Pub Date : 2025-12-04DOI: 10.1016/j.arbres.2025.11.012
Miguel Angel Martinez-Garcia, Timothy Aksamit, Takanori Asakura, Lucy Burr, Chang Chia-Ling, Rosa Maria Giron, Wei-Jie Guan, Deniz Kizilirmak, Yeon-Mok Oh, Miguel Penizzotto, Felix C Ringshausen, Anthony de Soyza, Christina Thornton, Conroy Wong
Bronchiectasis represents in frequency the third chronic inflammatory airway disease after chronic obstructive pulmonary disease (COPD) and asthma. It is produced by more than one hundred causes, both pulmonary and extrapulmonary. Despite advances in recent years in the understanding of this condition and the publication of several national and international guidelines on its management, in most cases the etiology remains unknown. Among the identified etiological forms, post-infectious and post-tuberculous are the most frequent. It is also striking how bronchiectasis associated with COPD and severe asthma has been progressively increasing over the years, probably due to greater awareness among healthcare professionals of the importance of such associations and the wider use of chest computed tomography (the diagnostic method of choice for bronchiectasis from a radiological perspective). However, it is remarkable, according to data obtained from national and international bronchiectasis registries, the considerable geographic heterogeneity in their etiology. Thus, in socially disadvantaged regions or in those with poorer healthcare access, post-infectious and particularly post-tuberculous forms clearly predominate. It is always necessary to perform the appropriate complementary tests, as highlighted in all bronchiectasis guidelines, to exclude at least the treatable etiologies (treatable trait), since this is undoubtedly associated with a better patient prognosis.
{"title":"The Worldwide Puzzle of Bronchiectasis Etiology in Adults.","authors":"Miguel Angel Martinez-Garcia, Timothy Aksamit, Takanori Asakura, Lucy Burr, Chang Chia-Ling, Rosa Maria Giron, Wei-Jie Guan, Deniz Kizilirmak, Yeon-Mok Oh, Miguel Penizzotto, Felix C Ringshausen, Anthony de Soyza, Christina Thornton, Conroy Wong","doi":"10.1016/j.arbres.2025.11.012","DOIUrl":"https://doi.org/10.1016/j.arbres.2025.11.012","url":null,"abstract":"<p><p>Bronchiectasis represents in frequency the third chronic inflammatory airway disease after chronic obstructive pulmonary disease (COPD) and asthma. It is produced by more than one hundred causes, both pulmonary and extrapulmonary. Despite advances in recent years in the understanding of this condition and the publication of several national and international guidelines on its management, in most cases the etiology remains unknown. Among the identified etiological forms, post-infectious and post-tuberculous are the most frequent. It is also striking how bronchiectasis associated with COPD and severe asthma has been progressively increasing over the years, probably due to greater awareness among healthcare professionals of the importance of such associations and the wider use of chest computed tomography (the diagnostic method of choice for bronchiectasis from a radiological perspective). However, it is remarkable, according to data obtained from national and international bronchiectasis registries, the considerable geographic heterogeneity in their etiology. Thus, in socially disadvantaged regions or in those with poorer healthcare access, post-infectious and particularly post-tuberculous forms clearly predominate. It is always necessary to perform the appropriate complementary tests, as highlighted in all bronchiectasis guidelines, to exclude at least the treatable etiologies (treatable trait), since this is undoubtedly associated with a better patient prognosis.</p>","PeriodicalId":8339,"journal":{"name":"Archivos De Bronconeumologia","volume":" ","pages":""},"PeriodicalIF":9.2,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145800075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Invasive Fungal Infections: No Trial, No Error, Just Uncertainty-Immunosuppression Diversifies, but Evidence Remains Anchored in Classical Models.","authors":"Amparo Solé, Catherine Orla Morrissey, Patricia Muñoz","doi":"10.1016/j.arbres.2025.11.010","DOIUrl":"https://doi.org/10.1016/j.arbres.2025.11.010","url":null,"abstract":"","PeriodicalId":8339,"journal":{"name":"Archivos De Bronconeumologia","volume":" ","pages":""},"PeriodicalIF":9.2,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145780040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-02DOI: 10.1016/j.arbres.2025.11.011
