Pulmonology最新文献

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.

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: 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.

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.

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.

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.