Tuberculosis and Respiratory Diseases最新文献

Cough is a prevalent symptom in lung cancer that impairs quality of life. Postoperative cough after lung resection (CAP) has an incidence of approximately 25-50%. CAP tends to peak around one month post-surgery, and often improves by three months. Risk factors for persistent CAP include female sex, extensive resection (e.g., lobectomy or lymph node dissection), and postoperative gastroesophageal reflux. Pulmonary rehabilitation programs significantly reduce postoperative cough incidence and improve cough-specific quality of life. In patients with lung cancer, cough occurs in over 50% of cases, regardless of stage or histology. A stepwise management algorithm is recommended: first treat the cancer and any contributing comorbidities, then use simple demulcents to soothe airways. If needed, add centrally acting antitussives such as codeine or dextromethorphan, followed by peripherally acting agents (e.g., levodropropizine, benzonatate, or levocloperastine). In refractory cases, the neurokinin-1 (NK1) receptor antagonist aprepitant reduced cough frequency in a randomized trial. Substance P, which activates NK1 receptors in vagal sensory pathways, appears to drive cough; aprepitant blocks this activation in preclinical models. Cough is a common and burdensome symptom in lung cancer, whether post-surgical or disease-related. This narrative review outlines a stepwise approach to evaluation and treatment, starting with cancer-directed therapy and supportive care, followed by evidence-backed antitussives. Emerging therapies like NK1 receptor antagonists show promise for refractory cases. High-quality trials are needed to further validate these approaches and integrate them into standard care to improve the quality of life of patients with lung cancer.

Chronic obstructive pulmonary disease (COPD) is a major global health burden, affecting over 392 million individuals and causing approximately 3.3 million deaths annually. Although spirometry remains the cornerstone for diagnosing airflow limitation, it incompletely reflects the structural and biological heterogeneity of the disease, and many smokers with preserved spirometry exhibit substantial parenchymal and airway abnormalities. Advances in imaging-particularly quantitative CT (QCT), magnetic resonance imaging (MRI), and positron emission tomography (PET)-enable comprehensive assessment of structural, functional, and inflammatory processes in COPD. QCT-derived emphysema metrics, including the 15th percentile lung density, mean lung density, and low-attenuation area percentage, are reproducible, sensitive to progression, and widely used as outcome measures. Small airway disease can be characterized using parametric response mapping and complementary voxel-based indices that detect subclinical gas trapping and regional volume changes. The concept of mechanically affected lung highlights functionally impaired regions adjacent to emphysema that contribute to disease progression and mortality. Airway remodeling metrics, such as Pi10, PiSlope, tapering slope, and airway fractal dimension, further provide prognostic information. Mucus plug burden independently predicts mortality and represents a potential surrogate endpoint in therapeutic trials. Advanced MRI techniques and ^18F-FDG PET offer radiation-free or inflammatory insights, respectively. Current evidence supports that imaging is ready to evolve from an adjunct to a core element of COPD research and care.

Tuberculosis survivors often face long-term physical, psychological, and social challenges beyond microbiological cure. Post-tuberculosis disease includes pulmonary damage, cardiovascular and neurological sequelae, and profound impacts on wellbeing and livelihoods. Despite growing recognition, most care remains focused on lung disease, neglecting multisystem and social needs. A holistic, people-centered framework integrating medical, rehabilitative, and community-based strategies is essential to restore health and societal participation for tuberculosis survivors.

Chronic Obstructive Pulmonary Disease (COPD) is a progressive lung disease characterized by airflow limitation and persistent respiratory symptoms. Small airway dysfunction (SAD) plays a crucial role in the progression of COPD, originating in airways less than 2 mm in diameter. Chronic exposure to smoke and toxins leads to inflammatory remodeling and luminal obstruction, which can be detected through micro-CT studies before spirometric airflow limitation becomes apparent. SAD exacerbates COPD by increasing airway resistance and promoting dynamic airway collapse during exhalation. Clinically, SAD manifests as gas trapping, hyperinflation, and exercise intolerance, correlating with accelerated lung function decline. Recent evidence suggests that SAD may represent a potentially modifiable and clinically meaningful trait in COPD, with management strategies including extrafine-particle inhalers, smoking cessation, pulmonary rehabilitation, and emerging biologic approaches. Various measurement methods, including pulmonary function tests and computed tomography (CT) imaging, are used to assess SAD. This review focuses on the role of SAD in COPD pathophysiology and the clinical implications of relevant and easily applicable measurements, such as FEF25-75%, impulse oscillometry, Pi10, and parametric response mapping (PRM) and potential treatment modalities of SAD in COPD.

Immune checkpoint inhibitors have transformed the treatment landscape of non-small cell lung cancer (NSCLC), extending their role from metastatic to resectable disease. While neoadjuvant and adjuvant immunotherapies have each shown clinical value, recent evidence suggests that a perioperative strategy-incorporating both preoperative and postoperative immune-based treatment-may provide more consistent and durable survival benefits, especially in stage IIIA and high PD-L1-expressing tumors. Despite concerns about feasibility and immune-related adverse events, phase III trials such as CheckMate 816, KEYNOTE-671, and AEGEAN have demonstrated that perioperative chemoimmunotherapy is both effective and tolerable in real-world practice. This review examines the rationale, clinical trial data, patient selection criteria, and safety profile of perioperative immunotherapy, and argues for its increasing adoption as a strategic standard in eligible NSCLC patients. Additionally, emerging biomarkers and ctDNA-based MRD surveillance hold promise for refining precision of perioperative treatment. Taken together, the evidence supports perioperative immunotherapy as a forward-looking, evidence-based approach to improving outcomes in resectable NSCLC.

Background: Smoking remains a major preventable cause of death and disease worldwide. The proliferation of electronic cigarettes (e-cigarettes) adds complexity to tobacco control policies. This study analyzed trends in smoking prevalence, e-cigarette use, dual use, age at smoking initiation, intention to quit, motivations for use, and second-hand smoke exposure among Korean adults over 11 years (2013-2023).

Methods: We analyzed data from the Korea National Health and Nutrition Examination Survey (KNHANES Ⅸ-2) collected between 2013-2023. Use of non-combustible tobacco products, including liquid-type e-cigarettes and heated tobacco products (HTPs), was assessed separately. Analyses were stratified by sex, age, and income.

Results: Current smoking prevalence decreased from 23.2% in 2013 to 18.5% in 2023. The decline was greater among males (41.4%→32.1%), and in the 30-39-year age group (30.7%→18.3%). Liquid-type e-cigarette use increased from 1.1% to 3.3%, prominently among young males. Heated tobacco product use remained stable at approximately 4.8%. Dual use of combustible cigarettes and e-cigarettes ranged from 4.7% to 6.2%. The average age at smoking initiation remained at 19.8 years, but decreased by 1.5 years among females. Intention to quit decreased to 13.1% in 2023, among females. Motivations for e-cigarette use were primarily "no cigarette smell" (43.9%) and "seems less harmful than cigarettes" (18.4%). Second-hand smoke exposure in workplaces and public places decreased by 6.6% and 9.4%, respectively.

Conclusion: While traditional smoking prevalence continues to decline, the increasing prevalence of e-cigarette use and dual use poses new public health challenges. These trends are particularly evident among young males and low-income groups.

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.