Respir Med [JOURNAL]
Sun
200 papers
Characteristics of patients with acute respiratory failure in obesity hypoventilation syndrome in the intensive care unit: A retrospective cohort study.
Mathew R, Box NR, Patri S … +7 more , Reyes S, Ploch M, Lee C, Pueringer M, Estrada-Y-Martin RM, Zhang S, Cherian SV
Respir Med · 2026 Jun · PMID 42362119 · Publisher ↗
BACKGROUND: Obesity hypoventilation syndrome (OHS), wherein there is wake hypercapnia in the obese not attributable to other hypoventilation etiologies can lead to frequent ICU admissions for respiratory failure. Our stu...
BACKGROUND: Obesity hypoventilation syndrome (OHS), wherein there is wake hypercapnia in the obese not attributable to other hypoventilation etiologies can lead to frequent ICU admissions for respiratory failure. Our study analyzed clinical characteristics and outcomes in OHS patients admitted in a safety-net community-based hospital ICU. METHODS: A retrospective cohort of known or suspected OHS patients admitted to the ICU with respiratory failure was analyzed by BMI subgroups. PRIMARY OUTCOMES: mortality, duration of mechanical ventilation, and ICU LOS. Secondary outcomes included predictors for heart failure, noninvasive ventilation (NIV) and high-flow nasal cannula use, right ventricular (RV) failure and other complications. RESULTS: Heart failure exacerbation and sepsis were commonly associated with respiratory failure in our cohort of 188 patients admitted over 5 years. Median ventilator duration and ICU LOS were 3 and 4 days respectively. Class 1 obesity (BMI 30-34.9 kg/m) patients had worse outcomes when compared to patients with class 4 obesity (BMI ≥50 kg/m), with increased rates of NIV failure (69% vs 34%; P = 0.007), RV failure (32% vs 20%, P = 0.17) and readmissions (5 vs 2; P = 0.002). Overall mortality rate in the cohort was 7%. In multivariable analysis, CKD demonstrated a trend towards increased mortality; however, this association did not remain statistically significant after adjustment for multiple variables. RV failure was significantly associated with increased duration of mechanical ventilation. CONCLUSIONS: In our cohort of OHS patients in the ICU with respiratory failure, prevalence of heart failure and sepsis was high. NIV was frequently successful, particularly in class 4 obesity. Patients with milder obesity showed several unfavorable clinical characteristics and respiratory support outcomes, although these findings should be interpreted cautiously.
The next frontier: From clinical remission to structural remission-rethinking airway remodeling in asthma.
Kotsiou OS, Daniil Z
Respir Med · 2026 Jun · PMID 42362118 · Publisher ↗
The concept of remission in asthma has gained increasing prominence with the expanding use of biologic therapies. However, a central conceptual and clinical question remains unresolved: does clinical remission represent...
The concept of remission in asthma has gained increasing prominence with the expanding use of biologic therapies. However, a central conceptual and clinical question remains unresolved: does clinical remission represent true disease resolution, or does it reflect suppression of the most visible manifestations of a still-active airway-wall disease? This review critically examines airway remodeling as a major determinant of asthma chronicity, severity, and incomplete reversibility, while evaluating the extent to which current therapeutic strategies are moving the field toward meaningful structural remission. Contemporary evidence indicates that asthma is not simply a disorder of variable bronchoconstriction, but a complex airway-wall disease characterized by persistent interactions among epithelial dysfunction, type 2 and non-type 2 inflammation, mucus dysregulation, extracellular matrix remodeling, vascular alterations, and airway smooth muscle expansion. These abnormalities may arise early, involve both large and small airways, and persist despite apparent clinical stability. Inhaled corticosteroids remain essential for controlling inflammatory activity and can attenuate selected remodeling features, particularly when introduced early, although their capacity to reverse established structural disease appears limited. Importantly, biologics have major disease-modifying potential, including exacerbation reduction, corticosteroid sparing, lung-function improvement, and possible prevention of further decline or remodeling-related damage. Evidence from bronchial biopsies, computed tomography, physiological studies, and biomarker analyses increasingly suggests that biologics can modify specific remodeling domains. Although complete structural normalization remains unproven, current data indicate that meaningful steps toward disease modification are already being achieved, making structural remission a more realistic long-term goal than previously believed.
Visualizing respiratory therapy effects: An EIT-based assessment of lung physiology.
Phoophiboon V, Bannatham K, Rittayamai N … +3 more , Nantawong P, Muangman P, Owattanapanich N
Respir Med · 2026 Jun · PMID 42349727 · Publisher ↗
BACKGROUND: The incentive spirometer (IS) promotes lung expansion, but its physiological effects remain unclear. We hypothesized that the low-cost Asepto syringe could be a viable alternative. This study compared the dif...
