Respiratory Medicine and Research最新文献

{"title":"Cardiac MRI differentiates classical idiopathic pulmonary arterial hypertension from lung phenotype and group 3 pulmonary hypertension.","authors":"Simon Valentin, Freddy Odille, Antoine Fraix, Nathalie Pace, Florian Fleurentin, Anne Guillaumot, Bruno Ribeiro Baptista, François Chabot, Damien Mandry, Ari Chaouat","doi":"10.1016/j.resmer.2026.101256","DOIUrl":"https://doi.org/10.1016/j.resmer.2026.101256","url":null,"abstract":"<p><strong>Background: </strong>Practical application of the classification of pulmonary hypertension (PH) occasionally presents challenges, particularly for idiopathic pulmonary arterial hypertension (iPAH) with a lung phenotype, which can overlap with group 3 PH. This study aimed to evaluate cardiac MRI as a discriminatory tool between classical iPAH, iPAH with a lung phenotype and group 3 PH.</p><p><strong>Methods: </strong>This retrospective study included incident patients diagnosed with iPAH or group 3 PH referred to a PH reference center. All included patients underwent cardiac MRI, right heart catheterization, and chest computed tomography within 48 hours of diagnosis.</p><p><strong>Results: </strong>The analysis included 34 patients, 11 with classical iPAH, 11 with iPAH and a lung phenotype (per predefined criteria) and 12 with group 3 PH (7 with chronic obstructive pulmonary disease and 5 with interstitial lung disease). No significant differences were observed regarding ventricular functions and flow rates. T1 mapping values in the interventricular septum and inferior ventricular insertion point were significantly higher in patients with classical iPAH compared to patients with iPAH and a lung phenotype (1305 [1234 - 1365] ms versus 1210 [1194 - 1251] ms, p=0.028 and 1398 [1355 - 1604] ms versus 1229 [1201 - 1289] ms, p=0.007, respectively. T1 mapping measurements were similar in the iPAH and a lung phenotype compared to group 3.</p><p><strong>Interpretation: </strong>cardiac MRI with T1 mapping, specifically targeting fibrotic areas, effectively discriminated classical iPAH and iPAH and a lung phenotype. These MRI measurements revealed divergent patterns that could explain the different treatment responses and prognoses observed across these PH subtypes.</p><p><strong>Clinical trial: </strong>This trial was registered before inclusion and analyses in www.</p><p><strong>Clinicaltrial: </strong>gov (NCT05624242).</p>","PeriodicalId":48479,"journal":{"name":"Respiratory Medicine and Research","volume":"89 ","pages":"101256"},"PeriodicalIF":1.8,"publicationDate":"2026-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147491809","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":"Serum concentration of Surfactant protein D at diagnosis is associated with malnutrition in patients with idiopathic pulmonary fibrosis.","authors":"Laurent Vernhet, Cédric Ménard, Chloé Rousseau, Stéphane Jouneau","doi":"10.1016/j.resmer.2026.101257","DOIUrl":"https://doi.org/10.1016/j.resmer.2026.101257","url":null,"abstract":"","PeriodicalId":48479,"journal":{"name":"Respiratory Medicine and Research","volume":"89 ","pages":"101257"},"PeriodicalIF":1.8,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147475973","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":"Chest mechanics after endoscopic lung volume reduction: Comparison between responders and non-responders based on dynamic hyperinflation","authors":"Olivier Taton ,&nbsp;Silvia Perez-Bogerd ,&nbsp;Alain Van Muylem ,&nbsp;Pierre Alain Gevenois ,&nbsp;Olivier Van Hove ,&nbsp;Benjamin Bondue ,&nbsp;Emmeline Brenard ,&nbsp;Dimitri Leduc","doi":"10.1016/j.resmer.2025.101194","DOIUrl":"10.1016/j.resmer.2025.101194","url":null,"abstract":"<div><h3>Background</h3><div>Endobronchial lung volume reduction (ELVR) improves lung function, exercise capacity, and quality of life in case of severe emphysema. Nevertheless, not all patients are improved by ELVR including those with substantially decreased lung volume. We tested the hypothesis that unilateral volume loss could impact differently both responders and non-responders.