Respir Med [JOURNAL]
Sun
200 papers
Association of asthma and COPD with pertussis risk: A systematic review and meta-analysis.
Liu X, Yu X, Yang Q … +3 more , Tian Z, Guo C, Liu K
Respir Med · 2026 · PMID 42309234 · Publisher ↗
BACKGROUND: Pertussis, caused by Bordetella pertussis, has resurged globally despite widespread childhood vaccination. With waning immunity, adolescent and adult cases have increased. Patients with asthma and chronic obs...
BACKGROUND: Pertussis, caused by Bordetella pertussis, has resurged globally despite widespread childhood vaccination. With waning immunity, adolescent and adult cases have increased. Patients with asthma and chronic obstructive pulmonary disease (COPD) may be more susceptible due to chronic airway inflammation and impaired immune function, but prior findings are inconsistent. This study aims to systematically evaluate the association between asthma and COPD with the risk of pertussis infection through a meta-analysis. METHODS: PubMed, Cochrane Library, Embase, Web of Science, CBM, CNKI, VIP, and Wanfang were searched from inception to August 7, 2025. Observational studies reporting adjusted effect measures (OR, RR, HR, IRR) were included. Study quality was assessed using the Newcastle-Ottawa Scale. Random-effects meta-analyses (DerSimonian-Laird) were performed when ≥3 studies reported comparable measures; otherwise, results were synthesized descriptively. PROSPERO: CRD420251109793. RESULTS: Ten studies (7 cohort, 3 case-control) including >18.6 million participants were analyzed. Asthma was associated with increased pertussis risk (pooled OR = 2.29, 95% CI 1.94-2.69; I = 89%), and COPD showed a similar association (pooled OR = 2.00, 95% CI 1.53-2.62; I = 94%). A supplementary RR-based analysis supported the asthma association (pooled RR = 3.36, 95% CI 2.77-4.08). Leave-one-out sensitivity analyses indicated robust results. CONCLUSION: Evidence from existing observational studies suggests that asthma and chronic obstructive pulmonary disease (COPD) are associated with an increased risk of pertussis infection. The findings indicate that clinical identification and vaccination management should be strengthened to reduce preventable infections and the public health burden.
High-density lipoprotein cholesterol influences the outcomes of lung transplantation in females, but not males.
Elgharably H, Awad AK, Lehr CJ … +4 more , Budev M, McCurry KR, Smith JD, Ayyat KS
Respir Med · 2026 Jun · PMID 42309233 · Publisher ↗
OBJECTIVE: High-density lipoprotein-cholesterol (HDL-C) has recently garnered attention in lung transplantation studies for its anti-inflammatory properties. Herein, we aimed to study the association between basal HDL-C...
OBJECTIVE: High-density lipoprotein-cholesterol (HDL-C) has recently garnered attention in lung transplantation studies for its anti-inflammatory properties. Herein, we aimed to study the association between basal HDL-C serum levels and outcomes of lung transplantation with respect to sex. METHODS: In this retrospective cohort study in a tertiary center between 2009 and 2019, 1063 patients that underwent single or double lung transplant were included. Continuous variables are presented as median [25th - 75th percentiles] and analyzed using the Wilcoxon rank-sum test. Primary outcome was primary graft dysfunction (PGD) at 72 h. Survival was evaluated using Kaplan-Meier analysis. Multivariable logistic regression was used to identify independent risk factors for long term mortality, PGD at 72 h, and chronic lung allograft dysfunction. RESULTS: Our study had 349 females and 714 males with a median age of 59 [49 - 63] years and 62 [55-67] years, respectively. Recipients with HDL-C >69 mg/dL had significantly better survival (HR 0.73 [95% CI 0.58-0.91, p = 0.03). Dividing the cohort based on sex, high HDL-C in female recipients was associated with significantly better survival, lower PGD grade, and shorter hospital stay. In male recipients, the same trends were observed but did not reach statistical significance. Higher baseline HDL-C level was associated with better survival (HR 0.46, 95% CI 0.22-0.96; p = 0.040), lower risk for PGD (OR 0.611, 95% CI 0.562-0.86, p = 0.002), chronic allograft dysfunction (OR 0.91, 95% CI 0.84-0.98; p=0.012). CONCLUSION: Higher baseline High-density lipoprotein-cholesterol levels before lung transplant were associated with better outcomes, including lower primary graft dysfunction grades, less graft failure, and better survival. The association between higher high-density lipoprotein-cholesterol levels and better outcomes after lung transplantation in females warrants further studies to better characterize its influence on lung transplantation outcomes.
A predictive model for mortality in VA-ECMO patients based on early coagulation-immune interactions: A single-center retrospective study.
Liu Z, Huang Z, Xiong B … +4 more , Wei J, Zhang J, Xiang S, Han L
Respir Med · 2026 · PMID 42309232 · Publisher ↗
OBJECTIVE: To develop and validate an early predictive model for in-hospital mortality in patients receiving veno-arterial extracorporeal membrane oxygenation (VA-ECMO) by analyzing dynamic changes in metabolic, inflamma...
