Respiratory medicine最新文献_第9页

Diagnostic accuracy of echocardiography in identifying heart failure related pleural effusions 超声心动图诊断心力衰竭相关胸腔积液的准确性。

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2025-12-30 DOI: 10.1016/j.rmed.2025.108627

Anuraag Sah , Matthew I. Derakhshesh , Hannah D. Bozell , Minahil Wasim , Fatima Javed , Peter Kirkpatrick , Emilio J. Fabian , Boris Shkolnik , Paul J. Feustel , Kurt Hu , Marc A. Judson , Radmila Lyubarova , Mikhail Torosoff , Amit Chopra

Rationale

Differentiating between congestive heart failure-related pleural effusion (CHF-PE) and non-CHF-PE is clinically important. However, this distinction can be challenging and often requires thoracentesis. Role of transthoracic echocardiography in the diagnosis of CHF-PE has never been evaluated.

Objective

Assess the diagnostic performance of echocardiography in differentiating CHF-PE from non-CHF-PE.

Methods

This is a single-center retrospective case-control study of patients with pleural effusions classified as either CHF-PE or non-CHF-PE based on a comprehensive clinical data analysis. Traditional indicators of CHF (reduced left ventricular ejection fraction) and contemporary echocardiographic parameters of elevated left atrial pressures (enlarged indexed left atrial volume - LAVI, increased E/A and E/e’ ratios) were investigated. Echocardiographic evaluations were blinded to the clinical classification of pleural effusions.

Results

The study cohort included 167 patients; most patients (112/167) were diagnosed with non-CHF-PE. Echocardiographic parameters of E/e’ > 14, E/A > 2, LAVI ≥34 ml/m2, and LVEF <40 % had high specificity (89 %, 98 %, 80 %, and 94 %, respectively) but low to modest individual sensitivity (45 %, 12 %, 72 %, and 27 %, respectively) in diagnosing CHF-PE. In a univariate logistic regression, both E/e’ and LAVI performed well in identifying CHF-PE (AUC = 0.832 and 0.835, respectively), however, the best results were seen when E/e’ and LAVI were combined (AUC = 0.903). Whereas reduced LVEF was not helpful in identifying CHF-PE (AUC = 0.635).

Conclusion

Echocardiographic parameters indicative of elevated left atrial pressure can be helpful in diagnosis of pleural effusions associated with CHF and may reduce the need for invasive thoracentesis in selected patients with pleural effusion.

理由：区分充血性心力衰竭相关胸腔积液（CHF-PE）和非CHF-PE具有重要的临床意义。然而，这种区分可能具有挑战性，通常需要胸腔穿刺。经胸超声心动图在诊断CHF-PE中的作用从未被评估过。目的：评估超声心动图鉴别CHF-PE与非CHF-PE的诊断性能方法：本研究是一项单中心回顾性病例对照研究，根据综合临床资料分析，将胸腔积液分为CHF-PE或非CHF-PE的患者。研究了传统的CHF（左室射血分数降低）指标和左房压升高的当代超声心动图参数（左房容积指数增大，E/A和E/ E’比值升高）。超声心动图评价对胸膜积液的临床分类不知情。结果：研究队列包括167例患者；大多数患者（112/167）被诊断为非chf - pe。超声心动图参数E/ E′>4、E/A > 2、LAVI≥34 ml/m2、LVEF结论：超声心动图参数提示左房压升高有助于诊断与CHF相关的胸腔积液，可减少部分胸腔积液患者行有创胸腔穿刺的必要性。

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引用次数: 0

Clinical value of vascular endothelial glycocalyx in acute exacerbation of chronic obstructive pulmonary disease 血管内皮糖萼在慢性阻塞性肺疾病急性加重期的临床价值

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2025-12-30 DOI: 10.1016/j.rmed.2025.108622

Yiqin Yan , Jialong Jiang , Lihan Xiang , Jinmei Zhang , Dandan Hu , Liming Lou , Yue Sun

Background

Current therapeutic strategies for chronic obstructive pulmonary disease (COPD) remain insufficient to halt disease progression or prevent acute exacerbations. This study aimed to investigate vascular endothelial glycocalyx components (Syndecan-1, Heparan Sulfate, and Hyaluronic Acid) as biomarkers for detecting disease severity and predicting acute exacerbations (AECOPD).

