Respiratory Medicine and Research最新文献

{"title":"Progressive course of anti-nuclear matrix protein-2 (NXP-2) positive-interstitial lung disease","authors":"Bess M. Flashner ,&nbsp;Ryosuke Imai ,&nbsp;Andrew J. Synn ,&nbsp;Julia K. Munchel ,&nbsp;Lida P. Hariri ,&nbsp;Fiona K. Gibbons ,&nbsp;Sydney B. Montesi ,&nbsp;Barry S. Shea ,&nbsp;Mary B. Rice ,&nbsp;Rene S. Bermea ,&nbsp;Robert W. Hallowell","doi":"10.1016/j.resmer.2025.101170","DOIUrl":"10.1016/j.resmer.2025.101170","url":null,"abstract":"<div><h3>Background</h3><div>Evaluating the etiology of interstitial lung disease (ILD) commonly involves ordering a myositis panel containing myositis-specific antibodies (MSAs), including anti-NXP-2. However, little is known about the presentation of patients with ILD and anti-NXP-2 positivity. We sought to define the course of anti-NXP-2-positive ILD in order to guide prognosis and potential treatment strategies.</div></div><div><h3>Methods</h3><div>We performed a retrospective chart review of patients with positive anti-NXP-2 antibodies who presented to two ILD referral centers in Boston, MA between 2012 and 2024. Patients were identified by query of the electronic medical record for patients positive for anti-NXP-2. We included those anti-NXP-2 positive patients with ILD on chest computed tomography (CT). Data regarding clinical presentation and disease course were abstracted from the medical record. For patients following longitudinally in the ILD clinic, we conducted survival analyses for ILD progression (composite of PFT progression, hospitalization, or death) using Kaplan-Meier curves and log-rank tests. Additionally, we used a Cox proportional-hazards model, adjusting for age, gender, forced vital capacity (FVC) at baseline, and immunosuppression to calculate hazard ratios. ILD patients with MSA-positive, NXP-2-negative ILD served as the comparator group.</div></div><div><h3>Results</h3><div>31 patients were identified (mean 70 years, SD 9). Three were diagnosed with dermatomyositis (DM) prior to presentation, but the remaining had ILD as the only manifestation of connective tissue disease. Most (97%) patients were symptomatic with dyspnea and/or cough at presentation. Other autoantibody positivity was common; only 42% were positive for anti-NXP-2 alone without positivity for other autoimmune serologies, including MSAs known to be associated with ILD. Clinical follow up data were available for 28 patients for a median follow up period of 24 months (range &lt;1 month-13 years). A majority (61%) were treated with immunosuppression, antifibrotics, or both. Over one third experienced acute exacerbation of ILD or death (<em>N</em> = 11, 35%). Progression-free survival was similar to that of other MSA-positive ILD patients, regardless of whether anti-NXP-2 was positive alone or co-positive for other autoantibodies.</div></div><div><h3>Conclusions</h3><div>We present the largest single series of anti-NXP-2-positive ILD. Anti-NXP-2-positive ILD can occur in the absence of DM/PM and can manifest as progressive pulmonary disease that is similar to other MSA-positive ILDs.</div></div>","PeriodicalId":48479,"journal":{"name":"Respiratory Medicine and Research","volume":"87 ","pages":"Article 101170"},"PeriodicalIF":2.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143839011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of non-small cell lung cancer after 2 years of immunotherapy","authors":"Cédric Mahiat ,&nbsp;Jacques Cadranel ,&nbsp;Constance Méteyé ,&nbsp;Samy Houari ,&nbsp;Lise Rosencher ,&nbsp;Christelle Epaud ,&nbsp;Jérémy Slomka ,&nbsp;Vincent Fallet ,&nbsp;Anthony Canellas","doi":"10.1016/j.resmer.2025.101169","DOIUrl":"10.1016/j.resmer.2025.101169","url":null,"abstract":"<div><h3>Background</h3><div>The optimal management strategy for metastatic or advanced-stage non-small-cell lung cancer (NSCLC) after 2 years of immune checkpoint inhibitor (ICI) remains unclear.</div></div><div><h3>Methods</h3><div>We conducted a single-center retrospective observational study to characterize the management of patients who received at least 2 years of ICI in the first-line setting for a metastatic or advanced-stage NSCLC.