During the coronavirus disease (COVID-19) pandemic, Japan's health insurance system allowed continuous positive airway pressure (CPAP) telephone consultations to extend clinic visit intervals. This study aimed to determine whether 6-month CPAP adherence in the telemedicine (TM) group was inferior to that in the standard care group.
Methods
Patients receiving long-term CPAP therapy for at least 6 months for obstructive sleep apnea (OSA) from two clinics in Japan were recruited between May and July 2020. The TM group consisted of patients who had not visited the clinic in person for 6 months, with physicians providing telephone consultations every 1–2 months. The standard care group included patients who visited the clinic monthly for physician consultation. In both groups, physicians reviewed CPAP usage data via telemonitoring. Patients were classified into three groups according to change in adherence: ≤ −5%, > −5 to <5%, and ≥5%. The primary outcome was the number of patients with worsened CPAP adherence (≤−5%).
Results
Of the 479 patients in the TM group and 146 in the standard care group, 120 were matched using propensity score 1:1 nearest neighbor matching and selected from both groups. Adherence worsened in 41 (34.2%) and 32 (26.7 %) patients in the TM and standard care groups, respectively. The TM group was not inferior to the standard care group in terms of the proportion of patients with worsened CPAP adherence (χ2 = 1.81, df = 1, P = 0.178).
Conclusions
This study found no significant difference in the 6-month CPAP adherence between the TM and standard care groups.
{"title":"Telemedicine for long-term continuous positive airway pressure therapy: A six-month follow-up study in Japan using propensity score matching","authors":"Toshiki Akahoshi , Daisuke Endo , Kenichi Nagaoka , Ayako Hori , Tatsuya Ito , Akihito Uematsu , Yutaka Kozu , Yasuhiro Gon , Kazuo Chin , Ryuji Furihata","doi":"10.1016/j.resinv.2024.11.002","DOIUrl":"10.1016/j.resinv.2024.11.002","url":null,"abstract":"<div><h3>Background</h3><div>During the coronavirus disease (COVID-19) pandemic, Japan's health insurance system allowed continuous positive airway pressure (CPAP) telephone consultations to extend clinic visit intervals. This study aimed to determine whether 6-month CPAP adherence in the telemedicine (TM) group was inferior to that in the standard care group.</div></div><div><h3>Methods</h3><div>Patients receiving long-term CPAP therapy for at least 6 months for obstructive sleep apnea (OSA) from two clinics in Japan were recruited between May and July 2020. The TM group consisted of patients who had not visited the clinic in person for 6 months, with physicians providing telephone consultations every 1–2 months. The standard care group included patients who visited the clinic monthly for physician consultation. In both groups, physicians reviewed CPAP usage data via telemonitoring. Patients were classified into three groups according to change in adherence: ≤ −5%, > −5 to <5%, and ≥5%. The primary outcome was the number of patients with worsened CPAP adherence (≤−5%).</div></div><div><h3>Results</h3><div>Of the 479 patients in the TM group and 146 in the standard care group, 120 were matched using propensity score 1:1 nearest neighbor matching and selected from both groups. Adherence worsened in 41 (34.2%) and 32 (26.7 %) patients in the TM and standard care groups, respectively. The TM group was not inferior to the standard care group in terms of the proportion of patients with worsened CPAP adherence (χ<sup>2</sup> = 1.81, df = 1, <em>P</em> = 0.178).</div></div><div><h3>Conclusions</h3><div>This study found no significant difference in the 6-month CPAP adherence between the TM and standard care groups.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"62 6","pages":"Pages 1233-1238"},"PeriodicalIF":2.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142627093","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}
Increasing expectations that biologics can be used as disease-modifying agents have introduced the concept of clinical remission (CR) in managements of severe asthma. Given the clinical relevance of computed tomography (CT) and blood biomarkers, we hypothesized that further refinement of CR criteria as well as incorporation of CT and blood biomarkers as indicators for structural and biological remission (SR, BR) would enable predicting long-term disease stability in patients with severe asthma treated with biologics.
