European Clinical Respiratory Journal最新文献

Background: Advances in intensive care have improved survival in patients with prolonged critical illness, including those with critical COVID-19. However, prolonged stays in intensive care units are associated with impairments in physical function, mental health, and health-related quality of life.

Methods: This retrospective study analyzed outcomes for 30 patients admitted to a specialized intensive care rehabilitation center between August 2020 and April 2022 after critical COVID-19.

Results: Patients had a median age of 62 years and had spent a median of 52 days in an intensive care unit prior to admission, followed by 32 days at the center. At the center, weaning from invasive mechanical ventilation via a tracheostomy tube was achieved in 12 of 13 patients within a median of 17 days, and 23 of 25 patients with a tracheostomy were decannulated after a median of 18 days. Functional outcomes improved significantly, as measured by the Functional Oral Intake Scale, the Chelsea Critical Care Physical Assessment Tool, and the Katz Index of Independence in Activities of Daily Living (p < 0.001). One- and two-year survival rates were 90% and 86%, respectively. Assessments of health-related quality of life showed physical functioning as the most affected domain.

Conclusion: These findings suggest that specialized rehabilitation may support functional recovery and favorable long-term outcomes in patients recovering from critical COVID-19, consistent with reports from other populations with prolonged critical illness.

Pulmonal hyalinizing granuloma (PHG) is a rare benign disease of unknown cause, first described by Engleman in 1977 (1). Fewer than 200 cases have been reported worldwide (2). We present the case of a middle-aged male referred to the respiratory clinic after a routine chest X-ray (CXR) and chest computed topography (CT) scan revealed multiple bilateral peripheral pulmonary lesions (PPL). Over a 10-year period, the patient´s PPLs increased in size and number, with heterogeneous hypermetabolism observed on fluorodeoxyglucose -positron emission tomography (FDG-PET) imaging. Initially, the PPLs were suspected to be metastases from a salivary gland cancer due to a hypermetabolic focus in the right parotid gland. However, a biopsy of the parotid gland revealed a benign Warthin's tumour, and CT-guided fine needle biopsies from the lung lesions did not show malignant cells. A thoracoscopic resection of one PPL was consistent with a diagnosis of hyalinizing granuloma.

Background: Exacerbations of chronic obstructive pulmonary disease (COPD) often require treatment with oral corticosteroids (OCS). While OCS can improve forced expiratory volume in first second (FEV1) in the short term, there are still concerns about their potential cardiovascular adverse effects. Evidence on whether short-term OCS use increases the risk of major adverse cardiovascular events (MACE) remains lacking.

Hypothesis: We hypothesized that short-term OCS use in patients with COPD would be associated with an increased one-year risk of MACE compared with antibiotic treatment alone.

Methods: We conducted a registry-based, nationwide cohort study in outpatients diagnosed with COPD in the Danish Register of COPD (DrCOPD) between 2010 and 2022. Exposure was defined as prescription of OCS and antibiotics for respiratory infections in the year before baseline (defined as DrCOPD entry). Exposed patients were propensity score matched on clinical parameters to patients prescribed antibiotics for respiratory infections but no OCS. The primary outcome was all MACE, as a composite outcome, within 365 days following baseline.

Results: A total of 4,666 patients were included. Short-term OCS exposure was not associated with increased risk of MACE during one-year follow-up compared to use of antibiotics for respiratory infections (hazard ratio = 0.84, 95% CI 0.66 - 1.07, p = 0.17). The findings were consistent in a sensitivity analysis using an adjusted Cox model in the unmatched population. Secondary analyses of individual MACE components showed no significant differences in risk. An additional sensitivity analysis stratified by cumulative OCS dose revealed no dose-response relationship for the primary outcome (all MACE).

Conclusion: Short-term OCS use was not associated with an increased risk of MACE within 365 days among outpatients with COPD.

Introduction: Longitudinal studies of lung function following COVID-19 remain limited. This study examined lung function in COVID-19 patients for two years after discharge from an intensive care unit (ICU).

Methods: Patients treated for COVID-19 in Uppsala ICU (mean 11.1 days) were assessed at four months, one year, and two years post-discharge. Lung function tests included spirometry, diffusing capacity for carbon monoxide (D_Lco), and body plethysmography. Logistic regression adjusted for age, sex, and body mass index (BMI) assessed the association between impaired D_Lco and patients' characteristics.

