Pub 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":"2025-11-17","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}
Numerous clinical studies have shown that long-term positive pressure ventilation (PPV) improves quality of life and prognosis in patients with amyotrophic lateral sclerosis (ALS). Pneumothorax is an important complication of PPV; however, few studies investigated pneumothorax in patients with ALS on long-term PPV.
Methods
This retrospective longitudinal cohort study included 85 patients with ALS treated from 2013 to 2024. We collected information from medical records on ALS and pneumothorax treatment, blood laboratory data, radiology data, equipment data, and mortality. Subsequently, we compared clinical parameters and prognosis between the pneumothorax and non-pneumothorax groups.
Results
Of the 85 patients, 61 underwent long-term PPV. Nine patients developed pneumothorax following the initiation of long-term PPV. In contrast, 24 patients without long-term PPV did not experience pneumothorax. Among patients who received tracheostomy PPV as a maximum respiratory management, the pneumothorax group tended to have a poorer prognosis from ALS onset than the non-pneumothorax group. Moreover, the pneumothorax group had higher inspiratory positive airway pressure and support pressure of ventilator settings than the non-pneumothorax group. Among the nine pneumothorax cases, there were no deaths directly related to the complication, two patients who developed pneumothorax during non-invasive PPV transitioned to tracheostomy PPV as a result of the complication.
Conclusions
Pneumothorax should be recognized as a serious complication that can occur in patients with ALS on PPV. Higher inspiratory positive airway pressure and support pressure settings on long-term PPV may be significant risk factors for pneumothorax.
{"title":"Impact of pneumothorax on clinical course of patients with amyotrophic lateral sclerosis on long-term ventilation","authors":"Nobuhiro Okagaki , Tomomasa Tsuboi , Yuichi Chihara , Kensuke Sumi , Hiroki Takeuchi , Kenji Yamamoto , Takashi Hajiro , Atsuo Sato","doi":"10.1016/j.resinv.2025.11.008","DOIUrl":"10.1016/j.resinv.2025.11.008","url":null,"abstract":"<div><h3>Background</h3><div>Numerous clinical studies have shown that long-term positive pressure ventilation (PPV) improves quality of life and prognosis in patients with amyotrophic lateral sclerosis (ALS). Pneumothorax is an important complication of PPV; however, few studies investigated pneumothorax in patients with ALS on long-term PPV.</div></div><div><h3>Methods</h3><div>This retrospective longitudinal cohort study included 85 patients with ALS treated from 2013 to 2024. We collected information from medical records on ALS and pneumothorax treatment, blood laboratory data, radiology data, equipment data, and mortality. Subsequently, we compared clinical parameters and prognosis between the pneumothorax and non-pneumothorax groups.</div></div><div><h3>Results</h3><div>Of the 85 patients, 61 underwent long-term PPV. Nine patients developed pneumothorax following the initiation of long-term PPV. In contrast, 24 patients without long-term PPV did not experience pneumothorax. Among patients who received tracheostomy PPV as a maximum respiratory management, the pneumothorax group tended to have a poorer prognosis from ALS onset than the non-pneumothorax group. Moreover, the pneumothorax group had higher inspiratory positive airway pressure and support pressure of ventilator settings than the non-pneumothorax group. Among the nine pneumothorax cases, there were no deaths directly related to the complication, two patients who developed pneumothorax during non-invasive PPV transitioned to tracheostomy PPV as a result of the complication.</div></div><div><h3>Conclusions</h3><div>Pneumothorax should be recognized as a serious complication that can occur in patients with ALS on PPV. Higher inspiratory positive airway pressure and support pressure settings on long-term PPV may be significant risk factors for pneumothorax.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"64 1","pages":"Article 101329"},"PeriodicalIF":2.0,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145532473","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.2025.11.006
Yuma Sato , Hidenori Kitai , Yuta Takashima , Naofumi Shinagawa , Jun Sakakibara-Konishi , Hiroya Ohkawa , Kanako C. Hatanaka , Yutaka Hatanaka , Hiroshi Yokouchi , Satoshi Konno
Huntingtin-interacting protein 1 (HIP1)-anaplastic lymphoma kinase (ALK) is a relatively rare fusion in ALK-positive lung cancers. HIP1-ALK (H19:A20) is a rare variant among HIP1-ALK-positive lung cancers, and data on the efficacy of ALK tyrosine kinase inhibitors are limited. We report a 37-year-old man with HIP1-ALK (H19:A20) lung adenocarcinoma treated with silicone stent placement and alectinib. Stent placement was effective in improving symptoms, and the best treatment response with alectinib was a partial response. Routine ALK screening using IHC or comprehensive genomic profiling should be considered for patients with lung cancer with suspected ALK gene.
