Respiratory medicine最新文献_第10页

Effect of physiotherapy on clinical outcomes in patients with acute brain injury: A post–hoc analysis of the ENIO study 物理治疗对脑损伤患者临床预后的影响：ENIO研究的事后分析。

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2025-12-22 DOI: 10.1016/j.rmed.2025.108598

Denise Battaglini , Irene Schiavetti , Alessio Signori , Raphael Cinotti , Karim Asehnoune , Francesca Gualdi , Loui Al-Husinat , Luca Montagnani , Patricia RM. Rocco , Marcus J. Schultz , Nicolò Antonino Patroniti , Chiara Robba

Background

Patients with Acute Brain Injury often require prolonged intensive care unit (ICU) stays and physiotherapy.

Objective

This study aimed to evaluate the frequency and types of physiotherapy used in acute brain injury patients, identify predictors for its initiation, and assess its effects on clinical outcomes, including extubation failure, ICU and hospital mortality, and ICU length of stay.

Methods

This post-hoc analysis of the ENIO study included 1012 patients with available physiotherapy data. Clinical outcomes were assessed using inverse probability of treatment weighting (IPTW).

Results

Among the patients included, 75.9 % received physiotherapy, with 19.4 % undergoing curative interventions and 80.6 % receiving prophylactic measures. Patients who received physiotherapy were older, more frequently had traumatic brain injuries, and were more likely to require an intracranial probe and external ventricular drainage compared to those who did not. After IPTW adjustment, no significant differences were observed between groups in terms of extubation failure (21.5 % vs. 20.1 %; OR = 0.96, 95 %CI = 0.71–1.30), ICU-mortality (3.0 % vs. 4.5 %; OR = 0.83, 95 %CI = 0.41–1.67), hospital-mortality (8.3 % vs. 7.5 %; OR = 1.21, 95 %CI = 0.76–1.95), or ICU-length of stay (mean 17.3 vs. 13.1 days, p = 0.21). Factors associated with physiotherapy initiation included ventilator-associated pneumonia and the presence of an intracranial probe, while a lower Glasgow Coma Scale score was associated with a reduced likelihood of treatment.

Conclusions

Physiotherapy was frequently applied in patients with acute brain injury, but no significant association was observed with extubation failure, mortality, or ICU stay. These findings underscore the need for prospective studies addressing timing, intensity, and modality of physiotherapy in this population.

背景：急性脑损伤患者往往需要延长重症监护病房（ICU）住院时间和物理治疗。目的：本研究旨在评估急性脑损伤患者使用物理治疗的频率和类型，确定其开始的预测因素，并评估其对临床结果的影响，包括拔管失败、ICU和住院死亡率以及ICU住院时间。方法：这项对ENIO研究的事后分析包括1012名有物理治疗数据的患者。使用治疗加权逆概率（IPTW）评估临床结果。结果：接受物理治疗的患者占75.9%，接受治疗干预的患者占19.4%，接受预防措施的患者占80.6%。接受物理治疗的患者年龄较大，更常发生创伤性脑损伤，与未接受物理治疗的患者相比，更有可能需要颅内探头和脑室外引流。调整IPTW后，两组间拔管失败率（21.5% vs. 20.1%； OR=0.96, 95%CI=0.71-1.30）、icu死亡率（3.0% vs. 4.5%； OR=0.83, 95%CI=0.41-1.67）、住院死亡率（8.3% vs. 7.5%； OR=1.21, 95%CI=0.76-1.95）或icu住院时间（平均17.3 vs. 13.1天，p=0.21）均无显著差异。与物理治疗开始相关的因素包括呼吸机相关性肺炎和颅内探头的存在，而格拉斯哥昏迷量表评分较低与治疗可能性降低相关。结论：急性脑损伤患者经常使用物理治疗，但与拔管失败、死亡率或ICU住院时间无显著相关性。这些发现强调了对这一人群进行物理治疗的时间、强度和方式进行前瞻性研究的必要性。

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引用次数: 0

Exacerbation risk in patients with bronchiectasis receiving DPP-1 inhibitors vs placebo: A meta-analysis of RCTs 支气管扩张患者接受DPP-1抑制剂与安慰剂的恶化风险：随机对照试验的荟萃分析

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2025-12-22 DOI: 10.1016/j.rmed.2025.108607

Giulia Carvalhal , Júlia Moreira Diniz , Larissa Calixto Hespanhol , David Curi Barbosa Izoton Cabral , Jafar Aljazeeri

Background

No therapies have been approved to alter bronchiectasis progression. Dipeptidyl peptidase-1 (DPP-1) inhibitors, which target neutrophil serine protease activation, are under investigation as potential disease-modifying agents.