Methods

100 patients with COPD and 50 healthy volunteers from the Third Affiliated Hospital of Zhejiang Chinese Medical University. The serum glycocalyx (SDC-1, HS, and HA) levels of the subjects were detected, and the differences were compared.

Results

The level of SDC-1, HS, and HA were higher in the exacerbation group than in the stable group and the control group (P < 0.05), and in the stable group than in the control group (P < 0.05). SDC-1, HS, and HA were negatively correlated with PaO₂, FVC % pred, FEV1 % pred, and FEV1/FVC (P < 0.05) while positively correlating with PaCO₂ (P < 0.05). The logistic regression analysis showed that SDC-1, HS, and HA were influential factors in the acute exacerbation of COPD (AECOPD). The receiver operating characteristics analysis showed that SDC-1, HS, and HA had good predictive efficacy in the AECOPD. Strong correlations between hospital stay and levels of glycocalyx were evident, especially for SDC-1, HS, signifying robust associations with prolonged hospitalization.

Conclusion

The circulating levels of glycocalyx degradation products (SDC-1, HS, and HA) were markedly elevated in AECOPD patients and demonstrated significant correlations with the severity of impaired lung function and gas exchange. Analysis revealed that these biomarkers were independent predictors of acute exacerbations and strongly associated with prolonged hospitalization. Therefore, our study provides clinical evidence that quantifying these components offers a promising, non-invasive approach for assessing disease severity and predicting outcomes in COPD.

背景：目前慢性阻塞性肺疾病（COPD）的治疗策略仍不足以阻止疾病进展或预防急性加重。本研究旨在研究血管内皮糖萼成分（Syndecan-1、硫酸肝素和透明质酸）作为检测疾病严重程度和预测急性加重（AECOPD）的生物标志物。方法选取浙江中医药大学第三附属医院慢性阻塞性肺病患者100例和健康志愿者50例。检测受试者血清糖萼（SDC-1、HS、HA）水平，并比较差异。结果急性加重组患者血清SDC-1、HS、HA水平高于稳定组和对照组（P < 0.05），稳定组高于对照组（P < 0.05）。SDC-1、HS、HA与PaO2、FVC % pred、FEV1 % pred、FEV1/FVC呈负相关（P < 0.05），与PaCO2呈正相关（P < 0.05）。logistic回归分析显示，SDC-1、HS、HA是影响慢性阻塞性肺病急性加重的因素。受试者工作特征分析显示，SDC-1、HS、HA对AECOPD有较好的预测效果。住院时间与糖萼水平之间存在明显的强相关性，特别是对于SDC-1， HS，这表明与住院时间延长存在密切关联。结论AECOPD患者循环中糖萼降解产物（SDC-1、HS和HA）水平明显升高，且与肺功能和气体交换受损程度显著相关。分析显示，这些生物标志物是急性加重的独立预测因子，与延长住院时间密切相关。因此，我们的研究提供了临床证据，量化这些成分为评估COPD疾病严重程度和预测预后提供了一种有希望的非侵入性方法。

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引用次数: 0

Personalizing the approach for the diagnosis of patients with concomitant Chronic Obstructive Pulmonary Disease and Heart failure 慢性阻塞性肺疾病合并心力衰竭患者的个性化诊断方法

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2025-12-30 DOI: 10.1016/j.rmed.2025.108628

Mira Abou-Rjeili , Raquel Farias , Yousof Mostafavi , Benjamin Smith , Nadia Giannetti , Jean Bourbeau

Chronic Obstructive Pulmonary Disease (COPD) and Heart failure (HF) are often concomitant, they are overlooked in practice. The objectives of this study were to determine the prevalence of HF in diagnosed COPD and COPD in diagnosed HF from a specialized clinics and determine patients’ characteristics which could be used to in clinical practice for active screening.

We conducted a prospective cohort study in a specialized COPD clinic and HF clinic. Patients underwent detailed cardiopulmonary evaluation to establish diagnosis and were followed for 12 months.

The prevalence of unrecognized COPD and HF were respectively 26.1 % and 26.8 %, and these patients were older, more likely to be male and heavy smokers. COPD patients with abnormal vs those with normal echocardiography had an increased rate of mod-severe exacerbation like events (1.3 vs 0.6). They also had a higher prevalence of self-reported heart disease, diabetes, abnormal ECG, cardiovascular medication use, higher blood eosinophil and troponin but no difference on lung function, computed tomography-assessed emphysema and gas trapping, symptom burden and health status.

