Tuberculosis and Respiratory Diseases最新文献

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.

Rare forms of interstitial lung diseases (ILDs) present with unique clinical features and require different treatment strategies. Respiratory bronchiolitis-associated ILD mainly affects smokers, showing ground-glass opacities on chest computed tomography (CT) scans and pigmented macrophages in the bronchoalveolar lavage fluid. Smoking cessation is essential for treatment, with corticosteroids used for severe cases. Desquamative interstitial pneumonia, also related to smoking, is characterized by exertional dyspnea, dry cough, restrictive lung function, and ground-glass opacities on high-resolution CT. Lymphoid interstitial pneumonia involves lymphocytic proliferation and is associated with autoimmune diseases or infections, treated with corticosteroids. Acute interstitial pneumonia resembles acute respiratory distress syndrome but occurs without a clear cause and is managed with supportive care. Idiopathic pleuroparenchymal fibroelastosis results in fibrosis in the upper lobes, primarily in nonsmokers, and is diagnosed through clinical and imaging findings, with no effective treatment to improve survival. Each condition has distinct pathological features, clinical presentations, and treatment approaches, along with variable prognoses.

Background: Incorrect inhalation technique is a primary cause of therapeutic failure in chronic obstructive pulmonary disease (COPD), leading to increased exacerbation frequency. Identifying predictors of suboptimal peak inspiratory flow (sPIF) can significantly enhance treatment efficacy in COPD patients. The objective of this study was to identify the prevalence and predictors of sPIF in hospitalized patients with acute exacerbation of COPD in a clinical setting.

Methods: This study enrolled 72 patients hospitalized for acute COPD exacerbation. It analyzed demographic, clinical, and lung function parameters. Peak inspiratory flow (PIF) was measured using an In-Check DIAL G16 (Alliance Tech Medical) across different resistance levels of the patients' inhalation devices, both before and after instruction in inhalation technique, and at various resistance settings (R2 and R5) upon admission and discharge.

Results: Initially, 52.7% of patients exhibited sPIF, which decreased to 19.4% following inhalation technique education (p<0.0001). Receiver operating curve analysis identified age >70 years, forced vital capacity <73% predicted (pred.), forced expiratory volume in 1 second (FEV1) <35% pred., residual volume (RV) >194% pred., RV/total lung capacity >70%, and diffusing capacity for carbon monoxide <36% pred. as independent predictors of sPIF. The most significant predictors were age (odds ratio [OR], 0.89) and FEV1 (OR 0.59).

Conclusion: Selecting a suitable dry powder inhaler for maintenance therapy in patients with acute exacerbation of COPD requires consideration of the patient's ability to achieve optimal PIF, with special attention to age and severity of functional impairment.

Hypersensitivity pneumonitis (HP) is characterized as an immune-mediated interstitial lung disease with heterogeneous clinical manifestations and presents complex diagnostic challenges. This clinical guideline provides a comprehensive framework for diagnosing and managing HP, accentuating the evolving classification into fibrotic and nonfibrotic subtypes. By integrating current clinical guidelines and expert consensus, it addresses essential aspects such as radiologic and histopathologic findings, diagnostic strategies, and pharmacologic management. Tailored to the healthcare context in Korea, this guideline presents clinicians with a structured approach to diagnose and manage HP, considering regional variations in antigen exposure and clinical presentation. The recommendations are based on both international and local data, aiming to enhance outcomes for Korean patients through timely and accurate diagnosis, individualized treatment plans, and meticulous monitoring.

Molecular profiling of tumors from patients plays a crucial role in precision oncology. While tumor tissue-based genomic testing remains the gold standard in clinical management of patients with non-small cell lung cancer, advances in genomic technologies, the analysis of various bodily fluids, mainly blood but also saliva, pleural/pericardial effusions, urine, and cerebrospinal fluid is now feasible and readily available. In this review, we will focus on the clinical application of circulating tumor DNA (ctDNA) in patients with non-small cell lung cancer in the setting of early-stage disease, locally advanced disease with attention to the potential of ctDNA in prognostication, risk stratification, minimal residual disease, and in advanced disease, its role in the detection of genomic markers and mechanisms of acquired resistance. The role of ctDNA and liquid biopsies in lung cancer screening will also be discussed.

Background: The Leicester Cough Questionnaire (LCQ) is a validated instrument for evaluating cough-related impairments within three domains: physical, psychological, and social. This study investigated how the physical, psychological, and social domains of chronic cough are interrelated using the LCQ.

Methods: Adult patients with chronic cough from 16 respiratory centers who completed the LCQ and underwent diagnostic workup were retrospectively reviewed. Spearman's rank correlation was used to examine the correlations among LCQ items across the physical, psychological, and social domains. Causal mediation analysis was performed to partition the total effect between domains into direct and indirect effects mediated by the third domain. The mediation analysis findings were subsequently validated in an independent cohort.

Results: Network analysis of LCQ items identified distinct patterns for each domain. Items in the physical domain showed weaker correlations both within and between domains compared to the psychological and social domains. In contrast, items in the psychological and social domains exhibited strong interrelationships. Mediation analysis demonstrated that direct effects from one domain to another differed among the three domains. The overall estimated effects of the physical domain on the social and psychological domains were largely mediated by the psychological (76.1%) and social domains (67.1%), respectively. Conversely, the mediating effect of the physical domain on the psychological and social domains was minimal, accounting for only 12.8% and 18.0%, respectively.

Conclusion: Given the strong correlations and impact of the psychological and social domains, it is recommended that a thorough evaluation including psychosocial factors be incorporated into the management of chronic cough.

Background: The development of frailty at hospital discharge affects the clinical outcomes in severe coronavirus disease 2019 (COVID-19) survivors who had no frailty before hospitalization. We aimed to describe the prevalence of new frailty using the clinical frailty scale (CFS) and evaluate its associated factors in patients with severe COVID-19 without pre-existing frailty before hospitalization.

Methods: We performed a secondary analysis of clinical data from a nationwide retrospective cohort collected from 22 hospitals between January 1, 2020 and August 31, 2021. The patients were at least 19 years old and survived until discharge after admission to the intensive care unit (ICU) because of severe COVID-19. Development of new frailty was defined as a CFS score ≥5 at hospital discharge.

Results: Among 669 severe COVID-19 survivors without pre-existing frailty admitted to the ICU, the mean age was 65.2±12.8 years, 62.5% were male, and 50.2% received mechanical ventilation (MV). The mean CFS score at admission was 2.4±0.9, and new frailty developed in 27.8% (186/483). In multivariate analysis, older age, cardiovascular disease, CFS score of 3-4 before hospitalization, increased C-reactive protein level, longer duration of corticosteroid treatment, and use of MV and extracorporeal membrane oxygenation were identified as factors associated with new-onset frailty.

Conclusion: Our study suggests that new frailty is not uncommon and is associated with diverse factors in survivors of severe COVID-19 without pre-existing frailty.