Pub Date : 2025-02-01DOI: 10.1016/j.rmed.2024.107920
Bo Chen , Wei Wang , Wenqian Zang , Jinjin Hu , Hengyun Li , Cong Wang , Yingwei Zhu , Yimin Mao , Pengfei Gao
Background
The clinical characteristics of acute pulmonary embolism (APE) according to mortality risk has been partly explored. Further research is required in light of the latest guide update on risk stratification for APE.
Methods
We collected the data from hospitalized patients with APE. Patients were classified according to the 2019 European Society of Cardiology's (ESC) guidelines. The clinical traits between different risk stratification of APE was investigated.
Results
A total of 1940 patients had APE. Patients who were stratified as high risk showed the highest frequency of both syncope (4.5 % vs 6.6 % vs 12.7 %; P = 0.002) and dyspnea (61.9 % vs 73.0 % vs 73.8 %, P = 0.007) when compared to the other two groups. The rates of deep venous thrombosis (DVT) were: 49.4 % in low-risk stratification, 63.2 % in intermediate-risk stratification, and 68.1 % in high-risk stratification, (Pfor trend = 0.001), while the proportion of low-risk stratification patients increased (2.5 %–13.3 %, Pfor trend<0.001).
Conclusion
In conclusion, clinical characteristics differ among pulmonary embolism patients with different risk stratification. Furthermore, the percentage of low-risk patients increased progressively while overall in-hospital death rates among APE patients gradually decreased.
背景：急性肺栓塞（APE）的临床特征与死亡风险的关系已得到部分探讨。根据最新的APE风险分层指南，需要进一步的研究。方法：收集APE住院患者的资料。根据2019年欧洲心脏病学会（ESC）指南对患者进行分类。探讨不同危险分层间的临床特征。结果：共有1940例患者发生APE。高危组患者出现两种晕厥的频率最高(4.5% vs 6.6% vs 12.7%；P=0.002)和呼吸困难（61.9% vs 73.0% vs 73.8%， P=0.007）。深静脉血栓（DVT）发生率：低危分层49.4%，中危分层63.2%，高危分层68.1% (p趋势=0.001)，低危分层患者比例增加（2.5% ~ 13.3%，p趋势）。结论：不同危险分层肺栓塞患者的临床特征存在差异。此外，低风险患者的比例逐渐增加，而APE患者的总体住院死亡率逐渐下降。
{"title":"Analysis of clinical characteristics in 1940 patients with acute pulmonary embolism","authors":"Bo Chen , Wei Wang , Wenqian Zang , Jinjin Hu , Hengyun Li , Cong Wang , Yingwei Zhu , Yimin Mao , Pengfei Gao","doi":"10.1016/j.rmed.2024.107920","DOIUrl":"10.1016/j.rmed.2024.107920","url":null,"abstract":"<div><h3>Background</h3><div>The clinical characteristics of acute pulmonary embolism (APE) according to mortality risk has been partly explored. Further research is required in light of the latest guide update on risk stratification for APE.</div></div><div><h3>Methods</h3><div>We collected the data from hospitalized patients with APE. Patients were classified according to the 2019 European Society of Cardiology's (ESC) guidelines. The clinical traits between different risk stratification of APE was investigated.</div></div><div><h3>Results</h3><div>A total of 1940 patients had APE. Patients who were stratified as high risk showed the highest frequency of both syncope (4.5 % vs 6.6 % vs 12.7 %; P = 0.002) and dyspnea (61.9 % vs 73.0 % vs 73.8 %, P = 0.007) when compared to the other two groups. The rates of deep venous thrombosis (DVT) were: 49.4 % in low-risk stratification, 63.2 % in intermediate-risk stratification, and 68.1 % in high-risk stratification, (P<sub>for trend</sub> = 0.001), while the proportion of low-risk stratification patients increased (2.5 %–13.3 %, P<sub>for trend</sub><0.001).</div></div><div><h3>Conclusion</h3><div>In conclusion, clinical characteristics differ among pulmonary embolism patients with different risk stratification. Furthermore, the percentage of low-risk patients increased progressively while overall in-hospital death rates among APE patients gradually decreased.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"237 ","pages":"Article 107920"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142897244","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.2024.107933
Annina Elmiger , Thimo Marcin , Luc Bovet , Patrick Brun , Sabina A. Guler
Background
Pulmonary rehabilitation (PR) aims to improve patients’ functioning in interstitial lung disease (ILD) and chronic obstructive pulmonary disease (COPD). The impact of change in functional independence during PR on subsequent survival has not been established. We aimed to determine functional independence during PR and its association with survival over three years post-PR.
