Tuberculosis and Respiratory Diseases最新文献

Background: Understanding of the life-sustaining treatment (LST) decisions in critically ill coronavirus disease 2019 (COVID-19) patients remains limited. This study aimed to identify factors influencing LST decisions, and compare clinical outcomes between patients with, and without, LST.

Methods: This multicenter, retrospective cohort study analyzed data from 1,081 COVID-19 patients admitted to intensive care units (ICUs) across Korea from January 1, 2020, to August 31, 2021. Patients were divided into LST and non-LST groups. Demographic, clinical, and outcome data were collected and compared.

Results: Of 1,081 patients, 207 (19.2 %) received LST. LST patients were older (median age: 76 years vs. 67 years, p<0.001), and had more comorbidities (85.5% vs. 70.4%, p<0.001), especially cardiovascular and chronic lung disease. They showed higher blood urea nitrogen, lower albumin, and elevated D-dimer levels (all p<0.05). ICU interventions, including mechanical ventilation (82.6% vs. 50.9%, p<0.001) and extracorporeal membrane oxygenation (ECMO) (18.8% vs. 9.8%, p<0.001), were more common. ICU and hospital mortality rates were significantly higher in LST patients (82.6% and 94.2%, respectively, p<0.001). Logistic regression identified age (odds ratio [OR], 1.054 per year; p<0.001), mechanical ventilation (OR, 2.789; p=0.002), and ECMO use (OR, 3.580; p=0.002) as independent predictors of LST.

Conclusion: Age, comorbidities, and ICU interventions significantly influence LST decisions, highlighting the need for ethical and evidence-based critical care guidelines.

Background: Pelargonium sidoides has been known to be effective in treating respiratory diseases. P. sidoides extract (Umckamin®, Han Wha Pharmaceuticals) was approved in Korea for acute bronchitis. YJP-40 (Umckamin plus®) is formulated with extract of P. sidoides and ivy leaf. Ivy leaf extract has an expectorant effect and has been used to treat bronchitis. The aim of this study was to compare the efficacy of YJP-40 syrup with Umckamin® syrup in patients with acute bronchitis.

Methods: This was a multicenter, randomized, double-blind, active-controlled, non-inferiority, phase III clinical trial. Patients were randomized 1:1 to either the test (YJP-40) or the control (Umckamin®) group. The primary endpoint was the change in bronchitis severity score (BSS) total score 7 days after administration.

Results: A total of 240 subjects (test group 121; control group 119) from seven hospitals were enrolled in this clinical trial. The average change in BSS total score 7 days after administration compared to before was -4.31±2.09 and -4.36±1.71 in the test group and the control group, respectively. The non-inferiority of the test group to the control group was demonstrated. The response rate at 7 days after administration was 87.16% (95/109) in the test group and 86.92% (93/107) in the control group (p=0.9778). There was no statistically significant difference between the groups in the incidence of adverse events.

Conclusion: YJP-40 can be a safe and effective treatment option for acute bronchitis.

Background: Pneumothorax is a notable complication of lung biopsy, and its early detection is crucial. This study aimed to compare the sensitivities of handheld portable lung ultrasonography and chest radiography in identifying early pneumothorax post-lung biopsy.

Methods: Upright chest radiography and lung ultrasonography were conducted at 3 and 24 hours following lung biopsy. The disappearance of lung sliding and the appearance of lung points on lung ultrasonography were indicative of pneumothorax.

Results: In this study of 86 patients, 23 were diagnosed with pneumothorax within 24 hours post-biopsy. No significant differences in sex, age, or baseline lung function were noted between the pneumothorax and non-pneumothorax groups. The sensitivities of lung ultrasonography and chest radiography for detecting pneumothorax were 73.9% and 47.8%, respectively, at 3 hours and 91.3% and 78.3%, respectively, at 24 hours. Additionally, at 3 hours, the area under the curve for lung ultrasonography in diagnosing pneumothorax was significantly higher than that for chest radiography (0.870 vs. 0.739, p=0.043); however, the difference was not significant at 24 hours (p=0.254).

Conclusion: These preliminary findings indicate that lung ultrasonography is more sensitive than chest radiography in detecting early pneumothorax following lung biopsy and could be beneficial for rapid pneumothorax diagnosis.

Sarcoidosis is a granulomatous inflammatory disease of unknown etiology that can affect the entire body, but its respiratory tract involvement is most common. In radiological findings, bilateral hilar and mediastinal lymph node enlargement is the most common finding, and when lung parenchyma is involved, findings such as micronodules, ground-glass shadows, reticular shadows, and fibrosis are seen. Biopsies for histological diagnosis are mainly performed on lymph nodes or lungs, and mediastinal lymph node biopsies are done via endobronchochial ultrasound-guided fine needle aspiration. Pathological findings are characterized by non-caseating, non-necrotizing granulomas, and in Korea, differentiation from tuberculosis is especially important. The natural history of sarcoidosis is very variable, with approximately two-thirds of subjects showing spontaneous remission and only 10% to 30% of patients showing a chronic or progressive form. The most important factor in determining treatment for sarcoidosis is whether there is a risk of death, organ failure, or loss of quality of life. Glucocorticosteroids are the mainstay of treatment, and if the disease progresses despite treatment, or if glucocorticosteroids cannot be reduced or cannot be used, immunosuppressants such as methotrexate and azathioprine can be considered. Response to glucocorticosteroids treatment is good, and most of the patients stabilize or improve, with a low mortality rate of around 3% to 5%.