BACKGROUND: The incentive spirometer (IS) promotes lung expansion, but its physiological effects remain unclear. We hypothesized that the low-cost Asepto syringe could be a viable alternative. This study compared the different number of IS balls and Asepto syringe in healthy volunteers, evaluating their impacts on tidal volume (Vt), end-expiratory lung volume (EELV), regional ventilation distribution, lung homogeneity, and dynamic lung strain. METHODS: In this prospective crossover pilot trial, healthy volunteers were randomly assigned to start with either the Asepto syringe or incentive spirometer. All participants used both devices, and lung function was assessed using Electrical Impedance Tomography (EIT). RESULTS: The study included 24 participants (63%female). Vital signs remained stable post-intervention. Three-ball IS produced the highest Vt in mL: 1868 [1313-2392], followed by the Asepto syringe 1264 [770-1728], 2-ball IS 1231 [942-1629] and 1-ball IS 920 [624-1591] compared to Vt at baseline (p < 0.0001). The 1- and 2-ball IS improved EELV in mL (439 [251-908] and 496 [117-767], respectively, p < 0.001) with a higher number of breaths achieving target per minute. All devices increased dorsal ventilation compared to baseline (p = 0.048). Although dynamic lung strain from IS and Asepto syringe was higher than baseline (p < 0.0001), all values were below threshold of potential lung injury. CONCLUSION: For promoting lung expansion in healthy volunteers, the Asepto syringe might be an alternative to employing an incentive spirometer. One-or two-ball IS improved EELV and adherence. Effects in patients with lung disease warrant further study.
Allergen Sensitization Characteristics and Temporal Trends in Allergic Rhinitis: A Single-Center Retrospective Study of 2,482 Patients in Beijing.
Liang X, Liu W, Qi H … +8 more , Du J, Wang L, Zhang H, Zhang X, Wu J, Wang H, Li L, Li Q
Respir Med · 2026 Jun · PMID 42349726 · Publisher ↗
OBJECTIVE: This study characterized the sensitization profile of allergic rhinitis (AR) in a large Beijing cohort, with the objectives of identifying key influencing factors (gender, age, season) and analyzing temporal t...
OBJECTIVE: This study characterized the sensitization profile of allergic rhinitis (AR) in a large Beijing cohort, with the objectives of identifying key influencing factors (gender, age, season) and analyzing temporal trends and correlation patterns among specific allergens. METHODS: We retrospectively analyzed 2,482 patients with clinically diagnosed allergic rhinitis and at least one positive serum-specific IgE test result at a single center in Beijing (2019-2025). Serum-specific IgE to 20 common inhalant and food allergens was measured. Analyses included univariate and multivariate regression, temporal trend assessment (2020-2024), correlation/clustering, and sensitization severity grading. RESULTS: Of 2,482 patients, 91.74% were sensitized to inhalant allergens and 48.07% to food allergens. In multivariate analysis, Alternaria sensitization was more frequent in males. Sensitization to dust mites, animal dander, and weed pollen was most common in school-aged children and adolescents, whereas sensitization to Alternaria and several food allergens was highest in preschool children. Seasonally, mugwort and ragweed short peaked in autumn and Alternaria in summer. From 2020 to 2024, Alternaria sensitization increased; house dust, dog epithelium, and D. farinae rose from 2020 to 2022 then fell. Three inhalant allergen clusters (house dust mites, animal dander with house dust, and pollens) were identified. High-grade sIgE sensitization (Grades 4-6) was more frequent for Alternaria and mugwort. CONCLUSION: In this single-center Beijing cohort, sensitization profiles varied distinctly by sex, age, and season, underscoring the need to consider these factors in the clinical evaluation of AR patients.
Treating tuberculosis without rifampicin: an open dilemma.
Calcagno A, Zaffagnini A, Pontali E … +7 more , Bertonazzi C, Del Puente F, Codecasa LR, Piccioni P, Piccioni D, Riccardi N, MYGRO Study Group
Respir Med · 2026 Jun · PMID 42349725 · Publisher ↗
BACKGROUND: The World Health Organization recommends the same treatment regimens for rifampicin-monoresistant (RR) and multidrug-resistant (MDR) TB. Aside of resistance, rifampicin cannot be used in all patients because...
BACKGROUND: The World Health Organization recommends the same treatment regimens for rifampicin-monoresistant (RR) and multidrug-resistant (MDR) TB. Aside of resistance, rifampicin cannot be used in all patients because of allergy, intolerance or drug-to-drug interactions (here called "functional" rifampicin mono-resistance or fRR). OBJECTIVES: Given the uncertainty on the best way to treat these forms of TB, we performed a literature review assessing the epidemiology and diagnostic tools for RR and fRR-TB, as well as treatment options and costs of the potential treatments. SOURCES: We performed a narrative review of the English-language literature by using the terms "tuberculosis"/"rifampicin" and "mono-resistance"/"rifampicin"/"tuberculosis" in the time frame 1960-2025; secondary articles were also manually evaluated from selected papers' bibliographies. CONTENT: We described the role of rifampicin in the antitubercular armamentarium, the epidemiology of RR, the laboratory methods used for detecting rifampicin resistance, the evolution of guidelines on the topic, as well as the studies that reported the use of non-standard regimens for patients with RR or fRR. We summarized the potential options with their pros and cons and suggested a potential flowchart in such scenarios. IMPLICATIONS: WHO-recommended regimens for RR/MDR are the key treatments for patients with RR or fRR-TB: despite the heterogeneity of available data, we identified scenarios where rifampicin can be substituted by alternative drugs and added to first-line antitubercular regimens.
Development and validation of a multidimensional nomogram for predicting 28-day mortality in sepsis patients with acute lung injury.
Zhang P, Sun C, Wu Y … +3 more , Zou R, Jiang C, Li X
Respir Med · 2026 Jun · PMID 42342137 · Publisher ↗
OBJECTIVE: To develop and validate a multidimensional nomogram for predicting 28-day mortality in sepsis patients with acute lung injury (ALI). METHODS: A retrospective analysis was conducted on 4620 sepsis patients with...
