Pub Date : 2026-01-06DOI: 10.1016/j.rmed.2026.108638
Fransuélida Da Conceição Soares , José Heriston de Morais Lima , Rafaela Pedrosa , Victor Alexandre Trigueiro Arcoverde , Daphnne Ingryd Fernandes do Nascimento , Danielle Utah Queiroga Ramos , Laís Felix da Silva Neves , Maria Patrícia Cavalcante De Oliveira , Larisse Xavier Almeida , Eduardo Ériko Tenório de França , Tatiana Onofre
Background
Cardiorespiratory fitness, recognized as an important marker of cardiovascular health, is a key determinant in the prognosis of heart failure (HF). These individuals frequently present with reduced exercise tolerance, highlighting the importance of simple and accessible methods for its assessment. The 6-min walk test (6MWT) and the 6-min step test (6MST) are reliable tools to estimate functional capacity, although differences in their protocols may lead to distinct functional and cardiorespiratory responses.
Objectives
To evaluate and compare the functional and cardiorespiratory responses between the 6MWT and the 6MST in individuals with HF.
Methods
This observational study included individuals with HF of both sexes, aged 18 years or older. They performed the 6MWT and the 6MST to assess functional capacity. Statistical significance was set at p < 0.05.
Results
A total of 60 individuals were included, showing reduced predicted percentage values in both tests, with lower performance in the 6MST compared to the 6MWT (69.7 % vs. 84.7 %; P < 0.001). Cardiorespiratory responses differed between tests, with the maximum heart rate (HRmax) during the 6MST significantly higher than the 6MWT (114.8 bpm vs. 104.2 bpm; P < 0.001). At the end of the tests, HR, systolic blood pressure (SBP), Borg dyspnea, and leg fatigue scores were significantly higher in the 6MST (P < 0.001).
Conclusions
Individuals with HF demonstrated impaired functional capacity, with lower predicted values in the 6MST. This test induced greater cardiovascular stress than the 6MWT, resulting in higher HRmax and SBP, as well as increased dyspnea and leg fatigue.
背景：心肺健康被认为是心血管健康的重要标志，是心力衰竭（HF）预后的关键决定因素。这些人经常表现出运动耐受性降低，强调了简单易行的评估方法的重要性。6分钟步行测试（6MWT）和6分钟步频测试（6MST）是评估功能容量的可靠工具，尽管它们的方案差异可能导致不同的功能和心肺反应。目的评价和比较HF患者6MWT和6MST的功能和心肺反应。方法本观察性研究纳入了18岁及以上的男女HF患者。他们进行了6MWT和6MST来评估功能能力。p <； 0.05为统计学意义。结果共纳入60名个体，两项测试的预测百分比值均有所降低，6MST的表现低于6MWT（69.7%对84.7%;P < 0.001）。不同试验的心肺反应不同，6MST期间的最大心率（HRmax）显著高于6MWT （114.8 bpm vs 104.2 bpm; P < 0.001）。试验结束时，6MST组的HR、收缩压（SBP）、Borg呼吸困难和腿部疲劳评分显著高于对照组（P < 0.001）。结论HF患者表现为功能能力受损，6MST预测值较低。与6MWT相比，该试验引起了更大的心血管压力，导致HRmax和收缩压升高，以及呼吸困难和腿部疲劳增加。
{"title":"Assessment and comparison of functional and cardiorespiratory responses between the six-minute walk test and the six-minute step test in individuals with heart failure","authors":"Fransuélida Da Conceição Soares , José Heriston de Morais Lima , Rafaela Pedrosa , Victor Alexandre Trigueiro Arcoverde , Daphnne Ingryd Fernandes do Nascimento , Danielle Utah Queiroga Ramos , Laís Felix da Silva Neves , Maria Patrícia Cavalcante De Oliveira , Larisse Xavier Almeida , Eduardo Ériko Tenório de França , Tatiana Onofre","doi":"10.1016/j.rmed.2026.108638","DOIUrl":"10.1016/j.rmed.2026.108638","url":null,"abstract":"<div><h3>Background</h3><div>Cardiorespiratory fitness, recognized as an important marker of cardiovascular health, is a key determinant in the prognosis of heart failure (HF). These individuals frequently present with reduced exercise tolerance, highlighting the importance of simple and accessible methods for its assessment. The 6-min walk test (6MWT) and the 6-min step test (6MST) are reliable tools to estimate functional capacity, although differences in their protocols may lead to distinct functional and cardiorespiratory responses.</div></div><div><h3>Objectives</h3><div>To evaluate and compare the functional and cardiorespiratory responses between the 6MWT and the 6MST in individuals with HF.