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High-flow nasal cannula versus CPAP for the prevention of bronchopulmonary dysplasia in preterm infants: a systematic review with meta-analysis and trial sequential analysis 高流量鼻插管与CPAP预防早产儿支气管肺发育不良:荟萃分析和试验序贯分析的系统综述
IF 3.1 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-01-20 DOI: 10.1016/j.rmed.2026.108651
Janneth Milena Avendaño-Vanegas , Henry Mauricio Parada-Gereda , Luis Alexander Peña-López , Leonardo Arzayus-Patiño

Background

Bronchopulmonary dysplasia (BPD) is common in preterm infants and is associated with invasive ventilation and prolonged oxygen therapy. Continuous positive airway pressure (CPAP) has been the standard non-invasive respiratory support for decades, but it may cause nasal trauma and poor tolerance. High-flow nasal cannula (HFNC) could improve comfort; however, its effectiveness in preventing BPD remains unconfirmed, and the available evidence is heterogeneous.

Methods

We conducted a systematic review and meta-analysis with trial sequential analysis (TSA) of randomised controlled trials comparing HFNC with CPAP for the prevention of BPD in preterm infants. Searches were performed in PubMed, Scopus, Cochrane Library, LILACS, and Science Direct up to June 2025, with no language restrictions. The primary outcome was the incidence of BPD; secondary outcomes included air leak and nasal injury. Methodological quality was assessed using the Cochrane RoB 2.0 tool, certainty of evidence with GRADE, and publication bias with funnel plots and Egger's and Begg's tests. The protocol was registered in PROSPERO (CRD420251076520).

Results

Twenty trials were included (n = 2871 preterm infants). No significant differences were found in the incidence of BPD between HFNC and CPAP (RR: 0.86; 95 % CI: 0.73–1.02; p = 0.08; I2 = 0 %). Similarly, no differences were observed for air leak (RR: 0.76; 95 % CI: 0.45–1.27; p = 0.29). However, HFNC significantly reduced the risk of nasal injury (RR: 0.40; 95 % CI: 0.33–0.49; p < 0.00001). TSA indicated insufficient evidence to confirm a 20 % reduction in BPD. Most studies were at low risk of bias; certainty of the evidence was rated as low for BPD and air leak, and high for nasal injury.

Conclusions

HFNC showed no significant differences compared with CPAP in preventing BPD or air leak in preterm infants, although it reduced the risk of nasal injury. TSA suggests that current evidence is insufficient to confirm or refute a 20 % relative risk reduction in BPD, highlighting the need for further high-quality trials to establish definitive conclusions.
背景:支气管肺发育不良(BPD)在早产儿中很常见,与有创通气和长时间氧疗有关。数十年来,持续气道正压通气(CPAP)一直是标准的无创呼吸支持,但它可能导致鼻外伤和耐受性差。高流量鼻插管(HFNC)可提高舒适度;然而,它在预防BPD方面的有效性仍未得到证实,现有证据也各不相同。方法采用试验序贯分析(TSA)对比较HFNC和CPAP预防早产儿BPD的随机对照试验进行系统评价和荟萃分析。检索在PubMed, Scopus, Cochrane Library, LILACS和Science Direct中进行,截止到2025年6月,没有语言限制。主要结局是BPD的发病率;次要结局包括漏气和鼻腔损伤。方法学质量评价采用Cochrane RoB 2.0工具,证据确定性采用GRADE,发表偏倚采用漏斗图和Egger’s和Begg’s检验。该协议在PROSPERO中注册(CRD420251076520)。结果纳入20项试验(n = 2871例早产儿)。HFNC组与CPAP组BPD发生率无显著差异(RR: 0.86; 95% CI: 0.73-1.02; p = 0.08; I2 = 0%)。同样,在空气泄漏方面也没有观察到差异(RR: 0.76; 95% CI: 0.45-1.27; p = 0.29)。然而,HFNC显著降低了鼻部损伤的风险(RR: 0.40; 95% CI: 0.33-0.49; p < 0.00001)。TSA没有足够的证据证实BPD降低了20%。大多数研究偏倚风险较低;证据的确定性在BPD和漏气中被评为低,在鼻损伤中被评为高。结论shfnc在预防早产儿BPD或漏气方面与CPAP相比无显著差异,但可降低鼻部损伤的风险。TSA表示,目前的证据不足以证实或反驳BPD相对风险降低20%的说法,强调需要进一步的高质量试验来建立明确的结论。
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引用次数: 0
Cone beam CT with integration improves diagnostic yield of bronchoscopic peripheral pulmonary lesion biopsies 整合锥形束CT提高了支气管镜下肺周围病变活检的诊断率
IF 3.1 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-01-20 DOI: 10.1016/j.rmed.2026.108666
Bryan S. Benn , James Dugan , Christian F. Cuvillier Padilla , Yifan Wang , Xiaofeng Wang , See-Wei Low

