Pub Date : 2025-12-15eCollection Date: 2025-11-01DOI: 10.1183/23120541.00864-2025
Takeshi Matsumoto
Overuse of short-acting β2-agonists in asthma may reflect a pattern of persistent eosinophilic inflammation, highlighting the need for individualised assessment and treatment strategies based on inflammatory markers and patient-reported inhaler use https://bit.ly/3H8rB0z.
{"title":"Reconsidering the overuse of short-acting β<sub>2</sub>-agonists: clinical relevance beyond symptom relief.","authors":"Takeshi Matsumoto","doi":"10.1183/23120541.00864-2025","DOIUrl":"10.1183/23120541.00864-2025","url":null,"abstract":"<p><p><b>Overuse of short-acting β<sub>2</sub>-agonists in asthma may reflect a pattern of persistent eosinophilic inflammation, highlighting the need for individualised assessment and treatment strategies based on inflammatory markers and patient-reported inhaler use</b> https://bit.ly/3H8rB0z.</p>","PeriodicalId":11739,"journal":{"name":"ERJ Open Research","volume":"11 6","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12704156/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145767407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Qing-Dai (indigo naturalis), which is used to treat inflammatory bowel disease in Japan, has been linked to pulmonary arterial hypertension (PAH) and is recognised in the 2022 European Society of Cardiology/European Respiratory Society guidelines as a drug associated with PAH. However, the long-term clinical course of Qing-Dai-induced PAH has not been studied.
Methods: This retrospective multicentre study included 20 patients diagnosed with PAH after Qing-Dai use in Japan between 2011 and 2024. Haemodynamic data were collected when PAH was diagnosed, within 1 year after Qing-Dai discontinuation and at the final follow-up evaluation. To elucidate the underlying mechanisms, we analysed the composition of Qing-Dai and examined its effects on vascular endothelial cells.
Results: The study cohort comprised 11 female and nine male patients (median age: 40 years; range: 19-70 years). The median duration of Qing-Dai exposure before PAH was diagnosed was 4.8 years (range: 0.5-15 years). Discontinuation of Qing-Dai and the use of PAH medications were associated with significant improvement in haemodynamic parameters. The mean pulmonary arterial pressure decreased from 52.5 to 25.0 mmHg, and the median pulmonary vascular resistance decreased from 10.8 to 2.6 Wood units. Six (30%) patients discontinued PAH medication and remained recurrence-free. One patient experienced PAH relapse after discontinuation of PAH medications. Seven (35%) patients exhibited persistent PAH despite treatment. A mass spectrometry analysis of Qing-Dai identified indirubin, which was found to induce endothelial apoptosis.
Conclusion: Discontinuation of Qing-Dai is important to PAH management. Routine follow-up is necessary to monitor potential recurrence.
{"title":"Long-term outcomes of Qing-Dai-induced pulmonary arterial hypertension.","authors":"Sarasa Isobe, Ly Tu, Yoshihiro Dohi, Takahiro Hiraide, Shiro Adachi, Naohiro Komura, Ichizo Tsujino, Takumi Inami, Fusako Sera, Yasuchika Kato, Masaru Hatano, Shuichi Ueno, Takeshi Ogo, Yoshiyuki Orihara, Hiroyuki Fujii, Kuniki Amano, David Montani, Christophe Guignabert, Marc Humbert, Koichiro Tatsumi, Yuichi Tamura","doi":"10.1183/23120541.00675-2025","DOIUrl":"10.1183/23120541.00675-2025","url":null,"abstract":"<p><strong>Background: </strong>Qing-Dai (indigo naturalis), which is used to treat inflammatory bowel disease in Japan, has been linked to pulmonary arterial hypertension (PAH) and is recognised in the 2022 European Society of Cardiology/European Respiratory Society guidelines as a drug associated with PAH. However, the long-term clinical course of Qing-Dai-induced PAH has not been studied.</p><p><strong>Methods: </strong>This retrospective multicentre study included 20 patients diagnosed with PAH after Qing-Dai use in Japan between 2011 and 2024. Haemodynamic data were collected when PAH was diagnosed, within 1 year after Qing-Dai discontinuation and at the final follow-up evaluation. To elucidate the underlying mechanisms, we analysed the composition of Qing-Dai and examined its effects on vascular endothelial cells.</p><p><strong>Results: </strong>The study cohort comprised 11 female and nine male patients (median age: 40 years; range: 19-70 years). The median duration of Qing-Dai exposure before PAH was diagnosed was 4.8 years (range: 0.5-15 years). Discontinuation of Qing-Dai and the use of PAH medications were associated with significant improvement in haemodynamic parameters. The mean pulmonary arterial pressure decreased from 52.5 to 25.0 mmHg, and the median pulmonary vascular resistance decreased from 10.8 to 2.6 Wood units. Six (30%) patients discontinued PAH medication and remained recurrence-free. One patient experienced PAH relapse after discontinuation of PAH medications. Seven (35%) patients exhibited persistent PAH despite treatment. A mass spectrometry analysis of Qing-Dai identified indirubin, which was found to induce endothelial apoptosis.</p><p><strong>Conclusion: </strong>Discontinuation of Qing-Dai is important to PAH management. Routine follow-up is necessary to monitor potential recurrence.</p>","PeriodicalId":11739,"journal":{"name":"ERJ Open Research","volume":"11 6","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12704148/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145767425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-15eCollection Date: 2025-11-01DOI: 10.1183/23120541.00224-2025
France Louis, Françoise Guissard, Virginie Paulus, Mare Sabbe, Geneviève Philippe, Renaud Louis, Florence Schleich
In a large cohort of 2167 patients seen in a secondary/tertiary hospital, we found that overuse of rescue bronchodilators was associated with young age, smoking habit, overweight, impaired spirometry and uncontrolled airway eosinophilic inflammation https://bit.ly/44buBSr.