Methods
This retrospective cohort study included patients with fibrotic ILD or COPD who participated in a 3-week inpatient PR program. The Functional Independence Measure (FIM) was assessed at PR entry and discharge. Correlations between FIM and demographics, clinical/functional parameters were analyzed. Time from PR to death/lung transplantation/censoring was assessed, stratified by baseline/changes in FIM above/below the median. Multivariable Cox proportional hazard models were used to determine the impact of FIM on mortality risk.
Results
223 patients (76 ILD/147 COPD) were included. Mean ± standard deviation (SD) age was 69 ± 10 for ILD and 67 ± 10 for COPD. FIM total and motor scores improved significantly in both groups. Baseline FIM showed a strong negative and change in 6-min walk distance (6MWD) a strong positive correlation with change in FIM during PR. Each 1-point increase in FIM motor score was associated with a 3 % lower risk of mortality (HR 0.97, 95%CI 0.94–1, p = 0.03).
Conclusions
Inpatient PR improves functional independence in patients with fibrotic ILD or COPD, and baseline and change in FIM are associated with survival up to three years post-PR. This emphasizes the importance of PR for all patients with chronic lung disease regardless of their initial level of independence.
{"title":"Pulmonary rehabilitation and functional independence: Impact on survival in patients with fibrotic interstitial lung disease or chronic obstructive pulmonary disease","authors":"Annina Elmiger , Thimo Marcin , Luc Bovet , Patrick Brun , Sabina A. Guler","doi":"10.1016/j.rmed.2024.107933","DOIUrl":"10.1016/j.rmed.2024.107933","url":null,"abstract":"<div><h3>Background</h3><div>Pulmonary rehabilitation (PR) aims to improve patients’ functioning in interstitial lung disease (ILD) and chronic obstructive pulmonary disease (COPD). The impact of change in functional independence during PR on subsequent survival has not been established. We aimed to determine functional independence during PR and its association with survival over three years post-PR.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included patients with fibrotic ILD or COPD who participated in a 3-week inpatient PR program. The Functional Independence Measure (FIM) was assessed at PR entry and discharge. Correlations between FIM and demographics, clinical/functional parameters were analyzed. Time from PR to death/lung transplantation/censoring was assessed, stratified by baseline/changes in FIM above/below the median. Multivariable Cox proportional hazard models were used to determine the impact of FIM on mortality risk.</div></div><div><h3>Results</h3><div>223 patients (76 ILD/147 COPD) were included. Mean ± standard deviation (SD) age was 69 ± 10 for ILD and 67 ± 10 for COPD. FIM total and motor scores improved significantly in both groups. Baseline FIM showed a strong negative and change in 6-min walk distance (6MWD) a strong positive correlation with change in FIM during PR. Each 1-point increase in FIM motor score was associated with a 3 % lower risk of mortality (HR 0.97, 95%CI 0.94–1, p = 0.03).</div></div><div><h3>Conclusions</h3><div>Inpatient PR improves functional independence in patients with fibrotic ILD or COPD, and baseline and change in FIM are associated with survival up to three years post-PR. This emphasizes the importance of PR for all patients with chronic lung disease regardless of their initial level of independence.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"237 ","pages":"Article 107933"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142907568","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}
Pub Date : 2025-02-01DOI: 10.1016/j.rmed.2025.107952
Davide Chimera , Sara Maio , Chiara Romei , Annalisa De Liperi , Greta Barbieri , Laura Tavanti , Roberta Pancani , Guido Marchi , Massimiliano Desideri , Nicoletta Carpenè , Luciano Gabbrielli , Alessandro Celi , Ferruccio Aquilini , Sandra Baldacci , Michele Cristofano , Lorenzo Ghiadoni , Laura Carrozzi , Francesco Pistelli , the Pisa COVID-19 Study Group
Background
The long-term evolution of COVID-19 in patients hospitalized during the pandemic's first wave remains largely unexplored. This study aimed to identify COVID-19 pulmonary phenotypes and their longitudinal patterns over a 12-month follow-up.
