Expert review of respiratory medicine最新文献

Introduction: Systemic sclerosis-associated interstitial lung disease (SSc-ILD) is a common complication of systemic sclerosis (SSc), contributing significantly to morbidity and mortality. We aim to bridge knowledge gaps, inform clinical practice, and identify future research directions in this rapidly evolving field.

Areas covered: This review provides a comprehensive analysis of the current understanding and emerging advances in the diagnosis, risk stratification, and treatment of SSc-ILD. High-resolution computed tomography (HRCT) and pulmonary function tests (PFTs) remain cornerstones of diagnosis, but limitations in sensitivity underscore the need for biomarkers such as Chemokine (C-C motif) Ligand 18 (CCL18), Krebs von den Lungen-6 (KL-6), Interleukin-6 (IL-6), and C-reactive protein (CRP) to enhance prognostic precision and treatment personalization. Therapeutic strategies emphasize immunosuppressants alongside antifibrotic agents. Emerging combination therapies and advanced modalities, including hematopoietic stem cell transplantation and chimeric antigen receptor T-cell therapy, show promise in refractory cases. Ongoing clinical trials exploring innovative targets highlight the evolving therapeutic landscape. The review emphasizes challenges in clinical trial design, advocating for adaptive and platform trial methodologies to address disease heterogeneity and enhance treatment sensitivity.

Expert opinion: Advances in biomarkers, composite indices, and personalized therapeutic approaches are key to overcoming existing limitations and improving outcomes for patients with SSc-ILD.

Background: The criteria for COPD exacerbation were redefined in the GOLD 2023 report. This study aimed to evaluate and compare the severity of exacerbations in patients hospitalized with COPD exacerbations [ECOPD] based on the new severity classification defined in the GOLD 2023 report.

Research design and methods: A prospective, cross-sectional, and observational study included a total of 513 ECOPD patients from nine university hospitals. Patients were classified into three groups according to the GOLD 2023 COPD exacerbation severity criteria.

Results: The mean age of the total patients was 68.9 ± 8.8 years, with 83.4% being male. The distribution of exacerbation severity was as follows: mild [24.4%], moderate [50.8%], and severe [24.8%]. The rate of ICU admission [0.8%-4.2%-27.5%] and in-hospital mortality [1.6%-3.9%-9.2%] increased progressively from the mild to the severe exacerbation group [p < 0.001; p = 0.012, respectively]. Factors affecting 180-day mortality included age, smoking pack-years, mMRC score, hypoxemia, elevated CRP, low HCT, low eosinophil, CCI, and experiencing moderate to severe exacerbations. Severe exacerbations were associated with COPD duration, smoking pack-years, mMRC score, hypoxemia, low eosinophil, reduced FEV₁%, and treatment non-adherence.

Conclusions: Our study demonstrates that the new ECOPD severity classification is a distinctive and objective tool for predicting ICU admission and in-hospital mortality.

Background: Drugs used to treat patients with SARS-CoV-2 infection have been tested in different clinical trials but less in real life studies. Our goal was to assess the effectiveness of several specific COVID-19 drugs.

Research design and methods: Retrospective study of all patients testing positive for SARS-CoV-2 infection between 1 March 2020 and 9 January 2022. We extracted sociodemographic, basal comorbidities, specific medication for their COVID-19, COVID-19 vaccination data, and outcomes such as death and admission to hospital and intensive care unit (ICU) during the different periods of the pandemic.

Results: The prescription of corticosteroids to out-of-hospital patients was related to a higher likelihood of hospital admission. Amongst hospitalized patients, all of the drugs studied (dexamethasone, prednisone, methylprednisolone, remdesivir, ritonavir/lopinavir and tocilizumab) were related to a higher likelihood of dying at 90 days or being admitted to an ICU. In patients admitted to an ICU, corticosteroids prevented intrahospital mortality (Odds ratio: 0.73; 95% confident intervals: 0.554-0.969). All drugs were related to longer length of hospital admission and ICU stays.

Conclusions: Most drugs used for COVID-19 patients had no clear benefit except in the case of corticosteroids, associated with a reduced risk of intrahospital mortality among ICU patients.

Background: The objective of this study was to evaluate the association between willingness to engage in self-care and clinical outcomes in patients hospitalized with community-acquired pneumonia (CAP).

Methods: An observational study in patients hospitalized with CAP was conducted. Patients were divided into two groups according to the willingness to engage in self-care, that was assessed with the Patient Activation Measure (PAM). Participants with scores ≤ 47.0 points were included in the unwillingness to engage in self-care group, and patients with PAM score > 47 points were included in the willingness to engage in self-care group. Main variables were assessed at hospital discharge and included clinical symptoms (cough, dyspnea, pain and fatigue), physical status, activity levels, psychological inflexibility and restrictions in daily life activities and social participation.

Results: A total of 66 patients were included in the study (34 in the patients unwilling to engage and 32 in the patients willing to engage). Significant differences were found in clinical symptoms, psychological inflexibility, and restrictions in daily life activities and social participation in favor to patients' willingness to engage in self-care at hospital discharge.

Conclusions: Patients with CAP willing to engage in self-care showed improvements in clinical symptoms, psychological flexibility, and fewer limitations in daily activities and social participation at discharge.

Background: This study investigated the acoustic characteristics of forced expiratory lung sounds during bronchial provocation tests and their predictive value for airway hyperresponsiveness (AHR).

