ERJ Open Research最新文献

The time has come to transition from the academic stage of breathomics to the demonstration of its clinical applicability in the management of patients with lung cancer https://bit.ly/4hs8nk8.

The 30-second sit-to-stand test predicts respiratory disease-specific daily physical activity during acute exacerbations of interstitial lung disease https://bit.ly/4rBHL4l.

Interstitial lung diseases (ILDs) remain poorly visible and unevenly managed. Strengthening collaboration, supporting primary care training and improving access to expert teams are key steps towards fairer, more accurate and earlier ILD care. https://bit.ly/3Kf3Xkx.

Objective: Progressive pulmonary fibrosis (PPF) is a chronic interstitial lung disease (ILD) characterised by fibrotic progression and poor prognosis, with effective treatment strategies for previously untreated patients remaining unclear. This study evaluated the efficacy and safety of upfront combination therapy with anti-inflammatory and antifibrotic agents in previously untreated PPF patients.

Methods: This multicentre, single-arm phase 2 study enrolled 34 patients with ILD (including unclassifiable idiopathic interstitial pneumonia, idiopathic nonspecific interstitial pneumonia, fibrotic hypersensitivity pneumonitis and rheumatoid arthritis-associated ILD) all with evidence of PPF. Tacrolimus (0.0375 mg·kg^-1 twice daily) and prednisolone (10 mg once daily) were initiated on day 1, with nintedanib (150 mg twice daily) added on day 8. The tacrolimus dosage was adjusted to maintain blood trough levels. The primary end-point was the change in the relative decline slope for forced vital capacity % predicted (%FVC) between before and after treatment.

Results: The protocol treatment was associated with a substantial improvement in the relative %FVC decline slope, from -20.9% per year before to +11.2% per year after treatment. Subgroup analysis revealed greater improvement in patients with an increased lymphocyte percentage in bronchoalveolar lavage fluid or elevated blood biomarkers. Adverse events, such as diarrhoea (67.6%) and hepatic dysfunction (29.4%), were manageable, with no severe cases or treatment discontinuations.

Conclusion: Early combination therapy with tacrolimus, prednisolone and nintedanib was associated with improved pulmonary function and was well tolerated in previously untreated PPF patients. Our findings suggest the potential of this regimen as an initial treatment strategy, but further validation in larger randomised controlled trials is warranted.

Background: Idiopathic pulmonary fibrosis (IPF) is characterised by progressive loss of pulmonary function and poor survival. Although biomarkers for disease progression and mortality exist, their reliability in large studies remains unproven. This study investigates prognostic biomarkers from the ISABELA trials, the largest IPF cohort to date, to identify those predicting worse clinical outcomes.

Methods: Plasma from 1280 IPF patients in ISABELA 1 and 2 (NCT03711162, NCT03733444) was analysed for 17 circulating soluble disease-related biomarkers at multiple time-points and for the MUC5B (rs35705950_T) genotype. Statistical learning algorithms investigated biomarker levels/status with disease progression (≥10% decline in forced vital capacity (FVC) or mortality within 1 year) and pharmacotherapy.

Results: Patients with ≥10% annual decline in FVC had higher median baseline of matrix metalloproteinase-7 (MMP-7) versus those with <10% decline (5.5 versus 4.2 µg·L^-1; p<0.005). Patients with baseline MMP-7 ≥5.2 μg·L^-1 and/or C-C motif chemokine ligand 18 (CCL18) ≥75.2 μg·L^-1 had increased risk of mortality (p<0.0001); with patients having both elevated biomarkers at an even greater risk. Machine learning identified CCL18 changes by week 26 as a predictor of disease progression. The rs35705950_T genotype predicted neither mortality nor disease progression.

Conclusions: We provide new insights into the prognostic value of MMP-7 and CCL18 in identifying high-risk IPF patients in the largest cohort to date. The combination of high baseline MMP-7 and CCL18 levels, along with longitudinal changes in CCL18, has the potential to enhance risk stratification and support efficacy assessment and monitoring in clinical trials.

Background: Lung cancer remains the leading cause of cancer-related deaths worldwide, with early detection significantly improving survival. Lung nodules are a common finding, both as incidental solitary pulmonary nodules (SPNs) and in lung cancer screening programmes. Accurately distinguishing benign from malignant nodules, particularly small ones, remains challenging. Determining which nodules require further investigation is crucial for optimising early lung cancer detection and reducing unnecessary procedures. Therefore, volatile organic compounds (VOCs) in exhaled breath are analysed using multicapillary column/ion mobility spectrometry (MCC/IMS) to differentiate malignant from benign SPNs, serving as potential biomarkers for lung cancer.

Methods: A total of 65 patients with an incidental, solitary pulmonary malignant (n=41) or benign (n=24) nodule were prospectively included. Two models were developed: a pre-computed tomography (CT) scan situation for triaging high-risk individuals prior to imaging, and a post-CT scan situation to assist with nodule management and follow-up.

Results: Four VOCs (VOC37, VOC46, VOC58 and VOC128) were identified as key compounds, showing strong diagnostic performance (area under the curve 0.900 for pre-CT scan and 0.897 for post-CT scan).

Conclusions: Our findings suggest that breath analysis could improve nodule management by refining patient selection for CT screening and reducing unnecessary invasive procedures or follow-up scans. Further validation through larger multicentre studies is needed to confirm these results.

Severe PH-COPD is a major unmet clinical challenge, the uniform management of which fails to address its heterogeneity. Multimodal assessment is essential to refine phenotyping, identify subgroups and guide targeted therapies. https://bit.ly/4g4H3Ie.

Expiratory variability index is not a specific or fully validated gold standard for small airway disease. It works best as a screening or follow-up tool, but should be combined with other techniques such as oscillometry or MBW for confirmation. https://bit.ly/4n15use.

As we enter our 11th year, ERJ Open Research celebrates record interest. We are dedicated to becoming the best-open access respiratory journal, balancing high-quality research with inclusivity and speed to serve the community. https://bit.ly/4bqyvLh.

A significant proportion of infants ventilated for respiratory syncytial virus developed subclinical airway dysfunction; structured follow-up and early pulmonary rehabilitation may redefine recovery in paediatric bronchiolitis care https://bit.ly/41xOVM8.