Chronic obstructive pulmonary disease (COPD), a major global health burden linked to smoking, is frequently underdiagnosed due to low awareness and delayed symptom recognition. This study explored the feasibility of non-invasive voice and cough sound analysis for COPD identification.
Methods
In this prospective study, 55 participants (26 with COPD, 29 without) underwent pulmonary function testing and provided sociodemographic and clinical data. Speech and cough sounds were recorded three times per participant and processed using acoustic feature extraction, feature selection via the minimum redundancy maximum relevance algorithm, and logistic regression classification. Model performance was evaluated using four-fold cross-validation. Statistical analysis was conducted with JMP software (p < 0.05).
Results
The vowel sound/u/showed statistically significant discriminatory ability in the mixed-gender cohort, but sensitivity and specificity were both below 80 %, indicating limited diagnostic performance. When restricted to male participants, both metrics exceeded 80 %, suggesting higher discriminatory power. Smartphone recordings yielded comparable accuracy to integrated circuit recorders. Adding COPD assessment test scores and smoking history did not improve classification.
Conclusions
Voice analysis may offer a non-invasive screening approach for COPD. However, this study was limited to male participants and a single disease target, restricting generalizability. Future research will expand to include related respiratory conditions such as bronchiectasis and assess performance across sexes and disease types.
{"title":"Identification of individuals with COPD using biometric voice and cough sound features","authors":"Yasushi Obase , Susumu Fukahori , Jun Iriki , Takahiro Takazono , Yusei Tsukamoto , Shinnosuke Takemoto , Noriho Sakamoto , Yusuke Hamanaka , Hideaki Watanabe , Kazumi Hirano , Chizu Fukushima , Tomoya Nishino , Hiroshi Mukae","doi":"10.1016/j.resinv.2025.101353","DOIUrl":"10.1016/j.resinv.2025.101353","url":null,"abstract":"<div><h3>Background</h3><div>Chronic obstructive pulmonary disease (COPD), a major global health burden linked to smoking, is frequently underdiagnosed due to low awareness and delayed symptom recognition. This study explored the feasibility of non-invasive voice and cough sound analysis for COPD identification.</div></div><div><h3>Methods</h3><div>In this prospective study, 55 participants (26 with COPD, 29 without) underwent pulmonary function testing and provided sociodemographic and clinical data. Speech and cough sounds were recorded three times per participant and processed using acoustic feature extraction, feature selection via the minimum redundancy maximum relevance algorithm, and logistic regression classification. Model performance was evaluated using four-fold cross-validation. Statistical analysis was conducted with JMP software (p < 0.05).</div></div><div><h3>Results</h3><div>The vowel sound/u/showed statistically significant discriminatory ability in the mixed-gender cohort, but sensitivity and specificity were both below 80 %, indicating limited diagnostic performance. When restricted to male participants, both metrics exceeded 80 %, suggesting higher discriminatory power. Smartphone recordings yielded comparable accuracy to integrated circuit recorders. Adding COPD assessment test scores and smoking history did not improve classification.</div></div><div><h3>Conclusions</h3><div>Voice analysis may offer a non-invasive screening approach for COPD. However, this study was limited to male participants and a single disease target, restricting generalizability. Future research will expand to include related respiratory conditions such as bronchiectasis and assess performance across sexes and disease types.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"64 1","pages":"Article 101353"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736906","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}
Nontuberculous mycobacterial pulmonary disease (NTM-PD) is a chronic respiratory infection with a growing incidence and mortality globally. Although the clinical features, treatment, and prognosis of Mycobacterium avium-intracellulare (MAI) pulmonary disease have been extensively reported, evidence regarding non-MAI NTM-PD remains limited.
Methods
This retrospective cohort study included patients newly diagnosed with NTM-PD between 2010 and 2017 at 18 hospitals in Kyushu, Japan. Data on baseline characteristics, causative organisms, radiological findings, treatment regimens, and clinical outcomes were collected and analysed.
