European Clinical Respiratory Journal最新文献

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.

Background: Cytomegalovirus (CMV) infection remains a significant cause of morbidity following solid organ transplantation, most frequently affecting the gastrointestinal tract. In transplant recipients presenting with diarrhea, alternative etiologies such as inflammatory bowel disease (IBD) should be considered. The emergence of antiviral resistance poses a therapeutic challenge, and molecular testing for resistance-associated mutations is essential in cases of treatment failure.

Case presentation: A lung transplant recipient developed chronic diarrhea leading to functional intestinal failure. CMV infection was identified in intestinal biopsies and initially managed with two courses of valganciclovir. Due to persistent symptoms, genotypic analysis was performed, revealing UL97 mutations conferring ganciclovir resistance. Sequential therapy with foscarnet, maribavir, and letermovir achieved virological clearance, but diarrhea persisted. Small bowel enteroscopy with biopsies showed ongoing mucosal inflammation and minimal residual CMV activity. These findings were consistent with ganciclovir-resistant CMV enteritis coexisting with de novo Crohn's disease. The patient was commenced on standard biological therapy for Crohn's disease, resulting in marked clinical improvement and recovery.

Conclusion: This case illustrates the diagnostic challenge of distinguishing CMV enteritis from de novo Crohn's disease and determining the primary driver of the clinical presentation.

Introduction: Successful smoking cessation remains a challenge. The 'Very Brief Advice' (VBA) method is the recommended clinical practice in Denmark for referral to smoking cessation programs. This study examines how healthcare providers use the Very Brief Advice (VBA) method for smoking cessation, comparing trained and untrained staff and exploring overall referral activity at a large Danish Hospital.

Methods: A cross-sectional survey was conducted at a major hospital in the Region of Southern Denmark. HCPs reported sociodemographic and work-related information as well as their use of the VBA in daily practice. Practices of smoking cessation support beyond the VBA-method and hospital-level data on monthly referrals (May 2018 to May 2022) were assessed as a secondary objective.

Results: Between June and September 2021, a total of 1,572 (out of 3,998) HCPs with regular patient contact completed survey and were included in the study. Results show that mandatory VBA training was only undertaken by 35.6% of the participants and nearly half (46.6%) of all participants reported that they never/almost never used VBA in their daily practice. A larger proportion of nurses completed the training, compared to other HCPs. A larger proportion of outpatient staff completed the training, compared to staff in inpatient units. Referral data showed a decline in monthly VBA-referrals, dropping from 299 per months in 2018 to 96 in 2022.

Conclusion: The use of the mandatory VBA method in a larger Danish hospital is limited and declining. We observed low participation in VBA training and low utilization among HCPs. Significant adjustments and reassessment of the implementation effort are necessary.Trial registration: Not relevant.

Introduction: Haemoptysis, a common symptom with a variety of aetiologies, requires a comprehensive diagnostic approach. Computed tomography of the thorax (CT) and bronchoscopy are crucial in this process. This study assesses the value of bronchoscopy in patients with haemoptysis and CT with no findings suspicious of malignancy.

Methods and materials: This study retrospectively assessed patients with haemoptysis referred between January 2019 and December 2022 to the Department of Respiratory Medicine, Odense University Hospital. All patients who underwent CT and subsequently bronchoscopy due to haemoptysis were included in the study. Patients were excluded if CT or bronchoscopy was not performed, as well as patients suspected of malignancy on CT. Data, including patient characteristics, medical history, haemoptysis progression, CT, bronchoscopy results, and clinical assessments, were collected with a six-month follow-up.

Results: A total of 469 patients were assessed for eligibility, of whom 306 were excluded, resulting in 163 eligible patients. There were 95 males (58.28%), and the mean age was 57.8 years (SD 14.48). Mild haemoptysis (92.02%) and longer than one week (63.80%) was the most common presentation. CT revealed abnormal findings in 77 (47.24%) patients and for 117 (71.78%) patients followed a bronchoscopy with no abnormal observations. No malignant findings were detected by bronchoscopy.

Conclusion: The findings of this study revealed that bronchoscopy did not identify malignant aetiology beyond the scope of CT. These findings combined with current evidence suggest minimal benefit of bronchoscopy subsequent to CT in the diagnostic evaluation of thoracic malignancy in these patients. Take Home Message The diagnostic approach for patients with haemoptysis typically includes computed tomography (CT) and bronchoscopy to exclude pulmonary malignancy. This study supports current evidence of minimal value of bronchoscopy subsequent to CT in the diagnostic evaluation of thoracic malignancy in these patients.

[This corrects the article DOI: 10.1080/20018525.2025.2546677.].

Background: Asthma is a chronic respiratory condition characterized by airway inflammation and hyperreactivity. Previous studies have suggested a potential association between asthma and bacterial colonization of the upper respiratory tract. This systematic review and meta-analysis aimed to compare bacterial carriage rates, specifically focusing on Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Staphylococcus aureus, among individuals with and without asthma.

