Multidisciplinary Respiratory Medicine最新文献

Pisa, Italy, November 6th-8th Every year, the Accademia di Ecografia Toracia (AdET), an Italian association focused on highlighting the scien-tific relevance of thoracic ultrasound (TUS) in clinical practice, presents the projects of its researchers from across Italy and beyond, in a National Congress where the results from AdET projects are shared and debated. Hereby we report the abstracts of the works submitted for publication.

This retrospective study assessed the impact of SARS-CoV-2 infection on patients with interstitial lung disease (ILD) at two tertiary centers in Southern Italy between January 2022 and December 2023. The cohort included 282 ILD patients (mean age 69.6 years; 54.9% male), with common diagnoses such as idiopathic pulmonary fibrosis (33.3%) and connective tissue disease-associated ILD (18.7%). SARS-CoV-2 infection occurred in 130 patients (46%), mostly with mild or asymptomatic cases. Pneumonia developed in 18 cases, with 72.2% requiring hospitalization and 5 COVID-19-related deaths. Patients with pneumonia had higher rates of ILD progression (27.7%) and incidental post-infection ILD diagnoses (22.2%) than those with mild infection. Vaccination rates were high, correlating with favorable outcomes in most cases. Importantly, pneumonia cases were often associated with incomplete vaccination or complex comorbidities. Differentiating COVID-19-related lung changes from ILD progression proved challenging, highlighting the importance of specialized radiologic assessment. Excluding COVID-related deaths, mortality rates were similar regardless of infection status, suggesting a degree of resilience among ILD patients. The study concludes that with high vaccine coverage and careful follow-up, most ILD patients had stable outcomes after SARS-CoV-2 infection. However, pneumonia remains a risk factor for adverse outcomes, underscoring the need for long-term, specialized ILD care.

Background: The prevalence of chronic respiratory diseases is increasing globally. Apart from smoking, other contributing factors include occupational exposures, of which wood dust is thought to play a role. This study aimed to investigate relationships between respiratory symptoms or lung function measurements and exposure to wood dust.

Methods: This was a prospective and comparative cross-sectional study carried out at Parakou, between June and September 2024. Overall, 108 woodworkers (exposed group) and 108 administrative agents from the city hall, the court and five selected banks (control group) were included. Data were collected on upper and lower respiratory symptoms persisting for at least one week in the last 12 months, demographic and occupational-related characteristics, comorbidities, lifestyles, followed by particulate matter  measurements in the workplace and spirometry testing.

Results: The mean ages of participants in exposed and control groups were 40±11 and 38±9 years-old, respectively (p=0.163). All were males. Seniority in the profession was longer in the exposed group (18±12 years vs 8±6 years; p<0.001). Workplace ventilation was found inadequate in the exposed group (27% vs 0%; p<0.001). In carpentry, Milicia excelsa (66%) and Afzelia africana (64%) were the types of wood most commonly used. Mean dust levels for PM10, PM2.5 and PM1.0 were 1.4±0.6 mg/m3, 1.2±0.6 mg/m3 and 1.2±0.6 mg/m3, respectively. Cleaning and protection methods for woodworkers included dry sweeping (61%), dust collection devices (7%), personal homemade face-masks (99%), and affiliation to company insurance schemes (12%).No worker had planned check-ups arranged with an occupational physician. Both respiratory symptoms (94% vs 56%; p<0.001) and work-related respiratory symptoms (92% vs 19%; p<0.001) were more common in the exposed versus control group. Exposure to wood dust (aPR=6.8; 95%CI=4.1-11.4; p<0.001) and asthma (aPR=5.4; 95%CI=2.9-10.1; p<0.001) were significantly associated with respiratory symptoms, after adjustment for biomass and passive smoking exposure and length in the profession. The exposed group had a higher prevalence of restrictive disorder suggestive pattern on spirometry than the control group (48% vs 20%; p<0.001).

Conclusions: Exposure to wood dust adversely affects respiratory function in woodworkers at Parakou, hence the need to raise awareness among these professionals and identify ways to improve their working conditions.

Background: Transthoracic needle biopsy (TNB) is one of the routine procedures for thoracic diseases, especially nodules or consolidation. The procedure can be guided by imaging tools, such as computed tomography (CT) scan and ultrasonography (US). This study reports the results of a five-year experience of transthoracic imaging-guided needle biopsy in a respiratory referral hospital.

Methods: We searched for a monthly sampling database in the procedure room from 2020 to 2024 and identified all transthoracic imaging-guided needle biopsies, either by CT or US-guided. We excluded a few data samples if there was a repetition of the data register. Data regarding pathology and procedure-related complications were analyzed, with the primary outcomes being disease proportion and positivity rate of the procedure.

