Respirology最新文献

Background and objective: There are few population-based longitudinal studies on the relationship of the single breath nitrogen (SBN₂) test (which functionally explores the small airways) with pulmonary diffusing capacity for carbon monoxide (DLCO). This study aimed to evaluate whether the slope of phase 3 (N₂-slope) from the SBN₂ test may predict DLCO and DLCO/alveolar volume (KCO) decline, and whether the N₂-slope and DLCO are related to COPD incidence.

Methods: Participants from an observational longitudinal population study underwent a SBN₂ test at baseline, and DLCO and spirometry at both baseline and follow-up, 8 years apart. Multivariable regressions adjusted for sex, age, height, and smoking status were run: (1) linear regression to assess the association between N₂-slope and DLCO or KCO decline; (2) logistic regression to assess the association between patterns of baseline normal/abnormal N₂-slope/DLCO and COPD incidence (both GOLD and ATS-ERS criteria).

Results: Six hundred and eighty-seven participants (54.6% males, mean age 37.0 years) showed a mean DLCO decline of -0.12 ± 0.76 mL/mmHg/min/year, a mean KCO decline of -0.03 ± 0.12 mL/mmHg/min/L/year, COPD incidence of 9.0% (GOLD) and 3.9% (ATS-ERS). The N₂-slope was significantly associated with DLCO and KCO decline (-0.137 mL/mmHg/min/year and -0.014 mL/mmHg/min/L/year, respectively, for a one-unit change in N₂-slope). Participants with abnormal N₂-slope and DLCO had the highest risk of developing COPD as measured by GOLD and ATS-ERS criteria (RR 4.42, 95% CI 1.20-16.26, and 6.68, 95% CI 1.48-30.23, respectively).

Conclusion: In this longitudinal population study, the N₂-slope is a predictor of DLCO and KCO decline, and abnormal N₂-slope combined with abnormal DLCO is related to COPD development.

Background and objective: Active video games (AVG) offer an alternative or complementary approach to traditional rehabilitation, yet their effects in patients with interstitial lung disease (ILD) remain underexplored. This study aimed to evaluate the effectiveness of AVG in individuals with ILD.

Methods: Forty-five patients with ILD were randomised into three equal groups: AVG, traditional aerobic exercise (TAE), and control (CG). Both the AVG and TAE groups participated in 30 min of moderate-intensity cycling twice weekly for 8 weeks. The AVG group additionally completed 30 min of exergaming after cycling. All groups were instructed to walk 30 min twice weekly. Outcomes were assessed at week 8. Primary outcomes included exercise capacity measured by the 6-min walk test (6MWT), incremental shuttle walk test (ISWT), and endurance shuttle walk test (ESWT). Secondary outcomes included spirometry, respiratory and quadriceps strength, fatigue, dyspnea, physical activity (PA) and psychological state. Satisfaction, attendance, and enjoyment were also recorded.

Results: After 8 weeks, the AVG group demonstrated greater improvements in 6MWT distance (p = 0.035), maximal inspiratory pressure (p = 0.002), St George's Respiratory Questionnaire (SGRQ) symptoms (p = 0.005) and activity (p = 0.008) scores, International Physical Activity Questionnaire (IPAQ) (p = 0.001), and the London Chest Activities of Daily Living Scale (LC-ADL) (p = 0.001) compared to TAE and CG. No significant differences were observed in ISWT, forced vital capacity (FVC), maximal expiratory pressure, quadriceps strength, dyspnea, or Hospital Anxiety and Depression Scale (HADS) scores (p > 0.05).

Conclusion: AVG combined with traditional aerobic exercise appears to be a safe and effective intervention in ILD, improving submaximal capacity, symptom control, physical activity, satisfaction, and adherence.

Trial registration: NCT06087692 at https://clinicaltrials.gov/ct2/show/NCT06087692.

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: As a well-established inflammatory biomarker, leukocyte count is associated with higher mortality in acute pulmonary embolism (PE). We aimed to confirm the prognostic utility of leukocyte count and its integration with simplified Pulmonary Embolism Severity Index (sPESI) for predicting all-cause hospital mortality in acute PE.

Methods: Data derived from a national, multicentre and prospective registry including patients with acute PE were analysed to develop and validate an in-hospital mortality prediction model incorporating leukocyte count and sPESI. Mendelian Randomisation (MR) was performed to assess the relationship between leukocyte count and mortality.

Results: A total of 7312 PE patients were stratified into three groups based on admission leukocyte count: < 4 × 10⁹/L (n = 301, 4.1%), (4-10) × 10⁹/L (n = 5074, 69.4%) and > 10 × 10⁹/L (n = 1937, 26.5%). Patients with leukocytosis exhibited a higher prevalence of anaemia, thrombocytopenia, hypoxemia, cardiac and renal injury, as well as haemodynamic instability. The in-hospital all-cause mortality was 3.0%, 2.3% and 6.4% (p < 0.001) across the three groups, respectively. The area under the curve (AUC) of sPESI was 0.719 (95% CI 0.681-0.756, p < 0.001), increasing to 0.738 (95% CI 0.701-0.775, p < 0.001) when combined with leukocyte count groups. The prognostic value of leukocyte count and its combination with sPESI was validated in a cohort with 7660 PE patients. MR analysis demonstrated that elevated leukocyte counts increased mortality risk (OR = 1.11, 95% CI 1.00-1.24, p = 0.047).

Conclusion: Admission leukocyte count enhances the prognostic accuracy of sPESI for in-hospital all-cause mortality in PE. Leukocyte count could serve as a potential biomarker for identifying PE patients at increased mortality risk.

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.

Lung cancer remains a leading cause of cancer mortality worldwide. Although immune checkpoint inhibitors (ICIs) have reshaped therapeutic strategies in lung cancer, their benefits remain limited. ICIs exert their therapeutic efficacy by activating T-cell effector functions, underscoring the central role of T cells in antitumor immunity. Thus, this review focuses on the role of T cells in lung cancer and summarises recent advances. Tumour-specific CD8⁺ T cells that attack tumour cells directly form the core of antitumor immunity, yet chronic antigenic stimulation drives functional impairment and exhaustion that constrain treatment responsiveness. Conversely, regulatory T cells modulate immune responses through diverse suppressive mechanisms and influence clinical outcomes. In addition, tertiary lymphoid structures (TLSs) that arise within tumours can amplify local immunity through interactions among follicular helper T cells, B cells, and other immune subsets, and are increasingly linked to therapeutic efficacy and prognosis. Emerging evidence also indicates that metabolic features of the tumour microenvironment modulate T-cell differentiation and persistence. Collectively, these insights provide a foundation for translating an improved understanding of T-cell-centred immune responses and their regulatory circuits into clinical practice. Overall, clarifying T-cell functional states is essential for optimising immunotherapy and achieving durable benefit in lung cancer.