Bronchoscopic lung insufflation (BLI) allows re-expansion of collapsed lung lobes after transplantation. Among 254 transplant cases at our center, two patients underwent BLI for lobar atelectasis. Case 1 had recurrent right middle-lobe collapse after initial recovery, and BLI under conscious sedation led to durable re-expansion without complications. Case 2 underwent BLI for right upper-lobe atelectasis but developed transient neurological deficits due to presumed cerebral gas embolism, despite initial re-expansion. Full recovery was achieved with supportive care. These cases highlight BLI as an effective treatment for post-transplant atelectasis, although rare but serious complications require careful monitoring.
{"title":"Bronchoscopic lung insufflation for post-transplant lobar atelectasis: Efficacy and a rare complication of cerebral gas embolism","authors":"Yojiro Yutaka , Akira Matsumoto , Ichiro Sakanoue , Hidenao Kayawake , Satona Tanaka , Daisuke Nakajima , Hiroshi Date","doi":"10.1016/j.resinv.2025.101339","DOIUrl":"10.1016/j.resinv.2025.101339","url":null,"abstract":"<div><div>Bronchoscopic lung insufflation (BLI) allows re-expansion of collapsed lung lobes after transplantation. Among 254 transplant cases at our center, two patients underwent BLI for lobar atelectasis. Case 1 had recurrent right middle-lobe collapse after initial recovery, and BLI under conscious sedation led to durable re-expansion without complications. Case 2 underwent BLI for right upper-lobe atelectasis but developed transient neurological deficits due to presumed cerebral gas embolism, despite initial re-expansion. Full recovery was achieved with supportive care. These cases highlight BLI as an effective treatment for post-transplant atelectasis, although rare but serious complications require careful monitoring.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"64 1","pages":"Article 101339"},"PeriodicalIF":2.0,"publicationDate":"2025-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145616020","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}
With proper patient selection excluding collateral ventilation, bronchoscopic lung volume reduction (BLVR) with endobronchial valves (EBVs) offers significant benefits but increases pneumothorax risk. Prioritized management of persistent pneumothorax post-BLVR remains unclear, with both EBV removal and video-assisted thoracic surgery (VATS) considered options. We report a 76-year-old man with severe emphysema who developed persistent pneumothorax and subcutaneous emphysema after left upper lobe BLVR. Following the patient's wishes, VATS was performed instead of EBV removal, resulting in a favorable outcome without delaying BLVR benefits. Depending upon the situation and patient wishes, prioritizing VATS over valve removal may be a reasonable strategy.
{"title":"A case of persistent pneumothorax after bronchoscopic lung volume reduction successfully treated with video-assisted thoracic surgery without removal of endobronchial valves","authors":"Tadashi Sakaguchi , Tomohito Tarukawa , Yoichi Nishii , Motoshi Takao , Osamu Hataji","doi":"10.1016/j.resinv.2025.101338","DOIUrl":"10.1016/j.resinv.2025.101338","url":null,"abstract":"<div><div>With proper patient selection excluding collateral ventilation, bronchoscopic lung volume reduction (BLVR) with endobronchial valves (EBVs) offers significant benefits but increases pneumothorax risk. Prioritized management of persistent pneumothorax post-BLVR remains unclear, with both EBV removal and video-assisted thoracic surgery (VATS) considered options. We report a 76-year-old man with severe emphysema who developed persistent pneumothorax and subcutaneous emphysema after left upper lobe BLVR. Following the patient's wishes, VATS was performed instead of EBV removal, resulting in a favorable outcome without delaying BLVR benefits. Depending upon the situation and patient wishes, prioritizing VATS over valve removal may be a reasonable strategy.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"64 1","pages":"Article 101338"},"PeriodicalIF":2.0,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145616018","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 : 2025-11-26DOI: 10.1016/j.resinv.2025.101337
Masamichi Itoga, Sadatomo Tasaka
Biologic therapies have revolutionized the treatment of severe asthma. However, the selection of the optimal biologic agent remains challenging because of the heterogeneity of disease phenotypes and frequent comorbidities. This mini-review explored the clinical relevance of comorbidities in the selection of biologics for patients with asthma.