</div></div><div><h3>Methods</h3><div>This observational study included individuals with HF of both sexes, aged 18 years or older. They performed the 6MWT and the 6MST to assess functional capacity. Statistical significance was set at p < 0.05.</div></div><div><h3>Results</h3><div>A total of 60 individuals were included, showing reduced predicted percentage values in both tests, with lower performance in the 6MST compared to the 6MWT (69.7 % vs. 84.7 %; P < 0.001). Cardiorespiratory responses differed between tests, with the maximum heart rate (HRmax) during the 6MST significantly higher than the 6MWT (114.8 bpm vs. 104.2 bpm; P < 0.001). At the end of the tests, HR, systolic blood pressure (SBP), Borg dyspnea, and leg fatigue scores were significantly higher in the 6MST (P < 0.001).</div></div><div><h3>Conclusions</h3><div>Individuals with HF demonstrated impaired functional capacity, with lower predicted values in the 6MST. This test induced greater cardiovascular stress than the 6MWT, resulting in higher HRmax and SBP, as well as increased dyspnea and leg fatigue.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"252 ","pages":"Article 108638"},"PeriodicalIF":3.1,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927633","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 : 2026-01-06DOI: 10.1016/j.rmed.2026.108640
Mélanie David , Quentin Marquant , Anne-Laure Brun , Kewin Panel , Alexandre Chabrol , Helene Salvator , Antoine Magnan , Matthieu Groh , Colas Tcherakian
Fibrotic interstitial lung disease (fILD) is a heterogeneous group of rare diseases with a poor prognosis. Given the pro-fibrotic effects of eosinophils, we aimed to assess the distribution of blood eosinophil count (BEC) in patients with fILD and to investigate its potential association with outcomes.
Single-center retrospective study of patients diagnosed with fILD between January 1, 2017 and December 31, 2022. For each patient, BECs during follow-up (except for those sampled during treatment with high-dose glucocorticoids) were pooled to assign a unique number (median). Patients’ characteristics were analysed by BEC (Eo-high and Eo-low subgroups corresponding to BEC ≥75th percentile and <75th percentile, respectively). Predictors of outcomes were assessed by multivariate logistic regression.
201 patients were included. BEC's median and 75th percentile were 0.2 × 109/L and 0.3 × 109/L, respectively. Baseline BEC and median BEC during follow-up were strongly correlated (r1 = 0.66, 95 % IC 0.52–0.78, p < 0.001). Eo-high patients were significantly older (73 vs. 67 years, p = 0.014) and more likely to experience AE-ILD (36 % vs. 15 %, p = 0.002). In multivariate analysis, a diagnosis of IPF (OR 2.62, 95 % IC 1.05–7.02, p = 0.05), idiopathic NSIP (OR 3.69, 95 % IC 0.99–13.74, p = 0.05), baseline supplemental oxygen therapy (OR 4.71, 95 % IC 2.09–10.82, p < 0.001) and median BEC ≥0.3 × 109/L (OR 2.76, 95 % IC 1.25–6.14, p = 0.01) were associated with AE-ILD.
BEC can be associated with AE-ILD. These findings pave the way for future research regarding the role of eosinophils in fILD.
纤维化间质性肺疾病（field）是一种预后不良的异质性罕见疾病。鉴于嗜酸性粒细胞的促纤维化作用，我们旨在评估field患者血液嗜酸性粒细胞计数（BEC）的分布，并研究其与预后的潜在关联。2017年1月1日至2022年12月31日诊断为field的患者的单中心回顾性研究。对于每位患者，将随访期间的BECs（高剂量糖皮质激素治疗期间取样的BECs除外）汇总为唯一数字（中位数）。以BEC（分别对应BEC≥75百分位和< 75百分位的eo -高亚组和eo -低亚组）分析患者特征。结果的预测因素通过多变量逻辑回归进行评估。纳入201例患者。BEC的中位数和第75百分位分别为0.2 x 109/L和0.3 x 109/L。随访期间基线BEC与中位BEC呈强相关（r1 = 0.66, 95% IC为0.52 ~ 0.78,p < 0.001）。eo高的患者明显年龄较大（73岁vs. 67岁，p = 0.014），经历AE-ILD （36% vs. 15%, p = 0.002）。在多因素分析中，诊断为IPF （OR 2.62, 95% IC 1.05-7.02, p = 0.05）、特发性NSIP （OR 3.69, 95% IC 0.99-13.74, p = 0.05）、基线补充氧治疗（OR 4.71, 95% IC 2.09-10.82, p < 0.001）和中位BEC≥0.3 × 109/L （OR 2.76, 95% IC 1.25-6.14, p = 0.01）与AE-ILD相关。BEC可与AE-ILD合并。这些发现为进一步研究嗜酸性粒细胞在field中的作用铺平了道路。
