Tuberculosis and Respiratory Diseases最新文献

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.

Background: Widely distributed in the environment, microplastics (MPs) are increasingly recognized as potential respiratory hazards. While several studies suggest their role in worsening allergic airway diseases, findings remain inconsistent. This study aimed to investigate the immunologic effects of repeated MP exposure in an acute murine model of ovalbumin (OVA)-induced asthma.

Methods: Female BALB/c mice were assigned to four groups: control with vehicle, control with MPs, OVA-sensitized with vehicle, and OVA-sensitized with MPs. An acute asthma model was established by sensitizing and challenging mice with OVA. Spherical polystyrene MPs of 1-5 μm were administered intranasally at 300 μg daily from day 0 to 21. Lung inflammation was assessed via bronchoalveolar lavage fluid (BALF) analysis, histopathology, cytokine measurements, and macrophage polarization by immunofluorescence.

Results: MP exposure did not exacerbate allergic inflammation in OVA-sensitized mice. Instead, it led to reduced eosinophilic infiltration and lower levels of interleukin 5 (IL-5) and IL-13, compared to vehicle-treated OVA mice. In contrast, MP exposure in control mice increased tumor necrosis factor-α and decreased interferon-γ levels, upregulated epithelial alarmins (IL-25 and IL-33), and elevated inflammation scores. Alarmin levels, including IL-25 and IL-33, were elevated by MP exposure in control mice, whereas no significant differences were observed between vehicle- and MP-treated mice in the OVA-sensitized group. Macrophage analysis showed a shift toward M1 polarization only in control mice.

Conclusion: While MP exposure aggravated inflammatory responses in healthy lungs, it did not exacerbate airway inflammation in asthmatic mice.

Background: Chronic obstructive pulmonary disease (COPD) is a heterogeneous lung disease characterized by persistent airflow limitation and is a leading cause of mortality worldwide. Pre-COPD refers to a pre-disease state associated with an increased risk of COPD development. This study aims to evaluate the clinical characteristics of individuals with COPD, pre-COPD, and smokers with normal lung function in South Korea, and to provide an updated analysis of the Korea COPD subgroup study (KOCOSS) cohort data.

Methods: We analyzed data from 4,502 participants in the KOCOSS database collected between 2012 and 2025, including 4,197 with COPD, 126 with pre-COPD, and 179 smokers with normal lung function. Baseline characteristics were compared across these groups.

Results: Patients with COPD were more likely to be male, older, and had a lower body mass index than those with pre-COPD and smokers with normal lung function. Symptom burden, as assessed by the COPD Assessment Test and modified Medical Research Council dyspnea scale, was highest in patients with COPD, followed by pre- COPD and smokers with normal lung function. Patients with COPD had the highest overall use of respiratory medications (89.3%), including inhalers and other treatments, followed by pre-COPD individuals (61.5%) and smokers with normal lung function (47.4%). Hypertension was the most common comorbidity across all groups, with no significant differences in the prevalence of comorbidities.

Conclusion: This analysis of the KOCOSS cohort highlights the distinct clinical characteristics of individuals with COPD, pre-COPD, and smokers with normal lung function. Notably, individuals without spirometric COPD still showed substantial symptom burden and inhaler use.

Background: Obstructive ventilatory defect (OVD) is the most common ventilatory pattern in bronchiectasis, with low forced expiratory volume in 1 second (FEV1), which is a well-known risk factor for acute exacerbation (AE). However, the impact of spirometry- defined restrictive components (restrictive ventilatory defects [RVD] or mixed ventilatory defects [MVD]) on AE remains unreported. This study evaluated the association between spirometry-defined restrictive components and AE risk in patients with bronchiectasis.

Methods: In this prospective cohort study, patients from 51 referral hospitals in the Republic of Korea were classified into the normal (FEV1/forced vital capacity (FVC) ≥ lower limit of normal [LLN] and FVC≥LLN, n=62), OVD (FEV1/FVC<LLN and FVC≥LLN, n=59), RVD (FEV1/FVC≥LLN and FVC<LLN, n=148), and MVD (FEV1/FVC<LLN and FVC<LLN, n=223) groups. Incidence rate ratios (IRRs) of AE associated with ventilatory defects were compared using the normal group as a reference group.

Results: The MVD group had the highest annual severe AE IRR (3.557; 95% confidence interval [CI], 0.918 to 17.851), followed by the RVD (2.678; 95% CI, 0.704 to 13.422) and OVD groups (1.926; 95% CI, 0.379 to 11.430) (p for trend=0.051) compared to the normal group. Lower FVC and FEV₁ were significantly associated with increased risk of any AE and severe AE in the RVD and MVD groups. The spirometry-defined restrictive component significantly affected the relationships of any AE and severe AE with FVC (p for interaction <0.05), not with FEV1.

Conclusion: The presence of a spirometry-defined restrictive component was associated with higher annual rates for any AE and severe AE, which modified the FVC, not FEV1, effect on the risk for such events.