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Exacerbation history as a predictor of future exacerbations and mortality in COPD patients: A real-world study from a Portuguese integrated care health unit 2013-2018. 慢性阻塞性肺病患者加重史作为未来加重和死亡率的预测因子:2013-2018年葡萄牙综合保健卫生单位的一项真实世界研究
IF 6.4 2区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2026-12-01 Epub Date: 2026-02-26 DOI: 10.1080/25310429.2026.2629617
Paula Simão, Ana Luísa Fernandes, Carla Ponte, Daniela Sousa Santos, Mário Bibi, Marisa Pardal, Julieta Maciel, Inês Esteves, Carlos Amaral, Hugo Martinho, Rita Amaral, Rita Lopes, Cristina Jácome, Filipa Bernardo

Background: This study estimated the risk of exacerbations, cardiovascular (CV) death and all-cause death in COPD patients, according to their exacerbation profile.

Methods: A real-world, retrospective study, based on electronic health records from the Unidade Local de Saúde de Matosinhos, was conducted. Individuals ≥40 years, diagnosed with COPD between 2013 and 2018 and with 1 year of history prior to diagnosis were followed for 1 year. Patients were divided based on their exacerbation history: Cohort A: no exacerbations; Cohort B: one moderate exacerbation; Cohort C: ≥2 moderate exacerbations; Cohort D: one severe exacerbation; Cohort E: ≥2 exacerbations, with ≥1 severe. The 1-year risk of exacerbations, CV death and all-cause death were estimated based on Cox proportional hazard models (reference Cohort A).

Results: In total, 5696 COPD cases were identified, with median age increasing from Cohort A to E (68 to 74 years). The risk of moderate exacerbations was higher in Cohorts C (hazard ratio, HR = 1.95; 95% CI 1.70-2.25) and D (HR = 1.69; 95% CI 1.51-1.90). For severe exacerbations, cohorts D (HR = 2.95; 95% CI 2.51-3.46) and E (HR = 3.12; 95% CI 2.59-3.77) showed an increased risk. Cohort E also had the highest risk of CV death (HR = 1.65; 95% CI 1.17-2.34). Cohort D had the highest risk of all-cause death (HR = 1.65; 95% CI 1.24-2.18).

Discussion: A higher number and severity of prior exacerbations in patients with COPD increase their risk of future exacerbations, all-cause and CV death. These findings highlight the importance of implementing effective strategies to prevent exacerbations and improve disease management.

背景:本研究根据COPD患者的加重情况估计COPD患者的加重、心血管(CV)死亡和全因死亡的风险。方法:基于Unidade Local de Saúde de Matosinhos的电子健康记录,进行了一项现实世界的回顾性研究。年龄≥40岁,2013年至2018年间诊断为COPD,诊断前病史1年的个体随访1年。根据患者的加重史进行分组:A组:无加重;队列B: 1例中度加重;队列C:≥2次中度加重;队列D:一次严重恶化;队列E:≥2次发作,其中≥1次严重。根据Cox比例风险模型(参考队列A)估计1年恶化、CV死亡和全因死亡风险。结果:共发现5696例COPD病例,中位年龄从A组增加到E组(68岁至74岁)。中度加重的风险在C组(风险比,HR = 1.95; 95% CI 1.70-2.25)和D组(HR = 1.69; 95% CI 1.51-1.90)较高。对于严重恶化,D组(HR = 2.95; 95% CI 2.51-3.46)和E组(HR = 3.12; 95% CI 2.59-3.77)显示风险增加。队列E也有最高的CV死亡风险(HR = 1.65; 95% CI 1.17-2.34)。队列D的全因死亡风险最高(HR = 1.65; 95% CI 1.24-2.18)。讨论:COPD患者既往加重的数量和严重程度增加了其未来加重、全因和心血管死亡的风险。这些发现强调了实施有效策略以预防恶化和改善疾病管理的重要性。
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引用次数: 0
Endobronchial ultrasound-guided mediastinal biopsies for the diagnosis of mediastinal diseases: A network meta-analysis. 支气管超声引导纵隔活检诊断纵隔疾病:网络荟萃分析。
IF 6.4 2区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2026-12-01 Epub Date: 2026-01-20 DOI: 10.1080/25310429.2025.2593067
Yong-Jia Qi, Jing Zhang, Esperanza Salcedo Lobera, Qiu-Yue Song, Ren-Hai Zhong, Konstantina Kontogianni, Zan-Sheng Huang, Miguel Ariza-Prota, Nitesh Gupta, Manu Madan, Venkata Nagarjuna Maturu, Virender Pratibh Prasad, Carolin Steinack, Na Wu, Thomas Gaisl, Felix Jf Herth, Ye Fan

