Pub Date : 2025-12-20DOI: 10.1016/j.rmed.2025.108602
Dong Ding , Tengda Wei , Miaomiao Wang , Huina Wang , Leiyu Wang , Liuqiao Sun , Shijie Ning , Haohao Liu
The health impacts of temperature variations (TV) on rhinitis remains insufficiently understood. This study investigates the association between both TVdaily and TVhourly (lag 0–7 days) and rhinitis-related outpatient visits. An individual time-stratified case-crossover design was applied, with stratified analyses by gender, age groups (≤17, 18–44, 45–60, ≥60 years), and seasons. A total of 58,717 rhinitis visits were recorded from 2013 to 2023. We found a significant positive correlation between TV and rhinitis visits, with the strongest effects observed for TVdaily0_4 (excess odds ratio [EOR]: 6.2 %, 95 %CI: 5.3 %,7.2 %) and TVhourly0_3 (EOR:7.2 %, 95 % CI:5.8 %, 8.5 %). Males and children (≤17 years) were more vulnerable, and the effects was most pronounced in autumn (September–November). Additionally, short-term TVhourly exhibited a stronger effect compared to TVdaily. Our findings provide robust evidence that exposure to short-term TV significantly increases the risk of rhinitis-related hospital visits, underscoring the need to incorporate TV into public health strategies to mitigating weather-related health risks.
{"title":"Rhinitis risk associated with temperature variability in Henan: Comparative analysis of daily and hourly exposure metrics","authors":"Dong Ding , Tengda Wei , Miaomiao Wang , Huina Wang , Leiyu Wang , Liuqiao Sun , Shijie Ning , Haohao Liu","doi":"10.1016/j.rmed.2025.108602","DOIUrl":"10.1016/j.rmed.2025.108602","url":null,"abstract":"<div><div>The health impacts of temperature variations (TV) on rhinitis remains insufficiently understood. This study investigates the association between both TV<sub>daily</sub> and TV<sub>hourly</sub> (lag 0–7 days) and rhinitis-related outpatient visits. An individual time-stratified case-crossover design was applied, with stratified analyses by gender, age groups (≤17, 18–44, 45–60, ≥60 years), and seasons. A total of 58,717 rhinitis visits were recorded from 2013 to 2023. We found a significant positive correlation between TV and rhinitis visits, with the strongest effects observed for TV<sub>daily</sub>0_4 (excess odds ratio [EOR]: 6.2 %, 95 %CI: 5.3 %,7.2 %) and TV<sub>hourly</sub>0_3 (EOR:7.2 %, 95 % CI:5.8 %, 8.5 %). Males and children (≤17 years) were more vulnerable, and the effects was most pronounced in autumn (September–November). Additionally, short-term TV<sub>hourly</sub> exhibited a stronger effect compared to TV<sub>daily</sub>. Our findings provide robust evidence that exposure to short-term TV significantly increases the risk of rhinitis-related hospital visits, underscoring the need to incorporate TV into public health strategies to mitigating weather-related health risks.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"251 ","pages":"Article 108602"},"PeriodicalIF":3.1,"publicationDate":"2025-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145811146","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 : 2025-12-20DOI: 10.1016/j.rmed.2025.108606
Vanessa M. McDonald , Tamara Blickisdorf , Joice M. de Oliveira , Hayley A. Scott
Obesity is a non-communicable chronic disease that is growing in prevalence in all regions of the world. In adult populations obesity rates have doubled since the 1990s. Defined as an excess in fat deposits that deleteriously effect health, obesity is complex and leads to multimorbidity, and death from disease. In people with obstructive airway diseases, obesity is even more common and negatively impacts outcomes for people living with these coexisting diseases.
Treatable Traits is a personalised medicine approach to managing obstructive airway diseases, focusing on clinically relevant traits that are identified in individuals followed by the application of individualised interventions. In airway diseases traits are grouped within three domains: pulmonary, extra-pulmonary and behavioural/risk-factors. Obesity is a key extra-pulmonary trait which we purpose to be a super trait due to its impact on individuals living with the disease and the major improvements gained from successful treatment.
In this review we explore the clinical relevance of obesity as a treatable trait of obstructive airway diseases, the optimal approach to measuring and treating obesity, the mechanisms, and the person-centred recommendations for shared decision making. All these areas enable the management of obesity as a treatable trait.