OBJECTIVE: To develop and validate a multidimensional nomogram for predicting 28-day mortality in sepsis patients with acute lung injury (ALI). METHODS: A retrospective analysis was conducted on 4620 sepsis patients with ALI from the MIMIC-IV database, then these patients were divided into training (n = 3119) and validation (n = 1501) cohorts (7:3). LASSO regression combined with Boruta algorithm was used to screen predictive variables. Thereafter, these variables were utilized to construct a nomogram model. The model performance was evaluated by AUROC, calibration curves, and decision curve analysis (DCA), and SHAP analysis was applied to identify core predictors. RESULTS: Twelve variables (e.g., SOFA score, lactate, creatinine) were selected to build the nomogram, which showed superior discriminative ability (AUROC = 0.869 in training set, 0.884 in validation set) compared with SOFA, APACHE II, and SAPS II scores. Calibration curves indicated good agreement between predicted and actual risks, and DCA confirmed stable clinical net benefit. SHAP analysis identified lactate, creatinine, and SOFA score as core risk factors, while platelet count and albumin as protective factors. CONCLUSION: The nomogram has excellent predictive efficacy and clinical interpretability for 28-day mortality in sepsis patients with ALI, providing a reliable tool for clinical precise intervention.
Relationship between changes in intestinal desulfovibrio levels and oxygen desaturation in patients with obstructive sleep apnea syndrome.
Sınır B, Ortan P, Sayin SS … +1 more , Uzel A
Respir Med · 2026 Jun · PMID 42342136 · Publisher ↗
PURPOSE: Obstructive sleep apnea syndrome (OSAS) causes intermittent hypoxia and sleep fragmentation, which may alter gut microbiota composition. We primarily aimed to compare intestinal Desulfovibrio detection/abundance...
PURPOSE: Obstructive sleep apnea syndrome (OSAS) causes intermittent hypoxia and sleep fragmentation, which may alter gut microbiota composition. We primarily aimed to compare intestinal Desulfovibrio detection/abundance between patients with moderate-to-severe OSAS and healthy controls. Secondarily, we evaluated the association between Desulfovibrio and polysomnographic oxygen desaturation parameters, including ODI and minimum SpO2. METHODS: In this prospective cross-sectional study, 30 patients with moderate or severe OSAS and 20 healthy volunteers were included. All participants followed a balanced diet for 15 days before overnight polysomnography and fecal sampling. Fecal samples collected the morning after polysomnography were stored at -80°C and analyzed by quantitative real-time PCR. Between-group comparisons and associations with polysomnographic parameters were evaluated. RESULTS: Desulfovibrio was detected in 11 of 50 participants (6 patients, 5 controls). Although bacterial concentration was numerically higher in the OSAS group, the difference was not statistically significant. No significant differences in demographic characteristics or sleep parameters were observed according to Desulfovibrio presence. Among patients with OSAS, Desulfovibrio was not significantly associated with apnea-hypopnea index or oxygen desaturation-related parameters. CONCLUSION: This is, to our knowledge, the first human study to examine whether intestinal Desulfovibrio colonization is increased in OSAS and related to intermittent hypoxia. In this cohort, Desulfovibrio colonization did not differ significantly between OSAS and control groups and was not associated with polysomnographic desaturation indices. Larger, adequately powered studies with broader microbiome profiling are needed.
Influence of COVID-19 on the effectiveness of a cardiac rehabilitation programme in patients with coronary heart disease.
Robledo-Rodríguez AM, Valdivieso Sánchez MDC, Toledo-Frías PA … +3 more , Fernández-Sánchez N, Tapia-Haro RM, Aguilar-Ferrándiz ME
Respir Med · 2026 Jun · PMID 42342135 · Publisher ↗
BACKGROUND: Cardiac rehabilitation (CR) improves quality of life, functional capacity, and cardiovascular outcomes in patients with coronary heart disease (CHD). However, post-COVID-19 sequelae may affect baseline physic...
BACKGROUND: Cardiac rehabilitation (CR) improves quality of life, functional capacity, and cardiovascular outcomes in patients with coronary heart disease (CHD). However, post-COVID-19 sequelae may affect baseline physical condition and potentially influence CR outcomes. OBJECTIVES: To compare baseline inspiratory muscle strength, hand grip force, cardiorespiratory function and quality of life in CHD patients with and without prior COVID-19, and to evaluate their response to a CR programme. METHODS: A prospective observational study was conducted with 77 CHD patients enrolled in a supervised CR programme. Participants were divided according to previous COVID-19 infection. The intervention included individualized aerobic, strength, and respiratory muscle training. Outcomes included body mass index, abdominal circumference, inspiratory muscle strength, manual grip force, cardiorespiratory function and health-related quality of life. RESULTS: Both groups showed significant within-group improvements in body mass index, abdominal circumference, maximal inspiratory pressure, manual grip force, METs, exercise test duration, and all SF-36 subscales (p ≤ 0.03). No significant between-group differences were observed either at baseline or post-intervention, except for vitality and health transition domains after CR (p ≤ 0.02). CONCLUSIONS: A structured CR programme was associated with significant improvements in functional capacity and quality of life in patients with CHD. No significant differences were observed between patients with and without prior COVID-19 infection. These findings suggest that a history of COVID-19 may not be associated with differences in response to CR; however, results should be interpreted with caution given the observational design and the limited clinical characterization of COVID-19.