Methods
COVID-19 patients discharged from Pisa University Hospital (Italy) between March–September 2020, were evaluated at T3, T12, and T24 months post-discharge. Assessments included spirometry, lung volumes, DLCO, and chest CT for those with persistent pneumonia signs (PS). Latent transition analysis (LTA) identified COVID-19 phenotypes and longitudinal patterns based on PS and lung function (PFTs). Risk factors for these patterns were evaluated using multinomial logistic regression.
Results
Of 307 discharged patients, 175, 136, and 33 were followed-up at T3, T12, and T24, respectively. At T12, 21.6 % had impaired DLCO, 4.4 % a restrictive ventilatory pattern, and 31,6 % still had PS, persisting until T24. LTA identified three cross-sectional phenotypes at both T3 and T12 (no PS with normal PFTs; PS with normal PFTs; PS with impaired PFTs), and four longitudinal patterns from T3 to T12: persistence of no PS with normal PFTs (47.9 %); resolution of both PS and PFTs (15.4 %); persistent PS (36.7 %), either with (11 %) or without (25.7 %) impaired PFTs. The last two patterns correlated significantly with longer hospitalization, more comorbidities, and severe COVID-19.
Conclusions
In our cohort of COVID-19 patients hospitalized during the pandemic's first wave, we observed distinct pulmonary phenotypes and longitudinal recovery patterns. More comorbidities and severe acute disease correlated with worse progression up to 24 months, suggesting long-term monitoring for such patients.
{"title":"COVID-19 pulmonary phenotypes and longitudinal patterns in the first wave of the pandemic","authors":"Davide Chimera , Sara Maio , Chiara Romei , Annalisa De Liperi , Greta Barbieri , Laura Tavanti , Roberta Pancani , Guido Marchi , Massimiliano Desideri , Nicoletta Carpenè , Luciano Gabbrielli , Alessandro Celi , Ferruccio Aquilini , Sandra Baldacci , Michele Cristofano , Lorenzo Ghiadoni , Laura Carrozzi , Francesco Pistelli , the Pisa COVID-19 Study Group","doi":"10.1016/j.rmed.2025.107952","DOIUrl":"10.1016/j.rmed.2025.107952","url":null,"abstract":"<div><h3>Background</h3><div>The long-term evolution of COVID-19 in patients hospitalized during the pandemic's first wave remains largely unexplored. This study aimed to identify COVID-19 pulmonary phenotypes and their longitudinal patterns over a 12-month follow-up.</div></div><div><h3>Methods</h3><div>COVID-19 patients discharged from Pisa University Hospital (Italy) between March–September 2020, were evaluated at T3, T12, and T24 months post-discharge. Assessments included spirometry, lung volumes, DLCO, and chest CT for those with persistent pneumonia signs (PS). Latent transition analysis (LTA) identified COVID-19 phenotypes and longitudinal patterns based on PS and lung function (PFTs). Risk factors for these patterns were evaluated using multinomial logistic regression.</div></div><div><h3>Results</h3><div>Of 307 discharged patients, 175, 136, and 33 were followed-up at T3, T12, and T24, respectively. At T12, 21.6 % had impaired DLCO, 4.4 % a restrictive ventilatory pattern, and 31,6 % still had PS, persisting until T24. LTA identified three cross-sectional phenotypes at both T3 and T12 (no PS with normal PFTs; PS with normal PFTs; PS with impaired PFTs), and four longitudinal patterns from T3 to T12: persistence of no PS with normal PFTs (47.9 %); resolution of both PS and PFTs (15.4 %); persistent PS (36.7 %), either with (11 %) or without (25.7 %) impaired PFTs. The last two patterns correlated significantly with longer hospitalization, more comorbidities, and severe COVID-19.</div></div><div><h3>Conclusions</h3><div>In our cohort of COVID-19 patients hospitalized during the pandemic's first wave, we observed distinct pulmonary phenotypes and longitudinal recovery patterns. More comorbidities and severe acute disease correlated with worse progression up to 24 months, suggesting long-term monitoring for such patients.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"237 ","pages":"Article 107952"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143010715","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.2025.107953
Shin-Lin Chiu , Tsay-I Chiang , Chiu-Liang Chen
Background
Chronic Obstructive Pulmonary Disease (COPD) is a challenging respiratory condition characterized by persistent airflow limitation and progressive lung function decline. The identification of robust biomarkers is crucial for early diagnosis, monitoring disease progression, and guiding therapeutic strategies.
Methods
In this study, we employed a comprehensive bioinformatics approach utilizing multiple Gene Expression Omnibus (GEO) datasets to identify potential COPD biomarkers. Differentially expressed genes (DEGs) were identified from GSE38974 and GSE76925, and Weighted Gene Co-expression Network Analysis (WGCNA) on GSE76925 revealed significant gene modules associated with COPD traits.