Herein, we summarize recent evidence on the prevalence of comorbidities associated with type 2 inflammation, including chronic spontaneous urticaria, atopic dermatitis, prurigo nodularis, chronic rhinosinusitis with nasal polyps, eosinophilic granulomatosis with polyangiitis, eosinophilic otitis media, aspirin-exacerbated respiratory disease, allergic rhinitis, allergic bronchopulmonary mycosis, obesity, and chronic obstructive pulmonary disease, and review the efficacy of five major biologics (omalizumab, mepolizumab, benralizumab, dupilumab, and tezepelumab) in these settings. Each biologic targets distinct immunologic pathways in type 2 inflammation, including IgE, IL-5, IL-5Rα, IL-4Rα, and thymic stromal lymphopoietin, respectively.
In conclusion, the assessment of comorbidities in addition to biomarkers is essential for tailoring biologic therapies for severe asthma. Integrating comorbidity profiles into treatment strategies allows for a more precise and effective use of biologics, ultimately improving outcomes in complicated asthma cases.
{"title":"How to choose a biologic agent considering comorbidities of bronchial asthma","authors":"Masamichi Itoga, Sadatomo Tasaka","doi":"10.1016/j.resinv.2025.101337","DOIUrl":"10.1016/j.resinv.2025.101337","url":null,"abstract":"<div><div>Biologic therapies have revolutionized the treatment of severe asthma. However, the selection of the optimal biologic agent remains challenging because of the heterogeneity of disease phenotypes and frequent comorbidities. This mini-review explored the clinical relevance of comorbidities in the selection of biologics for patients with asthma.</div><div>Herein, we summarize recent evidence on the prevalence of comorbidities associated with type 2 inflammation, including chronic spontaneous urticaria, atopic dermatitis, prurigo nodularis, chronic rhinosinusitis with nasal polyps, eosinophilic granulomatosis with polyangiitis, eosinophilic otitis media, aspirin-exacerbated respiratory disease, allergic rhinitis, allergic bronchopulmonary mycosis, obesity, and chronic obstructive pulmonary disease, and review the efficacy of five major biologics (omalizumab, mepolizumab, benralizumab, dupilumab, and tezepelumab) in these settings. Each biologic targets distinct immunologic pathways in type 2 inflammation, including IgE, IL-5, IL-5Rα, IL-4Rα, and thymic stromal lymphopoietin, respectively.</div><div>In conclusion, the assessment of comorbidities in addition to biomarkers is essential for tailoring biologic therapies for severe asthma. Integrating comorbidity profiles into treatment strategies allows for a more precise and effective use of biologics, ultimately improving outcomes in complicated asthma cases.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"64 1","pages":"Article 101337"},"PeriodicalIF":2.0,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145616019","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}
Sputum management is a critical and potentially lethal issue in patients following lung transplantation. Here, we describe a patient with idiopathic pleuroparenchymal fibroelastosis who underwent tracheotomy after deceased donor bilateral lung transplantation, in whom we were unable to remove the tracheostomy tube due to difficulty in sputum evacuation. The tube was successfully removed following the subsequent initiation of intrapulmonary percussive ventilation (IPV) treatment combined with pulmonary rehabilitation. IPV has been widely used for several decades for treating pulmonary conditions, including chronic obstructive pulmonary disease, cystic fibrosis, and bronchiectasis. However, it should also be considered for airway clearance after lung transplantation.
{"title":"Successful tracheostomy tube removal following airway clearance using intrapulmonary percussive ventilation treatment after bilateral lung transplantation in a patient with idiopathic pleuroparenchymal fibroelastosis","authors":"Satoshi Hamada , Tomohiko Yamaguchi , Yohei Oshima , Yoshihiro Nishino , Satona Tanaka , Daisuke Nakajima , Toyohiro Hirai","doi":"10.1016/j.resinv.2025.101336","DOIUrl":"10.1016/j.resinv.2025.101336","url":null,"abstract":"<div><div>Sputum management is a critical and potentially lethal issue in patients following lung transplantation. Here, we describe a patient with idiopathic pleuroparenchymal fibroelastosis who underwent tracheotomy after deceased donor bilateral lung transplantation, in whom we were unable to remove the tracheostomy tube due to difficulty in sputum evacuation. The tube was successfully removed following the subsequent initiation of intrapulmonary percussive ventilation (IPV) treatment combined with pulmonary rehabilitation. IPV has been widely used for several decades for treating pulmonary conditions, including chronic obstructive pulmonary disease, cystic fibrosis, and bronchiectasis. However, it should also be considered for airway clearance after lung transplantation.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"64 1","pages":"Article 101336"},"PeriodicalIF":2.0,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145616021","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}
Venous thromboembolism (VTE) is a frequent complication of cancer-associated thrombosis, and its management is critical when considering cancer treatment selection and prognosis. The aim of this study was to investigate the incidence and risk factors for VTE in patients with lung cancer using the CS-Lung003 platform, a multicenter prospective observational study of advanced lung cancer.
