Respiratory investigation最新文献_第3页

Reassessment of the relevance between microbiological macrolide-induced resistance and diagnosis and treatment outcome of Mycobacterium abscessus-related pulmonary disease 重新评估微生物诱导的大环内酯耐药性与脓肿分枝杆菌相关肺病的诊断和治疗结果之间的相关性。

IF 2.4 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2024-10-04 DOI: 10.1016/j.resinv.2024.09.012

Shiomi Yoshida , Kazunari Tsuyuguchi , Takehiko Kobayashi , Yu Kurahara , Yasuaki Shimatani , Toru Arai

Background

Treatment outcomes for Mycobacterium abscessus species–related pulmonary disease (MABS-PD) are generally poor because of inducible clarithromycin resistance (IR). The clinical management of patients with MABS with different genotypic and phenotypic susceptibility results is also not definitive. Here, we aimed to reassess the characteristics of patients with variant MABS and their association with diagnosis, treatment intervention, and sputum culture conversion.

Methods

We retrospectively analyzed 119 patients with MABS infection. Clinical characteristics and medical history were obtained via medical chart review. Isolates were tested for clarithromycin susceptibility and classified into erm(41) sequevars.

Results

In the IR, non-IR, and acquired resistance groups, the sputum culture conversion rates were 22% (5/23), 80% (40/50), and 8% (1/12), respectively. In contrast, in MAB, MAB T28, MAB C28, and M. abscessus subsp. massiliense (MAM), sputum culture conversion rates were 33% (12/36), 29% (22/31), 60% (3/5), and 70.8% (34/48), respectively. The proportion of patients with non-IR MAB T28 diagnosed and treated for MABS-PD was lower than those of patients with IR or acquired resistant T28 [35.7% (5/14), 80.7% (21/26), 100% (5/5); P < 0.05], whereas the sputum culture conversion rate was high in patients with non-IR MAB T28 [80.0%(4/5), 23.8%(5/21), 0%(0/5); P < 0.01)]. The sputum culture conversion rate in treated patients with MABS-PD with IR MAB C28 or acquired resistant MAM was low [0.0% (0/1) and 14.3% (1/7)].

Conclusions

Patients with MABS-PD and non-IR were likely to have sputum culture conversion. Our results indicated that phenotypical properties were associated with MABS-PD diagnosis and treatment.

背景：由于克拉霉素的诱导耐药性（IR），脓肿分枝杆菌相关肺病（MABS-PD）的治疗效果普遍不佳。对于基因型和表型药敏结果不同的 MABS 患者，临床治疗方法也不确定。在此，我们旨在重新评估变异型 MABS 患者的特征及其与诊断、治疗干预和痰培养转换的关系：我们对 119 例 MABS 感染患者进行了回顾性分析。方法：我们对 119 例 MABS 感染患者进行了回顾性分析，通过病历审查获得了患者的临床特征和病史。对分离菌进行克拉霉素敏感性检测，并将其分为erm(41)序列：结果：在IR、非IR和获得性耐药组中，痰培养转换率分别为22%（5/23）、80%（40/50）和8%（1/12）。相比之下，MAB、MAB T28、MAB C28 和大规模脓肿亚种（MAM）的痰培养转化率分别为 33%（12/36）、29%（22/31）、60%（3/5）和 70.8%（34/48）。因 MABS-PD 而确诊和治疗的非 IR MAB T28 患者的比例低于 IR 或获得性耐药 T28 患者[35.7%（5/14）、80.7%（21/26）、100%（5/5）；P 结论：MABS-PD和非IR患者很可能出现痰培养转换。我们的研究结果表明，表型特征与 MABS-PD 的诊断和治疗有关。

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引用次数: 0

Combined use of serum ferritin and KL-6 levels as biomarkers for predicting COVID-19 severity 联合使用血清铁蛋白和 KL-6 水平作为预测 COVID-19 严重程度的生物标志物。

IF 2.4 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2024-10-03 DOI: 10.1016/j.resinv.2024.09.011

Hiromu Tanaka , Erika Toya , Shotaro Chubachi , Ho Namkoong , Takanori Asakura , Shuhei Azekawa , Shiro Otake , Kensuke Nakagawara , Takahiro Fukushima , Mayuko Watase , Kaori Sakurai , Katsunori Masaki , Hirofumi Kamata , Makoto Ishii , Naoki Hasegawa , Yukinori Okada , Ryuji Koike , Yuko Kitagawa , Akinori Kimura , Seiya Imoto , Koichi Fukunaga

Objectives

To assess the value of serum ferritin and Krebs von den Lungen-6 (KL-6) levels for predicting severe COVID-19 (death or requirement for invasive mechanical ventilation [IMV]/high-flow oxygen).

