Pulmonary Therapy最新文献

Introduction: Obstructive sleep apnea (OSA) is common but frequently underdiagnosed in patients with atrial fibrillation (AF), particularly in low- and middle-income countries, where access to polysomnography is limited. This study evaluated the diagnostic accuracy of the STOP-BANG, Berlin, and Epworth Sleepiness Scale (ESS) questionnaires for OSA screening in Vietnamese patients with non-valvular AF.

Methods: This cross-sectional diagnostic accuracy study was conducted in a tertiary inpatient cardiology department in Ho Chi Minh City, Vietnam. Consecutive adults with chronic non-valvular AF completed the STOP-BANG, Berlin, and ESS questionnaires, followed by overnight unattended type III polysomnography (ApneaLink™, ResMed). OSA was defined as an apnea-hypopnea index ≥ 5 events/hour according to International Classification of Sleep Disorders (ICSD)-3 criteria. Diagnostic performance was assessed using sensitivity, specificity, area under the receiver operating characteristic curve (AUC), predictive values, and likelihood ratios.

Results: Among 126 participants (median age 61 years; 45.2% male vs. 54.8% female), OSA prevalence was 74.6%. STOP-BANG showed the highest diagnostic accuracy (AUC 0.903, 95% confidence interval [95% CI] 0.852-0.954), with sensitivity of 81.9% and specificity of 96.9%. The Berlin questionnaire demonstrated moderate performance (AUC 0.824, 95% CI 0.735-0.914; sensitivity 89.4%; specificity 59.4%). ESS performed poorly in this population (AUC 0.499, 95% CI 0.386-0.613; sensitivity 6.4%).

Conclusions: STOP-BANG demonstrated superior diagnostic accuracy and practicality for OSA screening in patients with non-valvular AF, supporting its use to guide referrals for confirmatory sleep testing in resource-limited settings.

Urgent action is required to limit the increase in global temperatures. While mitigation efforts are primarily directed at transitioning away from fossil fuels, given their overwhelming contribution to greenhouse gas emissions, infrastructural change is slow to effect. Thus, behavioural changes, which can be effected rapidly, are also critical. To limit healthcare-related emissions, a widespread transition away from pressurised metered-dose inhalers (pMDIs), containing hydrofluorocarbons with high global warming potential (GWP), to dry powder inhalers (DPIs) with minimal GWP, has been proposed. This paper discusses whether the stated grounds for this transition are robust and are proportionate to the potential environmental gain and, while not to be ignored, whether a greater emphasis should be placed upon other measures that may have a greater impact.

Introduction: Cystic fibrosis (CF) transmembrane conductance regulator (CFTR) modulators are the cornerstone treatment for CF, but nonadherence can reduce their effect. Long-term adherence data on elexacaftor/tezacaftor/ivacaftor (ETI) combined with the evening dose ivacaftor (IVA) are lacking. The aim of this study was to determine 3-year adherence to ETI and IVA based on pharmacy refill data.

Methods: A retrospective observational cohort study was conducted using pharmacy refill data. Medication adherence was calculated using the proportion of days covered (PDC). The primary outcome was the PDC for ETI and IVA, which were calculated at 1, 2, and 3 years after initiating ETI and IVA. The secondary outcome was the proportion of non-adherent people with CF (pwCF), defined as having a PDC < 0.8.

Results: A total of 128 pwCF were included (75 male [59%], mean age 28.8 ± 15.5 years). At year 1, the PDCs for ETI and IVA (N = 128 and 112) were (median, range) 0.98 (0.69-1.0) and 0.98 (0.68-1.0); at 2 years (N = 105 and 95), 0.99 (0.54-1.0) and 1.0 (0.69-1.0), and at 3 years (N = 56 and 51), 0.98 (0.49-1.0) and 0.99 (0.54-1.0). Over time, a statistically significant decrease in PDC was observed [p = 0.01 (ETI, years 1 vs. 3) and p = < 0.01 (IVA)]. The percentage of non-adherent pwCF increased over time, from 3.6% (IVA) and 3.3% (ETI) at year 1 to 15.7% (IVA) and 12.5% (ETI) at year 3.

