The prognosis of acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) is extremely poor. However, recent clinical reports suggest that direct hemoperfusion with polymyxin B-immobilized fiber column (PMX) treatment may have beneficial effects in patients with AE-IPF. The aim of this multicenter prospective study was to investigate the effectiveness and safety of PMX treatment in AE-IPF.
Methods
We conducted a prospective study of patients with AE-IPF treated by PMX at two institutions in Japan. Each patient received 2–3 sessions of PMX treatment with a target duration of 6–24 h. The primary endpoint was the survival rate at day 28 after the PMX treatment.
Results
The survival rate of the patients on day 28 after PMX treatment was 65% [95% confidence interval (CI): 40.3–81.5%]. The lower limit of 95% CI in the study was higher than the survival rate of 40%, which was the upper limit of the survival rate in AE-IPF receiving conventional treatments, as reported previously. The survival rate of the patients 12 weeks after PMX was 50% (95% CI: 27.1–69.2%). The changes in the difference between alveolar and arterial oxygen tension and the partial pressure of arterial oxygen/fraction of inspired oxygen improved as the number of PMX sessions increased, and significant improvements were observed at the end of the second PMX session. The safety of PMX was clinically acceptable.
Conclusions
This prospective multicenter study suggests that PMX treatment is safe for patients with AE-IPF and may improve their oxygenation and prognosis.
{"title":"Direct hemoperfusion with polymyxin B immobilized fiber column (PMX) treatment for acute exacerbation of idiopathic pulmonary fibrosis: A prospective multicenter cohort study","authors":"Shinji Abe , Arata Azuma , Yoshinobu Saito , Hiroki Hayashi , Takeru Kashiwada , Toru Tanaka , Tomohisa Baba , Akimasa Sekine , Hideya Kitamura , Ryo Okuda , Satoshi Ikeda , Takashi Ogura","doi":"10.1016/j.resinv.2024.11.017","DOIUrl":"10.1016/j.resinv.2024.11.017","url":null,"abstract":"<div><h3>Background</h3><div>The prognosis of acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) is extremely poor. However, recent clinical reports suggest that direct hemoperfusion with polymyxin B-immobilized fiber column (PMX) treatment may have beneficial effects in patients with AE-IPF. The aim of this multicenter prospective study was to investigate the effectiveness and safety of PMX treatment in AE-IPF.</div></div><div><h3>Methods</h3><div>We conducted a prospective study of patients with AE-IPF treated by PMX at two institutions in Japan. Each patient received 2–3 sessions of PMX treatment with a target duration of 6–24 h. The primary endpoint was the survival rate at day 28 after the PMX treatment.</div></div><div><h3>Results</h3><div>The survival rate of the patients on day 28 after PMX treatment was 65% [95% confidence interval (CI): 40.3–81.5%]. The lower limit of 95% CI in the study was higher than the survival rate of 40%, which was the upper limit of the survival rate in AE-IPF receiving conventional treatments, as reported previously. The survival rate of the patients 12 weeks after PMX was 50% (95% CI: 27.1–69.2%). The changes in the difference between alveolar and arterial oxygen tension and the partial pressure of arterial oxygen/fraction of inspired oxygen improved as the number of PMX sessions increased, and significant improvements were observed at the end of the second PMX session. The safety of PMX was clinically acceptable.</div></div><div><h3>Conclusions</h3><div>This prospective multicenter study suggests that PMX treatment is safe for patients with AE-IPF and may improve their oxygenation and prognosis.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 1","pages":"Pages 102-108"},"PeriodicalIF":2.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822525","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}
Progressive pulmonary fibrosis (PPF) is a critical concern in interstitial lung disease (ILD) management. The HAL score, which incorporates honeycombing (H), age >75 years (A), and serum lactate dehydrogenase >222 U/L (L), can predict acute exacerbations in patients with idiopathic interstitial pneumonia (IIP). This study aims to evaluate the predictive utility of the HAL score for PPF development.
Methods
This study was a post-hoc analysis of a multicenter prospective cohort study involving patients with IIP. PPF was diagnosed if at least two of the following three criteria were met: worsening respiratory symptoms, radiological progression, and physiological progression.
