Multidisciplinary Respiratory Medicine最新文献

Background: Alpha-1 antitrypsin deficiency is an autosomal, codominant disorder caused by mutations of the SERPINA1 gene. Several mutations have been described associated with the development of pulmonary and/or chronic liver diseases. We report a novel mutation Mangera, identified for the first time in an Italian patient originating from the city of Angera (Varese), Italy.

Case presentation: This case report describes a 64-year-old Italian male, a lifelong non-smoker, diagnosed with severe alpha-1 antitrypsin deficiency (AATD) as composed heterozygous with S allele and a novel mutation named Mangera. The patient presented with exertional dyspnea and had reduced serum AAT levels (0.54 g/L). Pulmonary function tests indicated mild airway obstruction with preserved diffusion capacity, and chest CT scans revealed early centrilobular emphysema and fibrotic changes. Genetic analysis was performed, finding a previously unreported mutation. Despite the severe AAT deficiency, the patient exhibited no significant clinical, radiological, or functional deterioration. Given the absence of disease progression, augmentation therapy was deferred in favor of ongoing annual monitoring.

Conclusions: This case report highlights the necessity of referring patients to specialized centers equipped with the expertise and tools required for precise diagnosis. Furthermore, the identification of the Mangera mutation expands the spectrum of known SERPINA1 variants associated with severe AATD, emphasizing the ongoing need for vigilance and thorough investigation in cases of suspected deficiency.

The Italian National Congress of Imaging in Pulmonology, held in Milan on November 21st, provided a unique educational platform exploring the evolving role of thoracic imaging in respiratory medicine. Organized by the Italian Respiratory Society (SIP-IRS) Imaging Study Group, the congress brought together over 160 participants, including pulmonologists, radiologists, interventional specialists, and early-career professionals, reflecting the essential role of multidisciplinary collaboration in modern respiratory care. Topics included functional imaging approaches to small airway disease in COPD and asthma, multimodal imaging in lung transplantation, the role of CT angiography for haemoptysis management, and radiomics applications for quantifying emphysema patterns and fibrotic changes. The role of imaging in guiding inhaled and biological therapies was explored, alongside a lively debate on thoracic ultrasound for interstitial lung disease screening. Advanced sessions covered medical thoracoscopy techniques, quantitative ultrasound and artificial intelligence in pleural diseases, shape-sensing robotic-assisted bronchoscopy for peripheral nodules, expanding cryobiopsy applications, and imaging's role in monitoring progressive pulmonary fibrosis therapeutics. A distinctive feature was the first "Images in Pulmonology" contest, won by a remarkable case simultaneously depicting lung cancer and new life. This meeting report summarizes key congress highlights and underscores the importance of fostering multidisciplinary collaboration and structured imaging education to bridge the gap between technological capabilities and clinical expertise in respiratory medicine.

Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of global morbidity and mortality, with significant burden in Italy. Prevalence estimates vary by data source: Health Search data indicate a prevalence of 2.7% among adults, whereas population-based analyses report higher estimates of approximately 5.6%. Triple therapy combining a long-acting muscarinic antagonist (LAMA), a long-acting beta2-agonist (LABA), and an inhaled corticosteroid (ICS) has been shown to improve lung function, reduce exacerbations, and potentially decrease mortality in moderate-to-severe COPD. Fixed-dose Single-Inhaler Triple Therapy (SITT) provides practical advantages over Multiple-Inhaler Triple Therapy (MITT), including improved treatment adherence, fewer inhaler technique errors, and comparable safety. This expert opinion review summarizes evidence from randomized controlled trials and real-world studies supporting the clinical, practical, and economic benefits of SITT. While access to SITT in Italy is influenced by regulatory frameworks, optimizing prescription practices and aligning treatment strategies with clinical evidence could enhance continuity of care and patient outcomes. The paper highlights strategies to improve COPD management, reduce treatment discontinuation, and ensure equitable access to effective therapies.

In recent decades lung ultrasound (LUS) has emerged as an invaluable bedside imaging tool for the evaluation of respiratory conditions such as pneumonia, bronchiolitis, pneumothorax, and pleural effusion in pediatric age, thanks to the thin chest wall and absence of rib ossification. Despite its growing application, optimizing technique and interpretation remains crucial for reliable diagnostic performance. The present educational paper provides practical tips and tricks to enhance the accuracy, efficiency, and clinical value of LUS in pediatric patients, focusing on probe selection, patient positioning, scanning technique, common artifacts, and interpretation pitfalls.

Background: Tracheostomy is a commonly performed procedure in patients requiring prolonged mechanical ventilation (MV) in Intensive Care Units (ICUs), including COVID-19-related ARDS. However, limited data exist on the timing and predictors of decannulation.

Aim: To compare time to decannulation between COVID-19 and non-COVID-19 ARDS patients and to identify predictive factors.

Methods: A retrospective study including 96 COVID-19 ARDS and 32 non-COVID-19 ARDS tracheostomized patients admitted to step-down units after ICU stay from March 2020 to May 2021. Clinical, demographic data and comorbidities were analysed as well as predictors for decannulation delay.

Results: Timing of decannulation was similar between the two groups. Multivariate analysis identified limb weakness assessed by the Medical Research Council (MRC) scale, duration of steroids therapy, clinical complications, PaO2/FiO2 ratio and smoking history as independent predictors of decannulation timing.

Conclusions: COVID-19 did not affect timing of decannulation compared to non-COVID-19 ARDS. ICU-acquired weakness, assessed through the MRC scale, was the strongest predictor of delayed decannulation.

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.