Pulmonology最新文献

Background and research question: We aimed to assess whether levels of digital biomarkers can reflect monthly patterns of asthma control.

Study design and methods: We performed a longitudinal study on patients with asthma and comorbid rhinitis who filled ≥26 days of data in a month in the MASK-air® app and who reported at least 1 day of treatment with an inhaled corticosteroid with or without a long-acting β₂-agonist (ICS ± LABA). We applied k-means cluster analysis to define clusters of months according to daily asthma control and medication use. Clusters were compared using digital biomarkers (visual analogue scale [VAS] on asthma symptoms and electronic daily asthma control score [e-DASTHMA]). We compared patients who did not switch with patients who switched their ICS ± LABA.

Results: We assessed 243 patients and 1358 months. We identified three clusters of poor asthma control despite high ICS ± LABA adherence, one cluster of poor asthma control and poor ICS ± LABA adherence, one cluster of good asthma control and high ICS ± LABA adherence and one cluster of good asthma control despite poor ICS ± LABA adherence. These clusters displayed relevant differences in VAS asthma and e-DASTHMA levels. Similar clusters were found in 'non-switchers' versus 'switchers'.

Conclusion: Levels of digital biomarkers reflect asthma control patterns and might be used to monitor patients with asthma.

Background: Non-cystic fibrosis bronchiectasis (NCFB) is a chronic respiratory disease marked by irreversible airway dilation, persistent inflammation, and recurrent infections. Impulse oscillometry (IOS) assesses lung function non-invasively, particularly in patients unable to perform spirometry, but its role in NCFB remains underexplored.

Research question: This systematic review examined the role of IOS in adults with NCFB, focusing on diagnostic value, correlation with disease severity, airway reversibility prediction, and associations with exacerbations, hospitalisations, and mortality.

Study design and methods: A systematic literature search in PubMed, Scopus, Web of Science, and Cochrane databases was performed in January 2025, following PRISMA guidelines. Eligible studies assessed IOS in adult NCFB and reported associations with clinical, radiological, or functional outcomes. Study quality was assessed using the Newcastle-Ottawa Scale adapted for cross-sectional studies.

Results: Seven studies were included. IOS was more sensitive than spirometry in detecting small-airway dysfunction, particularly in early disease. Several IOS parameters correlated with radiological and severity scores, though findings were heterogeneous. Associations with exacerbations and hospitalisations were inconsistent. One study suggested R5-R20 may predict bronchodilator response. IOS parameters appeared stable across disease stages.

Conclusion: IOS may complement conventional assessment of NCFB, especially for small-airway evaluation, but standardisation and longitudinal research remain necessary.

Fibrotic hypersensitivity pneumonitis (f-HP) is an interstitial lung disease in which various antigens in susceptible individuals may play a pathogenetic role. This study evaluates the role of transbronchial lung cryobiopsy (TBLC) and bronchoalveolar lavage (BAL) in identifying a UIP-like pattern and its association with fibrosis progression. We conducted a multicentre retrospective cohort study of patients diagnosed with f-HP who underwent BAL and TBLC between 2011 and 2023. A UIP-like pattern was defined by the presence of (A) patchy fibrosis and fibroblastic foci or (B) honeycombing ± (A). We investigated BAL's role in predicting UIP-like patterns within a clinical-radiological-serological framework, examining disease progression in these patients using spirometry and mortality data. A total of 195 patients were enrolled, 59 (30%) of whom exhibited a UIP-like pattern. These patients showed greater lung function decline, lower BAL lymphocytosis (14.4% vs. 37.4%, p < 0.001), higher nintedanib prescription (35% vs. 14%, p < 0.001), and higher 10-year mortality (HR 2.8, 95% CI 1.3-5.8, p = 0.004). f-HP patients with a UIP-like pattern exhibit worse clinical outcomes and higher mortality. In cases of low BAL lymphocytosis with a high pre-test clinical suspicion of f-HP, lung biopsy may not be necessary as it increases the likelihood of identifying a UIP-like pattern.

Introduction and objectives: Post-tuberculosis lung disease (PTLD), as other chronic respiratory disorders, may have infectious complications; some of them can be prevented with vaccinations. So far, no document has discussed the potential role of vaccination in PTLD. Therefore, the objective of this review was to describe vaccination recommendations to prevent infections potentially capable of complicating PTLD.

Materials and methods: A non-systematic review of the literature was conducted. The following keywords were used: tuberculosis, vaccination, vaccines and PTLD. PubMed/MEDLINE and Embase were used as the search engine, focusing on English-language literature only.

Results: We identified 9 vaccines potentially useful in PTLD. Influenza, pneumococcal and anti-COVID-19 vaccinations should be recommended. Patients with PTLD can also benefit from vaccination against shingles. Vaccination against pertussis is mainly relevant during childhood. Diphtheria, tetanus and measles vaccination are recommended for general population and should be considered in patients with PTLD not previously vaccinated. Tdap (Tetanus, diphtheria, and pertussis) booster should be repeated in every adult every ten years. Vaccination against BCG retains its importance during early childhood in countries where TB is endemic.

Conclusions: Vaccination deserves to be considered among the strategies to prevent and/or mitigate PTLD complications. Further evidence is necessary to better understand which vaccines have the greatest impact and cost-benefit.

Background: Severe asthma leads to considerable productivity loss; however, patients' financial impact and the potential reversal through biologic therapy remain unexplored.

Research question: What is the financial burden of productivity loss among employed individuals with severe asthma, and does it change during biologic therapy?

Study design and methods: Employed individuals from the Danish Severe Asthma Register (2016-2022) were included. Salary data were sourced from national registries, while productivity loss was measured using the Workplace Productivity and Activity Impairment (WPAI) Questionnaire at baseline and after a minimum of four months of biologic therapy.

Results: A total of 132 employed individuals (mean age 47.9 years, 39% female, mean annual salary € 74,646) were included. Before biologic therapy, productivity impairment was 39.1%. presenteeism and absenteeism rates were 35.8% and 11.3%, respectively, equating to annual productivity losses of € 28,880 per individual.On treatment, overall impairment was 17.6%, with significant reductions in both presenteeism and absenteeism, corresponding to annual loss reductions of € 16,506 per individual.

Interpretation: The financial burden of productivity loss in severe asthma is substantial, primarily due to presenteeism. Biologic therapy significantly enhances productivity, suggesting that much of the individual financial burden can be reversed.