Respiratory investigation最新文献_第2页

Factors associated with non-intervention of antifibrotic agents in IPF patients IPF 患者不使用抗纤维化药物的相关因素。

IF 2.4 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2024-10-02 DOI: 10.1016/j.resinv.2024.09.008

Background

The efficacy of antifibrotic agents in idiopathic pulmonary fibrosis (IPF) has been demonstrated and early introduction is recommended, especially in patients with preserved performance status (PS). We aimed to determine the proportion of untreated IPF cases using real-world data and to assess the factors associated with non-intervention.

Methods

A prospective observational study using questionnaires was performed on 518 patients with interstitial lung disease (ILD) and their attending physicians who visited a clinic, general hospital, or tertiary respiratory center between December 2019 and October 2020. Patients responded with subjective symptoms and PS, whereas physicians responded with diagnosis, treatment, and reasons for their treatment choices. Principal component analysis (PCA) was performed using age, sex, BMI, medical facility, specialized tests, and symptom severity.

Results

We included 207 patients with IPF. Among them, 168 has a good PS (≤2), which could be indicative of treatment; 130 (77.4%) were not treated with antifibrotic agents. The PCA revealed a trend consistent with that of antifibrotic agent therapy and the distribution of medical facilities, with a treatment intervention rate of 16% in general hospitals and 62% in tertiary respiratory centers. In general hospitals, low symptom severity (PS, mMRC, and no use of long-term oxygen therapy) was a relevant factor for non-intervention with antifibrotic agents (p < 0.001).

Conclusion

Antifibrotic treatment interventions varied by facility in cases with good PS. Patients with milder symptoms are not being treated early in general hospitals and more collaboration between general hospitals and specialized facilities is necessary.

背景：抗纤维化药物对特发性肺纤维化（IPF）的疗效已得到证实，建议尽早使用，尤其是对表现状态（PS）保持良好的患者。我们旨在利用真实世界的数据确定未经治疗的 IPF 病例比例，并评估与不干预相关的因素：2019年12月至2020年10月期间，我们对在诊所、综合医院或三级呼吸中心就诊的518名间质性肺病（ILD）患者及其主治医生进行了一项前瞻性观察研究，采用问卷调查的方式。患者回答了主观症状和 PS，而医生则回答了诊断、治疗和选择治疗的原因。利用年龄、性别、体重指数、医疗机构、专业检查和症状严重程度进行了主成分分析（PCA）：我们共纳入了 207 名 IPF 患者。其中，168 名患者的 PS 值良好（≤2），这可能是治疗的指标；130 名患者（77.4%）未接受抗纤维化药物治疗。PCA显示的趋势与抗纤维化药物治疗和医疗机构分布一致，综合医院的治疗干预率为16%，三级呼吸中心为62%。在综合医院，症状严重程度低（PS、mMRC 和未使用长期氧疗）是不干预抗纤维化药物治疗的一个相关因素（P 结论：在综合医院和三级呼吸中心，抗纤维化药物治疗干预率分别为 16%和 62%：在 PS 良好的病例中，抗纤维化治疗干预因医疗机构而异。综合医院没有对症状较轻的患者进行早期治疗，因此综合医院和专科医院之间有必要加强合作。

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引用次数: 0

Feasibility of a problem-solving exercise program based on short physical performance battery for older patients with chronic respiratory diseases: A multicenter, pilot clinical trial 为老年慢性呼吸系统疾病患者设计的基于短期体能测试的问题解决锻炼计划的可行性：多中心试点临床试验。

IF 2.4 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2024-10-02 DOI: 10.1016/j.resinv.2024.09.016

Background

This study aimed to assess the feasibility and safety of a problem-solving exercise program based on the items in the short physical performance battery (SPPB) for older patients with chronic respiratory diseases (CRDs) to inform future randomized controlled trials.

Methods

This was a multicenter, prospective, non-randomized feasibility study. Participants with CRD received an enhancement program based on the SPPB decline items (balance, walk, and/or chair stand) for 4 weeks. The feasibility, safety, and efficacy of the problem-solving exercise program in improving the SPPB score, physical function, and step count (measured using a pedometer) were assessed.

Results

Overall, 36 patients were enrolled in this study, and adherence to the exercise program was high (100%). No exercise program-related adverse events were observed. The implementation of the exercise program ranged from 70 to 100%. The mean daily step count increased from 2152 ± 1498 steps during the first week to 2899 ± 1865 steps in the last week (p<0.01). Additionally, the SPPB total score increased from 8.9 ± 1.8 points to 10.7 ± 1.3 points at the end of the program (p<0.001).

Conclusions

The problem-solving exercise program based on SPPB is feasible and safe for older patients with CRDs. However, the effectiveness of this exercise program should be validated in large-scale, randomized-controlled trials in the future.

Trial registration

University Hospital Medical Information Network Center (UMIN-CTR) UMIN: approval number: UMIN000048761.

