Tuberculosis and Respiratory Diseases最新文献

Chronic obstructive pulmonary disease (COPD) is a major global health issue, with acute exacerbations (AECOPD) significantly worsening outcomes and increasing healthcare burden. This review explores non-pharmacologic strategies aimed at preventing AECOPD. Pulmonary rehabilitation consistently demonstrates its effectiveness in reducing exacerbations and mortality while improving exercise capacity and quality of life. Lung volume reduction, through both surgical and bronchoscopic methods, has shown promise in select patient groups, leading to improved lung function and reduced exacerbation risk. Smoking cessation remains a critical intervention, while the role of electronic cigarettes is still debated; some evidence suggests they may help patients unable to quit tobacco smoking. Vitamin D supplementation has shown potential in reducing exacerbations, particularly in patients with severe deficiency, though conflicting results warrant further research. Furthermore, shielding measures, such as mask-wearing and social distancing, have gained attention during the COVID-19 pandemic for their role in reducing exacerbation risk. Lastly, vaccination, diet and nutrition, and non-invasive ventilation (NIV) may have important role in the prevention of AECOPD. These non-pharmacologic approaches should be integrated into comprehensive COPD management to improve outcomes and prevent AECOPD.

Background: Incorrect inhalation technique is one of the most common reasons for the ineffectiveness of Chronic Obstructive Pulmonary Disease (COPD) therapy, increasing the frequency of exacerbations. Selection of treatment based on Peak Inspiratory Flow (PIF) measurements or predictors of suboptimal PIF (sPIF) could optimize therapy in patients with COPD. The goal of this study was to investigate a prevalence and predictors of sPIF in hospitalized patients with acute exacerbation of COPD in clinical practice.

Methods: The study involved 72 patients hospitalized with acute COPD exacerbation. The analysis included demographic, clinical and lung function parameters. PIF was measured at the resistance level of patients' inhalation device using In-Check DIAL G16 before and after explaining the inhalation technique, as well as at medium-low resistance (R2) and high resistance (R5) at admission and on discharge.

Results: Upon admission and before explaining the inhalation technique, sPIF was observed in 52.7% of patients, while after the explanation, the proportion of patients with sPIF decreased to 19.4% (p < 0.0001). ROC analysis revealed that independent predictors of suboptimal PIF were age >70 years; FVC <73% pred.; FEV1< 35% pred.; RV > 194% pred.; RV/TLC > 70%; DLco < 36% pred. The most significant predictors of sPIF were age (OR 0.89) and FEV1 (OR 0.59).

Conclusion: When choosing dry powder inhaler for the maintenance therapy in patients with acute exacerbation of COPD, it is important to consider the patient's ability to generate the optimal PIF taking into account the patient's age and the severity of functional impairments.

Hypersensitivity pneumonitis (HP) is an immune-mediated interstitial lung disease characterized by heterogeneous clinical manifestations and complex diagnostic challenges. This clinical guideline aims to provide a comprehensive framework for the diagnosis and management of HP, with an emphasis on the evolving classification into fibrotic and non-fibrotic subtypes. Integrating current clinical guidelines and expert consensus, it addresses key aspects such as radiologic and histopathologic findings, diagnostic strategies, and pharmacologic management. Tailored to the healthcare context in Korea, this guideline offers clinicians a structured approach to diagnosing and managing HP, taking into account regional variations in antigen exposure and clinical presentation. The recommendations herein are based on both international and local data, aiming to improve outcomes for Korean patients through timely and accurate diagnosis, individualized treatment plans, and careful monitoring.

Background: Pneumothorax is a notable complication of lung biopsy, and its early detection is crucial. This study aimed to compare the sensitivities of handheld portable lung ultrasonography and chest radiography for identifying early pneumothorax after lung biopsy.

Methods: Both upright chest radiography and lung ultrasonography were performed 3 and 24 hours after lung biopsy. The disappearance of lung sliding and the appearance of lung points were considered evidence of pneumothorax on lung ultrasonography.

