Lung最新文献

Refractory chronic cough (RCC) remains a persistent clinical challenge, often resistant to traditional treatments. Emerging evidence now positions RCC as a disorder rooted in hypersensitivity, driven primarily by central neural processes rather than external physiological causes. Central to this understanding is the concept of interoception-the brain's ability to perceive and interpret internal bodily signals. Neuroimaging research has identified abnormalities in brain regions associated with interoception and inhibitory control among RCC patients. Interestingly, RCC shares neurophysiological characteristics with other disorders like overactive bladder and urinary urge incontinence (OAB/UUI), which also involve dysregulated interoceptive and inhibitory mechanisms. Behavioral treatments for OAB/UUI are highly effective and are regarded as the first-line treatment in many consensus guidelines. OAB/UUI behavioral treatments have been shown to induce central neuroplastic changes, further underscoring their efficacy and potential parallel for RCC interventions. Behavioral cough suppression therapy (BCST), an efficacious treatment for RCC, may leverage similar neuroplastic adaptations, enhancing interoceptive processing and inhibitory control. Given the multi-dimensional nature of interoception, which encompasses sensory perception shaped by learning, memory, and emotional context, BCST's engagement of multiple neural pathways offers an alternative therapeutic option compared to single-mechanism pharmacological treatments. Future research should prioritize exploring the mechanistic underpinnings of BCST and other interoception-based therapies for developing more comprehensive and effective treatment options. Such research holds promise for improving patient outcomes, alleviating the significant healthcare burden associated with RCC, and advancing our understanding of central hypersensitivity disorders.

Objective: This integrative review aims to evaluate the efficacy and safety of nebulized tranexamic acid (TXA) in managing hemoptysis, assessing its potential as a non-invasive alternative to traditional invasive procedures.

Methods: An integrative review was conducted in accordance with PRISMA guidelines and was registered on PROSPERO (CRD42024584812). The search included databases such as PubMed, EMBASE, Web of Science, and the Cochrane Central Register of Controlled Trials, encompassing studies published up to August 7, 2024. The inclusion criteria focused on human studies that utilized nebulized TXA for hemoptysis, with reported outcomes on bleeding cessation, recurrence, and adverse effects. Extracted data included patient demographics, underlying conditions, TXA dosing, administration methods, clinical outcomes, and reported adverse events.

Results: Fourteen studies met the inclusion criteria: five original research studies, and nine case reports involving 13 patients. The majority of patients were older adults with underlying conditions such as chronic obstructive pulmonary disease (COPD), acute respiratory distress syndrome (ARDS), and infections. Nebulized TXA demonstrated high efficacy in controlling hemoptysis across studies, with most patients experiencing rapid cessation of bleeding. In a randomized controlled trial, 96% of patients receiving TXA achieved complete resolution of hemoptysis within five days, compared to 50% in the placebo group. TXA use was also associated with shorter hospital stays and a decreased need for invasive interventions. The safety profile of nebulized TXA was favorable. However, the long-term safety of nebulized TXA, remains unexplored.

Conclusion: Nebulized tranexamic acid appears to be an effective and safe non-invasive treatment option for hemoptysis, particularly in non-massive cases. It provides rapid control of bleeding and may reduce the requirement for invasive procedures. However, further large-scale randomized controlled trials are necessary to confirm these findings and to establish optimal dosing regimens.

Background: Guidelines specify steroids as therapy for acute exacerbation of chronic obstructive pulmonary disease (AECOPD). However, the duration of survival benefit associated with steroids and the optimal dosage of nebulized budesonide (NB) during hospitalization remain unclear.

Methods: We conducted a retrospective study of hospitalized AECOPD patients. The primary endpoint was all-cause mortality after discharge. Cox regression analysis was used to determine the impact of steroid therapy on survival.

Results: Wilcoxon analysis showed the positive impact of systemic corticosteroids (SCs) therapy on survival during the early stage of follow-up (P = 0.038). NB therapy was associated with a significantly reduced risk of death within six months after discharge (adjusted Hazard ratio (HR), 0.36; 95% confidence interval (CI) 0.15-0.88). Subgroup analysis suggested that fewer than two AEs in the previous year (adjusted HR 0.05; 95% CI 0.01-0.38), age >  = 65 years (adjusted HR 0.31; 95% CI 0.11-0.90), body mass index (BMI) < 25 kg/m² (adjusted HR 0.33; 95% CI 0.12-0.92), and smoking index > 40 packets/year (adjusted HR 0.17; 95% CI 0.04-0.79) were involved in this association. Finally, treatment with a total dose of NB <  = 60 mg during hospitalization reduced six-month mortality compared to treatment without steroids (adjusted HR 0.39; 95% CI 0.17-0.92), but not the total dose of NB > 60 mg.

Conclusions: NB therapy for hospitalized AECOPD patients significantly reduced six-month mortality. Subgroup analysis showed that certain populations benefited more from NB therapy, and <  = 60 mg NB might be suitable treatment for hospitalized AECOPD patients.

