Tuberculosis and Respiratory Diseases最新文献

Although substantial progress has been made in the management of chronic obstructive pulmonary disease (COPD), significant unmet needs remain due to its heterogeneity and diverse underlying inflammatory mechanisms. Recent advances have expanded our understanding of COPD beyond a single pathophysiologic model, leading to the development of biologic therapies that target specific immune pathways. This review summarizes current evidence from clinical trials of biologics in COPD. Early attempts to inhibit non-type 2 inflammation yielded limited results, underscoring the need for more refined, endotype-based approaches. Subsequent Phase 3 trials have demonstrated substantial clinical benefits in defined patient subsets: dupilumab, which blocks interleukin (IL)-4 and IL-13 signaling, and mepolizumab, which targets IL-5, consistently reduced exacerbation frequency among patients with high blood eosinophil counts (≥300 cells/μL). In contrast, other biologics-benralizumab, tezepelumab, and IL-33/ST2 pathway inhibitors such as itepekimab, tozorakimab, and astegolimab-have shown variable efficacy, often dependent on biomarker profiles and patient characteristics. Together, these findings underscore the importance of precise patient stratification based on inflammatory endotypes. While biologics represent a major step forward for selected COPD populations, further research is required to clarify long-term outcomes, refine biomarker thresholds, and expand treatment options for non-eosinophilic COPD.

Background: Impulse oscillometry (IOS) provides an effort-independent assessment of respiratory mechanics and is particularly sensitive to small airway dysfunction. Although IOS has been shown to complement spirometry in asthma, its association with exacerbation risk and its relationship with Type 2 inflammatory biomarkers remain incompletely understood.

Methods: In this retrospective cross-sectional study, 128 adult patients with physician-diagnosed asthma who underwent both spirometry and IOS at a tertiary hospital between January 2023 and July 2024 were analyzed. Exacerbation events during 1-year follow-up were identified from medical records. IOS parameters included resistance at 5 and 20 Hz (R5, R20), reactance at 5 Hz (X5), resonant frequency (Fres), area under the reactance curve (AX), and R5-R20. Correlations between spirometric indices and IOS parameters were assessed. Diagnostic performance for exacerbation events was evaluated using receiver operating characteristic (ROC) analysis. Exploratory analyses examined associations between IOS indices, fractional exhaled nitric oxide (FeNO), and blood eosinophil counts.

Results: Thirty-three patients (25.8%) experienced exacerbations. AX showed the strongest correlations with FEV₁% predicted (r = -0.51, p < 0.001) and FEF₂₅-₇₅% predicted (r = -0.42, p < 0.001). Patients with exacerbations exhibited significantly higher R5, Fres, AX, and R5-R20 compared with those without exacerbations, with AX demonstrating the largest effect size (Cohen's d = 0.91). In ROC analysis, AX showed the highest discriminative ability for exacerbation events (AUC = 0.673). FeNO and blood eosinophil counts were not significantly correlated with IOS parameters and showed limited predictive performance when used alone; however, inclusion of AX significantly improved model discrimination.

Conclusion: IOS parameters, particularly AX, are significantly associated with asthma exacerbations and capture mechanical aspects of small airway dysfunction that are not fully reflected by spirometry or Type 2 inflammatory biomarkers. IOS may provide clinically meaningful complementary information for risk stratification in asthma.

Background: Bronchiectasis has a complex, heterogeneous pathogenesis with various aetiologies, with idiopathic bronchiectasis being the majority. This study aimed to investigate the characteristics of patients with idiopathic bronchiectasis, in comparison with post-infectious bronchiectasis.

Methods: We analyzed idiopathic and post-infectious (including post-TB) bronchiectasis patients from the Korean Multicenter Bronchiectasis Audit and Research Collaboration (KMBARC) registry, a prospective cohort study (1).

