Type 2 inflammation in the airways and lungs is inflammation induced by type 2 cytokines such as IL-4, IL-5, and IL-13, produced primarily by type 2 helper T cells and type 2 innate lymphoid cells, and causes changes in the physiology and structure of the airways. Type 2 inflammation is currently in the spotlight because of its direct link to the treatment of several airway and lung diseases. Abundant evidences have accumulated that inflammatory biomarkers such as blood eosinophils, fractional exhaled nitric oxide, and IgE are essential clinical tools in the diagnosis and management of asthma and COPD. It is well known that asthma and COPD have diverse inflammatory phenotypes even when clinical features are similar, and it has been demonstrated that assessment of airway inflammation with biomarkers can improve diagnostic accuracy, determine safer and more effective treatment strategies, and predict future risks such as exacerbations and lung function decline. The Japanese Respiratory Society has published clinical practice guidelines for the evaluation of type 2 inflammation in the airways and lungs. In addition to asthma and COPD, the guide covers a wide range of airway and lung diseases, including interstitial lung disease, allergic bronchopulmonary mycosis, allergic rhinitis, and eosinophilic chronic rhinosinusitis. It also provides comprehensive guidelines covering a variety of clinical biomarkers. The purpose of this guidance is to provide evidences for the interpretation of type 2 inflammation measurements and to promote the widespread use of inflammation assessment to further improve the efficiency of airway and respiratory disease management.
{"title":"Guidance for type 2 inflammatory biomarkers","authors":"Kazuto Matsunaga , Akira Koarai , Hiroshi Koto , Toshihiro Shirai , Masato Muraki , Masao Yamaguchi , Masayuki Hanaoka","doi":"10.1016/j.resinv.2025.01.003","DOIUrl":"10.1016/j.resinv.2025.01.003","url":null,"abstract":"<div><div>Type 2 inflammation in the airways and lungs is inflammation induced by type 2 cytokines such as IL-4, IL-5, and IL-13, produced primarily by type 2 helper T cells and type 2 innate lymphoid cells, and causes changes in the physiology and structure of the airways. Type 2 inflammation is currently in the spotlight because of its direct link to the treatment of several airway and lung diseases. Abundant evidences have accumulated that inflammatory biomarkers such as blood eosinophils, fractional exhaled nitric oxide, and IgE are essential clinical tools in the diagnosis and management of asthma and COPD. It is well known that asthma and COPD have diverse inflammatory phenotypes even when clinical features are similar, and it has been demonstrated that assessment of airway inflammation with biomarkers can improve diagnostic accuracy, determine safer and more effective treatment strategies, and predict future risks such as exacerbations and lung function decline. The Japanese Respiratory Society has published clinical practice guidelines for the evaluation of type 2 inflammation in the airways and lungs. In addition to asthma and COPD, the guide covers a wide range of airway and lung diseases, including interstitial lung disease, allergic bronchopulmonary mycosis, allergic rhinitis, and eosinophilic chronic rhinosinusitis. It also provides comprehensive guidelines covering a variety of clinical biomarkers. The purpose of this guidance is to provide evidences for the interpretation of type 2 inflammation measurements and to promote the widespread use of inflammation assessment to further improve the efficiency of airway and respiratory disease management.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 3","pages":"Pages 273-288"},"PeriodicalIF":2.4,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143437947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Immune-related pneumonitis (irP) is a severe immune-related adverse event that can occur after treatment with immune checkpoint inhibitors (ICIs); accurate monitoring and early diagnosis are crucial. Serum Krebs von den Lungen-6 (KL-6) and surfactant protein-D (SP-D) are used to diagnose and monitor the disease activity of various types of interstitial lung disease. This study evaluated the usefulness of KL-6 and SP-D for diagnosing irP in cancer patients receiving ICIs.
Patients and methods
This retrospective observational study included cancer patients treated with more than two cycles of ICIs from September 2014 to October 2023. Receiver operating characteristic (ROC) analysis was used to assess the diagnostic utility of KL-6 and SP-D.