Carlos Almonacid, Santiago Quirce, Marina Blanco, Alfonso Del Cubillo, José Valverde-Molina, Vicente Plaza
The Spanish Asthma Guideline (GEMA) 5.5 marks a significant conceptual and clinical advance in asthma management across Spanish-speaking healthcare systems. This updated edition incorporates the latest scientific insights into the pathophysiology, diagnosis, phenotyping, and treatment of asthma, while maintaining its practical, evidence-based orientation. A key innovation is the redefinition of therapeutic objectives: treatment is no longer limited to symptom control but is directed toward achieving and sustaining clinical remission, following the principles established by the Spanish REMAS consensus. The guideline also integrates recent evidence supporting the role of biologic therapies in specific inflammatory phenotypes, the implementation of maintenance and reliever therapy (MART) in adolescents, and a more rational approach to bronchodilator use in pediatric exacerbations. Further updates include refined recommendations on stepwise pharmacological strategies, expanded indications for advanced therapies in both adults and children, and updated management of associated conditions such as allergic bronchopulmonary aspergillosis and eosinophilic granulomatosis with polyangiitis. Organizationally, GEMA 5.5 strengthens the role of multidisciplinary asthma units, digital monitoring tools, and adherence-promoting interventions. Overall, GEMA 5.5 represents a paradigm shift toward personalized, remission-oriented asthma care, reinforcing its position as the leading Spanish-language reference for evidence-based clinical practice in respiratory medicine.
{"title":"Inside GEMA 5.5: Expert Insights on the Latest Changes in Asthma Management.","authors":"Carlos Almonacid, Santiago Quirce, Marina Blanco, Alfonso Del Cubillo, José Valverde-Molina, Vicente Plaza","doi":"10.1016/j.arbres.2025.11.011","DOIUrl":"https://doi.org/10.1016/j.arbres.2025.11.011","url":null,"abstract":"<p><p>The Spanish Asthma Guideline (GEMA) 5.5 marks a significant conceptual and clinical advance in asthma management across Spanish-speaking healthcare systems. This updated edition incorporates the latest scientific insights into the pathophysiology, diagnosis, phenotyping, and treatment of asthma, while maintaining its practical, evidence-based orientation. A key innovation is the redefinition of therapeutic objectives: treatment is no longer limited to symptom control but is directed toward achieving and sustaining clinical remission, following the principles established by the Spanish REMAS consensus. The guideline also integrates recent evidence supporting the role of biologic therapies in specific inflammatory phenotypes, the implementation of maintenance and reliever therapy (MART) in adolescents, and a more rational approach to bronchodilator use in pediatric exacerbations. Further updates include refined recommendations on stepwise pharmacological strategies, expanded indications for advanced therapies in both adults and children, and updated management of associated conditions such as allergic bronchopulmonary aspergillosis and eosinophilic granulomatosis with polyangiitis. Organizationally, GEMA 5.5 strengthens the role of multidisciplinary asthma units, digital monitoring tools, and adherence-promoting interventions. Overall, GEMA 5.5 represents a paradigm shift toward personalized, remission-oriented asthma care, reinforcing its position as the leading Spanish-language reference for evidence-based clinical practice in respiratory medicine.</p>","PeriodicalId":8339,"journal":{"name":"Archivos De Bronconeumologia","volume":" ","pages":""},"PeriodicalIF":9.2,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145800045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.arbres.2025.05.016
