Respiratory investigation最新文献

英文中文

Differential associations between type 2 inflammation and airway mucus plugs in asthma, asthma-COPD overlap, and COPD 2型炎症和气道粘液塞在哮喘、哮喘-慢性阻塞性肺病重叠和慢性阻塞性肺病中的差异关联

IF 2 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2025-11-01 Epub Date: 2025-10-17 DOI: 10.1016/j.resinv.2025.10.007

Kazuki Oga , Yusuke Hayashi , Naoya Tanabe , Tomoki Maetani , Yusuke Shiraishi , Ryo Sakamoto , Hironobu Sunadome , Susumu Sato , Hisako Matsumoto , Atsuyasu Sato , Toyohiro Hirai

Background

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.

背景：2型（T2）炎症影响哮喘、哮喘-慢性阻塞性肺疾病（COPD）重叠（ACO）和COPD气道粘液堵塞的机制尚不清楚，尽管它们具有临床相关性。本研究探讨了哮喘、慢性阻塞性肺病和慢性阻塞性肺病患者呼出一氧化氮分数（FeNO）和外周血嗜酸性粒细胞计数（BEC）的增加是否与粘液堵塞存在差异。方法：在超高分辨率计算机断层扫描上对粘液塞的存在和评分进行横切面视觉评估。结果：共有245例未接受生物制剂或口服皮质类固醇治疗的患者（分别为81例、45例和119例哮喘、ACO和COPD患者）被分为低、中、高T2炎症组。在哮喘患者中，T2炎症增加与黏液堵塞增加相关。在ACO患者中，高T2炎症组粘液塞患病率最高，粘液塞评分最高，而中、低T2炎症组之间无差异。在COPD患者中，粘液塞的患病率和评分在两组之间没有差异。结论：高FeNO和BEC与哮喘或ACO患者的粘液塞相关，但与COPD患者无关，提示需要基于疾病的方法去除粘液塞。

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引用次数: 0

Successful treatment of huntingtin-interacting protein-1-anaplastic lymphoma kinase-positive lung cancer with severe airway stenosis using silicone stent placement and alectinib 应用硅胶支架和阿勒替尼成功治疗伴严重气道狭窄的亨廷顿蛋白相互作用蛋白-1间变性淋巴瘤激酶阳性肺癌。

IF 2 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2025-11-01 Epub Date: 2025-11-11 DOI: 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.

亨廷顿蛋白相互作用蛋白1 (HIP1)-间变性淋巴瘤激酶（ALK）是ALK阳性肺癌中相对罕见的融合。HIP1-ALK （H19:A20）在HIP1-ALK阳性肺癌中是一种罕见的变异，关于ALK酪氨酸激酶抑制剂疗效的数据有限。我们报告一例37岁男性HIP1-ALK （H19:A20）肺腺癌患者接受硅胶支架置入和alectiinib治疗。支架置入在改善症状方面是有效的，使用阿勒替尼的最佳治疗反应是部分反应。对于怀疑ALK基因的肺癌患者，应考虑采用免疫组化或综合基因组谱法进行常规ALK筛查。

引用次数: 0

Recent advances in lung function standard value prediction equations: Comparison with the Global Lung Initiative prediction equation based on GAMLSS 肺功能标准值预测方程的最新进展：与基于GAMLSS的Global lung Initiative预测方程的比较

IF 2 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2025-11-01 Epub Date: 2025-09-20 DOI: 10.1016/j.resinv.2025.09.010

Toshitaka Shomura, Yosuke Wada, Masayuki Hanaoka

To accurately interpret lung function test (LFTs) results, it is necessary to appropriately select the lung function reference value prediction equation implemented in the measuring equipment of each medical institution.

The American Thoracic Society (ATS) and European Respiratory Society (ERS) task force, known as the Global Lung Function Initiative (GLI), recommends the use of a lung function standard value prediction equation that can calculate continuous standard values across a wide age range. Generalized additive models for location, scale, and shape (GAMLSS) are statistical techniques used to create accurate percentiles for a wide age range. This prediction equation was created using the lambda, mu, and sigma (LMS) method, a subtype of a statistical method known as generalized additive models for location, scale, and shape (GAMLSS). Lung function equations created using the LMS method can be used to calculate the z-score, which can contribute to a more accurate interpretation of the results. As for the contents of this review, an overview of the development of equations for predicting lung function using GAMLSS, such as spirometry, diffusion capacity, and static lung volume, is provided in the first portion of this review. The second section of this review compiles the statistical knowledge required to develop lung function reference-value prediction algorithms based on GAMLSS. This section briefly explains how to calculate the z-score and provides advice on addressing ethnic diversity in the lung function standard value prediction equations.