Results
Of the 724 cancer patients, 631 were included in the analysis, and 64 developed irP. The ROC analysis showed that KL-6 and SP-D had areas under the curve of 0.803 and 0.845, respectively. Serum KL-6 ≥ 500 U/mL had a sensitivity of 65.6% and a specificity of 83.4% for the diagnosis of irP, while SP-D ≥ 110 ng/mL had a sensitivity of 66.7% and a specificity of 88.6%. Combining both KL-6 ≥ 500 U/mL and SP-D ≥ 110 ng/mL resulted in a specificity of 96.6%, with a sensitivity of 46.7%. Combining either KL-6 ≥ 500 U/mL or SP-D ≥ 110 ng/mL resulted in a sensitivity of 85.0%, with a specificity of 75.5%. SP-D levels were significantly associated with irP severity, while KL-6 levels were not.
Conclusions
Serum KL-6 and SP-D are useful for diagnosing irP in cancer patients receiving ICIs.
{"title":"Utility of serum Krebs von den Lungen-6 and surfactant protein-D levels for the diagnosis of immune checkpoint inhibitor-induced immune-related pneumonitis","authors":"Shogo Nakai , Masato Karayama , Yusuke Inoue , Hideki Yasui , Hironao Hozumi , Yuzo Suzuki , Kazuki Furuhashi , Tomoyuki Fujisawa , Noriyuki Enomoto , Satoshi Funayama , Shintaro Ichikawa , Satoshi Goshima , Naoki Inui , Takafumi Suda","doi":"10.1016/j.resinv.2025.02.005","DOIUrl":"10.1016/j.resinv.2025.02.005","url":null,"abstract":"<div><h3>Background</h3><div>Immune-related pneumonitis (irP) is a severe immune-related adverse event that can occur after treatment with immune checkpoint inhibitors (ICIs); accurate monitoring and early diagnosis are crucial. Serum Krebs von den Lungen-6 (KL-6) and surfactant protein-D (SP-D) are used to diagnose and monitor the disease activity of various types of interstitial lung disease. This study evaluated the usefulness of KL-6 and SP-D for diagnosing irP in cancer patients receiving ICIs.</div></div><div><h3>Patients and methods</h3><div>This retrospective observational study included cancer patients treated with more than two cycles of ICIs from September 2014 to October 2023. Receiver operating characteristic (ROC) analysis was used to assess the diagnostic utility of KL-6 and SP-D.</div></div><div><h3>Results</h3><div>Of the 724 cancer patients, 631 were included in the analysis, and 64 developed irP. The ROC analysis showed that KL-6 and SP-D had areas under the curve of 0.803 and 0.845, respectively. Serum KL-6 ≥ 500 U/mL had a sensitivity of 65.6% and a specificity of 83.4% for the diagnosis of irP, while SP-D ≥ 110 ng/mL had a sensitivity of 66.7% and a specificity of 88.6%. Combining both KL-6 ≥ 500 U/mL and SP-D ≥ 110 ng/mL resulted in a specificity of 96.6%, with a sensitivity of 46.7%. Combining either KL-6 ≥ 500 U/mL or SP-D ≥ 110 ng/mL resulted in a sensitivity of 85.0%, with a specificity of 75.5%. SP-D levels were significantly associated with irP severity, while KL-6 levels were not.</div></div><div><h3>Conclusions</h3><div>Serum KL-6 and SP-D are useful for diagnosing irP in cancer patients receiving ICIs.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 3","pages":"Pages 259-264"},"PeriodicalIF":2.4,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143427997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-18DOI: 10.1016/S2212-5345(25)00015-2
{"title":"Appreciation to reviewers in 2024","authors":"","doi":"10.1016/S2212-5345(25)00015-2","DOIUrl":"10.1016/S2212-5345(25)00015-2","url":null,"abstract":"","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 2","pages":"Pages I-II"},"PeriodicalIF":2.4,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143436634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Adherence to inhalation therapy impacts treatment outcomes of asthma and chronic obstructive pulmonary disease. Although taste changes induced by inhaled medications may influence adherence, this matter remains underexplored. This study aimed to elucidate the characteristics of taste changes caused by inhaled medications and their association with adherence.
Methods
Consecutive patients who regularly visited our hospital from August 2023 to December 2023 were recruited. Sweet, bitter, sour, and salty taste changes were assessed using a visual analog scale. Adherence was measured using a structured questionnaire.
