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Background: The core management of most individuals with asthma and COPD is daily treatment with inhalers such as inhaled corticosteroids (ICS) and long-acting bronchodilators. The two main types of inhalers used are pressurized metered-dose inhalers (pMDIs) and dry powder inhalers (DPIs). Different studies have shown low adherence to inhaler treatments among subjects with asthma and COPD. In this study, we explored the differences in adherence between pMDIs and DPIs of combined ICS and long-acting β2-agonist inhalers (ICS + LABA) in a large cohort, free from commercial biases. Methods: In this historical prospective study, we included all adult subjects with asthma and/or COPD who acquired at least one ICS + LABA inhaler between 2016 and 2019. We carried out propensity score matching and then compared the maximal number of pMDIs and DPIs purchased in any continuous 12 months during the study period. We also compared once-a-day DPIs with twice-a-day DPIs. Results: Of the 36,998 matched subjects, 5897 (15.9%) purchased pMDIs. The overall median [IQR] inhalers purchased for pMDIs and DPIs were 1 [1, 4] and 3 [1, 8], respectively; for subjects with asthma, 1 [1, 3] and 2 [1, 6]; for subjects with COPD, 1 [1, 3] and 3 [1, 10]; and for subjects with asthma-COPD overlap, 2 [1, 7] and 6 [2, 12]. For all the comparisons, p < 0.001. The once-a-day DPI group had a slight but significantly better adherence than the twice-a-day DPI group. Conclusions: For ICS + LABA therapy, the number of DPIs purchased was significantly greater than the number of pMDIs purchased, as well as the once-a-day DPI relative to the other DPIs. Overall, subjects with asthma and/or COPD had low adherence to all inhalers, with the highest adherence observed among subjects with asthma-COPD overlap.
COVID-19 signs and symptoms varied among patients, with the most common being fever, fatigue, sore throat, cough, anorexia, and shortness of breath. (1) Background: This study aimed to assess effort, dyspnea, and cooperation scores in patients with mild and moderate post-COVID-19 forms, both at baseline and after completing a structured physical recovery program. (2) Methods: Our study included 160 post-COVID-19 patients who had experienced mild or moderate disease. (3) Results: Effort and dyspnea scores were significantly lower (p < 0.01), while cooperation scores were significantly higher after the rehabilitation program. Both men and women demonstrated significant increases in cooperation scores after recovery. Additionally, both groups showed statistically significant reductions in effort and dyspnea scores (p < 0.001). Among patients aged under and over 60 years, effort and dyspnea scores decreased after rehabilitation, and cooperation scores increased significantly (p < 0.001). No statistically significant differences were observed between genders in any of the three scores. Similarly, no significant differences by age were found in cooperation or dyspnea scores. A significant negative correlation was observed between cooperation and effort scores: patients with higher cooperation scores tended to report lower effort scores, and vice versa (p < 0.001, R = -0.571). (4) Conclusions: The improved cooperation demonstrated by patients during the physical recovery program was significantly associated with reductions in perceived effort and dyspnea, indicating a positive impact on post-COVID-19 rehabilitation outcomes.
Background and objectives: Hematological parameters are increasingly being investigated as readily accessible biomarkers for the diagnosis of obstructive sleep apnea syndrome (OSAS). In our study, we aimed to investigate the relationship between OSAS and albumin indices and the uric acid-to-HDL ratio (UHR).
Methods: The demographic and laboratory data and AHI (apnea-hypopnea index) values of 613 patients who underwent polysomnography were obtained retrospectively from their files. Blood parameters such as white blood cells (WBCs), red blood cell distribution width (RDW), red blood cells (RBCs), hemoglobin (Hb), hematocrit (Hct), platelets (PLTs), C-reactive protein (CRP), albumin, blood urea nitrogen (BUN), and high-density lipoproteins (HDLs) were obtained from the files. Laboratory indices such as the BUN-to-albumin ratio (BAR), neutrophil-to-albumin ratio (NAR), RDW-to-albumin ratio (RAR), CRP-to-albumin ratio (CAR), and UHR were calculated. OSAS was categorized as simple snoring (SS) (control) (AHI < 5), mild (5 ≤ AHI < 15), moderate (15 ≤ AHI < 30), and severe (AHI ≥ 30). The patients were also grouped as severe (AHI ≥ 30) and non-severe (5 > AHI < 30) OSAS and compared in terms of laboratory parameters and indices.