{"title":"What drives rescue bronchodilators overuse in asthma patients? Demographic features, low forced expiratory volume in 1 s and high sputum eosinophil counts.","authors":"France Louis, Françoise Guissard, Virginie Paulus, Mare Sabbe, Geneviève Philippe, Renaud Louis, Florence Schleich","doi":"10.1183/23120541.00224-2025","DOIUrl":"10.1183/23120541.00224-2025","url":null,"abstract":"<p><p><b>In a large cohort of 2167 patients seen in a secondary/tertiary hospital, we found that overuse of rescue bronchodilators was associated with young age, smoking habit, overweight, impaired spirometry and uncontrolled airway eosinophilic inflammation</b> https://bit.ly/44buBSr.</p>","PeriodicalId":11739,"journal":{"name":"ERJ Open Research","volume":"11 6","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12704179/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145767465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-15eCollection Date: 2025-11-01DOI: 10.1183/23120541.00433-2025
Sarah Basin, Mathias Poussel, Bruno Ribeiro Baptista, Charles Benaloul, Anne Guillaumot, François Goehringer, François Chabot, Ari Chaouat, Simon Valentin
Long-term evolution of Mycoplasma pneumoniae pneumonia revealed ad integrum recovery of pulmonary lesions and normalisation of pulmonary function in all patients. Peripheral deconditioning was frequent and should be systematically evaluated and addressed. https://bit.ly/4lA2DWA.
{"title":"<i>Ad Integrum</i> respiratory recovery after pneumonia caused by <i>Mycoplasma pneumoniae</i> in adult patients.","authors":"Sarah Basin, Mathias Poussel, Bruno Ribeiro Baptista, Charles Benaloul, Anne Guillaumot, François Goehringer, François Chabot, Ari Chaouat, Simon Valentin","doi":"10.1183/23120541.00433-2025","DOIUrl":"10.1183/23120541.00433-2025","url":null,"abstract":"<p><p><b>Long-term evolution of <i>Mycoplasma pneumoniae</i> pneumonia revealed <i>ad integrum</i> recovery of pulmonary lesions and normalisation of pulmonary function in all patients. Peripheral deconditioning was frequent and should be systematically evaluated and addressed.</b> https://bit.ly/4lA2DWA.</p>","PeriodicalId":11739,"journal":{"name":"ERJ Open Research","volume":"11 6","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12704160/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145767602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-15eCollection Date: 2025-11-01DOI: 10.1183/23120541.00139-2025
Timothy O Jenkins, George D Edwards, Suhani Patel, Claire M Nolan, Karen Ingram, Stuart Clarke, Helen Lammin, Puja Trivedi, Callum Glen, Carmel Moore, Karen Hayden, Lindsey Cook, Pamela Knight, Festus Meshe, Graham Ball, William D-C Man
Background: There is interest in digital technology-enabled models of pulmonary rehabilitation (Digital-PR) as a means of increasing capacity, uptake and accessibility. However, there are little data on real-world implementation or how Digital-PR could support other models of pulmonary rehabilitation delivery.
Methods: We conducted a mixed-methods, feasibility study to evaluate the acceptability of a hybrid model of pulmonary rehabilitation (Hybrid-PR) blending Digital-PR with traditional, supervised pulmonary rehabilitation (PR). To determine acceptability, we measured engagement and use of the app and conducted patient interviews. We assessed differences in PR completion, number of scheduled sessions and staff time between Hybrid-PR and a propensity-matched control group attending PR without Digital-PR (Control-PR).