Results
Data from 491 inhaler responses (463 patients, aged 68.2 ± 13.5 years) were analyzed. Inhaled corticosteroid (ICS)/long-acting beta2-agonist (LABA)/long-acting muscarinic antagonist (LAMA) therapy promoted the most significant bitter taste change. Besides a long duration of taste changes (over a minute), dry powder inhaler devices (β = 0.19, P < 0.001) were significantly associated with sweet taste changes. Younger age (β = −0.17, P < 0.001), absence of a water rinse before inhalation (β = −0.09, P = 0.027), and inhalers containing LAMA (β = 0.22, P < 0.001) were associated with bitter taste changes. Older age (β = 0.10, P = 0.025) was associated with sour taste changes. Bitter taste changes (β = −0.17, P = 0.027) among users of inhalers containing LAMA and younger age (β = 0.15, P = 0.011) among users of inhalers not-containing LAMA were associated with poor adherence.
Conclusions
ICS/LABA/LAMA therapy induced the most significant bitter taste changes. The absence of a water rinse before inhalation was associated with bitter taste changes. Bitter taste changes among users of inhalers containing LAMA were correlated with poor adherence, highlighting the need for targeted interventions to improve adherence.
{"title":"Impact of taste changes caused by inhalers on adherence to inhalation therapy among patients with asthma and chronic obstructive pulmonary disease","authors":"Takeshi Matsumoto, Yuichi Kajiwara, Tomoya Matoba, Akiko Kaneko, Takahiro Fujiki, Yusuke Kusakabe, Emi Nakayama, Ayaka Tanaka, Naoki Yamamoto, Mayuko Tashima, Chikara Ito, Kensaku Aihara, Shinpachi Yamaoka","doi":"10.1016/j.resinv.2025.02.004","DOIUrl":"10.1016/j.resinv.2025.02.004","url":null,"abstract":"<div><h3>Background</h3><div>Adherence to inhalation therapy impacts treatment outcomes of asthma and chronic obstructive pulmonary disease. Although taste changes induced by inhaled medications may influence adherence, this matter remains underexplored. This study aimed to elucidate the characteristics of taste changes caused by inhaled medications and their association with adherence.</div></div><div><h3>Methods</h3><div>Consecutive patients who regularly visited our hospital from August 2023 to December 2023 were recruited. Sweet, bitter, sour, and salty taste changes were assessed using a visual analog scale. Adherence was measured using a structured questionnaire.</div></div><div><h3>Results</h3><div>Data from 491 inhaler responses (463 patients, aged 68.2 ± 13.5 years) were analyzed. Inhaled corticosteroid (ICS)/long-acting beta2-agonist (LABA)/long-acting muscarinic antagonist (LAMA) therapy promoted the most significant bitter taste change. Besides a long duration of taste changes (over a minute), dry powder inhaler devices (β = 0.19, P < 0.001) were significantly associated with sweet taste changes. Younger age (β = −0.17, P < 0.001), absence of a water rinse before inhalation (β = −0.09, P = 0.027), and inhalers containing LAMA (β = 0.22, P < 0.001) were associated with bitter taste changes. Older age (β = 0.10, P = 0.025) was associated with sour taste changes. Bitter taste changes (β = −0.17, P = 0.027) among users of inhalers containing LAMA and younger age (β = 0.15, P = 0.011) among users of inhalers not-containing LAMA were associated with poor adherence.</div></div><div><h3>Conclusions</h3><div>ICS/LABA/LAMA therapy induced the most significant bitter taste changes. The absence of a water rinse before inhalation was associated with bitter taste changes. Bitter taste changes among users of inhalers containing LAMA were correlated with poor adherence, highlighting the need for targeted interventions to improve adherence.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 3","pages":"Pages 252-258"},"PeriodicalIF":2.4,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143419938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-14DOI: 10.1016/j.resinv.2025.02.003
Satoshi Hamada , Eriko Ogino , Hirotaka Yasuba
Identifying which biomarkers and comorbidities of type 2 (T2) inflammation to focus on when selecting biologics has remained challenging. We retrospectively examined which biomarkers and comorbidities could influence asthma control among T2-high severe asthma patients receiving biologics. Patients without any maintenance oral corticosteroids and exacerbations requiring systemic corticosteroids indicated super-responder (SR). Clinical remission (CR) was defined as fulfilling the following criteria in addition to achieving SR: asthma symptom improvement (asthma control test score ≥23) and pulmonary function improvement (%forced expiratory volume in 1 s ≥ 80%). We initiated and switched biologics to achieve SR and CR. In total, 111 patients were evaluated, among whom 85.6% and 27.0%–50.5% demonstrated SR and CR, respectively. CR was more frequently observed among patients with severe eosinophilic chronic rhinosinusitis (ECRS) than among those without it. Attention must be paid to the existence of severe ECRS to achieve CR in patients with uncontrolled T2-high severe asthma.