背景：本研究旨在评估基于短期体能测试（SPPB）项目的问题解决锻炼计划对老年慢性呼吸系统疾病（CRDs）患者的可行性和安全性，为未来的随机对照试验提供参考：这是一项多中心、前瞻性、非随机的可行性研究。患有慢性呼吸系统疾病的参与者接受了一项基于 SPPB 下降项目（平衡、行走和/或椅子站立）的增强计划，为期 4 周。研究评估了问题解决运动项目在改善 SPPB 评分、身体功能和步数（使用计步器测量）方面的可行性、安全性和有效性：本研究共招募了 36 名患者，他们对运动计划的依从性很高（100%）。没有观察到与运动计划相关的不良事件。运动计划的执行率从 70% 到 100% 不等。平均每日步数从第一周的 2152 ± 1498 步增加到最后一周的 2899 ± 1865 步（p 结论：基于问题解决的运动计划能够帮助患者在运动过程中提高身体素质：基于 SPPB 的问题解决运动计划对于患有慢性阻塞性肺病的老年患者是可行且安全的。然而，这项运动计划的有效性应在未来的大规模随机对照试验中得到验证：试验注册：大学医院医疗信息网络中心（UMIN-CTR）UMIN：批准号：UMIN000048761：UMIN000048761。

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引用次数: 0

Epidemiology of chronic pulmonary aspergillosis: A nationwide descriptive study 慢性肺曲霉菌病的流行病学：全国性描述性研究

IF 2.4 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2024-10-01 DOI: 10.1016/j.resinv.2024.09.015

Background

Chronic pulmonary aspergillosis (CPA) has recently gained attention owing to its substantial health burden. However, the precise epidemiology and prognosis of the disease are still unclear due to the lack of a nationwide descriptive analysis. This study aimed to elucidate the epidemiology of patients with CPA and to investigate their prognosis.

Methods

Using a national administrative database covering >99% of the population in Japan, we calculated the nationwide incidence and prevalence of CPA from 2016 to 2022. Additionally, we clarified the survival rate of patients diagnosed with CPA and identified independent prognostic factors using multivariate Cox proportional hazard analysis.

Results

During the study period, while the prevalence of CPA remained stable at 9.0–9.5 per 100,000 persons, its incidence declined to 2.1 from 3.5 per 100,000 person-years. The 1-, 3-, and 5-year survival rates were 65%, 48%, and 41%, respectively. During the year of CPA onset, approximately 50% of patients received oral corticosteroids (OCS) at least once, while about 30% underwent frequent OCS treatment (≥4 times per year) within the same timeframe. Increased mortality was independently associated with older age (>65 years) (hazard ratio [HR], 2.65; 95% confidence interval (CI), 2.54–2.77), males (1.24; 1.20–1.29), a history of chronic obstructive pulmonary disease (1.05; 1.02–1.09), lung cancer (1.12; 1.06–1.18); and ILD (1.19; 1.14–1.24); and frequent OCS use (1.13; 1.09–1.17). Conversely, decreased mortality was associated with a history of tuberculosis (HR, 0.81; 95% CI, 0.76–0.86), non-tuberculous mycobacteria (0.91; 0.86–0.96), and other chronic pulmonary diseases (0.89; 0.85–0.92).

Conclusions

The incidence of CPA decreased over the past decade, although the prevalence was stable and much higher than that in European countries. Moreover, the patients’ prognosis was poor. Physicians should be vigilant about CPA onset in patients with specific high-risk underlying pulmonary conditions.

背景：慢性肺曲霉菌病（CPA）最近因其对健康造成的巨大负担而备受关注。然而，由于缺乏全国性的描述性分析，该病的确切流行病学和预后仍不清楚。本研究旨在阐明 CPA 患者的流行病学并调查其预后：我们利用覆盖日本超过 99% 人口的全国行政数据库，计算了 2016 年至 2022 年 CPA 的全国发病率和流行率。此外，我们还明确了确诊为 CPA 患者的生存率，并使用多变量 Cox 比例危险分析确定了独立的预后因素：研究期间，CPA 的患病率稳定在每 10 万人 9.0-9.5 例，而发病率则从每 10 万人 3.5 例下降到 2.1 例。1年、3年和5年存活率分别为65%、48%和41%。在CPA发病当年，约50%的患者至少接受了一次口服皮质类固醇（OCS）治疗，约30%的患者在同一时期内接受了频繁的OCS治疗（每年≥4次）。死亡率的增加与以下因素独立相关：年龄较大（大于 65 岁）（危险比 [HR]，2.65；95% 置信区间 (CI)，2.54-2.77）、男性（1.24；1.20-1.29）、慢性阻塞性肺病病史（1.05；1.02-1.09）、肺癌（1.12；1.06-1.18）和 ILD（1.19；1.14-1.24）；以及频繁使用 OCS（1.13；1.09-1.17）。相反，死亡率的降低与结核病史（HR，0.81；95% CI，0.76-0.86）、非结核分枝杆菌（0.91；0.86-0.96）和其他慢性肺部疾病（0.89；0.85-0.92）有关：结论：在过去十年中，CPA 的发病率有所下降，但流行率保持稳定，且远高于欧洲国家。此外，患者的预后较差。医生应警惕具有特定高风险基础肺部疾病的患者是否会患上 CPA。

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引用次数: 0

Chronic obstructive pulmonary disease, asthma, and mechanical ventilation are risk factors for dyspnea in patients with long COVID: A Japanese nationwide cohort study 慢性阻塞性肺病、哮喘和机械通气是导致长 COVID 患者呼吸困难的危险因素：一项日本全国性队列研究

IF 2.4 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2024-09-28 DOI: 10.1016/j.resinv.2024.09.009

Background

Patients often experience multiple prolonged symptoms following acute coronavirus disease 2019 (COVID-19) recovery, defined as long coronavirus disease (COVID). Patients with long COVID may experience dyspnea during acute and post-acute phases. Therefore, this study aimed to identify specific risk factors for dyspnea in patients with long COVID.