Background

Robotic bronchoscopy has improved the ability to biopsy peripheral pulmonary lesions (PPL). Intra-procedure PPL, biopsy tool, and catheter visualization represents another means towards refining procedural outcomes. Recently, the ability to integrate this information in real-time became available through 3D mobile cone beam CT (CBCT) imaging. We analyzed the impact of imaging integration on diagnostic yield of shape sensing robotic assisted bronchoscopy (ssRAB) biopsies compared to procedures done without integration.

Methods

Patients undergoing ssRAB (Ion Endoluminal System) with 2D fluoroscopy (03/2023–03/2024) and with 3D CBCT with integration (Cios system) (04/2024–01/2025) were retrospectively identified. The primary outcome was diagnostic yield. Secondary outcomes included diagnostic accuracy and procedural complications.

Results

71 PPLs (67 patients) underwent ssRAB without integration and 102 PPLs (95 patients) were biopsied with integration. While demographics were similar, PPLs in the integration group were smaller (2.11 ± 1.26 cm vs 2.46 ± 1.19 cm, p = 0.010) and more frequently located in the peripheral lung third (n = 82 (80.4 %) vs n = 41 (57.7 %), p = 0.003).
Diagnostic yield without integration was 72 % (51/71) and with integration was 86 % (88/102) (p = 0.019). Diagnostic accuracy without integration was 78 % (55/71) and with integration was 89 % (91/102) (p = 0.036).
After controlling for other variables, biopsies with integration had a significantly higher diagnostic yield compared to those without integration (OR = 3.34, 95 % CI 1.39–8.44, p = 0.008). Pneumothorax rate (3 without integration vs 1 with integration, p = 0.3) was similar.

Interpretation

The use of 3D CBCT for real time integration of PPL location and biopsy tool and catheter relationship improves diagnostic yield of bronchoscopic biopsies performed via ssRAB.
背景:机器人支气管镜检查提高了周围肺病变活检(PPL)的能力。术中PPL、活检工具和导管可视化是改善手术结果的另一种手段。最近,通过3D移动锥形束CT (CBCT)成像,可以实时整合这些信息。我们分析了影像整合对形状传感机器人辅助支气管镜(ssRAB)活检的诊断率的影响,并与没有整合的手术进行了比较。方法回顾性分析采用二维透视(2023年3月23日- 2024年3月)和三维CBCT (Cios系统)(2024年4月- 2025年1月)进行ssRAB(离子腔内系统)检查的患者。主要结局是诊断率。次要结局包括诊断准确性和手术并发症。结果71例ppl(67例)行ssRAB无整合,102例ppl(95例)行整合活检。虽然人口统计学相似,但整合组的ppl较小(2.11±1.26 cm vs 2.46±1.19 cm, p = 0.010),并且更常位于周围肺三分之一(n = 82 (80.4%) vs n = 41 (57.7%), p = 0.003)。无整合的诊断率为72%(51/71),有整合的诊断率为86% (88/102)(p = 0.019)。无整合的诊断准确率为78%(55/71),有整合的诊断准确率为89% (91/102)(p = 0.036)。在控制了其他变量后,整合活检的诊断率明显高于未整合活检(OR = 3.34, 95% CI 1.39-8.44, p = 0.008)。气胸发生率(未合并3例vs合并1例,p = 0.3)相似。使用3D CBCT实时整合PPL位置、活检工具和导管关系,提高了通过ssRAB进行支气管镜活检的诊断率。
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引用次数: 0
PA/A ratio >1 detected by CT-scan during acute exacerbation of chronic obstructive pulmonary disease: A novel prognostic factor for long-term mortality based on a cohort study 慢性阻塞性肺疾病急性加重期ct扫描检测PA/A比值>1:基于队列研究的长期死亡率的新预后因素
IF 3.1 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-01-20 DOI: 10.1016/j.rmed.2026.108665
Chen Zhou , Jing Liu , Qun Yi , Jiaxin Zeng , Xueqing Chen , Xuelian Li , Liqing Peng , Haixia Zhou

Background

The pulmonary artery (PA) to aorta (A) (PA/A) ratio is a prognostic factor of many diseases, but the long-term prognostic value of PA/A during acute exacerbation of chronic obstructive pulmonary disease (AECOPD) has never been disclosed.