Results
In total, 1317 patients were enrolled. M. intracellulare (50.4 %), M. avium (40.5 %), M. abscessus complex (MABC) (2.4 %), and M. kansasii (2.4 %) were identified as the major causative organisms. Compared with patients with MAI, those with MABC exhibited a lower body mass index and a higher AFB sputum smear positivity rate. Patients with M. kansasii infection were predominantly male, frequently had underlying chronic obstructive pulmonary disease, and presented with cavitary lesions. Treatment initiation rates for MABC and M. kansasii were 71.9 % and 87.5 %, respectively. The response rate to the treatment in sputum mycobacterial evaluation was comparable between the two groups. However, the re-treatment rate was higher in the MABC group (30.4 % vs. 14.3 %). The 10-year mortality rates were 25.0 % and 15.6 % for MABC and M. kansasii, respectively.
Conclusions
Initial treatment responses for MABC and M. kansasii were favourable. However, long-term outcomes for MABC remained poor, potentially owing to the limited availability of effective continuation-phase therapies. Further large-scale prospective studies are warranted to understand the clinical management and prognosis of non-MAI NTM-PD.
{"title":"Clinical features of Mycobacterium abscessus complex and Mycobacterium kansasii pulmonary disease in Kyushu, Japan","authors":"Kazuaki Takeda , Takahiro Takazono , Shotaro Ide , Masataka Yoshida , Naoki Iwanaga , Naoki Hosogaya , Yusei Tsukamoto , Satoshi Irifune , Takayuki Suyama , Asuka Umemura , Tomo Mihara , Akira Kondo , Tsutomu Kobayashi , Eisuke Sasaki , Toyomitsu Sawai , Yasuhito Higashiyama , Kohji Hashiguchi , Minako Hanaka , Toshihiko Ii , Kiyoyasu Fukushima , Hiroshi Mukae","doi":"10.1016/j.resinv.2025.101358","DOIUrl":"10.1016/j.resinv.2025.101358","url":null,"abstract":"<div><h3>Background</h3><div>Nontuberculous mycobacterial pulmonary disease (NTM-PD) is a chronic respiratory infection with a growing incidence and mortality globally. Although the clinical features, treatment, and prognosis of <em>Mycobacterium avium-intracellulare</em> (MAI) pulmonary disease have been extensively reported, evidence regarding non-MAI NTM-PD remains limited.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included patients newly diagnosed with NTM-PD between 2010 and 2017 at 18 hospitals in Kyushu, Japan. Data on baseline characteristics, causative organisms, radiological findings, treatment regimens, and clinical outcomes were collected and analysed.</div></div><div><h3>Results</h3><div>In total, 1317 patients were enrolled. <em>M. intracellulare</em> (50.4 %), <em>M. avium</em> (40.5 %), <em>M. abscessus</em> complex (MABC) (2.4 %), and <em>M. kansasii</em> (2.4 %) were identified as the major causative organisms. Compared with patients with MAI, those with MABC exhibited a lower body mass index and a higher AFB sputum smear positivity rate. Patients with <em>M. kansasii</em> infection were predominantly male, frequently had underlying chronic obstructive pulmonary disease, and presented with cavitary lesions. Treatment initiation rates for MABC and <em>M. kansasii</em> were 71.9 % and 87.5 %, respectively. The response rate to the treatment in sputum mycobacterial evaluation was comparable between the two groups. However, the re-treatment rate was higher in the MABC group (30.4 % vs. 14.3 %). The 10-year mortality rates were 25.0 % and 15.6 % for MABC and <em>M. kansasii</em>, respectively.</div></div><div><h3>Conclusions</h3><div>Initial treatment responses for MABC and <em>M. kansasii</em> were favourable. However, long-term outcomes for MABC remained poor, potentially owing to the limited availability of effective continuation-phase therapies. Further large-scale prospective studies are warranted to understand the clinical management and prognosis of non-MAI NTM-PD.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"64 1","pages":"Article 101358"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839206","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 : 2026-01-01Epub Date: 2025-11-17DOI: 10.1016/j.resinv.2025.11.010
L. Thong , C. Daneshvar , M. Hassan , D. Breen
The involvement of cervical lymph nodes in lung cancer occurs frequently. Despite the involvement of this group of lymph nodes reflecting either stage N3 or M1b in patients with non-small cell lung cancer, they do not receive the same amount of attention as mediastinal lymph nodes. Furthermore, these lymph nodes are more accessible for histology samples compared to other group of lymph nodes. Critically, cervical lymph nodes are often missed on CT scans. Neck US and US-guided biopsy of cervical lymph nodes have more established roles in other primary malignancies (e.g. thyroid cancer) and non-malignant diseases. This scoping review explores existing literature on neck US and cervical lymph node biopsy in patients with suspected lung cancer. The role and potentials benefits of neck US and cervical lymph node biopsy in this group of patients is examined. We also explored whether the procedure is being performed routinely by respiratory physicians as part of their lung cancer algorithm.