</div></div><div><h3>Methods</h3><div>A retrospective analysis was performed on 20 patients, classified as 13 responders and 7 non-responders based on inspiratory capacity increase ≥200 ml at isotime. We compared changes in lung volume, diaphragm shape and strength, mediastinal shift, lung function, exercise capacity, and quality of life before and three months after ELVR.</div></div><div><h3>Results</h3><div>Compared to non-responders, responders showed a more improved diaphragm strength (4 vs<em>.</em> 2 cmH₂O, <em>p</em> = 0.0318) and shape in both sides (non-treated side total area: +42 (7–54) cm², <em>p</em> = 0.0079, non-treated side zone of apposition: +26 (18–52) cm², <em>p</em> = 0.0270). Responders had a larger mediastinal shift than non-responders (13 vs<em>.</em> 3 degrees, <em>p</em> = 0.0039) with significant positive correlations between mediastinal shift and improvements in lung function (FEV₁: <em>r</em> = 0.48, <em>p</em> = 0.0365), exercise capacity (6MWD: <em>r</em> = 0.78, <em>p</em> &lt; 0.0001, inspiratory capacity: <em>r</em> = 0.48, <em>p</em> = 0.0365), and quality of life (CAT: <em>r</em>=-0.58, <em>p</em> = 0.0096).</div></div><div><h3>Conclusions</h3><div>Dynamic hyperinflation responders present a larger mediastinal shift than non-responders. This shift could be a marker of improved diaphragm shape and strength in both treated and non-treated sides.</div></div><div><h3>Clinical trial registration</h3><div>NCT05799352</div></div>","PeriodicalId":48479,"journal":{"name":"Respiratory Medicine and Research","volume":"88 ","pages":"Article 101194"},"PeriodicalIF":1.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144767071","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":"Evolving paradigms in pulmonary hypertension: Highlights of the 6th French Pulmonary Hypertension Network Meeting","authors":"Athénaïs Boucly ,&nbsp;Antoine Beauvais ,&nbsp;Thomas Lacoste-Palasset ,&nbsp;Mitja Jevnikar ,&nbsp;Marianne Riou ,&nbsp;Sabina Solinas ,&nbsp;Fabrice Antigny ,&nbsp;Fabrice Bauer ,&nbsp;Laurent Bertoletti ,&nbsp;Damien Bonnet ,&nbsp;Ari Chaouat ,&nbsp;Vincent Cottin ,&nbsp;Michele D’Alto ,&nbsp;Marion Delcroix ,&nbsp;Mélanie Gallant Dewavrin ,&nbsp;Christophe Guignabert ,&nbsp;Sébastien Hascoet ,&nbsp;David G Kiely ,&nbsp;Xavier Jaïs ,&nbsp;Etienne-Marie Jutant ,&nbsp;David Montani","doi":"10.1016/j.resmer.2025.101215","DOIUrl":"10.1016/j.resmer.2025.101215","url":null,"abstract":"","PeriodicalId":48479,"journal":{"name":"Respiratory Medicine and Research","volume":"88 ","pages":"Article 101215"},"PeriodicalIF":1.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145415517","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":"Pulmonary ultrasound versus chest radiography in the diagnosis of community-acquired pneumonia in adults: an updated systematic review and meta-analysis","authors":"Víctor Juan Vera-Ponce ,&nbsp;Jhosmer Ballena-Caicedo ,&nbsp;Juan Carlos Bustamante-Rodríguez ,&nbsp;Fiorella E. Zuzunaga-Montoya ,&nbsp;Luisa Erika Milagros Vásquez-Romero ,&nbsp;Joan A. Loayza-Castro ,&nbsp;Mario J. Valladares-Garrido ,&nbsp;Carmen Inés Gutierrez De Carrillo ,&nbsp;Felix Llanos Tejada","doi":"10.1016/j.resmer.2025.101200","DOIUrl":"10.1016/j.resmer.2025.101200","url":null,"abstract":"<div><h3>Introduction</h3><div>Although chest radiography (CXR) has traditionally been used as the initial diagnostic test, pulmonary ultrasound (US) has emerged in recent years as a radiation-free, portable, and potentially more sensitive and specific alternative.</div></div><div><h3>Objective</h3><div>To evaluate the diagnostic accuracy of US compared to CXR for detecting community-acquired pneumonia (CAP) in adults through a systematic review and meta-analysis.