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.

背景:临床指南推荐支气管超声引导下经支气管穿刺(EBUS-TBNA)作为肺癌分期的初始诊断工具。然而,尽管纵膈钳活检和低温活检的可用性,其他纵膈疾病的最佳诊断方法仍不清楚。方法:我们检索了截至2025年2月21日的多个数据库和来源,并采用单臂、两两和网络荟萃分析方法,全面评估基于ebus的纵隔疾病活检的有效性和安全性。结果:包括1316名参与者的15项前瞻性研究评估了5种基于ebus的纵隔活检策略(EBUS-TBNA、镊子活检、低温活检以及EBUS-TBNA联合镊子活检或低温活检)。同时应用EBUS-TBNA可提高产钳活检和冷冻活检的疗效。EBUS-TBNA +冷冻活检产生了最好的诊断结果,比EBUS-TBNA (OR 4.01, 95% CrI 3.05-5.33)、镊子活检(OR 2.75, 95% CrI 1.94-3.92)、冷冻活检(OR 1.80, 95% CrI 1.33-2.45)和EBUS-TBNA +冷冻活检(OR 1.81, 95% CrI 1.20-2.72)有显著的益处。在所有基于ebus的活检方法中都观察到类似的良好安全性。结论:EBUS-TBNA是诊断纵隔病变的基础,EBUS-TBNA联合冷冻活检最有效。所有ebus引导下的活检都显示出良好的安全性。
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引用次数: 0
High flow nasal cannula versus conventional oxygen therapy during bronchoscopy: A systematic review and individual participant data meta-analysis. 支气管镜检查期间高流量鼻插管与传统氧疗:系统综述和个体参与者数据荟萃分析。
IF 6.4 2区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2026-12-01 Epub Date: 2026-01-14 DOI: 10.1080/25310429.2026.2613485
Jun Wang, Wei Tan, Jian Luo, Hao Qin, Rui Wang, Wen Zhang, Federico Longhini, Mujammil Irfan, Haosu Zhou, Xiuyan Song, Wei Zhang, Jie Li

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/.

背景:高流量鼻插管(HFNC)在预防支气管镜检查时低氧血症方面优于常规氧疗(COT)。然而,与HFNC有效性相关的因素仍不清楚。我们进行了个体参与者数据荟萃分析(IPD-MA),以确定支气管镜检查期间HFNC的治疗调节剂。方法:我们系统地回顾了比较成人支气管镜检查时HFNC和COT的随机对照试验(rct)(2000年1月- 2025年9月),并要求相应研究者提供IPD。支气管镜检查时的主要结果是血氧饱和度降低。常规meta分析采用随机效应模型;IPD-MA采用单阶段回归模型。结果以比值比(ORs)或平均差和95%置信区间(ci)报告。结果:纳入17项随机对照试验(3116例患者:HFNC 1680例,COT 1436例)。与COT相比,HFNC显著降低了支气管镜检查期间的去饱和(OR 0.23, 95% CI 0.15-0.34)、手术中断(OR 0.36, 95% CI 0.20-0.67)、呼吸支持升级(OR 0.25, 95% CI 0.11-0.55)和气道干预(OR 0.19, 95% CI 0.10-0.36)。IPD从6个随机对照试验(1344例患者)中获得。观察到治疗效果与身体质量指数、基线呼吸和心率之间存在显著的相互作用,较低的值具有更大的相对益处。HFNC流量≥45 L/min与去饱和风险降低相关(OR 0.28, 95% CI 0.12-0.65)。结论:HFNC在减少支气管镜检查时的去饱和和手术相关中断方面优于COT。探索性分析表明,较低的身体质量指数和较低的基线呼吸和心率对患者有更大的相对益处。HFNC流量≥45l /min可进一步降低脱饱和风险。需要对高危患者进行进一步的研究。试验注册:国际前瞻性系统评价注册;号:CRD420251008924;URL: https://www.crd.york.ac.uk/prospero/。
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引用次数: 0
Smoking exposure on diagnosis and survival of pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension: Data from REHAP registry. 吸烟暴露对肺动脉高压和慢性血栓栓塞性肺动脉高压的诊断和生存:来自REHAP登记的数据。
IF 6.4 2区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2026-12-01 Epub Date: 2026-03-10 DOI: 10.1080/25310429.2026.2640669
Karys Khilzi, Isabel Blanco, Lucilla Piccari, Joan A Barberà, Raquel López-Reyes, Isabel Otero-González, Sergio Alcolea, Jesús Ribas, María Álvarez-Barredo, Pilar Escribano-Subías, Diego A Rodriguez-Chiaradía