</div></div><div><h3>Results</h3><div>Among the 254 patients that received ICI in the first-line setting, 39 (15%) achieved 2 years of treatment (ICI in monotherapy, <em>n</em> = 14; ICI with chemotherapy, <em>n</em> = 25). ICI was discontinued after 2 years (&lt;30 months) in 31 (79%) of the cases. During the first 2 years, 29 patients (74%) had no disease progression (2 complete radiological responses, 25 partial radiological responses, and 2 stable diseases) and 10 patients (26%) experienced at least one oligo-progression, which was treated with local ablative treatment (LAT), allowing continuation of ICI up to 2 years. A positron emission tomography (PET) scan was performed at 2 years for 37 patients (95%), revealing a complete metabolic response (CMR) in 16 individuals (43%). None of these patients progressed subsequently (median follow-up: 13 months). After 2 years of ICI, the 12-month progression-free survival was 100% in case of CMR versus 49% (95% CI, 29–91) in the absence of CMR (<em>p</em> = 0.00037).</div></div><div><h3>Conclusions</h3><div>A CMR at 2 years of ICI is associated with a favorable prognosis. Further studies are needed to better establish the role of PET scan at 2 years, the relevance of LAT and the optimal duration of ICI.</div></div>","PeriodicalId":48479,"journal":{"name":"Respiratory Medicine and Research","volume":"87 ","pages":"Article 101169"},"PeriodicalIF":2.2,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143808117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Phenotypes and prognosis of systemic sclerosis: A cluster analysis","authors":"Stefan Nowak ,&nbsp;Dany Jaffuel ,&nbsp;Jacques Morel ,&nbsp;Engi Ahmed ,&nbsp;Anne Sophie Gamez ,&nbsp;Clément Boissin ,&nbsp;Jérémy Charriot ,&nbsp;Nicolas Molinari ,&nbsp;Arnaud Bourdin","doi":"10.1016/j.resmer.2025.101168","DOIUrl":"10.1016/j.resmer.2025.101168","url":null,"abstract":"<div><h3>Introduction</h3><div>Systemic sclerosis is a complex autoimmune disease with significant morbidity and mortality, primarily due to pulmonary complications, including diffuse interstitial lung disease and pulmonary hypertension. The disease course is unpredictable due to its heterogeneous presentation. Our study aimed to form homogeneous cohorts of patients with severe visceral systemic sclerosis and assess their prognoses.</div></div><div><h3>Materials and methods</h3><div>We conducted a single-center retrospective observational study on 198 patients. These patients were clustered based on factors associated with poor disease prognosis using a bottom-up hierarchical clustering technique.</div></div><div><h3>Results</h3><div>We identified four clusters in our population. Cluster 1 (<em>n</em> = 25) included 89 % of patients with pulmonary hypertension, 64 % of whom had associated interstitial lung disease. Cluster 2 (<em>n</em> = 11) included all patients with scleroderma renal crisis, 27 % of whom developed pulmonary hypertension. Cluster 3 (<em>n</em> = 109) exclusively consisted of female patients, 90 % of whom had a limited cutaneous form, with 62 % presenting anticentromere antibodies. These patients did not exhibit severe pulmonary disease. Cluster 4 (<em>n</em> = 53) included patients with significant occupational exposure, 79 % of whom had diffused interstitial lung disease and 83 % had anti-topoisomerase I antibodies. The survival rate was significantly lower in cluster 1 (<em>p</em> &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>This study characterized systemic sclerosis phenotypes, highlighting the heterogeneity in clinical presentation and disease course. The trajectory of patients within each cluster was associated with the onset of pulmonary hypertension onset, which adversely affected the prognosis.</div></div>","PeriodicalId":48479,"journal":{"name":"Respiratory Medicine and Research","volume":"87 ","pages":"Article 101168"},"PeriodicalIF":2.2,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143768692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound-guided pleural biopsy (USGB) outcomes: The impact of respiratory-led one stop shop","authors":"Shyun Ping Tiong,&nbsp;John De Jesus,&nbsp;Tashi Playle,&nbsp;Emily Harvey,&nbsp;Michael Ball,&nbsp;Siyamini Vythilingam,&nbsp;Rachelle Asciak","doi":"10.1016/j.resmer.2025.101167","DOIUrl":"10.1016/j.resmer.2025.101167","url":null,"abstract":"","PeriodicalId":48479,"journal":{"name":"Respiratory Medicine and Research","volume":"87 ","pages":"Article 101167"},"PeriodicalIF":2.2,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143725916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bronchoscopic