Result: A total of 104 patients (32% female, with a mean age of 60 years) participated in four months follow-up, 40 in one year follow-up, and 21 in two years follow-up after discharge. Impaired D_Lco was observed in 50%, 58%, and 33% of patients at four months, one year, and two years, respectively. A comparison showed that D_Lco% predicted declined from four months to one year (mean 79.0, SD 14.7, to 74.3, SD 15.7; p< 0.001), then improved between one and two years (p< 0.001). Forced vital capacity (FVC) % predicted improved between four months and one year (p < 0.001) and between one and two years (p = 0.004). Forced expiratory volume during the first second (FEV₁) % predicted improved only between four months and one year (p = 0.002). Total lung capacity improved between the one- and two-year follow-ups (p = 0.006). Impaired D_Lco at four months was significantly associated with age ≥60 years (adjusted odds ratios, 95% confidence interval: 6.73 (2.64-17.12), mechanical ventilation (4.74 (1.82-12.34), longer ICU stay (5.84 (2.13-16.01), minimum lymphocyte count at ICU (0.19 (0.04-0.83), and FVC % predicted (0.93 (0.89-0.96)) and FEV₁ % predicted (0.93 (0.89-0.97)).

Conclusion: Despite recovery between one and two years, one-third of patients exhibited impaired D_Lco two years after critical COVID-19, highlighting the need for pulmonary follow-up to address persistent lung function deficits.

Background: Risankizumab is used for prolongated duration by patients, necessitating further research to characterize the infectious risks involved.

Case presentation: A 30-year-old man on Risankizumab for psoriasis and alopecia presented with pleuritic chest pain, cough, hemoptysis, fever, and myalgias. Initial computed tomography (CT) scan showed a 4.9 × 7.7 × 6.1 cm irregular cavitary lesion in the medial right lower lobe with thickened walls and surrounding ground-glass opacification. Tuberculosis was ruled out with 3 negative acid-fast bacilli (AFB) samples and 2 negative samples for Mycobacterium tuberculosis and rifampin resistance assay (Xpert MTB/RIF). Empiric antibiotic therapy was initiated, though the patient remained persistently febrile and tachycardic despite reported symptomatic improvement. A repeat CT scan showed compression atelectasis of the right middle and lower lobes, and a large right pleural effusion with multiple air-fluid levels. The patient underwent a video-assisted thoracoscopic surgery (VATS) decortication. Pleural fluid culture grew methicillin-resistant Staphylococcus aureus, and sputum AFB culture from admission grew Mycobacterium avium three weeks after collection. The patient ultimately completed two weeks of oral doxycycline.

Conclusion: Given the lack of notable risk factors for lung abscess, this case suggests a possible association with Risankizumab, which may have contributed to immunosuppression.

Objectives: The study aimed to develop new national reference values for dynamic and static lung volumes, as well as diffusing capacity for carbon monoxide, measured in the same participants. These values were compared with existing reference values from GLI and ECCS. Additional aims included the development of lung function reference values based on arm span, the establishment of post-bronchodilator reference values for spirometry, the creation of reference values for bronchodilator response, and the identification of significant bronchodilator responses using z-scores. Furthermore, the study sought to observe and enhance the quality of Danish lung function laboratories.

Methods: Spirometry, body plethysmography, single-breath diffusion capacity, and bronchodilator testing were performed on 908 healthy non-smokers aged 18-97 years, selected from municipalities served by 13 participating Danish centres. Strict quality control was maintained in accordance with ATS/ERS standards. Sex, age, age squared, weight, and height (or arm span) were used as independent variables in the multiple regression equations. The resulting lung function data were compared with predicted values from GLI and ECCS.

Results: Sex-specific reference equations were established for 29 lung function parameters. Additionally, reference values based on arm span and post-bronchodilator spirometry were calculated, and bronchodilator response was established using four different endpoints, including z-scores. A substantial proportion of the new reference values differed clinically significantly from those predicted by GLI and ECCS equations. These discrepancies were more frequent in females than males, more pronounced for ECCS than GLI, and more common for flow and volume parameters than for diffusion capacity and ratios.

Conclusion: Given that many of the new reference values differ clinically significantly from those provided from GLI and ECCS, we recommend the nationwide adoption of the new DALFUMAT reference values.

