Respiratory medicine最新文献_第9页

Allergic sensitization in asthma and COPD in the NOVELTY study 哮喘和慢性阻塞性肺病的变应性致敏研究。

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2025-12-23 DOI: 10.1016/j.rmed.2025.108605

Christer Janson , Andrei Malinovschi , Magnus Borres , Rosa Faner , Rod Hughes , Anastasios Mangelis , Xiaomeng Ma , Hana Mullerova , Alberto Papi , Helen Reddel , Jose Maria Olaguibel

Background

Allergic sensitization is a hallmark of asthma, linked to increased disease burden. However, its role in chronic obstructive pulmonary disease (COPD) and asthma + COPD remains less understood.

Objective

This cross-sectional study evaluates the prevalence of allergic sensitization and its associations with disease severity, lung function, exacerbations and health status across these conditions in the multinational observational NOVELTY cohort.

Methods

Allergic sensitization was assessed from specific IgE (sIgE) to11 common aeroallergens. Physician-assessed severity, post-bronchodilator FEV1 % predicted, exacerbation history, and health status were evaluated. Mixed-effects multivariable regression models were used to assess associations, adjusted for age, sex, BMI, smoking history, and geographical region.

Results

Baseline sIgE data were available from n = 5389 participants (asthma:2707; asthma + COPD:773; COPD:1909). Allergic sensitization prevalence was 56 % in asthma, 36 % in asthma + COPD, and 19 % in COPD. In asthma, sensitization to any allergen, mites or molds was associated with more severe disease (odds ratios (OR) 1.46 to 2.91) and lower post-BD FEV₁ % predicted (coefficients −1.88 % to −8.94 %). Conversely, in COPD, sensitization was associated with higher FEV₁ and milder severity. Women were less likely than men to be sensitized across all diagnostic groups. Regional differences were evident, with higher sensitization rates in North America and Europe compared to Asia.

Conclusion

Allergic sensitization shows divergent clinical associations across asthma and COPD, being linked to more severe disease in asthma but higher lung function and milder severity in COPD.

Clinical implication

These findings emphasize the phenotypic heterogeneity of allergic sensitization in airway diseases and support its use in guiding personalized diagnostic and therapeutic strategies.

背景：过敏性致敏是哮喘的标志，与疾病负担增加有关。然而，其在慢性阻塞性肺疾病（COPD）和哮喘+COPD中的作用仍然知之甚少。目的：本横断面研究评估了在多国观察性新颖性队列中，过敏致敏的患病率及其与疾病严重程度、肺功能、恶化和健康状况的关系。方法：从特异性IgE （sIgE）到11种常见的空气过敏原进行过敏致敏评价。评估医生评估的严重程度、支气管扩张剂后预测的FEV1 %、加重史和健康状况。使用混合效应多变量回归模型评估相关性，并根据年龄、性别、BMI、吸烟史和地理区域进行调整。结果：基线sIgE数据来自n=5389名参与者（哮喘：2707；哮喘+COPD:773； COPD:1909）。哮喘患者过敏性致敏率为56%，哮喘+COPD患者为36%，COPD患者为19%。在哮喘中，对任何过敏原、螨虫或霉菌的致敏与更严重的疾病相关（比值比（or） 1.46至2.91），预测bd后fev1降低1%（系数-1.88%至-8.94%）。相反，在COPD中，致敏与较高的FEV1和较轻的严重程度相关。在所有诊断组中，女性比男性更不容易敏感。地区差异是明显的，与亚洲相比，北美和欧洲的致敏率更高。结论：过敏性致敏在哮喘和COPD中表现出不同的临床相关性，哮喘中与更严重的疾病有关，而COPD中与更高的肺功能和较轻的严重程度有关。临床意义：这些发现强调了气道疾病中过敏性致敏的表型异质性，并支持其在指导个性化诊断和治疗策略方面的应用。

