Respir Med [JOURNAL]
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200 papers
Infertility in women with asthma - does asthma also exist in the uterus?
Hansen AV, Tidemandsen C, Nielsen HS … +13 more , Serizawa R, Stubsgaard AJK, Gade EJ, Egerup P, Thuesen LL, Lundgaard AT, Jensen THL, Foster PS, McDonald VM, Gibson PG, Ulrik CS, Backer V, Freiesleben NC
Respir Med · 2026 Jun · PMID 42251918 · Publisher ↗
Prolonged time to pregnancy, increased need for fertility treatment, and increased pregnancy loss have been reported in women with asthma. However, it is unknown whether uterine inflammatory cells negatively affects fert...
Prolonged time to pregnancy, increased need for fertility treatment, and increased pregnancy loss have been reported in women with asthma. However, it is unknown whether uterine inflammatory cells negatively affects fertility in this group. We explored whether women with asthma undergoing fertility treatment have increased inflammatory cells in the endometrium compared to women without asthma. Thirty women with and without asthma (1:1) undergoing fertility treatment were included in this explorative observational study. Asthma was defined by symptoms and a positive bronchial challenge test. Participants underwent questionnaires, fractional exhaled nitric oxide measurement, blood sampling, spirometry, methacholine challenge, induced sputum, and 2/3D ultrasound scan of the uterus followed by endometrial biopsy near ovulation. Endometrial biopsies revealed no significant differences in inflammatory cell types between women with asthma versus women without asthma. Women with asthma had higher airway responsiveness, atopy, IgE, and eosinophil counts, as expected, but similar reproductive history and treatment characteristics. No differences were observed in plasma cells/mm2 (median(IQR) 0.15(0.14-0.65); 0.33(0.21-0.92), ns), mast cells/mm2 (median(IQR) 2.99(1.31-3.47); 3.72(3.25-9.57), ns) nor CD3 or CD20 lymphocytes or eosinophils. Biomarker analysis across tissues showed no significant association with asthma after multiple testing correction. This exploratory study found no evidence of differences in endometrial inflammatory cells between infertile women with and without asthma. However, the small sample size limits statistical power and a Type II error cannot be excluded.
CT assessment of body composition and lung evolution in cystic fibrosis after Elexacaftor-Tezacaftor-Ivacaftor: A cohort study.
Soria-Utrilla V, Piñar-Gutiérrez A, Sánchez-Torralvo FJ … +8 more , Adarve-Castro A, Padial M, Jiménez-Sánchez A, Quintana-Gallego ME, Olveira C, Girón MV, Olveira G, García-Luna PP
Respir Med · 2026 · PMID 42251917 · Publisher ↗
BACKGROUND: Elexacaftor-Tezacaftor-Ivacaftor (ETI) therapy markedly improves pulmonary function in people with cystic fibrosis (pwCF) but induces weight gain, raising concerns about body composition. CT scans routinely p...
BACKGROUND: Elexacaftor-Tezacaftor-Ivacaftor (ETI) therapy markedly improves pulmonary function in people with cystic fibrosis (pwCF) but induces weight gain, raising concerns about body composition. CT scans routinely performed to assess lung structure offer opportunistic nutritional assessment. In this study, we aimed to evaluate changes in body composition in pwCF after ETI through CT image analysis, and changes in radiological findings measured by the Bhalla score. METHODS: This observational study analyzed paired chest CT scans at the T12 vertebra level from 32 adult pwCF before and after ETI initiation. Body composition was quantified using FocusedON artificial intelligence-assisted software, assessing muscle, subcutaneous (SAT), visceral (VAT), and intermuscular adipose tissue (IMAT) areas, percentages, and Hounsfield units (HU). Muscle quality was stratified by attenuation. Respiratory status was evaluated via Bhalla score, spirometry, and bacterial colonization status. RESULTS: Post-ETI, weight (+4.1 kg) and BMI (+1.5 kg/m) increased significantly (p < 0.001), mainly reflecting increases in IMAT (from 0.3% to 0.5%), SAT (from 7.5% to 9.3%) and VAT (from 6.9% to 9.4%) percentages (p < 0.05). Muscle area and lean muscle area also increased significantly, although their relative percentages did not change significantly. Normal attenuation muscle significantly decreased (69.9 vs. 64.7%, p = 0.043), suggesting myosteatosis. Respiratory changes included improvements in FEV1 (+11.8%), FVC (+12.5%), Bhalla score (+3.7 points) (p < 0.001), and reduced colonization (78.1 vs. 43.8%, p = 0.004). CONCLUSIONS: ETI promotes adiposity-dominant weight gain with radiological features suggestive of myosteatosis, alongside robust lung improvements. FocusedON CT image analysis promotes integrated nutritional-radiological insights, supporting personalized CF care, although further validation is needed.
