Respiratory medicine最新文献

Background: Asthma, chronic obstructive pulmonary disease (COPD) and asthma-COPD Overlap (ACO) are inflammatory diseases characterized by specific T helper (Th) phenotypes. CD4 T follicular helper (Tfh) cells constitute a heterogeneous subset of T cells (Tfh1, Tfh2, Tfh17, Tfh17.1 and Tfr) essential for B cell differentiation and immunoglobulin production. Although alterations in their distribution and/or function have been associated with several pathologies, little is known about their relevance in these airway diseases.

Methods: We sought to evaluate, by flow cytometry, the pattern of blood follicular and non-follicular Th cell subpopulations in patients with asthma, COPD and ACO.

Results: We found a distinct and characteristic T cell pattern in these three inflammatory conditions: a predominance of cTfh2 in asthma patients, a Th17.1 and cTfh17.1 inflammatory profile in COPD patients, and a Th1 pattern in ACO patients. Regarding tobacco smoke, COPD patients who were active smokers had a higher ratio Th1/Th17 compared to ex-smokers with COPD, a trend not observed in ACO patients.

Conclusions: These results suggest that the assessment of the characteristic inflammatory profile for each of these pathologies could help to understand the pathobiology and to identify the most appropriate therapeutic target.

Purpose: Continuous positive airway pressure (CPAP) therapy is the gold standard treatment for obstructive sleep apnea, but adherence remains suboptimal. Subjective symptoms such as excessive daytime sleepiness may influence motivation to maintain therapy. This study examined whether baseline Epworth Sleepiness Scale (ESS) scores predict early CPAP adherence compared with objective measures such as the Apnea-Hypopnea Index (AHI).

Methods: We conducted a retrospective observational study of 400 adults with Obstructive Sleep Apnea prescribed CPAP between 2021 and 2023. Thirty days of CPAP adherence data was downloaded and categorized into five ordinal groups ranging from very low to very high adherence. Associations between ESS and adherence were assessed using chi-square tests, Goodman and Kruskal's gamma, and ordinal logistic regression adjusted for AHI, age, sex, and body mass index.

Results: Higher ESS scores were significantly associated with greater adherence (χ² = 28.7, P = 0.026; gamma = 0.199). Ordinal regression showed each 1-point increase predicted 7.4% higher odds of being in a greater adherence category (OR 1.072, 95% CI 1.027-1.117, P < 0.001). Age modestly predicted adherence (OR 1.010, P = 0.019). AHI, body mass index, and sex were not significant predictors. Patients with severe daytime sleepiness had the highest rates of excellent adherence (>90%).

Conclusion: Although causality cannot be inferred from a retrospective design, higher subjective sleepiness, measured by ESS, was associated with higher early adherence. Incorporating ESS into routine evaluation may identify patients at risk for nonadherence and guide targeted interventions.

Background: Obstructive sleep apnea (OSA) is a prevalent but frequently underdiagnosed type of sleep-disordered breathing. Excessive obesity is a primary reversible risk factor for OSA. A range of novel antidiabetic agents has recently demonstrated promising potential for improving OSA severity through weight loss and metabolic regulation.

Objective: This study aimed to examine the effectiveness and safety of novel antidiabetic agents for people with OSA.

Methods: We searched PubMed, Web of Science, Cochrane Library, and Embase database from inception to May 18, 2025. Pairwise meta-analysis and Bayesian network meta-analysis (NMA) were conducted to compare relative efficacy.

Results: A total of 8 RCTs and 2 non-RCTs involving 1280 OSA participants were enrolled. Compared with the control group, SGLT-2i (MD = -7.73 events/h, 95 % CI [-9.83, -5.64]), GLP-1 RAs (MD = -5.19 events/h, 95 % CI [-6.87, -3.51]), and tirzepatide (-21.89 events/h, 95 % CI [-26.01, -17.77]) could significantly decrease AHI. The NMA results suggested that tirzepatide ranking highest of producing the greatest AHI reduction (MD = -21.85 events/h, 95 % CI [-27.52, -16.34]), along with the most substantial decreases in body weight (MD = -19.41 kg, 95 % CI [-21.00, -17.82]) and blood pressure (MD_SBP = -5.86 mmHg, 95 % CI [-7.97, -3.74]; MD_DBP = -1.96 mmHg, 95 % CI [-3.45, -0.46]).

Conclusion: Based on indirect evidence, tirzepatide was associated with the largest estimated magnitude of AHI reduction, presumably mediated by its weight-loss effects. For obesity-related OSA patients intolerant to continuous positive airway pressure therapy, tirzepatide may represent a potential adjunctive or alternative pharmacological option. High-quality studies are still needed to validate these findings further.

Prospero registration number: CRD420251165267.

Background: Cystic fibrosis is a chronic autosomal-recessive disorder characterized by progressive lung disease, pancreatic insufficiency, and multiple systemic complications. Early identification and treatment of comorbidities such as allergic bronchopulmonary aspergillosis (ABPA), celiac disease (CD), and prediabetes/cystic fibrosis-related diabetes (CFRD) improves outcomes.

Methods: This prospective observational study included 68 pediatric CF patients registered in the Georgian National Monitoring Program of Rare Diseases (2022-2025). All children had a confirmed diagnosis of CF based on national criteria, established either through newborn screening (elevated IRT followed by sweat chloride and fecal elastase testing) or direct clinical referral for sweat chloride testing. Sweat chloride <29 mmol/L was considered negative, 30-60 mmol/L borderline (requiring repeat testing), and ≥60 mmol/L abnormal and referred for CFTR gene testing [4]. All patients underwent three fasting plasma glucose tests, total IgE measurement, and Aspergillus-specific IgG testing. Anti-tissue transglutaminase IgA (anti-TTG IgA) was measured once for celiac disease screening. Age-specific reference ranges and established diagnostic criteria for ABPA, CD, and CFRD were applied.