Purpose: Pulmonary hypertension (PH) is associated with morbidity and mortality in patients with interstitial lung disease (ILD). Several prediction models have been proposed to predict PH in ILD patients. We sought to discern how previously described prediction models perform in predicting PH in patients with ILD.

Methods: Patients with ILD who completed a baseline right heart catheterization, from Inova Fairfax Hospital, Northwestern Memorial Hospital, and Asan Medical Center in Korea were enrolled. The performance of various prediction models (FORD model, the FORD calculator, the PH-ILD Detection tool, and the mean pulmonary artery pressure prediction model) were assessed using receiver operating characteristic (ROC) curves and area under the receiver operating characteristic curve (AUROC). There were four definitions of pulmonary hypertension against which the models were evaluated.

Results: There were a total of 192 patients with ILD, of whom 32.8% (n = 63/192) met the modified 5th world symposium on PH definition of precapillary PH. Among the models assessed, the FORD calculator had an AUROC (0.733) that was marginally highest. Subgroup analysis revealed that the FORD index had the highest AUROC (0.817) in patients with idiopathic pulmonary fibrosis, while the FORD calculator had the highest AUROC (0.751) in patients with non-IPF ILD.

Conclusion: The FORD model can be used to predict group 3 PH in both IPF patients and non-IPF ILD patients. It could serve as a tool for ILD patient selection for right heart catheterization as well as an enrichment tool for clinical trials targeting the pulmonary vasculature.

Purpose: The priorities and concerns of sarcoidosis patients in the United States (US) have not been well-described.

Methods: A survey constructed by sarcoidosis patients and doctors was administered to US sarcoidosis patients. The survey queried patients concerning their demographics, disease state, disease impact on health and well-being, health care priorities and impressions of sarcoidosis care. Respondents were solicited via social media and networking with sarcoidosis clinicians.

Results: 1018 US sarcoidosis patients completed this survey. 65% were female, 63% White, 34% Black, and 87% > 45 years old. The most common organs involved were the lungs 87%, skin 30%, heart 25%, and eyes 25%. Household income was < $50 K in 31% and > $150 K in 14% of patients. There was a fairly even split between those living in urban (29%), suburban (42%), and rural (29%) environments. The patients'greatest concerns were fear of worsening disease, fear of sarcoidosis developing in more organs, and fear of sarcoidosis not improving. These were closely followed by concerns about poor health-related quality of life (HRQoL), inability to enjoy everyday activities, lack of medical research, disability from sarcoidosis, and pulmonary function status. Lack of physician knowledge and poor physician communication were ranked of lowest concern. Concerns about ineffective medications and cost of medical care were also ranked relatively low. Patients overwhelmingly considered information from their doctor as very useful.

Conclusion: In this survey of over 1000 US sarcoidosis patients, their greatest concerns were fear of poor clinical outcomes. The patients were relatively less concerned about their doctors' knowledge about sarcoidosis and poor physician communication. Although patients expressed significant concerns about poor HRQoL, not all domains of HRQoL were equally affected. US sarcoidosis patients rank concerns about disease progression higher than disease impact on HRQoL.

Purpose: Tuberculosis (TB) is a highly contagious infection and one of the world's leading causes of death from a single infectious agent. Currently, TB diagnosis can be established via mycobacterial cultures, Acid Fast Bacilli smear and molecular studies. In the ever-evolving landscape of medical advancements, breath tests have shown considerable promise. This systematic review aimed to evaluate the diagnostic accuracy of breath tests to detect pulmonary TB in various populations.

Methods: This systematic review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines. We searched Embase and PubMed to identify observational studies published from database inception to May 2024. All observational studies evaluating the diagnostic accuracy of breath tests to detect pulmonary tuberculosis were included. Authors independently reviewed each article for eligibility and risk-of-bias. A senior reviewer was consulted for discrepancies.

Results: The pooled sensitivity for the breath test in diagnosing TB was 0.85 (95% CI 0.78-0.90) whilst the pooled specificity was 0.83 (95% CI 0.72-0.90), although heterogeneity was high. Sub-group analysis by low/lower-middle World Bank income group status, high proportion of TB in test population, or use of a separate breath sampling kit did not reduce the heterogeneity. Publication bias was absent.

Conclusion: Our study found that pooled sensitivity and specificity of the breath tests in diagnosing pulmonary TB was high. Future research efforts can be directed towards investigating the diagnostic accuracy of electronic noses and gas chromatography combined with mass spectrometry, whilst improving standardisation and reproducibility of breath test techniques.

Purpose: In the INBUILD trial in patients with progressive pulmonary fibrosis (PPF), nintedanib slowed the decline in forced vital capacity (FVC) versus placebo, with a safety profile characterised mainly by gastrointestinal events. INBUILD-ON, the open-label extension of INBUILD, assessed the safety of nintedanib during longer-term treatment. Data on FVC were collected.