{"title":"Managing obesity as a treatable trait of obstructive airway diseases","authors":"Vanessa M. McDonald , Tamara Blickisdorf , Joice M. de Oliveira , Hayley A. Scott","doi":"10.1016/j.rmed.2025.108606","DOIUrl":"10.1016/j.rmed.2025.108606","url":null,"abstract":"<div><div>Obesity is a non-communicable chronic disease that is growing in prevalence in all regions of the world. In adult populations obesity rates have doubled since the 1990s. Defined as an excess in fat deposits that deleteriously effect health, obesity is complex and leads to multimorbidity, and death from disease. In people with obstructive airway diseases, obesity is even more common and negatively impacts outcomes for people living with these coexisting diseases.</div><div>Treatable Traits is a personalised medicine approach to managing obstructive airway diseases, focusing on clinically relevant traits that are identified in individuals followed by the application of individualised interventions. In airway diseases traits are grouped within three domains: pulmonary, extra-pulmonary and behavioural/risk-factors. Obesity is a key extra-pulmonary trait which we purpose to be a super trait due to its impact on individuals living with the disease and the major improvements gained from successful treatment.</div><div>In this review we explore the clinical relevance of obesity as a treatable trait of obstructive airway diseases, the optimal approach to measuring and treating obesity, the mechanisms, and the person-centred recommendations for shared decision making. All these areas enable the management of obesity as a treatable trait.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"252 ","pages":"Article 108606"},"PeriodicalIF":3.1,"publicationDate":"2025-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145811097","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 : 2025-12-19DOI: 10.1016/j.rmed.2025.108601
Yuhan Wang , Hailing Liu , Jingyi Zhang, Jiali Xiong, Ke Hu
Objective
Obesity hypoventilation syndrome is defined as daytime hypercapnia in obese individuals without other underlying causes, associated with reduced lung volume. Preserved ratio impaired spirometry (PRISm) and restrictive spirometric pattern (RSP) are different spirometry patterns. In this pilot study, we investigated the association between PRISm (with or without RSP) and daytime hypercapnia in obese patients.
Methods
We conducted a cross-sectional study in 106 obese patients (body mass index ≥ 30 kg/m2). Daytime hypercapnia was defined as an arterial carbon dioxide partial pressure (PaCO2) > 45 mmHg based on arterial blood gas analysis. PRISm was defined as FEV1/FVC ≥ 0.70 and FEV1 < 80 % predicted, and RSP was defined as FEV1/FVC ≥ 0.70 and FVC < 80 % predicted. We categorized PRISm and RSP into mutually exclusive groups (normal, PRISm alone, RSP alone, and PRISm + RSP).
Results
Among the 106 obese patients (mean age 47.5 ± 14.0 years, 65.1 % male), 30 (28.3 %) had daytime hypercapnia. The prevalence of daytime hypercapnia was 23.5 % (16/68) in the normal spirometry group, 63.6 % (7/11) in the PRISm alone group, and 23.1 % (6/26) in the PRISm + RSP group. In multivariable logistic regression analyses, after adjusting for age, sex, body mass index, ever smoking, apnea-hypopnea index, mean oxygen saturation by pulse oximetry, and FEV1, PRISm alone was independently associated with daytime hypercapnia (P = 0.043).
Conclusions
Our study observed an association between non-restrictive PRISm and daytime hypercapnia in obese patients. Further research is needed to elucidate the underlying mechanisms and clinical significance of this association.
{"title":"Preserved ratio impaired spirometry and restrictive spirometric pattern in obese populations: Clinical relevance with daytime hypercapnia","authors":"Yuhan Wang , Hailing Liu , Jingyi Zhang, Jiali Xiong, Ke Hu","doi":"10.1016/j.rmed.2025.108601","DOIUrl":"10.1016/j.rmed.2025.108601","url":null,"abstract":"<div><h3>Objective</h3><div>Obesity hypoventilation syndrome is defined as daytime hypercapnia in obese individuals without other underlying causes, associated with reduced lung volume. Preserved ratio impaired spirometry (PRISm) and restrictive spirometric pattern (RSP) are different spirometry patterns. In this pilot study, we investigated the association between PRISm (with or without RSP) and daytime hypercapnia in obese patients.</div></div><div><h3>Methods</h3><div>We conducted a cross-sectional study in 106 obese patients (body mass index ≥ 30 kg/m<sup>2</sup>). Daytime hypercapnia was defined as an arterial carbon dioxide partial pressure (PaCO<sub>2</sub>) > 45 mmHg based on arterial blood gas analysis. PRISm was defined as FEV<sub>1</sub>/FVC ≥ 0.70 and FEV<sub>1</sub> < 80 % predicted, and RSP was defined as FEV<sub>1</sub>/FVC ≥ 0.70 and FVC < 80 % predicted. We categorized PRISm and RSP into mutually exclusive groups (normal, PRISm alone, RSP alone, and PRISm + RSP).</div></div><div><h3>Results</h3><div>Among the 106 obese patients (mean age 47.5 ± 14.0 years, 65.1 % male), 30 (28.3 %) had daytime hypercapnia. The prevalence of daytime hypercapnia was 23.5 % (16/68) in the normal spirometry group, 63.6 % (7/11) in the PRISm alone group, and 23.1 % (6/26) in the PRISm + RSP group. In multivariable logistic regression analyses, after adjusting for age, sex, body mass index, ever smoking, apnea-hypopnea index, mean oxygen saturation by pulse oximetry, and FEV<sub>1</sub>, PRISm alone was independently associated with daytime hypercapnia (P = 0.043).</div></div><div><h3>Conclusions</h3><div>Our study observed an association between non-restrictive PRISm and daytime hypercapnia in obese patients. Further research is needed to elucidate the underlying mechanisms and clinical significance of this association.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"251 ","pages":"Article 108601"},"PeriodicalIF":3.1,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145805250","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 : 2025-12-19DOI: 10.1016/j.rmed.2025.108603
Izabela Domagala-Manczyk , Marta Miszczuk-Ciesla , Marta Maskey-Warzechowska , Michal Zielecki , Piotr Szczudlik , Marta Dabrowska
Introduction
Knowledge of factors impacting the effectiveness of training of correct inhalation technique could increase the effectiveness of inhalation technique.