Fasting therapy improves nocturnal hypoxemia and metabolic parameters in overweight/obese adults with sleep-related breathing disorder: An open-label pilot study.
Luo D, Sun J, Mo B … +4 more , Liu T, Qin J, Zhang L, Zhang T
Respir Med · 2026 Jun · PMID 42342134 · Publisher ↗
BACKGROUND: Sleep-related breathing disorder (SRBD) is a prevalent condition closely linked to obesity, yet effective and well-tolerated treatment options beyond CPAP are limited. Fasting therapy induces rapid weight los...
BACKGROUND: Sleep-related breathing disorder (SRBD) is a prevalent condition closely linked to obesity, yet effective and well-tolerated treatment options beyond CPAP are limited. Fasting therapy induces rapid weight loss and metabolic improvement, but its effects on SRBD remain unexplored. This pilot study aimed to evaluate the impact of fasting therapy on nocturnal hypoxemia and cardiometabolic health in adults at risk for SRBD. METHODS: In this open-label, single-arm pilot study, 57 adults with overweight/obesity, nocturnal hypoxemia, and symptoms of SRBD underwent a 7-day medically supervised fasting protocol. Nocturnal oxygenation, body composition, blood pressure, and metabolic parameters were assessed. Bonferroni correction was applied to the four primary oxygenation outcomes (adjusted α = 0.0125). RESULTS: After fasting therapy, average SpO increased from 94.8 ± 2.0% to 95.4 ± 1.7% (P < 0.001) and ODI decreased from 10.7 ± 14.7 to 6.5 ± 9.0 events/hour (P < 0.001), both remained significant after Bonferroni correction. Lowest SpO increased from 81.3 ± 8.7% to 83.8 ± 8.6% (P = 0.023), and CT90 decreased from 5.3 ± 11.2% to 2.9 ± 8.2% (P = 0.033), which showed nominal improvement that did not survive strict correction. Participants lost an average of 4.2 ± 1.7 kg (P < 0.001), with significant reductions in waist circumference (-6.3 ± 5.2 cm, P < 0.001) and visceral fat. Fasting glucose, insulin, HOMA-IR, triglycerides, and blood pressure also improved significantly (all P < 0.01, all secondary outcomes remained significant after Benjamini-Hochberg correction). Reduction in waist circumference correlated significantly with improvement in oxygenation indices. CONCLUSION: A short-term, medically supervised fasting therapy significantly improved nocturnal hypoxemia, body composition, and cardiometabolic parameters in adults with overweight/obesity and suspected SRBD. The correlation between central fat loss and oxygenation improvement suggests a plausible mechanism. These promising pilot results support the need for larger randomized controlled trials to confirm the efficacy of fasting therapy as a complementary strategy for SRBD management.
Corrigendum to "A new perspective on idiopathic pulmonary fibrosis research: From multi-dimensional mechanistic exploration to advances in precision therapy" [Respir. Med. 260 (2026) 1-15].
Zhang SM, Huang MZ, Wang YW … +5 more , Wang XF, Ding Y, Li JM, Zou XM, Ma CY
Respir Med · 2026 · PMID 42324176 · Publisher ↗
Abstract loading — click title to view on PubMed.
Environmental and occupational risks in asthma burden: A global analysis of trends, disparities, and future projections for ages 5-39.
Wang N, Li L, Yang X … +4 more , Yin K, Chen X, Yao Q, Zhang H
Respir Med · 2026 Jun · PMID 42323982 · Publisher ↗
BACKGROUND: Asthma is a global chronic respiratory disease whose development and exacerbation are significantly influenced by modifiable environmental and occupational exposures, such as air pollution and occupational as...
BACKGROUND: Asthma is a global chronic respiratory disease whose development and exacerbation are significantly influenced by modifiable environmental and occupational exposures, such as air pollution and occupational asthma triggers. Understanding the burden attributable to these factors among children, adolescents, and young adults is essential for effective prevention strategies. While prior epidemiological assessments have characterized the overall asthma burden, there remains a scarcity of focused investigations that examine the disease burden specifically associated with these risk factors in the 5-39-year age group. Notably, a comprehensive analysis utilizing the GBD 2021 dataset to quantify trends, disparities, and future projections of environment- and occupation-related asthma in this vulnerable population remains limited. METHODS: This study analyzed data from the GBD 2021 study to examine global, regional, and national trends in asthma prevalence, incidence, mortality, and disability-adjusted life years (DALYs) among individuals aged 5-39 years (children and young adults) between 1990 and 2021. Analyses were stratified by age group, gender, and socio-demographic index (SDI). We quantified trends in asthma burden using the estimated annual percentage change (EAPC); conducted a decomposition analysis to identify driving factors for changes from 1990 to 2021 among children and young adults aged 5-39 years; and summarized risk-attributable DALY-with a specific focus on air pollution and environmental/occupational risks. Finally, a Bayesian age-period-cohort (BAPC) model was applied to project future burden trends from 2022 to 2050. RESULTS: In 2021, the global number of asthma cases in this population was approximately 133 million, representing an 11.1% decrease compared to 1990 levels. The age-standardized incidence rate (ASIR) declined from 4487.86 per 100,000 population in 1990 to 3124.79 per 100,000 in 2021, with an EAPC of -1.04% (95% confidence interval [CI]: -1.196 to -0.891). High SDI regions had the highest prevalence rate (6980.77 per 100,000), while low-middle SDI regions had the lowest (2230.33 per 100,000). Both prevalence and incidence peaked in the 5-9 years age group. Males had higher asthma prevalence than females before age 15 years, with this pattern reversing thereafter. Key risk factors (by population attributable fraction [PAF]) included: for children, air pollution and environmental/occupational risks (3.5%); for young adults, environmental/occupational risks (13.9%) and high body-mass index (15.9%). Decomposition analyses indicated that population growth was the predominant driver of changes in asthma burden from 1990 to 2021 across SDI regions. The BAPC model predicted that the ASPR of asthma among children and young people globally would continue to increase, rising from approximately 4132 per 100,000 population in 2021 to approximately 4698 per 100,000 in 2050. CONCLUSIONS: Asthma burden in ages 5-39 years shows marked geographic and SDI disparities and pronounced sex- and age-specific patterns. The comparatively higher contribution of high BMI and environmental/occupational risks in young adults underscores the need for strengthened air-quality policies and workplace exposure control in addition to clinical management and weight control.