{"title":"Blood eosinophilia as a predictor of acute exacerbation in fibrotic interstitial lung diseases","authors":"Mélanie David , Quentin Marquant , Anne-Laure Brun , Kewin Panel , Alexandre Chabrol , Helene Salvator , Antoine Magnan , Matthieu Groh , Colas Tcherakian","doi":"10.1016/j.rmed.2026.108640","DOIUrl":"10.1016/j.rmed.2026.108640","url":null,"abstract":"<div><div>Fibrotic interstitial lung disease (fILD) is a heterogeneous group of rare diseases with a poor prognosis. Given the pro-fibrotic effects of eosinophils, we aimed to assess the distribution of blood eosinophil count (BEC) in patients with fILD and to investigate its potential association with outcomes.</div><div>Single-center retrospective study of patients diagnosed with fILD between January 1, 2017 and December 31, 2022. For each patient, BECs during follow-up (except for those sampled during treatment with high-dose glucocorticoids) were pooled to assign a unique number (median). Patients’ characteristics were analysed by BEC (Eo-high and Eo-low subgroups corresponding to BEC ≥75th percentile and <75th percentile, respectively). Predictors of outcomes were assessed by multivariate logistic regression.</div><div>201 patients were included. BEC's median and 75th percentile were 0.2 × 10<sup>9</sup>/L and 0.3 × 10<sup>9</sup>/L, respectively. Baseline BEC and median BEC during follow-up were strongly correlated (r1 = 0.66, 95 % IC 0.52–0.78, p < 0.001). Eo-high patients were significantly older (73 vs. 67 years, p = 0.014) and more likely to experience AE-ILD (36 % vs. 15 %, p = 0.002). In multivariate analysis, a diagnosis of IPF (OR 2.62, 95 % IC 1.05–7.02, p = 0.05), idiopathic NSIP (OR 3.69, 95 % IC 0.99–13.74, p = 0.05), baseline supplemental oxygen therapy (OR 4.71, 95 % IC 2.09–10.82, p < 0.001) and median BEC ≥0.3 × 10<sup>9</sup>/L (OR 2.76, 95 % IC 1.25–6.14, p = 0.01) were associated with AE-ILD.</div><div>BEC can be associated with AE-ILD. These findings pave the way for future research regarding the role of eosinophils in fILD.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"252 ","pages":"Article 108640"},"PeriodicalIF":3.1,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145934606","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}
Respiratory syncytial virus (RSV) has traditionally been viewed as a causative agent of pediatric illness, yet accumulating evidence shows substantial morbidity and mortality among adults, particularly older individuals, those with cardiopulmonary comorbidities, and the immunocompromised. Although recent vaccine approvals for older adults represent major progress in prevention, effective therapeutic options for established infection remain limited. Herein we provide a critical analysis of existing and emerging antiviral and monoclonal antibody (mAb) therapies for the management of RSV infection in adults, highlighting current options and compounds in clinical development. At present, ribavirin remains the only antiviral recommended for treatment in adults, and no mAb has received regulatory authorization for prophylaxis or therapy in this population. Several development programs for direct-acting antivirals have been discontinued for reasons unrelated to safety or efficacy in adults, contributing to an ongoing treatment gap. Nevertheless, newer drug candidates, including ziresovir, EDP-938, and S-337395, have shown encouraging antiviral activity and acceptable safety in adult studies. By examining both the scientific evidence and the structural factors shaping the current landscape, we emphasize the need for sustained adult-focused clinical development to complement preventive vaccination. Addressing this therapeutic gap will be essential to reduce the burden of RSV disease in high-risk adult populations, particularly as the global population ages.