Methods

Hospitalized patients with COVID-19, aged ≥18 years, were enrolled in this multicenter cohort study conducted at 26 medical institutions across Japan. Clinical data during hospitalization and patient-reported outcomes after discharge at the 3, 6, and 12-month follow-ups were retrieved from medical records and paper-based or smartphone application-based questionnaires, respectively.

Results

Generalized linear mixed model (GLMM) analysis of prolonged dyspnea at each time point during follow-up showed that this symptom was associated with chronic obstructive pulmonary disease (COPD) (odds ratio [OR], 2.74; 95% confidence interval [CI], 1.31–5.74), asthma (OR, 2.21; 95%CI, 1.17–4.16), and ventilator management (OR, 3.10; 95%CI, 1.65–5.83). In addition, patients with COPD (44.4%) and ventilator management (25.0%) were more frequently associated with delayed dyspnea onset. The generalized estimating equations analysis results with multiple imputed datasets, conducted as a sensitivity analysis, confirmed the adjusted GLMM analysis results.

Conclusions

Prolonged dyspnea was associated with COPD, asthma, and severe infection that required mechanical ventilation in the Japanese population with long COVID. Further investigation is needed to clarify its mechanism and develop prophylactic and therapeutic strategies for dyspnea in patients with long COVID.

背景患者在急性冠状病毒病 2019（COVID-19）康复后往往会出现多种长期症状，这被定义为长冠状病毒病（COVID）。长程冠状病毒病患者在急性期和急性期后可能会出现呼吸困难。因此，本研究旨在确定长程冠状病毒病患者出现呼吸困难的特定风险因素。方法在日本全国 26 家医疗机构开展的这项多中心队列研究纳入了年龄≥18 岁的 COVID-19 住院患者。住院期间的临床数据和出院后 3 个月、6 个月和 12 个月随访时的患者报告结果分别来自病历和纸质或智能手机应用问卷。结果对随访期间每个时间点的长时间呼吸困难进行广义线性混合模型（GLMM）分析后发现，该症状与慢性阻塞性肺病（COPD）（几率比[OR]，2.74；95%置信区间[CI]，1.31-5.74）、哮喘（OR，2.21；95%CI，1.17-4.16）和呼吸机管理（OR，3.10；95%CI，1.65-5.83）有关。此外，慢性阻塞性肺病患者（44.4%）和呼吸机管理患者（25.0%）更经常与呼吸困难延迟发生有关。作为一项敏感性分析，使用多个估算数据集进行的广义估计方程分析结果证实了调整后的 GLMM 分析结果。需要进一步研究以明确其机制，并制定针对长 COVID 患者呼吸困难的预防和治疗策略。

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引用次数: 0

Responsiveness and minimal clinically important difference of the COPD Assessment Test in fibrotic interstitial lung disease 慢性阻塞性肺病评估测试对纤维化间质性肺病的反应性和最小临床重要差异

IF 2.4 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2024-09-26 DOI: 10.1016/j.resinv.2024.08.006

Background and objective

Patients with fibrotic interstitial lung disease (FILD) have impaired health status. The simple questionnaire in the COPD assessment test (CAT) has been validated for idiopathic pulmonary fibrosis (IPF) and connective tissue disease-related interstitial lung disease (CTD-ILD), but no or limited data exist for patients with FILD as a whole. The aim of this study was to evaluate the reliability, repeatability and responsiveness of the CAT, and estimate the minimal clinically important difference (MCID) in patients with FILD.

Methods

This study was a retrospective chart review of 358 consecutive patients with FILD including 131 with IPF, who underwent clinical assessment over 6–12 month intervals. We assessed the cross-sectional and longitudinal validity of the CAT. MCID was estimated using distribution methods and anchor methods with mean change and regression models.

Results

Internal consistency (Cronbach's alpha = 0.898) and repeatability (intraclass correlation coefficient [ICC] = 0.865) for the CAT score was acceptable. A cross-sectional study showed constructive validity. Changes in the CAT over 6–12 months were significantly associated with change in anchors including physiological function, exercise capacity, and dyspnea regardless of IPF diagnosis. The estimated MCIDs of the CAT for the deterioration and improvement directions were at least +5 and at least −3 points, respectively.

Conclusions

The CAT is a reliable, responsive and clinically relevant instrument for assessing health status in patients with FILD.