Study design and methods: Adverse events and changes in FVC in INBUILD-ON were assessed descriptively in all patients and in two subgroups: patients who received nintedanib in INBUILD and continued nintedanib in INBUILD-ON ("continued nintedanib" group) (n = 212) and patients who received placebo in INBUILD and initiated nintedanib in INBUILD-ON ("initiated nintedanib" group) (n = 222). Changes in FVC were based on observed values.

Results: Median exposure to nintedanib in INBUILD-ON was 22.0 months. Diarrhoea was the most frequent adverse event. Amongst patients who had diarrhoea, 90.0% experienced only events of mild or moderate severity. Adverse events led to discontinuation of nintedanib at a rate of 16.7 per 100 patient-years. Serious and fatal adverse events were reported at rates of 37.2 and 9.5 per 100 patient-years. Mean (SE) changes in FVC from baseline to week 48 were - 71.6 (16.1) mL [- 128.5 (25.5) mL in continued nintedanib group (n = 106), - 14.8 (18.2) mL in initiated nintedanib group (n = 106)].

Conclusion: The safety profile of nintedanib in INBUILD-ON was consistent with that in INBUILD. Change in FVC in INBUILD-ON was consistent with decline in FVC in the nintedanib group of INBUILD. These results support the use of nintedanib in the long-term treatment of PPF.

Clinical trial registration: ClinicalTrials.gov; NCT03820726; registered January 29, 2019.

Background: Some studies have suggested that the forced expiratory flow between 25 and 75% of vital capacity (FEF_25-75) can be used as an early marker of bronchial hyperresponsiveness (BHR) in asthma and allergic rhinitis (AR), but is highly variable. Here, we aimed to assess whether the FEF_25-75 can be used to diagnose BHR in patients with asthma-like symptoms and AR.

Methods: PubMed, EMBASE, Web of Science, Wiley Online Library, Cochrane Library, SinoMed, CNKI, and Wanfang Data were searched to acquire eligible studies. Articles published before 30 Sep 2023 were included. Quality Assessment of Diagnostic Accuracy Studies 2 was used to evaluate the risk of bias and application concern of the included articles. Data were pooled using random-effects models. The univariable meta-regression and subgroup analyses were used to explore the sources of heterogeneity.

Results: Twenty-five studies were included, describing 12,310 patients with asthma-like symptoms and AR. In terms of the FEF_25-75, the pooled sensitivity and specificity were 0.56(95% CI 0.47-0.65) and 0.86 (95% CI 0.80-0.90), respectively. In addition, the pooled diagnostic odds ratio (DOR) was 8.00 (95% CI 6-10) and the area under the curve (AUC) was 0.80 (95% CI 0.76-0.83). Furthermore, we performed the univariable meta-regression and subgroup analyses, indicating that the disease types and ethnicity may be the sources of heterogeneity.

Conclusion: This meta-analysis showed that if BPT cannot be performed a value of FEF_25-75 < 65% of predicted may suggest the presence of BHR in patients with suspected asthma and /or AR.

Background: Along with lung volume reduction surgery (LVRS), bronchoscopic lung volume reduction is a treatment option for end-stage emphysema. However, comparisons among interventions remain insufficient.

Methods: We searched on PubMed, CENTRAL, Embase, and Web of Science. We included randomized controlled trials with outcomes measuring mid-term mortality within 6 months, changes in forced expiratory volume in one second (FEV₁), St. George's Respiratory Questionnaire (SGRQ), six-minute walk distance (6MWD) from baseline, adverse event related to procedures, and long-term mortality within 5 years. Bayesian network meta-analysis was performed. The certainty was assessed by CINeMA.

Results: Twenty-five randomized controlled trials involving 4,283 patients were included, identifying seven types of procedures and standard of care. Mid-term mortality increased in LVRS and endobronchial valve (EBV) (LVRS, risk ratio [RR] 3.26, 95% CrI 1.98-6.21, low certainty; EBV, RR 2.06 95% CrI 1.07-4.36, moderate certainty). LVRS showed the largest improvements: change in FEV₁ (187.2 mL, 95% CrI 166.4-209.6), 6MWD (42.2 m, 95% CrI 33.2-50.5), and SGRQ (- 13.29 points, 95% CrI - 27.25-0.75). Among bronchoscopic procedures, high efficacy was noted in EBV and endobronchial coil (EBC) for FEV₁ changes (EBV, 111.8 mL, 95% CrI 92.2-136.2; EBC, 74.1 mL, 95% CrI 47.6-101.7). Pneumothorax increased in these two procedures (EBV, RR 12.75, 95% CrI 5.52-35.48; EBC, RR 4.95, 95% CrI 1.12-40.90).

Conclusion: LVRS offers high efficacies but is accompanied by increased mid-term mortality. EBV and EBC also showed effectiveness; however, they increased pneumothorax, and EBV slightly increased mortality. For accurate assessment, long-term survival data of BLVR are needed.