Conclusions: Three-year adherence to ETI and IVA based on pharmacy refill data was high, yet declined over time.

Introduction: The association between severe asthma and obesity is well established, as higher body mass index (BMI) is associated with higher prevalence and incidence of severe asthma. Biologic agents have been recently developed for severe asthma treatment. However, the efficacy of biologic agents in patients with higher BMI is not well studied. The aim of this systematic review was to determine whether there is an association between BMI and the response to five novel biologic agents.

Methods: Our study design followed the PRISMA guidelines. A literature search was performed using the PubMed/Medline and the Scopus databases up to May 2025 for the following agents: mepolizumab, benralizumab, dupilumab, reslizumab, and tezepelumab. After meticulous screening, 21 articles were selected.

Results: Studies on mepolizumab showed that higher BMI was associated with failure to achieve clinical remission, while BMI < 30 kg/m² was associated with better clinical outcomes. Regarding benralizumab, significant improvements were observed in respiratory symptoms and reductions in annual asthma exacerbation rate for patients with BMI ≤ 35 kg/m² but not for patients with BMI > 35 kg/m². One study about dupilumab describes it as equally effective across all BMI levels. Reslizumab appears to be effective across different BMI levels; however, effectiveness seems to decrease in patients with high BMI. Regarding tezepelumab, no study was found.

Conclusions: Biologic agents are effective treatments for severe asthma, although mepolizumab, benralizumab, and reslizumab appear to have better results in patients with lower BMI. Dupilumab appears to be equally effective across all BMI categories, while no data are available for tezepelumab. More studies in patient populations with severe asthma and comorbid obesity are needed to evaluate the effectiveness of biologic therapies in this specific category of patients.

Trial registration: Registration and protocol: PROSPERO CRD42024609708.

Introduction: Add-on treatment with amikacin liposome inhalation suspension (ALIS) to a multidrug antibiotic regimen is the only US Food and Drug Administration-approved treatment for adults with refractory Mycobacterium avium complex lung disease (MACLD). In real-world settings, other antibiotics may be added on to treat refractory MACLD. We analyzed healthcare resource utilization in a US patient population who received add-on treatment for refractory MACLD.

Methods: This was a retrospective claims analysis using Merative™ MarketScan® databases (January 2016 to December 2022). Two patient cohorts were defined: an ALIS and non-ALIS cohort. Index date was date of first prescription with ALIS or non-ALIS antibiotic for refractory MACLD. Hospitalizations (all-cause, respiratory-related, nontuberculous mycobacteria (NTM)-related) and emergency room (ER) visits at 0-6-month and 7-12-month post-index periods were compared with baseline (6-month pre-index period) per cohort. Multivariate logistic regression models compared the odds of hospitalizations or ER visits between cohorts.

Results: The ALIS and non-ALIS cohorts comprised 116 and 63 patients, respectively. The most common add-on treatments for refractory MACLD in the non-ALIS cohort were parenteral amikacin (41.3%) and moxifloxacin (27.0%). In the ALIS cohort, significant reductions from baseline, as compared with the 7-12-month post-index period, were observed in all-cause (12.1% vs 22.4%), respiratory-related (8.6% vs 20.7%), and NTM-related hospitalizations (9.5% vs 19.8%) (P < 0.05 for all comparisons). There were no significant changes from baseline in hospitalizations at follow-up in the non-ALIS cohort. No significant changes from baseline in ER visits or hospital length of stay were observed in either cohort. Adjusted odds ratios (ORs) of all-cause (OR [95% confidence interval, CI] 0.45 [0.21-0.96]) and respiratory-related hospitalizations (OR 0.44 [0.21-0.96]) were statistically significantly lower in the ALIS cohort compared with the non-ALIS cohort.