Objectives
The aim of the study was to assess the effectiveness of inhalation technique training and to identify factors impacting the effectiveness of training.
Patients and methods
This single centre, interventional, non-randomized study involved 180 adult patients with asthma or COPD. Inhalation technique was evaluated using a checklist of common errors and peak inspiratory flow (PIF). Patients who made any mistakes during inhalation were trained. We searched for factors which may have impacted the effectiveness of inhalation training.
Results
A total of 115 asthma and 65 COPD patients were analyzed. In 140 patients using either metered-dose inhalers (MDI) or soft mist inhalers (SMI; SMI users were grouped with MDI users for analysis), only 9 patients (6.4 %) used inhalers correctly, for dry-powder inhalers (DPI) only 31 (28.2 %). The training of inhalation technique was successful in 112/131 MDI users (85.5 %) and 67/79 DPI users (84.8 %).
Among MDI users, patients who achieved short term improvement in inhalation technique were more likely to have asthma (68.8 % vs. 42.1 %, p = 0.047), be non-smokers (33 % vs 5.3 %, p = 0.039) and younger (64 vs. 66 years, p = 0.028) vs. patients without improvement; respectively among DPI users: cognitive disorders were less often found (0 % vs. 16.7 %, p = 0.018), patients more often read drug leaflets (80.6 % vs 50 %, p = 0.022) and had good self-esteem of inhalation skills (97 % vs. 75 %, p = 0.025).
Conclusions
Training in inhalation leads to short term improvement of inhalation technique for most trainees. As different factors are important for efficacy of training in inhalation skills for MDI and DPI, an individual approach for training is important.
{"title":"Limitation of the effectiveness of inhalation training in patients with asthma and COPD","authors":"Izabela Domagala-Manczyk , Marta Miszczuk-Ciesla , Marta Maskey-Warzechowska , Michal Zielecki , Piotr Szczudlik , Marta Dabrowska","doi":"10.1016/j.rmed.2025.108603","DOIUrl":"10.1016/j.rmed.2025.108603","url":null,"abstract":"<div><h3>Introduction</h3><div>Knowledge of factors impacting the effectiveness of training of correct inhalation technique could increase the effectiveness of inhalation technique.</div></div><div><h3>Objectives</h3><div>The aim of the study was to assess the effectiveness of inhalation technique training and to identify factors impacting the effectiveness of training.</div></div><div><h3>Patients and methods</h3><div>This single centre, interventional, non-randomized study involved 180 adult patients with asthma or COPD. Inhalation technique was evaluated using a checklist of common errors and peak inspiratory flow (PIF). Patients who made any mistakes during inhalation were trained. We searched for factors which may have impacted the effectiveness of inhalation training.</div></div><div><h3>Results</h3><div>A total of 115 asthma and 65 COPD patients were analyzed. In 140 patients using either metered-dose inhalers (MDI) or soft mist inhalers (SMI; SMI users were grouped with MDI users for analysis), only 9 patients (6.4 %) used inhalers correctly, for dry-powder inhalers (DPI) only 31 (28.2 %). The training of inhalation technique was successful in 112/131 MDI users (85.5 %) and 67/79 DPI users (84.8 %).</div><div>Among MDI users, patients who achieved short term improvement in inhalation technique were more likely to have asthma (68.8 % vs. 42.1 %, p = 0.047), be non-smokers (33 % vs 5.3 %, p = 0.039) and younger (64 vs. 66 years, p = 0.028) vs. patients without improvement; respectively among DPI users: cognitive disorders were less often found (0 % vs. 16.7 %, p = 0.018), patients more often read drug leaflets (80.6 % vs 50 %, p = 0.022) and had good self-esteem of inhalation skills (97 % vs. 75 %, p = 0.025).</div></div><div><h3>Conclusions</h3><div>Training in inhalation leads to short term improvement of inhalation technique for most trainees. As different factors are important for efficacy of training in inhalation skills for MDI and DPI, an individual approach for training is important.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"251 ","pages":"Article 108603"},"PeriodicalIF":3.1,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145805315","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 : 2025-12-18DOI: 10.1016/j.rmed.2025.108600
Giovanni Barisione , Sanja Stanojevic , Vito Brusasco
Background
The probabilistic interpretation of unusually low lung diffusing capacity (DL) has been recently standardized but the impact of different reactive gases, reference equations and structural abnormalities on definition of lower limits of normal (LLN) is not well established.
