A French national survey showed that 1447 children were treated with long-term continuous positive airway pressure (CPAP) or noninvasive ventilation (NIV) in 2019. Data about the ventilatory settings for children are scarce. The aim of the study was to report the CPAP/NIV settings from the survey according to the patients’ age and disorders.
Methods
CPAP and NIV settings were compared between 5 age groups (<1, 1–5, 6–11, 12–17 and ≥ 18 years), and 6 disease categories (upper airway disorders; neuromuscular disease, NMD; disorder of the central nervous system; cardiorespiratory disorder; congenital bone disease, CBD; and other).
Results
Age correlated positively with constant CPAP pressure (r = 0.364, p < 0.0001), and negatively with CPAP adherence (r = −0.173, p < 0.0001). Mean age at CPAP initiation, CPAP pressures and adherence did not differ between disorders. Regarding NIV, mean inspiratory positive airway pressure (IPAP) increased with age (r = 0.152, p = 0.0001), whereas respiratory rate (RR; r = −0.593, p < 0.0001) and adherence to NIV decreased with age (r = −0.154, p = 0.0002). NIV settings were quite similar between disease categories, with the CBD group having the highest IPAP, and NMD group having the lowest expiratory positive airway pressure and RR. Adherence tended to be higher with NIV than CPAP.
Conclusions
CPAP pressure and IPAP increase with age, while settings seem quite similar between diseases. Even if our study provides some information about CPAP/NIV settings, they should always be individually adapted according to the severity of the disease.
{"title":"Home noninvasive ventilation in pediatric patients: Does one size fit all?","authors":"Sonia Khirani , Lucie Griffon , Alessandro Amaddeo , Florent Baudin , Priscille Bierme , Jessica Taytard , Nathalie Stremler , Melisande Baravalle-Einaudi , Julie Mazenq , Iulia Ioan , Cyril Schweitzer , Marie-Emilie Lampin , Alexandra Binoche , Clémence Mordacq , Jean Bergounioux , Blaise Mbieleu , Robert Rubinsztajn , Elodie Sigur , Géraldine Labouret , Arnaud Bécourt , Brigitte Fauroux","doi":"10.1016/j.rmed.2025.107983","DOIUrl":"10.1016/j.rmed.2025.107983","url":null,"abstract":"<div><h3>Background</h3><div>A French national survey showed that 1447 children were treated with long-term continuous positive airway pressure (CPAP) or noninvasive ventilation (NIV) in 2019. Data about the ventilatory settings for children are scarce. The aim of the study was to report the CPAP/NIV settings from the survey according to the patients’ age and disorders.</div></div><div><h3>Methods</h3><div>CPAP and NIV settings were compared between 5 age groups (<1, 1–5, 6–11, 12–17 and ≥ 18 years), and 6 disease categories (upper airway disorders; neuromuscular disease, NMD; disorder of the central nervous system; cardiorespiratory disorder; congenital bone disease, CBD; and other).</div></div><div><h3>Results</h3><div>Age correlated positively with constant CPAP pressure (r = 0.364, p < 0.0001), and negatively with CPAP adherence (r = −0.173, p < 0.0001). Mean age at CPAP initiation, CPAP pressures and adherence did not differ between disorders. Regarding NIV, mean inspiratory positive airway pressure (IPAP) increased with age (r = 0.152, p = 0.0001), whereas respiratory rate (RR; r = −0.593, p < 0.0001) and adherence to NIV decreased with age (r = −0.154, p = 0.0002). NIV settings were quite similar between disease categories, with the CBD group having the highest IPAP, and NMD group having the lowest expiratory positive airway pressure and RR. Adherence tended to be higher with NIV than CPAP.</div></div><div><h3>Conclusions</h3><div>CPAP pressure and IPAP increase with age, while settings seem quite similar between diseases. Even if our study provides some information about CPAP/NIV settings, they should always be individually adapted according to the severity of the disease.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"238 ","pages":"Article 107983"},"PeriodicalIF":3.5,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143348825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Idiopathic pleuroparenchymal fibroelastosis (iPPFE) is a distinctive chronic interstitial lung disease characterized by upper lobe-dominant elastofibrosis. Deepening of the suprasternal notch is a notable physical feature in patients with iPPFE. However, the anatomical explanation and clinical significance of iPPFE have not yet been studied in detail.
Methods
We retrospectively examined 84 patients with iPPFE, 59 with idiopathic pulmonary fibrosis (IPF), 32 with chronic hypersensitivity pneumonitis (CHP), and 91 non-interstitial lung disease (ILD) controls. The depth of the suprasternal notch assessed on axial chest computed tomography and its association with clinical, radiological, and physiological parameters, and patient outcomes were investigated.