Aim

To investigate the long-term prognostic value of PA/A detected by CT-scan during AE stage of COPD inpatients.

Design

A non-interventional cohort study.

Methods

Patients surviving from AECOPD were prospectively enrolled from West China Hospital between September 2017 and July 2021 and followed-up till the fifth year after discharge. PA and A diameters were measured based on CT-scan during hospitalization. LASSO-COX analysis was used to identify the independent prognostic factors. Stratified analysis by sex, age groups were performed.

Results

Among the 1466 patients involved, 402 (27.4 %) died during follow-up (median follow-up time: 41.0 months). Multivariate LASSO-COX analysis showed that PA/A >1 during exacerbation period was associated with increased long-term mortality risk [HR = 1.498, 95 % CI (1.120–2.004), P = 0.007], especially in male and old subgroups. With the rise of PA/A ratio, mortality rate showed a significant upward trend. Kaplan–Meier analysis showed patients with PA/A >1 had significantly lower survival rate. After exacerbation, PA/A ratio showed a significant reduction in patients with PA/A ≤1 (exacerbation vs. stable stage: 0.79 ± 0.11 vs. 0.76 ± 0.11, P < 0.001), while that remained stagnant in patients with PA/A >1 (1.13 ± 0.12 vs. 1.13 ± 0.16, P = 0.592).

Conclusion

PA/A ratio >1 detected during AE stage was a steady and effective prognostic factor of long-term mortality in COPD patients. Further multicenter is warranted to validate the association.
肺动脉(PA)与主动脉(A) (PA/A)比值是许多疾病的预后因素,但PA/A在慢性阻塞性肺疾病(AECOPD)急性加重期的长期预后价值尚未披露。目的探讨慢性阻塞性肺病住院患者AE期ct扫描检测PA/A的长期预后价值。设计一项非干预性队列研究。方法前瞻性纳入2017年9月至2021年7月在华西医院住院的AECOPD患者,随访至出院后第5年。在住院期间通过ct扫描测量PA和A的直径。采用LASSO-COX分析确定独立预后因素。按性别、年龄组进行分层分析。结果1466例患者中,402例(27.4%)在随访期间死亡(中位随访时间:41.0个月)。多因素LASSO-COX分析显示,急性加重期PA/A >;1与长期死亡风险增加相关[HR = 1.498, 95% CI (1.120 ~ 2.004), P = 0.007],尤其是男性和老年亚组。随着PA/A比值的升高,死亡率呈明显上升趋势。Kaplan-Meier分析显示,PA/A >;1患者的生存率明显较低。PA/A≤1的患者加重后PA/A比值显著降低(加重期与稳定期比较:0.79±0.11 vs 0.76±0.11,P < 0.001),而PA/A≤1的患者加重后PA/A比值保持不变(1.13±0.12 vs 1.13±0.16,P = 0.592)。结论AE期检测pa /A比值>;1是COPD患者长期死亡稳定有效的预后因素。进一步的多中心验证这种关联是必要的。
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引用次数: 0
Efficacy of high-flow nasal cannula versus conventional oxygen therapy in high-risk patients undergoing bronchoscopy: a meta-analysis of RCTs. 高流量鼻插管与常规氧疗在高危支气管镜患者中的疗效:一项随机对照试验的荟萃分析。
IF 3.1 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-01-20 DOI: 10.1016/j.rmed.2026.108664
Weizhong Wang, Pan Zhang, Ting Xu, Haiying Guo, Shanshan Zhu, Xiaoyan Yao

Background: Patients with underlying conditions such as chronic obstructive pulmonary disease (COPD) or obesity are at high risk for hypoxemia during bronchoscopy. Whether a high-flow nasal cannula (HFNC) is superior to conventional oxygen therapy (COT) for preventing this complication is well-studied, but a focused synthesis in high-risk populations is needed.

Objectives: To compare the efficacy of HFNC versus COT in preventing intraprocedural hypoxemia and other complications in high-risk patients undergoing bronchoscopy.

Methods: We systematically searched PubMed, Embase, Cochrane Library, and Web of Science for RCTs up to October 2025. Methodological quality was assessed using the Cochrane Risk of Bias tool, and data were pooled with RevMan 5.3.