{"title":"Allergic sensitization in asthma and COPD in the NOVELTY study","authors":"Christer Janson , Andrei Malinovschi , Magnus Borres , Rosa Faner , Rod Hughes , Anastasios Mangelis , Xiaomeng Ma , Hana Mullerova , Alberto Papi , Helen Reddel , Jose Maria Olaguibel","doi":"10.1016/j.rmed.2025.108605","DOIUrl":"10.1016/j.rmed.2025.108605","url":null,"abstract":"<div><h3>Background</h3><div>Allergic sensitization is a hallmark of asthma, linked to increased disease burden. However, its role in chronic obstructive pulmonary disease (COPD) and asthma + COPD remains less understood.</div></div><div><h3>Objective</h3><div>This cross-sectional study evaluates the prevalence of allergic sensitization and its associations with disease severity, lung function, exacerbations and health status across these conditions in the multinational observational NOVELTY cohort.</div></div><div><h3>Methods</h3><div>Allergic sensitization was assessed from specific IgE (sIgE) to11 common aeroallergens. Physician-assessed severity, post-bronchodilator FEV1 % predicted, exacerbation history, and health status were evaluated. Mixed-effects multivariable regression models were used to assess associations, adjusted for age, sex, BMI, smoking history, and geographical region.</div></div><div><h3>Results</h3><div>Baseline sIgE data were available from n = 5389 participants (asthma:2707; asthma + COPD:773; COPD:1909). Allergic sensitization prevalence was 56 % in asthma, 36 % in asthma + COPD, and 19 % in COPD. In asthma, sensitization to any allergen, mites or molds was associated with more severe disease (odds ratios (OR) 1.46 to 2.91) and lower post-BD FEV<sub>1</sub> % predicted (coefficients −1.88 % to −8.94 %). Conversely, in COPD, sensitization was associated with higher FEV<sub>1</sub> and milder severity. Women were less likely than men to be sensitized across all diagnostic groups. Regional differences were evident, with higher sensitization rates in North America and Europe compared to Asia.</div></div><div><h3>Conclusion</h3><div>Allergic sensitization shows divergent clinical associations across asthma and COPD, being linked to more severe disease in asthma but higher lung function and milder severity in COPD.</div></div><div><h3>Clinical implication</h3><div>These findings emphasize the phenotypic heterogeneity of allergic sensitization in airway diseases and support its use in guiding personalized diagnostic and therapeutic strategies.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"251 ","pages":"Article 108605"},"PeriodicalIF":3.1,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145834608","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

Exploring the genetic link between obstructive sleep apnea and obesity: A bidirectional Mendelian randomization study 探索阻塞性睡眠呼吸暂停和肥胖之间的遗传联系：一项双向孟德尔随机研究。

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2025-12-23 DOI: 10.1016/j.rmed.2025.108609

Fuguo Cai , Wei Hong , Chaoliang Xiong , Ningning She , Rui Lu , Yewen Shi , Xiaoyong Ren

Background

Obstructive sleep apnea (OSA) and obesity are interrelated conditions with significant public health implications, but the genetic causal association between them remains unclear. This study investigates their bidirectional causality using Mendelian randomization (MR).

Methods

Genetic data for OSA were obtained from the FinnGen consortium, including 38,998 OSA cases and 336,659 controls, as well as a broader sleep-disorder phenotype comprising 44,299 cases and 329,251 controls. Genetic data for obesity-related traits were sourced from large-scale genome-wide association studies from the GIANT consortium, including body mass index (BMI; n = 681,275), waist–hip ratio (WHR; n = 224,459), and WHR adjusted for BMI (WHRadjBMI; n = 694,649). MR analyses were performed using inverse variance weighting (IVW) as the primary method, with weighted median and MR-Egger analyses for sensitivity assessment.

Results

OSA was causally associated with increased BMI (IVW: OR = 1.275, 95 % CI = 1.070–1.520, p = 0.0065), trunk fat mass (IVW: OR = 1.323, 95 %CI = 1.166–1.501, p = 1.46e-05), and whole-body fat mass (IVW: OR = 1.327, 95 %CI = 1.164–1.512, p = 2.21e-05). Conversely, obesity measures such as BMI (IVW: OR = 1.929, 95 %CI = 1.808–2.059, p = 3.05e-87), trunk fat mass (IVW: OR = 1.630, 95 %CI = 1.515–1.753, p = 4.21e-39), and leg fat mass (IVW: OR = 1.959, 95 %CI = 1.796–2.137, p = 5.93e-52) were causally linked to OSA. No significant association was found between WHR or WHRadjBMI and OSA (p > 0.05).

Conclusion

This study provides genetic evidence of a bidirectional causal relationship between OSA and obesity, emphasizing the role of systemic and regional fat distribution. Integrated management strategies targeting weight reduction and OSA treatment may mitigate the mutual burden of these conditions.

背景：阻塞性睡眠呼吸暂停（OSA）和肥胖是具有重大公共健康影响的相关疾病，但它们之间的遗传因果关系尚不清楚。本研究使用孟德尔随机化（MR）研究了它们的双向因果关系。方法：从FinnGen联盟获得OSA的遗传数据，包括38,998例OSA病例和336,659例对照，以及更广泛的睡眠障碍表型，包括44,299例病例和329,251例对照。肥胖相关性状的遗传数据来自GIANT联盟的大规模全基因组关联研究，包括体重指数（BMI, n=681,275）、腰臀比（WHR, n=224,459）和经BMI调整的腰臀比（WHRadjBMI, n=694,649）。MR分析采用逆方差加权（IVW）作为主要方法，采用加权中位数和MR- egger分析进行敏感性评估。结果：OSA与BMI （IVW: OR= 1.275, 95%CI= 1.070 ~ 1.520, p= 0.0065）、躯干脂肪量（IVW: OR=1.323, 95%CI=1.166 ~ 1.501, p=1.46e-05）、全身脂肪量（IVW: OR=1.327, 95%CI=1.164 ~ 1.512, p=2.21e-05）升高有因果关系。相反，肥胖指标如BMI （IVW: OR=1.929, 95%CI=1.808-2.059, p=3.05e-87）、躯干脂肪量（IVW: OR=1.630, 95%CI=1.515-1.753, p=4.21e-39）和腿部脂肪量（IVW: OR=1.959, 95%CI=1.796-2.137, p=5.93e-52）与OSA有因果关系。WHR、WHRadjBMI与OSA无显著相关性（p < 0.05）。结论：本研究提供了OSA与肥胖之间双向因果关系的遗传学证据，强调了全身和区域脂肪分布的作用。以减肥和OSA治疗为目标的综合管理策略可以减轻这些疾病的相互负担。