Results
Integrative analysis highlighted five candidate genes, with Secreted Phosphoprotein 1 (SPP1) emerging as a promising biomarker. SPP1 exhibited consistent negative correlations with lung function parameters in human datasets (GSE103174) and significant upregulation in COPD-relevant animal models (GSE36174 and GSE52509). Moreover, SPP1 levels were elevated across various respiratory samples, including alveolar epithelium, alveolar macrophages, sputum, and lung tissue, from COPD patients.
Conclusion
These findings highlight the potential of SPP1 as a diagnostic and prognostic biomarker for COPD, emphasizing the need for further investigation into its role in COPD pathogenesis and its effectiveness in clinical applications.
{"title":"Identification and validation of SPP1 as a potential biomarker for COPD through comprehensive bioinformatics analysis","authors":"Shin-Lin Chiu , Tsay-I Chiang , Chiu-Liang Chen","doi":"10.1016/j.rmed.2025.107953","DOIUrl":"10.1016/j.rmed.2025.107953","url":null,"abstract":"<div><h3>Background</h3><div>Chronic Obstructive Pulmonary Disease (COPD) is a challenging respiratory condition characterized by persistent airflow limitation and progressive lung function decline. The identification of robust biomarkers is crucial for early diagnosis, monitoring disease progression, and guiding therapeutic strategies.</div></div><div><h3>Methods</h3><div>In this study, we employed a comprehensive bioinformatics approach utilizing multiple Gene Expression Omnibus (GEO) datasets to identify potential COPD biomarkers. Differentially expressed genes (DEGs) were identified from GSE38974 and GSE76925, and Weighted Gene Co-expression Network Analysis (WGCNA) on GSE76925 revealed significant gene modules associated with COPD traits.</div></div><div><h3>Results</h3><div>Integrative analysis highlighted five candidate genes, with Secreted Phosphoprotein 1 (SPP1) emerging as a promising biomarker. SPP1 exhibited consistent negative correlations with lung function parameters in human datasets (GSE103174) and significant upregulation in COPD-relevant animal models (GSE36174 and GSE52509). Moreover, SPP1 levels were elevated across various respiratory samples, including alveolar epithelium, alveolar macrophages, sputum, and lung tissue, from COPD patients.</div></div><div><h3>Conclusion</h3><div>These findings highlight the potential of SPP1 as a diagnostic and prognostic biomarker for COPD, emphasizing the need for further investigation into its role in COPD pathogenesis and its effectiveness in clinical applications.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"237 ","pages":"Article 107953"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143010723","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.2025.107949
F.E. Smits, P.J. Rietveld, J.W.M. Snoep, F. van der Velde-Quist, E. de Jonge, A. Schoe
Purpose
The spontaneous breathing trial (SBT) is often performed to determine whether the patient can be extubated with a minimal risk of failure. The rapid shallow breathing index (RSBI) is an important parameter used in an SBT. However, weaning failure rates are between 15 and 20 %. Because of the high incidence of extubation failure a search for a better parameter is warranted. The aim of this study is to investigate whether oxygen consumption, pressure-time product, work of breathing and pressure swings predict weaning failure.
Methods
This is a single-center, prospective observational study conducted at the Leiden University Medical Center. Adult patients undergoing an SBT as per the ruling protocol in the LUMC will be included. Measurements of oxygen consumption, pressure-time product, work of breathing and pressure swings will be continuously recorded during 10 min prior, during and 10 min after the SBT. Data collection will not interfere with clinical decision making. The primary outcome is the ability of these parameters to predict extubation success or failure.
Discussion
Patient enrollment started in January 2024 and inclusions are expected to be complete in January 2026. Patient's risk and burden are minimal. We hypothesize that patients who fail extubation will have higher absolute baseline efforts but will not have the potential to increase those efforts when subjected to an SBT.
Trial registration
The study is retrospectively registered at ClinicalTrials.gov under identifier NCT06391424, submitted on 2024-04-30.
