Respiration最新文献

Introduction: Hematological conditions, mainly allogeneic hematopoietic cell transplantation (allo-HCT) and chronic lymphocytic leukemia (CLL), have known associations with bronchiectasis. However, data on these unique clinical entities remain limited. We aimed to evaluate the clinical characteristics and outcomes of patients with hematology-related bronchiectasis.

Methods: This retrospective study included patients with bronchiectasis following allo-HCT and CLL. Groups were matched and compared to a control group of bronchiectasis from non-hematological conditions (n = 126). Clinical variables, radiologic features, and disease outcomes were analyzed.

Results: Overall, 42 patients with bronchiectasis after allo-HCT (median age 59, 36% female) and 63 patients with bronchiectasis and CLL (median age 72, 40% female) were included. Both groups exhibited worse lung functions compared to the control. They had more isolations of Pseudomonas aeruginosa (PA) compared to the control group (21-31% vs. 9%) and less non-tuberculosis mycobacteria (3-5% vs. 21%). Allo-HCT and CLL patients also showed high rates of diffuse bronchiectasis distribution (38% and 40%), hypogammaglobulinemia (41% and 71%), and 1-year respiratory hospitalizations (50% and 54%). Only 26% of allo-HCT and 35% of CLL patients saw a pulmonologist, and only 14% performed routine airway clearance. Mortality was higher in both groups compared to controls. The key variables associated with mortality were bronchiolitis obliterans syndrome in the allo-HCT group (HR 11.1, 95% CI: 2.9-30.6) and PA isolation in the CLL group (HR 2.96, 95% CI: 1.3-6.8).

Conclusion: Hematology-related BE have distinct clinical and radiologic features with associated morbidity. These findings could help identify at-risk subgroups for early pulmonologist referral.

Background: Established structured weaning approaches, which are effective for patients in simple and difficult weaning, are often not appropriate for patients undergoing prolonged weaning. Addressing the complexity of weaning failure requires personalized precision medicine. The therapeutic concept of treatable traits (TTs) has been proposed as a new paradigm for the management of chronic respiratory diseases. It is based on a multidimensional assessment of specific characteristics, which can be addressed by specific interventions that go beyond traditional diagnostic criteria. The concept is increasingly adopted for other complex diseases.

Summary: This is a narrative review and an expert opinion on the development of a concept of TTs for patients undergoing prolonged weaning. The proposed TTs are based on a systematic review of risk factors for prolonged weaning, an analysis of claims data to assess risk factors within 96 h of IMV onset and data from the WEAN SAFE study. A multidisciplinary team identified clinically important TTs and determined appropriate interventions. The following TTs have been identified: airway disorders and complications associated with tracheostomy or intubation, such as airway obstruction, strictures or tracheomalacia, infectious aspects, anxiety, depression, delirium, post-traumatic stress disorder, anemia, pulmonary and cardio-renal disease. The multidimensional holistic approach also includes tailored sedation and pain management, nutritional therapy, early mobilization, and physiotherapy.

Key message: We propose a framework of relevant considerations for a multidimensional approach to the management of patients undergoing prolonged weaning that supports the regain of respiratory capacity, reduces the respiratory load, and thus could resolve the respiratory workload imbalance.

Introduction: Survivors of severe COVID-19 face complex challenges and a high degree of pulmonary sequelae. Therefore, we aim to describe their ongoing health burden.

Methods: In this single-center prospective cohort study, COVID-19 ICU survivors were invited 3 and 6 months after ICU discharge. We examined pulmonary function with pulmonary function tests (PFT) and cardiopulmonary exercise testing (CPET), and we established health-related quality of life (HRQL) and health status (HS) with the EuroQol five-dimension five-level (EQ-5D-5L), the short-form health survey 12 (SF-12), and the modified British Medical Research Council dyspnea scale (mMRC) questionnaires.

