Pub Date : 2025-11-01DOI: 10.1016/j.resinv.2025.10.011
Satoshi Hamada , Jun Ueki , Toyohiro Hirai , Emika Sano , Keiko Hino , Megumi Ikeda , Susumu Sato , Toru Oga , Tomomasa Tsuboi , Hajime Kurosawa , Hiroo Wada , Japanese White Paper on Home Respiratory Care 2024 working group
Background
The factors influencing caregiver burden in Japan remained understudied, particularly in nationwide surveys. Japan is among the countries experiencing the most rapid population aging and declining birth rates. Herein, we examined caregiver burden and the related factors in caregivers of patients receiving home oxygen therapy (HOT) based on data from the Japanese White Paper on Home Respiratory Care 2024.
Methods
Patients receiving HOT who responded to the Short Form-8 (SF-8) questionnaire comprised two summary scores (physical [PCS] and mental component summaries [MCS]) and caregivers of these patients who responded to the SF-8 questionnaire and the Burden Index of Caregiver-11 (BIC-11) questionnaire were included in the analysis.
Results
A total of 102 caregiver−patient pairs were included; the median age was 72 and 74 years, respectively. The BIC-11 total score in caregivers providing <3 h of daily care was significantly lower than that in those providing ≥3 h (p < 0.0001). Stepwise multiple linear regression analysis identified the following independent predictors of the BIC-11 total score: among caregivers, daily caregiving hours (β = 0.16, p = 0.043), PCS (β = −0.29, p = 0.0001), and MCS (β = −0.53, p < 0.0001); and among patients, male sex (β = 0.22, p = 0.020), a modified Medical Research Council score of 4 (β = 0.20, p = 0.048), and daily walking and exercising (β = −0.23, p = 0.027).
Conclusions
This study identified key factors associated with caregiver burden in HOT.
{"title":"Caregiver burden among caregivers of patients receiving home oxygen therapy: Insights of the Japanese White Paper on Home Respiratory Care 2024","authors":"Satoshi Hamada , Jun Ueki , Toyohiro Hirai , Emika Sano , Keiko Hino , Megumi Ikeda , Susumu Sato , Toru Oga , Tomomasa Tsuboi , Hajime Kurosawa , Hiroo Wada , Japanese White Paper on Home Respiratory Care 2024 working group","doi":"10.1016/j.resinv.2025.10.011","DOIUrl":"10.1016/j.resinv.2025.10.011","url":null,"abstract":"<div><h3>Background</h3><div>The factors influencing caregiver burden in Japan remained understudied, particularly in nationwide surveys. Japan is among the countries experiencing the most rapid population aging and declining birth rates. Herein, we examined caregiver burden and the related factors in caregivers of patients receiving home oxygen therapy (HOT) based on data from the Japanese White Paper on Home Respiratory Care 2024.</div></div><div><h3>Methods</h3><div>Patients receiving HOT who responded to the Short Form-8 (SF-8) questionnaire comprised two summary scores (physical [PCS] and mental component summaries [MCS]) and caregivers of these patients who responded to the SF-8 questionnaire and the Burden Index of Caregiver-11 (BIC-11) questionnaire were included in the analysis.</div></div><div><h3>Results</h3><div>A total of 102 caregiver−patient pairs were included; the median age was 72 and 74 years, respectively. The BIC-11 total score in caregivers providing <3 h of daily care was significantly lower than that in those providing ≥3 h (p < 0.0001). Stepwise multiple linear regression analysis identified the following independent predictors of the BIC-11 total score: among caregivers, daily caregiving hours (β = 0.16, p = 0.043), PCS (β = −0.29, p = 0.0001), and MCS (β = −0.53, p < 0.0001); and among patients, male sex (β = 0.22, p = 0.020), a modified Medical Research Council score of 4 (β = 0.20, p = 0.048), and daily walking and exercising (β = −0.23, p = 0.027).</div></div><div><h3>Conclusions</h3><div>This study identified key factors associated with caregiver burden in HOT.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 6","pages":"Pages 1300-1305"},"PeriodicalIF":2.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145401788","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}
Native airway structures may affect the host immune response to inhaled noxious particles. We hypothesized that a distinct airway tree structure may be associated with a higher blood eosinophil count (BEC) after smoking cessation, even in the absence of lung disease.
Methods
This cross-sectional study retrospectively evaluated consecutive male nonsmokers and smokers with no history of lung disease or airflow limitation who underwent lung cancer screening computed tomography (CT), spirometry, and BEC measurement. Total airway count (TAC), airway tree surface area-to-volume ratio (SAV), airway-to-lung size ratio (ALR), and segmental airway wall area percentage (WA%) were quantified using computed tomography (CT).
Results
The study included 205 nonsmokers, 123 past smokers, and 133 current smokers. BEC, neutrophil, lymphocyte, monocyte, and basophil counts were higher in current smokers than in past smokers and nonsmokers, but there was no difference between past smokers and nonsmokers. Higher TAC and SAV, but not ALR or WA%, were associated with greater log-transformed BEC in past smokers (r = 0.25, p = 0.005 and r = 0.25, p = 0.005, respectively), but not in current smokers or nonsmokers. These associations in past smokers remained significant after adjusting for age, body size, and pack-years. In contrast, TAC and SAV were not associated with neutrophil, lymphocyte, or monocyte count in past smokers.
