Expert review of respiratory medicine最新文献

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.

Introduction: Lung cancer is responsible for premature cancer deaths in women and is the first cause of cancer deaths in women in many countries The problem of lung cancer in women seems to be underestimated in many aspects, including low participation in clinical trials and screening tests.

Areas covered: Current research progress has contributed to a better understanding of the issue and makes it possible to describe the problem in a new light. In our paper the problem of lung cancer in women was discussed in a broad aspect, taking into account women's health, the harmful effects of smoking and the current diagnostic and treatment process. The results of treatment also differ in relation to sex. All these aspects of the diversity of women's lung cancer was presented on the basis of newest and most comprehensive literature.

Expert opinion: Lung cancer in women is and will remain an important health problem worldwide, which is justified by epidemiological data, basic research and treatment results.

Background: Immunomodulators tocilizumab and baricitinib have been used for the treatment of severe COVID-19, however, there are only few published studies comparing their efficacy.

Research design and methods: All consecutive non-ICU hospitalized severe COVID-19 patients who received baricitinib or tocilizumab, were included retrospectively. Primary outcomes were mortality or intubation on day 14, time to oxygen therapy weaning and duration of hospitalization. Safety was measured as treatment-related adverse events.

Results: 321 hospitalized patients with severe COVID-19 were included (mean age 62.4 years ± 14.7); 241 (75.1%) received baricitinib (mean age 64.2 years ± 15.2) and 80 (24.9%) tocilizumab (mean age 57.3 ± 11.7). Patients who received baricitinib presented significantly lower risk of mortality or intubation on day 14, compared to the tocilizumab group after adjusting for age, sex, vaccination, Charlson comorbidity index, body mass index, remdesivir administration and WHO ordinal scale at enrollment (OR: 0.42, 95% CI: 0.20-0.86). In the augmented inverse-probability weighting regression, the protective role of baricitinib remained statistically significant (OR: 0.76, 95% CI: 0.66-0.88). No difference in secondary bacterial infections was detected, but tocilizumab was associated with significant higher rate of liver injury (Odds Ratio, 95%CI, p < 0.001).

Conclusions: Our study suggests survival and safety are significantly better for baricitinib compared to tocilizumab in severe COVID-19. Clinical randomized trials are needed for confirmation.

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: The use of lung ultrasound (LUS) has recently become vital in the diagnosis and prognosis of various respiratory diseases. Its role in COVID-19 requires further investigation.

Research design and methods: Twenty-five consecutive, non-ICU hospitalized COVID-19 patients were included. LUS was performed on admission and sequentially every 3 days at 8 points in the chest. Based on the LUS findings a score was designed. Logarithmic regression models and ROC curve analysis were applied.

Results: A statistically significant positive correlation was found between LUS score at admission and the severity of SARS-COV-2 infection. Higher LUS score was significantly associated with lower PaO₂/FiO₂ ratio, use of HFNC, longer hospitalization and greater extent of chest CT infiltrates. A significant association between LUS score and risk of death or intubation or HFNC was found. For one point of increase in the score, risk of death or intubation or HFNC increased 1.93-fold (95% CI 1.02 to 3.65). The predictive role of the score was very satisfactory (area under the ROC curve = 0.87).

Conclusions: Lung ultrasound findings were significantly positively associated with clinical and radiological markers of severity of SARS-CoV-2 pneumonia. It therefore constitutes a promising and reliable technique for assessing pneumonia, comparable to chest CT.

Background: Elevated serum tumor-associated antigens (TAAs) were reported to be common in patients with interstitial lung disease (ILD), and correlated with pulmonary involvement or malignancy development. However there were no adequate longitudinal studies on the association between elevated TAAs and various types of ILDs in Chinese patients.

Research design and methods: The treatment-naïve ILD patients were retrospectively enrolled. The clinical, laboratory, imaging characteristics and prognosis were analyzed and compared among those with normal and different number of elevated TAAs.