为了准确地解释肺功能试验（LFTs）结果，有必要适当选择各医疗机构测量设备中实施的肺功能参考值预测方程。美国胸科学会（ATS）和欧洲呼吸学会（ERS）工作组，即全球肺功能倡议（GLI），建议使用肺功能标准值预测方程，该方程可以计算大年龄范围内的连续标准值。广义加性模型的位置，规模和形状（GAMLSS）是统计技术，用于创建准确的百分位数为广泛的年龄范围。这个预测方程是使用lambda， mu, and sigma （LMS）方法创建的，LMS是一种称为位置，规模和形状广义加性模型（GAMLSS）的统计方法的子类型。使用LMS方法创建的肺功能方程可用于计算z分数，这有助于更准确地解释结果。关于本综述的内容，本文第一部分概述了利用GAMLSS预测肺功能的方程的发展，如肺活量测定法、扩散能力和静态肺体积。本综述的第二部分汇编了基于GAMLSS开发肺功能参考值预测算法所需的统计知识。本节简要解释了如何计算z分数，并提供了在肺功能标准值预测方程中解决种族多样性的建议。

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引用次数: 0

Extent of pulmonary involvement on admission predicts long-term pulmonary and muscular sequelae of COVID-19: A longitudinal computed tomography study 入院时肺部受累程度可预测COVID-19的长期肺部和肌肉后遗症：一项纵向计算机断层扫描研究

IF 2 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2025-11-01 Epub Date: 2025-09-30 DOI: 10.1016/j.resinv.2025.09.014

Takashi Shimada , Naoya Tanabe , Shotaro Chubachi , Takanori Asakura , Ho Namkoong , Hiromu Tanaka , Shuhei Azekawa , Shiro Otake , Kensuke Nakagawara , Takahiro Fukushima , Mayuko Watase , Tomoki Maetani , Yusuke Shiraishi , Hideki Terai , Mamoru Sasaki , Soichiro Ueda , Yukari Kato , Norihiro Harada , Shoji Suzuki , Shuichi Yoshida , Koichi Fukunaga

Background

Studies on the association between chest computed tomography (CT) findings of extensive pulmonary involvement and long-term pulmonary and extrapulmonary coronavirus disease 2019 (COVID-19) sequelae are lacking. This study aimed to investigate the relationship between the severity of pneumonia on admission and residual pulmonary and extrapulmonary complications at three months post-hospitalization.

Methods

Using data from the Japan COVID-19 Task Force database, we conducted quantitative analysis of CT scans of 164 patients obtained at admission and three months later. The parameters included pneumonia volume, total lung volume, and area and density of the pectoralis muscle (PM), subcutaneous and epicardial adipose tissue, and vertebral bone density.

Results

Patients with extensive pneumonia on admission had high residual pneumonia volumes, reduced lung volumes, and decreased area and density of PM at three months. No significant differences were observed in the adipose tissue or bone parameters. The severity of pneumonia at admission was independently associated with PM atrophy.

Conclusions

CT-based quantification of pneumonia extent during the acute phase of COVID-19 may be useful in predicting long-term pulmonary sequelae and muscle wasting. This approach may allow the objective evaluation of Long COVID and facilitate the identification of potential therapeutic targets.

背景：广泛肺部受累的胸部计算机断层扫描（CT）表现与长期肺部和肺外冠状病毒病2019 （COVID-19）后遗症之间的关系尚缺乏研究。本研究旨在探讨入院时肺炎严重程度与住院后3个月残留肺及肺外并发症的关系。方法：利用日本COVID-19工作队数据库的数据，对入院时和3个月后获得的164例患者的CT扫描进行定量分析。参数包括肺炎体积、肺总体积、胸肌（PM）面积和密度、皮下和心外膜脂肪组织、椎体骨密度。结果：入院时广泛肺炎患者肺炎残留体积高，肺体积减小，3个月PM面积和密度降低。在脂肪组织和骨骼参数方面没有观察到显著差异。入院时肺炎严重程度与PM萎缩独立相关。结论：基于ct的COVID-19急性期肺炎程度量化可能有助于预测长期肺部后遗症和肌肉萎缩。该方法可实现对Long COVID的客观评价，并有助于确定潜在的治疗靶点。

