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.
{"title":"Extent of pulmonary involvement on admission predicts long-term pulmonary and muscular sequelae of COVID-19: A longitudinal computed tomography study","authors":"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","doi":"10.1016/j.resinv.2025.09.014","DOIUrl":"10.1016/j.resinv.2025.09.014","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 6","pages":"Pages 1215-1220"},"PeriodicalIF":2.0,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207264","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}
During the winter and spring of 2024–2025, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) XEC subvariant became the main cause of the epidemic, and at the same time, major influenza epidemics were also observed. To clarify the differences between COVID-19 and influenza, we conducted a comparative study of patients who required hospitalization during the same period.
Methods
We compared 193 patients with COVID-19 Omicron XEC subvariant and 98 patients with influenza H1N1 pdm09 who required hospitalization.
Results
The following characteristics were significantly more common in the COVID-19 group than in the influenza group: 1) males, 2) patients with chronic kidney disease, malignant tumors, autoimmune diseases, and patients using immunosuppressants, 3) patients with multiple underlying diseases, 4) healthcare-associated pneumonia, 5) pure viral pneumonia, 6) aspiration pneumonia, 7) cases in which antivirals had not been used since the diagnosis of infection, 8) patients who required invasive mechanical ventilation management or intensive care unit admission, and 9) deaths. On the other hand, the following characteristics were significantly more frequently observed in the influenza group than in the COVID-19 group: 1) patients without underlying diseases, 2) patients who had been vaccinated within the past year, 3) community-acquired pneumonia, and 4) mixed bacterial pneumonia.
Conclusions
There were many differences between the COVID-19 group and the influenza group that required hospitalization. The rates of severe illness and mortality in the elderly remain high in the COVID-19 group.
{"title":"Differences between influenza and COVID-19 patients who required hospitalization: A study of the 2024–2025 season","authors":"Naoyuki Miyashita , Yasushi Nakamori , Makoto Ogata , Naoki Fukuda , Akihisa Yamura , Tomoki Ito","doi":"10.1016/j.resinv.2025.09.012","DOIUrl":"10.1016/j.resinv.2025.09.012","url":null,"abstract":"<div><h3>Background</h3><div>During the winter and spring of 2024–2025, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) XEC subvariant became the main cause of the epidemic, and at the same time, major influenza epidemics were also observed. To clarify the differences between COVID-19 and influenza, we conducted a comparative study of patients who required hospitalization during the same period.</div></div><div><h3>Methods</h3><div>We compared 193 patients with COVID-19 Omicron XEC subvariant and 98 patients with influenza H1N1 pdm09 who required hospitalization.</div></div><div><h3>Results</h3><div>The following characteristics were significantly more common in the COVID-19 group than in the influenza group: 1) males, 2) patients with chronic kidney disease, malignant tumors, autoimmune diseases, and patients using immunosuppressants, 3) patients with multiple underlying diseases, 4) healthcare-associated pneumonia, 5) pure viral pneumonia, 6) aspiration pneumonia, 7) cases in which antivirals had not been used since the diagnosis of infection, 8) patients who required invasive mechanical ventilation management or intensive care unit admission, and 9) deaths. On the other hand, the following characteristics were significantly more frequently observed in the influenza group than in the COVID-19 group: 1) patients without underlying diseases, 2) patients who had been vaccinated within the past year, 3) community-acquired pneumonia, and 4) mixed bacterial pneumonia.</div></div><div><h3>Conclusions</h3><div>There were many differences between the COVID-19 group and the influenza group that required hospitalization. The rates of severe illness and mortality in the elderly remain high in the COVID-19 group.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 6","pages":"Pages 1210-1214"},"PeriodicalIF":2.0,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207297","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}
Idiopathic pulmonary fibrosis (IPF), a chronic and progressive interstitial lung disease, frequently leads to chronic respiratory failure, necessitating long-term oxygen therapy (LTOT). Although the prognosis of patients with IPF receiving LTOT is generally poor, limited data are available on clinical factors associated with post-LTOT survival. This study aimed to investigate whether baseline nutritional status at the time of initiation of LTOT is associated with survival outcomes in patients with IPF.