Results: Out of the 53 individuals screened, 23 participated in this study. Throughout both assessment points, participants maintained PFT results within range, apart from a decline in the transfer factor of the lung for carbon monoxide (TLCO). CPET showed improved fitness but persistent ventilatory deficiencies, indicated by altered dead space ventilation (VD/VT) and elevated arterial-alveoli gradient for oxygen (AaDO2). HRQL and HS remained compromised, with both physical (PCS) and mental component summary (MCS) scores significantly lower than the standardized norm population scores. Also, there was a rise in the prevalence of issues related to mobility, pain/discomfort, and anxiety/depression, and an increase in reported dyspnea.

Conclusion: These results enhance our comprehension of the complex difficulties faced by COVID-19 ICU survivors. Six months post-discharge, CPET revealed the presence of ventilatory insufficiencies. Additionally, there was a decline in HRQL and HS, notably affected by mental health concerns and an increase in the level of dyspnea.

Introduction: Currently, there is a lack of bronchoscopic lung volume reduction options that do not depend on fissure integrity. Endobronchial coils have been extensively studied to address this need but exhibited variable patient response and have been discontinued. Lung tension device (LTD) coils represent the next-generation coil treatment. This study aimed to evaluate safety, feasibility, and efficacy of LTD-coil treatment.

Methods: Patients with advanced emphysema and hyperinflation were enrolled at two European sites. LTD-coils (Free Flow Medical, Fremont, CA, USA) were implanted in the two most destructed lobes, as determined by quantitative CT analysis, in two separate procedures. The primary endpoint was 3-month follow-up after the last treatment.

Results: Fourteen patients (50% male, median age 64 years, FEV1 23%predicted, RV 249%predicted) received LTD-coil treatment: 12 received bilateral and 2 unilateral treatment. Six serious respiratory adverse events occurred within the initial 3 months posttreatment, including one device-associated death. Treatment significantly reduced in- and expiratory volume of the treated lobes (-410 [-710, -340], p = 0.004 and -650 [-730, -190] mL, p < 0.001, respectively) and improved quality of life (SGRQ total score -4.6 [-21.0, -2.6], p < 0.001). However, at a group level, no significant improvements in pulmonary function or 6-min walk distance were observed. Responder rates ranged from 18% to 54% for the different endpoints.

Conclusion: This first-in-human study shows that the new LTD-coil procedure is feasible with a safety profile comparable to the previous coil treatment. While the treatment effectively reduced lobar volume and modestly improved quality of life up to 3 months' follow-up, at a group level it did not significantly enhance pulmonary function or exercise capacity.

Introduction: Elexacaftor/tezacaftor/ivacaftor (ETI) has shown significant improvements in pulmonary and nutritional status in persons with cystic fibrosis (pwCF). Less is known about the extrapulmonary impact of ETI and effects on airway microbiology, lung clearance index (LCI), and fraction of exhaled nitric oxide (FeNO).

Methods: This is a multicenter prospective observational trial, including 79 pwCF ≥18 years eligible for ETI. Assessments were done at the initiation of and 3 and 6 months into treatment with ETI. Outcomes included forced expiratory volume in 1 s (FEV1), LCI, FeNO, sputum or cough swab culture, body mass index (BMI), cystic fibrosis questionnaire-revised respiratory domain (CFQ-R RD), sinonasal outcome test-22 (SNOT-22), general anxiety disorder-7 (GAD-7), patient health questionnaire-9 (PHQ-9), fecal elastase-1 (FE-1), adherence to baseline therapies, exacerbation rate, and adverse events.

Results: Our cohort included 79 pwCF (31 ± 11(SD) years) with a baseline ppFEV1 of 68 ± 23. Forty-two (53%) pwCF were previously treated with a CFTR modulator. In the entire study group, there were significant improvements from baseline in ppFEV1, LCI, FeNO, annualized exacerbation rate, BMI, CFQ-R RD, and SNOT-22 (p < 0.05 for all). Airway culture positivity for methicillin-susceptible Staphylococcus aureus and Pseudomonas aeruginosa also decreased during the study period. There was no significant change in FE-1, GAD-7, or PHQ-9. Adherence to dornase alfa and hypertonic saline decreased.