Methods

Data were analyzed on 2495 patients with COVID-19 from February 2020 to November 2022 using data from a nationwide COVID-19 database.

Results

Patients with high KL-6 and low ferritin levels were older with more comorbidities and higher mortality rates, whereas those with high ferritin and low KL-6 levels were younger, predominantly male, and more likely to need IMV. A high level of both markers was strongly associated with critical outcomes (adjusted odds ratio: 13.6, 95% confidence interval: 8.58–21.5). The combination of both markers had higher predictive value than either marker alone (area under the curve: 0.709, 0.745, and 0.781 for KL-6, ferritin, and KL-6 + ferritin, respectively).

Conclusions

The combination of both markers accurately predicted COVID-19 severity.

目的：评估血清铁蛋白和 Krebs von den Lungen-6 (KL-6)评估血清铁蛋白和Krebs von den Lungen-6 (KL-6)水平预测严重COVID-19（死亡或需要有创机械通气[IMV]/高流量供氧）的价值：利用全国COVID-19数据库中的数据，分析了2020年2月至2022年11月期间2495名COVID-19患者的数据：结果：KL-6水平高、铁蛋白水平低的患者年龄较大，合并症较多，死亡率较高；而铁蛋白水平高、KL-6水平低的患者年龄较轻，男性居多，更有可能需要IMV。两种指标的高水平与危重结果密切相关（调整后的几率比：13.6，95% 置信区间：8.58-21.5）。这两种标记物的组合比单独使用其中一种标记物具有更高的预测价值（曲线下面积：0.709，0.7% 置信区间：0.7%）：结论：KL-6、铁蛋白和 KL-6 + 铁蛋白的曲线下面积分别为 0.709、0.745 和 0.781：结论：两种标记物的组合可准确预测 COVID-19 的严重程度。

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引用次数: 0

Comparison of efficacy of gefitinib and osimertinib for untreated EGFR mutation-positive non-small-cell lung cancer in patients with poor performance status 比较吉非替尼和奥希替尼对表现状态不佳的未经治疗的表皮生长因子受体突变阳性非小细胞肺癌患者的疗效。

IF 2.4 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2024-10-03 DOI: 10.1016/j.resinv.2024.09.010

Kazuhisa Nakashima , Hiroaki Kodama , Haruyasu Murakami , Toshiaki Takahashi , Keita Kawakado , Takashi Yanagawa , Kashu Kitani , Takamasa Hottta , Masaaki Abe , Kosuke Hamai , Takuya Tanimoto , Nobuhisa Ishikawa , Tomoki Tamura , Shoichi Kuyama , Takeshi Isobe , Yukari Tsubata

Background

There is a dearth of studies on the efficacy and safety of the tyrosine kinase inhibitors osimertinib (OSI) and gefitinib (GEF) in treating epidermal growth factor receptor (EGFR) mutation-positive non-small cell lung cancer (NSCLC), even in patients with poor performance status (PS).

Methods

We retrospectively reviewed and compared data of 113 patients with EGFR mutation-positive NSCLC with Eastern Cooperative Oncology Group PS 2–4 who were administered OSI 80 mg/day or GEF 250 mg/day from May 2016 to March 2022.

Results

The GEF group (39 patients; median age: 74 years) included 20 patients with a PS of 2, 17 with a PS of 3, and 2 with a PS of 4. The OSI group (74 patients; median age: 76 years) included 48 patients with a PS of 2, 24 with a PS of 3, and 2 with a PS of 4. The overall response rates were 69% and 66% in the GEF and OSI groups, respectively. The disease control and PS improvement rates were 89% and 51% in both groups, respectively. The median progression-free survival in the GEF and OSI groups was 6.9 and 9.2 months, respectively (p = 0.15). The OSI group experienced better overall survival than the GEF group (median: 20.9 vs. 13.0 months, p = 0.0031). The incidence of pneumonitis was 10% and 11% in the GEF and OSI groups, respectively. One treatment-related death owing to pneumonitis occurred in the GEF group.

Conclusions

OSI may be a useful treatment for untreated EGFR mutation-positive NSCLC with poor PS.