detection of aspiration in patients with bronchiectasis and Mycobacterium avium complex pulmonary infection","authors":"Leah Lande ,&nbsp;Spencer Whealon ,&nbsp;Eden Singer ,&nbsp;Lee W. Greenspon ,&nbsp;Erin Rains ,&nbsp;Rebecca Kwait ,&nbsp;Meghan Buckley ,&nbsp;Weidan Peng ,&nbsp;Janet Sawicki ,&nbsp;Joseph O. Falkinham III ,&nbsp;Myra D. Williams ,&nbsp;Donald D. Peterson","doi":"10.1016/j.resmer.2025.101166","DOIUrl":"10.1016/j.resmer.2025.101166","url":null,"abstract":"<div><h3>Rationale</h3><div>To investigate whether gastroesophageal reflux with laryngopharyngeal reflux and aspiration play a role in the pathogenesis of bronchiectasis and <em>Mycobacterium avium</em> complex (MAC) pulmonary infection.</div></div><div><h3>Methods</h3><div>In this prospective case-control study, subjects included 31 patients with bronchiectasis undergoing bronchoscopy to investigate suspected MAC infection and 9 control subjects undergoing bronchoscopy for alternative reasons. Patients drank 45 mL of FD&amp;C Blue #1 mixed with 200 mL of tap water the night prior to bronchoscopy. During bronchoscopy, the bronchial mucosa was inspected for the presence of blue dye staining. Bronchoalveolar lavage (BAL) samples were obtained from the most affected segments on CT scan and were cultured for mycobacteria and assayed for pepsin and bile acids. Gastric aspirate samples were obtained for mycobacterial culture.</div></div><div><h3>Results</h3><div>93.8% of patients with confirmed pulmonary MAC infection and 91.7% of patients with evidence of bronchiectasis by CT scan, but negative mycobacterial cultures, had blue dye staining of the bronchial mucosa vs. 11.3% of control patients (<em>p</em> &lt; 0.001). Areas of abnormality on CT correlated with airways demonstrating blue staining by bronchoscopy in 100% of MAC patients and 90.9% of patients with bronchiectasis and negative mycobacterial cultures. MAC patients had higher median BAL pepsin levels compared to combined MAC negative patients (subjects with bronchiectasis and negative mycobacterial cultures and true controls), 5.4 ng/mL vs. 3.4 ng/mL (<em>p</em> = 0.019). 78.6% of MAC patients vs. 26.3% of combined MAC negative patients had BAL bile acid concentrations of &gt;/= 0.493 uM (<em>p</em> = 0.005). There was no significant difference in age, supraglottic index, reflux symptoms, gastric pH, or proton pump inhibitor use between the MAC positive vs. MAC negative patients. 42.8% of patients with growth of MAC on BAL also had growth of MAC in the gastric aspirate.</div></div><div><h3>Conclusions</h3><div>Reflux and aspiration of gastric contents into the airways show a strong association with bronchiectasis and may be associated with MAC pulmonary disease. The novel method introduced in this study of drinking blue dye the evening prior to bronchoscopy should be utilized in the evaluation of infectious and inflammatory lung diseases in which aspiration may play a role.</div></div>","PeriodicalId":48479,"journal":{"name":"Respiratory Medicine and Research","volume":"87 ","pages":"Article 101166"},"PeriodicalIF":2.2,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143681862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Update of guidelines for management of Community Acquired pneumonia in adults by the French Infectious Disease Society (SPILF) and the French-Speaking Society of Respiratory Diseases (SPLF): Endorsed by the French intensive care society (SRLF), the French microbiology society (SFM), the French radiology society (SFR) and the French emergency society (SFMU).","authors":"Aurélien Dinh, François Barbier, Jean-Pierre Bedos, Mathieu Blot, Vincent Cattoir, Yann-Erick Claessens, Xavier Duval, Pierre Fillâtre, Maxime Gautier, Yann Guegan, Sophie Jarraud, Alban Le Monnier, David Lebeaux, Paul Loubet, Constance de Margerie, Philippe Serayet, Yacine Tandjaoui-Lambotte, Emmanuelle Varon, Yves Welker, Damien Basille","doi":"10.1016/j.resmer.2025.101161","DOIUrl":"https://doi.org/10.1016/j.resmer.2025.101161","url":null,"abstract":"<p><p>Community-Acquired Pneumonia (CAP) of Presumed Bacterial Origin: Updated Management Guidelines Community-acquired pneumonia (CAP) of presumed bacterial origin is a common condition with varying severity, requiring either outpatient, hospital, or even critical care management. The French Infectious Diseases Society (SPILF) and the French Language