{"title":"Eosinophilic chronic rhinosinusitis as a predictor of super-responder and clinical remission in patients with uncontrolled type 2-high severe asthma treated with biologics","authors":"Satoshi Hamada , Eriko Ogino , Hirotaka Yasuba","doi":"10.1016/j.resinv.2025.02.003","DOIUrl":"10.1016/j.resinv.2025.02.003","url":null,"abstract":"<div><div>Identifying which biomarkers and comorbidities of type 2 (T2) inflammation to focus on when selecting biologics has remained challenging. We retrospectively examined which biomarkers and comorbidities could influence asthma control among T2-high severe asthma patients receiving biologics. Patients without any maintenance oral corticosteroids and exacerbations requiring systemic corticosteroids indicated super-responder (SR). Clinical remission (CR) was defined as fulfilling the following criteria in addition to achieving SR: asthma symptom improvement (asthma control test score ≥23) and pulmonary function improvement (%forced expiratory volume in 1 s ≥ 80%). We initiated and switched biologics to achieve SR and CR. In total, 111 patients were evaluated, among whom 85.6% and 27.0%–50.5% demonstrated SR and CR, respectively. CR was more frequently observed among patients with severe eosinophilic chronic rhinosinusitis (ECRS) than among those without it. Attention must be paid to the existence of severe ECRS to achieve CR in patients with uncontrolled T2-high severe asthma.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 3","pages":"Pages 247-251"},"PeriodicalIF":2.4,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143403309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The 6-min walk test (6MWT), used to monitor disease progression or exacerbation in interstitial lung disease, faces challenges such as requiring a 30-m walking path and difficulty assessing patients with gait disturbance. The 1-min sit-to-stand test (1STST) offers a convenient alternative, potentially addressing these issues. Despite its advantages, the effectiveness of the 1STST in patients with idiopathic pulmonary fibrosis (IPF) and progressive pulmonary fibrosis (PPF) still needs to be explored. We assessed 1STST's ability to detect exercise-induced desaturation in a randomized, crossover trial involving patients with IPF or PPF.
Methods
Participants were divided into group A (6MWT to 1STST) and B (1STST to 6MWT), with a 30-min rest period between the tests. The primary endpoint was the difference in nadir oxygen saturation (SpO2) between the groups throughout the study. Secondary endpoints included the percentage of participants with a nadir SpO₂ <88% during the tests, a decline of ≥4% in SpO2, and the variation in Borg scores post-tests.
Results
Twenty-three participants (91.3% male; mean age ± standard deviation: 77.2 ± 7.4 years) diagnosed with IPF and PPF were enrolled in this study. The difference in nadir SpO2 between the 1STST and 6MWT was 1.14% (95% confidence interval: −0.18, 2.48), with the 95% confidence intervals falling within the predefined equivalence range. No significant differences were observed in the secondary endpoints.
Conclusions
The results suggest that the 1STST is as effective as the 6MWT in detecting desaturation in patients with IPF and PPF.
Trial registration
This study was registered on the website of the Japan Registry of Clinical Trials (jRCT1032230037; URL: https://jrct.niph.go.jp/).
