Respiration最新文献

Introduction: Talc pleurodesis is a widely used intervention for recurrent pneumothorax and pleural effusion, particularly in nonsurgical candidates. However, some patients experience immediate failure or recurrence and require additional intervention. The safety and effectiveness of repeated talc administration remain unclear. This study investigated repeat-dose talc pleurodesis to determine its safety and efficacy in the management of initial failures and recurrence.

Methods: This retrospective study (January 2019-September 2024) analyzed hospitalized patients undergoing talc slurry pleurodesis. Data included demographics, comorbidities, indication, and number of talc doses for successful pleurodesis. The primary outcome was pleurodesis success after repeat dosing. Analyses used chi-square tests, Cox regression for recurrence risk, and Kaplan-Meier estimates for recurrence-free survival.

Results: Among 103 patients who underwent bedside talc slurry pleurodesis for pneumothorax (n = 70) or pleural effusion (n = 33), 80 (77.7%) achieved successful pleurodesis with a single 4 g dose (pneumothorax = 56; effusion = 24). Of the 23 patients with immediate pleurodesis failure, 16 (69.6%) achieved success following repeat-dose pleurodesis (pneumothorax = 7; effusion = 9), while 7 required alternative interventions. Recurrence after discharge occurred in 17 (21.3%) of the single-dose group (pneumothorax = 11; effusion = 6) compared with 1 (6.3%) in the repeat-dose group. Among 18 recurrence cases overall, 9 underwent repeat pleurodesis, with 8 (88.9%) achieving success.

Conclusion: Repeat-dose talc pleurodesis may represent a reasonable management approach for patients experiencing immediate failure or recurrence after an initial successful pleurodesis with minimal complications. Further research is needed to optimize protocols and improve outcomes for patients undergoing pleurodesis.

Introduction: Small airways dysfunction (SAD) is increasingly recognized as an early marker of respiratory disease. Recent cohort studies have reported wide variability in SAD prevalence across countries, suggesting a possible role of air pollution as a contributing factor. This study aimed to assess SAD prevalence in a general population from rural Switzerland, compare it to existing cohorts, and identify associated factors.

Methods: We analysed data from the Swiss Longitudinal Cohort Study (SWICOS), conducted in two neighbouring rural villages in Southern Switzerland (Cama and Lostallo). All participants underwent spirometry, with SAD defined as a maximal mid expiratory flow below the lower limit of normal. Air pollution data were obtained from official monitoring stations located within 10 km of the study site.

Results: The study included 423 participants (mean age 50.4 ± 16.3 years; 43.7% male). SAD prevalence was 2.60% (95% CI: 1.46-4.60), significantly associated with active smoking but not with age, BMI, or respiratory symptoms. Exposure to particulate matter was lower than in other international cohorts.

Conclusion: In this rural Swiss population study, SAD prevalence was slightly lower than in the Swiss urban cohort and markedly lower than in other recent studies, which involved populations exposed to higher levels of air pollution. These findings support growing evidence that air pollution exposure may contribute to early small airways impairment.

Introduction: Atrial fibrillation (AF) and obstructive sleep apnea syndrome (OSAS) manifest differently in men and women, which may influence treatment decisions and adherence. The aim of our study was to investigate clinical, polysomnographic, and biological characteristics of AF-OSAS patients and to compare gender differences in this specific population.

Methods: In a prospective single center study, the authors analyzed a population of consecutive patients with AF (paroxysmal or persistent). Anthropometric measurements, clinical and polysomnographic parameters were collected and evaluated. Soluble ST2, a serum biomarker of myocardial fibrosis, was measured.

Results: The study included 89 consecutive participants with AF, 67% were male (n = 60), with a mean age of 63 years (31-76 years), and mean body mass index (BMI) of 30 kg/m2. All patients had an apnea-hypopnea index (AHI) ≥5 events/hour. No significant differences were observed between men and women regarding BMI, hypersomnolence or snoring. Women had a lower arousal threshold (p = 0.04), lower hypoxic burden (p = 0.03), and lower ventilatory burden (p = 0.006), whereas men had elevated ST2 serum levels (p = 0.02) and a higher AHI (p = 0.01).

Conclusion: This study highlights the importance of systematically evaluating patients with atrial fibrillation for obstructive sleep apnea, due to its high prevalence, even in the absence of classic symptoms. The observed gender differences in clinical, laboratory, and polysomnographic parameters among AF patients emphasize the need for personalized diagnostic and management approaches.

Background: Pulmonary toxicity is a possible adverse event (AE) of all systemic treatments for lung cancer. Drug-induced parenchymal and interstitial lung disease (D-ILD) is a rare but potentially life-threatening pulmonary AE. Its clinical and radiological manifestations are highly variable and nonspecific, making recognition and diagnosis particularly challenging.

