Respirology最新文献

Background and objective: Patients diagnosed with benign central airway stenosis who are ineligible for surgical intervention require airway stents. The high complication rates associated with conventional silicone and metallic stents have led to the development of new devices with lower complication rates and easier insertion and removal. This paper presents our results, including the indications, patient characteristics, and outcomes.

Methods: We reviewed patients who underwent bronchoscopy for airway stenosis due to a benign cause between January 2015 and February 2023 in the interventional pulmonology unit of a tertiary university hospital. The causes and locations of stenosis, outcomes, and complications were analysed in patients who received a minimum of one biodegradable (BD) stent. All procedures were performed under general anaesthesia using a rigid bronchoscope.

Results: A total of 136 BD stents were implanted at 22 airway sites in 18 patients, with a median age of 56. Thirteen patients, three with prior metal stents and 10 with prior silicone stents, had a history of non-BD stent usage. Twelve procedures (54.5%) used bronchial stents, whereas 10 procedures (45.4%) used tracheal stents. The median duration of BD stent use was 10.6 months (range: 0.1-72.0 months). Early complications included one moderate granulation formation and two dislocations that necessitated stent fixation: one using clips and the other sutured to an additional stent.

Conclusion: The study indicates that BD stents are both safe and feasible for treating benign stenosis, offering a safer alternative to silicone and metallic stents while providing personalised treatment for patients.

Background and objective: Acute exacerbations of COPD (AECOPD) worsen outcomes, yet they are often underreported. The 14-item EXACT diary has been validated for trial use-the five-item CERT checklist is patient-centered. We compared the two tools' accuracy and early-warning performance for AECOPD.

Methods: This prospective study examined 63 COPD patients who completed EXACT and CERT daily. Two metrics were used for CERT: total score and binary (positive if ≥ 2 items were rated as moderate/severe). AECOPD patients were bootstrap matched to a non-exacerbator. Linear mixed-effects models assessed score differences on the day of AECOPD diagnosis and the previous days.

Results: Twelve patients developed clinically confirmed AECOPD. On the day of AECOPD diagnosis, all tools discriminated AECOPD (AUC: EXACT 0.90, CERT total score 0.88, and CERT binary 0.87; p < 0.01). At optimal thresholds, sensitivities ranged from 81% to 87%, and specificities ranged from 93% to 95%. One day before the AECOPD diagnosis, the CERT total score (5.9 vs. 1.4; p = 0.006) and the CERT binary outcome (70.4% vs. 9.3%; p = 0.009) significantly distinguished impending exacerbations. However, the EXACT score did not (39.6% vs. 34.3%; p = 0.186). The CERT total score yielded an AUC of 0.86 (sensitivity 83%, specificity 86%), and the binary rating achieved a specificity of 91% and a sensitivity of 70% one day before diagnosis.

Conclusion: Both EXACT and CERT can accurately detect AECOPD at the time of diagnosis. However, patients were able to recognise worsening symptoms one day before an AECOPD diagnosis when using the CERT.

Trial registration: clinicaltrials.gov (NCT04140097).

Background and objective: This study aims to assess the prevalence and longitudinal transitions of spirometric patterns defined by the lower limit of normal (LLN) criteria: normal airflow (FEV₁/FVC≥LLN, FEV₁ ≥ LLN); preserved ratio impaired spirometry (PRISm; FEV₁/FVC≥LLN, FEV₁ < LLN); or obstruction (FEV₁/FVC

Methods: Post-bronchodilator values of pulmonary function tests in the transitional states of these spirometric patterns were examined in the population-based Austrian LEAD study at visits 1 (V1) and 2 (V2). 7232 (aged ≥ 18 years) were re-examined after 4.3 ± 0.6 years and categorized into different spirometric patterns. Changes in static lung volumes and flow rates were additionally examined to better characterize changes in spirometric patterns and associated spirometric measurements.

Results: Whilst abnormal spirometry was found in 6.7% individuals at baseline, the prevalence of PRISm (2.2% and 1.6%), but not obstruction (4.5% and 6.1%), remained consistent over time (V1 and V2 respectively). Individuals with PRISm-V1 exhibited substantial rates of transition (48.9%) whilst individuals with obstruction-V1 remained relatively stable (77.8%). Most individuals who reverted from obstruction to improved spirometry had baseline FEV1/FVC values closer to the LLN threshold (optimal cut-off: 64.5%) while those who progressed to obstruction had an optimal predicted threshold of approximately 75%. Changes in pulmonary function tests over time were substantially different between transitional states, and notably more so in those with incident PRISm compared to incident obstructive individuals.

Conclusion: We demonstrate the changes in lung function in different transitional states of spirometric patterns over time which thereby illustrate the need for repeated spirometric assessments combined with lung volume measurements for accurate monitoring and diagnosis.

Background and objective: Amiodarone is an antiarrhythmic agent containing iodine. Amiodarone-induced lung disease (AILD) is a serious adverse effect that is difficult to diagnose. We aimed to evaluate the added value of identifying iodine deposition using the dual-energy-computed-tomography (DECT) technique for its diagnosis.

Material and methods: Patients with suspected AILD who underwent DECT were analysed. Two radiologists evaluated AILD probability on a 2-point scale (low vs. high) based on lung abnormalities and lung and liver amiodarone iodine deposition. In addition, two pulmonologists blinded to DECT findings assessed the AILD clinical probability on a 2-point scale using symptoms, dyspnoea questionnaires, pulmonary function tests, and standard CT. Cohen's k test was used to assess the reliability of the radiological and clinical assessments.