OBJECTIVE: To develop and validate an early predictive model for in-hospital mortality in patients receiving veno-arterial extracorporeal membrane oxygenation (VA-ECMO) by analyzing dynamic changes in metabolic, inflammatory, immune, and coagulation parameters. RESULTS: The in-hospital mortality rate was 66.7%. Non-survivors exhibited higher baseline severity (APACHE II: 31 vs 28, p = 0.001) and significantly impaired responses to ECMO, including persistent hyperlactatemia (6.6 vs 1.9 mmol/L, P < 0.001), uncontrolled inflammation, lymphocytopenia, and platelet consumption. Using LASSO regression for variable selection, multivariate analysis identified five independent predictors: post-ECMO lactate (OR = 1.27, 95% CI: 1.15-1.42, P < 0.001), age (OR = 1.03, 95% CI: 1.00-1.06, P = 0.029), post-ECMO PCT (OR = 1.06, 95% CI: 1.02-1.11, P = 0.004), post-ECMO CRP (OR = 1.01, 95% CI: 1.00-1.02, P = 0.005), and the directional change in platelet-to-lymphocyte ratio (ΔPLR = PLR_post - PLR_pre, OR = 0.997, 95% CI: 0.994-1.00, P = 0.044). The final model demonstrated good discrimination with an AUC of 0.858 (95% CI: 0.806-0.910) and good calibration (Hosmer-Lemeshow P = 0.386). CONCLUSIONS: We developed an efficient prediction model based on early multi-system dynamic responses. Its innovation lies in capturing the directional shift in coagulation-immune status (ΔPLR) from pre-to post-ECMO, alongside metabolic and inflammatory parameters. This tool enables accurate risk stratification within 6 h of cannulation, potentially guiding individualized therapy.
Effectiveness of preoperative pulmonary rehabilitation in patients with lung cancer combined with moderate to severe COPD: study protocol for a randomized controlled trial.
Yang JY, Lv L, Ni J
Respir Med · 2026 · PMID 42309231 · Publisher ↗
OBJECTIVE: The aim of this study is to evaluate the effectiveness of preoperative pulmonary rehabilitation in lung cancer patients with moderate to severe COPD by a randomized controlled trial protocol, and to explore th...
OBJECTIVE: The aim of this study is to evaluate the effectiveness of preoperative pulmonary rehabilitation in lung cancer patients with moderate to severe COPD by a randomized controlled trial protocol, and to explore the effect of preoperative pulmonary rehabilitation on surgical outcomes in high-risk patients. METHODS: A randomized, prospective, single-blind (evaluator) clinical trial. Participants(n = 70) will be randomly divided into two groups. The intervention group will receive 2 weeks preoperative pulmonary rehabilitation program (inspiratory muscle training + aerobic exercise + preoperative rehabilitation education), the control group will only receive preoperative rehabilitation education. Both groups will routinely receive the guidance training (contains breathing exercises and early ambulation) after surgery. RESULTS: The primary outcome is incidence of PPCs defined with the Melbourne Group Scale diagnostic scoring tool. Secondary outcomes include pre- and post-operative hospital length of stay (LOS), cardiopulmonary endurance, muscle strength, inspiratory muscle strength, pulmonary function,health-related quality of life (HRQoL), fatigue, the sleep quality,anxiety and depression. DISCUSSION: This trial was designed to test the hypothesis that preoperative pulmonary rehabilitation can improve preoperative cardiopulmonary function of patients with lung cancer complicated with moderate and severe COPD, reduce the incidence of PPCs, shorten the length of hospitalization, Improve fatigue, quality of life and more. TRIAL REGISTRATION: Chinese Clinical Trial Registry:ChiCTR2400093829,12 December 2024.
Multidimensional evaluation of clinical symptoms, pulmonary function, and imaging in long-term treatment of infants with post-infectious bronchiolitis obliterans.
He LT, Pan JH, Zhang L
Respir Med · 2026 · PMID 42303000 · Publisher ↗
OBJECTIVE: To investigate efficacy of standardized treatment for post-infectious bronchiolitis obliterans (PIBO) in infants and young children by evaluating changes in pulmonary function, and high-resolution computed tom...
OBJECTIVE: To investigate efficacy of standardized treatment for post-infectious bronchiolitis obliterans (PIBO) in infants and young children by evaluating changes in pulmonary function, and high-resolution computed tomography (HRCT) before and after treatment. METHODS: Thirty infants diagnosed with PIBO were treated with a two-phase protocol consisting of an intensive phase and a maintenance phase, including budesonide, azithromycin, montelukast, fluticasone propionate, and terbutaline sulfate. Pulmonary function was evaluated using TPTEF/TE, VPEF/VE, and impulse oscillometry (IOS). Imaging evaluation was performed using HRCT. RESULTS: Daytime respiratory symptoms significantly improved after 3 months of treatment (P < 0.05). Nocturnal symptoms and exercise-related limitations showed significant improvement after 6 months (P < 0.05) and 9 months (P < 0.05), respectively. The frequency of respiratory tract infections was significantly reduced after 12 months of continuous treatment (P < 0.05). Pulmonary function indices demonstrated significant improvement by the 9th month (P < 0.05). HRCT scores improved significantly, decreasing from 6 ± 1.08 at baseline to 4.5 ± 1.98 after 12 months of treatment (P < 0.05). Mosaic perfusion significantly improved at 6 months (P < 0.05), while emphysematous changes required 9 months of treatment to show significant improvement (P < 0.05). Structural abnormalities such as bronchiectasis, bronchial wall thickening, atelectasis, and peribronchial vascular bundle changes showed partial improvement after 12 months, but these differences did not reach statistical significance (P > 0.05). CONCLUSION: Standardized treatment for PIBO should be maintained for at least 9-12 months to achieve significant improvements in clinical symptoms, pulmonary function, and HRCT findings.