Mohammad Badran , David Gozal
{"title":"OSA and Accelerated Aging: An Overarching Pathway Driving End-Organ Morbidity and Mortality","authors":"Mohammad Badran , David Gozal","doi":"10.1016/j.arbres.2025.05.016","DOIUrl":"10.1016/j.arbres.2025.05.016","url":null,"abstract":"","PeriodicalId":8339,"journal":{"name":"Archivos De Bronconeumologia","volume":"61 12","pages":"Pages 727-729"},"PeriodicalIF":9.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144265176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.arbres.2025.03.018
Elena Díaz-García , Enrique Alfaro , Paula Pérez-Moreno , Cristina López-Fernández , Aldara García-Sánchez , Miguel Ángel Martínez-García , Eva Mañas , Irene Cano-Pumarega , Raquel Casitas , Francisco Campos-Rodríguez , Manuel Sánchez-de-la-Torre , Eduardo Nagore , Antonio Martorell-Calatayud , Luis Hernández Blasco , Esther Pastor , Jorge Abad-Capa , Josep María Montserrat , Valentín Cabriada-Nuño , Jaime Corral-Peñafiel , Eva Arias , Carolina Cubillos-Zapata
Objectives
Obstructive sleep apnoea (OSA) has been associated with increased cancer risk and mortality, yet specific biomarkers for patient stratification remain lacking. This study explores the role of immune checkpoint biomarkers, soluble Galectin-9 (sGalectin-9) and TIM-3 (sTIM-3), in identifying OSA patients at higher risk of cancer-related mortality.
Methods
We conducted a multicohort, prospective observational study including 684 patients, with and without cancer, who underwent sleep studies. Plasma levels of sGalectin-9 and sTIM-3 were assessed using bead-based multiplexed assays. In vitro and ex vivo models were employed to investigate the pathogenic mechanisms underlying biomarker upregulation and their immunological impact.
Results
In severe OSA patients with melanoma or lung cancer, sGalectin-9 and sTIM-3 were associated with tumour aggressiveness and with an increased mortality risk. In the three study cohorts, biomarker levels were higher in severe OSA patients than in the other groups. In non-cancer OSA patients’ monocyte intracellular Galectin-9 and T-lymphocyte membrane-bound TIM-3 were upregulated. Experimental data revealed that intermittent hypoxia drove the expression of these biomarkers, which were positively associated with inflammatory mediators and inversely related to T-cell proliferation and infiltration. These findings underscore a mechanistic link between hypoxemia and immune suppression.
Interpretation
sGalectin-9 and sTIM-3 are promising prognostic biomarkers for medium- to long-term survival in OSA patients with melanoma or lung cancer. Their upregulation highlights a potential pathophysiological pathway connecting OSA-induced hypoxemia to cancer aggressiveness through immune modulation. Further validation could inform risk stratification and personalised therapeutic strategies.
{"title":"Immune Checkpoint Biomarkers Galectin-9 and TIM-3 Predict Melanoma and Lung Cancer Mortality in Obstructive Sleep Apnoea","authors":"Elena Díaz-García , Enrique Alfaro , Paula Pérez-Moreno , Cristina López-Fernández , Aldara García-Sánchez , Miguel Ángel Martínez-García , Eva Mañas , Irene Cano-Pumarega , Raquel Casitas , Francisco Campos-Rodríguez , Manuel Sánchez-de-la-Torre , Eduardo Nagore , Antonio Martorell-Calatayud , Luis Hernández Blasco , Esther Pastor , Jorge Abad-Capa , Josep María Montserrat , Valentín Cabriada-Nuño , Jaime Corral-Peñafiel , Eva Arias , Carolina Cubillos-Zapata","doi":"10.1016/j.arbres.2025.03.018","DOIUrl":"10.1016/j.arbres.2025.03.018","url":null,"abstract":"<div><h3>Objectives</h3><div>Obstructive sleep apnoea (OSA) has been associated with increased cancer risk and mortality, yet specific biomarkers for patient stratification remain lacking. This study explores the role of immune checkpoint biomarkers, soluble Galectin-9 (sGalectin-9) and TIM-3 (sTIM-3), in identifying OSA patients at higher risk of cancer-related mortality.