Results
The depth of the suprasternal notch was anatomically correlated with the thickness of the pre-tracheal soft tissue and posterior or right deviation of the trachea in patients with iPPFE. The depth of the suprasternal notch effectively discriminated patients with iPPFE from those with IPF (sensitivity, 75 %; specificity, 86.4 %), CHP (sensitivity, 75 %; specificity, 84.4 %), and non-ILD controls (sensitivity, 75 %; specificity, 83.5 %), with a cutoff value of 9.5 mm. A log-rank test showed that patients with iPPFE with a deep suprasternal notch had significantly shorter survival than those without a deep suprasternal notch. In addition, a multivariate Cox regression analysis adjusted for age, sex, and %forced vital capacity showed that the depth of the suprasternal notch was an independent risk factor for mortality.
Conclusion
The suprasternal notch is a simple and useful indicator with diagnostic and prognostic implications for patients with iPPFE.
{"title":"Diagnostic and prognostic implications of a deep suprasternal notch in idiopathic pleuroparenchymal fibroelastosis","authors":"Yoshiaki Kinoshita, Chiharu Hirai, Keita Hara, Shota Takenaka, Takuhide Utsunomiya, Yuji Yoshida, Shota Nakashima, Hisako Kushima, Hiroshi Ishii","doi":"10.1016/j.rmed.2025.107986","DOIUrl":"10.1016/j.rmed.2025.107986","url":null,"abstract":"<div><h3>Background</h3><div>Idiopathic pleuroparenchymal fibroelastosis (iPPFE) is a distinctive chronic interstitial lung disease characterized by upper lobe-dominant elastofibrosis. Deepening of the suprasternal notch is a notable physical feature in patients with iPPFE. However, the anatomical explanation and clinical significance of iPPFE have not yet been studied in detail.</div></div><div><h3>Methods</h3><div>We retrospectively examined 84 patients with iPPFE, 59 with idiopathic pulmonary fibrosis (IPF), 32 with chronic hypersensitivity pneumonitis (CHP), and 91 non-interstitial lung disease (ILD) controls. The depth of the suprasternal notch assessed on axial chest computed tomography and its association with clinical, radiological, and physiological parameters, and patient outcomes were investigated.</div></div><div><h3>Results</h3><div>The depth of the suprasternal notch was anatomically correlated with the thickness of the pre-tracheal soft tissue and posterior or right deviation of the trachea in patients with iPPFE. The depth of the suprasternal notch effectively discriminated patients with iPPFE from those with IPF (sensitivity, 75 %; specificity, 86.4 %), CHP (sensitivity, 75 %; specificity, 84.4 %), and non-ILD controls (sensitivity, 75 %; specificity, 83.5 %), with a cutoff value of 9.5 mm. A log-rank test showed that patients with iPPFE with a deep suprasternal notch had significantly shorter survival than those without a deep suprasternal notch. In addition, a multivariate Cox regression analysis adjusted for age, sex, and %forced vital capacity showed that the depth of the suprasternal notch was an independent risk factor for mortality.</div></div><div><h3>Conclusion</h3><div>The suprasternal notch is a simple and useful indicator with diagnostic and prognostic implications for patients with iPPFE.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"238 ","pages":"Article 107986"},"PeriodicalIF":3.5,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143348826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.rmed.2024.107923
Zehua Yang , Yamei Zheng , Jie Zhao , Yi Zhong , Lei Zhang , Haihong Wu , Tian Xie , Yipeng Ding
Background
Chronic obstructive pulmonary disease (COPD) is characterized by persistent respiratory symptoms and airflow limitation. Interleukin-13 (IL13), associated with T-helper type 2 cells, plays a crucial role in COPD pathophysiology. This study aimed to investigate the relationship of single nucleotide polymorphisms (SNPs) in IL13 to COPD risk.
Methods
Five candidate SNPs of IL13 were genotyped using MassARRAY iPLEX platform in a cohort of472 COPD patients and 472 healthy controls. Logistic regression analysis was used to calculate odds ratios (ORs) and 95 % confidence intervals (CIs). Additionally, Multifactor dimensionality reduction (MDR) software was utilized to assess the combined impact of SNP-SNP interactions on COPD risk.
Results
IL13 rs20541 (OR: 1.24, p: 0.028), rs1295685 (OR: 1.31, p: 0.006), rs848 (OR: 1.27, p: 0.016), and rs847 (OR: 1.30, p: 0.007) were associated with COPD risk. Moreover, IL13 variants were related to the increased COPD risk in females, individuals aged ≥68 year, non-smokers or non-drinkers. The optimal multi-locus model was identified as the combination of rs20541 and rs1295685.
Conclusion
Our findings indicated the association between IL13 variants and an elevated risk of developing COPD, especially rs1295685 and rs847. These findings could have implications for understanding the role of IL13 variants in COPD predisposition.