</div></div><div><h3>Methodology</h3><div>Comprehensive searches were conducted in SCOPUS, Web of Science, PubMed, and EMBASE databases. Observational studies comparing US with CXR in diagnosing CAP were included, using computed tomography as the reference standard for all patients. Random-effect models were used for statistical analysis, calculating sensitivity, specificity, likelihood ratios (LR), and diagnostic odds ratios (DOR). Meta-regression analyses were performed, and SROC curves were constructed to compare diagnostic performance.</div></div><div><h3>Results</h3><div>Eight studies using CT as a reference standard were included. US showed superior performance with sensitivity 90.0 % (95 % CI: 81.3-96.2 %), specificity 90.8 % (95 % CI: 79.9-97.7 %), LR+ 9.45 (95 % CI: 3.73-23.94), LR- 0.12 (95 % CI: 0.06-0.24), and DOR 79.74. CXR demonstrated lower values with sensitivity 72.6 % (95 % CI: 61.7–82.4 %), specificity 82.0 % (95 % CI: 65.5–93.9 %), LR+ 3.98 (95 % CI: 1.87-8.49), LR- 0.36 (95 % CI: 0.23-0.54), and DOR 11.17. Both modalities showed significant heterogeneity, which was not explained by the sample size in meta-regression.</div></div><div><h3>Conclusions</h3><div>Pulmonary US demonstrates substantially higher diagnostic accuracy than CXR for CAP detection, with particularly strong performance in excluding pneumonia as evidenced by its low negative LR. While CXR maintains relevance where US is unavailable or for evaluating specific thoracic conditions, implementing US can optimize pneumonia diagnosis and potentially reduce unnecessary antibiotic use, particularly in emergency and critical care settings.</div></div>","PeriodicalId":48479,"journal":{"name":"Respiratory Medicine and Research","volume":"88 ","pages":"Article 101200"},"PeriodicalIF":1.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145026685","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":"Should segmentectomy indications be extended to NSCLC smaller than 3 cm without lymph node involvement? A retrospective single-center study","authors":"Damien Leveque ,&nbsp;Soufiane Lebal ,&nbsp;Tristan Goudou ,&nbsp;Mihaela Giol ,&nbsp;Denis Debrosse ,&nbsp;Marielle LE Roux ,&nbsp;Thérésa Khalife-Hocquemiller ,&nbsp;Anna Vayssette ,&nbsp;Juliette Camuset ,&nbsp;Alexandra Rousseau ,&nbsp;Jalal Assouad ,&nbsp;Harry Etienne","doi":"10.1016/j.resmer.2025.101179","DOIUrl":"10.1016/j.resmer.2025.101179","url":null,"abstract":"<div><h3>Introduction</h3><div>Surgical resection remains the standard treatment for stage IA non-small cell lung cancers (NSCLC). The dual objective of this study is to compare long-term outcomes of lobectomies and segmentectomies for stage IA NSCLC and to identify prognostic factors for resected stage IA NSCLC.</div></div><div><h3>Materials and Methods</h3><div>This is a retrospective monocentric study including patients diagnosed with NSCLC smaller than 3 cm, without lymph node involvement, from November 2015 to November 2021. The primary endpoint was event-free survival (EFS), defined as time from surgery to recurrence or all-cause death. Secondary endpoints included overall survival, recurrence-free survival, and short-term postoperative outcomes (length of stay, drainage duration, 30-day mortality, and postoperative complications). Prognostic factors were analyzed using multivariate Cox regression adjusted for variables identified in univariate analysis.</div></div><div><h3>Results</h3><div>A total of 457 patients underwent surgery for stage cIA NSCLC during the 11study period. Of these, 176 (38.5 %) had a segmentectomy, and 281 (61.5 %) underwent lobectomy. Among patients with cT1N0 tumors, the 5-year event-free survival did not significantly differ between the segmentectomy and lobectomy groups (adjusted HR = 0.59 (0.32; 1.08), <em>p</em> = 0.086), with 5-year event-free rates of 75.0 % and 83.0 %, respectively (<em>p</em> = 0.054). Multivariate analysis revealed an association between nodule type (solid vs. ground-glass or mixed) and event-free survival (death and/or recurrence) ([adjusted HR =2.07 (1.17–3.66), <em>p</em> = 0.01)]. Vascular and/or lymphatic invasion is associated with a decrease in event-free survival (recurrence or death) [adjusted HR = 2.25 (1.29; 3.92), <em>p</em> = 0.004]. Conversion from segmentectomy to lobectomy occurred in 6 patients (3.4 %), and they were included in the lobectomy group for analysis.