Respir Med [JOURNAL]
Sun
200 papers
The mean apnea-hypopnea duration in children with obstructive sleep apnea is closely associated with the apnea-hypopnea index rather than anatomical severity.
Luo C, Li Q, Chen W
Respir Med · 2026 May · PMID 41935700 · Publisher ↗
OBJECTIVE: To investigate correlations between mean apnea-hypopnea duration (MAD) and clinical/polysomnographic parameters in pediatric obstructive sleep apnea (OSA). METHODS: We analyzed 568 children diagnosed with OSA...
OBJECTIVE: To investigate correlations between mean apnea-hypopnea duration (MAD) and clinical/polysomnographic parameters in pediatric obstructive sleep apnea (OSA). METHODS: We analyzed 568 children diagnosed with OSA (2017-2024) using polysomnography. Participants were categorized into long MAD (≥11 s) and short MAD (<11 s) groups for comparative analysis. RESULTS: No significant differences existed in age, gender, or BMI. The long MAD group demonstrated significantly higher adenoid grades and elevated arousal indices. All respiratory event indices were increased in the long MAD group. Minimum oxygen saturation (including during REM sleep) was significantly lower, while oxygen desaturation indices were higher in this group. CONCLUSION: In pediatric OSA, the mean apnea-hypopnea duration enhances pathophysiological understanding but functions as a severity marker closely aligned with the apnea-hypopnea index.
High-flow nasal oxygen versus conventional oxygen therapy in patients with hypoxemic COVID-19 pneumonia: A randomized controlled trials based meta-analysis.
Zheng C, Zhu J, Lu Z … +4 more , Jiang L, Chen F, Zhang W, Jiang Y
Respir Med · 2026 May · PMID 41935699 · Publisher ↗
BACKGROUND: Although the COVID-19 pandemic has ended, severe cases of COVID-19 pneumonia (pneumonia caused by SARS-CoV-2) are still common in clinical practice. These patients frequently suffer from hypoxemia, for which...
BACKGROUND: Although the COVID-19 pandemic has ended, severe cases of COVID-19 pneumonia (pneumonia caused by SARS-CoV-2) are still common in clinical practice. These patients frequently suffer from hypoxemia, for which conventional oxygen therapy (COT) may be insufficient. High-flow nasal oxygen (HFNO) provides enhanced oxygen delivery, but its overall clinical benefits remain uncertain. Our meta-analysis assesses HFNO's effectiveness and safety compared to COT for treating COVID-19-related hypoxemia by combining data from RCTs. METHODS: We thoroughly explored six databases to identify suitable RCTs that examined HFNO versus COT in COVID-19 hypoxemic patients. Mortality and intubation were the main outcomes, while secondary outcomes included hospitalization indicators and blood gas monitoring indicators following oxygen therapy. RESULTS: Eight RCTs involving 2528 patients were included. HFNO therapy demonstrated significantly lower rates of total intubation (Risk ratio: 0.86 [0.78, 0.95], P = 0.003), as well as intubation at 7, 14, and 28 days compared with COT. Additionally, the HFNO group showed a shorter time to oxygen therapy de-escalation (MD: 3.53 [-4.50, -2.55] days, P < 0.00001). After oxygenation therapy, the HFNO group exhibited a lower respiratory rate (MD: 2.77 [-3.67, -1.88] breaths/min, P < 0.00001), PaCO (MD: 1.00 [-1.67, -0.33] mmHg, P = 0.003), and a higher SpO/FiO ratio (MD: 47.00 [34.77, 59.23], P < 0.00001). Similar baseline characteristics and mortality rates were found between the two groups. CONCLUSIONS: HFNO treatment demonstrated advantages over COT, with comparable mortality rates, reduced intubation requirements, and improved post-therapy monitoring metrics in patients with COVID-19-induced hypoxemia.
Capturing what people with COPD want: a systematic review of goal-oriented measurement instruments.
Souto-Miranda S, Rodrigues G, Spruit MA … +1 more , Marques A
Respir Med · 2026 May · PMID 41933707 · Publisher ↗
BACKGROUND: A core outcome set (COS) for chronic obstructive pulmonary disease (COPD) recommends measuring personal goal attainment following PR. However, the optimal method for this assessment remains unclear. This arti...
BACKGROUND: A core outcome set (COS) for chronic obstructive pulmonary disease (COPD) recommends measuring personal goal attainment following PR. However, the optimal method for this assessment remains unclear. This article provides a perspective on a review of existing patient-reported outcome measures (PROMs) and their measurement properties, in an attempt to identify the best PROM for assessing personal goals in individuals with COPD. METHODS: The review followed a two-phase approach. In the first phase, a systematic search of PubMed, ScienceDirect and Scopus was conducted to identify PROMs used to assess goal attainment in individuals with COPD after any intervention. In the second phase, measurement properties of the identified PROMs were reviewed using the Consensus-based Standards for the selection of health Measurement INstruments guidelines and search filter. RESULTS: Only one article, reporting on Goal Attainment Scaling, was included after full-text assessment. The Goal Attainment Scaling was used to measure the personal goals of individuals with COPD following a community pharmacist intervention. No studies on the measurement properties of Goal Attainment Scaling were found. CONCLUSION: This review highlights the lack of PROMs specifically developed and evaluated for assessing personal goals in COPD. Future research should focus on validating the use of Goal Attainment Scaling in the COPD and PR contexts or developing a new PROM to integrate into the COS. PROSPERO REGISTRATION ID: CRD42022313344.