Methods

We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing DPP-1 inhibitors versus placebo in patients with non-cystic fibrosis bronchiectasis. PubMed, Cochrane, EMBASE, Web of Science, Scopus, ClinicalTrials.gov, and ICTRP were searched from inception until April 26, 2025. Primary outcomes included time to first exacerbation and proportion of patients remaining exacerbation-free. Secondary outcomes included post-bronchodilator % Forced Expiratory Volume in 1 s (FEV₁), Quality of Life-Bronchiectasis (QoL-B) questionnaire scores, and rate of adverse events. Time-to-event outcome was analyzed using Kaplan-Meier (KM)-estimated individual patient data (IPD), whereas random-effects meta-analyses were performed for remaining outcomes.

Results

2523 patients from four RCTs were included, of whom 1689 (66.9 %) received DPP-1 inhibitors. Compared with placebo, DPP-1 inhibitors prolonged the time to first exacerbation (HR 0.79; 95 % CI: 0.71 to 0.88) and increased the proportion of patients remaining exacerbation-free (RR 1.33; 95 % CI 1.12 to 1.58). A slower decline in post-bronchodilator % FEV1 was observed (MD 1.1 %; 95 % CI 0.05 to 2.15), but no difference in QoL-B scores (MD 1.35; 95 % CI -0.72 to 3.42). The safety profile of DPP-1 inhibitors was acceptable and comparable to placebo. Moderate certainty was found across endpoints.

Conclusions

DPP-1 inhibitors prolong time to first exacerbation and reduce exacerbation rates in patients with bronchiectasis, with an acceptable safety profile. These findings support their potential as a disease-modifying strategy.

Registration

PROSPERO (CRD420251042542).

背景：尚未批准任何治疗方法来改变支气管扩张的进展。二肽基肽酶-1 （DPP-1）抑制剂，其目标是中性粒细胞丝氨酸蛋白酶的激活，作为潜在的疾病调节剂正在研究中。方法：我们对随机对照试验（rct）进行了系统回顾和荟萃分析，比较DPP-1抑制剂与安慰剂在非囊性纤维化支气管扩张患者中的疗效。PubMed, Cochrane， EMBASE, Web of Science, Scopus, ClinicalTrials.gov和ICTRP从成立到2025年4月26日进行了检索。主要结局包括首次恶化的时间和患者无恶化的比例。次要结局包括支气管扩张剂后1秒用力呼气量（FEV1） %、生活质量（QoL-B）问卷评分和不良事件发生率。使用Kaplan-Meier （KM）估计的个体患者数据（IPD）分析事件发生时间结局，而对剩余结局进行随机效应荟萃分析。结果：4项rct共纳入2523例患者，其中1689例（66.9%）接受了DPP-1抑制剂治疗。与安慰剂相比，DPP-1抑制剂延长了首次加重的时间（HR 0.79; 95% CI: 0.71至0.88），并增加了患者无加重的比例（RR 1.33; 95% CI 1.12至1.58）。观察到支气管扩张剂后FEV1 %下降较慢（MD为1.1%;95% CI 0.05至2.15），但QoL-B评分无差异（MD为1.35;95% CI -0.72至3.42）。DPP-1抑制剂的安全性是可接受的，与安慰剂相当。在各终点均发现中度确定性。结论：DPP-1抑制剂可延长支气管扩张患者首次加重的时间，降低加重率，具有可接受的安全性。这些发现支持了它们作为一种疾病改善策略的潜力。注册：普洛斯彼罗（CRD420251042542）。

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引用次数: 0

Prevalence and overlap of treatable traits in severe asthma and COPD: A cross-disease comparison in a tertiary care setting 严重哮喘和慢性阻塞性肺病可治疗特征的患病率和重叠：三级医疗机构的交叉疾病比较

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2025-12-20 DOI: 10.1016/j.rmed.2025.108604

Vanessa L. Clark , Joice Mara de Oliveira , Peter G. Gibson , Vanessa M. McDonald

Introduction/aim

Understanding the prevalence and overlap of treatable traits in severe asthma and COPD can guide personalised management. We aimed to determine the prevalence of traits in severe asthma and COPD compared to healthy controls in a tertiary care setting and to compare prevalence by diagnostic label.

Methods

Participants with severe asthma, COPD and healthy controls were recruited to a cross-sectional study and underwent multidimensional assessment to characterise their treatable traits.