Incidence, mortality and risk factors in COVID-19-associated pulmonary aspergillosis (CAPA): an umbrella review and meta-meta-analyses (2020-2025).
de Victoria Carazo JM, Guirao Arrabal E, Montero-Alonso MÁ … +3 more , Yuste Ossorio ME, García García F, Hernández Quero J
Respir Med · 2026 · PMID 42302999 · Publisher ↗
INTRODUCTION: COVID-19-associated pulmonary aspergillosis (CAPA) has emerged as a severe and potentially underrecognised complication in patients with SARS-CoV-2 infection, particularly in intensive care units (ICUs). Ex...
INTRODUCTION: COVID-19-associated pulmonary aspergillosis (CAPA) has emerged as a severe and potentially underrecognised complication in patients with SARS-CoV-2 infection, particularly in intensive care units (ICUs). Existing reviews show substantial heterogeneity in diagnostic criteria, incidence estimates, and reported risk factors, limiting reliable interpretation of the overall evidence base. MATERIALS AND METHODS: this umbrella review synthesised systematic reviews and meta-analyses published between 2020 and 2025 to clarify the incidence, mortality, and risk factors associated with CAPA. Searches were conducted in PubMed and Scopus. Eligibility was restricted to articles published in English and Spanish. Pooled estimates were re-calculated through a dedicated meta-metaanalysis. RESULTS: sixteen reviews met the inclusion criteria, nine of them with meta-analysis. The pooled incidence among critically ill patients was 11.3% (95% CI 9.2-13.9), strongly influenced by diagnostic variability and the limited use of bronchoalveolar lavage during the pandemic. Overall mortality reached 51.6% (IQR 48.3-54.5), and CAPA tripled the risk of death compared with non-CAPA patients (OR 3.08; 95% CI 2.73-3.49). Consistent risk factors identified across meta-analyses included advanced age (OR 1.05 per year), chronic obstructive pulmonary disease (OR 1.98), type 2 diabetes mellitus (OR 1.25), systemic corticosteroid exposure (OR 1.72), and IL-6 inhibitors (OR 2.32). DISCUSSION AND CONCLUSIONS: the marked heterogeneity observed across studies highlights the urgent need for harmonised and clinically applicable diagnostic criteria. CAPA remains an underdiagnosed condition associated with substantial mortality, underscoring the importance of early recognition strategies and improved diagnostic availability to guide timely management in high-risk patients.
Impact of BMI on optimal PEEP titrated by electrical impedance tomography in ARDS patients: A retrospective study.
Zhao Y, Chi Y, Yuan S … +12 more , Gao Y, Yang J, Zhang M, Xu M, Wang Q, Sun X, Han J, Frerichs I, Zhao Z, Long Y, Jiang J, He H
Respir Med · 2026 · PMID 42302998 · Publisher ↗
INTRODUCTION: Obese patients with acute respiratory distress syndrome (ARDS) may require higher positive end-expiratory pressure (PEEP), but the dose-response relationship between body mass index (BMI) and PEEP remained...
INTRODUCTION: Obese patients with acute respiratory distress syndrome (ARDS) may require higher positive end-expiratory pressure (PEEP), but the dose-response relationship between body mass index (BMI) and PEEP remained undetermined. This study aimed to investigate the relationship between BMI and the optimal PEEP titrated by electrical impedance tomography (EIT) in ARDS patients. METHODS: ARDS patients who underwent EIT-guided PEEP titration were analyzed retrospectively. Patients were classified as obese (BMI ≥28 kg/m) and non-obese (BMI <28 kg/m). All patients received a decremental PEEP trial from 18 to 3 cmHO, and the optimal PEEP was determined by the lowest sum of EIT-based regional overdistension and collapse. RESULTS: Among 115 ARDS patients reviewed, average BMI was 25.1 (22.4-28.0) kg/m, with 29 (25.2%) patients being obese and a mortality rate of 13.9%. Compared to non-obese patients, the titrated PEEP was higher in obese patients (12 [12-15] cmHO vs 9 [6-12] cmHO, p < 0.001). At the PEEP level of 18 cmHO, overdistension was lower in the obese group (18.0 [14.0-26.6] % vs 25.4 [18.0-35.0] %, p = 0.023). A positive linear correlation was found between BMI and EIT-derived best PEEP (Spearman R = 0.46, p < 0.001). For detecting the optimal PEEP ≥12 cmHO, a cutoff of BMI >30 kg/m would provide a specificity of 96.4% and a positive predictive value of 88.2%. CONCLUSION: A lower PEEP resulted in more collapse and a higher PEEP resulted in less overdistension in obese ARDS patients. The findings provided evidence to consider BMI in setting PEEP for this patient group.