{"title":"Impact of IL13 genetic polymorphisms on COPD susceptibility in the Chinese Han population","authors":"Zehua Yang , Yamei Zheng , Jie Zhao , Yi Zhong , Lei Zhang , Haihong Wu , Tian Xie , Yipeng Ding","doi":"10.1016/j.rmed.2024.107923","DOIUrl":"10.1016/j.rmed.2024.107923","url":null,"abstract":"<div><h3>Background</h3><div>Chronic obstructive pulmonary disease (COPD) is characterized by persistent respiratory symptoms and airflow limitation. Interleukin-13 (<em>IL13</em>), associated with T-helper type 2 cells, plays a crucial role in COPD pathophysiology. This study aimed to investigate the relationship of single nucleotide polymorphisms (SNPs) in <em>IL13</em> to COPD risk.</div></div><div><h3>Methods</h3><div>Five candidate SNPs of <em>IL13</em> were genotyped using MassARRAY iPLEX platform in a cohort of472 COPD patients and 472 healthy controls. Logistic regression analysis was used to calculate odds ratios (ORs) and 95 % confidence intervals (CIs). Additionally, Multifactor dimensionality reduction (MDR) software was utilized to assess the combined impact of SNP-SNP interactions on COPD risk.</div></div><div><h3>Results</h3><div><em>IL13</em> rs20541 (OR: 1.24, <em>p</em>: 0.028), rs1295685 (OR: 1.31, <em>p</em>: 0.006), rs848 (OR: 1.27, <em>p</em>: 0.016), and rs847 (OR: 1.30, <em>p</em>: 0.007) were associated with COPD risk. Moreover, <em>IL13</em> variants were related to the increased COPD risk in females, individuals aged ≥68 year, non-smokers or non-drinkers. The optimal multi-locus model was identified as the combination of rs20541 and rs1295685.</div></div><div><h3>Conclusion</h3><div>Our findings indicated the association between <em>IL13</em> variants and an elevated risk of developing COPD, especially rs1295685 and rs847. These findings could have implications for understanding the role of <em>IL13</em> variants in COPD predisposition.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"237 ","pages":"Article 107923"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142903420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.rmed.2025.107945
Liliane Patrícia de Souza Mendes , Verônica Franco Parreira , Bianca Carmona Rocha , Lissa M. Spencer , Marcelo Velloso , Jennifer A. Alison
Background
The Glittre-ADL test is a comprehensive test to evaluate functional capacity in patients with chronic obstructive pulmonary disease (COPD).
Aim
The primary aim was to validate the Glittre-ADL test with and without the backpack performed in three laps as an alternative to five laps in people with COPD.
Methods
Forty-eight participants with mild to severe COPD (mean ± SD age: 71 ± 7 years; FEV1: 46 ± 17 %predicted) were recruited and performed two 6-min walk tests (visit 1); two Glittre-ADL tests with backpack (visit 2), and the Glittre-ADL test with and without the backpack, in random order (visit 3).
Results
The Glittre-ADL tests were performed in five laps and symptoms, heart rate and oxygen saturation were recorded for three and five laps. The Glittre-ADL test performed in three laps provoked the same oxygen desaturation [mean ± SD oxygen saturation (SpO2): 90 ± 6 vs 90 ± 6, p = 0.249] and rate of perceived exertion (RPE) [RPE legs: 2.91 ± 2.23 vs 3.08 ± 2.56, p = 0.380; RPE arms: 1.91 ± 1.77 vs 2.16 ± 1.92, p = 0.306] to the Glittre-ADL test performed in five laps for both Glittre with the backpack and without the backpack SpO2 [mean ± SD: 90 ± 6 vs 90 ± 7, p = 0.249], and RPE [legs: 3.02 ± 2.28 vs 3.25 ± 2.37, p = 0.380; arms: 2.13 ± 1.91 vs 2.03 ± 1.84, p = 0.306]. The heart rate and dyspnoea were significantly lower for both Glittre-ADL tests performed in three laps.
Conclusion
The 3-lap Glittre-ADL test may be a more practical alternative to the 5-lap test, while still remaining a good test of functional capacity for activities of daily living.