Methods
Patients with a pathologic diagnosis of lung cancer at any stage were included. The incidence of VTE was calculated using the CS-Lung003 database, and risk factors were examined using logistic regression analysis.
Results
The analysis included 1744 patients (80 % male). Sixty patients (3.4 %) had VTE at/after enrollment in the CS-Lung003 trial. The median age was 69 years (range 63–76) in the group without VTE and 72 years (range 67–77) in the group with VTE. Adenocarcinoma was diagnosed in 58.7 % of patients in the group without VTE and 46.7 % in the group with VTE. Univariate analysis revealed male sex, body weight, and hypertension as risk factors for VTE. Overall survival was 29.1 months in the group without VTE and 30.6 months in the group with VTE. Among patients with stage IIIB–IV, the VTE group showed significantly longer overall survival compared with the non-VTE group (p = 0.041).
Conclusions
The incidence of VTE in this study was low, suggesting that there may have been patients with VTE complications that were not reported in the registry. In addition, most patients with VTE received therapeutic intervention; appropriate diagnosis and treatment may have allowed cancer treatment to continue. Appropriate diagnosis and treatment of VTE might allow lung cancer therapy continuation without compromising survival.
{"title":"Incidence and clinical features of venous thromboembolism in patients with lung cancer in Japan: results from the CS-Lung-003 prospective observational registry study","authors":"Yukari Tsubata , Nobuhiro Kanaji , Mika Nakao , Takeshi Masuda , Masahiro Yamasaki , Masahiro Kodani , Nobuhisa Ishikawa , Toshiyuki Kozuki , Masaaki Inoue , Kazuya Nishii , Katsuyuki Hotta , Katsuyuki Kiura , Takeshi Isobe","doi":"10.1016/j.resinv.2025.11.011","DOIUrl":"10.1016/j.resinv.2025.11.011","url":null,"abstract":"<div><h3>Background</h3><div>Venous thromboembolism (VTE) is a frequent complication of cancer-associated thrombosis, and its management is critical when considering cancer treatment selection and prognosis. The aim of this study was to investigate the incidence and risk factors for VTE in patients with lung cancer using the CS-Lung003 platform, a multicenter prospective observational study of advanced lung cancer.</div></div><div><h3>Methods</h3><div>Patients with a pathologic diagnosis of lung cancer at any stage were included. The incidence of VTE was calculated using the CS-Lung003 database, and risk factors were examined using logistic regression analysis.</div></div><div><h3>Results</h3><div>The analysis included 1744 patients (80 % male). Sixty patients (3.4 %) had VTE at/after enrollment in the CS-Lung003 trial. The median age was 69 years (range 63–76) in the group without VTE and 72 years (range 67–77) in the group with VTE. Adenocarcinoma was diagnosed in 58.7 % of patients in the group without VTE and 46.7 % in the group with VTE. Univariate analysis revealed male sex, body weight, and hypertension as risk factors for VTE. Overall survival was 29.1 months in the group without VTE and 30.6 months in the group with VTE. Among patients with stage IIIB–IV, the VTE group showed significantly longer overall survival compared with the non-VTE group (p = 0.041).</div></div><div><h3>Conclusions</h3><div>The incidence of VTE in this study was low, suggesting that there may have been patients with VTE complications that were not reported in the registry. In addition, most patients with VTE received therapeutic intervention; appropriate diagnosis and treatment may have allowed cancer treatment to continue. Appropriate diagnosis and treatment of VTE might allow lung cancer therapy continuation without compromising survival.</div></div><div><h3>Clinical trial registry/registration number</h3><div>UMIN-CTR/UMIN000026696.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"64 1","pages":"Article 101332"},"PeriodicalIF":2.0,"publicationDate":"2025-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145571142","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}
Patients with interstitial lung disease (ILD) often experience psychological symptoms. This study aimed to clarify the status of psychological support for patients with ILD in Japan.