Results: A total of 1,591 procedures were included in our final analysis. Almost all procedures (99.6%) used a 16-gauge needle core biopsy size. Computed tomography was used predominantly (89.9%) to guide the procedure rather than ultrasound. Adenocarcinoma was the most frequent pathology result of TNB (37.7%). The complications were rare (1.6%) and there was zero mortality reported within 24 hours after TNB procedures. Lung cancer was the most reported case, followed by lymphoma and tuberculosis (TB). The overall accuracy of the TNB procedure in lung and mediastinal consolidation was 96.3%.

Conclusions: Transthoracic needle biopsy has high accuracy and is considered a safe procedure with minor complications.

Pidotimod is a synthetic dipeptide that modulates both innate and acquired immunity, with the highest number of scientific publications (as documented in PubMed) which have demonstrated its efficacy and safety in different clinical settings. A board of experts promoted a multidisciplinary Delphi Consensus to increase clinicians' knowledge of the possible areas of pidotimod use and also offer useful tools for informed use based on consolidated data. A series of statements concerning the use of pidotimod in different clinical settings and conditions was anonymously voted on by a panel of qualified Italian specialists, including pediatricians, otorhinolaryngologists, allergologists, and pulmonologists, using a web platform. All the statements obtained full agreement from the panel about the scientific value of evidence on pidotimod efficacy and safety in managing children and adults with recurrent respiratory infections, both in prevention and add-on therapy. In addition, there was agreement about the use of pidotimod in specific situations, including combined therapy (antibiotics plus pidotimod) for pneumonia, Down syndrome, COVID-19, PFAPA, wheezing, and urinary infections. In conclusion, pidotimod is a safe and effective drug helpful in preventing recurrent respiratory infections in susceptible patients and as an adjuvant in managing patients with infections.

Introduction: We diagnosed and managed a patient with pulmonary fibrosis combined with myelodysplastic syndrome (MDS). This paper aims to investigate, through analysis of our clinical case, a review of the existing literature, and relevant genetic analyses, whether the concurrent occurrence of pulmonary fibrosis and MDS represents a clinical coincidence or reflects an underlying shared pathogenetic mechanism.

Case presentation: A 64-year-old male farmer with concurrent MDS and interstitial pulmonary fibrosis underwent whole-exome sequencing, which revealed abnormalities in the MTHFR, PCSK9, and IFIH1 genes.  A literature review demonstrated that these three genes are associated with both MDS and pulmonary fibrosis.  A search of previous literature identified six similar case reports over a 22-year period, suggesting that the concurrent occurrence of these two conditions may be linked to CD68+ cells, myeloperoxidase (MPO)-positive inflammatory cells, VEXAS syndrome, telomere diseases, and other factors.

Conclusion: MTHFR, IFIH1, PCSK9 and CTC1 are involved in key pathways including folate metabolism, immune regulation, inflammatory responses and telomere disorders, which may contribute to the pathogenesis of both MDS and pulmonary fibrosis. The coexistence of these two conditions is likely attributed to complex interactions among multiple gene mutations, environmental triggers, and dysregulated immune processes, rather than a single.

Background: In the assessment of acute respiratory failure (ARF), PaO2/FIO2 ratio is widely used, but may be misleading in the presence of hyperventilation-induced hypocapnia. The standard PaO2 (stPaO2), a theoretical value corrected for PaCO2, may improve clinical interpretation of gas exchange severity.

Methods: We conducted an online survey among Italian physicians using a case vignette of three hypothetical patients with identical PaO2 values but differing PaCO2 levels. Participants were asked to rank the severity of the cases based solely on arterial blood gas analysis (ABG). A second round was offered after introducing the concept of stPaO2 and providing corresponding values.

Results: A total of 2,241 (8.9%) physicians (median age 53 years, 54.1% male) completed the first round and 1,324 (59%) completed the second one of the survey. Initially, only 9.2% correctly identified the clinical severity  pattern-this increased significantly to 16.1% after introducing stPaO2 (p < 0.01). The improvement rate was higher among physicians with less than 10 years of clinical experience. Performance improved across all specialties, particularly in emergency and intensive care medicine.

Conclusions: The introduction of stPaO2 significantly enhanced physicians' ability to interpret ABG results in ARF. Although its calculation assumes ideal physiological conditions, stPaO2 remains a useful tool for unmasking hypoxemia in hyperventilating patients. Including stPaO2 in ABG reports may support more accurate clinical decision-making, particularly in emergency and critical care settings.

Background: Polycystic Ovary Syndrome (PCOS) is a multifaceted disorder that has also recently been associated with chronic respiratory diseases (CRDs). While several studies have highlighted that pulmonary health is frequently altered in women with PCOS and vice versa, no mechanistic investigation has elucidated an overlapped etiology, so far. Thus, in the present survey we explored the frequency of respiratory issues in a population of PCOS patients, and the medical characteristics that possibly link the two diseases.