背景：Glittre-ADL试验是一种评估慢性阻塞性肺疾病（COPD）患者功能能力的综合试验。目的：主要目的是验证glitre - adl测试是否在COPD患者中进行三圈背包，作为五圈背包的替代方案。方法：48例轻重度COPD患者(平均±SD年龄：71±7岁；FEV1: 46±17%预测)被招募并进行两次6分钟步行测试（访问1）；随机顺序进行两次带背包的glitre - adl测试（就诊2）和带背包和不带背包的glitre - adl测试（就诊3）。结果：glitre - adl测试进行了五圈，记录了三圈和五圈的症状、心率和血氧饱和度。三圈进行glitre - adl试验，引起相同的氧饱和度[平均±SD氧饱和度（SpO2）： 90±6 vs 90±6,p=0.249]和感知运动率（RPE） [RPE腿：2.91±2.23 vs 3.08±2.56,p= 0.380；RPE手臂：1.91±1.77 vs 2.16±1.92,p=0.306]与Glittre- adl测试（Glittre带背包和不带背包均在5圈内进行），SpO2[平均±SD: 90±6 vs 90±7，p=0.249]和RPE[腿：3.02±2.28 vs 3.25±2.37,p= 0.380；组：2.13±1.91 vs 2.03±1.84,p=0.306]。在三圈内进行的两项glitre - adl测试中，心率和呼吸困难明显降低。结论：3圈glitre - adl试验可能是比5圈试验更实用的替代方法，同时仍能很好地测试日常生活活动的功能能力。
{"title":"Glittre-ADL tests in three laps as an alternative to the five laps test","authors":"Liliane Patrícia de Souza Mendes , Verônica Franco Parreira , Bianca Carmona Rocha , Lissa M. Spencer , Marcelo Velloso , Jennifer A. Alison","doi":"10.1016/j.rmed.2025.107945","DOIUrl":"10.1016/j.rmed.2025.107945","url":null,"abstract":"<div><h3>Background</h3><div>The Glittre-ADL test is a comprehensive test to evaluate functional capacity in patients with chronic obstructive pulmonary disease (COPD).</div></div><div><h3>Aim</h3><div>The primary aim was to validate the Glittre-ADL test with and without the backpack performed in three laps as an alternative to five laps in people with COPD.</div></div><div><h3>Methods</h3><div>Forty-eight participants with mild to severe COPD (mean ± SD age: 71 ± 7 years; FEV<sub>1</sub>: 46 ± 17 %predicted) were recruited and performed two 6-min walk tests (visit 1); two Glittre-ADL tests with backpack (visit 2), and the Glittre-ADL test with and without the backpack, in random order (visit 3).</div></div><div><h3>Results</h3><div>The Glittre-ADL tests were performed in five laps and symptoms, heart rate and oxygen saturation were recorded for three and five laps. The Glittre-ADL test performed in three laps provoked the same oxygen desaturation [mean ± SD oxygen saturation (SpO<sub>2</sub>): 90 ± 6 vs 90 ± 6, p = 0.249] and rate of perceived exertion (RPE) [RPE legs: 2.91 ± 2.23 vs 3.08 ± 2.56, p = 0.380; RPE arms: 1.91 ± 1.77 vs 2.16 ± 1.92, p = 0.306] to the Glittre-ADL test performed in five laps for both Glittre with the backpack and without the backpack SpO<sub>2</sub> [mean ± SD: 90 ± 6 vs 90 ± 7, p = 0.249], and RPE [legs: 3.02 ± 2.28 vs 3.25 ± 2.37, p = 0.380; arms: 2.13 ± 1.91 vs 2.03 ± 1.84, p = 0.306]. The heart rate and dyspnoea were significantly lower for both Glittre-ADL tests performed in three laps.</div></div><div><h3>Conclusion</h3><div>The 3-lap Glittre-ADL test may be a more practical alternative to the 5-lap test, while still remaining a good test of functional capacity for activities of daily living.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"237 ","pages":"Article 107945"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142954107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.rmed.2024.107925
Pedro Magalhães Ferreira , Francisco Machado , David Barros Coelho , André Terras Alexandre , Hélder Novais Bastos , Patrícia Mota , Natália Melo , Susana Guimarães , Conceição Souto-Moura , André Carvalho , António Morais
Introduction and objectives
International guidelines for the diagnosis of Hypersensitivity Pneumonitis (HP) have improved the diagnostic standardization of this heterogeneous interstitial lung disease. Our goal was to determine how the final multidisciplinary discussion confidence level for suspected fibrotic HP (fHP) can be impacted by the application of different guidelines validated in this context.
Materials and methods
Retrospective study including patients submitted to transbronchial lung cryobiopsy (TBLC) with a final multidisciplinary meeting diagnosis of fHP. Both guidelines were applied to all patients in a stepwise fashion and directly compared according to the level of confidence in a fHP diagnosis.
Results
A total of 170 patients were diagnosed with fHP after TBLC and subsequent multidisciplinary discussion. Overall, there was a statistically significant change in proportion towards higher confidence diagnostic levels using the CHEST guideline (p < 0.0001). Changes were significant at three different levels: ATS/JRS/ALAT's “fHP not excluded” subgroup significantly upscaled to CHEST's “provisional low-confidence” subgroup (76.2 % increase; p < 0.001) and the proportion of patients in ATS/JRS/ALAT's “low confidence” subgroup significantly upscaled to both CHEST's “provisional high-confidence” (67.4 % increase; p < 0.001) and “definitive fHP” (50 % increase; p < 0.001) subgroups. The alternative application of the CHEST guideline in multidisciplinary discussion would have resulted in 73 less TBLC (42.9 % decrease versus the ATS/JRS/ALAT-oriented decision).