{"title":"Respiratory syncytial virus in high-risk adults: A critical appraisal of therapeutic options and unmet needs","authors":"Ilias Mariolis , Kyriaki Ranellou , Antonios-Periklis Panagiotopoulos , Cleo Anastassopoulou , Athanasios Tsakris","doi":"10.1016/j.rmed.2026.108639","DOIUrl":"10.1016/j.rmed.2026.108639","url":null,"abstract":"<div><div>Respiratory syncytial virus (RSV) has traditionally been viewed as a causative agent of pediatric illness, yet accumulating evidence shows substantial morbidity and mortality among adults, particularly older individuals, those with cardiopulmonary comorbidities, and the immunocompromised. Although recent vaccine approvals for older adults represent major progress in prevention, effective therapeutic options for established infection remain limited. Herein we provide a critical analysis of existing and emerging antiviral and monoclonal antibody (mAb) therapies for the management of RSV infection in adults, highlighting current options and compounds in clinical development. At present, ribavirin remains the only antiviral recommended for treatment in adults, and no mAb has received regulatory authorization for prophylaxis or therapy in this population. Several development programs for direct-acting antivirals have been discontinued for reasons unrelated to safety or efficacy in adults, contributing to an ongoing treatment gap. Nevertheless, newer drug candidates, including ziresovir, EDP-938, and S-337395, have shown encouraging antiviral activity and acceptable safety in adult studies. By examining both the scientific evidence and the structural factors shaping the current landscape, we emphasize the need for sustained adult-focused clinical development to complement preventive vaccination. Addressing this therapeutic gap will be essential to reduce the burden of RSV disease in high-risk adult populations, particularly as the global population ages.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"252 ","pages":"Article 108639"},"PeriodicalIF":3.1,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145934725","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 : 2026-01-04DOI: 10.1016/j.rmed.2026.108634
Gulay Yalcin , Fatma Mutluay
Background
Aerobic exercise is a fundamental component of cardiac rehabilitation in individuals with coronary artery disease (CAD). However, the comparative effects of interval and continuous aerobic training on exercise capacity and health-related quality of life (HRQoL) remain under debate.
Methods
This randomized controlled trial included 40 patients with clinically stable coronary artery disease. Participants were randomly assigned to either interval aerobic training or continuous aerobic training for six weeks. The 6-min walk test (6MWT) was used to evaluate exercise capacity, and the Short Form-36 (SF-36) questionnaire was used to assess health-related quality of life (HRQoL). All assessments were performed before and after the training program.
Results
Both training groups demonstrated significant improvements in exercise capacity and HRQoL following the intervention. Interval aerobic training resulted in greater improvements in 6-min walk distance, exercise test duration, and selected SF-36 domains compared with continuous aerobic training.
Conclusion
Both interval and continuous aerobic training improved exercise capacity and health-related quality of life in patients with coronary artery disease. Interval aerobic training was associated with superior improvements in submaximal exercise capacity and selected quality-of-life domains, suggesting that it may be an effective alternative within cardiac rehabilitation programs.
{"title":"The effect of interval and continuous aerobic training on exercise capacity and health-related quality of life in people with coronary artery DISEASE: A randomized controlled trial","authors":"Gulay Yalcin , Fatma Mutluay","doi":"10.1016/j.rmed.2026.108634","DOIUrl":"10.1016/j.rmed.2026.108634","url":null,"abstract":"<div><h3>Background</h3><div>Aerobic exercise is a fundamental component of cardiac rehabilitation in individuals with coronary artery disease (CAD). However, the comparative effects of interval and continuous aerobic training on exercise capacity and health-related quality of life (HRQoL) remain under debate.</div></div><div><h3>Methods</h3><div>This randomized controlled trial included 40 patients with clinically stable coronary artery disease. Participants were randomly assigned to either interval aerobic training or continuous aerobic training for six weeks. The 6-min walk test (6MWT) was used to evaluate exercise capacity, and the Short Form-36 (SF-36) questionnaire was used to assess health-related quality of life (HRQoL). All assessments were performed before and after the training program.</div></div><div><h3>Results</h3><div>Both training groups demonstrated significant improvements in exercise capacity and HRQoL following the intervention. Interval aerobic training resulted in greater improvements in 6-min walk distance, exercise test duration, and selected SF-36 domains compared with continuous aerobic training.</div></div><div><h3>Conclusion</h3><div>Both interval and continuous aerobic training improved exercise capacity and health-related quality of life in patients with coronary artery disease. Interval aerobic training was associated with superior improvements in submaximal exercise capacity and selected quality-of-life domains, suggesting that it may be an effective alternative within cardiac rehabilitation programs.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"252 ","pages":"Article 108634"},"PeriodicalIF":3.1,"publicationDate":"2026-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145912629","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 : 2026-01-02DOI: 10.1016/j.rmed.2025.108632
Gerald S. Zavorsky
Robert A. Rigby, Mikis D. Stasinopoulous, Achim Zeilis, Sanja Stanojevic, Gillian Heller, Fernanda de Bastiani, Thomas Kneib, Andreas Mayr, Reto Stauffer, and Nikolaus Umlauf contend that segmented linear regression (SLR) is inadequate for spirometry reference equations and over-/underdiagnoses abnormality compared with Generalized Additive Models of Location, Scale, and Shape (GAMLSS). Using a refined NHANES 2007-2012 dataset (n=16,596), I reassessed calibration and the lower limit of normal (LLN) discordance with additional analyses. Out-of-sample root mean square error (RMSE) and correlations were essentially identical across approaches, and overall, the prevalence below the LLN differed by <1 percentage point. Ages 5-80 were resampled to the 2020-2024 U.S. Census age structure, and observed below-LLN counts (z<−1.645) were compared with exact 95% binomial bands; most age-sex strata for FEV1, FVC, and FEV1/FVC fell within expected sampling variability, with modest departures mainly in older men. Age-stratified concordance showed 93.5-93.8% normal by both methods and 4.0-4.8% abnormal by both; discordance was uncommon (GAMLSS-only 0.20-0.78%, SLR-only 1.23-1.65%). Estimated week-to-week measurement variability produced LLN flip rates of ∼3% (FEV1), ∼3.5% (FVC), and ∼6% (FEV1/FVC), exceeding model-driven differences. GAMLSS remains useful, but simpler, transparent regressions can often yield comparable practical interpretation.