背景和目的纤维化间质性肺病（FILD）患者的健康状况受损。慢性阻塞性肺病评估测试（COPD assessment test，CAT）中的简易问卷已针对特发性肺纤维化（IPF）和结缔组织病相关间质性肺病（CTD-ILD）进行了验证，但没有关于整个纤维化间质性肺病患者的数据或数据有限。本研究的目的是评估 CAT 的可靠性、可重复性和响应性，并估算 FILD 患者的最小临床重要差异 (MCID)。我们评估了 CAT 的横向和纵向有效性。结果CAT评分的内部一致性（Cronbach's alpha = 0.898）和可重复性（类内相关系数 [ICC] = 0.865）均可接受。一项横断面研究显示了建设性有效性。无论 IPF 诊断与否，CAT 在 6-12 个月内的变化与生理功能、运动能力和呼吸困难等锚点的变化有显著相关性。结论 CAT 是一种可靠、反应灵敏且与临床相关的工具，可用于评估 FILD 患者的健康状况。

{"title":"Responsiveness and minimal clinically important difference of the COPD Assessment Test in fibrotic interstitial lung disease","authors":"","doi":"10.1016/j.resinv.2024.08.006","DOIUrl":"10.1016/j.resinv.2024.08.006","url":null,"abstract":"<div><h3>Background and objective</h3><div>Patients with fibrotic interstitial lung disease (FILD) have impaired health status. The simple questionnaire in the COPD assessment test (CAT) has been validated for idiopathic pulmonary fibrosis (IPF) and connective tissue disease-related interstitial lung disease (CTD-ILD), but no or limited data exist for patients with FILD as a whole. The aim of this study was to evaluate the reliability, repeatability and responsiveness of the CAT, and estimate the minimal clinically important difference (MCID) in patients with FILD.</div></div><div><h3>Methods</h3><div>This study was a retrospective chart review of 358 consecutive patients with FILD including 131 with IPF, who underwent clinical assessment over 6–12 month intervals. We assessed the cross-sectional and longitudinal validity of the CAT. MCID was estimated using distribution methods and anchor methods with mean change and regression models.</div></div><div><h3>Results</h3><div>Internal consistency (Cronbach's alpha = 0.898) and repeatability (intraclass correlation coefficient [ICC] = 0.865) for the CAT score was acceptable. A cross-sectional study showed constructive validity. Changes in the CAT over 6–12 months were significantly associated with change in anchors including physiological function, exercise capacity, and dyspnea regardless of IPF diagnosis. The estimated MCIDs of the CAT for the deterioration and improvement directions were at least +5 and at least −3 points, respectively.</div></div><div><h3>Conclusions</h3><div>The CAT is a reliable, responsive and clinically relevant instrument for assessing health status in patients with FILD.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142323738","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}

引用次数: 0

Efficacy and safety of long-term macrolide therapy for non-cystic fibrosis bronchiectasis: A systematic review and meta-analysis 长期大环内酯类药物治疗非囊性纤维化支气管扩张症的有效性和安全性：系统回顾与荟萃分析

IF 2.4 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2024-09-25 DOI: 10.1016/j.resinv.2024.09.004

Background

Long-term macrolide therapy for non-cystic fibrosis bronchiectasis (NCFB) can play a significant role. However, such data are insufficient regarding the efficacy against severe exacerbation and adverse effects, including the emergence of macrolide-resistant pathogens and prolonged macrolide use beyond 1 year.

Methods

Randomized controlled trials (RCTs) and prospective observational studies comparing the efficacy and safety of macrolides and placebo in adult patients with NCFB were screened on April 10, 2024. The primary outcome was severe exacerbation frequency.

Results

Ten RCTs ≤1 year study durations were included. Most studies mainly included patients with a history of >2 exacerbations. Macrolides had a tendency to reduce the frequency of severe exacerbations compared with placebo (odds ratio = 0.54, 95% confidence interval (CI) = 0.25–1.18). Macrolides significantly reduced the frequency of exacerbations (rate ratio = 0.58, 95% CI = 0.48–0.69), prolonged the time to first exacerbation (rate ratio = 0.41, 95% CI = 0.30–0.55), improved the changes in SGRQ scores [mean difference (MD) = -3.99, 95% CI = −4.63–3.44] and percent predicted forced expiratory volume in 1 s (MD = −2.30, 95% CI = 0.26–4.33), and reduced sputum volume (gram) (MD = −7.44, 95% CI = −9.15–5.74). Additionally, macrolides did not increase drug-related adverse events leading to discontinuation. Qualitative SR of pathogens indicated macrolides might increase the number of macrolide-resistant oropharyngeal and sputum pathogens and the emergence of Pseudomonas aeruginosa.

Conclusions

Our results support macrolide therapy for patients with NCFB. Studies with an observation period of >1 year or those focusing on patients with/without a minimal exacerbation history are required to determine the long-term effects on patients with NCFB.

背景长期使用大环内酯类药物治疗非囊性纤维化支气管扩张症（NCFB）可发挥重要作用。方法 2024 年 4 月 10 日筛选了在非囊性纤维化支气管扩张症成人患者中比较大环内酯类药物和安慰剂疗效和安全性的随机对照试验（RCT）和前瞻性观察研究。结果共纳入了 10 项研究时间不超过 1 年的 RCT。大多数研究主要纳入了有过两次病情加重病史的患者。与安慰剂相比，大环内酯类药物有降低严重恶化频率的趋势（几率比=0.54，95% 置信区间（CI）=0.25-1.18）。大环内酯类药物能明显降低病情加重的频率（比率 = 0.58，95% CI = 0.48-0.69），延长首次病情加重的时间（比率 = 0.41，95% CI = 0.30-0.55），改善 SGRQ 评分的变化 [平均差 (MD) = -3.99，95% CI = -4.63-3.44]和 1 秒用力呼气容积预测百分比（MD = -2.30，95% CI = 0.26-4.33），并减少了痰量（克）（MD = -7.44，95% CI = -9.15-5.74）。此外，大环内酯类药物不会增加导致停药的药物相关不良事件。病原体定性 SR 表明，大环内酯类药物可能会增加耐大环内酯类药物的口咽和痰液病原体的数量以及铜绿假单胞菌的出现。要确定大环内酯类药物对 NCFB 患者的长期疗效，还需要进行观察期为 1 年或以有/无极少加重病史的患者为重点的研究。

