Respiratory investigation最新文献_第9页

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。

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引用次数: 0

Fractional exhaled nitric oxide as a biomarker for the evaluating asthmatic patients with allergic bronchopulmonary mycosis 呼气一氧化氮分数作为评价过敏性支气管肺真菌病哮喘患者的生物标志物。

IF 2 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2025-11-01 Epub Date: 2025-11-11 DOI: 10.1016/j.resinv.2025.11.002

Kazuki Matsuda , Keiji Oishi , Junki Suizu , Ayumi Fukatsu-Chikumoto , Keita Murakawa , Kazuki Hamada , Shuichiro Ohata , Ryo Suetake , Toshiaki Utsunomiya , Yoriyuki Murata , Yoshikazu Yamaji , Taiga Kobayashi , Maki Asami-Noyama , Nobutaka Edakuni , Tsunahiko Hirano , Tomoyuki Kakugawa , Kazuto Matsunaga

Background

Fractional exhaled nitric oxide (FeNO) is a useful Type 2 biomarker for the diagnosis and management of asthma. Although allergic bronchopulmonary mycosis (ABPM) is an allergic disease characterized by Type 2 inflammation, the clinical significance of FeNO in asthma patients with ABPM has not been well investigated.

Methods

The clinical characteristics of patients with and without comorbid ABPM were compared retrospectively using a cohort of patients with asthma. The cut-off values of FeNO for predicting asthma patients with ABPM were examined. We evaluated the associations between FeNO and blood eosinophils, pulmonary function, and mucus plugs.

Results

Of the 177 patients with asthma, 22 had concomitant ABPM. Compared to the group of ashma patient without ABPM, FeNO was significantly higher in the ABPM complicated group. Two FeNO cut-off values were identified for predicting asthma patients with ABPM receiving ICS treatment: 95 ppb was associated with a high certainty for inclusion (sensitivity = 0.27, specificity = 0.97), and 25 ppb with a high certainty for exclusion (sensitivity = 0.82, specificity = 0.39). In asthma patients with ABPM, FeNO correlated with blood eosinophils (r = 0.46, p = 0.03) and mucus plug score (r = 0.508, p = 0.019), but not with percent forced expiratory volume in 1 s (%FEV₁) (r = −0.33, p = 0.18).

Conclusions

Elevated FeNO levels may aid in the detection of ABPM complications in patients with asthma treated with ICS. FeNO levels may be associated with mucus plugging in asthma patients with ABPM.

背景：呼气一氧化氮分数（FeNO）是诊断和治疗哮喘的一种有用的2型生物标志物。虽然变应性支气管肺真菌病（ABPM）是一种以2型炎症为特征的变应性疾病，但FeNO在哮喘ABPM患者中的临床意义尚未得到很好的研究。方法：回顾性比较合并和不合并ABPM的哮喘患者的临床特征。检测FeNO预测哮喘合并ABPM的临界值。我们评估了FeNO与血嗜酸性粒细胞、肺功能和粘液塞之间的关系。结果：177例哮喘患者中，22例合并ABPM。与无ABPM的ashma患者相比，ABPM合并组的FeNO明显高于无ABPM的ashma患者。确定了两个FeNO临界值用于预测ABPM哮喘患者接受ICS治疗：95 ppb与高确定性纳入相关（敏感性= 0.27，特异性= 0.97），25 ppb与高确定性排除相关（敏感性= 0.82，特异性= 0.39）。在哮喘合并ABPM患者中，FeNO与血嗜酸性粒细胞（r = 0.46, p = 0.03）和粘液堵塞评分（r = 0.508, p = 0.019）相关，但与1 s内用力呼气量百分比（%FEV1）无关（r = -0.33, p = 0.18）。结论：FeNO水平升高可能有助于检测ICS治疗哮喘患者的ABPM并发症。FeNO水平可能与ABPM哮喘患者的粘液堵塞有关。

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引用次数: 0

Cluster analysis of seasonal KL-6 variations in interstitial lung diseases 间质性肺疾病患者KL-6季节性变异的聚类分析

IF 2 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2025-11-01 Epub Date: 2025-09-23 DOI: 10.1016/j.resinv.2025.09.018

Yuki Iijima , Tsukasa Okamoto , Shiro Sonoda , Tsuyoshi Shirai , Masahiro Ishizuka , Haruhiko Furusawa , Tomoya Tateishi , Tatsuhiko Anzai , Kunihiko Takahashi , Yasunari Miyazaki

Background

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.

