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.

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.

Chronic obstructive pulmonary disease (COPD) is a major global health issue, as acute exacerbation COPD (AECOPD) significantly worsens outcomes and increases healthcare burden. This review explores non-pharmacologic strategies to prevent AECOPD. Pulmonary rehabilitation consistently demonstrates its effectiveness in reducing exacerbations and mortality, while improving exercise capacity and the quality of life. Lung volume reduction, through both surgical and bronchoscopic methods, has shown promise in select patient groups, leading to improved lung function and reduced exacerbation risk. Smoking cessation remains a critical intervention, while the role of electronic cigarettes remains debatable; some evidence suggests they may help patients unable to quit tobacco smoking. Vitamin D supplementation has shown potential in reducing exacerbations, particularly in patients with severe deficiency, though conflicting results warrant further research. Furthermore, shielding measures, like mask-wearing and social distancing, have gained attention during the coronavirus disease 2019 (COVID-19) pandemic for their role in reducing exacerbation risk. Lastly, vaccination, diet and nutrition, and non-invasive ventilation may be important to prevent AECOPD. These non-pharmacologic approaches should be integrated into comprehensive COPD management to improve outcomes and prevent AECOPD.

Background: Chronic obstructive pulmonary disease (COPD), characterized by progressive airflow obstruction and frequent exacerbations, is a significant global health burden. COPD severity has traditionally been assessed using expiratory flow measurements, like forced expiratory volume in 1 second. However, the role of inspiratory flow, specifically maximal forced inspiratory flow (FIFmax), in predicting exacerbation risk is gaining attention.

Methods: This retrospective cohort study evaluated COPD patients with a history of exacerbations who were receiving inhaled therapy. The eligible patients were followed up for 3 years with spirometric assessments. Patients were categorized into quartiles based on the annual change in FIFmax, from the greatest decrease (Q1) to the greatest increase (Q4). Primary outcome was acute exacerbation, stratified by severity as moderate-to-severe and severe exacerbation.

Results: In total, 180 patients were followed up for 3 years. A greater increase in FIFmax was linearly associated with lower rates of both moderate-to-severe and severe exacerbations (p-value for trend <0.001 for both), but time-to-event analysis revealed no significant association between FIFmax changes and moderate-to-severe exacerbations. In contrast, a significant association with severe exacerbations was observed (log-rank p=0.005). Even after adjusting for confounders, FIFmax remained an independent predictor of severe exacerbations (Q3: hazard ratio, 0.506 [95% confidence interval, 0.306 to 0.836], p=0.008; Q4: hazard ratio, 0.491 [95% confidence interval, 0.291 to 0.830], p=0.008).

Conclusion: Changes in FIFmax were not significantly associated with moderate-to-severe exacerbations, but were related to a reduced risk of severe exacerbations in COPD patients receiving inhaled therapy. These findings indicate that FIFmax may serve as a valuable prognostic marker for severe exacerbations in high-risk COPD patients.

Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a predominantly used method for lymph node (LN) metastasis assessment. This study aims to identify tissue adequacy improvement with the addition of EBUS-guided miniforcep biopsy (EBUS-MFB) to EBUS-TBNA in sampling LNs.

Methods: We assessed tissue adequacy in patients with mediastinal and hilar lymphadenopathy, comparing the combination of EBUS-MFB and EBUS-TBNA with EBUS-TBNA alone. EBUS-MFB was performed with the guide sheath (GS) dilatation technique. Tissue adequacy was a tumor cell count (TCC) of >100 and neoplastic cell neoplastic cell estimate of >25%. Further, we reported the diagnostic yield, tumor cell characteristics, and safety outcomes.

Results: Among 69 patients (74 nodes), malignant diseases were diagnosed in 41 nodes using both techniques. Tissue adequacy with EBUS-TBNA (93.8% in 30/32 nodes) was comparable with the combined group (96.9% in 31/32 nodes, p=0.317). EBUS-TBNA yielded higher TCC (84.4% with >1,000 cells) than EBUS-MFB (53.1%, p=0.004). The combined approach significantly improved the diagnostic yield in non-malignant diseases compared with EBUS-TBNA alone (97% vs. 78.8%, p=0.014). Of the 32 nodes, 20 demonstrated discordant results between EBUS-TBNA and EBUS-MFB, with EBUS-MFB correctly diagnosing six nodes that EBUS-TBNA misdiagnosed. The complication rate was low (2.9%) with only minor bleeding reported.

Conclusion: EBUS-TBNA alone and the combination of EBUS-MFB and EBUS-TBNA demonstrated comparable tissue adequacy, with EBUS-TBNA exhibiting better specimen characteristics, potentially sufficient for various molecular analyses. The addition of EBUS-MFB, performed using the GS-dilatation technique, to EBUS-TBNA improved the diagnostic yield and proved to be a safe and efficient approach, particularly in non-malignant diseases.