Results
Among the 144 patients, 29 (22.3%) developed PPF during the observation period. Among the three criteria for PPF, a higher HAL score significantly correlated with worsening respiratory symptoms (p = 0.001) and radiological progression (p = 0.022), but not with physiological progression (p = 0.717). Therefore, a higher HAL score significantly correlated with an increased PPF risk (12.5% for a score of 0, 25.9% for a score of 1, and 33.3% for a score of ≥2; p = 0.032). The HAL score also correlated with overall survival (p < 0.001). For the 92 patients (70.8%) with non-idiopathic pulmonary fibrosis (IPF), the HAL score was significantly associated with PPF development (p = 0.021), while not for the 38 patients (29.2%) with IPF (p = 0.872).
Conclusion
In patients with non-IPF, the HAL score correlated with PPF development and could be useful to monitor those patients and to avoid missed treatment opportunities.
{"title":"Association between the HAL score and the development of progressive pulmonary fibrosis in idiopathic interstitial pneumonia: A prospective observational study","authors":"Hiromasa Nakayasu , Masato Karayama , Noriyuki Enomoto , Yusuke Inoue , Hideki Yasui , Yuzo Suzuki , Hironao Hozumi , Kazuki Furuhashi , Masato Kono , Mikio Toyoshima , Shiro Imokawa , Masato Fujii , Taisuke Akamatsu , Naoki Koshimizu , Koshi Yokomura , Hiroyuki Matsuda , Yusuke Kaida , Yutaro Nakamura , Masahiro Shirai , Masafumi Masuda , Takafumi Suda","doi":"10.1016/j.resinv.2024.12.011","DOIUrl":"10.1016/j.resinv.2024.12.011","url":null,"abstract":"<div><h3>Background</h3><div>Progressive pulmonary fibrosis (PPF) is a critical concern in interstitial lung disease (ILD) management. The HAL score, which incorporates honeycombing (H), age >75 years (A), and serum lactate dehydrogenase >222 U/L (L), can predict acute exacerbations in patients with idiopathic interstitial pneumonia (IIP). This study aims to evaluate the predictive utility of the HAL score for PPF development.</div></div><div><h3>Methods</h3><div>This study was a post-hoc analysis of a multicenter prospective cohort study involving patients with IIP. PPF was diagnosed if at least two of the following three criteria were met: worsening respiratory symptoms, radiological progression, and physiological progression.</div></div><div><h3>Results</h3><div>Among the 144 patients, 29 (22.3%) developed PPF during the observation period. Among the three criteria for PPF, a higher HAL score significantly correlated with worsening respiratory symptoms (<em>p</em> = 0.001) and radiological progression (<em>p</em> = 0.022), but not with physiological progression (<em>p</em> = 0.717). Therefore, a higher HAL score significantly correlated with an increased PPF risk (12.5% for a score of 0, 25.9% for a score of 1, and 33.3% for a score of ≥2; <em>p</em> = 0.032). The HAL score also correlated with overall survival (<em>p</em> < 0.001). For the 92 patients (70.8%) with non-idiopathic pulmonary fibrosis (IPF), the HAL score was significantly associated with PPF development (<em>p</em> = 0.021), while not for the 38 patients (29.2%) with IPF (<em>p</em> = 0.872).</div></div><div><h3>Conclusion</h3><div>In patients with non-IPF, the HAL score correlated with PPF development and could be useful to monitor those patients and to avoid missed treatment opportunities.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 1","pages":"Pages 138-145"},"PeriodicalIF":2.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142855160","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}
Functional exercise capacity in pulmonary hypertension (PH) is routinely assessed using the 6-min walking test (6MWT). However, alternative tests are useful because of resource requirements. This study aimed to evaluate whether the 1-min sit-to-stand test (1STST) is useful and safe in PH and whether it can replace the 6MWT.
Methods
Adult patients with PH were recruited from our hospital between September 2023 and April 2024. The correlations between the number of 1STST repetitions (1STSTr) and 6-min walk distance (6MWD), pulmonary hemodynamic parameters, and quadriceps muscle strength; adverse events; and vital sign fluctuations during the tests were evaluated, and a questionnaire with an 11-point Likert scale (−5, 6MWT favor; 5, 1STST favor) was administered.
Results
Twenty-one patients with PH were enrolled in this study. The 1STSTr and 6MWD were 23.8 ± 7.8/min and 425.8 ± 116.8 m, respectively, with a strong correlation (r = 0.771). 1STSTr was significantly correlated with brain natriuretic peptide, but not with other pulmonary hemodynamic markers, respiratory function, or quadriceps muscle strength. No serious adverse events or motor impairments occurred with the 1STST.