血清Krebs von den Lungen-6 （KL-6）是反映间质性肺疾病（ILDs）病理生理和活动的生物标志物；然而，其波动模式仍未得到充分研究。方法本回顾性队列研究纳入910例ILD患者，患者至少有一年的定期KL-6测量。聚类分析表明，KL-6的年波动特征明显。患者人口统计、疾病分布和预后结果进行跨组比较。结果KL-6的变化最小（第1类，n = 722），夏季减少（第2类，n = 74），秋季增加（第3类，n = 21），冬季增加（第4类，n = 93）。第一年的平均KL-6值（p < 0.01）、预测强迫肺活量的百分比（p = 0.01）、特发性肺纤维化（p < 0.01）、非纤维化性过敏性肺炎（p < 0.01）和纤维化性过敏性肺炎（p = 0.04）的诊断与特定的KL-6波动模式显著相关。当季节性趋势被定义为连续两年属于同一群集时，非纤维化性超敏性肺炎与季节性趋势有显著相关性（p < 0.01）。经年龄和病因调整后的多因素分析显示，第4类患者预后较第1类患者差（风险比：1.62,95%可信区间：0.93-2.80,p = 0.09）。结论kl -6波动具有4种季节性特征，可为ILD的病因诊断和预后预测提供依据。

{"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":"2025-11-01","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}

引用次数: 0

Rethinking routine chest drainage in pneumothorax management: Outcomes from a nationwide Japanese database 重新思考常规胸腔引流在气胸治疗中的作用：来自日本全国数据库的结果

IF 2 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2025-11-01 Epub Date: 2025-09-23 DOI: 10.1016/j.resinv.2025.09.015

Yoshikane Yamauchi , Yukinori Sakao , Noriyoshi Sawabata , Toshiro Obuchi , Kenji Tsuboshima , Noriyuki Matsutani , Shouichi Okamoto , Hitoshi Igai , Akihiro Hayashi

Background

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.

背景：气胸的最佳治疗方法仍然存在争议，不断发展的证据挑战了常规胸腔引流的传统方法。方法分析来自日本全国数据库的1773例患者的资料，其中956例为原发性自发性气胸，817例为继发性自发性气胸。多变量和倾向评分匹配分析确定了与引流需求相关的因素，并比较了引流组和非引流组的结果。结果气胸分级是PSP（中度：比值比12.5，重度：比值比22.6 vs.轻度，p < 0.001）和SSP（中度：比值比16.1，重度：比值比26.9 vs.轻度，p < 0.001）患者胸腔引流需求的最重要决定因素，慢性阻塞性肺疾病是SSP的另一个因素（OR 3.04）。没有引流的PSP患者住院时间较短（中位数：6.0天vs 8.0天，p < 0.001），且更频繁地接受手术。无引流的SSP患者ICU住院率较低，住院时间较短（中位数：11.0天对14.0天，p < 0.001）。在所有级别的PSP气胸中均观察到不引流的益处，而在严重的SSP中，引流与更好的结果相关。在气胸分级匹配后，非引流PSP患者在非手术亚组（中位数：2天vs. 6天，p < 0.001）和手术亚组（中位数：5天vs. 8天，p < 0.001）的住院时间均较短。两组之间的死亡率具有可比性。结论虽然气胸分级仍然是胸腔引流的关键决定因素，但精心挑选的患者可以在不引流的情况下成功治疗，缩短住院时间而不影响预后。改进非引流管理标准可提高资源利用率和患者体验。

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引用次数: 0

Impact of physical activity on respiratory disease: Current status and therapeutic implications 身体活动对呼吸系统疾病的影响：现状和治疗意义

IF 2 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2025-11-01 Epub Date: 2025-09-25 DOI: 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.

