Respiration最新文献

Introduction: The relationship between preserved ratio impaired spirometry (PRISm) and depression remains unclear. This study aimed to assess the bidirectional relationship between PRISm and depression using data from a national cohort.

Methods: Data from wave 2 (2004-2005) to wave 4 (2008-2009) of the English Longitudinal Study of Ageing (ELSA) were analyzed. Lung function and depressive symptoms were measured at baseline and follow-up. Cox proportional hazard models were used to calculate the hazard ratio (HR) of PRISm with depression (study 1) and depression with PRISm (study 2).

Results: Studies 1 and 2 included 2,934 and 2,277 participants, respectively. The follow-up period extended from wave 2 to wave 4. In univariate analyses, a bidirectional association between PRISm and depression was observed, with unadjusted HRs of 1.49 (95% confidence interval [CI], 1.12-1.99; p = 0.007) in study 1 and 1.69 (95% CI, 1.13-2.52; p = 0.010) in study 2. However, in multivariable Cox models, baseline PRISm was not associated with subsequent depression development (adjusted HR 1.26; 95% CI, 0.94-1.69; p = 0.128). Conversely, participants with depression had a significantly higher risk of developing PRISm compared to those without depression (adjusted HR 1.54; 95% CI, 1.03-2.32; p = 0.038). These findings were consistent with z-score-based interpretive strategies, with an adjusted HR of 1.30 (95% CI, 0.95-1.77; p = 0.105) in study 1 and 1.59 (95% CI, 1.03-2.47; p = 0.038) in study 2.

Conclusions: Depression was associated with an increased risk of developing PRISm, whereas PRISm did not increase the risk of developing depression. Physicians should be vigilant for potential PRISm development in patients with depression.

Introduction: Establishing a diagnosis is paramount in medical practice as it shapes patients' experiences and guides treatment. Patients grappling with rare diseases face a triple challenge: prolonged diagnostic journeys, limited responses to existing therapies, and the absence of effective monitoring tools. Genetic diagnosis often provides crucial diagnostic and prognostic information, opening up possibilities for genotype-targeted treatments and facilitating counselling and relative testing. The NIHR BioResource - Rare Diseases (NBR) Study and the Cohort Study in Idiopathic and Hereditary Pulmonary Arterial Hypertension (PAH Cohort study) aimed to enhance diagnosis and treatment for PAH, successfully identifying the genetic cause in 25% of idiopathic cases. However, the diagnostic and therapeutic odyssey in patients with PAH remains largely unexplored.

Methods: Stakeholders from the NBR and PAH Cohort studies were recruited using purposive sampling. In-depth interviews and focus groups were recorded, transcribed, anonymised, and analysed thematically using MAXQDA software.

Results: The study involved 53 interviews and focus groups with 63 participants, revealing key themes across five stages of the diagnostic odyssey: initial health concerns and interactions with general practitioners, experiences of misdiagnosis, relief upon receiving the correct diagnosis, and mixed emotions regarding genetic results and the challenges of living with the disease. Following the diagnosis, participants embarked on a therapeutic journey, facing various challenges, including the disease's impact on professional and social lives, the learning curve associated with understanding the disease, shifts in communication dynamics with healthcare providers, therapeutic hurdles, and insurance-related issues. Building on these insights, we identified areas of unmet needs, such as improved collaboration with primary care providers and local hospitals, the provision of psychological support and counselling, and the necessity for ongoing patient education in the ever-evolving realms of research and therapy.

Conclusions: The study highlights the significant challenges encountered throughout the diagnostic and therapeutic journey in PAH. To enhance patient outcomes, it is crucial to raise awareness of the disease, establish clear diagnostic pathways, and seamlessly integrate genetic diagnostics into clinical practice. Streamlining the diagnostic process can be achieved by utilising existing clinical infrastructure to support research and fostering better communication within the NHS. Moreover, there is an urgent need for more effective therapies alongside less burdensome drug delivery methods.

Introduction: Bronchoscopic lung volume reduction (BLVR) using endobronchial coil treatment is a widely studied therapeutic option in patients with end-stage chronic obstructive pulmonary disease (COPD) and pulmonary emphysema. However, patient responses were inconsistent, and, from 2020, production discontinuation rendered the treatment unavailable. In the meantime, a next-generation lung tensioning coil (FreeFlow Coil 4; FreeFlow Medical, Inc., Fremont, CA, USA) has been developed by the inventor of the lung volume reduction coil implant technology. This case study presents the first documented successful BLVR using FreeFlow Coils 4.

Case presentation: A 68-year-old male patient with COPD, classified as Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 3, and homogenous emphysema with incomplete interlobar fissures was treated using the new developed FreeFlow Coil 4 in both upper lobes. Apart from a suspected coil-associated opacity, no adverse events occurred. At the 18-week follow-up, a significant improvement in lung function and quality of life was observed, as measured by forced expiratory volume in 1 s (+150 mL), residual volume (-0.50 L), 6-min walking distance (+75 m), and the total score of the St. George's Respiratory Questionnaire (SGRQ) (-35 points).