Peak inspiratory flow in Austrian patients with asthma and/or COPD using dry powder inhalers- a cross-sectional, observational real-world study.
Rowhani M, Hörmannstorfer-Fessl K, Kastner M … +3 more , Angotti-Arthofer R, Tiefenbacher F, Liendl-Xu L
Respir Med · 2026 · PMID 42251916 · Publisher ↗
BACKGROUND: Dry powder inhalers (DPIs) prescribed for respiratory diseases require patients to generate sufficient peak inspiratory flow (PIF) for optimal drug delivery to the airways. However, information is scarce rega...
BACKGROUND: Dry powder inhalers (DPIs) prescribed for respiratory diseases require patients to generate sufficient peak inspiratory flow (PIF) for optimal drug delivery to the airways. However, information is scarce regarding PIF of asthma and COPD patients in real-world practice and whether prescribed devices can be properly used. METHODS: The observational, non-interventional real-world study PIF NIS included Austrian asthma and COPD patients regularly using a DPI and assessed PIF with the In-Check DIAL G16 inhalation airflow training meter. RESULTS: The study examined 134 asthma patients (median age 60 years; mostly GINA step 1-3; median ACT score 21) and 123 COPD patients (69 years, mostly GOLD grade 1/2; median CAT score 15). Median PIF was 80 L/min [95% CI 75-90] (asthma) and 70 L/min [95% CI 60-75] (COPD). No asthma patient but six (4.9%) COPD patients failed to reach the minimum PIF required, and 17 (12.7%) asthma and 29 (23.6%) COPD patients did not reach the optimum PIF for their device. CONCLUSION: A considerable proportion of asthma and COPD patients does not achieve the optimal PIF for effective drug delivery to the lungs, some even fail to generate the minimal PIF which may lead to undertreatment of their disease. These findings highlight the importance of assessing PIF and suggest that selecting the appropriate inhaler type and proper patient inhaler training might be critical for the adequate inhaled treatment in these patients.
Description and impact on gas exchange of sleep related respiratory events for patients with chronic respiratory failure treated with non-invasive ventilation.
Tankéré P, Rabec C, Vagner A … +5 more , Mouillot P, Schenesse D, Mouraux S, Bonniaud P, Georges M
Respir Med · 2026 · PMID 42251915 · Publisher ↗
BACKGROUND: The rising prevalence of hypercapnic chronic respiratory failure (HCRF) raises questions about how to initiate and adjust noninvasive ventilation (NIV), which is the first-line treatment. The current literatu...
BACKGROUND: The rising prevalence of hypercapnic chronic respiratory failure (HCRF) raises questions about how to initiate and adjust noninvasive ventilation (NIV), which is the first-line treatment. The current literature regarding the prevalence of patient ventilator asynchronies (PVA) and their impact on patient gas exchange is limited. METHODS: This single center observational cohort study describes the monitoring of consecutive patients treated with a long-term indication for NIV. Polygraphy was used to assess leaks, upper airway obstruction (UAO), and PVA rate (% of recording time and events per hour of recording). Linear regressions were performed to assess correlations with PaCO, TcPCO and SpO. RESULTS: 123 patients with varying HCRF etiologies were included, median age 69.0 (59.0,78.0) years, with a slight female predominance. Median morning PaCO was 48.5 (43.1,54.8) mmHg. The main rate asynchrony scored was ineffective effort. In treated patients, morning PaCO was significantly positively correlated with PVA (both as a percentage and an index) and UAO index. Mean TcPCO and mean SpO were significantly correlated (respectively positively and negatively) with PVA as a percentage and an index. Other significant factors correlated with PaCO included disease categories, while UAO was also associated with hypoxemia. Leaks did not reach significance. CONCLUSION: Our findings indicate that asynchronies are associated with impaired gas exchange in patients receiving long-term NIV. Therefore, after adequately adjusting NIV pressure support and interface, close monitoring is required for patients with residual hypoventilation to detect and correct the underlying mechanisms.
Construction and validation of a risk-prediction model for pneumonia in critically ill patients with indwelling nasogastric tubes.
Ma Y, Zhang Y
Respir Med · 2026 · PMID 42251914 · Publisher ↗
OBJECTIVE: To identify predictors of pneumonia in critically ill patients with indwelling nasogastric tubes and develop a risk-prediction model. METHODS: This single-center retrospective cohort study screened critically...