规律的身体活动（PA）调节了主要呼吸系统疾病发生、进展和症状的关键病理生理机制。值得注意的是，低每日PA和高久坐时间独立预测哮喘、慢性阻塞性肺疾病（COPD）、间质性肺疾病（ILDs）和冠状病毒后肺部后遗症的肺功能下降更快、生活质量更差和过早死亡。相反，有组织的运动训练——以及日益流行的、与生活方式相结合的“多动少坐”项目——可以改善呼吸困难、运动能力、气道和全身炎症以及医疗保健利用。大型队列分析证实了明确的剂量-反应关系：达到≥7500步/天或≥150分钟/周的中等至高强度活动产生最大的临床益处，即使对肺功能受损的个体也是如此。机制研究还表明，运动可以抑制哮喘患者的2型气道炎症，增强COPD患者的骨骼肌氧化表型，并抵消ild相关的降糖作用。最近的随机试验表明，肺康复可以提高纤维化ILD患者的5年生存率，而远程康复和游戏化智能手机指导可以在不影响疗效的情况下缩小治疗差距。此外，主要的国际指南，如2024年全球哮喘倡议和2025年全球慢性阻塞性肺疾病倡议，现在明确承认PA是一种“可治疗的特征”。然而，PA在常规护理中的应用仍然受到行为、环境和政策障碍的限制。未来的工作必须完善个性化PA处方，将可穿戴衍生指标整合到决策支持算法中，并测试与新兴生物制剂和抗纤维化药物的协同效应。本综述综合了当代证据，突出了未解决的问题，并为临床医生提供了实用的建议，旨在将PA推广纳入全面的呼吸护理途径。

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引用次数: 0

Bacterial pneumonia co-infection in adult inpatients with coronavirus disease 2019 during the Omicron variants epidemic in Okinawa, Japan: risk factors and clinical outcomes 日本冲绳欧米克隆变异流行期间2019年冠状病毒病成年住院患者细菌性肺炎合并感染：危险因素和临床结果

IF 2 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2025-11-01 Epub Date: 2025-09-03 DOI: 10.1016/j.resinv.2025.08.006

Wakaki Kami , Shuhei Ideguchi , Kazuya Miyagi , Daisuke Tasato , Futoshi Higa , Hideta Nakamura , Takeshi Kinjo , Masashi Nakamatsu , Shusaku Haranaga , Akihiro Tokushige , Jiro Fujita , Kazuko Yamamoto

Background

The clinical characteristics and risk factors for bacterial pneumonia co-infection in patients with coronavirus disease 2019 (COVID-19) since the epidemic of Omicron variants remain unclear.

Methods

This retrospective study included adult inpatients with COVID-19 at four tertiary hospitals in Okinawa, Japan, between May and July 2023. Bacterial pneumonia co-infection was diagnosed on the basis of new infiltrates on chest radiography, the presence of neutrophils on sputum Gram stain with a positive culture, and the requirement for antimicrobial therapy. We evaluated patient characteristics, detected microbes, assessed patient outcomes, and analyzed the risk factors for bacterial pneumonia co-infection.

Results

Among 458 patients initially considered, 358 were eligible (median age 77 years; 55 % male, and 19 % unvaccinated against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Bacterial pneumonia was identified in 60 patients (17 %). The most common pathogens were Klebsiella pneumoniae, Staphylococcus aureus, and Haemophilus influenzae, with oral flora detected in 40 % of cases. Mortality was significantly higher in patients with bacterial pneumonia than in those without. Multivariate analysis identified age, male sex, cerebrovascular disease, delayed antiviral therapy, and lower oxygen saturation to fraction of inspired oxygen ratio as independent risk factors for bacterial pneumonia co-infection.

Conclusions

Co-infection with bacterial pneumonia significantly affected the outcomes of patients with COVID-19 during the XBB Omicron variant epidemic. Early antiviral therapy and targeted prevention strategies, particularly for patients with cerebrovascular disease, can help reduce the risk of bacterial pneumonia-associated complications.