Results: Five RCTs (1054 patients) were included. Compared to COT, HFNC significantly reduced oxygen desaturation (OR 0.14, 95% CI 0.08-0.27; P < 0.00001; I2 = 62%) and procedure interruptions (OR 0.18, 95% CI 0.09-0.34; P < 0.00001; I2 = 21%). HFNC also increased the lowest SpO2 (MD = 5.89%, 95% CI 3.19-8.58; P < 0.0001; I2 = 90%). No significant difference was found in procedure duration. Sensitivity analyses confirmed the robustness of the primary findings, and the certainty of evidence was moderate for most outcomes.

Discussion: HFNC significantly reduces the risk of hypoxemia and procedure interruptions compared with COT in high-risk patients undergoing bronchoscopy, supporting its use to improve procedural safety in this vulnerable population. Limitations include heterogeneity partly attributable to varying hypoxemia definitions and an inability to blind personnel.

Registration: PROSPERO CRD420251174924.

背景:患有慢性阻塞性肺疾病(COPD)或肥胖等基础疾病的患者在支气管镜检查时低氧血症的风险很高。高流量鼻插管(HFNC)是否优于传统氧疗(COT)来预防这种并发症已经得到了充分的研究,但需要在高危人群中进行重点综合。目的:比较HFNC与COT对高危支气管镜患者术中低氧血症及其他并发症的预防效果。方法:系统检索PubMed、Embase、Cochrane Library和Web of Science,检索截止到2025年10月的随机对照试验。采用Cochrane偏倚风险工具评估方法学质量,并使用RevMan 5.3对数据进行汇总。结果:纳入5项rct(1054例患者)。与COT相比,HFNC显著降低了氧饱和度(OR 0.14, 95% CI 0.08-0.27; P < 0.00001; I2 = 62%)和手术中断(OR 0.18, 95% CI 0.09-0.34; P < 0.00001; I2 = 21%)。HFNC也增加了最低SpO2 (MD = 5.89%, 95% CI 3.19 ~ 8.58; P < 0.0001; I2 = 90%)。手术时间无显著差异。敏感性分析证实了主要发现的稳健性,大多数结果的证据确定性中等。讨论:在接受支气管镜检查的高危患者中,与COT相比,HFNC显著降低了低氧血症和手术中断的风险,支持其用于提高这一弱势人群的手术安全性。局限性包括异质性,部分归因于不同的低氧血症定义和无法失明人员。注册号:PROSPERO CRD420251174924。
{"title":"Efficacy of high-flow nasal cannula versus conventional oxygen therapy in high-risk patients undergoing bronchoscopy: a meta-analysis of RCTs.","authors":"Weizhong Wang, Pan Zhang, Ting Xu, Haiying Guo, Shanshan Zhu, Xiaoyan Yao","doi":"10.1016/j.rmed.2026.108664","DOIUrl":"https://doi.org/10.1016/j.rmed.2026.108664","url":null,"abstract":"<p><strong>Background: </strong>Patients with underlying conditions such as chronic obstructive pulmonary disease (COPD) or obesity are at high risk for hypoxemia during bronchoscopy. Whether a high-flow nasal cannula (HFNC) is superior to conventional oxygen therapy (COT) for preventing this complication is well-studied, but a focused synthesis in high-risk populations is needed.</p><p><strong>Objectives: </strong>To compare the efficacy of HFNC versus COT in preventing intraprocedural hypoxemia and other complications in high-risk patients undergoing bronchoscopy.</p><p><strong>Methods: </strong>We systematically searched PubMed, Embase, Cochrane Library, and Web of Science for RCTs up to October 2025. Methodological quality was assessed using the Cochrane Risk of Bias tool, and data were pooled with RevMan 5.3.</p><p><strong>Results: </strong>Five RCTs (1054 patients) were included. Compared to COT, HFNC significantly reduced oxygen desaturation (OR 0.14, 95% CI 0.08-0.27; P < 0.00001; I<sup>2</sup> = 62%) and procedure interruptions (OR 0.18, 95% CI 0.09-0.34; P < 0.00001; I<sup>2</sup> = 21%). HFNC also increased the lowest SpO<sub>2</sub> (MD = 5.89%, 95% CI 3.19-8.58; P < 0.0001; I<sup>2</sup> = 90%). No significant difference was found in procedure duration. Sensitivity analyses confirmed the robustness of the primary findings, and the certainty of evidence was moderate for most outcomes.</p><p><strong>Discussion: </strong>HFNC significantly reduces the risk of hypoxemia and procedure interruptions compared with COT in high-risk patients undergoing bronchoscopy, supporting its use to improve procedural safety in this vulnerable population. Limitations include heterogeneity partly attributable to varying hypoxemia definitions and an inability to blind personnel.</p><p><strong>Registration: </strong>PROSPERO CRD420251174924.</p>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":" ","pages":"108664"},"PeriodicalIF":3.1,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146030713","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}
引用次数: 0
Impact of carbon footprint information on inhaler prescribing intentions by general practitioners: protocol for an online factorial randomised experiment 碳足迹信息对全科医生吸入器处方意向的影响:一项在线因子随机实验方案。
IF 3.1 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-01-19 DOI: 10.1016/j.rmed.2026.108657
Luise Kazda , Timothy E. Schlub , Michelle Guppy , Mike Forrester , Debbie Rigby , Alexandra Barratt , Darlene Cox , Michael J. Loftus , Katy Bell