OBJECTIVE: To identify predictors of pneumonia in critically ill patients with indwelling nasogastric tubes and develop a risk-prediction model. METHODS: This single-center retrospective cohort study screened critically ill patients with nasogastric tubes for ≥48 h between January 2023 and December 2024. Patients with pneumonia before admission or within 48 h after admission were excluded. Clinical characteristics, severity scores, mechanical ventilation, invasive procedures, inflammatory indices, and nutritional markers were compared between pneumonia and non-pneumonia groups. Independent predictors were identified using multivariate logistic regression and incorporated into a nomogram. Model performance was assessed using receiver operating characteristic curve analysis, calibration analysis, decision curve analysis, and temporal validation in patients admitted from January to April 2025. RESULTS: Among 252 patients in the development cohort, 73 developed pneumonia, with an incidence of 29.0%. Longer hospital stay, prolonged mechanical ventilation, invasive procedures, APACHE II score ≥20, and higher neutrophil-to-lymphocyte ratio were independent risk factors, whereas higher serum albumin and prognostic nutritional index were protective factors. The nomogram showed excellent discrimination, with an area under the curve of 0.937 (95% CI: 0.907-0.967), good calibration, and favorable clinical net benefit. In the temporal validation cohort of 42 patients, the model achieved an accuracy of 92.9%, sensitivity of 91.7%, specificity of 93.3%, and Kappa value of 0.829. CONCLUSION: The nomogram may help identify critically ill patients with indwelling nasogastric tubes at high risk of pneumonia and support targeted preventive strategies.
The association between thiamine use and mortality in critically ill patients with sepsis-associated acute respiratory failure: A retrospective analysis of the MIMIC-IV database.
Yin M, Suo X, Li M … +2 more , He Q, Xu D
Respir Med · 2026 · PMID 42251913 · Publisher ↗
BACKGROUND: Thiamine (vitamin B1) is a crucial cofactor in energy metabolism and antioxidant defense, yet its specific impact on patients with sepsis-associated acute respiratory failure remains unclear. METHODS: We cond...
BACKGROUND: Thiamine (vitamin B1) is a crucial cofactor in energy metabolism and antioxidant defense, yet its specific impact on patients with sepsis-associated acute respiratory failure remains unclear. METHODS: We conducted a retrospective cohort study of 6248 sepsis-associated acute respiratory failure patients in the MIMIC-IV database (2008-2019). Patients were categorized based on thiamine supplementation. The primary endpoints were in-hospital and ICU mortality, analyzed using Kaplan-Meier curves, multivariable Cox regression, propensity score matching (PSM), and subgroup analyses. RESULTS: The thiamine group comprised 1576 patients and the no-thiamine group 4672. After adjustment, the no thiamine group had a higher risk of hospital mortality (HR = 1.24, 95%CI 1.10-1.39) and ICU mortality (HR = 1.31, 95%CI 1.14-1.51). This protective association was confirmed in the PSM-matched cohort (n = 2784). Subgroup analysis indicated the benefit was most pronounced in patients aged ≥65 years, with no significant association observed in younger patients. CONCLUSION: Thiamine supplementation was independently associated with reduced in-hospital and ICU mortality in critically ill patients with sepsis-associated acute respiratory failure, particularly in the elderly.These findings support the need for randomized controlled trials to validate its potential as an adjunctive therapy.
Differential expression of succinylation in lung mitochondria of patients with chronic obstructive pulmonary disease and its correlation with oxidative stress.
Meng T, Zhang X, Bao Y … +4 more , Maihemuti M, Jiang C, Alabaidi B, Zhai L
Respir Med · 2026 Jun · PMID 42251912 · Publisher ↗
BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a global disease characterized by persistent airflow limitation. Its pathogenesis is complex and there is currently no effective treatment. Although mitochondri...
BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a global disease characterized by persistent airflow limitation. Its pathogenesis is complex and there is currently no effective treatment. Although mitochondrial dysfunction and oxidative stress are closely related to the pathological process of COPD, the specific role of succinylation in pulmonary mitochondria of COPD is not clear. OBJECTIVE: To reveal the expression of succinylation in lung mitochondria of COPD and its relationship with oxidative stress. METHODS: The proteomes of lung mitochondria from COPD patients (n = 3) and non-COPD individuals (n = 3) were analyzed using liquid chromatography - mass spectrometry and expression verification through RT-qPCR (n = 10 for each group) and Western blot (n = 10 for each group) analyses. RESULTS: Seventy-two succinylated proteins were up-regulated and 99 were down-regulated in the COPD group compared to the non-COPD group. These differentially expressed proteins were mainly involved in the mitochondrial respiratory chain, oxidative stress response, and energy metabolism pathways. mRNA and protein expression levels of HBB, HBA, and UQCRB were significantly increased in the COPD group (P < 0.001), whereas the expression levels of SOD2 and UQCRC1 were significantly decreased (P < 0.001). CONCLUSIONS: This study is the first to reveal the differential expression profile of succinylation in the mitochondria of lung tissue of patients with COPD and its relationship with oxidative stress and mitochondrial dysfunction. The identification of these five key proteins provides candidate biomarkers for early diagnosis and targeted therapy of COPD. This lays a foundation for exploration of the regulation mechanism of succinylation.