Conclusion
A higher branch count and surface area-to-volume ratio of the airway tree may be associated with persistent eosinophilic inflammation in past smokers without a history of lung disease.
背景：天然气道结构可能影响宿主对吸入有害颗粒的免疫反应。我们假设，即使在没有肺部疾病的情况下，戒烟后不同的气道树结构可能与较高的血嗜酸性粒细胞计数（BEC）有关。方法：本横断面研究回顾性评估了连续男性非吸烟者和吸烟者，无肺部疾病史或气流受限，接受了肺癌筛查计算机断层扫描（CT）、肺活量测定和BEC测量。采用计算机断层扫描（CT）对总气道计数（TAC）、气道树表面积容积比（SAV）、气道与肺大小比（ALR）和气道段壁面积百分比（WA%）进行量化。结果：该研究包括205名不吸烟者，123名过去吸烟者和133名目前吸烟者。当前吸烟者的BEC、中性粒细胞、淋巴细胞、单核细胞和嗜碱性粒细胞计数高于过去吸烟者和不吸烟者，但过去吸烟者和不吸烟者之间没有差异。在过去吸烟者中，较高的TAC和SAV与较高的对数转换BEC相关（分别为r = 0.25, p = 0.005和r = 0.25, p = 0.005），而在当前吸烟者和非吸烟者中则无关。在调整了年龄、体型和吸烟年限后，这些关联在过去的吸烟者中仍然显著。相比之下，TAC和SAV与既往吸烟者的中性粒细胞、淋巴细胞或单核细胞计数无关。结论：气道树较高的分支计数和表面积体积比可能与无肺部疾病史的既往吸烟者的持续嗜酸性粒细胞炎症有关。
{"title":"Airway tree morphology and blood eosinophil count in past smokers without a history of lung disease: A cross-sectional analysis of lung cancer screening computed tomography","authors":"Kohei Obata , Naoya Tanabe , Yusuke Hayashi , Tomoki Maetani , Yusuke Shiraishi , Katsuhiro Suzuki , Susumu Sato , Atsuyasu Sato , Toyohiro Hirai","doi":"10.1016/j.resinv.2025.11.003","DOIUrl":"10.1016/j.resinv.2025.11.003","url":null,"abstract":"<div><h3>Background</h3><div>Native airway structures may affect the host immune response to inhaled noxious particles. We hypothesized that a distinct airway tree structure may be associated with a higher blood eosinophil count (BEC) after smoking cessation, even in the absence of lung disease.</div></div><div><h3>Methods</h3><div>This cross-sectional study retrospectively evaluated consecutive male nonsmokers and smokers with no history of lung disease or airflow limitation who underwent lung cancer screening computed tomography (CT), spirometry, and BEC measurement. Total airway count (TAC), airway tree surface area-to-volume ratio (SAV), airway-to-lung size ratio (ALR), and segmental airway wall area percentage (WA%) were quantified using computed tomography (CT).</div></div><div><h3>Results</h3><div>The study included 205 nonsmokers, 123 past smokers, and 133 current smokers. BEC, neutrophil, lymphocyte, monocyte, and basophil counts were higher in current smokers than in past smokers and nonsmokers, but there was no difference between past smokers and nonsmokers. Higher TAC and SAV, but not ALR or WA%, were associated with greater log-transformed BEC in past smokers (r = 0.25, p = 0.005 and r = 0.25, p = 0.005, respectively), but not in current smokers or nonsmokers. These associations in past smokers remained significant after adjusting for age, body size, and pack-years. In contrast, TAC and SAV were not associated with neutrophil, lymphocyte, or monocyte count in past smokers.</div></div><div><h3>Conclusion</h3><div>A higher branch count and surface area-to-volume ratio of the airway tree may be associated with persistent eosinophilic inflammation in past smokers without a history of lung disease.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 6","pages":"Pages 1359-1364"},"PeriodicalIF":2.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145496515","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}
Fractional exhaled nitric oxide (FeNO) is a useful Type 2 biomarker for the diagnosis and management of asthma. Although allergic bronchopulmonary mycosis (ABPM) is an allergic disease characterized by Type 2 inflammation, the clinical significance of FeNO in asthma patients with ABPM has not been well investigated.
Methods
The clinical characteristics of patients with and without comorbid ABPM were compared retrospectively using a cohort of patients with asthma. The cut-off values of FeNO for predicting asthma patients with ABPM were examined. We evaluated the associations between FeNO and blood eosinophils, pulmonary function, and mucus plugs.
Results
Of the 177 patients with asthma, 22 had concomitant ABPM. Compared to the group of ashma patient without ABPM, FeNO was significantly higher in the ABPM complicated group. Two FeNO cut-off values were identified for predicting asthma patients with ABPM receiving ICS treatment: 95 ppb was associated with a high certainty for inclusion (sensitivity = 0.27, specificity = 0.97), and 25 ppb with a high certainty for exclusion (sensitivity = 0.82, specificity = 0.39). In asthma patients with ABPM, FeNO correlated with blood eosinophils (r = 0.46, p = 0.03) and mucus plug score (r = 0.508, p = 0.019), but not with percent forced expiratory volume in 1 s (%FEV1) (r = −0.33, p = 0.18).
