Pulmonology最新文献

Background: In COPD, the clinical significance of bronchodilator-induced changes in inspiratory capacity (IC) at rest remains uncertain. Unlike forced expiratory volume in one second (FEV₁), IC may better reflect symptom improvement, but no minimal clinically important difference (MCID) has been formally established.

Research question: To relate short-acting bronchodilator (SABD)-induced dyspnoea relief in stable COPD patients at rest with the concomitant IC changes and determine the MCID of the latter.

Study design and methods: In 106 stable COPD outpatients undergoing routine lung function testing, spirometry and plethysmography were performed before and after SABD administration. Dyspnoea was assessed using a visual analogue scale (VAS) and a five-point Likert scale. Three approaches were used to estimate MCID, namely two anchored methods (receiver operating characteristics (ROC)-based and difference-based) and a distribution-based method.

Results: Dyspnoea improvement was reported in 64% of patients. IC changes correlated strongly with symptom relief, while FEV₁ changes did not. ROC analysis identified an optimal IC threshold of 0.125 L (5% of baseline) with excellent predictive accuracy. The distribution-based estimate was 0.187 L, and the lowest difference-based estimate was 0.27 L. Averaging the ROC and distribution thresholds yielded a proposed MCID of 0.150 L.

Conclusion: IC changes after SABD administration at rest are more closely associated with dyspnoea relief than FEV₁ changes. An IC increase of 0.150 L may serve as a practical benchmark in future large-scale studies aiming at evaluation of the practical utility of IC changes in clinical practice, e.g. to inform therapeutic strategies, such as guiding the use of rescue SABD.

Background: Conventional bronchoscopy has imited diagnostic yield for challenging peripheral pulmonary nodules(C-PPNs), particularly for small (≤20 mm), pleural-contact, or reverse-angle (bifurcation angle ≤90°) nodules. This prospective multi-centre study evaluates the novel robotic bronchoscopy system (RBS) with ultra-thin catheters in C-PPNs under radiation-free conditions.

Methods: This multi-centre, prospective study enrolled 89 patients with C-PPN (characterised by a diameter ≤20 mm, pleural-contact, or an angle ≤90°) from three centres, who underwent RBS biopsy between 2022 and 2024. Diagnostic yield were conducted based on specific nodule characteristics. Univariate and multivariate logistic regressions were performed to evaluate the association between nodular-related factors and diagnostic yield.

Results: The average nodule size was 19.54 mm (53.9%, ≤20 mm). Pleural-contact was observed in 71.9% of nodules, and 64.0% exhibited a reverse-angle (≤90°). The novel system achieved 100% navigation and sampling success. Importantly, the diagnostic yield reached 84.2%, with 88.3% sensitivity for malignancy. Diagnostic performance were comparable across Single-criteria, Dual-criteria, and Triple-criteria groups (p = 0.416). Nodules ≤20 mm had lower yield (75.0%) compared to pleura-contact (90.6%, p = 0.013) or reverse-angle (89.5%, p = 0.028). Logistic regression confirmed nodule size >20 mm as a significant diagnostic yield predictor. Notably, no pneumothorax occurred, and only two patients experienced minor bleeding.

Conclusion: This prospective multi-centre study introduced the concept of C-PPN, establishing a valuable reference for subsequent research. Moreover, the novel system featuring ultra-thin catheters demonstrated superior performance, achieving 100% navigation success, 84.2% diagnostic yield and 0 pneumothorax, in such nodules without radiation guidance.

Introduction and objectives: Lower blood eosinophil counts have been associated with increased mechanical ventilation rates in patients with community-acquired pneumonia (CAP). However, the optimal eosinophil count threshold for identifying CAP patients at high risk of respiratory failure remains undefined. This study aimed to establish an optimal admission eosinophil count as a prognostic biomarker for respiratory failure in CAP.

Methods: This prospective, multicentre cohort study (PROGRESS) enrolled adult patients (≥18 years) hospitalised with community-acquired pneumonia (CAP). A receiver operating characteristic curve analysis with Youden's index was applied to identify the optimal eosinophil threshold for predicting mechanical ventilation. Associations were adjusted for corticosteroid use using multivariable regression. Additional outcomes - ICU admission and hospital length of stay - were compared between patients above and below the optimal eosinophil count threshold.