Methods and results
To assess the uncertainty zone of LLN (z-scores) interpretation in computed tomography (CT)-determined interstitial pulmonary fibrosis (IPF) and pulmonary emphysema (PE), we have measured the single-breath DL for carbon monoxide (DLCO) and nitric oxide (DLNO) in 120 adults, 66 of them with IPF and the other 54 with PE. 41 asymptomatic, never-smokers, served as a control group. Z-scores derived from Global Lung Function Initiative (GLI) for standard (11-s breath-hold time) DLCO and non-specific (ERS) or sex- and device-specific (Munkholm et al.) reference equations for DLNO (6-s breath-hold time) analyzed. DLCOz-scores from GLI and DLNOz-scores from any reference equations showed high sensitivity and specificity for both IPF and PE, with DLCO showing the highest diagnostic accuracy for PE and DLNO from Munkholm et al. for IPF. However, the best thresholds separating IPF and PE from control subjects were widely different and ranging from ∼14th percentile (−1.100 z-score) for DLCO GLI to ∼3rd percentile (−1.885 z-score) for DLNO ERS. The z-scores of DLCO GLI showed the strongest negative correlation with PE (r = −0.710, P < 0.0001) and DLNO ERS with IPF (r = −0.754, P < 0.0001) but in females z-scores from ERS were not significantly correlated with extent of IPF.
Conclusions
DLCO and DLNO thresholds separating subjects with IPF or PE from healthy controls may differ substantially from standard LLN of −1.645 and −1.960 z-scores. For DLCO it may be due to inhomogeneous impairment of blood-to-air barrier whereas for DLNO different devices and reference equations seem to play a major role.
Clinical trial registered with https://register.clinicaltrials.gov/prs/beta/records (ClinicalTrials.gov Identifier: NCT07091838).
{"title":"Zone of z-scores uncertainty in pulmonary function interpretation: A proof-of-concept study from CO and NO lung diffusing capacities","authors":"Giovanni Barisione , Sanja Stanojevic , Vito Brusasco","doi":"10.1016/j.rmed.2025.108600","DOIUrl":"10.1016/j.rmed.2025.108600","url":null,"abstract":"<div><h3>Background</h3><div>The probabilistic interpretation of unusually low lung diffusing capacity (DL) has been recently standardized but the impact of different reactive gases, reference equations and structural abnormalities on definition of lower limits of normal (LLN) is not well established.</div></div><div><h3>Methods and results</h3><div>To assess the uncertainty zone of LLN (<em>z</em>-scores) interpretation in computed tomography (CT)-determined interstitial pulmonary fibrosis (IPF) and pulmonary emphysema (PE), we have measured the single-breath DL for carbon monoxide (DL<sub>CO</sub>) and nitric oxide (DL<sub>NO</sub>) in 120 adults, 66 of them with IPF and the other 54 with PE. 41 asymptomatic, never-smokers, served as a control group. <em>Z</em>-scores derived from Global Lung Function Initiative (GLI) for standard (11-s breath-hold time) DL<sub>CO</sub> and non-specific (ERS) or sex- and device-specific (Munkholm et al.) reference equations for DL<sub>NO</sub> (6-s breath-hold time) analyzed. DL<sub>CO</sub> <em>z</em>-scores from GLI and DL<sub>NO</sub> <em>z</em>-scores from any reference equations showed high sensitivity and specificity for both IPF and PE, with DL<sub>CO</sub> showing the highest diagnostic accuracy for PE and DL<sub>NO</sub> from Munkholm et al. for IPF. However, the best thresholds separating IPF and PE from control subjects were widely different and ranging from ∼14th percentile (−1.100 <em>z</em>-score) for DL<sub>CO</sub> GLI to ∼3rd percentile (−1.885 <em>z</em>-score) for DL<sub>NO</sub> ERS. The <em>z</em>-scores of DL<sub>CO</sub> GLI showed the strongest negative correlation with PE (r = −0.710, <em>P</em> < 0.0001) and DL<sub>NO</sub> ERS with IPF (r = −0.754, <em>P</em> < 0.0001) but in females <em>z</em>-scores from ERS were not significantly correlated with extent of IPF.</div></div><div><h3>Conclusions</h3><div>DL<sub>CO</sub> and DL<sub>NO</sub> thresholds separating subjects with IPF or PE from healthy controls may differ substantially from standard LLN of −1.645 and −1.960 <em>z</em>-scores. For DL<sub>CO</sub> it may be due to inhomogeneous impairment of blood-to-air barrier whereas for DL<sub>NO</sub> different devices and reference equations seem to play a major role.</div><div>Clinical trial registered with <span><span>https://register.clinicaltrials.gov/prs/beta/records</span><svg><path></path></svg></span> (<span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> Identifier: NCT07091838).</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"251 ","pages":"Article 108600"},"PeriodicalIF":3.1,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145800708","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 : 2025-12-18DOI: 10.1016/j.rmed.2025.108593
Pau Marrades , Alessandro De Angelis , Alessandra Iorfida , Lidia Perea , Antonio Voza , Stefano Aliberti , James D. Chalmers , Oriol Sibila
Background
Bronchiectasis is a chronic and heterogeneous airway disease characterized by abnormal bronchial dilation, impaired mucus clearance, and recurrent infections. Despite advances in understanding its pathophysiology, current treatment strategies are still limited. Treatable traits (TT) approach, initially proposed for other chronic airway diseases such as Chronic Obstructive Pulmonary Disease and asthma, offers a precision medicine strategy focused on identifying and targeting clinically relevant, measurable, and modifiable traits.
