Pub Date : 2025-12-26DOI: 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.
{"title":"Relationship of body composition and lung function in adult and elderly males and females","authors":"Alina Ofenheimer , Emiel F.M. Wouters , Christoph Gross , Oliver Helk , Tobias Mraz , Mohammad Azizzadeh , Sylvia Hartl , Robab Breyer-Kohansal , Marie-Kathrin Breyer","doi":"10.1016/j.rmed.2025.108610","DOIUrl":"10.1016/j.rmed.2025.108610","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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).</div></div><div><h3>Findings</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"252 ","pages":"Article 108610"},"PeriodicalIF":3.1,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145850681","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 : 2025-12-24DOI: 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.
{"title":"Limited clinical utility of annual chest radiographs in adults with cystic fibrosis: A 10-year observational study from a UK centre","authors":"Hasti Robbie , Aditya Sharma , Cheng Fang , Christopher Stovin , Joe Bedford , Sam Norton , Michael D. Waller","doi":"10.1016/j.rmed.2025.108611","DOIUrl":"10.1016/j.rmed.2025.108611","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Method</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"252 ","pages":"Article 108611"},"PeriodicalIF":3.1,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145844127","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 : 2025-12-23DOI: 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.
{"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}
Pub Date : 2025-12-23DOI: 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.
{"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}
Pub Date : 2025-12-23DOI: 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.
{"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}
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}
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}
Pub Date : 2025-12-20DOI: 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.
{"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}
Pub Date : 2025-12-20DOI: 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 TVdaily and TVhourly (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 TVdaily0_4 (excess odds ratio [EOR]: 6.2 %, 95 %CI: 5.3 %,7.2 %) and TVhourly0_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 TVhourly exhibited a stronger effect compared to TVdaily. 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.
{"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}
Pub Date : 2025-12-20DOI: 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.
{"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}
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