The minimum SpO2 during the tests was significantly lower with the 6MWT (92.6 ± 3.1 vs. 88.0 ± 11.0). The questionnaire showed a predominant preference for the 1STST (3.2 ± 2.6).
Conclusions
To our knowledge, this is the first study in Japan to adapt the 1STST to PH patients. The 1STST is a reliable alternative to the 6MWT for measuring exercise capacity in PH patients.
Trial registration
This study was registered with the UMIN-CTR (number UMIN000052010).
背景：肺动脉高压（PH）患者的功能性运动能力通常通过6分钟步行试验（6MWT）进行评估。但是，由于资源需求，替代测试是有用的。本研究旨在评估1分钟坐立试验（1STST）在PH下是否有用和安全，是否可以取代6MWT。方法：于2023年9月至2024年4月在我院招募成年PH患者。1STST重复次数（1STSTr）与6分钟步行距离（6MWD）、肺血流动力学参数、股四头肌力量的相关性；不良事件;并采用李克特11分量表(- 5,6 mwt赞成；5, 1STST支持)。结果：21例PH患者入组本研究。1STSTr和6MWD分别为23.8±7.8 m /min和425.8±116.8 m，相关性较强（r = 0.771）。1STSTr与脑利钠肽显著相关，但与其他肺血流动力学指标、呼吸功能或股四头肌力量无关。1STST未发生严重不良事件或运动障碍。试验期间的最小SpO2明显低于6MWT（92.6±3.1 vs. 88.0±11.0）。问卷调查结果显示，1STST（3.2±2.6）占主导地位。结论：据我们所知，这是日本第一个将1STST应用于PH患者的研究。1STST是测量PH患者运动能力的可靠替代方案。试验注册：本研究已在UMIN-CTR注册（编号为UMIN000052010）。
{"title":"The utility and safety of one-minute sit-to-stand test in pulmonary hypertension: A prospective study","authors":"Kenichiro Takeda , Ayako Shigeta , Takeshi Inagaki , Nami Hayama , Chiaki Kawame , Yasuyuki Naraki , Akira Naito , Ayumi Sekine , Rika Suda , Toshihiko Sugiura , Nobuhiro Tanabe , Takuji Suzuki","doi":"10.1016/j.resinv.2024.12.003","DOIUrl":"10.1016/j.resinv.2024.12.003","url":null,"abstract":"<div><h3>Background</h3><div>Functional exercise capacity in pulmonary hypertension (PH) is routinely assessed using the 6-min walking test (6MWT). However, alternative tests are useful because of resource requirements. This study aimed to evaluate whether the 1-min sit-to-stand test (1STST) is useful and safe in PH and whether it can replace the 6MWT.</div></div><div><h3>Methods</h3><div>Adult patients with PH were recruited from our hospital between September 2023 and April 2024. The correlations between the number of 1STST repetitions (1STSTr) and 6-min walk distance (6MWD), pulmonary hemodynamic parameters, and quadriceps muscle strength; adverse events; and vital sign fluctuations during the tests were evaluated, and a questionnaire with an 11-point Likert scale (−5, 6MWT favor; 5, 1STST favor) was administered.</div></div><div><h3>Results</h3><div>Twenty-one patients with PH were enrolled in this study. The 1STSTr and 6MWD were 23.8 ± 7.8/min and 425.8 ± 116.8 m, respectively, with a strong correlation (<em>r</em> = 0.771). 1STSTr was significantly correlated with brain natriuretic peptide, but not with other pulmonary hemodynamic markers, respiratory function, or quadriceps muscle strength. No serious adverse events or motor impairments occurred with the 1STST.</div><div>The minimum SpO<sub>2</sub> during the tests was significantly lower with the 6MWT (92.6 ± 3.1 vs. 88.0 ± 11.0). The questionnaire showed a predominant preference for the 1STST (3.2 ± 2.6).</div></div><div><h3>Conclusions</h3><div>To our knowledge, this is the first study in Japan to adapt the 1STST to PH patients. The 1STST is a reliable alternative to the 6MWT for measuring exercise capacity in PH patients.</div></div><div><h3>Trial registration</h3><div>This study was registered with the UMIN-CTR (number UMIN000052010).</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 1","pages":"Pages 61-66"},"PeriodicalIF":2.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791580","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}
Coughing and other distress during bronchoscopy are undesirable for both patients and bronchoscopists. The efficacy of local anesthetics administered via aerosol sprays in the airways has been documented; however, the optimal administration method remains unclear. Furthermore, the efficacy of continuous salivary aspiration in reducing cough and other distress has not yet been evaluated.