Background

Many asthma patients experience suboptimal disease control and are disproportionally impacted by worsening environmental risk factors due to climate change. General practitioners (GPs) are well-placed and trusted to lead conversations to improve asthma management. The resulting treatment improvements have the potential to simultaneously reduce the significant greenhouse gas emissions from inhalers as a co-benefit.

Objectives

This study aims to explore whether adding environmental impact information for respiratory inhalers can influence clinician prescribing while improving quality of care and investigates optimal ways to communicate environmental impacts to GPs.

Methods

We will conduct a factorial (2 × 2 plus control) randomised online hypothetical experiment with Australian GPs. Following consent and baseline information on guideline-concordant maintenance-and-reliever-therapy (“MART”) prescribing, participants will be randomised 1:1:1:1:1 to five conditions: A. Emissions impact: collective action/with graphic; B. Emissions impact: single-action/with graphic; C. Emissions impact: collective action/no graphic; D. Emission impact: single-action/no graphic; E. Control: no further information. The required sample size is 250 GPs. The primary outcome is participant choice of inhaler type (binary choice of dry powder or pressurised metered dose). Secondary outcomes include participant level of confidence in their choice, management choice anxiety, acceptability and trustworthiness of information received (all measured on Likert scales) and reasons for inhaler choice (free text). Study duration will be less than 10 min. We will use t-tests and chi-squared tests for univariable analysis of continuous and binary outcomes respectively, and t, F or likelihood ratio tests for regression models as appropriate.

Results

Not applicable – this is a study protocol.