Peak inspiratory flow rate measurement in inhaler technique optimisation across inhaler devices.
De Vos R, Longstaff J, Sanders M … +5 more , Kostakis I, D'Cruz L, Lomax M, Brown TP, Chauhan AJ
Respir Med · 2026 · PMID 42251911 · Publisher ↗
BACKGROUND: Peak inspiratory flow rate (PIFR) is an important physiological parameter to assess during inhaler technique optimisation (ITO) and inhaler device selection, providing insight into patients' ability to genera...
BACKGROUND: Peak inspiratory flow rate (PIFR) is an important physiological parameter to assess during inhaler technique optimisation (ITO) and inhaler device selection, providing insight into patients' ability to generate appropriate inspiratory flow for effective medication delivery. OBJECTIVES: To determine the proportion of patients achieving optimal PIFR ranges before and after ITO across inhaler devices using the In-Check G-16 DIAL, and assess the relationship between PIFR ranges and clinical outcomes (self-reported exacerbation frequency, ACQ-6 and CAT scores). METHODS: 586 adult inhaler users (58.4% female) were recruited. PIFR was measured pre- and post-ITO by healthcare professionals using the In-Check G-16 DIAL. Optimal and suboptimal PIFR ranges were interpreted using the device's numerical and colour-coded display. Statistical analysis compared PIFR before and after ITO for each device and clinical outcomes across optimal and suboptimal pre-ITO PIFR. RESULTS: For pMDI, soft mist, and breath-actuated inhalers (n = 249), only 34.1% achieved the optimal PIFR of 20-60 L/min pre-ITO, increasing to 89.8% post-ITO. For DPI devices, 43% achieved a PIFR of >60 L/min pre-ITO (adjusted to >30 L/min for high-resistance devices), increasing to 96.1% post-ITO. No significant difference in clinical outcomes was found between PIFR ranges across all devices (p > 0.05). CONCLUSIONS: PIFR assessment is important for optimising inhaler technique, as many users initially fail to achieve optimal flow rates. Post-ITO, most users can attain optimal PIFR. For metered-dose inhalers, focus should be on decreasing flow rates or considering a switch to DPIs. PIFR does not appear to be a significant predictor of clinical outcomes across devices.
A new perspective on idiopathic pulmonary fibrosis research: From multi-dimensional mechanistic exploration to advances in precision therapy.
Zhang SM, Huang MZ, Wang YW … +5 more , Wang XF, Ding Y, Li JM, Zou XM, Ma CY
Respir Med · 2026 · PMID 42251910 · Publisher ↗
Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive interstitial lung disease characterised by irreversible fibrotic remodelling and a poor prognosis. The typical survival rate is 3-5 years after diagnosis. Alt...
Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive interstitial lung disease characterised by irreversible fibrotic remodelling and a poor prognosis. The typical survival rate is 3-5 years after diagnosis. Although considerable progress has been made in understanding its underlying biology, early detection remains difficult and available treatments provide only limited benefit. Current evidence points to IPF as a multifactorial disease driven by the interplay of alveolar epithelial cell injury, impaired repair mechanisms, immune dysregulation, particularly macrophage polarisation, fibroblast activation, and oxidative stress. These processes converge to promote excessive extracellular matrix deposition and progressive decline in lung function. In this review, we bring together current insights into the cellular and molecular mechanisms of IPF, with particular attention to interactions among the epithelial, immune, and mesenchymal compartments. We also discuss how genetic susceptibility, epigenetic regulation, and environmental exposures contribute to disease onset and patient variability. In addition to established antifibrotic therapies such as pirfenidone and nintedanib, we examine emerging approaches including targeted molecular treatments, antioxidant strategies, and regenerative therapies. Despite promising developments, translating mechanistic findings into meaningful clinical outcomes remains a major challenge. Moving forward, improved biomarkers, better patient stratification, and multi-targeted therapeutic strategies will be essential to achieving more effective and personalized treatment for IPF.
Association between phenotypic age acceleration and mortality in patients with chronic obstructive pulmonary disease.
Cheng H, Lin C, Chen S … +2 more , Lin W, Lu F
Respir Med · 2026 · PMID 42251909 · Publisher ↗
BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality worldwide. Chronological age poorly reflects biological heterogeneity in prognosis. Phenotypic age acceleration (PhenoAgeAccel), a...
BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality worldwide. Chronological age poorly reflects biological heterogeneity in prognosis. Phenotypic age acceleration (PhenoAgeAccel), a biomarker of multisystem biological aging, may offer prognostic value beyond traditional risk factors. OBJECTIVES: We investigated whether PhenoAgeAccel predicts all-cause and cause-specific mortality in patients with COPD. METHODS: Data from 1262 COPD participants in the National Health and Nutrition Examination Survey (NHANES, 1999-2010, 2015-2018) were linked to mortality records through 2019. PhenoAgeAccel was calculated from phenotypic age residuals. Multivariable Cox models estimated hazard ratios (HRs) for all-cause, cardiovascular, cancer, and chronic lower respiratory disease (CLRD) mortality. Restricted cubic splines assessed nonlinearity, with subgroup and sensitivity analyses performed. RESULTS: Each unit increase in PhenoAgeAccel was associated with higher all-cause (HR = 1.03; 95% CI: 1.02-1.05), cardiovascular (HR = 1.03; 95% CI: 1.02-1.05), cancer (HR = 1.03; 95% CI: 1.01-1.04), and CLRD mortality (HR = 1.02; 95% CI: 1.01-1.04). Participants in the highest quartile had over a fivefold increase in all-cause mortality compared to the lowest quartile. Kaplan-Meier curves demonstrated progressively reduced survival, and associations remained consistent across subgroup and sensitivity analyses. CONCLUSION: PhenoAgeAccel is an independent predictor of mortality in COPD, providing prognostic information beyond chronological age. It may serve as a practical biomarker for risk stratification and personalized management, warranting further validation in longitudinal and interventional studies.
Can AI chatbots effectively respond inquiries for patients with pulmonary arterial hypertension about exercise and physical activity: A comparative study of three chatbots.
Durdu H, Merç P, Cinar B … +1 more , Gunaydin ZY
Respir Med · 2026 · PMID 42250703 · Publisher ↗
OBJECTIVE: The utilization of artificial intelligence-based chatbots in the healthcare field is increasingly prevalent. Nonetheless, the quality of responses for these chatbots on this topic is unknown, particularly in c...
OBJECTIVE: The utilization of artificial intelligence-based chatbots in the healthcare field is increasingly prevalent. Nonetheless, the quality of responses for these chatbots on this topic is unknown, particularly in considering the sparse data about exercise and physical activity in patients with pulmonary arterial hypertension (PAH). The aim was to evaluate and compare the accuracy and readability of responses provided by ChatGPT, Gemini, and DeepSeek regarding exercise training and physical activity in patients with PAH. METHODS: ChatGPT, Gemini, and DeepSeek were prompted with the command "Can you list the 20 most frequently asked questions about exercise training and physical activity for patients with PAH worldwide?" The identified questions were reviewed by the research team, and 10 clinically relevant questions were selected. These questions were then posed to each chatbot in separate chat sessions. The accuracy of responses was assessed utilizing a 4-point Likert-type scale. For the readability assessment, the Flesch-Kincaid Grade Level (FKGL) was utilized. Data were analyzed utilizing the SPSS software. RESULTS: Overall, median accuracy scores ranged from 1 to 2 among the AI chatbots, with a significant difference observed only between ChatGPT and DeepSeek in favor of DeepSeek (p = 0.007). The readability scores of ChatGPT (9.09 ± 1.87) and DeepSeek (8.79 ± 1.35) were similar, Gemini's score (10.91 ± 1.23) higher than that of other chatbots (p = 0.011). CONCLUSION: All three chatbots provided responses to inquiries on exercise training and physical activity in PAH with acceptable accuracy. Additionally, responses generated by ChatGPT and DeepSeek were easier to read compared with those generated by Gemini.
The clinical efficacy of hydrogen combined with tetrandrine in the treatment of silicosis fibrosis: A randomized controlled intervention study.
Xiao K, Sang Y, Cao M … +7 more , Yang Y, Cheng M, Ma J, Wang S, Li X, Ding X, Du Z
Respir Med · 2026 · PMID 42250702 · Publisher ↗
OBJECTIVE: This study aimed to evaluate the efficacy of tetrandrine (Tet) alone and in combination with hydrogen (H) inhalation in patients with stage II silicosis. METHODS: In this prospective, randomized, double-blind,...
OBJECTIVE: This study aimed to evaluate the efficacy of tetrandrine (Tet) alone and in combination with hydrogen (H) inhalation in patients with stage II silicosis. METHODS: In this prospective, randomized, double-blind, controlled study, 116 patients with stage II silicosis treated at Lai Zhou City Chronic Disease Prevention and Treatment Hospital were enrolled. The assessed outcomes included pulmonary function, exercise tolerance, clinical symptoms, and serum interleukin-6 (IL-6) levels following treatment with Tet alone or Tet combined with H inhalation. RESULTS: From October 2023 to February 2024, 116 patients were enrolled, and 108 were included in the final analysis, with 54 patients in the Tet monotherapy group and 54 patients in the H plus Tet combination therapy group. Combination therapy with hydrogen significantly improved diffusing capacity for carbon monoxide (diffusing capacity of the lung for carbon monoxide) compared with Tet alone (7.370 L vs. 8.589 L, P < 0.05). Additionally, it significantly reduced serum IL-6 levels (4.74 mg/L vs. 2.32 mg/L, P < 0.05) and alleviated clinical symptoms, including dyspnea. CONCLUSIONS: H combined with Tet was more effective than Tet alone in the treatment of stage II silicosis.
