BMC Pulmonary Medicine最新文献

Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of global morbidity, with aging and smoking as key risk factors. However, the mediating role of biological aging in the smoking-COPD relationship has been rarely examined in Chinese populations.

Methods: In this hospital-based cohort study, 1,269 Chinese adults aged 40-84 years without COPD were enrolled. We developed Klemera-Doubal method-biological age (KDM-BA) using 11 routine clinical biomarkers. KDM-BA acceleration (KDM-BAAc) was calculated by regressing KDM-BA on chronological age (CA). Three Cox models were used to assess the association between KDM-BAAc and COPD risk. Restricted cubic spline models were used to evaluate the dose-response relationship between KDM-BAAc and COPD risk. Counterfactual mediation analysis was used to quantify BA acceleration's mediating role in smoking-COPD association.

Results: Over a mean follow-up of 3.4 years, 47 incident COPD cases occurred (incidence rate: 10.90/1000 person-years). Biological older was associated with higher COPD incidence [15.94 vs. 7.00/1,000 person-years; rate ratios (RR) = 2.28, 95% confidence intervals (95% CI) = 1.22-4.40]. Each 1-year increase in KDM-BAAc elevated COPD risk by 7% [fully adjusted hazard ratio (HR) = 1.07, 95% CI = 1.03-1.12]. Dose-response relationships were found between biological aging and COPD (fully adjusted P _{for overall} = 0.003). KDM-BAAc mediated 14.3% (fully adjusted) of smoking's effect on COPD. Results remained robust across sensitivity analysis.

Conclusion: Accelerated biological aging is associated with increased COPD risk and serves as a significant mediator in the smoking-COPD relationship among Chinese adults.

Objectives: To explore the impact of individualized pulmonary rehabilitation (PR) program on respiratory function, exercise endurance and quality of life in pneumoconiosis patients, aiming to provide scientific and effective methods for rehabilitation treatment of pneumoconiosis patients.

Methods: A total of 198 pneumoconiosis patients were selected based on the data of pneumoconiosis patients at various pneumoconiosis rehabilitation stations in Longyan City, Fujian Province from August 2022 to August 2023. Patients were randomly divided into control group and rehabilitation group according to the random digits table method. Patients in the two groups were given routine treatment, whereas patients in the rehabilitation group received individualized PR treatment in addition. Pulmonary function indicators (FEV₁, FVC, FEV₁/FVC, PEF, MEF_75%, MEF_50%, MEF_25%), six-minute walk distance (6MWD), Mini Nutritional Assessment Short Form (MNA-SF), COPD Assessment Test (CAT), modified Medical Research Council (mMRC) dyspnea scale, Borg scale, Hospital Anxiety and Depression Scale (HADS), maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) were used to evaluate and compare the efficacy of the two groups.

Results: Compared with the control group, statistically significant increases in FVC, FEV₁, FEV₁/FVC, PEF, MEF_75%, MEF_50% and MEF_25% were detected in the rehabilitation group after treatment (P < 0.05, effect size = 0.93,0.97,1.13,1.24,1.20,1.00,1.21). In the rehabilitation group, there were statistically significant improvements in FVC, FEV₁, FEV₁/FVC, PEF, MEF_75%, MEF_50%, MEF_25% following treatment compared to baseline measurements (P < 0.05). Compared with the control group, we observed a significant decreases in CAT, mMRC, Borg scale and HADS scores (P < 0.05, effect size =-1.12,-0.75,-1.30,-0.63,-1.07), and a significant increase in the MNA-SF score in the rehabilitation group after treatment (P < 0.05, effect size = 1.09). Following treatment, the MIP, MEP and 6MWD in the rehabilitation group significantly improved compared with the control group (P < 0.05, effect size = 0.78,0.69,1.22).

Conclusion: Individualized PR improved the respiratory function and exercise endurance of pneumoconiosis patients, and improved their quality of life.