Conclusions
This study suggests a significant increase in definite fHP diagnosis when applying the CHEST versus the ATS/JRS/ALAT guideline, resulting in almost a 43 % decrease in referrals to TBLC when compared with the latter due to a combination of less strict radiological criteria and a more prominent role of BAL.
{"title":"Clinical impact of pre-determined guideline selection for the diagnosis of fibrotic hypersensitivity pneumonitis","authors":"Pedro Magalhães Ferreira , Francisco Machado , David Barros Coelho , André Terras Alexandre , Hélder Novais Bastos , Patrícia Mota , Natália Melo , Susana Guimarães , Conceição Souto-Moura , André Carvalho , António Morais","doi":"10.1016/j.rmed.2024.107925","DOIUrl":"10.1016/j.rmed.2024.107925","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>International guidelines for the diagnosis of Hypersensitivity Pneumonitis (HP) have improved the diagnostic standardization of this heterogeneous interstitial lung disease. Our goal was to determine how the final multidisciplinary discussion confidence level for suspected fibrotic HP (fHP) can be impacted by the application of different guidelines validated in this context.</div></div><div><h3>Materials and methods</h3><div>Retrospective study including patients submitted to transbronchial lung cryobiopsy (TBLC) with a final multidisciplinary meeting diagnosis of fHP. Both guidelines were applied to all patients in a stepwise fashion and directly compared according to the level of confidence in a fHP diagnosis.</div></div><div><h3>Results</h3><div>A total of 170 patients were diagnosed with fHP after TBLC and subsequent multidisciplinary discussion. Overall, there was a statistically significant change in proportion towards higher confidence diagnostic levels using the CHEST guideline (p < 0.0001). Changes were significant at three different levels: ATS/JRS/ALAT's “fHP not excluded” subgroup significantly upscaled to CHEST's “provisional low-confidence” subgroup (76.2 % increase; p < 0.001) and the proportion of patients in ATS/JRS/ALAT's “low confidence” subgroup significantly upscaled to both CHEST's “provisional high-confidence” (67.4 % increase; p < 0.001) and “definitive fHP” (50 % increase; p < 0.001) subgroups. The alternative application of the CHEST guideline in multidisciplinary discussion would have resulted in 73 less TBLC (42.9 % decrease versus the ATS/JRS/ALAT-oriented decision).</div></div><div><h3>Conclusions</h3><div>This study suggests a significant increase in definite fHP diagnosis when applying the CHEST versus the ATS/JRS/ALAT guideline, resulting in almost a 43 % decrease in referrals to TBLC when compared with the latter due to a combination of less strict radiological criteria and a more prominent role of BAL.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"237 ","pages":"Article 107925"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142922781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.rmed.2024.107919
Arsal Tharwani , Omar Minai , Youlan Rao , Hyoshin Kim , Gustavo A. Heresi
Background
The minimally important difference (MID) in the 6-min walk test (6MWT) for pulmonary arterial hypertension (PAH) is estimated to be 33 m using distributional and anchor-based methods. Quality of life was used as the anchor. Here, we sought to determine whether the MID is predictive of clinical worsening.
Methods
This was a post hoc analysis of the pivotal clinical trial of tadalafil in PAH (n = 405) and its extension phase (n = 161). The 6MWT was determined at the end of the placebo-controlled phase of 16 weeks and dichotomized as < 33 or ≥33 m. Primary outcome was clinical worsening ascertained at 16 weeks and at 68 weeks of follow up. Cox proportional hazard analysis was used to determine the association between 6MWT and clinical worsening.
Results
Mean age for patients in the pivotal trial of tadalafil was 54 years old ( ± 15.5 yrs). There were 317 (78.3 %) female patients and 61 % with idiopathic PAH. 53 % of the patients were on background bosentan therapy. A 6MWT <33 m was associated with an increased risk of clinical worsening at 16 and 68 weeks. These results were unchanged after adjusting for age, sex, background therapy with bosentan, and tadalafil dose. There were no PAH hospitalizations during short-term and long-term follow up in patients achieving a 6MWT ≥33 m
Conclusions
The 6MWT MID of 33 m is predictive of short- and long-term clinical worsening. These results further validate 33 m as a relevant MID for the 6MWT.