{"title":"Efficacy and safety of long-term macrolide therapy for non-cystic fibrosis bronchiectasis: A systematic review and meta-analysis","authors":"","doi":"10.1016/j.resinv.2024.09.004","DOIUrl":"10.1016/j.resinv.2024.09.004","url":null,"abstract":"<div><h3>Background</h3><div>Long-term macrolide therapy for non-cystic fibrosis bronchiectasis (NCFB) can play a significant role. However, such data are insufficient regarding the efficacy against severe exacerbation and adverse effects, including the emergence of macrolide-resistant pathogens and prolonged macrolide use beyond 1 year.</div></div><div><h3>Methods</h3><div>Randomized controlled trials (RCTs) and prospective observational studies comparing the efficacy and safety of macrolides and placebo in adult patients with NCFB were screened on April 10, 2024. The primary outcome was severe exacerbation frequency.</div></div><div><h3>Results</h3><div>Ten RCTs ≤1 year study durations were included. Most studies mainly included patients with a history of >2 exacerbations. Macrolides had a tendency to reduce the frequency of severe exacerbations compared with placebo (odds ratio = 0.54, 95% confidence interval (CI) = 0.25–1.18). Macrolides significantly reduced the frequency of exacerbations (rate ratio = 0.58, 95% CI = 0.48–0.69), prolonged the time to first exacerbation (rate ratio = 0.41, 95% CI = 0.30–0.55), improved the changes in SGRQ scores [mean difference (MD) = -3.99, 95% CI = −4.63–3.44] and percent predicted forced expiratory volume in 1 s (MD = −2.30, 95% CI = 0.26–4.33), and reduced sputum volume (gram) (MD = −7.44, 95% CI = −9.15–5.74). Additionally, macrolides did not increase drug-related adverse events leading to discontinuation. Qualitative SR of pathogens indicated macrolides might increase the number of macrolide-resistant oropharyngeal and sputum pathogens and the emergence of <em>Pseudomonas aeruginosa</em>.</div></div><div><h3>Conclusions</h3><div>Our results support macrolide therapy for patients with NCFB. Studies with an observation period of >1 year or those focusing on patients with/without a minimal exacerbation history are required to determine the long-term effects on patients with NCFB.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142319941","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}

引用次数: 0

Negative-predictive value of SUVmax for Ascertaining the efficacy of osimertinib in EGFR mutation-positive non-small cell lung cancer SUVmax对确定奥希替尼在表皮生长因子受体突变阳性非小细胞肺癌中疗效的负预测价值

IF 2.4 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2024-09-23 DOI: 10.1016/j.resinv.2024.09.001

Background

Fluorine-¹⁸ 2-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) is routinely used to stage non-small cell lung cancer (NSCLC). However, whether ¹⁸F-FDG accumulation in primary tumors affects the efficacy of osimertinib in patients with epidermal growth factor receptor (EGFR) mutation-positive NSCLC remains unclear.

Methods

We retrospectively investigated 74 patients with advanced or postoperative recurrent EGFR mutation-positive NSCLC who underwent ¹⁸F-FDG PET/CT and were treated with osimertinib as first-line therapy between September 2018 and March 2023 at Kumamoto University Hospital. The maximum standardized uptake value (SUVmax) of each primary tumor was measured, and the patients were divided into two groups according to the median SUVmax. The effects of SUVmax on progression-free survival (PFS) and overall survival (OS) were assessed using a multivariate Cox proportional hazards model.

Results

The median SUVmax was 8.2 (interquartile range: 5.5–11.4). The median PFS in the high SUVmax group (≥8.2) was significantly shorter than that in the low SUVmax group (<8.2). The respective median PFSs were 11.2 months (95% confidence interval [CI]: 3.1–19.3 months) vs. 22.9 months (95% CI: 12.4–33.4 months) (P = 0.015), although the OS values did not differ significantly. Multivariate analysis showed that a high SUVmax was an independent negative predictive factor for PFS in patients treated with osimertinib (hazard ratio, 2.25; 95% CI: 1.15–4.39, P = 0.017).

Conclusions

High primary-lesion SUVmax in patients with EGFR mutation-positive NSCLC correlated with shorter PFS with first-line osimertinib therapy, suggesting that SUVmax is a useful predictive marker for the antitumor efficacy of osimertinib.

