Tuberculosis and Respiratory Diseases最新文献

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.

Background: Growing concern has emerged regarding the disease burden and longterm outcomes associated with post-tuberculosis lung disease (PTLD). This study is designed to assess the long-term effects of tuberculosis (TB) on lung health and quality of life, aiming to fill the critical evidence gap in PTLD research.

Methods: This investigation utilizes a nationwide, prospective, multicenter observational cohort design. Seven tertiary healthcare centers in Korea will recruit at least 350 participants in the treatment-phase group (with a minimum of 50 participants per site) between June 2025 and December 2026. Eligible participants are individuals aged ≥19 years who are either in the course of anti-TB treatment (treatment-phase group), or have previously completed treatment for pulmonary TB (post-treatment group). Exclusion criteria are diagnosis limited to extrapulmonary TB, age <19 years, or refusal to provide consent. Data will be gathered at baseline and annually for up to 5 years until December 2031. Baseline assessments will capture demographic characteristics, TB-related clinical history, relevant comorbidities, and medication use. Initial laboratory evaluations will cover blood analysis, urinalysis, and electrocardiographic measurements. Comprehensive clinical evaluations include symptom scoring, spirometry, chest imaging, and administration of quality of life questionnaires. Annual follow-up will involve repeating spirometry, chest imaging, and quality of life assessments. No additional interventions beyond routine clinical care will be mandated by the study protocol. All collected data will be anonymized and managed securely, adhering to both institutional and ethical regulatory standards (ClinicalTrials.gov: NCT06946784).

Conclusion: This will be the first nationwide observational cohort investigating PTLD in Korea, delivering key real-world evidence to inform national and international post-TB management policies.

Background: Although OM-85 may lessen respiratory symptoms and reduce acute exacerbations in chronic obstructive pulmonary disease (COPD), proof of its overall effectiveness remains incomplete.

Methods: This prospective, observational, single-arm study was conducted at four university hospitals in South Korea from June 2022 to December 2023. Adults with spirometry-confirmed COPD who were prescribed OM-85 were enrolled, and followed for 6 months (3-months treatment, 3-months observation). Symptoms and health-related quality of life were assessed using the modified Medical Research Council scale, COPD Assessment Test (CAT), and St. George's Respiratory Questionnaire (SGRQ). Acute exacerbations and adverse events were recorded.

Results: Of the 323 patients analyzed (mean age 73.3±7.8 years; 83.9% male), 39.0% had baseline CAT ≥10. Patients in this group experienced markedly greater and sustained improvements in both CAT and SGRQ scores compared with those with CAT <10 (p for interaction <0.001 for both), and the magnitude of these changes exceeded the minimal clinically important difference (CAT: -3.21±3.85; SGRQ: -10.42±14.87 at 6 months), indicating clinically meaningful symptom relief. Among these patients, achieving SGRQ responder status at 6 months was negatively associated with an increased frequency of acute exacerbations (odds ratio, 0.246; 95% confidence interval, 0.050 to 1.207; p=0.084), showing a nonsignificant trend. OM-85 was well tolerated, with only mild, reversible drugrelated adverse events.

Conclusion: OM-85 treatment resulted in meaningful improvements in symptoms and healthrelated quality of life, particularly among patients with more severe baseline symptoms, and was in general well tolerated.