Results: An eosinophil count threshold of ≤30/µL was optimal for predicting mechanical ventilation. Patients with eosinophil counts ≤30/µL experienced significantly higher mechanical ventilation rates (15.5% versus 7.3%; p < 0.0001; RR 2.12, 95% CI 1.61-2.80), regardless of glucocorticoid treatment. They also exhibited higher ICU admission rates (23.1% versus 10.9%; p < 0.0001; RR 2.11, 95% CI 1.70-2.63) and longer hospital stays among survivors (median 8.0 versus 7.0 days; p < 0.0001).

Conclusions: Admission eosinopenia (≤30 µL) is a robust, easily measured biomarker that predicts respiratory failure in hospitalised CAP. It supports early risk stratification and may guide timely escalation of care.

Background: High-flow nasal cannula (HFNC) is superior to conventional oxygen therapy (COT) in preventing hypoxaemia during bronchoscopy. However, factors associated with HFNC effectiveness remain unclear. We performed an individual participant data meta-analysis (IPD-MA) to identify treatment modifiers for HFNC during bronchoscopy.

Methods: We systematically reviewed randomised controlled trials (RCTs) comparing HFNC and COT during bronchoscopy in adults (January 2000-September 2025) and requested IPD from corresponding investigators. The primary outcome was desaturation during bronchoscopy. Conventional meta-analysis was performed using random-effect model; one-stage regression model was used for IPD-MA. Results were reported as odds ratios (ORs) or mean difference and 95% confidence intervals (CIs).

Results: Seventeen RCTs (3,116 patients: 1680 HFNC, 1436 COT) were included. Compared to COT, HFNC significantly reduced desaturation (OR 0.23, 95% CI 0.15-0.34), procedure interruption (OR 0.36, 95% CI 0.20-0.67), respiratory support escalation (OR 0.25, 95% CI 0.11-0.55), and airway intervention (OR 0.19, 95% CI 0.10-0.36) during bronchoscopy. IPD was obtained from six RCTs (1,344 patients). Significant interactions were observed between treatment effect and body mass index, baseline respiratory and heart rates, with greater relative benefit at lower values. HFNC flows ≥45 L/min were associated with reduced desaturation risk (OR 0.28, 95% CI 0.12-0.65).

Conclusions: HFNC is superior to COT in reducing desaturation and procedure-related interruptions during bronchoscopy. Exploratory analyses suggest greater relative benefits in patients with lower body mass index and lower baseline respiratory and heart rates. HFNC flows ≥45 L/min furtherreduce desaturation risk. Further studies are needed in higher-risk patients.

Trial registration: International Prospective Register of Systematic Reviews; No.:CRD420251008924; URL: https://www.crd.york.ac.uk/prospero/.

Background: Clinical guidelines recommend endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) as the initial diagnostic tool for lung cancer staging. However, despite the availability of mediastinal forceps biopsy and cryobiopsy, the optimal diagnostic approaches for other mediastinal conditions remain unclear.

Methods: We searched multiple databases and sources up to February 21, 2025, and employed single-arm, pairwise, and network meta-analytical approaches to comprehensively evaluate EBUS-based biopsies for mediastinal diseases in terms of efficacy and safety.

Results: Fifteen prospective studies including 1,316 participants evaluated five EBUS-based mediastinal biopsy strategies (EBUS-TBNA, forceps biopsy, cryobiopsy, and the combinations of EBUS-TBNA with forceps biopsy or cryobiopsy) were involved. Concomitant EBUS-TBNA enhanced the efficacy of both forceps biopsy and cryobiopsy. EBUS-TBNA plus cryobiopsy yielded the best diagnostic outcome, showing significant benefits over EBUS-TBNA (OR 4.01, 95% CrI 3.05-5.33), forceps biopsy (OR 2.75, 95% CrI 1.94-3.92), cryobiopsy (OR 1.80, 95% CrI 1.33-2.45), and EBUS-TBNA plus forceps biopsy (OR 1.81, 95% CrI 1.20-2.72). A similarly favourable safety profile was observed in all EBUS-based biopsy methods.