Exploring cough hypersensitivity patterns across respiratory diseases.
Koo HK, An TJ, Joo H … +11 more , Rhee CK, Kim SK, Min KH, Kim DK, Jang SH, Shin JW, Yoon HK, Song WJ, Kim JW, Moon JY, Korean Cough Study Group in the Korean Academy of Tuberculosis and Respiratory Disease (KATRD)
Respir Med · 2026 Jun · PMID 42323027 · Publisher ↗
BACKGROUND: Cough hypersensitivity is increasingly recognized as a key mechanism underlying chronic cough across diverse etiologies. The Cough Hypersensitivity Questionnaire (CHQ) was developed to systematically assess c...
BACKGROUND: Cough hypersensitivity is increasingly recognized as a key mechanism underlying chronic cough across diverse etiologies. The Cough Hypersensitivity Questionnaire (CHQ) was developed to systematically assess characteristic triggers and abnormal sensory perceptions; however, its structural and clinical relevance across respiratory diseases remains unclear. METHODS: We prospectively enrolled 300 adults with chronic cough from multiple respiratory centers. Participants completed four cough-related questionnaires: the Numeric Rating Scale (NRS), Leicester Cough Questionnaire (LCQ), Cough Assessment Test (COAT), and CHQ. Spearman correlation and network analyses were used to evaluate associations between CHQ items and other cough-related measures, including subgroup analyses by disease etiology. RESULTS: The CHQ demonstrated variable associations with conventional instruments and differing patterns across respiratory diseases. Triggers such as perfume and smoke correlated with LCQ hypersensitivity items, while the sensation item "urge to cough" exhibited broad correlations across physical, psychological, and social domains. Socially mediated triggers (e.g., talking) aligned with LCQ social interference items. In contrast, items such as hot air, dampness, laughter, and eating/drinking had minimal external associations. Internal CHQ correlations were sparse, and no significant associations were observed between CHQ and NRS, indicating a dissociation between hypersensitivity features and perceived severity. Disease-specific analyses suggested differing patterns, with broader associations observed in asthma and bronchiectasis compared with chronic obstructive pulmonary disease and idiopathic pulmonary fibrosis. CONCLUSION: The CHQ captures distinct and heterogeneous dimensions of cough hypersensitivity that are not adequately reflected by conventional cough measures, suggesting its potential utility for characterizing clinically relevant multidimensional aspects of chronic cough.
Investigation of the effects of aged garlic extract and S- allylcysteine on endothelin-1 levels and histopathological findings in an ovalbumin-induced allergic rhinitis rat model.
Alpa Ş, Eren İT, Gülbahçe-Mutlu E … +3 more , Türkoğlu FN, Akcan G, Nur Ayaz B
Respir Med · 2026 Jun · PMID 42320604 · Publisher ↗
Allergic rhinitis is characterised by symptoms such as sneezing, nasal itching, and rhinorrhea. Endothelin-1 (ET-1) is a potent vasoactive peptide that has also been implicated in airway inflammation. The aim of this stu...
Allergic rhinitis is characterised by symptoms such as sneezing, nasal itching, and rhinorrhea. Endothelin-1 (ET-1) is a potent vasoactive peptide that has also been implicated in airway inflammation. The aim of this study was to investigate the effects of aged garlic extract (AGE) and S-allylcysteine (SAC) on ET-1 levels and histopathological findings in an ovalbumin (OVA)-induced allergic rhinitis rat model. Allergic rhinitis was induced using OVA and alum adjuvant. AGE (250 mg/kg) and SAC (6.5 mg/kg) were administered orally by gavage. Serum ET-1 levels were measured at the end of the experiment. ET-1 levels were higher in the OVA group compared to the control group and were reduced in both the AGE- and SAC-treated groups. The differences between groups were statistically significant (p < 0.05). Histopathological examination of lung tissues revealed mild peribronchial fibrotic changes in the OVA and SAC groups, while nasal epithelial morphology did not show marked differences among the groups. These findings suggest that AGE and SAC may be associated with reduced ET-1 levels in this experimental model.
Should triple inhaled therapy be initiated earlier in the disease course of COPD to modify long-term outcomes, including mortality, exacerbations, and cardiovascular risk?