{"title":"Oxygen consumption, effort, and weaning in the mechanically ventilated patient in the intensive care unit: The extubate study: A protocol for an observational study","authors":"F.E. Smits, P.J. Rietveld, J.W.M. Snoep, F. van der Velde-Quist, E. de Jonge, A. Schoe","doi":"10.1016/j.rmed.2025.107949","DOIUrl":"10.1016/j.rmed.2025.107949","url":null,"abstract":"<div><h3>Purpose</h3><div>The spontaneous breathing trial (SBT) is often performed to determine whether the patient can be extubated with a minimal risk of failure. The rapid shallow breathing index (RSBI) is an important parameter used in an SBT. However, weaning failure rates are between 15 and 20 %. Because of the high incidence of extubation failure a search for a better parameter is warranted. The aim of this study is to investigate whether oxygen consumption, pressure-time product, work of breathing and pressure swings predict weaning failure.</div></div><div><h3>Methods</h3><div>This is a single-center, prospective observational study conducted at the Leiden University Medical Center. Adult patients undergoing an SBT as per the ruling protocol in the LUMC will be included. Measurements of oxygen consumption, pressure-time product, work of breathing and pressure swings will be continuously recorded during 10 min prior, during and 10 min after the SBT. Data collection will not interfere with clinical decision making. The primary outcome is the ability of these parameters to predict extubation success or failure.</div></div><div><h3>Discussion</h3><div>Patient enrollment started in January 2024 and inclusions are expected to be complete in January 2026. Patient's risk and burden are minimal. We hypothesize that patients who fail extubation will have higher absolute baseline efforts but will not have the potential to increase those efforts when subjected to an SBT.</div></div><div><h3>Trial registration</h3><div>The study is retrospectively registered at <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> under identifier NCT06391424, submitted on 2024-04-30.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"237 ","pages":"Article 107949"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143010745","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}
Pub Date : 2025-01-31DOI: 10.1016/j.rmed.2025.107979
Angelica Tiotiu , Nicolas Migueres , Francisco-Javier Gonzalez-Barcala , Pauline Roux , Jean-Philippe Oster , Natacha Moutard , Frederic de Blay , Philippe Bonniaud
Background
Patients with severe allergic asthma (SAA) and blood eosinophil count ≥0.3x109/L are eligible for multiple biologics. Several of them showed benefits on nasal polyps (NP), a frequent comorbidity of the severe asthma, but comparative studies on their effectiveness in the association SAA-NP are currently lacking.
Our objective
was to compare the effectiveness of anti-IgE, anti-IL5/R and anti-IL4R in patients with SAA-NP in real-world settings.
Methods
A real-world multicentre observational study was realized including patients with SAA-NP treated by anti-IgE, anti-IL5/R or anti-IL4R for 6 months. We analyzed the nasal and respiratory symptoms, the number of asthma attacks and salbutamol use/week, acute sinusitis and severe exacerbation rates, the asthma control score, the lung function parameters, the NP endoscopic score, the sinus imaging, and the blood eosinophil count 6 months before and after treatment.
Results
One hundred seven patients with SAA-NP were included: 35 treated by anti-IgE, 38 by anti-IL5/R and 34 by anti-IL4R. All the biologics showed similar effectiveness in improving asthma outcomes (symptoms, exacerbation rate, asthma control, lung function). Despite the amelioration of almost all rhinological parameters and sinus imaging in each group, greater benefits were found in the anti-IL4R group in terms of loss of smell (odds ratio OR 3.64[1.3–11.1], p = 0.017), nasal obstruction (OR12.00[2.00–23.10], p = 0.023), and NP endoscopic score (OR 18.10[4.43–24.50]).
Conclusion
All three biological classes improved asthma and sino-nasal outcomes in patients with SAA-NP. However, anti-IL4R was superior in improving the smell, nasal obstruction, and NP endoscopic size. Larger comparative studies are needed to confirm our results.