Results: Of 69 people undergoing Hybrid-PR, 87% opted for in-person, centre-based care and 13% for home-based care (10% supported by video-teleconferencing, 3% supported by telephone). 86% activated Digital-PR at least once, but only 35% activated regularly (at least weekly for 8 weeks). 88% never accessed the exercise components of Digital-PR. There were no significant differences in PR completion rates, number of supervised PR sessions, nor staff time in Hybrid-PR when compared to Control-PR. Both patients and staff identified digital literacy, limited flexibility to adapt/tailor Digital-PR and increased time-commitment as potential barriers.
Conclusion: Hybrid-PR was not considered acceptable due to intervention fidelity and limited patient engagement with Digital-PR. Hybrid-PR was not associated with reduction in scheduled supervised sessions. Poor digital literacy is an important barrier to implementation of Digital-PR in the real-world setting.
{"title":"Feasibility of a real-world digital hybrid pulmonary rehabilitation model using a smartphone app.","authors":"Timothy O Jenkins, George D Edwards, Suhani Patel, Claire M Nolan, Karen Ingram, Stuart Clarke, Helen Lammin, Puja Trivedi, Callum Glen, Carmel Moore, Karen Hayden, Lindsey Cook, Pamela Knight, Festus Meshe, Graham Ball, William D-C Man","doi":"10.1183/23120541.00139-2025","DOIUrl":"10.1183/23120541.00139-2025","url":null,"abstract":"<p><strong>Background: </strong>There is interest in digital technology-enabled models of pulmonary rehabilitation (Digital-PR) as a means of increasing capacity, uptake and accessibility. However, there are little data on real-world implementation or how Digital-PR could support other models of pulmonary rehabilitation delivery.</p><p><strong>Methods: </strong>We conducted a mixed-methods, feasibility study to evaluate the acceptability of a hybrid model of pulmonary rehabilitation (Hybrid-PR) blending Digital-PR with traditional, supervised pulmonary rehabilitation (PR). To determine acceptability, we measured engagement and use of the app and conducted patient interviews. We assessed differences in PR completion, number of scheduled sessions and staff time between Hybrid-PR and a propensity-matched control group attending PR without Digital-PR (Control-PR).</p><p><strong>Results: </strong>Of 69 people undergoing Hybrid-PR, 87% opted for in-person, centre-based care and 13% for home-based care (10% supported by video-teleconferencing, 3% supported by telephone). 86% activated Digital-PR at least once, but only 35% activated regularly (at least weekly for 8 weeks). 88% never accessed the exercise components of Digital-PR. There were no significant differences in PR completion rates, number of supervised PR sessions, nor staff time in Hybrid-PR when compared to Control-PR. Both patients and staff identified digital literacy, limited flexibility to adapt/tailor Digital-PR and increased time-commitment as potential barriers.</p><p><strong>Conclusion: </strong>Hybrid-PR was not considered acceptable due to intervention fidelity and limited patient engagement with Digital-PR. Hybrid-PR was not associated with reduction in scheduled supervised sessions. Poor digital literacy is an important barrier to implementation of Digital-PR in the real-world setting.</p>","PeriodicalId":11739,"journal":{"name":"ERJ Open Research","volume":"11 6","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12704153/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145767398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-15eCollection Date: 2025-11-01DOI: 10.1183/23120541.00274-2025
Nadia Nathan, Magdalena Grochowska, Katarzyna Krenke, Ralph Epaud, Philippe Reix, Matthias Griese, Camille Louvrier, Yohan Soreze, Cécile Mulard, Barbara Donnet, Hubert Ducou le Pointe, Clémence Dufour-Barba, Aurore Coulomb l'Herminé, Jean-Christophe Dubus, Honorata Marczak
Background: Neuroendocrine hyperplasia of infancy (NEHI), also called persistent tachypnoea of infancy (PTI), is one of the most prevalent forms of childhood interstitial lung disease (chILD) and one of the few with an overall favourable prognosis. Nevertheless, there is still much to be understood about the pathophysiology of NEHI and much to be done to harmonise diagnostic work-up and management.
Methods: A systematic search was conducted in PubMed, Embase, Cochrane Library, Scopus and Web of Science to identify eligible studies.
Results: The results are presented in a narrative format, providing an overview of the current understanding of NEHI epidemiology, clinical presentation, investigations and outcomes. In-depth discussions include the roles of clinical assessment, chest computed tomography scan and lung biopsy, along with prospects for new diagnostic tools. Additionally, the discussion covers the pathophysiology of NEHI, focusing on the possible roles of genetic predisposition and infectious triggers.
Conclusions: The morbidity of NEHI is particularly significant in the first months of life, underscoring the need for clinical and basic research to develop new targeted treatments. Some of these are discussed in this review. Finally, the improved diagnosis of this rare lung disease is facilitating the formation of new parent groups, which are becoming a crucial asset for progress.
