Tuberculosis and Respiratory Diseases最新文献

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.

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.