Methods
We conducted a secondary analysis on a nationwide survey of Japanese respiratory physicians to assess psychological support availability, consultation departments, reasons for palliative care referrals, and opinions on insurance coverage for psychologist-led psychotherapy.
Results
Of 1332 respondents, 1023 managed patients with ILD in the previous year. Among them, 34.5 % reported no psychological support availability and 42.9 % reported insufficient support. Psychiatry or psychosomatic medicine departments were consulted by 77.3 %, and palliative care teams by 52.2 %. Anxiety (47.4 %) and depression (44.6 %) were the reasons for palliative care referral. Overall, 93.6 % considered insurance coverage for psychologist-led psychotherapy helpful or essential.
Conclusions
Most physicians lack adequate psychological support resources for ILD despite frequent psychological symptoms. Systematic development of support structures and insurance coverage are needed.
{"title":"Psychological palliative care for patients with interstitial lung disease in Japan: A secondary analysis of a National Survey of Japanese Respiratory Physicians","authors":"Yoshinobu Matsuda , Tomoyuki Fujisawa , Tatsuya Morita , Masanori Mori , Norimichi Akiyama , Takafumi Koyauchi , Mitsunori Miyashita , Ryo Tachikawa , Keisuke Tomii , Hiromi Tomioka , Satoshi Hagimoto , Yasuhiro Kondoh , Yoshikazu Inoue , Takafumi Suda","doi":"10.1016/j.resinv.2025.11.009","DOIUrl":"10.1016/j.resinv.2025.11.009","url":null,"abstract":"<div><h3>Background</h3><div>Patients with interstitial lung disease (ILD) often experience psychological symptoms. This study aimed to clarify the status of psychological support for patients with ILD in Japan.</div></div><div><h3>Methods</h3><div>We conducted a secondary analysis on a nationwide survey of Japanese respiratory physicians to assess psychological support availability, consultation departments, reasons for palliative care referrals, and opinions on insurance coverage for psychologist-led psychotherapy.</div></div><div><h3>Results</h3><div>Of 1332 respondents, 1023 managed patients with ILD in the previous year. Among them, 34.5 % reported no psychological support availability and 42.9 % reported insufficient support. Psychiatry or psychosomatic medicine departments were consulted by 77.3 %, and palliative care teams by 52.2 %. Anxiety (47.4 %) and depression (44.6 %) were the reasons for palliative care referral. Overall, 93.6 % considered insurance coverage for psychologist-led psychotherapy helpful or essential.</div></div><div><h3>Conclusions</h3><div>Most physicians lack adequate psychological support resources for ILD despite frequent psychological symptoms. Systematic development of support structures and insurance coverage are needed.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"64 1","pages":"Article 101330"},"PeriodicalIF":2.0,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145571139","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}
Bronchoscopy is essential for diagnosing and managing respiratory diseases. However, secretions and airway reflexes can impair procedural quality and patient comfort. While anticholinergic pretreatment using agents such as atropine and hydroxyzine has historically mitigated these physiological responses, recent guidelines discourage their routine use because of concerns regarding hemodynamic changes and uncertain benefits. This study aimed to assess the efficacy of anticholinergic pretreatment during contemporary bronchoscopy.
Methods
We conducted a single-center, cross-sectional study comparing two cohorts of patients who underwent bronchoscopy with transbronchial and ultrasound-guided needle biopsies. Group A (n = 35) received pretreatment with intramuscular atropine (0.5 mg) and hydroxyzine (25 mg) between July 2022 and September 2023, while Group B (n = 35) underwent procedures without pretreatment between December 2024 and March 2025. Patient discomfort was evaluated using a visual analog scale. Propensity score adjustment with inverse probability of treatment weighting (IPTW) accounted for differences in baseline factors.