Sources and synthesis
We conducted a comprehensive update on the TT framework in bronchiectasis by searching on PubMed the recent literature until July 1, 2025, including clinical and translational studies and drawing comparisons with other pulmonary diseases. Historically, TT in bronchiectasis have been classified into pulmonary, extrapulmonary, etiological, and lifestyle domains. We reviewed diagnostic and monitoring tools, as well as biological pathways and emerging treatments as part of the TT framework. Multiple traits, including daily sputum production, chronic infection, frequent exacerbations, T2-high inflammation, and comorbidities, coexist in most patients. Available treatments, such as antibiotics, airway bronchodilators, inhaled corticosteroids, chest physiotherapy and pulmonary rehabilitation, can address some traits, but evidence remains limited. Emerging therapies mainly targeting neutrophilic pathways represent promising avenues for selected endotypes. However, challenges persist in prioritizing traits, managing complex interventions, and designing clinical trials that balance scientific rigor with real-life complexity.
Conclusions
The TT approach represents a paradigm shift toward precision medicine in bronchiectasis, with potential to improve patient-centered outcomes and prognosis. Future research should focus on validating this strategy through dedicated clinical studies always considering patient preferences and treatment goals.
{"title":"Bronchiectasis and treatable traits: the journey from concept to clinical practice","authors":"Pau Marrades , Alessandro De Angelis , Alessandra Iorfida , Lidia Perea , Antonio Voza , Stefano Aliberti , James D. Chalmers , Oriol Sibila","doi":"10.1016/j.rmed.2025.108593","DOIUrl":"10.1016/j.rmed.2025.108593","url":null,"abstract":"<div><h3>Background</h3><div>Bronchiectasis is a chronic and heterogeneous airway disease characterized by abnormal bronchial dilation, impaired mucus clearance, and recurrent infections. Despite advances in understanding its pathophysiology, current treatment strategies are still limited. Treatable traits (TT) approach, initially proposed for other chronic airway diseases such as Chronic Obstructive Pulmonary Disease and asthma, offers a precision medicine strategy focused on identifying and targeting clinically relevant, measurable, and modifiable traits.</div></div><div><h3>Sources and synthesis</h3><div>We conducted a comprehensive update on the TT framework in bronchiectasis by searching on PubMed the recent literature until July 1, 2025, including clinical and translational studies and drawing comparisons with other pulmonary diseases. Historically, TT in bronchiectasis have been classified into pulmonary, extrapulmonary, etiological, and lifestyle domains. We reviewed diagnostic and monitoring tools, as well as biological pathways and emerging treatments as part of the TT framework. Multiple traits, including daily sputum production, chronic infection, frequent exacerbations, T2-high inflammation, and comorbidities, coexist in most patients. Available treatments, such as antibiotics, airway bronchodilators, inhaled corticosteroids, chest physiotherapy and pulmonary rehabilitation, can address some traits, but evidence remains limited. Emerging therapies mainly targeting neutrophilic pathways represent promising avenues for selected endotypes. However, challenges persist in prioritizing traits, managing complex interventions, and designing clinical trials that balance scientific rigor with real-life complexity.</div></div><div><h3>Conclusions</h3><div>The TT approach represents a paradigm shift toward precision medicine in bronchiectasis, with potential to improve patient-centered outcomes and prognosis. Future research should focus on validating this strategy through dedicated clinical studies always considering patient preferences and treatment goals.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"251 ","pages":"Article 108593"},"PeriodicalIF":3.1,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145797881","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 : 2025-12-18DOI: 10.1016/j.rmed.2025.108588
Wentao Wu , Yuenan Ni , Wenjin Sun , Wenwen Zhou , Xuan Zhang , Lu Dai , Lei Chen , Feng-Ming Luo
Introduction
Chronic mountain sickness (CMS) is featured by high altitude polycythemia (HAPC) with clinical symptoms and transition from HAPC to CMS represents dynamic continuum. Red cell distribution width (RDW), reflecting hypoxia, has been reported in altitude diseases. We explore a potential link between RDW and CMS in HAPC patients.
Methods
Ten-year HAPC patients were enrolled in West China Hospital. CMS clinical symptoms were collected from medical records. Multivariable logistic regression and triple-knot restricted cubic splines analysis were employed to examine relationship between RDW and CMS clinical symptoms.
Results
Among 200 HAPC patients, 71 had CMS symptoms. CMS patients showed elevated red cell distribution width standard deviation (RDW-SD) (56.38 ± 11.72 vs 50.77 ± 7.00; p = 0.002) and red cell distribution width coefficient of variation (RDW-CV) (17.37 ± 3.74 vs 15.87 ± 2.56; p = 0.010). In logistic analysis, higher RDW group (dichotomized by the median) predicted CMS (RDW-SD: OR = 2.17[1.15–4.08], p = 0.016), with stronger association at ≥ 4500m (RDW-CV: OR = 3.57[1.01–12.57], p = 0.047). RDW-SD exhibited linear association overall (p for overall = 0.002; p for nonlinear = 0.194) and very high altitude, but nonlinear at < 4500m.
Conclusion
Elevated RDW is an indicator for presence of CMS clinical symptoms in HAPC patients, especially in very high altitude subgroup.
