Pub Date : 2025-05-01Epub Date: 2025-02-25DOI: 10.1016/j.resmer.2025.101161
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
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
{"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)","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":"10.1016/j.resmer.2025.101161","url":null,"abstract":"<div><div>Community-Acquired Pneumonia (CAP) of Presumed Bacterial Origin: Updated Management Guidelines</div><div>Community-acquired pneumonia (CAP) of presumed bacterial origin is a common condition with varying severity, requiring either outpatient, hospital, or even critical care management.</div><div>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.</div><div>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.</div><div>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</div></div>","PeriodicalId":48479,"journal":{"name":"Respiratory Medicine and Research","volume":"87 ","pages":"Article 101161"},"PeriodicalIF":2.2,"publicationDate":"2025-05-01","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}
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.
Methods
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.
Results
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 >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 %), Enterobacteriaceae (25.3 %), Staphylococcus aureus (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 viridans streptococci group. Methicilline Resistant Staphylococcus aureus percentage was 14.2 %.
Conclusion
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.
胸膜感染是近二十年来发病率不断上升的高死亡率疾病。了解主要致病生物是进行适当治疗的重要一步。本研究旨在描述成人非结核性胸膜感染的病因学和抗生素耐药性特征，在三级护理中心专门治疗呼吸系统疾病。方法回顾性研究于2014年1月至2023年12月在突尼斯Ariana Abderrahmen Mami肺炎和生理学医院微生物实验室进行。收集来自不同临床服务的任何原因的胸腔积液的成年患者的胸膜液样本。采用常规技术进行细菌分离鉴定。药敏试验采用纸片扩散法和Vitek 2法。结果在研究期间共抽取5235份胸膜液标本。性别比M/F为2:1，年龄中位数为57岁（四分位数间距为43-68岁）。9.6% %的病例培养阳性，31.4% %的脓性胸膜液培养阳性。革兰氏染色检测微生物的灵敏度为41.5 %(95 % CI 35.6 ~ 47.6)，特异性为99.8 %（95 % CI 99.6 ~ 99.9）。胸膜液白细胞计数1万/mL的敏感性为51.4 %(95 % CI 47.7-55.8)，特异性为91.7 %（95 % CI 90.8-92.4）。共分离出微生物544株。主要病原菌为绿杆菌链球菌群（32.1% %）、肠杆菌科（25.3% %）、金黄色葡萄球菌（10. %）和厌氧菌（9.3% %）。肠杆菌科病原菌对第三代头孢菌素耐药率为19% %，对碳青霉烯类耐药率为6.4 %。青绿链球菌组中有19. %对青霉素G耐药。耐甲氧西林金黄色葡萄球菌百分比为14.2% %。结论化脓性胸膜液常规培养阳性率为31.4% %，革兰氏阳性菌是近10年来成人非结核性胸膜感染的主要原因。这些结果强调需要新的分子方法来提高培养阴性脓胸的诊断。
{"title":"Microbiological characteristics of pleural infection in adults: A 10-year retrospective study from a tertiary respiratory care hospital","authors":"Khouloud Ben Dhaou , Imen Bouzouita , Asma Ghariani , Emna Mehiri-Zeghal , 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 >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":"2025-05-01","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}
Pub Date : 2025-05-01Epub Date: 2025-03-25DOI: 10.1016/j.resmer.2025.101169
Cédric Mahiat , Jacques Cadranel , Constance Méteyé , Samy Houari , Lise Rosencher , Christelle Epaud , Jérémy Slomka , Vincent Fallet , Anthony Canellas
Background
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.
Methods
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.
Results
Among the 254 patients that received ICI in the first-line setting, 39 (15%) achieved 2 years of treatment (ICI in monotherapy, n = 14; ICI with chemotherapy, n = 25). ICI was discontinued after 2 years (<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 (p = 0.00037).
Conclusions
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.