Conclusions
Elevated FeNO levels may aid in the detection of ABPM complications in patients with asthma treated with ICS. FeNO levels may be associated with mucus plugging in asthma patients with ABPM.
背景：呼气一氧化氮分数（FeNO）是诊断和治疗哮喘的一种有用的2型生物标志物。虽然变应性支气管肺真菌病（ABPM）是一种以2型炎症为特征的变应性疾病，但FeNO在哮喘ABPM患者中的临床意义尚未得到很好的研究。方法：回顾性比较合并和不合并ABPM的哮喘患者的临床特征。检测FeNO预测哮喘合并ABPM的临界值。我们评估了FeNO与血嗜酸性粒细胞、肺功能和粘液塞之间的关系。结果：177例哮喘患者中，22例合并ABPM。与无ABPM的ashma患者相比，ABPM合并组的FeNO明显高于无ABPM的ashma患者。确定了两个FeNO临界值用于预测ABPM哮喘患者接受ICS治疗：95 ppb与高确定性纳入相关（敏感性= 0.27，特异性= 0.97），25 ppb与高确定性排除相关（敏感性= 0.82，特异性= 0.39）。在哮喘合并ABPM患者中，FeNO与血嗜酸性粒细胞（r = 0.46, p = 0.03）和粘液堵塞评分（r = 0.508, p = 0.019）相关，但与1 s内用力呼气量百分比（%FEV1）无关（r = -0.33, p = 0.18）。结论：FeNO水平升高可能有助于检测ICS治疗哮喘患者的ABPM并发症。FeNO水平可能与ABPM哮喘患者的粘液堵塞有关。
{"title":"Fractional exhaled nitric oxide as a biomarker for the evaluating asthmatic patients with allergic bronchopulmonary mycosis","authors":"Kazuki Matsuda , Keiji Oishi , Junki Suizu , Ayumi Fukatsu-Chikumoto , Keita Murakawa , Kazuki Hamada , Shuichiro Ohata , Ryo Suetake , Toshiaki Utsunomiya , Yoriyuki Murata , Yoshikazu Yamaji , Taiga Kobayashi , Maki Asami-Noyama , Nobutaka Edakuni , Tsunahiko Hirano , Tomoyuki Kakugawa , Kazuto Matsunaga","doi":"10.1016/j.resinv.2025.11.002","DOIUrl":"10.1016/j.resinv.2025.11.002","url":null,"abstract":"<div><h3>Background</h3><div>Fractional exhaled nitric oxide (FeNO) is a useful Type 2 biomarker for the diagnosis and management of asthma. Although allergic bronchopulmonary mycosis (ABPM) is an allergic disease characterized by Type 2 inflammation, the clinical significance of FeNO in asthma patients with ABPM has not been well investigated.</div></div><div><h3>Methods</h3><div>The clinical characteristics of patients with and without comorbid ABPM were compared retrospectively using a cohort of patients with asthma. The cut-off values of FeNO for predicting asthma patients with ABPM were examined. We evaluated the associations between FeNO and blood eosinophils, pulmonary function, and mucus plugs.</div></div><div><h3>Results</h3><div>Of the 177 patients with asthma, 22 had concomitant ABPM. Compared to the group of ashma patient without ABPM, FeNO was significantly higher in the ABPM complicated group. Two FeNO cut-off values were identified for predicting asthma patients with ABPM receiving ICS treatment: 95 ppb was associated with a high certainty for inclusion (sensitivity = 0.27, specificity = 0.97), and 25 ppb with a high certainty for exclusion (sensitivity = 0.82, specificity = 0.39). In asthma patients with ABPM, FeNO correlated with blood eosinophils (r = 0.46, p = 0.03) and mucus plug score (r = 0.508, p = 0.019), but not with percent forced expiratory volume in 1 s (%FEV<sub>1</sub>) (r = −0.33, p = 0.18).</div></div><div><h3>Conclusions</h3><div>Elevated FeNO levels may aid in the detection of ABPM complications in patients with asthma treated with ICS. FeNO levels may be associated with mucus plugging in asthma patients with ABPM.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 6","pages":"Pages 1369-1376"},"PeriodicalIF":2.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145506638","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}
Family history is an important factor in recognizing the prognosis of interstitial lung disease (ILD), however, its significance in fibrotic hypersensitivity pneumonitis (HP), as based on the latest international guidelines, remains unclear. This study aimed to investigate the distinct clinical profile and leukocyte telomere length (LTL) of familial fibrotic HP.
Methods
We retrospectively reviewed 490 patients who underwent leukocyte telomere length (LTL) measurement, and identified 131 patients with fibrotic HP, including 19 familial cases. Chest HRCT images were reviewed using automatic deep learning-based lung analysis.