Pulmonology Society (SPLF), in collaboration with the French Societies of Microbiology (SFM), Emergency Medicine (SFMU), Radiology (SFR), and Intensive Care Medicine (SRLF), along with representatives of general practice, have coordinated an update of the previous management guidelines, which dated back to 2010. From a therapeutic perspective, the updated recommendations define the choice of initial empiric antibiotic therapy, indications for combination therapy, the use of anti-Pseudomonas beta-lactams, antibiotic treatment duration, and the indications and modalities for prescribing systemic corticosteroids. On a biological level, indications for biomarkers and microbiological investigations have been refined. Regarding imaging, the role of different modalities in the diagnosis and follow-up of CAP has been reassessed, including chest X-ray, pleuropulmonary ultrasound, and thoracic CT scan.</p>","PeriodicalId":48479,"journal":{"name":"Respiratory Medicine and Research","volume":" ","pages":"101161"},"PeriodicalIF":2.2,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microbiological characteristics of pleural infection in adults: A 10-year retrospective study from a tertiary respiratory care hospital","authors":"Khouloud Ben Dhaou ,&nbsp;Imen Bouzouita ,&nbsp;Asma Ghariani ,&nbsp;Emna Mehiri-Zeghal ,&nbsp;Leila Slim-Saidi","doi":"10.1016/j.resmer.2025.101164","DOIUrl":"10.1016/j.resmer.2025.101164","url":null,"abstract":"<div><h3>Introduction</h3><div>Pleural infection is a high-mortality disease with a rising incidence in the past two decades. The knowledge of the main causative organisms is an important step for appropriate treatment. This study aims to describe etiologic and antibiotic resistance features of non-tuberculous pleural infections in adults in a tertiary care center specializing in the treatment of respiratory diseases.</div></div><div><h3>Methods</h3><div>This retrospective study was conducted at the microbiology laboratory of Abderrahmen Mami pneumology and phthisiology hospital, Ariana, Tunisia from January 2014 to December 2023. Pleural fluid samples were collected from adult patients with pleural effusion, from any cause, admitted to the different clinical services. Bacterial isolation and identification were performed by conventional techniques. The disk diffusion and the Vitek 2 methods were used for the susceptibility testing.</div></div><div><h3>Results</h3><div>During the study period, 5235 pleural fluid specimens were included. The sex ratio M/F was 2:1, and the median age was 57 years (interquartile range: 43–68 years). Culture was positive in 9.6 % of all cases, and in 31.4 % of purulent pleural fluids. The Gram stain had 41.5 % (95 % CI 35.6–47.6) sensitivity and 99.8 % (95 % CI 99.6–99.9) specificity in detecting microorganisms. A pleural fluid leukocyte count &gt;10,000/mL showed a sensitivity of 51.4 % (95 % CI 47.7–55.8) and a specificity of 91.7 % (95 % CI 90.8–92.4). A total of 544 microorganisms were isolated. The main causative microorganisms were viridans streptococci group (32.1 %), <em>Enterobacteriaceae</em> (25.3 %), <em>Staphylococcus aureus</em> (10.2 %), and anaerobes (9.3 %). Among Enterobacteriaceae, 19 % were resistant to third-generation cephalosporins and 6.4 % to carbapenems. The resistance to penicillin G was detected in 19 % of the <em>viridans streptococci</em> group. Methicilline Resistant <em>Staphylococcus aureus</em> percentage was 14.2 %.</div></div><div><h3>Conclusion</h3><div>Conventional culture yielded 31.4 % positivity in purulent pleural fluids, and Gram-positive organisms were the leading cause of non-tuberculous pleural infections in adults over the past ten years. These results highlight the need for new molecular methods to improve culture-negative empyema diagnosis.