{"title":"One-minute sit-to-stand test to detect gas exchange capacity during exercise stress in patients with idiopathic or progressive pulmonary fibrosis: A randomized, crossover trial","authors":"Yoshito Miyata, Akihiko Tanaka, Yuiko Goto, Takaya Ebato, Hiromitsu Suganuma, Makoto Nojo, Hatsuko Mikuni, Tomoki Uno, Yoshitaka Uchida, Megumi Jinno, Shin Ohta, Tetsuya Homma, Yoshio Watanabe, Sojiro Kusumoto, Hironori Sagara","doi":"10.1016/j.resinv.2025.01.008","DOIUrl":"10.1016/j.resinv.2025.01.008","url":null,"abstract":"<div><h3>Background</h3><div>The 6-min walk test (6MWT), used to monitor disease progression or exacerbation in interstitial lung disease, faces challenges such as requiring a 30-m walking path and difficulty assessing patients with gait disturbance. The 1-min sit-to-stand test (1STST) offers a convenient alternative, potentially addressing these issues. Despite its advantages, the effectiveness of the 1STST in patients with idiopathic pulmonary fibrosis (IPF) and progressive pulmonary fibrosis (PPF) still needs to be explored. We assessed 1STST's ability to detect exercise-induced desaturation in a randomized, crossover trial involving patients with IPF or PPF.</div></div><div><h3>Methods</h3><div>Participants were divided into group A (6MWT to 1STST) and B (1STST to 6MWT), with a 30-min rest period between the tests. The primary endpoint was the difference in nadir oxygen saturation (SpO<sub>2</sub>) between the groups throughout the study. Secondary endpoints included the percentage of participants with a nadir SpO₂ <88% during the tests, a decline of ≥4% in SpO<sub>2,</sub> and the variation in Borg scores post-tests.</div></div><div><h3>Results</h3><div>Twenty-three participants (91.3% male; mean age ± standard deviation: 77.2 ± 7.4 years) diagnosed with IPF and PPF were enrolled in this study. The difference in nadir SpO<sub>2</sub> between the 1STST and 6MWT was 1.14% (95% confidence interval: −0.18, 2.48), with the 95% confidence intervals falling within the predefined equivalence range. No significant differences were observed in the secondary endpoints.</div></div><div><h3>Conclusions</h3><div>The results suggest that the 1STST is as effective as the 6MWT in detecting desaturation in patients with IPF and PPF.</div></div><div><h3>Trial registration</h3><div>This study was registered on the website of the Japan Registry of Clinical Trials (jRCT1032230037; URL: <span><span>https://jrct.niph.go.jp/</span><svg><path></path></svg></span>).</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 3","pages":"Pages 241-246"},"PeriodicalIF":2.4,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143379301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Systemic sclerosis-associated interstitial lung disease (SSc-ILD) is known to have a poor prognosis and the relationships between histological findings and response to anti-inflammatory therapy or prognosis have not been well investigated.
Methods
We examined SSc-ILD patients who underwent surgical lung biopsy at a single respiratory center between 2008 and 2021 and received anti-inflammatory therapy (corticosteroids and/or immunosuppressive drugs). These patients were classified into two groups: an inflammation group, where histological evidence of inflammation defined as “lymphoid aggregates with germinal centers” or “plasmacytosis” was observed, and a non-inflammation group, where these findings were not observed. The correlation of the histological conclusions of inflammation with treatment response and prognosis was retrospectively investigated.
Results
Twenty-seven patients were included in the study; 15 (55.6%) were allocated to the inflammation group and 12 (44.4%) to the non-inflammation group. Patient backgrounds did not differ between the groups. The first annual increase in % predicted FVC was significantly larger in the inflammation group than in the non-inflammation one (from 74.3% to 85.9% vs. 75.0%–74.7%, respectively; p = 0.021). The inflammation group took significantly longer to reach end-stage lung disease, defined as an FVC <50%, needing continuous oxygen, or death (p = 0.011). They also had a trend towards longer overall survival compared to the non-inflammation group (median survival: not reached vs. 6.6 years, p = 0.083).
Conclusions
Approximately half of the SSc-ILD patients showed histological evidence of inflammation, which may influence treatment response and long-term disease progression.
{"title":"Clinical significance of histological inflammation in systemic sclerosis-associated interstitial lung disease","authors":"Shuko Hirota , Yasuhiko Yamano , Reoto Takei , Jun Fukihara , Hajime Sasano , Toshiaki Matsuda , Kensuke Kataoka , Tomoki Kimura , Hisao Sano , Junya Fukuoka , Takeshi Johko , Yasuhiro Kondoh","doi":"10.1016/j.resinv.2025.01.001","DOIUrl":"10.1016/j.resinv.2025.01.001","url":null,"abstract":"<div><h3>Background</h3><div>Systemic sclerosis-associated interstitial lung disease (SSc-ILD) is known to have a poor prognosis and the relationships between histological findings and response to anti-inflammatory therapy or prognosis have not been well investigated.</div></div><div><h3>Methods</h3><div>We examined SSc-ILD patients who underwent surgical lung biopsy at a single respiratory center between 2008 and 2021 and received anti-inflammatory therapy (corticosteroids and/or immunosuppressive drugs). These patients were classified into two groups: an inflammation group, where histological evidence of inflammation defined as “lymphoid aggregates with germinal centers” or “plasmacytosis” was observed, and a non-inflammation group, where these findings were not observed. The correlation of the histological conclusions of inflammation with treatment response and prognosis was retrospectively investigated.</div></div><div><h3>Results</h3><div>Twenty-seven patients were included in the study; 15 (55.6%) were allocated to the inflammation group and 12 (44.4%) to the non-inflammation group. Patient backgrounds did not differ between the groups. The first annual increase in % predicted FVC was significantly larger in the inflammation group than in the non-inflammation one (from 74.3% to 85.9% vs. 75.0%–74.7%, respectively; p = 0.021). The inflammation group took significantly longer to reach end-stage lung disease, defined as an FVC <50%, needing continuous oxygen, or death (p = 0.011). They also had a trend towards longer overall survival compared to the non-inflammation group (median survival: not reached vs. 6.6 years, p = 0.083).</div></div><div><h3>Conclusions</h3><div>Approximately half of the SSc-ILD patients showed histological evidence of inflammation, which may influence treatment response and long-term disease progression.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 2","pages":"Pages 233-239"},"PeriodicalIF":2.4,"publicationDate":"2025-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143372224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The acute pleural empyema guidelines recommend thoracoscopic-assisted surgery. However, there is no clear guideline for chest tube removal after surgery. This study aimed to evaluate the duration from surgery to chest tube removal, identify associated factors.
