Respiratory Research最新文献

Background: Evidence on the association between nutritional status and clinical characteristics in nontuberculous mycobacterial pulmonary disease (NTM-PD) remains limited. We investigated this association and its impact on longitudinal outcomes in a nationwide cohort.

Methods: We analysed 627 patients from the NTM-KOREA cohort study who had initiated antibiotic therapy for NTM-PD. Baseline nutritional status was assessed using the Prognostic Nutritional Index (PNI) and Mini Nutritional Assessment Short Form (MNA-SF) tools. Clinical characteristics, physical function, and health-related quality of life (HRQOL) using Quality of Life Questionnaire-Bronchiectasis (QOL-B) were evaluated. Longitudinal analyses were performed at 6 and 12 months after therapy initiation.

Results: In the baseline anlysis group (N = 627; mean age: 64.3 ± 9.7 years; females: 73.7%), 112 (17.9%) patients were classified as malnourished according to the PNI, and MNA-SF identified 319 (50.9%) patients at risk and 40 (6.4%) as malnourished. Multivariable regression analysis revealed that the PNI-defined malnutrition group was associated with increased odds (odds ratio [95% confidence interval]) of having dyspnoea (2.37 [1.34 to 4.11]), acid-fast bacilli smear positivity (2.26 [1.44 to 3.57]), and cavitary lesions (2.03 [1.25 to 3.37]). This group was also associated with higher BACES (body mass index, age, cavity, erythrocyte sedimentation rate, and sex) scores (β = 0.9), shorter 6-min walking distance (β = -42.1 m), and lower QOL-B scores across physical functioning (β = -10.6), role functioning (β = -7.4), and respiratory symptoms (β = -8.0) (all P < 0.001). In the longitudinal anlysis group (n = 457), poor nutritional status reduced the likelihood of 6-month respiratory symptom improvement (0.44 [0.22 to 0.87]). In the treatment outcome analysis group (n = 119), MNA-defined malnutrition was significantly associated with an increased risk of premature treatment discontinuation within 1 year (26.41 [2.82 to 633.89]).

Conclusions: Baseline nutritional status was closely associated with disease severity and HRQOL in NTM-PD. Preliminary longitudinal data suggested that malnutrition may negatively impact symptomatic improvement and treatment adherence, highlighting the need for routine nutritional assessment.

Trial registration: ClinicalTrials.gov identifier NCT03934034, Registration date May 1, 2019.

Background: Bronchiectasis is a chronic respiratory disease characterized by recurrent exacerbations and persistent inflammation, often associated with bacterial pathogens such as Haemophilus influenzae and Pseudomonas aeruginosa. Phenotypic adaptations (e.g., antimicrobial resistance) complicate treatment and worsen a patient's quality of life.

Methods: Between 2019 and 2020, we isolated 52 H. influenzae and 48 P. aeruginosa strains from 62 non-CF bronchiectasis patients across three scheduled visits and during exacerbation episodes. Antimicrobial susceptibility (assessed by microdilution) and phenotyping assays (motility and hypermutability) were performed. Whole genome sequencing was applied for analyses of resistance determinants, virulence factors, and genetic diversity.

Results: Of the 62 patients, 31 were colonized by H. influenzae, 28 by P. aeruginosa, and 3 were co-colonized. Severe disease was predominantly linked to P. aeruginosa (70.6%), while exacerbations were more common with H. influenzae (81.8%). Multilocus sequence typing (MLST) revealed high genetic diversity, with ST1025 and ST253 most common in H. influenzae and P. aeruginosa, respectively. Antimicrobial resistance was low, but H. influenzae showed the highest resistance to cotrimoxazole (40.4%), while P. aeruginosa showed high resistance to aminoglycosides (27.1%) and fluoroquinolones (25%). Virulence profiling of P. aeruginosa identified 22.9% of strains as hypermutable, 27.1% as mucoid, 31.3% harboring the exoU gene, and 41.7% with impaired twitching motility. Persistent colonization occurred in 16 patients (25.8%), with antimicrobial resistance emerging following previous antimicrobial treatment in one case.

Conclusions: In this cohort, H. influenzae and P. aeruginosa showed similar prevalence, high genetic diversity, and rare co-colonization. P. aeruginosa was associated with more severe disease, higher antimicrobial resistance, and hypermutability, whereas H. influenzae was associated with acute exacerbations.

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) represent a novel class of antidiabetic agents recognized not only for their efficacy in glycemic control and weight management but also for their distinctive cardiovascular benefits. Type 2 diabetes mellitus, a prevalent chronic metabolic disorder worldwide, frequently coexists with chronic inflammatory airway diseases (CIADs), including chronic obstructive pulmonary disease (COPD), asthma, and obstructive sleep apnea (OSA). In recent years, growing attention has been directed toward the potential role of GLP-1RAs in the context of CIADs. This review examines the mechanistic underpinnings of GLP-1RAs in CIADs and evaluates their therapeutic potential in COPD, asthma, and OSA. Clinical evidence indicates that GLP-1RAs can reduce the risk of acute exacerbations in COPD, attenuate obesity-associated asthma exacerbations, and improve respiratory outcomes in patients with OSA. Although certain findings remain inconsistent and prospective clinical studies are still limited, the therapeutic promise of GLP-1RAs in CIADs has been preliminarily supported. Further large-scale randomized controlled trials are warranted to clarify their precise effects in chronic inflammatory airway diseases and to assess long-term efficacy and safety.