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引用次数: 0

Diagnostic utility of standardized assessment of ciliary ultrastructure by transmission electron microscopy in primary ciliary dyskinesia: a Japanese perspective 透射电子显微镜纤毛超微结构标准化评估在原发性纤毛运动障碍诊断中的应用：日本视角。

IF 2 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2025-11-01 Epub Date: 2025-10-15 DOI: 10.1016/j.resinv.2025.10.006

Akiko Miyabayashi , Keiko Wakabayashi , Hiroyuki Yamada , Masashi Ito , Kozo Morimoto , Minako Hijikata , Naoto Keicho

Background

Primary ciliary dyskinesia (PCD) is a rare genetic disorder associated with structural or functional ciliary defects. Its diagnosis usually requires a combination of tests, including observation of the cilium structure by transmission electron microscopy (TEM). In Japan, when TEM was previously the primary method for diagnosing PCD, there were no standardized methods for evaluating TEM findings, and the correlations with PCD-causing genes remained unclear.

Methods

Here, we evaluated 101 patients with suspected PCD using a standardized assessment of ciliary ultrastructure by TEM, based on the international guidelines that classify defects into Class 1 and Class 2.

Results

Class 1 or 2 ciliary defects on TEM were identified in 27 patients (26.7 %); Class 1 defects (n = 19) correlated well with the genotypes in Japanese patients with PCD, most commonly caused by DNAH5 and CCDC39/40. TEM proved valuable as a complementary tool, when genetic testing failed to yield a definitive diagnosis, particularly in cases where two heterozygous variants of unknown phase were identified in a single PCD-causing gene. It was especially informative in PCD patients with situs inversus. However, in cases involving homozygous DRC1 variants, which are most frequently identified among Japanese patients with PCD, only subtle ultrastructural defects were observed, highlighting the limitations of TEM as a standalone diagnostic method. Our study also demonstrated the need for and effectiveness of standardizing the assessment of ciliary ultrastructure by TEM.

Conclusions

The results of this study provide a crucial foundation for establishing a better TEM-based diagnostic system in Japan.

背景：原发性纤毛运动障碍（PCD）是一种罕见的遗传性疾病，与纤毛结构或功能性缺陷有关。其诊断通常需要综合检查，包括通过透射电子显微镜（TEM）观察纤毛结构。在日本，当TEM以前是诊断PCD的主要方法时，没有标准化的方法来评估TEM的结果，并且与PCD致病基因的相关性仍然不清楚。方法：在此，我们对101例疑似PCD患者进行了评估，根据国际指南将缺陷分为1级和2级，使用TEM对纤毛超微结构进行了标准化评估。结果：1级或2级纤毛缺损27例（26.7%）；1类缺陷（n = 19）与日本PCD患者的基因型密切相关，最常见的是由DNAH5和CCDC39/40引起。当基因检测无法产生明确诊断时，TEM作为一种补充工具被证明是有价值的，特别是在单个pcd致病基因中鉴定出两个未知阶段的杂合变异体的情况下。在PCD逆位患者中尤其有用。然而，在涉及纯合子DRC1变异体的病例中（在日本PCD患者中最常见），仅观察到细微的超微结构缺陷，突出了TEM作为独立诊断方法的局限性。本研究也证实了用透射电镜对纤毛超微结构进行标准化评价的必要性和有效性。结论：本研究结果为在日本建立更好的tem诊断系统提供了重要的基础。

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引用次数: 0

Effects of Daikin air purifiers on asthma control and pulmonary function: A multicenter, single-arm, observational pilot study 大金空气净化器对哮喘控制和肺功能的影响：一项多中心、单臂、观察性先导研究

IF 2 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2025-11-01 Epub Date: 2025-09-02 DOI: 10.1016/j.resinv.2025.08.008

Satoshi Hamada , Susumu Sato , Shota Hori , Shiqi Yu , Hironobu Sunadome , Kimihiko Murase , Toyohiro Hirai

Background

While numerous studies, including systematic reviews, have investigated the effects of air purifiers on asthma control in Western countries, there is a paucity of research conducted in Japan. This multicenter, single-arm, observational pilot study examined the effect of air purifiers on asthma control in Japanese patients.