Background: Exposure to cigarette smoke is a risk factor for endothelial dysfunction, leading to alterations in pulmonary vascular architecture and contributing to the development of pulmonary hypertension. Despite this evidence, the impact of smoking on pulmonary arterial hypertension (PAH) has only recently gained recognition.

Research question: The primary objective of this study was to further investigate the influence of cigarette smoking on the diagnosis and progression of patients with PAH and chronic thromboembolic pulmonary hypertension (CTEPH).

Study design and methods: We assessed the prevalence of cigarette smoking and analysed the demographics and clinical outcomes of ever-smokers versus never-smokers included in the Spanish Registry of Pulmonary Arterial Hypertension (REHAP).

Results: A total of 1763 patients from the REHAP registry were included in the study, of whom 1293 had PAH and 450 had CTEPH. Among these, 771 patients (43.7%) were classified as ever-smokers, comprising 44% (n = 570) of those diagnosed with PAH and 42.7% (n = 201) of those with CTEPH. In PAH patients, ever-smokers were significantly older at diagnosis and study enrolment compared to never-smokers. Notably, a poorer clinical course was observed in male PAH patients who were ever-smokers, with a statistically significant association. In contrast, no significant differences in survival rates were detected between ever-smokers and never-smokers with CTEPH.

Conclusion: Cigarette smoking is associated with delayed diagnosis and worse survival outcomes in PAH but not in CTEPH. Male ever-smokers patients with PAH has worse prognosis than female ever-smokers. Further research is warranted to elucidate the underlying mechanisms contributing to the negative correlation between smoking and PAH.