Methods
A retrospective cohort study was conducted in 95 patients having non-fistulous empyema due to pulmonary infection caused by common bacteria who underwent surgery at our hospital from January 2011 to March 2023. Postoperative lavage was conducted until two consecutive pleural fluid cultures were negative. The chest tube was clamped and removed if there was no exacerbation of fever or inflammatory findings for 2 days.
Results
Seventy-eight patients (82.1%) were men with a mean age of 72 years. The median duration from surgery to chest tube removal was 14 (interquartile range: 8–22) days. In the multivariable analysis, the independent factors associated with the duration from surgery to chest tube removal were lower prognostic nutritional index (hazard ratio [HR], 1.753; 95% confidence interval [CI], 1.101–2.792; P = 0.018) and positive preoperative pleural fluid culture (HR, 1.867; 95% CI, 1.069–3.261; P = 0.028). Ninety-two (96.8%) patients did not require additional treatment or rehospitalization.
Conclusions
Positive preoperative pleural fluid culture and nutritional status were significant independent factors associated with the duration from surgery to chest tube removal. Almost all patients did not require chest tube reinsertion in our approach. These findings using our approach may guide optimal management of chest tube removal in non-fistulous empyema.
{"title":"A refined approach to chest tube removal: Impact of preoperative pleural fluid culture and nutritional status in non-fistulous empyema surgery","authors":"Yasoo Sugiura , Toshinori Hashizume , Hiroyuki Fujimoto , Seiji Omura , Nozomi Watanobe","doi":"10.1016/j.resinv.2025.01.004","DOIUrl":"10.1016/j.resinv.2025.01.004","url":null,"abstract":"<div><h3>Background</h3><div>The acute pleural empyema guidelines recommend thoracoscopic-assisted surgery. However, there is no clear guideline for chest tube removal after surgery. This study aimed to evaluate the duration from surgery to chest tube removal, identify associated factors.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted in 95 patients having non-fistulous empyema due to pulmonary infection caused by common bacteria who underwent surgery at our hospital from January 2011 to March 2023. Postoperative lavage was conducted until two consecutive pleural fluid cultures were negative. The chest tube was clamped and removed if there was no exacerbation of fever or inflammatory findings for 2 days.</div></div><div><h3>Results</h3><div>Seventy-eight patients (82.1%) were men with a mean age of 72 years. The median duration from surgery to chest tube removal was 14 (interquartile range: 8–22) days. In the multivariable analysis, the independent factors associated with the duration from surgery to chest tube removal were lower prognostic nutritional index (hazard ratio [HR], 1.753; 95% confidence interval [CI], 1.101–2.792; P = 0.018) and positive preoperative pleural fluid culture (HR, 1.867; 95% CI, 1.069–3.261; P = 0.028). Ninety-two (96.8%) patients did not require additional treatment or rehospitalization.</div></div><div><h3>Conclusions</h3><div>Positive preoperative pleural fluid culture and nutritional status were significant independent factors associated with the duration from surgery to chest tube removal. Almost all patients did not require chest tube reinsertion in our approach. These findings using our approach may guide optimal management of chest tube removal in non-fistulous empyema.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 2","pages":"Pages 226-232"},"PeriodicalIF":2.4,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143222485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Idiopathic interstitial pneumonias (IIPs) may remain unclassifiable owing to inadequate, nonspecific, or conflicting clinical, radiological, or histopathological findings despite multidisciplinary discussion (MDD). Unclassifiable IIP (UCIIP) is a heterogeneous disease that can present with progressive pulmonary fibrosis (PPF). This study aimed to investigate the prevalence and clinical features of PPF in patients with UCIIP.
