-19.7) mL·month-1, p=0.22) and D LCO decline (0.11% (-0.19-0.41%), p=0.30) after starting pirfenidone https://bit.ly/45fZ5TR.

  Copyright ©The authors 2025.

• ERS International Congress 2023: highlights from the Thoracic Oncology Assembly. M.J. Catarata, A.W. Creamer, M. Dias, et al. 2024;10(1). PubMed · Publisher · Free full text

  Abstract

  Lung cancer is the leading cause of cancer mortality in the world. It greatly affects the patients' quality of life, and is thus a challenge for the daily practice in respiratory medicine. Advances in the genetic knowledge of thoracic tumours' mutational landscape, and the development of targeted therapies and immune checkpoint inhibitors, have led to a paradigm shift in the treatment of lung cancer and pleural mesothelioma. During the 2023 European Respiratory Society Congress in Milan, Italy, experts from all over the world presented their high-quality research and reviewed best clinical practices. Lung cancer screening, management of early stages of lung cancer, application of artificial intelligence and biomarkers were discussed and they will be summarised here.

  Copyright ©The authors 2024.

• Investigation and outcomes in patients with nonspecific pleuritis: results from the International Collaborative Effusion database. A. Sundaralingam, A. Aujayeb, K.A. Jackson, et al. 2023;9(2). PubMed · Publisher · Free full text

  Abstract

  Introduction: We present findings from the International Collaborative Effusion database, a European Respiratory Society clinical research collaboration. Nonspecific pleuritis (NSP) is a broad term that describes chronic pleural inflammation. Various aetiologies lead to NSP, which poses a diagnostic challenge for clinicians. A significant proportion of patients with this finding eventually develop a malignant diagnosis.

  Methods: 12 sites across nine countries contributed anonymised data on 187 patients. 175 records were suitable for analysis.

  Results: The commonest aetiology for NSP was recorded as idiopathic (80 out of 175, 44%). This was followed by pleural infection (15%), benign asbestos disease (12%), malignancy (6%) and cardiac failure (6%). The malignant diagnoses were predominantly mesothelioma (six out of 175, 3.4%) and lung adenocarcinoma (four out of 175, 2.3%). The median time to malignant diagnosis was 12.2 months (range 0.8-32 months). There was a signal towards greater asbestos exposure in the malignant NSP group compared to the benign group (0.63 versus 0.27, p=0.07). Neither recurrence of effusion requiring further therapeutic intervention nor initial biopsy approach were associated with a false-negative biopsy. A computed tomography finding of a mass lesion was the only imaging feature to demonstrate a significant association (0.18 versus 0.01, p=0.02), although sonographic pleural thickening also suggested an association (0.27 versus 0.09, p=0.09).

  Discussion: This is the first multicentre study of NSP and its associated outcomes. While some of our findings are reflected by the established body of literature, other findings have highlighted important areas for future research, not previously studied in NSP.

  Copyright ©The authors 2023.

• Reflecting real-world patients with mesothelioma in research: an interim report of baseline characteristics from the ASSESS-meso cohort. R.J.H. Conway, N. Smith, W. Cooper, et al. 2023;9(6). PubMed · Publisher · Free full text

  Abstract

  Objective: Mesothelioma varies in clinical phenotype and survival. Clinical trials are unavoidably affected by selection bias, reducing generalisability. ASSESS-meso is a UK, multicentre, prospective, mesothelioma cohort study (ISRCTN61861764). This pre-specified interim analysis, conducted when recruitment reached 25% of target, summarised participant characteristics and evaluated external validity through comparison with real-world and clinical trial cohorts.

  Methods: The study took place at 14 hospitals across the UK. People diagnosed with mesothelioma, at any anatomical site, were eligible. Clinical, radiological and biochemical data were collected at enrolment. In this interim report, the external validity of the cohort was investigated through comparison of baseline demographic data with populations included in the 2020 UK National Mesothelioma Audit (real-world cohort), and CHECKMATE-743 and MAPS trials (clinical trial cohorts).

  Results: 244 patients were enrolled between 7 April 2017 and 1 March 2022. The cohort was predominantly male (195 out of 244; 80%) with a median age of 74 years. Pleural disease and epithelioid subtypes were most prevalent. ASSESS-meso participants were more similar to the real-world population with regard to age, performance status, disease site and stage than the clinical trial population. ASSESS-meso participants were more likely to be formally staged and less likely to have undifferentiated histology compared with the real-world cohort, possibly reflecting high rates of discussion of ASSESS-meso participants at regional mesothelioma multidisciplinary team meetings. As expected, poorer performance status, non-epithelioid histology and neutrophil-lymphocyte ratio were associated with shorter survival in the adjusted analysis.

  Conclusion: ASSESS-meso is representative of the UK mesothelioma population. Future outputs from the cohort will help characterise different mesothelioma phenotypes with high external validity.