Introduction: Pulmonary nocardiosis lacks specific symptoms and characteristic test findings, making diagnosis and treatment challenging. Therefore, to clarify its clinical features, we analyzed 21 cases diagnosed as pulmonary nocardiosis at our institution.

Methods: We conducted a retrospective review of cases in which Nocardia species were isolated from respiratory specimens at Saitama Red Cross Hospital between January 2017 and May 2024.

Results: The cohort included 14 females and 7 males, with a mean age of 71.8 years. Underlying lung diseases were present in 14 cases (66.7%), with pulmonary nontuberculous mycobacterial (NTM) disease being the most common (8 cases). Mixed infections with other bacteria were observed in 10 cases (47.6%) at the time of pulmonary nocardiosis diagnosis, including 4 cases involving NTM. Additionally, during follow-up after diagnosis, 4 patients (19.0%) developed mixed infections with Pseudomonas aeruginosa. The prognosis of pulmonary nocardiosis itself was favorable.

Conclusion: Given that many patients have underlying lung diseases and that mixed infections (particularly with NTM and P. aeruginosa) are frequently observed both at diagnosis and during follow-up, it is crucial to always consider the possibility of pulmonary nocardiosis when symptoms or imaging findings worsen.

Background: Eosinophils are key factors to the pathogenesis of severe eosinophilic asthma and eosinophilic granulomatosis with polyangiitis (EGPA). Monoclonal antibodies targeting the interleukin-5 (IL-5) pathway (mepolizumab and benralizumab) often lead to rapid symptom control and enable tapering of oral corticosteroids (OCS) in many patients.

Case presentation: We present the case of a 51-year-old male patient with severe eosinophilic asthma, peripheral blood eosinophilia, and ear, nose, and throat (ENT) involvement, treated with benralizumab (30 mg every 8 weeks) and oral corticosteroids. During tapering of corticosteroids, the patient developed diffuse alveolar haemorrhage as a manifestation of overt vasculitis. Subsequently, elevated troponin T levels were detected, and further diagnostic work-up revealed both myocardial involvement consistent with EGPA and an acute myocardial infarction due to occlusion of the left anterior descending (LAD) artery.

Conclusion: Central immunopathogenic pathways involved in vasculitis are not targeted by IL-5 antibodies and vasculitic manifestations may relapse or even newly emerge despite ongoing biological therapy. Elevated troponin levels in EGPA patients should only be attributed to EGPA once other potential causes of myocardial injury are ruled out.

Background: Lung ultrasonography (LUS) is well-established for assessing pneumonia but underutilized in pulmonary fibrosis (PF). This study aimed to investigate the feasibility of LUS combined with transthoracic echocardiography (TTE) for assessment and stratification of PF.

Methods: In this cross-sectional study, consecutive patients with interstitial lung disease were enrolled and underwent LUS, TTE, chest high-resolution computed tomography (HRCT), and pulmonary function tests. The correlations between LUS, TTE findings, and disease severity were explored, and receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic accuracy for PF stratification.

Results: A total of 107 patients (aged 60.64 ± 11.03 years; 49 males) were included. LUS score and pleural line thickness correlated significantly with PF severity (r_s = 0.734 and 0.786, adjusted P < 0.001) and showed significant negative correlations with lung function. TTE assessment in severe PF revealed abnormalities including elevated echocardiographic probability of pulmonary hypertension, higher right ventricular diastolic dysfunction incidence, and lower tricuspid annular plane systolic excursion (TAPSE), among other parameters. For distinguishing severe from mild-moderate PF, the combination of LUS and TTE achieved an area under the ROC curve (AUC) of 0.962 (91.38% sensitivity, 87.76% specificity), which was significantly higher than that of either modality alone (P = 0.028).

Conclusions: This study demonstrated that the findings of LUS were correlated with disease severity and pulmonary function of patients with PF. LUS score showed a good capacity for diagnosing severe PF, and this capacity was enhanced by combining with TTE.