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 These cases suggest that immunosuppressants may be safely withdrawn in selected MDA5+DM-ILD patients, although late relapse risk warrants caution.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 These cases suggest that immunosuppressants may be safely withdrawn in selected MDA5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}
Pub Date : 2025-11-01DOI: 10.1016/j.resinv.2025.10.016
Lisa Steen Duus , Niklas Dyrby Johansen , Daniel Modin , Kira Hyldekær Janstrup , Joshua Nealon , Sandrine Samson , Matthew M. Loiacono , Rebecca C. Harris , Carsten Schade Larsen , Anne Marie Reimer Jensen , Brian L. Claggett , Scott D. Solomon , Martin J. Landray , Gunnar H. Gislason , Lars Køber , Pradeesh Sivapalan , Jens Ulrik Stæhr Jensen , Tor Biering-Sørensen
Background
Individuals with chronic lung disease (CLD) face an increased risk of influenza-related complications and mortality, and seasonal vaccination is recommended. Limited evidence exists on the effectiveness of high-dose (HD-IIV) vs. standard-dose (SD-IIV) inactivated influenza vaccines in this population.
Methods
DANFLU-1 trial was a pragmatic, open-label, randomized trial comparing HD-IIV vs. SD-IIV in adults aged 65–79 years during the 2021/2022 influenza season. Vaccines were allocated 1:1. CLD was identified using ICD-10 codes. The prespecified outcomes were hospitalizations due to pneumonia or influenza, respiratory, cardiovascular, cardiorespiratory, and all-cause hospitalizations, and mortality.
Results
The study population included 12,477 participants (mean age 71.7 ± 3.9 years, 47 % female), of whom 850 (6.8 %) had CLD. Hospitalization rates for all outcomes were significantly higher among participants with CLD. HD-IIV was associated with a lower risk of hospitalization for pneumonia or influenza (HR 0.36 (CI: 0.17-0.73); no CLD: HR 0.22 (CI: 0.08-0.57); CLD: HR 0.95 (CI: 0.28-3.30); p for interaction = 0.064), respiratory hospitalization, and all-cause mortality, and a lower incidence rate of all-cause hospitalization. Effect estimates were less favorable for HD-IIV compared to SD-IIV among CLD patients in preventing respiratory disease hospitalization and all-cause mortality.
Conclusion
In this prespecified analysis of the DANFLU-1 randomized trial of HD-IIV vs. SD-IIV, trends suggested that among participants with CLD, the benefit of HD-IIV may be attenuated compared with those without CLD, particularly in relation to respiratory disease hospitalization and all-cause mortality. Given the small sample size, these results should be considered hypothesis-generating and require further investigation.
{"title":"Effects of high-dose versus standard-dose influenza vaccine among patients with chronic lung disease: A prespecified analysis of the DANFLU-1 trial","authors":"Lisa Steen Duus , Niklas Dyrby Johansen , Daniel Modin , Kira Hyldekær Janstrup , Joshua Nealon , Sandrine Samson , Matthew M. Loiacono , Rebecca C. Harris , Carsten Schade Larsen , Anne Marie Reimer Jensen , Brian L. Claggett , Scott D. Solomon , Martin J. Landray , Gunnar H. Gislason , Lars Køber , Pradeesh Sivapalan , Jens Ulrik Stæhr Jensen , Tor Biering-Sørensen","doi":"10.1016/j.resinv.2025.10.016","DOIUrl":"10.1016/j.resinv.2025.10.016","url":null,"abstract":"<div><h3>Background</h3><div>Individuals with chronic lung disease (CLD) face an increased risk of influenza-related complications and mortality, and seasonal vaccination is recommended. Limited evidence exists on the effectiveness of high-dose (HD-IIV) vs. standard-dose (SD-IIV) inactivated influenza vaccines in this population.</div></div><div><h3>Methods</h3><div>DANFLU-1 trial was a pragmatic, open-label, randomized trial comparing HD-IIV vs. SD-IIV in adults aged 65–79 years during the 2021/2022 influenza season. Vaccines were allocated 1:1. CLD was identified using ICD-10 codes. The prespecified outcomes were hospitalizations due to pneumonia or influenza, respiratory, cardiovascular, cardiorespiratory, and all-cause hospitalizations, and mortality.</div></div><div><h3>Results</h3><div>The study population included 12,477 participants (mean age 71.7 ± 3.9 years, 47 % female), of whom 850 (6.8 %) had CLD. Hospitalization rates for all outcomes were significantly higher among participants with CLD. HD-IIV was associated with a lower risk of hospitalization for pneumonia or influenza (HR 0.36 (CI: 0.17-0.73); no CLD: HR 0.22 (CI: 0.08-0.57); CLD: HR 0.95 (CI: 0.28-3.30); p for interaction = <em>0.064</em>), respiratory hospitalization, and all-cause mortality, and a lower incidence rate of all-cause hospitalization. Effect estimates were less favorable for HD-IIV compared to SD-IIV among CLD patients in preventing respiratory disease hospitalization and all-cause mortality.</div></div><div><h3>Conclusion</h3><div>In this prespecified analysis of the DANFLU-1 randomized trial of HD-IIV vs. SD-IIV, trends suggested that among participants with CLD, the benefit of HD-IIV may be attenuated compared with those without CLD, particularly in relation to respiratory disease hospitalization and all-cause mortality. Given the small sample size, these results should be considered hypothesis-generating and require further investigation.</div></div><div><h3>Trial registration</h3><div>ClinicalTrials.gov: <span><span>NCT05048589</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 6","pages":"Pages 1309-1315"},"PeriodicalIF":2.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145416004","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 : 2025-10-23DOI: 10.1016/j.resinv.2025.10.010