{"title":"Real-world comparison of T2-biologics effectiveness in severe allergic asthma with nasal polyps","authors":"Angelica Tiotiu , Nicolas Migueres , Francisco-Javier Gonzalez-Barcala , Pauline Roux , Jean-Philippe Oster , Natacha Moutard , Frederic de Blay , Philippe Bonniaud","doi":"10.1016/j.rmed.2025.107979","DOIUrl":"10.1016/j.rmed.2025.107979","url":null,"abstract":"<div><h3>Background</h3><div>Patients with severe allergic asthma (SAA) and blood eosinophil count ≥0.3x10<sup>9</sup>/L are eligible for multiple biologics. Several of them showed benefits on nasal polyps (NP), a frequent comorbidity of the severe asthma, but comparative studies on their effectiveness in the association SAA-NP are currently lacking.</div></div><div><h3>Our objective</h3><div>was to compare the effectiveness of anti-IgE, anti-IL5/R and anti-IL4R in patients with SAA-NP in real-world settings.</div></div><div><h3>Methods</h3><div>A real-world multicentre observational study was realized including patients with SAA-NP treated by anti-IgE, anti-IL5/R or anti-IL4R for 6 months. We analyzed the nasal and respiratory symptoms, the number of asthma attacks and salbutamol use/week, acute sinusitis and severe exacerbation rates, the asthma control score, the lung function parameters, the NP endoscopic score, the sinus imaging, and the blood eosinophil count 6 months before and after treatment.</div></div><div><h3>Results</h3><div>One hundred seven patients with SAA-NP were included: 35 treated by anti-IgE, 38 by anti-IL5/R and 34 by anti-IL4R. All the biologics showed similar effectiveness in improving asthma outcomes (symptoms, exacerbation rate, asthma control, lung function). Despite the amelioration of almost all rhinological parameters and sinus imaging in each group, greater benefits were found in the anti-IL4R group in terms of loss of smell (odds ratio OR 3.64[1.3–11.1], p = 0.017), nasal obstruction (OR12.00[2.00–23.10], p = 0.023), and NP endoscopic score (OR 18.10[4.43–24.50]).</div></div><div><h3>Conclusion</h3><div>All three biological classes improved asthma and sino-nasal outcomes in patients with SAA-NP. However, anti-IL4R was superior in improving the smell, nasal obstruction, and NP endoscopic size. Larger comparative studies are needed to confirm our results.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"238 ","pages":"Article 107979"},"PeriodicalIF":3.5,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080972","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 : 2025-01-31DOI: 10.1016/j.rmed.2025.107980
Lyan Betsema , Mingshi Yang , Adam Bohr , Aitana Herrera , Susanne Kaae
Background
Patients with cystic fibrosis (CF) use inhaled medicines daily due to respiratory manifestations. However, only 31 % of users is inhaling correctly. Digital solutions targeting inhalation could help CF patients improve their technique and thus health outcomes. However, the use of electronic monitoring devices shows a decrease over time. Therefore, the aim of study was to investigate CF patients’ preferences for the use of electronic devices on their inhalation technique on a regular basis and reasons behind these preferences.
Methods
Semistructured interviews were conducted with 11 CF patients from four European countries to understand their disease history and experiences, daily use of inhaler medication, experiences with digital devices to achieve disease control, and expectations of new devices for monitoring inhalation. A conventional content analysis was applied.
Results
CF patients knew their body well due to their lifelong experiences. However, some patients still experienced periods with more symptoms and need for support. Non-app support was preferred. CF patients reported that digital systems should provide high benefits for regular use. Patients differed in their interest in digital systems for inhalation. Such systems were mostly relevant to CF patients starting a new inhaled treatment/inhaler device or during periods in which the disease was out of control.
Conclusions
CF patients perceived limited value of digital systems to monitor their inhalation and mostly considered them necessary for specific periods. Extensive experience in using inhalers and existing daily routines to manage a high treatment burden appear involved in limited need of such systems.
{"title":"Cystic fibrosis patients’ preferences for electronic devices that monitor their inhalation – A qualitative study","authors":"Lyan Betsema , Mingshi Yang , Adam Bohr , Aitana Herrera , Susanne Kaae","doi":"10.1016/j.rmed.2025.107980","DOIUrl":"10.1016/j.rmed.2025.107980","url":null,"abstract":"<div><h3>Background</h3><div>Patients with cystic fibrosis (CF) use inhaled medicines daily due to respiratory manifestations. However, only 31 % of users is inhaling correctly. Digital solutions targeting inhalation could help CF patients improve their technique and thus health outcomes. However, the use of electronic monitoring devices shows a decrease over time. Therefore, the aim of study was to investigate CF patients’ preferences for the use of electronic devices on their inhalation technique on a regular basis and reasons behind these preferences.</div></div><div><h3>Methods</h3><div>Semistructured interviews were conducted with 11 CF patients from four European countries to understand their disease history and experiences, daily use of inhaler medication, experiences with digital devices to achieve disease control, and expectations of new devices for monitoring inhalation. A conventional content analysis was applied.</div></div><div><h3>Results</h3><div>CF patients knew their body well due to their lifelong experiences. However, some patients still experienced periods with more symptoms and need for support. Non-app support was preferred. CF patients reported that digital systems should provide high benefits for regular use. Patients differed in their interest in digital systems for inhalation. Such systems were mostly relevant to CF patients starting a new inhaled treatment/inhaler device or during periods in which the disease was out of control.</div></div><div><h3>Conclusions</h3><div>CF patients perceived limited value of digital systems to monitor their inhalation and mostly considered them necessary for specific periods. Extensive experience in using inhalers and existing daily routines to manage a high treatment burden appear involved in limited need of such systems.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"238 ","pages":"Article 107980"},"PeriodicalIF":3.5,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080967","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}
Pub Date : 2025-01-30DOI: 10.1016/j.rmed.2025.107965
B Ronan O'Driscoll, Nawar Diar Bakerly
Introduction
Oxygen guidelines recommend a target saturation range (SpO2 range) of 88–92 % for patients at risk of hypercapnia. Saturations <88 % and saturations >92 % whilst using supplemental oxygen are associated with increased mortality.
