Pulmonology最新文献

Background and research question: We aimed to assess whether levels of digital biomarkers can reflect monthly patterns of asthma control.

Study design and methods: We performed a longitudinal study on patients with asthma and comorbid rhinitis who filled ≥26 days of data in a month in the MASK-air® app and who reported at least 1 day of treatment with an inhaled corticosteroid with or without a long-acting β₂-agonist (ICS ± LABA). We applied k-means cluster analysis to define clusters of months according to daily asthma control and medication use. Clusters were compared using digital biomarkers (visual analogue scale [VAS] on asthma symptoms and electronic daily asthma control score [e-DASTHMA]). We compared patients who did not switch with patients who switched their ICS ± LABA.

Results: We assessed 243 patients and 1358 months. We identified three clusters of poor asthma control despite high ICS ± LABA adherence, one cluster of poor asthma control and poor ICS ± LABA adherence, one cluster of good asthma control and high ICS ± LABA adherence and one cluster of good asthma control despite poor ICS ± LABA adherence. These clusters displayed relevant differences in VAS asthma and e-DASTHMA levels. Similar clusters were found in 'non-switchers' versus 'switchers'.

Conclusion: Levels of digital biomarkers reflect asthma control patterns and might be used to monitor patients with asthma.

Objective: To assess if diaphragmatic ultrasound (DU) reflects diaphragmatic muscle strenght when compared to respiratory tests and neurophysiological studies.

Methods: A systematic literature review was conducted on adults undergoing DU, compared to any respiratory or neurophysiological technique. The search strategy was applied in PubMed, Scopus, and Web of Science, and the analysis was conducted using the PRISMA methodology. Three eligibility assessment stages were performed: title, abstract, and full-text reading. The risk of bias was evaluated using the RoB 2.0, ROBINS-I, and Newcastle-Ottawa Scale tools.

Results: Out of 155 identified articles, 25 were selected for full-text review (14 non-randomised studies, 8 case-control studies, and 3 randomised studies). The overall risk of bias was moderate, with the main biases related to population selection and intervention assessment.Twenty-three articles used maximal inspiratory pressure measurement as a comparator which showed a weak-to-moderate correlation, significant in 10 studies, with diaphragmatic excursion. Three studies reported a weak association between diaphragmatic thickening and sniff pressure.Five articles reported a concordant correlation between diaphragmatic thickening and compound muscle action potential amplitude, significant only in one study.

Conclusion: The variability of results obtained across different pathologies does not support the use of DU alone to predict diaphragmatic muscle strength.

Fibrotic hypersensitivity pneumonitis (f-HP) is an interstitial lung disease in which various antigens in susceptible individuals may play a pathogenetic role. This study evaluates the role of transbronchial lung cryobiopsy (TBLC) and bronchoalveolar lavage (BAL) in identifying a UIP-like pattern and its association with fibrosis progression. We conducted a multicentre retrospective cohort study of patients diagnosed with f-HP who underwent BAL and TBLC between 2011 and 2023. A UIP-like pattern was defined by the presence of (A) patchy fibrosis and fibroblastic foci or (B) honeycombing ± (A). We investigated BAL's role in predicting UIP-like patterns within a clinical-radiological-serological framework, examining disease progression in these patients using spirometry and mortality data. A total of 195 patients were enrolled, 59 (30%) of whom exhibited a UIP-like pattern. These patients showed greater lung function decline, lower BAL lymphocytosis (14.4% vs. 37.4%, p < 0.001), higher nintedanib prescription (35% vs. 14%, p < 0.001), and higher 10-year mortality (HR 2.8, 95% CI 1.3-5.8, p = 0.004). f-HP patients with a UIP-like pattern exhibit worse clinical outcomes and higher mortality. In cases of low BAL lymphocytosis with a high pre-test clinical suspicion of f-HP, lung biopsy may not be necessary as it increases the likelihood of identifying a UIP-like pattern.

Introduction and objectives: Post-tuberculosis lung disease (PTLD), as other chronic respiratory disorders, may have infectious complications; some of them can be prevented with vaccinations. So far, no document has discussed the potential role of vaccination in PTLD. Therefore, the objective of this review was to describe vaccination recommendations to prevent infections potentially capable of complicating PTLD.

Materials and methods: A non-systematic review of the literature was conducted. The following keywords were used: tuberculosis, vaccination, vaccines and PTLD. PubMed/MEDLINE and Embase were used as the search engine, focusing on English-language literature only.

Results: We identified 9 vaccines potentially useful in PTLD. Influenza, pneumococcal and anti-COVID-19 vaccinations should be recommended. Patients with PTLD can also benefit from vaccination against shingles. Vaccination against pertussis is mainly relevant during childhood. Diphtheria, tetanus and measles vaccination are recommended for general population and should be considered in patients with PTLD not previously vaccinated. Tdap (Tetanus, diphtheria, and pertussis) booster should be repeated in every adult every ten years. Vaccination against BCG retains its importance during early childhood in countries where TB is endemic.

Conclusions: Vaccination deserves to be considered among the strategies to prevent and/or mitigate PTLD complications. Further evidence is necessary to better understand which vaccines have the greatest impact and cost-benefit.

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.