Diagnostic and prognostic value of LAMB2 in sepsis patients admitted to the intensive care unit.
Feng C, Ye H, Lv M … +4 more , Wang R, Wang H, Cao L, Shao M
Respir Med · 2026 Jun · PMID 41932656 · Publisher ↗
OBJECTIVE: Sepsis is a major cause of mortality in intensive care unit (ICU) patients. The LAMB2 gene encodes laminin β2, a critical basement membrane component involved in maintaining tissue and organ integrity. However...
OBJECTIVE: Sepsis is a major cause of mortality in intensive care unit (ICU) patients. The LAMB2 gene encodes laminin β2, a critical basement membrane component involved in maintaining tissue and organ integrity. However, the clinical significance of LAMB2 expression in sepsis diagnosis and prognosis remains unclear. This study aimed to evaluate the potential of LAMB2 as a biomarker for sepsis. METHODS: A total of 172 sepsis patients admitted to the ICU of the First Affiliated Hospital of Anhui Medical University between June 2023 and September 2024, and 39 non-septic healthy controls undergoing routine health examinations at the same hospital, were enrolled. All patients met the Sepsis 3.0 diagnostic criteria and were divided into sepsis (n = 88) and septic shock (n = 84) groups. Serum and monocyte LAMB2 levels were measured using ELISA and RT-qPCR, respectively. We also queried The Human Protein Atlas (HPA) datasets to profile baseline LAMB2 expression across human immune cell subsets. The diagnostic and prognostic value of LAMB2 was assessed via multivariate regression, ROC curve, and Kaplan-Meier survival analysis. RESULTS: Patients with septic shock showed significantly lower LAMB2 mRNA and serum levels compared to sepsis patients and healthy controls (p < 0.001). Serum LAMB2 was strongly negatively correlated with lactate levels (r = -0.823, p < 0.001). LAMB2 mRNA was inversely correlated with SOFA scores (r = -0.361, p < 0.001) and renal function markers, including creatinine (r = -0.426) and BUN (r = -0.304). The AUCs for predicting 28-day mortality using LAMB2 mRNA and serum levels were 0.613 and 0.676, respectively. CONCLUSION: Reduced LAMB2 levels were associated with organ dysfunction and poor outcomes in sepsis. Serum LAMB2 may serve as an independent predictor of disease severity and 28-day mortality.
Elevated pulmonary vascular resistance is associated with acute exacerbation admission in patients with chronic obstructive pulmonary disease-related pulmonary hypertension.
Chen Y, Liu M, Liu J … +6 more , Chen S, Zhang T, Zhong J, Li C, Zhu Z, Li F
Respir Med · 2026 May · PMID 41921789 · Publisher ↗
BACKGROUND AND OBJECTIVE: Pulmonary hypertension (PH) is defined by elevated mean pulmonary arterial pressure (mPAP), and elevated pulmonary vascular resistance (PVR) reflects pulmonary vascular abnormalities. The clinic...
BACKGROUND AND OBJECTIVE: Pulmonary hypertension (PH) is defined by elevated mean pulmonary arterial pressure (mPAP), and elevated pulmonary vascular resistance (PVR) reflects pulmonary vascular abnormalities. The clinical significance of severe PH in patients with chronic obstructive pulmonary disease (COPD) has not been fully elucidated. We aimed to investigate the predictive value of PVR for acute exacerbation (AE) admission in patients with COPD-related PH (COPD-PH). METHODS: We retrospectively analyzed COPD patients who underwent right heart catheterization (RHC) for the initial evaluation of PH from January 2019 to January 2023. These patients were classified into groups with or without PH, and further into non-severe or severe PH based on PVR. The clinical significance of PVR in predicting AE admission was analyzed. RESULTS: Among 2729 patients, 268 underwent RHC, and the clinical datas of 99 patients were included in the final analysis. 76 (76.8%) patients were readmitted due to acute exacerbation within one year. In Cox proportional hazards analyses with adjustment for covariates, severe PH patients had a higher risk of AE admission((HR 5.478, 95%CI 2.471 to 12.114, P = 0.000; HR 7.097, 95%CI 2.994 to 16.825, P = 0.000; HR 8.210, 95%CI 3.457 to 19.497, P = 0.000, respectively). Severe PH was associated with poorer AE admission rates (log-rank χ = 19.4; P < 0.0001). CONCLUSIONS: Elevated PVR serves as an independent predictor for acute exacerbation-related hospitalization in patients with COPD-PH: Specifically, a PVR >5 Wood units (defining severe PH) is independently associated with a significantly increased risk of admission due to AE. TRIAL REGISTRATION: The registration number(rhBNP-PH2022); Date of registration(June 30, 2022)(retrospectively registered).