Methods
Patients scheduled for bronchoscopy were assigned to 1 of 4 groups—group A (intrabronchial local anesthesia using a syringe without continuous oral suction); group B (intrabronchial local anesthesia using a spray catheter without continuous oral suction); group C (intrabronchial local anesthesia using a syringe with continuous oral suction using a saliva ejector); group D (intrabronchial local anesthesia using a spray catheter with continuous oral suction using a saliva ejector). The distress levels of the patients were evaluated using a questionnaire with a visual analog scale, and cough counts were quantified during bronchoscopy. Additionally, we assessed the total amount of lidocaine consumed and changes in vital signs.
Results
Local anesthesia in the airway using a spray catheter did not reduce patient distress; however, it reduced cough frequency (P = 0.03) and lidocaine dosage (P = 0.0004). Continuous suctioning of saliva did not reduce the patients’ distress or cough frequency.
Conclusion
The use of a spray catheter rather than a syringe is recommended for administering local anesthesia with lidocaine during bronchoscopy. Conversely, continuous suctioning of saliva is not routinely recommended for all patients.
{"title":"Effectiveness of intrabronchial local anesthesia with a spray catheter and continuous oral suction in reducing cough during bronchoscopy: A prospective study","authors":"Kazuo Tsuchiya, Tomotsugu Nuki, Tomo Tsunoda, Taisuke Ito, Rie Mori, Takuro Akashi, Yoshiyuki Oyama, Masaki Ikeda","doi":"10.1016/j.resinv.2024.12.002","DOIUrl":"10.1016/j.resinv.2024.12.002","url":null,"abstract":"<div><h3>Background</h3><div>Coughing and other distress during bronchoscopy are undesirable for both patients and bronchoscopists. The efficacy of local anesthetics administered via aerosol sprays in the airways has been documented; however, the optimal administration method remains unclear. Furthermore, the efficacy of continuous salivary aspiration in reducing cough and other distress has not yet been evaluated.</div></div><div><h3>Methods</h3><div>Patients scheduled for bronchoscopy were assigned to 1 of 4 groups—group A (intrabronchial local anesthesia using a syringe without continuous oral suction); group B (intrabronchial local anesthesia using a spray catheter without continuous oral suction); group C (intrabronchial local anesthesia using a syringe with continuous oral suction using a saliva ejector); group D (intrabronchial local anesthesia using a spray catheter with continuous oral suction using a saliva ejector). The distress levels of the patients were evaluated using a questionnaire with a visual analog scale, and cough counts were quantified during bronchoscopy. Additionally, we assessed the total amount of lidocaine consumed and changes in vital signs.</div></div><div><h3>Results</h3><div>Local anesthesia in the airway using a spray catheter did not reduce patient distress; however, it reduced cough frequency (<em>P</em> = 0.03) and lidocaine dosage (<em>P</em> = 0.0004). Continuous suctioning of saliva did not reduce the patients’ distress or cough frequency.</div></div><div><h3>Conclusion</h3><div>The use of a spray catheter rather than a syringe is recommended for administering local anesthesia with lidocaine during bronchoscopy. Conversely, continuous suctioning of saliva is not routinely recommended for all patients.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 1","pages":"Pages 67-73"},"PeriodicalIF":2.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792271","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 : 2025-01-01DOI: 10.1016/j.resinv.2024.12.007
Konosuke Morimoto , Shingo Masuda
Streptococcus pneumoniae, pneumococcus, is one of most important bacterial pathogens in adult community-acquired pneumonia. Although it can cause a variety of illness including invasive diseases (IPD), pneumonia has a greater impact than IPD from the perspective of health economics. 23 valent pneumococcal polysaccharide vaccine (PPSV23) and 13 valent pneumococcal conjugate vaccine (PCV13) have been recommended for people ≥65 years old until recently based on evidence in preventing IPD and pneumonia. Because the introduction and dissemination of PCVs for infants and its effects on herd immunity have led ‘serotype replacement’ in adult IPD and pneumococcal pneumonia since the 2000s, serotypes targeted by vaccines have sifted accordingly. With the availability of PCV21 this year, in addition to PCV15 and PCV20, vaccine prevention strategies for adult pneumococcal pneumonia need to be reconsidered. In this narrative review, we discuss current and future challenges regarding pneumococcal vaccines to prevent adult pneumococcal pneumonia.
