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: The co-occurrence of tuberculosis (TB) and diabetes mellitus (DM) presents a growing public global health concern. Managing DM during anti-TB therapy is challenging due to potential drug-drug interactions, especially with rifamycin (RIF).

Research question: Assess the effects of anti-TB drugs on the pharmacokinetics and pharmacodynamics of novel antidiabetic agents, including DPP-4 inhibitors (DPP4i), SGLT-2 inhibitors (SGLT2i) and GLP-1 receptor agonists (GLP-1a).

Study design and methods: A PRISMA-ScR-based scoping review was conducted among four databases.

Results: Ten studies involving 307 participants were included. RIF significantly reduced the plasma exposure of DPP4i (saxagliptin, gemigliptin, evogliptin) and canagliflozin, while other SGLT2i (dapagliflozin, empagliflozin, ertugliflozin) were minimally affected. No direct data was available for GLP-1a. Adverse events were rare in healthy participants but more frequent in elderly patients with poorly controlled DM. Linezolid and dapagliflozin co-administration may lead to severe pancytopenia.

Discussion: RIF co-administration with gemigliptin, evogliptin and canagliflozin requires caution and potential requiring dose adjustments, while saxagliptin, dapagliflozin, ertugliflozin and empagliflozin appear safer alternatives. Haematologic monitoring is recommended when combining linezolid and dapagliflozin. However, current evidence remains limited by small sample sizes, single-dose designs, inclusion of mainly healthy participants, and lack of data on GLP-1a or other anti-TB agents. The limited inclusion of DM patients with TB, restricted to one study with latent TB infection, further reduces generalisability. We developed a clinical decision algorithm to support co-treatment in TB - DM cases, but further dedicated studies are warranted to guide optimal co-treatment.

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.