背景氟-18 2-氟-2-脱氧-d-葡萄糖正电子发射断层扫描/计算机断层扫描（18F-FDG PET/CT）被常规用于非小细胞肺癌（NSCLC）的分期。然而，表皮生长因子受体（EGFR）突变阳性NSCLC患者原发肿瘤中的18F-FDG蓄积是否会影响奥希替尼的疗效仍不清楚。方法我们回顾性调查了熊本大学医院2018年9月至2023年3月期间接受18F-FDG PET/CT检查并接受奥希替尼一线治疗的74例晚期或术后复发EGFR突变阳性NSCLC患者。研究人员测量了每个原发肿瘤的最大标准化摄取值（SUVmax），并根据SUVmax的中位数将患者分为两组。采用多变量考克斯比例危险模型评估了SUVmax对无进展生存期（PFS）和总生存期（OS）的影响。高 SUVmax 组（≥8.2）的中位生存期明显短于低 SUVmax 组（8.2）。各自的中位 PFS 为 11.2 个月（95% 置信区间 [CI]：3.1-19.3 个月）vs 22.9 个月（95% CI：12.4-33.4 个月）（P = 0.015），但 OS 值无显著差异。多变量分析显示，高SUVmax是奥希替尼治疗患者PFS的独立负预测因素（危险比2.25；95% CI：1.15-4.39，P = 0.017）。结论表皮生长因子受体突变阳性NSCLC患者原发灶SUVmax高与奥希替尼一线治疗PFS短相关，表明SUVmax是奥希替尼抗肿瘤疗效的有效预测指标。

{"title":"Negative-predictive value of SUVmax for Ascertaining the efficacy of osimertinib in EGFR mutation-positive non-small cell lung cancer","authors":"","doi":"10.1016/j.resinv.2024.09.001","DOIUrl":"10.1016/j.resinv.2024.09.001","url":null,"abstract":"<div><h3>Background</h3><div>Fluorine-<sup>18</sup> 2-fluoro-2-deoxy<span>-d</span>-glucose positron emission tomography/computed tomography (<sup>18</sup>F-FDG PET/CT) is routinely used to stage non-small cell lung cancer (NSCLC). However, whether <sup>18</sup>F-FDG accumulation in primary tumors affects the efficacy of osimertinib in patients with epidermal growth factor receptor (<em>EGFR</em>) mutation-positive NSCLC remains unclear.</div></div><div><h3>Methods</h3><div>We retrospectively investigated 74 patients with advanced or postoperative recurrent <em>EGFR</em> mutation-positive NSCLC who underwent <sup>18</sup>F-FDG PET/CT and were treated with osimertinib as first-line therapy between September 2018 and March 2023 at Kumamoto University Hospital. The maximum standardized uptake value (SUVmax) of each primary tumor was measured, and the patients were divided into two groups according to the median SUVmax. The effects of SUVmax on progression-free survival (PFS) and overall survival (OS) were assessed using a multivariate Cox proportional hazards model.</div></div><div><h3>Results</h3><div>The median SUVmax was 8.2 (interquartile range: 5.5–11.4). The median PFS in the high SUVmax group (≥8.2) was significantly shorter than that in the low SUVmax group (<8.2). The respective median PFSs were 11.2 months (95% confidence interval [CI]: 3.1–19.3 months) vs. 22.9 months (95% CI: 12.4–33.4 months) (<em>P</em> = 0.015), although the OS values did not differ significantly. Multivariate analysis showed that a high SUVmax was an independent negative predictive factor for PFS in patients treated with osimertinib (hazard ratio, 2.25; 95% CI: 1.15–4.39, <em>P</em> = 0.017).</div></div><div><h3>Conclusions</h3><div>High primary-lesion SUVmax in patients with <em>EGFR</em> mutation-positive NSCLC correlated with shorter PFS with first-line osimertinib therapy, suggesting that SUVmax is a useful predictive marker for the antitumor efficacy of osimertinib.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142312532","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}

引用次数: 0

Epidemiological trends and clinical relevance of nontuberculous mycobacterial pulmonary disease in a referral hospital in Japan, 2017–2021 2017-2021 年日本一家转诊医院非结核分枝杆菌肺病的流行趋势和临床意义

IF 2.4 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2024-09-21 DOI: 10.1016/j.resinv.2024.09.007

Background

Epidemiological trends and clinical relevance of NTM species in Japan following the adoption of matrix-assisted laser desorption/ionization time-of-flight mass spectrometry remain unclear.

Methods

We analyzed the results of mycobacterial culture tests of respiratory specimens collected between January 2017 and December 2021. We assessed the clinical relevance of NTM species by analyzing the proportion of patients diagnosed with NTM pulmonary infection (NTM-PI). We illustrated the incidence and clinical relevance of each NTM species using a two-dimensional scatter plot. Medical chart review and radiological analysis were also performed for less common species.

Results

Among 65,368 respiratory specimens tested for acid-fast bacilli, NTM were identified in 12,802 specimens from 3177 patients. The number of incident cases with NTM-PI has continued to increase. Notably, the number of incident cases with M. abscessus species (MABS) was continuously increasing and accounted for 10.6% of all incident cases with NTM-PI. The clinical relevance of the common NTM species, M. avium complex, MABS and M. kansasii, ranged from 57 to 72%. Seven other species exhibited a higher clinical relevance than these common NTM species, with M. shinjukuense (100%) having the highest clinical relevance. On the other hand, 11 species, including M. fortuitum (32.4%), M. xenopi (20.0%), and M. gordonae (22.9%), showed clinical relevance below 50%.