Results: A total of 353 women participated in the survey. CRDs affected 27.4% of the surveyed PCOS patients, with asthma representing the most prevalent respiratory problem in 61.5% of cases. In 59.3% of women, respiratory and PCOS onset appaired at the same age and in 68% of cases first symptoms appeared in adolescence.

Conclusions: While several authors have linked respiratory issues and menstrual disturbances, there are no available surveys that investigate the frequency of CRDs in PCOS patients. Despite their qualitative nature, our results sustain previous indications on a possible link between CRDs and PCOS. In future, appropriate studies may elucidate possible etiological mechanisms joining respiratory health to PCOS.

Bronchiectasis is a heterogeneous, chronic airway disease characterized by irreversible bronchial dilation, persistent infection, and neutrophilic inflammation. As traditional treatments often fail to address the underlying pathophysiology, particularly the central role of dysfunctional neutrophils, this review explores recent advances in the understanding of neutrophil-driven mechanisms in bronchiectasis and highlights emerging targeted therapies for this condition. A comprehensive literature review of studies published between 2020 and 2025 focusing on neutrophil activity, biomarkers, and clinical trials evaluating novel anti-inflammatory agents for the treatment of bronchiectasis was conducted. Data were synthesized from experimental models, randomized controlled trials (WILLOW and ASPEN), and expert consensus guidelines (ERS 2023-2024). These results indicate that neutrophils contribute to tissue destruction in bronchiectasis via serine proteases and excessive neutrophil extracellular trap (NET) formation. Key emerging therapies include DPP-1 inhibitors (e.g., brensocatib), CXCR2 antagonists, PI3K inhibitors, and NET-targeting therapies. Biomarkers, such as neutrophil elastase activity, sputum procalcitonin, and NMR-derived metabolic phenotypes, may help personalize therapy, and combination treatment strategies alongside precision medicine are reshaping the therapeutic landscape of ABPA. Although targeting neutrophil dysfunction offers a promising avenue for advancing bronchiectasis care, balancing immunomodulation and infection control remains a challenge. The integration of novel therapies with biomarker-guided treatment and treatable trait approaches is essential to improve the outcomes of this complex disease.

Introduction: Neutrophil cytoplasmic antibody (ANCA)-related vasculitis (AAV) is characterized by necrotizing inflammation of small and medium-sized arteries. This heterogeneous group of vasculitides, including microscopic polyangiitis (MPA), granulomatosis with polyangiitis (GPA) and eosinophilic granulomatosis with polyangiitis (EGPA), further classified according to two distinct types of ANCA pattern, cytoplasmic ANCA (c) and perinuclear ANCA (p), mainly directed against proteinase 3 (PR3) and myeloperoxidase (MPO), respectively. The most frequent pulmonary imaging finding is honeycombing, typical of the usual interstitial pneumonia (UIP) pattern, particularly in AAV MPO-ANCA positive patients. Another pattern, although rare, is represented by organizing pneumonia (OP). The efficacy and reliability of lung ultrasound (LUS) is very good in connective tissue diseases, especially interstitial pulmonary fibrosis (ILD). Subpleural infiltrates on ultrasound are visualized as round or oval hypoechoic consolidations, without visible central flow in color Doppler and power Doppler modes.

Case presentation: We report a case of a 25-year-old woman who admitted to our hospital with fever (38°C), dyspnea and pleuritic chest pain. The medical history was positive for Hashimoto's thyroiditis. Laboratory tests showed elevated inflammatory markers, no evidence of respiratory failure. LUS revealed bilateral and multiple pulmonary consolidations with a rounded and anechoic appearance. We performed computed tomography (CT) which showed multiple bilateral peripheral and non-segmental peri-bronchovascular consolidations with air bronchogram, which corresponds to the OP pattern. Over the next three days, LUS monitoring revealed a rapid expansion in the size and number of consolidations. Transthoracic biopsy revealed a histopathological picture attributable to vasculitis. ANCA antibody determinations were positive for anti-PR3 ANCA antibodies (213 AU/ml),  MPO-ANCA antibodies were negative. The consolidations showed a clear improvement after the start of cortisone therapy 1 mg/kg i.v., subsequently followed by Rituximab (RTX) 1 g i.v.

Conclusion: There is emerging evidence to support that PR3-ANCA and MPO-ANCA antibodies have the potential to stratify patients into unique phenotypic subgroups. LUS allows also a multiple reassessments to monitor the response to therapy. In this case report in particular, LUS played a decisive role in the diagnostic steps, accelerating the achievement of the definitive diagnosis, thanks to the OP-like pattern which extended to involve the pleura.