Effects of adding balance training to pulmonary rehabilitation in individuals with COPD: A systematic review and meta-analysis of randomized controlled trials.
Sepúlveda-Loyola W, Aguayo JC, Pasten JG … +3 more , Cuyul-Vásquez I, Valenzuela-Fuenzalida JJ, Carvalho CRF
Respir Med · 2026 May · PMID 41921788 · Publisher ↗
BACKGROUND: COPD is associated with extrapulmonary manifestations, including balance impairment, which increases the fall risk and reduces functional independence and quality of life. Pulmonary rehabilitation (PR) rarely...
BACKGROUND: COPD is associated with extrapulmonary manifestations, including balance impairment, which increases the fall risk and reduces functional independence and quality of life. Pulmonary rehabilitation (PR) rarely includes specific balance exercises. This systematic review evaluated the effectiveness of adding balance training (BT) to conventional PR in COPD patients. METHODS: This review was registered in PROSPERO (CRD42024523748) and conducted in accordance with PRISMA guidelines. Six databases were searched up to July 2025 for RCTs involving COPD patients aged ≥50 years that compared PR + BT with PR alone. The outcomes included static balance, dynamic balance, overall balance, balance confidence, functional exercise capacity, and health-related quality of life. The risk of bias was assessed using the Cochrane RoB-2 tool, and meta-analyses were performed using JAMOVI software 5.4. RESULTS: Seven trials with 548 participants were included. BT protocols involved static and dynamic exercises, dual-task activities, and progression from stable to unstable surfaces. Compared with PR alone, PR + BT significantly improved static balance (MD = 3.29 s; 95% CI: 2.76 to 3.82), dynamic balance (MD = -2.08 s; 95% CI: 2.48 to -1.69), overall balance (MD = 3.09 score; 95% CI: 1.11 to 5.06), balance confidence (MD = 6.48 score; 95% CI: 2.48 to 10.48), and health-related quality of life (SMD = -0.78; 95% CI: 1.45 to -0.11). No significant differences were found for functional exercise capacity. CONCLUSION: Incorporating BT into PR improves balance and health-related quality of life among individuals with COPD. Given the high prevalence of balance impairments in this population, these findings support balance training as a clinically relevant component of PR.
3-dimensional bronchial deformation analysis in left upper lobectomy: inferior pulmonary ligament dissection versus preservation.
Kim MS, Ahn HY, Cho HS … +1 more , Lee C
Respir Med · 2026 May · PMID 41912042 · Publisher ↗
BACKGROUND: Upper lobectomy was the independent factor that caused a greater reduction in postoperative lung function. This was deducible from the upward movement of residual lobes caused by releasing inferior pulmonary...
BACKGROUND: Upper lobectomy was the independent factor that caused a greater reduction in postoperative lung function. This was deducible from the upward movement of residual lobes caused by releasing inferior pulmonary ligament. In case with left upper lobectomy, more dramatic postoperative pulmonary changes were developed compared with after right upper lobectomy, due to larger volume it has. We aim to analyze the bronchial deformation associated with the postoperative lung function in the setting of inferior pulmonary ligament dissection. METHODS: Patients who underwent left upper lobectomy between January 2021 and March 2023 were divided into two groups based on whether the inferior pulmonary ligament was dissected or preserved. Geometric data of the airways were assessed using a 3-dimensional model. To identify the impact of geometric changes on lung function, the relationship between bronchial deformation, cross-sectional area, and forced expiratory volume was analyzed to identify the impact of geometric changes on lung function. Inverse probability of treatment weighting was used to adjust for selection bias. RESULTS: Left lobar bronchus twist, cross-sectional area reduction ratio, and forced expiratory volume reduction ratio were significantly higher in the Dissection group than in the Preservation group before and after inverse probability of treatment weighting. After adjustment, the twist of the left lobar bronchus was a significant predictor of cross-sectional area and forced expiratory volume reduction ratio in the Dissection group. CONCLUSION: Inferior pulmonary ligament dissection during left upper lobectomy can lead to twist of the left lobar bronchus following cross-sectional area reduction, thereby causing pulmonary dysfunction.
Body position and immersion associate with lung function differently in healthy and asthmatic endurance athletes.
Rodrigues J, Jesus B, Caseiro P … +1 more , Rama L
Respir Med · 2026 May · PMID 41903613 · Publisher ↗
AIM: Lung function is known to change with immersion and body position. However, little is known about these changes in endurance athletes, particularly regarding the influence of allergies and asthma in this population....