Conclusion: ETI treatment led to significant improvements in respiratory and nutritional status, alongside a decrease in adherence to chronic supportive therapies. We did not observe any significant changes in exocrine pancreas function or in questionnaire scores for depression and anxiety.

German recommendations for the diagnosis of hypersensitivity pneumonitis (HP), also known as extrinsic allergic alveolitis, were last published in 2007. The current S2k Guideline for the Diagnosis and Treatment of Hypersensitivity Pneumonitis replaces these diagnostic recommendations. They were supplemented by the aspect of chronic, and in particular of the chronic fibrotic phenotype of HP, and also, as the first HP guideline, include treatment recommendations. Based on current scientific evidence and on expert opinion, 12 consensus recommendations were developed. They include important statements summarizing the diagnostic process, the treatment indication and therapeutic strategies for patients with HP. Particular emphasis was placed on the different clinical courses (acute and chronic) and their characteristics (inflammatory and/or fibrotic pattern), which present differential diagnostic challenges and ultimately result in different treatment approaches. In addition to general information (diagnosis, classification, clinical disease course, epidemiology, pathogenesis, risk factors, prognosis, and special aspects associated with occupational disease), the guideline will present the various clinical disease entities of HP, some in detail, others in tabular form. A major focus is on the various diagnostic steps and the different treatment approaches. The background information serves to provide a deeper understanding and inform the implementation of the recommendations. In particular, other current international guidelines for the diagnosis of HP as well as German guidelines for the diagnosis of interstitial lung diseases (ILDs) (Leitlinien zur Diagnostik interstitieller Lungenerkrankungen) in general and for the pharmacotherapy of fibrotic ILDs were integrated and considered in this guideline.

Introduction: People with post-COVID-19 condition (PCC) suffer from a wide range of symptoms, including anxiety. Studies have already shown that cranial electrotherapy stimulation (CES) has a positive effect on anxiety in anxious people. This randomised, controlled, double-blind, single-centre pilot study aimed to investigate the effects of CES as an adjunctive therapy during rehabilitation on anxiety symptoms in people with PCC.

Methods: Adults with PCC were randomised to an intervention group with rehabilitation and CES (100 μA) or a control group with rehabilitation and sham stimulation. CES was applied via electrodes to the earlobes for 60 min daily for 3 weeks. The Beck Anxiety Inventory (BAI) score was collected at baseline and at discharge.

Results: Forty people with PCC completed the trial. We found that both groups with (n = 20) and without CES (n = 20) improved significantly in terms of change in the BAI score (CES_group: p = 0.037; sham_group: p = 0.018), with no difference between groups (p = 0.82). In a subgroup analysis of anxious patients only (BAI: ≥16 points, baseline score), both groups (CES_anxious: n = 10, sham_anxious: n = 10) significantly improved the BAI score (CES_anxious: p = 0.008; sham_anxious: p = 0.002) with no difference between groups (p = 0.69).

Conclusion: This study suggests that CES had no additional benefit on anxiety symptoms during rehabilitation in people with PCC.

Introduction: Non-vitamin K antagonist oral anticoagulants (NOACs) increase the risk of bleeding during invasive procedures such as bronchoscopy. To mitigate this risk, NOACs are typically held before bronchoscopy. Current guidelines for discontinuing NOACs are based on drug half-lives and recommendations from similar invasive procedures. This study aimed to evaluate the safety of our local protocols for pausing NOAC therapy prior to bronchoscopy.

Methods: We performed a retrospective review of patients treated with NOACs who underwent bronchoscopy with invasive sampling in 2023. We adhered to local guidelines for NOAC discontinuation before procedures with a high bleeding risk. We documented bleeding incidents during bronchoscopy and any potential thromboembolic events, comparing these outcomes with a control group of 75 patients on acetylsalicylic acid (ASA) and 77 patients not on any anticoagulant (ACT) or antiplatelet (APT) therapy.

