Pulmonary Therapy最新文献

Introduction: Respiratory syncytial virus (RSV) is a public health concern, particularly among neonates/young infants, in individuals with chronic medical conditions, and for older adults. In contrast to children, limits in surveillance and substantial underreporting obscure the full impact of RSV infections on adults. A structured process for adult RSV disease decision-making can guide public health epidemiology and planning.

Methods: Twelve experts from six Asian countries (Indonesia, Malaysia, Philippines, Singapore, Taiwan, and Thailand) participated in a modified Delphi consensus study to guide surveillance, diagnosis, and impact of RSV in adults in Asia. The expert recommendations could be organized into four themes: epidemiology and surveillance, diagnosis, high-risk groups, and healthcare utilization.

Results: The expert panel recommended strengthening RSV disease monitoring through integration within current influenza and COVID-19 surveillance systems. Furthermore, to standardize RSV case definitions, it was recommended that the RSV respiratory infection clinical criteria exclude fever. Although rapid antigen tests are employed as standard of care, polymerase chain reaction (PCR) testing should be utilized whenever feasible. Along with year-round testing in Asia to establish incidence, an adjustment factor of at least 2.2-fold was recommended to address the underestimation of RSV-related hospitalization rates based on single-specimen PCR testing. For all adults aged ≥ 75 as well as for those adults aged ≥ 60 with comorbid or immunocompromising conditions, or those residing in long-term care facilities, the experts recommended universal RSV vaccination (contingent upon vaccine licensure), and cost-effectiveness analyses should be used to inform region-specific policy decisions.

Conclusions: Priority actions proposed for adult RSV infection and disease include streamlining diagnostic testing processes, launching disease awareness campaigns, and engaging public health authorities to advance prevention programs in coordinated efforts with policymakers and payers.

Chronic obstructive pulmonary disease (COPD) is a multifaceted lung condition characterized by persistent airflow limitation that leads to chronic symptoms, including dyspnea, cough, and exacerbations. To date, a major focus for the assessment and management of COPD has been on mitigating exacerbations. However, dyspnea is the most common symptom of COPD and is responsible for substantial negative effects on patients' quality of life. Dyspnea is also a substantial contributor to the symptoms associated with acute exacerbations in COPD. Though a portion of the current recommendations for the assessment and management of COPD are dedicated to dyspnea treatment intervention strategies, there remains a need for improvement in communication between healthcare practitioners and their patients regarding the understanding of dyspnea and the implementation of key nonpharmacologic and pharmacologic treatment options. This clinical commentary outlines practical considerations and recommendations for the real-world assessment and management of dyspnea in COPD, including underlying causes, patient and healthcare provider dialogue, measurement of severity, and management strategies.

Introduction: Patients undergoing lung transplantation require regular monitoring to ensure that the transplanted lung(s) stay healthy. This is usually achieved through a combination of home spirometry combined with regular reviews in hospital outpatient clinics. Administering questionnaires remotely could reduce the need for regular hospital clinic visits. This study aims to investigate whether a remotely administered questionnaire combined with home spirometry can reduce the number of hospital clinic visits.

Methods: Patients will be randomised to the intervention arm (questionnaire and home spirometry) or standard of care arm (home spirometry + clinic visit). Quality of life (St George's Respiratory Questionnaire), health economic data and usage acceptability will be collected at the beginning and end of the study period.

Planned outcomes: The primary outcome is to evaluate whether the number of hospital clinic visits are reduced in the intervention arm compared to the control arm. Secondary outcomes will evaluate the intervention influence on healthcare usage, the associated costs of service delivery and its environmental impact.

Trial registration number: ClinicalTrials.gov NCT05916495.

Introduction: This bench study evaluated the inspired oxygen fraction (FiO₂) delivered by different portable oxygen concentrators (POCs) compared to wall oxygen and a standalone concentrator (control device) using a respiratory failure-specific lung simulator replicating an adult with chronic respiratory disease at respiratory rates of 15, 20, 30, and 40 breaths per minute.

Methods: A lung simulator replicated an adult with chronic lung disease in respiratory failure. POCs and controls were tested at device-specific settings 2, 3, 5, and 6. One-way analysis of variance (ANOVA) assessed FiO₂ differences when more than two groups were compared; independent t tests were used for two-group comparisons.