Redefining asthma through new immune response pattern: A clinically driven perspective.
Yalçın S, Bostanoğlu Karaçin A, Aydın Ö … +3 more , Mungan D, Bavbek S, Çelebi Sözener Z
Respir Med · 2026 · PMID 42302997 · Publisher ↗
BACKGROUND: In 2023, the European Academy of Allergy and Clinical Immunology (EAACI) proposed an immune response-based classification that integrates molecular, endotypic, and clinical characteristics to define predomina...
BACKGROUND: In 2023, the European Academy of Allergy and Clinical Immunology (EAACI) proposed an immune response-based classification that integrates molecular, endotypic, and clinical characteristics to define predominant and co-occurring immune response groups in asthma. Applying this framework may clarify disease heterogeneity and support personalized treatment. OBJECTIVE: To classify asthma patients according to the EAACI immune response system and describe predominant and overlapping groups together with related clinical features. METHODS: A retrospective chart review was conducted between February and April 2025 in our tertiary asthma outpatient clinic. Patients meeting ≥1 clinical criterion for an immune response type were categorized into seven EAACI-defined groups. Demographic variables, Asthma Control Test (ACT) scores, treatment steps, and disease severity were analyzed. RESULTS: Among 401 patients (332 female, 69 male; mean age 53.4 ± 14 years), Type 1, 4b, 4a, 4c, 6, and 7 immune responses were present in 44.6%, 90%, 32.2%, 58.9%, 41.6%, and 15.5%, respectively, while all patients exhibited Type 5 features. The most frequent co-occurrence was among Types 4b, 4c, and 6. Step 5 treatment was more common in Type 4b (p = 0.002), whereas Step 3 predominated in Type 1 (p = 0.002). ACT scores did not differ significantly across immune response groups. CONCLUSION: Classification based on the EAACI immune response framework is feasible and clinically meaningful. The predominance of Type 4b, often coexisting with Types 4c and 6, underscores its clinical relevance. This phenotypic-endotypic linkage may inform future personalized therapy strategies in asthma.
Dose-dependent association between opioid administration and ventilator-associated pneumonia in sepsis patients receiving mechanical ventilation.
Lin S, Chi L, Lu W … +3 more , Jin P, Wang J, Bian J
Respir Med · 2026 · PMID 42297158 · Publisher ↗
BACKGROUND: This study aimed to investigate the association between opioid administration and the risk of ventilator-associated pneumonia (VAP) in mechanically ventilated (MV) patients in the intensive care unit (ICU). M...
BACKGROUND: This study aimed to investigate the association between opioid administration and the risk of ventilator-associated pneumonia (VAP) in mechanically ventilated (MV) patients in the intensive care unit (ICU). METHODS: Using a retrospective cohort design, we extracted data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. VAP diagnoses were identified using International Classification of Diseases (ICD) codes. Logistic regression and propensity score matching analyses were performed to evaluate the association between opioid exposure and VAP risk. Subgroup analyses evaluated the influence of comorbidities, including diabetes, congestive heart failure, and chronic pulmonary disease. RESULTS: Among 6978 patients, 668 (9.6%) developed VAP. Patients in the high-opioid group (fentanyl equivalent daily dose >2.47 mg/day) exhibited a significantly increased risk of VAP (OR: 2.12, 95% CI: 1.77-2.54, P < 0.001). After propensity score matching, the high-opioid group maintained a higher VAP risk compared to the low-opioid group (OR: 1.86, 95% CI: 1.52-2.27, P < 0.001). Secondary outcomes revealed that the high-opioid group had elevated risks of acute kidney injury (AKI) within 7 days of ICU admission (OR: 1.54, 95% CI: 1.35-1.76, P < 0.001). Additionally, 30-day mortality was higher in the high-opioid group (HR: 2.65, 95% CI: 2.24-3.13, P < 0.001). CONCLUSIONS: Our findings demonstrate a significant association between opioid administration and an increased risk of VAP, particularly in sepsis patients with specific comorbidities. These results highlight the need for careful opioid dosing strategies in critically ill, mechanically ventilated patients.
A qualitative study on the experiences and perspectives of adults with cystic fibrosis and healthcare professionals.
Akyazi N, Kemer SN, Yagli NV … +4 more , Saglam M, Damadoglu E, Karcioglu O, Bilgin S
Respir Med · 2026 · PMID 42297157 · Publisher ↗
BACKGROUND: Cystic fibrosis (CF) is a multisystemic disease increasingly affecting adults due to improved survival rates. However, the functional outcomes, participation in daily life, and influence of environmental fact...