{"title":"Pneumococcal vaccines for prevention of adult pneumonia","authors":"Konosuke Morimoto , Shingo Masuda","doi":"10.1016/j.resinv.2024.12.007","DOIUrl":"10.1016/j.resinv.2024.12.007","url":null,"abstract":"<div><div><em>Streptococcus pneumoniae</em>, pneumococcus, is one of most important bacterial pathogens in adult community-acquired pneumonia. Although it can cause a variety of illness including invasive diseases (IPD), pneumonia has a greater impact than IPD from the perspective of health economics. 23 valent pneumococcal polysaccharide vaccine (PPSV23) and 13 valent pneumococcal conjugate vaccine (PCV13) have been recommended for people ≥65 years old until recently based on evidence in preventing IPD and pneumonia. Because the introduction and dissemination of PCVs for infants and its effects on herd immunity have led ‘serotype replacement’ in adult IPD and pneumococcal pneumonia since the 2000s, serotypes targeted by vaccines have sifted accordingly. With the availability of PCV21 this year, in addition to PCV15 and PCV20, vaccine prevention strategies for adult pneumococcal pneumonia need to be reconsidered. In this narrative review, we discuss current and future challenges regarding pneumococcal vaccines to prevent adult pneumococcal pneumonia.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 1","pages":"Pages 96-101"},"PeriodicalIF":2.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822528","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}
Surgical lung biopsy (SLB) is recommended for diagnosing idiopathic pulmonary fibrosis in patients with interstitial lung disease (ILD). The safety of SLB is controversial, as the reported mortality and mobility vary according to the patient's background. This study aimed to assess SLB safety using eligibility criteria that excluded patients at the risk of postoperative complications, including acute exacerbations.
Methods
We retrospectively reviewed 94 patients with ILD who underwent SLB at our institution between 2010 and 2021. Two peripheral lung locations were resected using 3-port video-assisted thoracoscopic surgery. Complications within 30 and 90 days after surgery were evaluated based on the Clavien-Dindo classification. Preoperative high-resolution computed tomography findings were evaluated according to the guidelines of the American Thoracic Society, 2018. Patients with a radiological usual interstitial pneumonia (UIP) pattern, preoperative oxygen dependence, or organ failure incompatible with general anesthesia were excluded from the study.
Results
The median age of the patients was 66 years. The median vital capacity percentage was 81.0%. The following radiological patterns were observed: UIP, 0%; probable UIP, 30%; indeterminate UIP, 14%; and alternative diagnoses, 56%. The median operative time was 45 min. The 30- and 90-day mortality rates were both 0%. One patient (1%) developed an acute exacerbation of ILD on postoperative day 66. Other grade ≥ III complications were observed in 4 cases (4%), 3 of which were associated with air leakage. Home oxygen therapy was not initiated.
Conclusions
By excluding patients with poor SLB indications, our criteria are suggested to be valid for safe SLB.
{"title":"Safe surgical lung biopsy in the diagnosis of interstitial lung disease under strict patient selection","authors":"Takamitsu Hayakawa , Keigo Sekihara , Tomoya Tajiri , Motohisa Shibata , Tomoyuki Fujisawa , Takafumi Suda , Norihiko Shiiya , Kazuhito Funai","doi":"10.1016/j.resinv.2024.11.018","DOIUrl":"10.1016/j.resinv.2024.11.018","url":null,"abstract":"<div><h3>Background</h3><div>Surgical lung biopsy (SLB) is recommended for diagnosing idiopathic pulmonary fibrosis in patients with interstitial lung disease (ILD). The safety of SLB is controversial, as the reported mortality and mobility vary according to the patient's background. This study aimed to assess SLB safety using eligibility criteria that excluded patients at the risk of postoperative complications, including acute exacerbations.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed 94 patients with ILD who underwent SLB at our institution between 2010 and 2021. Two peripheral lung locations were resected using 3-port video-assisted thoracoscopic surgery. Complications within 30 and 90 days after surgery were evaluated based on the Clavien-Dindo classification. Preoperative high-resolution computed tomography findings were evaluated according to the guidelines of the American Thoracic Society, 2018. Patients with a radiological usual interstitial pneumonia (UIP) pattern, preoperative oxygen dependence, or organ failure incompatible with general anesthesia were excluded from the study.</div></div><div><h3>Results</h3><div>The median age of the patients was 66 years. The median vital capacity percentage was 81.0%. The following radiological patterns were observed: UIP, 0%; probable UIP, 30%; indeterminate UIP, 14%; and alternative diagnoses, 56%. The median operative time was 45 min. The 30- and 90-day mortality rates were both 0%. One patient (1%) developed an acute exacerbation of ILD on postoperative day 66. Other grade ≥ III complications were observed in 4 cases (4%), 3 of which were associated with air leakage. Home oxygen therapy was not initiated.</div></div><div><h3>Conclusions</h3><div>By excluding patients with poor SLB indications, our criteria are suggested to be valid for safe SLB.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 1","pages":"Pages 81-85"},"PeriodicalIF":2.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142795083","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 : 2025-01-01DOI: 10.1016/j.resinv.2024.12.009