Conclusion

This study will provide evidence on whether and how environmental impact information can influence prescribing intentions among GPs. Findings will inform future interventions aimed at aligning clinical and environmental goals in respiratory care.
背景:许多哮喘患者的疾病控制不佳,并且由于气候变化导致的环境风险因素恶化,对哮喘患者的影响不成比例。全科医生(全科医生)有良好的地位和信任来引导对话,以改善哮喘管理。由此产生的治疗改进有可能同时减少吸入器的大量温室气体排放,作为一种共同效益。目的:本研究旨在探讨增加呼吸吸入器的环境影响信息是否能影响临床医生的处方,同时提高护理质量,并探讨向全科医生传达环境影响的最佳方式。方法:我们将对澳大利亚全科医生进行一项阶乘(2×2加对照)随机在线假设实验。根据关于符合指南的维持和缓解治疗(“MART”)处方的同意和基线信息,参与者将按1:1:1:1:1随机分配到五种情况:A.排放影响:集体行动/带图表;B.排放影响:单动作/图形;C.排放影响:集体行动/无图示;D.排放影响:单动/无图形;控制中心:没有进一步的消息。所需的样本量为250 gp。主要结局是参与者对吸入器类型的选择(干粉或加压计量剂量的二元选择)。次要结果包括参与者对其选择的信心水平、管理选择焦虑、所收到信息的可接受性和可信度(全部用李克特量表测量)和吸入器选择的原因(免费文本)。学习时间不超过10分钟。我们将分别对连续和二元结果的单变量分析使用t检验和卡方检验,并酌情对回归模型使用t、F似然比检验。结论:本研究将为环境影响信息是否以及如何影响全科医生的处方意向提供证据。研究结果将为未来的干预措施提供信息,旨在使呼吸护理的临床和环境目标保持一致。
{"title":"Impact of carbon footprint information on inhaler prescribing intentions by general practitioners: protocol for an online factorial randomised experiment","authors":"Luise Kazda ,&nbsp;Timothy E. Schlub ,&nbsp;Michelle Guppy ,&nbsp;Mike Forrester ,&nbsp;Debbie Rigby ,&nbsp;Alexandra Barratt ,&nbsp;Darlene Cox ,&nbsp;Michael J. Loftus ,&nbsp;Katy Bell","doi":"10.1016/j.rmed.2026.108657","DOIUrl":"10.1016/j.rmed.2026.108657","url":null,"abstract":"<div><h3>Background</h3><div>Many asthma patients experience suboptimal disease control and are disproportionally impacted by worsening environmental risk factors due to climate change. General practitioners (GPs) are well-placed and trusted to lead conversations to improve asthma management. The resulting treatment improvements have the potential to simultaneously reduce the significant greenhouse gas emissions from inhalers as a co-benefit.</div></div><div><h3>Objectives</h3><div>This study aims to explore whether adding environmental impact information for respiratory inhalers can influence clinician prescribing while improving quality of care and investigates optimal ways to communicate environmental impacts to GPs.</div></div><div><h3>Methods</h3><div>We will conduct a factorial (2 × 2 plus control) randomised online hypothetical experiment with Australian GPs. Following consent and baseline information on guideline-concordant maintenance-and-reliever-therapy (“MART”) prescribing, participants will be randomised 1:1:1:1:1 to five conditions: A. Emissions impact: collective action/with graphic; B. Emissions impact: single-action/with graphic; C. Emissions impact: collective action/no graphic; D. Emission impact: single-action/no graphic; E. Control: no further information. The required sample size is 250 GPs. The primary outcome is participant choice of inhaler type (binary choice of dry powder or pressurised metered dose). Secondary outcomes include participant level of confidence in their choice, management choice anxiety, acceptability and trustworthiness of information received (all measured on Likert scales) and reasons for inhaler choice (free text). Study duration will be less than 10 min. We will use t-tests and chi-squared tests for univariable analysis of continuous and binary outcomes respectively, and t, F or likelihood ratio tests for regression models as appropriate.</div></div><div><h3>Results</h3><div>Not applicable – this is a study protocol.</div></div><div><h3>Conclusion</h3><div>This study will provide evidence on whether and how environmental impact information can influence prescribing intentions among GPs. Findings will inform future interventions aimed at aligning clinical and environmental goals in respiratory care.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"252 ","pages":"Article 108657"},"PeriodicalIF":3.1,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146019588","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}
引用次数: 0
Beyond corticosteroids: A systematic review and meta-analysis of novel therapies for hypersensitivity pneumonitis “超越皮质类固醇:超敏性肺炎新疗法的系统回顾和荟萃分析”。
IF 3.1 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-01-17 DOI: 10.1016/j.rmed.2026.108661
Omnia Azmy Nabeh , Youssef Mohamed Amin Soliman , Reem Ibrahim Elkorashy , Yosri Akl , Emad Elkholy , Mennatullah Abdelhaleem Ahmed Mohamed Hassan , Fatma Elzahraa Ahmed Abd elaleem , Rana kamal El Said Gabr , Katarzyna B. Lewandowska , Soha Aly Elmorsy

Introduction

Hypersensitivity pneumonitis (HP) is a complex immune-mediated interstitial lung disease triggered by inhaled antigens. While corticosteroids remain the mainstay of therapy, their benefit is limited in fibrotic HP. Several novel agents—including pirfenidone, nintedanib, rituximab, azathioprine, mycophenolate mofetil (MMF), leflunomide, and roflumilast—have been investigated as alternatives.

Methods

This meta-analysis followed PRISMA guidelines and was registered on PROSPERO (CRD42023428070). Eligible studies included clinical and non-clinical trials assessing both traditional and novel therapies in HP. Primary outcomes were mean difference from baseline (MDB) and percentage change from baseline (PCB) in forced vital capacity (FVC%) and diffusing capacity for carbon monoxide (DLCO%). Meta-analyses were performed using fixed- and random-effects models, with heterogeneity assessed via I2. Sensitivity analyses and publication bias assessments were also conducted. Risk of bias was evaluated using CASP and RoB-2 tools.

Results

Twenty-three studies comprising 975 patients (aged 39.3–83 years) were included. Rituximab, azathioprine, MMF, and corticosteroids showed non-significant pooled MDBs in FVC%, with MDB of −0.87 %, 2.49 %,1.96 %, and 2.03 %, respectively. For DLCO%, rituximab and MMF showed positive effects, with a MDB of 6.69 and 5.98, respectively, while azathioprine had minimal impact. Single-study analyses suggested that pirfenidone and nintedanib may stabilize lung function; their combination improved DLCO% but not FVC%. Leflunomide and roflumilast demonstrated promising effects in single reports.

