Tuberculosis and Respiratory Diseases最新文献

Background: This study has evaluated the adherence to the Global initiative for chronic Obstructive Lung Disease (GOLD) and Korean guidelines in prescription pattern of respiratory specialists for stable COPD management.

Methods: We collected data on medications between 2011 and 2022 using the Korea COPD Subtype Study (KOCOSS) cohort. Patients were divided into two groups, patients registered before and after 2019, and we analyzed the percentage of patients who met the appropriate criteria for treatment recommended by each of guidelines.

Results: Among 3,477 patients, 85.6% were treated with any drug, and 81.6% used inhaled medications. Compared to patients registered before 2019, there was an increase in inhaler prescriptions in patients registered after 2019 (79.7% and 86.7%, respectively), with dual bronchodilators being the most frequently prescribed medication. Of the treated patients, 56.9% aligned with the Korean 2018 guideline. Based on the criteria from the GOLD 2019 and 2023 guidelines, appropriate treatments were observed in 31.3% and 28.0% of cases. When considering the prescription of inhalers in both subgroups and applying the Korean 2018, GOLD 2019, and GOLD 2023 guidelines, the adherence rates were as follows: (56.6%, 37.8%, 24.0%) and (57.7%, 14.0%, 38.6%).

Conclusions: The adherence rate was higher to the Korean guideline compared to GOLD recommendation. In addition, the proportion of patients aligning with the Korean 2018 and GOLD 2023 guidelines increased in the patients enrolled after 2019 compared to those enrolled earlier. These results suggest that physicians adapt their treatment approaches in alignment with the domestic or recent international guidelines.

The International Severe Asthma Registry (ISAR) was established in 2017 to advance the understanding of severe asthma and its management, thereby improving patient care worldwide. As the first global registry for adults with severe asthma, ISAR enabled individual registries to standardize and pool their data, creating a comprehensive, harmonized dataset with sufficient statistical power to address key research questions and knowledge gaps. Today, ISAR is the largest repository of real-world data on severe asthma, curating data on nearly 35,000 patients from 28 countries worldwide, and has become a leading contributor to severe asthma research. Research using ISAR data has provided valuable insights on the characteristics of severe asthma, its burdens and risk factors, real-world treatment effectiveness, and barriers to specialist care, which are collectively informing improved asthma management. Besides changing clinical thinking via research, ISAR aims to advance real-world practice through initiatives that improve registry data quality and severe asthma care. In 2024, ISAR refined essential research variables to enhance data quality and launched QISAR, a web-based data acquisition and reporting system, which integrates data collection with clinical consultations and enables longitudinal data tracking at patient, center, and population levels. Quality improvement priorities include collecting standardized data during consultations and tracking and optimizing patient journeys via QISAR and integrating primary/secondary care pathways to expedite specialist severe asthma management and facilitate clinical trial recruitment. ISAR envisions a future in which timely specialist referral and initiation of biologic therapy can obviate long-term systemic corticosteroid use and enable more patients to achieve remission.

Chronic obstructive pulmonary disease (COPD) is a progressive respiratory disease marked by acute exacerbations that drive disease progression, hospitalizations, and mortality. Effective management prioritizes preventing these exacerbations due to their detrimental impact on long-term outcomes. This review synthesizes current evidence on pharmacologic interventions to reduce exacerbations, encompassing inhaled therapies, oral treatments, and emerging agents. Established inhaled agents, such as long-acting beta-agonists (LABAs), long-acting muscarinic antagonists (LAMAs), and inhaled corticosteroid (ICS) combinations, play a central role, with personalized selection based on patient factors like blood eosinophil count and exacerbation history. Oral treatments, including roflumilast and azithromycin, provide additional benefit for patients with specific profiles, such as chronic bronchitis or frequent exacerbations. Roflumilast, a PDE-4 inhibitor, has shown efficacy in reducing exacerbations when used alongside inhaled therapies, while azithromycin offers anti-inflammatory and antimicrobial effects, particularly benefiting elderly ex-smokers. Emerging therapies like ensifentrine, a dual PDE-3/4 inhibitor, and dupilumab, targeting type 2 inflammation, show potential for reducing exacerbations in select phenotypes. Collectively, this evidence supports a personalized, phenotype-driven approach to COPD management, optimizing therapeutic strategies to reduce exacerbation frequency and improve patient outcomes.

Background: Computed tomography (CT) scans are used to assess emphysema, a significant phenotype of chronic obstructive pulmonary disease (COPD), but variability in CT protocols and devices across the hospitals may affect accuracy. This study aims to perform kernel conversion among different CT settings and to evaluate differences in the correlation between emphysema index before and after kernel conversion, as well as clinical measures in COPD patients.