背景自欧米克隆变异流行以来，2019冠状病毒病（COVID-19）患者细菌性肺炎合并感染的临床特征及危险因素尚不清楚。方法回顾性研究2023年5月至7月在日本冲绳县四所三级医院住院的成年COVID-19患者。细菌性肺炎合并感染的诊断依据是胸片上的新浸润，痰革兰氏染色阳性中性粒细胞的存在，以及抗菌药物治疗的要求。我们评估了患者的特征，检测了微生物，评估了患者的预后，并分析了细菌性肺炎合并感染的危险因素。结果在最初考虑的458例患者中，358例符合条件（中位年龄77岁，55%为男性，19%未接种严重急性呼吸综合征冠状病毒2 （SARS-CoV-2）疫苗）。60例（17%）患者发现细菌性肺炎。最常见的病原体是肺炎克雷伯菌、金黄色葡萄球菌和流感嗜血杆菌，在40%的病例中检测到口腔菌群。细菌性肺炎患者的死亡率明显高于非细菌性肺炎患者。多因素分析发现，年龄、男性、脑血管疾病、延迟抗病毒治疗和较低的血氧饱和度与吸入氧比是细菌性肺炎合并感染的独立危险因素。结论在XBB Omicron变异流行期间，co -感染细菌性肺炎显著影响COVID-19患者的预后。早期抗病毒治疗和有针对性的预防策略，特别是对脑血管疾病患者，可以帮助降低细菌性肺炎相关并发症的风险。

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引用次数: 0

Survival and functional outcomes of single lung transplantation in secondary pulmonary hypertension 继发性肺动脉高压患者单肺移植的生存和功能结局。

IF 2 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2025-11-01 Epub Date: 2025-10-07 DOI: 10.1016/j.resinv.2025.09.022

Dai Shimizu , Kentaroh Miyoshi , Haruchika Yamamoto , Shin Tanaka , Seiichiro Sugimoto , Mikio Okazaki , Shinichi Toyooka

Background

The role of single lung transplantation (SLT) in secondary pulmonary hypertension (SPH) remains controversial. This study evaluated the feasibility and long-term outcomes of SLT in patients with SPH—defined as mean pulmonary artery pressure ≥25 mmHg measured by right heart catheterization immediately before transplantation—within Japan's allocation system, characterized by protracted waiting periods.

Methods

We retrospectively reviewed 83 deceased-donor lung transplantations, categorized into four groups: SLT without SPH (n = 14), SLT with SPH (n = 19), bilateral lung transplantation (BLT) without SPH (n = 12), and BLT with SPH (n = 38). Outcomes analyzed included 5-year survival, CLAD-free survival, and exercise tolerance.

Results

At transplantation, 68.6 % of recipients exhibited SPH, a significant increase compared to registration. Among SLT recipients, the SPH group demonstrated 5-year survival (83.2 %) and CLAD-free survival (65.9 %) not inferior to those of the non-SPH group (50.0 % and 56.8 %, respectively). Perfusion ratios and 6-min walk distances remained comparable between SPH and non-SPH groups for up to five years. Additionally, 5-year survival (83.2 % vs. 81.1 %) and CLAD-free survival (65.9 % vs. 64.5 %) were similar between SLT and BLT. High preoperative oxygen requirements were associated with poorer early graft function in SPH patients receiving SLT. No definitive predictors of CLAD or long-term survival were identified.

Conclusions

SLT is a viable option for patients with mild-to-moderate SPH, providing survival and functional outcomes comparable to BLT. Careful recipient and donor selection remains essential, particularly given the risk of SPH progression during extended waiting periods.