{"title":"The role of ultrasound-guided cervical lymph node biopsy in lung cancer: A scoping review","authors":"L. Thong , C. Daneshvar , M. Hassan , D. Breen","doi":"10.1016/j.resinv.2025.11.010","DOIUrl":"10.1016/j.resinv.2025.11.010","url":null,"abstract":"<div><div>The involvement of cervical lymph nodes in lung cancer occurs frequently. Despite the involvement of this group of lymph nodes reflecting either stage N3 or M1b in patients with non-small cell lung cancer, they do not receive the same amount of attention as mediastinal lymph nodes. Furthermore, these lymph nodes are more accessible for histology samples compared to other group of lymph nodes. Critically, cervical lymph nodes are often missed on CT scans. Neck US and US-guided biopsy of cervical lymph nodes have more established roles in other primary malignancies (e.g. thyroid cancer) and non-malignant diseases. This scoping review explores existing literature on neck US and cervical lymph node biopsy in patients with suspected lung cancer. The role and potentials benefits of neck US and cervical lymph node biopsy in this group of patients is examined. We also explored whether the procedure is being performed routinely by respiratory physicians as part of their lung cancer algorithm.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"64 1","pages":"Article 101331"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145532471","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 : 2026-01-01Epub Date: 2025-12-31DOI: 10.1016/j.resinv.2025.101359
Punchalee Kaenmuang , Fiammetta Danzo , Simon Bax , Richard J. Hewitt , Maria Kokosi , Vasileios Kouranos , Felix Chua , Peter M. George , Gisli Jenkins , Athol U. Wells , Carmel JW. Stock , Piersante Sestini , Elisabetta A. Renzoni
In fibrotic hypersensitivity pneumonitis, the relevance of bronchoalveolar lavage (BAL) lymphocytosis remains unclear. We investigated the relationship between BAL %lymphocytes, baseline pulmonary function tests (PFTs) and transplant-free survival. We retrospectively analysed 162 treatment-naïve patients (median age 64 years; 43 % male; 39 % ever-smokers) undergoing BAL within three months of PFTs. Mean FVC 79 %, DLCO 43 %, composite physiologic index (CPI) 48. Median BAL lymphocytes were 24 %(IQR 21–28). BAL %lymphocytes were associated with less severe disease, FVC [coefficient 0.28 (95 %C.I. 0.06–0.48), p = 0.01], FEV1 [0.20(0.0002–0.41), p = 0.05], and CPI [-0.11(-0.21 to −0.01, p = 0.04]. Although BAL% lymphocytes were not correlated with DLCO, significant opposite correlations were observed for its two components: positive with VA% [0.32 (0.18–0.45), p < 0.0005]; negative with KCO% [-0.37(-0.51 to −0.23), p < 0.0005]. In adjusted Cox regression models, BAL %lymphocytes, lower CPI, higher %FVC, %FEV1 and %DLCO were significantly associated with increased survival. These findings suggest BAL lymphocytosis reflects a pathophysiological pattern linked to better outcomes.