慢性高山病（CMS）以高原红细胞增多症（HAPC）为特征，具有临床症状，从HAPC到CMS的转变是动态连续的。反映缺氧的红细胞分布宽度（RDW）在高原疾病中有报道。我们探讨了HAPC患者的RDW和CMS之间的潜在联系。方法选取华西医院10年HAPC患者。从医疗记录中收集CMS的临床症状。采用多变量logistic回归和三结限制三次样条分析检验RDW与CMS临床症状的关系。结果200例HAPC患者中有71例出现CMS症状。CMS患者红细胞分布宽度标准差（RDW-SD）升高（56.38±11.72 vs 50.77±7.00,p = 0.002），红细胞分布宽度变异系数（RDW-CV）升高（17.37±3.74 vs 15.87±2.56,p = 0.010）。在logistic分析中，高RDW组（按中位数二分类）预测CMS (RDW- sd: OR = 2.17[1.15-4.08], p = 0.016)，且≥4500m时相关性更强（RDW- cv: OR = 3.57[1.01-12.57], p = 0.047）。RDW-SD总体上与海拔高度呈线性关系（总体p = 0.002，非线性p = 0.194），但在海拔4500m处呈非线性关系。结论RDW升高是HAPC患者，特别是非常高海拔亚组存在CMS临床症状的一个指标。
{"title":"Elevated red cell distribution width is an indicator for chronic mountain sickness in high altitude polycythemia patients: A retrospective study","authors":"Wentao Wu , Yuenan Ni , Wenjin Sun , Wenwen Zhou , Xuan Zhang , Lu Dai , Lei Chen , Feng-Ming Luo","doi":"10.1016/j.rmed.2025.108588","DOIUrl":"10.1016/j.rmed.2025.108588","url":null,"abstract":"<div><h3>Introduction</h3><div>Chronic mountain sickness (CMS) is featured by high altitude polycythemia (HAPC) with clinical symptoms and transition from HAPC to CMS represents dynamic continuum. Red cell distribution width (RDW), reflecting hypoxia, has been reported in altitude diseases. We explore a potential link between RDW and CMS in HAPC patients.</div></div><div><h3>Methods</h3><div>Ten-year HAPC patients were enrolled in West China Hospital. CMS clinical symptoms were collected from medical records. Multivariable logistic regression and triple-knot restricted cubic splines analysis were employed to examine relationship between RDW and CMS clinical symptoms.</div></div><div><h3>Results</h3><div>Among 200 HAPC patients, 71 had CMS symptoms. CMS patients showed elevated red cell distribution width standard deviation (RDW-SD) (56.38 ± 11.72 vs 50.77 ± 7.00; p = 0.002) and red cell distribution width coefficient of variation (RDW-CV) (17.37 ± 3.74 vs 15.87 ± 2.56; p = 0.010). In logistic analysis, higher RDW group (dichotomized by the median) predicted CMS (RDW-SD: OR = 2.17[1.15–4.08], p = 0.016), with stronger association at ≥ 4500m (RDW-CV: OR = 3.57[1.01–12.57], p = 0.047). RDW-SD exhibited linear association overall (p for overall = 0.002; p for nonlinear = 0.194) and very high altitude, but nonlinear at < 4500m.</div></div><div><h3>Conclusion</h3><div>Elevated RDW is an indicator for presence of CMS clinical symptoms in HAPC patients, especially in very high altitude subgroup.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"251 ","pages":"Article 108588"},"PeriodicalIF":3.1,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145797885","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 : 2025-12-18DOI: 10.1016/j.rmed.2025.108596
Carin E. Lau, Nicole M.D. van der Burg, Jaro Ankerst, Leif Bjermer, Ellen Tufvesson
Background
Chronic obstructive pulmonary disease (COPD) has many known dysregulated inflammatory proteins. A disintegrin and metalloproteinase 17 (ADAM17) is a protease that sheds several proteins involved in COPD pathogenesis. The aim was to investigate ADAM17, its phosphorylated form (pADAM17) and its substrates in bronchoalveolar lavage (BAL) and blood from COPD and control subjects.
Methods
Groups were matched by sex, age, BMI and smoking status to compare between COPD, smoking and never smoking control subjects. The expression of ADAM17 and pADAM17 was assessed using immunofluorescence in BAL cells (n = 6–13). Concentrations of soluble ADAM17 and its substrates were quantified using ELISA or Luminex in BAL fluid (BALF, n = 11–14) and blood (n = 10–30).
Results
COPD BAL samples had more ADAM17+ and pADAM17+ cells than controls and intracellular localisations were observed in epithelial cells of subjects with a smoking history. These elevations coincided with higher concentrations of several of the ADAM17 substrates in BALF from Smokers and COPD subjects, most prominently was the increased BALF HB-EGF found in COPD but not Smokers. Other changes in blood were also mostly related to epithelial injury and repair.
Conclusions
Our findings highlight an overabundance of ADAM17 and pADAM17 in COPD airways that is accentuated beyond smoking-induced changes. This broad catalytic-complex analysis has both combined individual biomarkers and discovered more novel disease-specific biomarkers that may all relate to the overarching functionality of ADAM17 in COPD, warranting further investigation into the role this enzyme plays in COPD pathogenesis.