Results

We recruited 140 participants with severe asthma, 45 COPD and 67 healthy controls, mean ± SD age, 56.6 ± 16.2 years, and 57.5 % female. Participants with severe asthma and controls, were younger compared to COPD p < 0.001. Of the 23 possible traits, fewer were identified in severe asthma (9.0 ± 2.8) and controls (2.4 ± 1.4) compared to COPD (10.6 ± 2.4; p < 0.001, with a difference between severe asthma and COPD; p < 0.001). Traits that were less prevalent in severe asthma were dyspnoea; p < 0.01, exertional O₂ desaturation; p < 0.001, mucous-hypersecretion; p < 0.05 and airflow obstruction; p < 0.001. Severe asthma was associated with more daytime-sleepiness; p < 0.01, and obesity; p < 0.05. The prevalence of chest infections, pathogen colonisation, smoking, nonadherence, inhaler-polypharmacy, dysfunctional breathing, anxiety or depression did not differ between disease groups.

Conclusion

This study provides further support for the treatable traits approach, revealing both diverse and overlapping traits in severe asthma and COPD. This advances the treatable traits paradigm and supports its implementation to improve personalised care in severe asthma and COPD.

前言/目的：了解严重哮喘和慢性阻塞性肺病的患病率和可治疗特征的重叠可以指导个性化管理。我们的目的是确定与三级医疗机构的健康对照相比，严重哮喘和慢性阻塞性肺病患者特征的患病率，并通过诊断标签比较患病率。方法：将患有严重哮喘、慢性阻塞性肺病和健康对照的参与者招募到一项横断面研究中，并对他们的可治疗特征进行多维评估。结果：我们招募了140名重度哮喘患者、45名慢性阻塞性肺病患者和67名健康对照者，平均±SD年龄（56.6±16.2岁），其中57.5%为女性。与COPD p2去饱和相比，患有严重哮喘和对照组的参与者更年轻；结论：本研究进一步支持了可治疗特征方法，揭示了严重哮喘和COPD的多样性和重叠特征。这推进了可治疗特征范式，并支持其实施，以改善严重哮喘和慢性阻塞性肺病的个性化护理。

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引用次数: 0

Rhinitis risk associated with temperature variability in Henan: Comparative analysis of daily and hourly exposure metrics 河南省鼻炎风险与温度变化相关：每日和每小时暴露指标的比较分析。

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2025-12-20 DOI: 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 TV_daily and TV_hourly (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_daily0_4 (excess odds ratio [EOR]: 6.2 %, 95 %CI: 5.3 %,7.2 %) and TV_hourly0_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_hourly exhibited a stronger effect compared to TV_daily. 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.

温度变化（TV）对鼻炎的健康影响尚不清楚。本研究探讨每日电视及每小时电视（滞后0至7天）与鼻炎相关门诊就诊之间的关系。采用个体时间分层病例交叉设计，按性别、年龄组（≤17岁、18-44岁、45-60岁、≥60岁）和季节进行分层分析。从2013年到2023年，共记录了58,717例鼻炎就诊。我们发现电视与鼻炎就诊之间存在显著的正相关，TVdaily0_4的影响最强（优势比[EOR]: 6.2%, 95%CI: 5.3%,7.2%）和TVhourly0_3（优势比：7.2%,95%CI: 5.8%, 8.5%）。男性和儿童（≤17岁）易感，秋季（9 - 11月）发病最为明显。此外，短期每小时电视比每日电视表现出更强的影响。我们的研究结果提供了强有力的证据，表明短期看电视会显著增加鼻炎相关的住院风险，强调了将电视纳入公共卫生战略以减轻与天气相关的健康风险的必要性。

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引用次数: 0

Managing obesity as a treatable trait of obstructive airway diseases 管理肥胖作为阻塞性气道疾病的可治疗特征。

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2025-12-20 DOI: 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.