Association of the combined triglyceride-glucose and frailty index with incident asthma risk: a prospective cohort analysis from CHARLS.
Zhou X, Wang Q, Zhang G … +2 more , Zhu J, Lei M
Respir Med · 2026 · PMID 42250701 · Publisher ↗
OBJECTIVES: Limited investigation exists regarding the relationships among the triglyceride-glucose index-frailty index (TyGFI) and incident asthma. This study investigates the association between TyGFI and risk of incid...
OBJECTIVES: Limited investigation exists regarding the relationships among the triglyceride-glucose index-frailty index (TyGFI) and incident asthma. This study investigates the association between TyGFI and risk of incident asthma in older Chinese people by combining TyG and FI, using prospective cohort data from the China Health and Retirement Longitudinal Study (CHARLS). METHODS: We used data from CHARLS Wave 1 (2011) as the baseline and Wave 3 (2015) as the follow-up. Cox hazard regression models were used to analyze the association between TyGFI and incident asthma risk. Restricted cubic spline (RCS) regression was used to test for nonlinearity, and stratified analyses were used to evaluate effect modification. RESULTS: The highest TyGFI quartile showed the greatest risk (HR = 4.30, 95% CI: 2.66-6.95). A significant nonlinear association was observed, with asthma risk rising dramatically when TyGFI exceeded 1.343. Stratified analyses indicated interaction by age. CONCLUSIONS: Higher TyGFI is significantly associated with risk of incident asthma in middle-aged and older Chinese adults, suggesting that integrating metabolic-frailty assessment may enhance the ability to identify individuals at high risk for incident asthma at an earlier stage.
Advancing in precision asthma management: The Treat-to-Target by Treatable Traits (T4) framework.
Farinha I, Álvarez-Gutiérrez FJ, Pérez de Llano L … +7 more , Domínguez-Ortega J, Ferreira J, Cosío BG, Muñoz Gall X, Plaza V, Sáinz JA, Pérez Grimaldi F
Respir Med · 2026 · PMID 42250700 · Publisher ↗
In the era of biologic therapy, the management of severe asthma is evolving towards personalized medicine frameworks that integrate clinical, functional, and biological traits. In this narrative review, we explore the co...
In the era of biologic therapy, the management of severe asthma is evolving towards personalized medicine frameworks that integrate clinical, functional, and biological traits. In this narrative review, we explore the convergence of Treatable Traits and Treat-to-Target principles within a unified concept known as Treat-to-Target by Treatable Traits (T4) Framework. The T4 Framework introduces an innovative methodology for the management of severe asthma through a trait-oriented and target-focused paradigm. We propose a conceptual approach that emphasizes remission as a realistic and clinically meaningful target, but that must be sought through a tailored approach to the multiple heterogeneous features of the disease. This T4 Framework aims to streamline treatment strategies, enhancing patient outcomes by addressing the specific characteristics of severe asthma and facilitating a more effective management pathway. Implementing the T4 Framework may significantly improve the personalization of asthma management, ultimately leading to better control and quality of life for patients with severe asthma.
Corrigendum to "The effect of inhaler prescription and comorbidities on the prognosis of COPD in never-smokers: A nationwide population-based study" [Respirat. Med. 258 (2026) 108864.
Sheen SS, Oh JH, Choi WI … +3 more , Kim K, Rhee CK, Park JH
Respir Med · 2026 · PMID 42248736 · Publisher ↗
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Cross-cultural adaptation and pilot psychometric validation of a quality-of-life questionnaire for adults with Primary Ciliary Dyskinesia in Spain.
Carretero-Vilarroig L, Jaijo T, Lucas JS … +5 more , Behan L, Dasí F, Sánchez-Thevenet P, Armengot-Carceller M, Reula A
Respir Med · 2026 · PMID 42248373 · Publisher ↗
BACKGROUND: The Quality-of-Life Primary Ciliary Dyskinesia (QOL-PCD) instrument is the only health-related QOL instrument specific to measuring patient-reported outcomes in PCD patients. The adaptation and validation of...