Methods

This study was conducted at the Kyoto University Hospital and the Ayabe City Hospital. The air purifiers (MCK704ABK: Daikin Industries, Ltd., Osaka, Japan) were equipped with electrostatic high-efficiency particulate air filters, capable of capturing 99.97 % of particles ≥0.3 μm. We examined changes in particulate matter (PM) 2.5 levels and forced expiratory volume in 1 s (FEV₁) before and after one month of air purifier use.

Results

Eighteen patients (median age: 64 [58, 70] years, 66.7 % female) participated in the study. The median PM2.5 concentration significantly decreased from 4.6 (3.4, 6.9) μg/m³ to 1.4 (0.7, 2.7) μg/m³ after using the air purifiers (p = 0.00042). FEV₁ significantly increased from 2.0 (1.7, 2.6) L to 2.1 (1.7, 2.6) L (p = 0.041). The median change in FEV₁ after air purifier use was 40 (−22.5, 112.5) mL. Patients with improved FEV₁ (ΔFEV1 >0 mL) had a significantly higher frequency of allergen sensitization compared to those without improvement (75.0 % vs. 16.7 %, p = 0.019).

Conclusion

The Daikin air purifiers demonstrated the potential to reduce PM levels and improve pulmonary function and asthma symptoms.

在西方国家，包括系统综述在内的大量研究调查了空气净化器对哮喘控制的影响，但在日本进行的研究却很少。这项多中心、单臂、观察性的初步研究考察了空气净化器对日本患者哮喘控制的影响。方法本研究在京都大学医院和绫边市医院进行。空气净化器（MCK704ABK: Daikin Industries, Ltd, Osaka, Japan）配备了静电高效微粒空气过滤器，可捕获99.97%≥0.3 μm的颗粒。我们检测了使用空气净化器前后一个月的颗粒物（PM） 2.5水平和1秒用力呼气量（FEV1）的变化。结果共纳入18例患者，中位年龄64[58,70]岁，女性占66.7%。PM2.5浓度中位数由使用空气净化器后的4.6 (3.4,6.9)μg/m3显著降低至1.4 (0.7,2.7)μg/m3 （p = 0.00042）。FEV1由2.0 (1.7,2.6)L显著增加至2.1 (1.7,2.6)L （p = 0.041）。使用空气净化器后FEV1的中位数变化为40 (- 22.5,112.5)mL。FEV1改善的患者（ΔFEV1 >0 mL）与未改善的患者相比，过敏原致敏的频率显著更高（76.0% vs. 16.7%, p = 0.019）。结论大金空气净化器具有降低PM水平、改善肺功能和哮喘症状的作用。

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引用次数: 0

Artificial intelligence for diagnosis in interstitial lung disease and digital ontology for unclassified interstitial lung disease 间质性肺疾病的人工智能诊断与未分类间质性肺疾病的数字本体

IF 2 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2025-11-01 Epub Date: 2025-09-24 DOI: 10.1016/j.resinv.2025.09.007

Tomohisa Baba , Tsubasa Goto , Yoshiro Kitamura , Tae Iwasawa , Koji Okudela , Tamiko Takemura , Akira Osawa , Takashi Ogura

Background

Multidisciplinary discussion (MDD) is the gold standard for diagnosis in interstitial lung disease (ILD). However, its inter-rater agreement is not satisfactory, and access to the MDD is limited due to a shortage of ILD experts. Therefore, artificial intelligence would be helpful for diagnosing ILD.

Methods

We retrospectively analyzed data from 630 patients with ILD, including clinical information, CT images, and pathological results. The ILD classification into four clinicopathologic entities (i.e., idiopathic pulmonary fibrosis, non-specific interstitial pneumonia, hypersensitivity pneumonitis, connective tissue disease) consists of two stages: first, pneumonia pattern classification of CT images using a convolutional neural network (CNN) model; second, multimodal (clinical, radiological, and pathological) classification using a support vector machine (SVM). The performance of the classification algorithm was evaluated using 5-fold cross-validation.