Results: Among the 866 patients enrolled in the study, 346 (40.0%) patients were determined as idiopathic, 363 (41.9%) patients as post-infectious. The idiopathic group exhibited shorter disease duration of bronchiectasis, higher BMI, lower prevalence of COPD, higher prevalence of rhinosinusitis, predominance of lower lobe distribution in bronchiectasis, lower usage of regular respiratory treatment, better pulmonary function, and statistically lower bronchiectasis severity index (BSI) compared to post-infectious bronchiectasis. Multivariable logistic regression analysis was performed for the variables of gender, age, body mass index, the history of asthma, COPD, rhinosinusitis, rheumatoid arthritis and gastroesophageal reflux disease (GERD), and smoking status. A higher body mass index (odds ratio, 1.09; 95% confidence interval, 1.04-1.15) and the history of rhinosinusitis (3.10; 1.57-6.14) were associated with idiopathic bronchiectasis. Conversely, the history of COPD was associated with post-infectious bronchiectasis (0.57; 0.41-0.80).

Conclusion: The characteristics of patients with idiopathic bronchiectasis might be a higher body mass index (BMI) and the history of rhinosinusitis in comparison with post-infectious bronchiectasis, potentially serving as exploratory clues to underlying systemic or non-pulmonary factors. Further research is needed to clarify their clinical significance.

Acute respiratory distress syndrome (ARDS) continues to be a major cause of morbidity and mortality in critical care, yet its diagnosis and classification have historically been limited by varying resources and reliance on advanced technology. In 2024, a global redefinition of ARDS was introduced to overcome these challenges, constituting the most substantial update since the Berlin definition in 2012. This review summarizes the principal revisions to the criteria, including the formal adoption of lung ultrasound, SpO₂/FiO₂ ratios, and the explicit consideration of non-intubated ARDS and contexts with limited resources. These modifications are intended to promote more inclusive diagnostics, earlier detection, and improved research relevance. We provide a critical analysis of the advantages and drawbacks of the new definition, focusing on the heterogeneity of oxygenation measures, complications in FiO₂ assessment, and challenges in imaging evaluation. Additionally, the review underlines ongoing areas for refinement, comprising the establishment of uniform ventilator parameters, greater integration of carbon dioxide metrics, and the application of phenotypic stratification to support the advancement of precision medicine. This conceptual update signals a significant transformation in ARDS diagnosis and is expected to foster broader and more accessible critical care methodologies as well as expanded research participation.

Background: Little information is available on the immune signaling pathway that drives severe coronavirus disease 2019 (COVID-19) in asthma. Our study uses single-cell RNA sequencing (scRNA-seq) to evaluate the association between immune dysfunction and progression to severe COVID-19 in asthma.

Methods: Four patients with asthma and eight patients without asthma from three centers in South Korea were analyzed. Samples were collected from each patient over three-time points: at the time of COVID-19 infection, 1 week later, and 2 weeks later.

Results: Patients were classified into four groups according to the presence or absence of asthma and COVID-19 severity: non-asthma/mild COVID-19 (n=5), non-asthma/severe COVID-19 (n=3), asthma/mild COVID-19 (n=3), and asthma/severe COVID-19 (n=1) groups. A high-quality scRNA-seq dataset composed of 155,565 cells was generated that characterized peripheral immune cells. Analysis of the proportion of cell type by time points showed a decrease in T-cells at the second time point in the asthma/severe COVID-19 group, compared to the others. When the proportion of T-cell subtype was analyzed by time point, an increase in the proportion of CD8+ T-cell was shown at the second time point in the asthma/severe COVID-19 group compared to the other groups: in differentially expressed genes analysis, notably, we observed relatively higher levels of cytotoxicity-related genes in the asthma/severe COVID-19 group compared to the others.

Conclusion: Our study provides new insights into the mechanisms underlying the progression of COVID-19 infection in patients with asthma. A reduction in the proportion of T-cells while expanding cytotoxic CD8+ T-cell proportion was associated with severe COVID-19 presentation in asthma.