Methods
In this post hoc analysis of a prospective multicenter registry of 222 patients with IIPs, 71 with UCIIP diagnosed using MDD were enrolled. PPF was defined based on worsening symptoms and radiological and physiological progression using the guideline criteria within 12 months or the criteria from the INBUILD trial within 24 months.
Results
The median age was 72 years, and surgical lung biopsy was performed in 19.7%. Of the 66 patients with adequate follow-up data, 30 (45.5%) met either criterion and were diagnosed with PPF. UCIIP patients with PPF had significantly higher serum surfactant protein-D level and percentage of bronchoalveolar fluid neutrophils, lower %forced vital capacity and %diffusing capacity for carbon monoxide, and a higher proportion of honeycombing on high-resolution computed tomography and desaturation on exertion than those without PPF. Additionally, they had significantly more anti-fibrotic therapy and long-term oxygen therapy, a higher incidence of acute exacerbation, and a poorer prognosis than those without PPF. Cox proportional hazards analysis revealed that PPF was a significant poor prognostic factor, regardless of the criteria.
Conclusions
PPF is common and associated with poor prognosis in patients with UCIIP. Appropriate evaluation and management of PPF are essential for UCIIP.
{"title":"Prevalence and clinical features of progressive pulmonary fibrosis in patients with unclassifiable idiopathic interstitial pneumonia: A post hoc analysis of prospective multicenter registry","authors":"Masato Kono , Noriyuki Enomoto , Yusuke Inoue , Hideki Yasui , Masato Karayama , Yuzo Suzuki , Hironao Hozumi , Kazuki Furuhashi , Mikio Toyoshima , Shiro Imokawa , Masato Fujii , Taisuke Akamatsu , Naoki Koshimizu , Koshi Yokomura , Hiroyuki Matsuda , Yusuke Kaida , Yutaro Nakamura , Masahiro Shirai , Masafumi Masuda , Tomoyuki Fujisawa , Takafumi Suda","doi":"10.1016/j.resinv.2025.01.007","DOIUrl":"10.1016/j.resinv.2025.01.007","url":null,"abstract":"<div><h3>Background</h3><div>Idiopathic interstitial pneumonias (IIPs) may remain unclassifiable owing to inadequate, nonspecific, or conflicting clinical, radiological, or histopathological findings despite multidisciplinary discussion (MDD). Unclassifiable IIP (UCIIP) is a heterogeneous disease that can present with progressive pulmonary fibrosis (PPF). This study aimed to investigate the prevalence and clinical features of PPF in patients with UCIIP.</div></div><div><h3>Methods</h3><div>In this post hoc analysis of a prospective multicenter registry of 222 patients with IIPs, 71 with UCIIP diagnosed using MDD were enrolled. PPF was defined based on worsening symptoms and radiological and physiological progression using the guideline criteria within 12 months or the criteria from the INBUILD trial within 24 months.</div></div><div><h3>Results</h3><div>The median age was 72 years, and surgical lung biopsy was performed in 19.7%. Of the 66 patients with adequate follow-up data, 30 (45.5%) met either criterion and were diagnosed with PPF. UCIIP patients with PPF had significantly higher serum surfactant protein-D level and percentage of bronchoalveolar fluid neutrophils, lower %forced vital capacity and %diffusing capacity for carbon monoxide, and a higher proportion of honeycombing on high-resolution computed tomography and desaturation on exertion than those without PPF. Additionally, they had significantly more anti-fibrotic therapy and long-term oxygen therapy, a higher incidence of acute exacerbation, and a poorer prognosis than those without PPF. Cox proportional hazards analysis revealed that PPF was a significant poor prognostic factor, regardless of the criteria.</div></div><div><h3>Conclusions</h3><div>PPF is common and associated with poor prognosis in patients with UCIIP. Appropriate evaluation and management of PPF are essential for UCIIP.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 2","pages":"Pages 216-223"},"PeriodicalIF":2.4,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143075333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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