Yuzo Suzuki
Idiopathic pleuroparenchymal fibroelastosis (iPPFE) is characterized by upper lobe-dominant fibrosis involving the pleura and subpleural lung parenchyma. Pathologically, it is characterized by parenchymal intra-alveolar fibrosis with marked deposition of elastic fibers and dense thickening of the visceral pleura. Since iPPFE was categorized as a rare idiopathic interstitial pneumonia (IIP) by the America Thoracic Society/European Respiratory Society, several studies have been conducted, revealing an overall picture of iPPFE in terms of epidemiology, clinical manifestations, and mortality, in addition to its radiological and histological characteristics. Subsequently, several clinical diagnostic criteria that were not necessary for pathological analyses were proposed. Further, the underlying diseases responsible for secondary PPFE and PPFE-like lesions and their clinical implications were delineated. Typically, patients with iPPFE exhibit lean body stature together with platythorax, as well as relatively severe impairment of pulmonary function. In addition to upper-lobe PPFE lesions, lower-lobe interstitial lung disease (ILD) is commonly observed in patients with iPPFE, with the usual interstitial pneumonia pattern being most frequent. These distinct features of iPPFE were mostly associated with mortality, resulting in a poor prognosis relative to fibrotic ILD. Despite increased knowledge regarding the clinical characteristics of iPPFE, no effective therapy has been established other than lung transplantation. The efficacy of antifibrotic therapy, nutrition intervention, and pulmonary rehabilitation has not been determined. This article reviews previous studies and discusses the etiology, clinical manifestations, mortality risk, and treatment of iPPFE.
{"title":"Idiopathic pleuroparenchymal fibroelastosis: A review of the previous literature and current knowledge","authors":"Yuzo Suzuki","doi":"10.1016/j.resinv.2024.12.009","DOIUrl":"10.1016/j.resinv.2024.12.009","url":null,"abstract":"<div><div>Idiopathic pleuroparenchymal fibroelastosis (iPPFE) is characterized by upper lobe-dominant fibrosis involving the pleura and subpleural lung parenchyma. Pathologically, it is characterized by parenchymal intra-alveolar fibrosis with marked deposition of elastic fibers and dense thickening of the visceral pleura. Since iPPFE was categorized as a rare idiopathic interstitial pneumonia (IIP) by the America Thoracic Society/European Respiratory Society, several studies have been conducted, revealing an overall picture of iPPFE in terms of epidemiology, clinical manifestations, and mortality, in addition to its radiological and histological characteristics. Subsequently, several clinical diagnostic criteria that were not necessary for pathological analyses were proposed. Further, the underlying diseases responsible for secondary PPFE and PPFE-like lesions and their clinical implications were delineated. Typically, patients with iPPFE exhibit lean body stature together with platythorax, as well as relatively severe impairment of pulmonary function. In addition to upper-lobe PPFE lesions, lower-lobe interstitial lung disease (ILD) is commonly observed in patients with iPPFE, with the usual interstitial pneumonia pattern being most frequent. These distinct features of iPPFE were mostly associated with mortality, resulting in a poor prognosis relative to fibrotic ILD. Despite increased knowledge regarding the clinical characteristics of iPPFE, no effective therapy has been established other than lung transplantation. The efficacy of antifibrotic therapy, nutrition intervention, and pulmonary rehabilitation has not been determined. This article reviews previous studies and discusses the etiology, clinical manifestations, mortality risk, and treatment of iPPFE.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 1","pages":"Pages 127-137"},"PeriodicalIF":2.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142855163","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 : 2025-01-01DOI: 10.1016/j.resinv.2024.12.013
Fei Gao , Siqi He , Jing Li , Xiaoyue Wang , Xiaoting Chen , Xiaoning Bu
Background
Preserved Ratio Impaired Spirometry (PRISm) (defined as the ratio of forced expired volume in the first second to forced vital capacity (FEV1/FVC) greater than 0·70 with a FEV1 of less than 80% predicted) is associated with a higher risk of hospitalizations and mortality in the general population. However, less is known about whether PRISm is associated with adverse clinical outcomes in patients with bronchiectasis. We aimed to investigate whether PRISm is associated with adverse clinical outcomes in bronchiectasis patients.