Yuya Ito , Takahiro Takazono , Hirokazu Yura , Masataka Yoshida , Kazuaki Takeda , Shotaro Ide , Naoki Iwanaga , Noriho Sakamoto , Katsunori Yanagihara , Hiroshi Mukae
Background
Pulmonary aspergillosis can complicate interstitial lung diseases (ILDs) during immunosuppressive treatment. This study aimed to clarify the clinical characteristics and prognostic differences of pulmonary aspergillosis in patients with ILDs by disease subtypes.
Methods
Patients diagnosed with both ILDs and pulmonary aspergillosis were retrospectively analyzed at Nagasaki University Hospital between October 1, 2008, and March 31, 2022. Pulmonary aspergillosis was categorized as invasive pulmonary aspergillosis (IPA) or chronic pulmonary aspergillosis (CPA). CPA was further subdivided into simple pulmonary aspergilloma (SPA), chronic cavitary pulmonary aspergillosis (CCPA), and subacute invasive aspergillosis (SAIA). Clinical characteristics and prognostic outcomes were compared among the subtypes.
Results
Fifty patients with both diseases were analyzed: 38 had CPA and 12 had IPA. All patients with IPA had a history of corticosteroid use and a significantly higher prevalence of diabetes mellitus than those with CPA. In contrast, honeycombing changes on chest computed tomography (CT) were more frequently observed in patients with CPA than in those with IPA. Kaplan–Meier analysis showed that patients with IPA had significantly higher mortality rates than those with CPA, and that among CPA subtypes, patients with SAIA had significantly higher mortality rates than those with SPA or CCPA. Univariate analysis showed that the presence of SAIA or IPA was significantly associated with 1-year mortality compared to other subtypes. The type of underlying ILD did not affect the prognosis.
Conclusions
Clinical characteristics and prognoses of pulmonary aspergillosis in patients with ILDs vary by subtype.
{"title":"Clinical characteristics and prognosis of pulmonary aspergillosis complicating interstitial lung diseases","authors":"Yuya Ito , Takahiro Takazono , Hirokazu Yura , Masataka Yoshida , Kazuaki Takeda , Shotaro Ide , Naoki Iwanaga , Noriho Sakamoto , Katsunori Yanagihara , Hiroshi Mukae","doi":"10.1016/j.resinv.2025.10.010","DOIUrl":"10.1016/j.resinv.2025.10.010","url":null,"abstract":"<div><h3>Background</h3><div>Pulmonary aspergillosis can complicate interstitial lung diseases (ILDs) during immunosuppressive treatment. This study aimed to clarify the clinical characteristics and prognostic differences of pulmonary aspergillosis in patients with ILDs by disease subtypes.</div></div><div><h3>Methods</h3><div>Patients diagnosed with both ILDs and pulmonary aspergillosis were retrospectively analyzed at Nagasaki University Hospital between October 1, 2008, and March 31, 2022. Pulmonary aspergillosis was categorized as invasive pulmonary aspergillosis (IPA) or chronic pulmonary aspergillosis (CPA). CPA was further subdivided into simple pulmonary aspergilloma (SPA), chronic cavitary pulmonary aspergillosis (CCPA), and subacute invasive aspergillosis (SAIA). Clinical characteristics and prognostic outcomes were compared among the subtypes.</div></div><div><h3>Results</h3><div>Fifty patients with both diseases were analyzed: 38 had CPA and 12 had IPA. All patients with IPA had a history of corticosteroid use and a significantly higher prevalence of diabetes mellitus than those with CPA. In contrast, honeycombing changes on chest computed tomography (CT) were more frequently observed in patients with CPA than in those with IPA. Kaplan–Meier analysis showed that patients with IPA had significantly higher mortality rates than those with CPA, and that among CPA subtypes, patients with SAIA had significantly higher mortality rates than those with SPA or CCPA. Univariate analysis showed that the presence of SAIA or IPA was significantly associated with 1-year mortality compared to other subtypes. The type of underlying ILD did not affect the prognosis.</div></div><div><h3>Conclusions</h3><div>Clinical characteristics and prognoses of pulmonary aspergillosis in patients with ILDs vary by subtype.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 6","pages":"Pages 1293-1299"},"PeriodicalIF":2.0,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145361654","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 : 2025-10-22DOI: 10.1016/j.resinv.2025.10.009