Respiratory syncytial virus (RSV) is a leading cause of acute respiratory infection in adults, with higher morbidity and mortality in older adults and those with chronic obstructive pulmonary disease (COPD) or asthma. Despite the burden, disease awareness remains low and treatment is limited to supportive care. Recent advances have led to the approval of multiple vaccines and updated guideline recommendations. We reviewed current literature, surveillance data, and international guidelines to assess the burden of RSV in adults and to evaluate evidence for vaccination in high-risk groups. Globally, RSV accounts for millions of infections and substantial hospitalizations and deaths among adults ≥60 years. COPD and asthma patients show disproportionately high risks of RSV-related hospitalization, exacerbations, and mortality. South Korean studies confirm RSV as a major contributor to pneumonia, COPD and asthma exacerbations, and bronchiectasis. As of 2025, three RSV vaccines (Arexvy, Abrysvo, mRESVIA) have US Food and Drug Administration approval; only Arexvy is approved in Korea for older adults. Advisory Committee on Immunization Practices (ACIP) now recommends vaccination for all adults ≥75 years and high-risk adults aged 50-74 years, while Global Initiative for Chronic Obstructive Lung Disease (GOLD), Global Initiative for Asthma (GINA), and Korean COPD guidelines endorse RSV vaccination for chronic respiratory disease patients. RSV is underrecognized yet imposes significant disease and healthcare burdens in older adults and those with chronic respiratory diseases. In the absence of effective antivirals, vaccination is a key preventive strategy. Expanding vaccination uptake, improving awareness, and integrating RSV vaccines into national immunization programs could substantially reduce RSV-related morbidity and mortality.

Background: Deep inspiratory maneuvers can modify airway diameter, leading to shortterm fluctuations in respiratory impedance (Zrs). However, the impact of the forceful breathing maneuvers used in spirometry on Zrs has not been systematically investigated. This study was designed to assess and compare the effects of spirometry maneuvers on Zrs, as measured by oscillometry, in adult patients with obstructive airway diseases (group I) versus those presenting with respiratory symptoms but without airflow obstruction on spirometry (group II).

Methods: All participants underwent oscillometry assessments both before and immediately following spirometry. Paired t-tests and unpaired t-tests were conducted to compare differences within and between groups, respectively. Bland-Altman plots were utilized to display the percentage change in Zrs parameters against the mean, along with the limits of agreement (LoA).

Results: In this cross-sectional study, 166 patients were enrolled (53% male), with a mean age of 40.4 years. Group I accounted for 62% of cases, while group II composed 38%. Patients in group I demonstrated greater impairment in both spirometry and Zrs parameters. Nearly all patients experienced changes in Zrs after spirometry compared to pre-spirometry values, regardless of group assignment. Except for R5 in group I, statistically significant paired differences in Zrs parameters were not observed between pre- and post-spirometry in either group. The cohort demonstrated mean biases between pre- and post-spirometry as follows: R5 4.6% (LoA: -44.8%, 54%); X5 5.8% (LoA: -69.5%, 81.2%); AX 4.3% (LoA: -93.9%,102.6%); and Fres 0.5% (LoA: -30.8%, 31.8%). The broad and random LoA reflect marked inter-individual variability.

Conclusion: Spirometry maneuvers cause fluctuations in Zrs parameters, especially in R5. Oscillometry performed after spirometry may cause clinically meaningful changes in Zrs parameters.

Biologic agents have revolutionized severe asthma management by supporting biomarker‑driven approaches. Five monoclonal antibodies-omalizumab, mepolizumab, reslizumab, benralizumab, and dupilumab-are in widespread use, while the recently approved tezepelumab, an anti-thymic stromal lymphopoietin, broadens therapeutic possibilities to encompass the type 2 inflammation‑low phenotype. Although biologics have become more accessible, clinicians frequently encounter difficulties in choosing the most appropriate initial biologic therapy. This review describes real‑world cases that demonstrate phenotype‑guided selection of biologics for individuals with asthma or eosinophilic granulomatosis with polyangiitis. Additionally, current advances in biologic therapies are examined regarding their capacity to improve both accessibility and clinical efficacy. Moving forward, the integration of emerging evidence with patient-specific factors could further promote disease modification in the management of severe asthma.