Results
Familial fibrotic HP patients were younger (age ≥60: 68.4 % vs. 91.9 %, p = 0.02) and had lower diffusing capacity for carbon monoxide (DLco) (mean [SD]: 70.9 [23.6] vs. 82.9 [23.2], p = 0.031) compared to non-familial cases. Despite similar imaging patterns and AI-based CT analysis, pathological features of usual interstitial pneumonia (UIP) were more frequent in familial cases. Age-adjusted LTL was significantly shorter in the familial group (mean [SD]: −0.26 [0.26] vs. −0.06 [0.28], p = 0.004). Furthermore, LTL correlated with serum KL-6 (r = −0.603, p = 0.006), %DLco(r = 0.629, p = 0.007), and fibrotic features according to deep learning-based CT analysis; the consolidation with traction bronchiectasis ratio (r = −0.48, p = 0.038) and the traction bronchiectasis ratio (r = −0.489, p = 0.034).
Conclusion
Familial fibrotic HP may represent a distinct clinical phenotype characterized by shorter telomeres, with LTL emerging as a potential biomarker for disease severity.
背景：家族史是判断间质性肺疾病（ILD）预后的重要因素，然而，根据最新的国际指南，家族史在纤维化超敏性肺炎（HP）中的意义尚不清楚。本研究旨在探讨家族性纤维化HP的独特临床特征和白细胞端粒长度（LTL）。方法：我们回顾性分析了490例接受白细胞端粒长度（LTL）测量的患者，并确定了131例纤维化HP患者，其中包括19例家族病例。使用基于自动深度学习的肺部分析对胸部HRCT图像进行审查。结果：与非家族性患者相比，家族性纤维化HP患者更年轻（年龄≥60岁：67.4% vs. 91.9%, p = 0.02），并且一氧化碳弥散能力（DLco）更低（平均[SD]: 70.9 [23.6] vs. 82.9 [23.2], p = 0.031）。尽管影像学和基于人工智能的CT分析相似，但常见性间质性肺炎（UIP）的病理特征在家族病例中更为常见。家族性组经年龄调整后的LTL显著缩短（平均[SD]: -0.26[0.26]比-0.06 [0.28],p = 0.004）。此外，根据基于深度学习的CT分析，LTL与血清KL-6 （r = -0.603, p = 0.006）、%DLco（r = 0.629, p = 0.007）和纤维化特征相关；实变与牵引支气管扩张的比值（r = -0.48, p = 0.038）和牵引支气管扩张的比值（r = -0.489, p = 0.034）。结论：家族性纤维化HP可能代表了一种独特的临床表型，其特征是端粒较短，LTL正在成为疾病严重程度的潜在生物标志物。
{"title":"Familial fibrotic hypersensitivity pneumonitis: A distinct clinical phenotype with shorter leukocyte telomere length","authors":"Masashi Nishimura , Hideya Kitamura , Yoichi Tagami , Kazushi Fujimoto , Takashi Fukushima , Ryota Otoshi , Takashi Niwa , Jun Aoki , Taiki Fukuda , Tomoe Sawazumi , Tae Iwasawa , Koji Okudela , Tamiko Takemura , Yayoi Natsume-Kitatani , Yu Hara , Takeshi Kaneko , Takashi Ogura","doi":"10.1016/j.resinv.2025.10.012","DOIUrl":"10.1016/j.resinv.2025.10.012","url":null,"abstract":"<div><h3>Background</h3><div>Family history is an important factor in recognizing the prognosis of interstitial lung disease (ILD), however, its significance in fibrotic hypersensitivity pneumonitis (HP), as based on the latest international guidelines, remains unclear. This study aimed to investigate the distinct clinical profile and leukocyte telomere length (LTL) of familial fibrotic HP.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed 490 patients who underwent leukocyte telomere length (LTL) measurement, and identified 131 patients with fibrotic HP, including 19 familial cases. Chest HRCT images were reviewed using automatic deep learning-based lung analysis.</div></div><div><h3>Results</h3><div>Familial fibrotic HP patients were younger (age ≥60: 68.4 % vs. 91.9 %, <em>p</em> = 0.02) and had lower diffusing capacity for carbon monoxide (DLco) (mean [SD]: 70.9 [23.6] vs. 82.9 [23.2], <em>p</em> = 0.031) compared to non-familial cases. Despite similar imaging patterns and AI-based CT analysis, pathological features of usual interstitial pneumonia (UIP) were more frequent in familial cases. Age-adjusted LTL was significantly shorter in the familial group (mean [SD]: −0.26 [0.26] vs. −0.06 [0.28], <em>p</em> = 0.004). Furthermore, LTL correlated with serum KL-6 (r = −0.603, <em>p</em> = 0.006), %DLco(r = 0.629, <em>p</em> = 0.007), and fibrotic features according to deep learning-based CT analysis; the consolidation with traction bronchiectasis ratio (r = −0.48, <em>p</em> = 0.038) and the traction bronchiectasis ratio (r = −0.489, <em>p</em> = 0.034).</div></div><div><h3>Conclusion</h3><div>Familial fibrotic HP may represent a distinct clinical phenotype characterized by shorter telomeres, with LTL emerging as a potential biomarker for disease severity.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 6","pages":"Pages 1338-1346"},"PeriodicalIF":2.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145459800","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 : 2025-11-01DOI: 10.1016/j.resinv.2025.10.008
Kaoruko Shimizu , Hiroyuki Sugimori , Naoya Tanabe , Nobuyasu Wakazono , Yoichi M. Ito , Hironi Makita , Susumu Sato , Masaharu Nishimura , Toyohiro Hirai , Satoshi Konno
Background
Chronic obstructive pulmonary disease (COPD) may be inconsistent with the severity of airflow limitation. This causes COPD underdiagnosis, necessitating approaches that facilitate timely diagnosis and intervention. Combining deep learning models (based on medical imaging) with regression methods improves numerical functional predictions. We aimed to evaluate and compare the prediction performance of two deep learning-based models (two-dimensional [2D]-convolutional neural network (CNN) and three-dimensional [3D]-CNN) for the percentage predicted forced expiratory volume in 1 s (%FEV1) in patients with COPD.