背景:婴儿期神经内分泌增生(NEHI),也称为婴儿期持续性呼吸急促(PTI),是儿童间质性肺疾病(chILD)最常见的形式之一,也是少数预后良好的疾病之一。尽管如此,关于NEHI的病理生理学还有很多需要了解的地方,在协调诊断检查和管理方面还有很多工作要做。方法:系统检索PubMed、Embase、Cochrane Library、Scopus和Web of Science,确定符合条件的研究。结果:结果以叙述形式呈现,概述了目前对NEHI流行病学、临床表现、调查和结果的理解。深入讨论包括临床评估,胸部计算机断层扫描和肺活检的作用,以及新诊断工具的前景。此外,讨论涵盖了NEHI的病理生理学,重点是遗传易感性和感染触发因素的可能作用。结论:新生儿NEHI的发病率在出生后的头几个月尤为显著,这强调了临床和基础研究开发新的靶向治疗方法的必要性。本文讨论了其中的一些问题。最后,这种罕见肺部疾病的改进诊断正在促进新的亲本群体的形成,这正在成为取得进展的关键资产。
{"title":"Persistent tachypnoea of infancy and neuroendocrine cell hyperplasia of infancy: from systematic review to future directions.","authors":"Nadia Nathan, Magdalena Grochowska, Katarzyna Krenke, Ralph Epaud, Philippe Reix, Matthias Griese, Camille Louvrier, Yohan Soreze, Cécile Mulard, Barbara Donnet, Hubert Ducou le Pointe, Clémence Dufour-Barba, Aurore Coulomb l'Herminé, Jean-Christophe Dubus, Honorata Marczak","doi":"10.1183/23120541.00274-2025","DOIUrl":"10.1183/23120541.00274-2025","url":null,"abstract":"<p><strong>Background: </strong>Neuroendocrine hyperplasia of infancy (NEHI), also called persistent tachypnoea of infancy (PTI), is one of the most prevalent forms of childhood interstitial lung disease (chILD) and one of the few with an overall favourable prognosis. Nevertheless, there is still much to be understood about the pathophysiology of NEHI and much to be done to harmonise diagnostic work-up and management.</p><p><strong>Methods: </strong>A systematic search was conducted in PubMed, Embase, Cochrane Library, Scopus and Web of Science to identify eligible studies.</p><p><strong>Results: </strong>The results are presented in a narrative format, providing an overview of the current understanding of NEHI epidemiology, clinical presentation, investigations and outcomes. In-depth discussions include the roles of clinical assessment, chest computed tomography scan and lung biopsy, along with prospects for new diagnostic tools. Additionally, the discussion covers the pathophysiology of NEHI, focusing on the possible roles of genetic predisposition and infectious triggers.</p><p><strong>Conclusions: </strong>The morbidity of NEHI is particularly significant in the first months of life, underscoring the need for clinical and basic research to develop new targeted treatments. Some of these are discussed in this review. Finally, the improved diagnosis of this rare lung disease is facilitating the formation of new parent groups, which are becoming a crucial asset for progress.</p>","PeriodicalId":11739,"journal":{"name":"ERJ Open Research","volume":"11 6","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12704159/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145767410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-15eCollection Date: 2025-11-01DOI: 10.1183/23120541.00246-2025
Eihab O Bedawi, Rebecca Burney, Sophie Harrad, Shakeeb H Moosavi, Jack Seymour, Alison M Condliffe, Emma Hedley, Catherine Henshall, Najib M Rahman
The question addressed by the study: The optimal treatment for pleural infection is yet to be determined and recruitment to trials can be challenging. Research into patient priorities in pleural infection is lacking. This qualitative study aimed to help us understand the patient perspective regarding priorities of care, to identify patient-centred study outcomes, and to explore the understanding of the risks and benefits of randomisation to different pleural interventions.
Methods: A prospective, multicentre, qualitative study using a semi-structured interview methodology explored key themes addressing the experiences of participation in a pleural infection randomised controlled trial (RCT) of combination intrapleural enzyme therapy versus surgery as well as priorities of care. Thematic analysis was conducted using the Framework method.
Results: Thematic analysis identified five main themes: emotions, level of explanation and understanding, reaction to randomisation, influences on physical wellbeing, and overall experience. Pain was a significant feature due to both the infection and interventions. The overriding emotions described by patients were fear and anxiety. Participants demonstrated high levels of support for randomised allocation to intervention.
The answer to the question: A pleural infection patient-reported outcome measure should be developed to assess pain, fatigue, anxiety and breathlessness, so that valid health-related quality of life data can be captured. Pain is an undertreated symptom of pleural infection and should be incorporated into treatment protocols. There was no clear patient preference between the interventions, and a surgical versus nonsurgical pleural infection RCT is acceptable to participants.