背景:暴露于香烟烟雾是内皮功能障碍的危险因素,导致肺血管结构的改变并促进肺动脉高压的发展。尽管有这些证据,吸烟对肺动脉高压(PAH)的影响直到最近才得到认可。研究问题:本研究的主要目的是进一步探讨吸烟对PAH合并慢性血栓栓塞性肺动脉高压(CTEPH)患者诊断和进展的影响。研究设计和方法:我们评估了吸烟的流行程度,并分析了西班牙肺动脉高压登记处(REHAP)中吸烟者与不吸烟者的人口统计学和临床结果。结果:研究共纳入了来自REHAP登记处的1763例患者,其中1293例患有PAH, 450例患有CTEPH。其中,771例患者(43.7%)被归类为长期吸烟者,其中44% (n = 570)被诊断为PAH, 42.7% (n = 201)被诊断为CTEPH。在PAH患者中,曾经吸烟的患者在诊断和研究入组时明显比从不吸烟的患者年龄大。值得注意的是,吸烟的男性多环芳烃患者的临床病程较差,具有统计学上的显著相关性。相比之下,在患有CTEPH的吸烟者和不吸烟者之间,生存率没有显著差异。结论:吸烟与PAH的延迟诊断和更差的生存结果有关,而与CTEPH无关。男性吸烟多环芳烃患者预后差于女性吸烟多环芳烃患者。需要进一步的研究来阐明吸烟与多环芳烃负相关的潜在机制。
{"title":"Smoking exposure on diagnosis and survival of pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension: Data from REHAP registry.","authors":"Karys Khilzi, Isabel Blanco, Lucilla Piccari, Joan A Barberà, Raquel López-Reyes, Isabel Otero-González, Sergio Alcolea, Jesús Ribas, María Álvarez-Barredo, Pilar Escribano-Subías, Diego A Rodriguez-Chiaradía","doi":"10.1080/25310429.2026.2640669","DOIUrl":"https://doi.org/10.1080/25310429.2026.2640669","url":null,"abstract":"<p><strong>Background: </strong>Exposure to cigarette smoke is a risk factor for endothelial dysfunction, leading to alterations in pulmonary vascular architecture and contributing to the development of pulmonary hypertension. Despite this evidence, the impact of smoking on pulmonary arterial hypertension (PAH) has only recently gained recognition.</p><p><strong>Research question: </strong>The primary objective of this study was to further investigate the influence of cigarette smoking on the diagnosis and progression of patients with PAH and chronic thromboembolic pulmonary hypertension (CTEPH).</p><p><strong>Study design and methods: </strong>We assessed the prevalence of cigarette smoking and analysed the demographics and clinical outcomes of ever-smokers versus never-smokers included in the Spanish Registry of Pulmonary Arterial Hypertension (REHAP).</p><p><strong>Results: </strong>A total of 1763 patients from the REHAP registry were included in the study, of whom 1293 had PAH and 450 had CTEPH. Among these, 771 patients (43.7%) were classified as ever-smokers, comprising 44% (<i>n</i> = 570) of those diagnosed with PAH and 42.7% (<i>n</i> = 201) of those with CTEPH. In PAH patients, ever-smokers were significantly older at diagnosis and study enrolment compared to never-smokers. Notably, a poorer clinical course was observed in male PAH patients who were ever-smokers, with a statistically significant association. In contrast, no significant differences in survival rates were detected between ever-smokers and never-smokers with CTEPH.</p><p><strong>Conclusion: </strong>Cigarette smoking is associated with delayed diagnosis and worse survival outcomes in PAH but not in CTEPH. Male ever-smokers patients with PAH has worse prognosis than female ever-smokers. Further research is warranted to elucidate the underlying mechanisms contributing to the negative correlation between smoking and PAH.</p>","PeriodicalId":54237,"journal":{"name":"Pulmonology","volume":"32 1","pages":"2640669"},"PeriodicalIF":6.4,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147391193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Minimum clinically important difference for the Urinary Symptom Profile questionnaire in people attending pulmonary rehabilitation. 在参加肺部康复治疗的人群中,泌尿症状问卷的最小临床重要差异。
IF 6.4 2区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2026-12-01 Epub Date: 2026-03-16 DOI: 10.1080/25310429.2026.2642521
Francis-Edouard Gravier, Yann Combret, Damien Parrot, Fanny Laporte, Léna Bocquet, Pauline Smondack, Jean-François Muir, Antoine Cuvelier, Fairuz Boujibar, Arnaud Nze Ossima, Clément Médrinal, Guillaume Prieur, Tristan Bonnevie
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引用次数: 0
Correspondence to 'Blood eosinopenia (≤30/µL) as an early predictor of respiratory failure in community-acquired pneumonia: A prospective multicentre study'. 符合“血酸性粒细胞减少(≤30/µL)作为社区获得性肺炎呼吸衰竭的早期预测因子:一项前瞻性多中心研究”。
IF 6.4 2区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2026-12-01 Epub Date: 2026-03-19 DOI: 10.1080/25310429.2026.2644819
Bihua Yao, Jiayan Chen, Huan Bao
{"title":"Correspondence to 'Blood eosinopenia (≤30/µL) as an early predictor of respiratory failure in community-acquired pneumonia: A prospective multicentre study'.","authors":"Bihua Yao, Jiayan Chen, Huan Bao","doi":"10.1080/25310429.2026.2644819","DOIUrl":"https://doi.org/10.1080/25310429.2026.2644819","url":null,"abstract":"","PeriodicalId":54237,"journal":{"name":"Pulmonology","volume":"32 1","pages":"2644819"},"PeriodicalIF":6.4,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147488539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Letter to the editor: Self-monitoring symptoms and pulse oximetry to predict imminent altitude illness in patients with chronic obstructive pulmonary disease. 致编辑的信:自我监测症状和脉搏血氧测定预测慢性阻塞性肺疾病患者即将发生的高原疾病。
IF 6.4 2区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2026-12-01 Epub Date: 2026-01-21 DOI: 10.1080/25310429.2026.2620224
Nikita Vaid, Rittu Sharma, Kanika Bhatia
{"title":"Letter to the editor: Self-monitoring symptoms and pulse oximetry to predict imminent altitude illness in patients with chronic obstructive pulmonary disease.","authors":"Nikita Vaid, Rittu Sharma, Kanika Bhatia","doi":"10.1080/25310429.2026.2620224","DOIUrl":"https://doi.org/10.1080/25310429.2026.2620224","url":null,"abstract":"","PeriodicalId":54237,"journal":{"name":"Pulmonology","volume":"32 1","pages":"2620224"},"PeriodicalIF":6.4,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146013361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
High-flow oxygen therapy in comparison with low-level pressure support ventilation for spontaneous breathing trials: A two-center, non-inferiority, randomized controlled study. 自主呼吸试验中高流量氧疗与低压力支持通气的比较:一项双中心、非劣效性、随机对照研究。
IF 6.4 2区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2026-12-01 Epub Date: 2026-02-18 DOI: 10.1080/25310429.2026.2630528
Apinut Jaroonpipatkul, Pichaya Kaeoperm, Nattapol Promlee, Wichian Srilam, Sorapop Pakdeewongse, Surat Tongyoo, Nuttapol Rittayamai