Background: Cardiorespiratory fitness is a strong predictor of life expectancy and all-cause mortality. Patients with chronic rhinosinusitis with nasal polyps (CRSwNP) often experience reduced physical activity levels due to nasal obstruction and high disease burden.

Objective: To evaluate whether mepolizumab, with or without sinus surgery, is associated with changes in habitual physical activity and cardiorespiratory fitness.

Methods: In this randomized trial (NCT05598814), 58 adults with severe CRSwNP were randomized (1:1) to receive either sinus surgery with mepolizumab (FESS) or mepolizumab alone (nonFESS). Inclusion criteria included CRS symptoms, nasal polyp score (NPS) ≥4, SNOT-22 score > 35, signs of type 2 inflammation, and prior functional endoscopic sinus surgery (FESS). Patients received 100 mg of mepolizumab every four weeks for six months. No exercise was prescribed, though participants were aware activity was being tracked. Physical activity (step count), fitness score (VO₂max/kg), and disease burden were assessed at baseline and follow-up.

Results: The FESS (n = 29) and nonFESS (n = 29) groups had a mean age of 52 (14) years, with 74% male participants. Both groups demonstrated significant increases in VO₂max (FESS: +1.95 ml/min/kg, +6%, p < 0.001; nonFESS: +1.50 ml/min/kg, +5%, p < 0.001) and daily step count (FESS: +1117 steps, p < 0.001; nonFESS: +1087 steps, p = 0.001). SNOT-22 scores decreased significantly in both groups, with greater improvement in the FESS group (-42 vs. -32 points, p = 0.040).

Conclusion: Mepolizumab was associated with improvement in physical activity, fitness, and quality of life. FESS provided additional quality-of-life benefits but did not further enhance fitness outcomes.

Background: Pulmonary Alveolar Proteinosis (PAP) is a rare respiratory disease characterized by proteinaceous material accumulation in the lungs, impairing gas exchange. The clinical course of the disease varies among patients. No current studies describe the Danish patient population. In 2024, the European Respiratory Society issued a guideline for the diagnosis and management of PAP. This study aimed to describe the demographical, clinical, laboratory, and radiological features of the Danish cohort of patients with PAP.

Methods: All patient followed at Department of Respiratory Diseases and Allergy at Aarhus University Hospital (AUH) in the period from 2006 to 2023 were invited to participate. Data were collected retrospectively through hospital records.

Results: Of 18 patients, 16 could be identified and agreed to participate in the study. The median age at diagnosis was 49.5 years and 62.5% of patients were male. Half the patients were referred from the Central Denmark Region. All patients presented with dyspnea at diagnosis with a median duration of symptoms of 11.7 months. A smoking history was present in 62.5%. Most diagnoses were made on the combined findings from high-resolution CT (HRCT), bronchoalveolar lavage (BAL) cytology and lung histology. Autoimmune PAP was diagnosed in 92.9%. Patients needing treatment received whole-lung lavage (WLL) or inhaled GM-CSF therapy as first-line therapy.

Conclusion: The first Danish cohort of patients with PAP revealed characteristics similar to international cohorts. Treatment strategies aligned with the 2024 guidelines, while diagnostic biopsies were frequently taken during BAL reflecting the historical practice prior to the introduction of the guidelines.

Introduction: The RheOx system delivers brief, high-voltage electrical pulses to the airway lining, promoting the regeneration of healthy tissue and reducing mucus production in COPD patients with chronic bronchitis. The procedure, called Rheoplasty, is performed under general anesthesia using a bronchoscope with a 2.8-mm working channel. Initially, we conduct Bilateral Bronchial Rheoplasty in stages, spaced approximately one month apart, to allow patients to recover and minimize risks. Recent studies have not reported any device-related Serious Adverse Events (SAEs) with Rheoplasty, but some procedure-related SAEs occurred within six months, in-cluding COPD exacerbation in 13.3% of cases and one instance of atrial fibrillation.

Case: We present the first case of simultaneous bilateral Bronchial Rheoplasty, treating both lungs during one procedure. Contrary to expectations, this did not increase complications in our patient. Consolidating the procedure into one session may reduce risks, patient discomfort, and costs, although further research is needed to confirm these benefits.