Methods
We audited SpO2 observations of all patients with a prescribed target range of 88–92 % at one hospital over a four-year period.
Results
Of 1,045,958 observations from patients with an oxygen prescription, 107,724 (10.3 %) had a target range of 88–92 % (at risk of hypercapnia). 26,668 of these observations (24.8 %) involved oxygen use. 89.6 % of the SpO2 observations with target SpO2 range 88–92 % were satisfactory with SpO2 ≥88 % breathing air or SpO2 88–92 % breathing oxygen. However, 1.2 % of SpO2 observations for these patients were too low (<88 %). This was commoner in observations involving use of supplemental oxygen (2.2 %) compared with observations on air (0.9 %).
Of the SpO2 observations with target SpO2 range 88–92 % which were recorded whilst the patient was receiving supplemental oxygen therapy, 9870 had SpO2 >92 % (over-oxygenated). This represented 9.2 % of all observations for patients with a target range of 88–92 % and 37.0 % of the 26,668 observations involving use of oxygen for these patients. Compared with nasal cannulae, SpO2 observations involving use of simple masks, Venturi masks and humidified oxygen were more commonly outside of the target range.
Summary
We found that excessive oxygen administration was much commoner than insufficient oxygen therapy for hospital patients at risk of hypercapnia. Excessive oxygen use implies an increased risk of harm to these patients, increased cost, and potentially delayed discharges.
{"title":"Are we giving too much oxygen to patients at risk of hypercapnia? Real world data from a large teaching hospital","authors":"B Ronan O'Driscoll, Nawar Diar Bakerly","doi":"10.1016/j.rmed.2025.107965","DOIUrl":"10.1016/j.rmed.2025.107965","url":null,"abstract":"<div><h3>Introduction</h3><div>Oxygen guidelines recommend a target saturation range (SpO<sub>2</sub> range) of 88–92 % for patients at risk of hypercapnia. Saturations <88 % and saturations >92 % whilst using supplemental oxygen are associated with increased mortality.</div></div><div><h3>Methods</h3><div>We audited SpO<sub>2</sub> observations of all patients with a prescribed target range of 88–92 % at one hospital over a four-year period.</div></div><div><h3>Results</h3><div>Of 1,045,958 observations from patients with an oxygen prescription, 107,724 (10.3 %) had a target range of 88–92 % (at risk of hypercapnia). 26,668 of these observations (24.8 %) involved oxygen use. 89.6 % of the SpO<sub>2</sub> observations with target SpO<sub>2</sub> range 88–92 % were satisfactory with SpO<sub>2</sub> ≥88 % breathing air or SpO<sub>2</sub> 88–92 % breathing oxygen. However, 1.2 % of SpO<sub>2</sub> observations for these patients were too low (<88 %). This was commoner in observations involving use of supplemental oxygen (2.2 %) compared with observations on air (0.9 %).</div><div>Of the SpO<sub>2</sub> observations with target SpO<sub>2</sub> range 88–92 % which were recorded whilst the patient was receiving supplemental oxygen therapy, 9870 had SpO<sub>2</sub> >92 % (over-oxygenated). This represented 9.2 % of all observations for patients with a target range of 88–92 % and 37.0 % of the 26,668 observations involving use of oxygen for these patients. Compared with nasal cannulae, SpO<sub>2</sub> observations involving use of simple masks, Venturi masks and humidified oxygen were more commonly outside of the target range.</div></div><div><h3>Summary</h3><div>We found that excessive oxygen administration was much commoner than insufficient oxygen therapy for hospital patients at risk of hypercapnia. Excessive oxygen use implies an increased risk of harm to these patients, increased cost, and potentially delayed discharges.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"238 ","pages":"Article 107965"},"PeriodicalIF":3.5,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143075347","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 : 2025-01-28DOI: 10.1016/j.rmed.2025.107968
Omer A. Choudhary , Jillian Dhawan , Sahar Sohrabipour , Julie Semenchuk , Tania Da Silva , Megha I. Masthan , Gillian C. Goobie , W. Darlene Reid , Jolene H. Fisher , Christopher J. Ryerson , Dmitry Rozenberg
Background/objectives
Pulmonary rehabilitation (PR) benefits individuals with chronic respiratory conditions beyond COPD; however, the quality of online resources has not been evaluated. The aims of this study were to assess the content, quality, and comprehensibility of YouTube videos that provide PR to individuals with chronic lung diseases other than COPD.
