Respiration最新文献

Introduction: Lung transplantation is a curative treatment for end-stage pulmonary sarcoidosis. Outcomes and prevalence of sarcoidosis recurrence are not well established despite sarcoidosis being the most common disease to recur following lung transplantation. We sought to evaluate our institution's experience of lung transplantation for pulmonary sarcoidosis.

Methods: This was a retrospective, single-centre study on consecutive lung transplant recipients for pulmonary sarcoidosis from December 1994 to March 2024. Medical records were reviewed for trans-bronchial biopsies (TBBxs), thoracic computed tomography (CT), positron emission tomography (PET), and spirometry. Post-transplant clinical outcomes and survival were explored.

Results: We reviewed 40 patients who underwent lung transplantation for pulmonary sarcoidosis out of 1,789 total lung transplantations between January 1994 and March 2024. Fourteen (35%) had pulmonary sarcoidosis recurrence. The average age at transplant was 51 years and time from transplant to recurrence was 15 months. The predominant CT finding in sarcoidosis recurrence was right upper lobe nodules (42%). More than half (60%) of non-necrotising granulomas on TBBx were detected outside the surveillance protocol, at a median 9-month post-transplant. Two of 3 patients treated with infliximab for recurrence had complete metabolic response on PET. Patients with sarcoidosis recurrence were younger at time of transplant than those without recurrence (44 vs. 54.6 years, p < 0.001) and trended toward improved overall survival (15.1 vs. 8.2 years, p = 0.23).

Conclusion: Sarcoidosis recurrence was common and did not have a significant impact on survival after lung transplantation. Right upper lobe nodules on CT and inclusion of a 9-month surveillance TBBx may be useful in identifying sarcoidosis recurrence.

Background: Sex-related differences in interstitial lung disease (ILD) phenotypes are well recognized, but it remains unclear whether sex itself independently influences outcomes in non-idiopathic pulmonary fibrosis (non-IPF) ILD once comorbidities, lung function, and treatment are considered.

Methods: In the prospective INSIGHTS-ILD registry (data cut 17 September 2025), we compared men and women with non-IPF ILD using descriptive analyses and Cox models with prespecified adjustment steps: Model A (age, comorbidity count, smoking), Model B (A + forced vital capacity [FVC] and diffusing capacity of the lung for carbon monoxide [DLCO]), and Model C (B + antifibrotic therapy). Prespecified subgroup analyses included age strata (≤55 and >55 years) and ILD entities. Longitudinal FVC and DLCO trajectories were assessed over 24 months.

Results: Among 883 patients (483 men, 400 women), exposures and disease entities differed significantly by sex: men reported more occupational/environmental exposures and had higher rates of fibrotic idiopathic interstitial pneumonia, whereas women more frequently had autoimmune-related ILD and a family history of ILD. Men had a higher comorbidity burden and more often received antifibrotic therapy at baseline. Survival was shorter in men (HR 1.51; 95% CI 1.03-2.21), but this association disappeared after adjustment in Model A (HR 1.04; 0.65-1.68), Model B (HR 1.03; 0.61-1.74), and Model C (HR 1.04; 0.62-1.77). Progression-free survival and transplant-free survival showed no consistent sex-related differences. Longitudinal FVC and DLCO declines were modest and largely parallel in both sexes, with no significant between-group differences. Findings were similar across age groups and ILD entities.

Conclusion: Men and women with non-IPF ILD differ in exposures, phenotypes, and comorbidities, but after accounting for these factors, sex is not an independent predictor of survival or functional progression. Risk assessment should therefore primarily be based on objective disease characteristics rather than sex alone.

Introduction: Bronchoscopic lung volume reduction (BLVR) with endobronchial valves (EBVs) is an effective and minimally invasive alternative to lung volume reduction surgery for some patients with severe emphysema. While generally well tolerated, it may lead to rare but serious complications. Pulmonary lobar torsion and secondary infarction are known postoperative complications after thoracic surgery but have not been previously reported following BLVR.