Background: Low-level pressure support ventilation (PSV) is the usual first spontaneous breathing trial (SBT) method. High-flow oxygen therapy (HFOT) via a dedicated connector through an endotracheal tube might be a credible alternative during SBT. This study aimed to compare the rate of SBT success between HFOT and low-level PSV.

Methods: We conducted a two-centre, open-label, non-inferiority randomised controlled trial. Adults mechanically ventilated patients for at least 24 hours and ready to wean were randomised to 30-minute SBTs with HFOT or low-level PSV. The primary outcome was SBT success rate (non-inferior margin of 10%). Extubation rate within 48 hours following successful SBT, reintubation rate within 48 hours after extubation, and hospital mortality were the exploratory outcomes.

Results: Among 162 enrolled patients, 81 received HFOT and 81 received low-level PSV. SBT succeeded in 77/81 patients (95.1%) in each arm (absolute difference 0.0%; 95% confidence interval [CI] -7.2 to 7.2; p = 1.000). No significant differences between HFOT and low-level PSV in extubation rates following successful SBT (88.3% vs 80.5%, respectively; p = 0.183) or reintubation rates within 48 hours after extubation (8.8% vs 17.7%, respectively; p = 0.140). Hospital mortality was lower with HFOT than with low-level PSV (11.1% vs 24.7%, respectively; difference -13.6%; 95% CI -25.2 to -2.0; p = 0.024).

Conclusion: Among mechanically ventilated patients meeting weaning criteria, HFOT demonstrated non-inferiority to low-level PSV for SBT success rates. Extubation and 48-hour reintubation rates were similar.

Clinical trial registration: Thai Clinical Trials Registry; registration number: TCTR20190703002; URL: www.thaiclinicaltrials.org.