肥胖是一种非传染性慢性疾病，在世界所有区域的发病率都在上升。自20世纪90年代以来，成年人的肥胖率翻了一番。肥胖被定义为有害健康的脂肪沉积过多，它是一种复杂的疾病，会导致多种疾病和疾病死亡。在患有阻塞性气道疾病的人群中，肥胖更为常见，并对患有这些共存疾病的人的预后产生负面影响。可治疗的特征是一种管理阻塞性气道疾病的个性化医学方法，侧重于在个体中确定的临床相关特征，然后应用个性化干预措施。在气道疾病的特征分为三个领域：肺，肺外和行为/危险因素。肥胖是一种关键的肺外特征，我们希望它成为一种超级特征，因为它对患者的影响以及成功治疗带来的重大改善。在这篇综述中，我们探讨了肥胖作为阻塞性气道疾病可治疗特征的临床相关性、测量和治疗肥胖的最佳方法、机制以及共同决策的以人为本的建议。所有这些方面都使肥胖成为一种可治疗的特征。

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引用次数: 0

Preserved ratio impaired spirometry and restrictive spirometric pattern in obese populations: Clinical relevance with daytime hypercapnia 肥胖人群保留比例受损肺活量计和限制性肺活量计模式：与日间高碳酸血症的临床相关性。

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2025-12-19 DOI: 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.

目的：肥胖低通气综合征被定义为无其他潜在原因的肥胖个体的日间高碳酸血症，与肺体积减小相关。保留比例受损肺活量测定法（PRISm）和限制性肺活量测定法（RSP）是两种不同的肺活量测定法。在这项初步研究中，我们调查了PRISm（伴有或不伴有RSP）与肥胖患者日间高碳酸血症之间的关系。方法：我们对106例肥胖患者（体重指数≥30 kg/m2）进行横断面研究。根据动脉血气分析，将白天高碳酸血症定义为动脉二氧化碳分压（PaCO2） bbbb45 mmHg。PRISm定义为FEV1/FVC≥0.70，预测FEV1 < 80%； RSP定义为FEV1/FVC≥0.70，预测FVC < 80%。我们将PRISm和RSP分为互斥组（正常组、单独PRISm组、单独RSP组和PRISm+RSP组）。结果：106例肥胖患者（平均年龄47.5±14.0岁，男性占65.1%）中有30例（28.3%）存在日间高碳酸血症。正常肺活量测定组白天高碳酸血症发生率为23.5%(16/68)，单独PRISm组为63.6% (7/11)，PRISm+RSP组为23.1%（6/26）。在多变量logistic回归分析中，在调整了年龄、性别、体重指数、是否吸烟、呼吸暂停低通气指数、平均血氧饱和度和FEV1后，PRISm单独与日间高碳酸血症独立相关（P=0.043）。结论：我们的研究观察到非限制性PRISm与肥胖患者日间高碳酸血症之间的关联。需要进一步的研究来阐明这种关联的潜在机制和临床意义。

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引用次数: 0

Limitation of the effectiveness of inhalation training in patients with asthma and COPD 哮喘和慢性阻塞性肺病患者吸入训练有效性的局限性。

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2025-12-19 DOI: 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.

前言：了解影响正确吸入技术训练效果的因素，可以提高吸入技术的效果。目的：本研究的目的是评估吸入技术训练的有效性，并确定影响训练有效性的因素。患者和方法：这项单中心、介入性、非随机研究纳入了180例哮喘或COPD成年患者。使用常见错误和吸气峰值流量（PIF）检查表评估吸入技术。对吸入过程中出现错误的患者进行了培训。我们寻找可能影响吸入训练效果的因素。结果：共分析了115例哮喘患者和65例COPD患者。在140例使用计量吸入器（MDI）或软雾吸入器（SMI； SMI使用者与MDI使用者分组进行分析）的患者中，只有9例（6.4%）患者正确使用吸入器，而使用干粉吸入器（DPI）的患者只有31例（28.2%）。112/131 MDI使用者（85.5%）和67/79 DPI使用者（84.8%）吸入技术培训成功。在MDI使用者中，吸入技术短期改善的患者患哮喘（68.8%对42.1%,p=0.047）、非吸烟者（33%对5.3%,p=0.039）和较年轻（64岁对66岁，p=0.028）的可能性高于未改善的患者；分别在DPI使用者中：认知障碍较少（0%比16.7%,p=0.018），患者更多地阅读药物传单（80.6%比50%，p=0.022），并且对吸入技能有良好的自尊心（97%比75%，p=0.025）。结论：吸入训练可使大多数受训者的吸入技术在短期内得到改善。由于不同的因素对MDI和DPI的吸入技巧训练的效果有重要影响，因此个性化的训练方法很重要。

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引用次数: 0

Zone of z-scores uncertainty in pulmonary function interpretation: A proof-of-concept study from CO and NO lung diffusing capacities 肺功能解释的z-评分不确定性区：一项来自CO和NO肺弥散能力的概念验证研究。