Methods
ResNet18-based regression prediction models were constructed for %FEV1 based on 200 computed tomography (CT) datasets. Five-fold cross-validation was performed to develop the predictive models, which were externally validated using 20 data points. In addition, 200 internal CT datasets were assessed using commercial software to develop a regression model for predicting airway (% wall area) and parenchymal indices (% low-attenuation volume).
Results
The 3D-CNN model demonstrated superior performance with an average root mean squared error (RMSE) of 10.73 and a correlation coefficient of 0.88, compared with that of the 2D-CNN model (RMSE: 16.76, correlation coefficient: 0.66) during internal validation. In the external validation approach, the 3D-CNN model maintained a performance (RMSE: 11.48, correlation coefficient: 0.59) better than that of the 2D-CNN model (RMSE: 12.38, correlation coefficient: 0.47), with both models outperforming the commercial software analysis (RMSE: 23.18).
Conclusions
Volumetric analysis using 3D-CNN may sufficiently capture the complex structural features of COPD in CT images. Further studies are required to validate these models with larger datasets and determine their validity for longitudinal applications.
{"title":"Superior performance of three-dimensional to two-dimensional convolutional neural network for predicting airflow limitation in patients with chronic obstructive pulmonary disease","authors":"Kaoruko Shimizu , Hiroyuki Sugimori , Naoya Tanabe , Nobuyasu Wakazono , Yoichi M. Ito , Hironi Makita , Susumu Sato , Masaharu Nishimura , Toyohiro Hirai , Satoshi Konno","doi":"10.1016/j.resinv.2025.10.008","DOIUrl":"10.1016/j.resinv.2025.10.008","url":null,"abstract":"<div><h3>Background</h3><div>Chronic obstructive pulmonary disease (COPD) may be inconsistent with the severity of airflow limitation. This causes COPD underdiagnosis, necessitating approaches that facilitate timely diagnosis and intervention. Combining deep learning models (based on medical imaging) with regression methods improves numerical functional predictions. We aimed to evaluate and compare the prediction performance of two deep learning-based models (two-dimensional [2D]-convolutional neural network (CNN) and three-dimensional [3D]-CNN) for the percentage predicted forced expiratory volume in 1 s (%FEV<sub>1</sub>) in patients with COPD.</div></div><div><h3>Methods</h3><div>ResNet18-based regression prediction models were constructed for %FEV<sub>1</sub> based on 200 computed tomography (CT) datasets. Five-fold cross-validation was performed to develop the predictive models, which were externally validated using 20 data points. In addition, 200 internal CT datasets were assessed using commercial software to develop a regression model for predicting airway (% wall area) and parenchymal indices (% low-attenuation volume).</div></div><div><h3>Results</h3><div>The 3D-CNN model demonstrated superior performance with an average root mean squared error (RMSE) of 10.73 and a correlation coefficient of 0.88, compared with that of the 2D-CNN model (RMSE: 16.76, correlation coefficient: 0.66) during internal validation. In the external validation approach, the 3D-CNN model maintained a performance (RMSE: 11.48, correlation coefficient: 0.59) better than that of the 2D-CNN model (RMSE: 12.38, correlation coefficient: 0.47), with both models outperforming the commercial software analysis (RMSE: 23.18).</div></div><div><h3>Conclusions</h3><div>Volumetric analysis using 3D-CNN may sufficiently capture the complex structural features of COPD in CT images. Further studies are required to validate these models with larger datasets and determine their validity for longitudinal applications.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 6","pages":"Pages 1316-1325"},"PeriodicalIF":2.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145445741","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}
Anti-MDA5 antibody–positive dermatomyositis–associated interstitial lung disease (MDA5+DM-ILD) is life-threatening, and drug-free remission is rarely reported. We describe two Japanese patients with subacute-onset MDA5+DM-ILD who achieved long-term remission after sequential withdrawal of corticosteroids and tacrolimus, guided by anti-MDA5 antibody negativization, biomarker stability (ferritin, KL-6, and lactate dehydrogenase [LDH]), and skin improvement. Pulmonary function improved, and both patients remained relapse-free for over 2 years after discontinuation. These cases suggest that immunosuppressants may be safely withdrawn in selected MDA5+DM-ILD patients, although late relapse risk warrants caution.
