Pulmonology最新文献

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.

Introduction and objectives: The study examines how hypoxaemia in obstructive sleep apnoea (OSA) relates to cancer. It focuses on CD25, an immune-checkpoint, analyzing its levels in OSA patients with and without cancer to assess whether CD25 could serve as a biomarker for cancer mortality.

Materials and methods: We investigated the plasma levels of soluble CD25 (sCD25) in three independent cohorts: patients with no evidence of cancer, with melanoma, and with lung cancer. We explored the role of hypoxaemia by intermittent hypoxia (IH) and HIF-1α inhibition in vitro models.

Results: Our results suggest that sCD25 increases with hypoxemia severity in OSA, both with or without cancer. OSA patients also exhibit early upregulation of membrane-bound CD25 in T lymphocytes. Our findings corroborate that IH, via HIF-1α, mediates the upregulation of both membrane-bound and sCD25. sCD25 levels correlate with markers of melanoma and lung cancer aggressiveness, and elevated sCD25 levels are associated with higher lung cancer mortality risk.

Conclusion: Our study indicates that hypoxia mediates the increase of CD25 in OSA patients. In turn, our data revealed sCD25 were related to tumour aggressiveness in OSA patients with melanoma or lung cancer, and suggest sCD25 as a potential novel biomarker to stratify OSA patients with lung cancer by mortality risk.

Background: Chronic respiratory diseases such as COPD, cystic fibrosis, and bronchiectasis are frequently associated with bronchial hypersecretion, leading to airflow obstruction and recurrent infections. Effective airway clearance techniques are essential but often limited by adherence, cost, and usability.

Research question: To evaluate the clinical efficacy, safety, tolerability, and comfort of Electrovest®, a novel portable electro-vibratory device that integrates neuromuscular electrical stimulation (NMES) to promote thoracic vibrations in patients with chronic hypersecretory respiratory diseases.

Study design and methods: A randomized, controlled, crossover pilot study including 21 clinically stable patients with hypersecretory chronic respiratory diseases underwent two interventions: Electrovest® and The Vest®. Pulmonary, muscular, functional, and comfort parameters were assessed before and after each therapy. The trial was registered (NCT07175012).

Results: Sputum mobilisation was similar between devices, but Electrovest® was rated as significantly more comfortable (p = 0.023). Electrovest® significantly improved PImax (p = 0.035), 6MWT distance (p = 0.005), and pectoral strength (p = 0.020). No muscle or renal injury was detected. Cough and Sputum Assessment Questionnaire (CASA-Q) scores improved in most domains.

Conclusion: Electrovest® is a safe, well-tolerated, and effective alternative for airway clearance in chronic hypersecretory respiratory diseases. Its portability, comfort, and potential for home use may enhance long-term adherence compared to traditional systems.

Dermatofibrosarcoma protuberans is a rare, locally aggressive sarcoma with a low metastatic potential. This report describes a 73-year-old woman with a history of recurrent scalp dermatofibrosarcoma protuberans who presented with an asymptomatic pulmonary nodule detected via computed tomography. The nodule, which gradually enlarged over four years, was confirmed as metastatic dermatofibrosarcoma protuberans through wedge resection and histopathological analysis. This case emphasizes that hematogenous spread to the lungs should be considered in dermatofibrosarcoma protuberans patients with a history of recurrence, particularly when pulmonary nodules are detected.

Background: Pre-chronic obstructive pulmonary disease (COPD) indicators are associated with COPD development, but their associations with lung function decline in persons without COPD and their longitudinal transitions remain uncertain.

Methods: In this prospective cohort study, 3526 subjects without COPD from the 2014-2015 national COPD surveillance in China were investigated for a second time during 2018-2020. Four potential pre-COPD indicators at baseline were chronic bronchitis, preserved ratio impaired spirometry (PRISm), low peak expiratory flow (PEF), and spirometric small airway dysfunction (sSAD). To include the incident COPD subjects in the lung function decline analysis for consistent indicators, forced expiratory volume in 1 s (FEV₁) <80% predicted was used instead of PRISm. Lung function outcomes were the declines in post-bronchodilator FEV₁, forced vital capacity (FVC), and FEV₁/FVC.

Results: Subjects with initial chronic bronchitis had faster declines in FEV₁ and FVC compared with those without initial chronic bronchitis among smokers. Consistent chronic bronchitis was associated with faster declines in FEV₁ and FVC among non-smokers. Consistent sSAD was associated with faster declines in FEV₁/FVC among smokers and non-smokers. Consistent FEV₁ <80% predicted and consistent low PEF were associated with a faster decline in FEV₁/FVC among smokers. Incident COPD developed from sSAD in almost half of the cases.

Conclusions: Initial chronic bronchitis and consistent FEV₁ <80% predicted, sSAD, and low PEF are associated with excessive lung function decline among smokers, while consistent chronic bronchitis and sSAD are associated with excessive lung function decline among non-smokers. Initial sSAD accounts for a larger proportion of incident COPD than initial chronic bronchitis, PRISm, and low PEF.

Introduction: The Spanish Society of Pulmonology and Thoracic Surgery created a registry for hospitalised patients with COVID-19 and the different types of respiratory support used (RECOVID). Objectives. To describe the profile of hospitalised patients with COVID-19, comorbidities, respiratory support treatments and setting. In addition, we aimed to identify varying profiles of patients according to outcomes and the complexity of respiratory support needed.

Methods: Multicentre, observational study in 49 Spanish hospitals. A protocol collected demographic data, comorbidities, respiratory support, treatment setting and 1-year follow-up. Patients were described using either frequency and percentages or median and interquartile range, as appropriate. A cluster analysis made it possible to identify different types of profile among the patients.

Results: In total, 2148 of 2454 hospitalised patients (87.5%) received care in the conventional ward, whilst 126 in IRCU and 180 in ICU. In IRCU, 30% required high-flow nasal oxygen whilst 25%, non-invasive mechanical ventilation and 17%, mechanical ventilation. Four clusters of patients were identified. Two clusters were more likely to require IRCU/ICU admission, although primarily Cluster 2: Cluster (C) 1 consisted of patients without comorbidities and C2, those with comorbidities. Both presented higher inflammatory levels and lower lymphocyte count and SpO2/FiO2; however, C2 showed worse values. Two different clusters identified patients requiring less complex respiratory support. C3 presented higher comorbidities and elevated lymphocyte count, SpO2/FiO2 and low C-reactive protein (CRP). C4 included those without comorbidities except for arterial hypertension, lymphopenia and an intermediate CRP. In-hospital mortality and subsequent 1-year mortality were greater for C2 (28.6% and 7.1%) and C1 (11.1%, 8.3%) than for C4 (3.3%, 1.8%) and C3 (0%, 0%).

Conclusions: The cluster analysis identified four clinical phenotypes requiring distinct types of respiratory support, with great differences present per characteristics and outcomes.