Results: Of the 86 patients in this study, 23 were diagnosed with pneumothorax within 24 hours of biopsy. No significant differences were observed in sex, age, or baseline lung function between the pneumothorax and non-pneumothorax groups. The sensitivities of lung ultrasonography and chest radiography for pneumothorax detection were 73.9% and 47.8%, respectively, at 3 hours and 91.3% and 78.3%, respectively, at 24 hours. Furthermore, at 3 hours, the area under the curve for lung ultrasonography for diagnosing pneumothorax was significantly higher than that for chest radiography (0.870 vs. 0.739, p = 0.043); however, the difference was not significant at 24 hours (p = 0.254).

Conclusion: These preliminary results show lung ultrasonography is more sensitive than chest radiography to detect early pneumothorax after lung biopsy and may be advantageous for the rapid diagnosis of pneumothorax.

Background: Coronavirus 2019 (COVID-19) vaccination appears to have potential benefits for patients with chronic obstructive pulmonary disease (COPD). However, limited information is available on whether COVID-19 vaccination reduces acute exacerbation of COPD (AECOPD).

Methods: In the present study, 41,606 individuals with COPD were enrolled using the Korean National Health Insurance System-severe acute respiratory syndrome coronavirus 2 (NHIS SARS-CoV-2) database from 2020-2021. A total of 3,602 individuals were included in the analytical cohort through 1:1 propensity score (PS) matching between vaccinated and unvaccinated individuals. The risk of AECOPD was assessed using a Cox proportional hazards regression analysis. A post hoc analysis assessed the impact of COVID-19 on AECOPD in vaccinated and unvaccinated individuals, adjusting for differences between infected and uninfected groups.

Results: During the study period, the incidence of exacerbation was lower in vaccinated individuals (1,683/10,000 PY) than in unvaccinated individuals (3,410/10,000 PY). In the Cox proportional hazards regression model, the risk of AECOPD was significantly lower in vaccinated individuals compared to unvaccinated individuals (hazard ratio [HR) = 0.55, 95% confidence interval [CI] = 0.41-0.72). In the post hoc analysis, COVID-19 was associated with an increased risk of AECOPD among unvaccinated individuals after adjustment (adjusted HR = 2.06, 95% CI = 1.28-3.33). In contrast, among vaccinated individuals, the risk of AECOPD did not differ significantly between those infected and uninfected with COVID-19 (adjusted HR = 1.35, 95% CI = 0.42-4.36).

Conclusion: COVID-19 vaccination may reduce the risk of AECOPD in individuals with COPD.

High-flow nasal cannula (HFNC) is a noninvasive respiratory support system that delivers heated (31-38℃), humidified (100%), and oxygen-enriched air at a constant high flow rate (15-60 L/min). Due to its numerous physiological benefits, with added convenience and minimal side effects, HFNC has been increasingly used in patients with acute hypoxemic respiratory failure over the past decade. However, the clinical benefits of long-term HFNC remain uncertain. Several studies, though, suggest its potential use as an alternative home oxygen therapy for patients with chronic stable lung diseases such as chronic obstructive pulmonary disease (COPD), interstitial lung disease, and bronchiectasis. The use of long-term home HFNC in patients with chronic respiratory failure is an emerging area with promising potential. Despite limited clinical research, this narrative review aims to describe the physiology of HFNC use and summarize the current evidence on its long-term application. It provides healthcare providers with insights and perspectives on the potential role of long-term home HFNC.

Background: Histone deacetylase (HDAC) inhibition offers the potential for anti-cancer effects in a variety of cancers, since HDAC plays an important role in cancer development and progression. Thus, we demonstrated the therapeutic efficacy of the new HDAC inhibitor, CG-745, in comparison with existing HDAC inhibitors, such as suberoylanilide hydroxamic acid (SAHA) in non-small lung cancer (NSCLC) cells.