Methods: We followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) in reporting this meta-analysis.

Results: A total of 619 records were initially identified, leading to the inclusion of eight studies that met predefined inclusion criteria. The pooled prevalence rates of bacterial carriage were analyzed using a fixed-effect model. The risk of bias assessment was conducted using the Newcastle-Ottawa Scale. A total of 5,399 subjects were included, comprising 1,572 (29.11%) individuals with asthma and 3,827 (70.88%) without asthma. The prevalence of S. pneumoniae carriage was significantly higher in individuals with asthma (30.8%, 95% CI: 19.5-42.1%) compared to those without (19.2%, 95% CI: 8.3-30%) with an odds ratio (OR) of 1.35 (95% CI: 1.10-1.66, p = 0.005; I² = 29%). In contrast, H. influenzae carriage rates were similar between groups (18.6% in individuals with asthma vs. 21.4% with no asthma; OR = 0.93, p = 0.84; I² = 0%). The prevalence of M. catarrhalis was low in individuals with asthma (4.7%), and the data for S. aureus was limited, showing a prevalence of 36.67% among individuals with asthma compared to 26.67% with no asthma.

Conclusion: This systematic review and meta-analysis showed that asthma may increase the risk of S. pneumoniae carriage. The similar carriage rates of H. influenzae between the two groups suggest distinct mechanisms of bacterial colonization, underscoring the need to further investigate asthma's role in predisposing individuals to specific bacterial infections.

Objective: Education programs are essential to involve individuals with asthma in disease management and improve outcomes. We aimed to investigate the effects of a pilot-tested online asthma education program (eAEP) on autonomy preferences and medication behavior in adults with asthma in general practices.

Methods: We performed a pre-planned secondary analysis of a cluster randomized trial comparing the eAEP with usual care (UC) in terms of Asthma Knowledge Test (AKT) scores. The Autonomy Preference Index (API) was used to assess patients' preferences for information (information preference) and involvement in medical decisions (participation preference). Participants evaluated eight statements regarding medication behavior. Outcomes were analyzed at baseline and six months.

Results: A total of 108 asthma patients (mean age: 47 years, 59% female) were analyzed. Increases in AKT scores were substantially larger in intervention groups (7.9 (95% CI 4.9-10.8), p < 0.001). API subscale scores increased in intervention and control groups, but group-differences were not statistically significant (participation preference: 2.8 (95% CI -4.1-9.6), p = 0.421; information preference: 1.1 (95% CI -1.8-4.1), p = 0.471). There was a positive correlation between changes in AKT and participation preference (r = 0.27, p = 0.031), but not information preference scores (r = 0.08, p = 0.472). Regarding medication behavior, there were some improvements in individual items in intervention groups, but no consistent patterns indicating a clear influence of API scores.

Conclusions: The eAEP did not result in larger increases in autonomy preferences compared to UC, but indicated beneficial effects on some forms of medication behavior. Larger studies are required for further insights.

Background: Malignant pleural effusion (MPE) occurs in up to 20% of malignancies, most commonly from a breast or pulmonary primary. It confers a poor prognosis, with a median survival of less than a year, and the mainstay in treatment has previously been achieving pleurodesis.

Aims and methods: This review provides an overview of the most up to date literature for the treatment of MPE using a PubMed search, with a focus on patient-centred care.

Results: There is increased focus on outpatient management and control of symptoms for patients with MPE, allowing more in-depth conversations to be had over what individual patient goals are. The development of new approaches such as indwelling pleural catheters (IPC) and local anaesthetic thoracoscopy (LAT) also increase the options available. When manging the complexities of MPE, such as non-expansile lung and septated effusions, various approaches can be taken to treat them including fibrinolytics and IPC.

Discussion: The treatment of MPE has changed in the last 15 years to focus on outpatient management and symptom control. Careful discussions must be undertaken on a patient-by-patient basis.

Pleural mesothelioma (PM) is a rare, aggressive malignancy of the pleura. The PM diagnosis is challenging, both in terms of imaging, sampling of representative biopsies and pathological examination, and the treatment options are limited. The main aim of this article is to summarize the most recent advances in the diagnosis and management of PM as presented in the Danish clinical guidelines for PM. An expert task force consisting of a lung physician, a pathologist, an oncologist, and a thoracic surgeon conducted an ad hoc literature search during November 2023-July 2024, reviewed the evidence and developed the current clinical guidelines after reaching consensus. The article appraises the radiological modalities and biopsy techniques that are employed in PM diagnostics, provides a comprehensive overview of the evidence behind the PM histopathological and cytological diagnosis, and asserts the state of the art and novel developments of oncological, multimodal, and palliative PM treatment and follow-up that are portrayed in the Danish clinical guidelines.