Minako Hanaka , Kazunori Tobino
Background
Sputum quality is widely considered a determinant of microbiological diagnostic yield in respiratory infections. However, its significance in the context of nontuberculous mycobacterial (NTM) lung disease remains unclear. This study aimed to investigate the association between sputum quality, as assessed using the Miller and Jones classification, and the detection rates of NTM via smear microscopy, polymerase chain reaction (PCR), and culture.
Methods
We conducted a cross-sectional study of 54 patients diagnosed with NTM lung disease at a single institution in Japan between September 2021 and September 2022. A total of 158 sputum samples were visually classified into five categories (M1–P3). Diagnostic yield was assessed using auramine-O fluorescence staining, Mycobacterium avium complex–polymerase chain reaction, and mycobacterial culture. Bacterial co-detection and treatment status were also analyzed.
Results
Nonpurulent sputum samples (M1 and M2) comprised over 60 % of all specimens and demonstrated clinically relevant positivity rates: 33 % for M1 and over 50 % for M2 by culture. No significant association was found between sputum quality and smear, PCR, or culture positivity. Purulent sputum (P2–P3) was significantly associated with bacterial co-detection (p = 0.0008), particularly Pseudomonas aeruginosa.
Conclusions
Sputum purulence was not associated with diagnostic yield for NTM. Nonpurulent samples should not be excluded from diagnostic evaluation. These findings support current guideline recommendations and highlight the importance of repeated sputum collection and adjunctive diagnostic tools in NTM lung disease.
{"title":"Diagnostic value of nonpurulent sputum in nontuberculous mycobacterial lung disease: A cross-sectional study based on the Miller and Jones classification","authors":"Minako Hanaka , Kazunori Tobino","doi":"10.1016/j.resinv.2025.10.009","DOIUrl":"10.1016/j.resinv.2025.10.009","url":null,"abstract":"<div><h3>Background</h3><div>Sputum quality is widely considered a determinant of microbiological diagnostic yield in respiratory infections. However, its significance in the context of nontuberculous mycobacterial (NTM) lung disease remains unclear. This study aimed to investigate the association between sputum quality, as assessed using the Miller and Jones classification, and the detection rates of NTM via smear microscopy, polymerase chain reaction (PCR), and culture.</div></div><div><h3>Methods</h3><div>We conducted a cross-sectional study of 54 patients diagnosed with NTM lung disease at a single institution in Japan between September 2021 and September 2022. A total of 158 sputum samples were visually classified into five categories (M1–P3). Diagnostic yield was assessed using auramine-O fluorescence staining, <em>Mycobacterium avium</em> complex–polymerase chain reaction, and mycobacterial culture. Bacterial co-detection and treatment status were also analyzed.</div></div><div><h3>Results</h3><div>Nonpurulent sputum samples (M1 and M2) comprised over 60 % of all specimens and demonstrated clinically relevant positivity rates: 33 % for M1 and over 50 % for M2 by culture. No significant association was found between sputum quality and smear, PCR, or culture positivity. Purulent sputum (P2–P3) was significantly associated with bacterial co-detection (p = 0.0008), particularly <em>Pseudomonas aeruginosa</em>.</div></div><div><h3>Conclusions</h3><div>Sputum purulence was not associated with diagnostic yield for NTM. Nonpurulent samples should not be excluded from diagnostic evaluation. These findings support current guideline recommendations and highlight the importance of repeated sputum collection and adjunctive diagnostic tools in NTM lung disease.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 6","pages":"Pages 1287-1292"},"PeriodicalIF":2.0,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145355514","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 : 2025-10-21DOI: 10.1016/j.resinv.2025.09.013
Zhikun Zheng
{"title":"Comment on “Reduced hemoglobin-corrected diffusing capacity in pulmonary arterial hypertension with preserved pulmonary function and morphology”","authors":"Zhikun Zheng","doi":"10.1016/j.resinv.2025.09.013","DOIUrl":"10.1016/j.resinv.2025.09.013","url":null,"abstract":"","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 6","pages":"Page 1286"},"PeriodicalIF":2.0,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145346756","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}
The mechanisms by which type 2 (T2) inflammation affects airway mucus plugging in asthma, asthma‒chronic obstructive pulmonary disease (COPD) overlap (ACO), and COPD remain unclear despite their clinical relevance. This study examined whether increased fractional exhaled nitric oxide (FeNO) and peripheral blood eosinophil count (BEC) are differentially associated with mucus plugging among patients with asthma, ACO, and COPD.