Results

The mean accuracies of the CNN model and SVM were 62.4 % and 85.4 %, respectively. For multimodal classification using SVM, the overall accuracy was very high, especially with sensitivities for idiopathic pulmonary fibrosis and hypersensitivity pneumonitis exceeding 90 %. When pneumonia patterns from CT images, pathological results, or clinical information were not used, the SVM accuracy was 84.3 %, 70.3 % and 79.8 %, respectively, suggesting that pathological results contributed most to MDD diagnosis. When an unclassifiable interstitial pneumonia was input, the SVM output tended to align with the most likely diagnosis by the expert MDD team.

Conclusions

The algorithm based on multimodal information can assist in diagnosing interstitial lung disease and is suitable for ontology diagnosis. (242 words)

多学科讨论（MDD）是诊断间质性肺疾病（ILD）的金标准。然而，其内部协议并不令人满意，并且由于缺乏ILD专家，对MDD的访问受到限制。因此，人工智能将有助于诊断ILD。方法回顾性分析630例ILD患者的临床资料、CT图像和病理结果。将ILD分为四种临床病理实体（特发性肺纤维化、非特异性间质性肺炎、超敏性肺炎、结缔组织病）分为两个阶段：首先，使用卷积神经网络（CNN）模型对CT图像进行肺炎模式分类；第二，使用支持向量机（SVM）进行多模式（临床、放射和病理）分类。使用5倍交叉验证对分类算法的性能进行评估。结果CNN模型和SVM的平均准确率分别为62.4%和85.4%。对于SVM多模态分类，总体准确率非常高，特别是对特发性肺纤维化和超敏性肺炎的敏感性超过90%。在不使用CT图像、病理结果和临床信息的情况下，SVM的准确率分别为84.3%、70.3%和79.8%，表明病理结果对MDD的诊断贡献最大。当输入无法分类的间质性肺炎时，支持向量机的输出倾向于与MDD专家团队最可能的诊断一致。结论基于多模态信息的诊断算法能够辅助诊断间质性肺疾病，适合本体论诊断。(242字)

{"title":"Artificial intelligence for diagnosis in interstitial lung disease and digital ontology for unclassified interstitial lung disease","authors":"Tomohisa Baba , Tsubasa Goto , Yoshiro Kitamura , Tae Iwasawa , Koji Okudela , Tamiko Takemura , Akira Osawa , Takashi Ogura","doi":"10.1016/j.resinv.2025.09.007","DOIUrl":"10.1016/j.resinv.2025.09.007","url":null,"abstract":"<div><h3>Background</h3><div>Multidisciplinary discussion (MDD) is the gold standard for diagnosis in interstitial lung disease (ILD). However, its inter-rater agreement is not satisfactory, and access to the MDD is limited due to a shortage of ILD experts. Therefore, artificial intelligence would be helpful for diagnosing ILD.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed data from 630 patients with ILD, including clinical information, CT images, and pathological results. The ILD classification into four clinicopathologic entities (i.e., idiopathic pulmonary fibrosis, non-specific interstitial pneumonia, hypersensitivity pneumonitis, connective tissue disease) consists of two stages: first, pneumonia pattern classification of CT images using a convolutional neural network (CNN) model; second, multimodal (clinical, radiological, and pathological) classification using a support vector machine (SVM). The performance of the classification algorithm was evaluated using 5-fold cross-validation.</div></div><div><h3>Results</h3><div>The mean accuracies of the CNN model and SVM were 62.4 % and 85.4 %, respectively. For multimodal classification using SVM, the overall accuracy was very high, especially with sensitivities for idiopathic pulmonary fibrosis and hypersensitivity pneumonitis exceeding 90 %. When pneumonia patterns from CT images, pathological results, or clinical information were not used, the SVM accuracy was 84.3 %, 70.3 % and 79.8 %, respectively, suggesting that pathological results contributed most to MDD diagnosis. When an unclassifiable interstitial pneumonia was input, the SVM output tended to align with the most likely diagnosis by the expert MDD team.</div></div><div><h3>Conclusions</h3><div>The algorithm based on multimodal information can assist in diagnosing interstitial lung disease and is suitable for ontology diagnosis. (242 words)</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 6","pages":"Pages 1179-1186"},"PeriodicalIF":2.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145118670","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}