{"title":"Patient perspectives and priorities in pleural infection: results of the MIST-3 feasibility trial qualitative substudy.","authors":"Eihab O Bedawi, Rebecca Burney, Sophie Harrad, Shakeeb H Moosavi, Jack Seymour, Alison M Condliffe, Emma Hedley, Catherine Henshall, Najib M Rahman","doi":"10.1183/23120541.00246-2025","DOIUrl":"10.1183/23120541.00246-2025","url":null,"abstract":"<p><strong>The question addressed by the study: </strong>The optimal treatment for pleural infection is yet to be determined and recruitment to trials can be challenging. Research into patient priorities in pleural infection is lacking. This qualitative study aimed to help us understand the patient perspective regarding priorities of care, to identify patient-centred study outcomes, and to explore the understanding of the risks and benefits of randomisation to different pleural interventions.</p><p><strong>Methods: </strong>A prospective, multicentre, qualitative study using a semi-structured interview methodology explored key themes addressing the experiences of participation in a pleural infection randomised controlled trial (RCT) of combination intrapleural enzyme therapy <i>versus</i> surgery as well as priorities of care. Thematic analysis was conducted using the Framework method.</p><p><strong>Results: </strong>Thematic analysis identified five main themes: emotions, level of explanation and understanding, reaction to randomisation, influences on physical wellbeing, and overall experience. Pain was a significant feature due to both the infection and interventions. The overriding emotions described by patients were fear and anxiety. Participants demonstrated high levels of support for randomised allocation to intervention.</p><p><strong>The answer to the question: </strong>A pleural infection patient-reported outcome measure should be developed to assess pain, fatigue, anxiety and breathlessness, so that valid health-related quality of life data can be captured. Pain is an undertreated symptom of pleural infection and should be incorporated into treatment protocols. There was no clear patient preference between the interventions, and a surgical <i>versus</i> nonsurgical pleural infection RCT is acceptable to participants.</p>","PeriodicalId":11739,"journal":{"name":"ERJ Open Research","volume":"11 6","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12704157/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145767412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-15eCollection Date: 2025-11-01DOI: 10.1183/23120541.00329-2025
Annalisa Boscolo, Nicolò Sella, Tommaso Pettenuzzo, Elisa Pistollato, Francesco Zarantonello, Sebastiano Ongaro, Francesco Monteleone, Francesca Medici, Paola Zanon, Alessandro Zambianchi, Serafino Talarico, Annachiara Cremone, Giulia Mormando, Honoria Ocagli, Alessandro De Cassai, Dario Gregori, Samir Jaber, Paolo Navalesi
Background: The benefits of preoxygenation with noninvasive respiratory support (NRS), including high-flow oxygen therapy (HFOT) and noninvasive ventilation (NIV), compared to conventional oxygen therapy (COT) during emergency endotracheal intubation (ETI) remain unclear. This network meta-analysis aims to evaluate whether preoxygenation with NRS is more effective than COT in minimising the lowest recorded peripheral capillary oxygen saturation (SpO2 ) during emergency ETI.
Methods: A comprehensive literature search was conducted (PROSPERO-CRD42024606842) across Medline, Embase and Scopus. The PICOS criteria were: P: critically ill adult patients requiring emergency ETI; I: randomisation for receiving preoxygenation with NRS; C: randomisation for COT; O: the lowest recorded SpO2 during emergency intubation (and additional secondary outcomes); S: randomised clinical trials (RCTs).
Results: 15 RCTs (2939 patients) met the inclusion criteria. Compared to COT, all NRS methods improved the lowest SpO2 during emergency ETI (mean difference for HFOT was 1.50, 95% CI 0.43-2.58, p=0.006; for NIV was 3.30, 95% CI 1.81-4.79, p<0.001) (low evidence). Moreover, NIV reduced the occurrence of severe desaturations (SpO2 <80%) (OR 0.31, 95% CI 0.15-0.61, p<0.001) (very low evidence). Finally, preoxygenation with NRS did not increase the risk of complications (including aspiration, hypotension, barotrauma, arrhythmia or cardiac arrest), and no differences were found in postintubation gas exchange, mechanical ventilation or mortality compared to COT.
Interpretation: During emergency ETI in critical care areas, despite a low certainty of evidence, preoxygenation with NRS overperformed COT in maintaining SpO2 . Only NIV reduced the incidence of severe desaturation, while the risk of complications and adverse events was similar across different preoxygenation devices.