Conclusions

The present study clarified the incidence and clinical relevance of NTM species using a two-dimensional scatter plot, which could serve as a useful tool for clinical decision-making and future epidemiological research.

背景日本采用基质辅助激光解吸/电离飞行时间质谱技术后，NTM 物种的流行趋势和临床相关性仍不清楚。方法我们分析了 2017 年 1 月至 2021 年 12 月期间收集的呼吸道标本的分枝杆菌培养检测结果。我们通过分析确诊为 NTM 肺部感染（NTM-PI）的患者比例，评估了 NTM 物种的临床相关性。我们用二维散点图说明了每种 NTM 的发病率和临床相关性。结果在 65,368 份进行了耐酸杆菌检测的呼吸道标本中，从 3177 名患者的 12,802 份标本中发现了 NTM。感染 NTM-PI 的病例数量持续上升。值得注意的是，感染脓毒性蘑菇菌（MABS）的病例持续增加，占所有感染非淋菌性肺结核病例的 10.6%。常见的非典型肺炎脓毒症菌种，即复合脓毒症疫霉菌、脓毒症疫霉菌和堪萨斯疫霉菌的临床相关性从57%到72%不等。其他 7 个物种的临床相关性高于这些常见的 NTM 物种，其中新宿臼菌（100%）的临床相关性最高。结论本研究利用二维散点图阐明了 NTM 物种的发病率和临床相关性，可作为临床决策和未来流行病学研究的有用工具。

{"title":"Epidemiological trends and clinical relevance of nontuberculous mycobacterial pulmonary disease in a referral hospital in Japan, 2017–2021","authors":"","doi":"10.1016/j.resinv.2024.09.007","DOIUrl":"10.1016/j.resinv.2024.09.007","url":null,"abstract":"<div><h3>Background</h3><p>Epidemiological trends and clinical relevance of NTM species in Japan following the adoption of matrix-assisted laser desorption/ionization time-of-flight mass spectrometry remain unclear.</p></div><div><h3>Methods</h3><p>We analyzed the results of mycobacterial culture tests of respiratory specimens collected between January 2017 and December 2021. We assessed the clinical relevance of NTM species by analyzing the proportion of patients diagnosed with NTM pulmonary infection (NTM-PI). We illustrated the incidence and clinical relevance of each NTM species using a two-dimensional scatter plot. Medical chart review and radiological analysis were also performed for less common species.</p></div><div><h3>Results</h3><p>Among 65,368 respiratory specimens tested for acid-fast bacilli, NTM were identified in 12,802 specimens from 3177 patients. The number of incident cases with NTM-PI has continued to increase. Notably, the number of incident cases with <em>M. abscessus</em> species (MABS) was continuously increasing and accounted for 10.6% of all incident cases with NTM-PI. The clinical relevance of the common NTM species, <em>M. avium</em> complex, MABS and <em>M. kansasii</em>, ranged from 57 to 72%. Seven other species exhibited a higher clinical relevance than these common NTM species, with <em>M. shinjukuense</em> (100%) having the highest clinical relevance. On the other hand, 11 species, including <em>M. fortuitum</em> (32.4%), <em>M. xenopi</em> (20.0%), and <em>M. gordonae</em> (22.9%), showed clinical relevance below 50%.</p></div><div><h3>Conclusions</h3><p>The present study clarified the incidence and clinical relevance of NTM species using a two-dimensional scatter plot, which could serve as a useful tool for clinical decision-making and future epidemiological research.</p></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142271988","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}

引用次数: 0

Exercise intolerance and oxygen dynamics in nontuberculous mycobacteria with bronchiectasis 非结核分枝杆菌支气管扩张症患者的运动不耐受性和氧动态变化

IF 2.4 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2024-09-20 DOI: 10.1016/j.resinv.2024.08.017

Background

Nontuberculous mycobacterial pulmonary disease (NTM-PD) patients often have exercise intolerance. Pulmonary rehabilitation (PR) to improve such patients' conditions is often not based on its exercise pathophysiology. We have reported that the oxygen consumption (ΔF_O2) by expiratory gas analysis, i.e., the inspired-expired-expiratory mean oxygen concentration difference, is related to the minute ventilation-carbon dioxide output (V′_E-V′_CO2)-slope and oxygen uptake (V′_O2) independent of the V′_E. The aim of this study was to investigate how ΔF_O2 is related to dynamic ventilatory variables, chest computed tomography (CT), and echocardiography findings in NTM-PD patients to understand their pathophysiological conditions.

Methods

Clinical data of NTM-PD patients with exertional dyspnea (n = 29) who underwent incremental exercise testing, chest CT, and echocardiography at the same time were compared with those of control participants (n = 12).

Results

In the NTM-PD group, 1) peak V′_O2 decreased (NTM-PD: 17.6 vs. controls: 28.7 mL⋅min⁻¹⋅kg⁻¹), and 2) ΔF_O2 at peak exercise was negatively correlated with respiratory frequency at peak exercise (correlation coefficient: r = −0.80, p < 0.0001), V′_E-V′_CO2-slope (r = −0.75, p < 0.0001), bronchiectasis CT score (r = −0.52, p = 0.0042), and the trans-tricuspid pressure gradient (r = −0.39, p = 0.0417), and positively correlated with peak V'_O2 (r = 0.71, p < 0.0001) and the body mass index (r = 0.42, p = 0.0217), but it was not correlated with V′_E at peak exercise and the cavity CT score.