Robert a: Rigby, Mikis D. Stasinopoulous, Achim Zeilis, Sanja Stanojevic, Gillian Heller, Fernanda de Bastiani, Thomas Kneib, Andreas Mayr， Reto Stauffer和Nikolaus Umlauf认为，与广义位置、尺度和形状加性模型（GAMLSS）相比，分段线性回归（SLR）不足以用于肺量测量参考方程和过度/不足诊断异常。使用精炼的NHANES 2007-2012数据集（n=16,596），我重新评估了校准和正常（LLN）不一致的下限，并进行了额外的分析。样本外均方根误差（RMSE）和相关性在两种方法之间基本相同，总体而言，低于lln的患病率差异为1，FVC和FEV1/FVC在预期的抽样变异性范围内，主要在老年男性中有适度的偏离。两种方法的年龄分层一致性均为93.5 ~ 93.8%正常，4.0 ~ 4.8%异常；差异不常见（gamlss仅为0.20-0.78%，slr仅为1.23-1.65%）。估计每周测量变异性产生的LLN翻转率为~ 3% （FEV1）、~ 3.5% （FVC）和~ 6% (FEV1/FVC)，超过了模型驱动的差异。GAMLSS仍然有用，但更简单的透明回归通常可以产生类似的实际解释。
{"title":"When the noise exceeds the signal: day-to-day variability in spirometry dominates LLN discordance","authors":"Gerald S. Zavorsky","doi":"10.1016/j.rmed.2025.108632","DOIUrl":"10.1016/j.rmed.2025.108632","url":null,"abstract":"<div><div>Robert A. Rigby, Mikis D. Stasinopoulous, Achim Zeilis, Sanja Stanojevic, Gillian Heller, Fernanda de Bastiani, Thomas Kneib, Andreas Mayr, Reto Stauffer, and Nikolaus Umlauf contend that segmented linear regression (SLR) is inadequate for spirometry reference equations and over-/underdiagnoses abnormality compared with Generalized Additive Models of Location, Scale, and Shape (GAMLSS). Using a refined NHANES 2007-2012 dataset (n=16,596), I reassessed calibration and the lower limit of normal (LLN) discordance with additional analyses. Out-of-sample root mean square error (RMSE) and correlations were essentially identical across approaches, and overall, the prevalence below the LLN differed by <1 percentage point. Ages 5-80 were resampled to the 2020-2024 U.S. Census age structure, and observed below-LLN counts (z<−1.645) were compared with exact 95% binomial bands; most age-sex strata for FEV<sub>1</sub>, FVC, and FEV<sub>1</sub>/FVC fell within expected sampling variability, with modest departures mainly in older men. Age-stratified concordance showed 93.5-93.8% normal by both methods and 4.0-4.8% abnormal by both; discordance was uncommon (GAMLSS-only 0.20-0.78%, SLR-only 1.23-1.65%). Estimated week-to-week measurement variability produced LLN flip rates of ∼3% (FEV<sub>1</sub>), ∼3.5% (FVC), and ∼6% (FEV<sub>1</sub>/FVC), exceeding model-driven differences. GAMLSS remains useful, but simpler, transparent regressions can often yield comparable practical interpretation.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"252 ","pages":"Article 108632"},"PeriodicalIF":3.1,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145900964","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 : 2026-01-02DOI: 10.1016/j.rmed.2026.108633
Mauro Maniscalco , Claudio Candia , Francesco Pennisi , Alfio Pennisi , Giuseppe De Simone , Pasquale Ambrosino
Chronic Obstructive Pulmonary Disease (COPD) remains a leading cause of morbidity and mortality worldwide. For patients with a high disease burden, triple therapy with fluticasone furoate/umeclidinium bromide/vilanterol trifenatate (FF/UMEC/VI) has demonstrated significant benefits in health-related quality of life (HRQoL), exacerbation reduction, and lung function improvement. Efforts have been made to define clinical stability (CS), yet real-world data on CS during FF/UMEC/VI therapy remain limited.