Methods
We retrospectively reviewed 55 patients with IPF and chronic respiratory failure who initiated LTOT. Patients were stratified into two groups based on 1-year survival following LTOT initiation: long-term survivors (≥1 year) and short-term survivors (<1 year). Nutritional status at baseline was assessed using the Geriatric Nutritional Risk Index (GNRI), Prognostic Nutritional Index (PNI), body mass index (BMI), and fat-free mass index (FFMI).
Results
Significant differences were identified between the two groups in BMI, GNRI scores, and the proportion of patients receiving antifibrotic agents. In multivariable analyses adjusted for age, sex and the use of antifibrotic agents, both a GNRI score <92 and a low FFMI were independently associated with increased mortality risk (p = 0.033 and p = 0.007, respectively). Kaplan–Meier analysis demonstrated significantly poorer 1-year survival in patients with GNRI <92 and low FFMI (p = 0.037 and p = 0.006, respectively).
Conclusion
GNRI and FFMI independently predicted 1-year survival in IPF patients on LTOT. These findings underscore the importance of nutritional evaluation at LTOT initiation and suggest that low GNRI and FFMI warrant closer monitoring and targeted nutritional interventions.
{"title":"Nutritional assessments as predictors of prognosis after long-term oxygen therapy in patients with idiopathic pulmonary fibrosis","authors":"Mayuko Ishiwari, Yuta Kono, Yuki Togashi, Kenichi Kobayashi, Ryota Kikuchi, Mariko Kogami, Shinji Abe","doi":"10.1016/j.resinv.2025.09.019","DOIUrl":"10.1016/j.resinv.2025.09.019","url":null,"abstract":"<div><h3>Background</h3><div>Idiopathic pulmonary fibrosis (IPF), a chronic and progressive interstitial lung disease, frequently leads to chronic respiratory failure, necessitating long-term oxygen therapy (LTOT). Although the prognosis of patients with IPF receiving LTOT is generally poor, limited data are available on clinical factors associated with post-LTOT survival. This study aimed to investigate whether baseline nutritional status at the time of initiation of LTOT is associated with survival outcomes in patients with IPF.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed 55 patients with IPF and chronic respiratory failure who initiated LTOT. Patients were stratified into two groups based on 1-year survival following LTOT initiation: long-term survivors (≥1 year) and short-term survivors (<1 year). Nutritional status at baseline was assessed using the Geriatric Nutritional Risk Index (GNRI), Prognostic Nutritional Index (PNI), body mass index (BMI), and fat-free mass index (FFMI).</div></div><div><h3>Results</h3><div>Significant differences were identified between the two groups in BMI, GNRI scores, and the proportion of patients receiving antifibrotic agents. In multivariable analyses adjusted for age, sex and the use of antifibrotic agents, both a GNRI score <92 and a low FFMI were independently associated with increased mortality risk (p = 0.033 and p = 0.007, respectively). Kaplan–Meier analysis demonstrated significantly poorer 1-year survival in patients with GNRI <92 and low FFMI (p = 0.037 and p = 0.006, respectively).</div></div><div><h3>Conclusion</h3><div>GNRI and FFMI independently predicted 1-year survival in IPF patients on LTOT. These findings underscore the importance of nutritional evaluation at LTOT initiation and suggest that low GNRI and FFMI warrant closer monitoring and targeted nutritional interventions.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 6","pages":"Pages 1204-1209"},"PeriodicalIF":2.0,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145157838","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 : 2025-09-25DOI: 10.1016/j.resinv.2025.09.020
Kazuhisa Asai