Results: Of the 613 participants, 366 (59.7%) were men, and the average age of participants was 55.22 ± 11.13 years. The biomarkers such as RBCs, Hb, Htc, CRP, BUN, creatinine, uric acid, HDLs, CAR, RAR, BAR, and UHR showed significant differences between OSAS patients and controls. WBCs, basophils, RBCs, RDW, Htc, PLTs, HDLs, uric acid, RAR, NAR, and UHR indices were significantly different between the severe OSAS and non-severe OSAS groups (p < 0.05). BAR (OR = 1.151; CI = 1.056 - 1.256; p = 0.001) and UHR (OR = 2.257; 95% CI = 1.507 - 3.382; p < 0.001) were the most important indices predicting OSAS, while RAR (OR = 1.844; CI = 1.224 - 2.778; p = 0.003) and UHR (OR = 2.203; 95% CI = 1.496 - 3.243; p < 0.001) were the strongest indices associated with severe OSAS.
Conclusion: In our study, RAR, BAR, and UHR indices were closely associated with the presence and severity of OSAS. These indices can be considered low-cost, readily available methods for predicting OSAS patients.
Background: Pulmonary hypertension (PH) is a frequent complication in patients with interstitial lung disease (ILD); its occurrence results in significant morbidity and mortality. Currently approved treatment options for PH-ILD include inhaled prostacyclin therapy, although this approach may be insufficient in patients who have developed simultaneous right ventricular failure. Moreover, there is no available treatment algorithm regarding the optimal therapy and timing of lung transplant referral for PH-ILD patients based on disease severity.
Design/methods: In this study, we created such a tool to guide PH-specific therapy in PH-ILD patients, especially as further treatment strategies are developed. We developed a 4-point PH-ILD Severity score that integrated both subjective and objective information (WHO FC, CI, TAPSE, PVR) from retrospective analysis of 57 PH-ILD patients.
Results: A score of 3 or greater in the PH-ILD Severity score yielded an AUC of 0.831 (p < 0.001) for the composite endpoint of clinical worsening (hospitalization due to a cardiopulmonary indication; decrease in 6 min walk distance by >15% at 2 consecutive visits; all-cause mortality; lung transplantation).
Conclusions: Further confirmation and evolution of this PH-ILD Severity score will assist in the development of optimal treatment plans in ILD patients diagnosed with concomitant PH.
Background: Uncontrolled asthma remains a significant clinical challenge, often linked to impaired lung function and increased diaphragmatic workload. Recent studies have shown promising results using a triple inhaled therapy comprising beclomethasone dipropionate/formoterol fumarate/glycopyrronium (BDP/FF/G). This study assessed the real-world efficacy of BDP/FF/G on lung function and diaphragmatic workload in patients with uncontrolled asthma. Methods: A prospective observational study enrolled 21 adult patients diagnosed with uncontrolled asthma despite high-dose ICS/LABA therapy. Patients underwent lung function tests and right diaphragmatic ultrasound assessments at baseline and after three months of treatment with BDP/FF/G (172/5/9 mcg, administered as two inhalations every 12 h). Results: After three months, significant improvements were observed in FEV1 (from 57.75 ± 12.30% to 75.10 ± 18.94%, p < 0.001) and FEF25-75 (from 47.80 ± 19.23% to 75.10 ± 36.06%, p < 0.001). Additionally, during the same period, we recorded significant reductions in residual volume (from 130.10 ± 28.20% to 92.55 ± 21.18%, p < 0.001) and total airway resistance (Rtot) (from 164.60 ± 83.21% to 140.70 ± 83.25%, p < 0.05). The mean asthma control test (ACT) score increased by 5.6 points (p < 0.001), surpassing the established minimal clinically important difference (MCID) of 3 points and raising the cohort mean above the well-controlled threshold. The right diaphragmatic workload was significantly decreased, as shown by a reduction in thickening fraction (TF) (from 63.86 ± 17.67% to 40.29 ± 16.65%, p < 0.01). Correlation analysis indicated significant associations between diaphragmatic function and some lung function parameters (FEV1, FEF25-75, and Rtot). Conclusions: In this real-world pilot, triple BDP/FF/G was linked to improvements in airflow, hyperinflation, symptoms, and a reduction in diaphragmatic thickening fraction, indicating potential physiological benefit. Due to the small sample size, single-centre design, and 3-month follow-up, these results should be viewed as hypothesis-generating and need to be confirmed in larger, controlled, multicentre studies with longer follow-up.