背景:在急诊气管插管(ETI)期间,与传统氧疗(COT)相比,预充氧加无创呼吸支持(NRS),包括高流量氧疗(HFOT)和无创通气(NIV)的益处尚不清楚。该网络荟萃分析旨在评估NRS预充氧是否比COT更有效地降低急诊ETI期间最低记录的外周毛细血管氧饱和度(S pO2)。方法:综合检索Medline、Embase和Scopus的文献(PROSPERO-CRD42024606842)。PICOS标准为:P:需要紧急ETI的危重成人患者;I:随机化接受NRS预充氧;C: COT随机化;O:紧急插管期间最低的S pO2记录(以及其他次要结果);S:随机临床试验(RCTs)。结果:15项rct(2939例)符合纳入标准。与COT相比,所有NRS方法在急诊ETI期间都能改善最低的spo2 (HFOT的平均差异为1.50,95% CI 0.43-2.58, p=0.006; NIV的平均差异为3.30,95% CI 1.81-4.79, pS pO2)。解释:在重症监护区急诊ETI期间,尽管证据的确定性较低,但NRS预氧在维持spo2方面优于COT。只有NIV降低了严重去饱和的发生率,而不同预充氧装置的并发症和不良事件的风险相似。
{"title":"Noninvasive respiratory support for preoxygenation in emergency intubation: a systematic review and network meta-analysis.","authors":"Annalisa Boscolo, Nicolò Sella, Tommaso Pettenuzzo, Elisa Pistollato, Francesco Zarantonello, Sebastiano Ongaro, Francesco Monteleone, Francesca Medici, Paola Zanon, Alessandro Zambianchi, Serafino Talarico, Annachiara Cremone, Giulia Mormando, Honoria Ocagli, Alessandro De Cassai, Dario Gregori, Samir Jaber, Paolo Navalesi","doi":"10.1183/23120541.00329-2025","DOIUrl":"10.1183/23120541.00329-2025","url":null,"abstract":"<p><strong>Background: </strong>The benefits of preoxygenation with noninvasive respiratory support (NRS), including high-flow oxygen therapy (HFOT) and noninvasive ventilation (NIV), compared to conventional oxygen therapy (COT) during emergency endotracheal intubation (ETI) remain unclear. This network meta-analysis aims to evaluate whether preoxygenation with NRS is more effective than COT in minimising the lowest recorded peripheral capillary oxygen saturation (<i>S</i> <sub>pO<sub>2</sub></sub> ) during emergency ETI.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted (PROSPERO-CRD42024606842) across Medline, Embase and Scopus. The PICOS criteria were: P: critically ill adult patients requiring emergency ETI; I: randomisation for receiving preoxygenation with NRS; C: randomisation for COT; O: the lowest recorded <i>S</i> <sub>pO<sub>2</sub></sub> during emergency intubation (and additional secondary outcomes); S: randomised clinical trials (RCTs).</p><p><strong>Results: </strong>15 RCTs (2939 patients) met the inclusion criteria. Compared to COT, all NRS methods improved the lowest <i>S</i> <sub>pO<sub>2</sub></sub> during emergency ETI (mean difference for HFOT was 1.50, 95% CI 0.43-2.58, p=0.006; for NIV was 3.30, 95% CI 1.81-4.79, p<0.001) (low evidence). Moreover, NIV reduced the occurrence of severe desaturations (<i>S</i> <sub>pO<sub>2</sub></sub> <80%) (OR 0.31, 95% CI 0.15-0.61, p<0.001) (very low evidence). Finally, preoxygenation with NRS did not increase the risk of complications (including aspiration, hypotension, barotrauma, arrhythmia or cardiac arrest), and no differences were found in postintubation gas exchange, mechanical ventilation or mortality compared to COT.</p><p><strong>Interpretation: </strong>During emergency ETI in critical care areas, despite a low certainty of evidence, preoxygenation with NRS overperformed COT in maintaining <i>S</i> <sub>pO<sub>2</sub></sub> . Only NIV reduced the incidence of severe desaturation, while the risk of complications and adverse events was similar across different preoxygenation devices.</p>","PeriodicalId":11739,"journal":{"name":"ERJ Open Research","volume":"11 6","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12704149/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145767401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-15eCollection Date: 2025-11-01DOI: 10.1183/23120541.00396-2025
Robert Chapman, Daryl Cheng, Mehran Azimbagirad, Shanshan Wang, Daisuke Yamada, Rishi K Gupta, John R Hurst, Joseph Jacob
Background: Preserved ratio impaired spirometry (PRISm) is a prevalent lung function abnormality associated with an increased body mass index and an increased risk of cardiovascular disease and metabolic disorders. However, the strength and consistency of these associations across populations remain unclear. This systematic review and meta-analysis aimed to quantify the relationship between PRISm and key cardiometabolic comorbidities, including diabetes mellitus, hypertension, hypercholesterolaemia, ischaemic heart disease and heart failure.
Methods: A systematic search of PubMed, Embase and Web of Science was conducted to identify observational studies comparing the prevalence of cardiometabolic comorbidities in PRISm and normal spirometry populations. Meta-analyses were performed for conditions reported in three or more studies, and heterogeneity was assessed using the I2 statistic. Sensitivity and influence analyses were conducted to ensure the robustness of findings.