Conclusions: Add-on treatment with ALIS in refractory MACLD may lead to reductions in hospitalizations over time and lower odds of hospitalizations compared with add-on treatment with non-ALIS antibiotics.

Purpose of review: This review aims to summarize the latest evidence on how climate change has altered the environmental exposures and their influence on the epidemiology, pathophysiology, and outcomes of interstitial lung diseases (ILD). Rising global temperatures are exacerbating environmental threats (like heatwaves, floods, and dust storms) and worsening air quality. This burden disproportionately affects certain vulnerable groups, accelerating the decline of their ILD. Epigenetic modifications play a vital role in explaining the interaction between the environmental factors and development and progression of ILD. Establishment of strong policies is critical for both reducing the rate of climate change and implementing better adaptation strategies to protect the vulnerable group from its ongoing consequences.

Obstructive sleep apnea (OSA) in women is often underdiagnosed due to various and different symptoms, significant delay of referrals, sex-specific polysomnographic patterns that are usually not detected by standard severity indices from the home sleep apnea test, and limitations of current screening tools. Up to 75% of women with OSA remain undiagnosed, with relevant clinical and socioeconomic consequences. Women often report daytime fatigue, insomnia, depression, anxiety, and poor sleep quality rather than excessive daytime sleepiness or snoring, which may lead to fewer sleep clinic referrals. Additionally, the menstrual phase significantly influences symptom expression. Comorbidities also exhibit sex-based differences: OSA in premenopausal women is strongly linked to depression, metabolic syndrome, and polycystic ovary syndrome, while postmenopausal women with OSA reported hypertension and diabetes more frequently, leading to a greater cardiometabolic risk in postmenopausal women with OSA. The screening questionnaires showed numerous limitations in women due to the lack of items concerning symptoms. Women's typical polysomnographic pattern, especially in the premenopause period, is characterized by predominant hypopneas, mild OSA with prevalent rapid eye movement (REM)-OSA, respiratory effort-related arousals (RERAs), and low arousal threshold, highlighting the crucial role of sleep fragmentation evaluation, beyond the apnea-hypopnea index (AHI). New indices such as hypoxic burden, pulse wave amplitude drops index and arousal burden may provide more appropriate OSA severity classification and risk stratification in women.After a review of the literature, we proposed four women phenotypes, highlighting the heterogeneity of OSA in women and the key role of sex-tailored OSA management. From a therapeutic perspective, women differ in apnea-hypopnea index (PAP) compliance, required lower PAP levels for the same disease severity as men, and experience mask-related side effects. However, we have to mention that this is suspected to be biased due to significant lower number of women included in cohorts and even lower in randomized controlled trials (RCTs). Mandibular advancement devices (MADs) and endotype-based pharmacotherapy may be beneficial in women with mild OSA and low arousal threshold or low muscle responsiveness. Emerging evidence suggests that a sex-centered approach to screening, diagnosis, and treatment may reduce the clinical and socioeconomic burden of OSA in women in the future.

Interstitial lung diseases (ILD) are a heterogenous group of respiratory disorders with varying degrees of inflammation and fibrosis. Idiopathic pulmonary fibrosis (IPF), the commonest and most debilitating type of ILD, is a chronic, progressive disease of the respiratory system characterized by fibrosis of the alveolar interstitium. Subsequent, relentless decline in lung function leads to progressive breathlessness and respiratory failure. Treatment options for IPF have remained mostly unchanged in the last decade, with the availability of two antifibrotic therapies: pirfenidone and nintedanib. Recently, the US Food and Drugs Administration (FDA) approved nerandomilast for the management of IPF and progressive pulmonary fibrosis. Nintedanib is also globally approved for the treatment of progressive non-IPF ILDs. While these therapies have been shown to reduce the decline of lung function, they do not reverse existing lung damage or fully address the complex pathophysiology of pulmonary fibrosis (PF). Accordingly, research in the field has shifted to developing new therapies with improved efficacy and minimal adverse effects that directly target the intricate pathogenesis in PF with the aim of arresting or reversing the disease. This review article will set the scene by first describing the pathogenesis and prevalence of ILDs, followed by exploring the current and emerging therapies in the field.