{"title":"Exploring the genetic link between obstructive sleep apnea and obesity: A bidirectional Mendelian randomization study","authors":"Fuguo Cai , Wei Hong , Chaoliang Xiong , Ningning She , Rui Lu , Yewen Shi , Xiaoyong Ren","doi":"10.1016/j.rmed.2025.108609","DOIUrl":"10.1016/j.rmed.2025.108609","url":null,"abstract":"<div><h3>Background</h3><div>Obstructive sleep apnea (OSA) and obesity are interrelated conditions with significant public health implications, but the genetic causal association between them remains unclear. This study investigates their bidirectional causality using Mendelian randomization (MR).</div></div><div><h3>Methods</h3><div>Genetic data for OSA were obtained from the FinnGen consortium, including 38,998 OSA cases and 336,659 controls, as well as a broader sleep-disorder phenotype comprising 44,299 cases and 329,251 controls. Genetic data for obesity-related traits were sourced from large-scale genome-wide association studies from the GIANT consortium, including body mass index (BMI; n = 681,275), waist–hip ratio (WHR; n = 224,459), and WHR adjusted for BMI (WHRadjBMI; n = 694,649). MR analyses were performed using inverse variance weighting (IVW) as the primary method, with weighted median and MR-Egger analyses for sensitivity assessment.</div></div><div><h3>Results</h3><div>OSA was causally associated with increased BMI (IVW: OR = 1.275, 95 % CI = 1.070–1.520, p = 0.0065), trunk fat mass (IVW: OR = 1.323, 95 %CI = 1.166–1.501, p = 1.46e-05), and whole-body fat mass (IVW: OR = 1.327, 95 %CI = 1.164–1.512, p = 2.21e-05). Conversely, obesity measures such as BMI (IVW: OR = 1.929, 95 %CI = 1.808–2.059, p = 3.05e-87), trunk fat mass (IVW: OR = 1.630, 95 %CI = 1.515–1.753, p = 4.21e-39), and leg fat mass (IVW: OR = 1.959, 95 %CI = 1.796–2.137, p = 5.93e-52) were causally linked to OSA. No significant association was found between WHR or WHRadjBMI and OSA (p > 0.05).</div></div><div><h3>Conclusion</h3><div>This study provides genetic evidence of a bidirectional causal relationship between OSA and obesity, emphasizing the role of systemic and regional fat distribution. Integrated management strategies targeting weight reduction and OSA treatment may mitigate the mutual burden of these conditions.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"252 ","pages":"Article 108609"},"PeriodicalIF":3.1,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145834635","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

Apnea-hypopnea index, blood pressure, daytime sleepiness, and sleeping quality in obstructive sleep apnea: randomized-controlled responses to Shitali respiratory training 阻塞性睡眠呼吸暂停患者的呼吸暂停低通气指数、血压、日间嗜睡和睡眠质量：对Shitali呼吸训练的随机对照反应

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2025-12-23 DOI: 10.1016/j.rmed.2025.108608

Ali Mohamed Ali Ismail , Naglaa Gadallah Mohammed Gadallah , Ahmed Mohamed Abdelhalim Elfahl

Background

Shitali respiratory or pranayamic yogic training might help to improve OSA symptoms but no study investigated the response of OSA to Shitali respiratory training (SRT).

Aim

This pranayama study aimed to investigate the response of OSA patients to SRT.

Methods

Forty from-both-sex OSA patients with polysomnography-based apnea-hypopnea-index (AHI) evidence were included. Patients – aged 35–58 years old - with mild and moderate OSA (5 < AHI <30 events/hour) were included. The closed envelope procedure was used to randomize and assign the OSA patients into the SRT group (received a 12-week daily SRT, n = 20) or control group (served as a waitlist OSA group, n = 20). Outcome measures were blood systole (BS), respiratory rate (RR), visual analogue scale (VAS) that detected partner rating of sleep disturbance by the participants’ snoring, AHI, blood diastole (BD), daytime sleepiness which was assessed by Epworth questionnaire (EQ), and sleeping quality which was assessed Pittsburgh quality of sleep index questionnaire (PQSIQ).

Results

After the 12-week SRT, the within-SRT group comparison of RR, AHI, BS, PQSIQ, BD, EQ, and VAS showed significant improvements. The waitlist OSA group did not show any significant improvement in all measures.

Conclusion

The course of a 12-week SRT is a good treatment to improve RR, AHI, BS, PQSIQ, BD, EQ, and VAS of partner rating of sleep disturbance in patients with OSA.