{"title":"Management of non-small cell lung cancer after 2 years of immunotherapy","authors":"Cédric Mahiat , Jacques Cadranel , Constance Méteyé , Samy Houari , Lise Rosencher , Christelle Epaud , Jérémy Slomka , Vincent Fallet , 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 (<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":"2025-05-01","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}
Pub Date : 2025-05-01Epub Date: 2025-02-07DOI: 10.1016/j.resmer.2025.101162
Hendrik Kever , Giuseppe Liistro , Dominique Butenda Babapu , Gregory Reychler
Background
Sitting to supine fall in vital capacity (∆VC) is commonly used to screen for diaphragmatic dysfunction (DD), but the predictive threshold value varies.
This systematic review aimed to compare the position-dependent change in vital capacity (VC) in patients with objectively confirmed DD.
Research question
What is the optimal predictive value of ∆VC to diagnose DD.
Study design and methods
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.
Results
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%.
Interpretation
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.
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.
{"title":"The positional change in vital capacity as a tool to identify diaphragm dysfunction: A qualitative systematic review","authors":"Hendrik Kever , Giuseppe Liistro , Dominique Butenda Babapu , 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":"2025-05-01","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}
Pub Date : 2025-05-01Epub Date: 2024-12-04DOI: 10.1016/j.resmer.2024.101145
Abouzar Chaudhry , Floriane Gallais , Pierre-Emmanuel Falcoz , Sylvie Colin De Verdiere , Thomas Villeneuve , Delphine Horeau , Eva Chatron , Elodie Blanchard , Olivier Collange , Benjamin Renaud-Picard
Introduction
Lung transplant (LT) recipients are at greater risk of complications from COVID-19. Treatment options are limited partly due to interactions with immunosuppressive agents. Convalescent plasma (CP) is a potential treatment option, but it has not been extensively studied in LT patients. We aimed to assess the efficacy and safety of CP use in France for COVID-19 infected LT patients.
Material and methods
We retrospectively recruited LT patients followed up in the 10 French LT centers, older than 18 years, infected with SARS-CoV-2 between the pandemic onset and July 1, 2023, and treated with high-titer CP.
Results
We collected the data from 27 patients who received CP for a COVID-19 infection in six out of the 10 French LT centers. The average delay between symptom onset and CP administration was 19.5 days, and 51.8 % of patients received four units. In patients treated within the first 9 days of infection, the survival rate was 100 % at one and three months vs. 75 % (p = 0.28) for late administration patients. Average loss of forced expiratory volume in 1 second at three months was 10.5 % in the early group vs. 3.3 % in the late group (p = 0.58). The average length of hospital stay was 18 and 24 days respectively (p = 0.07). Early use of CP was also more frequent in 2023.
Discussion
In this study highlighting the French experience for the use of CP in LT patients, we observed a limited, heterogenous but well-tolerated use of this therapy.
{"title":"Efficacy of convalescent plasma for the treatment of COVID-19 in lung transplant recipients: A multicenter French study","authors":"Abouzar Chaudhry , Floriane Gallais , Pierre-Emmanuel Falcoz , Sylvie Colin De Verdiere , Thomas Villeneuve , Delphine Horeau , Eva Chatron , Elodie Blanchard , Olivier Collange , Benjamin Renaud-Picard","doi":"10.1016/j.resmer.2024.101145","DOIUrl":"10.1016/j.resmer.2024.101145","url":null,"abstract":"<div><h3>Introduction</h3><div>Lung transplant (LT) recipients are at greater risk of complications from COVID-19. Treatment options are limited partly due to interactions with immunosuppressive agents. Convalescent plasma (CP) is a potential treatment option, but it has not been extensively studied in LT patients. We aimed to assess the efficacy and safety of CP use in France for COVID-19 infected LT patients.</div></div><div><h3>Material and methods</h3><div>We retrospectively recruited LT patients followed up in the 10 French LT centers, older than 18 years, infected with SARS-CoV-2 between the pandemic onset and July 1, 2023, and treated with high-titer CP.</div></div><div><h3>Results</h3><div>We collected the data from 27 patients who received CP for a COVID-19 infection in six out of the 10 French LT centers. The average delay between symptom onset and CP administration was 19.5 days, and 51.8 % of patients received four units. In patients treated within the first 9 days of infection, the survival rate was 100 % at one and three months vs. 75 % (<em>p</em> = 0.28) for late administration patients. Average loss of forced expiratory volume in 1 second at three months was 10.5 % in the early group vs. 3.3 % in the late group (<em>p</em> = 0.58). The average length of hospital stay was 18 and 24 days respectively (<em>p</em> = 0.07). Early use of CP was also more frequent in 2023.</div></div><div><h3>Discussion</h3><div>In this study highlighting the French experience for the use of CP in LT patients, we observed a limited, heterogenous but well-tolerated use of this therapy.</div></div>","PeriodicalId":48479,"journal":{"name":"Respiratory Medicine and Research","volume":"87 ","pages":"Article 101145"},"PeriodicalIF":2.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848010","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}
Pub Date : 2025-05-01Epub Date: 2025-03-21DOI: 10.1016/j.resmer.2025.101168
Stefan Nowak , Dany Jaffuel , Jacques Morel , Engi Ahmed , Anne Sophie Gamez , Clément Boissin , Jérémy Charriot , Nicolas Molinari , Arnaud Bourdin
Introduction
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.