Methods
This Japanese multicenter prospective observational cohort will enroll patients with severe asthma who will start a new biologic (including a change from another biologic). The enrolled patients will be longitudinally followed up for 3 years. At enrollment, patients will undergo postbronchodilator spirometry, blood tests, fractional exhaled nitric oxide, chest and sinus CT, and patient-reported outcome questionnaires. Follow-up examinations will be performed at 1, 3, 6, 12, 24, and 36 months. The rates of CR resulting from different criteria after 1 year of treatment with biologics will be compared, and factors associated with long-term disease stability after 3 years of biologic treatments will be identified.
Discussion
This multicenter study in Japan will provide data that will help establish more appropriate criteria for CR, structural remission, and biological remission to predict long-term disease stability in patients with severe asthma who receive biologic therapy.
Ethics and dissemination
The study was approved by the Ethics Committee of Kyoto University (No. R4419, approval date June 11th, 2024).
Trial registration
The University Hospital Medical Information Network (UMIN000053771).
{"title":"A protocol for a Japanese prospective cohort evaluating the features of patients with uncontrolled asthma achieving clinical remission: J-CIRCLE","authors":"Naoya Tanabe , Yu Hara , Kaoruko Shimizu , Satoshi Marumo , Jun Miyata , Kyohei Morita , Tetsuya Watanabe , Keiji Oishi , Masafumi Yamaguchi , Kazuhisa Asai , Yasutaka Nakano , Tsunahiko Hirano , Kazuto Matsunaga , Toshiyuki Koya , Hisako Matsumoto , Koichi Fukunaga , Satoshi Konno , Takeshi Kaneko , Toyohiro Hirai","doi":"10.1016/j.resinv.2024.10.009","DOIUrl":"10.1016/j.resinv.2024.10.009","url":null,"abstract":"<div><h3>Background</h3><div>Increasing expectations that biologics can be used as disease-modifying agents have introduced the concept of clinical remission (CR) in managements of severe asthma. Given the clinical relevance of computed tomography (CT) and blood biomarkers, we hypothesized that further refinement of CR criteria as well as incorporation of CT and blood biomarkers as indicators for structural and biological remission (SR, BR) would enable predicting long-term disease stability in patients with severe asthma treated with biologics.</div></div><div><h3>Methods</h3><div>This Japanese multicenter prospective observational cohort will enroll patients with severe asthma who will start a new biologic (including a change from another biologic). The enrolled patients will be longitudinally followed up for 3 years. At enrollment, patients will undergo postbronchodilator spirometry, blood tests, fractional exhaled nitric oxide, chest and sinus CT, and patient-reported outcome questionnaires. Follow-up examinations will be performed at 1, 3, 6, 12, 24, and 36 months. The rates of CR resulting from different criteria after 1 year of treatment with biologics will be compared, and factors associated with long-term disease stability after 3 years of biologic treatments will be identified.</div></div><div><h3>Discussion</h3><div>This multicenter study in Japan will provide data that will help establish more appropriate criteria for CR, structural remission, and biological remission to predict long-term disease stability in patients with severe asthma who receive biologic therapy.</div></div><div><h3>Ethics and dissemination</h3><div>The study was approved by the Ethics Committee of Kyoto University (No. R4419, approval date June 11th, 2024).</div></div><div><h3>Trial registration</h3><div>The University Hospital Medical Information Network (UMIN000053771).</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"62 6","pages":"Pages 1209-1214"},"PeriodicalIF":2.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142578079","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 : 2024-10-23DOI: 10.1016/j.resinv.2024.09.006
Koji Kuronuma
{"title":"Importance of vaccines against respiratory infections in adults","authors":"Koji Kuronuma","doi":"10.1016/j.resinv.2024.09.006","DOIUrl":"10.1016/j.resinv.2024.09.006","url":null,"abstract":"","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"62 6","pages":"Pages 1202-1203"},"PeriodicalIF":2.4,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142506835","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}
A pleural effusion is a common pulmonary manifestation of systemic lupus erythematosus (SLE), and differential diagnosis is needed to perform targeted treatments. An SLE patient with refractory chylothorax is presented. Chylothorax rarely occurs in SLE patients and occasionally follows a refractory clinical course despite intensive treatment with immunosuppressive therapies, resulting in a poor prognosis with malnutrition caused by frequent thoracenteses. In such cases, pleuro-peritoneal and peritoneal-venous shunts along with cell-free and concentrated ascites re-infusion therapy might be effective to improve the dyspnea while maintaining nutrition.