背景:低压支持通气(PSV)是常用的首次自主呼吸试验(SBT)方法。高流量氧疗(HFOT)通过专用连接器通过气管内管可能是一个可靠的替代方案,在SBT。本研究旨在比较HFOT和低水平PSV的SBT成功率。方法:我们进行了一项双中心、开放标签、非劣效性随机对照试验。机械通气至少24小时且准备断奶的成人患者被随机分配到HFOT或低水平PSV的30分钟sbt。主要结局为SBT成功率(非劣差10%)。观察SBT成功后48小时内拔管率、拔管后48小时内再插管率和住院死亡率。结果:162例入组患者中,81例接受HFOT治疗,81例接受低水平PSV治疗。SBT在每组中成功77/81例(95.1%)(绝对差0.0%;95%可信区间[CI] -7.2 ~ 7.2; p = 1.000)。HFOT组和低水平PSV组在SBT成功后拔管率(分别为88.3%和80.5%,p = 0.183)和拔管后48小时内再插率(分别为8.8%和17.7%,p = 0.140)方面无显著差异。HFOT患者的住院死亡率低于低水平PSV患者(分别为11.1%对24.7%;差异为-13.6%;95% CI为-25.2至-2.0;p = 0.024)。结论:在符合脱机标准的机械通气患者中,HFOT在SBT成功率方面比低水平PSV表现出非劣效性。拔管率和48小时再插管率相似。临床试验注册:泰国临床试验注册中心;注册号:TCTR20190703002;URL: www.thaiclinicaltrials.org。
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引用次数: 0
Prevalence of treatable traits among patients with very severe COPD across STAR and GOLD classification: A multicenter cohort study. STAR和GOLD分类中非常严重COPD患者可治疗特征的患病率:一项多中心队列研究
IF 6.4 2区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2026-12-01 Epub Date: 2026-01-14 DOI: 10.1080/25310429.2026.2613525
Weiwei Meng, Yiming Ma, Jiankang Wu, Jiayu Wang, Rui Zhao, Sisi Liu, Naishu Xie, Qixuan Huang, Lijun Liu, Yanchao Liang, Huihui Zeng, Yan Chen

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.

目的:本研究旨在通过气流阻塞分级(STAR)和全球慢性阻塞性肺疾病倡议(GOLD)分级系统,证明极严重慢性阻塞性肺疾病(COPD)患者中可治疗特征(tt)的患病率,并研究特定tt与未来加重相关再入院风险之间的关系。方法:共纳入589例住院患者。参与者接受了一个多维度的评估来描述tt的特征,然后随访一年。Cox回归分析用于确定TTs与未来加重相关再入院风险之间的关系。结果:非常严重的COPD住院患者表现出较高的TTs患病率。在STAR分类中,支气管扩张剂可逆性、肺气肿、频繁加重、频繁住院、氧饱和度降低、呼吸困难、运动不耐受、病原体定植、体重不足、糖尿病和不依从性的TTs与STAR 4显著相关。在GOLD分类中,包括支气管扩张剂可逆性、频繁恶化、频繁住院、氧饱和度降低、呼吸困难、运动不耐受、病原体定植、体重不足、心力衰竭、血脂异常、不依从性和室内使用生物质/煤在内的TTs与“GOLD 4”显著相关。此外,Cox回归分析显示,STAR 4患者有7个tt与未来恶化相关的再入院风险相关,而GOLD 4患者有2个tt是预测因子。结论:非常严重的COPD患者表现出更多需要干预的tt。此外,在STAR和GOLD分类中,特异性tt与非常严重COPD患者未来与加重相关的再入院相关,表明其评估的临床应用价值。
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引用次数: 0
Fibroblast-activation protein inhibitors based positron emission tomography (PET) for assessing lung disease: A systematic review with meta-analysis. 基于成纤维细胞活化蛋白抑制剂的正电子发射断层扫描(PET)用于评估肺部疾病:一项荟萃分析的系统综述。
IF 6.4 2区 医学 Q1 RESPIRATORY SYSTEM Pub Date : 2026-12-01 Epub Date: 2026-03-11 DOI: 10.1080/25310429.2026.2638024
Delong Huang, Qiaoli Zhao, Junhao Wu, Haoshu Zhong, Yiren Wang, Hemu Zhou, Yongqin Zhang, Fuyuan Ran, Jun Deng, Qiang Ren

Background: The incidence of lung diseases has been increasing in recent years, especially lung cancer and interstitial lung disease. However, the diagnosis of lung diseases such as lung cancer and ILD still has some limitations. Therefore, finding an appropriate imaging agent and technique is of great clinical value for the diagnostic evaluation of lung diseases.