背景：Shitali呼吸或调息瑜伽训练可能有助于改善OSA症状，但没有研究调查OSA对Shitali呼吸训练（SRT）的反应。目的：本调息研究旨在探讨OSA患者对SRT的反应。方法：纳入40例以多导睡眠图为基础的呼吸暂停低通气指数（AHI）证据的男女OSA患者。结果：12周SRT后，SRT组内RR、AHI、BS、PQSIQ、BD、EQ、VAS比较均有显著改善。等待名单OSA组在所有测量中没有显示出任何显著的改善。结论：12周的SRT疗程对改善OSA患者睡眠障碍同伴评分的RR、AHI、BS、PQSIQ、BD、EQ和VAS均有较好的疗效。

{"title":"Apnea-hypopnea index, blood pressure, daytime sleepiness, and sleeping quality in obstructive sleep apnea: randomized-controlled responses to Shitali respiratory training","authors":"Ali Mohamed Ali Ismail , Naglaa Gadallah Mohammed Gadallah , Ahmed Mohamed Abdelhalim Elfahl","doi":"10.1016/j.rmed.2025.108608","DOIUrl":"10.1016/j.rmed.2025.108608","url":null,"abstract":"<div><h3>Background</h3><div>Shitali respiratory or pranayamic yogic training might help to improve OSA symptoms but no study investigated the response of OSA to Shitali respiratory training (SRT).</div></div><div><h3>Aim</h3><div>This pranayama study aimed to investigate the response of OSA patients to SRT.</div></div><div><h3>Methods</h3><div>Forty from-both-sex OSA patients with polysomnography-based apnea-hypopnea-index (AHI) evidence were included. Patients – aged 35–58 years old - with mild and moderate OSA (5 < AHI <30 events/hour) were included. The closed envelope procedure was used to randomize and assign the OSA patients into the SRT group (received a 12-week daily SRT, n = 20) or control group (served as a waitlist OSA group, n = 20). Outcome measures were blood systole (BS), respiratory rate (RR), visual analogue scale (VAS) that detected partner rating of sleep disturbance by the participants’ snoring, AHI, blood diastole (BD), daytime sleepiness which was assessed by Epworth questionnaire (EQ), and sleeping quality which was assessed Pittsburgh quality of sleep index questionnaire (PQSIQ).</div></div><div><h3>Results</h3><div>After the 12-week SRT, the within-SRT group comparison of RR, AHI, BS, PQSIQ, BD, EQ, and VAS showed significant improvements. The waitlist OSA group did not show any significant improvement in all measures.</div></div><div><h3>Conclusion</h3><div>The course of a 12-week SRT is a good treatment to improve RR, AHI, BS, PQSIQ, BD, EQ, and VAS of partner rating of sleep disturbance in patients with OSA.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"252 ","pages":"Article 108608"},"PeriodicalIF":3.1,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145834677","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

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

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

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

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

Background

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

Objective

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

Methods

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

Results

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

Conclusions

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

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

{"title":"Effect of physiotherapy on clinical outcomes in patients with acute brain injury: A post–hoc analysis of the ENIO study","authors":"Denise Battaglini , Irene Schiavetti , Alessio Signori , Raphael Cinotti , Karim Asehnoune , Francesca Gualdi , Loui Al-Husinat , Luca Montagnani , Patricia RM. Rocco , Marcus J. Schultz , Nicolò Antonino Patroniti , Chiara Robba","doi":"10.1016/j.rmed.2025.108598","DOIUrl":"10.1016/j.rmed.2025.108598","url":null,"abstract":"<div><h3>Background</h3><div>Patients with Acute Brain Injury often require prolonged intensive care unit (ICU) stays and physiotherapy.</div></div><div><h3>Objective</h3><div>This study aimed to evaluate the frequency and types of physiotherapy used in acute brain injury patients, identify predictors for its initiation, and assess its effects on clinical outcomes, including extubation failure, ICU and hospital mortality, and ICU length of stay.</div></div><div><h3>Methods</h3><div>This post-hoc analysis of the ENIO study included 1012 patients with available physiotherapy data. Clinical outcomes were assessed using inverse probability of treatment weighting (IPTW).</div></div><div><h3>Results</h3><div>Among the patients included, 75.9 % received physiotherapy, with 19.4 % undergoing curative interventions and 80.6 % receiving prophylactic measures. Patients who received physiotherapy were older, more frequently had traumatic brain injuries, and were more likely to require an intracranial probe and external ventricular drainage compared to those who did not. After IPTW adjustment, no significant differences were observed between groups in terms of extubation failure (21.5 % vs. 20.1 %; OR = 0.96, 95 %CI = 0.71–1.30), ICU-mortality (3.0 % vs. 4.5 %; OR = 0.83, 95 %CI = 0.41–1.67), hospital-mortality (8.3 % vs. 7.5 %; OR = 1.21, 95 %CI = 0.76–1.95), or ICU-length of stay (mean 17.3 vs. 13.1 days, p = 0.21). Factors associated with physiotherapy initiation included ventilator-associated pneumonia and the presence of an intracranial probe, while a lower Glasgow Coma Scale score was associated with a reduced likelihood of treatment.</div></div><div><h3>Conclusions</h3><div>Physiotherapy was frequently applied in patients with acute brain injury, but no significant association was observed with extubation failure, mortality, or ICU stay. These findings underscore the need for prospective studies addressing timing, intensity, and modality of physiotherapy in this population.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"251 ","pages":"Article 108598"},"PeriodicalIF":3.1,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145828130","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

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

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

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

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

Background

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

Methods

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

Results

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

Conclusions

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

Registration

PROSPERO (CRD420251042542).