背景：单肺移植（SLT）在继发性肺动脉高压（SPH）中的作用仍有争议。本研究评估了sph患者SLT的可行性和长期结果，sph的定义是在移植前立即通过右心导管测量平均肺动脉压≥25 mmHg，在日本的分配系统中，其特点是等待时间长。方法：回顾性分析83例死亡供体肺移植病例，将其分为4组：无SPH的SLT （n = 14）、无SPH的SLT （n = 19）、无SPH的双侧肺移植（BLT）（n = 12）和双侧肺移植合并SPH （n = 38）。结果分析包括5年生存率、无clad生存率和运动耐量。结果：移植时，68.6%的受者表现出SPH，与登记时相比显著增加。在SLT接受者中，SPH组的5年生存率（83.2%）和无clad生存率（65.9%）不低于非SPH组（分别为50.0%和56.8%）。灌注比和6分钟步行距离在SPH组和非SPH组之间保持可比性长达5年。此外，SLT和BLT的5年生存率（83.2% vs. 81.1%）和无clad生存率（65.9% vs. 64.5%）相似。接受SLT的SPH患者术前高氧需要量与较差的早期移植物功能相关。没有确定明确的预测因子或长期生存。结论：SLT是轻度至中度SPH患者的可行选择，提供与BLT相当的生存和功能结果。仔细选择受体和供体仍然是必要的，特别是考虑到延长等待期SPH进展的风险。

{"title":"Survival and functional outcomes of single lung transplantation in secondary pulmonary hypertension","authors":"Dai Shimizu , Kentaroh Miyoshi , Haruchika Yamamoto , Shin Tanaka , Seiichiro Sugimoto , Mikio Okazaki , Shinichi Toyooka","doi":"10.1016/j.resinv.2025.09.022","DOIUrl":"10.1016/j.resinv.2025.09.022","url":null,"abstract":"<div><h3>Background</h3><div>The role of single lung transplantation (SLT) in secondary pulmonary hypertension (SPH) remains controversial. This study evaluated the feasibility and long-term outcomes of SLT in patients with SPH—defined as mean pulmonary artery pressure ≥25 mmHg measured by right heart catheterization immediately before transplantation—within Japan's allocation system, characterized by protracted waiting periods.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed 83 deceased-donor lung transplantations, categorized into four groups: SLT without SPH (n = 14), SLT with SPH (n = 19), bilateral lung transplantation (BLT) without SPH (n = 12), and BLT with SPH (n = 38). Outcomes analyzed included 5-year survival, CLAD-free survival, and exercise tolerance.</div></div><div><h3>Results</h3><div>At transplantation, 68.6 % of recipients exhibited SPH, a significant increase compared to registration. Among SLT recipients, the SPH group demonstrated 5-year survival (83.2 %) and CLAD-free survival (65.9 %) not inferior to those of the non-SPH group (50.0 % and 56.8 %, respectively). Perfusion ratios and 6-min walk distances remained comparable between SPH and non-SPH groups for up to five years. Additionally, 5-year survival (83.2 % vs. 81.1 %) and CLAD-free survival (65.9 % vs. 64.5 %) were similar between SLT and BLT. High preoperative oxygen requirements were associated with poorer early graft function in SPH patients receiving SLT. No definitive predictors of CLAD or long-term survival were identified.</div></div><div><h3>Conclusions</h3><div>SLT is a viable option for patients with mild-to-moderate SPH, providing survival and functional outcomes comparable to BLT. Careful recipient and donor selection remains essential, particularly given the risk of SPH progression during extended waiting periods.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 6","pages":"Pages 1235-1242"},"PeriodicalIF":2.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145252501","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

Diagnostic value of nonpurulent sputum in nontuberculous mycobacterial lung disease: A cross-sectional study based on the Miller and Jones classification 非结核性分枝杆菌肺病非化脓性痰的诊断价值：基于Miller和Jones分类的横断面研究

IF 2 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2025-11-01 Epub Date: 2025-10-22 DOI: 10.1016/j.resinv.2025.10.009

Minako Hanaka , Kazunori Tobino

Background

Sputum quality is widely considered a determinant of microbiological diagnostic yield in respiratory infections. However, its significance in the context of nontuberculous mycobacterial (NTM) lung disease remains unclear. This study aimed to investigate the association between sputum quality, as assessed using the Miller and Jones classification, and the detection rates of NTM via smear microscopy, polymerase chain reaction (PCR), and culture.

Methods

We conducted a cross-sectional study of 54 patients diagnosed with NTM lung disease at a single institution in Japan between September 2021 and September 2022. A total of 158 sputum samples were visually classified into five categories (M1–P3). Diagnostic yield was assessed using auramine-O fluorescence staining, Mycobacterium avium complex–polymerase chain reaction, and mycobacterial culture. Bacterial co-detection and treatment status were also analyzed.