Results: Wall oxygen generally delivered higher FiO₂ across all settings and respiratory rates. At 40 breaths/min and setting 2, however, the CAIRE FreeStyle^® Comfort^® with autoSAT^® delivered a slightly higher FiO₂ than wall oxygen (0.25 vs. 0.24, p < 0.01). Among POCs, the CAIRE FreeStyle^® Comfort^® (with or without autoSAT^®) achieved the highest FiO₂ values at elevated respiratory rates, while devices like the Inogen G4^® and G5^® performed more variably and showed reduced oxygen delivery at higher breathing frequencies.

Conclusions: Wall oxygen and standalone concentrators consistently outperformed POCs across most breathing conditions. While the CAIRE FreeStyle^® Comfort^® with autoSAT^® offered relative advantages at high respiratory rates, most POCs may not adequately sustain oxygenation during exertion or stress. These findings inform home oxygen therapy decisions, emphasizing the importance of device selection based on respiratory demand. Clinical validation of these bench findings is warranted.

Background: Sleep disorders, including snoring and obstructive sleep apnea (OSA), are significant health concerns. OSA affects an estimated 4 million (8.5%) individuals in Vietnam, with 2.3 million suffering from moderate-to-severe conditions. Despite the high prevalence, underdiagnosis and limited accessibility to sleep diagnostics remain challenges. This study aims to assess the feasibility and effectiveness of a guided, self-administered home sleep study using a level 3 diagnostic model.

Methods: A cross-sectional multicenter survey conducted from September 2023 to March 2024 included healthcare professionals (HCPs) across Vietnam. Participants completed questionnaires (Epworth Sleepiness Scale, STOP-BANG), and high-risk individuals underwent respiratory polygraphy using ApneaLink Air devices. Standardized instructions and technical support were provided remotely by trained technicians.

Results: Out of 1721 participants, 21.9% were diagnosed with OSA, comprising mild (32.4%), moderate (19.6%), and severe cases (9.2%). Prevalent symptoms included insomnia (22.2%), daytime sleepiness (40.7%), and memory decline (49.4%). Technical issues were minimal, supporting the feasibility of this approach.

Conclusion: A level 3 home sleep study model is effective for large-scale OSA screening. Integrating such approaches into public health initiatives can enhance early diagnosis and treatment access, reducing OSA-related health and economic burdens. Graphical abstract available for this article.

Emergency airway management is a lifesaving procedure but can be associated with significant risks, including hypoxia, hypotension, cardiac arrest, and death. Peri-intubation hypotension, reported in ≥ 40% of cases, is strongly associated with increased morbidity and mortality. While clinical guidelines emphasize the importance of preoxygenation and hemodynamic optimization prior to intubation, the latter remains poorly defined, with limited available data to guide evidence-based strategies to mitigate cardiovascular collapse during rapid sequence intubation. This review synthesizes current knowledge on the epidemiology, risk factors, and pathophysiology of peri-intubation hemodynamic deterioration. We review targeted strategies for hemodynamic optimization of physiologic parameters before intubation. These include volume expansion with fluid resuscitation, vasopressor utilization, selection of pharmacologic agents, invasive hemodynamic monitoring, and advanced preoxygenation techniques. In selected high-risk patients, we also discuss the potential role of extracorporeal membrane oxygenation as an adjunctive or rescue therapy. Our goal is to provide airway specialists with a comprehensive framework for mitigating cardiovascular collapse during emergent airway management and to stimulate further research into this high-risk and understudied domain.

Introduction: Hyperbaric oxygen therapy (HBOT), traditionally used for decompression sickness and chronic wounds, has recently attracted interest for its potential role in sleep breathing disorders (SBD). Because sleep is highly sensitive to oxygen homeostasis, altered oxygenation can significantly disrupt sleep architecture and efficiency.