</div></div><div><h3>Methods</h3><div>We conducted a multicohort, prospective observational study including 684 patients, with and without cancer, who underwent sleep studies. Plasma levels of sGalectin-9 and sTIM-3 were assessed using bead-based multiplexed assays. In vitro and ex vivo models were employed to investigate the pathogenic mechanisms underlying biomarker upregulation and their immunological impact.</div></div><div><h3>Results</h3><div>In severe OSA patients with melanoma or lung cancer, sGalectin-9 and sTIM-3 were associated with tumour aggressiveness and with an increased mortality risk. In the three study cohorts, biomarker levels were higher in severe OSA patients than in the other groups. In non-cancer OSA patients’ monocyte intracellular Galectin-9 and T-lymphocyte membrane-bound TIM-3 were upregulated. Experimental data revealed that intermittent hypoxia drove the expression of these biomarkers, which were positively associated with inflammatory mediators and inversely related to T-cell proliferation and infiltration. These findings underscore a mechanistic link between hypoxemia and immune suppression.</div></div><div><h3>Interpretation</h3><div>sGalectin-9 and sTIM-3 are promising prognostic biomarkers for medium- to long-term survival in OSA patients with melanoma or lung cancer. Their upregulation highlights a potential pathophysiological pathway connecting OSA-induced hypoxemia to cancer aggressiveness through immune modulation. Further validation could inform risk stratification and personalised therapeutic strategies.</div></div>","PeriodicalId":8339,"journal":{"name":"Archivos De Bronconeumologia","volume":"61 12","pages":"Pages 735-748"},"PeriodicalIF":9.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143969336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.arbres.2025.06.013
Qinglin Zhong , Binglin Lai
{"title":"A 46-Year-Old Female With a Left Bronchial Neoplasm Swaying With Respiration","authors":"Qinglin Zhong , Binglin Lai","doi":"10.1016/j.arbres.2025.06.013","DOIUrl":"10.1016/j.arbres.2025.06.013","url":null,"abstract":"","PeriodicalId":8339,"journal":{"name":"Archivos De Bronconeumologia","volume":"61 12","pages":"Pages 805-806"},"PeriodicalIF":9.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144641625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.arbres.2025.06.008
Roberto Bernabéu-Mora , Pilar Cubo Romano , Iñaki Martín Lesende , Elsa Naval Sendra , Juan José Soler-Cataluña , Francisco José Tarazona-Santabalbina
{"title":"COPD and Frailty: Results of a Study Using the Delphi Method","authors":"Roberto Bernabéu-Mora , Pilar Cubo Romano , Iñaki Martín Lesende , Elsa Naval Sendra , Juan José Soler-Cataluña , Francisco José Tarazona-Santabalbina","doi":"10.1016/j.arbres.2025.06.008","DOIUrl":"10.1016/j.arbres.2025.06.008","url":null,"abstract":"","PeriodicalId":8339,"journal":{"name":"Archivos De Bronconeumologia","volume":"61 12","pages":"Pages 783-786"},"PeriodicalIF":9.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144590346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.arbres.2025.04.003
D. Dacal Rivas , E. Martinez-Moragón , V. Plaza , C. Cisneros Serrano , C. Benchimol , H. Izaguirre Flores , S. Sánchez-Cuéllar , M.D. Martínez-Pitarch , C. Fernández Aracil , A. Trisán Alonso , J.C. Serrano Rebollo , Z. Vásquez Gambasica , R.M. Díaz Campos , P. Trujillo Mulato , I. Escribano Gimeno , D. Laorden , E. Arismendi , N. Marina Malanda , A. De Diego Damia , M. Ferrer Galvan , L.A. Pérez de Llano
Objectives
Only one-third of patients with severe asthma (SA) achieve a complete response to biologics. This study aims to characterize two types of failure: early (EF), occurring ≤12 months after biologic initiation, and late (LF), occurring at any time during follow-up after response has been achieved at 12 months.