Case presentation: A 70-year-old woman with chronic obstructive pulmonary disease underwent EBV placement in the right upper lobe, with a good lung function and clinical improvement. Fifteen months after placement, she presented with epigastric pain, hemoptysis, and respiratory distress. Imaging revealed a torsion of the right upper lobe, initially misinterpreted as pneumonia, which necessitated an urgent thoracotomy and lobectomy. Intraoperative and histopathological findings were compatible with the diagnosis of lobar torsion with ischemic necrosis.

Conclusion: This case presents the first reported pulmonary lobar torsion following EBV treatment. The clinical presentation can be nonspecific or with misleading symptoms, potentially leading to diagnostic delays. Clinicians should be aware of such complication in patients with previous BLVR presenting with new or unexplained clinical findings. Imaging and early surgical intervention are critical to prevent life-threatening complications.

Introduction: Postgraduate training in adult respiratory medicine in Switzerland has traditionally relied on fixed training times and procedural numbers. In line with competency-based medical education (CBME), the Swiss Society of Pneumology (SGP/SSP) initiated the development of an entrustable professional activity (EPA)-based curriculum to better align training with clinical practice and outcomes.

Methods: In 2023, the SGP Postgraduate Training Commission formed a multidisciplinary working group representing all Swiss linguistic regions and training centre types. Through a structured consensus process - including literature review, iterative consensus meetings using a modified Delphi process, and coaching by the Swiss Institute for Medical Education (SIME/SIWF/ISFM) - a national EPA list was created. All EPAs have been elaborated using the EQual rubric as a quality standard. Final approval was granted by the SGP and SIME in 2025.

Discussion: The novel EPA-based curriculum represents a shift from time- and number-based requirements to competency-oriented postgraduate education in adult respiratory medicine. We describe the development process, conceptual framework, and key lessons learnt. By integrating programmatic assessment and EPAs with frequent workplace-based assessments, it aims to enhance feedback culture, entrustment decisions, and individualized learning, providing a model for other national training programs and specialties adopting CBME.

Introduction: Currently, in early-stage lung cancer, often multiple nodules are present upon presentation, or a second lung lesion develops during follow-up. The nature of this lesion has profound impact on therapeutic options. We set out to assess the need of repeated (minimally invasive) diagnosis and treatment procedures by determining the incidence of second primary lung cancer (SPLC) and recurrence in our navigation bronchoscopy (NB) program for incidental pulmonary lesions.

Methods: We retrospectively reviewed reports of patients referred for NB and diagnosed with early-stage lung cancer between December 2017 and May 2021. Classification of synchronous, metachronous SPLC, or recurrent disease was based on molecular analysis or pathology-based MDT decisions.

Results: In our population of patients referred for NB, 188 patients were diagnosed as (early-stage) lung cancer. Twenty-four percent had a history of lung cancer upon referral for NB. In total, in 40.4% of the patients a new lung lesion that required additional diagnosis and treatment was found. These could be classified as metachronous SPLC in 26% and recurrence in 19%. In newly diagnosed patients, 22% developed SPLC or recurrent disease during a median follow-up time of only 3.3 years (range, 0.5-5.8 years).

Conclusion: Our findings demonstrate that in a patient cohort undergoing NB for peripheral pulmonary nodules, 40.4% had SPLC or recurrent disease. Most of these patients had metachronous SPLC, underlining the need to obtain adequate tissue that allows for molecular analysis. In newly diagnosed lung cancer patients 22% needed new procedures which impact the need for healthcare facilities.

Introduction: Single-use flexible bronchoscopes (SUFBs) have been gaining popularity owing to their portability and reports of infections related to reusable flexible bronchoscopes (RFBs). Hence, a need has arisen to compare the costs of using each type. This study sets out to assess the per-use cost of an RFB as a point of direct comparison to that of SUFBs in a single healthcare delivery unit.