Conclusion

Due to heterogeneity and limited high-quality evidence, definitive conclusions about novel therapies in HP remain elusive. However, rituximab and MMF showed promising results. Long-term randomized trials with standardized endpoints are needed to guide therapeutic decisions.
简介:超敏性肺炎(Hypersensitivity pneumonitis, HP)是一种由吸入抗原引发的复杂免疫介导的间质性肺疾病。虽然皮质类固醇仍是主要的治疗方法,但其对纤维化HP的疗效有限。一些新型药物——包括吡非尼酮、尼达尼布、利妥昔单抗、硫唑嘌呤、霉酚酸酯(MMF)、来氟米特和罗氟米特——已被研究作为替代品。方法:本荟萃分析遵循PRISMA指南,在PROSPERO注册(CRD42023428070)。符合条件的研究包括评估HP传统和新型治疗方法的临床和非临床试验。主要结局是强迫肺活量(FVC%)和一氧化碳扩散量(DLCO%)与基线的平均差异(MDB)和基线变化百分比(PCB)。采用固定效应和随机效应模型进行meta分析,并通过I2评估异质性。还进行了敏感性分析和发表偏倚评估。使用CASP和rob2工具评估偏倚风险。结果:纳入23项研究,975例患者(年龄39.3-83岁)。利妥昔单抗、硫唑嘌呤、MMF和皮质类固醇在FVC%中显示不显著的累积MDB, MDB分别为-0.87%、2.49%、1.96%和2.03%。对于DLCO%,利妥昔单抗和MMF表现出积极作用,MDB分别为6.69和5.98,而硫唑嘌呤的影响最小。单项研究分析表明吡非尼酮和尼达尼布可以稳定肺功能;它们的组合提高了DLCO%,但没有提高FVC%。来氟米特和罗氟司特在单一报告中显示出有希望的效果。结论:由于异质性和有限的高质量证据,关于HP新疗法的明确结论仍然难以捉摸。然而,利妥昔单抗和MMF显示出令人鼓舞的结果。需要有标准化终点的长期随机试验来指导治疗决策。
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引用次数: 0
Under the surface: Unveiling the respiratory health crisis among mussel pickers in Kozhikode district, Southern India. 在表面之下:揭示在印度南部Kozhikode地区贻贝采摘者的呼吸健康危机。
IF 3.1 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-01-17 DOI: 10.1016/j.rmed.2026.108653
Binub K, Dhananjayan V, Madayil D, Akshaya K, Ravichandran B, Thamaraikannan M, Panjakumar K, Mala A, M Jaseer

Occupational respiratory diseases pose a considerable health challenge in various industries, especially within the global seafood processing sector. The intricate interactions between lifestyle, pre-existing medical disorders and occupational exposures pose a serious threat to respiratory health. This cross-sectional study explores the respiratory health crisis among mussel workers in Kozhikode District, Southern India. The study aimed to quantify lung function morbidity and the prevalence of respiratory illnesses in this population. Pulmonary function test revealed key finding, including a concerning prevalence of respiratory impairment among mussel workers (21.5 %). Cough with phlegm (14 %), sinusitis (11.8 %), wheezing (4.3 %), shortness of breath (4.3 %), epistaxis (6.5 %), and most significantly, hemoptysis (3 %), other symptoms vertigo (7.53 %) and ophthalmic complaints (4.3 %) were observed. Significant correlations between lung health and variables such as alcohol consumption, history of tuberculosis, smoking, adherence to personal protective equipment (PPE) were determined. The occupational practice of marine mussel harvesting through breath-hold free-diving imposes significant pulmonary risk. Our findings demonstrate that mussel pickers develop a mixed obstructive and restrictive pulmonary impairment. This pathology may be driven by the synergistic effects of repetitive mechanical lung injury.