BACKGROUND: The Quality-of-Life Primary Ciliary Dyskinesia (QOL-PCD) instrument is the only health-related QOL instrument specific to measuring patient-reported outcomes in PCD patients. The adaptation and validation of the Spanish version of this questionnaire is a crucial step in formulating effective healthcare strategies that will improve the quality of life of these patients within the Spanish context. In this regard, the objective of the study was to cross-culturally adapt and pilot-validate a Spanish version for patients with PCD. METHODS: A total of 21 Spanish patients with PCD participated in this study. The QOL-PCD was translated and cross-culturally adapted following BESTCILIA Work Package 4 and ISPOR recommendations, respectively. Pilot psychometric validation was explored through internal consistency (Cronbach's α) and construct validity studies. Stability and convergent validity were studied in eight patients. QoL analyses were performed using Pearson correlations and a Welch t-test. RESULTS: The Spanish QOL-PCD questionnaire included 40 items evaluating the ten original scales. All participants demonstrated a clear understanding of the questionnaire. All scales shown moderate to good internal consistency. Test-retest reliability proved particularly strong for Physical Functioning, Vitality, Emotional Functioning, Role and Social Functioning. SF-36 and SNOT-22 comparisons demonstrated moderate to high correlations. As hypothesized, a positive correlation was found between lower respiratory symptoms and history of lung transplantation. CONCLUSION: The Spanish QOL-PCD questionnaire has robust psychometric properties and is therefore a validated tool for assessing quality of life (QoL) in Spanish adults with primary ciliary dyskinesia (PCD). This work will improve patient care and inform future PCD research.
Grading quality score of contrast electrical impedance tomography for lung ventilation-perfusion: development and preliminary evaluation of the impedance-time curve.
Gao Y, Chi Y, Yuan S … +5 more , Cai Q, Adler A, Long Y, Zhao Z, He H
Respir Med · 2026 · PMID 42248372 · Publisher ↗
BACKGROUND: The electrical impedance tomography (EIT) with saline-bolus method has been commonly used to assess regional ventilation-perfusion (V/Q) match at the bedside. Inherent technical challenges could result in low...
BACKGROUND: The electrical impedance tomography (EIT) with saline-bolus method has been commonly used to assess regional ventilation-perfusion (V/Q) match at the bedside. Inherent technical challenges could result in low-quality impedance curves when applying this method. This study aimed to develop and assess a quality assurance method to rate the impedance-time curve before analysis. METHODS: Five dimensions in three aspects for curve scoring were determined: signal quality of EIT data collection, impedance curve during tidal breathing (variability of tidal impedance), and impedance curve related to bolus injection (platform limb, descending limb, and ascending limb). The Quality Score of EIT data was created by assigning each dimension as optimal (0 point), sub-optimal (1 point), or poor (10 points). Curves with a cumulative score of 10 or above are considered failed and are not recommended for further analysis. We retrospectively included all EIT saline contrast data from a single center in 2023. Two raters independently scored each curve. RESULTS: 118 data were scored with an overall failing rate of 22.9%. 8/118 failed due to signal collection quality, 4/118 failed due to the tidal impedance curve and 19/118 failed due to the contrast curve. The interrater agreement is acceptable with kappa Coefficient: tidal impedance (κ = 0.82), platform limb (κ = 0.73), descending limb (κ = 0.89), ascending limb (κ = 0.90), and overall pass/fail (κ = 0.95). CONCLUSION: This scoring system reveals common quality problems that could cause potential inaccurate assessment of lung perfusion and regional V/Q. The quality score is initially repeatable across raters, but further validating investigation is needed.
Long-term therapy with elexacaftor/tezacaftor/ivacaftor improves cystic fibrosis lung disease and monocyte function.
Sangiorgi G, Cavinato L, Cristoferi M … +6 more , Chiappetta D, Pastore V, Cimino G, Cimino L, Ascenzioni F, Del Porto P
Respir Med · 2026 · PMID 42248371 · Publisher ↗
BACKGROUND: Elexacaftor/tezacaftor/ivacaftor (ETI) therapy rapidly improves monocyte antimicrobial activity in people with cystic fibrosis (pwCF). Here, we investigated the effect of long-term ETI therapy on Pseudomonas...
BACKGROUND: Elexacaftor/tezacaftor/ivacaftor (ETI) therapy rapidly improves monocyte antimicrobial activity in people with cystic fibrosis (pwCF). Here, we investigated the effect of long-term ETI therapy on Pseudomonas aeruginosa phagocytosis and on CFTR expression and function in monocytes. METHODS: Clinical information and biospecimens were obtained from 60 pwCF at initiation and after 12-48 months of ETI therapy. Monocyte phagocytosis was evaluated by flow cytometry after infection of PBMCs with P. aeruginosa expressing GFP. CFTR protein and mRNA levels were assessed by Western blot and qRT-PCR respectively. CFTR channel activity was evaluated by halide efflux assay. For comparison, measurements were also performed in non-CF subjects. RESULTS: Longitudinal analysis of the clinical parameters confirmed an improvement of lung function and microbiology from 12 months and up to 48 months after the initiation of ETI therapy. ETI therapy resulted in a significant increase in monocyte P. aeruginosa phagocytosis reaching levels similar to non-CF monocytes. A significant increase in the levels of CFTR protein but not mRNA was observed in monocytes during the first 12-36 months of ETI therapy compared to pre-therapy. The expression of CFTR protein and channel function remained significantly lower than those of non-CF monocytes during ETI therapy. CONCLUSION: Our data suggest that the beneficial clinical effect of long-term ETI therapy is accompanied by an increase in monocyte P. aeruginosa phagocytosis while the CFTR protein expression and function remain lower with respect to non-CF monocytes.