{"title":"ADAM17 and related epithelial injury markers in bronchoalveolar lavage and blood distinguish COPD from controls","authors":"Carin E. Lau, Nicole M.D. van der Burg, Jaro Ankerst, Leif Bjermer, Ellen Tufvesson","doi":"10.1016/j.rmed.2025.108596","DOIUrl":"10.1016/j.rmed.2025.108596","url":null,"abstract":"<div><h3>Background</h3><div>Chronic obstructive pulmonary disease (COPD) has many known dysregulated inflammatory proteins. A disintegrin and metalloproteinase 17 (ADAM17) is a protease that sheds several proteins involved in COPD pathogenesis. The aim was to investigate ADAM17, its phosphorylated form (pADAM17) and its substrates in bronchoalveolar lavage (BAL) and blood from COPD and control subjects.</div></div><div><h3>Methods</h3><div>Groups were matched by sex, age, BMI and smoking status to compare between COPD, smoking and never smoking control subjects. The expression of ADAM17 and pADAM17 was assessed using immunofluorescence in BAL cells (n = 6–13). Concentrations of soluble ADAM17 and its substrates were quantified using ELISA or Luminex in BAL fluid (BALF, n = 11–14) and blood (n = 10–30).</div></div><div><h3>Results</h3><div>COPD BAL samples had more ADAM17+ and pADAM17+ cells than controls and intracellular localisations were observed in epithelial cells of subjects with a smoking history. These elevations coincided with higher concentrations of several of the ADAM17 substrates in BALF from Smokers and COPD subjects, most prominently was the increased BALF HB-EGF found in COPD but not Smokers. Other changes in blood were also mostly related to epithelial injury and repair.</div></div><div><h3>Conclusions</h3><div>Our findings highlight an overabundance of ADAM17 and pADAM17 in COPD airways that is accentuated beyond smoking-induced changes. This broad catalytic-complex analysis has both combined individual biomarkers and discovered more novel disease-specific biomarkers that may all relate to the overarching functionality of ADAM17 in COPD, warranting further investigation into the role this enzyme plays in COPD pathogenesis.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"251 ","pages":"Article 108596"},"PeriodicalIF":3.1,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145800676","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}
Obesity has been associated with adverse outcomes in critical illness, including increased mortality, organ dysfunction, and prolonged ventilation. The “obesity paradox,” suggesting improved survival in obese patients, remains controversial in ICU populations. The independent role of body mass index (BMI) on outcomes with modern organ support remains uncertain.
Objective
To evaluate whether a BMI of 30–44.9 kg/m2 increases the risk of mortality, organ failure, and use of advanced life support compared with BMI of 18.5–29.9 kg/m2 in ICU patients.
Design
Retrospective multicenter cohort study using a real-world data platform. Patients were stratified by BMI and matched using propensity scores for demographic and clinical factors.
Exposure
BMI category at ICU admission (30–44.9 vs 18.5–29,9 kg/m2.
Main outcomes and measures
Outcomes were assessed during early and late weeks of ICU stay. Primary outcomes were all-cause mortality; secondary outcomes included cardiac arrest, hemodialysis initiation, ARDS, and use of ECMO.
Results
Among 29,617 matched patients, obesity was associated with higher early (HR 1.213 [95 % CI 1.16–1.267]) and late (HR 1.213 [95 % CI 1.16–1.267]) mortality. Hemodialysis use was more frequent early (HR 1.49 [95 % CI 1.387–1.6]) and late (HR 1.537 [95 % CI 1.352–1.747]). VV-ECMO was also higher early (HR 1.4 [95 % CI 1.022–1.916]) and late (HR 2.206 [95 % CI 1.14–4.161]). No significant differences were observed in cardiac arrest, ARDS, or ECMO.
Conclusions and relevance
Obesity independently increased ICU mortality and need for renal hemodialysis, underscoring the need for targeted preventive and management strategies in this high-risk population.
