European Respiratory Review最新文献

Pneumocystis pneumonia constitutes a critical life-threatening opportunistic infection, where the host's immune response plays a central role in its pathogenesis. Immunocompetent individuals are typically capable of eradicating Pneumocystis without exhibiting clinical symptoms. In contrast, individuals with compromised immune systems are vulnerable to developing Pneumocystis pneumonia, which can lead to severe inflammatory responses and consequent pulmonary damage. This review examines the roles of innate immunity, particularly macrophages and adaptive immunity, including CD4⁺ and CD8⁺ T-cells, as well as key cytokines, in the defence against Pneumocystis infection across various host categories, namely immunocompetent individuals, those infected with HIV and non-HIV-infected individuals, especially those undergoing corticosteroid therapy. By integrating findings from animal models and clinical studies, this review seeks to enhance our understanding of the pathogenesis of Pneumocystis infection across varied immunological contexts.

Introduction: Validated and reliable patient-reported outcome measures (PROMs) are recommended to assess the severity and impact of cough in interstitial lung disease (ILD). We systematically reviewed the literature to identify PROMs for cough in ILD, examining their psychometric properties.

Methods: We searched four databases from inception to 10 January 2025. English-language original articles that described the use of a PROM to measure cough in adults with ILD and addressed the psychometric properties, method of administration or results of usability testing were selected.

Results: 21 PROMs were evaluated in 35 studies, including 14 in idiopathic pulmonary fibrosis (IPF) and seven in other ILDs, eight cough-specific PROMs, and 13 disease-specific PROMs with a domain for cough. No tool had sufficient evidence for more than 5/7 of the psychometric properties evaluated. There was evidence for content validity for four PROMs in IPF (A Tool to Assess Quality of Life in Idiopathic Pulmonary Fibrosis (ATAQ-IPF), the Cough and Sputum Assessment Questionnaire (CASA-Q), Evaluating Respiratory Symptoms: COPD (E-RS™:COPD) and the Living with Idiopathic Pulmonary Fibrosis Questionnaire (L-IPF)). Only one study evaluated convergent validity using objective cough monitoring, demonstrating high validity for the Leicester Cough Questionnaire (LCQ) (r=-0.74- -0.80) and cough visual analogue scale (VAS) (r=0.80). Acceptable internal consistency (α>0.7) was demonstrated for 10 PROMs (ATAQ-IPF, the Cross-Atlantic modification of ATAQ-IPF, the Chinese version of ATAQ-IPF, CASA-Q, E-RS™:COPD, LCQ, L-IPF, the IPF-specific version of St George's Respiratory Questionnaire (SGRQ), the modified version of the Edmonton System Assessment System and SGRQ). The cough VAS demonstrated good predictive validity and L-IPF was responsive to ILD-specific therapies, with effect sizes ranging from 0.32 to 0.44.

Conclusion: Evidence supporting the measurement properties of available PROMs for cough in ILD is limited. Further validation of existing instruments and the development of new disease-specific PROMs are needed.

COPD is "a heterogeneous lung condition characterized by chronic respiratory symptoms due to abnormalities of the airways and/or alveoli that cause persistent, often progressive, airflow obstruction". COPD has been traditionally associated with tobacco smoking and accelerated lung function decline. However, our understanding of the pathogenesis of COPD has changed significantly over the past few years due to the recognition that different lung function trajectories starting in early life and progressing across the lifespan are also important pathways to COPD. Further, today, it is well accepted that there are multiple genetic, host and environmental factors (i.e., aetiotypes) that can cause COPD and contribute to its clinical heterogeneity. Here, we review current understanding of the environmental, genomic and immune factors associated with the early-life origins of COPD. We also discuss the current knowledge gaps and how this new knowledge can facilitate earlier detection and disease interception of COPD across the lifespan, thus reducing its disease burden and improving the well-being and prognosis of COPD patients.

Background: Recent advances in the measurement of physical activity have significantly enhanced the analyses and interpretation in relation to health and well-being. Thus, we sought to revise and expand the 2015 position statement on the measurement of physical activity and provide guidance to clinicians and researchers for measuring physical activity in cystic fibrosis (CF) clinical practice and research.

Methods: This study was registered with the International Prospective Register of Systematic Review (PROSPERO) database (CRD42022292165). Three databases (Medline, Embase and Cumulative Index to Nursing and Allied Health Literature) were searched for studies investigating the measurement of physical activity and sedentary time in people with CF irrespective of age or duration. The Quality Assessment for Diverse Studies was used to assess methodological concern. A mixed-methods framework synthesis was used to extract, map, chart, categorise and aggregate study findings.

Results: In total, 7439 potentially relevant publications were identified. Following screening of titles and abstracts, 422 full texts were retrieved and assessed for eligibility, with 90 studies included. There was considerable variation in the methods of assessment, data processing and analytical interpretation of data.

Conclusion: It is recommended that device-based physical activity metrics are presented as time spent in different intensity categories (e.g., light, moderate and vigorous) and to include sedentary and sleep time. For data analysis, the data resolution should be at least 1 s (minimum 30 Hz) to enable clinical teams to obtain representative categorisation of patients' physical activity patterns. Validated questionnaires (e.g., the Habitual Activity Estimation Scale) offer additional opportunities to assess physical activity, whilst diaries can add context but should be viewed as secondary outcome measurements.