Methods: The effect of CG-745 on apoptosis and reactive oxygen species (ROS) dependent mitochondrial dysfunction in human A549 and H460 cells was investigated by Annexin V assay, MitoSoX and Western blot. Also, to confirm HDAC expression, it was analyzed using real-time PCR. To confirm the inhibitory effect of EMT on CG-745 by TGF-β1, Western blot, scratch analysis, and matrigel invasion analysis were performed.

Results: Compared to SAHA, CG-745 inhibited cell viability and mRNA expression of HDACs such as HDAC1, HDAC2, HDAC3 and HDAC8. It also caused apoptosis, ROS and mitochondrial dysfunction in a concentration-dependent manner. CG-745 reversed EMT induced by TGF-β1 in A549 and H460 cells, and inhibited migration and invasion increased by TGF-β1. CG-745 has been shown to inhibit EMT and induce apoptosis in NSCLC cells.

Conclusion: It suggests that CG-745 could be a new treatment strategy for treatment of NSCLC.

Background: Small cell lung cancer (SCLC) is called 'smoker's disease' because it is strongly associated with smoking and most cases occur in smokers. However, it can also occur in never smokers. We investigated the clinical features of never smokers with SCLC and compared their treatment outcomes with those of smokers with SCLC.

Methods: We retrospectively reviewed the clinical data of patients who had proven SCLC and had received chemotherapy at a single cancer center between July 2002 and April 2021.

Results: Of 1,643 patients, 1,416 (86.2%) were enrolled in this study. A total of 162 (11.4%) and 1,254 (88.6%) patients were never smokers and smokers, respectively. There were more female never smokers than smokers (130, 80.2% vs. 79, 6.3%, p=0.000), and the incidence of ischemic heart disease was lower among never smokers than among smokers (4/1416, 2.5% vs. 83/1416, 6.6%, p=0.036). Never smokers showed less symptoms at diagnosis than smokers (80.9% vs. 87.2%, p=0.037); however, they showed more toxicity after first-line treatment (61.7% vs. 47.8%, p=0.001). The objective response rate (ORR) was significantly higher in never smokers (74.1% vs. 59.6%, p=0.000). In the multivariate analysis, never smoking and second-line treatment were associated with a better ORR. However, progression-free survival and overall survival were not significantly different between never smokers and smokers.

Conclusion: In conclusion, never smokers accounted for 11.4% of patients with small cell lung cancer. They had distinguishing clinical characteristics and showed better chemotherapeutic responses than smokers.

Objectives: To evaluate the changes in exacerbation rates and other clinical outcomes, and identify remaining difficulties in the management of chronic obstructive pulmonary disease (COPD) at Vietnamese COPD management units (CMUs).

Methods: A multi-center, prospective cohort study was conducted on COPD at the CMUs of 3 study sites. COPD exacerbation was the primary outcome of this study. Demographic and clinical informations were collected at study entry. Participants were followed-up for 12-15 months from the study inclusion.

Results: Over the follow-up period, reduction was observed in the prevalence of patients with hospitalization (decreased from 42.3% to 34.4%) and ICU/ED admission (decreased from 5.7% to 0.6%). The annual exacerbation rate and hospitalization rate were 0.75±0.89 and 0.56±0.70, respectively. The severity of symptoms, degree of airflow obstruction, and BMI were factors associated with increased frequency of COPD exacerbations and associated with increased annual exacerbation rate. Our results highlight the difficulties and challenges in managing COPD during the COVID-19 epidemic, including increasing numbers of smokers, inadequate testing request rates, and prescribing medication inconsistent with standard treatment guidelines.

Conclusion: Our results highlight the difficulties and challenges in managing COPD during the COVID-19 epidemic, including increasing numbers of smokers, inadequate testing request rates, and prescribing medication inconsistent with standard treatment guidelines. These findings provide a foundation for future interventions and policy improvements.