背景：关于酪氨酸激酶抑制剂osimertinib（OSI）和吉非替尼（GEF）治疗表皮生长因子受体（EGFR）突变阳性非小细胞肺癌（NSCLC）的疗效和安全性的研究很少，即使是对表现状态（PS）较差的患者也是如此：我们回顾并比较了东部合作肿瘤学组 PS 2-4 的 113 例 EGFR 突变阳性 NSCLC 患者的数据，这些患者在 2016 年 5 月至 2022 年 3 月期间接受了 OSI 80 毫克/天或 GEF 250 毫克/天的治疗：GEF组（39名患者；中位年龄：74岁）包括20名PS为2的患者、17名PS为3的患者和2名PS为4的患者；OSI组（74名患者；中位年龄：76岁）包括48名PS为2的患者、24名PS为3的患者和2名PS为4的患者。两组的疾病控制率和PS改善率分别为89%和51%。GEF组和OSI组的中位无进展生存期分别为6.9个月和9.2个月（P = 0.15）。OSI 组的总生存期优于 GEF 组（中位数：20.9 个月对 13.0 个月，p = 0.0031）。GEF组和OSI组的肺炎发生率分别为10%和11%。GEF组出现了一起因肺炎导致的治疗相关死亡病例：OSI可能是一种有效的治疗方法，适用于未经治疗且PS较差的表皮生长因子受体突变阳性NSCLC。

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引用次数: 0

Prevalence and characteristics of minimal pleural fluid on screening chest MRI 胸部磁共振成像筛查中最小胸腔积液的发生率和特征。

IF 2.4 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2024-10-02 DOI: 10.1016/j.resinv.2024.09.014

Kensuke Fukuda , Hirotaka Matsuzaki , Takuya Kawahara , Toshihiro Yamaguchi , Akira Saito , Nobutake Yamamichi , Hidenori Kage , Takeharu Yoshikawa

Background

Minimal pleural fluid is often seen incidentally on chest MRI. However, its prevalence and clinical characteristics remain unknown.

Methods

This retrospective observational study included 2726 participants who underwent comprehensive medical check-ups for screening, including chest CT and MRI, and transthoracic echocardiography between March 2018 and February 2019. Pleural fluid on MRI was manually measured for maximum thickness. Its distribution, change over time, and relevance to participant characteristics were analyzed. The pulmonary function data of 82 participants and their associations with fluid were also analyzed.

Results

Of the 2726 participants (mean age ± standard deviation, 59 ± 11 years), 2009 (73.7%) had minimal pleural fluid (thickness, 1–9 mm) on either side, with right-sided fluid being more frequent than left-sided fluid (P < 0.001). Negligible changes in fluid thickness were observed one year later. The following parameters were associated with less fluid: age, ≥65 years (P < 0.001); male sex (P = 0.006); current smoking (P < 0.001); body mass index, ≥25 kg/m² (P < 0.001); and mean arterial pressure, ≥100 mmHg (P = 0.01), whereas a ratio between early mitral inflow velocity and mitral annular early diastolic velocity>14 was associated with more fluid (P = 0.01). The presence of fluid was an independent explanatory variable for a higher percentage of predicted vital capacity (P = 0.048).

Conclusions

MRI was highly sensitive in detecting minimal pleural fluid. Pleural fluid found on MRI for health screening was assumed to be physiological and fluid thickness at the steady state might be variable among participants depending on age, sex, smoking habits, body shape, blood pressure, and cardiac diastolic capacity.

背景：胸部磁共振成像经常会偶然发现少量胸腔积液。然而，其发病率和临床特征仍然未知：这项回顾性观察研究纳入了 2018 年 3 月至 2019 年 2 月期间接受全面体检筛查（包括胸部 CT 和 MRI 以及经胸超声心动图）的 2726 名参与者。核磁共振成像上的胸腔积液由人工测量最大厚度。对其分布、随时间的变化以及与参与者特征的相关性进行了分析。此外，还分析了 82 名参与者的肺功能数据及其与积液的关联：在 2726 名参与者（平均年龄 ± 标准差，59 ± 11 岁）中，有 2009 人（73.7%）两侧胸腔积液极少（厚度为 1-9 毫米），右侧积液比左侧积液更常见（P 2），P 14 与更多积液相关（P = 0.01）。积液的存在是预测生命容量百分比较高的一个独立解释变量（P = 0.048）：结论：磁共振成像在检测极少量胸腔积液方面具有高度敏感性。在健康检查中通过磁共振成像发现的胸腔积液被假定为生理性胸腔积液，参与者在稳定状态下的积液厚度可能会因年龄、性别、吸烟习惯、体型、血压和心脏舒张能力的不同而不同。

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引用次数: 0

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

Maki Asami-Noyama , Kazuki Hamada , Yoshiyuki Asai , Takeshi Abe , Kosei Yonezawa , Michiya Watanabe , Yukari Hisamoto , Keita Murakawa , Ayumi Fukatsu , Kazuki Matsuda , Shuichiro Ohata , Ryo Suetake , Yoriyuki Murata , Yoshikazu Yamaji , Keiji Oishi , Nobutaka Edakuni , Tsunahiko Hirano , Tomoyuki Kakugawa , Kazuto Matsunaga