{"title":"The minimally important difference in the six-minute walk test predicts clinical worsening in pulmonary arterial hypertension","authors":"Arsal Tharwani , Omar Minai , Youlan Rao , Hyoshin Kim , Gustavo A. Heresi","doi":"10.1016/j.rmed.2024.107919","DOIUrl":"10.1016/j.rmed.2024.107919","url":null,"abstract":"<div><h3>Background</h3><div>The minimally important difference (MID) in the 6-min walk test (6MWT) for pulmonary arterial hypertension (PAH) is estimated to be 33 m using distributional and anchor-based methods. Quality of life was used as the anchor. Here, we sought to determine whether the MID is predictive of clinical worsening.</div></div><div><h3>Methods</h3><div>This was a post hoc analysis of the pivotal clinical trial of tadalafil in PAH (n = 405) and its extension phase (n = 161). The 6MWT was determined at the end of the placebo-controlled phase of 16 weeks and dichotomized as < 33 or ≥33 m. Primary outcome was clinical worsening ascertained at 16 weeks and at 68 weeks of follow up. Cox proportional hazard analysis was used to determine the association between 6MWT and clinical worsening.</div></div><div><h3>Results</h3><div>Mean age for patients in the pivotal trial of tadalafil was 54 years old ( ± 15.5 yrs). There were 317 (78.3 %) female patients and 61 % with idiopathic PAH. 53 % of the patients were on background bosentan therapy. A 6MWT <33 m was associated with an increased risk of clinical worsening at 16 and 68 weeks. These results were unchanged after adjusting for age, sex, background therapy with bosentan, and tadalafil dose. There were no PAH hospitalizations during short-term and long-term follow up in patients achieving a 6MWT ≥33 m</div></div><div><h3>Conclusions</h3><div>The 6MWT MID of 33 m is predictive of short- and long-term clinical worsening. These results further validate 33 m as a relevant MID for the 6MWT.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"237 ","pages":"Article 107919"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142882769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.rmed.2024.107937
Ranxun Chen, Guanning Zhong, Tong Ji, Qinghua Xu, Huarui Liu, Qingqing Xu, Lulu Chen, Jinghong Dai
Background
The relationship between serum lipid with idiopathic pulmonary fibrosis (IPF) required to be explored. We aim to evaluate the association of serum lipid levels with mortality in patients with IPF.
Materials and methods
This retrospective study included IPF patients with more than three years follow-up. We collected baseline demographics information, forced vital capacity (FVC)% predicted, carbon monoxide diffusion capacity (DLCO)% predicted, gender-age-physiology (GAP) index, and serum lipid levels, including triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C). We evaluate the relationship between the serum lipid levels and the disease severity, and the mortality in IPF.
Results
This study enrolled 146 patients, with the three-year survival rate of 71.23 %. The median follow-up time was 46.5 months. There was no significant difference in baseline lipid levels between the survival and non-survival group. TG levels were positively correlated with DLCO% predicted (r = 0.189, p = 0.022) and negatively correlated with GAP index (r = −0.186, p = 0.025). After adjusting for GAP index, smoking history, body mass index and the use of antifibrotic and lipid-lowering drug, lower TC levels (HR: 0.74, 95 % CI: 0.58–0.94, p = 0.013) were identified as an independent risk factor for mortality.
Conclusion
This study demonstrated that lower TC levels were associated with increased mortality in IPF. More investigations are required to explore the role of lipid metabolism in the pathogenesis of pulmonary fibrosis.
{"title":"Serum cholesterol levels predict the survival in patients with idiopathic pulmonary fibrosis: A long-term follow up study","authors":"Ranxun Chen, Guanning Zhong, Tong Ji, Qinghua Xu, Huarui Liu, Qingqing Xu, Lulu Chen, Jinghong Dai","doi":"10.1016/j.rmed.2024.107937","DOIUrl":"10.1016/j.rmed.2024.107937","url":null,"abstract":"<div><h3>Background</h3><div>The relationship between serum lipid with idiopathic pulmonary fibrosis (IPF) required to be explored. We aim to evaluate the association of serum lipid levels with mortality in patients with IPF.</div></div><div><h3>Materials and methods</h3><div>This retrospective study included IPF patients with more than three years follow-up. We collected baseline demographics information, forced vital capacity (FVC)% predicted, carbon monoxide diffusion capacity (DLCO)% predicted, gender-age-physiology (GAP) index, and serum lipid levels, including triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C). We evaluate the relationship between the serum lipid levels and the disease severity, and the mortality in IPF.</div></div><div><h3>Results</h3><div>This study enrolled 146 patients, with the three-year survival rate of 71.23 %. The median follow-up time was 46.5 months. There was no significant difference in baseline lipid levels between the survival and non-survival group. TG levels were positively correlated with DLCO% predicted (r = 0.189, p = 0.022) and negatively correlated with GAP index (r = −0.186, p = 0.025). After adjusting for GAP index, smoking history, body mass index and the use of antifibrotic and lipid-lowering drug, lower TC levels (HR: 0.74, 95 % CI: 0.58–0.94, p = 0.013) were identified as an independent risk factor for mortality.</div></div><div><h3>Conclusion</h3><div>This study demonstrated that lower TC levels were associated with increased mortality in IPF. More investigations are required to explore the role of lipid metabolism in the pathogenesis of pulmonary fibrosis.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"237 ","pages":"Article 107937"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142915541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.rmed.2025.107946
Kwonhyung Hyung , Sung A Kim , Nakwon Kwak , Jae-Joon Yim , Joong-Yub Kim
Background
Hemoptysis is one of the major symptoms in patients with nontuberculous mycobacterial pulmonary disease (NTM-PD). However, its prevalence, incidence, and impact on long-term prognosis remain uncertain. We evaluated the incidence of clinically significant hemoptysis, and determined its association with mortality in patients with NTM-PD.