Results: Three patients had elevated anti-TTG IgA; one was diagnosed with CD and treated with a gluten-free diet. Impaired fasting glucose was observed in 14 patients (22%). Two patients with persistently elevated HbA1c (≥6.0%) were referred to endocrinology for evaluation of prediabetes/CFRD. Aspergillus-specific IgG was elevated in two patients; one had markedly elevated total IgE (>1500 IU/mL) and was diagnosed with ABPA requiring systemic corticosteroids and antifungal therapy. Several patients had elevated IgE without ABPA but due to sensitization to multiple allergens, they were referred to an allergologist.

Conclusion: Comorbidities including CD, prediabetes/CFRD, and ABPA are present in Georgian children with CF and can negatively affect nutrition and lung function if untreated. Routine screening for glucose abnormalities, CD, and ABPA should be implemented into national CF care protocols for timely treatment and better outcomes.

Purpose: Robotic-assisted bronchoscopy (RAB) with embedded digital tomosynthesis (DT) provides real-time, intraoperative nodule localization. This study examines the performance of RAB with embedded DT and integrated AF to achieve tool-in-lesion (TIL) confirmation via cone beam computer tomography (CBCT).

Methods: This was a prospective, bicentric, single-arm, non-randomized observational trial. Thirty-one patients with peripheral pulmonary nodules underwent RAB with embedded DT. Navigation was guided by DT and augmented fluoroscopy (AF). Primary endpoints were successful navigation to target lesions and successful TIL as confirmed by CBCT. Secondary endpoints included diagnostic yield based on the strict Delphi consensus definition of diagnostic yield along with serious device or procedure-related adverse events.

Results: Thirty-one patients were enrolled across two sites. Thirty-one lung nodules were successfully biopsied. The mean lesion size measured by longest cross-sectional diameter was 16 mm (±6.7 mm). DT demonstrated TIL in 30 of 31 nodules (96.7 %), with one case resulting in tool-touching-lesion (TTL). Of the 30 nodules demonstrating TIL by DT, TIL was confirmed in 29 nodules by CBCT (concordance rate of 96.7 %). Overall TIL confirmed by CBCT was 29 of 31 nodules (93.5 %). A diagnosis was obtained in 30 of 31, resulting in a 96.7 % diagnostic yield by strict definition. Pneumothorax occurred in 1 of 31 cases (3 %).

Conclusions: RAB with embedded DT demonstrated a high rate of TIL confirmed by CBCT. The strong concordance between the DT with AF and CBCT demonstrates the reliability of DT and AF for real-time intraprocedural guidance.

Background: Volatile organic compounds (VOCs), play a major role in exacerbating air pollution and present a threat to human health. However, the association between specific VOCs and lung function in the general population has not been extensively explored.

Objectives: Our study aimed to examine the correlation between urinary VOC metabolites (mVOCs) concentrations and lung function, among a typical sample of the adult population.

Methods: The correlation between urinary mVOCs and lung function was analyzed using logistic regression models, QG-C, WQS, and BKMR models were employed.

Results: Our study revealed that higher concentrations of certain urinary mVOCs significantly correlated with an increased risk of abnormal lung function, especially URXAMC and URXDHB. A significant nonlinear correlation was observed between URXDHB and FEV1 % pred <80 % (P for overall <0.001, P for nonlinear <0.001), and a nonlinear correlation was noted between URXAMC and the incidence of FEV1 % pred <80 % (P for overall, P for nonlinear = 0.012).

Conclusion: VOCs exposure is associated with compromised lung health, and particularly strong correlations exist between URXAMC/URXDHB and abnormal lung function; These findings provide new insights for respiratory disease prevention and control.

Objective: Extrafine single inhaler triple therapy (efSITT) with beclometasone dipropionate, formoterol fumarate, and glycopyrronium (BDP/FF/G 87/5/9 μg) has shown clinical benefits in Chronic Obstructive Pulmonary Disease (COPD) patients, including fewer exacerbations in randomized controlled trials. The IMPROVE study evaluated its real-world effectiveness in Greece in COPD patients previously treated with dual bronchodilation, focusing on exacerbations and other clinical outcomes.

Methods: This prospective, multicenter, observational study was conducted over 52 weeks. The 1103 eligible patients had moderate-to-severe COPD, an indication for treatment with efSITT, and were symptomatic despite receiving dual bronchodilation. The number of exacerbations, COPD Assessment Test (CAT) score, lung function parameters, use of rescue medication and adherence were recorded at baseline (visit 1), 6 months (visit 2), and 12 months (visit 3) after treatment.

Results: The percentage of patients with ≥1 exacerbation decreased from 100 % at visit 1 to 23.1% at visit 3 (p < 0.001). The mean CAT score decreased from 22.5 points at visit 1, to 16.6 at visit 2 and 14.2 at visit 3 (p < 0.001 for all pair comparisons). The mean TAI score increased from 44.6 points at visit 1, to 47.1 at visit 2 and 47.6 at visit 3. (p < 0.001 for V1/2 and V1/3 pairs, p = 0.024 for V2/3). Between visit 1 and visit 3, mean FEV1 increased from 1.6 L to 1.7 L (p < 0.001, n = 396).

Conclusions: The IMPROVE findings indicate that extrafine BDP/FF/G improves clinical outcomes in symptomatic COPD patients previously treated with dual bronchodilation in a real-world setting in Greece.