{"title":"Refractory bilateral chylothorax and chylous ascites in a patient with systemic lupus erythematosus treated by pleuro-peritoneal and peritoneal-venous shunts along with cell-free and concentrated ascites re-infusion therapy","authors":"Yuki Kuwahara , Hiroki Tashiro , Go Takeshita , Yoshiaki Egashira , Akihito Maruyama , Yuki Ikeda , Shinya Kimura , Naoko Sueoka-Aragane , Koichiro Takahashi","doi":"10.1016/j.resinv.2024.10.006","DOIUrl":"10.1016/j.resinv.2024.10.006","url":null,"abstract":"<div><div>A pleural effusion is a common pulmonary manifestation of systemic lupus erythematosus (SLE), and differential diagnosis is needed to perform targeted treatments. An SLE patient with refractory chylothorax is presented. Chylothorax rarely occurs in SLE patients and occasionally follows a refractory clinical course despite intensive treatment with immunosuppressive therapies, resulting in a poor prognosis with malnutrition caused by frequent thoracenteses. In such cases, pleuro-peritoneal and peritoneal-venous shunts along with cell-free and concentrated ascites re-infusion therapy might be effective to improve the dyspnea while maintaining nutrition.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"62 6","pages":"Pages 1191-1194"},"PeriodicalIF":2.4,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142506837","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}
To compare the effectiveness and safety of low-dose sulfamethoxazole/trimethoprim (SMX/TMP) for Pneumocystis jirovecii pneumonia (PCP) prophylaxis in patients with systemic rheumatic disease (SRD) who were receiving glucocorticoids.
Methods
We retrospectively analyzed data obtained from Japanese patients with SRD who received glucocorticoids between January 2006 and April 2024. Patients were divided into two groups based on the initial dose of SMX/TMP: low-dose (one tablet twice weekly on non-consecutive days); conventional-dose (one tablet per day). The primary endpoint was the incidence of PCP after 1 year since the initiation of SMX/TMP. Secondary endpoints were discontinuation rates of SMX/TMP therapy and severe adverse drug reactions (ADRs) after 1 year since the initiation of SMX/TMP in both groups, before and after adjusting for patient characteristics.
Results
A total of 186 patients were included in this study: 60 in the low-dose group and 126 in the conventional-dose group. No patients developed PCP within one year after starting SMX/TMP; however, two patients in the low-dose group required escalation of the SMX/TMP dose to the conventional dose due to subclinical PCP. In the adjusted analysis, the low-dose group had a significantly lower discontinuation rate and a lower incidence rate of severe ADRs than the conventional-dose group.
Conclusions
Lower-dose SMX/TMP therapy was as effective as conventional therapy for PCP prophylaxis and was associated with lower discontinuation rates in patients with SRD receiving glucocorticoids.