In the field of chronic obstructive pulmonary disease (COPD), there is growing interest in methods for early detection with the goal of altering disease progression. At the same time, pulmonary function test (PFT) remains central to the diagnosis and management of COPD. Yet, spirometry remains underused, particularly in primary care, contributing to the underdiagnosis and misdiagnosis of COPD. Challenges hindering more aggressive use of spirometry include a lack of access in primary care clinics or public venues, the complexity of performing spirometry and a lack of comfort with interpretation. Enhancing PFT utilization will require new approaches including broadening availability and adopting different approaches to interpretation.

Background: Coronavirus disease 2019 (COVID-19) vaccination may offer benefits for patients with chronic obstructive pulmonary disease (COPD). However, the evidence on whether the vaccination decreases the frequency of acute exacerbation of COPD (AECOPD) is limited.

Methods: This study enrolled 41,606 individuals diagnosed with COPD using the Korean National Health Insurance System-severe acute respiratory syndrome coronavirus 2 (NHIS SARS-CoV-2) database between 2020 and 2021. A cohort of 3,602 individuals was analyzed through 1:1 propensity score matching of vaccinated and unvaccinated groups. The risk of AECOPD was evaluated using a Cox proportional hazards regression analysis. A post hoc analysis examined the impact of COVID-19 on AECOPD in vaccinated and unvaccinated groups among infected and uninfected subgroups.

Results: Throughout the study, the exacerbation rate was lower in the vaccinated group (1,683/10,000 person-years) compared to the unvaccinated group (3,410/10,000 personyears). The Cox proportional hazards model showed a significantly decreased risk of AECOPD in vaccinated individuals relative to unvaccinated individuals (hazard ratio [HR], 0.55; 95% confidence interval [CI], 0.41 to 0.72). post hoc analysis revealed that COVID-19 was associated with a higher risk of AECOPD in unvaccinated individuals (adjusted HR, 2.06; 95% CI, 1.28 to 3.33), while in vaccinated individuals, the risk did not significantly differ between those infected and not infected with COVID-19 (adjusted HR, 1.35; 95% CI, 0.42 to 4.36).

Conclusion: COVID-19 vaccination appears to decrease the risk of AECOPD among individuals with COPD.

Advances in targeted therapies and immune checkpoint inhibitors have significantly enhanced survival rates for patients diagnosed with metastatic non-small cell lung cancer (NSCLC). In non-metastatic NSCLC, adding immune checkpoint inhibitors postchemoradiotherapy has led to improved outcomes in stage III disease and during the perioperative period for stages IB-IIIA. Recently, adjuvant osimertinib and alectinib therapy have demonstrated improved survival rates for patients with epidermal growth factor receptor (EGFR) or anaplastic lymphoma kinase (ALK) alterations, respectively; these therapies are now considered standard treatments. Additionally, osimertinib has shown efficacy when administered postchemoradiotherapy in stage III NSCLC. These findings emphasize the importance of assessing EGFR and ALK status to accurately guide treatment decisions for nearly all NSCLC patients, whether they are undergoing curative surgery, chemoradiotherapy, or receiving palliative chemotherapy. This review summarizes recent trials on perioperative and postchemoradiation therapy and advocates for the necessity of molecular testing in non-metastatic NSCLC to enhance patient outcomes.

Background: Tuberculosis (TB) care quality assessment has been implemented in the Republic of Korea since 2018. This paper evaluates the results of six rounds of the quality assessment from 2018 to 2023, focusing on the sixth quality assessment in 2023.

Methods: This study used cross-linked databases from the Health Insurance Review and Assessment Service, the Korea Disease Control and Prevention Agency, and the Ministry of the Interior and Safety. The study population included newly diagnosed TB patients reported between January and June each year from 2016 to 2023. The sixth quality assessment employed five indicators, which included the treatment success rate. Trends were analyzed using linear regression, and statistical comparisons were performed using chi-square tests.

Results: The sixth quality assessment demonstrated statistically significant improvements across all indicators. Since the fifth assessment, over 95% of patients diagnosed with respiratory TB have undergone TB confirmation tests. Both phenotype and molecular drug susceptibility test coverages showed significant upward trends since the third and fourth assessments, respectively. The treatment success rate, introduced for the first time in the sixth assessment, was reported at 78.3%. Non-TB-related deaths (10.3%) were the most common outcome, other than treatment success.

Conclusion: The TB care quality assessment has contributed to standardizing TB care in Korea and improving management indicators. Further efforts are needed to enhance treatment success through refining the evaluation criteria and implementing innovative management strategies.