Methods
The presence and scores of mucus plugs were cross-sectionally visually assessed on ultra-high-resolution computed tomography. The T2 inflammation level was categorized into three groups: low (FeNO <25 ppb and BEC <300/μL), middle (FeNO ≥25 ppb or BEC ≥300/μL), and high (FeNO ≥25 ppb and BEC ≥300/μL).
Results
A total of 245 patients who did not receive biologics or oral corticosteroids, including 81, 45, and 119 patients with asthma, ACO, and COPD, respectively, were classified into low, middle, and high T2 inflammation groups. In patients with asthma, increased T2 inflammation was associated with increased mucus plugging. In patients with ACO, the high T2 inflammation group had the highest prevalence of mucus plugs and the highest mucus plug scores, whereas no difference was found between the middle and low T2 inflammation groups. In patients with COPD, the prevalence and scoring of mucus plugs did not differ among the groups.
Conclusion
The combination of high FeNO and BEC was associated with mucus plugs in patients with asthma or ACO but not in patients with COPD, suggesting the need for a disease-based approach to mucus plug removal.
{"title":"Differential associations between type 2 inflammation and airway mucus plugs in asthma, asthma-COPD overlap, and COPD","authors":"Kazuki Oga , Yusuke Hayashi , Naoya Tanabe , Tomoki Maetani , Yusuke Shiraishi , Ryo Sakamoto , Hironobu Sunadome , Susumu Sato , Hisako Matsumoto , Atsuyasu Sato , Toyohiro Hirai","doi":"10.1016/j.resinv.2025.10.007","DOIUrl":"10.1016/j.resinv.2025.10.007","url":null,"abstract":"<div><h3>Background</h3><div>The mechanisms by which type 2 (T2) inflammation affects airway mucus plugging in asthma, asthma‒chronic obstructive pulmonary disease (COPD) overlap (ACO), and COPD remain unclear despite their clinical relevance. This study examined whether increased fractional exhaled nitric oxide (FeNO) and peripheral blood eosinophil count (BEC) are differentially associated with mucus plugging among patients with asthma, ACO, and COPD.</div></div><div><h3>Methods</h3><div>The presence and scores of mucus plugs were cross-sectionally visually assessed on ultra-high-resolution computed tomography. The T2 inflammation level was categorized into three groups: low (FeNO <25 ppb and BEC <300/μL), middle (FeNO ≥25 ppb or BEC ≥300/μL), and high (FeNO ≥25 ppb and BEC ≥300/μL).</div></div><div><h3>Results</h3><div>A total of 245 patients who did not receive biologics or oral corticosteroids, including 81, 45, and 119 patients with asthma, ACO, and COPD, respectively, were classified into low, middle, and high T2 inflammation groups. In patients with asthma, increased T2 inflammation was associated with increased mucus plugging. In patients with ACO, the high T2 inflammation group had the highest prevalence of mucus plugs and the highest mucus plug scores, whereas no difference was found between the middle and low T2 inflammation groups. In patients with COPD, the prevalence and scoring of mucus plugs did not differ among the groups.</div></div><div><h3>Conclusion</h3><div>The combination of high FeNO and BEC was associated with mucus plugs in patients with asthma or ACO but not in patients with COPD, suggesting the need for a disease-based approach to mucus plug removal.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 6","pages":"Pages 1279-1285"},"PeriodicalIF":2.0,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145318721","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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