HF patients with abnormal vs those with normal spirometry had increased exacerbation like-events (16.7 % vs 6.3 % but reach statistical significance). They also had more heart disease, worse lung function by definition and gas trapping, higher blood eosinophil but no difference in symptom burden and health status.

In two specialized clinics the prevalence of concomitant disease -undiagnosed HF in COPD patients and undiagnosed COPD in HF patients was common. Distinctive features were limited to clinical characteristics, but specific biomarkers cannot be recommended.

慢性阻塞性肺疾病（COPD）和心力衰竭（HF）往往是合并症，在实践中被忽视。本研究的目的是确定在专门诊所诊断为慢性阻塞性肺病的心衰患病率和慢性阻塞性肺病在诊断为心衰的患者中的患病率，并确定患者的特征，这些特征可用于临床实践中的主动筛查。我们在一家专门的COPD诊所和心衰诊所进行了一项前瞻性队列研究。患者接受详细的心肺评估以确定诊断，并随访12个月。未被识别的COPD和HF患病率分别为26.1%和26.8%，这些患者年龄较大，多为男性和重度吸烟者。与超声心动图正常的COPD患者相比，超声心动图异常的COPD患者发生中度-重度加重样事件的比率增加（1.3 vs 0.6）。他们自我报告的心脏病、糖尿病、心电图异常、心血管药物使用、较高的嗜酸性粒细胞和肌钙蛋白的患病率也较高，但在肺功能、计算机断层扫描评估的肺气肿和气体潴留、症状负担和健康状况方面没有差异。肺活量异常与正常的HF患者加重样事件增加（16.7% vs 6.3%，但有统计学意义）。他们也有更多的心脏病，更差的肺功能和气体捕获，更高的血嗜酸性粒细胞，但症状负担和健康状况没有差异。在两个专科诊所中，伴发疾病——COPD患者中未确诊的HF和HF患者中未确诊的COPD的患病率很普遍。独特的特征仅限于临床特征，但不能推荐特定的生物标志物。

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引用次数: 0

Association of sleep apnea syndrome with respiratory infections: insights from NHANES and Mendelian randomization 睡眠呼吸暂停综合征与呼吸道感染的关联：来自NHANES和孟德尔随机化的见解。

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2025-12-30 DOI: 10.1016/j.rmed.2025.108626

Yingqi Yang , Xia Tang , Tianchi Zhuang , Chang You , Hongkai Yu , Lu Hu , Haokun Mei , Ting Xu , Haili Ren , Hairong Yu , Yibo Gu , Xiaoying Duan , Ning Li , Minghui Ji

Background

Sleep apnea syndrome (SAS) affects one billion people worldwide and is a potential risk factor for a range of diseases. However, its association with respiratory infections is currently unknown.

Methods

We first employed a multi-model logistic regression approach to control confounding factors and explore the association between SAS and respiratory infections with data from NHANES. Subsequently, a Mendelian randomization (MR) analysis was employed to investigate the causal relationship between SAS and 15 respiratory infections outcomes. Heterogeneity tests were conducted and MR-Egger and MR-PRESSO were used to test for horizontal pleiotropy. Leave-one-out analysis was performed to identify influential SNPs. The study adhered to STROBE-MR guidelines for reporting MR results.

Results

In data from NHANES, we observed that SAS was an independent risk factor for respiratory infections (Model 2: P = 0.031, OR = 1.147, 95 % CI = 1.012–1.299). MR analysis showed that SAS was a risk factor for acute upper respiratory infections (P = 0.014, OR = 1.049, 95 % CI = 1.010–1.090) and other acute lower respiratory infections (P = 0.001, OR = 1.128, 95 % CI = 1.052–1.210). In the reverse MR analysis, COVID-19 (very severe respiratory confirmed vs. population) (P = 0.013, OR = 0.969, 95 % CI = 0.945–0.993), anti-influenza virus subtype H3N2 IgG levels (P = 0.028, OR = 0.974, 95 % CI = 0.952–0.997) and respiratory tuberculosis (P = 0.047, OR = 0.972, 95 % CI = 0.946–1.000) were protective factors for SAS.

Conclusion

SAS is a causal risk factor for respiratory infections and certain infections or specific immune responses may in turn reduce the risk of SAS, revealing a complex bidirectional relationship between them. Future studies are needed to validate the underlying mechanisms.

