Lung India最新文献

Bronchoscopic device closure plays an important role in the nonsurgical management of bronchopleural fistulae. Herein, we describe the first Indian report of the use of Amplatzer VSD occluder device for the management of a large bronchopleural fistula using an innovative technique in which a snare was passed through the working channel of a flexible bronchoscope to grasp the Amplatzer VSD occluder device which was anchored parallel to the bronchoscope and then maneuvered into the fistula.

Chronic obstructive pulmonary disease (COPD) is a progressive respiratory disorder characterized by persistent airflow limitation and chronic inflammation. Conventional bronchodilators have been the mainstay of therapy; however, their efficacy in certain COPD phenotypes remains limited, and uncontrolled disease continues to be prevalent despite optimal conventional treatment. In recent years, biologic therapies have emerged as promising options, particularly for eosinophilic COPD phenotypes. This systematic review evaluates the efficacy, safety, and clinical implications of biologic agents and novel therapeutic approaches in COPD. A comprehensive search of PubMed, Scopus, and Cochrane Library databases was conducted for studies published up to March 2025, including randomized controlled trials, cohort studies, and real-world evidence on biologic treatments. Several agents, including monoclonal antibodies targeting eosinophilic inflammation such as anti-interleukin (IL)-5 and anti-IL-4/13 therapies, have demonstrated significant benefits in specific COPD subgroups with frequent exacerbations and elevated eosinophil counts. These biologics have been associated with reductions in exacerbation rates and improvements in quality-of-life metrics, with an acceptable safety profile. Biologic therapies therefore represent a new frontier in the personalized management of COPD, especially in eosinophilic phenotypes. Further high-quality studies are warranted to better define their long-term safety, cost-effectiveness, and broader applicability in COPD populations.

Background: Bronchiectasis is a chronic respiratory condition characterised by abnormal bronchial dilation, often accompanied by inflammation and infection. Tumour necrosis factor-alpha (TNF α) has been implicated in inflammatory processes, and its role in bronchiectasis severity remains underexplored. This study aimed to assess the correlation between serum TNF α levels and bronchiectasis severity using established scoring systems.

Methods: A cross-sectional study was conducted among 96 patients diagnosed with bronchiectasis. Serum TNF α levels were measured and analysed in relation to clinical parameters, radiological features, and severity scores such as FACED and Bronchiectasis Severity Index (BSI). Statistical tests including the Mann-Whitney U-test and Kruskal-Wallis test were used to identify significant associations.

Results: Elevated serum TNF α levels were significantly associated with fever, leukocytosis, recent hospital admissions, and bronchiectasis exacerbations. Patients with multi-lobar involvement and bilateral lung disease exhibited significantly higher TNF α levels (P = 0.01). Pseudomonas colonisation was linked to increased TNF α levels. Severity scoring demonstrated a strong association with TNF α levels, with higher values seen in patients categorised as moderate or severe by FACED and BSI scores.

Conclusion: Serum TNF α levels are a potential biomarker for assessing bronchiectasis severity. Elevated TNF α levels were notably linked to exacerbations, microbial colonisation, and severe disease presentations, underscoring its clinical relevance in guiding prognosis and management strategies.

Postoperative pneumonia (POP) represents a significant complication in lung cancer (LC) patients following lung resection, contributing to poor outcomes. This systematic review and meta-analysis aimed to identify clinical predictors and outcomes of POP in LC. A systematic search was conducted in EBSCOhost, Embase, PubMed/MEDLINE, Scopus, and Web of Science, with screening and reporting following preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Meta-analyses were performed in Jamovi 2.3.28, reporting results as odds ratios (OR) or standardised mean differences (SMD). Egger's test and Fail-safe N were used to assess publication bias and evidence robustness (PROSPERO: CRD42024551104). A total of 17 studies encompassing 21,104 LC patients (1,610 with POP and 19,494 without) were included. Reduced FEV1 (SMD: -0.48, 95%CI: [- 0.61, -0.36], P < 0.001) predicted POP. Surgical predictors of POP included VATS (OR: 0.575, 95%CI: [0.448, 0.737], P < 0.001), segmentectomy (OR: 0.459, 95%CI: [0.261, 0.805], P = 0.007), wedge resection (OR: 1.828, 95%CI: [1.189, 2.809], P = 0.006), lobectomy (OR: 0.626, 95%CI: [0.488, 0.803], P < 0.001), bilobectomy (OR: 2.367, 95%CI: [1.408, 3.979], P = 0.001), and pneumonectomy (OR: 1.750, 95%CI: [1.178, 2.600], P = 0.006). Left lung tumours increased POP risk (OR: 1.254, 95%CI: [1.050, 1.499], P = 0.013), while right lung tumours were protective (OR: 0.801, 95%CI: [0.670, 0.975], P = 0.015). POP was associated with longer surgery (SMD: 0.22, 95% CI: [0.11, 0.34], P < 0.001), extended hospitalisation (SMD: 1.19, 95%CI: [1.07, 1.30], P < 0.001), and significantly higher overall mortality OR: 12.12, 95% CI: [5.540, 26.550], P < 0.001). POP in LC patients is influenced by respiratory function, surgical approach, and tumour location, and predicts poor survival, emphasising the need for preventive strategies.

Background: Airway stenting is a complex bronchoscopic intervention that is infrequently performed in children due to limited training opportunities and a lack of appropriate paediatric equipment. We present our institutional data on children (<18 years) who underwent airway stent placement for various tracheobronchial pathologies.

Methods: We conducted a retrospective study of children with notable airway anomalies who underwent stent placement at our institute over a 3.5-year period (January 1, 2020, to June 30, 2023). Data collected included patient age, type and severity of airway obstruction, clinical condition at presentation, type of stent used, complications, outcomes, and follow-up findings.

Results: During the study period, 13 stents were deployed in 12 children with tracheobronchial obstruction. Indications for stenting included severe airway stenosis, airway malacia, stenosis with malacia, and tracheoesophageal fistula (TEF). Stent selection depended on age, lesion location, and device availability. No procedure-related mortalities were noted. The most common complication was granulation tissue formation. After an average 10-month follow-up, 85.7% were clinically stable following stent removal.

Conclusion: Although limited by sample size, our findings support the safety and efficacy of airway stenting in children with tracheobronchial obstruction. Stenting serves as a suitable therapeutic choice when conventional approaches have been unsuccessful or are not suitable. Therefore, it is crucial to establish a robust follow-up system to promptly address any potential complications.