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。

{"title":"Factors associated with non-intervention of antifibrotic agents in IPF patients","authors":"Maki Asami-Noyama , Kazuki Hamada , Yoshiyuki Asai , Takeshi Abe , Kosei Yonezawa , Michiya Watanabe , Yukari Hisamoto , Keita Murakawa , Ayumi Fukatsu , Kazuki Matsuda , Shuichiro Ohata , Ryo Suetake , Yoriyuki Murata , Yoshikazu Yamaji , Keiji Oishi , Nobutaka Edakuni , Tsunahiko Hirano , Tomoyuki Kakugawa , Kazuto Matsunaga","doi":"10.1016/j.resinv.2024.09.008","DOIUrl":"10.1016/j.resinv.2024.09.008","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"62 6","pages":"Pages 1124-1131"},"PeriodicalIF":2.4,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142372725","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}

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

Masatoshi Hanada , Tadayoshi Nonoyama , Tomoyuki Ikeuchi , Koki Sasaki , Kazuaki Suyama , Masaki Nakashita , Ryota Shiroishi , Ryosuke Segawa , Kengo Tanaka , Hideki Aoki , Chika Kitagawa , Yuichi Hori , Shuhei Hashimoto , Toshiro Matsuzaki , Shuntaro Sato , Shinichi Arizono , Takako Tanaka , Ryo Kozu

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。

{"title":"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","authors":"Masatoshi Hanada , Tadayoshi Nonoyama , Tomoyuki Ikeuchi , Koki Sasaki , Kazuaki Suyama , Masaki Nakashita , Ryota Shiroishi , Ryosuke Segawa , Kengo Tanaka , Hideki Aoki , Chika Kitagawa , Yuichi Hori , Shuhei Hashimoto , Toshiro Matsuzaki , Shuntaro Sato , Shinichi Arizono , Takako Tanaka , Ryo Kozu","doi":"10.1016/j.resinv.2024.09.016","DOIUrl":"10.1016/j.resinv.2024.09.016","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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).</div></div><div><h3>Conclusions</h3><div>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.</div></div><div><h3>Trial registration</h3><div>University Hospital Medical Information Network Center (UMIN-CTR) UMIN: approval number: UMIN000048761.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"62 6","pages":"Pages 1117-1123"},"PeriodicalIF":2.4,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142372726","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

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

Yuya Kimura , Yusuke Sasabuchi , Taisuke Jo , Yohei Hashimoto , Ryosuke Kumazawa , Miho Ishimaru , Hiroki Matsui , Akira Yokoyama , Goh Tanaka , Hideo Yasunaga

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

Emiko Matsuyama , Jun Miyata , Hideki Terai , Naoki Miyazaki , Toshiki Iwasaki , Kengo Nagashima , Mayuko Watase , Keeya Sunata , Ho Namkoong , Takanori Asakura , Katsunori Masaki , Shotaro Chubachi , Keiko Ohgino , Ichiro Kawada , Kazuhiro Minami , Rie Hagiwara , Soichiro Ueda , Takashi Yoshiyama , Hiroyuki Kokuto , Tatsuya Kusumoto , Koichi Fukunaga

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。

{"title":"Chronic obstructive pulmonary disease, asthma, and mechanical ventilation are risk factors for dyspnea in patients with long COVID: A Japanese nationwide cohort study","authors":"Emiko Matsuyama , Jun Miyata , Hideki Terai , Naoki Miyazaki , Toshiki Iwasaki , Kengo Nagashima , Mayuko Watase , Keeya Sunata , Ho Namkoong , Takanori Asakura , Katsunori Masaki , Shotaro Chubachi , Keiko Ohgino , Ichiro Kawada , Kazuhiro Minami , Rie Hagiwara , Soichiro Ueda , Takashi Yoshiyama , Hiroyuki Kokuto , Tatsuya Kusumoto , Koichi Fukunaga","doi":"10.1016/j.resinv.2024.09.009","DOIUrl":"10.1016/j.resinv.2024.09.009","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"62 6","pages":"Pages 1094-1101"},"PeriodicalIF":2.4,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142326453","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}

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

Toshiaki Matsuda , Yasuhiro Kondoh , Reoto Takei , Hajime Sasano , Jun Fukihara , Yasuhiko Yamano , Toshiki Yokoyama , Kensuke Kataoka , Fumiko Watanabe , Tomoki Kimura

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":"Toshiaki Matsuda , Yasuhiro Kondoh , Reoto Takei , Hajime Sasano , Jun Fukihara , Yasuhiko Yamano , Toshiki Yokoyama , Kensuke Kataoka , Fumiko Watanabe , Tomoki Kimura","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":"62 6","pages":"Pages 1088-1093"},"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

Natsuki Nakagawa , Masashi Ito , Takanori Asakura , Nobuyuki Horita , Yasushi Obase , Hiroshi Mukae

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。

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引用次数: 0