Research design and methods: Participants underwent a bronchial provocation test with incremental methacholine doses (0.072-1.25 mg). Forced expiratory volume in the first second (FEV1) was measured using spirometry, with pre-saline FEV1 as the baseline. AHR was defined as a ≥ 20% decline in FEV1%Ref (FEV1 relative to baseline). Simultaneously, lung sounds were recorded from the right lower lung field. Thirty-five acoustic features were extracted from the first-second forced expiratory lung sound, including 24 spectral parameters, 5 mel-frequency cepstral coefficients (MFCCs), and 6 entropy parameters. Correlation analysis, group comparisons, and logistic regression were conducted to assess the relationship between acoustic features and AHR.

Results: Seventeen patients tested positive for AHR. AHR was associated with decreased spectral parameters (A1-A3, MFCC2-MFCC5) and increased spectral entropy (p < 0.05). Logistic regression identified effective power (PT) and MFCC5 as independent predictors, yielding an AUC of 0.856 (95% CI: 0.769-0.944).

Conclusions: Acoustic features of breath sounds can predict AHR, offering a potential noninvasive alternative to bronchial challenge tests.

Background: The Original BRICS countries (Brazil, Russia, India, China, and South Africa) face similar challenges of a significant increase in the burden of chronic obstructive pulmonary disease (COPD).

Research design and methods: This analysis, based on data from the 2021 Global Burden of Disease (GBD 2021), examined trends in the incidence, mortality, and disability-adjusted life years (DALYs) rates of COPD in Original BRICS countries from 1990 to 2021. Linear regression was used to estimate the annual percentage change (EAPC) of age-standardized rates (ASR), and Bayesian age-period-cohort (BAPC) model was used to predict the COPD burden in 2050.

Results: The disease burden increased with age in 2021, particularly after 45 years old, with significant gender disparities. From 1990 to 2021, the EAPC for age-standardized incidence, mortality, and DALYs rates decreased, with China experiencing the sharpest decline. The COPD burden is predicted to be alleviated across Original BRICS countries in 2050, although men will still be more affected than women.

Conclusion: Despite the substantial improvements, the burden of COPD remains substantial in Original BRICS countries. In 2050, COPD is expected to more pronouncedly affect middle-aged and elderly populations, as well as people exposed to tobacco and environmental pollution.

Background: Cardiopulmonary exercise testing (CPET) is used in the evaluation of unexplained dyspnea. However, its interpretation requires expertise that is often not available. We aim to evaluate the utility of ChatGPT (GPT) in interpreting CPET results.

Research design and methods: This cross-sectional study included 150 patients who underwent CPET. Two expert pulmonologists categorized the results as normal or abnormal (cardiovascular, pulmonary, or other exercise limitations), being the gold standard. GPT versions 3.5 (GPT-3.5) and 4 (GPT-4) analyzed the same data using pre-defined structured inputs.

Results: GPT-3.5 correctly interpreted 67% of the cases. It achieved a sensitivity of 75% and specificity of 98% in identifying normal CPET results. GPT-3.5 had varying results for abnormal CPET tests, depending on the limiting etiology. In contrast, GPT-4 demonstrated improvements in interpreting abnormal tests, with sensitivities of 83% and 92% for respiratory and cardiovascular limitations, respectively. Combining the normal CPET interpretations by both AI models resulted in 91% sensitivity and 98% specificity. Low work rate and peak oxygen consumption were independent predictors for inaccurate interpretations.

Conclusions: Both GPT-3.5 and GPT-4 succeeded in ruling out abnormal CPET results. This tool could be utilized to differentiate between normal and abnormal results.

Background: Asthma remains a public health concern in the United States, with mortality disproportionately affecting demographic groups. This study aimed to describe national trends in asthma mortality from 1999 to 2020 and identify demographic and regional disparities.

Research design and methods: We retrospectively analyzed mortality data from the CDC WONDER database using International Classification of Diseases, Tenth Revision (ICD-10) codes J45 and J46. Age-adjusted mortality rates (AAMRs) were calculated by sex, race, age group, US Census region, state, and urban-rural classification. Joinpoint regression was employed to detect changes over time.

Results: A total of 82,686 asthma-related deaths were identified (37.2% males, 62.8% females). Overall, the AAMR declined from 1.72 in 1999 to 1.14 in 2020. Joinpoint analysis revealed a significant decline from 1999 to 2009, a plateau from 2009 to 2014, a further decline from 2014 to 2018, and a significant increase from 2018 to 2020. Non-Hispanic Black individuals (AAMR 2.73) and older adults (≥65 years) had the highest mortality rates, with females exhibiting higher rates than males (1.30 vs 0.95).

Conclusions: Despite declining trends, persistent disparities in asthma mortality underscore the need for targeted interventions, improved healthcare access, and ongoing surveillance.

Background: non-small cell lung cancer (NSCLC) is the most prevalent malignancy worldwide despite versatile screening programs. Therapy-related adverse events can be predicted with various tools including frailty. Frailty predictive power is less well studied in operable NSCLC.

Research design and methods: Retrospective analysis performed in NSCLC patients undergoing surgery in which ability of two preoperative frailty indexes mFI-5 and mFI-11 to predict the postoperative burden of adverse events was compared against conventional risk assessment tools such as American Society of Anesthesiologists (ASA), or the Revised Cardiac Risk Index (Lee score). Adverse events burden was categorized as any adverse event, any patient-related adverse event, any surgery-related adverse event, any administrative adverse event.

Results: In a sample of 98 patients with surgery for NSCLC, mFI-5 was the best predictor of adverse events burden (OR 36.34, p = 0.006 for any adverse event, 45.2, p = 0.002 for any patient- related adverse event, 23.1, p = 0.01 for any surgery-related adverse event, 12.26, p = 0.03 for any administrative adverse event.

Conclusions: Despite its sporadic use in this setting, preoperative frailty might be a more versatile predictor for postoperative adverse events in patients undergoing open surgery for NSCLC. Further studies with more complex approach for frailty are needed.