Summary: Effective management of D-ILD requires a high degree of clinical suspicion, supported by education of both patients and healthcare providers. Any lung cancer patient who develops new respiratory symptoms and/or new radiographic abnormalities should be promptly evaluated for possible D-ILD. However, the differential diagnosis is broad, including both infectious and noninfectious etiologies. Clinical, laboratory, microbial, and imaging findings should be incorporated to adjudicate the possibility of D-ILD. Given the absence of a definitive diagnostic test, D-ILD remains a complex diagnosis of exclusion that benefits from a multidisciplinary approach. Pulmonologists play an active role in an integrated diagnostic work-up and management of D-ILD, and they should therefore remain actively engaged in this clinically relevant subject.

Key messages: This review discusses the incidence, risk factors, clinical and radiographic features, and management strategies for D-ILD in the context of current systemic treatments for lung cancer. A practical framework for differential diagnosis is also provided to support clinical decision-making.

Introduction: Pneumocystis jirovecii pneumonia (PJP) is a significant cause of morbidity and mortality in children with advanced HIV disease (AHD) and other immunosuppressive conditions. Acquired tracheal stenosis in children living with HIV (CLHIV) has not been described.

Case presentation: A 4-month and 3-week-old child living with HIV presented with persistent respiratory symptoms after mechanical ventilation for 10 days for confirmed PJP and cytomegalovirus (CMV) pneumonia at the age of 3 months and 1 week. She tested positive for HIV at 3 months of age and had a high viral load of log 2.7 copies/mL. She was re-admitted to the PICU with multilobar pneumonia, requiring non-invasive ventilation with metapneumovirus identified from nasopharyngeal aspirate. Persistent wheeze and stridor were noted. During hospitalization, the mother was diagnosed with confirmed tuberculosis (TB). The child was referred for bronchoscopy due to the possibility of pulmonary TB and airway compression. A chest CT scan revealed short segment tracheal stenosis of >50% but no signs of TB as a possible cause. Bronchoscopy demonstrated significant narrowing occurring in the midtracheal region with the acquired nature configuration. The stenosis was successfully dilated twice, first with rigid bronchoscopy, followed by dilatation with flexible bronchoscopy and an angioplasty balloon.

Conclusion: Acquired tracheal stenosis in CLHIV is not well documented, although many young children with HIV infection have been ventilated for severe pneumonia. Bronchoscopy should be considered in children with persistent respiratory symptoms, and endoscopic procedures can be safely performed in immunosuppressed children.

Introduction: Shape-sensing robotic-assisted bronchoscopy (ssRAB) was shown to be superior in diagnosing peripheral pulmonary nodules (PPNs) compared to conventional bronchoscopy. Although RAB is established in the USA since 2019, the ION™ Endoluminal System was not CE marked in Europe until 2023.

Methods: The first prospective European single-center, premarket study, conducted between 2022 and 2023, assessed the diagnosis of PPNs with ssRAB, using the ION™ Endoluminal System. Patients with suspected lung cancer or metastasis, PPNs of 1-3 cm, and ≥3 airway generations out were included in this study and followed up for up to 6 months. The primary outcome was the rate of tool-in-lesion (TIL), confirmed by mobile cone-beam computed tomography or with malignant index biopsy finding. Secondary outcomes included procedural characteristics, diagnostic yield, and adverse events.

Results: A total of 43 patients with a mean nodule size of 19.2 × 16.9 × 15.8 mm, a mean distance of 17.4 ± 15.5 mm to the pleura, and mean 6.6th generation of airway were analyzed. TIL was achieved in 90.7% of all cases. Strict diagnostic yield was 67.4% and sensitivity for malignancy was 78.6%. No pneumothorax and no adverse events were reported outside of 3 cases of Nashville ≤2 bleeding. Predictors for successful diagnosis were the inner or middle third location (OR: 4.19, p = 0.039), CT bronchus sign (OR: 4, p = 0.044), and distance from pleural wall (OR: 1.05, p = 0.048). The lower lobe location (OR: 0.06, p < 0.001) was associated with nondiagnostic cases.

Conclusion: The first European cases show ssRAB is a safe procedure with promising results for enabling diagnosis of PPNs.

Introduction: Drug-induced interstitial lung disease (DILD) involves different pathogenic mechanisms, and it is difficult for clinicians to identify the culprit drug. There is currently no systematic research that allows us to understand the comprehensive situation of potential risk drugs and culprit drugs for DILD.

Methods: This study retrospectively analyzed all adverse events related to DILD in FAERS, compiled a list of potential risk drugs leading to DILD and calculated the reporting ratio. In addition, all drugs within the list were detected using disproportionality analysis, a list of culprit drugs was developed based on the signal detection results, and the signal distribution characteristics were summarized.

Results: We obtained 108,891 DILD-related reports and identified 1,445 potential risk drugs from them. Overall, the drug with the highest number of reports was methotrexate, followed by amiodarone, nivolumab, pembrolizumab, and rituximab. Classifying all potential risk drugs (second-level ATC subgroup), the subgroup with the highest number of reports is antineoplastic agents. Finally, we determined the list of culprit drugs, and 171 drugs showed positive signals by signal detection, while the other 1,274 drugs were determined to be negative, with amiodarone obtaining the highest number of positive signals. All the culprit drugs were classified and distributed them positively and negatively. The number of drugs with positive signals is less than that with negative signals, and antineoplastic agents (L01) have the highest proportion among all positive drugs.