{"title":"BAL cells analysis and lung function parameters in fibrotic hypersensitivity pneumonitis at baseline and in relation to survival","authors":"Punchalee Kaenmuang , Fiammetta Danzo , Simon Bax , Richard J. Hewitt , Maria Kokosi , Vasileios Kouranos , Felix Chua , Peter M. George , Gisli Jenkins , Athol U. Wells , Carmel JW. Stock , Piersante Sestini , Elisabetta A. Renzoni","doi":"10.1016/j.resinv.2025.101359","DOIUrl":"10.1016/j.resinv.2025.101359","url":null,"abstract":"<div><div>In fibrotic hypersensitivity pneumonitis, the relevance of bronchoalveolar lavage (BAL) lymphocytosis remains unclear. We investigated the relationship between BAL %lymphocytes, baseline pulmonary function tests (PFTs) and transplant-free survival. We retrospectively analysed 162 treatment-naïve patients (median age 64 years; 43 % male; 39 % ever-smokers) undergoing BAL within three months of PFTs. Mean FVC 79 %, DLCO 43 %, composite physiologic index (CPI) 48. Median BAL lymphocytes were 24 %(IQR 21–28). BAL %lymphocytes were associated with less severe disease, FVC [coefficient 0.28 (95 %C.I. 0.06–0.48), p = 0.01], FEV<sub>1</sub> [0.20(0.0002–0.41), p = 0.05], and CPI [-0.11(-0.21 to −0.01, p = 0.04]. Although BAL% lymphocytes were not correlated with DLCO, significant opposite correlations were observed for its two components: positive with VA% [0.32 (0.18–0.45), p < 0.0005]; negative with KCO% [-0.37(-0.51 to −0.23), p < 0.0005<strong>].</strong> In adjusted Cox regression models, BAL %lymphocytes, lower CPI, higher %FVC, %FEV<sub>1</sub> and %DLCO were significantly associated with increased survival. These findings suggest BAL lymphocytosis reflects a pathophysiological pattern linked to better outcomes.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"64 1","pages":"Article 101359"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145883568","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 : 2026-01-01Epub 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":"2026-01-01","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}
Fibrotic idiopathic interstitial pneumonias (IIPs) are progressive lung diseases with variable prognoses. Oscillometry, a non-invasive method for assessing respiratory impedance, has emerged as a potential tool for disease stratification. However, the association between standardized respiratory reactance (Xrs) measured by oscillometry and clinical outcomes in IIPs, including those other than idiopathic pulmonary fibrosis, remains unclear. Therefore, we investigated this association.
Methods
We retrospectively analyzed 101 patients with fibrotic IIPs treated at Shizuoka General Hospital from 2017 to 2022. Fibrosis was defined by high-resolution computed tomography findings of honeycombing, traction bronchiectasis, or subpleural reticulation. Patients were categorized into high-Xrs or low-Xrs groups based on whether Xrs parameters (X5, Fres, or AX) exceeded 1.64 standard deviations above Japanese standard values. The primary outcome was mortality. Cox proportional hazards analysis identified prognostic factors.
Results
Among 101 patients, 25 (24.8 %) were classified as high-Xrs. Median overall survival was significantly shorter in the high-Xrs group (21.1 months; 95 % CI, 13.2–43.3) compared to the low-Xrs group (78.7 months; 95 % CI, 56.8–not reached). A subgroup analysis of IPF and non-IPF patients showed significant survival differences between the high-Xrs and low-Xrs groups. Multivariate analysis identified low %FVC and high-Xrs classification as independent predictors of mortality.
Conclusions
High respiratory reactance measured by oscillometry was independently associated with impaired lung function and poor prognosis in patients with fibrotic IIPs. Oscillometry may be a valuable tool for risk stratification and prognostic assessment in this patient population.
{"title":"Oscillometrically assessed higher respiratory reactance is associated with impaired lung function and poorer prognosis in patients with fibrotic idiopathic interstitial pneumonias","authors":"Yuya Yamamoto , Taisuke Akamatsu , Keita Hirai , Toshihiro Shirai","doi":"10.1016/j.resinv.2025.101352","DOIUrl":"10.1016/j.resinv.2025.101352","url":null,"abstract":"<div><h3>Background</h3><div>Fibrotic idiopathic interstitial pneumonias (IIPs) are progressive lung diseases with variable prognoses. Oscillometry, a non-invasive method for assessing respiratory impedance, has emerged as a potential tool for disease stratification. However, the association between standardized respiratory reactance (Xrs) measured by oscillometry and clinical outcomes in IIPs, including those other than idiopathic pulmonary fibrosis, remains unclear. Therefore, we investigated this association.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 101 patients with fibrotic IIPs treated at Shizuoka General Hospital from 2017 to 2022. Fibrosis was defined by high-resolution computed tomography findings of honeycombing, traction bronchiectasis, or subpleural reticulation. Patients were categorized into high-Xrs or low-Xrs groups based on whether Xrs parameters (X5, Fres, or AX) exceeded 1.64 standard deviations above Japanese standard values. The primary outcome was mortality. Cox proportional hazards analysis identified prognostic factors.