Regular physical activity (PA) modulates key pathophysiological mechanisms underlying the onset, progression, and symptoms of major respiratory diseases. Notably, low daily PA and high sedentary time independently predict faster lung function decline, poorer quality of life, and premature mortality in asthma, chronic obstructive pulmonary disease (COPD), interstitial lung disease (ILDs), and post-coronavirus disease lung sequelae. Conversely, structured exercise training—and the increasingly popular, lifestyle-integrated “move-more–sit-less” programs—improve dyspnea, exercise capacity, airway and systemic inflammation, and healthcare utilization. Large cohort analyses corroborate a clear dose-response relationship: attaining ≥7500 steps/day or ≥150 min/week of moderate-to-vigorous activity yields the greatest clinical benefit, even in individuals with impaired pulmonary function. Mechanistic studies also revealed that exercise dampens type-2 airway inflammation in asthma, enhances the skeletal muscle oxidative phenotype in COPD, and counteracts ILD-related deconditioning. Recent randomized trials have shown that pulmonary rehabilitation can improve 5-year survival in fibrotic ILD, while telerehabilitation and gamified smartphone coaching can close access gaps without compromising efficacy. Additionally, major international guidelines such as the Global Initiative for Asthma 2024 and Global Initiative for Chronic Obstructive Lung Disease 2025 now explicitly recognize PA as a “treatable trait.” Nevertheless, PA uptake in routine care remains limited by behavioral, environmental, and policy barriers. Future work must refine personalized PA prescriptions, integrate wearable-derived metrics into decision-support algorithms, and test the synergistic effects with emerging biologics and anti-fibrotic agents. This review synthesizes contemporary evidence, highlights unanswered questions, and offers pragmatic recommendations for clinicians aiming to embed PA promotion in comprehensive respiratory care pathways.
{"title":"Impact of physical activity on respiratory disease: Current status and therapeutic implications","authors":"Kazuhisa Asai","doi":"10.1016/j.resinv.2025.09.020","DOIUrl":"10.1016/j.resinv.2025.09.020","url":null,"abstract":"<div><div>Regular physical activity (PA) modulates key pathophysiological mechanisms underlying the onset, progression, and symptoms of major respiratory diseases. Notably, low daily PA and high sedentary time independently predict faster lung function decline, poorer quality of life, and premature mortality in asthma, chronic obstructive pulmonary disease (COPD), interstitial lung disease (ILDs), and post-coronavirus disease lung sequelae. Conversely, structured exercise training—and the increasingly popular, lifestyle-integrated “move-more–sit-less” programs—improve dyspnea, exercise capacity, airway and systemic inflammation, and healthcare utilization. Large cohort analyses corroborate a clear dose-response relationship: attaining ≥7500 steps/day or ≥150 min/week of moderate-to-vigorous activity yields the greatest clinical benefit, even in individuals with impaired pulmonary function. Mechanistic studies also revealed that exercise dampens type-2 airway inflammation in asthma, enhances the skeletal muscle oxidative phenotype in COPD, and counteracts ILD-related deconditioning. Recent randomized trials have shown that pulmonary rehabilitation can improve 5-year survival in fibrotic ILD, while telerehabilitation and gamified smartphone coaching can close access gaps without compromising efficacy. Additionally, major international guidelines such as the Global Initiative for Asthma 2024 and Global Initiative for Chronic Obstructive Lung Disease 2025 now explicitly recognize PA as a “treatable trait.” Nevertheless, PA uptake in routine care remains limited by behavioral, environmental, and policy barriers. Future work must refine personalized PA prescriptions, integrate wearable-derived metrics into decision-support algorithms, and test the synergistic effects with emerging biologics and anti-fibrotic agents. This review synthesizes contemporary evidence, highlights unanswered questions, and offers pragmatic recommendations for clinicians aiming to embed PA promotion in comprehensive respiratory care pathways.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 6","pages":"Pages 1187-1193"},"PeriodicalIF":2.0,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145157839","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}
Immune checkpoint inhibitors are important in the treatment of advanced non-small cell lung cancer, with pneumonitis being a prevalent complication. Pneumonitis is a recognized adverse event of pleurodesis in lung cancer patients with pleural effusion. However, the association between pleurodesis and pneumonitis in patients with immunotherapy remains unclear.