背景：睡眠呼吸暂停综合征（SAS）影响全球10亿人，是多种疾病的潜在危险因素。然而，它与呼吸道感染的关系目前尚不清楚。方法：我们首先采用多模型逻辑回归方法控制混杂因素，并利用NHANES的数据探讨SAS与呼吸道感染之间的关系。随后，采用孟德尔随机化（MR）分析来调查SAS与15种呼吸道感染结局之间的因果关系。进行异质性检验，采用MR-Egger和MR-PRESSO进行水平多效性检验。进行留一分析以确定有影响的snp。本研究遵循STROBE-MR报告MR结果的指南。结果：在NHANES的数据中，我们观察到SAS是呼吸道感染的独立危险因素（模型2:P = 0.031, OR = 1.147, 95% CI = 1.012-1.299）。MR分析显示SAS是急性上呼吸道感染（P = 0.014, OR = 1.049, 95% CI = 1.010 ~ 1.090）和其他急性下呼吸道感染（P = 0.001, OR = 1.128, 95% CI = 1.052 ~ 1.210）的危险因素。在反向MR分析中，COVID-19（非常严重呼吸道确诊vs.人群）（P = 0.013, OR = 0.969, 95% CI = 0.945-0.993）、抗流感病毒亚型H3N2 IgG水平（P = 0.028, OR = 0.974, 95% CI = 0.952-0.997）和呼吸道结核（P = 0.047, OR = 0.972, 95% CI = 0.946-1.000）是SAS的保护因素。结论：SAS是呼吸道感染的一个因果危险因素，某些感染或特定免疫反应可反过来降低SAS的风险，两者之间存在复杂的双向关系。需要进一步的研究来验证潜在的机制。

{"title":"Association of sleep apnea syndrome with respiratory infections: insights from NHANES and Mendelian randomization","authors":"Yingqi Yang , Xia Tang , Tianchi Zhuang , Chang You , Hongkai Yu , Lu Hu , Haokun Mei , Ting Xu , Haili Ren , Hairong Yu , Yibo Gu , Xiaoying Duan , Ning Li , Minghui Ji","doi":"10.1016/j.rmed.2025.108626","DOIUrl":"10.1016/j.rmed.2025.108626","url":null,"abstract":"<div><h3>Background</h3><div>Sleep apnea syndrome (SAS) affects one billion people worldwide and is a potential risk factor for a range of diseases. However, its association with respiratory infections is currently unknown.</div></div><div><h3>Methods</h3><div>We first employed a multi-model logistic regression approach to control confounding factors and explore the association between SAS and respiratory infections with data from NHANES. Subsequently, a Mendelian randomization (MR) analysis was employed to investigate the causal relationship between SAS and 15 respiratory infections outcomes. Heterogeneity tests were conducted and MR-Egger and MR-PRESSO were used to test for horizontal pleiotropy. Leave-one-out analysis was performed to identify influential SNPs. The study adhered to STROBE-MR guidelines for reporting MR results.</div></div><div><h3>Results</h3><div>In data from NHANES, we observed that SAS was an independent risk factor for respiratory infections (Model 2: P = 0.031, OR = 1.147, 95 % CI = 1.012–1.299). MR analysis showed that SAS was a risk factor for acute upper respiratory infections (<em>P</em> = 0.014, OR = 1.049, 95 % CI = 1.010–1.090) and other acute lower respiratory infections (<em>P</em> = 0.001, OR = 1.128, 95 % CI = 1.052–1.210). In the reverse MR analysis, COVID-19 (very severe respiratory confirmed vs. population) (<em>P</em> = 0.013, OR = 0.969, 95 % CI = 0.945–0.993), anti-influenza virus subtype H3N2 IgG levels (<em>P</em> = 0.028, OR = 0.974, 95 % CI = 0.952–0.997) and respiratory tuberculosis (<em>P</em> = 0.047, OR = 0.972, 95 % CI = 0.946–1.000) were protective factors for SAS.</div></div><div><h3>Conclusion</h3><div>SAS is a causal risk factor for respiratory infections and certain infections or specific immune responses may in turn reduce the risk of SAS, revealing a complex bidirectional relationship between them. Future studies are needed to validate the underlying mechanisms.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"252 ","pages":"Article 108626"},"PeriodicalIF":3.1,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145888334","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

Google Trends as a health sentinel. ALERT study: Analyzing Symptoms Perceptions Related To Environmental pollution 谷歌趋势作为健康哨兵。ALERT研究：分析与环境污染有关的症状感知。

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2025-12-29 DOI: 10.1016/j.rmed.2025.108623

Benedetta Bondi , Fulvio Braido , Ilaria Baiardini , Federico Di Marco , Carola Montagnino , Martina Buscema , Cesare de Tommaso , Filippo Tarchino , Marcello Mincarini , Anna Maria Riccio , Diego Bagnasco

Background

The relationship between environmental pollution and human health is well-documented, and exposure has been linked to an increased risk of respiratory and psychological diseases. In our clinical practice, a trend of self-medication and self-diagnosis has emerged, defined as independent web searches for self-reported symptoms aimed at obtaining a diagnosis and related treatment in the absence of medical advice.