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2025-12-18 DOI: 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 (DL_CO) and nitric oxide (DL_NO) 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) DL_CO and non-specific (ERS) or sex- and device-specific (Munkholm et al.) reference equations for DL_NO (6-s breath-hold time) analyzed. DL_CO z-scores from GLI and DL_NO z-scores from any reference equations showed high sensitivity and specificity for both IPF and PE, with DL_CO showing the highest diagnostic accuracy for PE and DL_NO 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 DL_CO GLI to ∼3rd percentile (−1.885 z-score) for DL_NO ERS. The z-scores of DL_CO GLI showed the strongest negative correlation with PE (r = −0.710, P < 0.0001) and DL_NO 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

DL_CO and DL_NO 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 DL_CO it may be due to inhomogeneous impairment of blood-to-air barrier whereas for DL_NO 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).

背景：肺弥漫性异常低（DL）的概率解释最近已经标准化，但不同的反应气体、参考方程和结构异常对正常下限（LLN）定义的影响尚未得到很好的确定。方法和结果：为了评估计算机断层扫描（CT）确定的间质性肺纤维化（IPF）和肺气肿（PE）中LLN （z分数）解释的不确定区，我们测量了120名成年人的单呼吸一氧化碳（DLCO）和一氧化氮（DLNO），其中66名患有IPF， 54名患有PE。41例无症状，从不吸烟，作为对照组。对标准（11秒屏气时间）DLCO和非特异性（ERS）或性别和器械特异性（Munkholm等人）DLNO（6秒屏气时间）参考方程的z分数进行分析。GLI的dlcoz评分和任何参考方程的dlnoz评分对IPF和PE都显示出很高的敏感性和特异性，其中DLCO对PE和DLNO的诊断准确率最高。然而，将IPF和PE与对照受试者分开的最佳阈值差异很大，从DLCO GLI的第14个百分位数（-1.100 z-score）到DLNO ERS的第3个百分位数（-1.885 z-score）不等。DLCO GLI与PE呈显著负相关（r=-0.710）， PNO ERS与IPF呈显著负相关（r=-0.754）。结论：IPF或PE与健康对照的DLCO和DLNO阈值分别为-1.645和-1.960，与标准LLN存在显著差异。对于DLCO，可能是由于血气屏障的非均匀性损伤，而对于DLNO，不同的装置和参考方程似乎起主要作用。在https://register.Clinicaltrials: gov/prs/beta/records注册的临床试验（ClinicalTrials.gov标识号：NCT07091838）。

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引用次数: 0

Bronchiectasis and treatable traits: the journey from concept to clinical practice 支气管扩张症及其治疗特点：从概念到临床的历程

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2025-12-18 DOI: 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.

背景：支气管扩张是一种慢性异质性气道疾病，其特征是支气管异常扩张、粘液清除受损和反复感染。尽管在了解其病理生理方面取得了进展，但目前的治疗策略仍然有限。可治疗特征（TT）方法最初提出用于其他慢性气道疾病，如慢性阻塞性肺疾病和哮喘，提供了一种专注于识别和靶向临床相关、可测量和可改变特征的精准医学策略。来源和综合：我们通过检索PubMed截至2025年7月1日的最新文献，对支气管扩张的TT框架进行了全面更新，包括临床和转化研究，并与其他肺部疾病进行了比较。历史上，支气管扩张的TT分为肺、肺外、病因和生活方式。我们回顾了作为TT框架一部分的诊断和监测工具，以及生物学途径和新兴治疗方法。多种特征，包括每日产痰、慢性感染、频繁恶化、t2高炎症和合并症，在大多数患者中共存。现有的治疗方法，如抗生素、气道支气管扩张剂、吸入皮质类固醇、胸部物理治疗和肺部康复，可以解决一些特征，但证据仍然有限。新兴疗法主要针对中性粒细胞途径代表了有希望的途径选择内源性。然而，在确定特征的优先级、管理复杂的干预措施以及设计平衡科学严谨性与现实生活复杂性的临床试验方面，挑战仍然存在。结论TT方法代表了支气管扩张向精准医学的范式转变，具有改善以患者为中心的结果和预后的潜力。未来的研究应集中于通过专门的临床研究来验证这一策略，并始终考虑患者的偏好和治疗目标。

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引用次数: 0

Elevated red cell distribution width is an indicator for chronic mountain sickness in high altitude polycythemia patients: A retrospective study 红细胞分布宽度升高是高原红细胞增多症患者慢性高山病的一项回顾性研究

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2025-12-18 DOI: 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。

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引用次数: 0