Respiration最新文献

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: 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.

Introduction: Cystic fibrosis (CF) is associated with a high respiratory symptom and treatment burden. Elexacaftor/tezacaftor/ivacaftor (ETI) provides substantial improvements in physiological outcomes such as respiratory function and sweat chloride. This study sought to comprehensively examine an area of limited research in this field: the lived experiences of adults with CF after ETI initiation.

Methods: Adults with CF completed semi-structured interviews at least 6 weeks following the initiation of ETI. Participants shared their experiences regarding respiratory-related symptoms, airway clearance routines, and their capacity to participate in physical activity. Interviews were audio-recorded, transcribed verbatim and analysed using the Framework Method.

Results: Seventeen participants completed interviews (FEV₁ range before ETI initiation 31 to 87 % predicted). All participants reported improvements in respiratory-related symptoms including cough, sputum expectoration, dyspnoea, and chest tightness. As a result, there was a reduction in participants airway clearance treatment burden and improvements in their capacity to participate in physical activity, health-related quality of life and outlook for the future. The overall theme highlighted in this study was that ETI had "completely changed everything" and they can now do "everything I wasn't able to do before" due to the reductions in symptom and treatment burden.

Conclusion: Participants consistently described their experiences with ETI in positive terms. The results of this study confirm that ETI is in fact perceived to be a "miracle drug" and has had a transformative effect on the everyday lives of adults with CF through improved HRQoL and overall wellbeing, which led to positive views regarding their future with CF and ongoing medical care.

Introduction: IAB-1 is the first-in-human study of the implantable artificial bronchus (IAB) in patients with severe emphysema. The IAB is a bronchoscopically delivered, self-expanding, tapered stent made of polyether ether ketone. By restoring the original airway and preventing expiratory collapse, it allows release of hyperinflated air. It is indifferent to collateral ventilation and disease distribution.

Methods: In a primary bronchoscopy, 1 or 2 IABs are implanted in the most diseased lobe. A secondary bronchoscopy at 30 days allows implantation of 1 or 2 additional IABs in another lobe. The primary endpoint, evaluated at 90 days, was safety, defined as any of 10 prespecified respiratory serious adverse device events (SADEs). Secondary endpoints included other related adverse events and multiple efficacy measures.

Results: Twenty patients were implanted with 53 IABs: 5 subjects formed the early termination set (ETS) because of SADEs; 15, the full analysis set (FAS), continued to the 90-day endpoint. All 5 ETS patients and 2 FAS patients experienced 4 of the 10 primary respiratory SADEs: pneumonia, airway injury, COPD exacerbation, and pneumothorax. The majority of patients improved clinically with statistically significant outcomes in all effectiveness variables (residual volume, six-minute walk distance, modified Medical Research Council, COPD Assessment Test, Saint George Respiratory Questionnaire, and EuroQual 5-Dimensional) with the exception of forced expiratory volume in 1 s.

Conclusion: IAB-1 demonstrated feasibility and a risk profile that improved during the trial by identifying and addressing the need for improved patient selection, implant site selection, implant technique, and delivery system improvements. The IAB may be desirable for emphysema patients who are ineligible for other interventional treatments and wish to avoid surgery.

Bronchoscopic ablation is a promising minimally invasive treatment for peripheral lung tumours, avoiding the high complications associated with percutaneous approaches. However, existing ablation catheters are mostly incompatible with ultrathin bronchoscope (UTB), potentially limiting access to subpleural lesions. We report a case of successful bronchoscopic ablation using a novel 1.4 mm radiofrequency (RF) catheter delivered through a UTB. A 53-year-old woman with oligometastatic gastroesophageal adenocarcinoma underwent bronchoscopic ablation for a 12 mm apical right upper lobe metastasis. The UTB was navigated to the 8th airway generation under direct bronchoscopic vision, and the flexible RF catheter was smoothly inserted through the UTB's 1.7 mm working channel. Real-time cone-beam CT confirmed accurate catheter positioning, ensuring safe ablation without pleural puncture. A total of 26 kJ of energy was delivered over 513 seconds. The patient recovered without complications and was discharged 48 hours post-procedure. The RF catheter's small diameter and high flexibility allow UTB to remain precise and manoeuvrable in the peripheral airway. As peripheral bronchoscopy evolves beyond diagnostics, integrating miniaturized therapeutic tools such as the 1.4mm RF catheter will be crucial in expanding its clinical utility. Further results from ongoing clinical trials are highly anticipated to validate the long-term feasibility and safety of this technique.

Background:  Airway fibrostenosis, a severe complication of tracheobronchial tuberculosis (TBTB), causes respiratory morbidity including atelectasis, pneumonia, and respiratory failure. Early risk prediction remains challenging due to the lack of validated assessment tools.

Methods:  This retrospective cohort study analyzed TBTB patients undergoing bronchoscopic interventions between January 2021 and June 2024 with 6-month follow-up. A Cox regression model was developed in all 305 patients, internally validated with 1,000 bootstrap resamples. Performance was evaluated via C-index, ROC-AUC, calibration, and decision curve analysis. Kaplan-Meier analysis was used to stratify groups, with log-rank tests assessing differences.

Results:  Airway fibrostenosis incidence was 60.33% (184/305). Eight independent predictors were identified: symptom duration, affected lung lobes, diabetes, multiple TBTB types, bronchoscopic intervention frequency, initial sputum acid-fast bacilli smear grade, neutrophil-to-lymphocyte ratio, and CD8+ T-cell count. The nomogram demonstrated strong discrimination (C-index 0.77, 95%CI 0.75-0.81) with increasing predictive accuracy over time: 6-week AUC 0.773 (0.708-0.838), 8-week 0.792 (0.740-0.844), 12-week 0.830 (0.782-0.878), and 16-week 0.883 (0.842-0.923). High-risk patients exhibited a significantly higher probability of developing airway fibrostenosis compared to low-risk patients (P<0.001). Calibration and decision curve analyses confirmed clinical utility.

Conclusions:  This validated nomogram effectively predicts airway fibrostenosis risk in TBTB patients, enabling early identification of high-risk individuals for targeted interventions.