BMC Pulmonary Medicine最新文献

Introduction: Studies verifying the performance of antifibrotic drugs for the treatment of ANCA positive fibrotic ILD (ANCA-fILD) are lacking.

Materials and methods: This study assessed the clinical features of ANCA-fILD patients with or without add-on treatment with antifibrotic drugs. A retrospective study involving ANCA-positive patients treated from January 2012 to December 2023 at Peking Union Medical College Hospital was conducted, and a case‒control analysis was performed accordingly.

Results: A total of 105 ANCA-fILD patients were identified from 18,617 ANCA-positive patients treated from January 2012 to December 2023 at Peking Union Medical College Hospital; these patients were further divided into an add-on group (31 patients) and a non-add-on group (74 patients). On the basis of baseline FVC%pred matching (± 10%), 30 and 60 patients were ultimately included in the add-on and non-add-on groups, respectively. The decreases in pFVC (p = 0.03), FVC (p = 0.02), DLCO (p = 0.01), and pDLCO (p < 0.01) were less significant in the add-on group than in the non-add-on group. In the related sample analysis, the add-on group did not present significant differences in FVC (p = 0.47), pFVC (p = 0.53), DLCO (p = 0.90), and pDLCO (p = 0.43) between baseline and at the end of the 1-year follow-up, whereas the non-add-on group presented significant decreases in FVC (p < 0.01), pFVC (p < 0.01), DLCO (p < 0.0001) and pDLCO (p < 0.0001). The incidence rates of adverse events and acute exacerbations were similar between the two groups.

Conclusion: Add-on antifibrotic medications seem to effectively slow the deterioration of lung function in patients with ANCA⁺ fILD without causing any obvious new-onset adverse reactions.

Background: Idiopathic pulmonary fibrosis (IPF) is a progressive interstitial lung disease, with small airway dysfunction (SAD) increasingly recognized as part of its pathophysiology. This study evaluated SAD prevalence and its association with gas exchange and cardiovascular risk using oscillometry.

Methods: Forty-eight IPF patients underwent forced oscillation technique (FOT), impulse oscillometry (IOS), spirometry, plethysmography, and DLCO. Key oscillometry indices (R5, R20, R5-R20, X5, AX, Fres) were analyzed. Associations with DLCO%, GAP index, MRC dyspnea score, and Framingham Risk Score (FRS) were assessed. Multivariable regression adjusted for age, sex, smoking, TLC%, antifibrotic use, and GAP stage.

Results: SAD was highly prevalent, with abnormal AX in all participants, elevated Fres in > 90%, and abnormal R5-R20 in ~ 60%, using both FOT and IOS, confirming consistency across devices. AX and Fres correlated strongly with DLCO% (r = - 0.50, - 0.70; both p < 0.001) and remained independently associated after adjustment. Both also correlated with FRS (p < 0.05), suggesting a link between lung stiffness and cardiovascular risk. No associations were seen with GAP or MRC scores. FOT and IOS showed excellent agreement for oscillometric parameters (r > 0.8), demonstrating strong concordance between the two measurement systems.

Conclusion: SAD is a common, clinically relevant feature of IPF. AX and Fres may serve as sensitive, non-invasive markers for disease monitoring and cardiovascular risk assessment. Further multicenter, longitudinal studies are needed to validate these findings and establish the role of oscillometry in routine clinical practice.

Background: Pleuroparenchymal fibroelastosis (PPFE) is a rare interstitial lung disease (ILD) characterised by elastosis and fibrosis of the pleura and adjacent subpleural lung parenchyma, generally involving the upper lobes. Atypical presentations have been described, with a predominantly (intra-alveolar) airway-centred fibroelastosis without overt pleural involvement, considered to be 'consistent with PPFE'. The current case illustrates an atypical presentation of PPFE, highlighting the heterogeneity of this disease.

Case presentation: A 66-year-old Caucasian female, former smoker, presented with a persistent cough. High-resolution computed tomography (HRCT) revealed a nonspecific interstitial pneumonia (NSIP) pattern in the lower lobes and an intraparenchymal reticulonodular pattern in the upper lobes. Histology confirmed lower-lobe NSIP and intra-alveolar fibroelastosis in the upper lobes without pleural involvement, consistent with PPFE. On follow-up, imaging demonstrated progression of both patterns, with subsequent development of dense pleural consolidations in the upper lobes.

Conclusions: This case illustrates an atypical presentation of PPFE, with initial intra-alveolar localisation preceding overt pleural involvement. Clinicians and radiologists should be aware of secondary PPFE in ILD patients with radiological upper lobe intra-alveolar confluent reticulonodular abnormalities, even in the absence of dense pleural consolidations.

Background: Obesity has been recognized as a risk factor for both the onset and progression of asthma. The lipid accumulation product (LAP) is considered a reliable surrogate marker for visceral adiposity and its related metabolic complications. This study aimed to investigate the potential association between LAP and asthma in adults.

Methods: Data were obtained from the National Health and Nutrition Examination Survey (NHANES) spanning 2005 to March 2020. Multivariable logistic regression, smooth curve fitting, threshold effect analysis and subgroup analyses were conducted to evaluate the association between LAP and asthma in adults. In addition, sensitivity analyses were performed to assess the stability.

Results: Within the sample of 16,861 participants, 1,432 (8.5%) were diagnosed with current asthma. After full adjustment, each one-unit increase in ln LAP was associated with 39% higher odds of asthma prevalence. Compared with those in the lowest quartile (Q1), participants in the highest quartile (Q4) of ln LAP had a 65% increase in the odds of asthma (OR = 1.65, 95% CI: 1.15-2.38). In addition, gender difference and diabetes status altered the association between LAP and asthma (P for interaction < 0.05).

Conclusions: This study highlights a significant association between LAP and asthma prevalence in adults, particularly among females and individuals with diabetes.