Non-small cell lung cancer (NSCLC) is the leading cause of cancer-related mortality worldwide. Accurate determination of epidermal growth factor receptor (EGFR) mutation status is essential for selecting patients eligible for tyrosine kinase inhibitors (TKIs). However, invasive genotyping is often limited by tissue accessibility and sample quality. This study presents a non-invasive machine learning model combining clinical data, CT morphological features, and radiomic descriptors to predict EGFR mutation status. A retrospective cohort of 138 patients with confirmed EGFR status and pre-treatment CT scans was analyzed. Radiomic features were extracted with PyRadiomics, and feature selection applied mutual information, Spearman correlation, and wrapper-based methods. Five Random Forest models were trained with different feature sets. The best-performing model, based on 11 selected variables, achieved an AUC of 0.91 (95% CI: 0.81-1.00) under stratified five-fold cross-validation, with an accuracy of 0.88 ± 0.03. Subgroup analysis showed that EGFR-WT had a performance of precision 0.93 ± 0.04, recall 0.92 ± 0.03, F1-score 0.91 ± 0.02, and EGFR-Mutant had a performance of precision 0.76 ± 0.05, recall 0.71 ± 0.05, F1-score 0.68 ± 0.04. SHapley Additive exPlanations (SHAP) analysis identified tobacco use, enhancement pattern, and gray-level-zone entropy as key predictors. Decision curve analysis confirmed clinical utility, supporting its role as a non-invasive tool for EGFR-screening.
Respiratory infections and chronic lung disease are major contributors to morbidity in children. Aztreonam lysine for inhalation (AZLI) delivers high local antibiotic concentrations while limiting systemic exposure; however, its safety in younger patients remains uncertain. This systematic review and meta-analysis searched MEDLINE, CENTRAL, and Google Scholar for randomized and observational studies reporting adverse events in children and adolescents (≤18 years) receiving AZLI, with no date limit. Fourteen studies were included. Most studies were moderate-to-high quality. Comparative analysis showed no clinically relevant increase in common adverse events relative to placebo or other inhaled antibiotics. The pooled relative risk for severe respiratory disorders (grade 3/4) was 1.65 (95% CI 1.07-2.57), suggesting a higher incidence of serious respiratory events, while a protective effect against decline in pulmonary function was observed (RR 0.70, 95% CI 0.54-0.90). Adverse events were generally mild; serious adverse events and hospitalizations were infrequent and comparable between groups. Cumulative prevalence estimates indicated that respiratory irritation occurred in 10-25% of patients, whereas systemic effects were uncommon. Overall, AZLI appears to have an acceptable tolerability and safety profile in children and adolescents, though careful monitoring is warranted, especially for severe respiratory events.
Background: Several studies focused on the importance of managing small airways disease in the treatment of severe asthma, whose improvement can improve respiratory symptoms, lung function, and airways inflammation, potentially reaching the objective of clinical remission. Methods: Twenty-five patients with severe asthma and without bronchiectasis were enrolled. They were started on biological therapies with Omalizumab, Dupilumab, Benralizumab or Mepolizumab. Follow-up evaluations were conducted at baseline (T0) and after one year of biological therapy (T1). Assessments included clinical evaluations, spirometry, questionnaires, and inflammatory markers. Results: Predictive analysis identified baseline FeNO 350 mL/s levels as a significant predictor of clinical remission in both univariable and multivariable analysis. Higher FeNO 350 mL/s levels at T0 were associated with an increased likelihood of achieving remission (p = 0.012). The optimal cutoff value for FeNO 350 mL/s was determined to be 18 ppb, based on the Younden Index. Conclusions: Following patients with severe asthma on biological therapy for one year, FeNO 350 mL/s could be used as a predictive factor of clinical remission, highlighting its importance as inflammatory marker not only in small airways disease, but also in predicting clinical remission in severe asthmatic patients.
Airway involvement in eosinophilic disorders other than asthma is not well-defined, and the symptoms may be overshadowed by other more prominent eosinophilic extra-respiratory manifestations. This study aimed to evaluate the utility of fractional exhaled nitric oxide (FeNO) in diagnosing eosinophilic airway involvement in patients with persistent eosinophilia (>0.5 × 109/L). We conducted a retrospective analysis of adult patients with confirmed peripheral blood eosinophilia (>0.5 × 109/L) on at least two occasions one month apart. Patients with blood eosinophilia associated with known eosinophilic airway inflammatory diseases were excluded from the study. Pulmonary function testing, spirometry, and FeNO measurement were conducted. A total of 14 patients with various eosinophil-related disorders were identified, with a mean age of 65.7 years. Increased FeNO levels were associated with airflow obstruction and clinical symptoms such as coughing and wheezing. Notably, eosinophil levels were not predictive of eosinophilic airway involvement. FeNO could be a useful diagnostic tool for detecting bronchial eosinophilic airway inflammation in non-asthmatic disorders, thereby enabling appropriate treatment. Further studies with larger cohorts are needed to validate these findings.
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