AIM: Lung function is known to change with immersion and body position. However, little is known about these changes in endurance athletes, particularly regarding the influence of allergies and asthma in this population. This study aims to clarify related changes in trained endurance athletes' lung function associated to different body positions and immersion, and allergies and asthma influence on those changes. METHODS: Athletes underwent spirometry testing at rest in four randomized positions: seated on land, prone on land, seated while immersed, and prone while immersed. The sample was comprised of 45 male athletes: 15 swimmers, 15 triathletes, and 15 runners. Data from the spirometry tests were collected in a pool and pool's deck. RESULTS: All the lung function variables varied across the different positions (FVC, FEV, and FEF with p < 0.001, and PEF with p = 0.001), except for FEV/FVC, which remained unchanged (p = 0.207). Overall, athletes without self-reported allergies or asthma showed greater positional differences. CONCLUSIONS: Endurance athlete's FVC, FEV, and FEF appear to decrease primarily in response to hydrostatic pressure, while PEF decreases mainly in response to the change in body position. FVC in allergic athletes, and FEV, and FEF in asthmatic athletes appear to decrease mainly in response to the change in body position, and PEF decreases mainly in response to hydrostatic pressure. The specific effects in response to allergy and asthma appear to accumulate with the overall effects, leading to differences from the on-land seated condition to the other three positions, but no difference among the later three positions.
Oxygen desaturation index and fibrinogen: An independent association in sleep-disordered breathing - A retrospective cross-sectional study.
Han Y
Respir Med · 2026 May · PMID 41903612 · Publisher ↗
BACKGROUND AND AIMS: Obstructive sleep apnea (OSA) elevates cardiovascular risk partly through coagulation dysregulation, in which fibrinogen (FIB) plays a central role. However, the independent association between oxyge...
BACKGROUND AND AIMS: Obstructive sleep apnea (OSA) elevates cardiovascular risk partly through coagulation dysregulation, in which fibrinogen (FIB) plays a central role. However, the independent association between oxygen desaturation index (ODI), rather than apnea-hypopnea index (AHI), and FIB requires robust validation amid challenges of confounding. To determine whether ODI is an independent and robust predictor of plasma fibrinogen levels in a clinical sleep-disordered population. METHODS: We conducted a retrospective analysis of 690 OSA patients who underwent sleep monitoring and FIB measurement. Missing data were handled using multiple imputation and then LASSO regression was performed to identify key predictors of FIB. RESULTS: LASSO consistently selected ODI, diabetes, smoking, and alanine aminotransferase (ALT) as key predictors across all datasets (100% selection rate). In the adjusted model, ODI demonstrated a significant independent association with fibrinogen (β = 0.0039 per unit, 95% CI: 0.0025-0.0054, P < 0.001), corresponding to a 0.16 g/L increase across the interquartile range of ODI. This association remained stable after bootstrap validation, multiple imputation pooling (pooled β = 0.0041, P < 0.001). CONCLUSION: ODI is a robust and independent predictor of fibrinogen levels in sleep-disordered breathing, with a clinically meaningful effect size comparable to established cardiovascular risk factors. These findings underscore the pivotal role of hypoxemic burden in the prothrombotic state of OSA and support its integration into cardiovascular risk assessment.
Development and short-term effectiveness of a theory-informed, nurse-led structured rehabilitation consultation in primary care asthma management.
Santos A, Silva L
Respir Med · 2026 May · PMID 41895345 · Publisher ↗
AIM: To evaluate the effectiveness of a nurse-led, structured rehabilitation consultation for adults with asthma on asthma control, health-related quality of life, and patient enablement, compared with usual nursing care...
AIM: To evaluate the effectiveness of a nurse-led, structured rehabilitation consultation for adults with asthma on asthma control, health-related quality of life, and patient enablement, compared with usual nursing care. BACKGROUND: Despite effective pharmacotherapy, many adults experience poorly controlled asthma. Nurse-led rehabilitation approaches that combine education, inhaler technique training, and breathing and positioning strategies may strengthen self-management in primary care. METHODS: Two-arm, parallel-group randomised controlled trial conducted in primary care in northern Portugal (March-July 2023). Adults with physician-diagnosed asthma were randomised 1:1 to a four-week intervention (four individualised sessions; 60 min in week 1 and 45 min in weeks 2-4) or to usual care. Outcomes were assessed at baseline and 4 weeks using the Control of Allergic Rhinitis and Asthma Test (CARAT; primary outcome), the mini-Asthma Quality of Life Questionnaire (mini-AQLQ), and the modified Patient Enablement Instrument (mPEI). Analyses followed a per-protocol approach, including participants who completed baseline and follow-up assessments. Between-group comparisons and effect sizes (Cohen's d) were used. Of the 124 randomised participants, 98 completed follow-up and were included in the final analysis (intervention n = 48; control n = 50). Compared with usual care, the intervention produced greater improvement in asthma control (CARAT change 5.9 ± 1.2 vs 2.3 ± 0.7; p = 0.003; d = 0.6), quality of life (mini-AQLQ change 0.85 ± 0.23 vs 0.38 ± 0.13; p = 0.006; d = 0.5), and enablement (mPEI change 8.0 ± 3.3 vs 6.0 ± 3.5; p = 0.008; d = 0.6). No adverse events were reported. CONCLUSIONS: A brief, structured nurse-led respiratory rehabilitation consultation improved asthma control, quality of life, and enablement over 4 weeks. This model can be considered as an adjunct to routine asthma care in primary care settings.