Methods: The data were extracted from the Korea COPD Subgroup Study database, involving 484 COPD patients with CT scan images. These were processed with kernel conversion. Emphysema extent was quantified as the percentage of low-attenuation areas (%LAA-950) by deep learning-based program. The correlation between %LAA-950 and clinical parameters, such as lung function tests, the modified Medical Research Council (mMRC), six-minute walking distance (6MWD), COPD assessment test (CAT), and the St. George's Respiratory Questionnaire for COPD (SGRQ-c), were analyzed. These values were then compared across different CT settings.

Results: A total of 484 participants were included. Compared to before, kernel conversion reduced the variance in %LAA-950 values (before vs. after: 12.6±11.0 vs. 8.8±11.9). After kernel conversion, %LAA-950 showed moderate correlations with forced expiratory volume in one second (r = -0.41), residual volume/total lung capacity (r = 0.42), mMRC (r = 0.25), CAT score (r = 0.12), SGRQ-c (r = 0.21), and 6MWD (r = 0.15), all of which improved compared to the unconverted dataset (all, P<0.01).

Conclusion: CT images processed with kernel conversion improve the correlation between emphysema extent and clinical parameters in COPD.

Background: Neutrophil elastase (NE) has been proposed as a potential biomarker for evaluating the severity and prognosis of bronchiectasis. This study aimed to compare bronchial lavage quantification of NE levels and activities with those of sputum.

Methods: A cross-sectional study was conducted in which 24 Vietnamese adults with bronchiectasis were enrolled from June 2023 to August 2023. All participants underwent bronchoscopy to collect bronchial lavage fluid (BLF) from two bronchial locations: one in the region with the greatest bronchial dilatation and one in the normal bronchi or in patients with all lobes affected, the least abnormal lobe (ABLF and NBLF, respectively). Spontaneously expectorated sputum was also collected.

Results: Out of 24 cases, the prevalence of mild, moderate and severe bronchiectasis was 14/24 (58.4%), 5/24 (20.8%), and 5/24 (20.8%), respectively. NE concentration and activity were significantly higher in sputum and ABLF than in NBLF (p < 0.001). Sputum and ABLF were highly correlated (r = 0.841, p < 0.001) with no significant difference in NE activity between sputum and ABLF. Higher levels of NE activity were seen in more severe bronchiectasis than in mild bronchiectasis in all samples but were only statistically significant for NE activity in sputum (r = 0.418, p = 0.042).

Conclusion: NE activity and concentration are elevated in areas of the lung most affected by bronchiectasis. Sputum is a valid surrogate of pulmonary NE levels, as they correlate strongly with ABLF and confirm in a Vietnamese population the relationship between NE activity and disease severity.

Background: Current research on nontuberculous mycobacteria (NTM) is multidisciplinary; thus, proper organization is necessary to obtain comprehensive insights. Therefore, a bibliometric analysis was performed to identify NTM research characteristics in South Korea.

Methods: The Web of Science was searched for NTM articles authored by Koreans at Korean institutions until March 2023. We collected data on authors, publication year, article type, study design, research area, citations, research institutes, and funding sources for analysis.

Results: Of the 28,092 articles on NTM, Koreans authored 868. After excluding 167 unrelated studies, 701 relevant articles were analyzed. The first study was from 1992, with publication rates markedly increasing from 2004 onwards. Basic research constituted 41.3% (n=290) of papers, whereas clinical research represented 44.7% (n=313). Basic research consisted mostly of biochemistry studies (n=74, 10.6%), while clinical research primarily involved retrospective studies (n=113, 16.1%). Median citations were highest for systematic reviews and meta-analyses (median 23, interquartile range 15-93). Fifty-four institutions participated in NTM research, with the top five contributing to 71% (n=498) of the publications. The National Research Foundation of Korea was the most significant funding source, supporting 181 studies (32.5% of funded articles).

Conclusion: The quality and quantity of NTM research in South Korea has improved. However, it was concentrated within a few institutions and largely funded by few sources. Future research should use more diverse funding sources, be conducted in more institutions, and prioritize prospective study designs to enhance the understanding and treatment of NTM.