Quaranta VN, Dragonieri S, Cosentino G … +7 more , Motta V, Signorello JC, Di Stefano G, Ciasullo E, Radovanovic D, Carpagnano GE, Santus P
Respir Med · 2026 Jun · PMID 42320603 · Publisher ↗
BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a progressive and heterogeneous disorder in which exacerbations accelerate lung-function decline, increase cardiovascular morbidity, and worsen mortality. Altho...
BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a progressive and heterogeneous disorder in which exacerbations accelerate lung-function decline, increase cardiovascular morbidity, and worsen mortality. Although single-inhaler triple therapy (SITT; ICS/LABA/LAMA) is currently recommended for patients with persistent symptoms or frequent exacerbations despite dual bronchodilation, emerging evidence suggests that earlier initiation may improve long-term outcomes. OBJECTIVE: To evaluate whether earlier initiation of triple inhaled therapy in COPD could improve long-term outcomes, including lung-function preservation, exacerbation burden, mortality, cardiovascular risk, and healthcare resource utilisation. EVIDENCE SYNTHESIS: Pivotal randomized trials such as IMPACT and ETHOS showed that SITT reduces exacerbations and improves lung function, with significant reductions in all-cause mortality and cardiopulmonary events in high-risk populations. Post hoc analyses and real-world studies suggest that symptomatic patients without frequent exacerbations may also benefit from earlier escalation. Predictive models, including DEPICT, ACCEPT, and GALAXY, consistently indicate that earlier initiation of SITT, particularly in younger or pre-exacerbator phenotypes, may preserve lung function, delay disease progression, reduce exacerbations, lower mortality risk, and remain cost-effective. These benefits appear to be mediated partly through exacerbation prevention and attenuation of post-exacerbation cardiovascular vulnerability. CONCLUSIONS: Converging evidence from clinical trials, real-world studies, and predictive modelling supports the hypothesis that earlier initiation of SITT may represent a disease-modifying strategy in selected patients with COPD. Prospective pragmatic trials are needed to define optimal timing, target populations, and the balance between benefit and risk.
Unraveling the link: A systematic review and meta analysis of acute respiratory distress syndrome and delirium.
Othman MI, Nashwan AJ, Singh K … +5 more , Mannethodi K, Joy GV, Kunjavara J, Vahedian-Azimi A, Ait Hssain A
Respir Med · 2026 · PMID 42320602 · Publisher ↗
BACKGROUND: Acute Respiratory Distress Syndrome (ARDS) is a critical condition characterized by severe hypoxemia and pulmonary edema, often resulting from pneumonia, sepsis, trauma, or aspiration. It affects 10-15% of IC...
BACKGROUND: Acute Respiratory Distress Syndrome (ARDS) is a critical condition characterized by severe hypoxemia and pulmonary edema, often resulting from pneumonia, sepsis, trauma, or aspiration. It affects 10-15% of ICU patients and is associated with high mortality rates (30-40%). Delirium, an acute cognitive impairment, is prevalent in critically ill patients, particularly in the ICU, and correlates with adverse outcomes. OBJECTIVE: This systematic review and meta-analysis aim to summarize the current evidence regarding the relationship between ARDS and delirium, focusing on the prevalence of delirium in ARDS patients, its impact on delirium development and mortality, potential correlations between the two conditions, and their clinical outcomes. METHODS: A systematic search was conducted across PubMed, Scopus, and Web of Science from inception until September 2024, leading to the identification of 838 records. Pooled risk ratios and prevalence were calculated using a random-effects model. The risk of bias was assessed using the revised Cochrane risk of bias tool for randomized trials (RoB2) and Risk of Bias in non-randomized studies of interventions (ROBINS-I) tool. RESULTS: Thirteen studies involving 10,052 patients with ARDS were included. The pooled prevalence of delirium among ARDS patients was 41% (95% CI: 23%-58%), with substantial heterogeneity. Meta-analysis showed a higher risk of delirium among ARDS patients compared with controls; however, this association was not statistically significant (RR 1.34, 95% CI: 0.63-2.83). No statistically significant associations were observed between delirium and comorbid depression or anxiety. Delirium in ARDS patients was consistently associated with prolonged ICU stay, longer mechanical ventilation, and adverse clinical outcomes. CONCLUSION: Patients with ARDS frequently experience delirium, resulting in extended ICU admissions, prolonged mechanical ventilation, and cognitive impairment. Hypoxia, inflammation, sedation, and psychological factors contributes to delirium risk in ARDS patients. A multidisciplinary approach incorporating sedative minimization, early mobilization, and psychological support may mitigate delirium and improve patient outcomes. PROSPERO REGISTRATION NUMBER: (CRD42024564895): https://www.crd.york.ac.uk/PROSPERO/view/CRD42024564895.
The respiratory impacts of primary and secondhand exposure to electronic nicotine delivery systems in young adults: a prospective cohort study.
Vilcassim MJR, Majumder R, Stowe S … +1 more , Wells JM
Respir Med · 2026 · PMID 42320601 · Publisher ↗
INTRODUCTION: Electronic nicotine delivery systems (ENDS) are increasingly used among young adults, yet their respiratory effects, especially from secondhand exposure, remain unclear. This study evaluated changes in lung...