This retrospective study aimed to assess the prevalence of CS after 12 months (T12) of FF/UMEC/VI treatment in COPD patients. CS was defined as the concurrent presence at T12 of: no acute exacerbations in the prior 12 months, a ≥ 2-point improvement in COPD Assessment Test (CAT) score from baseline, and a forced expiratory volume in 1 s (FEV1) decline <100 mL.
A total of 47 patients was included. Of them, 10 (21.3 %) achieved CS. These individuals had a lower baseline exacerbation rate (P = 0.020) and a trend toward better baseline lung function. They also demonstrated greater improvement in 6-min walking distance compared with non-CS patients (P = 0.048).
These findings suggest that CS is attainable in routine clinical practice, with prevalence comparable to that observed in clinical trials. Patients achieving CS tended to have milder disease, indicating potential benefits of earlier FF/UMEC/VI initiation. This might have a relevant impact in clinical practice, especially in the setting of pulmonary rehabilitation. Nonetheless, further multicenter prospective studies are warranted to validate our findings and to identify predictors of treatment success.
{"title":"Clinical stability under FF/UMEC/VI triple inhaled therapy: A 12-month real life retrospective observational study","authors":"Mauro Maniscalco , Claudio Candia , Francesco Pennisi , Alfio Pennisi , Giuseppe De Simone , Pasquale Ambrosino","doi":"10.1016/j.rmed.2026.108633","DOIUrl":"10.1016/j.rmed.2026.108633","url":null,"abstract":"<div><div>Chronic Obstructive Pulmonary Disease (COPD) remains a leading cause of morbidity and mortality worldwide. For patients with a high disease burden, triple therapy with fluticasone furoate/umeclidinium bromide/vilanterol trifenatate (FF/UMEC/VI) has demonstrated significant benefits in health-related quality of life (HRQoL), exacerbation reduction, and lung function improvement. Efforts have been made to define clinical stability (CS), yet real-world data on CS during FF/UMEC/VI therapy remain limited.</div><div>This retrospective study aimed to assess the prevalence of CS after 12 months (T12) of FF/UMEC/VI treatment in COPD patients. CS was defined as the concurrent presence at T12 of: no acute exacerbations in the prior 12 months, a ≥ 2-point improvement in COPD Assessment Test (CAT) score from baseline, and a forced expiratory volume in 1 s (FEV<sub>1</sub>) decline <100 mL.</div><div>A total of 47 patients was included. Of them, 10 (21.3 %) achieved CS. These individuals had a lower baseline exacerbation rate (P = 0.020) and a trend toward better baseline lung function. They also demonstrated greater improvement in 6-min walking distance compared with non-CS patients (P = 0.048).</div><div>These findings suggest that CS is attainable in routine clinical practice, with prevalence comparable to that observed in clinical trials. Patients achieving CS tended to have milder disease, indicating potential benefits of earlier FF/UMEC/VI initiation. This might have a relevant impact in clinical practice, especially in the setting of pulmonary rehabilitation. Nonetheless, further multicenter prospective studies are warranted to validate our findings and to identify predictors of treatment success.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"252 ","pages":"Article 108633"},"PeriodicalIF":3.1,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145885888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-31DOI: 10.1016/j.rmed.2025.108625
Gloria Maria Citton , Caterina Antonaglia , Antonio Fabozzi , Alessia Steffanina , Silvia Giannone , Mattia Manna , Giulia Prezioso , Chiara Torregiani , Paola Confalonieri , Francesco Salton , Barbara Ruaro , Paolo Palange , Marco Confalonieri
Background
Obstructive Sleep Apnea Syndrome (OSAS) is the most common sleep-related breathing disorder, considered more prevalent in males. Recent evidences suggest that prevalence of OSAS in females is underestimated, with a clinical phenotype marked by sleep fragmentation, poor sleep quality, and neurobehavioral symptoms. We hypothesized that a low arousal threshold (low AT) may be more common in females, which may underline these clinical and polysomnographic differences.
Methods
In this retrospective multicentric study, 84 females and 93 males with OSA underwent a Home Sleep Apnea Test (HSAT) reviewed by a sleep expert. Low AT was predicted using the Edwards score criteria.
Results
Out of 177 patients, low AT was identified in 60.7 % of females and 40.9 % of males (p = 0.008). Stratifying by OSA severity, low AT was more prevalent in patients with mild disease, both in females and males. Among obese patients (Body Mass Index, BMI ≥30 kg/m2), low AT was present in 60.9 % of females compared to 24.3 % of males (p = 0.001).
Conclusion
Our findings indicate that a low AT is significantly more prevalent in OSA females, remembering that our female population mainly corresponds to post-menopausal females. This may explain the more pronounced sleep fragmentation and neurobehavioral symptoms in women.