Methods: This is a prospective, observational study in which we followed 25 RFBs throughout their use cycle. We applied a micro-costing approach that encompassed scope capital, servicing, staffing, and reprocessing costs to derive the per-use cost for RFBs. A sensitivity analysis provided data regarding how the per-use cost varies with bronchoscope fleet size and procedure volume. The per-use cost of RFBs was compared with the price of SUFBs.

Results: The per-use cost of RFBs was USD 198.26 to USD 202.40, and SUFBs were USD 300.00 to USD 400.00 each in the endoscopy unit. The RFB cost was primarily attributed to scope capital and servicing costs but was highly variable across procedural volume and scope fleet size. Sensitivity analysis showed that as case volume increases, the per-use cost drops in a nonlinear fashion, and as scope fleet increases, the per-use price increases accordingly. In high-volume units (>900 annual procedures), RFBs are the more cost-effective option, whereas in low-volume units (<400 annual procedures), cost favors SUFBs. For medium-volume units (400-900 annual procedures), SUFBs and RFBs are largely comparable in cost.

Conclusion: SUFBs offer cost savings in low-volume units, whereas high-volume units may favor RFBs. The additional implications of environmental impact and risk of nosocomial infection need be considered.

Introduction: Several post hoc analyses of clinical trials and observational studies have noticed that women may be at a higher risk of exacerbations than men among patients with chronic obstructive pulmonary disease (COPD), although the findings remain conflicting. These studies, however, did not consider the impact of mainstay treatments over longitudinal follow-up. We examined whether the risk of acute exacerbations differed between women and men in patients with COPD treated with long-acting bronchodilators.

Methods: This population-based study included 2 cohorts of patients with COPD who initiated a single long-acting bronchodilator (mono-bronchodilator cohort) or a dual combination of long-acting bronchodilators (dual-bronchodilator cohort) identified from a nationwide Taiwanese claims database (2017-2022). In each cohort, Cox regression models were executed to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of moderate-to-severe exacerbations comparing women to men after 1:10 variable-ratio propensity score (PS) matching.

Results: There were 51,945 patients (9,643 women and 42,302 men) in the mono-bronchodilator cohort and 88,271 patients (15,418 women and 72,853 men) in the dual-bronchodilator cohort after PS matching. The HR of moderate-to-severe exacerbations comparing women to men was 0.86 (95% CI, 0.80-0.92) and 0.88 (95% CI, 0.84-0.92) for each cohort, respectively. Results were consistent when analyzing moderate and severe exacerbations separately and did not change materially across prespecified subgroup and sensitivity analyses.

Conclusion: The present study including two sizable COPD cohorts of Asian patients suggests that women may have a lower risk of exacerbations than men when regularly receiving long-acting bronchodilators. The findings highlight the importance of considering maintenance treatments when evaluating sex differences in the risk of acute exacerbations.

Introduction: There are limited data on the prevalence and treatment of low bone density in young lung transplant recipients (LTRs), even though osteoporosis is common in patients with end-stage lung disease and transplant recipients. This study aimed to assess bone health in young LTRs.

Methods: We retrospectively reviewed medical records for LTRs aged 18-50 at transplant. Outcomes included posttransplant low bone density (Z score < -2), osteoporotic fractures, and treatment data.

Results: Among 150 LTRs (45% female, mean age 38 ± 9 years), with a median follow-up of 6.2 years, 103 (69%) underwent bone density scans; 82 occurred within the first year posttransplant. Of these, 19 (23%) showed low bone density within the first year. Posttransplant osteoporotic fractures occurred in 34 patients (23%), including femoral neck (32%) and vertebral fractures (29%) as first events. Eleven patients (32%) experienced multiple fractures. Pretransplant fracture history significantly predicted posttransplant fractures (HR 6.720, 95% CI: 1.572-28.724). Osteoporosis treatment was given to 41 patients (27%), primarily with bisphosphonates (93% as first line). Of those treated, 49% remained fracture free during follow-up.

