Tuberculosis and Respiratory Diseases最新文献

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.

Chronic obstructive pulmonary disease (COPD) is a progressive respiratory disorder frequently accompanied by multiple comorbidities, which can substantially influence prognosis and clinical management. Systemic inflammation and overlapping risk factors play significant roles in the pathogenesis of these comorbidities. Further, Preserved Ratio Impaired Spirometry (PRISm) has emerged as a condition indicating a high risk for COPD progression; nevertheless, the comorbidity burden of PRISm has not been adequately investigated. This review synthesizes major findings from clinically meaningful studies released in 2024, concentrating on cardiovascular diseases (CVD), pulmonary comorbidities, frailty, and obstructive sleep apnea (OSA) observed in both COPD and PRISm. CVD risk in COPD is modulated by disease phenotype, with severity and frequency of exacerbations being independent predictors of myocardial infarction and pulmonary embolism. Bronchiectasis may be present in as many as 69% of COPD patients and is linked to elevated rates of exacerbation and increased mortality. The newly proposed Radiological bronchiectasis, Obstruction, Symptoms, and Exposure (ROSE) criteria deliver an evidence-based approach to patient characterization in those with concurrent bronchiectasis and COPD. This approach has revealed that individuals fulfilling the ROSE criteria are at a higher risk for COPD exacerbations and exacerbation- related hospitalization. Additionally, recent evidence indicates a robust association between severe OSA and PRISm, with a notably higher prevalence in severe OSA cases (12.9%) versus mild/moderate OSA (6.2%). Both PRISm and COPD are associated with an accelerated progression of frailty, underlining the necessity for prompt recognition and multidisciplinary management of comorbidities. The collective evidence underscores the critical value of adopting a multidimensional assessment in COPD and PRISm, utilizing objective diagnostic criteria and the implementation of early therapeutic measures. It is recommended that future research emphasize longitudinal designs and precision-based interventions to optimize health outcomes within these groups.

Background: Occupational and environmental exposures to cadmium affects lung. Cadmium accumulation alters intracellular signaling and impairs innate immunity which leads to chronic inflammation. Various factor such as gender, age, smoking status, and comorbidities are known to be associated with blood cadmium levels. The objective of this study was to investigate the association between lung function and serum cadmium concentration, adjusting for these factors.

Methods: The study population included 7,448 adults who are over 40 years old and participated in the Korea National Health and Nutrition Examination Survey (KNHANES) from 2008 to 2017, excluding 2014-2015, when there were no measured values for heavy metals. To investigate the relationship between blood cadmium concentration and estimated glomerular filtration rate (eGFR) and forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC), weights were applied to the subjects and adjusted linear regression analysis was performed.

Results: According to gender, as the blood cadmium concentration increased FEV1/FVC decreased in male smokers with age, body mass index (BMI), education level, hypertension and diabetes adjusted (estimate, -0.01; 95% confidence interval [CI], -0.02 to 0.003). In female current smoker group, as the blood cadmium concentration increased, FEV1/FVC decreased with age, BMI, education level, hypertension, and diabetes adjusted (estimate, -0.02; 95% CI, -0.04 to -0.01).

Conclusion: Lung function represented by FEV1/FVC decreased as the blood cadmium concentration increased in the male and female smoker group. The relationship between blood cadmium concentration and kidney function remains controversial and requires future studies. As a result, our study provided insight into the effects of cadmium concentration on lung function.