Mapping the clinical use of inhaled bacteriophages in respiratory infections caused by multidrug-resistant pathogens: a scoping review.
Terzi I, Drakopanagiotakis F, Rafailidis P
Respir Med · 2026 May · PMID 41887374 · Publisher ↗
OBJECTIVE: Inhaled bacteriophage therapy is an emerging adjunctive strategy for treating lower respiratory tract infections caused by multidrug-resistant (MDR) pathogens. However, the clinical evidence base remains fragm...
OBJECTIVE: Inhaled bacteriophage therapy is an emerging adjunctive strategy for treating lower respiratory tract infections caused by multidrug-resistant (MDR) pathogens. However, the clinical evidence base remains fragmented. We conducted a scoping review to map the current landscape of human studies using nebulized, aerosolized, or dry-powder phage therapy for pulmonary infections. METHODS: We systematically searched PubMed, Scopus, Web of Science, and ClinicalTrials.gov for clinical studies published up to 1 June 2025. Eligible studies included clinical trials, cohort studies, and case reports/series reporting at least one dose of inhaled lytic phage for bacterial respiratory infections. Screening followed PRISMA-ScR guidelines. Key data were extracted on patient characteristics, pathogens, phage preparations, delivery methods, safety, and outcomes. RESULTS: Of 507 records identified, 31 studies met inclusion criteria: six clinical trials and 25 case reports or series. Target infections included ventilator-associated pneumonia, cystic fibrosis exacerbations, and chronic bronchiectasis, primarily due to Pseudomonas aeruginosa, Acinetobacter baumannii, or Klebsiella pneumoniae. Delivery methods varied widely, including nebulizers, dry-powder inhalers, and endotracheal instillation. Most studies reported clinical or microbiological improvement without major adverse events, though few used standardized outcome measures. CONCLUSIONS: Inhaled phage therapy has shown promise in compassionate and investigational settings for MDR respiratory infections. Despite heterogeneity in delivery methods and outcome reporting, preliminary data suggests feasibility and safety. Standardized protocols and controlled trials are needed to define its role in pulmonary antimicrobial therapy.
Causal associations between chronic obstructive pulmonary disease, pulmonary tuberculosis, asthma, and plasma metabolites: A bidirectional Mendelian randomization study.
Zhang M, Liu H, Cao W … +1 more , Fan L
Respir Med · 2026 May · PMID 41887373 · Publisher ↗
BACKGROUND: Epidemiological evidence has clarified circulating metabolite-respiratory pathology associations, but their fundamental causal mechanisms remain unclear. METHODS: A systematic two-sample Mendelian randomizati...
BACKGROUND: Epidemiological evidence has clarified circulating metabolite-respiratory pathology associations, but their fundamental causal mechanisms remain unclear. METHODS: A systematic two-sample Mendelian randomization analysis was performed to explore causal relationships between 1400 plasma metabolites and three major respiratory disorders ((chronic obstructive pulmonary disease (COPD), pulmonary tuberculosis (PTB), and asthma)) using genome-wide association studies (GWASs) data. Inverse variance-weighted (IVW) regression was the primary method, with MR-Egger and weighted median as supplements. Rigorous sensitivity analyses were performed using Cochrane's Q test, MR-Egger regression, Mendelian Randomization Pleiotropy RESidual Sum and Outlier (MR-PRESSO) test, leave-one-out analysis. RESULTS: 27 plasma metabolites showed significant causal associations with the three diseases. Notably, O-cresol sulfate levels were positively associated with an increased risk of asthma in both adults and children. In contrast, elevated levels of α-ketoglutarate were linked to a reduced asthma risk. O-cresol sulfate increased asthma risk while α-ketoglutarate reduced it; 3-hydroxy-2-methylpyridine sulfate elevated COPD risk, and 16α-hydroxy-DHEA-3-sulfate exerted a protective effect on both COPD and PTB, with N-methylhydroxyproline increasing PTB risk. Sensitivity analyses confirmed no bias from weak instruments, horizontal pleiotropy or reverse causality. CONCLUSION: Our study provides robust evidence supporting causal associations between 27 plasma metabolites and respiratory disease risk. The identified metabolites and their related metabolic pathways may serve as clinically actionable biomarkers for disease screening and prevention.
Oscillometry defined small airways dysfunction in patients with severe uncontrolled asthma and preserved spirometry.
Greig R, Suter P, Chan R … +1 more , Lipworth B
Respir Med · 2026 May · PMID 41887372 · Publisher ↗
Small airways dysfunction (SAD) is an important treatable trait in asthma that is often under-recognised. It can be assessed through spirometry as forced expiratory flow between 25% and 75% of vital capacity however this...