Results
Seventy patients were included (n = 35 per group). After IPTW adjustment, Group B reported greater distress from salivation and cough and lower willingness for repeat bronchoscopy (p = 0.03, p = 0.02, p = 0.001, respectively). Group B also showed higher use of lidocaine (p < 0.001). No significant differences in midazolam dosage or vital signs were observed among either group.
Conclusion
Anticholinergic pretreatment may reduce procedural discomfort, particularly that associated with secretions and airway reflexes, without evident adverse effects. Further randomized controlled trials are required to validate the role of pretreatment in contemporary bronchoscopy.
背景：支气管镜检查对于诊断和治疗呼吸系统疾病至关重要。然而，分泌物和气道反射会损害手术质量和患者舒适度。虽然使用阿托品和羟嗪等抗胆碱能预处理药物在历史上减轻了这些生理反应，但由于担心血流动力学变化和不确定的益处，最近的指南不鼓励常规使用这些药物。本研究旨在评估当代支气管镜检查中抗胆碱能预处理的疗效。方法：我们进行了一项单中心横断面研究，比较了两组接受支气管镜检查、经支气管和超声引导下穿刺活检的患者。A组（n = 35）在2022年7月至2023年9月期间接受了肌肉注射阿托品（0.5 mg）和羟嗪（25 mg）的预处理，而B组（n = 35）在2024年12月至2025年3月期间接受了没有预处理的手术。采用视觉模拟量表评估患者不适程度。倾向评分调整与治疗加权逆概率（IPTW）解释了基线因素的差异。结果共纳入70例患者，每组35例。调整IPTW后，B组患者的流涎和咳嗽症状加重，再次支气管镜检查意愿降低（p = 0.03, p = 0.02, p = 0.001）。B组的利多卡因使用率也较高（p < 0.001）。两组患者咪达唑仑剂量及生命体征无显著差异。结论抗胆碱能预处理可减少手术不适，特别是与分泌物和气道反射相关的不适，无明显不良反应。需要进一步的随机对照试验来验证预处理在当代支气管镜检查中的作用。
{"title":"Impact of atropine and hydroxyzine pretreatment in contemporary bronchoscopy","authors":"Kazuo Tsuchiya, Ryota Miyamoto, Tomo Tsunoda, Taisuke Ito, Takuro Akashi, Yoshiyuki Oyama, Masaki Ikeda","doi":"10.1016/j.resinv.2025.11.012","DOIUrl":"10.1016/j.resinv.2025.11.012","url":null,"abstract":"<div><h3>Background</h3><div>Bronchoscopy is essential for diagnosing and managing respiratory diseases. However, secretions and airway reflexes can impair procedural quality and patient comfort. While anticholinergic pretreatment using agents such as atropine and hydroxyzine has historically mitigated these physiological responses, recent guidelines discourage their routine use because of concerns regarding hemodynamic changes and uncertain benefits. This study aimed to assess the efficacy of anticholinergic pretreatment during contemporary bronchoscopy.</div></div><div><h3>Methods</h3><div>We conducted a single-center, cross-sectional study comparing two cohorts of patients who underwent bronchoscopy with transbronchial and ultrasound-guided needle biopsies. Group A (n = 35) received pretreatment with intramuscular atropine (0.5 mg) and hydroxyzine (25 mg) between July 2022 and September 2023, while Group B (n = 35) underwent procedures without pretreatment between December 2024 and March 2025. Patient discomfort was evaluated using a visual analog scale. Propensity score adjustment with inverse probability of treatment weighting (IPTW) accounted for differences in baseline factors.</div></div><div><h3>Results</h3><div>Seventy patients were included (n = 35 per group). After IPTW adjustment, Group B reported greater distress from salivation and cough and lower willingness for repeat bronchoscopy (p = 0.03, p = 0.02, p = 0.001, respectively). Group B also showed higher use of lidocaine (<em>p</em> < 0.001). No significant differences in midazolam dosage or vital signs were observed among either group.</div></div><div><h3>Conclusion</h3><div>Anticholinergic pretreatment may reduce procedural discomfort, particularly that associated with secretions and airway reflexes, without evident adverse effects. Further randomized controlled trials are required to validate the role of pretreatment in contemporary bronchoscopy.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"64 1","pages":"Article 101333"},"PeriodicalIF":2.0,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145571140","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}
Although bronchoscopic biopsy serves as a cornerstone for diagnosing lung cancer in elderly patients, whether this procedure leads to clinically relevant outcomes is still unclear. This study aimed to clarify the clinical significance of diagnostic bronchoscopy in lung cancer patients aged ≥80 years.