</div></div><div><h3>Results</h3><div>Among 101 patients, 25 (24.8 %) were classified as high-Xrs. Median overall survival was significantly shorter in the high-Xrs group (21.1 months; 95 % CI, 13.2–43.3) compared to the low-Xrs group (78.7 months; 95 % CI, 56.8–not reached). A subgroup analysis of IPF and non-IPF patients showed significant survival differences between the high-Xrs and low-Xrs groups. Multivariate analysis identified low %FVC and high-Xrs classification as independent predictors of mortality.</div></div><div><h3>Conclusions</h3><div>High respiratory reactance measured by oscillometry was independently associated with impaired lung function and poor prognosis in patients with fibrotic IIPs. Oscillometry may be a valuable tool for risk stratification and prognostic assessment in this patient population.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"64 1","pages":"Article 101352"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736941","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":"2026-01-01","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}
Pub Date : 2026-01-01Epub Date: 2025-12-29DOI: 10.1016/j.resinv.2025.101356
Yoshio Nakano , Masahisa Nakamura , Iwao Gohma
Background
Empyema often requires surgery such as video-assisted thoracoscopic surgery (VATS). Minimally invasive nonvascular interventional radiology (IR) techniques, including hydrodissection and guidewire dissection, may be alternatives. We compared outcomes of IR and VATS for stage II–III empyema.
Methods
We retrospectively analyzed 45 patients with stage II–III empyema treated at a single center between April 2021 and October 2024 (IR, n = 23; VATS, n = 22). Primary treatment success was resolution without conversion to surgical management; repeat IR procedures were considered part of the IR strategy. Groups were compared using appropriate statistical tests (p < 0.05).
Results
The Primary treatment success was 87.0 % (20/23) in the IR group and 100 % (22/22) in the VATS group (p = 0.233). The overall clinical outcome, including cases that required subsequent surgery, was 95.6 % in the IR group and 100 % in the VATS group (p = 1). One patient in the IR group required three IR sessions, all performed through the same access site. While IR recipients were significantly older (median 78.0 versus [vs.] 71.5 years; p = 0.046) and had worse performance status (p = 0.015), there was no significant difference in hospital stay, drainage duration, or antibiotic therapy. Ninety-day mortality was 8.7 % (2/23) for IR and 0 % (0/22) for VATS (p = 0.49), with no procedure-related deaths.
Conclusion
In this cohort, no statistically significant difference in overall outcomes was observed between IR-based management and VATS for stage II–III empyema.
{"title":"Non-vascular interventional radiology techniques versus video-assisted thoracoscopic surgery in stage II–III empyema: a retrospective cohort study","authors":"Yoshio Nakano , Masahisa Nakamura , Iwao Gohma","doi":"10.1016/j.resinv.2025.101356","DOIUrl":"10.1016/j.resinv.2025.101356","url":null,"abstract":"<div><h3>Background</h3><div>Empyema often requires surgery such as video-assisted thoracoscopic surgery (VATS). Minimally invasive nonvascular interventional radiology (IR) techniques, including hydrodissection and guidewire dissection, may be alternatives. We compared outcomes of IR and VATS for stage II–III empyema.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 45 patients with stage II–III empyema treated at a single center between April 2021 and October 2024 (IR, n = 23; VATS, n = 22). Primary treatment success was resolution without conversion to surgical management; repeat IR procedures were considered part of the IR strategy. Groups were compared using appropriate statistical tests (p < 0.05).</div></div><div><h3>Results</h3><div>The Primary treatment success was 87.0 % (20/23) in the IR group and 100 % (22/22) in the VATS group (p = 0.233). The overall clinical outcome, including cases that required subsequent surgery, was 95.6 % in the IR group and 100 % in the VATS group (p = 1). One patient in the IR group required three IR sessions, all performed through the same access site. While IR recipients were significantly older (median 78.0 versus [vs.] 71.5 years; p = 0.046) and had worse performance status (p = 0.015), there was no significant difference in hospital stay, drainage duration, or antibiotic therapy. Ninety-day mortality was 8.7 % (2/23) for IR and 0 % (0/22) for VATS (p = 0.49), with no procedure-related deaths.</div></div><div><h3>Conclusion</h3><div>In this cohort, no statistically significant difference in overall outcomes was observed between IR-based management and VATS for stage II–III empyema.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"64 1","pages":"Article 101356"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145865196","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}
Ultrasound (US)-guided percutaneous biopsy is increasingly being used for thoracic lesions abutting the chest wall; however, its comparative safety according to puncture site remains unclear. We assessed the diagnostic yield and complications of bedside US-guided core needle biopsy.