</div></div><div><h3>Conclusion</h3><div>For patients with clinical stage cIA NSCLC, segmentectomy appears to offer comparable oncologic outcomes to lobectomy. Tumor characteristics, including radiological appearance and histological factors, should be carefully considered when selecting the appropriate surgical strategy. Prospective multicenter studies are needed to confirm these findings.</div></div>","PeriodicalId":48479,"journal":{"name":"Respiratory Medicine and Research","volume":"88 ","pages":"Article 101179"},"PeriodicalIF":2.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144580404","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":"Prevalence and incidence of adult bronchiectasis in Hong Kong from 2008–2023: A population-based cohort study","authors":"ZhiLing Yuan ,&nbsp;Philip CM Au ,&nbsp;Ching Lung Cheung ,&nbsp;James Chung Man Ho ,&nbsp;Wang Chun Kwok","doi":"10.1016/j.resmer.2025.101220","DOIUrl":"10.1016/j.resmer.2025.101220","url":null,"abstract":"<div><div>While the incidence and prevalence of bronchiectasis was reported to be increasing in different parts of the world, the epidemiological data on adult bronchiectasis in Hong Kong is lacking. We aim to investigate the incidence and prevalence of adult bronchiectasis patients in Hong Kong, and to assess the changes in trends over time.</div><div>The study population was identified through the Clinical Data Analysis and Reporting System (CDARS) of Hospital Authority, Hong Kong. Patients aged 20 or above with the diagnostic code of bronchiectasis managed in all public hospitals and clinics in Hospital Authority, Hong Kong from 2008 to 2023 were retrospectively recruited. Joinpoint regression was employed to analyze trends in prevalence and incidence, estimating the average annual percent change (AAPC).</div><div>The overall prevalence of adult bronchiectasis in Hong Kong has been steadily rising from 2008 to 2023. The prevalence increased from 176.30 per 100,000 population (95 % CI 172.83 to 179.77) in 2008 to 238.09 per 100,000 population (95 % CI 234.34 to 241.85) in 2023, with AAPC 2.20 (95 % CI 1.82 to 2.22). The overall bronchiectasis incidence rate remained relatively stable from 18.48 per 100,000 population to 19.15 per 100,000 population from 2008 to 2023. In 2019, the incidence of bronchiectasis peaked at 25.38 per 100,000 population (95 % CI 21.64 to 29.11).</div><div>The prevalence of adult bronchiectasis has been increasing from year 2008 to 2023 in Hong Kong, with a largely stable incidence. The results concur with other epidemiological studies in other countries.</div></div>","PeriodicalId":48479,"journal":{"name":"Respiratory Medicine and Research","volume":"88 ","pages":"Article 101220"},"PeriodicalIF":1.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145519209","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":"When to test for myositis antibodies in usual interstitial pneumonia on chest CT?","authors":"Eliott Guillois ,&nbsp;Daniel Bertin ,&nbsp;Jules Milesi ,&nbsp;Paul Habert ,&nbsp;Mathieu Di Bisceglie ,&nbsp;Xavier Heim ,&nbsp;Benjamin Coiffard ,&nbsp;Romain Naud ,&nbsp;Ana Nieves ,&nbsp;Ngoc Anh Thu Nguyen ,&nbsp;Martine Reynaud-Gaubert ,&nbsp;Nathalie Bardin ,&nbsp;Julien Bermudez","doi":"10.1016/j.resmer.2025.101211","DOIUrl":"10.1016/j.resmer.2025.101211","url":null,"abstract":"<div><h3>Introduction</h3><div>Usual interstitial pneumonia (UIP) is a key pattern of interstitial lung disease (ILD), most commonly linked to idiopathic pulmonary fibrosis (IPF). Identifying underlying autoimmune conditions such as myositis is clinically relevant, yet guidelines provide limited recommendations regarding myositis antibody (MSA) screening.