INTRODUCTION: Electronic nicotine delivery systems (ENDS) are increasingly used among young adults, yet their respiratory effects, especially from secondhand exposure, remain unclear. This study evaluated changes in lung function and respiratory symptoms associated with primary and secondhand ENDS exposure among healthy young adults over six months. METHODS: A longitudinal cohort of 32 participants aged 19-45 years was enrolled: 12 primary ENDS users (vapers), 10 secondhand exposed participants, and 10 unexposed controls. Pulmonary function tests (PFTs) were conducted in months 1, 3, and 6, measuring Forced Expiratory Volume in one second (FEV), Forced Vital Capacity (FVC), and FEV/FVC ratios. Respiratory symptoms were assessed via questionnaires. One-way ANOVA with Tukey's post hoc tests compared spirometry results, while Kruskal-Wallis with Dunn's tests analyzed symptom data. Linear mixed-effects models adjusted for age, sex, race, and body mass index assessed longitudinal trends. RESULTS: At baseline, mean FEV/FVC ratios were lower in vapers (0.86 ± 0.05) and secondhand participants (0.85 ± 0.05) than controls (0.91 ± 0.05). Mixed-effects models showed reduced FEV/FVC ratios among secondhand participants (p = 0.042). Vapers reported higher symptom scores than controls (p = 0.025) and secondhand participants (p = 0.048) at baseline, with similar trends at month 3. They also experienced greater changes in symptom scores from month 1 to 3 (p = 0.039) and month 1 to 6 (p = 0.046). CONCLUSIONS: Primary and secondhand ENDS exposure were associated with reduced lung function and increased respiratory symptoms in healthy young adults, suggesting ENDS aerosols may negatively affect respiratory health. Larger, long-term studies are needed to confirm these associations.
Characterizing deep inspiration dynamics across obstructive sleep apnea severity levels.
Mousavi S, Mohebbi M, Naghan PA … +2 more , Chavoshian S, Yadollahi A
Respir Med · 2026 Jun · PMID 42320600 · Publisher ↗
BACKGROUND: Obstructive sleep apnea (OSA) is characterized by recurrent upper airway obstructions during sleep. While the apnea-hypopnea index (AHI) is the standard for assessing OSA severity, it fails to capture physiol...
BACKGROUND: Obstructive sleep apnea (OSA) is characterized by recurrent upper airway obstructions during sleep. While the apnea-hypopnea index (AHI) is the standard for assessing OSA severity, it fails to capture physiological details in respiratory signals, particularly those related to airway responses to obstruction. This study investigates deep inspiration patterns following apneas and hypopneas across OSA severity levels to uncover airflow dynamics beyond what AHI reflects. METHODS: Using data from 202 participants in the Sleep Heart Health Study (SHHS), respiratory airflow signals were extracted and processed to isolate deep inspirations following respiratory events. Two standardization methods, interpolation and averaged random subsampling, were used to normalize time series lengths. Various interpolation techniques and orders for polynomial regression were evaluated to model individual and group-level respiratory patterns. RESULTS: Post-event deep inspiration amplitude decreased progressively with increasing OSA severity, with severe OSA showing marked attenuation, particularly in the first and last sleep quartiles. Distance-based analyses confirmed prominent magnitude differences, while cosine and correlation metrics demonstrated preserved temporal shape, indicating impaired compensatory ventilation rather than altered recovery dynamics. CONCLUSION: These results highlight that airflow signal morphology reveals respiratory compensation mechanisms in OSA. Post-event inspiratory patterns may serve as complementary markers of disease severity, offering a more detailed understanding of OSA beyond AHI.
IL-17 inhibitor therapy and risk of chronic obstructive pulmonary disease and related pulmonary outcomes in patients with psoriasis: A real-world cohort study.
Adler R, Kozlov M, Kriplani K … +3 more , Muhanna S, Feig JL, Al-Ajam M
Respir Med · 2026 · PMID 42314776 · Publisher ↗
BACKGROUND: The interleukin-17 (IL-17)/T helper 17 axis has been implicated in chronic obstructive pulmonary disease (COPD) pathogenesis, although pulmonary safety concerns have limited enthusiasm for IL-17-targeted ther...
BACKGROUND: The interleukin-17 (IL-17)/T helper 17 axis has been implicated in chronic obstructive pulmonary disease (COPD) pathogenesis, although pulmonary safety concerns have limited enthusiasm for IL-17-targeted therapies. We evaluated pulmonary outcomes associated with IL-17 inhibitors in patients with psoriasis. METHODS: We performed a retrospective cohort study using the TriNetX Research Network. Adults with psoriasis were identified and categorized into IL-17 inhibitor exposure cohorts (secukinumab, ixekizumab, brodalumab, or bimekizumab) or matched psoriasis controls without IL-17 exposure. A target trial emulation framework with 1:1 propensity score matching adjusted for demographics, comorbidities, nicotine dependence, and healthcare utilization. Outcomes included incident COPD, COPD exacerbation or lower respiratory infection, respiratory infections, respiratory failure, persistent asthma, oxygen dependence, pulmonary hypertension, hypoxemia, and interstitial lung disease. RESULTS: After matching, 28,706 IL-17-treated patients and 28,706 controls were analyzed. IL-17 inhibition was associated with lower risks of COPD (2.5% vs 3.6%; hazard ratio [HR], 0.74; 95% CI, 0.67-0.81), respiratory infections (HR, 0.68; 95% CI, 0.64-0.71), respiratory failure (HR, 0.84; 95% CI, 0.76-0.93), persistent asthma (HR, 0.80; 95% CI, 0.70-0.91), oxygen dependence (HR, 0.77; 95% CI, 0.66-0.90), pulmonary hypertension (HR, 0.79; 95% CI, 0.68-0.90), and hypoxemia (HR, 0.87; 95% CI, 0.78-0.96) (all p ≤ 0.008). Ixekizumab demonstrated the largest risk reductions. No increased signal for interstitial lung disease was observed. CONCLUSIONS: In this large real-world cohort, IL-17 inhibitor therapy in psoriasis was associated with reduced incidence of multiple pulmonary outcomes, supporting the need for future prospective research into the effects of IL-17 inhibitor therapy on pulmonary morbidity.
