Respiration最新文献

Introduction: Hypersensitivity pneumonitis (HP) is an interstitial lung disease that may present as fibrotic (fHP) or nonfibrotic (nfHP). Fibrosis is associated with progression and poor outcomes; however, the transition to progressive pulmonary fibrosis (PPF) and its predictors remain unclear.

Methods: We retrospectively reviewed adult patients diagnosed with HP at a tertiary hospital (2010 and 2022). Patients were classified as having fHP or nfHP and were followed up for at least one year. Clinical, functional, radiological, and histological variables were analyzed. Progressive pulmonary fibrosis (PPF) was defined according to the 2022 clinical practice guideline of the American Thoracic Society (ATS), European Respiratory Society (ERS), Japanese Respiratory Society (JRS), and Asociación Latinoamericana de Tórax (ALAT).

Results: Of 298 HP patients, 191 were included (153 fHP and 38 nfHP). Among patients with fHP, 76 (49.7%) developed PPF after a median of 3.2 years. Median survival was 4.8 years in fHP with PPF versus 6.3 years without, with 1.6 years from PPF onset to death or transplantation. The independent predictors of PPF and survival were lower forced vital capacity, elevated lactate dehydrogenase, fibroblastic foci, and microscopic honeycombing.

Conclusion: Nearly half of fHP patients progressed to PPF within a few years, with markedly reduced survival. Early recognition of high-risk patients may support timely anti-fibrotic treatment and improve outcomes.

a) Background Endoscopic lung volume reduction (ELVR) via valves is a proven therapeutic option for patients with advanced chronic obstructive pulmonary disease (COPD) and emphysema without collateral ventilation. Body mass index (BMI), a simple measure of adiposity, has a complex relationship with COPD. A lower BMI is associated with increased mortality in this patient population. However, the influence of BMI on the outcome of ELVR remains unclear. b) Study design and methods This analysis was conducted with data from the Lung Emphysema Registry (www.lungenemphysemregister.de), a national, prospective, multicentric, producer-independent, open-label clinical trial. The aim of this study was to evaluate the impact of baseline BMI on treatment outcomes after ELVR. Patients were grouped according to their BMI as follows: underweight (BMI <20kg/m², n =76), normal weight (20-24.9kg/m², n=282), overweight (BMI 25-30kg/m², n=146), and obese (BMI >30 kg/m², n=45). c) Results Baseline parameters were characteristic of patients with advanced lung emphysema. Emphysema scores and heterogeneity indices of the target lobe were greater in patients with lower BMI. Patients with a lower BMI had worse lung function parameters (FEV1, RV, DLCO, pCO2) and a higher CAT score. All groups showed significant improvements after ELVR at the 3-month follow-up in terms of lung function parameters, exercise capacity and quality of life. Treatment outcomes were comparable across BMI groups, with the notable exception of more pronounced improvement in CAT scores among underweight patients. The complication rates were low and comparable among the groups, although obese patients had a higher rate of ICU admissions. d) Discussion This study suggests that ELVR provides meaningful clinical benefits regardless of BMI in patients with advanced lung emphysema, particularly when dyspnea is primarily attributable to pulmonary pathology. The findings suggest that BMI should be considered as a reflection of disease phenotype and clinical state rather than serving as a predictor for treatment response after ELVR.

Introduction Diagnosis and treatment decisions for many respiratory diseases are based on spirometric values. We compared the impact of changing the reference equations from GLI-2012 (race-specific) to GLI-2022 (race-neutral) in a predominantly Caucasian urban population. Methods PneumoLaus is a sub-study of CoLaus|PsyCoLaus, an ongoing prospective observational study conducted in Lausanne, Switzerland. Participants performed spirometry at baseline (2014-2017) and at follow-up (2018-2021, FU). We analysed changes of %predicted values (PV) for Forced Expiratory Volume in One second (FEV1) and Forced Vital Capacity (FVC) by comparing the GLI-2022 reference equation to GLI-2012. Sub-group analyses were performed for social class, sex and age using paired t-tests corrected by Holm-Bonferroni. We analysed the association of age, sex and social class on the differences using linear regression. Results A total of 3330 participants were included at baseline and 2005 at FU, >97% Caucasian. Employing GLI-2022 equations, the %PV increased significantly for both FEV1 (4.2%PV and +0.31 Z-score baseline, 4.6%PV and +0.28 Z-score FU, both p<0.0001) and FVC (4.9%PV and +0.34 Z-score baseline, 5.6%PV and + 0.29 Z-score FU, both p<0.0001). Younger individuals, males, and participants with only compulsory school education experienced the greatest increase. The prevalence of low FEV₁ and low FVC decreased using GLI-2022 references, while the prevalence of obstructive ventilatory impairment increased at baseline and FU (all p<0.05). Discussion In this predominantly Caucasian urban population-based cohort, applying GLI-2022 equations led to a general FEV1 and FVC %PV increase, particularly among younger individuals, males, and participants with only compulsory school education. Applying GLI-2022 equations also led to a general FEV1 and FVC z-score increase. These findings changes may carry relevant implications for clinical care and social policy decisions.