{"title":"Effectiveness and safety of lower dose sulfamethoxazole/trimethoprim for Pneumocystis jirovecii pneumonia prophylaxis in patients with systemic rheumatic diseases receiving moderate-to high-dose glucocorticoids","authors":"Shin-ichiro Ohmura , Takayuki Masui , Toshitaka Yukishima , Yusuke Ohkubo , Haruka Yonezawa , Toshiaki Miyamoto","doi":"10.1016/j.resinv.2024.10.007","DOIUrl":"10.1016/j.resinv.2024.10.007","url":null,"abstract":"<div><h3>Objectives</h3><div>To compare the effectiveness and safety of low-dose sulfamethoxazole/trimethoprim (SMX/TMP) for <em>Pneumocystis jirovecii</em> pneumonia (PCP) prophylaxis in patients with systemic rheumatic disease (SRD) who were receiving glucocorticoids.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed data obtained from Japanese patients with SRD who received glucocorticoids between January 2006 and April 2024. Patients were divided into two groups based on the initial dose of SMX/TMP: low-dose (one tablet twice weekly on non-consecutive days); conventional-dose (one tablet per day). The primary endpoint was the incidence of PCP after 1 year since the initiation of SMX/TMP. Secondary endpoints were discontinuation rates of SMX/TMP therapy and severe adverse drug reactions (ADRs) after 1 year since the initiation of SMX/TMP in both groups, before and after adjusting for patient characteristics.</div></div><div><h3>Results</h3><div>A total of 186 patients were included in this study: 60 in the low-dose group and 126 in the conventional-dose group. No patients developed PCP within one year after starting SMX/TMP; however, two patients in the low-dose group required escalation of the SMX/TMP dose to the conventional dose due to subclinical PCP. In the adjusted analysis, the low-dose group had a significantly lower discontinuation rate and a lower incidence rate of severe ADRs than the conventional-dose group.</div></div><div><h3>Conclusions</h3><div>Lower-dose SMX/TMP therapy was as effective as conventional therapy for PCP prophylaxis and was associated with lower discontinuation rates in patients with SRD receiving glucocorticoids.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"62 6","pages":"Pages 1195-1201"},"PeriodicalIF":2.4,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142506834","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 : 2024-10-22DOI: 10.1016/j.resinv.2024.10.008
Taku Nakashima
Interstitial pneumonia includes a range of disorders affecting the lung interstitium, significantly impacting life expectancy, especially during acute exacerbations. Concurrently, lung cancer remains a leading cause of cancer-related deaths worldwide. The coexistence of these two conditions presents a formidable challenge, complicating diagnosis, treatment, and prognosis. This review explores the critical issues associated with lung cancer comorbid with interstitial pneumonia, focusing on diagnostic challenges, prognosis, treatment complications, and the lack of effective research tools. Diagnosing lung cancer in patients with interstitial pneumonia is complicated due to overlapping imaging features and the risks associated with biopsies. The prognosis is poorer for patients with both conditions, as interstitial pneumonia promotes a more aggressive lung cancer phenotype. Standard treatment for interstitial pneumonia can inadvertently facilitate lung cancer progression, while anticancer therapies often exacerbate interstitial pneumonia. To address the lack of appropriate research tools, a novel murine model combining orthotopic lung cancer cell transplantation with bleomycin-induced interstitial pneumonia was developed to better understand their interaction. This new murine model successfully mimics the human condition, demonstrating increased tumor growth, metastasis, and alterations in the tumor microenvironment, including elevated tumor-associated macrophages, cancer-associated myofibroblasts, and regulatory T cells, alongside decreased cytotoxic T lymphocytes. Lung cancer comorbid with interstitial pneumonia represents a severe clinical challenge due to diagnostic difficulties and treatment-related complications. The novel murine model offers a valuable tool for future research to develop effective therapies. Dedicated efforts are needed to address this complex pathophysiology to improve patient outcomes.