{"title":"Sustained remission after discontinuation of immunosuppressive therapy in patients with anti-MDA5 antibody–positive dermatomyositis–associated interstitial lung disease: Two case reports","authors":"Hitokazu Tsukao, Ryosuke Kojima, Shinichi Nakanishi, Yudai Miyanishi, Yuya Fujii, Wataru Yamaguchi, Junya Nakaya, Toru Kojima","doi":"10.1016/j.resinv.2025.10.014","DOIUrl":"10.1016/j.resinv.2025.10.014","url":null,"abstract":"<div><div>Anti-MDA5 antibody–positive dermatomyositis–associated interstitial lung disease (MDA5<sup>+</sup>DM-ILD) is life-threatening, and drug-free remission is rarely reported. We describe two Japanese patients with subacute-onset MDA5<sup>+</sup>DM-ILD who achieved long-term remission after sequential withdrawal of corticosteroids and tacrolimus, guided by anti-MDA5 antibody negativization, biomarker stability (ferritin, KL-6, and lactate dehydrogenase [LDH]), and skin improvement. Pulmonary function improved, and both patients remained relapse-free for over 2 years after discontinuation. These cases suggest that immunosuppressants may be safely withdrawn in selected MDA5<sup>+</sup>DM-ILD patients, although late relapse risk warrants caution.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 6","pages":"Pages 1326-1329"},"PeriodicalIF":2.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145452902","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}
Dysfunctional breathing (DB) is frequently misdiagnosed or insufficiently treated, leading to a diminished quality of life and unnecessary medical intervention. While recent studies have focused on DB in patients with asthma and chronic obstructive pulmonary disease (COPD), its prevalence and contributing factors in the general population remain unclear. Additionally, tobacco use may exacerbate both respiratory symptoms and underlying comorbidities, while potentially contributing to DB.
Methods
The study aimed to investigate the prevalence and clinical characteristics of DB, as well as its associated factors. Furthermore, we examined the interaction between tobacco use and respiratory comorbidities in relation to DB prevalence.
Results
A cross-sectional Internet-based survey was conducted among 29,268 participants from the general Japanese population using the Nijmegen Questionnaire (NQ), a validated tool with high sensitivity and specificity for DB diagnosis. The findings indicated a DB prevalence of 11.0 %. Univariable logistic analysis identified significant associations between DB prevalence and respiratory comorbidities, including asthma, COPD, and bronchitis/pneumonia. Notably, non-respiratory conditions such as epilepsy and cerebrovascular disease were also significantly correlated with DB. Multivariate logistic analysis revealed that current tobacco use and respiratory comorbidities further increased DB prevalence.
Conclusions
These findings suggest that DB is relatively common in primary healthcare settings, and exacerbated by tobacco use, particularly among individuals with respiratory comorbidities. Recognizing and addressing factors associated with DB is crucial for improving diagnosis, treatment and overall patient outcomes.
{"title":"Prevalence of dysfunctional breathing in the Japanese community and the involvement of tobacco use status: The JASTIS study 2024","authors":"Kaho Hirai , Kazuhiro Yamada , Kazuhisa Asai , Masaya Tsutsumi , Takahiro Ueda , Erika Toyokura , Yuichiro Furukawa , Atsushi Miyamoto , Misako Nishimura , Kanako Sato , Tetsuya Watanabe , Shuichiro Maruoka , Yasuhiro Gon , Takahiro Tabuchi , Tomoya Kawaguchi","doi":"10.1016/j.resinv.2025.10.002","DOIUrl":"10.1016/j.resinv.2025.10.002","url":null,"abstract":"<div><h3>Background</h3><div>Dysfunctional breathing (DB) is frequently misdiagnosed or insufficiently treated, leading to a diminished quality of life and unnecessary medical intervention. While recent studies have focused on DB in patients with asthma and chronic obstructive pulmonary disease (COPD), its prevalence and contributing factors in the general population remain unclear. Additionally, tobacco use may exacerbate both respiratory symptoms and underlying comorbidities, while potentially contributing to DB.</div></div><div><h3>Methods</h3><div>The study aimed to investigate the prevalence and clinical characteristics of DB, as well as its associated factors. Furthermore, we examined the interaction between tobacco use and respiratory comorbidities in relation to DB prevalence.</div></div><div><h3>Results</h3><div>A cross-sectional Internet-based survey was conducted among 29,268 participants from the general Japanese population using the Nijmegen Questionnaire (NQ), a validated tool with high sensitivity and specificity for DB diagnosis. The findings indicated a DB prevalence of 11.0 %. Univariable logistic analysis identified significant associations between DB prevalence and respiratory comorbidities, including asthma, COPD, and bronchitis/pneumonia. Notably, non-respiratory conditions such as epilepsy and cerebrovascular disease were also significantly correlated with DB. Multivariate logistic analysis revealed that current tobacco use and respiratory comorbidities further increased DB prevalence.</div></div><div><h3>Conclusions</h3><div>These findings suggest that DB is relatively common in primary healthcare settings, and exacerbated by tobacco use, particularly among individuals with respiratory comorbidities. Recognizing and addressing factors associated with DB is crucial for improving diagnosis, treatment and overall patient outcomes.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 6","pages":"Pages 1377-1382"},"PeriodicalIF":2.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145557752","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}
Pathological usual interstitial pneumonia (UIP) is crucial in predicting the prognosis of fibrotic interstitial lung diseases (ILDs) other than idiopathic pulmonary fibrosis. However, pathological UIP assessment relies solely on lung biopsy, and no simple, non-invasive approach currently exists. In this study, we aimed to investigate its association with pathological UIP using a novel three-dimensional computed tomography (3D-CT) method.