Method: This review examines emerging evidence on HBOT's effects in modulating sleep physiology and alleviating major SBD phenotypes, including obstructive sleep apnea (OSA), central sleep apnea (CSA), and high-altitude-related breathing disorders. HBOT may exert therapeutic benefits through several mechanisms-reducing inflammation and oxidative stress, reversing tissue hypoxia, improving pulmonary function and oxygenation, enhancing neurocognitive function, modulating arousal threshold and loop gain, and influencing brain regions involved in sleep regulation. These physiological pathways provide a rationale for considering HBOT as an adjunctive or alternative therapy, especially for patient's intolerance of conventional treatments. This systematic review aims to synthesize existing evidence on the effects of HBOT in SBD, particularly OSA, CSA, and altitude-related sleep disturbances.

Conclusion: Current studies offer promising but preliminary evidence supporting HBOT's role in selected SBD populations. However, heterogeneity in protocols, small sample sizes, and limited long-term follow-up constrain interpretation. Future multicenter trials should focus on optimizing treatment pressure, duration, and patient selection, while ensuring safety across vulnerable populations. Understanding the interactions among hyperoxia, neurophysiology, and sleep regulation could unlock novel therapeutic directions for refractory or comorbid SBD.

Bronchiectasis is a chronic and progressive inflammatory lung disease characterized by dilated airways, impaired mucociliary clearance, recurrent infections, and inflammation. In this podcast, we discuss the heterogeneous causes and complex pathophysiology of bronchiectasis, reviewing the therapeutic tools we currently have available to target aspects of the vicious vortex that drives disease progression. Patient evaluation involves identifying underlying causes such as autoimmune diseases or immune deficiencies, conducting sputum cultures for bacteria, fungi, and mycobacteria, and performing pulmonary function tests. The primary objectives of treatment are to alleviate symptoms, reduce burdensome exacerbations, enhance quality of life, and slow disease progression, requiring shared decision-making to align clinical and patient priorities. Effective management necessitates a multimodal approach to address all aspects of pathophysiology including airway obstruction, infection, and inflammation. An unmet need remains to fully address the inflammation, which is predominantly neutrophilic, driving bronchiectasis. Emerging therapies that directly target dysregulated neutrophilic inflammation via inhibition of the enzyme dipeptidyl peptidase 1 (DPP1) reduce neutrophil serine protease (NSP) activity. Brensocatib, an oral, once-daily DPP1 inhibitor, was recently approved by the FDA and is indicated in the USA for the treatment of noncystic fibrosis bronchiectasis in adult and pediatric patients 12 years of age and older. In the phase 3, 52-week ASPEN trial, brensocatib significantly reduced exacerbation burden, and the 25-mg dose reduced lung function decline and nominally significantly improved patient-reported symptoms compared with placebo. Additional therapies in development include other DPP1 inhibitors (verducatib and HSK31858) and drugs targeting phosphodiesterase 3/4 inhibition (ensifentrine) and anti-interleukin-33 (itepekimab). Overall, the future is promising for patients with the historically neglected and underdiagnosed disease bronchiectasis, with growing awareness and new therapeutic tools becoming available. Podcast (MP4 81554 KB).

Introduction: Gut microbiota modulate systemic anti-inflammatory and immune responses in the lungs, suggesting a potential to support lung health through probiotic supplementation. We hypothesized that a probiotic blend (Lactobacilli) combined with herbal extracts (resB^®) could improve quality of life in patients with chronic obstructive pulmonary disease (COPD).

Methods: We conducted a randomized, double-blinded, placebo-controlled study (NCT05523180) evaluating the safety and impact of resB^® on quality of life in volunteers with COPD. Participants took resB^® or placebo (two capsules daily) for 12 weeks. The primary endpoint was change in quality of life by Saint George's Respiratory Questionnaire (SGRQ). Secondary outcomes included safety, serum and sputum biomarkers, and microbiome analysis. resB^® was well tolerated with no related adverse events.

Results: Participants receiving resB^® showed significant improvement in SGRQ symptom scores (P < 0.05), while placebo recipients did not. In the resB^® group, serum and sputum levels of matrix metalloproteinase 9, C-reactive protein, and interleukin 6 decreased (P < 0.05), correlating with increased stool Lactobacilli. Additionally, Veillonella abundance increased in both stool and sputum.

Conclusion: These findings suggest that resB^® improves respiratory symptoms and reduces inflammation in patients with COPD, potentially by modulating gut and lung microbiota.

Trial registration: ClinicalTrials.gov identifier NCT05523180.