Methods
This retrospective cohort study used nationwide administrative claims data in Japan. Patients aged ≥18 years who underwent immunotherapy for newly diagnosed non-small cell lung cancer between December 2015 and January 2023 were included in the study. Patients who used talc or OK-432 within 60 days prior to immune checkpoint inhibitors treatment were defined as having undergone pleurodesis. The incidence rates of pneumonitis in patients with and without pleurodesis were compared using cumulative incidence functions against time, and by conducting a Fine–Gray analysis to account for death as a competing risk factor for pneumonitis incidence.
Results
Among the 16,538 patients with non-small cell lung cancer who received immune checkpoint inhibitors, 509 underwent pleurodesis. The incidence of pneumonitis was higher in patients who underwent pleurodesis than in those who did not. The sub-distribution hazard ratio quantified by Fine–Gray analysis was 1.168 (95 % confidence intercal, 1.062–1.286).
Conclusions
Pleurodesis before immunotherapy in patients with advanced non-small cell lung cancer was associated with an increased incidence of pneumonitis.
{"title":"Association between pleurodesis before immunotherapy and pneumonitis in non-small cell lung cancer","authors":"Megumi Mizutani , Yasutaka Ihara , Kenji Sawa , Akira Sugimoto , Hiroaki Nagamine , Yoshiya Matsumoto , Yoko Tani , Takako Oka , Hiroyasu Kaneda , Tsubasa Bito , Tomoya Kawaguchi , Ayumi Shintani","doi":"10.1016/j.resinv.2025.09.016","DOIUrl":"10.1016/j.resinv.2025.09.016","url":null,"abstract":"<div><h3>Background</h3><div>Immune checkpoint inhibitors are important in the treatment of advanced non-small cell lung cancer, with pneumonitis being a prevalent complication. Pneumonitis is a recognized adverse event of pleurodesis in lung cancer patients with pleural effusion. However, the association between pleurodesis and pneumonitis in patients with immunotherapy remains unclear.</div></div><div><h3>Methods</h3><div>This retrospective cohort study used nationwide administrative claims data in Japan. Patients aged ≥18 years who underwent immunotherapy for newly diagnosed non-small cell lung cancer between December 2015 and January 2023 were included in the study. Patients who used talc or OK-432 within 60 days prior to immune checkpoint inhibitors treatment were defined as having undergone pleurodesis. The incidence rates of pneumonitis in patients with and without pleurodesis were compared using cumulative incidence functions against time, and by conducting a Fine–Gray analysis to account for death as a competing risk factor for pneumonitis incidence.</div></div><div><h3>Results</h3><div>Among the 16,538 patients with non-small cell lung cancer who received immune checkpoint inhibitors, 509 underwent pleurodesis. The incidence of pneumonitis was higher in patients who underwent pleurodesis than in those who did not. The sub-distribution hazard ratio quantified by Fine–Gray analysis was 1.168 (95 % confidence intercal, 1.062–1.286).</div></div><div><h3>Conclusions</h3><div>Pleurodesis before immunotherapy in patients with advanced non-small cell lung cancer was associated with an increased incidence of pneumonitis.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 6","pages":"Pages 1194-1200"},"PeriodicalIF":2.0,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145157836","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}
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)
{"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":"2025-09-24","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}
Serum Krebs von den Lungen-6 (KL-6) is a biomarker that reflects the pathophysiology and activity of interstitial lung disease (ILDs); however, its fluctuation patterns remain understudied.