引用次数: 0

Comment on “Reduced hemoglobin-corrected diffusing capacity in pulmonary arterial hypertension with preserved pulmonary function and morphology” 评论“血红蛋白校正的肺动脉高压弥散能力降低，肺功能和形态保留”。

IF 2 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2025-11-01 Epub Date: 2025-10-21 DOI: 10.1016/j.resinv.2025.09.013

Zhikun Zheng

引用次数: 0

Exacerbation and cardiopulmonary risk after prompt initiation of single-inhaler budesonide /glycopyrrolate/formoterol fumarate following COPD exacerbations: Insights from MITOS EROS (Japan) study 慢性阻塞性肺病（COPD）加重后立即开始使用单吸入器布地奈德/甘罗酸酯/富马酸福莫特罗后的加重和心肺风险：来自MITOS EROS（日本）研究的见解

IF 2 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2025-11-01 Epub Date: 2025-11-04 DOI: 10.1016/j.resinv.2025.10.015

Koichiro Takahashi , Yuri Yoshida , Naoyuki Makita , Kenichiro Nishida , Michihiro Yoshimura , Zhao Cheng , Aaro Salosensaari , Catarina Camarinha , Reiko Yamaura , Marta Cuntin , Michael Pollack

Background

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.

背景：先前的证据支持慢性阻塞性肺疾病（COPD）的单吸入器三联疗法的迅速启动，但缺乏日本特有的数据。本研究调查了布地奈德/甘罗酸酯/富马酸福莫特罗（BGF）启动与随后COPD加重或严重心肺事件的关系，这些患者在既往加重后启动BGF。方法：这是一项使用IQVIA综合索赔数据的COPD患者观察性队列研究。在BGF推出（2019年9月）至2023年3月期间，纳入年龄≥40岁的COPD加重（指数）后开始BGF的患者。根据指标加重后的治疗起始时间将患者分为BGF起始组：提示（≤30天）、延迟（31-180天）和非常延迟（181-365天）。多变量负二项回归模型评估了BGF启动策略与随后的恶化或严重心肺事件之间的关系。结果：纳入3402例符合条件的患者：840例及时启动，1143例延迟启动，1419例非常延迟启动。随访期间，急性COPD患者的年均急性加重发生率（95%可信区间[CI]）为：即刻者1.66(1.58-1.74)，迟发者2.36(2.30-2.43)，迟发者2.60（2.54-2.66）。与立即启动相比，延迟启动（调整后的比率比[RR]: 1.25; 95% CI: 1.13-1.38）和非常延迟启动（调整后的RR: 1.09; 95% CI: 0.99-1.20）的BGF显示COPD加重的风险增加。未观察到BGF起始策略与严重心肺事件之间的关联。结论：COPD加重后，及时启动BGF与随后加重的减少相关。患者应及时接受积极治疗以降低COPD发病率。

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引用次数: 0

Impact of Pseudomonas aeruginosa on the outcomes after lung transplantation: a single-center study 铜绿假单胞菌对肺移植后预后的影响：单中心研究。

IF 2 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2025-11-01 Epub Date: 2025-09-18 DOI: 10.1016/j.resinv.2025.09.002

Takashi Kanou, Hideki Nagata, Kenji Kimura, Eriko Fukui, Toru Kimura, Naoko Ose, Yasushi Shintani

Background

Lung transplantation (LTX) is an established treatment for end-stage pulmonary diseases. However, infections, particularly those caused by Pseudomonas aeruginosa, remain a major challenge, contributing to morbidity, mortality, and complications such as acute cellular rejection (ACR). This study aimed to investigate the relationship between the postoperative detection of P. aeruginosa in respiratory samples and post-LTX outcomes, including the incidence of ACR and overall survival.

Methods

We retrospectively analyzed 63 patients who underwent cadaveric LTX at our institution between 1999 and 2021. Patient characteristics, perioperative factors, and microbiological data were collected, and the association of P. aeruginosa detection within three months post-LTX with ACR and survival outcomes was analyzed. ACR was diagnosed by surveillance bronchoscopy and histological assessment.

Results

P. aeruginosa was detected in the respiratory samples of 21 patients (33 %) within three months post-LTX. Patients with the history of P. aeruginosa detection after LTX exhibited a significantly higher incidence of ACR (p = 0.02) and poorer 5-year overall survival rates (p = 0.03). A multivariate analysis confirmed that P. aeruginosa detection and older recipient age were independent risk factors for poor survival.