{"title":"Lung cancer with comorbid interstitial pneumonia: Current situation and animal model development","authors":"Taku Nakashima","doi":"10.1016/j.resinv.2024.10.008","DOIUrl":"10.1016/j.resinv.2024.10.008","url":null,"abstract":"<div><div>Interstitial pneumonia includes a range of disorders affecting the lung interstitium, significantly impacting life expectancy, especially during acute exacerbations. Concurrently, lung cancer remains a leading cause of cancer-related deaths worldwide. The coexistence of these two conditions presents a formidable challenge, complicating diagnosis, treatment, and prognosis. This review explores the critical issues associated with lung cancer comorbid with interstitial pneumonia, focusing on diagnostic challenges, prognosis, treatment complications, and the lack of effective research tools. Diagnosing lung cancer in patients with interstitial pneumonia is complicated due to overlapping imaging features and the risks associated with biopsies. The prognosis is poorer for patients with both conditions, as interstitial pneumonia promotes a more aggressive lung cancer phenotype. Standard treatment for interstitial pneumonia can inadvertently facilitate lung cancer progression, while anticancer therapies often exacerbate interstitial pneumonia. To address the lack of appropriate research tools, a novel murine model combining orthotopic lung cancer cell transplantation with bleomycin-induced interstitial pneumonia was developed to better understand their interaction. This new murine model successfully mimics the human condition, demonstrating increased tumor growth, metastasis, and alterations in the tumor microenvironment, including elevated tumor-associated macrophages, cancer-associated myofibroblasts, and regulatory T cells, alongside decreased cytotoxic T lymphocytes. Lung cancer comorbid with interstitial pneumonia represents a severe clinical challenge due to diagnostic difficulties and treatment-related complications. The novel murine model offers a valuable tool for future research to develop effective therapies. Dedicated efforts are needed to address this complex pathophysiology to improve patient outcomes.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"62 6","pages":"Pages 1183-1190"},"PeriodicalIF":2.4,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142506836","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}
Tocilizumab is effective in treating severe coronavirus disease 2019 (COVID-19). However, the specific time point it acts as a valid indicator of treatment efficacy remains unclear. This study aimed to determine the optimal day for assessing the prognostic value of the oxygen saturation/fraction of inspired oxygen (SpO2/FiO2) and ratio of respiratory rate-oxygenation (ROX) index in patients receiving tocilizumab for COVID-19.
Methods
All patients admitted to our hospital from March 2020 to July 2021 who received tocilizumab for COVID-19 were retrospectively identified from hospital charts. Biodata, medical history, and laboratory tests results were obtained from medical records. The prognostic values of the SpO2/FiO2 and ROX index for predicting mortality were assessed. Cox proportional hazard and receiver operating characteristic curve models were utilized.
Results
Of the 84 included patients, 34 died within 7 days after discharge. The patients who recovered had a mean age of 65 years and were younger than those who died. The multivariate analysis indicated that multiple comorbidities, cancer history, CURB-65 score, neutrophil and lymphocyte counts, neutrophil/lymphocyte ratio, and lactate dehydrogenase levels were higher in those who died compared with those who survived. No significant differences were found in dyspnea or total bilirubin levels between the two groups. The SpO2/FiO2 at 3 days post-tocilizumab initiation was strongly associated with survival.
Conclusions
The SpO2/FiO2 on day 3 post-tocilizumab initiation was a predictor of COVID-19 prognosis, which could be employed in determining clinical decisions. Prompt alternative interventions should be considered when this ratio does not improve.