Results: An increase of at least one TAA was present in 169/308 (54.87%) of our patients. Both baseline alveolar and interstitial scores were much higher, and lung involvement tended to be worse during follow up in patients with two and three or more elevated TAAs than in normal TAAs. Patients with three or more elevated TAAs had the highest interstitial scores and a higher all-cause mortality during follow-up than those with one elevated TAA or normal TAAs. The occurrence of malignancy was similar in all patients.

Conclusion: Elevated TAAs were present in 54.87% of ILD patients and associated with lung interstitial lesions, which might be a marker for lung involvement progression, while not for malignancy development in ILD.

Introduction: Idiopathic pulmonary fibrosis (IPF) is a chronic lung disease characterized by progressive scarring and reduced survival. The development of IPF is influenced by rare and common genetic variants, cigarette smoking, aging, and environmental exposures. Among the two dozen genetic contributors, the MUC5B promoter variant (rs35705950) is the dominant risk factor, increasing the risk of both familial and sporadic IPF and accounting for nearly 50% of the genetic predisposition to the disease.

Areas covered: This review provides an expert perspective on the genetic underpinnings of IPF rather than a systematic analysis, emphasizing key insights into its genetic basis. The articles referenced in this review were identified through targeted searches in PubMed, Scopus, and Web of Science for studies published between 2000 and 2023, prioritizing influential research on the genetic factors contributing to IPF. Search terms included 'idiopathic pulmonary fibrosis,' 'genetics,' 'MUC5B,' 'telomere dysfunction,' and 'surfactant proteins.' The selection of studies was guided by the authors' expertise, focusing on the most relevant publications.

Expert opinion: The identification of genetic variants not only highlights the complexity of IPF but also offers potential for earlier diagnosis and personalized treatment strategies targeting specific genetic pathways, ultimately aiming to improve patient outcomes.

Introduction: The first-line treatment landscape for patients with NSCLC harboring sensitizing EGFR mutations is rapidly evolving. Initially, osimertinib was the one and only option over earlier generation EGFR inhibitors based on the positive PFS and OS results from the FLAURA study.

Areas covered: This paper reviews and compares the pivotal studies that led to the approval of combination treatment with a focus on the efficacy and safety of amivantamab plus lazertinib in the front-line setting. The literature reviewed in this paper primarily includes key studies published in well-established journals and oncological conferences, such as ASCO, ESMO, and NEJM, between 2018 and 2024.

Expert opinion: Recent advancements, including the results of FLAURA-2 and MARIPOSA, have introduced combination therapies that demonstrate enhanced efficacy.

Background: NT-proBNP, traditionally used to assess heart failure, is increasingly recognized for its prognostic value in other diseases. This study evaluates its value in pneumonia.

Research design and methods: We conducted a retrospective cohort study of adult patients hospitalized for pneumonia at Wan Fang Hospital (2017-2021) to investigate whether elevated NT-proBNP levels predicted poorer outcomes. Logistic regression identified risk factors for 28-day mortality, while the Cox regression model identified predictors of post-discharge survival.

Results: Among 2,805 patients (79.6 ± 13.4 years, female 45%), the 28-day mortality rate was 18.2%, and the median post-discharge follow-up time was 359 days. Moderately (increased but < 10000 pg/mL) and severely (>10000 pg/mL) elevated NT-proBNP levels had higher 28-day mortality compared to normal NT-proBNP; adjusted odds ratios: 2.24 (1.34-3.75, p = 0.002) and 3.57 (2.03-6.27, p < 0.001). Moderately and severely elevated NT-proBNP levels related to shorter survival time than normal NT-proBNP levels; adjusted hazard ratios 1.60 (1.28-2.00, p < 0.001) and 2.03 (1.56-2.63, p < 0.001). All ratios were adjusted with comorbidities, sex, age, and clinical and laboratory tests.

Conclusions: Elevated NT-proBNP levels predict higher 28-day mortality and shorter survival time in patients with pneumonia across most subpopulations. This marker holds potential as a prognostic biomarker for pneumonia, especially in high-risk patients.