职业性呼吸系统疾病对各行各业,特别是全球海产品加工部门的健康构成相当大的挑战。生活方式、先前存在的疾病和职业暴露之间复杂的相互作用对呼吸系统健康构成严重威胁。横断面研究探讨了呼吸健康危机的贻贝工人在Kozhikode区,印度南部。目的是量化这一人群中肺功能的发病率和呼吸系统疾病的患病率。肺功能测试揭示了关键发现,包括贻贝工人中呼吸障碍的患病率(21.5%)。咳嗽伴痰(14%)、鼻窦炎(9.6%)、喘息(4.3%)、呼吸短促(4.3%)、鼻出血(6.5%),最显著的是咯血(3%)、其他症状(眩晕(7.53%)和眼病(4.3%)。确定了肺部健康与饮酒、结核病史、吸烟、个人防护装备(PPE)依从性等变量之间的显著相关性。通过屏住呼吸自由潜水捕捞贻贝的职业实践会带来严重的肺部风险。我们的研究结果表明,贻贝采摘者发展为混合性阻塞性和限制性肺损伤。这种病理可能是由重复性机械性肺损伤的协同作用驱动的。
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引用次数: 0
Corrigendum to "Association of circadian syndrome and lung health: A population-based cohort study" [Respir. Med. 240 (2025) 108031]. “昼夜节律综合征与肺部健康的关联:一项基于人群的队列研究”的勘误表[呼吸]。医学,240(2025)108031]。
IF 3.1 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-01-17 DOI: 10.1016/j.rmed.2026.108645
Shuwen Zhang, Jiangtao Lin
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引用次数: 0
Prognosis of patients with bronchiectasis receiving long-term oxygen therapy 支气管扩张患者长期吸氧治疗的预后分析。
IF 3.1 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-01-16 DOI: 10.1016/j.rmed.2026.108655
Kazuki Ono , Masashi Ito , Risako Harada , Takashi Ohe , Koji Furuuchi , Keiji Fujiwara , Tatsuya Kodama , Mitsuru Tabusadani , Kozo Morimoto

Objectives

Long-term oxygen therapy (LTOT) for bronchiectasis is recommended using the same eligibility criteria as for chronic obstructive pulmonary disease (COPD); however, the evidence supporting LTOT in bronchiectasis is limited, and no studies have evaluated the prognosis of the disease in these patients. The aim of the present study was to investigate the characteristics and prognosis of bronchiectasis in patients receiving LTOT.

Methods

This retrospective cohort study included patients with bronchiectasis and COPD who started LTOT between April 2011 and September 2022. Patients with interstitial lung disease (ILD) who started LTOT after June 2020 while receiving antifibrotic therapy were also included. We compared baseline characteristics and survival times among patients with bronchiectasis, COPD, and ILD. Furthermore, among patients with bronchiectasis, we compared these parameters between those with nontuberculous mycobacteria (NTM) culture-positive and NTM culture-negative results.

Results

A total of 93 consecutive patients with bronchiectasis were newly initiated on LTOT. Compared with patients with COPD and ILD, those with bronchiectasis had a significantly lower BMI, %FVC and %FEV. Survival was significantly shorter in patients with bronchiectasis (664 [372–1078] days) than in those with COPD (1008 [590–1722] days), whereas no significant difference was observed compared to ILD (669 [208–989] days). Patients who were NTM culture-positive (405 [156–646] days) had a significantly shorter survival than those who were NTM culture-negative (946 [573–1380] days).

Conclusions

The prognosis of bronchiectasis in patients was extremely poor, worse than that of COPD and comparable to that of ILD.
目的:支气管扩张的长期氧疗(LTOT)推荐使用与慢性阻塞性肺疾病(COPD)相同的资格标准;然而,支持LTOT治疗支气管扩张的证据是有限的,并且没有研究评估这些患者的预后。本研究的目的是探讨支气管扩张的特点和预后的患者接受LTOT。方法:这项回顾性队列研究纳入了2011年4月至2022年9月期间开始LTOT的支气管扩张和COPD患者。2020年6月后开始接受抗纤维化治疗的间质性肺疾病(ILD)患者也包括在内。我们比较了支气管扩张、COPD和ILD患者的基线特征和生存时间。此外,在支气管扩张患者中,我们比较了非结核分枝杆菌(NTM)培养阳性和NTM培养阴性结果的这些参数。结果:连续93例支气管扩张患者均为新开始的LTOT治疗。与COPD和ILD患者相比,支气管扩张患者的BMI、%FVC和%FEV均显著降低。支气管扩张患者的生存期(664[372-1078]天)明显短于COPD患者(1008[590-1722]天),而与ILD患者(669[208-989]天)相比无显著差异。NTM培养阳性患者(405[156-646]天)的生存期明显短于NTM培养阴性患者(946[573-1380]天)。结论:支气管扩张患者预后极差,其预后差于COPD,与ILD相当。
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引用次数: 0
High PEEP in perioperative vs. hypoxemic respiratory failure: Lessons from recent trials 围手术期高PEEP vs.低氧性呼吸衰竭:来自近期试验的经验教训。
IF 3.1 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-01-15 DOI: 10.1016/j.rmed.2026.108659
Lei Gu , Jian Yue , Yuxuan Chen , Wei Liu , Jing Lin
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引用次数: 0
期刊
Respiratory medicine
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