Pulmonology最新文献

Objective: To summarise the prevalence of preserved ratio impaired spirometry (PRISm), intending to inform prevention strategies and clinical management.

Methods: We systematically searched PubMed, Embase, Web of Science, and the Cochrane Library databases for cohort studies investigating the prevalence of PRISm. The quality of included studies was assessed with appropriate tools for evaluating risk of bias in prevalence studies. Publication bias was assessed using funnel plots and Egger's test.

Results: After deduplication, 24 of the 33 initially eligible studies were included in the meta-analysis. The pooled prevalence of PRISm was 10% (95% CI: 0.08, 0.12). Smoking was a significant risk factor for PRISm, while no significant association was found with respiratory symptoms. PRISm was significantly associated with comorbidities including hypertension, diabetes, cardiovascular disease, and stroke. Moreover, individuals with PRISm had higher all-cause mortality (OR 1.84, 95% CI: 0.99, 3.41) and cardiovascular mortality (OR 1.82, 95% CI: 1.35, 2.44). Lung function trajectories were heterogeneous, with 10-50% reverting to normal, 20-60% remaining stable, and 6-53% progressing to chronic obstructive pulmonary disease (COPD).

Conclusions: PRISm is associated with a high prevalence, smoking, cardiometabolic comorbidities, increased all-cause and cardiovascular mortality, and heterogeneous lung function trajectories, underscoring its clinical importance beyond COPD.

Background and objective: Bronchiectasis is a chronic lung condition characterised by persistent respiratory symptoms and permanent bronchial dilation. CFTR variants are commonly reported in patients with bronchiectasis with unclear clinical implications.This study aims to investigate the prevalence of CFTR variants in people with bronchiectasis and their association with clinical characteristics.

Methods: Patients were recruited from two centres in Milan, Italy and screened for CFTR variants. The prevalence of CFTR variants in people with bronchiectasis was compared to that of a control group of healthy blood donors. Sweat chloride levels, pulmonary function tests, airway microbiology, disease severity and respiratory symptoms were compared between CFTR variant carriers and non-carriers.

Results: The study included 454 adults with bronchiectasis and 250 individuals in the control group. Among those with bronchiectasis, 178 individuals (39.2%) carried at least one CFTR variant, with 41 (9.0%) identified as having a CF-causing variant. This prevalence was higher than that observed in the control group (n = 10, 4%). The odds ratio of carrying a CF-causing variant among bronchiectasis patients was 2.83 (95% CI: 1.39-5.79, p = 0.004). No significant association was found between CFTR carrier status and clinical outcomes.

Conclusions: CFTR variants are frequently observed in patients with bronchiectasis, although they are not associated with increased disease severity.

Rationale: The preoperative evaluation of candidates for resective surgery has been addressed in several guidelines, the most recent is the American College of Chest Physicians (ACCP) algorithm; however, validating information in routine clinical practice is scant.

Methods: This is a retrospective cohort study based on an ongoing registry of candidates for thoracic surgery that began in 2011; therefore, relevant data were prospectively collected. This study is based on patients who operated from January 2011 to 16 December 2023. The last survival update was done on 16 March 2024.

Results: Overall, postoperative mortality increased from 3.1% at 30 days to 5.5% at 90 days. Factors associated with mortality included age, predicted-postoperative (PPO) FEV₁, PPO-DLco, intermediate ACCP risk and pneumonectomy. Video-assisted thoracic surgery (VATS) reduced risk. When adjusted for covariates, independent risk factors were age, ACCP intermediate risk and pneumonectomy. Thirty-day mortality: age >70 years OR = 7.5 (95% CI 2.1-26.6), ACCP intermediate risk = 5.6 (1.2-25.8) and pneumonectomy = 6.5 (1.7-24.8); 60-day mortality: age >70 = 10.5 (3.0-37.1), ACCP intermediate risk = 4.5 (1.22-16.33) and pneumonectomy = 8.2 (2.2-29.3); 90-day mortality, age >70 = 6.5 (1.1-24.8), ACCP intermediate risk = 8.2 (2.3-29.26), pneumonectomy = 8.1 (2.78-24.3).

Conclusions: The ACCP algorithm remains a valid tool for the assessment of fitness for anatomical lung resection. Our data support some reworking of the algorithm (i.e. considering age >70 years and pneumonectomy in the decision algorithm as intermediate-risk determinants). Mortality continues to increase from 30 to 90 days with higher risk, and this should be considered in the risk/benefit analysis of therapeutic alternatives.