Conclusions

The detection of P. aeruginosa in respiratory samples was associated with an increased risk of ACR and poorer overall survival following LTX. These findings underscore the importance of vigilant monitoring for P. aeruginosa detection and development of targeted antimicrobial strategies to improve post-transplant outcomes. Further studies are warranted to explore the mechanisms linking P. aeruginosa to adverse outcomes and evaluate the efficacy of novel therapeutic interventions.

背景：肺移植（LTX）是终末期肺部疾病的一种成熟治疗方法。然而，感染，特别是由铜绿假单胞菌引起的感染，仍然是一个主要的挑战，导致发病率、死亡率和急性细胞排斥反应（ACR）等并发症。本研究旨在探讨呼吸样本中P. aeruginosa的术后检测与ltx术后预后的关系，包括ACR的发生率和总生存率。方法：我们回顾性分析了1999年至2021年间在我院接受尸体LTX治疗的63例患者。收集患者特征、围手术期因素和微生物学数据，分析ltx术后3个月内铜绿假单胞菌检测与ACR和生存结果的关系。经支气管镜监测和组织学检查诊断为ACR。结果：21例患者（33%）在ltx术后3个月内的呼吸道样本中检出铜绿假单胞菌。LTX术后有铜绿假单胞菌检测史的患者ACR发生率显著增高（p = 0.02）， 5年总生存率较差（p = 0.03）。多因素分析证实铜绿假单胞菌检测和受体年龄较大是生存率差的独立危险因素。结论：呼吸道样本中铜绿假单胞菌的检测与LTX后ACR风险增加和总生存率降低相关。这些发现强调了警惕监测铜绿假单胞菌检测和开发靶向抗菌策略以改善移植后预后的重要性。进一步的研究需要探索铜绿假单胞菌与不良后果的联系机制，并评估新的治疗干预措施的疗效。

{"title":"Impact of Pseudomonas aeruginosa on the outcomes after lung transplantation: a single-center study","authors":"Takashi Kanou, Hideki Nagata, Kenji Kimura, Eriko Fukui, Toru Kimura, Naoko Ose, Yasushi Shintani","doi":"10.1016/j.resinv.2025.09.002","DOIUrl":"10.1016/j.resinv.2025.09.002","url":null,"abstract":"<div><h3>Background</h3><div>Lung transplantation (LTX) is an established treatment for end-stage pulmonary diseases. However, infections, particularly those caused by <em>Pseudomonas aeruginosa,</em> remain a major challenge, contributing to morbidity, mortality, and complications such as acute cellular rejection (ACR). This study aimed to investigate the relationship between the postoperative detection of <em>P. aeruginosa</em> in respiratory samples and post-LTX outcomes, including the incidence of ACR and overall survival.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 63 patients who underwent cadaveric LTX at our institution between 1999 and 2021. Patient characteristics, perioperative factors, and microbiological data were collected, and the association of <em>P. aeruginosa</em> detection within three months post-LTX with ACR and survival outcomes was analyzed. ACR was diagnosed by surveillance bronchoscopy and histological assessment.</div></div><div><h3>Results</h3><div><em>P. aeruginosa</em> was detected in the respiratory samples of 21 patients (33 %) within three months post-LTX. Patients with the history of <em>P. aeruginosa</em> detection after LTX exhibited a significantly higher incidence of ACR (p = 0.02) and poorer 5-year overall survival rates (p = 0.03). A multivariate analysis confirmed that <em>P. aeruginosa</em> detection and older recipient age were independent risk factors for poor survival.</div></div><div><h3>Conclusions</h3><div>The detection of <em>P. aeruginosa</em> in respiratory samples was associated with an increased risk of ACR and poorer overall survival following LTX. These findings underscore the importance of vigilant monitoring for <em>P. aeruginosa</em> detection and development of targeted antimicrobial strategies to improve post-transplant outcomes. Further studies are warranted to explore the mechanisms linking <em>P. aeruginosa</em> to adverse outcomes and evaluate the efficacy of novel therapeutic interventions.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 6","pages":"Pages 1127-1131"},"PeriodicalIF":2.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092392","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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Respiratory investigation

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