Methods
This retrospective cohort study included 910 patients with ILD with at least one year of regular KL-6 measurements. Cluster analysis was performed to identify the distinct annual KL-6 fluctuation patterns. Patient demographics, disease distribution, and prognostic outcomes were compared across clusters.
Results
Four distinct clusters of KL-6 patterns were identified: minimal change (cluster 1, n = 722), decrease in summer (cluster 2, n = 74), increase in autumn (cluster 3, n = 21), and increase in winter (cluster 4, n = 93). Mean KL-6 value of the first year (p < 0.01), percent predicted forced vital capacity (p = 0.01), and diagnoses of idiopathic pulmonary fibrosis (p < 0.01), nonfibrotic hypersensitivity pneumonitis (p < 0.01), and fibrotic hypersensitivity pneumonitis (p = 0.04) were significantly associated with specific KL-6 fluctuation patterns. When seasonal trends were defined as belonging to the same cluster for two consecutive years, nonfibrotic hypersensitivity pneumonitis showed significant association with seasonal trends (p < 0.01). Multivariate analysis, adjusted for age and etiology, showed a trend for cluster 4 to have a poorer prognosis compared to cluster 1 (hazard ratio: 1.62, 95 % confidence interval: 0.93–2.80, p = 0.09).
Conclusion
KL-6 fluctuations were categorized into four seasonal patterns, which may provide insights for diagnosing ILD etiology and predicting the prognosis of patients with ILD.
{"title":"Cluster analysis of seasonal KL-6 variations in interstitial lung diseases","authors":"Yuki Iijima , Tsukasa Okamoto , Shiro Sonoda , Tsuyoshi Shirai , Masahiro Ishizuka , Haruhiko Furusawa , Tomoya Tateishi , Tatsuhiko Anzai , Kunihiko Takahashi , Yasunari Miyazaki","doi":"10.1016/j.resinv.2025.09.018","DOIUrl":"10.1016/j.resinv.2025.09.018","url":null,"abstract":"<div><h3>Background</h3><div>Serum Krebs von den Lungen-6 (KL-6) is a biomarker that reflects the pathophysiology and activity of interstitial lung disease (ILDs); however, its fluctuation patterns remain understudied.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included 910 patients with ILD with at least one year of regular KL-6 measurements. Cluster analysis was performed to identify the distinct annual KL-6 fluctuation patterns. Patient demographics, disease distribution, and prognostic outcomes were compared across clusters.</div></div><div><h3>Results</h3><div>Four distinct clusters of KL-6 patterns were identified: minimal change (cluster 1, n = 722), decrease in summer (cluster 2, n = 74), increase in autumn (cluster 3, n = 21), and increase in winter (cluster 4, n = 93). Mean KL-6 value of the first year (p < 0.01), percent predicted forced vital capacity (p = 0.01), and diagnoses of idiopathic pulmonary fibrosis (p < 0.01), nonfibrotic hypersensitivity pneumonitis (p < 0.01), and fibrotic hypersensitivity pneumonitis (p = 0.04) were significantly associated with specific KL-6 fluctuation patterns. When seasonal trends were defined as belonging to the same cluster for two consecutive years, nonfibrotic hypersensitivity pneumonitis showed significant association with seasonal trends (p < 0.01). Multivariate analysis, adjusted for age and etiology, showed a trend for cluster 4 to have a poorer prognosis compared to cluster 1 (hazard ratio: 1.62, 95 % confidence interval: 0.93–2.80, p = 0.09).</div></div><div><h3>Conclusion</h3><div>KL-6 fluctuations were categorized into four seasonal patterns, which may provide insights for diagnosing ILD etiology and predicting the prognosis of patients with ILD.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 6","pages":"Pages 1146-1152"},"PeriodicalIF":2.0,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145118667","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 optimal management of pneumothorax remains controversial, with evolving evidence challenging the conventional approach of routine chest drainage.