Method: A thorough search of all relevant literature up to 20 June 2024 was undertaken. Studies evaluating lung lesions with FAPI PET were screened and patient diagnostic data were extracted. Risk of bias was checked by the QUADAS-2. Meta-analysis was performed in STATA17.0. Subgroups were analysed for the effectiveness of FAPI PET/CT in the diagnostic assessment of various lung diseases.

Result: 19 studies were finally sieved. Meta-analysis showed that the sensitivity of FAPI PET/CT for the detection of lung tumours was 0.99 (95% CI: 0.90-1.00), with a specificity of 0.82 (95% CI: 0.72-0.89). The sensitivity of FAPI PET/CT for the assessment of non-neoplastic lesions was 0.93 (95% CI: 0.72-0.99) and the specificity was 0.96 (95% CI: 0.79-0.99). Subgroup analysis showed that FAPI PET/CT had a sensitivity of 0.93 (95% CI: 0.83-0.97) in lung tumour staging (n = 397). In addition, the sensitivity and specificity of FAPI PET/CT were 0.80 (95% CI: 0.70-0.89) and 0.90 (95% CI: 0.84-0.96) for pneumonia, and 1.00 for assessing idiopathic pulmonary fibrosis.

Conclusion: Our results show that FAPI PET/CT has an excellent diagnostic performance for lung tumours and non-tumour lesions.Points for clinical research: Currently CT is unable to accurately determine the activity of lung diseases such as IPF and hence may lead to delays in the diagnosis and treatment of some lung diseases. We aimed to find evidence-based medical evidence suitable for FAPI PET in lung diseases, especially non-oncological diseases, by performing a meta-analysis of FAPI PET in assessing lung diseases.

背景:近年来肺部疾病的发病率呈上升趋势,尤其是肺癌和肺间质性疾病。然而,对肺癌和ILD等肺部疾病的诊断仍有一定的局限性。因此,寻找合适的显像剂和技术对肺部疾病的诊断评价具有重要的临床价值。方法:全面检索截至2024年6月20日的所有相关文献。筛选FAPI PET评估肺部病变的研究并提取患者诊断数据。偏倚风险通过QUADAS-2进行检查。meta分析在STATA17.0中进行。对FAPI PET/CT在各种肺部疾病诊断评估中的有效性进行亚组分析。结果:最终筛选出19项研究。荟萃分析显示,FAPI PET/CT检测肺部肿瘤的敏感性为0.99 (95% CI: 0.90-1.00),特异性为0.82 (95% CI: 0.72-0.89)。FAPI PET/CT评估非肿瘤性病变的敏感性为0.93 (95% CI: 0.72-0.99),特异性为0.96 (95% CI: 0.79-0.99)。亚组分析显示,FAPI PET/CT对肺肿瘤分期的敏感性为0.93 (95% CI: 0.83-0.97) (n = 397)。此外,FAPI PET/CT对肺炎的敏感性和特异性分别为0.80 (95% CI: 0.70-0.89)和0.90 (95% CI: 0.84-0.96),评估特发性肺纤维化的敏感性和特异性分别为1.00。结论:FAPI PET/CT对肺肿瘤及非肿瘤病变均有较好的诊断价值。临床研究要点:目前CT还不能准确判断IPF等肺部疾病的活动性,可能导致一些肺部疾病的诊断和治疗出现延误。我们旨在通过对FAPI PET评估肺部疾病的meta分析,寻找适合FAPI PET治疗肺部疾病,特别是非肿瘤性疾病的循证医学证据。
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Pulmonology
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