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

{"title":"Exacerbation risk in patients with bronchiectasis receiving DPP-1 inhibitors vs placebo: A meta-analysis of RCTs","authors":"Giulia Carvalhal , Júlia Moreira Diniz , Larissa Calixto Hespanhol , David Curi Barbosa Izoton Cabral , Jafar Aljazeeri","doi":"10.1016/j.rmed.2025.108607","DOIUrl":"10.1016/j.rmed.2025.108607","url":null,"abstract":"<div><h3>Background</h3><div>No therapies have been approved to alter bronchiectasis progression. Dipeptidyl peptidase-1 (DPP-1) inhibitors, which target neutrophil serine protease activation, are under investigation as potential disease-modifying agents.</div></div><div><h3>Methods</h3><div>We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing DPP-1 inhibitors versus placebo in patients with non-cystic fibrosis bronchiectasis. PubMed, Cochrane, EMBASE, Web of Science, Scopus, <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>, and ICTRP were searched from inception until April 26, 2025. Primary outcomes included time to first exacerbation and proportion of patients remaining exacerbation-free. Secondary outcomes included post-bronchodilator % Forced Expiratory Volume in 1 s (FEV<sub>1</sub>), Quality of Life-Bronchiectasis (QoL-B) questionnaire scores, and rate of adverse events. Time-to-event outcome was analyzed using Kaplan-Meier (KM)-estimated individual patient data (IPD), whereas random-effects meta-analyses were performed for remaining outcomes.</div></div><div><h3>Results</h3><div>2523 patients from four RCTs were included, of whom 1689 (66.9 %) received DPP-1 inhibitors. Compared with placebo, DPP-1 inhibitors prolonged the time to first exacerbation (HR 0.79; 95 % CI: 0.71 to 0.88) and increased the proportion of patients remaining exacerbation-free (RR 1.33; 95 % CI 1.12 to 1.58). A slower decline in post-bronchodilator % FEV1 was observed (MD 1.1 %; 95 % CI 0.05 to 2.15), but no difference in QoL-B scores (MD 1.35; 95 % CI -0.72 to 3.42). The safety profile of DPP-1 inhibitors was acceptable and comparable to placebo. Moderate certainty was found across endpoints.</div></div><div><h3>Conclusions</h3><div>DPP-1 inhibitors prolong time to first exacerbation and reduce exacerbation rates in patients with bronchiectasis, with an acceptable safety profile. These findings support their potential as a disease-modifying strategy.</div></div><div><h3>Registration</h3><div>PROSPERO (CRD420251042542).</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"251 ","pages":"Article 108607"},"PeriodicalIF":3.1,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145828086","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

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

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

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

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

Introduction/aim

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

Methods

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

Results

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

Conclusion

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

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

{"title":"Prevalence and overlap of treatable traits in severe asthma and COPD: A cross-disease comparison in a tertiary care setting","authors":"Vanessa L. Clark , Joice Mara de Oliveira , Peter G. Gibson , Vanessa M. McDonald","doi":"10.1016/j.rmed.2025.108604","DOIUrl":"10.1016/j.rmed.2025.108604","url":null,"abstract":"<div><h3>Introduction/aim</h3><div>Understanding the prevalence and overlap of treatable traits in severe asthma and COPD can guide personalised management. We aimed to determine the prevalence of traits in severe asthma and COPD compared to healthy controls in a tertiary care setting and to compare prevalence by diagnostic label.</div></div><div><h3>Methods</h3><div>Participants with severe asthma, COPD and healthy controls were recruited to a cross-sectional study and underwent multidimensional assessment to characterise their treatable traits.</div></div><div><h3>Results</h3><div>We recruited 140 participants with severe asthma, 45 COPD and 67 healthy controls, mean ± SD age, 56.6 ± 16.2 years, and 57.5 % female. Participants with severe asthma and controls, were younger compared to COPD p < 0.001. Of the 23 possible traits, fewer were identified in severe asthma (9.0 ± 2.8) and controls (2.4 ± 1.4) compared to COPD (10.6 ± 2.4; p < 0.001, with a difference between severe asthma and COPD; p < 0.001). Traits that were less prevalent in severe asthma were dyspnoea; p < 0.01, exertional O<sub>2</sub> desaturation; p < 0.001, mucous-hypersecretion; p < 0.05 and airflow obstruction; p < 0.001. Severe asthma was associated with more daytime-sleepiness; p < 0.01, and obesity; p < 0.05. The prevalence of chest infections, pathogen colonisation, smoking, nonadherence, inhaler-polypharmacy, dysfunctional breathing, anxiety or depression did not differ between disease groups.</div></div><div><h3>Conclusion</h3><div>This study provides further support for the treatable traits approach, revealing both diverse and overlapping traits in severe asthma and COPD. This advances the treatable traits paradigm and supports its implementation to improve personalised care in severe asthma and COPD.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"252 ","pages":"Article 108604"},"PeriodicalIF":3.1,"publicationDate":"2025-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145811150","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