Methods
We analyzed data of 1773 patients (956 with primary spontaneous pneumothorax [PSP], 817 with secondary spontaneous pneumothorax [SSP]) from a nationwide Japanese database. Multivariate and propensity score matching analyses identified factors associated with drainage requirement and compared outcomes between drainage and non-drainage groups.
Results
Pneumothorax grade was the most significant determinant of chest drainage requirement in both PSP (moderate: odds ratio [OR] 12.5, severe: OR 22.6 vs. mild, p < 0.001) and SSP patients (moderate: OR 16.1, severe: OR 26.9 vs. mild, p < 0.001), with chronic obstructive pulmonary disease being an additional factor in SSP (OR 3.04). PSP patients without drainage had shorter hospital stays (median: 6.0 vs. 8.0 days, p < 0.001) and more frequently underwent surgery. SSP patients without drainage had lower ICU admission rates and shorter hospitalization (median: 11.0 vs. 14.0 days, p < 0.001). The benefits of non-drainage were observed across all pneumothorax grades in PSP, while in severe SSP, drainage was associated with better outcomes. After matching for pneumothorax grade, non-drainage PSP patients had shorter stays in both non-surgical (median: 2 vs. 6 days, p < 0.001) and surgical subgroups (median: 5 vs. 8 days, p < 0.001). Mortality rates were comparable between groups.
Conclusions
While pneumothorax grade remains the key determinant for chest drainage, carefully selected patients may be successfully managed without drainage, with shorter hospital stays without compromising outcomes. Refined criteria for non-drainage management could improve resource utilization and patient experience.
{"title":"Rethinking routine chest drainage in pneumothorax management: Outcomes from a nationwide Japanese database","authors":"Yoshikane Yamauchi , Yukinori Sakao , Noriyoshi Sawabata , Toshiro Obuchi , Kenji Tsuboshima , Noriyuki Matsutani , Shouichi Okamoto , Hitoshi Igai , Akihiro Hayashi","doi":"10.1016/j.resinv.2025.09.015","DOIUrl":"10.1016/j.resinv.2025.09.015","url":null,"abstract":"<div><h3>Background</h3><div>The optimal management of pneumothorax remains controversial, with evolving evidence challenging the conventional approach of routine chest drainage.</div></div><div><h3>Methods</h3><div>We analyzed data of 1773 patients (956 with primary spontaneous pneumothorax [PSP], 817 with secondary spontaneous pneumothorax [SSP]) from a nationwide Japanese database. Multivariate and propensity score matching analyses identified factors associated with drainage requirement and compared outcomes between drainage and non-drainage groups.</div></div><div><h3>Results</h3><div>Pneumothorax grade was the most significant determinant of chest drainage requirement in both PSP (moderate: odds ratio [OR] 12.5, severe: OR 22.6 vs. mild, p < 0.001) and SSP patients (moderate: OR 16.1, severe: OR 26.9 vs. mild, p < 0.001), with chronic obstructive pulmonary disease being an additional factor in SSP (OR 3.04). PSP patients without drainage had shorter hospital stays (median: 6.0 vs. 8.0 days, p < 0.001) and more frequently underwent surgery. SSP patients without drainage had lower ICU admission rates and shorter hospitalization (median: 11.0 vs. 14.0 days, p < 0.001). The benefits of non-drainage were observed across all pneumothorax grades in PSP, while in severe SSP, drainage was associated with better outcomes. After matching for pneumothorax grade, non-drainage PSP patients had shorter stays in both non-surgical (median: 2 vs. 6 days, p < 0.001) and surgical subgroups (median: 5 vs. 8 days, p < 0.001). Mortality rates were comparable between groups.</div></div><div><h3>Conclusions</h3><div>While pneumothorax grade remains the key determinant for chest drainage, carefully selected patients may be successfully managed without drainage, with shorter hospital stays without compromising outcomes. Refined criteria for non-drainage management could improve resource utilization and patient experience.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 6","pages":"Pages 1153-1163"},"PeriodicalIF":2.0,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145118669","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 : 2025-09-23DOI: 10.1016/j.resinv.2025.09.011
Hiroyuki Ura , Noriko Matsuoka , Hiroyuki Furuya
Background
Inhalation therapy is crucial in treating obstructive lung diseases, including asthma and chronic obstructive pulmonary disease (COPD). Improper inhalation techniques are associated with poor asthma and COPD management, increased exacerbation risk, and overutilization of healthcare resource. However, comprehensive analyses of prescription trends across diverse inhalation devices are limited. Therefore, we aimed to investigate inhalation device prescription trends in Japan from 2016 to 2022 using data from the National Database of Health Insurance Claims and Specific Health Checkups Open Data Japan.