Background: Hospital-acquired pneumonia (HAP), including its special type, ventilator-associated pneumonia (VAP), is one of the most important types of hospital-acquired infections. A paucity of large-scale epidemiological data on HAP in China remains. Therefore, we conducted a multi-center retrospective study to investigate the epidemiology, etiology, and risk factors of HAP with the goal of improving early prevention and prognosis.

Methods: From January to December 2019, 543 patients from 37 tertiary hospitals meeting the enrollment criteria (who meet the diagnosis of HAP/VAP according to the 2018 Chinese HAP/VAP Guideline and have clear clinical outcomes) were included. Patient data were retrospectively analyzed.

Results: The mortality of enrolled patients was 15.8%. Risk factors for poor prognosis and mortality among HAP patients included a diagnosis of VAP, admission to the Intensive Care Unit (ICU), positive airway secretion culture, liver dysfunction, history of heart failure, history of cancer, long-term catheter indwelling, Sequential Organ Failure Assessment (SOFA) score >2 and quick SOFA (qSOFA) score >1 (P<0.05). The top four pathogens of HAP were Acinetobacter baumannii (24.89%), Klebsiella pneumoniae (21.57%), Pseudomonas aeruginosa (13.73%) and Staphylococcus aureus (5.88%).

Conclusion: Given the high mortality rate associated with HAP, prevention and early diagnostic assessment of HAP and VAP during hospitalization are paramount for these patients. The main pathogens of HAP are Gram-negative bacteria, which frequently exhibit substantial antimicrobial resistance. Therefore, antibiotics should be selected carefully.

Introduction: To determine whether peak workload (Wpeak), expressed as a percentage of predicted value during a cardiopulmonary exercise test (CPET), can predict postoperative cardiopulmonary complications in high-risk patients undergoing lung cancer resection.

Methods: A retrospective cohort study was conducted on 226 consecutive patients who underwent anatomical lung resection (lobectomy or segmentectomy) for non-small cell lung cancer between 2013 and 2017. All patients were considered high risk, with preoperative FEV₁ and DLco <80% predicted and underwent full CPET within 30 days prior to surgery. The main endpoint was the occurrence of cardiopulmonary complications within 30 days postoperatively. The predictive ability of Wpeak (% predicted) for complications was evaluated using ROC analysis and optimal cutoff was identified. Outcomes were compared above and below this threshold.

Results: A Wpeak threshold of 52% predicted was identified as the optimal cutoff, with an area under the ROC curve of 0.59 (95% CI: 0.51-0.67; p = 0.015). Patients with Wpeak ≤52% had a significantly higher rate of postoperative complications (58% vs. 33%, p = 0.001), particularly respiratory complications (47% vs. 28%, p = 0.008), and longer hospital stays (mean 24 vs. 15 days, p = 0.002). They also had lower FEV₁, DLco, VO₂peak, and heart rate responses compared to patients with Wpeak >52%.

Conclusions: Wpeak ≤52% of predicted was associated with increased risk of postoperative complications and longer hospitalization. Although the discriminatory ability was modest (AUC 0.59), Wpeak ≤52% predicted was associated with higher postoperative complications and may serve as a complementary tool for risk stratification, especially in resource-limited settings. Further prospective validation is warranted.

Introduction: Shape-sensing robotic-assisted bronchoscopy (ssRAB) represents a major advancement in the bronchoscopic evaluation of pulmonary nodules suspicious for malignancy. Its use has expanded across multiple countries and healthcare systems; however, no global consensus currently exists to guide clinical practice or address areas of uncertainty.

Methods: This first world expert consensus was developed by an international panel of specialists in interventional pulmonology and ssRAB. The panel includes 18 experts representing 13 hospitals across 3 continents. A systematic literature review was conducted, followed by multiple rounds of structured questionnaires, sharing of clinical experience, and informed discussion, in order to identify key domains and establish consensus statements.

Results: A total of 38 recommendations were generated across domains including indications and contraindications, procedural set up, practical workflow, anesthesia considerations, diagnostic tools, training, reporting standards, and safety practices of ssRAB. Full consensus (100% agreement) was achieved for all 38 statements following three voting rounds and extensive discussion.

Conclusion: This first international expert consensus provides comprehensive, evidence-informed guidance on the clinical use of shape-sensing robotic-assisted bronchoscopy. It also highlights areas of ongoing uncertainty and can serve as a foundation for future research, education, and guideline development in this rapidly evolving field.

Background: Idiopathic pulmonary fibrosis (IPF) preferentially occurs in male patients and controversial results in gender-specific differences including overall mortality have been reported.

Methods: The INSIGHTS-IPF registry was a non-interventional, prospective cohort study including IPF patients from 20 interstitial lung disease expert centers in Germany. Sex-related disparities were analyzed regarding comorbidities, clinical course, and survival.