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

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2025-12-20 DOI: 10.1016/j.rmed.2025.108602

Dong Ding , Tengda Wei , Miaomiao Wang , Huina Wang , Leiyu Wang , Liuqiao Sun , Shijie Ning , Haohao Liu

The health impacts of temperature variations (TV) on rhinitis remains insufficiently understood. This study investigates the association between both TV_daily and TV_hourly (lag 0–7 days) and rhinitis-related outpatient visits. An individual time-stratified case-crossover design was applied, with stratified analyses by gender, age groups (≤17, 18–44, 45–60, ≥60 years), and seasons. A total of 58,717 rhinitis visits were recorded from 2013 to 2023. We found a significant positive correlation between TV and rhinitis visits, with the strongest effects observed for TV_daily0_4 (excess odds ratio [EOR]: 6.2 %, 95 %CI: 5.3 %,7.2 %) and TV_hourly0_3 (EOR:7.2 %, 95 % CI:5.8 %, 8.5 %). Males and children (≤17 years) were more vulnerable, and the effects was most pronounced in autumn (September–November). Additionally, short-term TV_hourly exhibited a stronger effect compared to TV_daily. Our findings provide robust evidence that exposure to short-term TV significantly increases the risk of rhinitis-related hospital visits, underscoring the need to incorporate TV into public health strategies to mitigating weather-related health risks.

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

{"title":"Rhinitis risk associated with temperature variability in Henan: Comparative analysis of daily and hourly exposure metrics","authors":"Dong Ding , Tengda Wei , Miaomiao Wang , Huina Wang , Leiyu Wang , Liuqiao Sun , Shijie Ning , Haohao Liu","doi":"10.1016/j.rmed.2025.108602","DOIUrl":"10.1016/j.rmed.2025.108602","url":null,"abstract":"<div><div>The health impacts of temperature variations (TV) on rhinitis remains insufficiently understood. This study investigates the association between both TV<sub>daily</sub> and TV<sub>hourly</sub> (lag 0–7 days) and rhinitis-related outpatient visits. An individual time-stratified case-crossover design was applied, with stratified analyses by gender, age groups (≤17, 18–44, 45–60, ≥60 years), and seasons. A total of 58,717 rhinitis visits were recorded from 2013 to 2023. We found a significant positive correlation between TV and rhinitis visits, with the strongest effects observed for TV<sub>daily</sub>0_4 (excess odds ratio [EOR]: 6.2 %, 95 %CI: 5.3 %,7.2 %) and TV<sub>hourly</sub>0_3 (EOR:7.2 %, 95 % CI:5.8 %, 8.5 %). Males and children (≤17 years) were more vulnerable, and the effects was most pronounced in autumn (September–November). Additionally, short-term TV<sub>hourly</sub> exhibited a stronger effect compared to TV<sub>daily</sub>. Our findings provide robust evidence that exposure to short-term TV significantly increases the risk of rhinitis-related hospital visits, underscoring the need to incorporate TV into public health strategies to mitigating weather-related health risks.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"251 ","pages":"Article 108602"},"PeriodicalIF":3.1,"publicationDate":"2025-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145811146","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

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

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2025-12-20 DOI: 10.1016/j.rmed.2025.108606

Vanessa M. McDonald , Tamara Blickisdorf , Joice M. de Oliveira , Hayley A. Scott

Obesity is a non-communicable chronic disease that is growing in prevalence in all regions of the world. In adult populations obesity rates have doubled since the 1990s. Defined as an excess in fat deposits that deleteriously effect health, obesity is complex and leads to multimorbidity, and death from disease. In people with obstructive airway diseases, obesity is even more common and negatively impacts outcomes for people living with these coexisting diseases.

Treatable Traits is a personalised medicine approach to managing obstructive airway diseases, focusing on clinically relevant traits that are identified in individuals followed by the application of individualised interventions. In airway diseases traits are grouped within three domains: pulmonary, extra-pulmonary and behavioural/risk-factors. Obesity is a key extra-pulmonary trait which we purpose to be a super trait due to its impact on individuals living with the disease and the major improvements gained from successful treatment.

In this review we explore the clinical relevance of obesity as a treatable trait of obstructive airway diseases, the optimal approach to measuring and treating obesity, the mechanisms, and the person-centred recommendations for shared decision making. All these areas enable the management of obesity as a treatable trait.