Emerging evidence demonstrates the evolving role of fungi in the pathophysiology and disease progression observed in bronchiectasis. Fungal-associated traits are linked to disease severity, exacerbation frequency and airway inflammation. Structural abnormalities and impaired mucociliary clearance, characteristic of bronchiectasis, predispose to fungal colonisation, with subsequent immunopathogenic responses dependent on underlying host immunity. The diagnosis of fungal infection remains challenging in clinical settings, owing to the limitations of existing diagnostic modalities; however, the development of culture-independent molecular techniques shows promise. The use of next-generation sequencing has significantly advanced our understanding of the fungal microbiome in bronchiectasis, identifying fungi that are challenging to culture. Integrative microbiomics further elucidates the intricate and dynamic role of fungi in relation to other microbial kingdoms, and across distant organs such as the gut, revealing important relationships with bacterial pathogens including Pseudomonas aeruginosa. Airway inflammatory profiling has shown fungal-associated inflammatory endotypes which may serve as treatable traits. Environmental influences on fungi and bronchiectasis-exacerbated by air pollution and climate change-underscore the key role of the exposome in fungal-associated endotypes in bronchiectasis. This review outlines the clinical significance of fungi in bronchiectasis, the current diagnostic and treatment challenges, and emerging fungal-associated endotypes in the context of environmental influence on disease.

Background: Insomnia disorder and obstructive sleep apnea (OSA) are two of the most common sleep disorders in the general population. Their coexistence, referred to as comorbid insomnia and sleep apnea (COMISA), exacerbates nighttime disturbances, increases daytime dysfunction, and further diminishes overall quality of life. COMISA is also associated with elevated cardiovascular and mental health risks, including resistant hypertension, heart failure, stroke, depression, and anxiety. Despite its clinical importance, COMISA often remains underdiagnosed, and its management poses notable challenges.

Objectives: This narrative review article aims to provide a comprehensive overview of the current understanding of COMISA, focusing on its definition, epidemiology, pathophysiological mechanisms, clinical presentation, diagnostic challenges and treatment approaches, including the diagnostic decision-making process and criteria for selecting appropriate therapeutic strategies.

Methods: Literature review of published studies with different designs, including peer-reviewed observational studies, randomized controlled trials, meta-analyses, and international clinical guidelines, was conducted. Databases used included PubMed, Scopus, and Web of Science, and they covered epidemiological, clinical, and therapeutic topics focusing on COMISA. Emphasis was placed on the cardiovascular, psychological, and therapeutic outcomes, as reported in the cited literature.

Results: Patients diagnosed with COMISA typically present with symptoms such as greater sleep fragmentation, prolonged sleep latency, persistent daytime fatigue, cognitive deficits, and elevated psychological distress, compared with individuals with insomnia or OSA alone. COMISA is also associated with a threefold increased risk of resistant hypertension and heightened cardiovascular mortality. Despite the fact that continuous positive airway pressure (CPAP) remains the cornerstone of OSA treatment, its effectiveness is often limited by comorbid insomnia, making combined cognitive behavioral therapy for insomnia (CBT-I) and CPAP interventions more promising, as well as emerging pharmacotherapies, such as dual orexin receptor antagonists. Patients with significant insomnia-related impairment or suboptimal CPAP adherence may benefit from these combined or alternative approaches.

Conclusions: COMISA represents a complex clinical entity that is associated with impairments in clinical outcomes and quality of life, requiring a multidisciplinary, personalized approach to simultaneously address sleep-disordered breathing and insomnia symptoms. Early recognition, individualized treatment strategies, and long-term monitoring are essential to improve prognosis and therapeutic success in this high-risk population.