Results: Of the 1,043 IPF patients included, 842 (80.7%) were male and 201 (19.3%) were female. Male patients were more likely to have a history of smoking (p < 0.001) and environmental exposure, especially metal dust, wood dust, and solvents (p = 0.032). While males at baseline had a higher prevalence of coronary artery disease, atrial fibrillation, emphysema, and obstructive sleep apnea syndrome, in females, gastro-esophageal reflux disease and depression or depressive disorders were more frequent. Female IPF patients had more frequently a history of immunosuppressive therapy (p = 0.003). Regardless of gender, the INSIGHTS-IPF cohort as a whole showed a progressive worsening of lung function parameters over time. All-cause mortality did not differ between females and males (HR: 0.81; 95% CI: 0.63-1.04; p = 0.093) and female gender was not a significant predictor for mortality in IPF (HR 0.74; 95% CI: 0.54-1.03; p = 0.071). Interestingly, the GAP score underestimated the observed 2-year and 3-year mortality in females in GAP stage II.

Conclusion: In the German INSIGHTS-IPF registry, no differences in lung function decline and survival could be observed between female and male patients with IPF, indicating differences between IPF cohorts from the USA and Europe.

Introduction: Photodynamic therapy (PDT) is a minimally invasive, organ-preserving treatment option for patients with centrally located early-stage non-small cell lung cancer. While first-generation photosensitizers such as Photofrin are well established, second-generation agents like Chlorin e6 offer improved pharmacokinetics and potentially better clinical outcomes. The objective of this study was to assess the safety profile and therapeutic efficacy of different photosensitizers used in PDT for centrally located early-stage lung cancer (CELC).

Methods: We retrospectively analyzed 62 CELC lesions in 36 patients treated with PDT between 2015 and 2024. Patients received one of three photosensitizers - Photofrin, Chlorin e6, or Foscan - followed by bronchoscopic light activation. Outcomes included complete remission (CR), local tumor control (LTC), disease-free survival (DFS), and treatment-related adverse events.

Results: CR rates were 87.5% (28/32) for Chlorin e6, 100% (3/3) for Foscan, and 68.8% (22/32) for Photofrin, with a nonsignificant trend favoring Chlorin e6 over Photofrin (p = 0.13). Mean DFS was longest in the Chlorin e6 group (43.3 months; 95% CI: 32.5-54.1), followed by Photofrin (24.0 months; 95% CI: 17.2-30.8) and Foscan (7.3 months; 95% CI: 6.3-8.4). Durable LTC was achieved in 84.1% of lesions without need for escalation to systemic or surgical treatment. Chlorin e6 demonstrated a more favorable safety profile than Photofrin.

Conclusion: PDT is a safe and effective treatment modality for CELC, achieving high rates of LTC. Among the evaluated photosensitizers, Chlorin e6 showed a favorable balance of efficacy and safety.

Introduction: Fibrosing mediastinitis (FM)-also known as mediastinal fibrosis or sclerosing mediastinitis-is a rare, benign, but potentially life-threatening disorder of unclear etiology. This study aimed to evaluate the clinical characteristics, geographic distribution, and long-term survival of patients with FM and to identify prognostic factors for all-cause mortality.

Methods: Of 215 patients screened, 192 were diagnosed with FM and included in the final cohort. The clinical characteristics and survival of patients with FM were reported. Prognostic factors were evaluated by Cox regression model.

Results: The mean age of FM patients was 66.6 ± 13.4 years. Geographic clustering was evident in northwestern China. Compared with survivors, deceased patients showed higher rates of edema (50.0% vs. 22.3%, P = 0.016), lower serum cholesterol (3.8 ± 0.8 mmol/L vs. 4.5 ± 1.1 mmol/L, P = 0.004), and elevated NT-proBNP (751.8 pg/mL vs. 220.5 pg/mL, P = 0.001). Echocardiography indicated more severe right ventricular remodeling in the deceased group. Chest CT commonly revealed bilateral mediastinal involvement (85.4%), lobar vascular compression, and mediastinal lymphadenopathy (88.5%). Over a median follow-up of 23 months, the 1-, 3-, and 5-year survival rates were 94.5%, 86.3%, and 84.6%, respectively. Right heart failure was the leading cause of death (50%). Multivariable Cox analysis identified smoking (HR 4.32, 95% CI 1.61-11.62, P = 0.004) and elevated systolic pulmonary artery pressure (sPAP) (HR 1.02 per mmHg, 95% CI 1.01-1.03, P = 0.017) as independent predictors of all-cause mortality. FM-related deaths were more strongly associated with current smoking (HR 15.18, P < 0.001), presence of pleural effusion (HR 5.10, P = 0.03), and elevated sPAP (HR 1.02 per mmHg, P = 0.011).

Conclusion: FM predominantly affects older adults and is geographically clustered in northwestern China. Smoking and elevated sPAP are key prognostic indicators for mortality. Despite substantial cardiopulmonary impairment, long-term survival remains relatively favorable.