BACKGROUND: Cystic fibrosis (CF) is a multisystemic disease increasingly affecting adults due to improved survival rates. However, the functional outcomes, participation in daily life, and influence of environmental factors in adults with CF remain underexplored. This study aimed to evaluate the impairments and multidimensional functioning of adults with CF within the International Classification of Functioning, Disability and Health (ICF) framework, based on the perspectives of both patients and healthcare professionals. MATERIALS AND METHODS: A qualitative multicenter study was conducted with 101 participants, including 30 adults with CF (≥18 years) and 71 healthcare professionals (27 physicians, 40 physiotherapists, and 4 nurses). Adults with CF participated in in-depth interviews, while healthcare professionals completed an online questionnaire containing six open-ended ICF-based questions. RESULTS: Eighty-three ICF categories were identified: body structures (20.5%), body functions (28.9%), activities and participation (20.5%), and environmental factors (30.1%). Both groups most frequently referred to lungs (s4301), sensations associated with cardiovascular and respiratory functions (b460), socializing (d9205), and immediate family (e310). Adults with CF emphasized environmental influences-such as e310-immediate family (76.67%), e1101-drugs (83.33%), and d9205-socializing (%73)-more than healthcare professionals, who focused primarily on physiological and e580-health services, systems and policies (67.61%). CONCLUSIONS: The most prominent ICF categories identified in both groups reflect the physical, psychosocial, and environmental dimensions of CF. Adults with CF placed greater emphasis on environmental and social factors, whereas healthcare professionals focused more on physiological aspects. These findings highlight the importance of the ICF framework, which supports a biopsychosocial, patient-centered, and multidisciplinary approach in the assessment of adults with CF. CLINICAL TRIAL REGISTRATION: NCT06128499.
Correspondence: A two-step algorithm for pharmacologic management of COPD: Bridging foundational and personalized medicine.
Barjaktarevic IZ, Tashkin DP, Cooper CB
Respir Med · 2026 Jun · PMID 42297156 · Publisher ↗
Abstract loading — click title to view on PubMed.
Nonlinear association of methylmalonic acid with chronic obstructive pulmonary disease and the mediating role of systemic inflammation: A population-based study.
Wang J, Jiang H, Wang Y … +3 more , Pu S, Liu W, Shi Y
Respir Med · 2026 · PMID 42288061 · Publisher ↗
BACKGROUND: Methylmalonic acid (MMA), a sensitive biomarker of mitochondrial dysfunction, has been associated with various chronic diseases, but its role in chronic obstructive pulmonary disease (COPD) remains unclear. T...
BACKGROUND: Methylmalonic acid (MMA), a sensitive biomarker of mitochondrial dysfunction, has been associated with various chronic diseases, but its role in chronic obstructive pulmonary disease (COPD) remains unclear. This study aimed to investigate the association between serum MMA and COPD and the statistical mediation of systemic inflammation. METHODS: Based on NHANES 2013-2014 data, 5139 adults were included. Multivariable logistic regression was used to analyze the association between MMA and COPD. Restricted cubic spline (RCS) assessed non-linear relationships, and statistical mediation analysis examined the mediating effects of inflammatory indices. Subgroup and sensitivity analysis were used to verify the stability of the results. RESULTS: A significant inverted L-shaped non-linear association between MMA and COPD was identified (P for non-linearity = 0.038), with an inflection point at 135 nmol/L (ln-MMA = 4.91). Below this threshold, each one-unit increase in ln-MMA was associated with a 4.59-fold increased odds ratio of COPD (OR = 4.59, 95%CI: 1.54-13.65), whereas the association disappeared above the threshold. Systemic inflammation partially statistically mediated this association (3.7%-10.2%), with monocyte-to-lymphocyte ratio (MLR) and systemic inflammatory response index (SIRI) showing the strongest mediating effects. The results of subgroup analysis and sensitivity analysis were stable. CONCLUSIONS: MMA was nonlinearly associated with COPD prevalence, systemic inflammation statistically accounts for part of this association. MMA may serve as a candidate biomarker for COPD prevalence in future prospective studies, although temporal ordering cannot be established from this cross-sectional analysis.
Radiology reporting affects clinical follow-up of incidental findings on low-dose CT scan for lung cancer screening.
Thurm C, Keating LH, Raja MU … +5 more , Mohammed IF, Imtiaz A, Chorzepa A, Russo A, Jonathan Robitsek R
Respir Med · 2026 · PMID 42285233 · Publisher ↗
RATIONALE: Although low-dose computed tomography (LDCT) performed for lung cancer screening (LCS) frequently identifies previously unrecognized significant incidental findings (SIFs), the most effective way to report the...
RATIONALE: Although low-dose computed tomography (LDCT) performed for lung cancer screening (LCS) frequently identifies previously unrecognized significant incidental findings (SIFs), the most effective way to report these findings remains unclear. Clinical follow-up of SIFs is suboptimal, likely resulting in missed opportunities to improve patient outcomes, but research on contributing factors remains limited. METHODS: We retrospectively reviewed medical records of 296 patients undergoing LDCT between 12/01/2023-09/30/2024. SIF frequency, report structure, and clinical follow-up over 6-months were evaluated. Using mixed-effects logistic regression, follow-up likelihood was examined as a function of radiology report structure, including presence of impression section reporting (IS), management recommendations (MR), and a Lung Imaging and Reporting Data System (Lung-RADS) S Modifier. RESULTS: Most (n = 212) patients had at least one SIF. Of 337 SIFs, 63.8% were reported in the IS; 50.5% were given MRs, while 36.2% were addressed at follow-up. IS reporting (OR: 2.43; CI: 1.06-5.59), MRs (OR: 2.83; CI: 1.31-6.13), and increasing comorbidity burden (OR: 1.13; CI: 1.00-1.27) were associated with greater odds of follow-up. Among SIFs not highlighted in the IS or given MRs, only 17.2% were addressed at follow-up. If either was done, the follow-up rate was 46.2%; if both, 50.6%. S-Modifier use did not improve follow-up. CONCLUSIONS: SIFs found on LDCT conducted for LCS are common, but clinical follow-up rates are suboptimal and impacted by reporting practices and provider-related factors. IS reporting and MRs significantly increase likelihood of follow-up. Efforts to improve SIF follow-up, including standardizing reporting practices, are indicated.