Objective

This study aims to investigate the relationship between air pollution and public health, focusing on the impact of particulate matter (PM 2.5, PM 10), nitrogen dioxide (NO2), ozone (O3), and other pollutants on respiratory and mental health, and their relationship with web searches for health-related topics.

Methods

The study compares search trends for specific terms (e.g., cough, dyspnea, asthma, etc.), obtained using Google Trends, a tool for assessing public interest in health-related issues, with air main pollutants concentrations collected over the same period in 2024 in Genoa, Liguria region.

Results

Correlation between searches for cough and levels of PM 2.5, O3, benzene, and NO2 was established, while depression also showed a connection to PM 2.5 and benzene.

Discussion

These findings underscore the potential of Google Trends as a valuable resource for epidemiological surveillance. The study highlights the necessity for healthcare systems to adapt to the implications of air quality on health outcomes. It emphasizes the need for innovative approaches, including real-time tracking of air pollution and its health impacts, to enhance patient care and inform clinical practice. The integration of technology and data analytics in healthcare is proposed as a forward-looking strategy to improve therapeutic adherence and patient management in the context of environmental health challenges.

背景：环境污染与人类健康之间的关系有据可查，暴露与呼吸系统和心理疾病的风险增加有关。在我们的临床实践中，出现了自我用药和自我诊断的趋势，定义为在没有医疗建议的情况下，对自我报告的症状进行独立的网络搜索，目的是获得诊断和相关治疗。目的：本研究旨在探讨空气污染与公众健康的关系，重点关注颗粒物（PM 2.5、PM 10）、二氧化氮（NO2）、臭氧（O3）等污染物对呼吸和心理健康的影响，以及它们与健康相关主题网络搜索的关系。方法：该研究将使用谷歌trends（评估公众对健康相关问题的兴趣的工具）获得的特定术语（如咳嗽、呼吸困难、哮喘等）的搜索趋势与热那亚、利古里亚地区2024年同期收集的空气主要污染物浓度进行了比较。结果：咳嗽搜索与PM 2.5、O3、苯和NO2水平之间存在相关性，而抑郁症也与PM 2.5和苯有关。讨论：这些发现强调了谷歌趋势作为流行病学监测的宝贵资源的潜力。该研究强调了卫生保健系统必须适应空气质量对健康结果的影响。它强调需要采用创新方法，包括实时跟踪空气污染及其对健康的影响，以加强病人护理并为临床实践提供信息。将医疗保健中的技术和数据分析整合为一种前瞻性战略，可以在环境健康挑战的背景下提高治疗依从性和患者管理。

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引用次数: 0

Relationship of body composition and lung function in adult and elderly males and females 成人及老年男女体成分与肺功能的关系。

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2025-12-26 DOI: 10.1016/j.rmed.2025.108610

Alina Ofenheimer , Emiel F.M. Wouters , Christoph Gross , Oliver Helk , Tobias Mraz , Mohammad Azizzadeh , Sylvia Hartl , Robab Breyer-Kohansal , Marie-Kathrin Breyer

Background

The relationship between body compartments and lung function including lung volumes as well as the effects of aging on this relationship remains to be explored. The aim of this study is to evaluate the association between appendicular lean mass index (ALMI), lean mass index (LMI), fat mass index (FMI), and visceral adipose tissue index (VATI) on spirometric and body plethysmographic lung function in the adult and elderly population.

Methods

This observational, cross-sectional study used data from 10.616 adults (≥18–82 years) from the prospective population-based LEAD cohort, conducted between 2011 and 2022 in Vienna, Austria. In total, 1923 participants were elderly (age >65 years). Body compartments were measured by dual-energy X-ray absorptiometry scans and indexed by height squared to account for differences related to body height. Lung function was measured by spirometry (forced expiratory volume in the 1st second; FEV1 and forced vital capacity; FVC) and by body plethysmography (total lung capacity; TLC, fractional residual capacity; FRC, and residual volume; RV).