Results

Nonpurulent sputum samples (M1 and M2) comprised over 60 % of all specimens and demonstrated clinically relevant positivity rates: 33 % for M1 and over 50 % for M2 by culture. No significant association was found between sputum quality and smear, PCR, or culture positivity. Purulent sputum (P2–P3) was significantly associated with bacterial co-detection (p = 0.0008), particularly Pseudomonas aeruginosa.

Conclusions

Sputum purulence was not associated with diagnostic yield for NTM. Nonpurulent samples should not be excluded from diagnostic evaluation. These findings support current guideline recommendations and highlight the importance of repeated sputum collection and adjunctive diagnostic tools in NTM lung disease.

背景：痰质被广泛认为是呼吸道感染微生物诊断产率的决定因素。然而，其在非结核分枝杆菌（NTM）肺病中的意义尚不清楚。本研究旨在探讨采用Miller和Jones分级法评估的痰液质量与涂片镜检、聚合酶链反应（PCR）和培养的NTM检出率之间的关系。方法：我们对2021年9月至2022年9月期间在日本一家机构诊断为NTM肺病的54例患者进行了横断面研究。158份痰液标本目视分为5类（M1-P3）。采用auramine-O荧光染色、鸟分枝杆菌复合体-聚合酶链反应和分枝杆菌培养评估诊断率。分析了细菌共检及治疗情况。结果：非化脓性痰样本（M1和M2）占所有样本的60%以上，并显示出临床相关的阳性率：培养M1为33%，M2为50%以上。痰液质量与涂片、PCR或培养阳性无显著相关性。脓性痰（P2-P3）与细菌共检显著相关（p = 0.0008），特别是铜绿假单胞菌。结论：痰脓与NTM的诊断率无关。不应将非化脓性样本排除在诊断评估之外。这些发现支持了目前的指南建议，并强调了反复痰液收集和辅助诊断工具在NTM肺部疾病中的重要性。

{"title":"Diagnostic value of nonpurulent sputum in nontuberculous mycobacterial lung disease: A cross-sectional study based on the Miller and Jones classification","authors":"Minako Hanaka , Kazunori Tobino","doi":"10.1016/j.resinv.2025.10.009","DOIUrl":"10.1016/j.resinv.2025.10.009","url":null,"abstract":"<div><h3>Background</h3><div>Sputum quality is widely considered a determinant of microbiological diagnostic yield in respiratory infections. However, its significance in the context of nontuberculous mycobacterial (NTM) lung disease remains unclear. This study aimed to investigate the association between sputum quality, as assessed using the Miller and Jones classification, and the detection rates of NTM via smear microscopy, polymerase chain reaction (PCR), and culture.</div></div><div><h3>Methods</h3><div>We conducted a cross-sectional study of 54 patients diagnosed with NTM lung disease at a single institution in Japan between September 2021 and September 2022. A total of 158 sputum samples were visually classified into five categories (M1–P3). Diagnostic yield was assessed using auramine-O fluorescence staining, <em>Mycobacterium avium</em> complex–polymerase chain reaction, and mycobacterial culture. Bacterial co-detection and treatment status were also analyzed.</div></div><div><h3>Results</h3><div>Nonpurulent sputum samples (M1 and M2) comprised over 60 % of all specimens and demonstrated clinically relevant positivity rates: 33 % for M1 and over 50 % for M2 by culture. No significant association was found between sputum quality and smear, PCR, or culture positivity. Purulent sputum (P2–P3) was significantly associated with bacterial co-detection (p = 0.0008), particularly <em>Pseudomonas aeruginosa</em>.</div></div><div><h3>Conclusions</h3><div>Sputum purulence was not associated with diagnostic yield for NTM. Nonpurulent samples should not be excluded from diagnostic evaluation. These findings support current guideline recommendations and highlight the importance of repeated sputum collection and adjunctive diagnostic tools in NTM lung disease.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 6","pages":"Pages 1287-1292"},"PeriodicalIF":2.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145355514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0