{"title":"Prognostic significance of oxygen saturation/fraction of inspired oxygen 3 days after initiation of tocilizumab treatment in patients with COVID-19","authors":"Yusuke Kurosawa , Yutaka Kozu , Kaori Soda , Yasunori Itoda , Yusuke Jinno , Shun Yokota , Mamiko Hoshi , Tsukasa Nishizawa , Hisato Hiranuma , Kenji Mizumura , Tetsuo Shimizu , Tadateru Takayama , Kazuo Chin , Yasuhiro Gon","doi":"10.1016/j.resinv.2024.10.005","DOIUrl":"10.1016/j.resinv.2024.10.005","url":null,"abstract":"<div><h3>Background</h3><div>Tocilizumab is effective in treating severe coronavirus disease 2019 (COVID-19). However, the specific time point it acts as a valid indicator of treatment efficacy remains unclear. This study aimed to determine the optimal day for assessing the prognostic value of the oxygen saturation/fraction of inspired oxygen (SpO<sub>2</sub>/FiO<sub>2</sub>) and ratio of respiratory rate-oxygenation (ROX) index in patients receiving tocilizumab for COVID-19.</div></div><div><h3>Methods</h3><div>All patients admitted to our hospital from March 2020 to July 2021 who received tocilizumab for COVID-19 were retrospectively identified from hospital charts. Biodata, medical history, and laboratory tests results were obtained from medical records. The prognostic values of the SpO<sub>2</sub>/FiO<sub>2</sub> and ROX index for predicting mortality were assessed. Cox proportional hazard and receiver operating characteristic curve models were utilized.</div></div><div><h3>Results</h3><div>Of the 84 included patients, 34 died within 7 days after discharge. The patients who recovered had a mean age of 65 years and were younger than those who died. The multivariate analysis indicated that multiple comorbidities, cancer history, CURB-65 score, neutrophil and lymphocyte counts, neutrophil/lymphocyte ratio, and lactate dehydrogenase levels were higher in those who died compared with those who survived. No significant differences were found in dyspnea or total bilirubin levels between the two groups. The SpO<sub>2</sub>/FiO<sub>2</sub> at 3 days post-tocilizumab initiation was strongly associated with survival.</div></div><div><h3>Conclusions</h3><div>The SpO<sub>2</sub>/FiO<sub>2</sub> on day 3 post-tocilizumab initiation was a predictor of COVID-19 prognosis, which could be employed in determining clinical decisions. Prompt alternative interventions should be considered when this ratio does not improve.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"62 6","pages":"Pages 1176-1182"},"PeriodicalIF":2.4,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142442516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The efficacy and safety of mucolytics in patients with chronic obstructive pulmonary disease (COPD) and chronic bronchitis or exacerbations of COPD have been reported. We conducted a systematic review and meta-analysis of mucolytics in patients with stable COPD.
Methods
Reports from randomized controlled trials to evaluate the efficacy and safety of mucolytics, including ambroxol, bromhexine, carbocisteine, erdosteine, fudosteine, l-methylcysteine, and N-acetylcysteine used in patients with stable COPD were searched for in PubMed, Scopus, Embase, Web of Science, the Cochrane Library, and the Igaku Cyuo Zasshi database.
Results
Twenty-three reports with ambroxol, carbocisteine, erdosteine, l-methylcysteine, or N-acetylcysteine were included in the review. Mucolytics significantly reduced the rates of exacerbation and hospitalization, shortened the duration of antibiotic use and exacerbations, prolonged the time to first exacerbation, and had a tendency to reduce the occurrence of two or more exacerbations in patients with stable COPD compared to placebo. Mucolytics did not improve mortality, number of lost workdays, scores on St. George's respiratory questionnaire, forced expiratory volume in 1 s, or forced vital capacity. The safety profile of mucolytics was comparable to that of placebo.
Conclusions
Mucolytics reduce exacerbations and hospitalizations in patients with stable COPD and have a safety profile comparable to that of placebo.