Methods
This is a multicentre retrospective study of adults treated with the same biologic for ≥24 months. Response was defined as no severe exacerbations in the preceding 12 months, asthma control test ≥20, and no need for maintenance oral corticosteroids. Failure (EF or LF) was defined as non-achievement of any of these objectives.
Results
Two hundred and seventy-two patients were analysed with a mean follow-up of 46.1 ± 19.4 months. At 12 months, 97/272 were classified as PF, but 40% of them recovered response on subsequent visits (by changing inhaled therapy in 74%). Among the 175 responders at 12 months, 124 (70.8%) maintained response throughout the study period, while 51 (29.1%) experienced SF; those patients had lower FEV1 values after 12 months of biological therapy. SF reverted in 36% of cases, with inhaled therapy changes in 41.6%. FEV1 decreased by ≥100 mL in 12 of 16 cases who did not recover response after SF.
Conclusion
Most patients who achieve response at 12 months maintain it over time, but 29% of them suffer LF. Optimization of inhaled therapy can aid response recovery from EF or LF. Maximizing pulmonary function helps to prevent loss of response.
{"title":"Early Failure, Late Failure, and Sustained Response to Biologics in Severe Asthma: A Long-term, Real-world, Multicentre study","authors":"D. Dacal Rivas , E. Martinez-Moragón , V. Plaza , C. Cisneros Serrano , C. Benchimol , H. Izaguirre Flores , S. Sánchez-Cuéllar , M.D. Martínez-Pitarch , C. Fernández Aracil , A. Trisán Alonso , J.C. Serrano Rebollo , Z. Vásquez Gambasica , R.M. Díaz Campos , P. Trujillo Mulato , I. Escribano Gimeno , D. Laorden , E. Arismendi , N. Marina Malanda , A. De Diego Damia , M. Ferrer Galvan , L.A. Pérez de Llano","doi":"10.1016/j.arbres.2025.04.003","DOIUrl":"10.1016/j.arbres.2025.04.003","url":null,"abstract":"<div><h3>Objectives</h3><div>Only one-third of patients with severe asthma (SA) achieve a complete response to biologics. This study aims to characterize two types of failure: early (EF), occurring ≤12 months after biologic initiation, and late (LF), occurring at any time during follow-up after response has been achieved at 12 months.</div></div><div><h3>Methods</h3><div>This is a multicentre retrospective study of adults treated with the same biologic for ≥24 months. Response was defined as no severe exacerbations in the preceding 12 months, asthma control test ≥20, and no need for maintenance oral corticosteroids. Failure (EF or LF) was defined as non-achievement of any of these objectives.</div></div><div><h3>Results</h3><div>Two hundred and seventy-two patients were analysed with a mean follow-up of 46.1<!--> <!-->±<!--> <!-->19.4 months. At 12 months, 97/272 were classified as PF, but 40% of them recovered response on subsequent visits (by changing inhaled therapy in 74%). Among the 175 responders at 12 months, 124 (70.8%) maintained response throughout the study period, while 51 (29.1%) experienced SF; those patients had lower FEV1 values after 12 months of biological therapy. SF reverted in 36% of cases, with inhaled therapy changes in 41.6%. FEV1 decreased by ≥100<!--> <!-->mL in 12 of 16 cases who did not recover response after SF.</div></div><div><h3>Conclusion</h3><div>Most patients who achieve response at 12 months maintain it over time, but 29% of them suffer LF. Optimization of inhaled therapy can aid response recovery from EF or LF. Maximizing pulmonary function helps to prevent loss of response.</div></div>","PeriodicalId":8339,"journal":{"name":"Archivos De Bronconeumologia","volume":"61 12","pages":"Pages 749-756"},"PeriodicalIF":9.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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