Tuberculosis and Respiratory Diseases最新文献

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.

Background: In South Korea, NTM is not a notifiable disease, and the absence of a national surveillance system hampers accurate assessment of its incidence. Therefore, this study utilized National Health Insurance Service (NHIS) claims data to investigate nationwide trends in NTM occurrence over the past decade.

Methods: We used National Health Insurance Service (NHIS) claims (2010-2022) to assemble a cohort with ICD-10 A31 (A31.0, A31.1, A31.8, A31.9). For incidence, cases diagnosed in 2010-2011 were excluded. Incidence was estimated under three definitions: (A) ≥2 outpatient visits or ≥1 inpatient admission with A31 during the study period; (B) same as A, but with ≤180 days between visits; (C) meeting B plus ≥1 antibiotic prescription within 180 days (treatment initiation). Age-standardized prevalence and incidence were calculated using the 2010 Korean population.

Results: A total of 178,287 newly diagnosed NTM cases were identified from 2012-2022 (mean age 51.4 years; 66.8% female). The age-standardized prevalence increased from 15.5 per 100,000 in 2010 to 69.8 in 2022. Incidence peaked in 2017 (38.9/100,000) and declined to 26.9 in 2022. Age-specific incidence of NTM infection showed distinct sex-related patterns. Among men, incidence was consistently concentrated in older adults, particularly those ≥80 years, throughout 2012-2022. In contrast, women experienced a marked epidemiologic shift beginning in 2017, with incidence in their 20s and 30s surpassing older age groups. Medical Aid beneficiaries consistently showed higher incidence rates. By region, Daejeon and Chungnam showed the greatest increase in incidence rates in 2022 compared with 2012.

Conclusion: NTM infection is increasing in Korea, with distinct epidemiologic patterns by sex, age, and socioeconomic status. The rising burden, especially among young women and the socioeconomically disadvantaged, warrants targeted public health strategies.

Background: Cough is a key symptom of chronic respiratory diseases such as asthma, idiopathic pulmonary fibrosis (IPF), chronic obstructive pulmonary disease (COPD), and bronchiectasis (BE). Some patients develop chronic cough (CC), defined as lasting over eight weeks, yet its characteristics remain unclear. This study aimed to characterize CC across different chronic respiratory diseases using validated cough assessment tools.

Methods: This multicenter, prospective cross-sectional study (the COASESS study) was conducted at 10 university hospitals. CC was assessed for intensity (numeric rating scale, NRS), frequency (cough symptom score, CSS), and quality of life (cough assessment tool [COAT], Leicester Cough Questionnaire [LCQ]). Cough hypersensitivity was evaluated using the Cough Hypersensitivity Questionnaire (CHQ). Age, sex, and smoking status were also recorded.

Results: Of 303 enrolled patients, 266 with chronic respiratory diseases were analyzed. Asthma patients were younger, more often female, and never-smokers, while COPD and IPF patients were older male ever-smokers (P < 0.001). COAT, LCQ, NRS, and CSS scores differed significantly across diseases, with asthma and IPF showing greater symptom burden and poorer quality of life than COPD or BE (P < 0.001). CHQ total scores were similar across groups, but asthma patients more often reported triggers like talking and post-nasal drip.

Conclusions: This study identified distinct CC characteristics across chronic respiratory diseases. Asthma and IPF were associated with greater symptom burden, and cough hypersensitivity varied by underlying condition. These findings support the need for disease-specific CC assessment and management.

Cough is one of the most common yet least quantifiable respiratory symptoms. Despite its prevalence-affecting up to 10% of adults worldwide-objective measurement remains challenging. Conventional descriptors such as "frequent" or "severe" are inherently subjective and poorly reproducible, limiting clinical interpretation and standardization. Over the past five decades, technological advances have transformed cough assessment from manual counting and provocation testing to automated acoustic monitoring and neurophysiologic imaging. Modern validated systems such as the Leicester Cough Monitor and VitaloJAK™ provide reproducible measures of cough frequency, now accepted as regulatory trial endpoints. In contrast, cough intensity remains difficult to capture objectively. Physiologic tools including peak cough flow, esophageal manometry, and electromyography provide mechanistic insights but are invasive and impractical for real-world use. Acoustic amplitude serves as a promising noninvasive surrogate, yet suffers from ambient noise interference and lack of cross-device calibration. Functional MRI and experimental brain PET have further revealed cortical and subcortical dysregulation underlying cough hypersensitivity, reframing chronic cough as a disorder of aberrant sensory processing. However, these approaches remain research tools, constrained by cost, accessibility, and limited validation. The future of cough assessment lies in integrated, multimodal systems that combine physiologic, acoustic, and neuroimaging signals through AI-based analytics. Such approaches could transform cough into a measurable digital biomarker-an objective "fifth vital sign." Realizing this vision will require collaborative efforts among clinicians, engineers, and policymakers to ensure validation, standardization, and clinical applicability.

Background: Lung cancer remains the leading cause of cancer-related mortality worldwide. To improve lung cancer care quality, the Health Insurance Review and Assessment Service (HIRA) in Korea conducted the first phase of second-cycle adequacy assessment, incorporating patient-centered and outcome-based indicators.

Methods: This study analyzed HIRA claims data from 106 medical institutions treating lung cancer for the period July 2022 to June 2023. The assessment evaluated treatment adequacy based on structural, procedural, and outcome indicators across tertiary care hospitals, general hospitals, and clinics.

Results: The second-cycle evaluation adopted a comprehensive framework, incorporating multidisciplinary care and end-of-life management. Among 21,517 cases, 44 tertiary care hospitals managed 75.9%, while 62 general hospitals handled 24.1%. The average adequacy score was 91.09, with 80.7% of institutions rated grade 1. The multidisciplinary consultation rate was 30.8%, exceeding the 12.6% target. Surgery within 30 days of diagnosis was performed in 93.2% of cases, while the overall surgical mortality rate was 1.19%, lower in tertiary care hospitals (1.04%) than in general hospitals (1.88%). The 30 days readmission rate was 2.26%, while 56.8% of patients received hospice counseling.

Conclusion: The second-cycle assessment emphasized patient-centered and outcome-based care, integrating multidisciplinary consultation and hospice indicators. These findings suggest that lung cancer treatment institutions in South Korea maintain high adequacy standards. Continuous improvements will be necessary to exploit medical advances and improve lung cancer management.