  Copyright ©The authors 2023.

• ERS International Congress 2021: highlights from the Thoracic Surgery and Lung Transplantation Assembly. S. Bos, S. Ricciardi, E.J. Caruana, et al. 2022;8(2). PubMed · Publisher · Free full text

  Abstract

  The thoracic surgery and lung transplantation assembly of the European Respiratory Society (ERS) is delighted to present the highlights from the 2021 ERS International Congress. We have selected four sessions that discussed recent advances across a wide range of topics including: digital health surveillance in thoracic surgery, emerging concepts in pulmonary metastasectomy, advances in mesothelioma care, and novel developments in lung graft allocation and monitoring. The sessions are summarised by early career members in close collaboration with the assembly faculty. We aim to give the reader an update on the highlights of the conference in the fields of thoracic surgery and lung transplantation.

  Copyright ©The authors 2022.

• High sensitivity of PD-L1 analysis from pleural effusion in nonsmall cell lung cancer. L. Hagmeyer, S. Schäfer, M. Engels, et al. 2021;7(1). PubMed · Publisher · Free full text

  Abstract

  Background: Programmed cell death protein 1 (PD-1)/programmed cell death protein ligand 1 (PD-L1) immune checkpoint inhibitors have been approved for monotherapy of metastatic nonsmall cell lung cancer (mNSCLC) depending on tumour cells' PD-L1 expression. Pleural effusion is common in mNSCLC. The significance of immunocytochemistry PD-L1 analysis from pleural effusion samples is unclear. Aim: The aim of the study was to analyse the sensitivity regarding immunocytochemistry PD-L1 analysis of pleural effusion in NSCLC as compared to immunohistochemistry of pleural biopsies. Patients and Methods: Fifty consecutive subjects (17 female, median age 72.5 years, seven never-smokers) were enrolled in this prospective controlled two-centre study. Inclusion criteria were pleural effusion, suspected or known lung cancer, indication for pleural puncture and thoracoscopy, and written informed consent. Immunocytochemistry and immunohistochemistry PD-L1 analyses were performed with the Dako-PDL1-IHC-22C3pharmDx assay. Analysis for sensitivity, specificity, and positive and negative predictive value was performed for PD-L1 detection from pleural effusion. Results: 50 subjects underwent pleural puncture and thoracoscopy. Pathological diagnoses were lung cancer (48), lymphoma (1) and mesothelioma (1). Sensitivity, specificity, positive predictive value and negative predictive value of PD-L1-testing with expression ≥50% defined as positive were 100% (95% CI 46-100%), 63% (36-84%), 45% (18-75%) and 100% (66-100%), and with expression ≥1% defined as positive 86% (56-97%), 43% (12-80%), 75% (47-92%) and 60% (17-93%). Conclusion: PD-L1 analysis in tumour-positive pleural effusion samples shows a very high sensitivity and negative predictive value, especially regarding PD-L1 expression levels ≥50% (European Medicines Agency approval). Negative results are reliable and help in the decision against a first-line checkpoint inhibitor monotherapy. However, a 1% cut-off level (United States Food and Drug Administration approval) leads to a markedly lower negative predictive value, making other invasive procedures necessary (NCT02855281).

  Copyright ©ERS 2021.

2010s

• Asbestos-related diseases in mineworkers: a clinicopathological study. N. Ndlovu, D. Rees, J. Murray, et al. 2017;3(3). PubMed · Publisher · Free full text

  Abstract

  The accurate diagnosis of asbestos-related diseases is important because of past and current asbestos exposures. This study evaluated the reliability of clinical diagnoses of asbestos-related diseases in former mineworkers using autopsies as the reference standard. Sensitivity, specificity, positive predictive value and negative predictive value were calculated. The 149 cases identified had clinical examinations 0.3-7.4 years before death. More asbestos-related diseases were diagnosed at autopsy rather than clinically: 77 versus 52 for asbestosis, 27 versus 14 for mesothelioma and 22 versus 3 for lung cancer. Sensitivity and specificity values for clinical diagnoses were 50.6% and 81.9% for asbestosis, 40.7% and 97.5% for mesothelioma, and 13.6% and 100.0% for lung cancer. False-negative diagnoses of asbestosis were more likely using radiographs of acceptable (versus good) quality and in cases with pulmonary tuberculosis at autopsy. The low sensitivity values are indicative of the high proportion of false-negative diagnoses. It is unlikely that these were the result of disease manifestation between the last clinical assessment and autopsy. Where clinical features suggest asbestos-related diseases but the chest radiograph is negative, more sophisticated imaging techniques or immunohistochemistry for asbestos-related cancers should be used. Autopsies are useful for the detection of previously undiagnosed and misdiagnosed asbestos-related diseases, and for monitoring clinical practice and delivery of compensation.

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