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

{"title":"Managing obesity as a treatable trait of obstructive airway diseases","authors":"Vanessa M. McDonald , Tamara Blickisdorf , Joice M. de Oliveira , Hayley A. Scott","doi":"10.1016/j.rmed.2025.108606","DOIUrl":"10.1016/j.rmed.2025.108606","url":null,"abstract":"<div><div>Obesity is a non-communicable chronic disease that is growing in prevalence in all regions of the world. In adult populations obesity rates have doubled since the 1990s. Defined as an excess in fat deposits that deleteriously effect health, obesity is complex and leads to multimorbidity, and death from disease. In people with obstructive airway diseases, obesity is even more common and negatively impacts outcomes for people living with these coexisting diseases.</div><div>Treatable Traits is a personalised medicine approach to managing obstructive airway diseases, focusing on clinically relevant traits that are identified in individuals followed by the application of individualised interventions. In airway diseases traits are grouped within three domains: pulmonary, extra-pulmonary and behavioural/risk-factors. Obesity is a key extra-pulmonary trait which we purpose to be a super trait due to its impact on individuals living with the disease and the major improvements gained from successful treatment.</div><div>In this review we explore the clinical relevance of obesity as a treatable trait of obstructive airway diseases, the optimal approach to measuring and treating obesity, the mechanisms, and the person-centred recommendations for shared decision making. All these areas enable the management of obesity as a treatable trait.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"252 ","pages":"Article 108606"},"PeriodicalIF":3.1,"publicationDate":"2025-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145811097","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

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

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2025-12-19 DOI: 10.1016/j.rmed.2025.108601

Yuhan Wang , Hailing Liu , Jingyi Zhang, Jiali Xiong, Ke Hu

Objective

Obesity hypoventilation syndrome is defined as daytime hypercapnia in obese individuals without other underlying causes, associated with reduced lung volume. Preserved ratio impaired spirometry (PRISm) and restrictive spirometric pattern (RSP) are different spirometry patterns. In this pilot study, we investigated the association between PRISm (with or without RSP) and daytime hypercapnia in obese patients.

Methods

We conducted a cross-sectional study in 106 obese patients (body mass index ≥ 30 kg/m²). Daytime hypercapnia was defined as an arterial carbon dioxide partial pressure (PaCO₂) > 45 mmHg based on arterial blood gas analysis. PRISm was defined as FEV₁/FVC ≥ 0.70 and FEV₁ < 80 % predicted, and RSP was defined as FEV₁/FVC ≥ 0.70 and FVC < 80 % predicted. We categorized PRISm and RSP into mutually exclusive groups (normal, PRISm alone, RSP alone, and PRISm + RSP).

Results

Among the 106 obese patients (mean age 47.5 ± 14.0 years, 65.1 % male), 30 (28.3 %) had daytime hypercapnia. The prevalence of daytime hypercapnia was 23.5 % (16/68) in the normal spirometry group, 63.6 % (7/11) in the PRISm alone group, and 23.1 % (6/26) in the PRISm + RSP group. In multivariable logistic regression analyses, after adjusting for age, sex, body mass index, ever smoking, apnea-hypopnea index, mean oxygen saturation by pulse oximetry, and FEV₁, PRISm alone was independently associated with daytime hypercapnia (P = 0.043).

Conclusions

Our study observed an association between non-restrictive PRISm and daytime hypercapnia in obese patients. Further research is needed to elucidate the underlying mechanisms and clinical significance of this association.

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

{"title":"Preserved ratio impaired spirometry and restrictive spirometric pattern in obese populations: Clinical relevance with daytime hypercapnia","authors":"Yuhan Wang , Hailing Liu , Jingyi Zhang, Jiali Xiong, Ke Hu","doi":"10.1016/j.rmed.2025.108601","DOIUrl":"10.1016/j.rmed.2025.108601","url":null,"abstract":"<div><h3>Objective</h3><div>Obesity hypoventilation syndrome is defined as daytime hypercapnia in obese individuals without other underlying causes, associated with reduced lung volume. Preserved ratio impaired spirometry (PRISm) and restrictive spirometric pattern (RSP) are different spirometry patterns. In this pilot study, we investigated the association between PRISm (with or without RSP) and daytime hypercapnia in obese patients.</div></div><div><h3>Methods</h3><div>We conducted a cross-sectional study in 106 obese patients (body mass index ≥ 30 kg/m<sup>2</sup>). Daytime hypercapnia was defined as an arterial carbon dioxide partial pressure (PaCO<sub>2</sub>) > 45 mmHg based on arterial blood gas analysis. PRISm was defined as FEV<sub>1</sub>/FVC ≥ 0.70 and FEV<sub>1</sub> < 80 % predicted, and RSP was defined as FEV<sub>1</sub>/FVC ≥ 0.70 and FVC < 80 % predicted. We categorized PRISm and RSP into mutually exclusive groups (normal, PRISm alone, RSP alone, and PRISm + RSP).</div></div><div><h3>Results</h3><div>Among the 106 obese patients (mean age 47.5 ± 14.0 years, 65.1 % male), 30 (28.3 %) had daytime hypercapnia. The prevalence of daytime hypercapnia was 23.5 % (16/68) in the normal spirometry group, 63.6 % (7/11) in the PRISm alone group, and 23.1 % (6/26) in the PRISm + RSP group. In multivariable logistic regression analyses, after adjusting for age, sex, body mass index, ever smoking, apnea-hypopnea index, mean oxygen saturation by pulse oximetry, and FEV<sub>1</sub>, PRISm alone was independently associated with daytime hypercapnia (P = 0.043).</div></div><div><h3>Conclusions</h3><div>Our study observed an association between non-restrictive PRISm and daytime hypercapnia in obese patients. Further research is needed to elucidate the underlying mechanisms and clinical significance of this association.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"251 ","pages":"Article 108601"},"PeriodicalIF":3.1,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145805250","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