{"title":"Efficacy and safety of mucolytics in patients with stable chronic obstructive pulmonary disease: A systematic review and meta-analysis","authors":"Hiroshi Ohnishi , Takuya Tanimoto , Ryunosuke Inaba , Masamitsu Eitoku","doi":"10.1016/j.resinv.2024.10.004","DOIUrl":"10.1016/j.resinv.2024.10.004","url":null,"abstract":"<div><h3>Background</h3><div>The efficacy and safety of mucolytics in patients with chronic obstructive pulmonary disease (COPD) and chronic bronchitis or exacerbations of COPD have been reported. We conducted a systematic review and meta-analysis of mucolytics in patients with stable COPD.</div></div><div><h3>Methods</h3><div>Reports from randomized controlled trials to evaluate the efficacy and safety of mucolytics, including ambroxol, bromhexine, carbocisteine, erdosteine, fudosteine, <span>l</span>-methylcysteine, and N-acetylcysteine used in patients with stable COPD were searched for in PubMed, Scopus, Embase, Web of Science, the Cochrane Library, and the Igaku Cyuo Zasshi database.</div></div><div><h3>Results</h3><div>Twenty-three reports with ambroxol, carbocisteine, erdosteine, <span>l</span>-methylcysteine, or N-acetylcysteine were included in the review. Mucolytics significantly reduced the rates of exacerbation and hospitalization, shortened the duration of antibiotic use and exacerbations, prolonged the time to first exacerbation, and had a tendency to reduce the occurrence of two or more exacerbations in patients with stable COPD compared to placebo. Mucolytics did not improve mortality, number of lost workdays, scores on St. George's respiratory questionnaire, forced expiratory volume in 1 s, or forced vital capacity. The safety profile of mucolytics was comparable to that of placebo.</div></div><div><h3>Conclusions</h3><div>Mucolytics reduce exacerbations and hospitalizations in patients with stable COPD and have a safety profile comparable to that of placebo.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"62 6","pages":"Pages 1168-1175"},"PeriodicalIF":2.4,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142432958","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}
Approximately 20% of patients with pulmonary alveolar proteinosis (PAP) present with pulmonary fibrosis on high-resolution computed tomography (HRCT). Although transbronchial lung cryobiopsy (TBLC) has recently been used to diagnose fibrotic interstitial lung disease, no studies have investigated whether TBLC is useful for the histopathological detection of pulmonary fibrosis coexisting with PAP. Therefore, the present study aimed to investigate the utility of TBLC for evaluating pulmonary fibrosis in patients with PAP.
Methods
We retrospectively reviewed patients diagnosed with PAP who underwent TBLC at our hospital between May 2021 and March 2023. We collected data including patient background, HRCT findings, and histopathological findings of the TBLC samples.
Results
Seven patients met the inclusion criteria, with a median age was 69 years; 5 patients were male. Six patients were diagnosed with autoimmune PAP, and one was diagnosed with unclassified PAP. Periodic acid-Schiff staining-positive materials in the alveoli were observed in six out of seven patients. Pulmonary fibrosis, defined as fibrosis with architectural distortion, was found in two patients. Fibroblastic foci and airway-centered fibrosis were presented in two and one patient, respectively. As a result of a multidisciplinary discussion, we diagnosed one each with fibrotic HP coexisting with PAP and PAP-associated fibrosis.
Conclusion
Two of the seven patients with PAP presented histopathologically with pulmonary fibrosis in samples obtained through TBLC. Thus, TBLC should be considered when the coexistence of pulmonary fibrosis is suspected.
背景约 20% 的肺泡蛋白沉积症（PAP）患者在高分辨率计算机断层扫描（HRCT）中表现为肺纤维化。虽然经支气管肺冷冻活检（TBLC）最近已被用于诊断纤维化间质性肺病，但还没有研究探讨 TBLC 是否有助于组织病理学检测与肺泡蛋白沉积症并存的肺纤维化。因此，本研究旨在探讨 TBLC 在评估 PAP 患者肺纤维化方面的实用性。方法我们回顾性分析了 2021 年 5 月至 2023 年 3 月期间在我院接受 TBLC 检查并确诊为 PAP 的患者。结果7名患者符合纳入标准，中位年龄为69岁；5名患者为男性。六名患者被诊断为自身免疫性 PAP，一名患者被诊断为未分类 PAP。在七名患者中，有六名患者的肺泡中观察到周期性酸-希夫染色阳性物质。在两名患者中发现了肺纤维化，即伴有结构变形的纤维化。分别有两名和一名患者出现成纤维细胞灶和以气道为中心的纤维化。经过多学科讨论，我们诊断出与 PAP 和 PAP 相关纤维化并存的纤维化 HP 各一名。因此，当怀疑同时存在肺纤维化时，应考虑使用 TBLC。