Materials and methods
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.
Results
We identified four clusters in our population. Cluster 1 (n = 25) included 89 % of patients with pulmonary hypertension, 64 % of whom had associated interstitial lung disease. Cluster 2 (n = 11) included all patients with scleroderma renal crisis, 27 % of whom developed pulmonary hypertension. Cluster 3 (n = 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 (n = 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 (p < 0.001).
Conclusion
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.
{"title":"Phenotypes and prognosis of systemic sclerosis: A cluster analysis","authors":"Stefan Nowak , Dany Jaffuel , Jacques Morel , Engi Ahmed , Anne Sophie Gamez , Clément Boissin , Jérémy Charriot , Nicolas Molinari , 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> < 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":"2025-05-01","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}
Non-invasive ventilation (NIV) is the reference treatment for chronic respiratory failure (CRF) due to impairment of the ventilatory system. Home initiation is increasingly practiced. To better support this ambulatory shift, we aimed to assess the implementation constraints and short-term efficacy according to different aetiologies of CRF.
Methods
This retrospective study with cross-sectional and longitudinal analysis included patients initiated with NIV at Angers University Hospital. Patients were separated according to the following aetiologies: obesity hypoventilation syndrome (OHS), chronic obstruction pulmonary disease (COPD), amyotrophic lateral sclerosis (ALS), myopathy and chest wall disease. Implementation constraints were assessed by analysing the variability of NIV settings, the number of masks tried and the duration of hospitalisation. NIV effectiveness was assessed by measuring residual PaCO2 (arterial pressure in CO2), apnoea hypopnea index (AHIflow) and tidal volume (VT) (as displayed by the NIV software).
Results
Between October 2020 and May 2022, 102 patients were started with NIV, including a majority of ALS patients. We found a moderate variability in NIV settings (pressure, slope, triggers, etc.) within the different etiological groups, particularly in ALS. On the other hand, ALS patients required more interface trials than other groups and often had unmet efficacy criteria at hospital discharge. Interestingly, longitudinal follow-up showed a progressive improvement in efficacy criteria, particularly in patients who were initially inadequately ventilated.
Conclusion
Each aetiological group has specific constraints in the initiation of NIV that should be considered when initiating NIV in the outpatient setting.