Pulmonary exacerbations in cystic fibrosis after fatherhood with and without CFTR modulators.
Cohen-Cymberknoh M, Hadad SM, Shteinberg M … +9 more , Livnat G, Yaacoby-Bianu K, Heching M, Prais D, Gur M, Bar-Yoseph R, Golan-Tripto I, Hazan G, Reiter J
Respir Med · 2026 · PMID 42248370 · Publisher ↗
BACKGROUND: Advances in cystic fibrosis (CF) management, quality of life, and fertility treatments have encouraged more men with CF (mwCF) to pursue parenthood. However, data on the impact of fatherhood on CF disease cou...
BACKGROUND: Advances in cystic fibrosis (CF) management, quality of life, and fertility treatments have encouraged more men with CF (mwCF) to pursue parenthood. However, data on the impact of fatherhood on CF disease course, particularly in the era of CFTR modulators (CFTRm), remain limited. METHODS: We conducted a multicenter retrospective cohort study in six CF centers (2007-2023). Demographic and clinical parameters, including forced expiratory volume in 1 s (FEV), body mass index (BMI), bacterial colonization, and pulmonary exacerbation (PEx) rates were compared for the year before and the year after fatherhood. Data were stratified by CFTRm therapy and analyzed per child for the effect of having multiple children, as well as grouped data. RESULTS: Among 170 mwCF (18-50 years), 32 fathered 52 children (17 had multiple children). Mean paternal age at childbirth was 30.5 ± 5.5, mean FEV declined from 74.6 ± 18.9% to 73.4 ± 19.6% (p = 0.03), while BMI remained stable (23.3 ± 3.2 to 23.4 ± 3.3; p = 1). Mild PEx increased from 0.4 ± 0.6 to 1.0 ± 1 (p = 0.001), and severe PEx (requiring intravenous antibiotic treatment), from 0.4 ± 0.9 to 0.7 ± 1.2 (p = 0.02). In mwCF on CFTRm, no significant changes were observed in FEV1, or PEx. Outcomes were not affected by the number of prior children, their order, or having had twins. CONCLUSION: Fatherhood may be associated with an increase in PEx, particularly among mwCF not treated with CFTRm. CFTRm therapy, therefore, appears to mitigate this risk, supporting its protective effect. These findings underscore the importance of routine and structured follow-up and counseling for mwCF during fatherhood.
Clinical determinants of maximal aerobic capacity in patients with obstructive sleep apnea syndrome.
Eyuboglu F, Ilhan M, Cerezci TK … +1 more , Dalkilic O
Respir Med · 2026 · PMID 42248369 · Publisher ↗
BACKGROUND: Investigating the clinical determinants of maximal aerobic capacity in patients with obstructive sleep apnea syndrome (OSAS) may help better understand the systemic effects of the disease, improve clinical ma...
BACKGROUND: Investigating the clinical determinants of maximal aerobic capacity in patients with obstructive sleep apnea syndrome (OSAS) may help better understand the systemic effects of the disease, improve clinical management, and predict long-term risks of cardiovascular mortality and morbidity. OBJECTIVES: This cross-sectional study aims to identify the fundamental clinical determinants of maximal aerobic capacity in patients with OSAS. METHODS: Physical and demographic characteristics and polysomnography results of 60 OSAS patients (54 M, 6 F; AHI: 30.3 ± 20.6) were recorded. We evaluated handgrip strength, inspiratory and expiratory respiratory muscle strength (MIP, MEP), the 6-min walk test (6MWT), exercise capacity (cardiopulmonary exercise test), sleep quality (Pittsburgh Sleep Quality Index, PSQI), and daytime sleepiness (Epworth Sleepiness Scale, ESS). RESULTS: VOmax was negatively correlated with age (r = -0.447, p < 0.001), BMI (r = -0.295, p = 0.023), arousal count (r = -0.374, p = 0.004), arousal index (r = -0.286, p = 0.028), and ESS score (r = -0.322, p = 0.013), and positively correlated with 6MWT distance (r = 0.380, p = 0.003). No significant associations were found between VO and disease severity (AHI), nadir SpO, or muscle strength. In regression analysis, age (β = -0.32, p = 0.006) and arousal count (β = -0.26, p = 0.023) were independent predictors (R = 0.441). CONCLUSION: Aerobic capacity in OSAS is associated with age, sleep fragmentation, functional capacity, and subjective sleep parameters, but not with disease severity or nocturnal oxygenation. These findings support the multifactorial nature of aerobic capacity in OSAS.
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