Findings

In the overall study population, ALMI was positively associated with FEV1, FVC and TLC and negatively with RV and FRC. In contrast, VATI showed a negative association with all lung function parameters investigated. These effects can also be found in the elderly population.

Conclusion

The present study confirms significant associations between body compartments and lung function in adults and in elderly and shows the need to consider body compartments in the assessment and interpretation of lung function results.

背景：体室与肺功能（包括肺容量）之间的关系以及年龄对这种关系的影响仍有待探讨。本研究的目的是评估成人和老年人阑尾瘦质量指数（ALMI）、瘦质量指数（LMI）、脂肪质量指数（FMI）和内脏脂肪组织指数（VATI）与肺活量和体体积特征肺功能之间的关系。方法：这项观察性横断面研究使用了来自2011年至2022年在奥地利维也纳进行的前瞻性人群为基础的LEAD队列的10.616名成年人（≥18-82岁）的数据。总共有1923名参与者是老年人（年龄在50到65岁之间）。通过双能x射线吸收仪扫描测量身体隔间，并以身高的平方为索引，以解释与身高相关的差异。肺功能通过肺活量测定法（第一秒用力呼气量；FEV1和用力肺活量；FVC）和体容积描记法（总肺活量；TLC、分数残气量；FRC和残气量；RV）测量。结果：在整个研究人群中，ALMI与FEV1、FVC和TLC呈正相关，与RV和FRC呈负相关。相反，VATI与所调查的所有肺功能参数呈负相关。这些影响也可以在老年人中发现。结论：本研究证实了成人和老年人的体隔与肺功能之间的显著关联，并表明在评估和解释肺功能结果时需要考虑体隔。

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引用次数: 0

Limited clinical utility of annual chest radiographs in adults with cystic fibrosis: A 10-year observational study from a UK centre 每年胸部x线片对囊性纤维化成人的有限临床应用：来自英国中心的10年观察性研究。

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2025-12-24 DOI: 10.1016/j.rmed.2025.108611

Hasti Robbie , Aditya Sharma , Cheng Fang , Christopher Stovin , Joe Bedford , Sam Norton , Michael D. Waller

Background

In the United Kingdom, annual chest radiography is recommended to monitor disease progression in people with cystic fibrosis (CF), yet robust evidence for its utility or relationship with clinical outcomes is lacking. This study explores disease progression on serial chest radiographs, together with relationships of other markers of disease severity.

Method

Single centre, retrospective analysis of annual chest radiographs in adults with CF across ≥10 years. A novel chest x-ray (CXR) scoring system was developed, and annual chest radiographs scored, along with time-matched spirometry and body mass index.

Results

28 patients, aged 33.0 (31.0–39.5) years were included. Mean follow-ups were 11.4 (SD = 1.9) years with a total of 304 CXR scored (mean = 10.9/person). Overall inter-observer agreement was good. No significant or only weak associations were found between changes in total CXR score, or individual CXR variables, and changes in any clinical parameter.

Conclusions

Our new and practical CXR score shows annual changes in CXR in adults with CF are insufficiently sensitive to detect disease progression and show no relationship to changes in other clinical parameters. These data suggest limited value in routine annual CXR for stable adults with CF.

背景：在英国，建议每年进行胸部x线检查以监测囊性纤维化（CF）患者的疾病进展，但缺乏其效用或与临床结果的关系的有力证据。本研究探讨了系列胸片的疾病进展，以及疾病严重程度的其他标志物的关系。方法：单中心回顾性分析≥10年的CF成人年度胸片。开发了一种新的胸部x线（CXR）评分系统，每年的胸片评分，以及时间匹配的肺活量测定和体重指数。结果：纳入28例患者，年龄33.0（31.0 ~ 39.5）岁。平均随访11.4年（SD=1.9），共304例CXR评分（平均=10.9/人）。观察员间总的协议是好的。在总CXR评分或单个CXR变量的变化与任何临床参数的变化之间没有发现显著或仅发现弱关联。结论：我们新的实用的CXR评分显示，CF成人CXR的年度变化不足以敏感地检测疾病进展，与其他临床参数的变化没有关系。这些数据表明，对于稳定的成年CF患者，每年常规CXR的价值有限。

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引用次数: 0

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。

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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。

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引用次数: 0