Methods
We retrospectively analyzed 803 patients diagnosed with lung cancer who underwent bronchoscopy at our hospital from April 2015 to March 2019. Those aged ≥80 years and <80 years were classified as the elderly group (n = 154) and young group (n = 649), respectively.
Results
The diagnostic yield of bronchoscopy in the elderly and young groups was 92.9 % and 83.5 %, respectively; complication rates were 9.6 % and 7.2 %. Approximately 89 % of the patients in the elderly group received specific lung cancer treatment. The 5-year survival rates for elderly and young patients who underwent surgery were 74.5 % and 78.2 %, respectively. In the elderly group, 11 % of the patients chose best supportive care (BSC) only, compared with 2 % in the young group. Notably, patients with non-diagnostic bronchoscopic results selected BSC more frequently in the elderly versus young groups (30.4 % versus 0 %, respectively).
Conclusions
Bronchoscopy in elderly patients with lung cancer demonstrated a high diagnostic yield and an acceptable safety profile, enabling specific treatments in the majority of cases. These findings support the clinical usefulness of bronchoscopy in guiding treatment decisions for elderly patients. However, non-diagnostic results were associated with a higher likelihood of BCS, highlighting the importance of achieving a definitive diagnosis in this population.
{"title":"High diagnostic yield and treatment impact of bronchoscopy in elderly lung cancer patients (≥ 80 years): A single-center retrospective study","authors":"Shingo Maeda , Takuma Ina , Atsuhiko Ota , Masaaki Matsunaga , Tomoya Horiguchi , Aki Ikeda , Ryoma Moriya , Takaya Sato , Chiaki Sawada , Yuko Oya , Shotaro Okachi , Yasuhiro Goto , Sumito Isogai , Naozumi Hashimoto , Masashi Kondo , Kazuyoshi Imaizumi","doi":"10.1016/j.resinv.2025.101335","DOIUrl":"10.1016/j.resinv.2025.101335","url":null,"abstract":"<div><h3>Background</h3><div>Although bronchoscopic biopsy serves as a cornerstone for diagnosing lung cancer in elderly patients, whether this procedure leads to clinically relevant outcomes is still unclear. This study aimed to clarify the clinical significance of diagnostic bronchoscopy in lung cancer patients aged ≥80 years.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 803 patients diagnosed with lung cancer who underwent bronchoscopy at our hospital from April 2015 to March 2019. Those aged ≥80 years and <80 years were classified as the elderly group (n = 154) and young group (n = 649), respectively.</div></div><div><h3>Results</h3><div>The diagnostic yield of bronchoscopy in the elderly and young groups was 92.9 % and 83.5 %, respectively; complication rates were 9.6 % and 7.2 %. Approximately 89 % of the patients in the elderly group received specific lung cancer treatment. The 5-year survival rates for elderly and young patients who underwent surgery were 74.5 % and 78.2 %, respectively. In the elderly group, 11 % of the patients chose best supportive care (BSC) only, compared with 2 % in the young group. Notably, patients with non-diagnostic bronchoscopic results selected BSC more frequently in the elderly versus young groups (30.4 % versus 0 %, respectively).</div></div><div><h3>Conclusions</h3><div>Bronchoscopy in elderly patients with lung cancer demonstrated a high diagnostic yield and an acceptable safety profile, enabling specific treatments in the majority of cases. These findings support the clinical usefulness of bronchoscopy in guiding treatment decisions for elderly patients. However, non-diagnostic results were associated with a higher likelihood of BCS, highlighting the importance of achieving a definitive diagnosis in this population.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"64 1","pages":"Article 101335"},"PeriodicalIF":2.0,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145564599","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 : 2025-11-18DOI: 10.1016/j.resinv.2025.11.004
Parth Aphale, Himanshu Shekhar, Shashank Dokania
{"title":"Critical appraisal of “Effects of Daikin air purifiers on asthma control and pulmonary function: A multicenter, single-arm, observational pilot study”","authors":"Parth Aphale, Himanshu Shekhar, Shashank Dokania","doi":"10.1016/j.resinv.2025.11.004","DOIUrl":"10.1016/j.resinv.2025.11.004","url":null,"abstract":"","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"64 1","pages":"Article 101325"},"PeriodicalIF":2.0,"publicationDate":"2025-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145532469","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}
In Japan, discharge for pulmonary tuberculosis requires microbiological confirmation of non-infectivity, leading to prolonged hospitalization. International guidelines increasingly support early discharge based on clinical stability. This study aimed to describe the clinical characteristics and healthcare utilization of hospitalized tuberculosis patients in Japan and to estimate the proportion potentially eligible for early discharge and associated cost savings.