{"title":"Constraints to the initiation of home non-invasive ventilation and short-term efficacy in different diagnostic groups (as a prelude to an ambulatory shift)","authors":"Claire Drouet , Pascaline Priou , Frédéric Gagnadoux , Wojciech Trzepizur","doi":"10.1016/j.resmer.2025.101154","DOIUrl":"10.1016/j.resmer.2025.101154","url":null,"abstract":"<div><h3>Introduction</h3><div>Non-invasive ventilation (NIV) is the reference treatment for chronic respiratory failure (CRF) due to impairment of the ventilatory system. Home initiation is increasingly practiced. To better support this ambulatory shift, we aimed to assess the implementation constraints and short-term efficacy according to different aetiologies of CRF.</div></div><div><h3>Methods</h3><div>This retrospective study with cross-sectional and longitudinal analysis included patients initiated with NIV at Angers University Hospital. Patients were separated according to the following aetiologies: obesity hypoventilation syndrome (OHS), chronic obstruction pulmonary disease (COPD), amyotrophic lateral sclerosis (ALS), myopathy and chest wall disease. Implementation constraints were assessed by analysing the variability of NIV settings, the number of masks tried and the duration of hospitalisation. NIV effectiveness was assessed by measuring residual PaCO2 (arterial pressure in CO2), apnoea hypopnea index (AHI<sub>flow</sub>) and tidal volume (V<sub>T</sub>) (as displayed by the NIV software).</div></div><div><h3>Results</h3><div>Between October 2020 and May 2022, 102 patients were started with NIV, including a majority of ALS patients. We found a moderate variability in NIV settings (pressure, slope, triggers, etc.) within the different etiological groups, particularly in ALS. On the other hand, ALS patients required more interface trials than other groups and often had unmet efficacy criteria at hospital discharge. Interestingly, longitudinal follow-up showed a progressive improvement in efficacy criteria, particularly in patients who were initially inadequately ventilated.</div></div><div><h3>Conclusion</h3><div>Each aetiological group has specific constraints in the initiation of NIV that should be considered when initiating NIV in the outpatient setting.</div></div>","PeriodicalId":48479,"journal":{"name":"Respiratory Medicine and Research","volume":"87 ","pages":"Article 101154"},"PeriodicalIF":2.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143042395","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}
Pulmonary hypertension (PH) is commonly associated with chronic obstructive pulmonary disease (COPD), with an estimated prevalence of 39%. PH reduces functional capacity and exercise tolerance, and increases the risk of COPD exacerbations and hospitalizations. PH associated with COPD (PH–COPD) typically manifests with moderate severity, progressing gradually in tandem with the level of bronchial obstruction. However, a specific subgroup with severe PH displays disproportionately high pulmonary vascular resistance, reduced diffusion capacity, and a severe prognosis.
Methods
This article is a systematic literature review of clinical trials including randomized controlled trials (RCTs), non-RCTs, cohort studies and registry data regarding PAH-approved drugs, in the context of PH–COPD, from January 2003 to January 2025.
Results
There have been three positive and three negative RCTs with phosphodiesterase-5 inhibitors, as well as one positive and one negative RCT with endothelin receptor antagonists. These RCTs suffered from limitations especially in severe PH cases. Additional data came from 16 studies, including non-RCTs, cohort studies and registry data, and the results were conflicting. The most robust study, a large phase 3 RCT using inhaled treprostinil, was terminated early due to an unfavorable benefit-risk ratio.
Conclusion
The evidence does not support PAH-approved drugs for mild-to-moderate PH–COPD, though potential benefits may exist for the severe PH subgroup. Large, multicenter RCTs are necessary to provide robust medical evidence and phase 2 and phase 3 clinical trials are ongoing. In the interim, suspected or confirmed severe PH–COPD should prompt referral to PH centers for personalized care and potential clinical trial participation.