Methods
We performed a retrospective cohort study with inpatients admitted with acute exacerbations of bronchiectasis between January 2017 and January 2022. Clinical data including anthropometry, spirometry, laboratory, etiological and radiologic variables were collected. Patients were divided into the normal spirometry group, the PRISm group and the obstructive spirometry group. All patients were followed up for 1 year. The primary outcome was readmission of bronchiectasis at 1 year.
Results
Of 487 bronchiectasis patients, we found 142 (29.2%) had normal spirometry, 67 (13.8%) had PRISm and 278 (57.1%) had obstructive spirometry. Patients with obstructive spirometry were more likely to be male and to smoke, had higher fibrinogen values and more lobes affected. Patients with PRISm (HR 1.929, 95% CI 1.049 to 3.546) and obstructive spirometry (HR 2.406, 95%CI 1.506 to 3.845) had a higher risk of readmissions compared with those with normal spirometry after adjustment for potential confounders.
Conclusions
PRISm was associated with significant increased risk for readmissions in patients with bronchiectasis compared with normal spirometry, which should receive special attention.
{"title":"Association between preserved ratio impaired spirometry and 1-year clinical outcomes in patients with bronchiectasis patients: A cohort study","authors":"Fei Gao , Siqi He , Jing Li , Xiaoyue Wang , Xiaoting Chen , Xiaoning Bu","doi":"10.1016/j.resinv.2024.12.013","DOIUrl":"10.1016/j.resinv.2024.12.013","url":null,"abstract":"<div><h3>Background</h3><div>Preserved Ratio Impaired Spirometry (PRISm) (defined as the ratio of forced expired volume in the first second to forced vital capacity (FEV1/FVC) greater than 0·70 with a FEV1 of less than 80% predicted) is associated with a higher risk of hospitalizations and mortality in the general population. However, less is known about whether PRISm is associated with adverse clinical outcomes in patients with bronchiectasis. We aimed to investigate whether PRISm is associated with adverse clinical outcomes in bronchiectasis patients.</div></div><div><h3>Methods</h3><div>We performed a retrospective cohort study with inpatients admitted with acute exacerbations of bronchiectasis between January 2017 and January 2022. Clinical data including anthropometry, spirometry, laboratory, etiological and radiologic variables were collected. Patients were divided into the normal spirometry group, the PRISm group and the obstructive spirometry group. All patients were followed up for 1 year. The primary outcome was readmission of bronchiectasis at 1 year.</div></div><div><h3>Results</h3><div>Of 487 bronchiectasis patients, we found 142 (29.2%) had normal spirometry, 67 (13.8%) had PRISm and 278 (57.1%) had obstructive spirometry. Patients with obstructive spirometry were more likely to be male and to smoke, had higher fibrinogen values and more lobes affected. Patients with PRISm (HR 1.929, 95% CI 1.049 to 3.546) and obstructive spirometry (HR 2.406, 95%CI 1.506 to 3.845) had a higher risk of readmissions compared with those with normal spirometry after adjustment for potential confounders.</div></div><div><h3>Conclusions</h3><div>PRISm was associated with significant increased risk for readmissions in patients with bronchiectasis compared with normal spirometry, which should receive special attention.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 1","pages":"Pages 163-169"},"PeriodicalIF":2.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142896573","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 : 2025-01-01DOI: 10.1016/j.resinv.2024.12.014
Akihito Ueda , Kanji Nohara
This study analyzed changes in pneumonia hospitalizations in Japan before and after the COVID-19 pandemic using Diagnosis Procedure Combination data. The proportion of inpatients with non-aspiration pneumonia (non-AP) decreased by 48.8%, whereas that of inpatients with aspiration pneumonia (AP) decreased by only 8.8%. The proportion of AP among all pneumonia cases increased from approximately 33%–47% post-pandemic. The significant reduction in non-AP incidence likely reflects its sensitivity to external factors such as public health measures. Conversely, the limited decrease in AP demonstrates its stronger association with internal factors that are less affected by lifestyle changes. This study provides insights into the differential impact of the pandemic on pneumonia subtypes, revealing how external interventions may have varying effects on different forms of pneumonia. These findings highlight the complex interplay between public health measures and the epidemiology of respiratory infections in the context of a global pandemic.