Conclusion: BLVR with FreeFlow Coils 4 has shown promising outcomes, significantly improving both pulmonary function and quality of life in 1 patient. However, larger studies and randomized controlled trials are imperative to investigate the efficacy and safety profile of the new coil system.

Introduction: Lung cancer is a leading cause of cancer-related deaths worldwide, with rising incidence in resource-limited settings. Research suggests an increased risk of lung cancer in individuals with a history of pulmonary tuberculosis (TB), but the association needs further clarification. This systematic review aims to provide a more comprehensive understanding of this relationship.

Methods: We systematically searched the PubMed/Medline, EMBASE, and Scopus databases for relevant studies up to March 15, 2024. The quality of the included studies was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklist. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using either random-effects or fixed-effects models, depending on the level of heterogeneity. All statistical analyses were performed using Comprehensive Meta-Analysis software, version 3.0.

Results: A total of 37 studies were included (9 cohort and 28 case-control). A significant association between prior pulmonary TB and lung cancer was found in both cohort (OR: 2.3; 95% CI, 1.4-3.8) and case-control (OR: 1.9; 95% CI, 1.4-2.5) studies. Subgroup analyses revealed a stronger association in East Asia (OR: 2.4; 95% CI, 1.3-4.1).

Conclusion: Our study provides strong evidence of an increased risk of lung cancer following pulmonary TB. The findings emphasize the need for comprehensive public health strategies, including targeted screening, early detection, and smoking cessation. Future studies should investigate the mechanisms linking TB and lung cancer, as well as the effectiveness of integrated prevention programs, particularly in high-burden regions.

Introduction: Post-tracheostomy tracheal stenosis is a clinically relevant late complication of tracheostomy. To date, there is no standardized treatment strategy for post-tracheostomy tracheal stenosis. Contact cryoablation is one of the applicable methods. The aim of the present study was to explore the efficacy and safety of contact cryoablation for the treatment of post-tracheostomy tracheal stenosis.

Methods: A total of 63 consecutive patients were included in this unicentre, combined retrospective and prospective observational study in an intensive care unit of a German neurological specialist hospital from 30 April 2020 to 21 March 2024. Post-tracheostomy tracheal stenoses were confirmed by tracheoscopy. All eligible patients were primarily treated with contact cryoablation. Primary endpoint was the rate of successful removal of the tracheostomy tube (decannulation) until hospital discharge. Technical success was defined as the absence of an endoscopically relevant residual post-tracheostomy tracheal stenosis, and clinical success was defined as the absence of symptoms, e.g., dyspnoea and stridor, both at discretion of the endoscopist and treating physician.

Results: A total of 78 interventions were performed (median: 1 per patient). Cryoablation was applied in 67% of patients at least once. A total of 70% of patients could be decannulated after treatment. Technical success and clinical success were achieved in 88% and 70% of patients, and in only 5% of patients surgical treatment was performed. No complications were observed.

Conclusion: Contact cryoablation appears to be an effective, complication-free, simple, and non-surgical treatment option for patients with post-tracheostomy tracheal stenosis. It could be an excellent option for every patient with suitable stenosis morphology. However, other endoscopic modalities must be available or complementarily used for non-suitable stenosis morphologies.

Introduction: Airway stenosis is the most common and serious complication of tracheobronchial tuberculosis (TBTB). Systemic anti-tuberculosis treatment is the basic treatment for TBTB airway stenosis, and supplemented with tracheoscopic intervention, it can effectively minimize the occurrence of TBTB stenosis or reduce the degree of stenosis; however, some patients still have restenosis after the intervention. However, some patients still have restenosis after intervention.

Methods: We retrospectively collected the clinical data of patients diagnosed with tuberculous airway stenosis in the Second Hospital of Lanzhou University and Lanzhou Pulmonary Hospital from January 2021 to June 2023. The patients were divided into the restenosis group and the non-restenosis group according to whether or not restenosis occurred in the airway within 1 year of the intervention, and the differences in the clinical data between the two groups were compared, and the variables with statistically significant differences in the univariate analysis were analyzed by multifactorial binary logistic regression.