Introduction: Altitude, a factor not considered in most reference equations for single-breath diffusing capacity of the lung for carbon monoxide (DLCOsb), plays a crucial role in its assessment. This variable is particularly relevant for Latin American populations residing at different altitudes.

Methods: This analytical, prospective, multicentre study was conducted in Latin American adults living at low and high altitudes with normal spirometry. Healthy, asymptomatic subjects were identified through the PLATINO survey. To determine the model with the best performance based on standard estimated error (SEE), predicted DLCOsb values were obtained using the Vásquez García, Crapo, García Rio, and Global Lung Function Initiative (GLI) equations.

Results: A total of 269 subjects were included: 90 at low altitude and 179 at high altitude. Women comprised 66.9% (180/269), and the median age was 34 years (IQR 25-51). At both sea level and high altitude, the Vásquez García equation, which includes haemoglobin (Hb), showed the best predictive performance. In both settings, GLI-predicted values were lower than measured values (SEE: 2.158 at low altitude and 5.1 at high altitude).

Conclusions: Although with wide limits of agreement for all models, Vázquez-García's equation shows the best performance in the interpretation of DLCOsb in Latin American populations residing at any altitude. Even with adjustments for altitude and Hb, the GLI model underestimates the predicted values of DLCOsb and could require an adjustment factor or inclusion of the altitude variable in the model's new version.

Background: The redistribution of pulmonary blood volume (PBV) across COVID-19 severity levels and its prognostic value for the less pathogenic, predominantly upper respiratory tract-infecting Omicron variant remain unclear. This study investigates PBV distribution patterns and validates its predictive utility for Omicron outcomes.

Methods: This retrospective study enrolled consecutive patients (November 2022-January 2023) with baseline CT and clinical data, followed for six months. Patients were divided into mild/moderate (MM) and severe/critical (SC) groups according to COVID-19 severity. Pre-trained deep learning algorithms quantified total, lobar, and vessel-size-specific PBV. Adjusted multivariable analyses determined odds ratios (OR) for clinical outcomes, and logistic regression models based on PBV were constructed to predict adverse events.

Results: Among 921 patients (61 ± 20 years, 460 men), 755 were in the MM group and 166 in the SC group. Compared to MM patients, SC patients showed significantly lower total PBV (259 mL vs. 239 mL, p = 0.002) and redistribution from lower to upper lobes (upper vs. lower; MM, 21% vs. 23%; SC, 23% vs. 18%) and from small-calibre (≤5 mm², 44% vs. 32%, p < 0.0005) to large-calibre (>10 mm², 39% vs. 51%, p < 0.0005) vessels. PBV (especially in vessels ≤5 mm²) predicted six-month composite outcomes (OR = 4.66, AUC = 0.79, sensitivity = 92%) and mortality (OR = 3.34, AUC = 0.75, sensitivity = 93%) for the Omicron variant with high sensitivity, but at a higher risk threshold (42%) than that reported for more pathogenic variants in previous publications.

Conclusions: Severe/critical COVID-19 is associated with reduced PBV and its redistribution across lung regions and vessel sizes. PBV retains predictive value for clinical outcomes in the immune-evasive Omicron variant.

Introduction: Urinary incontinence (UI) is common among individuals with chronic respiratory diseases (CRDs) and may limit attendance, completion, and response to pulmonary rehabilitation (PR). This study aims to assess what is the prevalence of UI among individuals attending PR, and how does PR affect UI and other clinical outcomes, and if UI is associated with PR completion and response.

Methods: A multicenter prospective cohort study was conducted. UI was assessed using the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI-SF) questionnaire before and after an 8-week program. Completion was defined as attending at least 70% of sessions. Response was defined as achieving minimum clinically important differences (MCIDs) in any clinical outcome.

Results: Among 341 individuals with CRDs 48% female, mean age of 63 (SD 10)), UI prevalence was 38% (95% CI 32 to 44) and remained unchanged following PR. PR led to a positive effect on urinary symptoms (ICIQ-UI-SF mean change -1.8, 95% CI -2.5 to -1.1), although the magnitude of change was below the established MCID of 4 points. PR also led to a positive improvement on the Saint George's Respiratory Questionnaire total score (-4, 95% CI -7 to -2). The associations between UI and PR completion and response were imprecise due to wide confidence intervals.

Conclusions: UI is common among individuals attending PR, yet PR has a small effect on urinary symptoms. Despite this, individuals with UI may still achieve improvements from the program. Our findings suggest that UI should not delay PR initiation but should be screened and managed as part of the multidisciplinary care that defines PR.