Small airways dysfunction (SAD) is an important treatable trait in asthma that is often under-recognised. It can be assessed through spirometry as forced expiratory flow between 25% and 75% of vital capacity however this is limited due to being both effort and volume dependent. Forced oscillometry technique is effort independent and showing to be more sensitive for SAD. We reviewed patients with severe uncontrolled asthma prior to commencing biologic therapy to identify the incidence of abnormal SAD defining values. SAD was identified in 63% of patients. Of the 31 patients with preserved spirometry (normal FEV1 and FEV1/FVC), only 6% had an impaired FEF25-75 while 29% had impaired oscillometry. This result highlights SAD is a common finding in severe uncontrolled asthma and that oscillometry is more sensitive than spirometry at identifying SAD, particularly when spirometry is preserved.
Corticosteroids for treating sepsis: A systematic review and network meta-analysis.
Luo X, Yang J, Zhang Z … +3 more , Sun H, Gao M, Wu S
Respir Med · 2026 · PMID 41865776 · Publisher ↗
PURPOSE: Corticosteroids have been applied in sepsis treatment for decades, yet their clinical efficacy-particularly regarding optimal dosage, administration regimens, and impact on long-term prognosis-remains controvers...
PURPOSE: Corticosteroids have been applied in sepsis treatment for decades, yet their clinical efficacy-particularly regarding optimal dosage, administration regimens, and impact on long-term prognosis-remains controversial and incompletely defined. This systematic review and network meta-analysis aimed to comprehensively evaluate corticosteroids' effect on improving sepsis patients' outcomes and clarify the comparative effectiveness of different corticosteroid dosages and regimens. MATERIALS AND METHODS: Four electronic databases (PubMed, Embase, Web of Science, Cochrane Library) were searched from inception to March 2023 to identify randomized controlled trials (RCTs) of corticosteroids in adult sepsis patients. R software, Stata 15.0, and RevMan 5.4 analyzed data. Primary outcomes (≤30-day short-term mortality, ≥90-day long-term mortality) and secondary outcomes (ICU length of stay [LOS], mechanical ventilator-free days, vasopressor-free days, renal replacement therapy-free days) were synthesized. Surface under the cumulative ranking curve (SUCRA) ranked efficacy; funnel plots assessed publication bias. The study was prospectively registered on PROSPERO (CRD 42023454288). RESULTS: A total of 18 eligible RCTs involving 7591 patients were included. Corticosteroids reduced ≤30-day mortality (hydrocortisone [H] 100 mg/d: odds ratio [RR] = 0.22, 95% CI = 0.072-0.62), this finding is based on one small-scale RCT and requires confirmatory studies) and ≥90-day mortality (H 100 mg/d: RR = 0.33; H 200 mg/d + fludrocortisone 50 μg/d: RR = 0.79). Specific regimens improved secondary outcomes: H 200 mg/d shortened ICU LOS (mean difference [MD] = -2.6), H 200 mg/d + fludrocortisone increased ventilator/vasopressor-free days, and H 300 mg/d prolonged renal replacement therapy-free days. CONCLUSION: Notably, the mortality benefit of H 100 mg/d is preliminary due to limited evidence from a single small RCT. Corticosteroids reduce sepsis patients' short/long-term mortality and organ support duration, but no "optimal" dosage consensus exists. Further research is needed to refine dosage and personalize therapy.
Explainable artificial intelligence for predicting length of stay and treatment response in pediatric asthma and allergic rhinitis: An irregular fuzzy cellular automata approach across pre- and during-COVID-19 periods.
Kashani M, Rostami M, Karimi Darabi M … +2 more , Jamshidi F, Rafeeinia A
Respir Med · 2026 May · PMID 41864248 · Publisher ↗
OBJECTIVE: The COVID-19 pandemic significantly altered treatment strategies and healthcare utilization patterns in pediatric respiratory diseases. Given the need for interpretable predictive tools in clinical decision-ma...
OBJECTIVE: The COVID-19 pandemic significantly altered treatment strategies and healthcare utilization patterns in pediatric respiratory diseases. Given the need for interpretable predictive tools in clinical decision-making, this study aimed to investigate changes in treatment approaches and to predict hospital length of stay and treatment response in children with asthma and allergic rhinitis across pre- and during-COVID-19 periods. METHODS: This retrospective study analyzed medical records of 450 hospitalized children under 12 years diagnosed with asthma and/or allergic rhinitis at Abuazar Hospital, Ahvaz, between January 2018 and December 2021, according to GINA and ARIA criteria. An Irregular Fuzzy Cellular Automata (IFCA) model was implemented using Python. Data preprocessing included one-hot encoding and balancing with SMOTE. Model performance was evaluated using 5-fold cross-validation and compared with Random Forest and SVM models. RESULTS: Antibiotic use significantly decreased during COVID-19 (38.2% vs. 58.7%), while corticosteroid use increased (72.3% vs. 57.2%) (P < 0.001). The IFCA model achieved 86.2% accuracy and an AUC-ROC of 0.89, outperforming baseline models. Disease severity (SHAP = 0.35) and treatment type (SHAP = 0.28) were the most influential predictors. CONCLUSION: The IFCA model provides accurate and interpretable predictions for hospitalization outcomes in pediatric asthma and allergic rhinitis, supporting clinical decision-making and resource optimization during pandemic conditions.