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed patients with UIP who underwent systematic MSA screening at our center. Clinical and serological characteristics were compared between MSA-positive (MSA+) and MSA-negative (MSA-) groups. Logistic regression was used to identify predictive factors.</div></div><div><h3>Results</h3><div>Among 134 patients, 15 (11 %) were MSA+. Compared with MSA- patients, MSA+ cases were more likely to present with autoimmune disease (<em>p</em> = 0.03), ANA ≥ 1:320 (<em>p</em> &lt; 0.001), and positive rheumatoid factor (<em>p</em> = 0.04). A four-parameter profile combining ANA &lt; 1:320, absence of rheumatoid factor, no hypergammaglobulinemia, and no Raynaud’s phenomenon strongly predicted MSA negativity with excellent specificity (100 %), modest sensitivity (35 %), and good overall discriminative ability (AUC = 0.82).</div></div><div><h3>Discussion</h3><div>In patients with UIP, a simple four-parameter profile (ANA &lt; 1:320, absence of rheumatoid factor, absence of hypergammaglobulinemia, and absence of Raynaud’s phenomenon) strongly predicts negative MSA status. These findings support a more targeted approach to MSA screening, potentially improving diagnostic accuracy, guiding treatment decisions, and reducing unnecessary testing in UIP.</div></div>","PeriodicalId":48479,"journal":{"name":"Respiratory Medicine and Research","volume":"88 ","pages":"Article 101211"},"PeriodicalIF":1.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145265143","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":"Use of hemi-cannula in patients with high risk of recannulation in an intermediate respiratory care unit. A descriptive analysis and study of the predictor variables of the use of posterior non-invasive mechanical ventilation","authors":"Sergio Lopez-Ruz,&nbsp;Alba Fernández-Boza,&nbsp;Maria Andrea Jaimes-Castaño,&nbsp;Carlos Carrera-Cueva,&nbsp;Belen Muñoz-Sánchez,&nbsp;Emilio Garcia-Díaz,&nbsp;Demetrio González-Vergara,&nbsp;Javier Toral-Marin,&nbsp;Maria Barca-Hernando","doi":"10.1016/j.resmer.2025.101185","DOIUrl":"10.1016/j.resmer.2025.101185","url":null,"abstract":"<div><h3>Background</h3><div>Information about the decannulation process in patients with high risk of recannulation is limited. However, devices such as the hemi-cannula, which maintain airway permeability for a controlled period, may enhance the safety of this process.</div></div><div><h3>Aims</h3><div>Describe and analyze the variables in the decannulation process of patients with high risk of recannulation, who have used a hemi-cannula and correlate these variables with the posterior need for Non-Invasive Mechanical Ventilation (NIMV).</div></div><div><h3>Methods</h3><div>Unicentric study analyzing a retrospective cohort of consecutive patients admitted to the Intermediate Respiratory Care Unit (IRCU) to continue the decannulation process from April 2022 to April 2024. Sociodemographic and clinical variables were described and analyzed. SPSS software was used to analyze the data with T student for independent data and Chi-square with Fischer correction.</div></div><div><h3>Results</h3><div>The final cohort included 19 patients, whom most of them had no previous respiratory pathology, but a 47.4 % had some cardiovascular risk factors. All of the patients had polyneuropathy at the admission to the IRCU. No 30-day mortality was observed in any patient. The recannulation rate was 10.5 %. 21 % of the patients required subsequent NIMV. Statistical significance at the analysis of the correlation between the mean number of days of Invasive Mechanical Ventilation (IMV) and the need for subsequent NIMV was found. However, there was not with the remaining variables.