Methods
This retrospective study analyzed 120 patients who underwent transbronchial lung cryobiopsy for ILD diagnosis. Clinical data, CT scans, pulmonary function test results, and pathological findings were collected. The bilateral lower lobe volume to total lung volume ratio (hereafter, b-LLV/TLV ratio) was assessed using 3D-CT. Logistic regression analysis evaluated the association between pathological UIP and patient characteristics, including the b-LLV/TLV ratio.
Results
Among the 120 patients, 53 (44 %) had pathological UIP. Univariate analysis showed that UIP was significantly associated with older age (71.0 vs. 65.0 years, P = 0.0033) and b-LLV/TLV ratio (36.9 % vs. 41.6 %, P = 0.0069). Multivariate analysis confirmed that b-LLV/TLV ratio (OR = 0.9053; 95 % CI, 0.8461–0.9596; P = 0.0005) was an independent predictor of UIP, which was unaffected by age (OR = 1.0690; 95 % CI, 1.0224–1.2435; P = 0.0028) or sex (OR = 3.5868; 95 % CI, 1.3106–10.7061; P = 0.0123). Notably, UIP showed no association with the pulmonary function test results, whereas the b-LLV/TLV ratio was more effective in predicting UIP.
Conclusions
A reduced b-LLV/TLV ratio was significantly associated with pathological UIP, suggesting that 3D-CT lung volume analysis may serve as a noninvasive diagnostic tool.
背景：病理性常见性间质性肺炎（UIP）是预测除特发性肺纤维化外的纤维化间质性肺疾病（ILDs）预后的关键。然而，病理UIP评估仅依赖于肺活检，目前还没有简单、无创的方法。在这项研究中，我们旨在通过一种新的三维计算机断层扫描（3D-CT）方法来研究其与病理性UIP的关系。方法：本回顾性研究分析了120例经支气管肺低温活检诊断ILD的患者。收集临床资料、CT扫描、肺功能检查结果及病理结果。使用3D-CT评估双侧下肺叶容积与全肺容积比（以下简称b-LLV/TLV比）。Logistic回归分析评估病理性UIP与患者特征之间的关系，包括b-LLV/TLV比率。结果：120例患者中，53例（44%）有病理性UIP。单因素分析显示，UIP与年龄（71.0 vs. 65.0, P = 0.0033）和b-LLV/TLV比值（36.9% vs. 41.6%, P = 0.0069）显著相关。多因素分析证实，b-LLV/TLV比值（OR = 0.9053; 95% CI, 0.8461-0.9596; P = 0.0005）是UIP的独立预测因子，不受年龄（OR = 1.0690; 95% CI, 1.0224-1.2435; P = 0.0028）和性别（OR = 3.5868; 95% CI, 1.3106-10.7061; P = 0.0123）的影响。值得注意的是，UIP与肺功能测试结果没有关联，而b-LLV/TLV比值在预测UIP方面更有效。结论：b-LLV/TLV比值降低与病理性UIP显著相关，提示3D-CT肺容量分析可作为一种无创诊断工具。
{"title":"Three-dimensional computed tomography lung volume analysis associates with the presence of pathological usual interstitial pneumonia in interstitial lung disease","authors":"Kenji Tsumura , Yoshiaki Zaizen , Tomonori Chikasue , Midori Zaizen , Masaki Okamoto , Masaki Tominaga , Shuichi Tanoue , Junya Fukuoka , Kiminori Fujimoto , Tomoaki Hoshino","doi":"10.1016/j.resinv.2025.11.001","DOIUrl":"10.1016/j.resinv.2025.11.001","url":null,"abstract":"<div><h3>Background</h3><div>Pathological usual interstitial pneumonia (UIP) is crucial in predicting the prognosis of fibrotic interstitial lung diseases (ILDs) other than idiopathic pulmonary fibrosis. However, pathological UIP assessment relies solely on lung biopsy, and no simple, non-invasive approach currently exists. In this study, we aimed to investigate its association with pathological UIP using a novel three-dimensional computed tomography (3D-CT) method.</div></div><div><h3>Methods</h3><div>This retrospective study analyzed 120 patients who underwent transbronchial lung cryobiopsy for ILD diagnosis. Clinical data, CT scans, pulmonary function test results, and pathological findings were collected. The bilateral lower lobe volume to total lung volume ratio (hereafter, b-LLV/TLV ratio) was assessed using 3D-CT. Logistic regression analysis evaluated the association between pathological UIP and patient characteristics, including the b-LLV/TLV ratio.</div></div><div><h3>Results</h3><div>Among the 120 patients, 53 (44 %) had pathological UIP. Univariate analysis showed that UIP was significantly associated with older age (71.0 vs. 65.0 years, P = 0.0033) and b-LLV/TLV ratio (36.9 % vs. 41.6 %, P = 0.0069). Multivariate analysis confirmed that b-LLV/TLV ratio (OR = 0.9053; 95 % CI, 0.8461–0.9596; P = 0.0005) was an independent predictor of UIP, which was unaffected by age (OR = 1.0690; 95 % CI, 1.0224–1.2435; P = 0.0028) or sex (OR = 3.5868; 95 % CI, 1.3106–10.7061; P = 0.0123). Notably, UIP showed no association with the pulmonary function test results, whereas the b-LLV/TLV ratio was more effective in predicting UIP.</div></div><div><h3>Conclusions</h3><div>A reduced b-LLV/TLV ratio was significantly associated with pathological UIP, suggesting that 3D-CT lung volume analysis may serve as a noninvasive diagnostic tool.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 6","pages":"Pages 1352-1358"},"PeriodicalIF":2.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145496489","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}