Results: Eighty-one DECT exams were included in the final analysis. Twenty-one (25.9%) patients were considered to have a high AILD probability. Ground-glass opacities (GGO) were the commonest abnormality (39 [48.1%] patients) and showed the highest iodine deposition (grade 2 in 16 [19.8%] patients). Per the clinical assessments, 24 (29.6%) patients had a high AILD probability; dyspnoea was the commonest symptom (73 [90.1%] patients). A substantial correlation was found between the clinical evaluation and radiological evaluation using DECT with Cohen's k = 0.61. Specifically, moderate correlation was found in cases of iodine deposition in GGO and lung atelectasis.

Conclusion: DECT facilitated detection of iodine deposition in AILD-associated lung abnormalities and in the liver. Radiological evaluation of AILD using DECT showed substantial correlation with clinical AILD and may help in difficult diagnoses.

Background and objective: The COPD Exacerbation Recognition Tool (CERT) contains five symptoms that may change at the onset of an exacerbation. It was designed to help patients with COPD recognise the onset of an exacerbation and seek medical attention. This study tested its sensitivity and specificity and further examined its properties.

Methods: Stable and exacerbating patients presenting to three tertiary hospitals in China were enrolled. Patients' responses to the CERT were compared with physicians' diagnoses made using GOLD 2021 criteria. The CERT was assessed as recommended, and as a total score, using scores assigned to the degree of change for each of the five symptoms (total score 15). Exploratory factor analysis (EFA) was used to identify the key components of the CERT and potentially reduce the number of items.

Results: Sensitivity and specificity of the original CERT were 92.4% and 72.1%. Using a cut-off value of 6, the score-based CERT had the better sensitivity (94.3%) and specificity (86.9%). Concordance between CERT and physician diagnosis was higher with the scored version (kappa 0.833) versus the original version (kappa 0.666). Using EFA, two components were identified 'cough and sputum' and 'breathlessness and activity limitation' with a cumulative variance of 82.3%.

Conclusion: The original and scored-based CERT both had good sensitivity and specificity, but the score-based version showed better concordance with physician diagnosis. The use of two representative items in a 2-item scored version was also effective in identifying acute exacerbations.

Trial registration: ChiCTR2400090589 registered with https://www.chictr.org.cn.

Background and objective: Fatigue significantly impacts quality of life in fibrosing interstitial lung diseases (fILDs). Oxyhaemoglobin desaturation contributes to fatigue in chronic obstructive pulmonary disease; however, this has not been investigated in fILD. This study aimed to elucidate the relationship between fatigue and clinical features, including oxyhaemoglobin desaturation, in fILD.

Methods: Participants had stable fILD with exertional desaturation (SpO₂ ≤ 88% on 6-min walk test, 6MWT). Univariate and multivariate analyses were performed with fatigue as the dependent variable and the clinical features related to fatigue as independent variables. Fatigue was assessed using the Fatigue Severity Scale (FSS). Independent variables were specified a priori using directed acyclic graphs based on previous studies: age, BMI, severity (FVC%), Dyspnoea-12 score, physical activity (mean daily steps), desaturation (nadir SpO₂ during 6MWT and during daily life), presence of corticosteroids, and obstructive sleep apnoea.

Results: One hundred and sixteen participants were included with mean (SD) age of 70.9 (9.8), FVC% of 69.8 (16.1). Seventy-two participants (62%) had substantial fatigue (≥ 36 on FSS). Univariate analysis showed no relationship between FSS and nadir SpO₂ during 6MWT (r = -0.03, p = 0.76) or minimum SpO₂ during daily life (r = 0.04, p = 0.74). Multiple regression analyses showed associations between higher fatigue on FSS and greater breathlessness on Dyspnoea-12 (standardised beta = 0.546, p < 0.001) and lower daily steps (standardised beta = -0.188, p = 0.02).

Conclusion: Dyspnoea and physical activity are associated with fatigue in fILD. Exertional desaturation does not appear to contribute to fatigue in this group.

Trial registration: ClinicalTrials.gov Registry (URL: https://clinicaltrials.gov/study/NCT03737409).

Background and objective: Oral corticosteroids (OCS) are the guideline recommended treatment for all asthma attacks, but benefits must be considered alongside the potential for cumulative side-effects. There is interest in trialling biomarker-directed management of attacks to rationalise OCS treatment in those with least benefit. Understanding stakeholder perspectives on the risks and benefits associated with OCS treatment can inform trial design and shared decision-making discussions in clinical practice. The aim was to examine patients' and healthcare professionals' preferences for the risks and benefits associated with OCS treatment for asthma attacks.

Methods: Discrete choice experiment (DCE) by patients with asthma and HCPs in the UK and New Zealand. Preferences were analysed using logit models.

Results: Eight hundred and twenty-four patients and 171 HCPs completed the DCE. Avoiding the risks of permanent side effects had the greatest impact on treatment preference by patients and HCPs. Avoidance of side effects was weighted higher by patients than HCPs. Patients with uncontrolled asthma were more prepared to trade risk for benefit. Symptom recovery was the most valued clinical benefit to patients and HCPs. Patients preferred 'improving lung function' over 'avoiding additional GP treatment or hospitalisation', whereas HCPs preferred avoidance of further healthcare utilisation. Based on their responses we estimated the minimum clinically important difference for the treatment failure outcome at 20%.

Conclusion: Patients and HCPs will trade-off treatment benefits to avoid the side-effects associated with OCS. The risk-benefit balance of OCS should feature in shared decision-making discussions with patients experiencing outpatient asthma attacks. The findings support developing trials to personalise acute asthma treatment.