Tuberculosis and Respiratory Diseases最新文献

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.

The importance of pulmonary rehabilitation (PR) in chronic obstructive pulmonary disease (COPD) is well established, but improving adherence remains a challenge, particularly among patients with low physical activity (PA) despite adequate physical capacity (PC). This prospective study categorized COPD patients into 'Do do' (≥30 min/day moderate-to-vigorous PA [MVPA]) and 'Don't do' (<30 min/day MVPA) groups using Fitbit data. Baseline characteristics, pulmonary function, exercise capacity, and patient-reported outcomes (PROs)-including the mMRC, COPD Assessment Test (CAT) and Patient Health Questionnaire-9 (PHQ-9)-were assessed. Factors associated with low PA were identified by logistic regression analysis. Among the 96 patients, 44 were in the 'Do do' group and 52 in the 'Don't do' group. 'Don't do' group exhibited significantly lower 6-minute walk distance (6MWD, 424m vs. 488m, p = 0.005) and reduced pulmonary function (FEV1: 46.73% vs. 54.48%, p = 0.005), as expected. However, PRO analysis revealed that the 'Don't do' group had higher dyspnea scores (mMRC: 1.77 vs. 1.30, p = 0.019) and greater breathlessness on the CAT (OR 1.31, 95% CI 1.06-1.62), even after adjusting for 6MWD and pulmonary function. This trend persisted in the 'Can do' subgroup with high PC, indicating that dyspnea remains a major barrier to PA despite preserved PC. Low PA in COPD patients is influenced not only by PC but also by subjective symptoms such as breathlessness and fatigue. These findings highlight the importance of integrating PROs into PR assessments to identify barriers and enhance adherence. Addressing symptom burden through targeted interventions may improve PA engagement and optimize PR outcomes.

Background: Programmed cell death 1/programmed cell death ligand 1 (PD-1/PD-L1) inhibitors are effective therapies for non-small cell lung cancer (NSCLC), but their use can lead to pneumonitis, which may be severe. The purpose of this study is to investigate the utility of Krebs von den Lungen-6 (KL-6) for the prediction and diagnosis of PD-1/PD-L1 inhibitor-related pneumonitis in patients with NSCLC.

Methods: We conducted a prospective observational study at a university-affiliated tertiary hospital in Korea from February 2022 to June 2023. Baseline KL-6 levels were measured immediately prior to the initiation of PD-1/PD-L1 inhibitor therapy. In patients who develop pneumonitis, KL-6 levels were measured every 1-2 weeks starting at pneumonitis onset. In patients without pneumonitis, KL-6 levels were measured every six weeks. We compared the clinical characteristics and serial KL-6 levels between the pneumonitis and non-pneumonitis groups.

Results: A total of 18 patients were enrolled, of whom 11 developed pneumonitis. Baseline KL-6 levels did not significantly differ between the pneumonitis and non-pneumonitis groups (261 U/ml vs 373 U/mL, P = 0.375). In the pneumonitis group, KL-6 levels generally followed an upward trend, with a median level of 412 U/mL at the time of pneumonitis onset. In contrast, KL-6 levels did not demonstrate clear overall change in the non-pneumonitis group.

Conclusions: In this pilot cohort, baseline KL-6 was not clearly associated with PD-1/PD-L1 inhibitor-related pneumonitis in patients with NSCLC, whereas post-baseline increases were more frequently observed among patients who developed pneumonitis (including all-cause pneumonitis cases).

Idiopathic pulmonary fibrosis is a deadly lung disease primarily affecting aged individuals. Even though there are two FDA-approved drugs, Nintedanib and Pirfenidone, with a recent addition of another drug, Nerandomilast, yet they only reduce the progress of the disease. The mean survival rate is between 5-7 years even after treatment with antifibrotics. Cells of lymphoid lineage have been long reported to modulate the outcome of pulmonary fibrosis. In this review, we discuss how the cell of lymphoid lineage regulates the inflammatory niche within the lungs, leading to the development and progress of pulmonary fibrosis. The review also addresses possible therapeutic strategies that can be leveraged by specifically targeting the lymphoid cells in the pulmonary fibrotic niche.

Background: To evaluate the association between pulmonary hypertension and hospital admission rates in patients with bronchiectasis.

Methods: We retrospectively analyzed data from 130 bronchiectasis patients at the National Medical Center, Korea (November 2012 to October 2022). Pulmonary hypertension was evaluated using high-resolution computed tomography (CT) and echocardiography. Patients were categorized into two groups based on the diameter of the main pulmonary artery (mPA). Logistic regression analysis was performed to identify risk factors associated with hospitalization.

Results: 40 patients had suspected pulmonary hypertension on echocardiography. A higher percentage of patients with an mPA diameter > 29 mm (N=61) had a history of previous exacerbations, elevated echocardiographic parameters related to pulmonary hypertension, and reduced lung function compared to those with an mPA diameter ≤ 29 mm (N=69). In univariate analysis, the hospitalization group showed an increased main pulmonary artery (mPA) diameter; PA (mPA to aorta) ratio; involvement of lung lobes, cavities, and nodules; and increased systolic pulmonary artery pressure and peak tricuspid regurgitation velocity. In multivariate analysis, mPA diameter >29 mm (adjusted odds ratio [OR], 2.47; 95% confidence interval [CI], 1.14-5.32) and the involvement of more than two lobes (adjusted OR, 2.57; 95% CI, 1.14-5.77) were significant risk factors for hospitalization.

Conclusion: CT parameters demonstrated comparable accuracy to models incorporating echocardiographic data for predicting hospitalization in bronchiectasis patients.

Background: Asthma remission has recently emerged as an aspirational treatment goal, yet its definition remains inconsistent across studies and expert groups. The absence of a standardized framework hampers its application in clinical practice and research, particularly in Korea where biologics use is rapidly increasing. This study aimed to establish a consensus definition of clinical remission in severe asthma among Korean experts.

Methods: A two-round modified Delphi survey, followed by a focused third round, was conducted among 28 board-certified pulmonologists from the Korean Academy of Tuberculosis and Respiratory Diseases (KATRD). The questionnaire consisted of 6 domains and 27 items. Responses were analyzed using agreement rates, interquartile ranges, and content validity ratios to determine consensus levels.

Results: Consensus was reached on defining clinical remission as a composite of no exacerbations, no systemic corticosteroid use, sustained symptom control (ACT ≥20 on at least three occasions over 12 months), and stabilization and optimization of pulmonary function while on maintenance treatment. Experts agreed that pulmonary function should be assessed based on clinical judgment rather than absolute thresholds. Complete remission was additionally defined as fulfilling all clinical remission criteria with normalization of type 2 inflammation (blood eosinophils <300/μL and FeNO <25 ppb).

Conclusion: This Delphi consensus provides a regionally relevant and pragmatic framework for defining remission in severe asthma. These statements may help guide clinical practice, inform guideline development, and support future research on remission as a treatment goal.