</div></div>","PeriodicalId":48479,"journal":{"name":"Respiratory Medicine and Research","volume":"87 ","pages":"Article 101164"},"PeriodicalIF":2.2,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143591631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"“Lung tensioning device” for emphysema: The comeback of the coil","authors":"Nicolas Guibert,&nbsp;Thomas Villeneuve,&nbsp;Juliette Edme,&nbsp;Julien Mazières,&nbsp;Gavin Plat,&nbsp;Valentin Héluain","doi":"10.1016/j.resmer.2025.101163","DOIUrl":"10.1016/j.resmer.2025.101163","url":null,"abstract":"","PeriodicalId":48479,"journal":{"name":"Respiratory Medicine and Research","volume":"87 ","pages":"Article 101163"},"PeriodicalIF":2.2,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The positional change in vital capacity as a tool to identify diaphragm dysfunction: A qualitative systematic review","authors":"Hendrik Kever ,&nbsp;Giuseppe Liistro ,&nbsp;Dominique Butenda Babapu ,&nbsp;Gregory Reychler","doi":"10.1016/j.resmer.2025.101162","DOIUrl":"10.1016/j.resmer.2025.101162","url":null,"abstract":"<div><h3>Background</h3><div>Sitting to supine fall in vital capacity (∆VC) is commonly used to screen for diaphragmatic dysfunction (DD), but the predictive threshold value varies.</div><div>This systematic review aimed to compare the position-dependent change in vital capacity (VC) in patients with objectively confirmed DD.</div></div><div><h3>Research question</h3><div>What is the optimal predictive value of ∆VC to diagnose DD.</div></div><div><h3>Study design and methods</h3><div>We searched Medline/PubMed, Embase and Scopus, including backward citations, for studies from database inception to December 5, 2023. Included trials measured position change in VC in adult patients with DD, confirmed independently by a parameter other than ∆VC. Risk of bias was assessed using the Downs and Black checklist.</div></div><div><h3>Results</h3><div>Of 497 records identified, 10 studies were included, totalling 393 adults, of which 284 had DD. In patients with confirmed unilateral diaphragmatic paralysis, mean change in VC ranged from 7 to 23%, and in those with bilateral diaphragmatic paralysis, from 19 to 37%. In studies providing only values for DD without specifying unilateral or bilateral involvement, it ranged from 31 to 42%. In control groups, it ranged from 3 to 9%.</div></div><div><h3>Interpretation</h3><div>The change in VC appears to be a valid test for confirming DD when using a cut-off value of 20%, though this approach results in very low sensitivity.</div><div>A cut-off value of 15% should be used in a screening setting as an initial approach of a multimodal strategy, without being sensible enough to exclude milder forms of DD.</div></div>","PeriodicalId":48479,"journal":{"name":"Respiratory Medicine and Research","volume":"87 ","pages":"Article 101162"},"PeriodicalIF":2.2,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143464108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-acting muscarinic antagonists (LAMA) in asthma: What is the best strategy?","authors":"Guillaume Mahay ,&nbsp;Maeva Zysman ,&nbsp;Nicolas Guibert ,&nbsp;Cindy Barnig ,&nbsp;Laurent Guilleminault ,&nbsp;Clairelyne Dupin","doi":"10.1016/j.resmer.2025.101157","DOIUrl":"10.1016/j.resmer.2025.101157","url":null,"abstract":"<div><div>The use of long-acting muscarinic antagonists (LAMA) in asthma is supported by their mechanism of action and evidence of drug synergy with inhaled corticosteroids ± long-acting β-agonists. This review discusses the scientific rationale, clinical data, and recommendations for the use of LAMA in the asthma therapeutic strategy. Adding a LAMA to a dual therapy with an inhaled corticosteroid and long-acting β-agonist has been shown to reduce exacerbations, increase asthma control, and improve quality of life, with a good safety profile. In addition, using a single inhaler device containing multiple drugs enhances patients’ adherence to therapy. Some predictive factors of the efficacy of this triple therapy have been suggested in the literature: patients with a history of at least one exacerbation within the past 12 months, male patients, those younger than 65 years, and non-smokers have been reported to have a greater improvement from baseline forced expiratory volume in 1 second (FEV1) compared with patients without these characteristics, while patients with high bronchial hyperresponsiveness and persistent airway limitations (PAL) seem to show better gains in the exacerbation rate. However, eosinophil levels do not seem to predict the efficacy of LAMA. The role and long-term benefits of LAMA combined with biologic therapy in severe asthma remain uncertain, with more clinical data needed.</div></div>","PeriodicalId":48479,"journal":{"name":"Respiratory Medicine and Research","volume":"87 ","pages":"Article 101157"},"PeriodicalIF":2.2,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143387236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}