{"title":"Pulmonary Arterial Hypertension-approved drugs in Pulmonary Hypertension associated with COPD: A systematic literature review","authors":"Beatrice Le Bon Chami , Fida Charif , Claude Semaan , Vanessa Bironneau , Elisa Larrieu-Ardilouze , Magali Croquette , Xavier Jaïs , Lucilla Piccari , David Montani , Etienne-Marie Jutant","doi":"10.1016/j.resmer.2025.101165","DOIUrl":"10.1016/j.resmer.2025.101165","url":null,"abstract":"<div><h3>Introduction</h3><div>Pulmonary hypertension (PH) is commonly associated with chronic obstructive pulmonary disease (COPD), with an estimated prevalence of 39%. PH reduces functional capacity and exercise tolerance, and increases the risk of COPD exacerbations and hospitalizations. PH associated with COPD (PH–COPD) typically manifests with moderate severity, progressing gradually in tandem with the level of bronchial obstruction. However, a specific subgroup with severe PH displays disproportionately high pulmonary vascular resistance, reduced diffusion capacity, and a severe prognosis.</div></div><div><h3>Methods</h3><div>This article is a systematic literature review of clinical trials including randomized controlled trials (RCTs), non-RCTs, cohort studies and registry data regarding PAH-approved drugs, in the context of PH–COPD, from January 2003 to January 2025.</div></div><div><h3>Results</h3><div>There have been three positive and three negative RCTs with phosphodiesterase-5 inhibitors, as well as one positive and one negative RCT with endothelin receptor antagonists. These RCTs suffered from limitations especially in severe PH cases. Additional data came from 16 studies, including non-RCTs, cohort studies and registry data, and the results were conflicting. The most robust study, a large phase 3 RCT using inhaled treprostinil, was terminated early due to an unfavorable benefit-risk ratio.</div></div><div><h3>Conclusion</h3><div>The evidence does not support PAH-approved drugs for mild-to-moderate PH–COPD, though potential benefits may exist for the severe PH subgroup. Large, multicenter RCTs are necessary to provide robust medical evidence and phase 2 and phase 3 clinical trials are ongoing. In the interim, suspected or confirmed severe PH–COPD should prompt referral to PH centers for personalized care and potential clinical trial participation.</div></div>","PeriodicalId":48479,"journal":{"name":"Respiratory Medicine and Research","volume":"87 ","pages":"Article 101165"},"PeriodicalIF":2.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143898531","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}
Pub Date : 2025-05-01Epub Date: 2025-01-24DOI: 10.1016/j.resmer.2025.101156
Asma Tariq , Maher Ghamloush , Greg Schumaker , Anthony Faugno , Lori Lyn Price , Leslie Lussier , Anjan Devaraj , Amrita Karambelkar , Beverly Wong , Elizabeth Han , Lydia Ran , Edward Shi , Alison Travers , Suma Gondi , Derek Lejeune , Gizem Koybasi , Nicholas S. Hill
Background
The use of high flow nasal oxygen therapy (HFNO) may improve clinical outcomes in acute hypoxemic respiratory failure (AHRF) compared to conventional oxygen. However, whether the use of HFNO improves clinical outcomes in COVID-19 pneumonia remains unclear. In this study, we describe the use of HFNO, as compared to conventional oxygen therapy (COT), in moderate to severe COVID-19 pneumonia.
Methods
This is a retrospective cohort study conducted at one academic medical center and one community hospital between March 1, 2020 and July 14, 2020. The primary purpose of the study was to determine the success of HFNO in preventing the composite outcome of invasive mechanical ventilation (IMV) or in-hospital death compared to COT. Secondary objectives included determining the predictors of this composite outcome, rate of endotracheal intubation, hospital mortality and outcomes of early versus late HFNO failure. Logistic and quantile regression were used to test for associations.
Results
A total of 197 patients were included, 166 in the HFNO and 31 in the COT group. There was no significant difference between the groups in the composite outcome of IMV or death, odds ratio (OR) = 0.36, p = 0.08. Use of HFNO as opposed to COT was associated with a significant reduction in the rate of IMV (64 % versus 87 %, p = 0.03). Older age and coronary artery disease were associated with HFNO failure. There was no significant mortality difference between early and late IMV.
Conclusion
In our study, HFNO did not reduce our primary composite outcome of IMV or death in moderate to severe AHRF, although we found that HFNO was associated with lower rate of intubation compared to COT. We detected no benefit of early vs late IMV. Utilizing HFNO in COVID-19 patients with AHRF may be a reasonable initial respiratory support strategy with close monitoring. Additional studies are needed to determine subset(s) of such patients that would benefit the most from HFNO use.