肥胖与危重疾病的不良结局相关，包括死亡率增加、器官功能障碍和通气时间延长。“肥胖悖论”，即肥胖患者生存率提高，在ICU人群中仍然存在争议。身体质量指数（BMI）对现代器官支持结果的独立作用仍不确定。目的评价与BMI为18.5-29.9 kg/m2的ICU患者相比，BMI为30-44.9 kg/m2是否会增加死亡、器官衰竭和使用高级生命支持的风险。设计采用真实世界数据平台的回顾性多中心队列研究。根据BMI对患者进行分层，并使用人口统计学和临床因素的倾向评分进行匹配。ICU入院时的暴露程度（30-44.9 vs 18.5 - 29,9 kg/m2）。主要结局和措施在ICU住院的前和后几周评估结局。主要结局是全因死亡率；次要结局包括心脏骤停、血液透析开始、ARDS和ECMO的使用。结果在29,617例匹配的患者中，肥胖与较高的早期死亡率（HR 1.213 [95% CI 1.16-1.267]）和晚期死亡率（HR 1.213 [95% CI 1.16-1.267]）相关。早期（HR 1.49 [95% CI 1.387-1.6]）和晚期（HR 1.537 [95% CI 1.352-1.747]）使用血液透析的频率更高。VV-ECMO早期（HR 1.4 [95% CI 1.022-1.916]）和晚期（HR 2.206 [95% CI 1.14-4.161]）也较高。在心脏骤停、ARDS或ECMO方面没有观察到显著差异。肥胖独立增加ICU死亡率和肾血液透析需求，强调在这一高危人群中需要有针对性的预防和管理策略。
{"title":"Temporal trends in ICU outcomes by BMI: A retrospective propensity-score matched study","authors":"Abhi Chand Lohana , Subhash Chander , F.N.U. Sorath , Vishal Deepak","doi":"10.1016/j.rmed.2025.108599","DOIUrl":"10.1016/j.rmed.2025.108599","url":null,"abstract":"<div><h3>Importance</h3><div>Obesity has been associated with adverse outcomes in critical illness, including increased mortality, organ dysfunction, and prolonged ventilation. The “obesity paradox,” suggesting improved survival in obese patients, remains controversial in ICU populations. The independent role of body mass index (BMI) on outcomes with modern organ support remains uncertain.</div></div><div><h3>Objective</h3><div>To evaluate whether a BMI of 30–44.9 kg/m<sup>2</sup> increases the risk of mortality, organ failure, and use of advanced life support compared with BMI of 18.5–29.9 kg/m<sup>2</sup> in ICU patients.</div></div><div><h3>Design</h3><div>Retrospective multicenter cohort study using a real-world data platform. Patients were stratified by BMI and matched using propensity scores for demographic and clinical factors.</div></div><div><h3>Exposure</h3><div>BMI category at ICU admission (30–44.9 vs 18.5–29,9 kg/m<sup>2</sup><strong>.</strong></div></div><div><h3>Main outcomes and measures</h3><div>Outcomes were assessed during early and late weeks of ICU stay. Primary outcomes were all-cause mortality; secondary outcomes included cardiac arrest, hemodialysis initiation, ARDS, and use of ECMO.</div></div><div><h3>Results</h3><div>Among 29,617 matched patients, obesity was associated with higher early (HR 1.213 [95 % CI 1.16–1.267]) and late (HR 1.213 [95 % CI 1.16–1.267]) mortality. Hemodialysis use was more frequent early (HR 1.49 [95 % CI 1.387–1.6]) and late (HR 1.537 [95 % CI 1.352–1.747]). VV-ECMO was also higher early (HR 1.4 [95 % CI 1.022–1.916]) and late (HR 2.206 [95 % CI 1.14–4.161]). No significant differences were observed in cardiac arrest, ARDS, or ECMO.</div></div><div><h3>Conclusions and relevance</h3><div>Obesity independently increased ICU mortality and need for renal hemodialysis, underscoring the need for targeted preventive and management strategies in this high-risk population.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"251 ","pages":"Article 108599"},"PeriodicalIF":3.1,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145797882","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 : 2025-12-18DOI: 10.1016/j.rmed.2025.108579
Milos Jesenak , Anna Bobcakova , Korneliusz Golebski , Inge Kortekaas Krohn , Sven F. Seys , Zuzana Rennerova , Peter Durdik , Ellen Tufvesson , Adam Markocsy , Radovan Kosturiak , Zuzana Diamant
The airway epithelium not only acts as a physical barrier between the environment and the host, but also functions as an active immunological interface, facilitating crosstalk between the epithelial cells, immune cells and the microbiome aimed at protecting the host. Therefore, maintaining airway epithelial barrier integrity and its functions is crucial for prevention of chronic inflammatory airway diseases, such as allergy, asthma and chronic obstructive pulmonary disease.
The potential to restore the epithelial barrier by therapeutic interventions has increasingly gained interest over recent years. As part of their disease-modifying properties, various treatment modalities including small molecule drugs, biologics, bronchial thermoplasty and allergen immunotherapy, showed beneficial effects on epithelial barrier integrity in select patient populations.
In this review, we summarize current knowledge, discuss recent evidence of therapeutic interventions on restoring epithelial barrier function and highlight unmet needs and future research directions.
{"title":"Airway epithelial barrier integrity: an emerging treatable trait in asthma management","authors":"Milos Jesenak , Anna Bobcakova , Korneliusz Golebski , Inge Kortekaas Krohn , Sven F. Seys , Zuzana Rennerova , Peter Durdik , Ellen Tufvesson , Adam Markocsy , Radovan Kosturiak , Zuzana Diamant","doi":"10.1016/j.rmed.2025.108579","DOIUrl":"10.1016/j.rmed.2025.108579","url":null,"abstract":"<div><div>The airway epithelium not only acts as a physical barrier between the environment and the host, but also functions as an active immunological interface, facilitating crosstalk between the epithelial cells, immune cells and the microbiome aimed at protecting the host. Therefore, maintaining airway epithelial barrier integrity and its functions is crucial for prevention of chronic inflammatory airway diseases, such as allergy, asthma and chronic obstructive pulmonary disease.</div><div>The potential to restore the epithelial barrier by therapeutic interventions has increasingly gained interest over recent years. As part of their disease-modifying properties, various treatment modalities including small molecule drugs, biologics, bronchial thermoplasty and allergen immunotherapy, showed beneficial effects on epithelial barrier integrity in select patient populations.</div><div>In this review, we summarize current knowledge, discuss recent evidence of therapeutic interventions on restoring epithelial barrier function and highlight unmet needs and future research directions.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"252 ","pages":"Article 108579"},"PeriodicalIF":3.1,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145800657","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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