{"title":"Successful treatment of huntingtin-interacting protein-1-anaplastic lymphoma kinase-positive lung cancer with severe airway stenosis using silicone stent placement and alectinib","authors":"Yuma Sato , Hidenori Kitai , Yuta Takashima , Naofumi Shinagawa , Jun Sakakibara-Konishi , Hiroya Ohkawa , Kanako C. Hatanaka , Yutaka Hatanaka , Hiroshi Yokouchi , Satoshi Konno","doi":"10.1016/j.resinv.2025.11.006","DOIUrl":"10.1016/j.resinv.2025.11.006","url":null,"abstract":"<div><div>Huntingtin-interacting protein 1 (HIP1)-anaplastic lymphoma kinase (ALK) is a relatively rare fusion in ALK-positive lung cancers. HIP1-ALK (H19:A20) is a rare variant among HIP1-ALK-positive lung cancers, and data on the efficacy of ALK tyrosine kinase inhibitors are limited. We report a 37-year-old man with HIP1-ALK (H19:A20) lung adenocarcinoma treated with silicone stent placement and alectinib. Stent placement was effective in improving symptoms, and the best treatment response with alectinib was a partial response. Routine ALK screening using IHC or comprehensive genomic profiling should be considered for patients with lung cancer with suspected ALK gene.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 6","pages":"Pages 1365-1368"},"PeriodicalIF":2.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145506622","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}
Previous evidence supported prompt initiation of single-inhaler triple therapy in chronic obstructive pulmonary disease (COPD), but data specific to Japan are lacking. This study investigated the association between budesonide/glycopyrrolate/formoterol fumarate (BGF) initiation and subsequent COPD exacerbations or severe cardiopulmonary events in Japanese patients initiating BGF following previous exacerbations.
Methods
This was an observational cohort study among patients with COPD using IQVIA Integrated claims data. Between BGF launch (September 2019) and March 2023, patients aged ≥40 years initiating BGF following COPD exacerbations (index) were included. Patients were categorized into BGF initiation groups by treatment initiation timing following index exacerbations: prompt (≤30 days), delayed (31–180 days), and very delayed (181–365 days). Multivariable negative binomial regression models evaluated the associations between BGF initiation strategies and subsequent exacerbations or severe cardiopulmonary events.
Results
3402 eligible patients were included: 840 prompt, 1143 delayed, and 1419 very delayed BGF initiators. The crude COPD exacerbation event rate (95 % confidence interval [CI]) per person-year was 1.66 (1.58–1.74) for prompt, 2.36 (2.30–2.43) for delayed, and 2.60 (2.54–2.66) for very delayed initiators during follow-up. Compared to prompt initiation, delayed (adjusted rate ratio [RR]: 1.25; 95 % CI: 1.13–1.38) and very delayed (adjusted RR: 1.09; 95 % CI: 0.99–1.20) BGF initiation showed an increased risk of COPD exacerbations. No associations were observed between BGF initiation strategies and severe cardiopulmonary events.
Conclusion
Following COPD exacerbations, initiating BGF promptly was associated with reduction in subsequent exacerbations. Patients should receive prompt and proactive treatment to reduce COPD morbidity.
{"title":"Exacerbation and cardiopulmonary risk after prompt initiation of single-inhaler budesonide /glycopyrrolate/formoterol fumarate following COPD exacerbations: Insights from MITOS EROS (Japan) study","authors":"Koichiro Takahashi , Yuri Yoshida , Naoyuki Makita , Kenichiro Nishida , Michihiro Yoshimura , Zhao Cheng , Aaro Salosensaari , Catarina Camarinha , Reiko Yamaura , Marta Cuntin , Michael Pollack","doi":"10.1016/j.resinv.2025.10.015","DOIUrl":"10.1016/j.resinv.2025.10.015","url":null,"abstract":"<div><h3>Background</h3><div>Previous evidence supported prompt initiation of single-inhaler triple therapy in chronic obstructive pulmonary disease (COPD), but data specific to Japan are lacking. This study investigated the association between budesonide/glycopyrrolate/formoterol fumarate (BGF) initiation and subsequent COPD exacerbations or severe cardiopulmonary events in Japanese patients initiating BGF following previous exacerbations.</div></div><div><h3>Methods</h3><div>This was an observational cohort study among patients with COPD using IQVIA Integrated claims data. Between BGF launch (September 2019) and March 2023, patients aged ≥40 years initiating BGF following COPD exacerbations (index) were included. Patients were categorized into BGF initiation groups by treatment initiation timing following index exacerbations: prompt (≤30 days), delayed (31–180 days), and very delayed (181–365 days). Multivariable negative binomial regression models evaluated the associations between BGF initiation strategies and subsequent exacerbations or severe cardiopulmonary events.</div></div><div><h3>Results</h3><div>3402 eligible patients were included: 840 prompt, 1143 delayed, and 1419 very delayed BGF initiators. The crude COPD exacerbation event rate (95 % confidence interval [CI]) per person-year was 1.66 (1.58–1.74) for prompt, 2.36 (2.30–2.43) for delayed, and 2.60 (2.54–2.66) for very delayed initiators during follow-up. Compared to prompt initiation, delayed (adjusted rate ratio [RR]: 1.25; 95 % CI: 1.13–1.38) and very delayed (adjusted RR: 1.09; 95 % CI: 0.99–1.20) BGF initiation showed an increased risk of COPD exacerbations. No associations were observed between BGF initiation strategies and severe cardiopulmonary events.</div></div><div><h3>Conclusion</h3><div>Following COPD exacerbations, initiating BGF promptly was associated with reduction in subsequent exacerbations. Patients should receive prompt and proactive treatment to reduce COPD morbidity.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 6","pages":"Pages 1330-1337"},"PeriodicalIF":2.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145452926","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.2025.10.011
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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号