Respirology最新文献

Background and objective: Relatively little is known about how to maximise participation in lung cancer screening for Australians at high risk of developing the disease. A discrete choice experiment was conducted to elicit and quantify preferences of Australians eligible for lung cancer screening (LCS) to maximise participation in the National Lung Cancer Screening Program (NLCSP) and estimate likely participation.

Methods: Respondents completed an online survey of six LCS factors or 'attributes' (invitation to screen, eligibility assessment, appointment booking, model of care, health care worker support and out-of-pocket costs). Results were analysed using mixed logit (MIXL), multinomial logit (MNL) and latent class analysis to explore heterogeneity in respondents' choices. Willingness to pay (WTP) for screening attributes were estimated based on the ratio of the coefficient on attributes to cost.

Results: Respondents (n = 757) were aged 50-70 years with smoking histories (> 30 pack-year history and either currently smoke or quit ≤ 10 years). The MIXL showed that participants preferred support from a program navigator, with the highest estimated WTP of $24, plus personalised invitations and lower screening costs. The results identified participation rates that could be achieved through optimal LCS program design, across the most optimistic screening program scenario (87.4%), the scenario proposed in the NLCSP (51.5%) and the least preferred scenario (35.0%).

Conclusion: The results are highly relevant for the NLCSP, which commenced on 1 July 2025. Potential participants place significant value on program navigators, a role not funded within the program, which could significantly improve uptake.

Background and objective: The role of lung ultrasound's (LUS) in diagnosing and assessing connective tissue disease (CTD)-related interstitial lung disease (ILD) remains controversial. We aimed to evaluate the diagnostic performance of a quantitative LUS score and the correlations between LUS scores and quantitative computed tomography (QCT) parameters in patients with CTD-ILD.

Methods: This prospective study included individuals with CTD and clinical suspicion of ILD attending our hospital between December 2023 and November 2024. LUS was performed using a 14 intercostal scanning protocol; high-resolution computed tomography (HRCT) was analysed using artificial intelligence-based QCT software. Participants underwent pulmonary function tests (PFTs) and completed the King's Brief Interstitial Lung Disease (KBILD) questionnaire. We analysed the LUS score's diagnostic efficacy and its correlations with QCT findings, PFT results, and KBILD scores.

Results: Among 206 patients with CTD enrolled, 145, 30, and 31 were categorised into ILD, preclinical ILD, and non-ILD groups, respectively. Patients with ILD exhibited higher LUS scores and QCT parameters but lower PFT results and KBILD scores than those without ILD or with preclinical ILD. At cutoff scores of 5.5 and 14.5, LUS distinguished non-ILD from preclinical ILD and ILD with sensitivities of 93.1% and 93.8% (specificities: 83.9% and 86.9%, respectively). LUS scores correlated positively with all QCT parameters, particularly fibrosis extent (r = 0.784; p < 0.001). Median LUS scores differed significantly among PFT and HRCT-defined ILD extent groups.

Conclusion: LUS facilitates early diagnosis of CTD-ILD, and quantitative LUS score correlates with QCT-defined ILD extent.

Trial registration: Chinese Clinical Trial Registry (registration number ChiCTR2400080909).

Background and objective: Checkpoint inhibitor pneumonitis (CIP) is a serious immune-related adverse event. Patients with interstitial lung disease (ILD) or chronic obstructive pulmonary disease (COPD) may be at increased risk, but data comparing these populations is limited. We aimed to evaluate differences in CIP incidence, onset, recurrence, and outcomes among patients with ILD, COPD, and those without pre-existing lung disease.

Methods: We conducted a retrospective cohort study using the TriNetX Research Network, identifying patients who received immune checkpoint inhibitors (ICIs) between January 2017 and January 2023. Patients were stratified into ILD, COPD, and control groups. CIP was identified using ICD codes. Propensity score matching (1:1:1) was used to adjust for baseline characteristics. Outcomes included CIP incidence, time to onset, recurrence, hospitalisation, and mortality.

Results: Among 184,000+ ICI recipients, 3147 had ILD, 8657 had COPD, and 47,031 had no known lung disease. After matching (n = 3147/group), CIP incidence was highest in ILD patients (4.6%) compared to COPD (1.9%) and controls (1.5%) (p < 0.001). Time to CIP onset was similar across groups. ILD patients with CIP had higher recurrence (16.4% vs. 9.1% and 8.3%) and higher all-cause hospitalisation (61% vs. 40% and 39%) compared to COPD and control groups. All-cause mortality was also higher in the ILD-CIP group (41.1%).

Conclusion: ILD significantly increases the risk of developing CIP and worsens associated outcomes, including recurrence and mortality. These findings support closer surveillance and risk stratification in ICI-treated patients with underlying ILD.

Background and objective: Pulmonary nodules (PNs) in children are often detected incidentally through chest radiographs or computed tomography (CT) scans. However, there is no established diagnostic algorithm to guide the clinical diagnosis and management of paediatric PNs. This study aims to identify PN characteristics that may signal systemic diseases or malignancies in children.

Methods: This single-centre, retrospective study reviewed the medical records of patients aged 0-18 years diagnosed with a PN between October 2007 and October 2023. Data collected included demographics, underlying systemic diseases, symptoms, diagnostic tests, imaging reasons, radiological findings, final diagnoses, and follow-up.

Results: A total of 206 children were included in the study, with 54.9% male. PNs were identified due to respiratory symptoms in 43.7% of cases, and incidentally in 56.3%. A total of 59.2% of children had an underlying systemic disease. PNs were detected by CT in 100% of cases and by chest radiography in 6.3%. In 66% of cases, PNs were nonspecific. Notably, 23.3% of patients had a newly diagnosed systemic disease after the detection of a PN. Larger PNs (≥ 5 mm) and specific radiological features (e.g., ground-glass opacity, fibrosis, cavitation) were more commonly associated with newly diagnosed systemic diseases. A PN diameter of ≥ 5 mm predicted malignancy, while ≥ 3.8 mm indicated a higher likelihood of systemic disease.

Conclusion: Pulmonary nodules in children can be early indicators of newly diagnosed systemic diseases and malignancies. Nodule size, distribution, and radiological features may serve as important predictors for identifying underlying systemic diseases or malignancies in paediatric patients.

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: 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.