Challenging uniform size criteria for EBUS-TBNA sampling: Comparative analysis by lymph node station.
Strumpf ZB, Balijepalli S, Galchenko P … +3 more , Helmy F, Young BP, Avasarala SK
Respir Med · 2026 · PMID 42276524 · Publisher ↗
PURPOSE: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is essential for mediastinal staging in non-small cell lung cancer (NSCLC), yet uniform lymph node (LN) size criteria for sampling rem...
PURPOSE: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is essential for mediastinal staging in non-small cell lung cancer (NSCLC), yet uniform lymph node (LN) size criteria for sampling remain unvalidated. METHODS: This single-center retrospective study evaluated consecutive patients who underwent EBUS-TBNA for initial staging of NSCLC with available PET-CT were included. Nonparametric tests compared LN sizes across mediastinal stations 4R, 4L, and 7. RESULTS: Among 205 patients (median age 69 years), 1306 LNs were analyzed, including 770 nodes ≥5 mm and 449 mediastinal LNs. Significant size variation was observed across stations in benign nodes (p < 0.001), particularly between 4R or 4L versus 7, while malignant nodes did not differ significantly (p = 0.065). CONCLUSIONS: These findings suggest that uniform LN size cutoffs for EBUS-TBNA may not be optimal across mediastinal stations. Prospective, multicenter validation is warranted to refine evidence-based criteria for EBUS-guided mediastinal staging.
Long-term patterns of health services utilization after hospitalization for COPD. A nationwide registry-based study from Norway.
Holte JH, Moger TA, Edvardsen A … +4 more , Tjerbo T, Vøllestad NK, Hellesø R, Hubbard A
Respir Med · 2026 · PMID 42270050 · Publisher ↗
Chronic obstructive pulmonary disease (COPD) is commonly regarded as an ambulatory care-sensitive condition (ACSC), for which targeted outpatient and primary care can improve patients' outcomes and reduce their risk of h...
Chronic obstructive pulmonary disease (COPD) is commonly regarded as an ambulatory care-sensitive condition (ACSC), for which targeted outpatient and primary care can improve patients' outcomes and reduce their risk of hospitalization. Yet little is known about how COPD patients' use of such services evolves in real-life settings. Using national health registry data from Norway (2008-2020), linked to demographic and socioeconomic registers, we explore how COPD patients' combined use of primary and specialist services evolves in the first four years after an acute respiratory hospital episode, and assess whether these patterns align with clinical guidelines and vary by sociodemographic characteristics. A two-stage clustering approach was employed to identify individuals with similar care trajectories. The 13 057 patients were first grouped by the number of respiratory hospital episodes after the index episode (0, 1-2, or 3+), then K-medoid clustering was performed within each group to identify similar patterns of respiratory-related outpatient and primary health service utilization. Four distinct care trajectories emerged within each group, with similar combination patterns: (1) predominantly GP services (most common), (2) GP and outpatient services, (3) GP, out-of-hours primary care and infrequent outpatient services, and (4) frequent physiotherapist, GP and outpatient services (rarest). Notably, groups 2 and 4 had higher income and education than groups 1 and 3, and many patients do not follow care trajectories according to current guidelines for COPD treatment. Understanding the mechanisms that explain these variations in health services use, and their implications for care quality and equity, is essential for improving COPD management in universal healthcare systems.
Association between the PaO/FiO-to-PaCO ratio and mortality in patients with sepsis: a retrospective study with dual-cohort validation.
Yuan S, Dou L, Tan Y … +4 more , Wang J, Xu S, Chen R, Guo T
Respir Med · 2026 · PMID 42270049 · Publisher ↗
BACKGROUND: Sepsis patients face a high mortality risk. Available prognostic biomarkers have certain limitations. This study explored the prognostic utility of the PaO/FiO-to-PaCO ratio (PFP) in sepsis. METHODS: This stu...