Bidirectional association between chronic periodontitis and bronchiectasis: A nationwide, population-based cohort study.
Zo S, Kim MJ, Kang MG … +8 more , Kim SH, Moon SM, Yang B, Choi H, Moon JY, Min KH, Kim JS, Lee H
Respir Med · 2026 May · PMID 41862105 · Publisher ↗
BACKGROUND: This study investigated the potential bidirectional association between chronic periodontitis (CP) and bronchiectasis using the Korean National Health Insurance Service claims database. METHODS: In study I, i...
BACKGROUND: This study investigated the potential bidirectional association between chronic periodontitis (CP) and bronchiectasis using the Korean National Health Insurance Service claims database. METHODS: In study I, individuals with CP (n = 54,535) were matched to those without CP, and in study II, individuals with bronchiectasis (n = 2804) were matched to those without bronchiectasis, using 1:1 propensity score matching. Individuals were followed until the date of bronchiectasis diagnosis (study I), the date of CP diagnosis (study II), death, or December 31, 2019, whichever came first. RESULTS: In study I, during a median follow-up of 11.8 years, 4.25% of the CP group and 0.77% of the control group developed bronchiectasis. The risk of developing bronchiectasis was significantly higher in the CP group compared to the matched controls (hazard ratio [HR] 3.35; 95% confidence interval [CI] 3.02-3.73). In study II, the risk of CP was also higher in the bronchiectasis group compared with matched controls (HR 1.07; 95% CI 1.01-1.15). CONCLUSION: CP and bronchiectasis were bidirectionally associated, although CP had a stronger impact on bronchiectasis risk than the reverse association.
Cross-exclusion of patients with chronic obstructive pulmonary disease and heart failure in randomized controlled drug trials.
Kaşkal M, Wat D, Nazareth D … +2 more , Lip GYH, Frost F
Respir Med · 2026 May · PMID 41862104 · Publisher ↗
Chronic obstructive pulmonary disease (COPD) and heart failure (HF) frequently coexist, yet patients with both conditions are often excluded from randomized controlled trials(RCTs). We conducted a secondary analysis of 7...
Chronic obstructive pulmonary disease (COPD) and heart failure (HF) frequently coexist, yet patients with both conditions are often excluded from randomized controlled trials(RCTs). We conducted a secondary analysis of 72 RCTs (28 COPD/COPD exacerbations (ECOPD); 44 HF) including 181,325 participants. In COPD/ECOPD trials, only 10.8% of participants with HF, while 6.9% explicitly excluded them. In HF trials, 31.4% included participants with COPD, whereas 47.2% excluded them. There is frequent cross-exclusion of patients with coexisting COPD and HF in RCTs, limiting the applicability of current evidence to this clinically significant population with both conditions, and underscoring the need for more inclusive trial designs.
Long-term follow-up results of patients with combined pulmonary fibrosis and emphysema: A single-center experience.
Calis AG, Uzer F, Gurbuz AF … +2 more , Erdem G, Cilli A
Respir Med · 2026 · PMID 41856387 · Publisher ↗
BACKGROUND: Combined pulmonary fibrosis and emphysema (CPFE) is a distinct clinical syndrome characterized by the coexistence of upper-lobe emphysema and lower-lobe fibrosis, most commonly in male smokers. Despite increa...
BACKGROUND: Combined pulmonary fibrosis and emphysema (CPFE) is a distinct clinical syndrome characterized by the coexistence of upper-lobe emphysema and lower-lobe fibrosis, most commonly in male smokers. Despite increasing recognition, long-term outcomes and prognostic determinants remain incompletely understood. The aim of this study is to evaluate long-term follow-up results of patients diagnosed with CPFE. PATIENTS AND METHOD: Between January 2015 and December 2024, a total of 588 patients with suspected CPFE were screened. Patients with at least one year of follow-up including radiological and physiological parameters were included in the study. Demographic data, comorbidities, pulmonary function tests, diffusing capacity for carbon monoxide (DLCO), 6-min walk test, echocardiographic findings, radiological progression, treatment strategies, and survival outcomes were analyzed. Emphysema severity was assessed using lobar scoring, and fibrotic patterns were classified according to Fleischner Society Criteria. RESULTS: The final study population comprised 118 patients. The cohort was predominantly male (89.8%) with a mean age of 70 years, and 95.8% were current or former smokers. The median follow-up duration was 38 ± 6 months (range, 12-96 months). Radiological progression was observed in 67.8% of patients. Baseline and follow-up forced vital capacity (FVC) (%) values failed to predict progression, while DLCO decline at year 1 was significantly more frequent in patients with progression (p = 0.039). Regarding treatment, 36 patients (30.5%) received pirfenidone, six patients (5.1%) were treated with nintedanib, four patients (3.4%) received systemic corticosteroids, and one patient (0.8%) was treated with a biological agent. During the follow-up period, 38 patients died, while 80 survived. The mean overall survival was 5.61 ± 0.6 years, with a 5-year survival rate of 67.8%. Severe emphysema, acute exacerbation, 6-min walk test desaturation, lower values of FVC and DLCO, and higher pulmonary artery pressures were more significant in non-survivors. Cox regression analysis demonstrated that baseline DLCO (%) was an independent predictor of mortality (HR = 0.934, 95% CI: 0.902-0.966, p < 0.001). CONCLUSION: CPFE has a tendency to progress, and that FVC alone is not a reliable tool for disease monitoring. The majority of patients are undertreated, and the long-term prognosis is generally poor. These findings emphasise the necessity for multidimensional assessment strategies in CPFE management.