{"title":"Impact of COVID-19 pandemic on pneumonia trends in Japan: Insights from diagnosis procedure combination data","authors":"Akihito Ueda , Kanji Nohara","doi":"10.1016/j.resinv.2024.12.014","DOIUrl":"10.1016/j.resinv.2024.12.014","url":null,"abstract":"<div><div>This study analyzed changes in pneumonia hospitalizations in Japan before and after the COVID-19 pandemic using Diagnosis Procedure Combination data. The proportion of inpatients with non-aspiration pneumonia (non-AP) decreased by 48.8%, whereas that of inpatients with aspiration pneumonia (AP) decreased by only 8.8%. The proportion of AP among all pneumonia cases increased from approximately 33%–47% post-pandemic. The significant reduction in non-AP incidence likely reflects its sensitivity to external factors such as public health measures. Conversely, the limited decrease in AP demonstrates its stronger association with internal factors that are less affected by lifestyle changes. This study provides insights into the differential impact of the pandemic on pneumonia subtypes, revealing how external interventions may have varying effects on different forms of pneumonia. These findings highlight the complex interplay between public health measures and the epidemiology of respiratory infections in the context of a global pandemic.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 1","pages":"Pages 170-173"},"PeriodicalIF":2.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142896630","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 : 2025-01-01DOI: 10.1016/j.resinv.2024.11.010
Tatsuya Nagano
There are 4 subtypes of chronic rhinosinusitis (CRS): eosinophilic CRS with nasal polyps (ECRSwNP), ECRS without NPs (ECRSsNP), non-ECRSwNP, and non-ECRSsNP. Most ECRS cases are categorized as ECRSwNP, and the number of patients with ECRSwNP has recently increased. ECRS is associated mainly with helper T-cell type 2 inflammation and eosinophils. Recently, Interleukin-25, -33, or TSLP, helper T-cell type 17, and Group 2 innate lymphoid cells have also been shown to be involved in the molecular mechanism of ECRS. ECRS can lead to several complications including bronchial asthma and/or aspirin intolerance. Conventionally, surgery and corticosteroids have been used to treat ECRS, but biologics have since been applied. Mepolizumab, benralizumab, and tezepelumab have been reported to improve asthma complicated by NPs more than asthma uncomplicated by NPs. Omalizumab, mepolizumab, benralizumab, and dupilumab have been reported to significantly improve Sinonasal Outcome Test-22 scores, nasal polyp scores, and nasal congestion severity in phase III trials. Benralizumab, dupilumab, and tezepelumab have been reported to improve both ECRS and complicated bronchial asthma.
{"title":"Biologics treatment for eosinophilic chronic rhinosinusitis complicated by bronchial asthma: Narrative review","authors":"Tatsuya Nagano","doi":"10.1016/j.resinv.2024.11.010","DOIUrl":"10.1016/j.resinv.2024.11.010","url":null,"abstract":"<div><div>There are 4 subtypes of chronic rhinosinusitis (CRS): eosinophilic CRS with nasal polyps (ECRSwNP), ECRS without NPs (ECRSsNP), non-ECRSwNP, and non-ECRSsNP. Most ECRS cases are categorized as ECRSwNP, and the number of patients with ECRSwNP has recently increased. ECRS is associated mainly with helper T-cell type 2 inflammation and eosinophils. Recently, Interleukin-25, -33, or TSLP, helper T-cell type 17, and Group 2 innate lymphoid cells have also been shown to be involved in the molecular mechanism of ECRS. ECRS can lead to several complications including bronchial asthma and/or aspirin intolerance. Conventionally, surgery and corticosteroids have been used to treat ECRS, but biologics have since been applied. Mepolizumab, benralizumab, and tezepelumab have been reported to improve asthma complicated by NPs more than asthma uncomplicated by NPs. Omalizumab, mepolizumab, benralizumab, and dupilumab have been reported to significantly improve Sinonasal Outcome Test-22 scores, nasal polyp scores, and nasal congestion severity in phase III trials. Benralizumab, dupilumab, and tezepelumab have been reported to improve both ECRS and complicated bronchial asthma.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 1","pages":"Pages 35-39"},"PeriodicalIF":2.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771825","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}
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