Methods
This nationwide retrospective cohort study analyzed patients hospitalized for pulmonary tuberculosis, who received rifampicin and isoniazid within 7 days of admission. Data were extracted from an inpatient claims database between June 2010 and March 2023. Patients who met the following predefined clinical criteria were eligible for early discharge: absence of drug resistance, absence of severe comorbidities, and functional independence. Cost simulation was performed under the assumption that patients eligible for early discharge were discharged 14 days after treatment initiation.
Results
Overall, 22,634 patients were eligible. Their mean age was 71.1 years; approximately 40 % required some assistance with activities of daily living. The mean length of hospitalization was 59.2 days (standard deviation, 50.7); the median hospitalization cost was USD 8,974 (interquartile range, 5,696–14,706). Overall, 32.9 % of patients met the criteria for early discharge. Under the hypothetical early discharge scenario, the median estimated cost saving per patient was USD 4,625 (interquartile range, 2,332–8,560).
Conclusions
Early discharge may be feasible for a subset of hospitalized pulmonary tuberculosis patients in Japan and could contribute toward optimizing healthcare resource utilization by reducing hospitalization costs.
{"title":"Clinical characteristics and healthcare resource utilization among patients hospitalized for pulmonary tuberculosis: A national inpatient database study in Japan","authors":"Jumpei Taniguchi , Shotaro Aso , Hiroki Matsui , Kiyohide Fushimi , Hideo Yasunaga","doi":"10.1016/j.resinv.2025.11.007","DOIUrl":"10.1016/j.resinv.2025.11.007","url":null,"abstract":"<div><h3>Background</h3><div>In Japan, discharge for pulmonary tuberculosis requires microbiological confirmation of non-infectivity, leading to prolonged hospitalization. International guidelines increasingly support early discharge based on clinical stability. This study aimed to describe the clinical characteristics and healthcare utilization of hospitalized tuberculosis patients in Japan and to estimate the proportion potentially eligible for early discharge and associated cost savings.</div></div><div><h3>Methods</h3><div>This nationwide retrospective cohort study analyzed patients hospitalized for pulmonary tuberculosis, who received rifampicin and isoniazid within 7 days of admission. Data were extracted from an inpatient claims database between June 2010 and March 2023. Patients who met the following predefined clinical criteria were eligible for early discharge: absence of drug resistance, absence of severe comorbidities, and functional independence. Cost simulation was performed under the assumption that patients eligible for early discharge were discharged 14 days after treatment initiation.</div></div><div><h3>Results</h3><div>Overall, 22,634 patients were eligible. Their mean age was 71.1 years; approximately 40 % required some assistance with activities of daily living. The mean length of hospitalization was 59.2 days (standard deviation, 50.7); the median hospitalization cost was USD 8,974 (interquartile range, 5,696–14,706). Overall, 32.9 % of patients met the criteria for early discharge. Under the hypothetical early discharge scenario, the median estimated cost saving per patient was USD 4,625 (interquartile range, 2,332–8,560).</div></div><div><h3>Conclusions</h3><div>Early discharge may be feasible for a subset of hospitalized pulmonary tuberculosis patients in Japan and could contribute toward optimizing healthcare resource utilization by reducing hospitalization costs.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"64 1","pages":"Article 101328"},"PeriodicalIF":2.0,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145532472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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