BACKGROUND: Sepsis patients face a high mortality risk. Available prognostic biomarkers have certain limitations. This study explored the prognostic utility of the PaO/FiO-to-PaCO ratio (PFP) in sepsis. METHODS: This study analyzed MIMIC-IV data on 16,546 patients with sepsis admitted to the ICU and categorized into three groups by PFP values calculated from the first arterial blood gas within 24 h of admission. Associations between PFP and mortality were assessed using Kaplan-Meier, Cox regression, and restricted cubic splines (RCS) analyses, and validated using clinical data from a regional hospital. Machine learning was used to develop predictive models for 28- and 90-day mortality, with and without PFP, to evaluate its predictive strength against existing models. RESULTS: Mortality rates at 28 and 90 days varied significantly across PFP groups (P < 0.001). Cox regression and Kaplan-Meier analyses showed that lower PFP was associated with higher mortality risk (log-rank P < 0.001), Especially among patients receiving mechanical ventilation, which was confirmed by subgroup and sensitivity analyses.RCS analyses demonstrated a nonlinear association between PFP and mortality (cutoff: 4.85). In external validation, lower PFP was linked to higher mortality risk (cutoff: 4.85; log-rank P < 0.001). Machine learning models for 28- and 90-day mortality identified PFP as a significant predictor. Models including PFP improved integrated discrimination improvement (IDI) compared with baseline models (IDI = 0.6%, P = 0.001; IDI = 0.3%, P = 0.002), indicating improved discrimination. CONCLUSION: Lower PFP values correlate with higher 28-day and 90-day mortality in septic ICU patients. PFP has modest supplementary prognostic value, mainly in mechanically ventilated patients, not a universal biomarker for all sepsis patients.
Physiological responses and clinical associations of the one-minute sit-to-stand test and the six-minute walk test in systemic sclerosis.
Næser E, Elkjær AL, Aaen KT … +2 more , Bendstrup E, Søndergaard K
Respir Med · 2026 · PMID 42263959 · Publisher ↗
BACKGROUND: The One-Minute Sit-To-Stand Test (1-STST) is a simple alternative to the Six-Minute Walk Test (6MWT), but its clinical utility in systemic sclerosis (SSc) remains insufficiently characterized. This study eval...
BACKGROUND: The One-Minute Sit-To-Stand Test (1-STST) is a simple alternative to the Six-Minute Walk Test (6MWT), but its clinical utility in systemic sclerosis (SSc) remains insufficiently characterized. This study evaluated the convergent validity of the 1-STST with the 6MWT and their associations with clinical characteristics in patients with SSc. METHODS: In this cross-sectional study, 80 adults with SSc performed both tests on the same day; 40 repeated testing after one week to assess test-retest reliability. Clinical characteristics, lung function, imaging, comorbidities, patient-reported outcomes, and physiological responses were collected. Associations were assessed using Spearman correlation analyses, and multivariable regression identified independent determinants of performance. RESULTS: The 1-STST correlated strongly with 6MWT distance (ρ = 0.78; p < 0.001) and showed good test-retest reliability (ICC 0.85). It elicited less desaturation and heart rate increase than the 6MWT. Muscular pain was more frequently reported during the 1-STST (34.2% vs. 13.8%; p < 0.005). Both tests showed moderate correlations with dyspnea and weak correlations with lung function. After excluding patients with musculoskeletal limitations, correlations between 1-STST and pulmonary function strengthened. In multivariable analyses, 1-STST performance was independently associated with age and Scleroderma HAQ, whereas 6MWT distance was associated with age and DLCO. CONCLUSIONS: The 1-STST is a valid, reliable, and pragmatic tool for assessing functional capacity in SSc. It reflects a composite functional signal influenced by musculoskeletal and cardiopulmonary factors, whereas the 6MWT more consistently reflects cardiopulmonary capacity. The 1-STST may serve as a complementary tool to the 6MWT in clinical assessment of SSc.
Comparative outcomes based on pre-Bronchoscopic lung volume reduction (BLVR) Six-minute walk distance (6MWD).
Mahajan AK, Patel PP, Duong DK … +10 more , Shah N, Collar N, Muldowney F, Wang H, Khan A, Jang H, Subramanian M, Suzuki K, Randhawa S, Weyant MJ
Respir Med · 2026 · PMID 42263958 · Publisher ↗
INTRODUCTION: Bronchoscopic lung volume reduction (BLVR) is a minimally invasive procedure that improves shortness of breath and quality of life in some patients with emphysema. A key indicator of functional capacity for...
INTRODUCTION: Bronchoscopic lung volume reduction (BLVR) is a minimally invasive procedure that improves shortness of breath and quality of life in some patients with emphysema. A key indicator of functional capacity for patients with underlying emphysema is a 6-min walk test (6MWD). This study aims to assess outcomes for patients who underwent BLVR stratified by 6MWD. METHODS: This single center, retrospective study analyzes patients who underwent BLVR. Patients were stratified into groups based on pre-BLVR 6MWD. The low functional capacity group walked between 100 and 250 m, the intermediate functional capacity group walked between 251 and 400 m, and the high functional capacity group walked greater than 400 m. The primary endpoint of this study is the percentage of FEV1 responders in each group based on pre-procedural 6MWD following BLVR. Secondary outcomes included changes in 6MWD and SGRQ for each group based on pre-procedural 6MWD following BLVR. RESULTS: A total of 96 patients were stratified based on pre-BLVR 6MWD. At 12-months, patients in the low functional capacity group demonstrated an FEV1 responder rate of 51.6%, 48.1% in the intermediate functional capacity group, and high functionality group demonstrated an FEV1 responder rate of 30.8%. The average change in 6MWD following BLVR in the low functionality group was an increase by 53.3 m and an increase of 5.2 m in the intermediate functionality group. The average change in 6MWD in the high functionality group demonstrated a decrease by 53.2 m. Finally, the improvement in SGRQ in the low functionality group was 8.0, the improvement in the intermediate functionality group was 10.1, and the high functionality group showed an improvement by 10.1. CONCLUSION: This study demonstrates that at 12-months there is no statistically significant association between pre-BLVR 6MWD testing and the FEV1 responder rate or the changes in mean SGRQ. Conversely, subjects in the high functional capacity group showed a statistically significant lower mean change in 6MWD compared to patients who walked less than 400 m. The greatest improvement in average 6MWD following BLVR was seen in the low functional capacity group.