Divergent prognostic roles of air trapping and reduced inspiratory reserve in COPD: Exacerbations versus functional decline.
Kang HR, Song JH, Park S … +7 more , Ra SW, Lee CY, Hwang YI, Kim DK, Lee JH, Yoo KH, Kim Y
Respir Med · 2026 Jun · PMID 42314775 · Publisher ↗
BACKGROUND: Lung hyperinflation is a key feature of COPD, yet it remains unclear if its primary components-reduced inspiratory reserve (IC/TLC) and air trapping (RV/TLC)-predict distinct clinical trajectories. We investi...
BACKGROUND: Lung hyperinflation is a key feature of COPD, yet it remains unclear if its primary components-reduced inspiratory reserve (IC/TLC) and air trapping (RV/TLC)-predict distinct clinical trajectories. We investigated the independent prognostic roles of these indices regarding acute exacerbations and functional decline. METHODS: We analyzed 1214 COPD patients from the prospective KOCOSS cohort. Patients were stratified into four phenotypes using IC/TLC (<25%) and RV/TLC (>40%). Outcomes included 1-year acute exacerbation (AE) risk and 3-year longitudinal changes in health status (SGRQ) and exercise capacity (6MWD). RESULTS: IC/TLC and RV/TLC predicted divergent outcomes. Lower IC/TLC was an independent predictor of acute instability, including 1-year AE risk (OR 0.97; p = 0.020) and health status deterioration. Conversely, higher RV/TLC specifically predicted a steeper 3-year decline in 6MWD (β -0.34 m/year; p = 0.030). The "Combined" phenotype (low IC/TLC + high RV/TLC) exhibited the greatest vulnerability, with a two-fold higher AE risk (OR 2.06; p = 0.015) and accelerated SGRQ worsening. Notably, these associations were independent of airflow limitation, as annual FEV1 decline did not differ across phenotypes. CONCLUSIONS: IC/TLC and RV/TLC provide complementary prognostic information. Reduced inspiratory reserve identifies patients at risk for acute events, while air trapping marks those prone to long-term functional loss. Lung volume-based phenotyping allows for refined risk stratification beyond standard spirometry.
Sarcopenia predicts dynamic lung function trajectories in middle-aged and older adults: A national cohort study.
Wu Y, Han Y, Xia H … +8 more , Li Y, Zhang X, Qiao L, Cai Z, Li H, Huang P, Wu J, Chen B
Respir Med · 2026 · PMID 42314774 · Publisher ↗
BACKGROUND: Sarcopenia, defined by progressive loss of skeletal muscle mass and strength, may be related to reduced expiratory performance in later life. However, evidence linking relative muscle strength (RMS) to peak e...
BACKGROUND: Sarcopenia, defined by progressive loss of skeletal muscle mass and strength, may be related to reduced expiratory performance in later life. However, evidence linking relative muscle strength (RMS) to peak expiratory flow (PEF) and PEF-based respiratory performance in Asian populations remains limited. This study examined cross-sectional and longitudinal associations between RMS and PEF-based outcomes and explored nonlinear and subgroup variations. METHODS: Data were obtained from the China Health and Retirement Longitudinal Study (CHARLS). RMS was computed as maximal handgrip strength divided by appendicular skeletal muscle mass (ASM). The primary respiratory measures were peak expiratory flow (PEF), PEF% predicted, low PEF% predicted (<80%), and severe low PEF% predicted (<60%). PEF% predicted was calculated using sex-, age-, and height-specific adult reference equations from Zhong. Multivariable regression models examined associations between RMS and PEF-based outcomes; longitudinal models estimated four-year changes and incident low/severe low PEF% predicted. RESULTS: Each one standard deviation (1-SD) higher RMS was associated with higher PEF% predicted (β = 2.92, 95% CI 2.31-3.53) and higher absolute PEF (β = 10.29, 95% CI 7.92-12.66). Nonlinear analyses suggested that the association plateaued at RMS values around 1.8-2.0. Longitudinally, the third RMS quartile showed the strongest association with slower PEF decline (β = 3.12 units/year less decline vs Q1). Associations were generally more evident in males and smokers, with endpoint-specific subgroup differences for diabetes or stroke. Higher RMS was also correlated with lower CRP and more favorable metabolic profiles, suggesting possible inflammatory and metabolic pathways. CONCLUSIONS: Higher RMS was associated with better PEF-based expiratory performance and lower odds of low PEF% predicted in middle-aged and older adults. These findings support RMS as a simple functional marker related to PEF performance during aging, while recognizing that PEF does not replace spirometry-based assessment of obstructive or restrictive lung disease.
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