Methods
Patients enrolled in a prospective observational cohort (NCT01616745) between July 2011 and May 2023 were analyzed. We evaluated risk factors for clinically significant hemoptysis—defined as hemoptysis events requiring interventions such as bronchial artery embolization or surgical resection—and its association with all-cause mortality.
Results
Among 506 patients from the ongoing cohort, 43 patients (8.5 %) experienced clinically significant hemoptysis during a median follow-up of 5.1 years. The overall incidence of clinically significant hemoptysis was 2.1 (95 % confidence interval [CI]; 1.5–2.9) cases per 100 person-years. Identified risk factors included a history of tuberculosis (incidence rate ratio [IRR], 1.91; 95 % CI, 1.02–3.60), higher C-reactive protein (CRP) (IRR, 1.20 for 1 mg/dl increase; 95 % CI, 1.01–1.43), and lower % predicted forced vital capacity (FVC) (IRR, 0.81 for 10 % increase; 95 % CI, 0.66–0.98). Clinically significant hemoptysis was independently associated with an increased risk of all-cause mortality (adjusted hazard ratio, 2.39; 95 % CI, 1.31–4.36).
Conclusion
In patients with NTM-PD, those with history of tuberculosis, higher CRP levels, and lower % predicted FVC were at a higher risk of subsequent clinically significant hemoptysis. Importantly, clinically significant hemoptysis was associated with an elevated risk of all-cause mortality.
{"title":"Clinically significant hemoptysis and all-cause mortality in patients with nontuberculous mycobacterial pulmonary disease","authors":"Kwonhyung Hyung , Sung A Kim , Nakwon Kwak , Jae-Joon Yim , Joong-Yub Kim","doi":"10.1016/j.rmed.2025.107946","DOIUrl":"10.1016/j.rmed.2025.107946","url":null,"abstract":"<div><h3>Background</h3><div>Hemoptysis is one of the major symptoms in patients with nontuberculous mycobacterial pulmonary disease (NTM-PD). However, its prevalence, incidence, and impact on long-term prognosis remain uncertain. We evaluated the incidence of clinically significant hemoptysis, and determined its association with mortality in patients with NTM-PD.</div></div><div><h3>Methods</h3><div>Patients enrolled in a prospective observational cohort (NCT01616745) between July 2011 and May 2023 were analyzed. We evaluated risk factors for clinically significant hemoptysis—defined as hemoptysis events requiring interventions such as bronchial artery embolization or surgical resection—and its association with all-cause mortality.</div></div><div><h3>Results</h3><div>Among 506 patients from the ongoing cohort, 43 patients (8.5 %) experienced clinically significant hemoptysis during a median follow-up of 5.1 years. The overall incidence of clinically significant hemoptysis was 2.1 (95 % confidence interval [CI]; 1.5–2.9) cases per 100 person-years. Identified risk factors included a history of tuberculosis (incidence rate ratio [IRR], 1.91; 95 % CI, 1.02–3.60), higher C-reactive protein (CRP) (IRR, 1.20 for 1 mg/dl increase; 95 % CI, 1.01–1.43), and lower % predicted forced vital capacity (FVC) (IRR, 0.81 for 10 % increase; 95 % CI, 0.66–0.98). Clinically significant hemoptysis was independently associated with an increased risk of all-cause mortality (adjusted hazard ratio, 2.39; 95 % CI, 1.31–4.36).</div></div><div><h3>Conclusion</h3><div>In patients with NTM-PD, those with history of tuberculosis, higher CRP levels, and lower % predicted FVC were at a higher risk of subsequent clinically significant hemoptysis. Importantly, clinically significant hemoptysis was associated with an elevated risk of all-cause mortality.</div></div><div><h3>Clinical trial registration</h3><div><span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>; No.: NCT01616745.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"237 ","pages":"Article 107946"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142966303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The association between interstitial lung abnormalities (ILA) and various conditions and diseases, including drug-related pneumonitis (DRP), has been reported. However, the association of the presence of ILA with developing DRP in patients undergoing cytotoxic agent-based chemotherapy, one of the standard treatments for malignancies, remains unclear. This warrants urgent investigation.
Methods
We included consecutive patients diagnosed with malignancy and treated with cytotoxic agents with/without immune checkpoint inhibitors (ICIs). We used Gray's method and multivariate Fine-Gray sub-distribution hazards analysis to evaluate the cumulative incidence of DRP (common terminology criteria for adverse events grade of ≥3) and the association between ILA and DRP development, respectively.