Methods
A search was conducted on YouTube for videos related to PR on non-COPD conditions, with the first 350 videos screened for eligibility (2004–2024). Videos were assessed for content based on predefined scoring matrix derived from PR guidelines, evaluated for their quality using the modified DISCERN tool and Global Quality Scale (GQS), and assessed for their understandability and actionability using the Patient Education Materials and Assessment Tool. Engagement metrics including viewing rate and interaction index were also analyzed.
Results
Of the 59 videos included, there was significant heterogeneity in PR content (i.e. aerobic, strength training, flexibility, etc.). 83 % of the videos were published following the onset of COVID-19 pandemic (March 2020), and 85 % of the videos were not directed at specific disease states. Video quality was moderate, with median modified DISCERN and GQS of 3 IQR[3–4] and 3 IQR[2–4] out of 5, respectively. Mean understandability and actionability were above the 70 % threshold. Engagement metrics revealed that median video views were 2857 (IQR[637–10,729]), but engagement was low (1.4 % IQR[1.0–2.7]).
Conclusion
The study highlights variability in PR content and moderate quality of videos, with reasonable comprehensibility. There is a need for more standardized and disease-specific PR online video resources for non-COPD states.
{"title":"Assessment of online YouTube videos as a source of information and instruction for pulmonary rehabilitation","authors":"Omer A. Choudhary , Jillian Dhawan , Sahar Sohrabipour , Julie Semenchuk , Tania Da Silva , Megha I. Masthan , Gillian C. Goobie , W. Darlene Reid , Jolene H. Fisher , Christopher J. Ryerson , Dmitry Rozenberg","doi":"10.1016/j.rmed.2025.107968","DOIUrl":"10.1016/j.rmed.2025.107968","url":null,"abstract":"<div><h3>Background/objectives</h3><div>Pulmonary rehabilitation (PR) benefits individuals with chronic respiratory conditions beyond COPD; however, the quality of online resources has not been evaluated. The aims of this study were to assess the content, quality, and comprehensibility of YouTube videos that provide PR to individuals with chronic lung diseases other than COPD.</div></div><div><h3>Methods</h3><div>A search was conducted on YouTube for videos related to PR on non-COPD conditions, with the first 350 videos screened for eligibility (2004–2024). Videos were assessed for content based on predefined scoring matrix derived from PR guidelines, evaluated for their quality using the modified DISCERN tool and Global Quality Scale (GQS), and assessed for their understandability and actionability using the Patient Education Materials and Assessment Tool. Engagement metrics including viewing rate and interaction index were also analyzed.</div></div><div><h3>Results</h3><div>Of the 59 videos included, there was significant heterogeneity in PR content (i.e. aerobic, strength training, flexibility, etc.). 83 % of the videos were published following the onset of COVID-19 pandemic (March 2020), and 85 % of the videos were not directed at specific disease states. Video quality was moderate, with median modified DISCERN and GQS of 3 IQR[3–4] and 3 IQR[2–4] out of 5, respectively. Mean understandability and actionability were above the 70 % threshold. Engagement metrics revealed that median video views were 2857 (IQR[637–10,729]), but engagement was low (1.4 % IQR[1.0–2.7]).</div></div><div><h3>Conclusion</h3><div>The study highlights variability in PR content and moderate quality of videos, with reasonable comprehensibility. There is a need for more standardized and disease-specific PR online video resources for non-COPD states.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"238 ","pages":"Article 107968"},"PeriodicalIF":3.5,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143067369","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}
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