Results: A total of 154 patients with tuberculous airway stenosis were included in this study, including 64 patients in the restenosis group, and the restenosis rate was 41.6%. Univariate analysis showed that the systemic immune inflammation index (SII) was higher in the restenosis group than in the non-restenosis group, and the composition of diabetic patients, stenosis length >3 cm, and positive antacid staining of tracheal secretions were higher in the restenosis group than in the non-restenosis group (all p < 0.05). The composition of microscopically inactive, anti-tuberculosis treatment before intervention and balloon dilatation was lower (all p < 0.05). Multifactorial binary logistic regression analysis showed that diabetes (OR = 5.758, 95% CI: 1.434-23.119), stenosis length (OR = 6.349, 95% CI: 2.653-15.197), SII (OR = 1.002, 95% CI: 1.001-1.003), anti-tuberculosis treatment before interventional therapy (OR = 0.250, 95% CI: 0.084-0.746), and TBTB microscopic classification and staging (OR = 0.306, 95% CI: 0.099-0.941) were independent influencing factors of restenosis after interventional therapy for tuberculous airway stenosis.

Conclusion: Diabetes, stenosis length >3 cm, and high SII were independent risk factors for restenosis after intervention for tuberculous airway stenosis, before interventional anti-tuberculosis treatment and microscopic inactivity were independent protective factors.

Introduction: During the COVID-19 pandemic, the effectiveness of vaccines against SARS-CoV-2 in immunodeficient patients not only did affect the individual risk of these vulnerable patients but endangered the selection of new variants of concern due to prolonged virus shedding by these patients.

Methods: In a tertiary center for pulmonary diseases, we investigated the immune response of 11 patients with primary humoral immunodeficiency and 13 healthy controls on the humoral and cellular level after full vaccination with an mRNA or vector vaccine against SARS-CoV-2.

Results: In the majority of patients (73%), we found antibodies against the spike protein above the threshold of positivity. Likewise, patients showed a promising cellular response: the upregulated production of INFγ, TNFα, and CXCL10 by T cells did not differ from the response of healthy controls.

Conclusion: These results stress the importance to further discern an adequate immunological correlate of protection and the need to follow the effect of booster immunizations in this population at risk.

Introduction: Chronic obstructive pulmonary disease (COPD) is the third leading cause of death globally, characterized by airflow limitation and lung hyperinflation due to emphysema. Bronchoscopic lung volume reduction (BLVR) with endobronchial valves offers a minimally invasive treatment option for emphysema, aiming to reduce lung hyperinflation, thereby improving lung function and exercise tolerance.

Methods: This study evaluated the efficacy of BLVR in a real-life nationwide setting using comprehensive Danish registries. The study population included patients who underwent BLVR between January 1, 2013, and December 31, 2021. We assessed clinical outcomes, including forced expiratory volume in 1 s (FEV1), Medical Research Council (MRC) dyspnea score, and the rates of exacerbations and pneumonia before and after the procedure. A control cohort of matched COPD patients was also analyzed.

Results: Following BLVR, a significant increase in FEV1, similar to the improvements reported in randomized controlled trials, was observed. Additionally, the proportion of patients classified as GOLD stage IV decreased from 71.3% to 60.6% after BLVR. The incidence rate ratio for severe exacerbations significantly dropped to 0.56 (95% confidence interval 0.47-0.67, p < 0.01) after BLVR. No significant changes were observed in the rates of moderate and severe pneumonia, and mortality rates did not differ significantly from those in the matched control cohort.

Conclusion: This study demonstrates the real-life efficacy of BLVR using endobronchial valves, highlighting a significant improvement in FEV1 and a reduction in severe COPD exacerbations. The procedure did not increase pneumonia rates or affect mortality, supporting continued use of BLVR for managing patients with COPD.

Introduction: Troublesome coughing that persists for more than 8 weeks without evident aetiology or effective therapy is termed unexplained chronic cough (UCC). Using impulse oscillometry (IOS) and spirometry, we assessed the functionalities of the large and small airways, respectively, in patients with UCC and in healthy control subjects.

Methods: On a single occasion, 50 patients with UCC (mean age, 61 years; 82% women) and 23 subjectively healthy controls (mean age, 58.9 years; 95.7% women) underwent IOS and spirometry. Patients with UCC were also subjected to fractional exhaled nitric oxide (FeNO) measurement, and they answered a local questionnaire, a visual analogue scale (VAS) for cough and cough-related symptoms, and a health-related quality of life questionnaire.

Results: Forty-nine (98%) patients with UCC reported cough symptoms from exposure to chemicals, 39 (78%) had problems with cold air, and 38 (76%) had cough symptoms following exercise. The mean VAS cough score was 62 mm in the patient group. FeNO was measured in 25 patients, showing a mean value of 16.6 ppb. Women with UCC had significantly greater airway resistance and reactance than men with UCC. The UCC group showed significantly increased peripheral airway resistance and reactance, and lower FEV1% predicted values (albeit within the normal range), as compared with the healthy control group.

Conclusion: Patients with UCC show increased peripheral airway resistance and significantly lower FEV1% predicted values compared with healthy control subjects. Routine measurements of lung function with both IOS and spirometry could have added value to the diagnosis of UCC.