Conclusions

Exertional oxygen consumption, independent of ventilatory ability, is associated with exercise tolerance and ventilatory efficiency, while being related to tachypnea and bronchiectasis rather than cavitation in NTM-PD patients. These findings may be useful in considering exercise physiology-based PR for NTM-PD patients with exertional dyspnea.

背景非结核分枝杆菌肺病（NTM-PD）患者通常有运动不耐受的问题。改善这类患者病情的肺康复（PR）往往不是基于其运动病理生理学。我们曾报道，呼气分析法得出的耗氧量（ΔFO2），即吸气-呼气-呼气平均氧浓度差，与分钟通气-二氧化碳输出量（V′E-V′CO2）斜率和摄氧量（V′O2）相关，而与 V′E 无关。方法将同时接受增量运动测试、胸部 CT 和超声心动图检查的有劳力性呼吸困难的 NTM-PD 患者（29 人）与对照组（12 人）的临床数据进行比较。结果在 NTM-PD 组中，1）V′O2 峰值降低（NTM-PD：17.6 vs. 对照组：28.7 mL-min-1-kg-1）；2）运动峰值时的ΔFO2 与运动峰值时的呼吸频率呈负相关（相关系数：r = -0.80, p < 0.0001）、V′E-V′CO2-斜率（r = -0.75, p < 0.0001）、支气管扩张 CT 评分（r = -0.52, p = 0.0042）和经三尖瓣压力梯度（r = -0.39，p = 0.0417），与V'O2峰值（r = 0.71，p <0.0001）和体重指数（r = 0.42，p = 0.结论NTM-PD患者的运动耗氧量与通气能力无关，与运动耐量和通气效率相关，同时与呼吸急促和支气管扩张有关，而与空洞化无关。这些发现可能有助于考虑对有劳力性呼吸困难的 NTM-PD 患者进行基于运动生理学的 PR。

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引用次数: 0

The association between the use of Shoseiryuto and reduction in intravenous steroid dose among adult inpatients with asthma exacerbation: A national database study in Japan 哮喘加重的成年住院患者使用舒赛洛特与减少静脉注射类固醇剂量之间的关系：日本国家数据库研究

IF 2.4 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2024-09-19 DOI: 10.1016/j.resinv.2024.09.005

Background

Shoseiryuto, a Japanese herbal medicine, is used to treat asthma exacerbation; however, the effect of Shoseiryuto in a clinical setting is yet to be elucidated. We aimed to examine the effect of Shoseiryuto for inpatients with asthma exacerbation and the reduction in the total amount of intravenous steroids administered during hospitalization, in-hospital mortality, and length of hospital stay using a national inpatient database in Japan.

Methods

Using data from the Japanese Diagnosis Procedure Combination database (July 2010–March 2022), we identified patients aged ≥18 years who were admitted due to asthma exacerbation. We performed propensity score overlap weighting analyses to estimate the in-hospital outcomes between patients who received Shoseiryuto within 3 days of admission (Shoseiryuto group) and those who did not (control group). The outcomes measured were the dose of intravenous steroids administered, in-hospital mortality, and length of hospital stay for patients alive at discharge.

Results

Among 51,459 eligible patients, 131 received Shoseiryuto. In the propensity score overlap weighting analyses, the use of Shoseiryuto was significantly associated with reduced amount of intravenous steroid during hospitalization (67 mg versus 149 mg, 95% confidence interval [CI]: −68 to −92), but was not associated with reduced in-hospital mortality (1.9% versus 3.5%, 95% CI: −28 to 25) or length of hospital stay (17.3 days versus 18.3 days, 95% CI: −4.2 to 2.4).

Conclusions

The use Shoseiryuto in inpatients with asthma exacerbation was significantly associated with reduced steroid use. Our results elucidated the potential role of Shoseiryuto in the treatment of asthma exacerbation.

背景正骨汤是一种日本草药，可用于治疗哮喘加重；然而，正骨汤在临床环境中的效果尚待阐明。方法利用日本诊断程序组合数据库（2010 年 7 月至 2022 年 3 月）中的数据，我们确定了年龄≥18 岁、因哮喘加重入院的患者。我们进行了倾向得分重叠加权分析，以估算入院 3 天内接受正舒丸治疗的患者（正舒丸组）与未接受正舒丸治疗的患者（对照组）的院内疗效。测量的结果包括静脉注射类固醇的剂量、院内死亡率以及出院时存活患者的住院时间。在倾向得分重叠加权分析中，使用寿喜龙与住院期间静脉注射类固醇量的减少有显著相关性（67 毫克对 149 毫克，95% 置信区间 [CI]：-68 到 -92），但与住院死亡率的降低无关（1.9% 对 3.5%，95% 置信区间 [CI]：-68 到 -92）。结论哮喘加重的住院患者使用舒赛洛特与减少类固醇用量显著相关。我们的研究结果阐明了缩宫素在治疗哮喘加重中的潜在作用。

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引用次数: 0