Respiration最新文献

Introduction: Gender disparities in long-term health-related quality of life (HRQOL) after pulmonary embolism (PE) are only rarely investigated. The present study aimed to explore gender disparities in HRQOL of patients with PE up to 4 years after hospital discharge.

Methods: Data from the German "Lungenembolie Augsburg (LEA)" cohort study were used. Baseline characteristics of adult hospitalized patients with PE were collected during their hospital stay. Participants completed postal questionnaires at 3 months, 6 months, and then yearly for 4 years after their PE. The Pulmonary Embolism Quality of Life Questionnaire (PEmb-QoL) and the European Quality of Life Questionnaire (EQ-5D-5L) were used to measure HRQOL. Multivariable linear mixed models were applied to determine the association between gender and HRQOL. Interaction effects between gender and various covariables were examined.

Results: In 569 participants (45% women, mean age 62.9 ± 14.5 years), significant interaction effects of gender with other covariables were found in most subscales of the PEmb-QoL and the EQ-5D-5L. Among patients without chronic obstructive pulmonary disease, women scored significantly worse in the subscales "limitations of activities of daily living" and "work-related problems." Among patients with obesity, women had significantly more limitations of activities of daily living than men. Among patients younger than 64 years, women had significantly more emotional complaints than men. The observed gender differences were restricted to the first 3 months after PE.

Conclusion: Gender disparities regarding HRQOL were observed in specific subgroups and mainly occurred in the first 3 months after PE.

Introduction: Chronic obstructive pulmonary disease (COPD) is the third cause of death in Spain. The ETHOS (NCT02465567) and IMPACT (NCT02164513) RCTs showed reduced exacerbations and all-cause mortality for single-inhaler triple therapy (SITT), but no studies have evaluated the potential impact on COPD outcomes of higher SITT adoption in Spain.

Methods: We used literature-based data on patient characteristics, incidence, COPD severity changes, treatment distributions/transitions, mortality, exacerbations, and medical costs, to inform a stochastic simulation of the Spanish COPD population for 2025-2034 under two scenarios: "status quo" and "increased SITT," in which higher SITT use is driven by airflow limitation, exacerbation history (as per 2025 GOLD report), and SITT replacing multiple-inhaler triple therapy. Additionally, we present results separately for the subset of patients that met the criteria for SITT use, referred to as "flagged population."

Results: In our 10-year simulation, increased SITT use in the flagged population could lead to 51,000 deaths avoided resulting in a 14.6% reduction in mortality rates and extended patient life by 1.2 years per COPD-flagged patient. Additionally, increased SITT use in the flagged population reduced severe and moderate exacerbations by 62,000 (an 11.5% reduction) and 366,000 (an 11.6% reduction), respectively, resulting in total medical savings of EUR 384 million.

Conclusion: Based on our simulation, increased use of SITT in the Spanish COPD population, consistent with the most recent 2025 GOLD report recommendations, could reduce mortality and exacerbations and their corresponding medical costs. Increasing SITT utilization in patients with COPD may constitute a long-term strategy with relevant clinical and economic benefits.

Introduction: Continuous positive airway pressure (CPAP) is the standard treatment for obstructive sleep apnea (OSA), yet diagnostic and treatment models have historically overlooked sex-specific responses. This study aimed to examine sex differences in changes in sleep-related symptoms, cognitive functions, and quality of life (QOL) following CPAP initiation in individuals with OSA.

Methods: A prospective repeated-measures study was conducted at a sleep clinic. Adults diagnosed with OSA (apnea-hypopnea index ≥5) were assessed at four time points after CPAP initiation. Outcomes measures included Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, Mini-Mental State Examination, Hospital Anxiety and Depression Scale, and QOL. Generalized estimating equations were used for longitudinal analysis.

Results: Of 121 participants, 15.7% were female (mean age: 50.8 years). CPAP adherence did not differ by sex. At baseline, women reported significantly poorer sleep quality and physical functions. Adjusted analyses revealed women exhibited poorer sleep quality (β = 3.23, p < 0.00001) but better cognitive function (β = 0.70, p = 0.025) compared to men after receiving CPAP treatment. When examining sex differences over time, women showed progressive improvements in sleep quality (β = -1.12, p = 0.001), depressive symptoms (β = -0.90, p = 0.004), and the physical domain of QOL (β = 0.49, p = 0.019) throughout the treatment period.

Conclusion: CPAP therapy significantly improved sleep quality, depressive symptoms, cognitive function, and physical well-being in female patients with OSA. Implementing sex-specific treatment and support strategies may strengthen patient engagement, improve adherence, and optimize therapeutic outcomes.

Introduction: Iriscope, a novel ultra-thin video probe designed to be inserted through the bronchoscope working channel enables direct visualization of peripheral lung lesions. However, its diagnostic value in comparison or in combination with established bronchoscopic guidance techniques remains unclear. This study aims to evaluate the added benefit of combining Iriscope with radial endobronchial ultrasonography (R-EBUS) compared to R-EBUS alone for the diagnosis of peripheral lung lesions sized 20-50 mm.

Methods: 81 patients were randomized into two groups: bronchoscopy guided by R-EBUS or bronchoscopy guided by both Iriscope and R-EBUS. Fluoroscopic guidance and forceps biopsy were used in both groups. In the combined group, the Iriscope was used first, followed by insertion of the ultrasound probe through the working channel for lesion visualization. Biopsies were taken in case of abnormal lesion visualized by R-EBUS. The primary outcome was diagnostic yield. Secondary outcomes included yield stratified by lesion size, presence of bronchus sign, and lesion visualization on fluoroscopy.

Results: The diagnostic yield was higher in the combined group (32/40, 80%) compared to R-EBUS alone (23/41, 55%, p = 0.036). The improved yield in the combined approach was consistent regardless of lesion size, bronchus sign presence, or fluoroscopic visualization.

Conclusion: Combining Iriscope with R-EBUS significantly improves diagnostic yield compared to R-EBUS alone in patients with peripheral lung lesions sized 20-50 mm.

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.