Results
Among 786 patients, 58 (7.3 %) demonstrated ILA. Patients with ILA were older, predominantly male, and reported a higher smoking history compared to those without ILA. The 90-day cumulative incidence of cytotoxic agent-induced DRP with/without ICIs was significantly higher in patients with ILA than in those without ILA (6.0 % vs. 1.2 %, p = 0.006). Multivariate analysis, adjusted for age, sex, and smoking history, revealed that ILA was associated with an increased risk of developing DRP due to cytotoxic agents with/without ICIs (hazard ratio [HR] 3.11, 95 % confidence interval [CI]: 1.06–9.14, p = 0.039) and cytotoxic agents alone (HR: 5.53, 95 % CI: 1.55–19.7, p = 0.008).
Conclusions
The presence of ILA is associated with an increased risk of developing DRP in patients undergoing cytotoxic agent-based chemotherapy. Therefore, evaluating the presence of ILA before determining chemotherapy regimens that include cytotoxic agents is recommended.
背景与目的：间质性肺异常（ILA）与多种疾病，包括药物相关性肺炎（DRP）之间的关系已被报道。然而，在接受基于细胞毒性药物的化疗（恶性肿瘤的标准治疗方法之一）的患者中，ILA的存在与发生DRP的关系尚不清楚。这需要紧急调查。方法：我们纳入了连续诊断为恶性肿瘤并接受细胞毒性药物治疗的患者（含/不含免疫检查点抑制剂（ICIs））。我们分别使用Gray's方法和多变量Fine-Gray亚分布风险分析来评估DRP的累积发生率（不良事件等级≥3的常用术语标准）和ILA与DRP发展之间的关系。结果：786例患者中，58例（7.3%）表现为ILA。ILA患者年龄较大，以男性为主，与没有ILA的患者相比，吸烟史较高。有/没有ICIs的ILA患者的90天累积细胞毒性药物诱导DRP发生率显著高于没有ICIs的患者（6.0% vs. 1.2%, p = 0.006）。经年龄、性别和吸烟史校正的多因素分析显示，ILA与细胞毒性药物合并/不合并ICIs（风险比[HR] 3.11, 95%可信区间[CI]: 1.06-9.14, p = 0.039）和单独使用细胞毒性药物（风险比[HR]: 5.53, 95% CI: 1.55-19.7, p = 0.008）导致DRP发生的风险增加相关。结论：ILA的存在与接受细胞毒性药物化疗的患者发生DRP的风险增加有关。因此，建议在确定包括细胞毒性药物的化疗方案之前评估ILA的存在。
{"title":"Association of interstitial lung abnormalities with cytotoxic agent-induced pneumonitis in patients with malignancy","authors":"Kyohei Oishi , Hironao Hozumi , Nobuko Yoshizawa , Shintaro Ichikawa , Yusuke Inoue , Hideki Yasui , Yuzo Suzuki , Masato Karayama , Kazuki Furuhashi , Noriyuki Enomoto , Tomoyuki Fujisawa , Satoshi Goshima , Naoki Inui , Takafumi Suda","doi":"10.1016/j.rmed.2024.107924","DOIUrl":"10.1016/j.rmed.2024.107924","url":null,"abstract":"<div><h3>Background and objective</h3><div>The association between interstitial lung abnormalities (ILA) and various conditions and diseases, including drug-related pneumonitis (DRP), has been reported. However, the association of the presence of ILA with developing DRP in patients undergoing cytotoxic agent-based chemotherapy, one of the standard treatments for malignancies, remains unclear. This warrants urgent investigation.</div></div><div><h3>Methods</h3><div>We included consecutive patients diagnosed with malignancy and treated with cytotoxic agents with/without immune checkpoint inhibitors (ICIs). We used Gray's method and multivariate Fine-Gray sub-distribution hazards analysis to evaluate the cumulative incidence of DRP (common terminology criteria for adverse events grade of ≥3) and the association between ILA and DRP development, respectively.</div></div><div><h3>Results</h3><div>Among 786 patients, 58 (7.3 %) demonstrated ILA. Patients with ILA were older, predominantly male, and reported a higher smoking history compared to those without ILA. The 90-day cumulative incidence of cytotoxic agent-induced DRP with/without ICIs was significantly higher in patients with ILA than in those without ILA (6.0 % vs. 1.2 %, <em>p</em> = 0.006). Multivariate analysis, adjusted for age, sex, and smoking history, revealed that ILA was associated with an increased risk of developing DRP due to cytotoxic agents with/without ICIs (hazard ratio [HR] 3.11, 95 % confidence interval [CI]: 1.06–9.14, <em>p</em> = 0.039) and cytotoxic agents alone (HR: 5.53, 95 % CI: 1.55–19.7, <em>p</em> = 0.008).</div></div><div><h3>Conclusions</h3><div>The presence of ILA is associated with an increased risk of developing DRP in patients undergoing cytotoxic agent-based chemotherapy. Therefore, evaluating the presence of ILA before determining chemotherapy regimens that include cytotoxic agents is recommended.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"237 ","pages":"Article 107924"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142903233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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