Tuberculosis and Respiratory Diseases最新文献

Antifibrotic drugs, available for the best part of the last decade in many parts of the world, have improved outcomes in patients with idiopathic pulmonary fibrosis and progressive pulmonary fibrosis. However, it is unclear whether patients suffering from these devastating conditions have timely and adequate access to antifibrotic therapy in the Asia-Pacific region (APAC). In this mixed-methods narrative review of 12 APAC countries, integration of questionnaire-based insights of 31 regional clinical experts in interstitial lung disease (ILD) with publicly available pharmaco-economic information has been used to understand how country-specific challenges impact on antifibrotic accessibility. Overall, a broad range of approaches are utilized to provide antifibrotic treatment including centrally or state-determined drug budgets, pharmaceutical industry- subsidized initiatives, charitable support and self-paying (out-of-pocket) options. Impediments to antifibrotic access commonly arise from prohibitive drug pricing in relation to income, absence of universal coverage for pharmaceutical costs, lack of formal pharmaco-economic analysis or restrictions on the use of generic preparations. Unequal access to antifibrotic drugs is a vital unmet therapeutic need in the APAC region, one that is likely to be exacerbated by a rising fibrotic ILD burden.

Background: Anti-tuberculosis (TB) treatment, although infrequently associated with Clostridium difficile infection (CDI), necessitates updated research on the incidence and clinical features of CDI among TB patients, especially as the demographic of older TB patients in South Korea is growing.

Methods: A total of 168 patients with rifampin-susceptible pulmonary TB were enrolled in this study. Initial clinical features of the CDI-suspected group, risk factors for CDI, the primary outcome of all-cause mortality, and secondary outcomes, including delayed conversion of acid-fast bacillus (AFB) smear and culture, were analyzed.

Results: The incidence rate of CDI among TB patients was 15.0 cases per 10,000 patient- days. Among initial features associated with TB-related CDI, patients exhibiting diarrhea of Bristol stool scale type 7 for more than 2 days were more likely to receive a CDI diagnosis. Old age and hypoalbuminemia were significant risk factors for CDI occurrence. In the primary outcome analysis, CDI was associated with a 4.63-fold increase in all-cause mortality according to the unadjusted analysis. However, this association dissipated in the adjusted analysis. Older age, underlying respiratory disease, and pneumonia at baseline were strong predictors of all-cause mortality. No significant factors were detected in the analysis of delayed AFB smear and culture conversion.

Conclusion: Despite the lack of an independent association between CDI and all-cause mortality among TB patients, monitoring older adults with undernutrition and persistent diarrhea for CDI is crucial.

Chronic obstructive pulmonary disease (COPD) is a progressive respiratory disorder associated with substantial morbidity and healthcare costs. Effective outpatient management can prevent exacerbations and reduce hospitalization rates. Since 2014, the South Korean government has conducted annual COPD quality assessment to improve disease management and ensure high-quality healthcare services. The results of the 9th COPD quality assessment, conducted between January and December 2023, were recently published. Healthcare institutions providing outpatient services for COPD (International Classification of Diseases 10th Revision [ICD-10] codes J43, J44 except J43.0) were evaluated based on pulmonary function test (PFT) rates, rate of continuous outpatient visits, and inhaled bronchodilator prescription rates. The monitoring indices included COPD-related hospitalization, emergency room (ER) visits, and duration of inhaled bronchodilator prescriptions. A total of 6,339 institutions and 158,906 patients were assessed in 2023. The PFT rate increased from 58.7% in 2014 to 80.3% in 2023, with the highest rates observed in tertiary hospitals (92.0%) and the lowest in clinics (53.6%). The inhaled bronchodilator prescription rate reached 91.5%, demonstrating a continuous improvement in pharmacological therapy. However, the rate of continuous outpatient visits declined to 80.2%, and COPD-related hospitalization (10.8%) and ER visits (6.4%) increased, indicating persistent gaps in outpatient management. The COPD quality assessment program has significantly improved diagnostic and pharmacological management; however, it highlights ongoing challenges in rate of continuous outpatient visits. Addressing regional disparities, strengthening primary care, and increasing public awareness are essential for the optimization of COPD management. Future efforts should focus on enhancing the implementation of PFTs and ensuring adequate reimbursement for inhaler education.

In January 2025, a catastrophic wildfire in Los Angeles, California, resulted in extensive economic losses and created a substantial risk to public respiratory health. With the progression of climate change, the increasing frequency and severity of wildfires have become a critical global issue due to their substantial impact on respiratory health. Wildfire smoke comprises elevated levels of ambient air pollutants, such as particulate matter (PM2.5, PM10), carbon monoxide (CO), nitrogen oxides (NOx), ozone (O3), and a range of toxic substances. Notably, wildfire-related PM is especially detrimental because it can penetrate deeply into the lower respiratory tract and alveoli, provoking stronger oxidative and inflammatory responses, and leading to both the development and worsening of respiratory conditions, including asthma and chronic obstructive pulmonary disease (COPD). Research indicates that short-term exposure to wildfire smoke is linked to acute exacerbations of asthma, COPD, and pneumonia, contributing to higher mortality rates and increased demands on healthcare utilization. Long-term exposure may increase the risk of developing COPD, accelerate disease progression, and is potentially linked to a heightened risk of lung cancer and mortality. Collectively, these data underscore the substantial threat posed by wildfire smoke, escalating morbidity, mortality, and socioeconomic burdens. This review systematically summarizes recent advances in our understanding of respiratory health impacts linked with wildfire smoke exposure. By aggregating current evidence, the review seeks to guide healthcare practitioners and public health officials, thereby promoting evidence-based interventions for clinical management, health communication, and disaster response amid the escalating risk associated with wildfires.

Cryptogenic organizing pneumonia (COP), one of the idiopathic interstitial pneumonias (IIP), exhibits an acute or subacute course. It can be diagnosed after excluding secondary causes or diseases. COP accounts for approximately 5% to 10% of IIPs, with the average age of diagnosis ranging from 50 to 60 years. Patients primarily present with dry cough and dyspnea. They often experience fever, fatigue, and weight loss. Common radiologic findings on high-resolution computed tomography include localized consolidations, which are typically subpleural or located in the lower zones, though they can occur in all regions of the lungs. While treatment can be initiated without histopathological diagnosis, tissue biopsy may be necessary when the diagnosis is unclear. Response to steroid therapy is generally good, with rapid clinical improvement and a favorable prognosis, although relapses are common.