Conclusions: EBUS-TBNA is the diagnostic cornerstone for mediastinal lesions, with EBUS-TBNA plus cryobiopsy being most effective. All EBUS-guided biopsies demonstrated a favourable safety profile.

Background: Patients with chronic obstructive pulmonary disease (COPD) are susceptible to altitude-related adverse health effects (ARAHE).

Research question: Does structured self-monitoring (SSM) predict imminent ARAHE in COPD patients during altitude travel.

Methods: Patients with moderate to severe COPD without chronic respiratory failure, living below 800 m, ascended by bus within 5 h to a clinic at 3100 m and stayed there for 2 days. During the altitude sojourn, patients regularly monitored themselves for symptoms of acute mountain sickness (AMS) and/or drops of pulse oximetry (SpO₂) to ≤84%, events designated as positive SSM. Measures of diagnostic accuracy of SSM in predicting subsequent ARAHE (defined as AMS Lake Louise score >4 and/or SpO₂ <80% for >30 min or <75% for >15 min and/or any condition requiring medical intervention) were computed. www.ClinicalTrials.org NCT03957759.

Results: Among 153 COPD patients (79 women, mean ± SD age 57 ± 10y) travelling to 3100 m, SSM was positive in 55 (36%), ARAHE occurred in 116 (76%). Concordance statistics indicated a diagnostic accuracy of SSM in predicting ARAHE of 0.65 (95%CI 0.58 to 0.72). In SSM positive patients, the odds ratio for ARAHE was 4.9 (95%CI 1.8 to 12.9). Positive and negative predictive values of SSM for ARAHE were 91% (95%CI 80 to 97) and 33% (95%CI 24 to 43). In exploratory analyses, supplementing SSM by nocturnal pulse oximetry with alarm capability enhanced diagnostic accuracy considerably (sensitivity improved from 43% to 73% concordance statistic increased to 0.80).

Conclusions: Lowlanders with COPD ascending to 3100 m commonly experience ARAHE. Due to its high positive predictive value, performing SSM may allow patients to predict imminent ARAHE and take timely appropriate actions such as descend or use oxygen. Negative SSM does not reliably indicate a low risk of ARAHE.

Objectives: This study aimed to demonstrate the prevalence of treatable traits (TTs) and investigate the relationship between specific TTs and future exacerbation-related readmission risk among patients with very severe chronic obstructive pulmonary disease (COPD) across both STaging of Airflow obstruction by Ratio (STAR) and Global Initiative for Chronic Obstructive Lung Disease (GOLD) grading system.

Methods: A total of 589 hospitalised patients were included. Participants underwent a multidimensional assessment to characterise the TTs and were then followed up for one year. Cox regression analyses were used to determine the association between the TTs and future exacerbation-related readmission risk.

Results: Hospitalised patients with very severe COPD exhibit a higher prevalence of TTs. In the STAR classification, TTs of bronchodilator reversibility, emphysema, frequent exacerbations, frequent hospital admission, O₂ desaturation, dyspnoea, exercise intolerance, pathogen colonisation, underweight, diabetes and not adherence were significantly related with 'STAR 4'. In the GOLD classification, TTs including bronchodilator reversibility, frequent exacerbations, frequent hospital admission, O2 desaturation, dyspnoea, exercise intolerance, pathogen colonisation, underweight, heart failure, dyslipidemia, not adherence and indoor use of biomass/coal were significantly linked with 'GOLD 4'. Furthermore, Cox regression analysis showed that patients with STAR 4 exhibited seven TTs associated with future exacerbation-related readmission risk, whereas two TTs were predictors in patients with GOLD 4.

Conclusion: Patients with very severe COPD exhibited more TTs that require intervention. Additionally, specific TTs were associated with future exacerbation-related readmissions in patients with very severe COPD across STAR and GOLD classification, indicating their clinical utility of evaluating them.