背景：与常规氧相比，高流量鼻氧治疗（HFNO）可能改善急性低氧性呼吸衰竭（AHRF）的临床结果。然而，HFNO的使用是否能改善COVID-19肺炎的临床结果仍不清楚。在本研究中，我们描述了HFNO与传统氧疗（COT）在中重度COVID-19肺炎中的应用。方法回顾性队列研究于2020年3月1日至2020年7月14日在一家学术医疗中心和一家社区医院进行。本研究的主要目的是确定与COT相比，HFNO在预防有创机械通气（IMV）复合结局或院内死亡方面的成功。次要目的包括确定这一综合结果的预测因素、气管插管率、住院死亡率和早期与晚期HFNO衰竭的结果。采用逻辑回归和分位数回归来检验相关性。结果共纳入197例患者，其中HFNO组166例，COT组31例。两组间IMV和死亡的综合转归比较差异无统计学意义，优势比(or) = 0.36, p = 0.08。与COT相比，HFNO的使用与IMV发生率的显著降低相关（64%对87%，p = 0.03）。老年和冠状动脉疾病与HFNO衰竭有关。早期和晚期IMV患者的死亡率无显著差异。结论在我们的研究中，尽管我们发现与COT相比，HFNO与较低的插管率相关，但HFNO并没有降低中重度AHRF患者的IMV或死亡的主要综合结局。我们没有发现早期和晚期IMV的好处。在密切监测的情况下，对COVID-19合并AHRF患者应用HFNO可能是合理的初始呼吸支持策略。需要进一步的研究来确定这类患者中哪些能从HFNO使用中获益最多。
{"title":"The role of high flow nasal oxygen therapy in acute hypoxemic respiratory failure due to COVID-19 pneumonia","authors":"Asma Tariq , Maher Ghamloush , Greg Schumaker , Anthony Faugno , Lori Lyn Price , Leslie Lussier , Anjan Devaraj , Amrita Karambelkar , Beverly Wong , Elizabeth Han , Lydia Ran , Edward Shi , Alison Travers , Suma Gondi , Derek Lejeune , Gizem Koybasi , Nicholas S. Hill","doi":"10.1016/j.resmer.2025.101156","DOIUrl":"10.1016/j.resmer.2025.101156","url":null,"abstract":"<div><h3>Background</h3><div>The use of high flow nasal oxygen therapy (HFNO) may improve clinical outcomes in acute hypoxemic respiratory failure (AHRF) compared to conventional oxygen. However, whether the use of HFNO improves clinical outcomes in COVID-19 pneumonia remains unclear. In this study, we describe the use of HFNO, as compared to conventional oxygen therapy (COT), in moderate to severe COVID-19 pneumonia.</div></div><div><h3>Methods</h3><div>This is a retrospective cohort study conducted at one academic medical center and one community hospital between March 1, 2020 and July 14, 2020. The primary purpose of the study was to determine the success of HFNO in preventing the composite outcome of invasive mechanical ventilation (IMV) or in-hospital death compared to COT. Secondary objectives included determining the predictors of this composite outcome, rate of endotracheal intubation, hospital mortality and outcomes of early versus late HFNO failure. Logistic and quantile regression were used to test for associations.</div></div><div><h3>Results</h3><div>A total of 197 patients were included<strong>,</strong> 166 in the HFNO and 31 in the COT group. There was no significant difference between the groups in the composite outcome of IMV or death, odds ratio (OR) = 0.36, <em>p</em> = 0.08. Use of HFNO as opposed to COT was associated with a significant reduction in the rate of IMV (64 % versus 87 %, <em>p</em> = 0.03). Older age and coronary artery disease were associated with HFNO failure. There was no significant mortality difference between early and late IMV.</div></div><div><h3>Conclusion</h3><div>In our study, HFNO did not reduce our primary composite outcome of IMV or death in moderate to severe AHRF, although we found that HFNO was associated with lower rate of intubation compared to COT. We detected no benefit of early vs late IMV. Utilizing HFNO in COVID-19 patients with AHRF may be a reasonable initial respiratory support strategy with close monitoring. Additional studies are needed to determine subset(s) of such patients that would benefit the most from HFNO use.</div></div>","PeriodicalId":48479,"journal":{"name":"Respiratory Medicine and Research","volume":"87 ","pages":"Article 101156"},"PeriodicalIF":2.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143349318","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}
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