Tuberculosis and Respiratory Diseases最新文献

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.

Background: High-resolution chest computed tomography (CT) is a crucial assessment tool for diagnosing Birt-Hogg-Dubé (BHD) syndrome. This study aimed to analyze differences of lung cysts between BHD and other cystic lung diseases.

Methods: From January 2020 to December 2022, patients with multiple lung cysts who underwent chest CT at Gangnam Severance Hospital were included.

Results: Over a 3-year period (from January 2020 to December 2022), out of 52,823 patients who underwent a chest CT scan, 301 (0.6%) patients with multiple lung cysts were enrolled in this study. Of enrolled patients, 24 (8.0%) were diagnosed with BHD. In patients with BHD, 95.8% exhibited bilateral cysts, and 83.3% showed basal predominance. The cysts' maximal diameter averaged 32.1 mm (interquartile range, 26.5 to 43.5). Additionally, 95.8% of patients with BHD had diverse cyst sizes and morphologies. Multivariate logistic regression analysis revealed that bilateral cysts (odds ratio [OR], 12.393; 95% confidence interval [CI], 1.613 to 274.682; p=0.038), basal predominance (OR, 8.511; 95% CI, 2.252 to 39.392; p=0.002), maximum diameter (OR, 1.053; 95% CI, 1.009 to 1.108; p=0.032), and diversity of morphology (OR, 19.513; 95% CI, 2.833 to 398.119; p=0.010) were significant factors associated with BHD diagnosis. A multivariate prediction model for BHD diagnosis demonstrated a sensitivity of 95.83%, a specificity of 81.22%, and an area under the receiver operating characteristic curve of 0.951 (95% CI, 0.914 to 0.987).

Conclusion: Distinguishing features of lung cysts from other cystic lung diseases include bilateral cysts, basal dominance, large size, and irregular shape.

Background: Lung ultrasound (LUS) has proven valuable in the initial assessment of coronavirus disease 2019 (COVID-19), but its role in detecting pulmonary fibrosis following intensive care remains unclear. This study aims to assess the presence of pulmonary sequelae and fibrosis-like changes using LUS in survivors of severe COVID-19 pneumonia one month after discharge.

Methods: We prospectively enrolled patients with severe COVID-19 who required mechanical ventilation in the intensive care unit (ICU) and conducted LUS assessments from admission to the outpatient visit after discharge. We tracked changes in key LUS findings and applied our proprietary LUS scoring system. To evaluate LUS accuracy, we correlated measured LUS values with computed tomography scores.

Results: We evaluated B-line presence, pleural thickness, and consolidation in 14 eligible patients. The LUS scores exhibited minimal changes, with values of 19.1, 19.2, and 17.5 at admission, discharge, and the outpatient visit, respectively. Notably, the number of B-lines decreased significantly, from 1.92 at admission to 0.56 at the outpatient visit (p<0.05), while pleural thickness increased significantly, from 2.05 at admission to 2.48 at the outpatient visit (p≤0.05).

Conclusion: This study demonstrates that LUS can track changes in lung abnormalities in severe COVID-19 patients from ICU admission through to outpatient follow-up. While pleural thickening and B-line patterns showed significant changes, no correlation was found between LUS and high-resolution computed tomography fibrosis scores. These findings suggest that LUS may serve as a supplementary tool for assessing pulmonary recovery in severe COVID-19 cases.

High-flow nasal cannula (HFNC) is a noninvasive respiratory support system that delivers air that is heated at 31°C-38°C, humidified 100%, and oxygen-enriched at a constant high flow rate of 15-60 L/min. Because of its numerous physiological benefits, convenience, and minimal side effects, HFNC has been increasingly used over the past decade in patients with acute hypoxemic respiratory failure, yet the clinical benefits of long-term HFNC remain uncertain. Several studies have suggested its potential use as an alternative home oxygen therapy for patients with chronic stable lung diseases, such as chronic obstructive pulmonary disease (COPD), interstitial lung disease, and bronchiectasis. The use of long-term home HFNC in patients with chronic respiratory failure is an emerging area with promising potential. Despite limited clinical research, this review aims to describe the physiology of HFNC use and summarize the current evidence on its long-term application, to provide healthcare providers with insights and perspectives on the potential role of long-term home HFNC.

Chronic obstructive pulmonary disease (COPD) is a progressive respiratory disorder characterized by acute exacerbations that accelerate disease progression, increase hospitalizations, and elevate mortality. Effective management focuses on preventing these exacerbations owing to their significant impact on long-term outcomes. This review compiles current evidence regarding pharmacologic interventions aimed at reducing exacerbations, which include inhaled therapies, oral treatments, and novel agents. Established inhaled agents, such as long-acting beta-agonists, long-acting muscarinic antagonists, and combinations of inhaled corticosteroids, are fundamental, with the personalized selection based on patient-specific factors like blood eosinophil levels and history of exacerbations. Oral treatments, including roflumilast and azithromycin, confer additional benefits for patients with particular characteristics, such as chronic bronchitis or frequent exacerbations. Roflumilast effectively reduces exacerbations as a phosphodiesterase 4 (PDE-4) inhibitor in conjunction with inhaled therapies, while azithromycin provides anti-inflammatory and antimicrobial properties, particularly advantageous for elderly former smokers. Innovative therapies such as ensifentrine, a dual PDE-3/4 inhibitor, and dupilumab, which targets type 2 inflammation, demonstrate potential for lowering exacerbations in specific subgroups. This body of evidence endorses a personalized, phenotype-driven approach to COPD management, aimed at optimizing therapeutic strategies to decrease exacerbation frequency and enhance patient outcomes.

Idiopathic nonspecific interstitial pneumonia (iNSIP) is recognized as a distinct entity among various types of idiopathic interstitial pneumonias. It is identified histologically by the nonspecific interstitial pneumonia pattern. A diagnosis of iNSIP is feasible once secondary causes or underlying diseases are ruled out. Usually presenting with respiratory symptoms such as shortness of breath and cough, iNSIP has a subacute or chronic course. It predominantly affects females aged 50 to 60 years who are non-smokers. Key imaging findings on chest high-resolution computed tomography include bilateral reticular opacities in lower lungs, traction bronchiectasis, reduced lung volumes and, ground-glass opacities. Abnormalities are typically diffuse across both lungs with subpleural distributions. Treatment often involves systemic steroids, either alone or in combination with other immunosuppressants, although evidence supporting effectiveness of these treatments is limited. Prognosis is generally more favorable for iNSIP than for idiopathic pulmonary fibrosis, with many studies reporting a 5-year survival rate above 70%. Antifibrotic agents should be considered in a condition, termed progressive pulmonary fibrosis, where pulmonary fibrosis progressively worsens.