Although smoking prevalence has shown a decreasing trend, the total number of smokers remains high due to population growth. Smoking causes several diseases, including lung cancer, COPD, coronary heart disease, stroke and peripheral vascular disease. Most of the adverse effects of smoking are reversible and smoking cessation treatments are a cost-effective and high-impact intervention for reducing the risk of mortality and morbidity from smoking-related illness. Smoking cessation may have a significant impact in patients diagnosed with lung cancer, as continued tobacco use can critically compromise treatment efficacy, increase the risk of recurrence and reduce overall survival. Moreover, the benefits of smoking cessation in lung cancer patients can also improve quality of life. The tremendous health and economic consequences of the smoking epidemic should make tobacco control a top priority for governments worldwide. This review aims to highlight the necessity of incorporating smoking cessation as a standard component of lung cancer treatment protocols to enhance patients' clinical outcomes and quality of life. At the same time, we identified a lack of current evidence regarding the optimal timing of smoking cessation among lung cancer patients, which provides the basis for further investigation.

The prevalence of allergic upper respiratory diseases is rising, and while air pollution may worsen them, study results vary, and comprehensive analyses are lacking. This study aimed to systematically evaluate the link between air pollution and these diseases (allergic rhinitis, asthma and chronic sinusitis (with/without nasal polyps)) to provide evidence for reducing their prevalence. A systematic search of PubMed, Embase, Web of Science and Scopus was conducted to find studies published up to 1 September 2024, regarding association between air pollution and allergic upper respiratory diseases. Meta-analyses calculated odds ratios and 95% confidence intervals for the outcomes. Sensitivity and subgroup analyses were performed to explore heterogeneity, and publication bias was assessed using Egger and Begg tests with funnel plots. We included 64 studies with 12 440 647 participants. The prevalence of allergic rhinitis, asthma and chronic sinusitis due to air pollution was 16%, 11% and 12%, respectively. Allergic rhinitis was linked to nitrogen dioxide (NO₂) (OR 1.083), particulate matter with aerodynamic diameter <10 µm (PM₁₀) (OR 1.026) and <2.5 µm (PM_2.5) (OR 1.104), sulfur dioxide (SO₂) (OR 1.116), ozone (OR 1.058) and carbon monoxide (CO) (OR 1.070). Asthma was associated with NO₂ (OR 1.146), PM_2.5 (OR 1.087), PM₁₀ (OR 1.037), polluted air (OR 1.038), ozone (OR 1.032), SO₂ (OR 1.090) and CO (OR 1.184). Chronic sinusitis was linked to PM_2.5 (OR 1.135), polluted air (OR 1.767), NO₂ (OR 1.091), SO₂ (OR 1.08), CO (OR 1.13), PM₁₀ (OR 1.22) and oxides of nitrogen (OR 1.18). Subgroup analyses showed that age (especially the young), region (especially in Europe), gender (especially men) and pollutant concentration (particularly high levels of pollution) affected these associations. Air pollution is positively correlated with prevalence of allergic rhinitis and asthma, increasing risk of allergic upper respiratory tract diseases.

The advent of positron emission tomography (PET) combined with computed tomography (CT) in the field of inflammatory/infectious diseases heralds an era of personalised disease management using these noninvasive technologies. This nuclear medicine technique can be a useful tool in tuberculosis (TB) for assessing the extent of extrapulmonary disease, evaluating treatment response and identifying patients at higher risk of disease relapse. The fusion of functional imaging provided by PET with the anatomical and morphological details captured by CT has enabled clinicians to better understand the dynamics of the pathophysiology and natural course of Mycobacterium tuberculosis infection. Using its whole-body field of view, host responses are most commonly visualised using ¹⁸F-fluorodeoxyglucose, which reflects the glycolytic activity of cells. The strict indications for PET/CT in TB are matched by the caution required in interpreting its qualitative, quantitative and volumetric imaging patterns. In this narrative review, we aim to summarise evidence supporting the use of this molecular imaging modality in thoracic presentations of TB, particularly pulmonary and lymph node involvement, together with concepts to aid in the reporting and interpretation of the tests. We will also explore future indications for PET/CT in TB and discuss challenges to its routine use.

Primary ciliary dyskinesia (PCD) is a heterogeneous multiorgan genetic disease characterised by motile cilia impairment that primarily affects the respiratory system. Multiple breath washout (MBW) is an emerging pulmonary function test. Its main outcome, the lung clearance index (LCI), is a valuable sensitive measure in obstructive lung disease, especially in cystic fibrosis. The potential value of MBW as a monitoring tool for patients with PCD is not well known. This systematic review summarises all articles published by the end of 2022 reporting MBW data in patients with PCD and compares MBW parameters to spirometry and chest imaging findings. We searched PubMed, Embase and Scopus for original studies with MBW measurements in patients with PCD. 14 studies were included in the analysis with a total number of 398 patients. The mean/median LCI ranged from 7.98 to 11.8, whereas mean/median forced expiratory volume in 1 s (FEV₁) z-score ranged from -1.98 to -0.5. The LCI was abnormally increased in all studies, whereas only two studies had abnormally decreased FEV₁ The LCI also had a stronger correlation with chest computed tomography and magnetic resonance imaging results, compared to FEV₁ In conclusion, this review shows that the LCI is abnormally high in PCD from the preschool age up to adulthood. MBW appears to be more sensitive than spirometry in identifying pulmonary function impairment at the early stages of disease. These findings support the use of the LCI in daily clinical practice and provide evidence of using it as an outcome measure in upcoming clinical trials for patients with PCD.