Tuberculosis and Respiratory Diseases最新文献

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.

Background: Little is known about the transition to frequent exacerbators in stabilized patients with chronic obstructive pulmonary disease (COPD).

Methods: This study utilized data obtained from the Korean COPD Subgroup Study cohort (KOCOSS), including 511 infrequent exacerbators. The outcome for these groups was progression to frequent exacerbators. Multivariable logistic regression analysis was used to investigate the risk factors for progression.

Results: Within 1 year, 40 patients (7.8%) progressed to frequent exacerbators. Among patients with severe airflow limitation and those who used inhaled corticosteroids (ICS), the incidence of progression was significantly higher. The risk factors for this progression were older age (adjusted odds ratio [aOR], 2.01; 95% confidence interval [CI], 1.19 to 3.39 per 10-year increase), decreased percent-predicted post-bronchodilator forced expiratory volume in 1 second (FEV₁ %predicted, aOR, 1.32; 95% CI, 1.05 to 1.66 per 10% predicted decrease), increased blood eosinophil count (aOR, 1.20; 95% CI, 1.07 to 1.35 per 100 cells/μL increase), and use of ICS-containing inhalers (aOR, 3.30; 95% CI, 1.59 to 6.85). In stratified analysis, decreased percent-predicted post-bronchodilator FEV₁ (aOR, 1.39; 95% CI, 1.05 to 1.85 per 10%pred decrease) and ICS-containg inhalers (aOR, 4.01; 95% CI, 1.61 to 9.95) predicted progression among patients with eosinophils <300/μL, while higher eosinophils ≥300/μL showed a nonsignificant trend (aOR, 1.16; 95% CI, 1.00 to 1.36; p=0.058).

Conclusion: Among stable COPD patients, older age, decreased lung function, an increased eosinophil count, and use of ICS-containing inhalers were associated with progression to frequent exacerbators.

Non-pharmacological interventions are integral to the multidisciplinary management of fibrosing interstitial lung diseases (ILDs), complementing pharmacological therapies by addressing functional decline, symptom burden, and quality of life. Palliative care is fundamental, offering a structured approach to symptom control-particularly dyspnoea-and facilitating advance care planning. Oxygen therapy may provide symptomatic benefit in patients with resting, nocturnal, or exertional hypoxemia, though evidence remains limited and extrapolated mainly from idiopathic pulmonary fibrosis cohorts. Pulmonary rehabilitation, encompassing supervised exercise and patient education, has demonstrated short-term improvements in exercise tolerance; however, long-term effects on dyspnoea and health-related quality of life are inconsistent. Nutritional status is an emerging area of interest, with data linking low body mass index and unintentional weight loss, underscoring the potential value of dietary assessment and intervention. Psychological support is critical, as ILD patients frequently experience anxiety, depression, and psychological distress. Although peer-led interventions remain under-investigated, they appear to address significant unmet needs in patient education and emotional support. Occupational therapy provides tailored strategies to maintain functional independence and manage fatigue, thereby improving daily living. Immunisation against influenza, pneumococcus, and SARS-CoV-2 is essential, given the elevated risk of infection-related morbidity and mortality. For selected patients with progressive disease refractory to medical therapy, lung transplantation offers a potential survival advantage, necessitating timely referral and evaluation. Although results are promising, evidence is still limited for some interventions and further research is warranted to establish robust, evidence-based guidelines for non-pharmacological management in fibrosing ILD.

Background: Data associating progression of interstitial lung abnormalities (ILA) and serum biomarkers, including white blood cell differential counts and Krebs von den Lungen-6 (KL-6) are sparse. This study aimed to explore the clinical characteristics and evaluate the relationship between disease progression and serum biomarkers in patients with ILA.

Methods: This retrospective cohort study collected data, such as clinical characteristics, pulmonary function test, chest computed tomography (CT), complete blood cell counts, and KL-6 levels from 159 patients (63 with ILA and 74 with interstitial lung diseases [ILDs]) from October 2021 to September 2022. In 52 patients who had previously undergone chest CT, the utility of serum biomarkers in reflecting radiologic progression were evaluated using the receiver operating characteristic curve analysis.

Results: Patients with ILA (n=63) had clinical characteristics similar to patients with idiopathic pulmonary fibrosis. Serum KL-6 levels did not correlate with forced vital capacity or diffusing capacity of the lung for carbon monoxide in patients with ILA. Among the 52 patients with ILA, 13 showed radiological progression. Serum KL-6 showed moderate performance with area under the curves ranging from 0.57-0.89 (p = 0.014) for radiological progression. KL-6 > 400 U/mL were frequently observed in patients with radiological progression (61.5% vs. 20.5%, p =0.006). In multivariate analysis, age and KL-6 was independently associated with the radiological progression in patients with ILA.

Conclusions: Serum KL-6 level could be a potential indicator reflecting the progression of ILA in asymptomatic patients. Patients with serum KL-6>400U/mL require careful observation for radiological progression.

Background: Mediastinal lymphadenopathy is a sign for intrathoracic pathological process. Tuberculous mediastinal lymphadenopathy (TML) could be an early sign for tuberculosis infection, especially in developing countries. Its incidence remains unclear due to underdiagnosis and limited access to diagnostic tools. Prompt diagnosis is crucial, as delayed treatment may lead to fatal complications. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a reliable procedure for getting samples and establish the diagnosis, although its use is limited by various factors. This study aims to elaborate the role of EBUS features to assess TML.

Methods: This is a cross-sectional study that recruited 18 years old patients with suspected TML who underwent EBUS-TBNA. Mediastinal lymph nodes were evaluated through systematic approach by EBUS, focusing on the largest lymph nodes for further characteristics analysis. By TBNA needle, the retracted sample was evaluated for pathology, acid fast bacilli, Mycobacterium tuberculosis (MTB) culture and Xpert Ultra examinations.

Results: One hundred patients were recruited. Fifty-three patients received a final diagnosis of TML. There were significant association between TML and short axis size (p value <0.001), oval shape lymph node (p value 0.034), indistinct margin (p value <0.001), presentation of central hilar (p value <0.001), internal echo (p<0.049), thin layer echogenicity (p value 0.033) and nodal matting (p value <0.001). Xpert Ultra were showed the highest sensitivity in TML (71.7%) among diagnostic modalities.

Conclusion: Endobronchial ultrasonographic features of small size, round shape, indistinct margin, central hilar, internal echo, thin layer and nodal matting were suggestive to lead for TML.