COPD-sleep-disordered breathing overlap and vascular risk markers in non-obese adults: The Nagahama study.
Nagasaki T, Sato S, Murase K … +12 more , Sunadome H, Hamada S, Matsumoto T, Takahashi N, Muraki M, Kawaguchi T, Tabara Y, Matsuda F, Matsumoto H, Hirai T, Chin K, Nagahama Study Group
Respir Med · 2026 · PMID 41850500 · Publisher ↗
BACKGROUND: Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea/sleep-disordered breathing (SDB) often coexist and may amplify vascular injury, yet the cardiovascular impact of COPD-SDB overlap in th...
BACKGROUND: Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea/sleep-disordered breathing (SDB) often coexist and may amplify vascular injury, yet the cardiovascular impact of COPD-SDB overlap in the absence of obesity remains unclear. We investigated whether overlap syndrome is associated with higher vascular markers than either condition alone. We also estimated its prevalence by obesity status. METHODS: In this population-based cohort, 9850 community residents were enrolled. Moderate-to-severe SDB was defined as an actigraphy-modified 3% oxygen desaturation index ≥15 events/h. COPD was defined as a smoking history of ≥10 pack-years and an FEV/FVC ratio <0.70. Overlap syndrome was defined as coexistence of COPD and moderate-to-severe SDB. Maximum common carotid artery intima-media thickness (CCA-IMT), cardio-ankle vascular index (CAVI), and brachial-ankle pulse wave velocity (baPWV) were assessed. Multivariable models were stratified by obesity. RESULTS: A total of 6140 were analyzed. Overlap syndrome was identified in 46 participants (0.75%) overall, including 30 of 5087 non-obese participants (0.59%), and 16 of 1053 obese participants (1.52%). Because all overlap cases were male, subsequent adjusted analyses were restricted to men. Compared with moderate-to-severe SDB alone, overlap was associated with higher adjusted CCA-IMT in non-obese male participants. Overlap was also associated with higher CAVI and baPWV among non-obese men after multivariable adjustment. CONCLUSIONS: COPD-moderate-to-severe SDB overlap was not negligible. Among non-obese men, overlap syndrome was associated with greater subclinical atherosclerosis and arterial stiffness than moderate-to-severe SDB alone, suggesting a higher vascular-risk phenotype.
A review of artificial intelligence-based research on chronic obstructive pulmonary disease.
Abulizi A, Zhou J, Abudukelimu N … +3 more , Yehaiya G, Abudukelimu M, Abudukelimu H
Respir Med · 2026 · PMID 41839412 · Publisher ↗
In recent years, with the rapid development of artificial intelligence (AI), Chronic Obstructive Pulmonary Disease (COPD), one of the world's three major chronic diseases, has achieved remarkable progress in diagnosis, g...
In recent years, with the rapid development of artificial intelligence (AI), Chronic Obstructive Pulmonary Disease (COPD), one of the world's three major chronic diseases, has achieved remarkable progress in diagnosis, grading, and prognosis, which is of great significance for promoting the clinical transformation of respiratory diseases. To deeply explore the application of AI in the diagnosis and management of COPD, this paper reviews recent studies based on machine learning and deep learning, covering screening and diagnosis, disease grading and assessment, disease management and monitoring, and treatment. First, the technical basis of COPD-related research is analyzed from five perspectives: traditional research methods, supervised learning, unsupervised learning, semi-supervised learning, and reinforcement learning. Then, the commonly used datasets and model evaluation metrics are summarized. Finally, the application scenarios of AI in COPD research are elaborated, focusing on three aspects: early screening and diagnosis, disease monitoring and risk prediction, and disease classification and risk stratification. This paper summarizes the main research hotspots at home and abroad over the past five years with representative models, and analyzes and compares the advantages and limitations of each type of model in specific COPD tasks through comparative experiments. The study also outlines prospects for the future development of this field, aiming to provide theoretical references and insights for subsequent research.
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