Conclusion: This study comprehensively displays all drugs related to DILD from a landscape perspective, promoting the rational use of drugs in clinical practice.

Introduction: The aim of our study was to identify routine serum biomarkers that may be related to alpha-1 antitrypsin deficiency lung disease phenotypes and severity.

Method: Observational, cross-sectional, multicentre study conducted in patients with a Pi*ZZ genotype. Serum biomarkers, including neutrophil/lymphocyte ratio (NLR), eosinophil/lymphocyte ratio (ELR) and platelet/lymphocyte ratio (PLR), were calculated. Data were analysed to establish possible associations between biomarkers and lung function and lung phenotypes.

Results: Among the 897 patients included, 48.4% were men with a mean age of 53.9 (standard deviation 14.7) years. Patients with chronic obstructive pulmonary disease (COPD) (n = 337) had higher haemoglobin levels (15.3 mg/dL vs. 13.9 mg/dL, p < 0.001), gamma-glutamyl transferase (GGT) (50.1 IU/L vs. 35.7 IU/L, p < 0.001), eosinophils (0.22 109/L vs. 0.19 109/L, p < 0.001), NRL (2.55 vs. 1.86), PLR (132.6 vs. 119.8), and ELR (0.12 vs. 0.1) compared to those without COPD. In multivariate analysis, older age, male sex, higher haematocrit, elevated alanine transaminase and GGT levels, and a higher NRL and PLR were associated with a worse forced expiratory volume in the first second (FEV1) (%). A higher Charlson score, elevated haematocrit and white cell count, as well as increased levels of AAT, aspartate aminotransferase (AST), GGT, and PLR were associated with worse carbon monoxide transfer coefficient (KCO) (%). Exacerbations were associated with female sex, and a higher PLR.

Conclusion: Some blood biomarkers are increased in patients worse lung function. However, the correlations between these biomarkers and the different measures of lung function are weak, and thus, identifying a single routine biomarker that accurately predicts disease severity and progression is challenging.

Introduction: Previous studies yielded inconsistent results regarding whether bronchoscopic lung volume reduction using endobronchial valves (EBVs) improves pulmonary ventilation. The aim of this study was to evaluate changes in ventilation following EBV treatment using a novel technique for assessing specific pulmonary ventilation: X-ray velocimetry (XV LVAS, 4DMedical, Los Angeles, CA, USA).

Methods: Pulmonary ventilation was assessed using XV pretreatment and 6 weeks after treatment. The main outcome was mean specific ventilation (MSV) (mL/mL) which is defined as the volume change in a lung region (from start to end of inspiration), divided by the volume of that region at the start of inspiration.

Results: Nineteen patients were included (79% female, mean FEV₁: 30% of predicted, median RV: 207 %pred). After EBV treatment, RV decreased significantly by 0.90 L (interquartile range: -1.2 to -0.67, p < 0.001). EBV treatment resulted in a significant increase in MSV of the whole lung. When stratifying by treated and non-treated lungs, a significant increase in MSV was found in the treated lung, while a significant decrease was found for the non-treated (contralateral) side. No significant associations were found between changes in X-ray velocimetry (XV) measurements and changes in clinical outcomes.

Conclusion: For the first time, XV was utilized to measure specific pulmonary ventilation before and after EBV treatment. Our results demonstrate an overall increase in pulmonary ventilation across the whole lung, driven by an increase in the treated lung, despite a decrease in the non-treated lung. No association was observed between changes in pulmonary ventilation and changes in clinical outcomes.

Introduction: Long-term home noninvasive ventilation (LTH-NIV) supports patients with chronic respiratory failure. The S3-NIV questionnaire is an easy and quick tool to evaluate outpatients initiated to home mechanical ventilation. The aim of our study was to translate and validate the Italian version of the S3-NIV questionnaire and test its internal consistency and factorial structure, providing with Italian cultural adaptation of the original S3-NIV questionnaire.

Methods: This is a prospective, national, observational, multicenter study enrolling consecutive outpatients accessing between December 2023 and June 2024 to a dedicated ambulatory for chronic respiratory failure requiring LTH-NIV for different underlying diseases (i.e., chronic obstructive pulmonary disease, neuromuscular disorders, obesity hypoventilation syndrome). Internal consistency was assessed using Cronbach's alpha.

Results: The translation and back-translation process from the English version was performed. A total of 228 out of 340 screened patients were enrolled Internal consistency of the total score was good (Cronbach's α coefficient of 0.84) as well as for the "respiratory symptoms" and the 'sleep and side effects' subdomains (0.82 and 0.74, respectively). Kaiser exploratory analysis confirmed good homogeneity: 0.85.

Conclusion: The S3-NIV questionnaire Italian translation and cultural adaptation has good global reliability and internal consistency. This tool has been confirmed to be a simple, quickly available, and easy-to-use tool for the outpatients' clinical assessment of stable patients with chronic respiratory failure initiated on LTH-NIV.