Lorlatinib has demonstrated significant efficacy for treating anaplastic lymphoma kinase (ALK)-positive non-small cell lung cancer (NSCLC); however, its safety profile—particularly regarding immune-related adverse events—remains incompletely characterized. We describe a case of ALK-positive NSCLC complicated by autoimmune thyroiditis during lorlatinib therapy. The temporal link between lorlatinib exposure, the emergence of thyroid autoantibodies, and their resolution following drug withdrawal raises the possibility that lorlatinib may influence autoimmune responses.
{"title":"Drug-induced autoimmune thyroiditis during lorlatinib treatment in a patient with ALK-positive non-small cell lung cancer","authors":"Yuki Yamazaki , Yuko Morishima , Yuka Aida , Toshihiro Shiozawa , Kensuke Nakazawa , Kazufumi Yoshida , Ikuo Sekine , Nobuyuki Hizawa","doi":"10.1016/j.resinv.2025.10.013","DOIUrl":"10.1016/j.resinv.2025.10.013","url":null,"abstract":"<div><div>Lorlatinib has demonstrated significant efficacy for treating anaplastic lymphoma kinase (ALK)-positive non-small cell lung cancer (NSCLC); however, its safety profile—particularly regarding immune-related adverse events—remains incompletely characterized. We describe a case of ALK-positive NSCLC complicated by autoimmune thyroiditis during lorlatinib therapy. The temporal link between lorlatinib exposure, the emergence of thyroid autoantibodies, and their resolution following drug withdrawal raises the possibility that lorlatinib may influence autoimmune responses.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 6","pages":"Pages 1306-1308"},"PeriodicalIF":2.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145416058","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}
While cardiac transthyretin amyloidosis is increasingly recognized in older adults, it remains unclear whether similarly frequent deposition occurs in the lungs. This retrospective study aimed to investigate the prevalence of pulmonary transthyretin amyloidosis (PTA) in the general elderly population. Among consecutive 274 patients aged ≥75 years who underwent lung resection, five cases of PTA were identified by histological examination (prevalence 1.8 %). These patients were asymptomatic without obvious radiological abnormalities in the background lung. Histopathology revealed scattered transthyretin-positive amyloid deposits in alveolar septa with minimal architectural distortion, which was frequently difficult to detect on hematoxylin & eosin staining alone. Subclinical PTA is not uncommon in elderly individuals and routine amyloid/transthyretin staining may be helpful.
{"title":"Prevalence of subclinical pulmonary transthyretin amyloidosis in a pathology-based elderly cohort: the diagnostic value of routine amyloid staining","authors":"Akira Ogata , Yasunori Enomoto , Satoshi Baba , Takashi Tsuchida , Mitsue Kawashima , Shiori Meguro , Hideya Kawasaki , Kazuhito Funai , Toshihide Iwashita","doi":"10.1016/j.resinv.2025.10.017","DOIUrl":"10.1016/j.resinv.2025.10.017","url":null,"abstract":"<div><div>While cardiac transthyretin amyloidosis is increasingly recognized in older adults, it remains unclear whether similarly frequent deposition occurs in the lungs. This retrospective study aimed to investigate the prevalence of pulmonary transthyretin amyloidosis (PTA) in the general elderly population. Among consecutive 274 patients aged ≥75 years who underwent lung resection, five cases of PTA were identified by histological examination (prevalence 1.8 %). These patients were asymptomatic without obvious radiological abnormalities in the background lung. Histopathology revealed scattered transthyretin-positive amyloid deposits in alveolar septa with minimal architectural distortion, which was frequently difficult to detect on hematoxylin & eosin staining alone. Subclinical PTA is not uncommon in elderly individuals and routine amyloid/transthyretin staining may be helpful.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 6","pages":"Pages 1347-1351"},"PeriodicalIF":2.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145465658","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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