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

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2025-12-19 DOI: 10.1016/j.rmed.2025.108603

Izabela Domagala-Manczyk , Marta Miszczuk-Ciesla , Marta Maskey-Warzechowska , Michal Zielecki , Piotr Szczudlik , Marta Dabrowska

Introduction

Knowledge of factors impacting the effectiveness of training of correct inhalation technique could increase the effectiveness of inhalation technique.

Objectives

The aim of the study was to assess the effectiveness of inhalation technique training and to identify factors impacting the effectiveness of training.

Patients and methods

This single centre, interventional, non-randomized study involved 180 adult patients with asthma or COPD. Inhalation technique was evaluated using a checklist of common errors and peak inspiratory flow (PIF). Patients who made any mistakes during inhalation were trained. We searched for factors which may have impacted the effectiveness of inhalation training.

Results

A total of 115 asthma and 65 COPD patients were analyzed. In 140 patients using either metered-dose inhalers (MDI) or soft mist inhalers (SMI; SMI users were grouped with MDI users for analysis), only 9 patients (6.4 %) used inhalers correctly, for dry-powder inhalers (DPI) only 31 (28.2 %). The training of inhalation technique was successful in 112/131 MDI users (85.5 %) and 67/79 DPI users (84.8 %).

Among MDI users, patients who achieved short term improvement in inhalation technique were more likely to have asthma (68.8 % vs. 42.1 %, p = 0.047), be non-smokers (33 % vs 5.3 %, p = 0.039) and younger (64 vs. 66 years, p = 0.028) vs. patients without improvement; respectively among DPI users: cognitive disorders were less often found (0 % vs. 16.7 %, p = 0.018), patients more often read drug leaflets (80.6 % vs 50 %, p = 0.022) and had good self-esteem of inhalation skills (97 % vs. 75 %, p = 0.025).

Conclusions

Training in inhalation leads to short term improvement of inhalation technique for most trainees. As different factors are important for efficacy of training in inhalation skills for MDI and DPI, an individual approach for training is important.

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

{"title":"Limitation of the effectiveness of inhalation training in patients with asthma and COPD","authors":"Izabela Domagala-Manczyk , Marta Miszczuk-Ciesla , Marta Maskey-Warzechowska , Michal Zielecki , Piotr Szczudlik , Marta Dabrowska","doi":"10.1016/j.rmed.2025.108603","DOIUrl":"10.1016/j.rmed.2025.108603","url":null,"abstract":"<div><h3>Introduction</h3><div>Knowledge of factors impacting the effectiveness of training of correct inhalation technique could increase the effectiveness of inhalation technique.</div></div><div><h3>Objectives</h3><div>The aim of the study was to assess the effectiveness of inhalation technique training and to identify factors impacting the effectiveness of training.</div></div><div><h3>Patients and methods</h3><div>This single centre, interventional, non-randomized study involved 180 adult patients with asthma or COPD. Inhalation technique was evaluated using a checklist of common errors and peak inspiratory flow (PIF). Patients who made any mistakes during inhalation were trained. We searched for factors which may have impacted the effectiveness of inhalation training.</div></div><div><h3>Results</h3><div>A total of 115 asthma and 65 COPD patients were analyzed. In 140 patients using either metered-dose inhalers (MDI) or soft mist inhalers (SMI; SMI users were grouped with MDI users for analysis), only 9 patients (6.4 %) used inhalers correctly, for dry-powder inhalers (DPI) only 31 (28.2 %). The training of inhalation technique was successful in 112/131 MDI users (85.5 %) and 67/79 DPI users (84.8 %).</div><div>Among MDI users, patients who achieved short term improvement in inhalation technique were more likely to have asthma (68.8 % vs. 42.1 %, p = 0.047), be non-smokers (33 % vs 5.3 %, p = 0.039) and younger (64 vs. 66 years, p = 0.028) vs. patients without improvement; respectively among DPI users: cognitive disorders were less often found (0 % vs. 16.7 %, p = 0.018), patients more often read drug leaflets (80.6 % vs 50 %, p = 0.022) and had good self-esteem of inhalation skills (97 % vs. 75 %, p = 0.025).</div></div><div><h3>Conclusions</h3><div>Training in inhalation leads to short term improvement of inhalation technique for most trainees. As different factors are important for efficacy of training in inhalation skills for MDI and DPI, an individual approach for training is important.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"251 ","pages":"Article 108603"},"PeriodicalIF":3.1,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145805315","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