{"title":"Pulmonary fibrosis in pulmonary alveolar proteinosis evaluated by transbronchial lung cryobiopsy: A single-center retrospective study","authors":"Kensuke Kanaoka , Toru Arai , Takayuki Takimoto , Mitsuhiro Moda , Ryota Shintani , Misaki Ryuge , Naoko Takeuchi , Tomoko Kagawa , Kazunobu Tachibana , Yoshikazu Inoue , Hiromitsu Sumikawa , Maiko Takeda , Shigeki Shimizu","doi":"10.1016/j.resinv.2024.10.002","DOIUrl":"10.1016/j.resinv.2024.10.002","url":null,"abstract":"<div><h3>Background</h3><div>Approximately 20% of patients with pulmonary alveolar proteinosis (PAP) present with pulmonary fibrosis on high-resolution computed tomography (HRCT). Although transbronchial lung cryobiopsy (TBLC) has recently been used to diagnose fibrotic interstitial lung disease, no studies have investigated whether TBLC is useful for the histopathological detection of pulmonary fibrosis coexisting with PAP. Therefore, the present study aimed to investigate the utility of TBLC for evaluating pulmonary fibrosis in patients with PAP.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed patients diagnosed with PAP who underwent TBLC at our hospital between May 2021 and March 2023. We collected data including patient background, HRCT findings, and histopathological findings of the TBLC samples.</div></div><div><h3>Results</h3><div>Seven patients met the inclusion criteria, with a median age was 69 years; 5 patients were male. Six patients were diagnosed with autoimmune PAP, and one was diagnosed with unclassified PAP. Periodic acid-Schiff staining-positive materials in the alveoli were observed in six out of seven patients. Pulmonary fibrosis, defined as fibrosis with architectural distortion, was found in two patients. Fibroblastic foci and airway-centered fibrosis were presented in two and one patient, respectively. As a result of a multidisciplinary discussion, we diagnosed one each with fibrotic HP coexisting with PAP and PAP-associated fibrosis.</div></div><div><h3>Conclusion</h3><div>Two of the seven patients with PAP presented histopathologically with pulmonary fibrosis in samples obtained through TBLC. Thus, TBLC should be considered when the coexistence of pulmonary fibrosis is suspected.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"62 6","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142425027","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}
A 64-year-old light-smoking woman was clinically diagnosed with lung large-cell neuroendocrine carcinoma (LCNEC) with a metastatic brain tumor. An Oncomine Dx Targeted Test using metastatic brain tissue revealed that the patient's lung cancer cells had an EML4-ALK rearrangement. Patients with LCNEC and anaplastic lymphoma kinase (ALK) gene rearrangements are rare, and there is currently no standard treatment. Based on the genomic analysis, we treated the patient with brigatinib, an ALK inhibitor. We describe here a patient with LCNEC who responded significantly to brigatinib without serious adverse events.
{"title":"Therapeutic effects of an ALK inhibitor, brigatinib, on lung large cell neuroendocrine carcinoma with EML4-ALK fusion","authors":"Takayuki Suetsugu , Yutaka Masada , Tomoki Kozono , Kahoru Morita , Hajime Yonezawa , Kazuhiro Tabata , Naohiko Seki , Keiko Mizuno , Kentaro Tanaka , Hiromasa Inoue","doi":"10.1016/j.resinv.2024.09.013","DOIUrl":"10.1016/j.resinv.2024.09.013","url":null,"abstract":"<div><div>A 64-year-old light-smoking woman was clinically diagnosed with lung large-cell neuroendocrine carcinoma (LCNEC) with a metastatic brain tumor. An Oncomine Dx Targeted Test using metastatic brain tissue revealed that the patient's lung cancer cells had an EML4-ALK rearrangement. Patients with LCNEC and anaplastic lymphoma kinase (ALK) gene rearrangements are rare, and there is currently no standard treatment. Based on the genomic analysis, we treated the patient with brigatinib, an ALK inhibitor. We describe here a patient with LCNEC who responded significantly to brigatinib without serious adverse events.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"62 6","pages":"Pages 1157-1160"},"PeriodicalIF":2.4,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142425028","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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