Conclusion: Young LTRs face high rates of low bone density and fractures, including serious and recurrent fractures. These findings underscore the need for early screening and intervention to reduce osteoporosis-related morbidity in this vulnerable population.

Introduction: The physiological basis for dyspnea, a hallmark of post-COVID syndrome (PCS), remains poorly understood.

Methods: In this analysis of the prospective, multicenter, population-based, longitudinal COVIDOM study, we studied 936 previously healthy adults assessed ≥6 months after a mostly mild, PCR-confirmed SARS-CoV-2 infection. Participants underwent comprehensive pulmonary function testing including spirometry, body plethysmography, diffusing capacity for carbon monoxide, and airwave oscillometry. Dyspnea was assessed by questionnaires (mMRC ≥1/MDP-A1 domain ≥1). We performed cross-sectional and longitudinal analyses for lung function in relation to both dyspnea and a previously defined PCS severity score (PCS-S).

Results: Between 11/2020 and 05/2023, we examined 936 previously healthy COVIDOM participants (median age 37 [IQR 28-51], 56% female). Dyspnea prevalence increased significantly with PCS severity (low PCS-S: 19.3%; intermediate PCS-S: 53.8%; high PCS-S: 81.8%; p < 0.001). Women suffered more frequently from dyspnea and PCS. Small airway dysfunction (SAD), as indicated by abnormal R5-20 Hz or AX5 Hz measures, tended to be more frequent in participants with high PCS severity and dyspnea compared to those with low PCS and no dyspnea (37% vs. 25%, p = 0.058) with corresponding R5-20 Hz of 0.03 [0.01-0.07] vs. 0.01 [0-0.03] kPa·L-1·s-1 (p < 0.01). Longitudinally, however, none of the baseline or follow-up lung function parameters, including measures of SAD, differed between participants with persistent dyspnea and those who became asymptomatic.

Conclusion: Oscillometry-derived R5-R20 Hz differed significantly between dyspneic PCS patients and controls. The high frequency of SAD and the absence of longitudinal improvement might indicate the potential clinical relevance of SAD assessment, despite its only numeric differences between PCS severity groups.

Introduction: Shape-sensing robotic-assisted bronchoscopy (ssRAB) is a novel technique for the diagnosis of peripheral pulmonary lesions (PPLs). There are no prior studies who have assessed the learning curve using learning curve cumulative summation (LC-CUSUM) and cumulative summation (CUSUM) analyses with diagnostic yield (DY) as the main endpoint.

Methods: We performed a single-center analysis of the learning curve of ssRAB combined with cone beam computed tomography (CBCT) procedures for the diagnosis of PPL performed by two bronchoscopists experienced with 3D imaging-guided bronchoscopy techniques using (1) an LC-CUSUM followed by CUSUM analysis, (2) a CUSUM analysis, with strict DY as endpoint. We will compare these methods.

Results: A total of 131 patients with a median lesion size of 12 mm (9-18 mm) were navigated by two bronchoscopists. In the first method, the LC-CUSUM analysis indicated that both bronchoscopists were statistically declared proficient after 43 and 42 procedures, with subsequent CUSUM analysis confirming sustained performance thereafter. In the second method, CUSUM analysis revealed that both bronchoscopists were deemed in control during all procedures.

Conclusion: The CBCT-enhanced ssRAB performance of bronchoscopists experienced with CBCT-guided navigation bronchoscopy was in control from the start. LC-CUSUM and CUSUM are useful tools for assessing the learning curve and procedural performance. While CUSUM indicated that performance of the experienced bronchoscopists were in control from the start, LC-CUSUM inherently assumes initial non-proficiency leading to a larger number of procedures required to establish proficiency with statistical certainty. In the diagnosis of PPL, there will always be variability in performance, which may be attributable to patient-specific characteristics.