Lung cancer location drives lateralized ventilation loss and adverse outcome.
Yu K, Wang H, Li C … +6 more , Cheng B, Zheng X, Chen P, Fu W, He J, Liang W
Respir Med · 2026 · PMID 42263957 · Publisher ↗
BACKGROUND: Evidence suggests that the hypoxic tumor microenvironment (TME) contributes to the initiation and progression of non-small cell lung cancer (NSCLC). However, the degree to which tumor growth affects ventilati...
BACKGROUND: Evidence suggests that the hypoxic tumor microenvironment (TME) contributes to the initiation and progression of non-small cell lung cancer (NSCLC). However, the degree to which tumor growth affects ventilation in the ipsilateral lung, and the clinical significance of this functional change, is not well understood. This study aimed to measure ventilation impairment on the tumor-bearing side using ventilation-perfusion scintigraphy (VPS) and to evaluate its association with patient survival. METHODS: This retrospective study included 365 patients with pathologically confirmed NSCLC diagnosed between 2009 and 2020. Tumor location and bilateral pulmonary ventilation were evaluated using VPS. Ipsilateral ventilation impairment was determined by comparing the relative ventilation contributions of each lung. Subgroup analyses were performed by histological subtype, tumor size, and anatomical location. Survival outcomes were assessed using Kaplan-Meier analysis and univariate Cox regression. RESULTS: Quantitative VPS analysis showed that pulmonary ventilation on the tumor-bearing side was significantly lower than on the contralateral side (χ = 17.74, p < 0.001), a pattern consistently observed in both LSCC (χ = 16.30, p < 0.001) and LUAD (χ = 4.81, p = 0.028) subgroups. Further analysis confirmed an association between tumor presence and reduced ipsilateral ventilation: in patients with right-sided tumors, ventilation was 4.08% ± 1.34% lower than in unaffected right lungs (52.74% vs. 56.82%, p = 0.003); a similar difference was observed in left-sided tumors (43.19% vs. 47.26%, p = 0.003). Subgroup analysis indicated significant impairment in LSCC (left lung: 42.51% vs. 49.02%, p = 0.002; right lung: 50.97% vs. 57.50%, p = 0.002), while LUAD showed a similar but non-significant trend (p > 0.05). Stratified analysis by tumor size demonstrated a consistent decline in ventilation across different tumor volumes. Spearman correlation analysis suggested that ipsilateral ventilation impairment was not solely explained by space-occupying effects (left lung: ρ = -0.225, p = 0.011; right lung: ρ = -0.322, p < 0.001). Survival analysis showed that patients with tumors in the lower-ventilated lung had a significantly higher risk of mortality (HR = 2.40, 95% CI: 1.28-4.51, p = 0.017). CONCLUSION: This study is the first to systematically demonstrate that pulmonary ventilation is significantly reduced in the tumor-bearing lung of patients with NSCLC. This reduction is not solely explained by the space-occupying effect of the tumor, but may also reflect a more complex interaction between tumor biology and regional pulmonary function. In addition, the presence of a tumor in the lower-ventilated lung was associated with worse prognosis. These findings support the potential value of functional imaging in prognostic assessment and suggest that ventilation metrics may serve as functional biomarkers for risk stratification in NSCLC.
Musculoskeletal adverse effects associated with inhaled levofloxacin in a patient with cystic fibrosis: A case report.
Alwadaei S, Allsup N, Shiferaw D
Respir Med · 2026 Jun · PMID 42259475 · Publisher ↗
Inhaled levofloxacin is widely used in cystic fibrosis (CF) patients with chronic Pseudomonas aeruginosa infection and is generally well tolerated. The most commonly reported adverse effects are bronchospasm and dysgeusi...
Inhaled levofloxacin is widely used in cystic fibrosis (CF) patients with chronic Pseudomonas aeruginosa infection and is generally well tolerated. The most commonly reported adverse effects are bronchospasm and dysgeusia, with limited evidence of systemic toxicity. We report a case of a 26-year-old woman with CF who developed recurrent diffuse musculoskeletal pain temporally associated with inhaled levofloxacin therapy. Symptoms occurred exclusively during treatment cycles, resolved upon discontinuation, and have not recurred since cessation. This case highlights a potential association between inhaled levofloxacin and musculoskeletal adverse effects, emphasizing the need for clinician awareness despite the drug's favorable safety profile.
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