{"title":"Sex differences in low arousal threshold in obstructive sleep apnea","authors":"Gloria Maria Citton , Caterina Antonaglia , Antonio Fabozzi , Alessia Steffanina , Silvia Giannone , Mattia Manna , Giulia Prezioso , Chiara Torregiani , Paola Confalonieri , Francesco Salton , Barbara Ruaro , Paolo Palange , Marco Confalonieri","doi":"10.1016/j.rmed.2025.108625","DOIUrl":"10.1016/j.rmed.2025.108625","url":null,"abstract":"<div><h3>Background</h3><div>Obstructive Sleep Apnea Syndrome (OSAS) is the most common sleep-related breathing disorder, considered more prevalent in males. Recent evidences suggest that prevalence of OSAS in females is underestimated, with a clinical phenotype marked by sleep fragmentation, poor sleep quality, and neurobehavioral symptoms. We hypothesized that a low arousal threshold (low AT) may be more common in females, which may underline these clinical and polysomnographic differences.</div></div><div><h3>Methods</h3><div>In this retrospective multicentric study, 84 females and 93 males with OSA underwent a Home Sleep Apnea Test (HSAT) reviewed by a sleep expert. Low AT was predicted using the Edwards score criteria.</div></div><div><h3>Results</h3><div>Out of 177 patients, low AT was identified in 60.7 % of females and 40.9 % of males (p = 0.008). Stratifying by OSA severity, low AT was more prevalent in patients with mild disease, both in females and males. Among obese patients (Body Mass Index, BMI ≥30 kg/m<sup>2</sup>), low AT was present in 60.9 % of females compared to 24.3 % of males (p = 0.001).</div></div><div><h3>Conclusion</h3><div>Our findings indicate that a low AT is significantly more prevalent in OSA females, remembering that our female population mainly corresponds to post-menopausal females. This may explain the more pronounced sleep fragmentation and neurobehavioral symptoms in women.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"252 ","pages":"Article 108625"},"PeriodicalIF":3.1,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145893273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-31DOI: 10.1016/j.rmed.2025.108630
Feng Chen , Mingzhu Lu , Jia Ye , Lei Zhang , Lei Gu , Wei Liu
Objective
The association between FeNO and blood eosinophil count among children and adolescents with asthma in the United States was investigated using data from the National Health and Nutrition Examination Survey (NHANES) 2007–2012.
Methods
A total of 934 children and adolescents with asthma aged 7–19 years were included in the analysis. Multivariate linear regression, smooth curve fitting, threshold effect analysis, and subgroup analyses were performed to evaluate the association between FeNO and blood eosinophil count.
Results
After adjustment for covariates, each one-unit increase in blood eosinophil count was associated with a 5.34 ppb increase in FeNO among children and adolescents with asthma (β = 5.34, 95 % CI: 4.16–6.52). Moreover, FeNO and blood eosinophil count demonstrated a nonlinear relationship pattern, with evidence suggesting a change in the slope at higher blood eosinophil counts. Subgroup analyses revealed significant interactions across age, sex, race/ethnicity, and body mass index (BMI).
Conclusions
This population-based study demonstrated a significant positive association between FeNO and blood eosinophil count among children and adolescents with asthma in the United States.
{"title":"Association between fractional exhaled nitric oxide (FeNO) and blood eosinophil count among children and adolescents with asthma in the United States: a population-based study","authors":"Feng Chen , Mingzhu Lu , Jia Ye , Lei Zhang , Lei Gu , Wei Liu","doi":"10.1016/j.rmed.2025.108630","DOIUrl":"10.1016/j.rmed.2025.108630","url":null,"abstract":"<div><h3>Objective</h3><div>The association between FeNO and blood eosinophil count among children and adolescents with asthma in the United States was investigated using data from the National Health and Nutrition Examination Survey (NHANES) 2007–2012.</div></div><div><h3>Methods</h3><div>A total of 934 children and adolescents with asthma aged 7–19 years were included in the analysis. Multivariate linear regression, smooth curve fitting, threshold effect analysis, and subgroup analyses were performed to evaluate the association between FeNO and blood eosinophil count.</div></div><div><h3>Results</h3><div>After adjustment for covariates, each one-unit increase in blood eosinophil count was associated with a 5.34 ppb increase in FeNO among children and adolescents with asthma (β = 5.34, 95 % CI: 4.16–6.52). Moreover, FeNO and blood eosinophil count demonstrated a nonlinear relationship pattern, with evidence suggesting a change in the slope at higher blood eosinophil counts. Subgroup analyses revealed significant interactions across age, sex, race/ethnicity, and body mass index (BMI).</div></div><div><h3>Conclusions</h3><div>This population-based study demonstrated a significant positive association between FeNO and blood eosinophil count among children and adolescents with asthma in the United States.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"252 ","pages":"Article 108630"},"PeriodicalIF":3.1,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145893315","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}
Anti-melanoma differentiation-associated gene 5 (MDA5) antibody is associated with clinically amyopathic dermatomyositis (CADM) and life-threatening rapidly progressive interstitial lung disease (RP-ILD). Although ILD without skin or muscle involvement has been reported in anti-MDA5-positive patients, the clinical characteristics of this atypical presentation remain unclear.