Results: A total of 18 studies were included, comprising over 500 000 participants. Meta-analysis showed significant associations between PRISm and diabetes (OR 2.08, 95% CI 1.78-2.42), hypertension (OR 1.78, 95% CI 1.55-2.03), ischaemic heart disease (OR 2.05, 95% CI 1.59-2.64), heart failure (OR 2.82, 95% CI 1.40-5.67) and hypercholesterolaemia (OR 1.46, 95% CI 1.16-1.85). PRISm populations also exhibited a higher body mass index (mean difference 1.49 kg·m-2, 95% CI 0.92-2.05 kg·m-2).
Conclusion: PRISm is strongly associated with cardiometabolic disease, reinforcing its role as a systemic condition rather than a purely pulmonary abnormality. These findings highlight the need for integrated screening and management strategies for PRISm patients to address their broader multimorbid risk profile.
背景:保留比肺功能受损(PRISm)是一种普遍的肺功能异常,与体重指数增加、心血管疾病和代谢紊乱的风险增加有关。然而,这些关联在人群中的强度和一致性仍不清楚。本系统综述和荟萃分析旨在量化PRISm与主要心脏代谢合并症的关系,包括糖尿病、高血压、高胆固醇血症、缺血性心脏病和心力衰竭。方法:系统检索PubMed、Embase和Web of Science,以确定比较PRISm和正常肺活量测定人群中心脏代谢合并症患病率的观察性研究。对三个或更多研究中报告的情况进行荟萃分析,并使用I2统计量评估异质性。进行敏感性和影响分析以确保研究结果的稳健性。结果:共纳入18项研究,参与者超过50万人。meta分析显示PRISm与糖尿病(OR 2.08, 95% CI 1.78-2.42)、高血压(OR 1.78, 95% CI 1.55-2.03)、缺血性心脏病(OR 2.05, 95% CI 1.59-2.64)、心力衰竭(OR 2.82, 95% CI 1.40-5.67)和高胆固醇血症(OR 1.46, 95% CI 1.16-1.85)之间存在显著相关性。PRISm种群的体重指数也较高(平均差1.49 kg·m-2, 95% CI 0.92 ~ 2.05 kg·m-2)。结论:PRISm与心脏代谢疾病密切相关,强化了其作为全身性疾病而非纯粹肺部异常的作用。这些发现强调需要对PRISm患者进行综合筛查和管理策略,以解决其更广泛的多病风险概况。
{"title":"Associations of preserved ratio impaired spirometry with cardiometabolic comorbidities: a systematic review and meta-analysis.","authors":"Robert Chapman, Daryl Cheng, Mehran Azimbagirad, Shanshan Wang, Daisuke Yamada, Rishi K Gupta, John R Hurst, Joseph Jacob","doi":"10.1183/23120541.00396-2025","DOIUrl":"10.1183/23120541.00396-2025","url":null,"abstract":"<p><strong>Background: </strong>Preserved ratio impaired spirometry (PRISm) is a prevalent lung function abnormality associated with an increased body mass index and an increased risk of cardiovascular disease and metabolic disorders. However, the strength and consistency of these associations across populations remain unclear. This systematic review and meta-analysis aimed to quantify the relationship between PRISm and key cardiometabolic comorbidities, including diabetes mellitus, hypertension, hypercholesterolaemia, ischaemic heart disease and heart failure.</p><p><strong>Methods: </strong>A systematic search of PubMed, Embase and Web of Science was conducted to identify observational studies comparing the prevalence of cardiometabolic comorbidities in PRISm and normal spirometry populations. Meta-analyses were performed for conditions reported in three or more studies, and heterogeneity was assessed using the I<sup>2</sup> statistic. Sensitivity and influence analyses were conducted to ensure the robustness of findings.</p><p><strong>Results: </strong>A total of 18 studies were included, comprising over 500 000 participants. Meta-analysis showed significant associations between PRISm and diabetes (OR 2.08, 95% CI 1.78-2.42), hypertension (OR 1.78, 95% CI 1.55-2.03), ischaemic heart disease (OR 2.05, 95% CI 1.59-2.64), heart failure (OR 2.82, 95% CI 1.40-5.67) and hypercholesterolaemia (OR 1.46, 95% CI 1.16-1.85). PRISm populations also exhibited a higher body mass index (mean difference 1.49 kg·m<sup>-2</sup>, 95% CI 0.92-2.05 kg·m<sup>-2</sup>).</p><p><strong>Conclusion: </strong>PRISm is strongly associated with cardiometabolic disease, reinforcing its role as a systemic condition rather than a purely pulmonary abnormality. These findings highlight the need for integrated screening and management strategies for PRISm patients to address their broader multimorbid risk profile.</p>","PeriodicalId":11739,"journal":{"name":"ERJ Open Research","volume":"11 6","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12704154/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145766866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-15eCollection Date: 2025-11-01DOI: 10.1183/23120541.00435-2025
Rocío Díaz-Campos, María Ángeles Muñoz-Lucas, Miguel Jiménez-Gómez, Irina Bobolea, Andrea Trisán-Alonso, Carolina Cisneros-Serrano, Luis Miguel Callol-Sánchez, José Javier Jareño-Esteban, Rocío García-García, Adrián Peláez-Laderas, Antolín López-Viña, Carlos Melero-Moreno
Background: There is growing interest in identifying novel, non-invasive biomarkers reflecting endogenous inflammatory processes in asthma. This study aimed to evaluate the presence of volatile organic compounds (VOCs) in exhaled breath from patients with clinically controlled asthma and assess how tobacco exposure influences their expression.