Results: Out of 1,300 patients who had bronchoscopy in 2023, 100 were on NOACs (48 on rivaroxaban, 36 on apixaban, 12 on dabigatran, and 4 on edoxaban). We further analyzed 75 patients who had invasive sampling: transbronchial biopsy in 49; bronchial biopsy in 12; EBUS-guided transbronchial needle aspiration in 42; and conventional TBNA in 18. Mild to moderate bleeding occurred in 9 of these 75 patients (12%) receiving NOACs, compared to 11 of 75 patients (14.7%) on ASA and 7 of 77 patients (9.1%) without ACT or APT therapy. Bleeding was observed in patients with either lung cancer (n = 16) or interstitial lung disease (n = 10), with one exception. There was no significant association between bleeding and factors such as age, platelet count, or INR levels. No severe bleeding or thromboembolic events were reported in any of the groups.

Conclusion: Following local recommendations for NOAC discontinuation before bronchoscopy is effective in minimizing complications and ensuring patient safety during invasive procedures.

Introduction: The objective of this study was to compare the diagnostic performance of ultrasonography (US) and chest radiography for detecting pneumothorax in patients with trauma using a meta-analytic approach.

Methods: PubMed, Embase, and the Cochrane Library were systematically searched to identify eligible studies until March 2023. The diagnostic performance of US and chest radiography was assessed using sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic score, diagnostic odds ratio (DOR), and area under the receiver operating characteristic curve (AUC).

Results: Overall, 21 studies involving 4,087 patients with trauma were included. The overall sensitivity, specificity, PLR, NLR, diagnostic score, DOR, and AUC of US for detecting pneumothorax were 0.83, 0.99, 73.72, 0.17, 6.06, 427.80, and 0.99, respectively. The corresponding values of chest radiography for detecting pneumothorax were 0.37, 1.00, 175.59, 0.63, 5.63, 279.97, and 0.86. US was associated with a higher sensitivity (ratio: 2.24; 95% confidence interval [CI]: 1.70-2.95; p < 0.001) or AUC (ratio: 1.15; 95% CI: 1.11-1.19; p < 0.001) and lower NLR (ratio: 0.27; 95% CI: 0.17-0.43; p < 0.001) compared with chest radiography.

Conclusion: Lung US was associated with better diagnostic performance than chest radiography for detecting pneumothorax in patients with trauma.

Introduction: The objective of this study was to compare the diagnostic performance of ultrasonography (US) and chest radiography for detecting pneumothorax in patients with trauma using a meta-analytic approach.

Methods: PubMed, Embase, and the Cochrane Library were systematically searched to identify eligible studies until March 2023. The diagnostic performance of US and chest radiography was assessed using sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic score, diagnostic odds ratio (DOR), and area under the receiver operating characteristic curve (AUC).

Results: Overall, 21 studies involving 4,087 patients with trauma were included. The overall sensitivity, specificity, PLR, NLR, diagnostic score, DOR, and AUC of US for detecting pneumothorax were 0.83, 0.99, 73.72, 0.17, 6.06, 427.80, and 0.99, respectively. The corresponding values of chest radiography for detecting pneumothorax were 0.37, 1.00, 175.59, 0.63, 5.63, 279.97, and 0.86. US was associated with a higher sensitivity (ratio: 2.24; 95% confidence interval [CI]: 1.70-2.95; p < 0.001) or AUC (ratio: 1.15; 95% CI: 1.11-1.19; p < 0.001) and lower NLR (ratio: 0.27; 95% CI: 0.17-0.43; p < 0.001) compared with chest radiography.

Conclusion: Lung US was associated with better diagnostic performance than chest radiography for detecting pneumothorax in patients with trauma.