Tuberculosis and Respiratory Diseases最新文献

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.

Interstitial lung disease (ILD) comprises a heterogeneous group of disorders characterized by interstitial compartment proliferation, inflammatory infiltration, and potential fibrosis with abnormal collagen deposition. Diagnosis requires a multidisciplinary consensus integrating clinical, radiological, and pathological findings. Idiopathic interstitial pneumonia (IIP) includes idiopathic pulmonary fibrosis (IPF), idiopathic nonspecific interstitial pneumonia, desquamative interstitial pneumonia, acute interstitial pneumonia, and respiratory bronchiolitis-ILD, each exhibiting distinct prognostic and therapeutic implications. Some non-IPF ILDs progress despite standard treatment, classified as progressive fibrosing-ILD or progressive pulmonary fibrosis (PPF), diagnosed by worsening symptoms, physiological decline, and radiological progression. Nintedanib is conditionally recommended for refractory PPF cases. Combined pulmonary fibrosis and emphysema is characterized by upper-lobe predominant emphysema and lower-lobe fibrosis, frequently complicated by pulmonary hypertension and lung cancer. Interstitial lung abnormality, observed in both smokers and the general population, is associated with increased mortality and disease risk, warranting further research. Despite advancements, refinement in classification, diagnostic criteria, and therapeutic strategies remains crucial for improving patient outcomes.

Background: Solid organ transplantation (SOT) recipients are at increased risk of post-transplant tuberculosis (TB). However, the effect of this risk on mortality remains unclear. We examined the incidence and risk factors of posttransplant TB, and its effect on mortality in SOT recipients in Taiwan.

Methods: We collected data on 8,205 patients who received their first transplants from 2009 to 2018 from the National Health Insurance Research Database, and identified 201 new TB cases. Transplants were identified and verified by the medical procedure codes. A Cox proportional-hazards model was used to identify the determinants of TB infection.

Results: For the 7,685 recipients, with 34,412 person-years (PYs), 1,630 deaths (393.41/1,000 PYs) were reported. Male sex was associated with a 44 % increase in the risk of TB (hazard ratio [HR], 1.44; 95% confidence interval [CI], 1.05 to 1.98). In addition, age over 65 years was associated with a 4-fold increase in the risk of TB (HR, 4.04; 95% CI, 2.04 to 8.00). The mortality rates in the population varied by transplantation organ type (lungs, 187.75/1,000 PYs; heart, 81.11/1,000 PYs; liver:, 58.47/1,000 PYs; pancreas, 42.36/1,000 PYs; and kidneys, 23.76/1,000 PYs). Recipients with posttransplant TB had a 2.53-fold increased risk of mortality (HR, 2.53; 95% CI, 1.94 to 3.29).

Conclusion: Posttransplant TB is associated with an increased risk of mortality in SOT recipients. Preventing TB can mitigate this risk, which underscores the importance of monitoring and managing TB in this population.

This review examines the role of extracorporeal membrane oxygenation (ECMO) in the management of severe acute respiratory distress syndrome (ARDS), emphasizing its contribution to lung-protective ventilation through optimizing oxygenation and ensuring optimal decarboxylation. Key determinants of oxygen delivery during ECMO include circuit blood flow, cannula size and positioning, and hemoglobin concentration. Strategies for troubleshooting oxygenation issues are reviewed, including recirculation, increased oxygen consumption, and oxygenator dysfunction. In contrast, carbon dioxide removal (decarboxylation), which ECMO circuits efficiently achieve, is primarily influenced by sweep gas flow and the patient's systemic PaCO₂. Effective management of these factors is crucial to ensure optimal ECMO support, enable ultra-protective lung ventilation, and improve outcomes in critically ill patients with severe ARDS.

Background: Coronavirus disease 2019 (COVID-19) significantly impacted healthcare utilization and disease outcomes worldwide. During the pandemic, overall asthma exacerbations reportedly declined; however, the specific effect of COVID-19 infection on subsequent exacerbation patterns in asthma patients remains unclear.

Methods: Using a nationwide health insurance claims database from South Korea, we identified patients who had both asthma and a confirmed COVID-19 diagnosis in 2020. We defined the pre-COVID-19 period as the 12 months immediately preceding the date of each patient's COVID-19 diagnosis, and the post-COVID-19 period as the 12 months following that date. Baseline characteristics, annual exacerbation rates, and direct medical costs were compared between these two timeframes.

Results: Among 82,825 confirmed COVID-19 cases, 2,965 patients with asthma met the inclusion criteria. Compared to the pre-COVID-19 period, the proportion of patients experiencing moderate and moderate-to-severe exacerbations decreased, whereas after COVID-19 infection, severe exacerbations increased. A binomial mixed model showed that moderate and moderate-to-severe exacerbations declined significantly (incidence rate ratio [IRR]=0.848, p<0.001; and IRR=0.912, p<0.001, respectively), while after COVID-19 infection, severe exacerbations increased (IRR=1.220, p<0.001). Of those who were non-exacerbators prior to COVID-19, 10.8% became exacerbators. This group was older, more frequently male, and had a greater comorbidity burden. Total direct medical costs escalated markedly from USD (2,965.50 to 4,850.41; p<0.001), particularly among those who developed as exacerbators after COVID-19 infection.

Conclusion: COVID-19 infection had a paradoxical impact on asthma exacerbations, reducing moderate exacerbations, while increasing severe events. The substantial rise in medical costs contributes to the economic burden of asthma care.