Methods
We retrospectively reviewed the medical records of 168 consecutive patients who underwent pulmonologist-performed bedside core biopsy using an 18-gauge needle under real-time US guidance without a coaxial system between April 2011 and July 2022 at a single center. Typically, two to three passes were performed. Lesions were prospectively classified ultrasonographically as solid or heterogeneous. Diagnostic yield and complications were graded using the Clavien–Dindo system and compared according to puncture site and lesion morphology.
Results
Adequate tissue was obtained in 159 (94.6 %) patients. The final diagnosis was malignancy, infection, and other benign conditions in 81.8 %, 13.8 %, and 4.4 % patients, respectively. Complications occurred in 7.1 % of patients, and pneumothorax was the most frequent complication (4.7 %). All complications were managed conservatively. Grade IV–V adverse events occurred in three (1.5 %) patients undergoing lung parenchymal biopsies. Of these, one patient died during follow-up due to pleural dissemination along the biopsy tract. No adverse events ≥ Grade III occurred after chest-wall, pleural, or mediastinal biopsies. No adverse events occurred in 156 patients.
Conclusions
US-guided percutaneous core biopsy has a high diagnostic accuracy and low complication rate. However, safety varies according to site, with serious adverse events limited to patients with lung parenchymal targets. US-guided core biopsy is a feasible first-line approach for accessible extrapulmonary thoracic lesions; however, careful consideration is required for intrapulmonary targets.
{"title":"Ultrasound-guided percutaneous core biopsy of thoracic lesions: Diagnostic yield and site-specific safety","authors":"Yosuke Murakami, Shota Sogabe, Kazuki Uchida, Takafumi Kawabata, Hiroaki Ota, Yuri Hiramatsu, Mitsukuni Sakabe, Ryuta Yamamoto, Ryunosuke Oi, Akiko Maeda, Kohei Yoshimine, Saori Nishizawa, Hiromi Ide, Minako Hanaka, Kazunori Tobino","doi":"10.1016/j.resinv.2025.101347","DOIUrl":"10.1016/j.resinv.2025.101347","url":null,"abstract":"<div><h3>Background</h3><div>Ultrasound (US)-guided percutaneous biopsy is increasingly being used for thoracic lesions abutting the chest wall; however, its comparative safety according to puncture site remains unclear. We assessed the diagnostic yield and complications of bedside US-guided core needle biopsy.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed the medical records of 168 consecutive patients who underwent pulmonologist-performed bedside core biopsy using an 18-gauge needle under real-time US guidance without a coaxial system between April 2011 and July 2022 at a single center. Typically, two to three passes were performed. Lesions were prospectively classified ultrasonographically as solid or heterogeneous. Diagnostic yield and complications were graded using the Clavien–Dindo system and compared according to puncture site and lesion morphology.</div></div><div><h3>Results</h3><div>Adequate tissue was obtained in 159 (94.6 %) patients. The final diagnosis was malignancy, infection, and other benign conditions in 81.8 %, 13.8 %, and 4.4 % patients, respectively. Complications occurred in 7.1 % of patients, and pneumothorax was the most frequent complication (4.7 %). All complications were managed conservatively. Grade IV–V adverse events occurred in three (1.5 %) patients undergoing lung parenchymal biopsies. Of these, one patient died during follow-up due to pleural dissemination along the biopsy tract. No adverse events ≥ Grade III occurred after chest-wall, pleural, or mediastinal biopsies. No adverse events occurred in 156 patients.</div></div><div><h3>Conclusions</h3><div>US-guided percutaneous core biopsy has a high diagnostic accuracy and low complication rate. However, safety varies according to site, with serious adverse events limited to patients with lung parenchymal targets. US-guided core biopsy is a feasible first-line approach for accessible extrapulmonary thoracic lesions; however, careful consideration is required for intrapulmonary targets.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"64 1","pages":"Article 101347"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145681715","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}
Preserved ratio impaired spirometry (PRISm), defined as a forced expiratory volume in 1 s (FEV1) to forced vital capacity (FVC) ratio ≥0.70 and a predicted FEV1 <80 %, is associated with increased morbidity and mortality. However, determinants of PRISm, particularly in younger populations, remain poorly characterised. We aimed to address this knowledge gap.