</div></div><div><h3>Conclusions</h3><div>The use of devices such as the hemi-cannula can enhance safety during the complex decannulation process in patients with high risk of recannulation, reducing the likelihood of reintubation or readmission to the Intensive Care Unit (ICU).</div></div>","PeriodicalId":48479,"journal":{"name":"Respiratory Medicine and Research","volume":"88 ","pages":"Article 101185"},"PeriodicalIF":2.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144502145","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 antagonist versus leukotriene receptor antagonist as additional treatment in uncontrolled asthma patients used inhaled corticosteroids and long-acting β2 adrenergic agonist: a randomized phase 2 screening trial","authors":"Fumiya Nihashi ,&nbsp;Kazuki Furuhashi ,&nbsp;Mitsuru Niwa ,&nbsp;Hirotsugu Hasegawa ,&nbsp;Yusuke Kaida ,&nbsp;Mikio Toyoshima ,&nbsp;Naoki Koshimizu ,&nbsp;Toshihiro Shirai ,&nbsp;Masato Fujii ,&nbsp;Kazutaka Mori ,&nbsp;Masaki Ikeda ,&nbsp;Yusuke Inoue ,&nbsp;Hideki Yasui ,&nbsp;Hironao Hozumi ,&nbsp;Yuzo Suzuki ,&nbsp;Masato Karayama ,&nbsp;Noriyuki Enomoto ,&nbsp;Tomoyuki Fujisawa ,&nbsp;Naoki Inui ,&nbsp;Takafumi Suda","doi":"10.1016/j.resmer.2025.101191","DOIUrl":"10.1016/j.resmer.2025.101191","url":null,"abstract":"<div><div>Bronchial asthma is a common disease treated primarily with inhaled corticosteroids (ICS) and long-acting beta-2 agonists (LABA), yet optimal add-on therapy with long-acting muscarinic antagonists (LAMA) or leukotriene receptor antagonists (LTRA) remains unclear. This multicenter, randomized, open-label phase 2 screening trial compared the efficacy of adding tiotropium (LAMA) versus montelukast (LTRA) to ICS/LABA therapy in adult patients with poorly controlled asthma. Patients were randomly assigned to receive either tiotropium or montelukast for 12 weeks. Primary outcome was the change in forced expiratory volume in 1 second (FEV₁), secondary outcomes included changes in asthma control questionnaire (ACQ-5), asthma control test (ACT) scores, and peak expiratory flow (PEF). Ninety-four patients were analyzed. Over 12 weeks, the tiotropium group showed significant improvements in FEV₁ and PEF, while the montelukast group showed no improvement in respiratory function. Both groups, however, showed significant improvements in ACQ-5 and ACT. The primary endpoint, change in FEV₁ improved similarly in both groups (tiotropium 2.03 ± 0.74 to 2.10 ± 0.72 L vs montelukast 2.08 ± 0.69 to 2.13 ± 0.67 L; <em>p</em> = 0.736), while the tiotropium group exhibited a significantly greater improvement in PEF (tiotropium 5.41 ± 1.85 to 5.92 ± 1.93 L/s vs montelukast 5.58 ± 1.84 to 5.65 ± 1.82 L/s; <em>p</em> = 0.025). Subgroup analysis of patients with allergic rhinitis revealed the ACQ-5 score was significantly improved in the montelukast group (tiotropium 0.94 ± 0.64 to 0.68 ± 0.76 L/s vs montelukast 1.26 ± 1.15 to 0.53 ± 0.86 L/s; <em>p</em> = 0.002). Adding tiotropium to ICS/LABA therapy improves respiratory function, whereas adding montelukast enhances symptom control, particularly in patients with allergic rhinitis. These findings underscore the importance of personalized treatment approaches in asthma management by demonstrating that both tiotropium and montelukast confer distinct benefits according to patient characteristics, while also addressing a significant gap in the literature regarding optimal adjunctive therapies for adult asthma, given the scarcity of studies directly comparing these add-on strategies. Further research is needed to establish definitive guidelines for optimal add-on therapies in asthma.</div></div>","PeriodicalId":48479,"journal":{"name":"Respiratory Medicine and Research","volume":"88 ","pages":"Article 101191"},"PeriodicalIF":1.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145410487","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}