Methods
Temporal changes in prescription patterns were analyzed across different device types, therapeutic categories, and patient demographics.
Results
Our findings revealed major shifts toward combination therapies, particularly triple combination therapy (inhaled corticosteroid [ICS]/long-acting beta2-agonist [LABA]/long-acting muscarinic antagonist [LAMA]), in addition to the preference for newer devices, such as the Ellipta dry powder and Aerosphere pressurized metered-dose inhalers. Age- and sex-specific patterns emerged, with distinct preferences observed across demographic groups. The pediatric population primarily received ICS mono- and ICS/LABA combination therapies, while older adults showed increased use of the triple combination therapy. Sex disparities were particularly pronounced in the older population, with older male patients requiring LABA/LAMA and triple combination therapies more often than older female patients. An economic analysis revealed that while dry powder inhalers had the highest overall cost, the introduction of generic formulations markedly reduced expenditures.
Conclusions
The shift toward combination therapies and newer inhaler devices in Japan highlights the critical need for personalized treatment strategies that balance patient characteristics with economic factors.
{"title":"Evaluation of inhalation device prescribing trends: A retrospective database study in Japan","authors":"Hiroyuki Ura , Noriko Matsuoka , Hiroyuki Furuya","doi":"10.1016/j.resinv.2025.09.011","DOIUrl":"10.1016/j.resinv.2025.09.011","url":null,"abstract":"<div><h3>Background</h3><div>Inhalation therapy is crucial in treating obstructive lung diseases, including asthma and chronic obstructive pulmonary disease (COPD). Improper inhalation techniques are associated with poor asthma and COPD management, increased exacerbation risk, and overutilization of healthcare resource. However, comprehensive analyses of prescription trends across diverse inhalation devices are limited. Therefore, we aimed to investigate inhalation device prescription trends in Japan from 2016 to 2022 using data from the National Database of Health Insurance Claims and Specific Health Checkups Open Data Japan.</div></div><div><h3>Methods</h3><div>Temporal changes in prescription patterns were analyzed across different device types, therapeutic categories, and patient demographics.</div></div><div><h3>Results</h3><div>Our findings revealed major shifts toward combination therapies, particularly triple combination therapy (inhaled corticosteroid [ICS]/long-acting beta2-agonist [LABA]/long-acting muscarinic antagonist [LAMA]), in addition to the preference for newer devices, such as the Ellipta dry powder and Aerosphere pressurized metered-dose inhalers. Age- and sex-specific patterns emerged, with distinct preferences observed across demographic groups. The pediatric population primarily received ICS mono- and ICS/LABA combination therapies, while older adults showed increased use of the triple combination therapy. Sex disparities were particularly pronounced in the older population, with older male patients requiring LABA/LAMA and triple combination therapies more often than older female patients. An economic analysis revealed that while dry powder inhalers had the highest overall cost, the introduction of generic formulations markedly reduced expenditures.</div></div><div><h3>Conclusions</h3><div>The shift toward combination therapies and newer inhaler devices in Japan highlights the critical need for personalized treatment strategies that balance patient characteristics with economic factors.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 6","pages":"Pages 1164-1173"},"PeriodicalIF":2.0,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145118668","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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