Connective tissue disease (CTD) comprising a various range of autoimmune disorders is often accompanied by lung involvement, which can lead to life-threatening complications. The main types of CTDs that can present as interstitial lung disease (ILD) include rheumatoid arthritis, systemic sclerosis, Sjögren's syndrome, mixed connective tissue disease, idiopathic inflammatory myopathies, and systemic lupus erythematosus. CTD-ILD poses a significant challenge in clinical diagnosis and management due to its heterogeneous nature and variable prognosis. Early diagnosis by clinical, serological, and radiographic assessments is crucial to differentiate CTD-ILD from idiopathic forms and to adopt appropriate therapeutic strategies. Therefore, we have reviewed the numerous clinical manifestations and diagnostic approaches for each type of CTD-ILD, considering the diversity and complexity of CTD-ILD. The significance of a multidisciplinary approach in optimizing the management of CTD-ILD has been underscored by recent therapeutic advancements, which include the use of immunosuppressive agents, antifibrotic therapies, and newer biological agents targeting specific pathways implicated in the pathogenesis. Therapeutic strategies should be tailored to each condition, considering the type of CTD, the extent of lung involvement, and the presence of extrapulmonary manifestations. Furthermore, we aimed to provide clinical guidance including therapeutic recommendations for the effective management of CTD-ILD, based on PICO analysis.

Background: Lung ultrasound (LUS) has proven valuable in the initial assessment of coronavirus disease 2019 (COVID-19), but its role in detecting pulmonary fibrosis following intensive care remains unclear. This study aims to assess the presence of pulmonary sequelae and fibrosis-like changes using LUS in survivors of severe COVID-19 pneumonia one month after discharge.

Methods: We prospectively enrolled patients with severe COVID-19 who required mechanical ventilation in the ICU and conducted LUS assessments from admission to the outpatient visit after discharge. We tracked changes in key LUS findings and applied our proprietary LUS scoring system. To evaluate LUS accuracy, we correlated measured LUS values with CT scores.

Results: We evaluated B-line presence, pleural thickness, and consolidation in 14 eligible patients. The LUS scores exhibited minimal changes, with values of 19.1, 19.2, and 17.5 at admission, discharge, and the outpatient visit, respectively. Notably, the number of B-lines decreased significantly, from 1.92 at admission to 0.56 at the outpatient visit (p < 0.05), while pleural thickness increased significantly, from 2.05 at admission to 2.48 at the outpatient visit (p < 0.05).

Conclusions: This study demonstrates that lung ultrasound (LUS) can track changes in lung abnormalities in severe COVID-19 patients from ICU admission through to outpatient follow-up. While pleural thickening and B-line patterns showed significant changes, no correlation was found between LUS and HRCT fibrosis scores. These findings suggest that LUS may serve as a supplementary tool for assessing pulmonary recovery in severe COVID-19 cases.

Chronic obstructive pulmonary disease (COPD) can be caused by various factors, including lung infections, asthma, air pollution, childhood growth disorders, and genetic factors, though smoking is the predominant risk factor. The main pathological mechanisms in COPD involve small airway disease, emphysema, mucus hypersecretion, and vascular disorders. COPD in non-smokers is characterized by a normal 1-second forced expiratory volume decline, equal sex distribution, younger age of onset, fewer comorbidities, milder airflow obstruction, preserved diffusing capacity of the lungs for carbon monoxide, and radiological features such as more air-trapping and less severe emphysema compared to COPD in smokers. Nevertheless, non-smokers with COPD still experience a high prevalence of acute exacerbations, nearly equal to that of smokers with COPD. Moreover, COPD itself is an independent risk factor for developing lung cancer, regardless of smoking status. Given that COPD coexists with numerous comorbidities, effectively managing these comorbidities is crucial, requiring multifaceted efforts for comprehensive treatment.

Background: This study aimed to determine whether a shorter high-dose rifampicin regimen is non-inferior to the standard 6-month tuberculosis regimen.

Methods: This multicenter, randomized, open-label, non-inferiority trial enrolled participants with respiratory specimen positivity by Xpert MTB/RIF assay or Mycobacterium tuberculosis culture without rifampicin-resistance. Participants were randomized at 1:1 to the investigational or control group. The investigational group received high-dose rifampicin (30 mg/kg/day), isoniazid, and pyrazinamide until culture conversion, followed by high-dose rifampicin and isoniazid for 12 weeks. The control group received the standard 6-month regimen. The primary outcome was the rate of unfavorable outcomes at 18 months post-randomization. The non-inferiority margin was set at <6% difference in unfavorable outcomes rates. The study is registered with ClinicalTrials.gov (NCT04485156).

Results: Between 4 November 2020 and 3 January 2022, 76 participants were enrolled. Of these, 58 were included in the modified intention-to-treat analysis. Unfavorable outcomes occurred in 10 (31.3%) of 32 in the control group and 10 (38.5%) of 26 in the investigational group. The difference was 7.2% (95% confidence interval, ∞ to 31.9%), failing to prove non-inferiority. Serious adverse events and grade 3 or higher adverse events did not differ between the groups.

Conclusion: The shorter high-dose rifampicin regimen failed to demonstrate non-inferiority but had an acceptable safety profile.