Respirology最新文献

Background and objective: Genetic polymorphisms have been associated with susceptibility to interstitial lung diseases including idiopathic pulmonary fibrosis (IPF). We have now examined the relation between single nucleotide polymorphisms (SNPs) and clinical course, including acute exacerbation (AE), in addition to disease susceptibility for IPF and unclassifiable idiopathic interstitial pneumonias (IIPs).

Methods: DNA samples were collected from 223 IPF patients and 160 unclassifiable IIP patients included in a prospective, multicentre observational study in Japan. Nonfibrotic control subjects (n = 379) were selected from a previous study. Genotyping of TERT rs2736100, TERC rs1881984, MUC5B rs35705950, DSP rs2076295, and AKAP13 rs62025270 was conducted with commercial assays. The association between these SNPs and disease susceptibility, prognosis, or the cumulative incidence of AE was assessed.

Results: TERT rs2736100 and MUC5B rs35705950 were significantly associated with IPF risk, and DSP rs2076295 was linked to prognosis and the incidence of AE in IPF patients. TERT rs2736100 was significantly associated with prognosis in IPF patients and the incidence of AE in patients with unclassifiable IIPs. No individuals with the TT genotype of MUC5B rs35705950 were identified, and the proportion of those with the T allele was low (minor allele frequency of 0.005 in control subjects). In addition, no individuals with the minor allele (A) of AKAP13 rs62025270 were detected.

Conclusion: Consideration of genetic polymorphisms has the potential to facilitate prediction not only of prognosis but also of AE in individuals with IIPs, providing a foundation for the development of personalised management strategies based on genetic profiles.

Background and objective: Women with asthma should continue controller therapy during pregnancy, but current evidence on the effects of inhaled corticosteroids (ICS) and long-acting beta2-agonists (LABA) on adverse fetal outcomes remains unclear.

Methods: This was a population-based retrospective cohort study. Data were derived from the Health and Welfare Database, Birth Certificate Application, and Maternal and Child Health Database in Taiwan, from January 1, 2007 to December 31, 2018. Pregnant women with asthma were enrolled. Three independent variables included ICS use, ICS dose-response effects, and LABA use during pregnancy. Adverse fetal outcomes included low birth weight, small for gestational age, preterm birth, and congenital anomalies. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were used to adjust for confounders, including sociodemographics, comorbidities, comedications, and asthma severity. Logistic regression models were used to calculate adjusted odds ratios (aORs).

Results: There were 4538 pregnant women with asthma enrolled in this study. After adjustment, neither ICS nor LABA use was significantly associated with any adverse fetal outcomes. However, among women exposed to ICS, high-dose ICS use during pregnancy was associated with a significantly higher risk of congenital anomalies (aOR: 3.87; 95% CI: 1.29-11.60) within 1 year of delivery.

Conclusions: ICS or LABA use during pregnancy was not associated with the risk of adverse fetal outcomes. Pregnant women with asthma should be advised to maintain controller therapy and avoid potential allergens to reduce the need for high-dose ICS.

Background and objective: Diagnosing pulmonary ground-glass nodules (GGNs) on chest CT imaging remains challenging in clinical practice. Moreover, different stages of GGNs may require different clinical treatments. Hence, we sought to predict the progressive state of pulmonary GGNs (absorption or persistence) for accurate clinical treatment and decision-making.

Methods: We retrospectively enrolled 672 patients (absorption group: 299; control group: 373) from two medical centres from January 2017 to March 2023. Clinical information and radiomic features extracted from regions of interest of all patients on chest CT imaging were collected. All patients were randomly divided into training and test sets at a ratio of 7:3. Three models were constructed-Rad-score (Model 1), clinical factor (Model 2), and clinical factors and Rad-score (Model 3)-to identify GGN progression. In the test dataset, two radiologists (with over 8 years of experience in chest imaging) evaluated the models' performance. Receiver operating characteristic curves, accuracy, sensitivity, and specificity were analysed.

Results: In the test set, the area under the curve (AUC) of Model 1 and Model 2 was 0.907 [0.868-0.946] and 0.918 [0.88-0.955], respectively. Model 3 achieved the best predictive performance, with an AUC of 0.959 [0.936-0.982], an accuracy of 0.881, a sensitivity of 0.902, and a specificity of 0.856. The intraclass correlation coefficient of Model 3 (0.86) showed better performance than radiologists (0.83 and 0.71).

Conclusion: We developed and validated a radiomics-based machine-learning method that achieved good performance in predicting the progressive state of GGNs on initial computed tomography. The model may improve follow-up management of GGNs.

Background and objective: Lobectomy is the primary treatment for early-stage non-small cell lung cancer. However, pulmonary function declines postoperatively, presenting a significant challenge. This study investigated pulmonary function following lobectomy and compared these changes with predicted lung function based on the traditional segmental method, focusing on resected lobe-specific variability.

Methods: This prospective cohort study included 419 patients who underwent lobectomies for NSCLC. Pulmonary function tests measuring forced vital capacity (FVC), forced expiratory volume in one second (FEV₁), and diffusion capacity for carbon monoxide (DLCO) were conducted preoperatively and at 1, 3, 6, and 12 months postoperatively. We compared the observed pulmonary function values to the predicted postoperative (PPO) values based on the traditional segmental method and analysed lobe-specific differences using mixed-effects models.

Results: Left upper and right lower lobectomies demonstrated observed pulmonary function values similar to their PPOs as early as 2 weeks postoperatively. However, the other lobes declined significantly, with an approximately 25% reduction in FVC, FEV1, and DLCO, regardless of the number of segments in the lobe. Three months postoperatively, observed pulmonary function values exceeded PPO values across all lobes. Surgical approach (open vs. video-assisted thoracoscopic surgery), right upper lobectomy in the reference to right lower lobectomy, and postoperative decreased physical activity were significant factors related to the non-recovery of lung function to their PPOs at 6 months after surgery.

Conclusion: Postoperative pulmonary function recovery varied significantly by resected lobe, with most lobes showing better recovery than predicted postoperative values. Accurate outcome prediction requires accounting for lobe-specific characteristics and compensatory mechanisms.