Procedures
We conducted a multicenter retrospective study of anti-MDA5 antibody-positive ILD in 10 hospitals in Japan between January 2006 and December 2024. Patients were classified into three subgroups: classic dermatomyositis (DM), CADM, and hypocutaneous amyopathic DM (HADM), which is defined as ILD without skin or muscle involvement. The clinical features and outcomes among the groups were analyzed.
Results
Of the 89 patients, 19 (21.3 %) were classified as having classic DM, 59 (66.3 %) as having CADM, and 11 (12.4 %) as having HADM. Compared to classic DM and CADM, patients with HADM were older, more often smokers, and more likely to first present to pulmonologists. Chest HRCT patterns of ILD were similar across the three groups, and the frequency of RP-ILD was comparable; however, patients with HADM were less likely to receive triple combination therapy (glucocorticoids, calcineurin inhibitor, and intravenous cyclophosphamide). Notably, the HADM group had the poorest prognoses. Among patients with HADM, those with RP-ILD had significantly higher anti-MDA5 antibody titers than those without RP-ILD.
Conclusions
A subset of patients with anti-MDA5-positive ILD presents without prominent skin or muscle involvement and may be associated with an increased risk of RP-ILD and poor prognosis. Increased awareness and early recognition of this subtype, together with timely and appropriate immunosuppressive treatment, may improve outcomes.
{"title":"Anti-MDA5 antibody-positive interstitial lung disease without prominent skin or muscle manifestations: A high-risk and potentially overlooked subgroup","authors":"Atsushi Muto , Satoshi Watanabe , Yuko Waseda , Seisuke Okazawa , Toshiki Kido , Keigo Saeki , Toshiyuki Kita , Hazuki Takato , Hiroki Shirasaki , Yukio Kawagishi , Kenta Yamamura , Kazumasa Kase , Kazuhiko Iwasaki , Satoshi Tanaka , Yasunori Iwata , Yasuhito Hamaguchi , Takashi Matsushita , Seiji Yano","doi":"10.1016/j.rmed.2025.108629","DOIUrl":"10.1016/j.rmed.2025.108629","url":null,"abstract":"<div><h3>Purpose</h3><div>Anti-melanoma differentiation-associated gene 5 (MDA5) antibody is associated with clinically amyopathic dermatomyositis (CADM) and life-threatening rapidly progressive interstitial lung disease (RP-ILD). Although ILD without skin or muscle involvement has been reported in anti-MDA5-positive patients, the clinical characteristics of this atypical presentation remain unclear.</div></div><div><h3>Procedures</h3><div>We conducted a multicenter retrospective study of anti-MDA5 antibody-positive ILD in 10 hospitals in Japan between January 2006 and December 2024. Patients were classified into three subgroups: classic dermatomyositis (DM), CADM, and hypocutaneous amyopathic DM (HADM), which is defined as ILD without skin or muscle involvement. The clinical features and outcomes among the groups were analyzed.</div></div><div><h3>Results</h3><div>Of the 89 patients, 19 (21.3 %) were classified as having classic DM, 59 (66.3 %) as having CADM, and 11 (12.4 %) as having HADM. Compared to classic DM and CADM, patients with HADM were older, more often smokers, and more likely to first present to pulmonologists. Chest HRCT patterns of ILD were similar across the three groups, and the frequency of RP-ILD was comparable; however, patients with HADM were less likely to receive triple combination therapy (glucocorticoids, calcineurin inhibitor, and intravenous cyclophosphamide). Notably, the HADM group had the poorest prognoses. Among patients with HADM, those with RP-ILD had significantly higher anti-MDA5 antibody titers than those without RP-ILD.</div></div><div><h3>Conclusions</h3><div>A subset of patients with anti-MDA5-positive ILD presents without prominent skin or muscle involvement and may be associated with an increased risk of RP-ILD and poor prognosis. Increased awareness and early recognition of this subtype, together with timely and appropriate immunosuppressive treatment, may improve outcomes.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"252 ","pages":"Article 108629"},"PeriodicalIF":3.1,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145893333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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