Methods: Exhaled breath samples from 120 clinically controlled asthma patients and 89 healthy controls were collected using BioVOC breath samplers. Samples were analysed by gas chromatography-mass spectrometry, assessing five previously characterised VOCs: hexanal, heptanal, nonanal, propanoic acid and nonanoic acid.
Results: Compared to healthy controls, asthma patients exhibited a lower frequency of propanoic acid exhalation (25.0% versus 53.9%; p<0.001) and higher frequencies of nonanoic acid (30.8% versus 15.7%; p=0.019). These differences persisted after adjusting for smoking status. Stratified analysis revealed reduced propanoic acid exhalation in both smoking and non-smoking asthma subgroups compared to their respective controls (21.0% versus 55.6% and 29.3% versus 51.4%, respectively; p<0.001). Additionally, asthma current and former smokers had significantly increased detection of nonanoic acid compared to controls (33.9% versus 11.1%; p=0.0359). Multivariate analysis identified propanoic acid as a protective factor against asthma (OR 0.2 (95% CI 0.1-0.4); p<0.001), whereas nonanoic acid significantly increased asthma risk (OR 4.5 (95% CI 1.8-12.6); p=0.003).
Conclusions: Exhaled propanoic and nonanoic acids may serve as complementary non-invasive biomarkers for monitoring controlled asthma, independently of tobacco exposure. VOC analysis has promising potential to improve asthma management, therapeutic monitoring and patient stratification.
{"title":"Breathomics in controlled asthma: identification of nonanoic and propanoic acids as volatile organic compounds.","authors":"Rocío Díaz-Campos, María Ángeles Muñoz-Lucas, Miguel Jiménez-Gómez, Irina Bobolea, Andrea Trisán-Alonso, Carolina Cisneros-Serrano, Luis Miguel Callol-Sánchez, José Javier Jareño-Esteban, Rocío García-García, Adrián Peláez-Laderas, Antolín López-Viña, Carlos Melero-Moreno","doi":"10.1183/23120541.00435-2025","DOIUrl":"10.1183/23120541.00435-2025","url":null,"abstract":"<p><strong>Background: </strong>There is growing interest in identifying novel, non-invasive biomarkers reflecting endogenous inflammatory processes in asthma. This study aimed to evaluate the presence of volatile organic compounds (VOCs) in exhaled breath from patients with clinically controlled asthma and assess how tobacco exposure influences their expression.</p><p><strong>Methods: </strong>Exhaled breath samples from 120 clinically controlled asthma patients and 89 healthy controls were collected using BioVOC breath samplers. Samples were analysed by gas chromatography-mass spectrometry, assessing five previously characterised VOCs: hexanal, heptanal, nonanal, propanoic acid and nonanoic acid.</p><p><strong>Results: </strong>Compared to healthy controls, asthma patients exhibited a lower frequency of propanoic acid exhalation (25.0% <i>versus</i> 53.9%; p<0.001) and higher frequencies of nonanoic acid (30.8% <i>versus</i> 15.7%; p=0.019). These differences persisted after adjusting for smoking status. Stratified analysis revealed reduced propanoic acid exhalation in both smoking and non-smoking asthma subgroups compared to their respective controls (21.0% <i>versus</i> 55.6% and 29.3% <i>versus</i> 51.4%, respectively; p<0.001). Additionally, asthma current and former smokers had significantly increased detection of nonanoic acid compared to controls (33.9% <i>versus</i> 11.1%; p=0.0359). Multivariate analysis identified propanoic acid as a protective factor against asthma (OR 0.2 (95% CI 0.1-0.4); p<0.001), whereas nonanoic acid significantly increased asthma risk (OR 4.5 (95% CI 1.8-12.6); p=0.003).</p><p><strong>Conclusions: </strong>Exhaled propanoic and nonanoic acids may serve as complementary non-invasive biomarkers for monitoring controlled asthma, independently of tobacco exposure. VOC analysis has promising potential to improve asthma management, therapeutic monitoring and patient stratification.</p>","PeriodicalId":11739,"journal":{"name":"ERJ Open Research","volume":"11 6","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12704180/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145766919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}