Methods
We conducted a cross-sectional analysis of 12,350 participants from a Japanese community-based cohort using data from the Tohoku Medical Megabank Project. Participants underwent spirometry, blood pressure measurement, laboratory testing, and completed standardised questionnaires. Multivariate logistic regression was used to identify factors associated with PRISm across three age groups: 20–39, 40–59, and ≥60 years. Interactions between age groups and other explanatory variables were assessed.
Results
In the 20–39-year group, PRISm was independently associated with being men, diabetes mellitus, hypothyroidism, and low body mass index (BMI <18.5 kg/m2), and inversely associated with age. Among participants aged ≥60 years, PRISm was significantly associated with increasing age, overweight status (BMI ≥25.0–<30.0 kg/m2), being men, current smoking, hypertension, diabetes mellitus, bronchial asthma, elevated eosinophil counts (≥300 cells/μL), and birth weight ≥2000–<2500 g. Significant interactions were observed between age and BMI, bronchial asthma, and thyroid dysfunction.
Conclusions
Our findings indicate that PRISm in younger adults is associated with hypothyroidism and underweight status, whereas in older adults, it is more closely related to constitutional and lifestyle-related factors. These results highlight the heterogeneity of PRISm and indicate that its pathophysiology and optimal management may vary by age group.
{"title":"Age-related factors associated with preserved ratio impaired spirometry: The Tohoku medical Megabank project community-based cohort study","authors":"Chikashi Iwasaki , Kumi Nakaya , Mitsuhiro Yamada , Naoki Nakaya , Mana Kogure , Rieko Hatanaka , Ippei Chiba , Masato Takase , Sayuri Tokioka , Taku Obara , Masatsugu Orui , Naoya Fujino , Akira Koarai , Tomoko Kobayashi , Yohei Hamanaka , Eiichi N Kodama , Satoshi Nagaie , Soichi Ogishima , Nobuo Fuse , Shinichi Kuriyama , Atsushi Hozawa","doi":"10.1016/j.resinv.2025.101343","DOIUrl":"10.1016/j.resinv.2025.101343","url":null,"abstract":"<div><h3>Background</h3><div>Preserved ratio impaired spirometry (PRISm), defined as a forced expiratory volume in 1 s (FEV<sub>1</sub>) to forced vital capacity (FVC) ratio ≥0.70 and a predicted FEV<sub>1</sub> <80 %, is associated with increased morbidity and mortality. However, determinants of PRISm, particularly in younger populations, remain poorly characterised. We aimed to address this knowledge gap.</div></div><div><h3>Methods</h3><div>We conducted a cross-sectional analysis of 12,350 participants from a Japanese community-based cohort using data from the Tohoku Medical Megabank Project. Participants underwent spirometry, blood pressure measurement, laboratory testing, and completed standardised questionnaires. Multivariate logistic regression was used to identify factors associated with PRISm across three age groups: 20–39, 40–59, and ≥60 years. Interactions between age groups and other explanatory variables were assessed.</div></div><div><h3>Results</h3><div>In the 20–39-year group, PRISm was independently associated with being men, diabetes mellitus, hypothyroidism, and low body mass index (BMI <18.5 kg/m<sup>2</sup>), and inversely associated with age. Among participants aged ≥60 years, PRISm was significantly associated with increasing age, overweight status (BMI ≥25.0–<30.0 kg/m<sup>2</sup>), being men, current smoking, hypertension, diabetes mellitus, bronchial asthma, elevated eosinophil counts (≥300 cells/μL), and birth weight ≥2000–<2500 g. Significant interactions were observed between age and BMI, bronchial asthma, and thyroid dysfunction.</div></div><div><h3>Conclusions</h3><div>Our findings indicate that PRISm in younger adults is associated with hypothyroidism and underweight status, whereas in older adults, it is more closely related to constitutional and lifestyle-related factors. These results highlight the heterogeneity of PRISm and indicate that its pathophysiology and optimal management may vary by age group.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"64 1","pages":"Article 101343"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145681716","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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